Dermatitis Outbreaks in Hotel Hot Tubs and Swimming Pools

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Dec. 7, 2000 -- Relaxing in the hotel hot tub ... getting a few laps in the swimming pool ... sounds good after a tough day on the sightseeing or conference circuit? But a new CDC report says beware of the water you're stepping into -- and it's not due to E. coli this time. There's another bacterium showing up in those waters, and it's causing skin rashes and outer ear infections.

During the last year, outbreaks of the bacteria Pseudomonas aeruginosa were reported in swimming pools and hot tubs in Colorado and Maine, says Michael Beach, PhD, an epidemiologist with the CDC's National Center for Infectious Diseases.

Although the report cites only three incidents in two locations, "Every year, we see a handful of these outbreaks across the U.S.," Beach tells WebMD. "Really, they can happen anywhere.

"Most folks tend to think of those happening in the '80s, but it still happens on a regular basis," says Beach. "The bottom-line message is that these outbreaks shouldn't be happening. They can be prevented if pool operators simply maintain the pools and hot tubs the way that they're regulated at the state and local level."

One Colorado incident -- which occurred in February 1999 -- involved 15 adults and children who developed a skin rash after using the same hotel pool and hot tub. Among them were people attending two different birthday parties and local residents who were using the pool on a pay-to-swim basis.

Another 25 local residents who used the same pool and/or hot tub in the same month also developed rashes; of those, 14 had a "more severe illness" that lasted more than six weeks, the CDC report says. An inspection of the pool and hot tub showed that the bacteria were on the hot tub hand rail and in the filter. Inspectors also found that chlorine levels in the pool and hot tub had dropped below state-required levels for 69 hours during the contamination period.

"The decline in pool chlorine was the result of a faulty chlorine pellet dispenser; also hotel staff did not perform routine onsite water testing for either the pool or the hot tub," says the report.

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The Maine incidents also occurred in February 1999, and involved nine people attending a high school basketball tournament who had stayed at a hotel in Bangor. The nine all had skin rashes that lasted about seven days; one also had an outer ear infection. The pool and hot tub were crowded during the outbreak period, and chlorine levels measured at very low to zero during at least one weekend during the contamination period.

In the Maine case, use of an off-site contractor to monitor chlorine and pH levels may have contributed to the problem, says Beach. "This is something pool and hot tub operators need think about. Their staff needs to be better trained when there's an emergency."

His best advice: If you're thinking about stepping into hotel waters, become an advocate. Ask a few questions at the front desk first. "If users of pools and hot tubs make it clear they're interested in seeing improved water testing -- and they start asking about it at hotels -- then operators will respond to that," Beach tells WebMD.

The report is right on target, says Samuel Stanley, MD, professor of infectious diseases at Washington University School of Medicine in St. Louis.

"Most such cases are sporadic ... one or two cases in a home hot tub. But this type of outbreak involving more people certainly calls attention to a problem that is so easily preventable. By making sure chlorine levels are correct, tub and pool owners prevent a whole host of bacteria from taking residence, including Psuedonomas aeruginosa, and E. coli and Shigella, two bacterial causes of diarrhea and dysentery," Samuel tells WebMD. "Whereas fecal matter in water causes E. coli and Shigella, all that Psuedonomas aeruginosa needs is unchlorinated water to trigger its growth."

Ultimately, caution is the catchword. You can ask at the front desk, but unfortunately those people may not know, says Stanley. "If there is a nice thing about Psuedonomas aeruginosa, it's that it tends to run its course and doesn't require antibiotics. But there have been cases involving immunocompromised patients -- people with HIV infection -- who have had this exposure, and it can be quite dangerous for them, causing necrosis of the skin. They should be even more careful."

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