mycobacteria risks from water and ice machines 799
figure 5. Drinking water and ice machine (DWIM) 4 water and ice. Heterotrophic plate counts (HPCs; CFU/mL) and effects from interventions.
levels in ice. Further research is needed in this area to get DWIMs to make ice with consistently low HPCs. The HPCs in our children’s hospital DWIMs have con-
sistently met goal levels for 4 years; thus, we are recommending that HSCT patients be allowed to drink water directly from the DWIMs. We have added the 0.005-µm filter and silver- impregnated components as well as and copper tubing to all DWIMs in the new hospital, and we plan to add UV disinfec- tion devices to all machines used by HSCT patients. Because the ice HPCs have not met goal levels, HSCT
patients are not allowed to ingest the ice. To replace the pre- viously used ice chips, nurses currently freeze the unopened bottles of water and allow patients to drink that ice water as it melts. We plan to closely monitor the DWIMs in the new hospital
and to continue water and ice cultures monthly. We will take action to decrease levels if they increase. We continue to watch for any RGM isolates in HSCT patient cultures, and we plan to reinstitute the bottled water policy if any RGM isolates are detected while we investigate the causes further.
acknowledgments
Financial support: No financial support was provided relevant to this article. Potential conflicts of interest: All authors report no conflicts of interest rele- vant to this article.
Address correspondence to Susan Kline, MD, MPH, 420 Delaware St SE, MMC 250, Minneapolis, MN 55455 (
Kline003@umn.edu).
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3. IrohTam PY, Kline S, Wagner J, et al. Rapidly growing myco- bacteria among pediatric hematopoietic cell transplant patients traced to the hospital water supply. Pediatr Infect Dis J 2014;33:1043–1046.
4. Covert T, Rodgers M, Reyes A, Stelema G. Occurrence of non- tuberculous mycobacteria in environmental samples. Appl Environmental Microbiol 1999;65:2492–2496.
5. Goslee S, Wolinsky E. Water as a source of potentially pathogenic mycobacteria. Am Rev Respir Dis 1976;113: 287–292.
6. duMoulin G, Stottmeier K. Waterborne mycobacteria: an increasing threat to health. ASM News 1986;52:525–529.
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