According to a study published in the Annals of Internal Medicine, a commercial water filter may have contributed to the infection of four heart surgery patients at Brigham and Women’s Hospital, three of whom have died.
       Health care-associated M. abscessus outbreaks, described as a “rare but well-described nosocomial pathogen”, formerly referred to “contaminated water systems” such as ice and water machines, humidifiers, hospital plumbing, for patients undergoing surgery bypass surgery, heating and cooling equipment, medicines and disinfectants.
        In June 2018, Brigham and Women’s Hospital infection control reported invasive Mycobacterium abscessus subsp.abscessus in several patients undergoing heart surgery. Abscess infections, which can cause infections of the blood, lungs, skin, and soft tissues, especially in people with weakened immune systems.
        The researchers conducted a descriptive study to better understand infection clusters. They looked for commonalities between cases, such as the heating and cooling equipment used, or operating rooms, hospital floors and rooms, and access to certain equipment. The researchers also took water samples from every room the patients stayed in, as well as from two drinking fountains and ice makers on the cardiac surgery floor.
       All four patients were “actively treated with multidrug antimycobacterial therapy,” but three of them died, Klompas and colleagues wrote.
        The researchers found that all patients were at the same hospital level but had no other common factors. When examining ice makers and water dispensers, they noticed a significant growth of mycobacteria on the cluster blocks, but not elsewhere.
        Then, using whole genome sequencing, they found genetically identical elements in drinking fountains and ice machines on the floor of the hospital where the infected patients were located. Water leading to the cars passes through a carbon-filtered water purifier with exposure to ultraviolet light, which the researchers found reduces chlorine levels in the water, potentially encouraging mycobacteria to colonize the cars.
       After the high-risk patients switched to sterile distilled water, increased the maintenance of water dispensers, turned off the purification system, there were no more cases.
       ”Installing commercial plumbing fixtures to improve the taste and minimize odor of patients’ drinking water may have the unintended consequences of promoting microbial colonization and reproduction,” the researchers write. water resources (e.g. increased water recycling to reduce heat consumption) may inadvertently increase the risk of patient infection by depleting chlorine supplies and encouraging microbial growth.”
        Klompas and colleagues concluded that their study “demonstrates the risk of unintended consequences associated with systems designed to improve water use in hospitals, the propensity for microbial contamination of ice and drinking fountains, and the risk this poses to patients.” support for water management programs to monitor and prevent nosocomial mycobacterial infections.
       “More broadly, our experience confirms the potential risks of using tap water and ice in the care of vulnerable patients, as well as the potential value of new initiatives to minimize exposure of vulnerable patients to tap water and ice during routine care,” they wrote.