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CONSIDINE & FUREY, LLPCOUNSELORS AT LAWONE BEACON STREET, 22nd FLOORBOSTON, MA 02108Kevin M. Considine, Esq.Telephone: (617) 723-7200kconsidine@Telecopier: (617) 723-5700October 6, 2017By EmailDepartment of Public Health250 Washington StreetBoston, MA 02108Reg.Testimony@state.ma.usRe: Proposed Amendments to 105 CMR 435.000: Minimum Standards for Swimming Pools.Dear Sir/Madam:Please be advised that Considine & Furey, LLP represents the following entities in the submission of this written testimony concerning the proposed amendments to 105 CMR 435.000: Minimum Standards for Swimming Pools:Float BostonFrost and Float Spa Float Above515 Medford Street1201 Washington StreetSomerville, MA Somerville, MA West Newton, MA Go With The FloatFloat Tank AssociationUmbra Heavy Industries, Inc. Northampton, MA San Francisco, CALincoln, NEAt Peace Float CabinsWave Float Rooms LLCZero Gravity Float Rooms Colleyville, TXClarence, NYAustin, TXPro Float Inc.Ocean Float Rooms Ltd. Blue Water WellnessChilliwack, BC, CanadaLondon, UKNewburyport, MA The latest Department of Public Health (“DPH”) amendments to 105 CMR 435.000 provide separate regulations for float tanks. There are only a few small businesses in Massachusetts that provide floating therapy services to customers using float tanks. Float tanks, however, are very different from swimming pools and hot tubs. Therefore, it is extremely important to those businesses that float tanks have a separate set of regulations and are treated independently. As further explained below, many regulations for swimming pools and hot tubs are unnecessary for float tanks and certain regulations would make the floating business economically unfeasible.Because we have serious concerns that adopting the proposed regulations will have a significant negative impact on the present floating therapy industry, we respectfully request a meeting to discuss in further detail the comments below.A.FloatingFloating is a relaxation technique in which a person spends an hour or longer in an Epsom salt bath with minimal sensory stimulation. The tub or tank is kept dark and as quiet and still as possible. This allows the body’s adrenaline response to disengage and relaxation response to take over, reducing stress and anxiety levels and allowing access to meditative states. A typical float tank is seven to eight feet long, four to five feet wide, and contains less than 12” depth of Epsom salt solution. The solution is kept as concentrated as practical without resulting in precipitation or crystallization; typically this means a specific gravity in the range of 1.23 to 1.27, comparable to the Dead Sea. This results in a floating medium that is 40-50% Epsom salt by mass. The solution is kept near skin temperature (93–94?F) to minimize the sensation of temperature and make it safe to float for indefinite periods of time. Float tanks were developed in the late 1950s in university psychology departments, notably CalTech, and have been studied extensively since then. They have been commercialized for use by the public since the early 1970s, and by 1981 there were $4 million in sales in the industry. After some quiet years, the benefits of floating are being rediscovered by the general public, and the industry has been in resurgence for the last decade in many countries including the USA, Canada, United Kingdom, Australia, Sweden and Germany.B.Floating is different from swimming pools and hot tubs42576751212851.Concentrated Epsom Salt Solution a.Hostile medium for pathogen growthFloating is done in Epsom salt (magnesium sulfate) solutions at specific gravities exceeding 1.23. At this density, the solution is in excess of 40% Epsom salt by mass. It is a relatively inhospitable medium for pathogen growth even before any sanitizer or oxidizer is added. Challenge tests performed by NSF International for the Float Tank Association show that for instance Pseudomonas aeruginosa suffers a 6.42 log10 kill after 24 hours in float tank solution, even with no disinfectant added.Not all microbes are killed by saltwater. Hardy bacteria like Enterococcus faecium can survive in float solution, so active disinfection is still necessary and used.b.No ingestion of water, cuts are covered, and no submersion of the headIn swimming pools, the eyes, nose, mouth and ears are well documented points of contact with aquatic pathogens. Swimmers spend most of their time with their heads near the pool surface which increases the likelihood of contact with floating contaminants.In flotation, one never floats on her side or stomach so the eyes, nose and mouth always remain above the water. The float solution is extremely bitter to the taste so patrons will very diligently avoid taking any into the mouth or ingesting it, or allowing any eye or nose contact. They will cover small scrapes, and will not enter with any open wound. If float solution does accidentally contact these sensitive areas, sharp discomfort (stinging) ensues and the patron will very likely need to rinse the area immediately. This would remove any pathogens that might be present. Additionally, standard practice for float operators is offer disposable ear protection to the patrons which will prevent entry of water into the ear canal (earplugs also mitigate stray sounds and improve the float experience).2.Required User Practicesa.Sequential UseSince float tanks are typically occupied by only one person at a time, there is no route of infection from one occupant directly to a neighbor. A filtration and purification cycle run between successive patrons can efficiently limit cross-contamination provided it achieves 3–4 full turnovers of the float solution. Running filtration only while a tank is unoccupied between patrons eliminates any hazard of entrapment or hair entanglement.b.Necessary ShoweringPatrons emerge from the float tank covered in salt solution. The quantity is sufficient that if they simply dry off and do not shower, they’ll end up with an irritating salt crust over most of their body; therefore they are extremely likely to shower after their float thus mitigating the skin transmission route.c.Low Bather LoadCompared to pools and spas, float tanks have extremely low bather loads. They are typically used by at most one person every 90 minutes to 2 hours (allowing for a cleaning cycle between patrons), or only six to eight patrons a day. Patrons float quietly, making no exertion. Water temperature is such to minimize sweating. There is no reason to wear sunscreen. They are usually personally instructed to shower before entering the tank. They usually do not wear swimsuits, eliminating another path for contamination.d.User ProfileFloating is a relatively expensive practice. This tends to limit use to an older and more mature audience than typical of swimming pools or hot tubs. In particular, children are rare and infants are not allowed. Because patrons float alone, there is no party atmosphere to encourage irresponsible behavior. Patrons are significantly more likely to follow instructions requesting them to shower before entering their tank. Patrons who have paid $50 and up for a session are much more likely to value the experience and the cleanliness of the tank. Because tanks are quite small, patrons are unlikely to consciously contaminate the water they will be laying in for the next hour.3.Environment and Operationa.EnclosureFloating is always conducted indoors, in private spaces well separated from common areas. Float tanks are usually fully enclosed, raising the relative importance of air quality inside the tank. Sufficient ventilation must be provided to prevent excessive CO2 buildup. Use of chlorine should be kept to the minimum necessary level to avoid causing respiratory distress in sensitive patrons. b.InspectionFloat tanks are visually inspected between successive float sessions as part of cleaning and preparing the room for the next appointment. This makes it likely that a fecal or other contamination incident is found before any other person is exposed.c.DilutionEvery time a patron exits a float tank, they carry salt and water away with them. These amounts are noticeable in the small volume of a typical float tank, and require additional fresh water and Epsom salt to be added on a regular basis, approximately weekly, to maintain the tank depth and specific gravity.ments of Proposed Regulations1.435.060 (A)(7) Minimum turnovers between float sessionsIn the low-hazard environment of a float tank, we recommend that three turnovers of the float solution through the filtration system between sessions, rather than five, is a conservative and appropriate standard, supported by real-world experience. It is our understanding that five turnovers gets you to 99% theoretical filtration while three turnovers brings you to 95%, but we have not seen information showing that 99% is safe while 95% is not. Even if a contamination incident should occur, the subsequent turnovers would exceed 99% filtration on the next cycle, as the tank is filtered after each session.It is very common for float centers to have 15 minutes of filtration time built into their schedule. Manufacturers know this and typically build their systems to achieve three turnovers in 15 minutes. Bumping this up to five turnovers would either require float centers to overhaul all of the sanitation equipment to be able to achieve five turnovers in 15 minutes, or to extend their filtration time, leading to a reduction in the amount of floats they can offer in a day. At Float Boston, for example, this would require either spending $40,000 to upgrade the equipment or losing 10% of our possible income. Until there is further research clearly showing that five turnovers are necessary for the base level of safe practice we would like to see this remain at three turnovers.In addition, the DPH should be aware that new float tank systems are becoming available in which the entire quantity of solution can be emptied to an external vat after each use and returned to the float tank through the filtration system. This guarantees 100% filtration, in which case a single turnover should be accepted as sufficient.2.435.060 (B) Compliance with NSF/ANSI 50Requiring NSF/ANSI 50 certification of float tank recirculation and filtration components is burdensome for float tank operators.??The only equipment available with?NSF/ANSI 50 certification is designed for large public swimming pools.??It can be extremely expensive in the context of a float tank, especially when a tank operator needs to?acquire multiple copies of the equipment to manage multiple float tanks. Preferred equipment like magnetic drive pumps are not available at all with NSF/ANSI 50?certifications.??In particular, certified UV sanitizers and ozonators cost $8000 to $10,000 more, each, than non-certified versions, as they are required to have features and capacity to support?very large pool systems.??They are over-built for a small float tank.??Then, one of the difficulties of running a float center is that each tank typically includes its own filtration?system, so the cost of an expensive piece of equipment must be multiplied by the number of tanks in the facility.??The resulting balance of equipment cost to income can be?much different than for other types of pools.??At the same time, the float industry is currently relatively small compared to other recreational water, and as a result?manufacturers of filtration and sanitation equipment do not yet have much incentive to make equipment specifically for float tanks.The industry is still small, though growing rapidly, and the manufacturing base for these important equipment items is not yet mature.??The NSF is working on a new?CCS (16534) for UV and ozone units that would be more appropriate to the needs of float-tank-sized systems.??Though we understand and support the desire to regulate a?minimum standard for float tank sanitation systems, it would be much preferable to wait until a more appropriate standard is published and available.??In the meantime, it?would be reasonable to require tank manufacturers to state in writing that the device will function as intended in the provided float tank environment. Sanitation efficacy can?further be validated by bacteriological testing of float tanks.We request that the regulations allow that in float tanks, recirculation and purification equipment may be used if the component is certified under NSF/ANSI 50, or with?written assurance from the manufacturer of the float tank that it is appropriate for use with that recirculation and filtration system.3.435.290 Disinfectant ResidualsThere are several concerns with mandating chlorine or bromine as primary disinfectants in float tanks. To begin with, widespread industry experience and also a study done by NSF International found that most chlorine and bromine test kits are inaccurate in floatation tank solution, especially at concentrations below 5 ppm. Residual levels of these chemicals therefore cannot be effectively monitored or managed. Conversely, one manufacturer confirms that its hydrogen peroxide test does work in float tank solution. Halogen effectiveness requires further chemical addition to balance pH and total alkalinity, both of which also cannot be accurately measured in the float solution. Disinfection byproducts created from halogen use have been shown to be linked to respiratory health concerns and mutagenicity. While no study on disinfection byproducts has been performed specifically on floatation tanks, the enclosed nature and passive air flow systems found on many float tanks raises a concern that this problem could be especially pronounced in this environment, both for the public who use the float tanks for long periods of time, and for the staff in float centers who are continuously in that environment. Bromine use in pool and spa settings also offers relatively poor control of Pseudomonas aeruginosa, and is more commonly associated with dermatoses. Because float tanks are generally used by a single patron at a time, the direct infection path between occupants does not exist, and the need to maintain a killing residual in the float solution is not present. Further, the EPA has expressed the opinion that float tanks are not a type of swimming pool, and therefore chemicals including chlorine, bromine and hydrogen peroxide are not approved for use in float tanks under the Federal Insecticide, Fungicide, and Rodenticide Act. For all these reasons, jurisdictions such as Washington State have specifically not recommended the use of chlorine or bromine as float tank sanitizers or disinfectants. The Float Tank Association recommends the use of one of the following for sanitation of float tanks: ultraviolet light, ultraviolet light in conjunction with hydrogen peroxide, ultraviolet light in conjunction with ozone, or ozone alone. a.Other considerations If the Department believes that halogen disinfection must be used despite the problems and uncertainties described above, then some other factors should be considered. It is desirable to keep the chlorine levels in float tanks as low as practical if their use is required. Germany and Canada allow even swimming pools to operate with 0.5?ppm residuals, provided appropriate pH levels are used. Lower pH levels are known to improve the effectiveness of chlorine as a disinfectant, and there is generally no problem with operating a float tank with a pH as low as 6.5. Concentrated Epsom salt solution is already highly irritating to the eyes and nose, and is sufficiently corrosive to unprotected metal components that a slight extra acidity is of no significant concern. We therefore recommend that, if chlorine be required as a disinfectant, the operational level should be 0.5–2.0?ppm with a pH of 6.5–7.5.4.435.320 Float Tank Operationsa.Section (A) Signatures for OrientationsIn all cases, a float operator provides orientation to new patrons before their first float session. It does not seem that any benefit is served by requiring signatures of the operator and the user. Section (A)(2) of 435.320 should be dropped as unnecessarily burdensome to the operator.b.Section (B)(1) Frequency of DrainingDraining and refilling float tank solution every 14 days is unnecessarily and exceptionally burdensome to the operator, and no evidence exists that it is necessary. The North American Float Tank Association knows of no other jurisdiction in the world that mandates draining so frequently.In order to maintain the specified minimum specific gravity of 1.23, a float tank must contain 800 or more pounds of Epsom salt. This amount of salt is expensive to replace, costing $400 to $800, when purchased in bulk shipped to Massachusetts, depending on the grade of salt purity expected. In addition, dissolving that much salt is a time-consuming process of many hours, and since the process is endothermic, additional hours of heating time are required to bring the solution up to operating temperature. Float tanks would need to be taken out of service for at least a full day twice every month to meet this requirement.As discussed above, the experience and best practice of the float industry going back four decades indicates instead that replacement every 180 days is reasonable and sufficient for sanitation in the context of a concentrated Epsom salt float solution. Ultimately, the real way to validate the quality of float tank water is to test regularly against bacteriological standards.The Washington State Guidelines for Regulating Floatation Systems does not mandate a solution replacement frequently, but instead requires testing for Heterotrophic Plate Count and Total Coliform, performed monthly for the first six months of operation as a business, and with approval from the Board of Health, every six months thereafter. We support this as an appropriate measure to minimize hazard to the public. c.Maximum Operating TemperatureIt should additionally be specified that the maximum safe operating temperature for a float tank is 96?F. Any tank exceeding this temperature should be closed immediately until the temperature is reduced.d.Maximum Operating DepthFor safety, it would be appropriate to add a requirement that the maximum operating water depth in a float tank be twelve or fifteen inches, measured from the water line to the deepest point of the basin. With water density maintained above 1.23, this depth is sufficient for floating, but still allows a patron to easily sit upright when desired.e.Visual InspectionIn order to insure that a contamination event is caught promptly, the float tank basin should be visually inspected after each successive use.Respectfully submitted,COLIN ROALD, Float BostonSARA GARVIN, Float BostonCRISTINA BASTIANELLI, Frost and Float Spa DAVID BASTIANELLI, SR, Frost and Float Spa DAVID BASTIANELLI, JR, Frost and Float Spa DINA BASTIANELLI, Frost and Float Spa STEPHEN BRYLA, Go With The Float BRIAN HUFF, Float AboveMARINDA RIGHTER, Float AboveASHKAHN JAHROMI, Float Tank AssociationGRAHAM TALLEY, Float Tank AssociationKEVIN JOHNSON, Zero Gravity Float RoomsPETE O’BRIEN, At Peace Float CabinsCRAIG SILVER, Wave Float Rooms LLCJEREMY WARNER, Umbra Heavy Industries, Inc.CHRIST PETROVICS,?Pro Float Inc.?CHRIS KOSTER,?Ocean Float Rooms Ltd.KELSEY CORREIA, Blue Water WellnessBy their Attorney,/s/ Kevin M. ConsidineKevin M. ConsidineCc: Commissioner, Monica Bharel, MD, MPH General Counsel, Margret Cooke ................
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