Infection Prevention in Shoulder Surgery

The microbiome of the shoulder demonstrates distinctive differences to other orthopaedic surgical sites. Recent studies have demonstrated that the most common organisms found in deep shoulder infections are coagulase-negative staph lococcal species and Propionibacterium acnes . Many studies support diligent hand washing, decreasing operative time, routine glove changing, minimizing operating room traffic, and covering instruments as means for decreasing the risk of deep infection. On the other hand, hair clipping and the use of adhesive drapes may have little effect on decreasing the incidence of deep infection. Although generally considered the most efficacious skin preparation solution, chlorhexidine gluconate has minimal effect on eradication of P. acnes from the surgical site; however, the addition of preoperative topical applications of benzoyl peroxide to standard surgical preparation has shown promise in decreasing the rate of P . acnes culture positivity. Additionally, the use of local antibiotic formulations seems to be an effective means of preventing deep infection.