The 2007 swim season
has nearly closed and the following question arises: What important
issues are public health officials focusing on for the future?
Cryptosporidium’s chlorine resistance has resulted in
its emergence as the leading cause of diarrheal illness outbreaks
in U.S. swimming pools, transforming how we think about future RWI
prevention activities — and what role patrons can
with chlorine-sensitive germs also force us to reflect on existing
prevention activities. For the decade 1995 to 2004, 28 percent to
38 percent of diarrheal illness outbreaks were caused by germs such
as giardia, shigella, toxigenic E. coli and
norovirus, which are reasonably sensitive to chlorine
disinfection. Spa-associated outbreaks primarily result from
infection with chlorine-sensitive bacteria such as
pseudomonas or Legionella.
outbreaks are preventable under current standards, underscoring the
need for improved operation. Furthermore, in a 2002 survey, 8.3
percent of 22,000 pool inspections and 11 percent of 4,500 spa
inspections resulted in immediate pool or spa closure to protect
What can be done to
improve this poor level of operation and prevent future outbreaks?
With infrequent pool inspections and high employee turnover rates
at many aquatics facilities, what mechanisms are available to
improve operation, ensure needed operator training, and protect the
public? How can we drive the message home to operators that water
quality and health are critically intertwined?
certification is one side of the coin. The other side is creating
an aware, informed and activist swimmer or parent population that
could raise the bar of operation. These informed and activist
swimmers, by virtue of daily attendance, would increase daily
operator-patron interactions concerning water quality and other
potential RWI prevention measures. Basic human nature suggests that
the prospect of these daily interactions with patrons would
stimulate increased operator vigilance.
Why create an aware,
informed and activist public? The 20th century saw improvements in
water quality due to new disinfection methods and technology, and
pool operation codes that outlined the best practices for assuring
swimmers’ health and safety.
However, these 20th
century changes were done behind the scenes without the involvement
or understanding of the general public. One result of this is
uninformed consumers with:
- Little perception of the risk or behaviors associated with
the spread of RWIs
- Unrealistic water quality expectations (such as believing
pool water is essentially sterile)
- A belief that chlorination works instantly and on all microbes
- No knowledge of their role in RWI prevention.
The 21st century’s RWI prevention plan requires that we engage
swimmers and create a cadre of informed consumers who understand
the health ramifications of public bathing, appropriate hygiene
measures and the operational parameters needed for reducing risk.
After all, who, besides the operator and staff, is at the pool
every open hour of every day? Swimmers and
How will these
activist swimmers promote change? As illustrated in the 2006 comic
strip “Rose is Rose,” the activist swimmer will
- Observant — can they see the main drain in the deep
- Proactive — teach themselves about RWIs, pass that
information to others, let the pool management know that action is
needed, check the water for adequate chlorine and pH levels using
available tools such as test strips
- Inquisitive — asking if the operator or staff has
specialized training or is certified, how often water quality is
measured and how the facility performed on the last
The Centers for
Disease Control’s 2006 decision to recommend that consumers
check chlorine and pH levels (for example, use test strips) has
caused some angst for the aquatics community. For high-performing
operators, swimmer activism presents an opportunity to sell safety
and RWI prevention by continuing to set an example of excellence.
For low performers, it can be a wake-up call about their critical
role in prevention and the needs of their patrons.
The benefits of
having a core group of swimmers (or parents) who are engaged and
savvy about basic pool operation and water quality requirements are
at least two-fold. First, it would send a strong signal to aquatics
personnel and other swimmers that optimal operation and water
quality are a critical, 24/7 activity. Second, it could lead to
improved swimmer behaviors that are vitally needed to reduce the
incidence of people swimming while ill with diarrhea; this is also
essential for reducing the ongoing crypto problem.
Consumer activism is
nothing new and will be a natural outcome as swimmers become
increasingly knowledgeable about RWIs and prevention issues.
Evidence of this expanding awareness has been visible recently in
popular culture through numerous comic strips and videos
illuminating water quality and fecal contamination issues, and
highlighting the communal bathing nature of public swimming. The
industry has already jumped into the market with new test strip
products that are targeted, along with sunglasses and sunscreen,
directly to swimmers.
Clearly, change is
coming. The challenge is to ensure that public health and the
aquatics sector partner to create clear and understandable messages
that will inform and support future consumer activism and increase
the potential for improved nationwide operation, increased safety
and reduced risk for RWI outbreaks.