Iodine is more effective than chlorhexidine in protecting the surgical site for closed fractures
In patients with closed fractures, treatment of the skin at the surgical site with alcoholic iodine solution resulted in fewer infections than treatment with chlorhexidine solution. In patients with open fractures, the risk of infection did not differ between groups. The study is published in The New England Journal of Medicine.
Clinical guidelines universally recommend the use of skin antiseptic solutions with alcohol to prevent surgical site infection. However, there is no consensus on the efficacy of individual antiseptics in preventing surgical infections. In particular, there are no acceptable studies evaluating the effectiveness of different skin antiseptics in treating the surgical site for fractures.
To determine the most effective skin antiseptic solution for limb fracture surgery, Sheila Sprague of McMaster University and Gerard Slobogean of the University of Maryland School of Medicine and their American and Canadian colleagues compared the efficacy of the two most common skin antiseptics, alcoholic iodine and chlorhexidine solutions, in preventing surgical site infection in patients with closed and open fractures.
A total of 6785 patients with a closed fracture of the lower extremities or pelvis were used for analysis. An additional 1700 cases of open fractures were included in the primary analysis. The distribution by age, sex, race, or ethnicity was balanced between groups.
In the population of patients with closed fractures, surgical site infection occurred in 77 of 3205 patients in the iodine group and in 108 of 3272 patients in the chlorhexidine group (odds ratio 0.74, p = 0.049). The absolute difference in the risk of surgical site infection between the iodine-treated group and the chlorhexidine-treated group was -0.8 percentage points.
In the open fracture patient population, surgical site infection occurred in 54 of 825 patients (6.5 percent) in the iodine group and 60 of 826 patients (7.3 percent) in the chlorhexidine group (odds ratio 0.86, p = 0.45).
Although this study does not provide comprehensive data on the efficacy of skin antiseptics, it does show that alcoholic iodine solution protects better against surgical infections in closed fracture surgeries. However, larger clinical studies are needed to examine the effects of different antiseptics.