Is there value in the routine practice of discarding the incision scalpel from the surgical field to prevent deep wound contamination with Cutibacterium acnes? An update.

Abstract

Cutibacterium acnes (C.Acnes) is the most common microbe implicated in periprosthetic infection in shoulder arthroplasty. This is an update on a previous pilot study where we demonstrated the persistence of C. Acnes on the skin and contamination of the scalpel used for initial skin incision despite a robust pre surgical skin prep protocol.14 METHODS: A consecutive case series of patients undergoing primary or revision anatomic or reverse total shoulder arthroplasty by a single fellowship-trained surgeon at a tertiary referral hospital from November 2019 to December 2022 was collected. The scalpel blade used for initial skin incision for all patients was swabbed with cultures being held for 21 days according to C.Acnes specific protocol. Demographic data, medical comorbidities, surgical information, culture results, and any infections were documented. 100 patients (51 males, 49 females) meeting inclusion criteria were identified (mean age 66.91, range 44-93 years). Cultures returned positive for C.Acnes in 12 patients (12%) 11/12 being male OR 13.2 (95% Cl [1.73. 194.87]). No association was found between positive culture and age, BMI, medical comorbidities or procedure type. There were no postoperative infections in this patient cohort and they will continue to be monitored for development of infection. Despite stringent pre-surgical preparation and scrub protocols a significant portion of patients undergoing shoulder arthroplasty have C.Acnes in culturable quantities on their skin at the time of incision. C.Acnes contamination is much more common in male patients. These findings should be taken into consideration in regard to preventive measures such as discarding the initial scalpel and avoiding unnecessary dermal contact during the procedure.