2017-18 HSC Section 4 Green Book

P ART I A L L Y U S ED HYA L URON I C AC I D F I L L E R S

a new needle before commencing the augmentation. The syringe should be discarded if the contents are cloudy. A meticulously clean setting is critical for the whole procedure. In practice, most practitioners save the materials for weeks or a few months at a maximum to be used before expiry. All the fi llers tested in this study had expired. The expiry date for fi llers is related to their physical properties more than contamination risks. In fact, many products can generally be used beyond their expiry dates, but we cannot recommend this for fi llers. The contamination by skin fl ora in our study indicates the responsibility of injection procedures. No correlation was found between the periods of storage and the risk of contamination. It is clear that if there is no contamination from the beginning, the material will not be contaminated even after years of storage regardless of the physical properties of the fi ller. The main limiting factor to our study was the number of syringes tested. However, we examined a larger number of HA syringes and a longer storage period compared with other trials that showed no positive cultures. In contrast to the results from the few previously conducted studies, we found a risk for contamination in our trial and we recommend taking more caution when reusing HA fi llers. Storage at room temperature may be a possible risk factor in our study, and further studies to compare refrigeration with room tempera- ture storage are needed. No clear correlation was found between the length of storage time and the risk of contamination. We conclude that although the risk of contamination may be small, there is still a risk,

although it does not necessarily mean that infection will occur. The results of this study may contribute to future practice by in fl uencing the formation of policies that ensure safety and cost ef fi ciency that bene fi t patients.

References

1. Bellew SG, Carroll KC, Weiss MA, Weiss RA. Sterility of stored nonanimal, stabilized hyaluronic acid gel syringes after patient injection. J Am Acad Dermatol 2005;52:988 – 90. 2. Goulart JM. Groysman T. LaBombardi V. Comite S, et al. Sterility of injectable fi llers containing nonanimal stabilized hyaluronic acid, hyaluronic Acid, or calcium hydroxylapatite after long-term storage. Cosmet Dermatol 2010;23:400 – 2. 3. Bhatia AC, Arndt KA, Dover JS, Kaminer M, et al. Bacterial sterility of stored nonanimal stabilized hyaluronic acid-based cutaneous fi ller. Arch Dermatol 2005;141:1317 – 8. 4. Safo PK, Wahlgren C, Obagi S. Safety of storing and reusing hyaluronic acid fi llers: a retrospective chart review. Cosmet Dermatol 2011;24:22 – 6. 5. Davis K, Bottone EJ, Lucas D, Lebwohl M. Sterility of refrigerated injectable collagen syringes after injection of patient. J Am Acad Dermatol 1992;27:959 – 61. 6. Lange-Asschenfeldt B, Marenbach D, Lang C, Patzelt A, et al. Distribution of bacteria in the epidermal layers and hair follicles of the human skin. Skin Pharmacol Physiol 2011;24:305 – 11. 7. O ’ Gara JP, Humphreys H. Staphylococcus epidermidis bio fi lms: importance and implications. J Med Microbiol 2001;50:582 – 7. 8. National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32:470 – 85. 9. Boyce JM, Pittet D. Guideline for hand hygiene in health-care settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/Infectious Diseases Society of America. MMWR Recomm Rep 2002;51:1 – 45.

Address correspondence and reprint requests to: Amr Abduljabbar, MD, Department of Dermatology, King Saud University, Riyadh 45142, Saudi Arabia, or e-mail: amr8002@hotmail.com

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