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Indoor private pool

Question
Hello, we consider the purchase of a house with a covered private pool, but I worry that this may not be ideal for our son who has CF. Can we trust regular pool maintenance? What should we do extra? Can we specifically avoid Pseudomonas? Or should we just not buy this house? Thanks for your reply!
Answer
Thanks for your interesting question. Your concern about the possible exposure to Pseudomonas in a pool is relevant.

Patients with cystic fibrosis, but also children with an immune disorder are more vulnerable to the bacterium Pseudomonas aeruginosa. When infection with this pathogen occurs, the chance of chronic infection is real and this may have a negative influence on the long term course of the lung disease. That is why infection with this pathogen should be avoided, if at all possible.

Patients with cystic fibrosis who have infection with Pseudomonas can transmit this bacterium to other patients. That is why, in nearly all CF centres, specific measures are taken to segregate patients with and without Pseudomonas aeruginosa. In addition strict hand hygiene at the hospital and also outside of the hospital has proven efficacy. Most frequently however Pseudomonas infection is contracted from the environment. Avoiding all contact with Pseudomonas aeruginosa in daily life is however difficult. This pathogen occurs everywhere but especially where it is moist and warm. Stagnant water is a more common source of Pseudomonas aeruginosa than moving waters, hence the link often made between Pseudomonas and pools, small lakes, showers, yaccuzis. It is however very difficult to demonstrate that infection with Pseudomonas is really the consequence of contact with these specific environmental niches. The lung disease severity itself seems to be a risk factor in the acquisition of Pseudomonas infection.

Because of the really increased risk of contracting Pseudomonas infection, it is advised not to use yaccuzis and tropical swimming pools. The high temperatures and the bubbling of the water will lead to little aerosols that increase the risk of inhalation and infection with Pseudomonas.

Many studies tried to evaluate whether there is an increased risk of Pseudomonas infection with the use of usual public and private pools. Pools that are not well maintained do have an increased concentration of Pseudomonas compared to pools that are well maintained. The use of well maintained public pools is appropriate for patients with cystic fibrosis.

As to a private pool, it is really important to follow the guidelines for maintenance and disinfection. This information is readily available at firms that do install pools. Take care however and know that excessive chlorination causes irritation to the airways. You thus need to follow the guidelines very strictly.


To make a long story short: There is no evidence that the purchase of a house with a private pool is contraindicated for a patient with cystic fibrosis if you strictly follow maintenance guidelines. We do suggest that you discuss this with your treating physician and ask for his opinion as well.

Best regards,
Dr. E. De Wachter
30.08.2011