Help! rash!

[TubsAndCues]

I don't agree that you necessarily have to decontaminate your spa and dump the water.  


The reason for the difference is because a chlorine shock does a better job of destroying chloramines than MPS, but MPS does a better job of preventing them.

Hey Tony!

Just so you know, I recommend the drain and "decontaminate" the tub method for 2 reasons.  

First, the guy that came up with the procedure knows a whole lot more about bacteria than I do.  

Second, I've dealt with probably a couple hundred cases over the 6 years I've been in the spa industry.  In my experience, the people with the best luck at not having it come back are the ones who followed those instructions.  It's not 100% perfect, we've had people that have had to do it a couple of times before they stopped breaking out.

Have people been able to get rid of it with out draining?  Yep.  And I know both of them, but in both cases they ended up with it again a few weeks later.  

I do have a question for you though regarding your statement about MPS preventing chloramines.  I was wondering if you could explain that because I've never heard it explained that way.  

thanks!

[Vinny]

Sounds to me like the tub.  I'll give you word for word the sheet we hand our customers:

==================================================

Psuedomonas:
The word Psuedomonas is used loosely to describe both bacteria and the rash it can cause when it infects a spa or hot tube.  Its proper name is Psuedomonas Aeruginosa dn is commonly found in soil, water and on plants.

This bacteria does not compete very well with other common bacteria.  The spa's higher temperature kills off its competitors, leaving Psuedomonas alone to multiply very rapidly.  It feeds on proteins, oils, ammonia and nitrogen.

The rash that is associated with the bacteria is know as Psuedomonas Folliculitis.  It is an inflammation of the hair follicles , and usually occurs within 8 to 48 hours after exposure.  It will appear as red bumps or postules with white heads that do not pop.

The rash is usually, but not always, located between the shoulders and the waist (in the trunk of the body).  It is not unusual for one person to get it and another who was in the spa to not get it.  It seems that the wider the opening of the skin pores the more likely one is to get the rash.

Within 3 to 7 days after exposure the rash normally goes away on its own without treatment.  A regular skin lotion can be used to help the itching which can accompany the rash.

Spa disinfection techniques:
1.  Drain the spa completely
2.  Clean the surface with an alkaline surface cleaner
3.  Remove and clean the spa filter(s)
4.  If time permits, allow spa to dry completely
5.  Refill spa (use a new hose or allow water to run for a few minutes before filling spa.
6.  Balance the spa water
7.  Shock the spa with a double dose of Chlorine Concentrate
8.  Maintain a higher than normal sanitizer level for 1 week.

NOTE:  This treatment plan was developed by Dr. Donald Ahearn, Professor of Microbiology at Georgia State University

====================================================

There you go.  What I've found is that this critter tends to pop up after 1 fo 2 main things happens - either a fresh fill after the tub has set empty for a while and stuff can grow in the lines OR if your sanitizer level dropped for a period of time (I'm guessing the latter since you noted the water was slightly cloudy).  Either way, once Psuedomonas gets a foot hold you have to drain and refill.

I've actually seen many cases where a large number of people use a tub and only one of them breaks out with the rash and other cases where only one of them doesn't.

Good luck with the treatment!

I am a little confused about this.

I was originally under the impression that Psuedomonas were able to grow in a hot tub but then was told by what seemed like a knowledgeable source that it has to be introduced and even if the tub gets cloudy from so many bacteria it doesn't mean that Psuedomonas are living in it. It was explained to me that Psuedomonas usually come from going into a public spa, not washing the suit and having it introduced into your spa. I was also under the impression that it can infect anyone but again was told that the skin needs to be broken in order to get infected.

So the reason I am confused is we assume that a rash is Psuedomonas but there may not be any evidence that there is. If it is a fresh fill and Psuedomonas have not been introduced into the tub - how does it become the "hot tub rash". Also, a problem with using dichlor is that as the CYA goes up - it becomes harder to kill the Psuedomonas bacteria because the contact time is much higher than the "regular" bacteria. Once we have used dichlor for a month, we have approched 100 PPM CYA and the chlorine is almost all locked up in the CYA especially since we are only using 3 PPM ... this is why we do want to shock with higher amounts of chlorine every so often.

Draining and refilling might be an option but I would also have to say that you still need to superdisinfect the tub before draining if you think you have a Psuedomonas problem.

[Bonibelle]

Vinny, Pseudomonas is a very typical water contaminant. I was surprised when I found out that it caused the hot tub rash because I was used to it being identified as more of a nussiance bacteria than a true pathogen. It is known to be an organism that can cause problems in burn victims and is a common hospital caused infection (the reason they don't like cut flowers in water in hospital rooms)  In  pharmaceutical manufacturing processes pseudomonas turns up as a contaminant in tanks, and preparation areas that are steamy and wet. I don't personally believe it evolves a resistant strain that sanitizers don't kill..rather, that it multiplies in ideal conditions so fast that the sanitizers can't stay ahead of it. They are used up before all the cells are destroyed. The organisms also form a slime type layer that can make it difficult to completely remove.

Here I found this website:http://ttp://www.textbookofbacteriology.net/pseudomonas.html

[Vinny]

Thanks Boni!

Anyone want to buy a hot tub!!!  After reading that - it's a nasty bugger.

[tony]

Hey Tony!

Just so you know, I recommend the drain and "decontaminate" the tub method for 2 reasons.  

First, the guy that came up with the procedure knows a whole lot more about bacteria than I do.  

Second, I've dealt with probably a couple hundred cases over the 6 years I've been in the spa industry.  In my experience, the people with the best luck at not having it come back are the ones who followed those instructions.  It's not 100% perfect, we've had people that have had to do it a couple of times before they stopped breaking out.

Have people been able to get rid of it with out draining?  Yep.  And I know both of them, but in both cases they ended up with it again a few weeks later.  

I do have a question for you though regarding your statement about MPS preventing chloramines.  I was wondering if you could explain that because I've never heard it explained that way.  

thanks!

The problem with Psuedomonas is it needs a longer contact time with a sanitizer than most bacterias so if your sanitizer level gets a little low, this particular bacteria will survive and thus can infect those who are suseptable.  If left unattended, this bacteria can protect itself via a biofilm and needs a super decontamination to break the film and kill the bug.  As Bonielle mentioned Pseudomonas are fairly common and in our environment and hot tubs are very Psuedomona friendly in that it can live in the hot temps where other bacterias will not.  The CYA issue is also something to be considered though IlliniFan's situation involves bromine and not dichlor.

I myself have experienced a couple of bumps here and there...but it has happened when I knew I shouldn't have used the spa and did anyway...but could always clear it up without much problem.  I do agree...the very safe way to go is to drain and fill and bring your sanitizer level up to a higher than normal level for a period of time if you experience a couple of non postule bumps and certainly if you get a full blown out rash.

I learned the info about non chlorine shock from the poolspa forum from either waterbear or chem geek who are a world of chemical knowlege.  If you did a search over there you could find long detailed posts regarding the chemistry of all this.  I had also heard about MPS and its better oxidizing capabilities years ago.  I had been a chlorine shocker for years and have tried this method for a while now with pretty good results.  You have to realize my kids are in their late teens and they and their friends can foul a 500 gallon tub in a couple of hours.  The only thing that fixes that is heavy chlorine.  Luckily this happens during the summer where I can and do throw an extra drain and fill in.  I am going on five and a half years of ownership soon and have always followed Vermonters Dichlor Dosing or a slight variation of it mainly because of the testing he did in his spa and the results he kindly shared.

  

[morgan23]

I just wanted to add that we had a similar situation with our 2.5week old Jacuzzi 470.  We followed the dealer's instructions: supercholorinate (3tbs) on the first fill, then MPS (1tbs) after every use and shock with dichlor (2tbs) once a week.  

Well after one week of using it at least once daily, DH and I soaked in what we later realized was a cloudy tub. This was last Sunday night (which is why we didn't realize the tub was nasty- it was dark!).  Monday morning I woke up with a what looked like chicken pox all over my lower abdomen + back. It eventually spread onto my upper arms and thigh as well.    It wasn't itchy at first but eventually became quite painful and I visited my doc. on Tuesday where he diagnosed hot tub rash. Evidently I had the classic case.    We decided to just watch the rash and if it didn't get better within a few days I would call in for a Rx....well it's been a week (today is Sunday) and my rash is almost gone.  It did blister quite a bit in some spots and on Wed. night I thought I'd been hit by a truck- started running a fever and felt flu-like symptoms- but by the time I got a hold of the doc. on Thursday, I was a LOT better and so no antibiotics or anything for me.

Anyways, I called our dealer and they suggested super-shocking(?) the tub since the water was only a week old at the time I got infected. We got chlorine up to 10ppm and kept it there for nearly a day. The water cleared up almost immediately and has been testing within limits for PH, alklinity, etc..  The dealer told us to continue using MPS after each soak, but I'm wary since that didn't seem to work well the first time and we have two small kids that like to jump in with us (lord knows they don't need this rash!).  So I've switched to dichlor (1tbs) after each use and using the MPS once a week to 'shock'.  I'm also super paranoid about testing the water now! LOL My DH rolls his eyes, but he only got one or two spots on his leg that aren't bothering him at all.

Chlorine has generally been between 2-3ppm when I test (we generally soak at night and I usually test the next AM).  We also have a ozonator and use one of the Nature2 cartridges.

Can anyone tell me if we're on the right track as far as keeping our tub sanitary with dichlor?  I worry that I'm either using too much or too little- sometimes I'll test before getting in and the chlorine level is 1ppm or less...is that normal if it's been 24hrs since we added dichlor?

[Cyn]

I am sure one of the old timers will respond and I would rather they tell you what you should be doing, but I have to admit I am astounded at the dealers telling so many users to use MPS after each soak rather than dichlor.  MPS is not a sanitizer.  So you would be going at least a week with no santizer and then you are shocking with dichlor.  By the end of the week you are soaking in MPS and dirty water.  I just don't get it.  Maybe one of the long timers can give us a heads up about why that would ever be something a dealer would advise you to do.  

[Vinny]

Theoretically all of us are not supposed to soak without using dichlor before and during our soaks. The Vermonter method that we use is based on a microbiologist's (Vermonter) recommendation using his tub as a test vessel. The reason for adding chlorine after we soak is to not soak in high levels of chlorine, as you noted possibly 0 PPM chlorine.

The correct method is not to throw 1,2 or 3 teaspoons into a tub and hope for the best but to measure how much dichlor is used to achieve a 3PPM reading 20 minutes after we add the dichlor (higher reading is good as well). The therory is that at 3 PPM and 20 minutes you have basically killed the bacteria that could have grown into billions in 24 hours. It also means that 1 person in a 500 gallon tub may need more than 1 person in a 250 gallon tub and 1 person needs less in a tub vs having 5 people in a tub... the magic number is 3 PPM in 20 minutes.

Putting the correct amount and achieving this goal means that as the chlorine dwindles down hours later the bacteria hasn't had a chance to get a foothold as the residue chlorine is still killing bacteria although slowly as the chlorine PPM gets lower. In 24 hours, assuming that there was a residue for hours after adding the dichlor the bacteria hasn't grown to epic proportions and it is considered safe to some degree. If you don't soak for a couple of days, then more chlorine needs to be added to stop the bacteria from getting out of control.

I would say that if you use dichlor after every soak, achieve 3 PPM at 20 minutes and if you skip days add the amount needed then you will be OK.

MPS is expensive and I suspect that is why some dealers push it. I also think that is why they push Nature 2 (N2)and ozone as needing less chemicals as well. Chlorine costs about $30 a 5 lb pail, MPS about $15 for 2 lbs  and N2 costs about $25 for a cartridge. 5 lbs of chlorine lasts about 8 to 10 months, N2 4 months and 2lbs of MPS probably 2 months if that ... I can see why some would push it. MPS is a good product but it is only for oxidizing, not for sanitizing. Clear water does not equal clean water.

I will note that I do skip a day of dosing and will soak in the tub, I will not skip 2 days of dosing and soak in the tub.

[IlliniFan]

I like you followed my dealer's instructions.  I was to put 4 oz of reserve which is bromide salt initially and 2 oz of MPS.  Then follow with 2 oz of mps after each soak to activate bromine. and add once a week 2 oz of reserve.  But then the rash came on Friday.  Today I think I am running a slight temp and feel flu ish as well.  Rash is resolving.  I have been very happy with dealer, but he is chemically challenged.  I like you wish there was more education regarding maintenance.  In his defence, he did give me bromine tabs.  But do I only shock with MPS or should I do something different.  Thank you for your input.

[morgan23]

Vinny, I tested the first couple of times I started throwing dichlor in and we would get 3ppm or more after 20 minutes of the jets being on/circulating. 99% of the time it's just me and DH soaking (sans suits).  The kids go in every other day or so, but usually only with DH.

At any rate, I try to keep the levels at 3ppm or more after that first 20 min....just concrned about the levels dropping to 1ppm or less hours later.  But your explanation makes sense so I'm less worried about it now.

Thank you for the info!

IlliniFan, glad to hear your rash is resolving. It's no fun, is it!

[mark 2550]

(Illini Fan) I like yourself am new to this water chemistry my local dealer suggested (EZ SPA OM ) so I bought the start-up kit around $70.00. At first I micro manage the system now that I have routine every thing has been great, very easy system to use shock weekly and add EZ boost after each soak have been using the system for 2.5 months and water is clear and test strips are so close in to range eveytime we test we don't worry might be worth checking out. By the way I live in mid-state illinois so we our expierencing the same type of weather , just came in from a 30 degree soak and couldn't be happier.

[tinybubbles]

Nobody has challenged the notion that Illi has psuedomonas folliculitis.  There are other things that can cause bumps and break outs.  Many people, including myself, are sensitive to MPS.  I've had to toss out the MPS that I use to shock weekly and start doing this with dichlor.  Just a thought.

[Vinny]

morgan23, I hope my post didn't come off as "holyer than thou". I was trying to address a misconception that some people have in using dichlor while answering your question. After rereading it, it sounded a little or a lot like it might be an arrogant response ... it wasn't intended to be.

tony, did chemgeek explain how MPS works because waterbear tried to and everywhere he led me I kept reading to use MPS as a shock ... even on the old pool solutions/pool forum websites. He was telling me that weekly addition of MPS will keep chloramines from forming, not destroying chloramines as we all believe, I couldn't find evidence of what he was saying.

[morgan23]

Vinny, I didn't take it as such- I've been lurking here for a while and know that you are one of the 'good guys'  .  
I'm glad you put the info out there, because after reading sooooo many different posts regarding water chemistry I was getting a bit overwhelmed.

I really wish that dealers would be more informed re: sanitation for spas. We really like our dealer and he's been great except for the info he gives out on using MPS as a 'sanitizer' (which we now know it's not!).

[tony]

morgan23, I hope my post didn't come off as "holyer than thou". I was trying to address a misconception that some people have in using dichlor while answering your question. After rereading it, it sounded a little or a lot like it might be an arrogant response ... it wasn't intended to be.

tony, did chemgeek explain how MPS works because waterbear tried to and everywhere he led me I kept reading to use MPS as a shock ... even on the old pool solutions/pool forum websites. He was telling me that weekly addition of MPS will keep chloramines from forming, not destroying chloramines as we all believe, I couldn't find evidence of what he was saying.

He did and there is a post over on the other forum regarding it but trying to find it may be tough.  I know he spoke with folks from Dupont for information, but what you have heard...I also have heard...that mps does a better job at preventing than destroying...though I believe they will do so...just not as complete.