Cleaning and Disinfecting Aquatic Therapy Equipment: A Practical Plan

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Most aquatic therapy teams track pool chemistry closely. A written plan for the noodles, belts, dumbbells, kickboards and snorkels that go in and out of that water all day is easier to overlook. When an accreditation surveyor or health inspector asks to see that plan, “our chemistry meets code” is not the answer they are looking for.

The gap is fixable. This guide covers why surveyors look for an equipment plan, what a reasonable plan contains, and how to clean equipment without wrecking the foam or your water balance. Use it as a starting point with your infection preventionist, not as a substitute for your own policies.

Why “the water meets code” is not the whole answer

Pool codes treat water and equipment separately. CDC’s Model Aquatic Health Code (MAHC) is model guidance that becomes law only where a state, local, territorial or tribal jurisdiction adopts it.¹ It has its own section on shared equipment, apart from its water quality rules. Items that touch a swimmer’s eyes, nose, ears or mouth (snorkels, nose clips, goggles) are to be cleaned and sanitized between uses. Other shared equipment, and the code names fins, kickboards, tubes, lifejackets and noodles, is to be kept clean and stored in a way that prevents mold and other biological growth.²

Chlorinated water does not keep equipment clean. The MAHC’s scientific annex notes that handheld and flotation equipment used in aquatic therapy or play has been found to harbor potentially harmful microorganisms even while submerged in properly chlorinated water, most likely from biofilms on its surfaces. Biofilms resist chlorine and shelter the organisms inside them.³ Studies of therapy pools point the same way. Biofilm-forming opportunistic pathogens have been recovered from hydrotherapy equipment.⁴ Antibiotic-resistant bacteria have been found on the surfaces around therapy pools as well as in the water.⁵

Healthcare surveyors look for an infection-control system. DNV and The Joint Commission are among the accrediting organizations CMS approves, and CMS-approved standards must meet or exceed Medicare’s.⁶ For hospitals, the Medicare condition of participation on infection prevention requires a hospital-wide program that is documented in policies and procedures, follows nationally recognized guidelines and maintains a clean and sanitary environment. It also calls for competency-based staff training and audits of whether staff follow the policies.⁷ Pool equipment is patient-care equipment, so a surveyor expects to see it covered by that program: in writing, based on national guidance, taught to staff and documented. Other settings answer to different rules, so check which apply to you. We have not quoted any accreditor’s standard numbers here; read your accreditor’s current manual.

CDC’s environmental infection control guideline gives the baseline for noncritical equipment. Follow the manufacturer’s cleaning and maintenance instructions. Where there are none, clean the item, then apply an EPA-registered hospital disinfectant as the label directs.⁸

Step 1: Sort your equipment by risk

Infection control teams sort equipment using the Spaulding scheme: critical, semicritical and noncritical. Most pool equipment touches only intact skin, which makes it noncritical, the lowest-risk group. CDC lists low-level disinfectants as suitable for noncritical items. CDC also notes that items briefly touching nonintact skin, such as hydrotherapy tanks, are usually still treated as noncritical but disinfected with intermediate-level products.⁹ (“Hydrotherapy” covers several different things; see the Encyclopedia entry.)

Add two practical questions to that scheme. What does the item touch? And can it be scrubbed clean and dried, or does it soak up water? The tiers below are a starting point to adapt with your infection preventionist. The method follows the sources cited above. Frequencies and examples are our clinical judgment. [Expert opinion]

Tier	Examples	Starting-point plan
1. Touches the face	Snorkels, mouthpieces, goggles, nose clips	Clean and sanitize between users, as the MAHC asks.2 Issuing these to one patient is often simpler.
2. Hard and non-absorbent	Plastic dumbbells, rings, sinking toys, hard kickboards, portable steps	Clean and disinfect on a set schedule (for example, end of day) and whenever soiled. Wipe-on products are practical here.
3. Closed-cell foam or sealed covers	Noodles, foam dumbbells, foam belts with sealed skins	Scrub, rinse, disinfect for the label contact time, rinse if the label says to, then dry completely. Inspect each time for splits, tears and crumbling.
4. Absorbent or fabric-covered	Open-cell foam, fabric or mesh belts and vests, padded cuffs	Hardest to clean and dry. Follow the manufacturer’s instructions; consider single-patient issue or a non-absorbent replacement.
Any tier, soiled	Blood, feces, vomit or wound drainage	Take it out of use and follow your body-fluid and fecal-incident policies.

Patient screening is part of the same plan. For large hydrotherapy pools, CDC advises a risk assessment before use and deferring patients with draining wounds or fecal incontinence.⁸

Step 2: Build the daily routine

1. Clean first. Cleaning removes soil and organic material. Anything left on the surface makes disinfection less effective, and friction (scrubbing) is a dependable way to remove it.¹⁰ The MAHC annex adds that soaking in disinfectant might not penetrate biofilm. It advises scrubbing equipment routinely, then cleaning, sanitizing and thoroughly drying it, preferably as the manufacturer recommends.³ A quick dip on its own is not a plan.
2. Disinfect with an EPA-registered product, for the full contact time. The contact time is how long the surface must stay visibly wet for the product to work. If the surface dries early, reapply.¹¹ Pesticide labels, which include disinfectant labels, are legally enforceable.¹² If you choose a shorter contact time than the label lists, you are using the product off-label and accept the liability.⁹ Contact times vary by product and organism, so read yours.
3. Rinse when the label calls for it, and always before items go back in the pool if residue is a concern (more on this below).
4. Dry completely. In the research summarized in the MAHC annex, damp materials that were not submerged held the most bacteria.³ The MAHC also asks facilities that supply shared equipment to provide enough equipment and space to clean, sanitize, dry and store it.² Racks that allow airflow on all sides help.
5. Keep clean and dirty apart. The MAHC asks that used, unsanitized equipment be kept separate from clean equipment, with non-absorbent, easily cleaned bins for used items.² A labeled “used” bin at the pool exit makes this easy.
6. Inspect and retire. Shared equipment is to be kept in good repair.² Foam that is split, pitted or crumbling cannot be scrubbed clean and should be replaced. [Expert opinion]
7. Clean the cleaning tools. In one multi-facility study, the pool surroundings that yielded the most antibiotic-resistant isolates were barefoot areas and floor cleaning equipment.⁵ Brushes, buckets and mops need their own routine.
8. Log it. Record the date and time, the items or tier, the product and its EPA registration number, the contact time and the staff initials. The infection prevention condition of participation requires documentation of program activities.⁷

Step 3: Protect your equipment and your pool chemistry

A common worry is that disinfecting equipment will carry residue into the pool, raise chlorine demand or wear out the foam. Each of these can be managed.

• Dirty equipment already uses up chlorine. Chlorine binds with the body waste, dirt and sweat that come into the pool and forms chloramines.¹³ Biofilms also consume chlorine.³ Equipment that has been scrubbed and dried brings less of both into the water.
• Rinse off residue. CDC’s guideline notes that cleaning chemicals must be rinsed from equipment to avoid adverse reactions.¹⁰ Apply the same rule to anything headed back into the pool, then let it dry.
• Watch combined chlorine when the routine starts. Most health departments limit combined chlorine to 0.4 ppm or less.¹³ Ask your pool operator to watch the trend for the first few weeks.
• Check material compatibility. Federal law requires users to follow all applicable label instructions on EPA-registered products, including material compatibility.⁹ CDC also tells facilities to follow the equipment manufacturer’s cleaning instructions.⁸ Ask the equipment maker which products and dilutions its foam tolerates, and keep the answer in your policy binder.
• Stronger is not better. CDC advises against using high-level disinfectants on noncritical items.⁸ Pick the right product for the tier, not the harshest one on the shelf.
• UV does not reach the deck rack. UV is a disinfectant, but it does not leave a persistent disinfecting residual in the water.³ It treats water as it passes through the system, so equipment drying on deck is outside its reach. [Expert opinion] In one hospital therapy pool with a UV-peroxide system, bacterial counts in the water were still relatively high compared with the fill water, and Mycobacterium species made up a significant share of the microbes in the water.¹⁴

Step 4: If you have been cited

1. Read the finding closely. Note exactly what was cited and the deadline and format your accreditor or agency requires for a response.
2. Bring in your infection preventionist. In hospitals, the infection preventionist is responsible for infection-control policies that follow nationally recognized guidelines.⁷ A policy written with that person, and approved through your infection control committee, carries more weight than one written by the pool team alone.
3. Write the policy. Cover the scope, equipment tiers, products (with EPA registration numbers), step-by-step methods, frequency, responsible staff, drying and storage, retirement criteria and logs. Cite your sources: MAHC section 5.10.5, the CDC/HICPAC guidelines, product labels and manufacturers’ instructions.
4. Train and check competency. Competency-based training is part of the hospital requirement.⁷
5. Log and audit. Keep the logs, spot-check them, and fix gaps. Logs are the evidence a surveyor will ask for next time.

Training and documentation matter in practice, not only on paper. In one hospital hydrotherapy outbreak, MRSA was traced to surface contamination of a bathtub. Bathing was stopped, and no further cases occurred after the facility strengthened cleaning and disinfection and trained staff in hand hygiene.¹⁵

What the research says

• Equipment can harbor organisms in chlorinated water. The MAHC annex reports that handheld and flotation equipment used in aquatic therapy has harbored potentially harmful microorganisms even while submerged in properly chlorinated water.³
• Biofilm on hydrotherapy equipment. All of the microorganisms isolated from hydrotherapy equipment surfaces at one spa center were opportunistic pathogens, and all could form biofilms in the lab.⁴
• Surfaces count too. Across eleven health care facilities, 307 antibiotic-resistant isolates came from surfaces around therapy pools, compared with 102 from the water.⁵
• Secondary treatment is not a cure-all. A hospital therapy pool with a UV-peroxide system still had relatively high bacterial counts compared with its fill water, and Mycobacterium species made up a significant share of the microbes in the water.¹⁴
• Maintenance failures have consequences. Investigators linked a community Legionnaires’ disease outbreak to an aquatic therapy center and named lack of facility maintenance as the main cause.¹⁶
• Cleaning protocols stop outbreaks. After a hydrotherapy-linked MRSA outbreak, no further cases occurred once cleaning and disinfection were strengthened and staff were trained in hand hygiene.¹⁵

Before you finalize your plan

Check three things: your state or local pool code (which may or may not adopt the MAHC), your accreditor’s current standards and your own infection control team’s policies. This article is general education, not legal or regulatory advice.

Frequently asked questions

Our pool chemistry meets code. Isn’t that enough for the equipment?

No. Therapy equipment has been found to harbor microorganisms, likely in biofilms, even in properly chlorinated water, so it needs its own cleaning plan (CDC, 2024)³.

Do we have to disinfect noodles between every patient?

The MAHC asks that noodles and similar gear be kept clean and stored to prevent biological growth, and that items touching the eyes, nose, ears or mouth be cleaned and sanitized between uses. Your infection control team sets the exact frequency (CDC, 2024)².

Will disinfecting equipment raise our chlorine demand?

Dirt, sweat and body waste already use up chlorine. Scrubbing, rinsing as the label directs and drying should mean less is carried into the water. Watch combined chlorine as you start (CDC, 2025)¹³.

Our pool has UV. Doesn’t that cover the equipment?

No. UV does not leave a lasting disinfectant residual in the water, and it treats only water passing through the system (CDC, 2024)³.

Can we shorten the disinfectant contact time to save time?

No. The surface must stay visibly wet for the full contact time on the label. If it dries early, reapply (EPA, 2026)¹¹.

What will a surveyor want to see?

In hospitals, a written policy based on national guidelines, competency-based staff training, and documentation such as logs and audits (42 CFR 482.42)⁷.

References

Research and guidance cited in this post

1. Centers for Disease Control and Prevention (CDC). About the Model Aquatic Health Code. Accessed October 30, 2026. cdc.gov/model-aquatic-health-code/php/about.
2. Centers for Disease Control and Prevention (CDC). 2024 Model Aquatic Health Code: Code Language. 5th ed. Atlanta, GA: CDC; December 2024. Sections 4.10.5 and 5.10.5. Current edition page.
3. Centers for Disease Control and Prevention (CDC). 2024 Annex to the Model Aquatic Health Code: Scientific Rationale. 5th ed. Atlanta, GA: CDC; December 2024. Annex to sections 4.7.3.4.5, 5.10.5.4 and 5.10.5.5. Current edition page.
4. Jarząb N, Walczak M. The presence of biofilm forming microorganisms on hydrotherapy equipment and facilities. J Water Health. 2017;15(6):923-931. doi:10.2166/wh.2017.025. PubMed: 29215356.
5. Koeck DE, Huber S, Hanifi N, Köster M, Schierling MB, Höller C. Occurrence of antibiotic-resistant bacteria in therapy pools and surrounding surfaces. Int J Environ Res Public Health. 2018;15(12):2666. doi:10.3390/ijerph15122666. Free full text: PMC6313675. PubMed: 30486403.
6. Centers for Medicare & Medicaid Services (CMS). Accrediting Organizations (AOs). Accessed October 30, 2026. cms.gov.
7. Condition of participation: Infection prevention and control and antibiotic stewardship programs. 42 CFR §482.42. Electronic Code of Federal Regulations. Accessed October 30, 2026. ecfr.gov.
8. Sehulster L, Chinn RYW; Healthcare Infection Control Practices Advisory Committee (HICPAC). Guidelines for Environmental Infection Control in Health-Care Facilities. CDC; 2003 (updated July 2019). Recommendations.
9. Rutala WA, Weber DJ; Healthcare Infection Control Practices Advisory Committee (HICPAC). Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008. CDC. A rational approach to disinfection and sterilization.
10. Rutala WA, Weber DJ; HICPAC. Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008. CDC. Cleaning.
11. US Environmental Protection Agency (EPA). Selected EPA-Registered Disinfectants. Last updated August 24, 2026. epa.gov.
12. US Environmental Protection Agency (EPA). Introduction to Pesticide Labels. Accessed October 30, 2026. epa.gov.
13. Centers for Disease Control and Prevention (CDC). Chloramines and Pool Operation. Healthy Swimming. June 23, 2025. cdc.gov.
14. Angenent LT, Kelley ST, St Amand A, Pace NR, Hernandez MT. Molecular identification of potential pathogens in water and air of a hospital therapy pool. Proc Natl Acad Sci U S A. 2005;102(13):4860-4865. doi:10.1073/pnas.0501235102. Free full text: PMC555732. PubMed: 15769858.
15. Baier C, Ebadi E, Mett TR, et al. Epidemiologic and molecular investigation of a MRSA outbreak caused by a contaminated bathtub for carbon dioxide hydrotherapy and review of the literature. Can J Infect Dis Med Microbiol. 2020;2020:1613903. doi:10.1155/2020/1613903. Free full text: PMC7181014. PubMed: 32377283.
16. Rousseau C, Ginevra C, Simac L, et al. A community outbreak of Legionnaires’ disease with two strains of L. pneumophila serogroup 1 linked to an aquatic therapy centre. Int J Environ Res Public Health. 2022;19(3):1119. doi:10.3390/ijerph19031119. Free full text: PMC8834728. PubMed: 35162143.

How to cite this article

First published October 2026 · Permanent URL: https://www.aquatictherapyuniversity.com/blog/cleaning-disinfecting-aquatic-therapy-equipment

How to cite

ATU Educational Services, LLC. (2026). Cleaning and Disinfecting Aquatic Therapy Equipment: A Practical Plan. Aquatic Therapy University Blog. https://www.aquatictherapyuniversity.com/blog/cleaning-disinfecting-aquatic-therapy-equipment

Permissions: You may quote and cite this article with attribution. Reproducing or adapting the full article requires written permission from ATU Educational Services, LLC.

For education only; not a substitute for individual clinical judgment, your infection control team or legal advice.