Nontuberculous mycobacterial aerosols in pools and spas.
Glazer-CS; Martyny-JW; Martinez-KF; Newman-LS; Murphy-J; Lee-B; Sanchez-TL; Sells-TM; Heifets-L; Rose-CS
Am J Respir Crit Care Med 2003 Apr; 167(7):A610
Hot tub exposure has been causally associated with a prednisone responsive granulomatous lung disease featuring nontuberculous mycobacterial (NTM) growth in both clinical and environmental samples. Little is known about prevalence and risk factors for NTM contamination and associated illness in these settings. We analyzed the frequency of NTM growth and aerosolization in hot tubs and warm water therapy pools and the factors associated with NTM growth. We randomly selected 18 warm water therapy pools and publicly owned hot tubs in a major U.S. metropolitan area. We characterized each site by water chemistry parameters (pH, disinfectanct level); maintenance, disinfection, and water quality characteristics; and air and water sampling for quantitative culture (NTM and total bacteria). We detected NTM in air or water from 13/18 (72%) sites and found a strong correlation between the maximum air and water concentrations (rho 0.49, P = 0.04). Use of halogen (chlorine or bromine) disinfection was associated with significantly lower air and water NTM concentrations compared to UV light and hydrogen peroxide (p = 0.01-0.04). Higher water turnover rates were also associated with lower NTM concentrations (p = 0.02-0.03). Our findings suggest that NTM are frequently detectable in air and water of indoor spas and therapy pools and that particular maintenance and disinfection approaches affect mycobacterial bioaerosol concentrations in these settings.
Bacteria; Aerosol-particles; Aerosols; Lung-disease; Environmental-factors; Risk-factors; Sampling; Halogens; Water-sampling; Air-sampling; Pulmonary-system-disorders; Biohazards; Microorganisms
Abstract; Conference/Symposia Proceedings
American Journal of Respiratory and Critical Care Medicine, 2003 International Conference, The American Thoracic Society, Seattle, WA, May 16-21, 2003