MMWR Update

What price beauty? SSIs are linked to liposuction

After assisting in investigating an outbreak of surgical site infections (SSIs) following cosmetic surgery in Caracas, Venezuela, the Centers for Disease Control and Prevention reminds that all surgical instruments used in liposuction or liposculpture procedures should be cleaned carefully and sterilized after the procedure.

Providers should sterilize the equipment in accordance with a validated reprocessing protocol provided by the medical device manufacturer. The exclusive use of low- or intermediate-level disinfectants to reprocess surgical instruments between patient procedures is inconsistent with Food and Drug Administration guidance and recommended standards of practice, the CDC emphasized.

During October 1996-March 1998, nine patients in eight hospitals in Caracas, Venezuela, acquired SSIs caused by rapidly growing mycobacteria (RGM). All episodes of RGM infection occurred within two months after liposuction or liposculpture. All case patients were previously healthy women aged 28 to 49 years. Eight surgeons and surgical teams performed the cosmetic surgery on the women. The median time from surgical procedure to onset of infection was 15 days (range: four to 45 days). Clinical findings included fever, local inflammation, microabscesses, purulent drainage from the wound, or fistulae.

All hospitals cleaned liposuction and liposculpture cannulae with tap water and soap followed by low-level disinfection with a commercial quaternary ammonium solution, the CDC reported. The epidemiologic investigation did not reveal other risk factors such as exposure to certain persons, cleaning solutions, medical supplies, or contaminated quaternary ammonium compounds. Following the outbreak, two of the surgical facilities modified their reprocessing procedures for surgical instruments used in cosmetic surgical procedures by replacing quaternary ammonium compounds used for low-level disinfection with either high-level disinfection using 2% glutaraldehyde or ethylene oxide gas sterilization. No further cases of RGM infections complicating cosmetic surgical procedures were reported.

"The underlying mechanism for the cluster of SSIs described in this report was not determined," the CDC concluded. "However, potential causes included contaminated tap water used in cleaning cannulae during liposuction or liposculpture or contamination of the quaternary ammonium solution used to disinfect these instruments."

Nosocomial infections associated with contaminated quaternary ammonium compounds that were used to disinfect patient-care supplies or equipment have been reported, but none of these infections were caused by RGM. National Nosoco mial Infections Surveillance system data indicate that among 5,652 integumental surgical procedures performed during 1986-1996 in the United States, only 1.4% had SSI. SSI caused by RGM following aesthetic surgical procedures is rare. Prior reports include infection following face-lift and augmentation mammoplasty procedures that implicated contaminated gentian violet skin-marking solution as the source of infec tion, the CDC concluded.

Reference

1. Centers for Disease Control and Prevention. Rapidly growing mycobacterial infection following liposuction and liposculpture — Caracas, Venezuela, 1996-1998. MMWR 1998; 47:1,065-1,067.