Previously published reports of tattoo-related nontuberculous mycobacterial infections suggested that tap water or distilled water used to dilute inks at tattoo parlors was a likely source of contamination.4 Findings from the recent outbreak investigations, however, suggested that the inks were contaminated before distribution. During the response to the New York outbreak, the outbreak strain of mycobacteria was isolated from an unopened ink container. Thus, contamination could have occurred at various points in the ink-production process — for instance, from unsanitary manufacturing processes or the use of contaminated ingredients such as water, glycerin, or pigments.