The Dangers of Mycobacterium Abscessus in Healthcare Water Systems
In this article the healthcare water safety specialists at Legionella Control International highlight the dangers posed by Mycobacterium abscessus in healthcare water systems.
The review begins by looking at where environmental mycobacteria can be found and under what circumstances this bacterium become a danger to human health. It highlights who is at greater risk, typical symptoms of infection, and why healthcare settings present an increased risk to patient health. It concludes by looking at a number of practical measures management teams can take to control the contamination of hospital water systems to keep water supplies safe to use.
A version of this article highlighting the dangers of Mycobacterium abscessus in healthcare water systems appeared in Legionella Control International’s newsletter. To get it in your inbox, sign up for free here.
The dangers of Mycobacterium abscessus in healthcare water systems
Environmental mycobacteria exist in the world around us, hence the name. You’ll likely have it in the soil in your garden. It exists in earth and soil elsewhere too. If you were to test any local lakes, streams, or other bodies of water, you’d find it there as well.
However, the bigger issue is that these mycobacteria can also find their way into manmade water systems such as those found in hospitals and healthcare settings. Mycobacterium abscessus is one example of an environmental mycobacterium, and it can cause a series of infections in humans, some serious. Here, we look at the possible risks of encountering Mycobacterium abscessus in hospital water systems and healthcare settings generally and what can be done to protect people from harm.
What sort of infections does Mycobacterium abscessus cause?
The most common infection caused by Mycobacterium abscessus is a skin infection, although it can potentially cause others as well. For example, if someone who has a lung disease should inhale M. abscessus from contaminated water droplets in the air (an aerosol), it can cause a severe lung infection. Typical examples of lung diseases like this include cystic fibrosis.
Mycobacterium abscessus infections are often tricky to treat because it is resistant to many different antibiotics …
Research suggests that those who contract the infection who do not have pre-existing conditions tend to be aged 60 or over. Conversely, those who do have conditions such as cystic fibrosis may develop the infection at a younger age.
Are some people at greater risk of infection of M. abscessus than others?
Skin infections – along with those affecting damaged skin and the soft tissues beneath – are most common, as we have seen. As far as hospitals and healthcare settings are concerned, these are the most usual examples of infection that may occur.
Examples of situations where someone may be at risk of infection might include someone who has undergone surgery, or with one or more open wounds. These open wounds provide a place for M. abscessus to enter the body. Similarly, anyone who needs an injection could have a higher risk of infection via the injection site. This is easily tackled by following proper hygiene and disinfection procedures before the injection is administered.
There is little to suggest that transmission of Mycobacterium abscessus can occur between two or more people.
Why are hospital water systems and healthcare settings generally at risk of Mycobacterium abscessus infections?
We can see that some of those who are at risk of these infections may be at risk because they have had medical treatments for skin conditions or suffered injuries, or they have undergone surgical procedures. They may also need an injection, blood sample, or transfusion, all of which would involve breaking the skin.
M. abscessus has been noted to contaminate hospital water systems, medical equipment and devices, so any such water systems or items within a healthcare setting could be at risk of colonisation or contamination. Mycobacterium abscessus infections are often tricky to treat because it is resistant to many different antibiotics, hence the importance of controlling or eliminating its presence to start with.
The formation of a multidisciplinary Water Safety Group, guided by an experienced Authorising Engineer, deploying a well-developed Water Safety Plan will go a long way to reducing water safety risk to acceptable levels in any healthcare setting …
Preventing contamination is far easier than treating an infection after the fact. Even simple steps such as thoroughly washing hands before and after treatment, such as wound dressing or injections, for example, can be enough to prevent Mycobacterium abscessus from spreading. Good water hygiene practices, control procedures and regular testing are also essential if water safety is to be maintained.
What are the symptoms of a Mycobacterium abscessus infection?
If a Mycobacterium abscessus infection occurs on the skin, it will present in much the same way as many other skin infections. The skin may feel warm and tender, and in some cases, pus may be produced. Pus can be sampled and sent to a lab to confirm whether an M. abscessus infection is present.
Someone infected by M. abscessus might also feel poorly, experiencing a fever or aching muscles. Many symptoms can seem more like a general infection or even a cold or flu, and so they are often confused with a more common illness.
Regular testing of the water at higher risk points in the system can help minimise the chances of someone being affected by mycobacteria such as M. abscessus …
Antibiotics can be used to help treat infection, although traditional ones may not produce results. Any pus should be drained, while in some cases, the affected tissue is also removed.
The importance of preventing contamination of medical equipment
Even when good water hygiene practices are in place and individuals follow the usual handwashing procedures, this counts for nothing when items of medical equipment are already contaminated. As such, it is important to make sure everyone is aware of how to maintain medical equipment to make sure it is safe for use.
Controlling mycobacteria in hospital water systems
Mycobacteria can also contaminate man-made water systems, and since many hospitals and healthcare settings can have large and often complex water systems, this can make them more challenging to maintain.
Regular testing of the water at various points in the system can help minimise the chances of someone being affected by mycobacteria such as M. abscessus. This proactive approach is essential in helping to maintain a safe water system for everyone to use. It is especially important in cases where mycobacterial infections are difficult to treat and may require extensive treatment over the course of several months.
Maintaining safe water systems in healthcare settings
The formation of a multidisciplinary Water Safety Group guided by an experienced Authorising Engineer (Water), developing a Water Safety Plan, water safety risk assessments, Point of Use filters (POU filters) on taps and other water outlets, regular and appropriate chemical dosing of the water systems, regular testing and various other measures may all prove useful in maintaining a safe water system.
Many healthcare settings would benefit from seeking expert advice in this area, thereby making sure their premises, and their water systems remain as safe as possible. Such an approach would help keep this mycobacteria at the lowest possible levels and so help protect vulnerable patients from harm.
Leading healthcare water safety specialists
Legionella Control International are world leading water safety specialists, supporting those responsible for the control of legionella and other waterborne pathogens in hospitals and other healthcare environments. Our water safety teams help keep water systems safe to use, protecting staff, patients, visitors and others from harm.
We are experienced in the healthcare role of Authorising Engineer (Water) and can assist organisations in the development of water safety management teams, policies, and procedures to safeguard people across large scale and multi-site property portfolios, complex facilities and those considered to be higher risk.
If you are concerned by any of the issues raised or you would like to speak with one of our healthcare water specialists, please call us today on 0330 223 36 86.