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Dynamics of Cutibacterium repopulation onto the skin surface of the shoulder after chlorhexidine application

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Abstract

Purpose

The objective of this study was to characterize the temporal dynamics of Cutibacterium repopulation of the skin surface after application of chlorhexidine to the shoulder.

Methods

Ten shoulders in five male subjects were used. A skin swab was taken prior to (0 minutes) and then at three, 30, 60, 120, and 240 minutes after skin preparation with 2% chlorhexidine gluconate and 70% isopropyl alcohol. Semi-quantitative bacterial load was measured for each timepoint.

Results

From zero minutes (pre-treatment) to three minutes, chlorhexidine-isopropyl alcohol reduced the skin bacterial load in eight out of ten shoulders. Of these eight shoulders, four (50%) had growth by 30 minutes, seven (88%) had growth by 60 minutes, and all eight (100%) had growth by 240 minutes. Compared to the three minutes after chlorhexidine application, bacterial load had significantly increased by 60 minutes but were still significantly lower than the pre-prep bacterial load (0 minutes).

Conclusion

Following standard surgical skin preparation with chlorhexidine-isopropyl alcohol, the surface of the shoulder is repopulated with Cutibacterium within one hour, presumably from reservoirs in sebaceous glands not penetrated by topical antiseptic agents. Since these dermal glands are transected by skin incision for shoulder arthroplasty, this study suggests that they may be sources of wound contamination during surgery in spite of skin preparation with chlorhexidine.

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Fig. 1
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Fig. 3

Modified from the National Institutes of Health (NIH), Department of Health and Human Services

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Data availability

Data has not been deposited into a public repository but is available upon request.

Code availability

N/A

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Acknowledgements

The authors would also like to thank Susan DeBartolo (University of Washington, Department of Orthopaedics and Sports Medicine) for her editorial work on this manuscript.

Funding

The authors acknowledge support for this study from the University of Washington’s Douglas T. Harryman II/Depuy Endowed Chair for Shoulder Research and The Rick and Anne Matsen Endowed Professorship for Shoulder Research. Dr. Long reports his efforts on this project were supported by the following National Institutes of Health awards: National Institute of General Medical Sciences T32 GM086270-11 and National Institute of Arthritis and Musculoskeletal and Skin Diseases 1K23AR080209-01.

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Authors and Affiliations

  1. Investigation Performed at the University of Washington, Department of Orthopedics and Sports Medicine, Seattle, WA, USA

    Jason E. Hsu, Anastasia J. Whitson, Rufus Van Dyke, John C. Wu & Frederick A. Matsen III

  2. Harborview Medical Center Department of Anesthesiology and Pain Medicine Division of Critical Care Medicine, University of Washington, 325 9th Avenue, Seattle, WA, 98104, USA

    Dustin R. Long

Authors
  1. Jason E. Hsu
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  2. Anastasia J. Whitson
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  3. Rufus Van Dyke
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  4. John C. Wu
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  5. Frederick A. Matsen III
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  6. Dustin R. Long
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Contributions

All authors contributed to the study conception and design as well as the material preparation, data collection and analysis. The first draft of the manuscript was written by Drs. Long, Hsu, and Matsen and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jason E. Hsu.

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Consent to participate

Informed consent was obtained from all patients included in this study.

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Competing interests

Authors Anastasia Whitson and Drs. Van Dyke, Wu, and Matsen declare they have no financial interests. Dr. Jason Hsu reports the relevant financial activities outside of the submitted work: Consultation/personal fees for DJO Surgical, committee member of the American Shoulder and Elbow Surgeons, and Associate Editor for the Journal of Bone and Joint Surgery

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Hsu, J.E., Whitson, A.J., Van Dyke, R. et al. Dynamics of Cutibacterium repopulation onto the skin surface of the shoulder after chlorhexidine application. International Orthopaedics (SICOT) 47, 1511–1515 (2023). https://doi.org/10.1007/s00264-023-05786-x

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