HEALTH AND SAFETY HEALTH AND SAFETY ISSUES AT SPAS AND HOT ISSUES AT SPAS AND HOT

TUBSTUBS

ByBy

DAWN VIEBROCKDAWN VIEBROCK

GRANT COUNTY HEALTH GRANT COUNTY HEALTH DISTRICTDISTRICT

HEALTH AND SAFETY HEALTH AND SAFETY CONCERNSCONCERNS

DROWNINGDROWNING

HAIR ENTANGLEMENTHAIR ENTANGLEMENT BODY ENTRAPMENTBODY ENTRAPMENT HOT TUB TEMPERATURESHOT TUB TEMPERATURES

ENTRY AND EXIT FROM TUBENTRY AND EXIT FROM TUB

ALCOHOL/DRUG USEALCOHOL/DRUG USE

HEALTH AND SAFETY HEALTH AND SAFETY CONCERNS (CONT)CONCERNS (CONT)

SKIN RASHESSKIN RASHES

DIARRHEAL ILLNESSESDIARRHEAL ILLNESSES

RESPIRATORY ILLNESSRESPIRATORY ILLNESS

DROWNINGDROWNING

MAIN HAZARD FROM HOT TUBSMAIN HAZARD FROM HOT TUBS

700 DEATHS NATIONALLY SINCE 1980700 DEATHS NATIONALLY SINCE 1980

1/3 CHILDREN UNDER AGE 51/3 CHILDREN UNDER AGE 5

PREVENTION MEASURES:PREVENTION MEASURES:

– PROHIBIT BATHING ALONEPROHIBIT BATHING ALONE

– REQUIRE CHILDREN UNDER AGE 12 TO BE REQUIRE CHILDREN UNDER AGE 12 TO BE ACCOMPANIED BY ADULTACCOMPANIED BY ADULT

HAIR ENTANGLEMENTHAIR ENTANGLEMENT

SINCE 1978 49 INCIDENTS SINCE 1978 49 INCIDENTS 13 DEATHS13 DEATHS HAIR BECOMES ENTANGLED IN DRAIN COVERHAIR BECOMES ENTANGLED IN DRAIN COVER

VICTIM’S HEAD HELD UNDER WATERVICTIM’S HEAD HELD UNDER WATER

PREVENTION:PREVENTION:

– INSTALL NEW DRAIN COVERSINSTALL NEW DRAIN COVERS

– ENCOURAGE PERSONS WITH LONG ENCOURAGE PERSONS WITH LONG HAIR TO PIN UP HAIRHAIR TO PIN UP HAIR

HAIR ENTANGLEMENT HAIR ENTANGLEMENT (CONT)(CONT)

BODY ENTRAPMENTBODY ENTRAPMENT

SINCE 1980 18 INCIDENTS, 5 SINCE 1980 18 INCIDENTS, 5 DEATHS IN CHILDREN AGE 2-14 DEATHS IN CHILDREN AGE 2-14 (POOLS AND SPAS) NATIONALLY (POOLS AND SPAS) NATIONALLY

1996 16 YR. OLD GIRL DROWNED 1996 16 YR. OLD GIRL DROWNED IN SPA - BODY FORMED VACUUM IN SPA - BODY FORMED VACUUM SEAL AGAINST OUTLETSEAL AGAINST OUTLET

PREVENTION:PREVENTION:– INSTALL NEW DRAIN COVERSINSTALL NEW DRAIN COVERS

HIGH TEMPERATURESHIGH TEMPERATURES

DILATES BLOOD VESSELSDILATES BLOOD VESSELS– CAN CAUSE DROWSINESS, FAINTING CAN CAUSE DROWSINESS, FAINTING

RISK, UNCONSCIOUSNESS, DROWNINGRISK, UNCONSCIOUSNESS, DROWNING

ELEVATES BODY TEMPERATURE AND ELEVATES BODY TEMPERATURE AND TEMPERATURE OF INTERNAL ORGANSTEMPERATURE OF INTERNAL ORGANS

YOUNG CHILDREN’S BODIES DO NOT YOUNG CHILDREN’S BODIES DO NOT ADJUST WELL TO HIGH ADJUST WELL TO HIGH TEMPERATURESTEMPERATURES

HIGH TEMPERATURES HIGH TEMPERATURES (CONT)(CONT)

PREGNANT WOMENPREGNANT WOMEN– HIGH TEMPERATURES CAN CAUSE HIGH TEMPERATURES CAN CAUSE

NEURAL TUBE DEFECTS IN NEURAL TUBE DEFECTS IN NEWBORNS SUCH AS SPINA BIFIDA NEWBORNS SUCH AS SPINA BIFIDA (DEFECT IN WALLS OF SPINAL (DEFECT IN WALLS OF SPINAL CANAL), ANENCEPHALY (LACK OF CANAL), ANENCEPHALY (LACK OF BRAIN AND SPINAL CORD), OR BRAIN AND SPINAL CORD), OR ENCEPHALOCELE (PROTUSION OF ENCEPHALOCELE (PROTUSION OF BRAIN THROUGH CRAINIAL FISSURE)BRAIN THROUGH CRAINIAL FISSURE)

HIGH TEMPERATURES HIGH TEMPERATURES (CONT)(CONT)

PREVENTION:PREVENTION:– KEEP TEMPERATURE OF SPA AT 104° F OR LESSKEEP TEMPERATURE OF SPA AT 104° F OR LESS

– PROHIBIT CHILDREN UNDER AGE 6 FROM USING SPAPROHIBIT CHILDREN UNDER AGE 6 FROM USING SPA

– CAUTION PERSONS WITH DIABETES, HEART CAUTION PERSONS WITH DIABETES, HEART DISEASE, HIGH/LOW BLOOD PRESSURE DISEASE, HIGH/LOW BLOOD PRESSURE AND PREGNANT WOMEN ABOUT USING AND PREGNANT WOMEN ABOUT USING SPASPA

– USE SPA FOR NO MORE THAN 15 MIN.USE SPA FOR NO MORE THAN 15 MIN.

ENTRY AND EXIT ENTRY AND EXIT ACCIDENTSACCIDENTS

SLIPPING/FALLING WHILE GETTING SLIPPING/FALLING WHILE GETTING IN OR OUT OF SPAIN OR OUT OF SPA

COULD CAUSE SERIOUS INJURYCOULD CAUSE SERIOUS INJURY

POSSIBLE UNCONSCIOUSNESS POSSIBLE UNCONSCIOUSNESS LEADING TO DROWNINGLEADING TO DROWNING

PREVENTION:PREVENTION:– MAKE SURE HANDRAILS ARE PRESENT MAKE SURE HANDRAILS ARE PRESENT

AND SECURELY MOUNTEDAND SECURELY MOUNTED

ENTRY AND EXIT ENTRY AND EXIT ACCIDENTSACCIDENTS

HANDRAILS INSTALLED PER WAC HANDRAILS INSTALLED PER WAC 246-260-110 (6) (b) (I) (C)246-260-110 (6) (b) (I) (C)

ALCOHOL/DRUG USEALCOHOL/DRUG USE

ALCOHOL AND CERTAIN PRESCRIBED ALCOHOL AND CERTAIN PRESCRIBED DRUGS CAN CAUSE DROWSINESSDRUGS CAN CAUSE DROWSINESS

RAISE OR LOWER BLOOD PRESSURERAISE OR LOWER BLOOD PRESSURE BODY TEMPERATURE MAY INCREASE BODY TEMPERATURE MAY INCREASE

MORE QUICKLYMORE QUICKLY

DROWING CAN OCCUR DUE TO DROWING CAN OCCUR DUE TO FALLING AND/OR PASSING OUTFALLING AND/OR PASSING OUT

INTERFERES WITH JUDGEMENT INTERFERES WITH JUDGEMENT

ALCOHOL/DRUG USE ALCOHOL/DRUG USE (CONT)(CONT)

PREVENTATIVE MEASURES:PREVENTATIVE MEASURES:– PROHIBIT USE BY ANY PERSONS PROHIBIT USE BY ANY PERSONS

UNDER THE EFFECT OF ALCOHOL OR UNDER THE EFFECT OF ALCOHOL OR DRUGSDRUGS

SKIN RASHESSKIN RASHES

AKA HOT TUB FOLLICULITISAKA HOT TUB FOLLICULITIS

CAUSED BY CAUSED BY PSEUDOMONAS PSEUDOMONAS AERUGINOSAAERUGINOSA

THRIVES IN TEMPERATURES OF 93-105° THRIVES IN TEMPERATURES OF 93-105° FF

INCUBATION PERIOD 12-48 HOURSINCUBATION PERIOD 12-48 HOURS

SKIN RASHES (CONT)SKIN RASHES (CONT)

SYMPTOMSSYMPTOMS– HISTORY OF USING HOT TUB WITHIN HISTORY OF USING HOT TUB WITHIN

PAST 3 DAYSPAST 3 DAYS

– ITCHY, BUMPY RED RASHITCHY, BUMPY RED RASH– BUMPS MAY DEVELOP INTO DARK RED BUMPS MAY DEVELOP INTO DARK RED

TENDER NODULESTENDER NODULES

– MAY DEVELOP SMALL PUSTULES (PUS-FILLED MAY DEVELOP SMALL PUSTULES (PUS-FILLED BLISTERS)BLISTERS)

SKIN RASHES (CONT)SKIN RASHES (CONT)

– RASH MAY BE DENSER UNDER RASH MAY BE DENSER UNDER SWIMSUIT AREAS WHERE MATERIAL SWIMSUIT AREAS WHERE MATERIAL HOLDS THE CONTAMINATED WATER HOLDS THE CONTAMINATED WATER IN CONTACT WITH THE SKIN FOR A IN CONTACT WITH THE SKIN FOR A LONGER PERIOD OF TIMELONGER PERIOD OF TIME

– MULTIPLE MEMBERS OF FAMILY OR MULTIPLE MEMBERS OF FAMILY OR PARTY WITH SAME RASH AND SAME PARTY WITH SAME RASH AND SAME HOT TUB EXPOSUREHOT TUB EXPOSURE

SKIN RASHES (CONT)SKIN RASHES (CONT)

PREVENTATIVE MEASURES:PREVENTATIVE MEASURES:– STRICTLY CONTROL DISINFECTION STRICTLY CONTROL DISINFECTION

AND pH LEVELS.AND pH LEVELS.– DO NOT ALLOW USAGE OF SPA WHEN DO NOT ALLOW USAGE OF SPA WHEN

LEVELS ARE NOT WITHIN THE LEVELS ARE NOT WITHIN THE GUIDELINESGUIDELINES

– ROUTINELY DRAIN SPA AND CLEAN ROUTINELY DRAIN SPA AND CLEAN SURFACES THOROUGHLYSURFACES THOROUGHLY

– ROUTINELY CHECK/CLEAN FILTRATION ROUTINELY CHECK/CLEAN FILTRATION SYSTEMSYSTEM

DIARRHEAL ILLNESSESDIARRHEAL ILLNESSES BACTERIABACTERIA

– E-COLI O157:H7E-COLI O157:H7– SHIGELLASHIGELLA

VIRUSESVIRUSES– HEPATITIS AHEPATITIS A– NORWALKNORWALK

PARASITESPARASITES– GIARDIAGIARDIA– CRYPTOSPORIDIUMCRYPTOSPORIDIUM

DIARRHEAL ILLNESSES DIARRHEAL ILLNESSES (CONT)(CONT)

FREE CHLORINE AT NEUTRAL pH FREE CHLORINE AT NEUTRAL pH KILLS MOST BACTERIA IN LESS THAN KILLS MOST BACTERIA IN LESS THAN 1 MINUTE.1 MINUTE.

VIRUSES MORE RESISTANT TO VIRUSES MORE RESISTANT TO CHLORINECHLORINE

PARASITES QUITE RESISTANT TO PARASITES QUITE RESISTANT TO CHLORINECHLORINE

GERMS THRIVE AT HOT TUB GERMS THRIVE AT HOT TUB TEMPERATURESTEMPERATURES

DIARRHEAL ILLNESSES DIARRHEAL ILLNESSES (CONT)(CONT)

DISINFECTION TIMES FOR FECAL DISINFECTION TIMES FOR FECAL CONTAMINANTS IN CHLORINATED CONTAMINANTS IN CHLORINATED WATER (1 PPM):WATER (1 PPM):– E-COLI BACTERIAE-COLI BACTERIA < < 1 MINUTE< < 1 MINUTE– HEPATITIS A VIRUSHEPATITIS A VIRUS 16 MINUTES16 MINUTES– GIARDIA PARASITEGIARDIA PARASITE 20-45 MINUTES20-45 MINUTES– CRYPTOSPORIDIUM CRYPTOSPORIDIUM 9600 MINUTES9600 MINUTES

PARASITEPARASITE (6.7 DAYS)(6.7 DAYS)– NORWALK VIRUSNORWALK VIRUS NO EFFECT UP TO NO EFFECT UP TO

3.5 PPM3.5 PPM

DIARRHEAL ILLNESSES DIARRHEAL ILLNESSES (CONT)(CONT)

PREVENTION MEASURES:PREVENTION MEASURES:– ADEQUATE DISINFECTION LEVELS (BETWEEN 3.0-10.5 PPM, DEPENDING ON pH)ADEQUATE DISINFECTION LEVELS (BETWEEN 3.0-10.5 PPM, DEPENDING ON pH)

– pH LEVELS WITHIN GUIDELINES (7.2-8.0)pH LEVELS WITHIN GUIDELINES (7.2-8.0)

IDEAL RANGE 7.4-7.6 IDEAL RANGE 7.4-7.6

– FOLLOW CONTAMINATION GUIDELINES IF FOLLOW CONTAMINATION GUIDELINES IF CONTAMINATION FROM FECES OR VOMIT CONTAMINATION FROM FECES OR VOMIT OCCURSOCCURS

– PROHIBIT USE BY ILL PERSONSPROHIBIT USE BY ILL PERSONS

RESPIRATORY ILLNESSESRESPIRATORY ILLNESSES LEGIONNAIRE’S DISEASE LEGIONNAIRE’S DISEASE

(LEGIONELLOSIS)(LEGIONELLOSIS)

CAUSED BY BACTERIUM CAUSED BY BACTERIUM Legionella pneumophila

SEVERAL OUTBREAKS ASSOCIATED WITH WHIRLPOOLS– 1994 - CRUISE SHIPS– 1996 - HOME IMPROVEMENT CENTER 1996 - HOME IMPROVEMENT CENTER

IN VIRGINIAIN VIRGINIA

POTENTIAL WARNING POTENTIAL WARNING SIGNSSIGNS

WATER CLOUDYWATER CLOUDY– FILTER NOT WORKING PROPERLYFILTER NOT WORKING PROPERLY– TURNOVER TIME TOO LONGTURNOVER TIME TOO LONG

STRONG “CHLORINE” SMELLSTRONG “CHLORINE” SMELL– INDICATES PRESENCE OF CHLORAMINES. SPA INDICATES PRESENCE OF CHLORAMINES. SPA

MAY NEED SHOCK TREATMENT OR DRAINING, MAY NEED SHOCK TREATMENT OR DRAINING, CLEANING AND REFILLING CLEANING AND REFILLING

GENERAL PREVENTATIVE GENERAL PREVENTATIVE MEASURESMEASURES

ADEQUATE TEST KIT WITH FRESH ADEQUATE TEST KIT WITH FRESH REAGENTSREAGENTS

CHECK DISINFECTION AND pH CHECK DISINFECTION AND pH LEVELS SEVERAL TIMES PER DAY, LEVELS SEVERAL TIMES PER DAY, MORE OFTEN DURING TIMES OF MORE OFTEN DURING TIMES OF HEAVY USAGEHEAVY USAGE

ACCURATE THERMOMETERACCURATE THERMOMETER SIGNAGE ADEQUATE, READIBLE SIGNAGE ADEQUATE, READIBLE

AND PROMINENTLY POSTEDAND PROMINENTLY POSTED

GENERAL PREVENTATIVE GENERAL PREVENTATIVE MEASURES (CONT)MEASURES (CONT)

RULES ENFORCEDRULES ENFORCED

ROUTINELY CHECK EQUIPMENT ROUTINELY CHECK EQUIPMENT

MAKE SURE ALL SAFETY EQUIPMENT MAKE SURE ALL SAFETY EQUIPMENT (i.e. EMERGENCY SHUT OFF/ALARM) IS (i.e. EMERGENCY SHUT OFF/ALARM) IS PRESENT AND IN GOOD CONDITIONPRESENT AND IN GOOD CONDITION

KEEP FIRST AID KIT HANDY AND KEEP FIRST AID KIT HANDY AND WELL-STOCKEDWELL-STOCKED

GENERAL PREVENTATIVE GENERAL PREVENTATIVE MEASURES (CONT)MEASURES (CONT)

FREQUENTLY CHECK TURNOVER FREQUENTLY CHECK TURNOVER TIME TO INSURE THAT VOLUME OF TIME TO INSURE THAT VOLUME OF POOL IS RECIRCULATED AT POOL IS RECIRCULATED AT PROPER INTERVALS FOR USAGEPROPER INTERVALS FOR USAGE

ROUTINELY DRAIN, CLEAN AND REFILL ROUTINELY DRAIN, CLEAN AND REFILL SPA AT A MINIMUM PER FORMULA:SPA AT A MINIMUM PER FORMULA:– SPA VOLUME ÷ 3 ÷ AVG. NUMBER SPA VOLUME ÷ 3 ÷ AVG. NUMBER

USERS/DAY = NUMBER OF DAYS BETWEEN USERS/DAY = NUMBER OF DAYS BETWEEN DRAINING, CLEANING AND REFILLINGDRAINING, CLEANING AND REFILLING

HEALTH AND SAFETY HEALTH AND SAFETY ISSUES AT SPAS AND HOT ISSUES AT SPAS AND HOT

TUBSTUBS

REMEMBER: AS A SPA OR HOT REMEMBER: AS A SPA OR HOT TUB OWNER YOU MAY BE LEGALLY TUB OWNER YOU MAY BE LEGALLY LIABLE FOR THE SAFETY OF ALL LIABLE FOR THE SAFETY OF ALL PERSONS WHO USE YOUR PERSONS WHO USE YOUR FACILITY. FACILITY. YOUYOU HAVE THE HAVE THE ULTIMATE RESPONSIBILITY. ULTIMATE RESPONSIBILITY.