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Legionella Disease in Whirlpool Baths

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
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