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Spa pools may be a cause of Legionnaires' disease

OnMedica Editorial

Friday, 17 September 2004

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A Health Protection Agency (HPA) study has highlighted serious problems with spa pools being a cause of Legionnaires' disease because they are not managed or maintained properly. The study raises the question of whether routine legionella testing should be included within new Health and Safety Executive (HSE) and HPA guidelines.

This research carried out in collaboration with local authority environmental health officers will be presented to delegates on the second day of the Agency's scientific conference at Warwick University. The year long study, surveyed over 100 spa pools. Out of 88 premises, 23 spa pools were found to contain legionella bacteria. 16 of these had passed current accepted levels for routine microbiological parameters.

Speaking at the Agency's annual conference, Dr Susanne Surman-Lee, who led the research said, "In every spa pool related outbreak that we have investigated the pool had not been managed or designed according to guidelines or had poorly trained staff. In addition, at present, testing for legionella is not mandatory for spa pools. Because spa pools are increasing in popularity we need greater recognition and understanding of the risks associated with their use and misuse. They have the potential to cause infection because the water systems become contaminated with bacteria and the high temperatures of the water make considerable demands upon the disinfection and filtration systems making it easy for the bacteria to develop and spread if not adequately maintained. The jets from spa pools then produce aerosols containing legionella which can then be inhaled and cause illness."

"It's been assumed that if the pool water is satisfactory for routine microbiological checks then growth and spread of legionella would also be under control. But we discovered that the legionella bacterium, may be present in high numbers in both privately owned and public facilities even when routine microbiological and safety checks appear satisfactory."

During 2003, there were 27 cases of Legionnaires' disease in England where spa pools were identified as the source of infection, with three deaths. So far this year there has been only one case of Legionnaires' reported to be associated with a spa pool.

The HPA has published spa pool guidelines since 1994 and a new joint document with the HSE is being produced which will update advice on risks and legislation associated with spa pools.

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