An outbreak of severe bacterial infections caused by Burkholderia cepacia (B. cepacia) in the intensive care unit of a Spanish hospital in 2006, led to the discovery of a contaminated body milk as the reservoir.
The moisturising product was used in the care of the bedridden patients and was administered by nurses throughout the unit.
The hospital's tests confirmed that the product was contaminated with the bacteria in the manufacturing, transportation or storage stages before the application of the product to the patients.
Although in healthy consumers the presence of low levels of bacteria in a product is unlikely to pose problems, in critically ill patients it can cause severe and sometimes fatal infections, according to the study.
Furthermore, B. cepacia have a high resistance to numerous antimicrobials and antiseptics and are known to be able to survive in a wider variety of hospital environments.
The authors of the study conclude that hospitals should not use cosmetics products for which there is no guarantee of sterilisation during the manufacturing process.
"In severely ill patients the presence of bacteria, even within accepted limits, may lead to severe life-threatening infections," say the authors.
In Europe cosmetics products are not obliged to be sterilised at manufacturer level, although there are limits on the levels and types of bacteria that are permitted.
In fact, the majority of cosmetics formulations would not withstand the heating necessary for sterilisation explained Gerald Renner from European cosmetics, toiletry and perfumery trade association Colipa.
"This does not mean there are no microbiological controls on products" he told CosmeticsDesign.com.
Products have preservatives to control and keep microbes below accepted levels which have been set by regulatory bodies, he explained.
"About thirty to forty years ago microbial contamination of cosmetics products was a big issue," said Renner, adding that nowadays however the problem is increasingly marginal.
Products can be recalled via the European RAPEX system if the microbiology exceeds the stated levels, but this is extremely rare, said Renner.
Commenting on the infections in the Spanish hospital Renner said it is important to consider whether this was the intended, normal condition of use for this type of product.
Some moisturising formulations may well withstand sterilisation, said Renner, suggesting that these might be a better choice for hospital communities.
Source: Critical Care, 2008, Volume 12, Issue 1 "Moisturizing body milk as a reservoir Burkholderia cepacia: outbreak of nosocomial infection in a multidisciplinary intensive care unit"