Effect of XPERIENCE advanced surgical irrigation on Cutibacterium Acnes contamination in shoulder arthroplasty

The current study seeks to assess if the XPERIENCE® Advanced Surgical Irrigation (XASI) wash can reduce the incidence of Cutibacterium acnes (C. Acnes) pathogen contamination in shoulder arthroplasty surgery. XASI is an intra-operative surgical irrigant employed to cleanse and remove debris including micro-organisms, from the surgical wound space. It was designed as a no-rinse intraoperative surgical irrigation solution. It consists of citric acid, sodium citrate, and sodium lauryl sulfate in water. Citric acid and sodium citrate serve as pH buffers and aid in metal ion chelation, while sodium lauryl sulfate acts as a surfactant, assisting in debris removal including micro-organisms. XASI will be placed into the wound (following skin incision and once the wound is opened to expose the shoulder joint) as a wash and allowed to remain in the surgical field until the shoulder arthroplasty procedure has been completed. Following the completion of the surgical procedure, the wound will then be washed appropriately with normal saline irrigation prior to wound closure. For each procedure, a 500ml container is emptied into the surgical wound site in all cases. Recruited patients will be randomized into two groups: 1) specimen swabs taken before receiving 500ml of XASI (Group 1, which is the control group for the purpose of the study), or 2) receiving 500ml of XASI before specimen swabs are taken (Group 2, which is the intervention group for the purpose of the study). All participants will therefore undergo the XPERIENCE® wash. Swabs will be taken from six different sites from around the skin incision and surgeon’s instruments, and is expected to add an extra 2-3 minutes to the operating time.