Too Many People Are Using Neti Pots and Vaporizers Unsafely, Survey Suggests

Water straight from the tap needs to be boiled and cooled before using it for nasal rinses.

Editor’s note: A Florida resident died on February 20, 2023, after being infected with the “brain eating” amoeba Naegleria fowleri, according to local broadcaster Fox 4. The resident had reportedly been rinsing their sinuses daily with unboiled tap water. The Centers for Disease Control and Prevention (CDC) said in a statement to the station that this was the first reported case of the deadly N. fowleri infection in the United States in 2023.

Many people may be using water straight from the tap for neti pots, CPAP (sleep apnea) machines, vaporizers, and humidifiers, a practice that could put them at risk for acquiring serious and even potentially life-threatening infections, according to survey findings published in the February 2023 issue of Emerging Infectious Diseases, from the Centers for Disease Control and Prevention (CDC).

Using unsterilized tap water in equipment like a neti pot, a device for rising nasal passages to reduce congestion, is potentially risky because low levels of microorganisms remain in drinking water distribution systems and wells, according to the survey authors. These include biofilm pathogens, a type of germ that can stick to water pipes and infiltrate the water system.

The list of potential pathogens in tap water includes Pseudomonas aeruginosa, nontuberculous mycobacteria (NTM), Legionella spp., and Naegleria fowleri. These germs are responsible for a large portion of the 120,000 hospitalizations, 7,000 deaths, and billions in direct healthcare costs annually related to waterborne diseases, per the report.

Report Reveals Gaps in Knowledge About Tap Water Use in Medical Devices Used at Home

In August 2021, researchers from the CDC surveyed 1,004 people across the United States to find out people’s level of awareness regarding the risks of using tap water in medical devices like neti pots and CPAP (continuous positive airway pressure) machines.

About 1 in 3 people surveyed incorrectly answered that tap water does not contain bacteria or other living organisms.

Additional findings from the survey:

• Sixty-two percent of participants said (incorrectly) that tap water can be used for nasal rinsing.
• Fifty percent believed it was safe to rinse contact lenses with tap water, another no-no.
• Forty-two percent thought tap water was safe for use in respiratory devices such as vaporizers (often used to treat asthma, allergies, and bronchitis), humidifiers, or CPAP machines, which is also incorrect.

The findings suggest that many people aren’t aware of the risks of using nonsterile tap water for home medical devices, which could put them at risk for acquiring an opportunistic infection, according to the authors.

The elderly, people who have weakened immune systems, young children, and infants are at higher risk for having serious health complications or even death from a waterborne disease.

“This is an important topic, and this report does a good job of raising people's awareness of the importance of using sterilized water anytime they are washing out their airways or sinuses, and anytime they are adding water to their CPAP machine,” says Paul Pottinger, MD, professor of medicine in the division of allergy and infectious diseases at the University of Washington School of Medicine in Seattle. Dr. Pottinger was not involved in the research.

Why Is Tap Water Safe to Drink but Not Safe to Use in Home Medical Devices?

In general, our bodies are able to cope with commonplace germs in tap water. “Our intestinal system has a wonderful immune system that allows it to cope with microorganisms that may be contained in the water,” says Pottinger.

But of course, anyone who has gotten sick with acute gastroenteritis (also known as a stomach virus) when traveling abroad knows that sometimes tap water is not safe to drink, he says.

“Thankfully, here in the United States, we usually have access to water that is considered clean enough to be drinkable. This is usually called ‘potable water,’” says Pottinger.

But our bodies are more likely to have trouble when potable water containing unsafe germs comes into contact with the nasal passages or lungs, because the immune function of those areas is different than that of the intestinal system, Pottinger explains. “Unfortunately, we have lost patients to fatal infections.”

In Rare Cases, Using Unsterilized Tap Water in a Neti Pot Has Been Fatal

Death caused by improper use of a neti pot is rare, but it does happen. A 69-year-old Seattle woman contracted Balamuthia mandrillaris when she rinsed her sinuses with untreated tap water in a neti pot, according to a paper published in 2018 in the International Journal of Infectious Diseases (PDF).

Naegleria fowleri, commonly called a “brain-eating amoeba,” caused two deaths in neti pot users in 2011, according to a CBS report.

Acanthamoeba keratitis, a rare but serious eye infection, can cause blindness or other permanent eye damage, per the CDC. About 85 percent of people in the United States who get this infection are contact lens wearers, who may have cleaned their lenses with unsterilized tap water or contaminated or previously used contact lens solution, according to the agency.

How to Properly Treat Water Before Using in a Neti Pot or CPAP Machine

“The easiest way to sterilize water and make it suitable for use in a neti pot or CPAP machine is to bring it to a rolling boil for one minute and then allow it to cool to room temperature,” says Pottinger. That water will stay acceptable until it is used, so long as it is kept covered in a clean area, he adds.

You can also buy water that’s distilled or sterile, but make sure it clearly specifies that designation on the label, according to the CDC. “Sterilized water is water that has been treated, either by filtration or heat or chemicals, to kill any microbes that it contains. It poses no risk for infection even when administered into the sinus pathway,” says Pottinger.

But keep in mind, water doesn’t need to be sterile to be safe to drink, he says.