Controlling Nontuberculous Mycobacteria in Healthcare Water Systems
Nontuberculous mycobacteria, often abbreviated to NTM, are separate from mycobacteria tuberculosis, which as the name suggests, are responsible for causing tuberculosis in humans.
Nontuberculous mycobacteria can still cause lung infections, however, and should be viewed as a significant risk factor in a manmade water system, especially within hospitals and healthcare environments.
Potable water, i.e., drinking water, should of course be safe to drink at all times. However, there have been many instances where a potable water source has been identified as the source of nontuberculous mycobacterial infections. Indeed, it is possible for someone to become infected by using a variety of outlets seen in the average water system in a building.
Here, we are focusing on healthcare facilities and the particular challenges involved in reducing the presence of NTM within a water system to lower the risk of infection.
A version of this article the control of Nontuberculous mycobacteria in healthcare water systems appeared in Legionella Control International’s newsletter. To get it in your inbox, sign up for free here.
What makes healthcare facilities more prone to problems with their water systems?
There are several answers to this question about water system safety. Firstly, a hospital or healthcare facility may be larger than many other buildings, and it will certainly be more complex. In some cases, older buildings may be repurposed to provide healthcare facilities. In others, a modern building may receive an extension to the main facility, something that will involve changes being made to the existing water systems. Such changes should not be made without proper consideration to the safety of the water systems involved, but this is not always the case.
Another aspect to consider is the equipment used within the facility. Some items of equipment use water, for example – one of the most obvious is a hydrotherapy bath. Other items of medical equipment may not use water directly but may provide a way for NTM to spread and become present in different areas of the facility.
Even regular taps and shower heads can become contaminated if the water system is not properly monitored, cleaned, and maintained. Someone washing their hands under a contaminated tap may then spread bacteria to other areas of the facility, for example, or potentially become ill themselves.
Why is a water safety risk assessment so important for the control of NTM?
Every healthcare facility should conduct a full water safety risk assessment of all its water systems, this is a legal requirement. This should identify all potential risk factors and decide whether reduction or removal is the best step for each one. In some cases, the water risk assessment may indicate that removal of some sections of pipework or water outlets would be the best action to take.
However, it may not be practical to remove a shower if it is only occasionally used. In this case, it may be better to implement a regular process where the shower head is flushed through and the information recorded. This would keep the water moving, avoid stagnation and so reduce the opportunity for NTM to flourish there.
NTM can multiply and spread more readily whenever biofilm is present inside a water distribution system. Biofilm is typically seen as a slimy coating found inside pipes and in other similar areas, and acts as a protective “hide-out” for bacteria. They are harder to form when water is flowing through an area, hence the need for regular use. Flushing an irregularly, or little used outlet, like a tap or shower head, can certainly help to reduce the formation of biofilms and so reduce the risks associated with NTM contamination.
Other bacteria, including legionella, can also be combatted in a similar manner. Therefore, a thorough risk assessment will allow those in control of the water safety plan at the healthcare facility to find the best ways to keep all bacteria, and other waterborne pathogens at safe levels.
Recognising the most susceptible groups in healthcare settings
NTM infections can affect anyone, but as with legionella infections, there are groups that are more prone to contracting them. For example, older patients are more likely to be affected, as are those with medical conditions – particularly if those conditions affect the lungs.
Members of the hospital water safety group or WSG should therefore be drawn from various areas of the healthcare facility. Some will have specialised knowledge that could prove essential to developing a rounded water safety plan (WSP) that keeps the bacteria to a minimum – and certainly at a safe level.
It’s important that the water safety group also includes a water safety specialist, known as an Authorising Engineer (Water) who can provide independent, specialist water safety and engineering advice to the WSG.
Contaminated water supplies or medical equipment pose a risk to anyone who uses them or comes into contact with them. However, any procedure that is invasive, involves breaking the skin, or requires injections or any other kind of preparatory work, can potentially be a risk factor.
Calling in the water safety experts to make sure everything is covered
The average hospital or healthcare facility will employ many people who possess extensive and detailed knowledge of their area of work. They can have a marked influence over the strength of the water safety plan (WSP) where NTM infections are concerned.
However, many facilities also call experts who have experience in risk assessing and advising on water supplies in just these kinds of situations. If you would like to make sure your facility is safe and not at risk of NTM infections, you can find out more about our services. Everyone involved in testing the water supply and performing regular maintenance and checks should have the knowledge to do so, hence why calling an expert is often the safest way to do it.
Leading 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 the workplace, including hospitals and other healthcare environments. Our water safety teams help keep water systems safe to use, protecting staff, 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. We also offer expert risk assessments, safety auditing, training and more.
If you are concerned by any of the issues raised or you would like to speak with one of our water specialists, please call us today on 0330 223 36 86.