WATER HYGIENE AND SAFETY
Reducing non-tuberculous mycobacteria risks
Non-tuberculous mycobacteria is a persistent bacterium that poses a significant risk in augmented care facilities. Carole Armstrong, Senior Marketing and Communications manager at Aquatools in the UK, considers the role of design in healthcare facilities to reduce this risk at the specification stage, and how to maintain water quality within an operational facility. She takes a closer look at point-of-use filters as a secondary barrier, and the technology behind the solution.
What are non-tuberculous mycobacteria and what are the dangers? Recognised as an ‘emerging public health concern’, non-tuberculous mycobacteria (NTM) are posing an ever- increasing risk to immunocompromised populations. There has been a documented global increase in pulmonary NTM infections and disease, requiring an introspective analysis of existing water quality and safety measures. In healthcare environments it is paramount to be informed on this growing threat, to protect those who are most at risk and to carry out the best possible care. Non-tuberculous mycobacteria, also known as
environmental mycobacteria, is a bacterium that can cause respiratory and healthcare-acquired infections (HCAIs). As with other opportunistic pathogens, including Legionella and Pseudomonas aeruginosa, the bacteria do not typically cause harm to the wider population. However, for certain demographics, such as patients in augmented care settings, the risk of infection and subsequent severe illness (and even fatality) is significantly higher. It is particularly harmful for those with pre-existing lung conditions, a weakened immune system, autoimmune diseases or those taking immunosuppressive medications.
A persistent bacterium needs specialist attention NTM naturally occur within water and form biofilm within water systems. Once formed, this biofilm can survive temperatures up to 50°C and current chemical shock treatments are ineffective in preventing colonisation, making the NTM bacteria very difficult to get rid of. Similar to Legionella, the bacteria colonise organic materials and natural plastics, with higher colonisation rates in shower hoses and EPDM (Ethylene Propylene Diene Monomer) flexible hoses compared to copper or glass. This tenacity means that additional measures are required to reduce the risk of infection when designing, constructing and operating augmented care facilities. The NHS Technical Bulletin (NETB) No. 2024/3,
published in August 2024, provides additional guidance over and above the existing advice outlined in the Health Technical Memorandum HTM 04-01, on how to manage the risks posed by waterborne pathogens such as Legionella and Pseudomonas.1,2
In augmented care facilities, any non-sterilised water poses a potential threat: water and ice used for drinking and food preparation; water used for personal hygiene, including toilet flushing; water used for cleaning; the entire water distribution system, its outlets and the drainage system; and, significantly for manufacturers, any fittings,
components and equipment that have been tested with water prior to being installed. In healthcare environments, it is the responsibility of
the professionals and institutions to protect vulnerable individuals against HCAIs, which are, unfortunately, contracted by an estimated 300,000 patients in England annually.3
that action is taken before more immunocompromised individuals fall ill as a result. This requires an awareness at all levels to understand
the transmission pathways and minimise the risk. This translates specifically to the facility design stage, the specification and installation of fixtures and fittings, and the day-to-day operation of augmented care facilities. For all new augmented care units, the NETB No.
2024/3 is clear that the design stage is fundamental to eliminating the risk of infection. For existing facilities, the Water Safety Group and Infection Prevention and Control
October 2025 Health Estate Journal 49 With NTM infections on the rise, it is imperative
Filters can be used with taps or showers.
All images courtesy Aquatools
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