Selected Interventions Made and Recommendations for Other Healthcare Facilities to Decrease Risk of Healthcare-Associated Nontuberculous Mycobacterial Infection
| Intervention Made at Our Hospital . | Recommendations for Other Healthcare Facilities . |
|---|---|
| Clinical practice and equipment-related interventions | |
| Sterile water use for direct patient-care activities of patients at risk | • Healthcare facilities with infections from NTM should consider avoidance of tap water [35] and use of sterile water for patient care activities, such as oral care, enteral tube flushing, speech assessment, consumption, and bathing. • Local epidemiology should determine target patient groups, potentially including critically ill and immunosuppressed patients, those with disrupted gastrointestinal tracts, and patients with early postoperative wounds. Continuing to avoid tap water after hospital discharge may also reduce risk for recent lung or heart transplant recipients. |
| HCU sterile water use and disinfection protocol | • Hospitals should adhere to FDA and manufacturer recommendations for HCU use, water changes, and disinfection practices [36, 37]. |
| Epidemiologic and clinical surveillance for NTM infection | • Hospital epidemiologists should perform retrospective and prospective surveillance for invasive NTM infections. • Clinicians should consider NTM infection when evaluating patients with infection after cardiac surgery, especially for atypical clinical manifestations and prolonged incubation periods. • Clinicians should request mycobacterial cultures, particularly for surgical specimens. |
| Environmental and engineering-based interventions | |
| Periodic flushing of both cold water and recirculating hot water; removal of flow restrictors and redundancies in plumbing system | • Facilities with high-efficiency and/or recirculating water systems should consult with water engineering experts about periodically flushing stagnant or recirculating water from the circulation, avoiding or removing flow restrictors, and minimizing redundancies in the plumbing system. |
| Monitoring of hot water temperatures and flow times to water outlets | • Water engineering personnel should perform surveillance of hot water temperatures throughout the hot water distribution system [38]. |
| Monitoring of chloramine levels in hospital water supply | • Water engineering personnel should measure disinfectant (eg, chloramine or chorine) levels at entry to the facility and at point of use. If proximal disinfectant levels are low, healthcare facilities may need to contract with municipal water authorities. |
| Installation of point-of-use water filters in clinical locations | • Facilities with endemic NTM should consider use of 0.2-µm point-of-use water filters [32]. |
| Mycobacterial cultures of biofilms obtained from hospital water outlets | • If facilities experience outbreaks of NTM, they should evaluate the water system and associated equipment for NTM colonization. |
| Intervention Made at Our Hospital . | Recommendations for Other Healthcare Facilities . |
|---|---|
| Clinical practice and equipment-related interventions | |
| Sterile water use for direct patient-care activities of patients at risk | • Healthcare facilities with infections from NTM should consider avoidance of tap water [35] and use of sterile water for patient care activities, such as oral care, enteral tube flushing, speech assessment, consumption, and bathing. • Local epidemiology should determine target patient groups, potentially including critically ill and immunosuppressed patients, those with disrupted gastrointestinal tracts, and patients with early postoperative wounds. Continuing to avoid tap water after hospital discharge may also reduce risk for recent lung or heart transplant recipients. |
| HCU sterile water use and disinfection protocol | • Hospitals should adhere to FDA and manufacturer recommendations for HCU use, water changes, and disinfection practices [36, 37]. |
| Epidemiologic and clinical surveillance for NTM infection | • Hospital epidemiologists should perform retrospective and prospective surveillance for invasive NTM infections. • Clinicians should consider NTM infection when evaluating patients with infection after cardiac surgery, especially for atypical clinical manifestations and prolonged incubation periods. • Clinicians should request mycobacterial cultures, particularly for surgical specimens. |
| Environmental and engineering-based interventions | |
| Periodic flushing of both cold water and recirculating hot water; removal of flow restrictors and redundancies in plumbing system | • Facilities with high-efficiency and/or recirculating water systems should consult with water engineering experts about periodically flushing stagnant or recirculating water from the circulation, avoiding or removing flow restrictors, and minimizing redundancies in the plumbing system. |
| Monitoring of hot water temperatures and flow times to water outlets | • Water engineering personnel should perform surveillance of hot water temperatures throughout the hot water distribution system [38]. |
| Monitoring of chloramine levels in hospital water supply | • Water engineering personnel should measure disinfectant (eg, chloramine or chorine) levels at entry to the facility and at point of use. If proximal disinfectant levels are low, healthcare facilities may need to contract with municipal water authorities. |
| Installation of point-of-use water filters in clinical locations | • Facilities with endemic NTM should consider use of 0.2-µm point-of-use water filters [32]. |
| Mycobacterial cultures of biofilms obtained from hospital water outlets | • If facilities experience outbreaks of NTM, they should evaluate the water system and associated equipment for NTM colonization. |
Abbreviations: FDA, US Food and Drug Administration; HCU, heater-cooler unit; NTM, nontuberculous mycobacteria.
Selected Interventions Made and Recommendations for Other Healthcare Facilities to Decrease Risk of Healthcare-Associated Nontuberculous Mycobacterial Infection
| Intervention Made at Our Hospital . | Recommendations for Other Healthcare Facilities . |
|---|---|
| Clinical practice and equipment-related interventions | |
| Sterile water use for direct patient-care activities of patients at risk | • Healthcare facilities with infections from NTM should consider avoidance of tap water [35] and use of sterile water for patient care activities, such as oral care, enteral tube flushing, speech assessment, consumption, and bathing. • Local epidemiology should determine target patient groups, potentially including critically ill and immunosuppressed patients, those with disrupted gastrointestinal tracts, and patients with early postoperative wounds. Continuing to avoid tap water after hospital discharge may also reduce risk for recent lung or heart transplant recipients. |
| HCU sterile water use and disinfection protocol | • Hospitals should adhere to FDA and manufacturer recommendations for HCU use, water changes, and disinfection practices [36, 37]. |
| Epidemiologic and clinical surveillance for NTM infection | • Hospital epidemiologists should perform retrospective and prospective surveillance for invasive NTM infections. • Clinicians should consider NTM infection when evaluating patients with infection after cardiac surgery, especially for atypical clinical manifestations and prolonged incubation periods. • Clinicians should request mycobacterial cultures, particularly for surgical specimens. |
| Environmental and engineering-based interventions | |
| Periodic flushing of both cold water and recirculating hot water; removal of flow restrictors and redundancies in plumbing system | • Facilities with high-efficiency and/or recirculating water systems should consult with water engineering experts about periodically flushing stagnant or recirculating water from the circulation, avoiding or removing flow restrictors, and minimizing redundancies in the plumbing system. |
| Monitoring of hot water temperatures and flow times to water outlets | • Water engineering personnel should perform surveillance of hot water temperatures throughout the hot water distribution system [38]. |
| Monitoring of chloramine levels in hospital water supply | • Water engineering personnel should measure disinfectant (eg, chloramine or chorine) levels at entry to the facility and at point of use. If proximal disinfectant levels are low, healthcare facilities may need to contract with municipal water authorities. |
| Installation of point-of-use water filters in clinical locations | • Facilities with endemic NTM should consider use of 0.2-µm point-of-use water filters [32]. |
| Mycobacterial cultures of biofilms obtained from hospital water outlets | • If facilities experience outbreaks of NTM, they should evaluate the water system and associated equipment for NTM colonization. |
| Intervention Made at Our Hospital . | Recommendations for Other Healthcare Facilities . |
|---|---|
| Clinical practice and equipment-related interventions | |
| Sterile water use for direct patient-care activities of patients at risk | • Healthcare facilities with infections from NTM should consider avoidance of tap water [35] and use of sterile water for patient care activities, such as oral care, enteral tube flushing, speech assessment, consumption, and bathing. • Local epidemiology should determine target patient groups, potentially including critically ill and immunosuppressed patients, those with disrupted gastrointestinal tracts, and patients with early postoperative wounds. Continuing to avoid tap water after hospital discharge may also reduce risk for recent lung or heart transplant recipients. |
| HCU sterile water use and disinfection protocol | • Hospitals should adhere to FDA and manufacturer recommendations for HCU use, water changes, and disinfection practices [36, 37]. |
| Epidemiologic and clinical surveillance for NTM infection | • Hospital epidemiologists should perform retrospective and prospective surveillance for invasive NTM infections. • Clinicians should consider NTM infection when evaluating patients with infection after cardiac surgery, especially for atypical clinical manifestations and prolonged incubation periods. • Clinicians should request mycobacterial cultures, particularly for surgical specimens. |
| Environmental and engineering-based interventions | |
| Periodic flushing of both cold water and recirculating hot water; removal of flow restrictors and redundancies in plumbing system | • Facilities with high-efficiency and/or recirculating water systems should consult with water engineering experts about periodically flushing stagnant or recirculating water from the circulation, avoiding or removing flow restrictors, and minimizing redundancies in the plumbing system. |
| Monitoring of hot water temperatures and flow times to water outlets | • Water engineering personnel should perform surveillance of hot water temperatures throughout the hot water distribution system [38]. |
| Monitoring of chloramine levels in hospital water supply | • Water engineering personnel should measure disinfectant (eg, chloramine or chorine) levels at entry to the facility and at point of use. If proximal disinfectant levels are low, healthcare facilities may need to contract with municipal water authorities. |
| Installation of point-of-use water filters in clinical locations | • Facilities with endemic NTM should consider use of 0.2-µm point-of-use water filters [32]. |
| Mycobacterial cultures of biofilms obtained from hospital water outlets | • If facilities experience outbreaks of NTM, they should evaluate the water system and associated equipment for NTM colonization. |
Abbreviations: FDA, US Food and Drug Administration; HCU, heater-cooler unit; NTM, nontuberculous mycobacteria.
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