Summer means children and adults will be heading to swimming pools and water parks for relief from the heat. Unfortunately, public swimming pool facilities are also the homes of many hazards for children and adults, ranging from the spread of water-borne infections, the health problems associated with pool chemicals in concentrations that are too high or too low, drownings and other injuries.

Water-based physical activity is good for both mental and physical health. For those coping with arthritis and other disabilities, it may be a major form of exercise and therapy.

Many of the risks can be reduced with proper maintenance of facilities, appropriate disinfection practices, availability of safety equipment and safe practices in the use of pool chemicals. All pools and recreation areas follow safety guidelines and standards, but the codes for public aquatic facilities vary both among and within states and are not federally regulated. The nature of inspections and the type of problems health inspectors are expected to look for also vary widely.

Network for Aquatic Facility Inspection Surveillance

In 2013, the Centers for Disease Control (CDC) established the Network for Aquatic Facility Inspection Surveillance (NAFIS) which serves as a clearinghouse for inspection data from public health agencies across the U.S. that perform pool inspections.

More than three-quarters of the routine inspections revealed at least one violation.

Routine inspections are typically conducted one to three times per year. Inspections are also done when a complaint has been filed, along with follow-up inspections to determine whether identified violations have been corrected and whether the facility can reopen.

What Inspectors Found
A recent report from NAFIS contained data from 16 public health agencies in five states that was obtained during routine inspections during 2013. The results give an informative — and concerning — picture of current facilities across the United States.

The report contains information obtained during over 84,000 routine inspections of 48,632 public aquatic venues, mostly swimming pools during 2013. More than three-quarters of the routine inspections revealed at least one violation; over 12 percent of the inspections resulted in immediate closing of the facility because of at least one violation that represented a serious threat to public health.

Decontamination Challenges — Wading Pools and Water Parks
Nearly 12 percent of the inspections revealed violations of disinfectant concentrations, specifically too little disinfectant or malfunctioning automatic chemical feeders. The chemicals are used to kill potentially infectious bugs using chlorination or bromination.

Decontamination is more challenging in wading pools and water play venues such as water parks where the water is shallow and likely to be aerosolized — sprayed into the air. Both conditions decrease the amount of active chemical decontaminate available. Added to this, of course, is the fact that young children often contaminate the water from incontinence or swim diapers.

Equipment and Enclosures
The best way to prevent transmission of pathogens in the water is for aquatic facility operators to be trained in water disinfection management and the mechanical systems, such as automatic feeders, used to deliver disinfectants. A secondary method of disinfection, such as ultraviolet light or ozone to render some pathogens in wading pools and aquatic play venues inactive, also helps.

Decontamination is more challenging in wading pools and water play venues such as water parks where the water is shallow.

When safety equipment is absent, poorly maintained or inadequate, the risk for injuries and drowning increases. Poorly maintained fencing, which was identified in 5% of inspections, also increases this risk. Drowning is the leading cause of death in children aged one to four years, and more than half of these occur in a pool. Non-fatal drownings can result in prolonged hospitalization and chronic disability, as well as brain damage from oxygen deprivation.

To minimize the risk of drowning, experts recommend maintaining enclosures properly. This includes the fences, self-closing and self-latching gates and doors, and safety equipment. Using a finer mesh in fencing material can help prevent small children from being able to climb into protected enclosures. Lifeguards should have unobstructed views of the areas they watch, so they can see the entire water play area.

Hot Tubs and Spas
Hot tubs and spas were also included in the inspection and of 14,637 routine hot tub/spa inspections, 15.1% resulted in immediate closure, most commonly because of disinfectant concentration, poor chemical safety and water temperature violations.

Some pathogens thrive in the hotter temperatures of hot tubs and spas.

It can be difficult to maintain adequate disinfectant concentration in hot tubs and spas because of higher water temperatures and the fact that the microbes in water become aerosolized by the jets, both of which decrease chemical activity.

Some pathogens thrive in the hotter temperatures of tubs and spas, leading to a buildup of residue on the surfaces of the tubs that acts to protect the microorganisms from the action of disinfectants. Higher concentrations of disinfectant, cleaning residues and debris from accessible surfaces, and frequent draining and cleaning of hot tubs and spas are needed to keep spas and hot tubs safe.

No Need to Stay Away

That routine inspections frequently identified significant breaches of guidelines, leading to the closure of the facilities, indicate there is a need to improve public swimming facilities, hot tubs and aquatic play facilities.

Public and environmental health officials play a major role in preventing illness and injury at these facilities. States can use the inspection data to tailor their inspection programs to meet the specific needs of their communities. On the national level, the information can be used to create standards for aquatic facilities, as well as provide guidelines for maintenance and inspection.

Swimming pools and water parks are part of summer fun. The report encourages people to take part in water-based physical activity. It is good for both mental and physical health. And for those coping with arthritis and other disabilities, it may be a major form of exercise and therapy. All you need to do is find safe and well-maintained facilities, and report any concerns you may have to your local health department.