Healthcare outbreaks associated with contaminated antiseptics and disinfectants: a scoping review

Most outbreaks associated with contaminated antiseptics and disinfectants had been attributed to user errors, as identified in our previous review in 2007. Although numerous regulations and guidelines have been established for proper use of antiseptics and disinfectants since then, such outbreaks continue to occur. To address this issue, we conducted a literature review of outbreaks and pseudo-outbreaks linked to contaminated antiseptics and disinfectants, aiming to update the outbreak characteristics and propose new prevention strategies.

We searched the published literature from 2006 to 2024 via the PubMed database.

Among 2,307 publications identified, twenty-one outbreaks and 4 pseudo-outbreaks were reviewed. Among the outbreaks, seventeen (81%) were linked to antiseptics including chlorhexidine or low-level disinfectants including quaternary ammonium compounds. A median of 12 individuals (range: 3-256) developed infections, including ventilator-associated pneumonia, skin and soft tissue infections, or catheter-related infections, resulting from direct use of contaminated mouthwashes and skin antiseptics on patients, leading to 55 fatalities. Thirteen (62%) outbreaks were attributed to intrinsically contaminated products, which led to product recall and regulatory changes. Seven (33%) were linked to extrinsically contaminated antiseptics or disinfectants, all associated with improper practices in preparation and storage. Control measures included use of sterile water for preparation, disinfection or replacement of dispensers and containers, and prohibition of using solutions prepared in the hospital laboratory.

To avoid outbreaks associated with contaminated antiseptics and disinfectants, healthcare personnel should understand the risks of contaminated antiseptics and disinfectants, and prevention strategies to avoid extrinsic contamination.