Recent reports of whirlpool-associated septicemia(1), skin infections(2),
urinary tract infections(3), pneumonia(4), legionellosis and Pontiac fever(5,6)
have raised serious public health concerns about the risks associated
with whirlpool bathtubs.
A typical whirlpool bathtub incorporates a system of inaccessible air
and water piping(7). When a bather fills the tub and activates the system,
normal flora, dirt, sloughed skin, body fluids, bath oils and additives,
fecal matter and soap scum circulate through the system and build up inside
the piping as biofilm. Biofilm is abundant in nutrient containing aquatic
environments, and due to physiological cooperation, they are inherently
more resistant to various antimicrobial treatments and cleaning methods.
Manufacturers recommend flushing the system with automatic dishwasher
detergent, bleach, vinegar or baking soda(8,9,10), but the effectiveness
of those products is highly doubtful .
Most systems permit dirty bath water to back-fill the air piping when
the pump is turned off. Unlike the water circulation piping, the air piping
will not admit fluid while the pump is operating. Even if industry-recommended
cleaning agents were effective, they cannot reach the air piping, which
makes the complete system uncleanable by any means.Although the tub is
drained after use, it appears that the circulation system itself does
not fully drain.
|in 1996 a whirlpool spa display at a home improvement
store in Virginia was the source of infection for 14 people hospitalized
with Legionnaires disease. In contrast with other spa- or whirlpool-associated
outbreaks, in this outbreak, none of the people who got Legionnaires'
disease actually entered the water. Instead, all were exposed only
by walking by or spending time in the area surrounding the spa