Whirlpool Baths, Hot Tubs and Spas

Health problems associated with hot tubs
Precautions for spa owners
Using a public hot tub

Health Problems Associated With Hot Tubs

Whirlpools, spas, or hot tubs can be a source of health problems such as skin rashes, respiratory problems, urinary tract infections, or even life-threatening illnesses if they are not properly cleaned and maintained. In the past 20 years, public whirlpools and hot tubs have been the source of several outbreaks of diseases including Pontiac fever, folliculitis (an itchy skin rash caused by a bacterium called Pseudomonas aeruginosa), and respiratory illnesses such as bronchitis. In February 1999, about 15 people developed folliculitis after they had used a hotel pool and hot tub in Colorado. In February 2000, there was another outbreak of skin rashes and folliculitis among people who used a hotel hot tub and swimming pool in Bangor, Maine.¹ In another incident a 10-year old girl even got a skin inflammation called atopic eczema after sharing a hot tub with a friend whom had fever blisters caused by herpes simplex.²

One of the most severe infections that one can get from whirlpools or hot tubs is from the bacterium, Legionella pneumophila, which can cause Legionnaires' disease. In 1996, a whirlpool spa display at a home improvement store in Virginia infected 14 people who were hospitalized with Legionnaires' disease. What made this outbreak so different from other ones associated with spas/whirlpools/hot tubs was that in this case, none of the people who got infected actually entered the water. Instead, these people got sick with Legionnaires' disease just by walking by the spa display or spending time in the area around it.³ After this incident, the Virginia Department of Health recommended that whirlpool spas being used as displays be regularly inspected, maintained with biocides, and have their filters changed regularly.

In addition to some state departments of health taking action, the Centers for Disease Control and Prevention (CDC) recently developed guidelines for the cleaning and maintenance of whirlpool spas on cruise ships after a recent outbreak of Legionnaires' disease on a ship. Generally, however, such guidelines do not exist. For example, hot tubs or whirlpools can be particularly hazardous in hotels, resorts, and inns because there are no standard guidelines for hotels to use to know how to properly clean them like there are for swimming pools. Though there are guidelines for homeowners developed by the National Spa and Pool Institute, these do not address commercial uses.

Precautions for Spa Owners 

• Make sure it is disinfected properly and maintained according to the manufacturer's recommendations

• Buy a spa with an ozonator. Ask your spa supplier. This can eliminate the need to handle toxic spa chemicals.

• If you are suffering health problems, consider getting rid of it.

Using a Public Hot Tub 

• Ask hotel/health club management how they clean and maintain their whirlpools and hot tubs.

• If it is a communal hot tub, such as at a hotel or health spa, ask when they last changed the water and checked the pH levels. The pH level should be between 7.2 and 7.8.

• Make sure the drain is topped with an "anti-vortex" cover that prevents suction injuries. Though these do not have anything to do with germs, they can give an idea of how well the spa or whirlpool is maintained.

• If there is a hot tub or whirlpool in your hotel room, play it safe by cleaning it yourself. Pour two ounces of bleach into the filled tub and let it run through the system. Then drain the water and refill the tub before using.

References

1. Centers for Disease Control. Pseudomonas dermatitis/folliculitis associated with pools and hot tubs?Colorado and Maine, 1999-2000. MMWR Weekly. December 8, 2000;49(48):1087-1091.

2. Lore D. Romantic, but safe? Hotel hot tub may be risky for couples on a getaway. The Atlanta Journal and Constitution. February 10, 2000.

3. Hershey J, Burrus B, Marcussen V, et al. Legionnaires disease associated with a whirlpool spa display?Virginia. September-October, 1996. MMWR. January 31, 1997;46(04):83-6.