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Facts About...


What is it?

A waterpipe, also known as hookah, is an alternative smoking device. There are two types of material smoked in a hookah: herbal (with no nicotine or tobacco) or tobacco-based.

The Smoke-Free Ontario Act prohibits smoking of tobacco in enclosed public places/workplaces and prohibited places. The Act does not apply to waterpipe smoking in enclosed areas if the material is herbal and does not contain tobacco.

What are the risks?

  • There is potential for the risk for communicable diseases when using waterpipes. Infections such as tuberculosis, herpes, hepatitis and meningitis have been associated with the use of waterpipes. Using a disposable mouthpiece insert while sharing a waterpipe does not prevent the transmission of contagious diseases.
  • Waterpipe smoking can cause decreased lung function, lung cancer, respiratory illness, gum disease, heart disease and low birth weight.
  • Second-hand smoke from waterpipes is deadly because burning tobacco releases cancer- causing agents and the burning fuel (charcoal) emits toxins.
  • Even after it has been passed through water, the smoke produced by a waterpipe contains high levels of toxic compounds, including carbon monoxide, dangerous metals and cancer- causing chemicals.

Each client must be provided with their own waterpipe (head, body, hose, water bowl and mouthpiece) and a disposable mouthpiece insert for each visit and should not use and/or share equipment that has not properly been cleaned and disinfected between clients.

How is the waterpipe cleaned and disinfected?

    Waterpipe Diagram
  1. Dismantle the entire waterpipe (head, body, hose, water bowl, and mouthpiece) after each use.
  2. Clean all parts of the waterpipe (including the full length of the inner hose) using a detergent solution and a scrub brush. Ensure the brush can reach into the smallest parts of the waterpipe. Hoses (inside and outside) must be made with smooth nonabsorbent material, such as plastic and metal, that can be cleaned and disinfected.
  3. Rinse all parts of the waterpipe with clean water.
  4. Disinfect all parts of the waterpipe by using at least a low- level disinfectant, (if using chlorine bleach, mix 5 ml bleach in 2.5 L water, allow the waterpipe to remain wet for 10 minutes, then rinse all parts thoroughly with potable water). For all other disinfectants, ensure to follow manufacturer’s instructions for use, dilution and contact time.
  5. Air dry all parts and store in a clean and sanitary manner to prevent contamination until next use.

If the hose or any other parts of the waterpipe cannot be cleaned and disinfected as noted above, a single-use, disposable hose or part must be provided to each client.

Source: Adapted with permission from Simcoe Muskoka District Health Unit

More information can be obtained from

Durham Region Health Department, Environmental Help Line 905-723-3818 or 1-888-777-9613

January 6, 2017