Hot Tub/Spa Inspections — United States, 2002, 2008, and Beyond (50m Lecture)

State and local health departments routinely inspect public hot tubs/spas to assess compliance with regulatory standards. These inspections are the primary means of protecting public health by ensuring good operation and maintenance. In 2002, two state and four local health departments partnered with CDC to report on an analysis of data from hot tub/spa inspections conducted May 1–September 1, 2002. 

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The six sites were a convenience sample of hot tub/spa inspection programs that maintained electronic databases. Collected data included water chemistry, filtration/recirculation system, and policy/management (e.g., record keeping) inspection items. Code noncompliance was documented by recording the corresponding violation.

The 2002 study revealed 5,378 violations were identified during 5,209 hot tub/spa inspections. The majority of inspections (56.8%) found >1 violation(s) (median: one; range: one to eight); 11.0% of inspections resulted in immediate hot tub/spa closure due to serious violations. Disinfectant residual violations were identified during 17.1% of inspections. The proportion of inspections identifying disinfectant residual violations, by setting, ranged from 9.1% at private clubs/gyms to 21.9% at campgrounds.

The 2002 study highlighted the need for aquatic inspections and garnered intense media attention for environmental health pool programs. Budget cuts threaten pool inspection programs across the U.S. warranting a follow-up study that underscores their importance. Six state and 12 local health departments collaborated with CDC to produce a second snapshot of ~40,000 hot tub/spa inspections conducted in 2008. Hot tub/spa inspection data can be used not only to justify the need for inspection programs but also yield critical information to direct public health–decision making. For example, state and local programs can collect and then analyze inspection data to identify venues with repeated violations that threaten public health and consequently target educational and regulatory enforcement activities towards those venues. CDC is currently piloting a national surveillance system that collects inspection data. The findings of the analysis of these data will be used to direct the development of CDC resources.