When a car or a room is rented the occupant expects that everything will be well – clean, orderly and proper. If one were to use a hot tub, spa, or pool one should expect the same thing – clean, orderly and proper. Surprisingly, or unfortunately, this is not always true. In 2004 the CDC published a disturbing summary of spa, hot tub and whirlpool violations from 5 states. About 11% (500/4,533) of these spa inspections resulted in the immediate closing of spas until the violation was corrected. Even today hot tubs, spas and pools are often unsafe and unacceptable for human occupancy. See why this is so.
Infected Hot Tubs, Spas and Pools – Microbe Soups
The club member came to the hot tub to relax at the end of a long work day. However, prior to getting in she noticed that it was cloudy and it had a slight odor that was a bit unpleasant. Fortunately, she decided to avoid using the tub and simply showered and returned home. This tub was heavily contaminated with several types of potentially-dangerous bacteria. The hot tub also had an inadequate level of bromine disinfectant (sanitizer).
How do microbes such as bacteria get in hot tubs, spas and pools? The answer is simple – microbes are shed from the skin and mucous membranes of the bathers into all of these waters. Another bather asks, "Are the microbes dangerous or harmful?" The answer is – the microbes may or may not be harmful. If they are dead then they are not harmful for an infectious disease. If the microbes are alive they may be harmful should they be of certain dangerous types such as: Pseudomonas aeruginosa, Staphylococcus aureus, or even the common species Escherichia coli, or the yeast Candida. Pseudomonas aeruginosa is a well-known culprit of folliculitis as documented in a hot tub epidemic of softball players in Alaska in 1986.
Spa, Hot Tub and Pool Infections and Diseases
Some bathers actually acquire skin and intestinal diseases from recreational waters such as pools, spas, or hot tubs. Bacterial skin diseases may be simple rashes, or more dangerous ulcers, boils and abscesses (see photos below). Urinary tract (urethritis, cystitis) and genital (vaginosis) infections may result from the use of hot tubs and spas. Often the responsible agent is a bacterium such as Pseudomonas aeruginosa, Staphylococcus aureus or Streptococcus pyogenes. Candida species of yeasts may cause infections and be spread in hot tubs and spas. Intestinal diseases include selected types of bacterial and viral infections acquired when contaminated water in the mouth is swallowed.
Since bacteria are common contaminants of the water and derived from the skin and mucocutaneous membranes of bathers there is a need is to continuously remove and destroy these bacteria to prevent infectious diseases.
Importance of Spa Filters and Sanitizers
Continuous removal and destruction of microbes in water can be done. Adequate bromine or chlorine at 2 to 8 ppm (parts per million) and a proper pH of 7.2 to 7.8 is usually sufficient to kill or inactivate many of the bacteria and viruses common in hot tubs, spas and pools. Further, efficient pumps and filters assure good circulation and contact of the bromine or chlorine with bacteria and viruses. Filters also trap and remove bacteria which are then killed or inactivated as the bromine or chlorine reacts with the trapped microbes.
Signs of a Healthy Hot Tub, Spa or Pool
Healthy recreational waters look, feel and smell good. Such recreational waters are produced by efficient filters and adequate levels of chlorine and bromine used at an optimal pH range of 7.2 to 7.8. All bathers need assurance that their bathing waters are tested, treated, maintained, and recorded in a daily log by qualified personnel. Knowing the basic facts of the bacteriology of hot tubs, spas and pools is a good first step for users and operators alike.
Bathing should be the pause that refreshes without fear of infection– nothing more or nothing less could be asked by anyone.
Sources
EPI.alaska.gov. "Hot Tub Folliculitis Strikes Softball Team". Accessed, June 14, 2010).
MMWR, July 2, 2004 / 53(25);553-555. "Surveillance Data from Public Spa Inspections – United States – May-September, 2002." Accessed June 14, 2010.
Donald Reinhardt - Think, read, write & live well always. DJR has a PhD in Biology/Microbiology & is a Fellow & Diplomate, ASM Amer Acad Micro.
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