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Association of Bacillus cereus Infection with Contaminated Alcohol Prep Pads

  • Susan A. Dolan (a1), Cynthia Littlehorn (a2), Mary P. Glodé (a3) (a4), Elaine Dowell (a2), Karen Xavier (a5), Ann-Christine Nyquist (a1) (a3) (a4) and James K. Todd (a1) (a2) (a3) (a4)...



Bacillus species have caused healthcare-associated outbreaks of invasive disease as well as pseudo-outbreaks. We report an outbreak investigation of blood cultures positive for Bacillus cereus associated with alcohol prep pads (APPs) contaminated with B. cereus and Bacillus species resulting in a rapid internal product recall and subsequent international product recall.


Epidemiologic and microbiologic outbreak investigation.


A 300-bed tertiary care children's hospital in Aurora, Colorado.


Patients with blood or cerebrospinal fluid cultures positive for B. cereus.


Three patients with blood cultures positive for B. cereus were identified in late 2010. Breaches in procedural and surgical techniques, common interventions, and products were explored. The following 3 common products were cultured: sterile saline syringes, chlorhexidine/alcohol skin preparation solution, and APPs. Repetitive sequence-based polymerase chain reaction (Rep-PCR) was used to compare isolates obtained from patients and from APPs and was confirmed by independent pulsed-field gel electrophoresis.


There appeared to be a significant increase in blood cultures positive for B. cereus during 2009-2010. B. cereus and other Bacillus species were cultured from the internal contents of 63.3% of APPs not labeled as sterile, and 8 of the 10 positive lots were manufactured after 2007. None of the isolates obtained from the patients matched strains isolated from the APPs. However, some lots of APPs had strains that were indistinguishable from one another.


APPs that were not labeled as sterile were contaminated with Bacillus species. The product was immediately recalled internally and replaced with APPs from another manufacturer that were labeled as sterile. On January 3, 2011, the manufacturer voluntarily recalled its APPs. Healthcare facilities, healthcare providers, and users of APPs should avoid the use of APPs not specifically labeled as sterile.


Corresponding author

Department of Epidemiology, Children's Hospital Colorado, 13123 East 16th Avenue, Aurora, CO 80045 (


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1. Logan, NA, Hoffmaster, AR, Shadomy, SV, Stauffer, KE. Bacillus and other aerobic endospore-forming bacteria. In: Versalovic, J, Carroll, KC, Funke, G, Jorgensen, JH, Landry, ML, Warnock, DW, eds. Manual of Clinical Microbiology. Vol 1, 10th ed. Washington, DC: American Society for Microbiology, 2011:381402.
2. Ahmed, RP, Sankar-Mistry, P, Jackson, S, Ackermann, HW, Ka-satiya, SS. Bacillus cereus phage typing as an epidemiological tool in outbreaks of food poisoning. J Clin Microbiol 1995;33: 636640.
3. Ihde, DC, Armstrong, D. Clinical spectrum of infection due to Bacillus species. Am J Med 1973;5:839845.
4. Tuazon, CU, Murray, HW, Levy, C, Solny, MN, Curtin, JA, Shea-gren, JN. Serious infections from Bacillus sp. JAMA 1979;241: 11371140.
5. Christenson, JC, Byington, C, Korgenski, EK, et al. Bacillus cereus infections among oncology patients at a children's hospital. Am J Infect Control 1999;27:543546.
6. Arnaout, MK, Tamurrro, RF, Bodner, SM, et al. Bacillus cereus causing fulminant sepsis and hemolysis in two patients with acute leukemia. J Pediatr Hematol Oncol 1999;21:431435.
7. Gaur, AH, Patrick, CC, McCullers, JA, et al. Bacillus cereus bacteremia and meningitis in immunocompromised children. Clin Infect Dis 2001;32:14561462.
8. Hilliard, NJ, Schelonka, RL, Waites, KB. Bacillus cereus bacteremia in a preterm neonate. J Clin Microbiol 2003;41:34413444.
9. Ozkocarnan, V, Ozcelik, T, Ali, R, et al. Bacillus spp. among hospitalized patients with haematological malignancies: clinical features, epidemics and outcomes. J Hosp Infect 2006;64:169174.
10. Bryce, EA, Smith, JZ, Tweeddale, M, Andruschak, BJ, Maxwell, MR. Dissemination of Bacillus cereus in an intensive care unit. Infect Control Hosp Epidemiol 1993;14:459462.
11. Gray, J, George, RH, Durbin, GM, Ewer, AK, Hocking, MD, Morgan, ME. An outbreak of Bacillus cereus respiratory tract infections on a neonatal unit due to contaminated ventilator circuits. J Hosp Infect 1999;41:1922.
12. Van Der Zwet, WC, Parlevliet, GA, Savelkoul, PH, et al. Outbreak of Bacillus cereus infections in a neonatal intensive care unit traced to balloons used in manual ventilation. J Clin Microbiol 2000;38:41314136.
13. Kalpoe, JS, Hogenbirk, K, van Maarseveen, NM, et al. Dissemination of Bacillus cereus in a paediatric intensive care unit traced to insufficient disinfection of reusable ventilator air-flow sensors. J Hosp Infect 2008;68:341347.
14. Sasahara, T, Hayashi, S, Morisawa, Y, Sakihama, T, Yoshimura, A, Hira, Y. Bacillus cereus bacteremia outbreak due to contaminated hospital linens. Eur J Clin Microbiol Infect Dis 2011;30:219226.
15. Noble, RC, Reeves, SA. Bacillus species Pseudosepsis caused by contaminated commercial blood culture media. J Am Med Assoc 1974;230:10021004.
16. Gurevich, I, Tafuro, P, Krystofiak, SP, Kalter, SP, Cunha, BA. Three clusters of Bacillus pseudobacteremia related to a radiometric blood culture analyzer. Infect Control 1984;5:7174.
17. Goldstein, B, Abrutyn, E. Pseudo-outbreak of Bacillus species: related to fiberoptic bronchoscopy. J Hosp Infect 1985;6:194200.
18. Richardson, AJ, Rothburn, MM, Roberts, C. Pseudo-outbreak of Bacillus species: related to fiberoptic bronchoscopy. J Hosp Infect 1986;7:208210.
19. York, MK. Bacillus species pseudobacteremia traced to contaminated gloves used in collection of blood from patients with acquired immunodeficiency syndrome. J Clin Microbiol 1990; 28:21142116.
20. Morrell, RM, Wasilauskas, BL. Tracking laboratory contamination by using a Bacillus cereus pseudoepidemic as an example. J Clin Microbiol 1992;30:14691473.
21. Morris, T, Brecher, SM, Fitzsimmons, D, Durbin, A, Arbeit, RD, Maslow, JN. A pseudoepidemic due to laboratory contamination deciphered by molecular analysis. Infect Control Hosp Epidemiol 1995;16:8287.
22. Loeb, M, Wilcos, L, Thronley, D, Gun-Munro, J, Richardson, H. Bacillus species pseudobacteremia following hospital construction. Can J Infect Control 1995;10:3740.
23. Lui, PYF, Ke, SC, Chen, SL. Use of pulsed-field gel electrophoresis to investigate a pseudo-outbreak of Bacillus cereus in a pediatric unit. J Clin Microbiol 1997;35:15331535.
24. Ohsaki, Y, Kayano, S, Tachibana, M, et al. Undetected Bacillus pseudo-outbreak after renovation work in a teaching hospital. J Infect 2007;53:673687.
25. Meites, E, Taur, Y, Marino, L, et al. Investigation of increased rates of isolation of Bacillus species. Infect Control Hosp Epidemiol 2010;31:12571263.
26. Pullen, G, Dahl, K, Bulgara, J. Outbreak of pseudobacteremia with Bacillus species at a children's hospital traced to dust contamination of blood collection supplies on open shelving. In: Program and abstracts of the 32nd Annual Educational Conference and International Meeting of the Association for Professionals in Infection Control. Baltimore, MD: Association for Professionals in Infection Control, 2005. Abstract 54120.
27. Hsueh, PR, Teng, LJ, Yang, PC, Pan, HL, Ho, SW, Lüh, KT. Nosocomial pseudoepidemic caused by Bacillus cereus traced to contaminated ethyl alcohol from a liquor factory. J Clin Microbiol 1999;37:22802284.
28. Berger, SA. Pseudobacteremia due to contaminated alcohol swabs. J Clin Microbiol 1983;18:974975.
29. US Food and Drug Administration. Triad group issues a voluntary nationwide recall of all lots of alcohol prep pads, alcohol swabs, and alcohol swabsticks due to potential microbial contamination. Accessed January 6, 2011.
30. US Food and Drug Administration. Federal government takes action against drug manufacturer and distributor. Accessed June 13, 2011.
31. Dolan, SA, Dowell, E, LiPuma, JJ, Valez, S, Chan, K, James, JF. An outbreak of Burkholderia cepacia complex associated with intrinsically contaminated nasal spray. Infect Control Hosp Epidemiol 2011;32:804810.


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