This blog post was authored by Katie Keating, RN, MS, and reviewed by the Bronchiectasis and NTM Content Review and Evaluation Committee.

Summer fun and great outdoor weather are approaching. Sunshine is uplifting to most of us after being indoors through a long and challenging winter. By taking specific precautions throughout the summer, you may lessen your chance of getting an NTM infection or experiencing a flare-up. Educating yourself on these suggestions may enable you to truly enjoy your summer and avoid infection.

Below are some excerpts that are taken from the paper Reducing Exposure to Nontuberculous Mycobacteria (NTM), by Joseph O. Falkinham, III, Ph.D. (revised June 11, 2020). Other relevant publications also are referenced.

Flush and run water in unused lines to reduce water age. Water age refers to the time water stays in pipes in houses. The average water age in household plumbing is one to three days. When water stays in your pipes for more than three days it can lead to a loss of disinfectant and may cause NTM and other waterborne germs to grow. Increased water age can occur in plumbing in unused areas of a house (e.g., in an unused bathroom or unoccupied wing of a house). The solution is simple: have someone unlikely to be at risk for NTM disease flush commodes and run water (5 minutes) in taps in unused bathrooms and seldom-used laundry tubs, half baths, and outside faucets.¹

Blogger’s note: Many of us will be traveling over the summer months and it is good to remember the above statement. Rental homes may not have flushed the systems for days before your arrival. Let others who do not have NTM lung disease or sensitive immune systems flush the infrequently used faucets, outdoor faucets, gardening hoses, etc. Doing something as simple as this can save you from getting an infection or reinfection while traveling.

Don’t drink water or use ice from a refrigerator. Many refrigerators come with outside taps for chilled water and ice. Do not use them as high numbers of NTM may be collecting in the refrigerator tap water and ice. The tap water coming into the refrigerator collects in a large reservoir and the warmth of the machinery raises the temperature of the water (before cooling), so the reservoir may contain lots of NTM. Use ice trays and bottles that are filled with boiled (10 min) or 0.2 micrometer-filtered water if you want cold water.¹

Blogger’s note: My refrigerator water filter was tested years ago by the lab at Virginia Tech — the mycobacterium matched what was in my recent sputum sample.

Please keep in mind soda filters and other outside filters when you are away from home. These filters should be changed frequently. Many dining establishments are not in compliance with recommended filter changes. Filter changes are expensive and time-consuming. You may want to ask yourself the following questions. Will you still drink carbonated beverages from filtered machines? When was the last time you changed the water filter in your refrigerator?

Avoid dust from potting soils. Commercial potting soil is rich in peat. Peat can harbor very high numbers of NTM (1 million per gram). As peat or potting soil dries, the dust generated can have high numbers of NTM. In a study of pulmonary NTM patients, they found that a proportion (who were gardeners) had been infected from their potting soil.² When gardening, use an N95 mask (such as those purchased in a pharmacy) to avoid dust inhalation.¹ Or simply wet the potting soil or peat moss in the original container and then transfer.³

Author’s note: Many patients enjoy gardening. It is important not to take away hobbies that bring one joy. Wear an inexpensive dust mask (preferably an N95 mask) to prevent breathing in dirt particles while working with potting soil or in the garden. Wet down the soil to reduce the number of particles released into the air.

The laboratory at Virginia Tech has not found many NTM in ocean waters (if at all), however, they do find very high numbers in estuaries where the salty ocean water is diluted by fresh during tidal action (i.e., brackish). The NTM can be located in coastal swamps with lots of vegetation. I would not worry about sitting on a sandy beach and inhaling onshore salt breezes. However, I would avoid wading in coastal swamps.¹

Author’s note: I love sitting on a beach chair with my feet in the ocean enjoying the saltwater breeze at the end of the day especially when the beach is less crowded. I am so glad that I can still feel safe in the ocean. I avoid being close to stagnant waters (such as on a kayak or canoe) frequently found in lakes, rivers, or ponds.

NTM germs lurk in warm, wet places like hot tubs, heated indoor pools, and steamy bathrooms. If you are at risk for the disease, it is recommended to avoid hot tubs or indoor pools. Use a vent fan to clear up steam after a shower or bath.⁴

Author’s note: I used to love hot tubs, but I have refrained from using them for many years since I was diagnosed. NTM can get in the tiny droplets from the hot tub via the vibrating action of the jets. Some patients still enjoy indoor pools — a quality-of-life decision similar to gardening. I still prefer to err on the side of being cautious. When it comes to bathing, I try to open the window in the bathroom after taking a shower, whenever I can.

The above information can help protect those with or at risk of NTM lung disease in the summer months. I love the sunlit days of summer, the intake of Vitamin D, outdoor events, and the greater interaction with others. I want you to enjoy the long days of summer as much as possible. The efforts to prevent infection and take proactive measures (while sometimes an annoyance) far outweigh the discomfort and risk of dealing with an NTM lung infection.

Best wishes for a great summer.

References:

1. Reducing Exposure to Nontuberculous Mycobacteria (NTM), Joseph O. Falkinham, III Ph.D. Revised: 11 June 2020.
2. De Groot, M.A., N.R. Pace, K. Fulton, and J.O. Falkinham, III. 2006. Relationships between Mycobacterium isolates from patients with pulmonary mycobacterial infection and potting soils. Appl. Environ. Microbiol. 72: 7062–7606.
3. https://www.atsjournals.org/doi/full/10.1513/AnnalsATS.201301-013FR
4. https://www.webmd.com/lung/ntm-lung-disease#1