How often do you see dry swimmers entering your pool? Until two years ago, that was a regular occurrence at South Davis Recreation Center in Bountiful,Utah. A shower-first policy was in effect, but most swimmers simply
ignored the rule, recalls Scott McDonald, aquatics and fitness
But those attitudes changed for good after summer 2007, when
Utah experienced one of the largest cryptosporidium
outbreaks ever linked to recreational water. Today, McDonald
regularly overhears patrons reminding each other to shower, and few
complain if they are asked to hit the showers before swimming.
He’s made some policy changes as well. A guard often is
posted at the locker rooms to remind patrons of the rules, and each
swim season McDonald makes a point of informing coaches about how
important it is for their teams to abide by the shower policy.
Swimmers and facility operators in Utah learned the hard way
what health officials have been saying for some time: When it comes
to crypto, many of the old protocols aren’t enough.
In other words, simply relying on chlorine disinfection to make up
for lax hygiene won’t stop the parasite. Nor is it acceptable
to hope that new crypto-killing technological
“silver bullets” will solve the problem.
Experts say that effective crypto prevention requires a
new strategy. “Think of healthy swimming as a
three-legged-stool, with one leg being public health agencies, one
being aquatics operators, and the last being the pool-visiting
public,” says Michele Hlavsa, an epidemiologist at the
Centers for Disease Control and Prevention in Atlanta. “If any one of the
three legs fail, then healthy swimming won’t hold
Surprisingly, it appears some operators are not yet carrying
their share of the load. Experts say many aquatics professionals
still worry that talking about squeamish subjects such as feces
(the main way crypto enters recreational water) will scare
the public away from the water.
Anecdotal evidence suggests otherwise, and health officials warn
that those fears can be just as dangerous as failing to shower
before swimming. What it comes down to is this: If operators and
patrons do their part, in conjunction with public health officials,
it’s possible to reduce the risk of crypto without
risking anyone’s reputation. The alternative may be facing
those patrons after an outbreak has already occurred, when they
— and their attorneys — are in a far less forgiving
How well does patron education combined with operators redoubling
their efforts and employing the latest technology against
crypto work? Just ask Donna Russell.
In 2007, Utah documented nearly 2,000 crypto cases. In
2008, the state recorded only 30. “I think it’s amazing
that we didn’t have any outbreaks last year,” says
Russell, aquatics supervisor at the Clearfield
Aquatics Center in Clearfield, Utah. “Usually it’s
more than a one-year cycle.”
While it’s too early to call these decreases a trend,
operators such as Russell credit 2008’s success to a
combination of operator response and public awareness.
Across the state, health agencies such as the Salt Lake Valley Health
Department have worked with medical care providers and aquatics
professionals to develop comprehensive campaigns to contain the
outbreak and prevent a repeat performance. Here’s what that
- Crypto testing was required for anyone seeking
gastrointestinal issue-related medical care.
- A public education campaign was launched, including
televised public service announcements and informational materials
for groups such as the YMCA.
- Signs informing patrons of crypto dangers and
proper hygiene were posted at aquatics venues.
- Press conferences were organized to further spread the
word about the need for patrons to help prevent crypto,
along with healthy swimming behaviors.
- Strategies were formulated to improve communication
between health officials, medical professionals and facility
- UV systems were installed in 35 Salt Lake County public
Though there’s no way to scientifically gauge the
effectiveness of these measures, Linda Bogdanow, epidemiology
supervisor at the Salt Lake Valley Health Department, reports that
in the four weeks following implementation of control measures, the
number of confirmed crypto cases dropped an average of 55
percent each week.
“It ended on a positive,” Russell says of the
outbreak. “As the patrons talked to us and watched the news,
they understood [their responsibility]. I don’t think
we’ve had any long-lasting effects; our programs are as busy
as they’ve always been.”
As the Utah example demonstrates, fighting crypto requires
a collaborative strategy. But that doesn’t explain two of the
main reasons such a strategy is so necessary in today’s
facilities. First, larger and more elaborate aquatics centers can
accommodate much bigger bather loads. Second, the pool is no longer
just about swimming. Patrons of all ages, sizes and abilities are
jumping in for fitness, therapy and, most of all, recreation.
For that reason, the goal is to keep the parasite from ever
getting in the water in the first place.
“Prevention is still the most important thing we can
do,” says Tom Lachocki, Ph.D., CEO of the National Swimming Pool
Foundation in Colorado Springs, Colo.
Not everyone has gotten the message, though.
“There’s been good progress, but there’s still
room to improve consumer awareness on how they can help to keep
themselves healthy,” Lachocki adds.
Indeed, a December 2008 Aquatics International survey
of approximately 400 readers found about 15 percent of respondents
have not implemented information campaigns to specifically prevent
crypto. And in interviewing crypto cases from a
2008 outbreak in New Mexico, CDC researchers found roughly 30
percent of those infected went swimming while ill.
Julie Marsden reports similar findings. As director of the
Division of Communicable Disease Control and Prevention for the
Montgomery County (Pa.) Health Department, she
investigated a 2007 outbreak that included 51 crypto cases
stemming from a local day camp. Education probably could have
prevented some of them, she says. “They were not aware of the
two-week recommendation until we brought it to their attention via
the investigation,” Marsden recalls.
So what healthy swimming behaviors should you expect of
Joan Shields, a former CDC Foundation Fellow now with the
FDA, sayscrypto prevention simply comes down to good hygiene. The
CDC suggests the following practices for everyone who enters a
- Refrain from swimming when you have diarrhea. Stay out of
the water for at least two weeks after symptoms disappear.
- Avoid getting pool water in your mouth and, if you do,
don’t swallow it.
- Wash your hands after using the toilet or changing
- Shower before swimming and after using the restroom.
- Don’t change diapers at poolside.
- Make sure children take regular bathroom breaks.
The bottom line is, “pool patrons need to realize that
they’re part of keeping the water clean,” says Linda
Golodner, president emeritus of the National Consumers
To spread this message, Golodner helped develop the Healthy
Pools campaign, a joint effort of the NCL, CDC,Water Quality and
Health Council,American Chemistry Council and the Association of Pool &
Spa Professionals. That public information campaign, along with
additional efforts by CDC and other agencies, includes free
marketing resources such as fact sheets, signage and fliers.
Available online, these useful tools are ideal for operators who
don’t have the time or budgets to create their own.
Golodner adds that it’s important to place materials where
patrons are sure to notice them. She also suggests creating
education specifically for children. You might even make it part of
a learn-to-swim program. For this impressionable demographic,
direct communication may be particularly important. The CDC
recommends developing a short safety and RWI orientation for kids,
and other larger groups, before allowing them in the pool.
These ideas sound simple, Lachocki says, but “[some]
operators still believe that if they educate patrons, they’ll
lose customers and their business will go under.”
That attitude can be disastrous. Large outbreaks such as the one in
Utah have put crypto on the mainstream media map. And in
today’s Google-centric world, patrons can easily access
crypto information on their own. Once they do,
they’re likely to question why their pool operator
didn’t warn them, especially if they get sick. In that case,
the inquiry may come directly from a lawyer.
On the other hand, if you’re proactive, there’s no
reason to see educated patrons as a threat, Hlavsa says.
“Look at them as allies who can help get the message
out,” she suggests. “That’s a much more powerful
tool to help get someone to reconsider their line of
Unfortunately, as Hlavsa also notes, “Not every swimmer will
self-police.” That’s where operators come in. Leading
by example, you and your team can help reinforce the healthy
swimming messages you’ve preached.
That means setting policies to ensure safe behavior and publicly
enforcing them. Provide clean, convenient restrooms and ask for
parents’ help in keeping the diaper-changing area clean. Many
operators also report success with scheduled bathroom breaks; they
clear the pool hourly and remind patrons to use the restrooms.
It may take time for some patrons to come around, but if you
explain that the reason behind the rules is to protect their
health, most operators discover the public will happily comply.
Even if every patron abides by rules, fecal accidents happen.
With increased programming and recreational opportunities for
little ones, seniors and special populations, the risk is greater
than ever. So operators need to be prepared with a defined fecal
response plan, experts say.
In some places, codes may require documented fecal response
protocols. But 20 percent of operators lack comprehensive and
up-to-date plans, according to the Aquatics International
survey. If you need more information to update or create a plan for
your pool, a detailed set of fecal response guidelines is available
online from the CDC.
Fecal accidents aren’t pleasant, and neither is the fact that
everyone carries trace amounts of fecal matter. Sooner or later,
crypto will find a way into your pool.
Fortunately, a number of proven operational strategies can be
combined with chlorine to help mitigate the threat of
crypto once it’s in the water. These supplemental
technologies include UV sanitization, which destroys
crypto in water that passes by an ultraviolet light
source; ozone systems, which inject ozone (a gas composed of three
oxygen molecules) on the pool filter that works in tandem with a
chemical coagulant to better facilitate the decomposition of
organic materials; and chemical clarifiers.
The addition of a chemical clarifier also can significantly
increase the effectiveness of chlorine, according to researcher
James Amburgey, University of North
Carolina at Charlotte. Other research has shown that because
they remove smaller particles, DE filters are more effective at
eliminating crypto oocysts from pool water than
traditional sand filters.
All of these developments are promising, and approximately 20
percent of the survey respondents claim to have either a UV or
ozone system in place. However, there are drawbacks to the
technology. Everything comes with a hefty price tag — as much
as $50,000 for a large commercial pool — and nothing is 100
Science and technology may someday provide a magic bullet that
completely destroys crypto, but until then, the only
surefire way to remove it from your pool is maintain a concentrated
level of chlorine for a specific period of time.
Approximately 45 percent of the survey respondents say they
regularly hyperchlorinate. Yet as Hlavsa points out, pools must be
closed, and the process requires long hours and large amounts of
chemicals. And, of course, as soon as the pool is reopened and one
swimmer jumps in carrying crypto, the water becomes
According to Lachocki, researchers are seeking better solutions,
one of which may be the chemical compound chlorine dioxide.
It’s been shown to effectively destroy crypto, but
there’s not yet a safe, practical way to use it in a
Ultimately, Hlavsa says the ideal disinfectant would not be
turnover dependent, meaning it would destroy crypto as quickly as
standard chlorination does other pathogens.
Time will tell whether such a product is developed, but until then
evidence suggests that if operators educate patrons and use
what’s available, crypto doesn’t have to
dampen the aquatic fun.
Less than 5 percent of survey respondents report ever having
been notified by health officials that a crypto case had
been linked to their facility, and it appears the number of
crypto outbreaks decreased last year. CDC researchers are
still analyzing the data, but Hlavsa says so far the agency has
only received 15 provisional reports of RWI outbreaks for 2008 to
date, about half of which were caused by crypto. A total
of 26 outbreaks occurred in 2007.
Despite that good news, health officials know another outbreak
is looming — especially for operators who aren’t
bringing patrons into the fight.
“Being honest with people and asking for their help to reduce
the risk of crypto is the only mature way to grow business
over the long term,” Lachocki says. “We can’t
hide from problems like crypto. The best way to deal is to
hit them head on.”