Scuba Diving Equipment: Is Your Gear Making You Sick?

What should you do if you run out of air? This has always been one of the most frequently asked and significant questions for new and experienced divers. Even more so today. Not because the answers have changed, but rather because our understanding of the out-of-air situation and the way divers are equipped have evolved. As a result, the choice of which ascent you make and how you make it may be completely different today than it was a few years ago.

During certification course we learn about air embolism, decompression sickness, squeezes and other injuries we can cause to ourselves while diving. But what about illnesses others could cause to us? Detailed information about diseases that can be transmitted by dive equipment is rarely provided in certification courses for one simple reason: we have only incomplete answers to the most basic questions:

• To what extent are we at risk of passing disease while scuba diving?
• What can be done to prevent the passing of disease?
• What is the best way to disinfect scuba equipment?

No one knows the exact degree of risk, but it is thought that the incidence of what is now being called “scuba disease” is under-reported because its symptoms occur after an incubation period and are often attributed to another cause. Although no good statistics exist, the fact that previously healthy divers complain of respiratory and flu-like illnesses after diving suggests the possible presence of disease-causing microorganisms in their scuba gear. It’s only reasonable that we make ourselves aware of potential risks and develop practical ways of dealing with them.

Who’s Getting Sick from What?

Let’s start with what you cannot contract from dive gear – the AIDS virus. The U.S. Surgeon General and the Centers for Disease Control agree that HIV cannot be transmitted by shared scuba diving equipment.

What can divers contract? Snorkels, BC oral inflators, masks and protective suits have all been implicated in some illnesses or skin diseases. Fortunately, most of these problems have come from specific sources – allergic reactions, irritation, improper fit, misuse, urination in suits – and can be resolved with proper selection, fit, use and care.

The more difficult challenge is the host of flu-like symptoms (fever, chills, body aches, headaches, coughing and nausea) and respiratory infections from microbes that can survive inside the dark, moist confines of a regulator’s second stage.

The good news: Medical studies into regulator-related scuba illnesses were conducted by the U.S and Australian navies in the 1950s and 1960s in an era when use of double-hose regulators amplified the space in which germs could breed. The studies led to disinfection procedures that all but eliminated these diseases.

The not-so-good news: These procedures are not in widespread use by the dive industry or by recreational divers. The result is that divers need to know what steps they can take to protect themselves from potential illness from regulators and other scuba equipment.

Step 1: Own It

By being the sole user of an item of equipment, you eliminate the possibility of another user passing on disease-causing organisms to you. It’s well accepted that owning your own equipment makes diving more comfortable and convenient. But it also makes diving more healthy. By using only your own gear, you avoid transmitting or contracting scuba diseases, while improving the comfort and fit of the equipment you use. The overall result is that you increase your enjoyment while protecting your health.

Step 2: Don’t Share It

There is already a very good reason not to loan out your personal life-support equipment, not even to your best buddy: Doing so is potentially unsafe for you both. You’ve configured your gear for your personal needs and style, not your buddy’s. Also, something could happen to your gear without your knowledge that may affect its performance. To that list add the fact that sharing gear means you will most certainly share germs.

In training, the obsolete practice of buddy breathing, when divers pass a primary regulator back and forth, presents one of the higher risks of disease transmission. Not only is the use of an alternate air source during training and actual emergencies today’s preferred technique, it also reduces the likelihood of spreading illnesses. Of course, in an out-of-air emergency the first priority is to get air, not to worry about catching someone else’s cold germs.

Step 3: Use Protection

To lessen the possibility of disease transmission, some dive stores either provide each new user of a rental regulator with a personal regulator mouthpiece or require the user to buy one. To make changing mouthpieces faster and easier, Scubapro now manufactures a reusable Quick Release Mouthpiece Clip.

Another device now on the market is the mouthpiece shield. The ScubaGuard by Amoeba has been nicknamed the “scuba condom.” It is a disposable latex cover that goes over the regulator or snorkel mouthpiece. The ScubaGuard does not fit specialty mouthpieces or those that have any additional structure, such as Sea Quest’s and U.S. Divers’ Comfo-Bite mouthpiece. When ScubaLab tested the ScubaGuard on a breathing machine, we found that if the cover extends into the airway of the mouthpiece it will increase breathing resistance. After consultations with ScubaLab, Amoeba has enlarged the hole in the ScubaGuard to reduce the likelihood of this happening. Keep in mind, however, that changing and covering mouthpieces does not protect against organisms that may breed inside the regulator’s second stage.

Step 4: Keep It Clean

Rinsing your gear in fresh, warm water after each dive (even if you dived in fresh water), followed by air drying, should be enough to prevent disease for a healthy diver who is the single user. While this kind of normal equipment care is not specifically meant to kill germs, it does make conditions less hospitable for bacteria, as does a technician’s annual cleaning, servicing and adjustment of your regulator. Detergents, a distilled white vinegar soaking or commercial ultrasonic cleaners (a vibrating chemical bath) will do an even better job than plain water. Just remember that no cleaning agent is guaranteed to kill viruses and bacteria unless it is also a disinfectant.

Step 5: Kill, Kill, Kill

The only way to kill these nasty critters is with a chemical disinfectant or sanitizer. Unfortunately, we could find no manufacturer with an environmentally friendly, easy-to-use cleaner and disinfectant for use by recreational divers. Indeed, few manufacturers endorse any specific cleaner at all for recreational dive gear. Of the manufacturers who do, most of their recommendations are for ultrasonic cleaners or detergent washes, not disinfectants.

Some disinfectant chemicals on the market can damage or break down regulator components if you leave them in the solution too long. Many disinfectants can be toxic if not handled, rinsed off and disposed of properly. Be sure to read all directions and warnings, and follow them.

One of the most common and safest disinfectants is a diluted household bleach solution. The CDC recommends one-quarter cup of bleach to one gallon of water and a soaking time of up to 10 minutes. Other disinfectants we recommend: West Penetones’ Wescodyne (sanitizer and disinfectant), SC Johnson Professional’s J-152 (sanitizer), Texas Gulf Industries’ Santimine 150 (sanitizer) and Timsen.

Step 6: Start Healthy to Stay Healthy

Finally, the healthier you are, the better you can ward off disease. Your short-term fitness on a dive trip is important in prevention, so eat well, get rest, go easy on alcohol, and avoid anything that may wear you down, such as late nights, sunburn and dehydration.

Saltwater Aspiration Syndrome

So you’ve made the inside of your regulator cleaner than an operating room, but you still have symptoms of scuba disease after diving. It might not be bacteria in your regulator, but salt water in your lungs that’s to blame.

Divers can experience flu-like symptoms and short-term respiratory distress when even small amounts of saltwater mist is inhaled into the lungs. It’s called saltwater aspiration syndrome, and here’s how to avoid it.

• Buy a better regulator. Given today’s affordable, state-of-the-art regulators, there’s no reason to use one that’s not up to par. Before you buy a regulator find out how dry it breathes. We’ve found wide variations in the dryness of regulators. In general, all regulators will have a more difficult time staying dry when you are in odd positions (upside down, on your back, etc.) or just after you have replaced the regulator in your mouth, but top performers keep this to a minimum.
• Have your regulator serviced regularly. Pay particular attention to the mouthpiece, exhaust non-return, and diaphragm. Some regulators breathe wetter due to the non-return exhaust valves not seating as well as they should. Proper maintenance can help prevent this. If your regulator is breathing wet, try this simple test: With no air pressure to the regulator and the first-stage dust cap firmly in place, exhale forcefully through the second stage and then inhale forcefully. You should get no air on the inhale. If your regulator doesn’t pass the test, have it serviced before diving.

• Keep your reg in your mouth as much as possible. The best way to keep your regulator breathing dry is to keep water out of the second stage. Use your power inflator, not your oral inflator, to minimize the number of times you remove your second stage from your mouth. Enter and exit the water with your reg in your mouth and use your regulator on the surface during rough water conditions. Do not buddy breathe to share air, but use an alternate air source.
• Always exhale before you inhale on a regulator. If you are clearing a regulator in the water, take your first breath cautiously. If any water remains in the second stage, tilt your head so the exhaust is at the lowest point, helping to drain the rest of the water out. The best method for clearing a regulator: put the second stage in your mouth, tilt your head so the exhaust is at the lowest point, then exhale while gently pushing the purge button.
• Keep your mouth shut. Even if your regulator is working properly, you will inhale a saltwater mist if you do not keep your mouth firmly sealed around the mouthpiece.

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