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Background: Hospital outbreaks caused by Mycobacteroides abscessus complex are a major cause for concern in vulnerable patients such as the cardiothoracic transplant population., Aim: To describe the outbreak investigation and mitigation steps undertaken to address an increase in healthcare-associated M. abscessus complex cases in an inpatient cardiothoracic transplant population., Methods: We extracted clinical characteristics from patients with M. abscessus pre-outbreak (March 2018 to December 2020) and during the outbreak (January 2021 to June 2022) from the electronic medical record. A multi-disciplinary team conducted the outbreak investigation and devised a mitigation strategy to implement at our institution., Findings: The baseline incidence of healthcare-associated M. abscessus was 0.11 cases per 10,000 patient-days; this increased to 0.24 cases per 10,000 patient-days during the outbreak. There were 1/9 (11%) cardiothoracic transplant patients in the pre-outbreak group compared with 7/12 (58%) during the outbreak, and respiratory specimen types compromised 6/9 (67%) of M. abscessus results in the pre-outbreak group compared with 10/12 (83%) during the outbreak. Among the clinical care activities involving water, a variety of water sources were utilized, including filtered and tap water. The incidence of healthcare-associated M. abscessus subsequently decreased to 0.06 cases per 10,000 patient-days after implementing an outbreak-mitigation strategy of sterile water precautions., Conclusions: Robust educational efforts from a multi-disciplinary team on eliminating exposure to tap water were effective measures to reduce healthcare-associated M. abscessus incidence at our institution. Non-tuberculous mycobacteria infection surveillance, targeted education, and water mitigation strategies may be beneficial preventative strategies for other lung transplant centres facing similar issues., Competing Interests: Conflict of interest statement M.P.A. is a consultant for Abbvie. M.G.I. declares that research support from GSK was paid to Northwestern; received consulting fees from Adagio Therapeutics, ADMA Biologics, Adamis Pharmaceuticals, AlloVir, Atea, Cidara Therapeutics, Genentech/Roche, Janssen, Shionogi, Takeda, Telaris, and Eurofins Viracor; and payment for participating in data safety monitoring boards or advisory boards from Adamis Pharmaceuticals, AlloVir, National Institutes of Health, CSL Behring, Janssen, Merck, Seqirus, Takeda, and Talaris; all of these ended December 2022; he also receives author royalties from UpToDate, which is ongoing; M.G.I. also serves as Chair of the International Society for Influenza and other Respiratory Virus Diseases Antiviral Group and was Editor-in-Chief of Transplant Infectious Disease. All other authors report no conflicts of interest relevant to this article., (Copyright © 2024 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)