Skin Antisepsis Before Surgical Fixation of Limb Fractures: The PREPARE Trial
The PREPARE Trial was a cluster-randomized, crossover trial part of the PREP-IT program, which compared alcohol-based anti-septic solutions of iodine povacrylex vs. chlorhexidine gluconate in operative fracture patients. THE PREPARE Trial included a total of 8485 patients who underwent fracture fixation: 1700 patients with open limb fractures and 6785 with closed lower-limb or pelvic fractures. Randomization occurred at the hospital level. The primary outcome of interest was the incidence of surgical-site infection, which included superficial incisional infections within 30 days and deep incisional or organ-space infections within 60 days post-surgery. Secondary outcomes included unplanned fracture-related reoperations and serious adverse events. The iodone povacrylex group had a lower incidence of surgical site infections in closed-fracture patients, but the rates were similar in open-fracture patients between the two groups. In the closed-fracture group, 5.5% in the iodine group and