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While home chlorhexidine washes prior to shoulder surgery lower skin loads of most bacteria, they are not effective against Cutibacterium (Propionibacterium)

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Abstract

Purpose

Chlorhexidine showers prior to shoulder arthroplasty are commonly recommended by surgeons to lower the risk of periprosthetic infection; however, the effectiveness of these washes in eliminating bacteria from the skin of the shoulder has not been thoroughly evaluated. The objective of this study was to determine the degree to which pre-operative chlorhexidine washes effectively eliminate bacteria from the epidermal skin surface and from the dermis freshly incised during shoulder arthroplasty.

Methods

Around 66 patients undergoing primary shoulder arthroplasty were instructed to shower with chlorhexidine before surgery. Each patient had three skin swabs: (1) the epidermis at a pre-operative clinic appointment, (2) the epidermis at surgery after home chlorhexidine showers but prior to skin preparation, and (3) the dermis after incision of the prepared skin. The bacterial loads of Cutibacterium and other bacterial types from each swab were compared to determine whether the showers were effective in altering the bacterial loads.

Results

Chlorhexidine washes were effective in reducing the skin load of other bacterial species (p < 0.005), but they did not decrease the skin load of Cutibacterium (p = 0.585).

Conclusions

Pre-operative skin showers with chlorhexidine were not effective in reducing the load of Cutibacterium on the skin of patients having shoulder arthroplasty. Since Cutibacterium is responsible for the highest percentage of shoulder periprosthetic infections, research is needed to identify more effective means of removing these bacteria from the surgical field.

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Acknowledgments

We thank Susan DeBartolo, University of Washington Department of Orthopedics and Sports Medicine (blinded for review purposes), for her editorial work on this manuscript.

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Authors and Affiliations

  1. Department of Orthopedic and Sports Medicines, University of Washington Medical Center, 1959 NE Pacific Street, Box 356500, Seattle, WA, 98195-6500, USA

    Frederick A. Matsen, Anastasia J. Whitson & Jason E. Hsu

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  1. Frederick A. Matsen
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  2. Anastasia J. Whitson
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  3. Jason E. Hsu
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Correspondence to Frederick A. Matsen.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This was a level III cohort study approved by our Institutional Review Board (IRB #50408). For this type of study, formal consent is not required.

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Matsen, F.A., Whitson, A.J. & Hsu, J.E. While home chlorhexidine washes prior to shoulder surgery lower skin loads of most bacteria, they are not effective against Cutibacterium (Propionibacterium). International Orthopaedics (SICOT) 44, 531–534 (2020). https://doi.org/10.1007/s00264-019-04477-w

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