The PREPARE trial is a 25-hospital, cluster-randomized crossover trial comparing two alcohol-based skin antiseptics before extremity fracture fixation. It asked: does 0.7% iodine povacrylex in alcohol or 2% chlorhexidine gluconate in alcohol better prevent surgical-site infection? Closed (n=6,785) and open (n=1,700) fracture populations were analyzed separately.
Guidelines recommended chlorhexidine-plus-alcohol as the preferred skin antiseptic based largely on abdominal and cesarean delivery trials — with no large RCT specifically in orthopedic trauma patients. PREPARE changes that directly: for every closed lower-limb or pelvic fracture you take to the OR, reach for iodine povacrylex in alcohol (e.g., 3M DuraPrep), not chlorhexidine.
For open fractures, the data are clear that neither agent wins. Saline irrigation and pre-existing biofilm blunt any antiseptic advantage at the skin surface, so use whichever agent is available.
The key mechanistic insight worth knowing: iodine povacrylex is not the same as povidone iodine. Its water-insoluble povacrylex copolymer resists washout by blood and fluid and improves drape adhesion. Properties that matter in a closed wound but are overwhelmed by liters of irrigation in an open fracture débridement.
The PREPARE trial is a 25-hospital, cluster-randomized crossover trial comparing two alcohol-based skin antiseptics before extremity fracture fixation. It asked: does 0.7% iodine povacrylex in alcohol or 2% chlorhexidine gluconate in alcohol better prevent surgical-site infection? Closed (n=6,785) and open (n=1,700) fracture populations were analyzed separately.
Guidelines recommended chlorhexidine-plus-alcohol as the preferred skin antiseptic based largely on abdominal and cesarean delivery trials — with no large RCT specifically in orthopedic trauma patients. PREPARE changes that directly: for every closed lower-limb or pelvic fracture you take to the OR, reach for iodine povacrylex in alcohol (e.g., 3M DuraPrep), not chlorhexidine.
For open fractures, the data are clear that neither agent wins. Saline irrigation and pre-existing biofilm blunt any antiseptic advantage at the skin surface, so use whichever agent is available.
The key mechanistic insight worth knowing: iodine povacrylex is not the same as povidone iodine. Its water-insoluble povacrylex copolymer resists washout by blood and fluid and improves drape adhesion. Properties that matter in a closed wound but are overwhelmed by liters of irrigation in an open fracture débridement.