Infection Rate After Subcutaneous Botulinum Toxin Type a Without Prophylactic Isopropyl Alcohol Antisepsis

Abstract

Purpose:: Current protocols call for cutaneous antisepsis using isopropyl alcohol swabs prior to subcutaneous injection of botolinum toxin type A for prevention of infection. Studies involving venipuncture and insulin injection show no difference in infection rates between groups receiving isopropyl alcohol skin preparation and groups receiving no skin preparation. We sought to determine the incidence of infection after subcutaneous botulinum toxin type A injection without prior isopropyl alcohol antisepsis.

Methods:: Retrospective review of a consecutive case series. Charts of all patients who received botulinum toxin type A injection without the use of isopropyl alcohol antisepsis between June 2000 and October 2006 were reviewed. Chart review included the indication for injection, number of injection visits, number of injections, and complications, including infection.

Results:: Charts of 142 patients were reviewed. Indications for treatment included cosmetic (54 patients), blepharospasm (43 patients), hemifacial spasm (25 patients), entropion (16 patients) and other (4 patients). There were 100 females and 42 males. Mean age was 61.6 years (range, 16.0-98.3). Mean number of treatment visits was 6 (range, 1 to 25). The mean total number of injections per patient was 82 (range, 2 to 410). We found no infection in any patient. The total number of injections was 11627. The most common complication reported was bruising, found in 3/142 patients (2.1%).

Conclusions:: Omission of isopropyl alcohol antisepsis prior to subcutaneous botulinum toxin type A injection does not appear to significantly affect infection rate.

Keywords: clinical (human) or epidemiologic studies: outcomes/complications • eyelid • injection