Chlorhexidine showers prior to shoulder arthroplasty are commonly used by surgeons in hopes of reducing 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.
Sixty-six 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.
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).
Bacterial loads on the epidermal skin surface of patients having elective shoulder
arthroplasty before (dark columns) and after (light columns) prescribed
chlorhexidine showers. Results are shown for coagulase negative Staphylococcus
(left), Cutibacterium (center) and other bacteria (right).
The authors concluded that 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 preventing these bacteria from entering the surgical field.
Comment: While Chlorhexidine showers may be effective in removing other bacteria from the skin surface, they do not appear to be effective in reducing the amount of Cutibacterium, the most common organism causing shoulder periprosthetic infections.
