State health investigators suspect that a deadly outbreak of infections at Monarch Medspa in Timonium last year may have stemmed from "visibly dirty" equipment or two health care workers who carried the same bacterium found in patients, according to a report released Friday.
The investigation found that doctors and nurses sometimes failed to wear gloves and that there was no separation of sterilized and dirty equipment. Health officials inspected the facility and interviewed patients after three infections were reported in September 2012; one of those patients, a 59-year-old Lochearn woman, died days after undergoing liposuction.
The outbreak prompted state health officials to close the facility, which has not reopened. Monarch officials declined to comment.
It also led to the passage of a law this year in the General Assembly giving health regulators more oversight of facilities like Monarch, which are less scrutinized because patients pay out of their own pockets rather than billing private or government insurers. The law becomes effective Oct. 1.
All three patients who contracted infections at Monarch underwent liposuction, a procedure that inserts tubes into small incisions to suck out excess fat. The report also found a suspected fourth case in which a patient reported pain, redness and pus drainage, symptoms of a possible infection; the patient was treated with antibiotics but no cultures were collected to confirm an infection.
Inspection of the facility revealed unsanitary conditions, including a clogged sink in the liposuction procedure room, with debris and liquid leaking from it onto surgical supplies stored below. Nonsterile surgical dressings were found to be stored in high-traffic areas and expired supplies were found on shelves.
The doctor who performed all three liposuction procedures, as well as a nurse who came in contact with each patient, tested positive as carriers of Group-A streptococcus, the same bacteria that caused the infections. The bacteria is the same that causes strep throat but can cause more serious infections in other parts of the body, sometimes causing shock, organ failure and death.
The doctor also reported self-treating an infection of the hands in August 2012, keeping the doctor out of work for five days, the report said.
State health officials concluded it would be "impossible" to know whether the bacteria originated with a patient or one of the health care workers. They also could not determine whether the bacteria was spread through potentially contaminated equipment or directly from a health care provider to a patient, the report said.
If Monarch seeks to reopen the facility, state health officials will require the company to address all infection control elements in a Centers for Disease Control checklist, undergo another inspection, and institute infection control procedures.
The Timonium facility, in a Deereco Road shopping center, was Monarch's only operation in Maryland. The company has four other locations in the greater Philadelphia area, in Pennsylvania and Delaware. Its services include laser hair and tattoo removal, Botox injections, breast augmentation, face-lifts and liposuction.
The new state law regarding cosmetic surgery centers will allow state health officials to impose accreditation and inspection requirements on any facility performing procedures such as liposuction or others that require anesthesia.