title: The effect of axillary hair on surgical antisepsis around the shoulder.
abstract: BACKGROUND
  Infection after shoulder surgery can have devastating consequences. Recent literature has implicated Propionibacterium acnes as a causative agent for postoperative shoulder infections. Axillary hair removal has been suggested as a method for infection prevention, although data quantifying its effect on the bacterial load around the shoulder are lacking.
  
  
  METHODS
  We clipped one randomly selected axilla in 85 healthy male volunteers with commercially available surgical clippers. Aerobic and anaerobic culture specimens were taken from the clipped and unclipped axillae. Each shoulder was then prepared with 2% chlorhexidine gluconate and 70% isopropyl alcohol. Repeated culture specimens were then taken from both axillae. Cultures were held for 14 days and recorded with a semiquantitative system (0-4 points). Results were compared by the Wilcoxon signed rank test.
  
  
  RESULTS
  There was no difference in the burden of P. acnes between the clipped and unclipped axillae before or after surgical preparation (P = .109, P = .344, respectively). There was a significantly greater bacterial burden in the clipped shoulder compared with the unclipped shoulder before preparation (P < .001) but not after preparation (P = .285). There was a significant reduction in total bacterial load and P. acnes load for both axillae after surgical preparation (P < .001 for all).
  
  
  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 is effective at removal of all bacteria and specifically P. acnes from the axilla.
authors.affiliation: Department of Orthopaedic Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA. Electronic address: marecek@usc.edu.
authors.forename: Geoffrey S
authors.initials: GS
authors.lastname: Marecek
authors.affiliation: Department of Orthopaedic Surgery, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Weatherford
authors.affiliation: Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Eric B
authors.initials: EB
authors.lastname: Fuller
authors.affiliation: Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Saltzman
mesh_terms: D019840:2-Propanol / Q000008:administration & dosage; D000328:Adult; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage; D000985:Antisepsis; D001365:Axilla / Q000382:microbiology*; D058491:Bacterial Load; D002710:Chlorhexidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D006197:Hair; D006204:Hair Removal; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D011425:Propionibacterium acnes / Q000302:isolation & purification*; D012782:Shoulder / Q000382:microbiology* / Q000601:surgery; D012785:Shoulder Joint / Q000601:surgery; D012867:Skin / Q000382:microbiology*; D055815:Young Adult
chemical_list: D000891:Anti-Infective Agents, Local; C010882:chlorhexidine gluconate; D019840:2-Propanol; D002710:Chlorhexidine
keywords: Propionibacterium acnes; Shoulder; axilla; infection; surgical preparation