Pool Reflections …
A day in the life of a Florida public pool inspector
By Lauren Broom
Legionella pneumophila is a bacteria that can be transmitted to people mainly from poorly maintained spas. The bacteria loves the hot water temperature of 77°F - 108°F usually found in a spa. It also loves when the water in the spa is not circulating for a period of time. Additionally, the Legionella bacteria is spread by aerosolized water droplets or mist created by the spa therapy jets.
The mist of water contains the bacteria that allows it to get deep into the lungs and cause specific symptoms. These symptoms can be loss of appetite, body aches, headache, fatigue, fever, chills, diarrhea, abdominal pain, pneumonia and nonproductive cough. The severity of symptoms can vary by person. The groups of people most likely to be impacted by this bacteria are elderly people, pregnant women, children and others with conditions that lower their immune system.
Legionella is found in natural and artificial fresh water environments worldwide. Within a spa environment, Legionella will reside in the biofilm in the spa piping, jets and other spa equipment. Biofilm is a community of microorganisms surrounded by the slime they secrete, attached to either an inert or living organism.
Water temperature between 77°F -108°F causes rapid growth of Legio- nela in spa water. Spa water which is not circulating for a period of time creates better environments for this bacteria to form in the biofilm in the spa plumbing lines, spa therapy jets and return lines. Decreased filtration and improper water chemistry can have some affect on the bacteria’s presence in the water.
Scaling water conditions will increase the amount of rough surfaces in the spa pipes, equipment, return lines and spa therapy jets, which bacteria can invade.
Filtration helps to remove sediment from the water, otherwise the bacteria is able to easily bind with these sediments in the water.
Bacteria in biofilm or amoebae residing in the spa lines and equipment form a perfect environment for it to survive.
Lack of spa disinfection can also contribute to bacteria being present in sufficient levels to cause illness.
High pH levels will decrease the percentage of chlorine working in the water. This reduces the chlorine’s ability to kill the bacteria.
High cyanuric acid levels will also prevent chlorine from disinfecting at its peak performance.
Legionella Pneumophila Outbreak, Indian River County, FL
In 2016, two people were infected with Legionella pnuemophila in a 55+ community in Indian River County, Florida. I worked on this outbreak right from the start.
The people who were ill visited either a local hospital or doctor’s office after developing pneumonia or other symptoms of Legionella. The doctor’s office used a simple urine antigen test to determine if the antigen was present. If a patient is currently symptomatic with pneumonia and tests antigen positive, the doctor’s typical diagnosis is Legionella. If so, the doctor’s office or laboratory reports the results to the local health department.
Once received by the Health Dept., the case is assigned to a nurse or environmental health professional to contact the ill person. A lengthy interview is conducted to determine how the person became infected. In this instance, we found that both individuals used a public spa in the same 55+ community within the same week of each other.
The public spa is then assigned to an environmental health pool inspector to conduct an inspection for risk factors that may exist, which could have contributed to the Legionella outbreak. Possible violations are noted on an inspection report and given to the property owner.
In this example, the spa was inspected and the following violations were found: No disinfectant level; a high pH level; The ORP controller was not operating properly. Poorly maintained ORP controllers can contribute to many issues in the spa. ORP shall be maintained between 700-850 mV per Florida Dept. of Health; and there was no daily log of chlorine and pH levels.
These violations were noted and the spa was immediately closed.
The spa was reinspected and once all violations had been corrected, the spa was allowed to re-open. A formal notice of violation was also issued to the property owner to alert them that if these violations existed during the next year, there would be fines imposed or further involvement by the Department of Health.
This public spa was serviced by an offsite licensed pool service contractor. The conditions found upon inspection were possibly due to negligence on the part of the pool service tech by not maintaining proper disinfectant levels, pH levels, operable ORP controller and current daily chemical log on the property.
There were other legal issues surrounding this property. The family of one of the ill persons retained a lawyer and sued the property owner and the pool service company.
The lawyer issued a public records request from the Florida Dept. of Health for inspection records and other documents within specific time periods that were relevant to this outbreak. They could not obtain any medical records protected by HIPAA.
The lawsuit resulted in a finding that the pool service company and property owner were both negligent due to improper maintenance of the public spa. The property owner and pool service company both had to pay monetary damages to the family who filed the lawsuit.
A pool service tech can maintain the following items in order to minimize the potential for Legionella outbreaks in public spas they service.
These items should be a priority to the pool service tech and should be closely monitored. Prevention of this type of recreational water illness outbreak should be of the utmost importance, due to the possible legal and financial ramifications. I hope the pool service techs that read this article may think of their spas in a whole different way moving forward and learn how to keep the people using them from becoming ill.
Poorly maintained spa