How effective is hydrogen peroxide in reducing Cutibacterium in shoulder skin?

 Addition of 3% hydrogen peroxide to standard skin preparation reduces Cutibacterium acnes–positive culture rate in shoulder surgery: a prospective randomized controlled trial

These authors sought to evaluate the effectiveness of hydrogen peroxide in reducing the levels of Cutibacterium in skin punch biopsies from the skin of the posterior shoulder.

Patients were randomized to a standard skin preparation vs. an additional sterile preparation with 3% hydrogen peroxide. After draping, a 3-mm punch biopsy was obtained from the posterior arthroscopic portal site of all patients. 

Seventy male patients were randomized into the hydrogen peroxide group and 70 male patients were in the traditional group. Twelve (17.1%) patients in the hydrogen peroxide group and 24 (34.2%) patients in the traditional group had positive cultures for Cutibacterium P = .033).  

Comment: This is a well-done prospective randomized controlled trial, most deserving of the American Shoulder and Elbow Surgeons' Neviaser Clinical Science Award (see this link).

The results are interesting. As shown in the table from the paper reproduced above, the primary effect of hydrogen peroxide was on the shoulders with either very light or light growth of Cutibacterium.

In shoulders with more than light growth, there was no benefit of hydrogen peroxide: 10 of 70 (14%) traditional prep shoulders had moderate to heavy growth of Cutibacterium in comparison to 9 of 70 (13%) hydrogen peroxide shoulders.

Considering all 70 shoulders, it is impressive that with or without hydrogen peroxide, over 27% (19/70) of the dermal biopsies in male shoulders showed moderate or heavy Cutibacterium growth in spite of (1) a skin cleanse with 2% chlorhexidine gluconate cloths, (2) IV antibiotics, (3) a skin cleanse with saturated 7.5% povidone-iodine solution surgical scrub brushes, and (4) application of 2% chlorhexidine gluconate and 70% isopropyl alcohol. 

Up to this point, no means of prophylaxis has been successful in eradicating Cutibacterium from the skin. In those shoulders with moderate to heavy loads of Cutibacterium in the skin, inoculation of the would appears likely, starting from the moment the skin is incised. 

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Here are some videos that are of shoulder interest

Shoulder arthritis - what you need to know (see this link)

Shoulder arthritis - x-ray appearance (see this link)

The smooth and move for irreparable cuff tears (see this link)

The total shoulder arthroplasty (see this link).

The ream and run technique is shown in this link.

The cuff tear arthropathy arthroplasty (see this link).

The reverse total shoulder arthroplasty (see this link).

Shoulder rehabilitation exercises (see this link).

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Note that author has no financial relationships with any orthopaedic companies