Tap water avoidance protocol decreases rate of hospital-onset pulmonary NTM
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The implementation of a tap water avoidance protocol in four units at Duke University Hospital reduced overall pulmonary nontuberculous mycobacteria acquisition by 76%, according to study data published in Clinical Infectious Diseases.
The intervention “successfully mitigated an outbreak of pulmonary Mycobacterium abscessus” at the hospital, Arthur W. Baker, MD, MPH, assistant professor of medicine in the division of infectious diseases at Duke University School of Medicine, told Healio. “The primary intervention was to use sterile water instead of tap water for patient care activities among high-risk patients, such as lung transplant recipients.”
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According to Baker, the tap water avoidance protocol was instituted for all patients in three ICUs and one intermediate stepdown unit in late May 2014.
“On these four units, sterile water replaced tap water for routine activities such as oral care, rinsing of suction catheters and enteral tube irrigation,” he explained, adding that patients were restricted from showering, and bathing was performed with waterless bath products or sterile water.
According to the study, Baker and colleagues retrospectively identified all patients who had positive cultures for nontuberculous mycobacteria (NTM) obtained at the hospital from the beginning of the initial M. abscessus complex outbreak in August 2013 through December 2015 to assess the impact of the protocol. They also performed mycobacterial cultures of biofilms from water faucets, shower heads, ice machines and a water basin of the units with the tap water avoidance protocol in place.
The study demonstrated that over the 29-month study period, 105 patients experienced 137 unique episodes of hospital-onset respiratory NTM isolation in the four intervention units. According to the study, the incidence rate of NTM isolation which included the species M. chelonae-M. immunogenum, M. avium complex, M. gordonae and M. abscessus decreased from 41 episodes per 10,000 patient-days during the 10-month outbreak period to 9.9 patients per 10,000 patient-days during the 19-month intervention period (IRR = 0.24; 95% CI, 0.17-0.34) — a decrease of 76%.
“Other hospitals with endemic NTM, new water systems or patients at high risk for pulmonary NTM infection, such as lung transplant recipients, should consider implementation of similar protocols,” Baker said.
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