Original Research
Environmental Health & Infectious Disease

Shisha — The Hazardous Pastime: Microbial Investigation of Shisha Apparatus in Public Cafés in the UAE

Summary

Waterpipe tobacco smoking, commonly known as shisha or hookah, has experienced a dramatic increase in popularity across the Middle East, particularly in the Gulf Cooperation Council (GCC) countries. This social practice, often perceived as less harmful than cigarette smoking, involves the passage of tobacco smoke through water before inhalation. However, the communal nature of shisha smoking in public cafés—where the same apparatus is shared among multiple patrons—raises significant public health concerns regarding the transmission of infectious agents.

This study, published in the Malaysian Journal of Public Health Medicine, represents one of the few investigations specifically examining the microbial contamination of shisha apparatus in the United Arab Emirates. Led by researchers from Canadian University Dubai and Ajman University, the investigation sought to determine whether the shared use of waterpipes could facilitate the spread of pathogenic microorganisms among smokers in public café settings.

Study Design and Methodology

The research team employed a cross-sectional design, collecting a total of 110 samples from different components of used shisha apparatus across public cafés in seven cities within the UAE. The sample collection period spanned from November 2016 to February 2017. Samples were obtained from various parts of the shisha apparatus, including the mouthpiece, hose, water bowl, and other contact surfaces that would be exposed during normal use.

Microbiological analysis was conducted at Canadian University Dubai laboratories using established protocols for culturing, isolating, and identifying bacterial and fungal organisms. Following initial identification, samples were transferred to Iranian Hospital Dubai for antibiotic sensitivity testing to determine the resistance profiles of isolated bacterial strains against commonly used antibiotics. Statistical analysis employed quantitative data methods, with results expressed as percentages.

Microbial Findings

The investigation revealed the presence of five distinct bacterial strains across the sampled shisha apparatus. These organisms represent a range of pathogenic potential, from opportunistic environmental bacteria to clinically significant pathogens.

Antibiotic Resistance Implications

Perhaps the most alarming finding of this research was the detection of methicillin resistance in the Staphylococcus saprophyticus isolate. Methicillin-resistant staphylococci pose a significant clinical challenge because they are resistant to beta-lactam antibiotics, which are first-line treatments for many staphylococcal infections. The identification of such resistant organisms on shared recreational equipment highlights a potentially underrecognized route of transmission for antimicrobial-resistant bacteria.

The presence of antibiotic-resistant bacteria on shisha apparatus is particularly concerning given the growing global threat of antimicrobial resistance. The World Health Organization has identified antimicrobial resistance as one of the top ten global public health threats, and the finding of resistant organisms in everyday social settings underscores the breadth of this challenge.

Public Health Context

The growing popularity of shisha smoking, particularly among younger demographics and increasingly among women in GCC countries, amplifies the public health significance of these findings. Unlike cigarettes, which are used individually, shisha pipes are frequently shared in social settings, creating opportunities for person-to-person transmission of microorganisms through contaminated mouthpieces, hoses, and water.

Previous research on waterpipe microbiology has confirmed the presence of biofilm formation within shisha water bowls, suggesting that microbial colonization of these devices may be persistent and difficult to eliminate through routine cleaning. Studies examining shisha water have identified multiple gram-negative organisms, including Pseudomonas aeruginosa, with lipopolysaccharide (LPS) in their cell walls potentially contributing to chronic airway disease through repeated inhalation of bacterial aerosols.

The combination of chemical toxicants in shisha smoke and microbial exposure creates a compound risk for smokers. While the chemical hazards of waterpipe smoking—including carbon monoxide, heavy metals, and carcinogenic compounds—have received considerable attention, the infectious disease dimension has been relatively underexplored.

Implications for Public Health and Policy

The findings of this study carry several important implications for public health authorities and regulatory bodies in the UAE and similar regions where shisha smoking is prevalent. First, they support the development of mandatory hygiene standards for shisha establishments, including requirements for thorough disinfection of apparatus between users and, where possible, the provision of individual disposable components.

Second, these results bolster the case for public health campaigns that communicate the infection transmission risks associated with shared shisha use, complementing existing messaging about the chemical and respiratory hazards of waterpipe smoking. Third, the detection of antibiotic-resistant organisms on shisha apparatus suggests that antimicrobial resistance surveillance programmes should consider communal recreational equipment as a potential environmental reservoir.

Limitations

Several limitations should be considered when interpreting these findings. The study employed a convenience sampling approach across seven UAE cities, which may not be fully representative of all shisha establishments nationwide. The sample collection period of four months may not capture seasonal variations in microbial contamination. The study did not assess the cleaning and hygiene practices of individual cafés or correlate microbial findings with specific sanitation protocols. Additionally, the investigation focused on culturable bacteria and fungi, meaning that non-culturable organisms or viruses—which could also pose health risks—were not assessed. Future research should consider the use of molecular techniques to provide a more comprehensive picture of the microbial ecology of shisha apparatus.

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