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 the CDC.

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 the water?

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 to outbreaks.

• 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 policies.