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1) Souvenir, D., D. E. Anderson, Jr., S. Palpant, et
al. 1998. Blood cultures positive for coagulasenegative staphylococci: antisepsis, pseudobacteremia, and therapy of patients. J. Clin. Microbiol. 36: 1923῍1926.
2) Qian, Q. F., Y. W. Tang, C. P. Kolbert, et al.
2001. Direct identification of bacteria from
positive blood cultures by amplification and
sequencing of the 16S rRNA gene: evaluation
of BACTEC 9240 instrument true-positive and
false-positive results. J. Clin. Microbiol. 39:
3578῍3582.
3) Liu, P. Y., S. C. Ke, S. L. Chen. 1997. Use of
pulse-field gel electrophoresis to investigate a
pseudo-outbreak of Bacillus cereus in a pediatric unit. J. Clin. Microbiol. 35: 1533῍1535.
4) Hsuh, P., L. Teng, P. Yang, H. Pan, S. Ho, K. Luh.
6)
7)
8)
9)
1999. Nosocomial pseudoepidemic caused by
Bacillus cereus traced to contaminated ethyl
alcohol from a liquor factory. J. Clin. Microbiol.
37: 2280῍2284.
Barrie, D., P. N. Ho#man, J. A. Wilson, J. M. Kramer. 1994. Contamination of hospital linen by
Bacillus cereus. Epidemiol. Infect. 113: 297῍
306.
P;QRS 2003. TUVWX#$YZ[%45
\]^_%`S p. 14῍33, abcDd7ef
g5#$,( h 3 iῌjkl mnop qr
s P;QR t ) uvwFxyDz{ |}S
CDC: Guidelines for Environmental Infection
Control in Health-Care Facilities Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC)
2003. June 6, Vol. 52/No. RR-10. http://www.
cdc.gov/ncidod/hip/enviro/guide.htm
~S 1994. 0
7OS
45: 63῍80.
Oosthuizen, M. C., B. Steyn, J. Theron, et al.
2002S Proteomic analysis reveals di#erential
protein expression by Bacillus cereus during
biofilm formation. Appl. Environ. Microbiol.
68: 2770῍2780.
Outbreak of Bacillus cereus Pseudobacteremia Linked to
Contaminated Washcloths
Yoshio Izawa,1) Makoto Ito2)
1)
2)
Divisions of Clinical Microbiology,
Infection Control and Epidemiology, Department of Pathology and
Laboratory Medicine, Toyota Medical Corporation, Kariya General
Hospital, 5῍15 Sumiyoshi, Kariya, Aichi 448῍8505, Japan
During the summer and autumn seasons of 2002 in an acute-care tertiary hospital, an outbreak of
pseudobacteremia caused by Bacillus cereus occurred in chronically ill patients with an indwelling
peripheral venous catheter. The source of Bacillus contamination was examined by analyzing extensive
surveillance cultures of the patient’s skin, fabrics, medical equipment, and environmental surfaces. An
unexpectedly high level of B. cereus contamination was identified in washcloths that were routinely used
in nursing practices, such as backrubs, towel baths, and perineal care. The laundry of washcloths was
outsourced. Clean, dry washcloths that were supplied following washing and sodium hydrochloride
disinfection, were then soaked in water and heated in a steam bath at 65῍70 in the hospital ward before
being used for care. Under these conditions, we consistantly found 103῍104 CFU/ml of Bacillus species in
the freshly prepared washcloths. Up to 106 CFU/ml of contaminating microorganisms could be recovered
26 ]^_%` Vol. 15
No. 2
2005.
Bacillus cereus 89
from washcloths stored at ambient temperature for more than 72 hours. It was postulated that the Bacillus
cereus present in these washcloths might be transferred to the patient’s skin during sanitary care, which
would then cause contamination of blood culture specimens following needle sticks. Spore-forming
Bacillus species that are naturally resistant to ethanol-based antiseptics may comprise the majority of B.
cereus found in hospital environments. Thus, the polices and procedures for washcloths were revised to
include steam heating beyond 85 for 60 minutes and prohibition of prolonged storage in a wet state.
These control measures were e#ective and substantially reduced the occurrence of pseudobacteremia due
to Bacillus species. In conclusion, caregivers should be aware that washcloths may become contaminated
with environmental spore-forming bacteria such as nonpathogenic Bacillus species.
!"
Vol. 15
No. 2
2005. 27
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