HEALTH AND SAFETY ISSUES AT SPAS AND HOT TUBS By DAWN VIEBROCK GRANT COUNTY HEALTH DISTRICT

HEALTH AND SAFETY CONCERNS n DROWNING n HAIR ENTANGLEMENT n BODY ENTRAPMENT n HOT TUB TEMPERATURES n ENTRY AND EXIT FROM TUB n ALCOHOL/DRUG USE

HEALTH AND SAFETY CONCERNS (CONT) n SKIN RASHES n DIARRHEAL ILLNESSES n RESPIRATORY ILLNESS

DROWNING n MAIN HAZARD FROM HOT TUBS n 700 DEATHS NATIONALLY SINCE 1980 n 1/3 CHILDREN UNDER AGE 5 n PREVENTION MEASURES: –PROHIBIT BATHING ALONE –REQUIRE CHILDREN UNDER AGE 12 TO BE ACCOMPANIED BY ADULT

HAIR ENTANGLEMENT n SINCE INCIDENTS n 13 DEATHS n HAIR BECOMES ENTANGLED IN DRAIN COVER n VICTIM’S HEAD HELD UNDER WATER n PREVENTION: –INSTALL NEW DRAIN COVERS –ENCOURAGE PERSONS WITH LONG HAIR TO PIN UP HAIR

HAIR ENTANGLEMENT (CONT)

BODY ENTRAPMENT n SINCE INCIDENTS, 5 DEATHS IN CHILDREN AGE 2-14 (POOLS AND SPAS) NATIONALLY n YR. OLD GIRL DROWNED IN SPA - BODY FORMED VACUUM SEAL AGAINST OUTLET n PREVENTION: –INSTALL NEW DRAIN COVERS

HIGH TEMPERATURES n DILATES BLOOD VESSELS –CAN CAUSE DROWSINESS, FAINTING RISK, UNCONSCIOUSNESS, DROWNING n ELEVATES BODY TEMPERATURE AND TEMPERATURE OF INTERNAL ORGANS n YOUNG CHILDREN’S BODIES DO NOT ADJUST WELL TO HIGH TEMPERATURES

HIGH TEMPERATURES (CONT) n PREGNANT WOMEN –HIGH TEMPERATURES CAN CAUSE NEURAL TUBE DEFECTS IN NEWBORNS SUCH AS SPINA BIFIDA (DEFECT IN WALLS OF SPINAL CANAL), ANENCEPHALY (LACK OF BRAIN AND SPINAL CORD), OR ENCEPHALOCELE (PROTUSION OF BRAIN THROUGH CRAINIAL FISSURE)

HIGH TEMPERATURES (CONT) n PREVENTION: –KEEP TEMPERATURE OF SPA AT 104° F OR LESS –PROHIBIT CHILDREN UNDER AGE 6 FROM USING SPA –CAUTION PERSONS WITH DIABETES, HEART DISEASE, HIGH/LOW BLOOD PRESSURE AND PREGNANT WOMEN ABOUT USING SPA –USE SPA FOR NO MORE THAN 15 MIN.

ENTRY AND EXIT ACCIDENTS n SLIPPING/FALLING WHILE GETTING IN OR OUT OF SPA n COULD CAUSE SERIOUS INJURY n POSSIBLE UNCONSCIOUSNESS LEADING TO DROWNING n PREVENTION: –MAKE SURE HANDRAILS ARE PRESENT AND SECURELY MOUNTED

ENTRY AND EXIT ACCIDENTS n HANDRAILS INSTALLED PER WAC (6) (b) (I) (C)

ALCOHOL/DRUG USE n ALCOHOL AND CERTAIN PRESCRIBED DRUGS CAN CAUSE DROWSINESS n RAISE OR LOWER BLOOD PRESSURE n BODY TEMPERATURE MAY INCREASE MORE QUICKLY n DROWING CAN OCCUR DUE TO FALLING AND/OR PASSING OUT n INTERFERES WITH JUDGEMENT

ALCOHOL/DRUG USE (CONT) n PREVENTATIVE MEASURES: –PROHIBIT USE BY ANY PERSONS UNDER THE EFFECT OF ALCOHOL OR DRUGS

SKIN RASHES n AKA HOT TUB FOLLICULITIS n CAUSED BY PSEUDOMONAS AERUGINOSA n THRIVES IN TEMPERATURES OF ° F n INCUBATION PERIOD HOURS

SKIN RASHES (CONT) n SYMPTOMS –HISTORY OF USING HOT TUB WITHIN PAST 3 DAYS –ITCHY, BUMPY RED RASH –BUMPS MAY DEVELOP INTO DARK RED TENDER NODULES –MAY DEVELOP SMALL PUSTULES (PUS- FILLED BLISTERS)

SKIN RASHES (CONT) –RASH MAY BE DENSER UNDER SWIMSUIT AREAS WHERE MATERIAL HOLDS THE CONTAMINATED WATER IN CONTACT WITH THE SKIN FOR A LONGER PERIOD OF TIME –MULTIPLE MEMBERS OF FAMILY OR PARTY WITH SAME RASH AND SAME HOT TUB EXPOSURE

SKIN RASHES (CONT) n PREVENTATIVE MEASURES: –STRICTLY CONTROL DISINFECTION AND pH LEVELS. –DO NOT ALLOW USAGE OF SPA WHEN LEVELS ARE NOT WITHIN THE GUIDELINES –ROUTINELY DRAIN SPA AND CLEAN SURFACES THOROUGHLY –ROUTINELY CHECK/CLEAN FILTRATION SYSTEM

DIARRHEAL ILLNESSES n BACTERIA –E-COLI O157:H7 –SHIGELLA n VIRUSES –HEPATITIS A –NORWALK n PARASITES –GIARDIA –CRYPTOSPORIDIUM

DIARRHEAL ILLNESSES (CONT) n FREE CHLORINE AT NEUTRAL pH KILLS MOST BACTERIA IN LESS THAN 1 MINUTE. n VIRUSES MORE RESISTANT TO CHLORINE n PARASITES QUITE RESISTANT TO CHLORINE n GERMS THRIVE AT HOT TUB TEMPERATURES

DIARRHEAL ILLNESSES (CONT) n DISINFECTION TIMES FOR FECAL CONTAMINANTS IN CHLORINATED WATER (1 PPM): –E-COLI BACTERIA< < 1 MINUTE –HEPATITIS A VIRUS16 MINUTES –GIARDIA PARASITE20-45 MINUTES –CRYPTOSPORIDIUM 9600 MINUTES PARASITE(6.7 DAYS) PARASITE(6.7 DAYS) –NORWALK VIRUSNO EFFECT UP TO 3.5 PPM

DIARRHEAL ILLNESSES (CONT) n PREVENTION MEASURES: –ADEQUATE DISINFECTION LEVELS (BETWEEN PPM, DEPENDING ON pH) –pH LEVELS WITHIN GUIDELINES ( ) IDEAL RANGE IDEAL RANGE –FOLLOW CONTAMINATION GUIDELINES IF CONTAMINATION FROM FECES OR VOMIT OCCURS –PROHIBIT USE BY ILL PERSONS

RESPIRATORY ILLNESSES n LEGIONNAIRE’S DISEASE (LEGIONELLOSIS) n CAUSED BY BACTERIUM n CAUSED BY BACTERIUM Legionella pneumophila n SEVERAL OUTBREAKS ASSOCIATED WITH WHIRLPOOLS – CRUISE SHIPS – HOME IMPROVEMENT CENTER IN VIRGINIA

POTENTIAL WARNING SIGNS n WATER CLOUDY –FILTER NOT WORKING PROPERLY –TURNOVER TIME TOO LONG n STRONG “CHLORINE” SMELL –INDICATES PRESENCE OF CHLORAMINES. SPA MAY NEED SHOCK TREATMENT OR DRAINING, CLEANING AND REFILLING

GENERAL PREVENTATIVE MEASURES n ADEQUATE TEST KIT WITH FRESH REAGENTS n CHECK DISINFECTION AND pH LEVELS SEVERAL TIMES PER DAY, MORE OFTEN DURING TIMES OF HEAVY USAGE n ACCURATE THERMOMETER n SIGNAGE ADEQUATE, READIBLE AND PROMINENTLY POSTED

GENERAL PREVENTATIVE MEASURES (CONT) n RULES ENFORCED n ROUTINELY CHECK EQUIPMENT n MAKE SURE ALL SAFETY EQUIPMENT (i.e. EMERGENCY SHUT OFF/ALARM) IS PRESENT AND IN GOOD CONDITION n KEEP FIRST AID KIT HANDY AND WELL-STOCKED

GENERAL PREVENTATIVE MEASURES (CONT) n FREQUENTLY CHECK TURNOVER TIME TO INSURE THAT VOLUME OF POOL IS RECIRCULATED AT PROPER INTERVALS FOR USAGE n ROUTINELY DRAIN, CLEAN AND REFILL SPA AT A MINIMUM PER FORMULA: –SPA VOLUME ÷ 3 ÷ AVG. NUMBER USERS/DAY = NUMBER OF DAYS BETWEEN DRAINING, CLEANING AND REFILLING

HEALTH AND SAFETY ISSUES AT SPAS AND HOT TUBS n REMEMBER: AS A SPA OR HOT TUB OWNER YOU MAY BE LEGALLY LIABLE FOR THE SAFETY OF ALL PERSONS WHO USE YOUR FACILITY. YOU HAVE THE ULTIMATE RESPONSIBILITY.