Box VI.

Measures for preventing non-tuberculous mycobacteria (NTM)

Measures to reduce health care-and hygiene-associated NTM disease

Avoid the following

Exposure of injection sites, intravenous catheters and surgical wounds to tap water and tap water-derived fluids

Cleaning of endoscopes with tap water

Contamination of clinical specimens with tap water and ice

Use of benzalkonium chloride as a skin disinfectant prior to local injections

Household and personal measures

Avoid using saunas, hot tubs or any water with an aerator. Hot water usage should be done in proper ventilation

Replacement of shower heads at regular intervals; temperature of water heater should be ≥54.4°C

Sterilized water should be used in humidifiers; avoid ultrasonic humidifiers

Take steps to reduce GERD; avoid foods that may trigger it and avoid vulnerable body positions that may cause aspiration

NTM-associated hypersensitivity lung disease

Ensure regular cleaning of indoor pools, hot tubs and hot water pipes

GERD, gastroesophageal reflux disease. Source: Ref. 10