title: 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.
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.
  
  
  METHODS
  A comparative in situ study of 2 water system treatments to prevent RGM transmission.
  
  
  METHODS
  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 log(10) 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-log(10) reduction. HPC bacteria were not recovered from newly installed filters, although low quantities were found in water from 2-week-old filters.
  
  
  CONCLUSIONS
  POU membrane filters may be a feasible prevention measure for healthcare facilities to limit exposure of sensitive individuals to RGM in potable water systems.
authors.affiliation: National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA. mwilliams7@cdc.gov
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Williams
authors.forename: Tai-Ho
authors.initials: TH
authors.lastname: Chen
authors.forename: Tim
authors.initials: T
authors.lastname: Keane
authors.forename: Nadege
authors.initials: N
authors.lastname: Toney
authors.forename: Sean
authors.initials: S
authors.lastname: Toney
authors.forename: Catherine R
authors.initials: CR
authors.lastname: Armbruster
authors.forename: W Ray
authors.initials: WR
authors.lastname: Butler
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Arduino
mesh_terms: D001999:Bronchoscopy; D004197:Disease Reservoirs / Q000382:microbiology; D060766:Drinking Water / Q000382:microbiology*; D005374:Filtration; D054879:Halogenation; D006801:Humans; D009165:Mycobacterium Infections, Nontuberculous / Q000382:microbiology / Q000517:prevention & control*; D016926:Mycobacterium chelonae; D019095:Point-of-Care Systems; D012866:Skilled Nursing Facilities; D018508:Water Purification / Q000379:methods*
chemical_list: D060766:Drinking Water