Preoperative iodine povacrylex in alcohol for fixation of closed lower-extremity or pelvic fractures,
does it really help with Reduced surgical-site infection versus chlorhexidine in alcohol?
research showsGrade B. In 6,785 closed-fracture patients, surgical-site infection occurred in 77/3,360 (2.4%) versus 108/3,425 (3.3%): adjusted OR 0.74 (95% CI 0.55 to 0.999), P=.049, adjusted risk difference -0.8 points (95% CI -1.6 to 0.0). The P value and upper confidence limit are extremely borderline.
ads claimThis does not mean iodine is always superior to chlorhexidine. It compares two specific alcohol formulations in closed lower-extremity and pelvic fracture fixation.
Useful facts when choosing a product
- The preparations were 0.7% free iodine povacrylex in 74% isopropyl alcohol and 2% chlorhexidine gluconate in 70% isopropyl alcohol.
- The adjusted absolute infection difference was -0.8 points.
- The separately enrolled open-fracture population was null.
What the research actually shows
PREPARE was a cluster-randomized crossover trial in which 25 US and Canadian hospitals alternated the two alcohol-based preparations every two months. Closed lower-extremity/pelvic fractures and open fractures were separately prespecified populations. PCORI and CIHR funded the trial, operated by McMaster University and the University of Maryland Baltimore. No antiseptic-manufacturer product donation, commercial analysis, medical writing, or publication funding was reported. Registration preceded recruitment.
Axis 6 B0 evidence ① Allocation concealment: "Hospitals were randomly assigned to an initial antiseptic solution by the Methods Centre using a computer-generated sequence, with allocation implemented at the cluster-period level." ② Masking: "A central adjudication committee whose members were unaware of the treatment assignments adjudicated the primary outcome." Surgical-team masking was infeasible, but objective infection adjudication was masked. ③ Analysis population and missing data: "The primary analysis included all eligible enrolled patients according to the antiseptic solution assigned to their hospital during that crossover period." Primary-outcome follow-up was 95%. ④ Prespecified primary endpoint: "The primary outcome was surgical-site infection, including superficial incisional infection within 30 days or deep incisional or organ-space infection within 90 days." — matches registration NCT03523962
Why this is classified as B (76)
A large publicly funded hard-outcome trial had documented allocation, adjudication, analysis, and prespecification, but only one confirmatory trial, giving B with 76 points.
Counterpoint. Significance was extremely borderline at P=.049 and an OR upper limit of 0.999.
Rejudgment record. Cross-check applied — Large publicly funded cluster-randomized crossover trial with masked infection adjudication and documented design gates, limited to one confirmatory trial
| Endpoint | H | Hard endpoint - actual events such as death |
| Replication | R1 | Single confirmatory trial |
| Independence | I2 | Decisive evidence is publicly or non-profit funded |
| Effect size | E+ | Meets the clinically important threshold |
The scoring table and the verdict agree (B).
Sub-claim grades by effect
This ingredient is marketed for several effects. A single overall grade blends strong and weak claims together, so each effect is graded separately here. The overall grade reflects the strongest disconfirming or core claim.
| Effect (sub-claim) | Grade | Basis |
|---|---|---|
| Reduced SSI after closed-fracture fixation | B | The absolute difference was -0.8 points and extremely borderline. |
| Reduced SSI after open-fracture fixation | D | The separately enrolled population was null at P=.45. |
Cross-check — AI research and Codex final gate
Evidence Table
| Study | Design | Sample | Funding | Endpoint | Result | Weight |
|---|---|---|---|---|---|---|
| PREP-IT Investigators. 2024 PREPARE Closed | 25-hospital cluster-randomized crossover trial | 3,425 | Public funding from PCORI and CIHR | Superficial SSI within 30 days or deep/organ-space SSI within 90 days | 2.4% vs 3.3%; adjusted OR 0.74 (95% CI 0.55-0.999), P=.049; risk difference -0.8 points (-1.6 to 0.0) | Large hard infection outcome |
Receipt — 1 References
All 1 cited sources were verified for existence at the original page (as of 2026-08-26).
Final verification and publication gate: Codex · Verification cutoff: 2026-08-26 · Corrections: none
Cite this verdict
[Chamgap] Benefit of Iodine Povacrylex-Alcohol for Surgical-Site Infection After Closed-Fracture Fixation — Evidence Grade B·76. 1 cited sources checked. Source: https://chamgap.com/en/verdicts/joint-bone/iodine-povacrylex-alcohol-closed-fracture-surgical-site-infection/ · CC BY 4.0CC BY 4.0 — free to use with attribution; do not distort grades, numbers, or verdict meaning.
What this document does and does not do
Chamgap is an information source. It reports what research has and has not confirmed; it does not tell readers what to take or buy. That decision belongs to readers and, when needed, medical or legal professionals. This verdict reflects literature available up to the search date and may change as new research appears. Nothing here is medical advice.