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October 21, 1983

Hot Tub Hygiene

Author Affiliations

American Medical Association Chicago

JAMA. 1983;250(15):2031. doi:10.1001/jama.1983.03340150073032

The emergence of Pseudomonas urinary tract infections and pneumonia related to whirlpool bath exposure, as Salmen, Rose, and their respective colleagues report in this week's JOURNAL (pp 2025 and 2027), is indeed new. What is not new is that the skin infection Pseudomonas folliculitis has been clearly linked to exposure to inadequately filtered and chlorinated hot bath waters.

A flurry of epidemiologic studies in the late 1970s validated the observation that Pseudomonas folliculitis was contracted from contaminated whirlpools.1-3 By 1981, the Centers for Disease Control (CDC), Atlanta, saw the public health hazard potential and established standards for maintenance of proper pH, chlorination, and filtration of hot tubs.4

The whirlpool environment differs dramatically from the static water of swimming pools, explaining why the bacteriainduced folliculitis clinically surfaced with the popularity of spas. Water is mechanically agitated by circulation through pressurized jets. This turbulence, in addition to the increased concentration

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