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Is there a need for state health department sanitary codes for public hydrotherapy and swimming pools?

The Board of Health of the Commonwealth of Virginia has an outdated sanitary code for its public hydrotherapy and swimming pools. The code is restricted to pools in hotels and other lodging places. The absence of modern regulations for public hydrotherapy and swimming pools has permitted serious deficiencies in pool maintenance, which are highlighted in this report. The most notable of these deficiencies was the presence of high levels of bacterial contamination that could predispose to infect in the water of one public hot tub. The results of this study indicate that the Virginia Board of Health sanitary code for pool water must be revised immediately and should include all public hydrotherapy and swimming pools. Other states and communities may want to assess their codes for swimming pools and hydrotherapy tubs to avoid deficiencies that could be detrimental to public health.

Bacteria

Epidemiology of infections with Pseudomonas aeruginosa in burn patients: the role of hydrotherapy.

Pseudomonas aeruginosa remains a cause of serious wound infection and mortality in burn patients. By means of restriction fragment length polymorphism analysis and a DNA probe for the pilin gene of Pseudomonas, a lethal strain of nosocomial P. aeruginosa was identified as the cause of an outbreak of wound infections among burn patients. Environmental surveys suggested an association of the outbreak with hydrotherapy provided to many patients in a common facility. In a trial of burn wound care without hydrotherapy, overall mortality was reduced significantly, mortality associated with pseudomonas sepsis was eliminated, and the strain of P. aeruginosa associated with earlier mortality was eradicated. Moreover, fewer nosocomial pseudomonas infections, lower levels of pseudomonas resistance to aminoglycoside antibiotics, significantly fewer pseudomonas infections of skin graft donor sites, and later appearance of Pseodomonas species in burn patients were found during the period when hydrotherapy was not used.

Adolescent

Learning disabilities. Using hydrotherapy: maximising benefits.

People with a learning disability are increasingly using hydrotherapy for exercise, socialising, and the release of tension and energy. For those with a physical disability, it offers an opportunity for independent activity from which they may be precluded outside the hydrotherapy pool. The author discusses guidelines for staff involved in hydrotherapy sessions before examining in detail the benefits this form of treatment has to offer.

Humans

A single blind randomized, controlled trial of hydrotherapy for varicose veins.

Sixty-one patients suffering from primary varicosity were divided into 2 groups, one receiving regular hydrotherapy, the other no such treatment for 31/2 weeks. Objective evaluation of the venous competence showed an apparently greater benefit in the control group in respect to light reflex rheographic venous filling time. The leg volume changes, however, indicated a stronger and more persistent reduction in the experimental group. The same applied for ankle and calf circumferences, which were reduced significantly only in patients treated with hydrotherapy. Furthermore some (but not all) of the subjective symptoms yielded significantly more frequent improvement in this group. In conclusion this controlled study implies that hydrotherapy may help patients suffering from primary varicose veins, a notion which was previously often stated but so far not scientifically verified.

Female

Hydrotherapy pools of the future--the avoidance of health problems.

The need to minimize the threat of infection to patients and the high incidence of health problems in hydrotherapy pool workers, have led to recommendations especially tailored to the design and operation of the water and air treatment plant of hydrotherapy pools. Hitherto unpublished surveys are detailed which confirm that pathogenic species of Pseudomonas aeruginosa in pools (in which ears may be wetted) cause a high incidence of otitis externa, but rarely cause body rashes (pseudomonas folliculitis) unless there has also been prolonged skin wetting. In brominated pools contact dermatitis is common and can be distinguished clinically from pseudomonas folliculitis by the onset of a pruritic rash less than 12 hours after exposure to the pool and reactivation of the rash on re-exposure to the brominated pool.

Cross Infection

[Immunological changes during hydrotherapy].

Immunological tests were performed in 34 patients undergoing hydrotherapy according to Kneipp. IgM, alpha2-macroglobulin and complement factor C3 concentrations were increased after this treatment, but not in ten healthy volunteers. Specific antibody activities (staphylococci, E. coli, streptococci) remained unchanged. After intracutaneous testing with different protein and bacterial antigens reactions were significantly more intense (diameter of reaction) after hydrotherapy, while total number of reacting patients remained the same. Pokeweed stimulation ratio was increased in the lymphocyte transformation test, while PHA and PPD stimulation rates remained unaltered.

Adult

A survey of burn hydrotherapy in the United States.

One hundred burn care facilities in the United States were surveyed to determine the present use of hydrotherapy in burn care. It was found that 92% of the burn units that were polled practice this treatment in some form. There was no consensus as to how the procedure is carried out, how long it takes, how often it is done, or who does it. Most burn facilities that were contacted use a disinfectant solution for hydrotherapy, and the procedure is carried out once a day for 30 minutes or less. In most of these facilities, nurses perform the procedure. Although immersion therapy continues to play an important role in most burn care facilities, spray or shower techniques are also incorporated into many programs.

Burn Units

[Hydrotherapy pools, microbiological and chemical results (author's transl)].

The results of microbiological and chemical examinations of water samples collected from hydrotherapy pools for non incontinent patients proved that the officially agreed parameters for the surveillance of public swimming pools (Osterr. Bäderhygiene-Gesetz and Verordnung) have to be extended to meet the requirements of epidemiology. Similarly the requirements for treatment and operating conditions of those waters should be more rigorous. Minimal requirements for the treatment of water in hydrotherapy pools are recommended. The results of the study indicated also that the microbicide action of chlorine (chlorine gas, hypochlorite solution) was superior to those of DIHALO (chlorine-bromine-hydantoine). Suggestions are made for proper handling of waters which would lose their therapeutical potencies by any kind of treatment.

Baths

Two sources of contamination of a hydrotherapy pool by environmental organisms.

As a result of occasional water discolouration, the hydrotherapy pool of a large teaching hospital was monitored for free and combined chlorine, alkalinity, calcium hardness, total dissolved solids and cyanuric acid levels together with bacteriological analysis. The hose pipe supplying the pool and the dual water pumps were also examined as potential sources of bacterial contamination. The pool water yielded high counts of Pseudomonas vesicularis, Pseudomonas aeruginosa, and CDC Group IV C2, even in the presence of adequate levels of free chlorine. This was found to be due to high concentrations of cyanuric acid which resulted in a 'chlorine lock'. The source of the P. vesicularis and CDC Group IV C2 was found to be the pool hose and this problem was alleviated by flushing it with water each day before use. The source of the P. aeruginosa was the pool pumps, and was eradicated by regularly shock dosing them with 6-8 ppm of free chlorine.

Bacterial Typing Techniques

[Hydrotherapy in cauterization wounds. A histologic study (author's transl)].

Investigations have have been carried out in guinea pigs to test the usefullness of hydrotherapy. Concentrated sulfuric acid was applied to the skin for a period of 30 sec and 5 min. After this the skin was washed with tap water for 1 hr. The treated area was then subjected to macroscopic and microscopic examination. When the acid was applied for 30 sec, followed by rinsing, an almost complete restitution of the skin was found on the test area macroscopically and microscopically. Significant differences were also observed after an exposition of 5 min in comparison with untreated control animals.

Animals

[Lumbar hypermobility: where swimming becomes hydrotherapy].

In this paper the authors discuss the clinical problem of lumbar hypermobility. The therapeutical possibilities are resumed briefly. The philosophy of medical training therapy ("Heilgymnastik") is described. More extensive the extra-advantages of hydrotherapy (methodical back-stroke swimming) are searched for in a theoretical deductive way. The authors found that: 1. swimming is a low-impact sport so far as the articulations are concerned, 2. back-stroke is done mainly in a lumbar kyphosis, 3. swimming is also an excellent cardiopulmonary training, 4. when swimming the muscles of the shoulder girdle and pelvic girdle are trained in a nearly isokinetic way (power-endurance), 5. the short transverso-spinal muscles are indirectly trained in their tonic more than phasic stretch reflex (posture function), 6. the muscles of the trunk are trained in a nearly isometric way in the appropriate angles (erect position), 7. the position of the head in the water facilitates the abdominal muscles (tonic neck reflex), 8. the cool temperature of the water generates training-enhancing stress-responses, 9. endurance-training is ideal for the postural function of the lower back muscles (especially the deeper layers near the spine) which are anatomical and physiological suited for this purpose, 10. warming-up and cooling-down procedures prepare the neuromuscular, the cardiovascular and metabolic functions before the workout-session (a cold shower afterwards acts to tonicize the skin and muscles).

Adult

Hydrotherapy burn treatment: use of chloramine-T against resistant microorganisms.

The presence of highly resistant gram-negative microogranisms is an area of major concern in the treatment of burned patients. Criteria for the germicide used for hydrotherapy must include effectiveness against the organism, absence of gross side effects, and conservation of human effort and materials. In the program described, these criteria seem to be successfully met. Microbial samplings from numerous patients and repeated examinations of residue taken from equipment demonstrate the elimination of pseudomonas and other gram-negative organisms.

Bacteria