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An increase in nontuberculous mycobacteria (NTM) infections in post-surgical patients has been linked to contaminated water emitted from heater-cooler devices used in surgery. Infection preventionists and their clinical colleagues should immediately review cleaning and disinfection procedures for the devices and ensure only sterile water is used in them, public health agencies advise.
“The most important action to protect patients will be to remove contaminated heater-coolers from operating rooms, and ensure that those in service are correctly maintained,” the CDC advises.
The FDA warns against using tap water to rinse, fill, refill or top-off the device water tanks since this may introduce NTM organisms. Use only sterile water or water that has been passed through a filter of less than or equal to 0.22 microns, the FDA notes. In addition, clinicians should direct the heater-cooler’s vent exhaust away from the surgical field to reduce the risk of aerosolizing tank water into the sterile field and exposing the patient.
Heater-cooler devices are often used during cardiac surgical procedures to warm and cool a patient’s blood during cardiopulmonary bypass. Commonly found in soil and water, NTM usually only threatens immune-compromised patients and is not transmitted from person to person. Bacterial growth is so slow that the patient may not become symptomatic until months or even years after the procedure. The CDC cited several recent reports of NTM infections1-3 in making the following recommendations:
Healthcare providers should have increased suspicion for NTM infections among patients who have signs of infection and a history of cardiac surgery. When seeing patients, actions that providers should consider include:
Financial Disclosure: Senior Writer Gary Evans, Associate Managing Editor Dana Spector and Nurse Planner Kay Ball report no consultant, stockholder, speaker’s bureau, research, or other financial relationships with companies having ties to this field of study. Consulting Editor Patrick Joseph, MD, is laboratory director of Genomic Health Inc, CareDx Clinical Laboratory, and Siemens Clinical Laboratory.