Original Article

Providing Risk Management Model Using Mineral Spa Based on International Standards with Safety and Environmental Approach

Providing Risk Management Model Using Mineral Spa


The aim of this article was to present a model for measuring and managing the risk of using hot mineral spas, based on structural safety with environmental approach. A conceptual model of risk was prepared in four stages: 1) determining the general outline of the model, 2) identifying spa structure safety indicators, 3) evaluating and scoring the indicators and 4) determining the quantitative and qualitative categories of the model and providing solutions. In this study, 30 spa structure safety indicators were extracted, and the weight of each indicator was obtained based on the amount of risk for users. Moreover, a questionnaire was prepared by analytic hierarchy process analysis method. According to the standard level allowed for each indicator, spa structure safety risk categories were prepared in five ranges for each indicator based on the obtained weights and the opinions of health experts. The results of the risk associated with each spa were obtained by combining 30 spa structure safety indicators. To assess the risk of using hot mineral spas by the method invented in this study, first, the extracted model indicators were scored in six spas of Iran. Then, risk level of the six spas was evaluated. According to the risk scores, hot spas named Gavmishgoli and Qotoursoo had an unacceptable level of risk. Qinarjeh, Shabil, and Sabalan had a high level of risk. Borjloo had a moderate level of risk. The proposed risk model provides a framework for a standard and safe mineral spa.

Ghalamghash J, Mousavi S, Hassanzadeh J, Schmitt A. Geology, zircon geochronology, and petrogenesis of Sabalan volcano (northwestern Iran). J Volcano. Geotherm. Res. 2016; 327:192-207.
2. Hoseinpour R, Riyahi L. Relationship between medical therapy tourism and the rate of tourism attraction in Ardabil province. J Health. 2018; 9(2):159-171.
3. Araujo A, Sarraguça M, Ribeiro M, Coutinho P. Physicochemical fingerprinting of thermal waters of Beira Interior region of Portugal. Environ Geochem Health. 2017; 39(3):483-496.
4. Fazlzadeh M, Sadeghi H, Bagheri P, Poureshg Y, Rostami R. Microbial quality and physical–chemical characteristics of thermal springs. Environ Geochem Health. 2016; 38(2):413-422.
5. INSO. Tourism and related services - medical spas -Service requirements. INSO: 22715. Iranian National Standardization Organization; 2019.
6. Margarucci LM, Spica VR, Gianfranceschi G, Valeriani F. Untouchability of natural spa waters: Perspectives for treatments within a personalized water safety plan. Environ Int. 2019; 133.
7. World Health Organization (WHO). Guidelines for safe recreational water environments: Swimming pools and similar environments. World Health Organization; 2003.
8. Sadeghi H, BagheriArdebilian P, Rostami R, Poureshgh Y, Fazlzadeh M. Biological and physicochemical quality of thermal spring pools, with emphasis on Staphylococcus aureus: Sarein tourist town, Ardabil. J Env Health Eng. 2014; 1(3):203-215.
9. INSO. Tourism and related services –Hydrotherapy center – Hot and cold spring - General requirements and specifications. INSO: 20483. Iranian National Standardization Organization 2017.
10. INSO. Tourism and related services –wellness spa – Service requirements. INSO: 15572. Iranian National Standardization Organization 2018.
11. INSO. Swimming pools - general requirements. INSO: 11203. Iranian National Standardization Organization 1992.
12. Team EE. Comprehensive guidance to reduce infection risk from spa pools and whirlpool baths.

Europe's Journal on Infectious Disease Surveillance, epidemiology, prevention.. 2006; 11(11):2925.
13. Gholami PS, Nassiri P, Yarahmadi R, Hamidi A, Mirkazemi R. Assessment of health, safety and environment management system function in contracting companies of one of the petro-chemistry industries in Iran, a case study. Saf Sci. 2015; 77:42-47.
14. Lund JW. Balneological use of thermal waters. Geo-Heat Center Quarterly Bulletin. 2000; 21(3).
15. Sevillano D, Romero-Lastra PT, Casado I, Alou L, González N, Collado L, Dominquez A, Arias CM, Corvillo L, Armijo F, Romero M, Maraver F. Impact of the biotic and abiotic components of low mineralized natural mineral waters on the growth of pathogenic bacteria of human origin: a key to self-control of spa water quality. J Hydrol. 2018; 566:227-234.
16. Serbulea M, Payyappallimana U. Onsen (hot springs) in Japan—transforming terrain into healing landscapes. Health Place. 2012; 18(6):1366-1373. doi:10.1016/j.healthplace.2012.06.020.
17. Mirhosseini SM, Moattar F, Negarestani A, Karbasi AR. Role of hot springs’ hydrochemistry in Balneotherapy, Case Study: Fotoyeh and sanguyeh springs, western Hormozgan. Hormoz Med J. 2015; 19(3):194-203.
18. Ncube S, Mlunguza NY, Dube S, Ramganesh S, Ogola HJO, Nindi M, Chimuka L, Madikizela LM. Physicochemical characterization of the pelotherapeutic and balneotherapeutic clayey soils and natural spring water at Isinuka traditional healing spa in the Eastern Cape Province of South Africa. Sci Total Environ. 2020; 717:137284.
19. Armstrong TW, Haas CN. Quantitative microbial risk assessment model for Legionnaires' disease: assessment of human exposures for selected spa outbreaks. J Occup Environ Hygiene. 2007; 4(8):634-646.
20. Valeriani F, Margarucci LM, Romano Spica V. Recreational use of spa thermal waters: criticisms and perspectives for innovative treatments. Intl J Environ Res Public Health. 2018; 15(12): 2675.
21. Glavaš N, Mourelle ML, Gómez CP, Legido JL, Šmuc NR, Dolenec M, Kovac N. The mineralogical, geochemical, and thermophysical characterization of healing saline mud for use in pelotherapy. Appl Clay Sci. 2017; 135:119-128.
22. Stanhope J, Weinstein P, Cook A. Health effects of natural spring waters: a protocol for systematic reviews with a regional case example. J Integr Med. 2015; 13(6):416-420.
23. Erfurt PJ. An assessment of the role of natural hot and mineral springs in health, wellness and recreational tourism. Phd thesis, Cairns, Australia: James Cook University, 2011.
24. Purdy G. ISO 31000: 2009—setting a new standard for risk management. Risk Analysis Int J. 2010; 30(6):881-886.
25. Hamzah Z, Rani N, Saat A, Wood AK. Determination of hot springs physico-chemical water quality potentially use for balneotherapy. Malaysian J Anal Sci. 2013; 17(3):436-44.
26. Nowicki P, Simon A, Kafel P, Casadesus M. Recognition of customer satisfaction standards of ISO 10000 family by spa enterprises–a case study analysis. Tech methodol qual. 2014; 92(5):91-105.
27. Gallè F, Dallolio L, Marotta M, Raggi A, and Di Onofrio V, Liguori G, Toni F, Leoni E. Health-related behaviors in swimming pool users: Influence of knowledge of regulations and awareness of health risks. Intl J Environ Res Public Health. 2016; 13(5):513.
28. Hang C, Zhang B, Gong T, Xian Q. Occurrence and health risk assessment of halogenated disinfection byproducts in indoor swimming pool water. Sci Total Environ. 2016; 543:425-31.
29. Newbold J. Management of spa pools: controlling the risk of infection. Health Protection Agency, London, United Kingdom. 2006.
30. Pantelić NĐ, Jaćimović S, Štrbački J, Milovanović DB, Dojčinović BP, Kostić AŽ. Assessment of spa mineral water quality from Vrnjačka Banja, Serbia: geochemical, bacteriological, and health risk aspects. Environ Monit Assess. 2019; 191(11):648.
31. Ristić D, Vukoičić D, Nikolić M, Milinčić M, Kićović D. Capacities and energy potential of thermal-mineral springs in the area of the Kopaonik tourist region (Serbia). Renewable Sustainable Energy Rev. 2019; 102:129-38.
IssueVol 13 No 1 (2021) QRcode
SectionOriginal Article(s)
Balneotherapy Safety Risk model Thermal spring

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How to Cite
Mohammad Hoseini T, Saadati H, Nasehi F, Nasl Seraji J. Providing Risk Management Model Using Mineral Spa Based on International Standards with Safety and Environmental Approach. Int J Occup Hyg. 2021;13(1):22-37.