Are public pools a growing health threat?

Although the number of violations reported in inspections across the country is alarming, CDC researchers say they are not that different from rates over the last 40 years.
By Stephen Feller  |  Updated June 3, 2016 at 9:15 AM
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WASHINGTON, June 3 (UPI) -- Parents have a lot to worry about when chasing their children around. Monitoring safety is a big part of the job, but the U.S. Centers for Disease Control and Prevention suggests parents go even farther, checking water at pools and being aware of safety equipment.

More than 1 of every 10 public aquatic centers in the United States was closed in 2013 for water quality or safety violations, according to a recent report from the U.S. Centers for Disease Control and Prevention.

Researchers requested inspections from 2013 for about 40 percent of the nations' pools -- found in Florida, California, Arizona, New York and Texas -- receiving and reviewing inspections for about 15 percent of the public pools across the country, discovering nearly 80 percent of inspection reports included an average of two violations per facility.

Media coverage warned of "dirty" public pools full of bacteria as the summer swimming season approaches.

Just under 12 percent of inspected facilities had disinfectant concentration violations, which can result in outbreaks due to bacteria, fecal matter or other infectious outbreaks, while nearly 13 percent of facilities had safety equipment violations and 5 percent had pool chemical safety violations.

While 650 disease outbreaks have been linked to aquatic facilities since 1978, there were between 3,000 and 5,000 emergency room visits related to pool chemicals from 2003 to 2012 and there are about 4,000 deaths per year due to drowning -- the leading cause of death for children between 1 and 4 years old.

While the new study is alarming, the CDC found closure, contamination and safety rates were overall similar to those found in much smaller studies during the last 40 years -- which does not make the statistics more comforting, but they're not an unexpected revelation.

"I think the numbers are concerning," Michelle Hlavsa, chief of the CDC's Healthy Swimming Program, told UPI. "We need to be clear on how we're communicating what we found. So when we say this number found at least one violation, that violation can be anything."

The recent study, published by the CDC as part of its Morbidity and Mortality Weekly Report, is the first of its kind produced by the agency since creating the Network for Aquatic Facility Inspection Surveillance in 2013 to monitor inspections after nearly a decade of gradually increasing reports of outbreaks. The creation of NAFIS led to the CDC working with the New York State Department of Health to create the Model Aquatic Health Code in 2014, a set of recommendations for best practices among municipalities responsible for aquatic facilities such as pools and water parks.

For the report, researchers requested inspection reports for 16 counties in the five states, receiving them from nine. Some counties missed the deadline for submission, in many cases because they could not access or gather the data in time.

Based on the review of inspections for 15.7 percent of the 309,000 public aquatic venues in the United States, 78.5 percent of reports contained data that could lead to immediate closure, though just 12.3 percent actually closed.

Hlavsa said this is because violations can range from improper chemical levels to missing life rings and shepherds' hooks -- used to help people who are drowning -- or concerns about the amount of deck space next to a pool should CPR be required to care for a swimmer.

Pool inspectors measure chlorine content and pH of pool water -- pH should be between 7.2 and 7.8, chlorine concentration should be at least 1 part per million in a regular pool and 3 parts per million in a hot tub, and bromine concentration should be 3 parts per million for pools and 4 parts per million for hot tubs -- which is expected to minimize pathogens in the water.

Most bacteria in pool water is expected to be killed by chlorine, however the cryptosporidium bacteria, which moved from natural bodies of water to recreational ones during the last 20 years, is resistant to the chemical, though not to others used for pool cleaning.

Additionally, children in pools, especially young children, often have less developed hygienic habits, leading to fecal matter and urine getting into pools. Parents who allow their children to swim in pools with diapers, even "swimming diapers," contribute to the dirty water. Although swimming diapers are made to withstand exposure to water, they aren't water-tight, so excrement can escape them.

The MAHC was designed to cover all potential safety and cleanliness issues in pools, as well as bring together fractured methods across the country of caring for aquatic facilities. While some municipalities have adopted methods, for most, it comes down to state and local laws.

For Broward County, located in South Florida, requirements are entirely based on state standards, which requires no set schedule for inspections. All public pools in the county are inspected twice per year, Candy Sims, a public information office for the Florida Department of Health, told UPI.

Reinspections are also done when violations are found -- which is why many municipalities have far more inspections listed in the CDC report than they do facilities, Hlavsa said.

According to the CDC, reporting methods also vary between municipalities which contributed to some of the trouble municipalities had in collecting inspection data, be it because of technological issues or different measures of issues. The agency has recommended standardizing reporting methods but states and municipalities have not adopted many of them yet, which is not a surprise to researchers because they are so new.

"Working together to make this data easy to pull, easy to analyze," Hlavsa said. "I hope if anything, this report shows the value of these data and the role of these inspections in public health."

In the MAHC, pool operators are recommended to use ultraviolet light or ozone treatment systems, because they killed pathogens, including those resistant to chlorine, and to base measurements on pool filters, as the CDC did in a 2013 report, rather than with smaller water samples.

The hope, Hlavasa said, is for the recommendations to adopted nationwide to allow for higher quality pool facilities and greater ease in tracking problems. With the MAHC so new, however, she it will be years before the agency has an idea of their effect.

In the meantime, the CDC suggests parents pick up pH strips and water testing kits to check water if their children are sensitive to chemicals and to be aware of the proper safety equipment being present poolside, regardless of whether or not a lifeguard is on duty.

"No one should get sick or hurt when visiting a public pool, hot tub or water playground," Dr. Beth Bell, director of CDC's National Center for Emerging and Zoonotic Infectious Diseases, said in a press release. "That's why public health and aquatics professionals work together to improve the operation and maintenance of these public places so people will be healthy and safe when they swim."

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