Basic ScienceThe effect of axillary hair on surgical antisepsis around the shoulder
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Materials and methods
Eighty-five healthy male volunteers were enrolled in the study. Eligible volunteers were men aged 18 to 80 years; only men were enrolled as P. acnes infection is more common in men than in women.14, 15 Enrollment was precluded if volunteers had active infections or antibiotic use in the previous 2 weeks or a history of dermatologic conditions in the axillae. The median age of participants was 27 years (range, 21-53 years).
We clipped one randomly selected axilla in each volunteer with
Results
The right axilla was clipped in 42 participants; the left was clipped in 43. Only 3 subjects had no axillary hair before clipping; 14 had perspiration, and 4 had acne. Only 1 subject reported tobacco use. A summary of baseline characteristics is found in Table II.
All subjects had positive cultures from the clipped axilla, whereas 7 subjects had negative cultures from the unclipped axilla. The most commonly isolated organism was coagulase-negative staphylococcus (124 of 170; 72.9%), followed by
Discussion
The role of P. acnes in the pathogenesis of postoperative shoulder infection and specifically in periprosthetic glenohumeral arthroplasty infection is increasingly recognized in the literature.2, 5, 7, 9, 16, 20, 26 This awareness has prompted surgeons to pursue various methods of risk reduction and infection prevention. Some of the proposed methods include excluding the axilla from the surgical field, preoperative antibiotics targeted to P. acnes, preoperative axillary cleansing, and axillary
Conclusions
Removal of axillary hair has no effect on the burden of P. acnes in the axilla. Clipped axillae had a higher total bacterial burden. A 2% chlorhexidine gluconate surgical preparation was effective at removal of all bacteria and specifically P. acnes from the axilla, whether or not axillary hair had been removed.
Disclaimer
The authors, their immediate families, and any research foundation with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.
Acknowledgments
The authors would like to acknowledge Mary Kwasny, ScD, for her assistance with statistical analysis and Eric Pang, MD, for his assistance with data collection.
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Cited by (0)
Investigation performed at Northwestern Memorial Hospital, Chicago, IL, USA.
The Northwestern University Institutional Review Board approved this study: No. CR3_STU00030047.