Heated baths are provided in most fitness centres and resorts; whirlpool baths are found in hotels, homes, and healthcare centres. There is no wonder why people are drawn to warm water as the heat opens pores, relieves aches and pains, and provides a sense of comfort for those looking for a temporary escape. Tubs that do not have pipe work and drain directly to waste present minor risk as long as they are properly cleaned and disinfected regularly. However, few people realize when they fill a spa bath they are adding fresh water to the water still remaining in the pipes from the last bather. This may contain faecal matter, skin, and other debris. This may not present a health problem if the water is kept properly disinfected and a strict cleaning and disinfection program is maintained.

Health Problems
Follicular Dermatitis
A combination of a high level of contamination in the water by Pseudomonas aeruginosa, long exposure times or high temperatures can allow the bacteria to colonise the hair follicles and cause the full body rash. The rash disappears spontaneously in 2 to 10 days.

Eye, Ear and Skin infection
The presence of a variety of micro-organisms such as Pseudomonas aeruginosa, Mycobacterium marium, Papilloma viruses and Acanthamoeba can cause a variety of infections. These infections can be caused by having an injury or skin lesions present or in some cases solely due to the particular microbe being present in the water. Immune deficiency predisposes to these infections.

Skin Irritation
Chlorine can combine with ammonia and nitrogen compounds in the water to form chloramines, sometimes called combined chlorine. Chloramines smell bad. If the water is not drained frequently and/or low chlorine disinfectant levels are maintained, a skin irritation due to the presence of chloramines can occur.

Respiratory Infection
Aerosols produced while spa baths are running are inhaled and can deposit in the alveoli of the lungs. Sporadic cases and outbreaks of Legionnaires' Disease have been reported world-wide from spa baths. In addition infections can occur through the inhalation of other bacteria, amoebae and viruses.

Genital and Urinary Tract Infections
Urinary tract infections, predisposing to females, can occur from water contaminated with Pseudomonas, Coliforms, Candida albicans and other bacteria. Genital infections can occur by sexually transmitted organisms such as Trichomonas, Chlamydia, Herpes etc.

Gastro-intestinal Infections
Through the faecal contamination of poorly disinfected pool water, micro-organisms such as Giardia, Cryptosporidium and Salmonella can be ingested.

Systemic Infections
Cases have been reported of Hepatitis being transferred via whirlpool and heated spa baths.

Heat Stress

Excessive exposure to temperatures above 40 oC can cause hyperthermia and heart conditions.

The discussion of disinfection methods will continue in BioTalk 20.