Overview
Between April 1 and October 31, 1985, eight patients of one cosmetic surgeon developed wound infections from rapidly growing mycobacteria. Investigators studied the outbreak to find the source. They compared patients by procedure, setting and exposures, and tested the materials used in surgery.
Findings
- 8 patients infected, April 1 to October 31, 1985; one surgeon.
- All infections followed facelift or breast augmentation done in the surgeon's office.
- No infections followed procedures done at the hospital, or other procedures done in the office.
- The investigation implicated a gentian violet skin-marking solution as the source (P < 0.001).
- Among patients exposed to gentian violet, infection was significantly more likely after facelift or breast augmentation than after blepharoplasty (P < 0.001).
- Other risk factors: use of antibiotics and glucocorticoids after surgery.
- Mycobacterium chelonae, subspecies abscessus, was found in the surgeon's gentian violet stock and in 5 of the 8 patients.
- The same organism was in the gentian violet stock at the supplying pharmacy.
- No further cases occurred after a sterile skin-marking agent replaced the contaminated one.
What it means for a patient
- In this outbreak, a contaminated product used in surgery caused a cluster of wound infections after facelift and breast augmentation.
- Skin-marking ink used to plan incisions was the source here. Sterile supplies stopped the outbreak.
- Ask whether your surgery center uses sterile, single-use marking supplies and follows infection-control standards.
- This outbreak involved one office and 8 patients. It does not give an overall infection rate for facelift.
Why this paper matters
It traced facelift and breast surgery infections to a non-sterile skin marker and showed the outbreak ended once a sterile marker was used. It showed that a surgical supply from a pharmacy carried the organism into office surgery. Cited 184 times (NIH iCite, 2026-09-25).
Terms
- Mycobacterium chelonae (subspecies abscessus): a rapidly growing bacterium that can infect wounds.
- Rapidly growing mycobacteria: a group of bacteria related to tuberculosis that grow in days rather than weeks.
- Gentian violet: a purple dye used to mark the skin before surgery.
- Epidemiologic investigation: a study of an outbreak to find its cause.
- Augmentation mammoplasty: breast enlargement surgery.
- Glucocorticoids: steroid drugs that reduce inflammation.
- Blepharoplasty: eyelid surgery.