Tincture of benzoin: clinical and microbiological implications of reusable containers

At our institution, tincture of benzoin solution is commonly used as a topical adhesive agent. As a cost-saving practice, multiple-dose bottles are routinely used in the operating rooms and the clinic on multiple patients. Although clinically pathogenic organisms are known to be capable of survival in both benzoin and its isopropyl alcohol solvent, no prior controlled studies have investigated the potential for tincture of benzoin solution to support the growth of specific pathogens under clinically relevant conditions. In this study, multiple aerobic, anaerobic, and spore-forming bacteria were exposed to tincture of benzoin solution, as well as Candida albicans and Mycobacterium fortuitum. Bacillus cereus was the only index organism demonstrating a clear ability to survive a 15 minute incubation in tincture of benzoin, although 24 hours of exposure to tincture of benzoin resulted in no subsequent viable cultures of this organism after 72 hours of incubation. Thus although certain bacilli might, under ideal circumstances, remain viable and infectious within multiple-dose bottles of tincture of benzoin, the risk of causing iatrogenic infection appears to be rather minimal. Still, the use of multiple-dose dispensers of topical agents, particularly in surgical patients, should be carefully scrutinized for their clinical risk-to-economic benefit ratio.