Piercing Infection Outbreak Linked to Contaminated Antiseptic, Upper Ear Site

Public health researchers in Rochester, N.Y., found that a 2003 outbreak of severe infections in people who had upper-ear piercings was caused by the combination of contaminated antiseptic solution and the greater risk of piercing ear cartilage, which has a poor blood supply.

The study in the October issue of the American Journal of Preventive Medicine reports the findings from an epidemiologic investigation that followed the outbreak.

We got a number of complaints from parents who said their daughters had serious infections in their ears after cartilage piercings, recalls study co-author Nancy Bennett, MD, deputy director of the Monroe County, N.Y., public health department.

All of the infected piercings involved customers who had their upper ears pierced at a single body art parlor. Several dozen people experienced redness, swelling and pain, with some also complaining of discharge, swollen lymph glands and diminished hearing.

The infections were found to be caused by Pseudomonas aeruginosa, a common organism. Of 15 people whose infections were confirmed to be due to the pseudomonas, nine were hospitalized and treated with intravenous antibiotics. All needed to take oral antibiotics and have the infected areas surgically cleaned and drained.

Public health researchers visited the facility and found it to be clean. The owner used sterilized tools and proper piercing techniques. Each customer had been given care information along with an antiseptic solution to clean the piercing.

The solution, however, mixed by the owner, contained benzalkonium chloride an antiseptic that is not effective against pseudomonas says Bennett. Laboratory studies showed that the solution used during the outbreak was contaminated with pseudomonas.

Researchers compared the 15 cases of confirmed pseudomonas infections to 61 control cases who were pierced at the facility during the same time period, but who did not become infected. The comparison showed that the combination of contaminated solution and the poor blood flow to the cartilage portions of the ear led to the infections.

The National Environmental Health Association recommends that chloroxyenol soap, which is effective against pseudomonas, be used to clean cartilage piercings.

Reference: Hallfors DD, et al. Risk factors for cartilage infections of the ear. Am J Prev Med 29(3), 2005.