Public and private swimming pools have long been a source of
recreational fun for patrons of all ages, but are they safe?
In a time of increasing risk, both in and out of the
pool, who oversees the safety of these recreational outlets?
If you have been anywhere around aquatic headlines in the last
year, you probably noticed two big issues at the forefront;
cryptosporidiosis and suction entrapment.
According to the Centers for Disease Control (CDC), the total
number of reported cases of cryptosporidiosis, the leading cause
of recreational water illnesses (RWIs), increased from 3,505 in
2003 to 3,911 in 2004, and continued to climb to 8,269 reported
cases in 2005.1
At the end of the 2007 summer swim season, in an
unprecedented case, the metro area of Salt Lake City, Utah,
reported over 1,300 confirmed cases of cryptosporidiosis;
previously, confirmed cases in their state averaged 30 incidents
per year. 2 In
an attempt to reign in the situation, in August the Utah
Department of Health banned toddlers 5 and under from all public
swimming pools for the remainder of the 2007 swim season, a
preventative measure they may enact again in 2008.
Also a frequent hot topic, drowning continues to be one of the
top five leading causes of unintentional death in the United
States, and the second leading cause of injury-related deaths
worldwide for children 14 years old and under. 3
A lesser known hazard and cause of drowning, suction
entrapment became infamous on June 15, 2002, when Virginia
Graeme Baker drowned in a residential swimming pool after being
held underwater by a powerful suction force from a drain. 6
Her tragic death
spurred her grandfather, a United States Senator, to bring the
issue to the United States Congress for increased regulations
regarding child drowning prevention.
Why does it seem that there is a lack of standards and
regulations governing these types of facilities until it’s too
Across the United States, codes governing public pool design,
construction, and operation are reviewed and approved by
different state and local public health officials.
Of the 50 states, 48 possess some type of pool regulation
or guideline, and 2 states, Kansas and Mississippi, possess
Unfortunately, many of the 48 states with codes and guidelines
have outdated or complex and hard to understand text, and many
do not fully address the current identified risks.
For example, in the Salt Lake Valley where the RWI
incidents have spiked, their codes and regulations have not been
updated since September 6, 1984.
And for those codes that are updated regularly, the
requirements run the gamut from generic to specific; in the
state of Missouri, to control communicable diseases, they
specifically prohibit spitting in one section of their code, and
in the city of Wichita, Kansas, codes go so far as to detail the
amount of free chlorine residual required in swimming pools,
spas, and wading pools. 4
In addition to non-relevant and often lacking aquatic
regulations, state and county health departments are continually
asked to cut budgets and decrease staff.
With so many current aquatic facilities, and more being
added each year, the limited staff and department budgets
restrict many health professionals, and make them unable to
complete the necessary tasks to ensure public safety in aquatic
What is the government doing to make sure we are swimming in
Currently, government agencies are racing to catch up in a race
against time. Two
notable improvements in the efforts to regulate aquatic
environments have come from the Centers for Disease Control and
In the first-ever response to the lack of nationwide regulations
and standards and an increasing awareness of the dangers
associated with aquatic environments, the CDC is sponsoring a
project to develop a national code and risk reduction plan,
called the Model Aquatic Health Code.
The project is “intended to transform the typical health
department program and aquatic facility design, construction,
alteration, replacement, and operation efforts into a
data-driven, knowledge-based, risk reduction effort to prevent
disease and injuries and promote healthy recreational water
In addition to the CDC’s effort to establish a national aquatic
code, President Bush and Congress signed the “Virginia Graeme
Baker Pool and Spa Safety Act” into law on December 19, 2007.
6 The law
promotes the safety of young children around swimming pools, hot
tubs, and spas, specifically addressing anti-entrapment
prevention and increased barriers for residential pools and
What can we do?
No matter what is happening at the governmental level,
facilities looking for the best defense against these identified
risks and others should look no farther than great design and
Although everyone would like top-notch equipment and facility
designs to ward off potential problems, properly maintaining
your current facility and equipment is just as important.
Maintaining excellent water quality at all times is also
important, and simple additions may also benefit your facility,
such as equipping your facility with enhanced treatment
technology, for example UV, to decrease the risk of your water
to harbor crypto spores.
Reduce the risk of entrapment by ensuring drain covers and
outlets are secure and intact.
Replace any broken grates immediately and if there is any
question regarding the safety of your facility consult a
professional to evaluate your compliance with the new
Also equally important, your staff should be thoroughly trained
to handle any type of health incident at your aquatic facility.
Although all lifeguards are trained to minimize the risk
of drowning, they should also be trained to minimize the risk of
spreading RWIs and in other health concerns.
If your facility does not have a process for addressing
health incidents such as these, talk to your peers and utilize
resources such as the Centers for Disease Control to create your
Above all, know the risks, know the regulations, and make a plan
for your facility to stay safe at all times; because if you
don’t, no one else will!
1 Centers for
Disease Control (CDC),
Morbidity and Mortality Weekly Report,
Cryptosporidiosis Surveillance - United States, 2003-2005
Utah Health News,
Swimming Restrictions Extended for Kids Under Age Five
3 Centers for
Disease Control (CDC),
10 Leading Causes of Injury Death:
Highlight Unintentional Injury, 2004
4 Association of Pool and Spa
Pool and Spa Codes
5 Centers for
Disease Control (CDC),
Model Health Aquatic Code
Pool and Spa News,
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