Recommendations for Hydrotherapy Tanks

Recommendations of CDC’s Division of Healthcare Quality Promotion.

(This information was taken directly from page 20 of the MMWR report titled “Guidelines for Environmental Infection Control in Health-Care Facilities” [PDF – 48 pages])

1. Drain and clean hydrotherapy equipment (for example, Hubbard tanks, tubs, whirlpools, whirlpool spas, or birthing tanks) after each patient’s use, and disinfect equipment surfaces and components by using an EPA-registered product in accordance with the manufacturer’s instructions. Category II
2. In the absence of an EPA-registered product for water treatment, add sodium hypochlorite to the water:
   1. Maintain a 15-ppm chlorine residual in the water of small hydrotherapy tanks, Hubbard tanks, and tubs. Category II
   2. Maintain a 2-5-ppm chlorine residual in the water of whirlpools and whirlpool spas. Category II
   3. If the pH of the municipal water is in the basic range (for example, when chloramine is used as the primary drinking water disinfectant in the community), consult the facility engineer regarding the possible need to adjust the pH of the water to a more acidic level before disinfection, to enhance the biocidal activity of the chlorine. Category II
3. Clean and disinfect hydrotherapy equipment after using tub liners. Category II
4. Clean and disinfect inflatable tubs unless they are single-use equipment. Category II
5. No recommendation is offered regarding the use of antiseptic chemicals (for example, chloramine-T) in the water during hydrotherapy sessions. Unresolved issue
6. Conduct a risk assessment of patients before their use of large hydrotherapy pools, deferring patients with draining wounds or fecal incontinence from pool use until their condition resolves. Category II
7. For large hydrotherapy pools, use pH and chlorine residual levels appropriate for an indoor pool as pro-vided by local and state health agencies. Category IC (States)
8. No recommendation is offered regarding the use in health-care settings of whirlpool or spa equipment manufactured for home or recreational use. Unresolved issue

Recommendations are rated according to the following categories:

• Category IA
  • Strongly recommended for implementation and strongly supported by well-designed experimental, clinical, or epidemiologic studies.
• Category IB
  • Strongly recommended for implementation and supported by certain experimental, clinical, or epidemiologic studies and a strong theoretic rationale.
• Category IC
  • Required by state or federal regulation, or representing an established association standard. (Note: Abbreviations for governing agencies and regulatory citations are listed where appropriate. Recommendations from regulations adopted at state levels are also noted. Recommendations from AIA guidelines cite the appropriate sections of the standards.)
• Category II
  • Suggested for implementation and supported by suggestive clinical or epidemiologic studies, or a theoretic rationale.
• Unresolved issue
  • No recommendation is offered. No consensus or insufficient evidence exists regarding efficacy.