There are some topics that I think are worth repeating, especially when the "culprit" can be found in acute care facilities, long term care facilities, hotels, spas, cruise ships, gyms and even our own homes. Regardless of the name you know it by - Hot Tub, Whirlpool, Foot Spa Bath - the fact of the matter is any reservoir that holds water and has the ability for water to recirculate (and pool in out of sight places) has the potential to cause harm. I should likely also add - may have more than one user at any given time any of whom may have questionable personal hygiene practices, may have open sores or may have a communicable disease.
In August 2012, Lee and I wrote two blogs "Are their Monsters in Your Drain" and "Life Slime - the stuff nightmares are made of" both of which focused on outbreaks associated with biofilms found in sink drains, Hot Tubs and the like. A Class Action Law Suit recently filed, claims that Hot Tubs are infested with dangerous, flesh-eating bacteria. The Law Suit claims that the cesspools (I mean Hot Tubs) are not limited to one (1) ship, but have been associated with infections on different ships at different times. One complainant claims he contracted "hot tub folliculitis" in December of 2011 from a cruise ship whirlpool and that the severe infection resulted in spending a week in the hospital, $70,000 in medical bills and nearly cost him his leg. While it remains to be proven, there could be an additional 50 people or more who were also infected on this voyage. The suit, further alleges that a May 2012 cruise on a different ship resulted in at least two (2) passengers becoming infected with MRSA and Staphylococcus aureus.
I think many of us have heard in the media more than once about a cruise ship being struck with Norovirus, but I would hazard a bet that most of you did not stop to consider the perils of taking that dip in the warm, inviting hot tub. The Vessel Sanitation Program (VSP) at the CDC regulates the cruise industry with a mandate to prevent and control the introduction, transmission, and spread of gastrointestinal (GI) illnesses on cruise ships (e.g. Norovirus). Perhaps they should add to their mandate, to prevent and control the transmission and spread of hot tub folliculitis. VSP does have an Operations Manual that details a sanitation programs to minimize the risk for acute gastroenteritis within which there is a section on Recreational Water Facilities (aka hot tubs). In accordance to the Operations Manual there are very specific requirements with regards to water quality, recirculation etc, etc. One would intuitively think that if the requirements specified were followed such an occurrence would be hard pressed to happen.
As both Lee & I stressed in our earlier blogs, having established procedures that detail how to clean and disinfect and with what frequency to disinfect areas that are harbingers of biofilm will help stop their growth and development. I guess we should have further specified that you MUST follow the maintenance, cleaning and sanitation procedures.