Summary
This multidisciplinary investigation describes a two-phase nosocomial outbreak of Mycobacterium abscessus at a tertiary care hospital from 2013–2015, linked to hospital water systems. Phase 1 affected predominantly lung transplant patients via aerodigestive exposure to tap water, whilst phase 2 involved cardiac surgery patients with invasive infections through contaminated water in cardiopulmonary bypass equipment. Implementation of tap water avoidance measures for high-risk patients, intensified disinfection protocols, and water engineering improvements to promote flow and disinfectant concentration successfully mitigated both outbreak phases.
UK applicability
UK hospitals operating similar water systems and serving comparable patient populations (transplant and cardiac surgery cohorts) may face comparable risks from nontuberculous mycobacteria colonisation. The infection control and water engineering strategies documented here—tap water avoidance protocols, heater-cooler unit disinfection, and enhanced water flow management—are directly applicable to UK healthcare infrastructure and could inform guidance from national infection prevention bodies.
Key measures
Incidence rate ratio (4.6; 95% CI 2.3–8.8); cases per 10,000 patient-days during baseline (0.7), phase 1 (3.0), and phase 2 (12/24 cardiac surgery cases); molecular fingerprinting of clinical isolates
Outcomes reported
The study documented a biphasic outbreak of M. abscessus at a tertiary care hospital, with incidence rates increasing 4.6-fold during phase 1 (August 2013–May 2014) compared to baseline. Molecular fingerprinting identified two clonal strains linked to hospital tap water, and targeted water engineering interventions and disinfection protocols resolved both outbreak phases.
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