Hospital Water Safety and Nontuberculous Mycobacteria Risk: A National Evaluation of Organisational Readiness Across NHS Hospitals.

OBJECTIVES

Following a Prevention of Future Deaths report highlighting risks from Mycobacterium abscessus in hospital water systems, NHS Estates Technical Bulletin (NETB) 2024/3 introduced updated measures to reduce risks from waterborne pathogens, including nontuberculous mycobacteria (NTM). This study described organisational responses and reported surveillance, design practices and water safety controls across NHS providers in England following publication of the bulletin.

METHODS

A Freedom of Information Survey was sent to all NHS England organisations (n = 180). Questions explored awareness of NETB 2024/3; high-risk patient groups; water safety governance; NTM testing; control/remediation measures; and design activities. Structured data were collated, and free-text responses thematically analysed.

RESULTS

The response rate was 90% (n=162). Awareness of NETB 2024/3 guidance was high (n=145, 90%), and almost all organisations had Water Safety Groups (99%). 71% reported caring for high-risk patient groups (n=115). Environmental NTM testing was undertaken by 14 Trusts (9%), six of these (42.9%) reported NTM detection, most often heater-cooler units and theatres. 13% (n=21) had Water Safety Plans specifically defining NTM risk mitigation. Testing strategies varied, from reactive sampling to scheduled programmes. Control measures for waterborne pathogens generally included temperature management (98%) and outlet descaling (94%); 70% (n=113) had undertaken design modifications in high-risk areas.

CONCLUSIONS

Design and control measures for waterborne pathogens varied considerably between organisations. Common themes included pipework reconfiguration and reduced use of tap water for patient care. Approaches to NTM testing and management were heterogeneous. Greater consensus on when environmental NTM testing informs management, and how results should guide action, could support organisational decision-making.