539. Mycobacterium chelonae Infection After Liposuction: Implications for Infection Control Oversight in the Outpatient Setting
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Atypical mycobacterial infections have been associated with skin and soft tissue infections after cosmetic procedures and outbreaks have occurred. Increased use of alternative medicine providers and increasing numbers of procedures performed in outpatient settings that are not regulated may be contributing factors. In November 2008 we were notified by an infectious disease physician reporting a hospitalized patient who had subcutaneous abdominal abscesses after undergoing outpatient abdominal liposuction. The abscess showed 3+ acid-fast bacilli (AFB) on smear and culture grew Mycobacterium chelonae. We investigated this case to identify other cases of post-liposuction atypical mycobacterial infections and determine risk factors for this infection at this office.
Methods: We conducted case finding and reviewed public health surveillance of AFB lab results from surgical wound sites, outpatient office medical records, and infection control procedures. Environmental samples from the office were obtained to identify a source.
Results: No new cases were identified. The office did not have written infection control policies. There were no written procedures for cleaning and disinfection of liposuction equipment or for sterilization by autoclave. The office never used biological indicators to assure sterilization as recommended by the autoclave manufacture’s instructions. Environmental samples taken from the office procedure room did not reveal a source for the M. chelonae.
Conclusion: The lack of proper procedures for cleaning, disinfection, and sterilization of liposuction equipment at this office were alarming. As healthcare procedures continue to move to the outpatient setting, the absence of regulatory oversight may lead to further infections in this setting that could be prevented. Our investigation shows that this case’s infection was likely an isolated occurrence, however, our findings at this medical office further highlight the unaddressed infection control monitoring problems in outpatient settings.
Moon Kim, MD, MPH, Acute Communicable Disease Control Program, Dept. of Public Health, Los Angeles, CA, Laurene Mascola, MD, MPH, Los Angeles County Department of Public Health, Los Angeles, CA and  M. J. Kim, None..
L. Mascola, None.