1. Session 7: Problems with Spa Pools
Facilitator notes:
Legionnaires’ disease: Risk assessment, outbreak investigation and control
Session 7: Problems with Spa Pools
ECDC, 2012

2. Problems with Spa Pools and Recreational Water
Swimming pools
Plunge pools – cold and hot
Hot tubs / spa pools
Whirlpool baths
Spas – natural spa
Hydrotherapy pools

3. Problems with Spa Pools (Hot tubs) - General Matters
Pools that contain water for recreational use
Sitting - rather than swimming
Multiple users - BUT smaller numbers than swimming pools
Floatation tanks - alternative therapies
Whirlpool baths - domestic and generally single person units, emptied after each use

4. Problems with Spa Pools
Domestic pools – on display at garden centres and other stores (linked to outbreaks)
Other infectious diseases are associated with these pools
Increased incidence associated with increased pool numbers (?)
Growing domestic use
Growing use at holiday complexes
Hydrotherapy pools – warm water for therapeutic use
Birthing pools – where Legionella has also been found

5. Problems with Spa Pools

6. Problems with Spa Pools
Natural spa pools
Minimal/absence of water treatment
Water piped for many miles
Clients;
preponderance of senior citizens
impaired immunity, underlying diseases
higher sensitivity to infections

7. Problems with Spa Pools
Warm water > 32°C (30 – 40°C and often >37°C )
Aerated (by water jets and bubbles) – via nozzles
Often treated – disinfection, coagulation, filtration
Not emptied after each use
Potential for water management failures

8. Problems with Spa Pools
Large (16 seated) pools
Complex water pipes serving pool
Often impossible to remove and clean pipe work

9. Problems with Spa Pools
Large surface area in pool pipe work
Quality of water – for re-filling important
Poor management and monitoring of pool water disinfectants
Training of staff important in monitoring and responding to poor water results.
Poor water safety plan/risk assessments – for water management

10. Facilitator notes:
Acknowledgements The creation of this training material was commissioned in 2010 by ECDC to Health Protection Agency (UK) and the University of Chester (UK) with the direct involvement of Louise Brown, Janice Gidman, Emma Gilgunn-Jones, Ian Hall (on behalf of the ECDC Legionnaires Disease Outbreak Toolbox Development Group), Tim Harrison, Rob Johnston, Carol Joseph, Sandra Lai, John Lee, Falguni Naik, Nick Phin, Michelle Rivett, and Susanne Surman-Lee. The revision and update of this training material was commissioned in 2017 by ECDC to Transmissible (NL) with the direct involvement of Arnold Bosman and Kassiani Mellou.