Abstract
Benzalkonium chloride (BC) is an unreliable disinfectant. A matched case-control study and environmental investigation were conducted to determine the cause of and risk factors for a cluster of postinjection abscesses at a private medical clinic where BC was used as a disinfectant. Twenty-eight case-patients who had an abscess at the injection site were matched with 126 control patients who had received an intramuscular injection at the clinic on the same day. Risk factors for abscess development in a multivariable logistic model were corticosteroid injection and being female. All case-patients had received a corticosteroid injection from a multidose vial. Cultures of abscesses from 20 of 23 case-patients grew Pseudomonas aeruginosa. Cultures of BC prepared at the clinic also grew P aeruginosa, suggesting that BC was the source of infection. Injection site cleaning with BC did not appear to be the route of infection since use of BC at the time of injection was not associated with abscess development. A more likely route of infection was injection of contaminated corticosteroid from multidose vials that could have been inoculated with pseudomonads via needle puncture after vial septa were wiped with contaminated BC. Benzalkonium chloride should not be used to clean injection vial septa or injection sites.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Dixon R. E., Kaslow R. A., Mackel D. C., Fulkerson C. C., Mallison G. F. Aqueous quaternary ammonium antiseptics and disinfectants. Use and misuse. JAMA. 1976 Nov 22;236(21):2415–2417. [PubMed] [Google Scholar]
- Donowitz L. G. Benzalkonium chloride is still in use. Infect Control Hosp Epidemiol. 1991 Mar;12(3):186–187. doi: 10.1086/646314. [DOI] [PubMed] [Google Scholar]
- Fox J. G., Beaucage C. M., Folta C. A., Thornton G. W. Nosocomial transmission of Serratia marcescens in a veterinary hospital due to contamination by benzalkonium chloride. J Clin Microbiol. 1981 Aug;14(2):157–160. doi: 10.1128/jcm.14.2.157-160.1981. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Frank M. J., Schaffner W. Contaminated aqueous benzalkonium chloride. An unnecessary hospital infection hazard. JAMA. 1976 Nov 22;236(21):2418–2419. [PubMed] [Google Scholar]
- KUNDSIN R. B., WALTER C. W. Investigations on adsorption of benzalkonium chloride U.S.P. by skin, gloves, and sponges. AMA Arch Surg. 1957 Dec;75(6):1036–1042. doi: 10.1001/archsurg.1957.01280180168027. [DOI] [PubMed] [Google Scholar]
- LEE J. C., FIALKOW P. J. Benzalkonium chloride-source of hospital infection with gram-negative bacteria. JAMA. 1961 Sep 9;177:708–710. doi: 10.1001/jama.1961.73040360013012a. [DOI] [PubMed] [Google Scholar]
- MALIZIA W. F., GANGAROSA E. J., GOLEY A. F. Benzalkonium chloride as a source of infection. N Engl J Med. 1960 Oct 20;263:800–802. doi: 10.1056/NEJM196010202631608. [DOI] [PubMed] [Google Scholar]
- Miller L. T. Single derivatization method for routine analysis of bacterial whole-cell fatty acid methyl esters, including hydroxy acids. J Clin Microbiol. 1982 Sep;16(3):584–586. doi: 10.1128/jcm.16.3.584-586.1982. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Nakashima A. K., McCarthy M. A., Martone W. J., Anderson R. L. Epidemic septic arthritis caused by Serratia marcescens and associated with a benzalkonium chloride antiseptic. J Clin Microbiol. 1987 Jun;25(6):1014–1018. doi: 10.1128/jcm.25.6.1014-1018.1987. [DOI] [PMC free article] [PubMed] [Google Scholar]
- PLOTKIN S. A., AUSTRIAN R. Bacteremia caused by Pseudomonas sp. following the use of materials stored in solutions of a cationic surface-active agent. Am J Med Sci. 1958 Jun;235(6):621–627. doi: 10.1097/00000441-195806000-00001. [DOI] [PubMed] [Google Scholar]
- Sautter R. L., Mattman L. H., Legaspi R. C. Serratia marcescens meningitis associated with a contaminated benzalkonium chloride solution. Infect Control. 1984 May;5(5):223–225. doi: 10.1017/s019594170006015x. [DOI] [PubMed] [Google Scholar]