Do spray coolant anesthetics contaminate an aseptic field?

576 infection was diagnosed during the acute phase of the arthropathy. We would like to emphasize that the initial articular symptoms were localized in the axial skeleton and that liver enzymes were increased, as has been previously reported in HPV infections (5). We therefore suggest investigation of the possibility of an HPV infection when a previously healthy patient presents with sudden and unexplained polyarthralgia, even in the absence of a skin rash andlor hematologic disturbances. Maxime Dougados, MD Bernard Amor Clinique de Rhurnatologie Hbpital Cochinf Jean Jacques Lefrere, MD Anne Marie Courouce, PhD Centre National de Transfusion Sanguine Paris. France I . Anderson MJ, Davis LR, Hodgson J , Jones SE, Murtaza L, Pattison JR, Stroud CE, White JM: Occurrence of infection with parvovirus-like agent in children with sickle cell anemia during a two-year period. J Clin Pathol 35:744-749, 1982 2. Anderson MJ, Jones SE, Fisher-Hoch SP, Lewis E, Hall SM, Bartlett CLR, Cohen BJ, Mortimer PP, Pereira MS: Human parvovirus, the cause of erythema infectiosum (fifth disease)? (letter). Lancet 1:1378, 1983 3. White DG, Woolf AD, Mortimer PP, Cohen BJ, Blake DR, Bacon PA: Human parvovirus arthropathy. Lancet 1:419421, 1985 4. Reid MD, Bronn T, Reid TMS, Rennie JAN, Eastmond CJ: Human parvovirus associated arthritis: a clinical and laboratory description. Lancet 1:422-425, 1985 5. Cohen BJ, Mortimer PP, Pereira MS: Diagnostic assay with monoclonal antibodies for the human serum parvovirus-like virus. J Hyg Lond 91:113-130, 1983 6. Lefrere JJ, Courouce AM, Soulier JP: Le parvovirus B19. Presse Med (in press)

LETTERS Do spray coolant anesthetics contaminate an aseptic field? To the Editor: Joint aspiration is a more tolerable procedure for the patient if a local skin anesthetic is used first. Lidocaine injections into the skin produce cutaneous anesthesia, but at the expense of initial pain. Also, such injections are less useful when small joints, such as the finger joints, are injected. Extreme cooling of the skin by using spray coolants, such as Fluori-methane and Ethyl chloride, is an available alternative that can be a fairly effective anesthetic. The question we posed was whether the spray from nozzles of previously used coolant spray bottles would introduce organisms onto a cleansed aseptic field and thus contaminate the field. The University of Connecticut Health Center outpatient clinics and emergency room were surveyed, and all previously opened spray coolant bottles still in use were identified. Cultures of the coolant were obtained by spraying culture media for 10 seconds. Nutrient agar and tryptic soy broth were used as the media for identifying routine organisms, and PPBE agar was used to identify yeast and fungi. The culture plates were examined at 24, 48, and 72 hours. We identified a total of 10 spray bottles that had been opened and were still in use, and the coolants from these bottles were cultured. No bacterial or fungal growth occurred in any culture plate or bottle over a period of 72 hours. The use of a spray coolant for anesthetizing a cleansed aseptic area of skin is thus shown to be safe and is not associated with a potential introduction of new bacterial or fungal organisms to the skin. Micha Abeles, MD Peggy Garjian, MD University of Connecticut Health Center Farmington, CT