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Skin Antisepsis before Surgical Fixation of Extremity Fractures.
Sprague, Sheila; Slobogean, Gerard; Wells, Jeffrey L; O'Hara, Nathan N; Thabane, Lehana; Mullins, C Daniel; Harris, Anthony D; Wood, Amber; Viskontas, Darius; Apostle, Kelly L; O'Toole, Robert V; Joshi, Manjari; Johal, Herman; Al-Asiri, Jamal; Hymes, Robert A; Gaski, Greg E; Pilson, Holly T; Carroll, Eben A; Babcock, Sharon; Halvorson, Jason J; Romeo, Nicholas M; Matson, Christopher A; Higgins, Thomas F; Marchand, Lucas S; Bergin, Patrick F; Morellato, John; Van Demark, Robert E; Potter, G David; Gitajn, I Leah; Chang, Gerard; Phelps, Kevin D; Kempton, Laurence B; Karunakar, Madhav; Jaeblon, Todd; Demyanovich, Haley K; Domes, Christopher M; Kuhn, Gabrielle R; Reilly, Rachel M; Gage, Mark J; Weaver, Michael J; von Keudell, Arvind G; Heng, Marilyn; McTague, Michael F; Alnasser, Ahmad; Mehta, Samir; Donegan, Derek J; Natoli, Roman M; Szatkowski, Jan; Scott, Alesha N; Shannon, Steven F.
Afiliação
  • Sprague S; From the Division of Orthopedic Surgery, Department of Surgery (S.S., H.J., J.A.-A., J.L., D.P., S. Bzovsky, O.P.S., J.L.G., M.B.), and the Department of Health Research Methods, Evidence, and Impact (L.T., D.H.-A., G.G.), McMaster University, Hamilton Health Sciences Hospital, General Site (F.M.),
  • Slobogean G; From the Division of Orthopedic Surgery, Department of Surgery (S.S., H.J., J.A.-A., J.L., D.P., S. Bzovsky, O.P.S., J.L.G., M.B.), and the Department of Health Research Methods, Evidence, and Impact (L.T., D.H.-A., G.G.), McMaster University, Hamilton Health Sciences Hospital, General Site (F.M.),
  • Wells JL; From the Division of Orthopedic Surgery, Department of Surgery (S.S., H.J., J.A.-A., J.L., D.P., S. Bzovsky, O.P.S., J.L.G., M.B.), and the Department of Health Research Methods, Evidence, and Impact (L.T., D.H.-A., G.G.), McMaster University, Hamilton Health Sciences Hospital, General Site (F.M.),
  • O'Hara NN; From the Division of Orthopedic Surgery, Department of Surgery (S.S., H.J., J.A.-A., J.L., D.P., S. Bzovsky, O.P.S., J.L.G., M.B.), and the Department of Health Research Methods, Evidence, and Impact (L.T., D.H.-A., G.G.), McMaster University, Hamilton Health Sciences Hospital, General Site (F.M.),
  • Thabane L; From the Division of Orthopedic Surgery, Department of Surgery (S.S., H.J., J.A.-A., J.L., D.P., S. Bzovsky, O.P.S., J.L.G., M.B.), and the Department of Health Research Methods, Evidence, and Impact (L.T., D.H.-A., G.G.), McMaster University, Hamilton Health Sciences Hospital, General Site (F.M.),
  • Mullins CD; From the Division of Orthopedic Surgery, Department of Surgery (S.S., H.J., J.A.-A., J.L., D.P., S. Bzovsky, O.P.S., J.L.G., M.B.), and the Department of Health Research Methods, Evidence, and Impact (L.T., D.H.-A., G.G.), McMaster University, Hamilton Health Sciences Hospital, General Site (F.M.),
  • Harris AD; From the Division of Orthopedic Surgery, Department of Surgery (S.S., H.J., J.A.-A., J.L., D.P., S. Bzovsky, O.P.S., J.L.G., M.B.), and the Department of Health Research Methods, Evidence, and Impact (L.T., D.H.-A., G.G.), McMaster University, Hamilton Health Sciences Hospital, General Site (F.M.),
  • Wood A; From the Division of Orthopedic Surgery, Department of Surgery (S.S., H.J., J.A.-A., J.L., D.P., S. Bzovsky, O.P.S., J.L.G., M.B.), and the Department of Health Research Methods, Evidence, and Impact (L.T., D.H.-A., G.G.), McMaster University, Hamilton Health Sciences Hospital, General Site (F.M.),
  • Viskontas D; From the Division of Orthopedic Surgery, Department of Surgery (S.S., H.J., J.A.-A., J.L., D.P., S. Bzovsky, O.P.S., J.L.G., M.B.), and the Department of Health Research Methods, Evidence, and Impact (L.T., D.H.-A., G.G.), McMaster University, Hamilton Health Sciences Hospital, General Site (F.M.),
  • Apostle KL; From the Division of Orthopedic Surgery, Department of Surgery (S.S., H.J., J.A.-A., J.L., D.P., S. Bzovsky, O.P.S., J.L.G., M.B.), and the Department of Health Research Methods, Evidence, and Impact (L.T., D.H.-A., G.G.), McMaster University, Hamilton Health Sciences Hospital, General Site (F.M.),
  • O'Toole RV; From the Division of Orthopedic Surgery, Department of Surgery (S.S., H.J., J.A.-A., J.L., D.P., S. Bzovsky, O.P.S., J.L.G., M.B.), and the Department of Health Research Methods, Evidence, and Impact (L.T., D.H.-A., G.G.), McMaster University, Hamilton Health Sciences Hospital, General Site (F.M.),
  • Joshi M; From the Division of Orthopedic Surgery, Department of Surgery (S.S., H.J., J.A.-A., J.L., D.P., S. Bzovsky, O.P.S., J.L.G., M.B.), and the Department of Health Research Methods, Evidence, and Impact (L.T., D.H.-A., G.G.), McMaster University, Hamilton Health Sciences Hospital, General Site (F.M.),
  • Johal H; From the Division of Orthopedic Surgery, Department of Surgery (S.S., H.J., J.A.-A., J.L., D.P., S. Bzovsky, O.P.S., J.L.G., M.B.), and the Department of Health Research Methods, Evidence, and Impact (L.T., D.H.-A., G.G.), McMaster University, Hamilton Health Sciences Hospital, General Site (F.M.),
  • Al-Asiri J; From the Division of Orthopedic Surgery, Department of Surgery (S.S., H.J., J.A.-A., J.L., D.P., S. Bzovsky, O.P.S., J.L.G., M.B.), and the Department of Health Research Methods, Evidence, and Impact (L.T., D.H.-A., G.G.), McMaster University, Hamilton Health Sciences Hospital, General Site (F.M.),
  • Hymes RA; From the Division of Orthopedic Surgery, Department of Surgery (S.S., H.J., J.A.-A., J.L., D.P., S. Bzovsky, O.P.S., J.L.G., M.B.), and the Department of Health Research Methods, Evidence, and Impact (L.T., D.H.-A., G.G.), McMaster University, Hamilton Health Sciences Hospital, General Site (F.M.),
  • Gaski GE; From the Division of Orthopedic Surgery, Department of Surgery (S.S., H.J., J.A.-A., J.L., D.P., S. Bzovsky, O.P.S., J.L.G., M.B.), and the Department of Health Research Methods, Evidence, and Impact (L.T., D.H.-A., G.G.), McMaster University, Hamilton Health Sciences Hospital, General Site (F.M.),
  • Pilson HT; From the Division of Orthopedic Surgery, Department of Surgery (S.S., H.J., J.A.-A., J.L., D.P., S. Bzovsky, O.P.S., J.L.G., M.B.), and the Department of Health Research Methods, Evidence, and Impact (L.T., D.H.-A., G.G.), McMaster University, Hamilton Health Sciences Hospital, General Site (F.M.),
  • Carroll EA; From the Division of Orthopedic Surgery, Department of Surgery (S.S., H.J., J.A.-A., J.L., D.P., S. Bzovsky, O.P.S., J.L.G., M.B.), and the Department of Health Research Methods, Evidence, and Impact (L.T., D.H.-A., G.G.), McMaster University, Hamilton Health Sciences Hospital, General Site (F.M.),
  • Babcock S; From the Division of Orthopedic Surgery, Department of Surgery (S.S., H.J., J.A.-A., J.L., D.P., S. Bzovsky, O.P.S., J.L.G., M.B.), and the Department of Health Research Methods, Evidence, and Impact (L.T., D.H.-A., G.G.), McMaster University, Hamilton Health Sciences Hospital, General Site (F.M.),
  • Halvorson JJ; From the Division of Orthopedic Surgery, Department of Surgery (S.S., H.J., J.A.-A., J.L., D.P., S. Bzovsky, O.P.S., J.L.G., M.B.), and the Department of Health Research Methods, Evidence, and Impact (L.T., D.H.-A., G.G.), McMaster University, Hamilton Health Sciences Hospital, General Site (F.M.),
  • Romeo NM; From the Division of Orthopedic Surgery, Department of Surgery (S.S., H.J., J.A.-A., J.L., D.P., S. Bzovsky, O.P.S., J.L.G., M.B.), and the Department of Health Research Methods, Evidence, and Impact (L.T., D.H.-A., G.G.), McMaster University, Hamilton Health Sciences Hospital, General Site (F.M.),
  • Matson CA; From the Division of Orthopedic Surgery, Department of Surgery (S.S., H.J., J.A.-A., J.L., D.P., S. Bzovsky, O.P.S., J.L.G., M.B.), and the Department of Health Research Methods, Evidence, and Impact (L.T., D.H.-A., G.G.), McMaster University, Hamilton Health Sciences Hospital, General Site (F.M.),
  • Higgins TF; From the Division of Orthopedic Surgery, Department of Surgery (S.S., H.J., J.A.-A., J.L., D.P., S. Bzovsky, O.P.S., J.L.G., M.B.), and the Department of Health Research Methods, Evidence, and Impact (L.T., D.H.-A., G.G.), McMaster University, Hamilton Health Sciences Hospital, General Site (F.M.),
  • Marchand LS; From the Division of Orthopedic Surgery, Department of Surgery (S.S., H.J., J.A.-A., J.L., D.P., S. Bzovsky, O.P.S., J.L.G., M.B.), and the Department of Health Research Methods, Evidence, and Impact (L.T., D.H.-A., G.G.), McMaster University, Hamilton Health Sciences Hospital, General Site (F.M.),
  • Bergin PF; From the Division of Orthopedic Surgery, Department of Surgery (S.S., H.J., J.A.-A., J.L., D.P., S. Bzovsky, O.P.S., J.L.G., M.B.), and the Department of Health Research Methods, Evidence, and Impact (L.T., D.H.-A., G.G.), McMaster University, Hamilton Health Sciences Hospital, General Site (F.M.),
  • Morellato J; From the Division of Orthopedic Surgery, Department of Surgery (S.S., H.J., J.A.-A., J.L., D.P., S. Bzovsky, O.P.S., J.L.G., M.B.), and the Department of Health Research Methods, Evidence, and Impact (L.T., D.H.-A., G.G.), McMaster University, Hamilton Health Sciences Hospital, General Site (F.M.),
  • Van Demark RE; From the Division of Orthopedic Surgery, Department of Surgery (S.S., H.J., J.A.-A., J.L., D.P., S. Bzovsky, O.P.S., J.L.G., M.B.), and the Department of Health Research Methods, Evidence, and Impact (L.T., D.H.-A., G.G.), McMaster University, Hamilton Health Sciences Hospital, General Site (F.M.),
  • Potter GD; From the Division of Orthopedic Surgery, Department of Surgery (S.S., H.J., J.A.-A., J.L., D.P., S. Bzovsky, O.P.S., J.L.G., M.B.), and the Department of Health Research Methods, Evidence, and Impact (L.T., D.H.-A., G.G.), McMaster University, Hamilton Health Sciences Hospital, General Site (F.M.),
  • Gitajn IL; From the Division of Orthopedic Surgery, Department of Surgery (S.S., H.J., J.A.-A., J.L., D.P., S. Bzovsky, O.P.S., J.L.G., M.B.), and the Department of Health Research Methods, Evidence, and Impact (L.T., D.H.-A., G.G.), McMaster University, Hamilton Health Sciences Hospital, General Site (F.M.),
  • Chang G; From the Division of Orthopedic Surgery, Department of Surgery (S.S., H.J., J.A.-A., J.L., D.P., S. Bzovsky, O.P.S., J.L.G., M.B.), and the Department of Health Research Methods, Evidence, and Impact (L.T., D.H.-A., G.G.), McMaster University, Hamilton Health Sciences Hospital, General Site (F.M.),
  • Phelps KD; From the Division of Orthopedic Surgery, Department of Surgery (S.S., H.J., J.A.-A., J.L., D.P., S. Bzovsky, O.P.S., J.L.G., M.B.), and the Department of Health Research Methods, Evidence, and Impact (L.T., D.H.-A., G.G.), McMaster University, Hamilton Health Sciences Hospital, General Site (F.M.),
  • Kempton LB; From the Division of Orthopedic Surgery, Department of Surgery (S.S., H.J., J.A.-A., J.L., D.P., S. Bzovsky, O.P.S., J.L.G., M.B.), and the Department of Health Research Methods, Evidence, and Impact (L.T., D.H.-A., G.G.), McMaster University, Hamilton Health Sciences Hospital, General Site (F.M.),
  • Karunakar M; From the Division of Orthopedic Surgery, Department of Surgery (S.S., H.J., J.A.-A., J.L., D.P., S. Bzovsky, O.P.S., J.L.G., M.B.), and the Department of Health Research Methods, Evidence, and Impact (L.T., D.H.-A., G.G.), McMaster University, Hamilton Health Sciences Hospital, General Site (F.M.),
  • Jaeblon T; From the Division of Orthopedic Surgery, Department of Surgery (S.S., H.J., J.A.-A., J.L., D.P., S. Bzovsky, O.P.S., J.L.G., M.B.), and the Department of Health Research Methods, Evidence, and Impact (L.T., D.H.-A., G.G.), McMaster University, Hamilton Health Sciences Hospital, General Site (F.M.),
  • Demyanovich HK; From the Division of Orthopedic Surgery, Department of Surgery (S.S., H.J., J.A.-A., J.L., D.P., S. Bzovsky, O.P.S., J.L.G., M.B.), and the Department of Health Research Methods, Evidence, and Impact (L.T., D.H.-A., G.G.), McMaster University, Hamilton Health Sciences Hospital, General Site (F.M.),
  • Domes CM; From the Division of Orthopedic Surgery, Department of Surgery (S.S., H.J., J.A.-A., J.L., D.P., S. Bzovsky, O.P.S., J.L.G., M.B.), and the Department of Health Research Methods, Evidence, and Impact (L.T., D.H.-A., G.G.), McMaster University, Hamilton Health Sciences Hospital, General Site (F.M.),
  • Kuhn GR; From the Division of Orthopedic Surgery, Department of Surgery (S.S., H.J., J.A.-A., J.L., D.P., S. Bzovsky, O.P.S., J.L.G., M.B.), and the Department of Health Research Methods, Evidence, and Impact (L.T., D.H.-A., G.G.), McMaster University, Hamilton Health Sciences Hospital, General Site (F.M.),
  • Reilly RM; From the Division of Orthopedic Surgery, Department of Surgery (S.S., H.J., J.A.-A., J.L., D.P., S. Bzovsky, O.P.S., J.L.G., M.B.), and the Department of Health Research Methods, Evidence, and Impact (L.T., D.H.-A., G.G.), McMaster University, Hamilton Health Sciences Hospital, General Site (F.M.),
  • Gage MJ; From the Division of Orthopedic Surgery, Department of Surgery (S.S., H.J., J.A.-A., J.L., D.P., S. Bzovsky, O.P.S., J.L.G., M.B.), and the Department of Health Research Methods, Evidence, and Impact (L.T., D.H.-A., G.G.), McMaster University, Hamilton Health Sciences Hospital, General Site (F.M.),
  • Weaver MJ; From the Division of Orthopedic Surgery, Department of Surgery (S.S., H.J., J.A.-A., J.L., D.P., S. Bzovsky, O.P.S., J.L.G., M.B.), and the Department of Health Research Methods, Evidence, and Impact (L.T., D.H.-A., G.G.), McMaster University, Hamilton Health Sciences Hospital, General Site (F.M.),
  • von Keudell AG; From the Division of Orthopedic Surgery, Department of Surgery (S.S., H.J., J.A.-A., J.L., D.P., S. Bzovsky, O.P.S., J.L.G., M.B.), and the Department of Health Research Methods, Evidence, and Impact (L.T., D.H.-A., G.G.), McMaster University, Hamilton Health Sciences Hospital, General Site (F.M.),
  • Heng M; From the Division of Orthopedic Surgery, Department of Surgery (S.S., H.J., J.A.-A., J.L., D.P., S. Bzovsky, O.P.S., J.L.G., M.B.), and the Department of Health Research Methods, Evidence, and Impact (L.T., D.H.-A., G.G.), McMaster University, Hamilton Health Sciences Hospital, General Site (F.M.),
  • McTague MF; From the Division of Orthopedic Surgery, Department of Surgery (S.S., H.J., J.A.-A., J.L., D.P., S. Bzovsky, O.P.S., J.L.G., M.B.), and the Department of Health Research Methods, Evidence, and Impact (L.T., D.H.-A., G.G.), McMaster University, Hamilton Health Sciences Hospital, General Site (F.M.),
  • Alnasser A; From the Division of Orthopedic Surgery, Department of Surgery (S.S., H.J., J.A.-A., J.L., D.P., S. Bzovsky, O.P.S., J.L.G., M.B.), and the Department of Health Research Methods, Evidence, and Impact (L.T., D.H.-A., G.G.), McMaster University, Hamilton Health Sciences Hospital, General Site (F.M.),
  • Mehta S; From the Division of Orthopedic Surgery, Department of Surgery (S.S., H.J., J.A.-A., J.L., D.P., S. Bzovsky, O.P.S., J.L.G., M.B.), and the Department of Health Research Methods, Evidence, and Impact (L.T., D.H.-A., G.G.), McMaster University, Hamilton Health Sciences Hospital, General Site (F.M.),
  • Donegan DJ; From the Division of Orthopedic Surgery, Department of Surgery (S.S., H.J., J.A.-A., J.L., D.P., S. Bzovsky, O.P.S., J.L.G., M.B.), and the Department of Health Research Methods, Evidence, and Impact (L.T., D.H.-A., G.G.), McMaster University, Hamilton Health Sciences Hospital, General Site (F.M.),
  • Natoli RM; From the Division of Orthopedic Surgery, Department of Surgery (S.S., H.J., J.A.-A., J.L., D.P., S. Bzovsky, O.P.S., J.L.G., M.B.), and the Department of Health Research Methods, Evidence, and Impact (L.T., D.H.-A., G.G.), McMaster University, Hamilton Health Sciences Hospital, General Site (F.M.),
  • Szatkowski J; From the Division of Orthopedic Surgery, Department of Surgery (S.S., H.J., J.A.-A., J.L., D.P., S. Bzovsky, O.P.S., J.L.G., M.B.), and the Department of Health Research Methods, Evidence, and Impact (L.T., D.H.-A., G.G.), McMaster University, Hamilton Health Sciences Hospital, General Site (F.M.),
  • Scott AN; From the Division of Orthopedic Surgery, Department of Surgery (S.S., H.J., J.A.-A., J.L., D.P., S. Bzovsky, O.P.S., J.L.G., M.B.), and the Department of Health Research Methods, Evidence, and Impact (L.T., D.H.-A., G.G.), McMaster University, Hamilton Health Sciences Hospital, General Site (F.M.),
  • Shannon SF; From the Division of Orthopedic Surgery, Department of Surgery (S.S., H.J., J.A.-A., J.L., D.P., S. Bzovsky, O.P.S., J.L.G., M.B.), and the Department of Health Research Methods, Evidence, and Impact (L.T., D.H.-A., G.G.), McMaster University, Hamilton Health Sciences Hospital, General Site (F.M.),
N Engl J Med ; 390(5): 409-420, 2024 Feb 01.
Article em En | MEDLINE | ID: mdl-38294973
ABSTRACT

BACKGROUND:

Studies evaluating surgical-site infection have had conflicting results with respect to the use of alcohol solutions containing iodine povacrylex or chlorhexidine gluconate as skin antisepsis before surgery to repair a fractured limb (i.e., an extremity fracture).

METHODS:

In a cluster-randomized, crossover trial at 25 hospitals in the United States and Canada, we randomly assigned hospitals to use a solution of 0.7% iodine povacrylex in 74% isopropyl alcohol (iodine group) or 2% chlorhexidine gluconate in 70% isopropyl alcohol (chlorhexidine group) as preoperative antisepsis for surgical procedures to repair extremity fractures. Every 2 months, the hospitals alternated interventions. Separate populations of patients with either open or closed fractures were enrolled and included in the analysis. The primary outcome was surgical-site infection, which included superficial incisional infection within 30 days or deep incisional or organ-space infection within 90 days. The secondary outcome was unplanned reoperation for fracture-healing complications.

RESULTS:

A total of 6785 patients with a closed fracture and 1700 patients with an open fracture were included in the trial. In the closed-fracture population, surgical-site infection occurred in 77 patients (2.4%) in the iodine group and in 108 patients (3.3%) in the chlorhexidine group (odds ratio, 0.74; 95% confidence interval [CI], 0.55 to 1.00; P = 0.049). In the open-fracture population, surgical-site infection occurred in 54 patients (6.5%) in the iodine group and in 60 patients (7.3%) in the chlorhexidine group (odd ratio, 0.86; 95% CI, 0.58 to 1.27; P = 0.45). The frequencies of unplanned reoperation, 1-year outcomes, and serious adverse events were similar in the two groups.

CONCLUSIONS:

Among patients with closed extremity fractures, skin antisepsis with iodine povacrylex in alcohol resulted in fewer surgical-site infections than antisepsis with chlorhexidine gluconate in alcohol. In patients with open fractures, the results were similar in the two groups. (Funded by the Patient-Centered Outcomes Research Institute and the Canadian Institutes of Health Research; PREPARE ClinicalTrials.gov number, NCT03523962.).
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Infecção da Ferida Cirúrgica / Clorexidina / Fraturas Ósseas / Fixação de Fratura / Iodo / Anti-Infecciosos Locais Tipo de estudo: Clinical_trials / Etiology_studies Limite: Humans País como assunto: America do norte Idioma: En Ano de publicação: 2024 Tipo de documento: Article
Texto completo
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PubMed Links
Buscar no Google

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Infecção da Ferida Cirúrgica / Clorexidina / Fraturas Ósseas / Fixação de Fratura / Iodo / Anti-Infecciosos Locais Tipo de estudo: Clinical_trials / Etiology_studies Limite: Humans País como assunto: America do norte Idioma: En Ano de publicação: 2024 Tipo de documento: Article