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Unsanitary tattooing linked with CA-MRSA skin infections, CDC says
CDC reports 44 outbreaks of CA-MRSA in Ohio, Kentucky and Vermont associated with 13 unlicensed tattoo artists.
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Health officials have detected clusters of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) skin and soft tissue infections associated with deficient infection control practices among illegal tattooists.
Thirteen unlicensed tattoo artists used nonsterile equipment and suboptimal infection control practices, linking them to 44 cases of CA-MRSA in six separate communities in Ohio, Kentucky and Vermont from June 2004 through August 2005, according to the CDC investigation.
“Persons considering a tattoo should be aware of the potential for CA-MRSA infection and should only use the services of a licensed tattooist who follows proper infection-control procedures,” CDC researchers advised in a recent Morbidity and Mortality Weekly Report. “MRSA infections should be added to education and prevention campaigns highlighting the risks of unlicensed tattooing.”
Recommendations for proper tattoo infection control precautions include using sterilized or single-use equipment, including needles, tattoo guns, and ink supplies.
“Clinicians should consider CA-MRSA in their differential diagnosis for staphylococcus diseases, including skin infections,” researchers wrote. “Clinicians can contact their local health departments to determine the prevalence of CA-MRSA in their community and whether the disease is reportable.”
Link to tattoos
CA-MRSA is a reportable disease in all three states during outbreaks or when clusters are identified. The CDC was notified of the four clusters in Ohio, one in Kentucky and one in Vermont and local health departments, along with the CDC, conducted investigations to identify the sources of exposure and any primary and secondary cases. Researchers defined primary cases as skin infection that occurred in a tattoo recipient and secondary as skin infection that occurred in a non-recipient, but contact of the primary person.
Researchers identified 34 primary cases and 10 secondary cases in the three states. Most patients were white (63%) and males (73%) and ranged in age from 15 to 42 years.
Local health departments and law enforcement officials conducted investigations of the artists and found that although four of the six tattoo artists available for interview wore gloves, the artists did not adhere to other infection control measures, such as changing the gloves between clients, following proper hand hygiene and disinfection of the equipment and surfaces. Furthermore, 13 Ohio patients revealed they received their tattoos in a public place from artists who used homemade tattooing equipment such as guitar string needles and computer ink-jet printer cartridges as dye.
Most infections were mild to moderate, ranging from cellulitis and small pustules to larger abscesses. Researchers said treatment consisted of drainage for larger abscesses (n=20) and/or antibiotic therapy (n=24) with trimethoprim-sulfamethoxazole, levofloxacin and clindamycin. Four patients developed bacteremia that required in-patient therapy with intravenous vancomycin. All patients recovered.
As for the source of infection, the researchers found that three of the artists in Ohio had recently been incarcerated in correctional facilities, a potential site for exposure to MRSA infection, according to the CDC. None of the 34 primary cases were incarcerated. Five patients reported seeing lesions on the hands of tattoo artists that was consistent with MRSA skin infection description.
Health officials implemented interventions, which consisted of educational forums targeting local infection-control professionals, medical providers and the affected population, specifically students in one Ohio community.
“In addition, public service announcements were issued on the radio and in local newspapers, discussing the risks of acquiring tattoos from unlicensed tattooists and the possibility of skin infections with CA-MRSA,” the researchers wrote in the report.
Since implementation of these prevention campaigns, no new clusters have been reported in the affected areas, according to the CDC.
For more information:
- CDC. Methicillin-resistant Staphylococcus aureus skin infections among tattoo recipients – Ohio, Kentucky, and Vermont, 2004-2005. MMWR. 55;677-679.