Ask Andrea: Does Hepatitis C transmit in the pool?

A reader asked whether a patient with hepatitis C should be kept out of aquatic therapy. Here is my answer, with the CDC guidance it is based on.

Want to go deeper? Explore the Aquatic Therapy Precautions and Contraindications overview →

Question: We have a patient that may benefit from aquatic therapy - however, the patient is positive for Hepatitis C - would this be a concern for aquatic therapy?

Answer: Hepatitis C (and B)  is spread primarily by blood-to-blood contact, like occurs with transfusions, needle sticks, and IV drug use. The CDC is not aware of any instances in which a person has become infected with these germs after being exposed to a blood spill in a pool (see their statement below). Hep B and C are not fecal borne, like Hepatitis A.

Even if an infected patient had a cut or other method of blood spill, properly treated pool water will kill the pathogens almost immediately. The way that I read it, the CDC feels that blood spills are not even a reason for the pool to shut down, the likelihood of any blood borne pathogen to transmit is so infinitesimal. That said, you should always follow your facility infection control policies and any existing guidelines from your local or state regulatory agencies if they conflict with this information!

Here is an excerpt from the CDC's policy:

Responding to blood in the pool

Chlorine kills germs found in blood (such as hepatitis B and HIV). CDC is not aware of any instances in which a person has become infected with bloodborne germs after being exposed to a blood spill in a pool. While there is no public health reason to recommend closing the pool after a blood spill, some aquatic staff choose to do so temporarily.

A 2021 review of hepatitis C epidemiology agrees: transmission is most commonly linked to direct blood exposure, such as transfusions, unsafe injections and IV drug use.¹

For education only; not a substitute for individual clinical judgment.