An Outbreak of Pseudomonas Aeruginosa Infection Linked to a “Black Friday” Piercing Event

Abstract

IntroductionOutbreaks linked to cosmetic piercing are rare, but can cause significant illness. We report the investigation and management of a point-source outbreak that occurred during a Black Friday promotional event in North West England.MethodsOutbreak investigation was led by Public Health England, and included active case finding among individuals pierced at a piercing premises between 25/11/2016 (Black Friday) and 7/12/2016. Detailed epidemiological, environmental (including inspection and sampling), and microbiological investigation was undertaken.ResultsDuring the Black Friday event (25/11/2016), 45 people were pierced (13 by a newly-appointed practitioner). Eleven cases were identified (7 microbiologically-confirmed, 2 probable, and 2 possible). All cases had clinical signs of infection around piercing sites, and five required surgical intervention, with varying degrees of post-operative disfigurement. All confirmed and probable cases had a scaffold piercing placed with a guide bar by the newly-appointed practitioner. Pseudomonas aeruginosa, indistinguishable at nine-locus variable-number tandem repeat loci, was isolated from four of the confirmed cases, and from pre- and post-flush samples from five separate water taps (three sinks) in the premises. Water samples taken after remedial plumbing work confirmed elimination of Pseudomonas contamination.DiscussionAlthough high levels of Pseudomonas water contamination and some poor infection control procedures were identified, infection appeared to require additional exposure to an inexperienced practitioner, and the more invasive scaffold piercing. A proactive collaborative approach between piercers and health and environmental officials is required to reduce outbreak risk, particularly when unusually large events are planned

Community Outbreak of Pseudomonas aeruginosa Infections Associated with Contaminated Piercing Aftercare Solution, Australia, 2021

“…The VNTR type for cases connected to that 2016 outbreak differed from cases unrelated to the outbreak and matched the VNTR type of isolates found in bottles of aftercare solution (5). In another outbreak in 2016 linked to a northwestern England piercing event, VNTR typing was also used to identify isolates from clinical samples of suspected case-patients, which matched isolates from water samples collected from the premises (9). Molecular subtyping was used to investigate an outbreak at an Oregon, USA, jewelry store in 2004 and successfully linked isolates from case-patients with P. aeruginosa piercing-related infections to isolates retrieved from a disinfectant bottle, as well as to isolates recovered from 2 workers and from wastewater located beneath sinks in the store (3).…”

“…Piercing-related P. aeruginosa infection outbreaks associated with aftercare solutions have been reported previously (3,5,9). In a 2016 outbreak in England, variable-number tandem-repeat (VNTR) typing was used to identify isolates from clinical samples collected from suspected case-patients and from environmental samples (opened and unopened bottles of aftercare solutions) to investigate possible links (5).…”

“…Infections tend to occur (on average) 2-4 weeks after piercing procedures (4) and have historically been attributed to exposure of piercing sites to swimming pools and fresh water, lack of adequate preoperative/intraoperative antisepsis of piercing sites, poor hand hygiene, and using contaminated solutions during or after piercing procedures (3,5-8). However, limited reports exist on P. aeruginosa infection outbreaks related to piercing (3,9) In late…”