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

2. 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

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

4. 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

5. HAIR ENTANGLEMENT n SINCE 1978 49 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

6. HAIR ENTANGLEMENT (CONT)

7. BODY ENTRAPMENT n SINCE 1980 18 INCIDENTS, 5 DEATHS IN CHILDREN AGE 2-14 (POOLS AND SPAS) NATIONALLY n 1996 16 YR. OLD GIRL DROWNED IN SPA - BODY FORMED VACUUM SEAL AGAINST OUTLET n PREVENTION: –INSTALL NEW DRAIN COVERS

8. 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

9. 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)

10. 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.

11. 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

12. ENTRY AND EXIT ACCIDENTS n HANDRAILS INSTALLED PER WAC 246- 260-110 (6) (b) (I) (C)

13. 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

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

15. SKIN RASHES n AKA HOT TUB FOLLICULITIS n CAUSED BY PSEUDOMONAS AERUGINOSA n THRIVES IN TEMPERATURES OF 93- 105° F n INCUBATION PERIOD 12-48 HOURS

16. 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)

17. 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

18. 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

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

20. 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

21. 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

22. DIARRHEAL ILLNESSES (CONT) n PREVENTION MEASURES: –ADEQUATE DISINFECTION LEVELS (BETWEEN 3.0-10.5 PPM, DEPENDING ON pH) –pH LEVELS WITHIN GUIDELINES (7.2-8.0) IDEAL RANGE 7.4-7.6 IDEAL RANGE 7.4-7.6 –FOLLOW CONTAMINATION GUIDELINES IF CONTAMINATION FROM FECES OR VOMIT OCCURS –PROHIBIT USE BY ILL PERSONS

23. RESPIRATORY ILLNESSES n LEGIONNAIRE’S DISEASE (LEGIONELLOSIS) n CAUSED BY BACTERIUM n CAUSED BY BACTERIUM Legionella pneumophila n SEVERAL OUTBREAKS ASSOCIATED WITH WHIRLPOOLS –1994 - CRUISE SHIPS –1996 - HOME IMPROVEMENT CENTER IN VIRGINIA

24. 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

25. 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

26. 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

27. 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

28. 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.