{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:50:10Z","timestamp":1787755810146,"version":"build-2784847793"},"reference-count":16,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"Suppl 1","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,6,18]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Skin antisepsis remains a vital component in prophylaxis against surgical site infection (SSI); however, for open fractures, it is unclear whether alcohol-based or aqueous solutions should be preferred. The purpose of this study was to compare the use of alcohol-based and aqueous skin antisepsis solutions, using data from the 2 PREP-IT trials, with respect to the risks of SSI and unplanned reoperation following surgery for an open fracture.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Individual patient data from the 2 cluster-randomized, crossover clinical trials were combined to create a single data set of patients undergoing surgery for an open fracture. A regression model was used to analyze the effects of an alcohol-based versus an aqueous solution, as well as for potential interaction with the use of chlorhexidine or iodine as the primary agent. The primary outcome was SSI within 90 days.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A total of 3,338 participants undergoing surgery for an open fracture were included in the final analysis, with 1,700 receiving an alcohol-based solution and 1,638 receiving an aqueous solution. Overall, the use of an alcohol-based skin antiseptic solution, compared with an aqueous solution, did not reduce the risk of SSI at 90 days (odds ratio [OR], 0.99; 95% confidence interval [CI], 0.66 to 1.48; p = 0.95), or the risk of unplanned reoperation at 1 year (OR, 0.98; 95% CI, 0.75 to 1.28; p = 0.88). Planned subgroup analyses also found no significant difference in the risk of SSI or unplanned reoperation when participants were stratified by Gustilo-Anderson type, fracture location, or the primary ingredient of the skin preparation solution (chlorhexidine versus iodophor).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>This analysis found no difference in the risk of SSI or reoperation when comparing alcohol-based and aqueous skin preparation solutions. Furthermore, this analysis demonstrated no harm with use of an alcohol-based solution for open fractures, and the PREPARE trial found that skin preparation with 0.7% iodine povacrylex in 74% isopropyl alcohol was associated with a reduced risk of SSI for closed fractures. Given these findings, surgeons may wish to consider streamlining their policy by treating all fractures with a single skin antiseptic, 0.7% iodine povacrylex in 74% isopropyl alcohol.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level III<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.24.01244","type":"journal-article","created":{"date-parts":[[2025,6,18]],"date-time":"2025-06-18T11:00:28Z","timestamp":1750244428000},"page":"4-11","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Alcohol-Based Versus Aqueous Skin Antisepsis Before Surgical Fixation of Open Fractures"],"prefix":"10.2106","volume":"107","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0434-4989","authenticated-orcid":false,"given":"Kyle","family":"Gouveia","sequence":"first","affiliation":[{"name":"Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada"},{"name":"Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, 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Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lehana","family":"Thabane","sequence":"additional","affiliation":[{"name":"Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada"},{"name":"Research Institute of St. Joe\u2019s Hamilton, St. Joseph\u2019s Healthcare Hamilton, Hamilton, Ontario, Canada"},{"name":"Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3603-3344","authenticated-orcid":false,"given":"Kyle J.","family":"Jeray","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Prisma Health, Greenville, South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1374-0712","authenticated-orcid":false,"given":"Rachel M.","family":"Reilly","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Duke University School of Medicine, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohit","family":"Bhandari","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada"},{"name":"Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9111-9239","authenticated-orcid":false,"given":"Gerard P.","family":"Slobogean","sequence":"additional","affiliation":[{"name":"Center for Orthopaedic Injury Research and Innovation, R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1466-8063","authenticated-orcid":false,"given":"Sheila","family":"Sprague","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada"},{"name":"Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the PREP-IT Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,6,18]]},"reference":[{"issue":"2","key":"bib1-20250619","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.2106\/JBJS.RVW.N.00051","article-title":"Open Tibial Fractures: Updated Guidelines for Management","volume":"3","author":"Mundi","year":"2015","journal-title":"JBJS 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