What are the health concerns of hot tub and pool use?

Hot tubs and pools can provide an environment for bacteria to grow. These bacteria can make you sick with an infection or disease. Legionella bacteria can cause Legionnaires’ disease, which can be fatal. Pseudomonas bacteria can cause a number of serious infections, such as severe skin rashes, eye and ear infections, and pneumonia.

How can I make sure the water is safe?

If you are unsure of the maintenance or water quality, do not enter the pool or hot tub. “If in doubt, stay out.”

To make your hot tub or pool as safe and enjoyable as possible, always consider the following precautions:

Cleanliness and disinfection

It is the owner’s responsibility to ensure the hot tub or pool is clean and the water is properly disinfected to prevent the spread of disease. It is important to maintain the proper level of disinfectant to ensure clean and safe water. Chlorine and bromine are the most popular disinfectants. The more frequent a hot tub or pool is used, the faster the disinfectant in the water gets used up.

Before and after use, you should check the disinfectant level and add disinfectant if it is low. Then, test the disinfectant level before entering the water to ensure it is not too high. Even if the hot tub or pool will not be used for a while it is important to maintain the disinfectant level. There are other important measures of water quality, such as pH, that must also be checked and adjusted as necessary. Pool chemicals should always be used safely and stored in a locked location or out of the reach of children. Your local pool supplier may offer water testing services to help you properly maintain water quality by identifying problems, knowing which chemicals to add, and knowing how and when to safely add them.

For more information on disinfectants and water quality, see HealthLinkBC File #27b Residential hot tubs and pools: Safe water quality.

To help keep hot tubs clean, you should also drain and scrub them with a bleach solution. Your cleaning schedule will vary depending on how many people use your pool or hot tub, and how often it is used. At a minimum, clean it as per the manufacturer’s instructions. Filters and pumping systems should be cleaned and serviced on a regular basis.

Steam condensing under the hot tub or pool cover can be a perfect place for many bacteria to live, so it should be wiped off with a bleach solution.

Bacteria and dirt on surfaces and decks may enter into the water with you. Keep surfaces and decks clean. Always shower or bathe with soap before using a hot tub or pool. This helps keep the water free of germs and body oils, resulting in the use of less disinfectant.

If you have been vomiting, have diarrhea, an open wound, or any other infection or illness, you should not go in a pool or hot tub until you have been symptom-free for at least 48 hours.

Water temperature

The temperature of a hot tub should never be hotter than 40^oC (104^oF), or 38.9 °C (102.0^oF) if you are pregnant.

Sitting in hot water for a long time can cause severe heat-related illnesses, such as nausea, dizziness or fainting, and even death. Avoid staying in the hot tub for more than 10 minutes at one time. Have a clock visible nearby to keep track of time.

Get out right away if you feel dizzy, faint, have a rapid pulse, irregular heartbeat, stomach pain, or tingling in your feet and hands.

How can I ensure the safety of pool and hot tub users?

It is the owner’s responsibility to ensure the hot tub or pool is safely maintained and free from hazards, entrapments, and other dangers, including keeping bathers informed of all risks.

Bather load

All hot tubs and pools are designed for a maximum number of bathers at one time. You should know what the number is and not exceed it.

Children and supervision

Children must be supervised at all times. Most hot tub or pool accidents involving children occur when the children are not supervised, or while their supervisors are distracted, even for a moment.

All hot tub and pools should have restricted access to prevent drowning. Access can be restricted by using a fence or lockable gate. Cover and lock your hot tub when it is not in use.

Children are at higher risk of overheating than adults. Keep small children, especially infants, out of hot tubs and spas. Their small bodies do not regulate temperature well and overheat too quickly.

Physical hazards

Pool and hot tub users are always at risk of getting trapped underwater by the suction from an outlet opening. To help prevent this, all pool outlets should have a properly constructed and installed screen over them. You should know where the shut-off switch to the pump is located so that it can be shut off quickly if needed. Bathers should be discouraged from placing their heads under the water in case hair or jewelry may be caught in an outlet.

Be careful getting in and out, as many hot tubs have very slippery sides. Be aware of flooring choices around your pool and hot tub as some present more of a slip hazard than others.

Properly installed handrails can reduce the risk of injuries from slips or falls. Make sure the handrails cannot trap someone under water. Never dive into a hot tub or shallow pool. Always enter feet first.

Alcohol and drugs

Alcohol and drugs increase risk. Most adult accidents in the pool and hot tub environments are alcohol or drug related.

Alcoholic beverages and some drugs can cause drowsiness. They can also lower the body’s resistance to the effects of overheating.

Walk, do not run

Hot tubs and pools are slippery places. Do not allow running on the pool deck.

For more simple safety rules around pools and hot tubs, see HealthLinkBC File #39 Safety tips for swimmers.

For more information

For more health and safety tips on using pools and hot tubs, contact your local environmental health officer at your local public health authority by visiting www2.gov.bc.ca/gov/content/health/about-bc-s-health-care-system/partners/health-authorities/regional-health-authorities.

For more information on proper care and maintenance of your hot tub, contact your service provider or manufacturer.