The green hair-chlorine connection is a firmly embedded myth:  Almost half of respondents to our 2012 swimmer survey agreed that chlorine in the pool can turn hair green.  We would like to expose this urban legend at its roots and offer an explanation of how it might have grown.

Copper, Not Chlorine, is Responsible for Green Hair

Green hair is caused by the presence of copper, not chlorine, in swimming pool water.  Copper sulfate, for example, is added to pools to help control algae.  Tiny particles of this greenish-blue compound can turn blonde or white hair green.  Copper may also be leached into pool water from metal plumbing or from copper ionizer equipment and form copper sulfate in the water.  One research study titled “The Green Hair Problem¹” concluded that hair that had been extensively damaged–either by harsh cosmetic treatment or by exposure to sun and weathering–showed the highest degree of green coloration from absorbed copper.

To avoid an unwanted green tint:

• Wear a swim cap, or
• Use a shampoo formulated to help remove copper (yes, they exist) after swimming.

We suggest there could be a semantic reason for the chlorine/green hair linkage.  The root “chloro” is Greek for “green.”  Chlorophyll, for example, is the organic compound in plants that absorbs sunlight and lends a green color to leaves.  In 1810 the chemical element chlorine was named for the greenish color of its gas. Nevertheless, chlorine does not impart a green color to pool water. 

Chlorine is added to pool water to destroy bacteria, viruses and parasites in water that would otherwise put swimmers at risk for disease.  Most chlorine is added to pool water in the form of compounds of chlorine that are either white solids or colorless liquids.  Although some pools are designed to bubble chlorine gas into the water, the greenish chlorine gas reacts quickly with pool water to produce dissolved “free chlorine,” which is colorless. 

Chlorine is a well-known pool chemical and its name implies the color “green.” We think it is conceivable that those two factors together helped shape a myth linking chlorine and green hair.  Hopefully we have helped expose the roots of this myth and untangled the truth.  Happy swimming!

¹Bhat, G.R., Lukenbach, E.R., Kennedy, R.R. and Parreira, R.M. (1978).  The green hair problem:  A preliminary investigation, J. Soc. Cosmet. Chem., 30, 1-8.

Splish, Splash, Beware of Risky Behavior

Exposing buttocks to the spray of water and placing mouths over water spouts may expose kids to germs that can spread illness, especially diarrhea.  According to a 2010 study by Nett et al., children who engage in these practices raise the risk of fecal contamination of play water.  The researchers found these activities take place regardless of the presence of educational signs, hygiene attendants or adult supervisors. 

What You Didn’t Bargain for in Water Parks

Exposing the buttocks, even if diapered or clothed, to interactive fountains increases the risk for fecal contamination of splash park water.  (According to a 2000 study by Gerba, swimmers may have up to 10 grams of residual fecal material adhering to their skin.)  Children squealing and laughing happily in water parks are likely to ingest some of the sprayed water, risking ingesting contaminants found in feces.  The “fecal to oral route” of disease transmission, which public health professionals strive to interrupt, can be quite direct in water parks!  Similarly, by placing their mouths over water spouts, children risk spreading germs from their mouths to others in the resulting spray.

A 2007 outbreak of cryptosporidiosis in a municipal park in suburban Idaho sickened roughly 50 people exposed to a splash feature there.  Cryptosporidiosis is caused by the waterborne parasite cryptosporidium and is characterized by diarrhea or abdominal cramps, nausea, vomiting, fever or body aches. There are no effective antibiotics for cryptosporidiosis.  A report by CDC following the outbreak noted “…young children were observed to be the predominant users of the splash park, and diapered children frequently sat on top of splash features.  There was no opportunity for children to shower before enjoying the splash feature.  Nearby restrooms lacked showers and even lacked soap for hand-washing.

Recommendations: The Short Run and the Long Run

In the short run, parents and adult supervisors can be vigilant in halting risky behaviors exhibited by children in interactive water parks, such as sitting on water spouts and covering water spouts with their mouths.  But are adults even aware that these behaviors are risky?  Interestingly, Nett et al. (2010) reported approximately one-third of splash park supervisors surveyed were unsure if splash parks can cause diarrhea; a small fraction perceived no link.  Public education is needed. 

Water used in these parks is usually filtered and disinfected, but risky behaviors can expose children to pathogens in the short interval of time that water is in the play area before being recirculated through the treatment process.  In the long run, therefore, design barriers to disease transmission could be imposed in water play areas. Nett et al. (2010) suggest supplemental ultraviolet light disinfection of play water to provide added protection against chlorine-resistant pathogens, such as cryptosporidium (this was done at the site of the Idaho outbreak to reduce the risk of another outbreak).  We agree, and also suggest the physical design of water parks could be altered to ensure water spouts are beyond the reach of children, such as a vertical shower design.  We think this could help curtail the spread of germs via the troublesome exposure routes described here, clearing the path for pure summer joy.

Bruce Bernard, PhD, is President of SRA International, Inc. and Associate Editor of the International Journal of Toxicology.

“Remember the Alamo!” was the battle cry of Texans avenging the deaths in 1836 of nearly 200 of their own at the hands of the Mexican Army at the Alamo, a small mission chapel in San Antonio.  One hundred seventy-two years later in Alamosa, Colorado—a place with a similar name—a different sort of battle was being fought.  A waterborne enemy, Salmonella bacteria, launched a surprise attack on the community, killing one person and sickening up to 1,300 others.  The community rose up to meet a deadly challenge.

No Disinfection, Animal Visitors

In 2008, the Alamosa water system served about 8900 people. Groundwater was drawn from three very deep wells and stored in two elevated water towers and one ground-level covered reservoir. The city had been granted a disinfection waiver in 1974; arsenic in the water supply was one problem noted, but bacteria were not. Nevertheless, bacteria found a point of entry into the system in early March of that year.

A 2009 report by the Colorado Department of Public Health and Environment (CDPHE) focused attention on the Weber Reservoir, a 320,000 gallon rectangular concrete structure built in 1979.  The reservoir was in poor condition and had not been maintained adequately for a number of years. The roof and sides of the concrete structure showed several cracks and holes.  The relatively warm environment of the storage reservoir could have made it “an attractive location for wildlife to gather,” according to the CDPHE report. During the winter following the outbreak “numerous footprints from small animals in the snow inside the fence surrounding the reservoir” were observed.  In July of that year, bird feces were noted on the top of the tank including in the area of one of the corners repaired after the outbreak.

Based on data collected in Alamosa and a relevant literature review, the CDPHE report concluded Salmonella probably were delivered to the Weber Reservoir either by an animal or fecally-contaminated runoff.  The contamination affected the entire city’s drinking water; the CDPHE report states that a telephone survey found about 40 percent of the infant population of Alamosa was sick during the outbreak.

A Community Responds

As an immediate response to the outbreak, chlorination equipment was installed; the whole system, including the three storage tanks and 50 miles of distribution lines, was dosed with a high level of chlorine to eradicate Salmonella and then after sufficient contact time, the system was flushed to reduce the chlorine to the desired residual level. Disinfection with chlorine is a highly effective method of destroying Salmonella.

A “bottled water advisory” was issued by the Colorado Department of Public Health and Environment team.  A “boil water advisory” was not issued at first because there was concern that arsenic levels could be elevated in drinking water during system flushing and by consumer boiling.  According to the investigative report, “a bottled water advisory for such a large system in response to an actual disease outbreak was unprecedented in Colorado and presented a major public health challenge along with severe community disruption and economic impacts.” 

Media reports from the Easter weekend of 2008 describe volunteers from Alamosa and surrounding communities delivering bottled water and informational flyers to residents.  The bottled water advisory was followed by a boil water order; after three weeks the municipal water was deemed safe. Continuous chlorination has been in effect in Alamosa since late-March, 2008. Chlorine residual monitoring is conducted throughout the city, and no further outbreaks have occurred. 

Lessons from Alamosa

In the wake of the Alamosa outbreak, Colorado’s Safe Drinking Water program implemented several strategies to reduce the likelihood of further waterborne disease outbreaks in the state. Among these measures are: prioritizing responding to problems at water systems that do not disinfect; enhancing oversight of sampling, water storage and distribution piping during inspections; and launching training initiatives to help public drinking water systems optimize storage and distribution system operating and maintenance practices.

A significant lesson from Alamosa stems from the fact that routine bacteria monitoring—called “total coliform monitoring”—is not a good indicator for the culprit in the outbreak, Salmonella.  Although Alamosa officials were not sampling city water properly, the report states it is possible that even appropriately collected Salmonella-contaminated samples could have been analyzed as negative for this pathogen. The CDPHE report underscores this fact as a strong argument for all water systems to provide disinfection, especially in light of the fact that ingestion of as few as 10 Salmonella organisms may be enough to cause illness. Communities that resist disinfection, such as the British Columbian city of Chilliwack, should take notice.

The routine provision of safe drinking water is a quiet victory over waterborne illness that occurs in thousands of US communities every day. Unfortunately, it is most appreciated in the context of the possibilities of defeat and the accompanying human loss and suffering.  That’s why it is important to remember the Alamosa outbreak.  Lives depend on it.

Chris Wiant, M.P.H., Ph.D., is president and CEO of the Caring for Colorado Foundation. He is also chair of the Water Quality & Health Council and a former member of the Colorado Water Quality Control Commission.

What are the sneakiest hiding spots for kitchen germs?  Microbiologist Lisa Yakas, of NSF-International recently set out to answer that question.  Her findings confirm that germs are especially partial to environments that feature moisture and food residue. 

Twenty volunteer families enlisted in Yakas’ NSF-International project in which participants swabbed 14 common kitchen surfaces.  Next the surfaces were tested for yeast, mold and the bacteria E. coli, Salmonella and Listeria.  The presence of these germs signal a potential elevated health risk, especially for susceptible people, such as pregnant women, older adults, children and people with a compromised immune system. 

 Most volunteers thought the most contaminated kitchen surface would turn out to be the microwave control pad. That was not the case.  Hard-to -access surfaces that are not regularly cleaned or disinfected but that regularly contact food were the germiest.  Yakas recounts several of these examples in the video.  The table below lists these surfaces, the particular germs found inhabiting them, and tips for reducing your risk of illness from these germs. 

Each year, 48 million people in the United States–one in six of us–become sick from germs taken in with our food.  Most of these illnesses cause only mild symptoms, but 128,000 people are hospitalized and 3,000 die of foodborne diseases annually, according to estimates by the US Centers for Disease Control and Prevention (CDC).  CDC reports that from 2009-2010, among foodborne outbreaks with a known single setting where food was consumed, approximately one in five originated in a private home.  That’s why one of the most important lines of defense against foodborne illness is the education of home-based food handlers according to researcher Dr. Elizabeth Scott (2003 study).¹  We agree, and we hope this new information is helpful to you in your efforts to keep a clean, safe kitchen.  And by the way, the handiest food safety tip we know is about hands themselves:  Be sure to wash your hands thoroughly before and after touching food!

Ralph Morris, MD, MPH, is a Physician and Preventive Medicine and Public Health official living in Bemidji, MN.

¹The other two lines of defense against foodborne illness are: (1) improving the hygienic quality of raw foodstuffs and (2) using food processing technologies, e.g. pasteurization and irradiation, and employing hazard analysis and critical control point concepts.

First: Control Germs

Pool water must be sanitized to help control the germs introduced by swimmers. Researchers report that on average each swimmer introduces 0.14 grams of fecal matter to the pool; for children the amount is likely higher. (That little statistic should encourage swimmers to shower before swimming.)

Recreational water illnesses that can be contracted by exposure to even low levels of fecal matter in the water include diarrhea, swimmer’s ear and various skin infections. Swimming in a pool of water without sanitizer is comparable to immersing oneself into a large communal bath tub with the neighbors. Need more be said about the need to treat pool water by sanitizing it?

Pool Sanitizers

Destroying waterborne germs that can make swimmers sick is the goal of swimming pool sanitation. Sanitation can be carried out by adding chemicals or by subjecting pool water to ultra-violet (UV) light. Common sanitizing chemicals include the traditional chlorine-based sanitizers, chlorine generated from salt in saltwater pools, bromine-based sanitizers, copper and silver ions, and ozone gas. The following table provides information on these options.

Common Swimming Pool Sanitizers

All of the sanitizers in the table destroy germs, but only chlorine- and bromine-based sanitizers have staying power, meaning the provision of a reliable fast acting residual that results in continuous, efficient germ control lasting past the time of application. This is of utmost importance because the swimmers themselves introduce an unpredictable load of germs and impurities into the water. When pools are properly maintained—and this includes not only chemical but physical treatment such as filtration—chlorine- and bromine-based sanitizers provide a residual level of protection against the incursion of unwanted substances that can reduce pool water quality and make people sick. That is why many “alternative” pool sanitizers—including ozone, metal ions (minerals) and UV—still require a secondary level of protection, most often provided by chlorine-based sanitizers.

In conclusion, in order to maintain swimming pools as healthful recreational environments, they cannot go completely “chemical treatment free.” To claim otherwise is simply inaccurate.

Fred Reiff, P.E., is a retired official from both the U.S. Public Health Service and the Pan American Health Organization, and lives in the Reno, Nevada area.

¹Sanitizers that are sensitive to UV radiation in sunlight lose their effectiveness more rapidly than those that are stabilized.
²Stabilized chlorine is chlorine chemically bonded to cyanuric acid; stabilized chlorine helps preserve chlorine from the destructive effects of UV radiation in sunlight.

Definitions, definitions…

Cleaning, accomplished with soap–or detergent–and water, refers to the physical removal of dirt and grime, and in the process, some portion of the germs on a given surface. Sometimes cleaning tools, including sponges and cloths, simply move germs from one surface to another. Disinfecting, on the other hand, refers to killing a high percentage of the germs on a surface or rendering them incapable of reproducing. Sanitizing is another relevant term in this discussion. According to www.flu.gov, sanitizing lowers the number of germs on surfaces to a safe level, as judged by public health standards or requirements. The process works by either cleaning or disinfection to reduce the risk of spreading infection. Finally, sterilizing destroys all forms of microbial life and is used mainly in healthcare and laboratory settings.

The Order of Operations

If disinfecting a surface is the task at hand—for example, you might be tackling a food preparation counter that has just contacted raw meat or fish—the order of operations is important. Just remember “C” (cleaning) comes before “D” (disinfection). First, clean the surface with detergent or general household cleaner to remove any visible food or waste particles. Second, rinse the surface with water, dry and then apply disinfectant.

A quick home-made disinfectant can be prepared by adding one-half tablespoon of ordinary household bleach to one-half gallon of plain water. Apply the solution to the (cleaned, dry) surface and let air dry. That’s it! No rinsing is required at that bleach solution concentration.

Why Chlorine Bleach?

Chlorine bleach is an inexpensive, effective surface disinfectant at very low dilutions. A 2011 Water Quality & Health Council survey of 1,000 American adults found that nearly half of all respondents (47 percent) overestimated the amount of bleach needed in a gallon of water to kill common foodborne germs. In a 2009 study by Yang et al.¹, five common household products were tested for their ability to destroy three of the most common kitchen germs (E. coli O157:H7, Salmonella and Listeria). Of chlorine bleach, hydrogen peroxide, white vinegar, lemon/lime juice and baking soda, only chlorine bleach solution successfully destroyed all three of these types of foodborne bacteria. Chlorine bleach is also effective against viruses, and it is widely recommended for disinfecting surfaces against the extremely contagious norovirus (norovirus posters).

Safety Always

Always keep chlorine bleach out of the reach of children. Make chlorine bleach solutions fresh daily, as they break down over time. Use the chart below to help you make up only the quantity you expect to need for the day. Never combine chlorine bleach with ammonia-containing products.

Joan B. Rose, PhD, is the Homer Nowlin Chair in Water Research at Michigan State University and a member of the Water Quality and Health Council.

ⁱWhen disinfecting against flu virus, leave disinfecting solution on surface for 10 minutes, then rinse.

¹Yang, H., Kendall, P.A., Medeiros, L. and Sofos, J.N. (2009). Inactivation of Listeria monocytogenes, Escherichia coli O157:H7, and Salmonella Typhimurium with Compounds Available in Households. Journal of Food Protection, v. 72, No. 6, pp. 1201-120ne8.

ⁱⁱWhen disinfecting against norovirus, air dry after applying disinfecting solution. If object is intended for food or mouth contact, rinse with plain water before using.

What happens to chlorine when it is added to drinking water or swimming pools?  According to the US Centers for Disease Control & Prevention’s Chlorine Residual Testing Fact Sheet, chlorine proceeds through a series of reactions:

1. The Chlorine Demand is Satisfied:  Upon initial dosing, chlorine reacts with any organic matter in water.  The amount of chlorine used in these reactions is known as the “chlorine demand” of the water.  Raw water taken from lakes and streams for drinking water treatment is likely to have a high chlorine demand based on the presence of natural organic material, e.g., decaying plant and animal matter. Groundwater, which normally contains far lower levels of organic matter, has a low chlorine demand.
2. Combined Chlorine Forms:  When the chlorine demand of the water is satisfied, some portion of the remaining chlorine reacts with nitrogen in the water to form compounds known as chloramines.  Nitrogen-containing compounds may result from decaying organic matter in raw water secured for drinking water treatment.  In swimming pools, swimmers add nitrogen-containing compounds to the water in the form of substances such as urine and perspiration. Chloramines may impart a chemical odor to water, which is sometimes inaccurately described as a “chlorine” odor.  The chlorine that combines chemically with nitrogen and nitrogen-containing compounds is known as “combined chlorine.”
3. Free Chlorine Destroys Germs:  Chlorine remaining in water after the chlorine demand is satisfied and combined chlorine is formed is known as “free chlorine.”  This is the chlorine portion available for disinfection.  Many waterborne germs are either killed or rendered incapable of reproducing, helping to prevent waterborne disease outbreaks. The time required to destroy viruses, bacteria and parasites present in raw water at a given chlorine concentration varies with the organism and is known as the “contact time.”
4. A Chlorine Residual Remains:  Following a given contact time during which chlorine destroys germs, some chlorine remains in the water.  This remaining, or residual level, acts as a safeguard against additional microbial contamination that, in the case of swimming pools, for example, could be introduced as more swimmers enter the pool. Chlorine and bromine are unique in their ability to impart this kind of protection. EPA requires all US facilities that treat water to maintain a chlorine residual of no more than 4 parts per million, whether chlorine is used as a primary disinfectant or not.  Swimming pool operators generally maintain a chlorine residual of 1 to 3 parts per million.  Swimming pools that are treated primarily with metal ions, such as copper, require a low level of chlorine to provide residual protection.

A Safety Marker Too

By monitoring the chlorine residual throughout a drinking water distribution system, water treatment operators can quickly identify points at which the residual declines or disappears. A sudden decline in the chlorine residual could indicate a leak in the drinking water distribution system. Swimming pool operators monitor the chlorine residual regularly. As the number of swimmers and conditions in the pool varies, the disinfectant level can be adjusted to maintain the chlorine residual.

In both drinking water and swimming pools, the chlorine residual represents a smart use of chemistry and provides a remarkable public health safeguard!

Chris Wiant, M.P.H., Ph.D., is president and CEO of the Caring for Colorado Foundation. He is also chair of the Water Quality & Health Council.

ⁱOne other disinfectant—bromine–provides a residual level of protection in water. Bromine is used in swimming pools, but more frequently in spas. It is not used in drinking water disinfection.

Buying Eggs

Buy eggs from a refrigerated case. Open the carton and inspect for clean, uncracked shells. The egg carton should be imprinted with a USDA grade shield and indicate a future “sell by” date (see photos below).

Refrigerating Eggs

Any bacteria present in an egg can multiply quickly at room temperature, so refrigerate eggs as soon as possible after purchasing them. The USDA recommends storing eggs in their carton in the coldest part of the refrigerator (40 degrees F or below). Do not store eggs on the refrigerator door shelf, which is warmer than interior areas.

Refrigerated eggs should not be left out for more than two hours. Hard-cooked eggs should be refrigerated within two hours of cooking and used within one week. It may seem counter-intuitive, but hard-cooked eggs spoil faster than fresh eggs because in cooking eggs, a protective coating on the egg shell is washed away.

Dying Eggs

Always wash hands thoroughly before and after handling eggs. Dye hard-cooked eggs using food-safe coloring and return eggs to the refrigerator within two hours.

Blowing out Eggshells

In some traditions, egg contents are blown out of shells before decorating. Use only eggs that have been kept refrigerated and are uncracked. To destroy bacteria that may be present on the shell surface, before blowing out contents, wash the egg in hot water followed by a rinse in a solution of one teaspoon liquid chlorine bleach in ½ cup of water.

Hunting Eggs

If eggs are to be consumed, they should be hidden in places that are free of dirt, moisture, pets and other sources of bacteria. Eggs in contact with soil can pick up bacteria, especially if the shells are cracked. The total “hide + hunt time” should not exceed two hours. “Found” eggs should be washed, re-refrigerated and eaten within seven days of cooking.

Norovirus is Not Limited to Cruises and It is Not a Stomach Flu

As Cruise Critic points out, although it is sometimes known as the “cruise ship virus,” norovirus is not limited to cruise ships.  It is a seasonally recurring virus, especially in nursing homes, hospitals, schools and other confined venues because of the close quarters and the ability of the virus to spread so quickly. It is commonly associated with foodborne disease.  The elderly and the very young are most prone to norovirus infection although it also affects many healthy people.  Norovirus is frequently associated with cruise travel because health officials are required to track illnesses on ships and report the number of cases of diarrhea to the Centers for Disease Control and Prevention (CDC) within 24 hours of arrival at a US port. 

Norovirus has another misnomer:  It is frequently called the “stomach flu.” But, norovirus is not flu:  Flu is characterized by fever, fatigue, muscular aches and pains and inflammation of the respiratory passages although the flu can sometimes cause nausea and vomiting.  Norovirus infects the gastrointestinal system.

The Sick Should Not Go Cruising

If you are sick, don’t risk spreading your illness by boarding a cruise ship. Although symptoms usually last only a few days, people remain contagious for at least three days after being sick with norovirus.  Norovirus can spread quickly in enclosed spaces like cruise ships, putting everyone at risk.  Both feces and vomit are infectious.  Vomiting can produce miniscule particles suspended in the air that can enter the mouths of others and be swallowed.   

It is possible to have norovirus infections multiple times over a lifetime because the virus mutates into new forms.  In other words, norovirus can ruin more than one cruise for you.  If you are planning a cruise, purchasing travel insurance is a good idea, letting you cancel your trip without financial penalty.

Norovirus can Spread in Several Different Ways

Understanding the many ways norovirus spreads can help you avoid norovirus on land and sea:

• Consuming contaminated food, drinks or ice
• Touching surfaces or objects contaminated with norovirus and then putting hands or fingers into your mouth
• Having direct contact with another person who is infected, e.g., sharing food or eating from the same utensils as someone who is ill
• Taking in norovirus particles spread through the air by someone vomiting

Hand Washing is Key and Hand Sanitizer May Not be as Helpful

According to CDC, good hand hygiene is one of the most critical control strategies in managing infectious disease outbreaks. Wash hands with warm water and soap for about 30 seconds–including vigorous rubbing and getting under the fingernails too–followed by thorough drying with paper towels. Hand-washing is especially important after using the bathroom and before preparing food or eating. Hand sanitizers may not be as effective against norovirus because not enough of the virus is killed or removed.

All Aboard for Cruise Ship Infection Control

CDC’s Vessel Sanitation Program specifies isolating infected persons for at least 48 hours after the resolution of the last symptom.  Food handlers suffering from any communicable disease should be excluded from food preparation and service.  Additionally, according to NBCNEWS.com, self-service buffets are now disappearing and passengers are given a “welcome letter” offering tips on hand-washing and remaining in their cabins when ill.

When norovirus is about, infection control measures need stepping up to prevent germ transmission. The virus can live for days on surfaces and it is hard to kill.  Frequently touched hard surfaces must be properly cleaned and disinfected. Additionally, norovirus “incidents” of diarrhea or vomiting must be promptly cleaned and affected surfaces disinfected with solutions of chlorine bleach to help reduce the transmission of norovirus (downloadable poster resources).  Anything that has been in contact with vomit or diarrhea should be discarded or disinfected.  Affected fabrics should be machine washed with detergent, hot water and bleach–if recommended–choosing the longest wash cycle, then machine dried.  Carpets and upholstery should be steam-cleaned.

Keeping your cruise safe and enjoyable is a matter of common sense and hygiene. Bon voyage!

Barbara M. Soule, R.N. MPA, CIC, FSHEA, is an Infection Preventionist and a member of the Water Quality & Health Council.