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Point-of-Use Membrane Filtration and Hyperchlorination to Prevent Patient Exposure to Rapidly Growing Mycobacteria in the Potable Water Supply of a Skilled Nursing Facility

Published online by Cambridge University Press:  02 January 2015

Margaret M. Williams ,
Tai-Ho Chen ,
Tim Keane ,
Nadege Toney ,
Sean Toney ,
Catherine R. Armbruster ,
W. Ray Butler  and
Matthew J. Arduino
Margaret M. Williams*
Affiliation:
National Center for Emerging and Zoonotic Infectious Diseases, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
Tai-Ho Chen
Affiliation:
Office of Surveillance, Epidemiology, and Laboratory Services/Epidemiology Investigative Service Program, CDC, Atlanta, Georgia Pennsylvania Department of Health, Harrisburg, Pennsylvania
Tim Keane
Affiliation:
Environmental Infection Control Consultants, Chalfont, Pennsylvania
Nadege Toney
Affiliation:
National Center for Emerging and Zoonotic Infectious Diseases, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
Sean Toney
Affiliation:
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of Tuberculosis Elimination, CDC, Atlanta, Georgia
Catherine R. Armbruster
Affiliation:
National Center for Emerging and Zoonotic Infectious Diseases, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
W. Ray Butler
Affiliation:
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of Tuberculosis Elimination, CDC, Atlanta, Georgia
Matthew J. Arduino
Affiliation:
National Center for Emerging and Zoonotic Infectious Diseases, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
*
1600 Clifton Road, MS-C16, Atlanta, GA, 30333 ([email protected])
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Abstract

Background.

Healthcare-associated outbreaks and pseudo-outbreaks of rapidly growing mycobacteria (RGM) are frequently associated with contaminated tap water. A pseudo-outbreak of Mycobacterium chelonae–M. abscessus in patients undergoing bronchoscopy was identified by 2 acute care hospitals. RGM was identified in bronchoscopy specimens of 28 patients, 25 of whom resided in the same skilled nursing facility (SNF). An investigation ruled out bronchoscopy procedures, specimen collection, and scope reprocessing at the hospitals as sources of transmission.

Objective.

To identify the reservoir for RGM within the SNF and evaluate 2 water system treatments, hyperchlorination and point-of-use (POU) membrane filters, to reduce RGM.

Design.

A comparative in situ study of 2 water system treatments to prevent RGM transmission.

Setting.

An SNF specializing in care of patients requiring ventilator support.

Methods.

RGM and heterotrophic plate count (HPC) bacteria were examined in facility water before and after hyperchlorination and in a subsequent 24-week assessment of filtered water by colony enumeration on Middlebrook and R2A media.

Results.

Mycobacterium chelonae was consistently isolated from the SNF water supply. Hyperchlorination reduced RGM by 1.5 log10 initially, but the population returned to original levels within 90 days. Concentration of HPC bacteria also decreased temporarily. RGM were reduced below detection level in filtered water, a 3-log10 reduction. HPC bacteria were not recovered from newly installed filters, although low quantities were found in water from 2-week-old filters.

Conclusion.

POU membrane filters may be a feasible prevention measure for healthcare facilities to limit exposure of sensitive individuals to RGM in potable water systems.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 9 , September 2011 , pp. 837 - 844
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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