Optimizing Surgical Site Disinfection: Insights from the PREPARE Trial

Introduction:

Surgical site infections (SSIs) pose a significant risk to patients undergoing surgery, leading researchers to investigate the impact of different skin disinfectants on infection rates. A groundbreaking international trial, the PREPARE trial, led by McMaster University and the University of Maryland School of Medicine, has provided valuable insights into the choice of skin disinfectant for fracture surgeries. The findings, published in The New England Journal of Medicine, present a compelling case for adopting iodine povacrylex in alcohol as a superior solution in preventing SSIs for patients undergoing surgery for closed fractures.

The PREPARE Trial:

The PREPARE trial enrolled nearly 8,500 participants at 25 hospitals in Canada and the United States, making it one of the largest and most comprehensive studies on surgical site disinfection. The research focused on patients undergoing surgery for closed lower extremity or pelvic fractures (6,785 patients) and those with open fractures (1,700 patients).

Key Findings:

• Iodine Povacrylex vs. Chlorhexidine Gluconate: Patients with closed fractures who received 0.7% iodine povacrylex in 74% isopropyl alcohol for skin disinfection experienced fewer post-operative SSIs compared to those who received 2% chlorhexidine gluconate in 70% isopropyl alcohol.

• Open Fractures: For patients with open fractures, there was no significant difference in the risk of infection between the two antiseptic solutions.

• Potential Impact: The trial suggests that adopting iodine povacrylex in alcohol as a preoperative skin disinfectant could prevent surgical site infections in thousands of patients undergoing surgery for closed fractures each year.

Patient Involvement:

The trial's patient partner, Jeffrey Wells, emphasized the importance of patient involvement in the research process. Patient perspectives played a crucial role in trial design, implementation, and dissemination, ensuring that the study considered the real-world impact on individuals undergoing surgical procedures.

Clinical Implications:

• Policy Considerations: The findings have the potential to prompt hospitals to reconsider their policies regarding skin disinfectants for fracture surgeries. Adopting iodine povacrylex in alcohol may become a recommended practice to enhance patient outcomes.

• Broader Applicability: While the trial specifically focused on fracture surgery patients, the results may have implications for other surgical disciplines. Understanding the most effective skin disinfectant can contribute to standardized practices across various surgical procedures.

• Addressing Lack of Consensus: The trial addresses the lack of consensus in previous guidelines regarding the most effective antiseptic agent. The robust nature of the study enables clinicians to make evidence-based decisions for optimizing surgical site disinfection.

Conclusion:

The PREPARE trial's findings mark a significant advancement in perioperative care by identifying a more effective skin disinfectant for fracture surgeries. As hospitals and healthcare providers consider implementing these insights, the potential to reduce surgical site infections and enhance patient safety becomes a tangible reality. This collaborative effort between McMaster University and the University of Maryland School of Medicine exemplifies the importance of large-scale, international studies in shaping best practices in healthcare.

Publish Time: 09:45

Publish Date: 2024-02-02