How Hygienic is Your Hot Tub?


Hot tubs are meant to be relaxing and romantic; they’re a place to ease muscle tension and rejuvenate interpersonal relationships. However, there’s nothing romantic or relaxing about a potential disease outbreak.

Some recent articles, with click inducing titles like “This Will Make You Never, Ever Want to Get in a Hot Tub Again” would have you believe that every hot tub is a dangerous cesspool. According to Centers for Disease Control and Prevention (CDC) epidemiologist Michele Hlavsa and University of Arizona Professor Charles Gerba, there is potential for hazard, but can be prevented if you take the right precautions.

The Dangers

Germs thrive in warm and wet environments, making spas a ripe place for growing hot tub germs. A recently released report from the CDC reported that there were 16 related hot tub related outbreaks between 2009 and 2010. A high 43.8% of the cases were reportedly from Pseudomonas and 25% were confirmed to be caused by Legionella.

Hlavsa of the CDC said one of the most common issues that happen in bacteria-laden spa water is hot tub rash (which we’ve covered in a more extensive post). Hot tub rash, or Pseudomonas folliculitis, is caused by an inadequately sanitized hot tub—levels of the bacterium pseudomonas aeruginosa increase when disinfectant levels fall. The infection gets into the base of the hair follicle and manifests as irritated bumps, often in the shape of the bathing suit.

Another disease, caused by the Legionella bacterium, also manifests itself in hot tub water that isn’t well sanitized. Legionnaire’s disease is a severe type of pneumonia that can be transmitted through inhalation or mists or tiny airborne droplets that have the bacteria in them. Those most likely to come down with Legionnaire’s disease are senior citizens, smokers, and those with weakened immune systems.

Another issue that leads people to believe hot tubs are unsafe is what bathers bring (or leave behind) in the water that can cause irritation. Things like body oils, lotions, and other cosmetics make the sanitizer in the water (chlorine, bromine, etc.) work much harder, leaving less power to work against things in the water that are potentially harmful.

Urine also has an unpleasant side effect when it interacts with chlorine. Those two products form chloramines which are responsible for eye irritation or respiratory tract annoyances during times of hot tub use. Unfortunately, urinating in a hot tub is not uncommon with one in five adults admitting to the practice. Word to the wise: that really strong chlorine smell is usually an indication of the presence of chloramines.

But don’t fear. You can keep your hot tub environment hygienic and safe with just a few simple practices.

Shower Before You Get In

Showering before using the hot not only saves the sanitizer work by not having to combat organic materials and cosmetics, but it helps you rid yourself of any (ahem) less-than-pleasant residue your body may have accumulated throughout the day.

We won’t sugar coat it. According to Professor Gerba, “The average bather has about a tenth of a gram of feces in his gluteal fold, which is a nice way of saying butt crack.”  So if you have a hot tub filled with five people, there’s a good chance you effectively have a tablespoon of poop in the water.* Yikes. If you don’t want to be a part of that statistic, shower before using a hot tub using soap, and pay particular attention to that gluteal fold.

Professor Gerba offers a memorable statistic: “The average bather has about a tenth of a gram of feces in his gluteal fold which is a nice way of saying butt crack.” Don’t be average. Shower with soap and clean the gluteal fold before getting in.

Keep a Watchful Eye on Water Sanitizers

Make sure you’re testing your hot tub water twice a week and keeping everything within appropriate range. If you use chlorine, be sure that the level of free chlorine available is between 2 and 4 parts per million. If you use bromine, that should be between 4 and 6 ppm. The pH should be in the 7.2-7.8 range.

Always Check the Water

If you’re visiting a hotel hot tub or a spa, you can take matters into your own hands and check the chemistry levels yourself. Michele Hlavsa recommends purchasing your own test strips and taking them with you to the gym or hotel to make sure you get into a safe hot tub. If you don’t have test strips, use the eye and smell test. Look for any calcium build up along the water line and stay out of the water if there is a very strong chemical smell.

Don’t use a hot tub if you have gastric distress (diarrhea).

Keep hot tub water out of your mouth and avoid swallowing it, whether intentionally (ewww) or accidentally.

*People DO NOT like being reminded of this fact at a party. Or during viewings of “The Bachelor.”
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