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Extended Skin Cleaning On The Shoulder With Chlorhexidine Reduces The Cutaneous Bacterial Load But Fails To Decrease Suture Contamination In Patients Undergoing Arthroscopy Rotator Cuff Repair

Extended Skin Cleaning On The Shoulder With Chlorhexidine Reduces The Cutaneous Bacterial Load But Fails To Decrease Suture Contamination In Patients Undergoing Arthroscopy Rotator Cuff Repair

Chih-Kai Hong, MD, TAIWAN Kai-Lan Hsu, MD, UNITED STATES Fachuan Kuan, MD, TAIWAN Ya-Ting Lee, BS, TAIWAN Pei-Fang Tsai, BS, TAIWAN Po-Lin Chen, MD, PhD, TAIWAN Wei-Ren Su, MD, MSc, TAIWAN

Department of Orthopaedic Surgery, National Cheng Kung University Hospital, Tainan, TAIWAN


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Summary: Extensive skin cleaning to the shoulder region with chlorhexidine helps reduce the shoulder cutaneous bacterial load, but the detection of C. acnes suture contamination in patients undergoing arthroscopic rotator cuff repair remained untouched.


Purpose

To investigate whether preoperative skin cleaning of the chin, neck, and chest with chlorhexidine soap could reduce suture contamination by Cutibacterium acnes (C. acnes) in patients undergoing arthroscopic rotator cuff repair.

Methods

This study included patients who underwent primary arthroscopic rotator cuff repair. Exclusion criteria included age <18 years, previous shoulder surgery, history of shoulder infection, and allergy to chlorhexidine. Patients were randomized into three groups. Patients in the control group cleaned their skin with soap and water, as usual. Patients in the shoulder group cleaned their shoulders with chlorhexidine soap 3 days before surgery, whereas patients in the extended shoulder group additionally cleaned their chest, back, neck, and face with chlorhexidine soap. On the day of surgery, skin swab samples were obtained from the shoulder after surgical draping. After rotator cuff repair, sutures were cut from the anchor ends. Both traditional culture methods and polymerase chain reaction (PCR) were used.

Results

Ninety patients were enrolled (32 in the control group, 29 in the shoulder group, and 29 in the extended shoulder group) in the present study. The culture-positive rate from the posterior shoulder skin samples in the extended shoulder group (17.2%) was significantly lower than that in the control (40.6%) and shoulder (48.3%) groups (P = 0.036), whereas the culture-positive rates were not different among the three groups in other skin samples as well as the suture samples. The detection rates of C. acnes in suture samples were 12.5%, 13.8%, and 17.2% in the control, shoulder, and extended shoulder groups, respectively (P = 0.603).

Conclusion

Extensive skin cleaning to the shoulder region with chlorhexidine helps reduce the shoulder cutaneous bacterial load, but the detection of C. acnes suture contamination in patients undergoing arthroscopic rotator cuff repair remained untouched regardless of the use of chlorhexidine soap in skin cleaning on the preoperative days.


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