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Outbreaks Open Access
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Abstract

Despite concerns about infection risks of floating tanks, outbreaks have rarely been reported. In May 2017, an outbreak of skin rash occurred among visitors of a floating tank open for the public in Norway. We assessed the extent and cause of the outbreak and the risk factors for infection in a retrospective cohort study among the visitors of the floating tank using a standardized web-based questionnaire. An environmental investigation was conducted including microbiological analysis of the floating tank water. Of the 46 respondents to the questionnaire (61 distributed), 22 reported symptoms, most commonly palmar and plantar rash, swollen lymph nodes, ear canal pain and itching. None of the investigated risk factors, such as sex, age, duration of bathing or use of the shower after bathing, were significantly associated with illness. The results of the environmental investigation indicated that the water was heavily contaminated by and heterotrophic bacteria. The outbreak investigation highlights the need to ensure adequate hygienic operation of floating tanks. Awareness about responsibilities should be raised among the operators of floating tanks and relevant operational parameters for floating tanks should be made available for local health authorities.

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/content/10.2807/1560-7917.ES.2019.24.38.1900134
2019-09-19
2024-04-19
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2019.24.38.1900134
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References

  1. Floatation Tank Association. North American float tank standard 2017. San Francisco: The Floatation Tank Association; 2017. Available from: https://www.floatation.org/wp-content/uploads/2018/09/North-American-Float-Tank-Standard-Version-2.pdf
  2. Nadolny E, MacDougall C. Evidence brief: risk of infection in the use of floatation tanks. Toronto: Ontario Agency for Health Protection and Promotion (Public Health Ontario); 2016. Available from: https://www.publichealthontario.ca/en/eRepository/EB_Floatation_Tanks_Infection_Risk.pdf
  3. Jonsson K, Kjellgren A. Curing the sick and creating supermen – How relaxation in flotation tanks is advertised on the Internet. Eur J Integr Med. 2014;6(5):601-9.  https://doi.org/10.1016/j.eujim.2014.05.005 
  4. Eykelbosh A, Beaudet S. Float tanks: considerations for environmental public health. Vancouver: The National Collaborating Centre for Environmental Health (NCCEH); 2016. Available from: http://www.ncceh.ca/sites/default/files/Float_Tanks_Considerations_EPH_July_2016.pdf
  5. Westphal T. Hygiene in floating tanks. Frankfurt am Main: Amt für Gesundheit [Office of Health]; 2019. German. Available from: https://www.lgl.bayern.de/aus_fort_weiterbildung/veranstaltungen/kongresse_veranstaltungen/doc/
  6. Lovdata. Forskrift for badeanlegg, bassengbad og badstu m.v. [Norwegian regulation on public pools and saunas]. Oslo: Lovdata; 1996. Norwegian. Available from: https://lovdata.no/dokument/SF/forskrift/1996-06-13-592?q=bassengbad
  7. Malterud K, Thesen J. [Whirlpool and pseudomonas infection--a local outbreak]. Tidsskr Nor Laegeforen. 2007;127(13):1779-81. Norwegian. PMID: 17599127 
  8. Barna Z, Kádár M. The risk of contracting infectious diseases in public swimming pools. A review. Ann Ist Super Sanita. 2012;48(4):374-86.  https://doi.org/10.4415/ANN_12_04_05  PMID: 23247134 
  9. Cox GF, Levy ML, Wolf JE Jr. Is eczema herpeticum associated with the use of hot tubs. Pediatr Dermatol. 1985;2(4):322-3.
  10. Jacobson JA. Pool-associated Pseudomonas aeruginosa dermatitis and other bathing-associated infections. Infect Control. 1985;6(10):398-401.  https://doi.org/10.1017/S0195941700063475  PMID: 3851782 
  11. Trüeb RM, Gloor M, Wüthrich B. Recurrent Pseudomonas folliculitis. Pediatr Dermatol. 1994;11(1):35-8.  https://doi.org/10.1111/j.1525-1470.1994.tb00071.x  PMID: 8170847 
  12. McCausland WJ, Cox PJ. Pseudomonas infection traced to motel whirlpool. J Environ Health. 1975;37(5):455-9.
  13. Feder HM Jr, Grant-Kels JM, Tilton RC. Pseudomonas whirlpool dermatitis. Report of an outbreak in two families. Clin Pediatr (Phila). 1983;22(9):638-42.  https://doi.org/10.1177/000992288302200910  PMID: 6883896 
  14. Khabbaz RF, McKinley TW, Goodman RA, Hightower AW, Highsmith AK, Tait KA, et al. Pseudomonas aeruginosa serotype 0:9. New cause of whirlpool-associated dermatitis. Am J Med. 1983;74(1):73-7.  https://doi.org/10.1016/0002-9343(83)91121-X  PMID: 6401393 
  15. Breitenbach RA. Pseudomonas folliculitis from a health club whirlpool. Postgrad Med. 1991;90(3):169-70, 173.  https://doi.org/10.1080/00325481.1991.11701042 
  16. Hollyoak V, Boyd P, Freeman R. Whirlpool baths in nursing homes: use, maintenance, and contamination with Pseudomonas aeruginosa. Commun Dis Rep CDR Rev. 1995;5(7):R102-4. PMID: 7613584 
  17. Gregory DW, Schaffner W. Pseudomonas infections associated with hot tubs and other environments. Infect Dis Clin North Am. 1987;1(3):635-48. PMID: 3504439 
  18. Hopkins RS, Abbott DO, Wallace LE. Follicular dermatitis outbreak caused by Pseudomonas aeruginosa associated with a motel’s indoor swimming pool. Public Health Rep. 1981;96(3):246-9. PMID: 6785818 
  19. Centers for Disease Control (CDC). An outbreak of Pseudomonas folliculitis associated with a waterslide--Utah. MMWR Morb Mortal Wkly Rep. 1983;32(32):425-7. PMID: 6410176 
  20. Berger RS, Seifert MR. Whirlpool folliculitis: a review of its cause, treatment, and prevention. Cutis. 1990;45(2):97-8. PMID: 2107063 
  21. Alsedà M, Godoy P, Gardeazabal J, Borràs MA. [Community outbreak of Pseudomonas aeruginosa folliculitis associated with a spa]. Med Clin (Barc). 2014;142(2):86-7.  https://doi.org/10.1016/j.medcli.2013.06.027  PMID: 24054771 
  22. Berrouane YF, McNutt LA, Buschelman BJ, Rhomberg PR, Sanford MD, Hollis RJ, et al. Outbreak of severe Pseudomonas aeruginosa infections caused by a contaminated drain in a whirlpool bathtub. Clin Infect Dis. 2000;31(6):1331-7.  https://doi.org/10.1086/317501  PMID: 11095998 
  23. Schlech WF 3rd, Simonsen N, Sumarah R, Martin RS. Nosocomial outbreak of Pseudomonas aeruginosa folliculitis associated with a physiotherapy pool. CMAJ. 1986;134(8):909-13. PMID: 3955486 
  24. Highsmith AK, Le PN, Khabbaz RF, Munn VP. Characteristics of Pseudomonas aeruginosa isolated from whirlpools and bathers. Infect Control. 1985;6(10):407-12.  https://doi.org/10.1017/S0195941700063499  PMID: 3934099 
  25. International NSF. Test report: Organism time kill in float lab water. Ann Arbor: NSF International; 2012.
  26. Surendran PK, Mahadeva I, Gopakumar K. Salt tolerance of bacteria isolated from tropical marine fish and prawn. Fishery Technology.1983;20(2):105-10.
  27. Cogen AL, Nizet V, Gallo RL. Skin microbiota: a source of disease or defence? Br J Dermatol. 2008;158(3):442-55.  https://doi.org/10.1111/j.1365-2133.2008.08437.x  PMID: 18275522 
  28. Roser DJ, van den Akker B, Boase S, Haas CN, Ashbolt NJ, Rice SA. Pseudomonas aeruginosa dose response and bathing water infection. Epidemiol Infect. 2014;142(3):449-62.  https://doi.org/10.1017/S0950268813002690  PMID: 24229610 
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