Know the Hidden Dangers in Hot Tubs
Imagine this: you finally arrive at your dream vacation spot in sunny Florida. You get to the hotel, check-in, and begin a few weeks of fun. After visiting the theme parks, you decide to sit by the pool and relax. You pull up a chair near the hot tub, grab a drink, and settle in for some suds and sun. Repeat and enjoy!
But now imagine after several days you start feeling weak; then it feels like the flu…and it gets worse. Finally, you end up in the hospital fighting for your life with pneumonia. How? Why?
You contracted Legionnaire’s Disease, a completely preventable, but all too common, disease. It often spreads through improper sanitation and maintenance of hot tubs or spas. It happens in hotels all over the world, but usually more in warmer climates like Florida. Every year, thousands of tourists worldwide learn this hard lesson. For some, including a family that recently visited Florida from England, it results in death. Death from the failure to follow simple sanitation procedures for hot tubs.
A Little Lesson in Legionnaire’s Disease
A hot tub or spa is a large bath or small pool with heated water (90-104°F) and is usually used for soaking and relaxation. Most people assume that the spas are safe and even therapeutic. What most people don’t know is that potentially life threatening bacteria thrive in this warm-water environment. Without proper maintenance, hot tubs and spas become juicy little factories for the mass production of bacteria, including the organism that causes Legionnaire’s Disease.
Legionnaire’s Disease is caused by the bacteria Legionella. The disease got its name when an outbreak of the disease occurred at a convention of the American Legion. According to the Centers for Disease Control and Prevention (CDC), as many as 8,000 to 18,000 people each year are hospitalized with Legionnaire’s Disease in the United States. The actual count is much higher as many cases are misdiagnosed as simple pneumonia. According to the CDC, symptoms of the disease include high fever, chills, and cough, and some people may also suffer from muscle aches and headaches. As Legionnaire’s Disease looks the same as pneumonia on a chest x-ray, a urine sample is usually required for diagnosis. Those infected usually begin to notice symptoms within 10 days of exposure to the Legionella bacteria.
According to the CDC, Legionnaire’s causes death in up to 30% of cases. Although the health risk is severe, many cases can be treated successfully with antibiotics and those in good health can sometimes recover from the infection. While anyone can get it, those most at risk of contracting Legionnaire’s are older (usually 65 years or more) current or former smokers, or those who have some form of chronic lung condition. People who have weak immune systems from diseases like cancer, diabetes, and those taking drugs to suppress the immune system or kidney failure are also at greater risk of getting sick from Legionella bacteria.
Take a Deep Breath – Contracting Legionnaire’s
Legionella bacteria are naturally occurring in natural and man-made water environments. It actually lives in municipal and natural water systems in low concentrations and without danger to the public.
However, when the Legionella gets in hot tubs, they amplify in scale, sediment and biofilm in the tub system. It may be surprising to learn that you do not get the disease from drinking or contacting the water nor do you get it from person-to-person contact. You can touch and even kiss without transmitting the disease. It spreads when water containing the Legionella bacteria is aerosolized in water vapor and inhaled into the lungs. When people breathe in the mist or vapor (small droplets of water in the air) they breathe in water contaminated with Legionella. Breathing in the vicinity of a hot tub or spa that has not been properly maintained, cleaned, and disinfected is one of the most common forms of transmission. So it is not safe just to stay out of the water, one can get Legionnaire’s just by breathing in the vapors near a hot tub or spa.
Preventing the Spread of Legionnaire’s Disease
The danger to the public from unkempt spas is so great that it constitutes a “public health hazard” in the state of Florida to fail to properly maintain public spas and pools. Health codes require specific maintenance and testing of public swimming and bathing places, including hot tubs and spas. Adherence to uniform standards for maintenance of public pools and spas prevents the spread of Legionnaire’s Disease. If proper attention is paid to filters, PH and chlorine levels, the Legionella bacteria dies and the chance of contracting Legionnaire’s disease from hot tubs and spas is eliminated.
Now, Back to Our Story…
After 10 days in Orlando, on their last vacation day, Mom and Dad sat by the hotel hot tub enjoying the Florida sun. Little did they know they were soaking in Legionella bacteria and disease as well. Soon after they arrived home, Dad began feeling sick with flu-like symptoms. They thought it was a bug, but it got worse and worse until he became so sick he had to be hospitalized. Hospital urine tests confirmed the diagnosis: Legionnaire’s Disease. Within a few weeks, he was dead.
U.S. and European health agencies investigated. It turns out this hotel was not new to them. Unknown to our family visiting from England, earlier that same year, an outbreak of Legionnaire’s Disease was linked to that same hotel and to that same hot tub. Sadly, profits were put before safety and the spa and pool continued to be poorly maintained allowing Legionella bacteria to continue to thrive. The Orange County Health Department examined the hotel and again they found pool and spa maintenance violations so bad that they again shut down the spa. Environmental samples from the hot tub tested positive for Legionella bacteria. In the end, chronic lack of maintenance and refusal to follow simple sanitation procedures were the cause of the continued spread of Legionnaire’s disease from the hotel spa tub.
How Can we Protect Ourselves?
The problem with Legionnaire’s disease is that one cannot see Legionella bacteria. It can be present in clear water and in seemingly well-maintained spas. Many times, the improper sanitation cannot be detected without testing the pool water. The spa can appear clean and safe when, in fact, it is actually filled with bacteria living in the sediment and sludge of the spa tub’s hidden pipes and filters.
You also cannot go by hotel name alone. In fact, the family from England stayed at an international chain hotel with a quality reputation. Finally, as we have learned it is not enough to just stay out of the spa tub as the bacteria can spread in the air, sometimes even long distances from the spa tub. A stroll across the pool area or in a courtyard can be enough to become exposed to the bacteria.
In private hot tubs and spas, simple testing of water and application of chemicals according to directions in the owner’s manual will prevent the growth of the bacteria and the spread of the disease. If you are visiting a friend’s spa, before going near the spa ask them to check the water using a chemical test kit that can be purchased at most large retail stores and even local food stores. Another option is to turn off the spa so that water vapors are not generated from the whirlpool or steam from the spa. In public pools, you can ask to see the pool and spa maintenance logs for proof of regular spa maintenance and testing.
Better yet, contact the maintenance department of the hotel and ask them to test and verify that the spa and pool water is safe and clean with appropriate disinfectants. If the hotel refuses, find another one. Most hotels will gladly comply with such a request and then you and your family can relax and enjoy the hot spa with peace of mind.
- Ed Normand is an attorney and Jim Kelemen a law clerk with Wooten, Normand & Kimbrough in Orlando, Florida.
American Society of Heating, Refrigeration, and Air-Conditioning Engineers, Inc. (2000). American Society of Heating, Refrigeration & Air-Conditioning Engineers, Guideline 12-2000 – Minimizing the Risk of Legionellosis Associated with Building Water Systems. Retrieved from www.ashrae.org
Bodager, D., Walsh, D., Osias, T., & Overfield, D. (Spring 2009). Legionella Positive Environmental Samples from a Hot Tub at a Local Resort Hotel, Orange County, December 2008. Florida Journal of Environmental Health, 202, 5-7.
Centers for Disease Control and Prevention. (2008, June 27). Patient Facts: Learn More about Legionnaire’s disease. Retrieved April 5, 2011, from http://www.cdc.gov/legionella/patient_facts.htm
Eisenstein, L. & Bodager, D. (Fall 2008). Outbreak of Legionellosis Associated with Exposure to a Hotel Outdoor Hot Tub. Florida Journal of Environmental Health, 200, 14-19.