Piercing Ear Cartilage May Increase Risk of Infection
Body piercing is all the rage and has been increasing in popularity for some time now. But many types of piercing, particularly ear piercing, are performed in unregulated or loosely controlled environments, and often by people who are not sufficiently trained in infection control. Unfortunately, like unsanitary nail salons and hairdressers, this lack of regulation can present serious public health risks.
An outbreak of Pseudomonas aeruginosa (a serious bacterial infection) due to unsafe infection control practices at a piercing kiosk in Oregon recently illustrated the potential dangers associated with commercial ear piercing establishments. In response to this outbreak, a group of investigators from the Oregon public health agencies set out to examine the risks of infection with Pseudomonas aeruginosa after ear piercing. The results of their investigation, published in the February 25, issue of the Journal of the American Medical Association , found that the risk of infection is higher for ear cartilage piercing that for ear lobe piercing.
About the Study
Using sales records from the kiosk, the Oregon Department of Human Services in Portland conducted a cohort study (a study where the researchers compare a particular group of people who all share a common characteristic with a second group of people who do not share that characteristic) of all the people who had received piercings at the kiosk over the month prior to the outbreak. They did this by sending questionnaires to all the customers and collecting environmental samples from the kiosk, including countertops, plumbing fixtures, and ear-piercing guns. The kiosk workers were also screened for Pseudomonas aeruginosa by stool and hand cultures.
From the questionnaires, the researchers identified all the confirmed cases of infection with Pseudomonas aeruginosa (defined as infections that developed within two weeks of the piercing and cultured positively for Pseudomonas aeruginosa ) and all the suspected cases of infection with Pseudomonas aeruginosa (defined as any sign of infection at the piercing site, such as local pain or tenderness or drainage of pus or blood lasting at least 14 days).
The researchers looked at 186 piercings received by 118 people. They identified seven confirmed Pseudomonas aeruginosa infections and 18 suspected infections. Of these, most were treated initially with antibiotics that were ineffective against Pseudomonas aeruginosa, four were hospitalized, four required outpatient surgery, and several were cosmetically deformed.
They also found that of these infections, upper ear cartilage piercing was far more likely to result in either confirmed or suspected Pseudomonas aeruginosa infection than was piercing of the ear lobe.
The researchers did not find Pseudomonas aeruginosa on any of the solid surfaces or in the tap water at the kiosk. They did, however, find traces of the bacteria on two of the workers (one from a stool sample and one from a hand culture), in a disinfectant solution, and in wastewater located in traps beneath the sinks.
How Does This Affect You?
The researchers concluded that ear cartilage piercing is inherently more risky than ear lobe piercing in terms of infection. One reason for this is the lack of blood flow to the cartilage area. Oral antibiotics are carried to infection sites by the blood, making cartilage, which has fewer capillaries than other types of tissue, harder to reach. A second complicating factor is Pseudomonas aeruginosa’s resistance to antibiotics. Remember, most of the people who reported an infection after their ear piercing were initially treated with antibiotics known to be ineffective against Pseudomonas aeruginosa.
So what’s to be done? The researchers make several suggestions. First, state and local public health departments must enforce stricter regulation of piercing kiosks and parlors. Additionally, better infection control training must be required for employees in these settings. Finally, physicians who treat infections resulting from ear piercings, particularly when the piercing is in the cartilage, should consider Pseudomonas aeruginosa as a possible cause of the infection and treat it aggressively.
If your child is considering a body piercing of any kind, have them talk with your primary care physician about the potential risks. Additionally, safety regulations for body piercing are handled by individual state health authorities. Make sure the piercing establishment is adhering to these regulations. Is the location licensed? Is the location clean and safe? Do they follow the local safety regulations? Taking the time to answer these questions now may help prevent a form of self-expression from becoming a lifelong reminder of a youthful indiscretion.
American Public Health Association
Keene WE, Markum AC, Samadpour M. Outbreak of Pseudomonas aeruginosa infections caused by commercial piercing of upper ear cartilage. JAMA. 2004;291:1981-985.
Pseudomonas aeruginosa . University of Wisconsin, Madison. Available at: http://www.bact.wisc.edu/ . Accessed February 25, 2004.
Last reviewed Feb 26, 2004 by ]]>Richard Glickman-Simon, MD]]>
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