Public Health and Your Local Pool
Summertime Campaign Asks, "Are You Swimming in a Healthy Pool?"

Dr. Joan Rose addresses the media at the Healthy Pools launch event, National Press Club, Washington DC (June 2, 2004)

For millions of Americans a summertime swim is a seasonal rite of passage. There are approximately 360 million annual visits in the United States to swimming pools either in the backyard, local recreation center, neighborhood swim club or vacation hotel. According to U.S. Census data, recreational swimming ranks as the second most popular exercise activity in the country. Unfortunately, many ventures into a swimming pool occur in poorly maintained or neglected facilities, which can make for some unnecessary and uncomfortable summertime sick days.

In fact, research reported by the U.S. Centers for Disease Control (CDC) in 2003 found that 54% of all swimming pools tested were in violation of at least one public health code. These infractions included faulty water disinfection practices, improper water chemistry, filtration system irregularities, improper record keeping and licensing problems. As a result, more than two thousand Recreational Water Illnesses (RWIs) and four deaths occurred in 1999-2000 because of water system failures in recreation pools. This total was ten times the rate of the decade before and affected 10,000 people, according to the CDC.

Too often when we take to the pool in search of an invigorating, healthy experience, we may actually be entering risky waters where public health is at stake.

Recreational Water Illness

RWIs can be spread by swallowing, breathing or having contact with contaminated water from swimming pools, spas, lakes, rivers or oceans. The results can include symptoms such as skin, ear, respiratory, eye and wound infections. The most commonly reported RWI is diarrhea, which can emanate from contact with germs such as Giardia, E. coli, Shigella and Cryptosporidium.

It's a basic public health issue. The stool of a person who is ill with diarrhea contains millions of germs. When that person enters the swimming pool, so do the germs associated with his/her illness. The result can lead to contamination of the water, opening the rest of the pools occupants to potential RWI episodes if the pool water is ingested or contacts an open wound.

Pool Treatment 101

Maintaining a high standard of water quality is every pool owner's aim. The most popular method towards achieving this goal is through the proper use of chlorine. For general pool treatment, chlorine has three essential characteristics:

1. It acts as a rapid and persistent sanitizer;
2. It is an effective algaecide;
3. It is a strong oxidizer of undesired contaminants.

Routine chlorination kills harmful microorganisms that can cause health-related problems, such as diarrhea, Legionnaires disease, and the viruses that cause ear infections and athlete's foot. While chlorine kills most germs that cause RWIs within minutes, it takes longer to kill some germs such as Cryptosporidium that can survive for days in even a properly disinfected pool. Therefore, healthy swimming behaviors and good hygiene are needed to protect you and your family from RWIs and will help stop germs from getting in the pool.

Chlorine should be regularly added to the pool water and levels should be tested daily - at a minimum - for proper disinfection. Hourly if the pool is heavily used.

However, you should not smell "chlorine." Ironically, a strong chemical odor does not mean there is too much chlorine in the water, it means there is not enough. A strong chemical odor is actually an indication of the presence of chloramines and an unhealthy pool. Chloramines form when chlorine combines with perspiration, urine, saliva, body oils, lotions and other wastes introduced into pools by swimmers. Chloramines render chlorine less effective for killing germs, and high levels may cause skin, eye, or respiratory irritation.

In addition to utilizing chlorine, swimming pool operators should vigilantly monitor pH levels, and make adjustments accordingly. Proper pH levels ensure that the chlorine is working effectively. The pH should be maintained between 7.2 and 7.8. While the dispersal of chemicals evenly throughout your pool is important, proper filtration and circulation are also essential for the removal of debris. Understanding the proper use of return jets, the pump and the filter will go a long way toward eliminating most problems.

The chemicals needed in pools to maintain the required standards differ from pool to pool, and day to day. Guidelines set by the National Spa and Pool Institute (NSPI) are widely used. However, it is also advisable to check your local or state health code.

Public Opinion on Swimming Pool Public Health

It's a fact that many swimmers are not aware that a simple summertime swim can lead to illness. A public survey commissioned by the National Consumers League (NCL) confirmed this, finding that approximately 60 percent of respondents believe that it is unlikely that someone can get sick from swimming in a swimming pool.

Additional data collected by the May 2004 NCL research included the following data points:

• 75% believed diapered children are at the root of diarrheal contamination in swimming pools
• One-fifth of respondents believed if you could smell the chlorine, the pool was safe.
• One-fifth said a little urine doesn't harm the health of the pool water.
• 88% agreed you should use soap and water after using the bathroom if you plan to jump back in the pool. Nearly 75% said they shower before going in.
• Nearly 94% said a "poop" accident should be reported immediately.

To increase public education and affect public awareness on this issue, a Healthy Pools partnership comprised of the CDC, National Consumers League, the Water Quality and Health Council, the Chlorine Chemistry Division of the American Chemistry Council and the National Spa & Pool Institute was formed in the spring of 2004. The cooperative joined together in a campaign to promote basic public health awareness and personal responsibility as the best means of ensuring an enjoyable, healthy swimming experience.

"Sense"-able Swimming

While the Healthy Pools campaign focused on the dissemination of a variety of swimming pool health issues involving proper maintenance, good personal hygiene and public education on the issue, the hallmark of the campaign was the partnership's "Sense"-able Swimming tips. As an easy-to-use method of checking on the health of pool water, "Sense"-able Swimming follows these basic but effective rules of thumb:

• Sight: The painted stripes and the drain at the bottom of the pool should appear crisp and clear at the bottom of the pool
• Touch: Swimming pool sides should not be sticky or slippery
• Smell: Chlorine is essential to a healthy pool, but a heavy chemical odor signals a problem
• Sound: The sound of active pool cleaning equipment is the sound of an active pool maintenance program
• Taste: Don't swallow pool water, and try to avoid getting it in your mouth at all
• Common Sense: Don't swim when you are ill with diarrhea

To publicize the Healthy Pools message, the partnership executed a multi-faceted public relations campaign, communicating both the need for the general public to recognize the signs of unhealthy pool water and the necessity of taking personal responsibility for ensuring the quality of the water in which communities swim. The Healthy Pools campaign successfully promoted the messages of the partnership through the following efforts:

National Consumers League president Linda Golodner discusses the Healthy Pools campaign with ABC Radio

• A June 2nd press conference at the National Press Club in Washington DC, featuring CDC epidemiologist Michael Beach, National Consumers League president Linda Golodner and noted Michigan State University microbiologist Joan Rose
• Development and launch of the campaign website, www.healthypools.org, complete with Healthy Pools campaign information documents, including:

"Sense"-able Swimming Fact Sheet Healthy Swimming Pool Frequently Asked Questions Swimming Pools: Myth & Fact Pool Treatment 101 CDC's Six "Pleas" for Healthy Swimming NCL's Healthy Pools Public Survey Results Healthy Pools Coloring Book

• Publication of a Healthy Swimming op-ed in The Washington Times bylined by NCL's Linda Golodner
• Distribute the "Make a Splash for Public Health This Summer" press release to media outlets
• Distribute the "Sense"-able Swimming press release through North American Precis Syndicate (NAPS)
• National broadcast media pick up of the Healthy Pools campaign June 2nd launch through an NBC network news service report, yielding an office of more than five million viewers nationwide
• Successful national broadcast media pitches garnering appearances by CDC's Michael Beach on the CBS's The Early Show, CNN's American Morning and CNN Headline News

The summer months have the potential to provide the healthiest experiences of the year and recreational swimming is a popular way for Americans to beat the heat. Yet many times, that simple summertime swim can become a source of health risk and some unpleasant experiences. However, the Healthy Pools campaign has offered the tools for a healthy alternative. With a measure of awareness, personal responsibility and common sense, millions of Americans can enjoy the sunny swimming months assured that their summer dips will be in healthy pools.