Air Spas and Whirlpools:  A Comparison

Brief history of nursing home bathing

For years, the primary means by which nursing home residents were bathed included showering and bathing in tubs ill suited for geriatric use.  Constructed of porcelain or cast iron, these tubs required residents to either step into them or be transported via a hydraulic lift.   

Since geriatric residents pose unique hygiene challenges, the next generation of tubs included dedicated lifting systems and whirlpool jets to facilitate the bathing process.  Primitive by today’s standards, these whirlpools required manual cleaning and disinfecting as automatic disinfection systems were not yet available.  As such, there were sometimes cross-contamination issues.  Years later, automatic disinfection systems became available, so cleaning and disinfection issues became more of a protocol or individual staff issue than a design concern.    

Rise of air spa popularity

Due largely to the cross-contamination issues of the older generation whirlpool systems and to the negative publicity home spas and public hot tubs received in recent years, air spa systems have grown in popularity.  Original selling points included the argument that the air lines stay dry and bacteria free because no water is circulated through them.  Unfortunately, early generation air spas were alleged to be “waterproof” actually allowed significant amounts of contaminated water to seep back into the lines causing infection control issues.  Later generations of air spas then became available with disinfectant systems that allowed the lines to be cleaned and disinfected.  More recently, a new generation of air spas has emerged once again alleging waterproof air lines.

Comparison/Contrast of whirlpools and air spas

Principles of whirlpool
Whirlpool action is generated by a motor that circulates water from the tub into an inlet where the water is infused with air and dispensed out through whirlpool jets. 

Whirlpools provide significant water movement beneath the surface of the water.  The air-infused water produces microscopic bubbles that assist in cleaning hard to reach areas.

Whirlpool jets cause very little disturbance on the surface of the water.  This lessens the chance of easily agitated residents becoming upset and combative. 

Principles of Air Spa
Air spas agitate the water via an air blower forcing heated air through lines that lead to portals in the tub’s bottom.  Air travels upward, massaging the body before reaching the surface.  

Air bubbles can only travel straight up; therefore there is less water movement under the surface than with whirlpools.

Depending upon the amount of air exiting the portals, there can be significant turbulence at the surface.

Benefits of Whirlpools

• Whirlpools have been proven to provide true hydrotherapy benefits.  As such, certain therapies and treatments using true whirlpool baths are eligible for reimbursement under Medicare CPT billing code 97022.
• Whirlpools are recognized to improve circulation by dilating blood vessels, enabling them to carry more oxygen and nutrients. 
• Whirlpools are recognized to alleviate pain associated with arthritis and muscle spasms, and help in the treatment of high blood pressure and migraines.   
• Studies indicate diabetic patients require reduced doses of insulin after hydrotherapy sessions.   
• Many physicians and therapists recommend hydrotherapy as part of a rehab program following surgery or injury.
• Whirlpools cause less surface disturbance than air spas.  This helps minimize chances of residents becoming agitated and combative. 
• Whirlpools vaporize less water than air spas.  Decreased surface agitation means less water (and corresponding pathogens) becomes airborne and potentially inhaled.  This is an infection control advantage - especially with highly incontinent or immuno-compromised residents.

Benefits of Air Spas

• Air system can be turned on prior to resident entering the tub in order to warm the seat.
• Air system can be turned on while tub is filling to begin massaging the feet
• Air system can be left on during the draining of the tub, thereby lessening the chance of water seeping back into the air lines.
• Air system can be left on during and after the bath thereby drying the lines.
• Air spas cannot “spray” water like whirlpools if the water level is not high enough

What to look for in an air spa system

• Air spa outlet should be placed to provide even, complete water agitation. 
• Air jets should be placed directly underneath certain areas that need to be cleaned, such as the perineal area, and the chair should have openings to allow cleaning in those areas. 
• Air spas should have variable speed motors.  High settings can cause significant surface turbulence, frightening many residents.  Variable speed motors allow you to adjust the agitation to each individual.
• The disinfection system should be housed internally for safety.  Hoses that dispense disinfectant can be mistaken for shower hoses and staff can accidentally spray residents with hazardous quaternary disinfectants.  
• The air spa system should include a means to flush the air lines.  Even “closed” air systems allow condensation and contaminated water from the tub to seep into the lines.  Also, airborne bacteria in the bathing area re-circulate through the air blower and end up in the lines.  If the system cannot be flushed, bacteria grow and reproduce.
• The air spa system should have a means to agitate the cleaner and disinfectant as it is injected in the lines.  As the cleaner or disinfectant is flushed in the system, the air blower can facilitate in effectively flushing and “scrubbing” the lines.
• The transfer chair should be easy to clean and disinfect.  A removable seat allows care- givers to effectively clean and disinfect the underside of the chair, minimizing cross-contamination.  
• The transfer chair should not have porous materials that can absorb contaminated water and possibly transfer harmful pathogens to the next bath.
• The system should have a safety back-up that automatically turns on the air blower after the last bath of the day.  This assures the lines are dry and minimizes the chance of bacteria growth.