‘Medical Spa’ Workers Infect Patients with Potentially Lethal Bacteria

The patients arrived at the weight-loss clinics for liposuction, and left with an unwelcome add-on: streptococcus infection. The cause, a study showed, was probably a staff unaware of or unwilling to perform proper infection control.

The strain of streptococcus that the 13 people contracted is a bacterium that can cause relatively mild illnesses, such as “strep” throat, or impetigo, a skin infection characterized by spreading pustules that most often occurs in children, and is contagious. And streptococcus can cause other severe and even life-threatening problems, such as pneumonia or toxic shock syndrome.

Reuters wrote about the outbreak in Maryland and Delaware that occurred in 2012 and was investigated by state officials. Last month, JAMA Internal Medicine published a study about the incident titled “Invasive Group A Streptococcus Infections Associated With Liposuction Surgery at Outpatient Facilities Not Subject to State or Federal Regulation,” which pretty well sums up a key problem with the whole affair.

Dr. Daniel J. Morgan of the Department of Public Health and Epidemiology at the University of Maryland School of Medicine in Baltimore contributed an accompanying commentary in the journal about the lack of patient protections in outpatient cosmetic surgery.

Liposuction is a procedure in which doctors suction excess fat out of the body. It’s often performed in outpatient centers; in this case, it was a chain of so-called “medical spas,” with licensed doctors or nurses. But they weren’t subject to state regulation.

The risks associated with the surgery are infection, like this outbreak, or errors with the anesthetic, which Morgan told Reuters has killed patients at other such facilities.

When the outbreak occurred, Reuters explained, the Maryland Department of Health and Mental Hygiene knew that three patients had been hospitalized with invasive strep infection. All had undergone liposuction at the Maryland clinic, and one died.

To trace the source of the contagion, researchers from the U.S. Centers for Disease Control and Prevention (CDC) and the Pennsylvania Department of Health contacted everyone who had undergone liposuction at any of the chain locations between July and September of 2012.

In Maryland and Delaware, there were 66. Among them was another confirmed infection, and nine more suspected cases.

The four people with confirmed cases of infection were hospitalized for an average of 19 days, including the one who died. The same doctor had done all of their procedures. He was tested, and found to harbor the bacteria that caused the infections in his throat. It was no surprise that other employees also carried the same strain.

Although he and the surgical team said they wore surgical gloves and masks during the procedures, they didn’t do so during preparation for the surgery, nor postoperative care.

Although cosmetic surgeries such as breast augmentation and liposuction often are performed by board-certified specialists, nonspecialists also may perform liposuction, without anesthesia and in outpatient facilities like the medical spas, according to the JAMA researchers.

Accredited outpatient surgical centers and hospitals must comply with infection prevention guidelines applicable to federally or state-certified ambulatory surgical centers.

If you have one of these procedures, choose only facilities that are accredited. And your chances of a positive outcome are better if the surgeon is a board-certified dermatologist or plastic surgeon. Still, as Morgan told Reuters, even if the practitioner is experienced, and even if you’ve verified accreditation, there’s still no certainty that the facility is safe.

But, “There were some big red flags noted in this outbreak which should steer one away from a facility such as a dirty environment or seeing staff eating in an operating room,” he said.

Don’t make a decision based solely on price: The least expensive facility might be cutting more corners, and in the case of invasive procedures like liposuction, versus, for example, laser therapy or electrolysis, following safety procedures is more critical.

The lead author of the JAMA study called liposuction “a major surgical procedure” that comes “with some risks,” including fat embolism (fat tissue enters the bloodstream and blocks a blood vessel.), necrosis (cellular death) of the skin and underlying tissues and severe infections like those described in this publication.”

So before undergoing liposuction, discuss your situation and the risk of complications with both your primary care doctor and the potential surgeon, and also determine the infection practices of the facility where the procedure will be done.

Morgan said new legislation to require facilities to adhere to state and federal regulation would help reduce risk to patients, but the businesses shouldn’t depend on them; they should set their own high standards of infection control training for their workers.

As the JAMA researchers concluded, “Additional oversight of outpatient cosmetic surgery facilities is needed to assure that they maintain appropriate infection control practices and other patient protections.”

For more information, see our backgrounder on cosmetic surgery.

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