Whether your facility has one water venue or many, it is at risk for a recreational water illness (RWI) outbreak.
RWIs are caused by germs spread by swallowing, breathing in mists
or aerosols of, or having contact with, contaminated water in
swimming pools, hot tubs, waterparks, water-play areas, interactive
fountains, lakes, rivers or oceans. Chemicals in the water or
chemicals that evaporate from the water and cause indoor air
quality problems also can cause RWIs.
To help pool operators manage the RWI risk, the Centers for Disease
Control and Prevention now encourages operators to take their own
six steps for healthy swimming.
1 Build partnerships. An inspector can be a great
resource for RWI prevention. Inspectors will know if an RWI
outbreak has been detected in the community or if any amendments to
the aquatic code are planned. If your local or state aquatics
program does not maintain an operator contact list, work with other
operators to help compile such a list.
Inspectors also can be partners in educating the public about
healthy swimming. One great opportunity to collaborate on getting
healthy swimming messages out is Recreational Water Illness and
Injury Prevention Week (RWIIPW), held every year during the week
before Memorial Day, when the media is looking for swimming-related
stories. The focus of RWIIPW 2011 (May 23–29) is preventing
swimmer’s ear. Your patrons also have a vested interest in
the quality of the water. Enlist season-pass holders, visiting
groups and other patrons as partners.
2 Train staff. Take an operator training course
and learn about pool operation, maintenance, RWIs and RWI
prevention. Studies show that trained operators are more likely to
maintain proper free chlorine and pH levels than the untrained.
Educate your staff about RWIs and prevention basics so they
understand the importance of their duties (for example, regular
poolside monitoring of free chlorine and pH levels regardless of
whether remote monitoring also is being done).
3 Educate swimmers. Swimmers can take just a few
simple steps to help protect themselves and others from RWIs. So
educate them and parents of young swimmers about healthy swimming
behaviors, such as not entering the water while ill with diarrhea.
If child-care providers bring groups of diaper- or toddler-aged
children to your facility, teach them about healthy swimming
behaviors, stressing the importance of these behaviors. RWI
outbreaks of cryptosporidiosis have been started by
toddlers in child care who got in the water while ill with
diarrhea. Healthy swimming messages can be included in posters
strategically placed at the facility entrance and in bathrooms, on
the back of ticket stubs, and in contracts for group events. Free
English and Spanish healthy swimming brochures are available from
4 Maintain water quality. Maintain required free
chlorine and pH levels throughout the venue to kill most germs,
such as E. coli, Giardia and norovirus within
minutes. But keep in mind cryptosporidium is extremely
chlorine-tolerant and the leading cause of RWI outbreaks. To kill
this parasite, incorporate supplemental disinfection (ozone or low-
or medium-pressure UV) into your operation. An added benefit of
supplemental disinfection is that it also can break down combined
chlorines, another common cause of RWI outbreaks.
5 Evaluate and improve facilities. Ask yourself
the following questions: Are the bathrooms and showers
well-maintained and stocked? Would you walk in barefoot as your
patrons do? Would you change your child’s diaper at the
diaper-changing stations? If you are building a new facility, ask
aquatics and public health experts for feedback on the design. Are
there enough hygiene facilities for patrons? Does the location of
showers encourage patrons to at least rinse off before getting in
6 Develop and implement RWI prevention policies.
These policies should:
• Be sure employees who must enter the water feel comfortable
communicating to you that they have diarrhea. If they report the
illness, take steps such as reassigning them to administrative or
other nonfood handling duties, at least until their symptoms
resolve. Make it easier for ill patrons to stay out of the water
(for example, consider rescheduling events or returning deposits if
illness is reported).
• Develop a response plan for fecal incidents in the
water. The first steps of any plan should include closing the venue
to swimmers and removing the feces.
• Close venues to swimmers often (e.g., hourly) to
promote bathroom breaks. This could help minimize the amount of
urine and feces in the water, and some facilities have found that
concessions sales increased with mandatory bathroom breaks.
• Establish a preventive maintenance program to ensure
that disinfection, circulation and filtration equipment runs
optimally. Investigations have shown that old tubing, which should
be regularly replaced on feed pumps, can be a factor contributing
• Develop an outbreak/emergency response plan. How will the
facility support an outbreak investigation to learn why an outbreak
occurred and how to prevent future outbreaks? How will the facility
respond to questions from the public or media?
Developing effective RWI prevention policies and storing them in a
binder is not good enough. Investigations have revealed that
facilities can have well-written policies, but if staff members
aren't aware of them, they don’t follow them. Implementing
policies includes training staffers to enforce them with patrons
when needed. Make sure employees know what to do if a problem is
identified, especially if you are not on site. Enforce the policies
and let staffers know you will support them when they enforce the