Key points
- Delays in recognizing nontuberculous mycobacteria (NTM) outbreaks can result in further infections.
- Reporting infections can lead to timely outbreak detection and decrease the risk of new infections.
Overview
NTM outbreaks usually link back to a water source or breaches in infection control practices.
Places with increased risk of NTM infections include:
- Tattoo parlors.
- Nail salons.
- Hot tubs or spas.
- Healthcare settings.
NTM outbreaks can result from various medical procedures and practices, including:
- Cosmetic surgery.
- Dental procedures.
- Injection preparation and administration.
- Manufacturing of medical products.
- Medical tourism.
- Medication preparation.
- Medicine compounding and mixing.
- Surgery (e.g., breast surgery, heart surgery, eye surgery with exposure to consumer-grade humidifiers, etc.).
Delays in recognizing NTM outbreaks can result in delays in public health actions and increase the risk of additional infections.
Recommendations
Health departments should:
- Emphasize good infection control and water management practices.
- Encourage healthcare facilities to establish a water management program.
- Serve as a resource for healthcare facilities on infection control practices related to water.
- Investigate clusters of NTM infections within and across healthcare facilities to determine common exposures and potential sources of infections.
- Consult with CDC as needed for epidemiology and laboratory support, especially if there is concern for the potential of a multi-state outbreak (e.g., contaminated medical product, medical tourism).
- Evaluate laboratory capacity for NTM testing and species identification. Consider developing capacity for species identification if it is not present.
- Consider making extrapulmonary NTM infections notifiable.
- Coordinate with CDC to conduct surveillance for NTM infections.
Resources
- Council of State and Territorial Epidemiologists Standardized Case Definition for Extrapulmonary Nontuberculous Mycobacteria Infections
- Oregon Health Authority Extrapulmonary NTM Investigative Guidelines
- Morbidity and Mortality Weekly Report article describing the Oregon Health Authority's experience with making extrapulmonary NTM reportable in Oregon
- Tennessee Department of Health website on reporting extrapulmonary NTM infections
- Developing a Water Management Program to Reduce Legionella Growth and Spread in Buildings