Status:
Active
Health advisory:
210531
Date Issued:
31 May 2021
Issued by:
Dr Bruce Bolam, Executive Director, Communicable Disease
Issued to:
Health professionals including general practitioners, plastic and ENT surgeons, infectious disease physicians, emergency department clinicians and the community

Key messages

  • New South Wales Health has reported ear and body piercing-related infections caused by the bacteria Pseudomonas aeruginosa. 
  • All patients reported by NSW Health had used batch number BF996 of the aftercare product ‘PROTAT Sea Salt and Tea Tree Spray’. 
  • Subsequent testing found batch number BF996 of this aftercare product to have been contaminated with Pseudomonas aeruginosa. This product was available for retail purchase in-store or online with a use by date of 10/23 (October 2023).
  • Anyone with bottles of ‘PROTAT Natural Sea Salt and Tea Tree Spray’, Batch number BF996 should discard these immediately. The batch number of a bottle can be found on the product label.
  • Pseudomonas aeruginosa contamination was found in only batch BF996 of ‘PROTAT Natural Sea Salt and Tea Tree Spray’ and other batches of this product can be used safely.
  • The Pseudomonas bacteria can cause piercings to become seriously infected, requiring admission to hospital for intravenous antibiotics or surgical management. 
  • Clinicians should consider Pseudomonas infection in any patient who presents with infection at a piercing site, following procedures in the past month. 
  • Anyone who has used this product and develops pain, swelling, inflammation or discharge from the piercing site should seek medical attention.


What is the issue?

New South Wales Health has detected an increase in cases of piercing-related infections testing positive for Pseudomonas aeruginosa, a bacteria which can cause serious soft tissue, blood and systemic infections.

  • All affected patients had undergone piercing within one month prior to their infection and used an affected batch of PROTAT Natural Sea Salt and Tea Tree Spray (Batch number BF996). Pseudomonas aeruginosa is an uncommon cause of infection after ear piercing, but analysis of emergency department presentations has shown a significant increase in piercing-related infections in NSW in recent months. 
  • A significant proportion of these infections required hospital admission with intravenous antibiotics and surgical management.
  • Cases have been linked to an infected batch of this product. Production has ceased and the distributors are undertaking a voluntary recall of the affected batch.

Who is at risk?

Anyone who has undergone body piercing is at risk of developing an infection. The level of risk depends on the level of infection control used during and after the procedure, where the piercing is, the technique used, and several other factors, including an individual’s ability to heal.

Poor practices during or after piercings can lead to infections and other complications including infection with Pseudomonas aeruginosa and septicaemia.

New South Wales Health confirmed detection of Pseudomonas aeruginosa in a batch of PROTAT Natural Sea Salt and Tea Tree Spray (Batch number BF996). While the product has been withdrawn, any bottles of this product should be discarded and not used. 

Symptoms

  • Increased pain, redness, swelling, irritation or itchiness around the piercing site.
  • Thick infected discharge from the piercing site – this may be yellow, green or grey and may have an unusual odour.
  • Problems with healing or scarring.

Diagnosis

Consider Pseudomonas aeruginosa infection in any patient who presents with infection at a piercing site, following procedures in the past month. 

Recommendations

For medical professionals:

Consider Pseudomonas aeruginosa infection in patients presenting with skin or soft tissue infections up to one month after piercing procedures. In these patients, antibiotic regimens should currently include coverage for Pseudomonas aeruginosa.

For piercing-related infections, send a swab for culture and seek Infectious Diseases advice early.

  • Health professionals should currently consider Pseudomonas aeruginosa infection in patients presenting with skin or soft tissue infections up to one month after piercing procedures. In these patients, antibiotic regimens should include coverage for Pseudomonas.
  • For piercing-related infections, send a swab for culture and seek Infectious Diseases advice early.
  • Pseudomonas aeruginosa infection requires prompt antibiotic treatment (often with ciprofloxacin). 
  • Remove piercings during treatment of localised infection, as hardware may be contaminated. 
  • Consider seeking expert infectious diseases or clinical microbiology advice in serious infections. 
  • Refer any sign of progressive or deep infection such as a collection in the ear early for ENT review, as Pseudomonas infection of the ear may need surgical drainage. 

For consumers:

  •  Any consumers who have the affected product should stop using it immediately and discard the product. If consumers have any questions, they can contact Protat by calling 1300 364 223 or emailing protat@protat.com.au
  • If you have any of the symptoms described or have other concerns about your piercing, seek medical advice immediately or call NURSE-ON-CALL on 1300 60 60 24 (24/7). 

More information

Consumer information

Better Health Channel: Piercings

Contacts

For more information, please contact the Communicable Disease Prevention and Control section at the Department of Health on 1300 651 160 (24 hours).