These authors sought to evaluate the effect on cutaneous Cutibacterium acnes when adding hydrogen peroxide to a standard sterile preparation for shoulder surgery.
Patients were randomized to a standard skin preparation vs. an additional sterile preparation with 3% hydrogen peroxide.
The first skin cleanse was done with 2% chlorhexidine gluconate cloths. Routine perioperative antibiotics were administered within 1 hour of surgery, either weight-based cefazolin or vancomycin for those with a cephalosporin allergy. In the operating room, the upper extremity, including the shoulder and axilla, was cleansed with saturated 7.5% povidone-iodine solution surgical scrub brushes and then wiped clean with a sterile towel. The study population then had sterile preparation with five 3% hydrogen peroxide–soaked gauzes. The remainder of the preparation was uniform. Two 26-mL stick applicators with 2% chlorhexidine gluconate and 70% isopropyl alcohol formulation were used to cleanse the shoulder, axilla, and arm.
After draping, a 3-mm punch biopsy was obtained from the posterior arthroscopic portal site of all patients. Anaerobic and aerobic culture substrates were used and held for 13 days.
Twelve (17.1%) patients in the hydrogen peroxide group and 24 (34.2%) patients in the traditional group had positive cultures for C acnes. Evaluation of the semiquantitative assessment of C acnes growth showed no statistically significant differences between groups.
Comment: In spite of a multifaceted effort to eliminate Cutibacterium from these shoulders, it is impressive that substantial amounts of bacteria still remained in some of them.
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