Hot Tub Dermatitis


The human body is constantly besieged by germs, both airborne and waterborne. Some are relatively benign, but others posses the potential to cause serious illness. Most must gain entrance through a natural body orifice or a skin lesion to do damage, but some are virulent enough to inflict harm by simple contact with the skin.

Whenever people are in close proximity to one another, the potential for transmitting germs from one to an¬other is increased. When that proximity occurs in water, those germs that are not killed by the water itself can move between individuals with relative ease. Thus, pool and spa operators are constantly faced with the chal¬lenge of keeping those who utilize their facilities safe from infection by harmful organisms that thrive in water. The proper maintenance of the spa or pool includes monitoring the correct level of pH and chlorine or bromine levels to insure that these organisms do not flourish.

Pseudomonas is one of the pool and spa operators’ chief concerns. It is the water-loving bacterium that causes “hot tub” dermatitis, an affliction that can come from simple skin contact with infected water. Generally found in hot tubs or spas, it can also survive even in lower temperature swimming pools. Symptoms, normally just a rash, usually present themselves within 36 to 72 hours of immersion in infected water. Because the water is held in contact with the skin for a longer period of time, the rash is generally located in areas covered by a bathing suit. This germ is frequently found in wooden tubs because it is nearly impossible to remove from the wood once it has become embedded. If not treated, the disease can spread to other parts of the body and may cause symptoms such as lesions or fever. To reduce the risk for transmission of any waterborne pathogen, pool and hot tub operators should:

  • follow manufacturers’ recommendations and regulatory requirements for pH and disinfectant levels
  • develop a thorough working knowledge of basic aquatic facility operations
  • monitor hot tubs more closely than pools because the elevated temperatures cause more rapid chlorine dissipation
  • increase pH and disinfectant monitoring vigilance during periods of heavy bather loads
  • require remote-monitoring vendors to provide timely low-disinfectant-level notification
  • train pool staff re: system capabilities, maintenance, and emergency alert procedures of remote monitoring systems
  • understand the appropriate use and effects of cyanurates on water disinfecting and testing
  • require users to obey the statutory cleansing-shower-before-use requirement

Educating hot tub users and swimmers about the potential for waterborne disease transmission could provide multiple benefits: peer pressure could help enforce patron cleanliness, and user interest and awareness could encourage improved maintenance and monitoring.

Please call us at 800-463-8546 to discuss this or any other risk management safety tip, or visit our web site at to learn more about YMCA risk management issues.


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