Archive for the ‘Safety’ Category

Pool Chemical Safety: There’s No Substitute for Vigilance

Friday, July 7th, 2017

Pool Chemical SafetyWe could not safely enjoy a refreshing dip in the pool this summer without someone shouldering the responsibility of using and storing pool chemicals correctly. Someone has to apply and store the chemicals that keep pool water sanitized and so clear that a swimmer floundering in deep water is visible to life guards. Pool chemical safety is the responsibility of backyard pool owners, professional pool service providers, community pool managers and life guards. It’s one of those usually “invisible” jobs that may be noticed only when something goes wrong.

Why Pool Chemicals?

Swimming pools are essentially communal bath tubs. Pool chemicals are necessary to help maintain appropriate pool water quality. That is especially true when patrons neglect the standard advice to shower before swimming. Knowing that each swimmer who enters the water without first showering brings with them about 0.14 grams of fecal matter adhering to the perianal area, the potential for exposure to disease-causing germs in the water becomes intuitively obvious.

Pool disinfectants are added to destroy pathogens (disease-causing germs) that could be ingested by swallowing even a small amount of water. Other chemicals help control the pH of the water to maximize the effectiveness of disinfectants. Chlorine-based disinfectants, for example, are effective at destroying a wide range of pathogens in pool water when pool testing strips indicate a “free chlorine” level between 1 and 3 parts per million and pH between 7.2 and 7.8. Swimming pools would become nasty “petri dishes” without appropriate water disinfection.

Pool Chemical Mishaps

According to a 2014 CDC report1, in 2012, an estimated 4,876 people visited an emergency department for injuries associated with pool chemicals. Nearly half of these were younger than 18 years old, and the most common diagnosis was poisoning by inhalation of vapors, fumes or gases. The CDC report includes a description of a 2013 incident in Minnesota in which seven children and one adult were taken to emergency departments after being in a pool in which both the chlorine level and the pH exceeded state limits. The study cites several issues that may have caused or contributed to the event, including a failure of the facility’s automated chemical feed and monitoring system as well as a failure of pool operators to check equipment and pool chemistry. There is no substitute for vigilance when it comes to monitoring pool chemistry.

Pool chemical handlers and others can be injured when critical safety rules for storing and using pool chemicals are ignored. Inhaling fumes when opening pool chemical containers, mixing pool chemicals, attempting to pre-dissolve pool chemicals, and accidentally splashing chemicals in the eyes are some common mistakes. Other mistakes may not be immediately obvious, for example inadvertently spilling a cola-type soft drink near chemicals in the storage area could set off a dangerous chemical reaction that puts people at risk. That is why one of the rules of safe pool chemical storage is to refrain from bringing food or drink into the storage area. Another “recipe for disaster” is storing liquid chemicals above bags of solid chemicals; in the event that the container of liquid chemical leaks onto the bagged chemical, an unwanted chemical reaction could occur that endangers the health of pool staff and patrons. That is why it is important to store liquid chemicals securely in the lowest location.

Free Pool Chemical Safety Resources

CDC offers a pair of free, laminated pool chemical safety posters that are available in English or Spanish. The posters list important guidelines for safely using and storing pool chemicals. Another free resource is the online and smart phone-friendly Pool Chemical Safety video. The video, which illustrates many of the do’s and don’ts of safe pool chemical management, was developed by the American Chemistry Council and The Chlorine Institute. Please help promote these tools to the pool chemical handlers you know. If you are swimming in a healthy pool, you have them to thank.

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 member of the National Drinking Water Advisory Council.

Click here to download this article.


195% confidence interval [CI] = 2,821–6,930

Zika Virus: What Can We Expect this Summer?

Friday, June 2nd, 2017
Mosquito repellent can help reduce exposure to mosquitoes that carry Zika virus; infants younger than two months can be protected with mosquito netting.

Mosquito repellent can help reduce exposure to mosquitoes that carry Zika virus; infants younger than two months can be protected with mosquito netting.

As summertime approaches and vulnerable areas of the US warm up, concerns over the potential spread of Zika virus are on the rise. The virus is spread mainly through the bite of an infected Aedes aegypti mosquito, but also can be transmitted sexually. Zika virus is associated with birth defects (microcephaly) in infants of infected mothers and Guillain-Barre Syndrome, an immune system disorder.

Last summer, several regions of the US were identified as possible sites of Zika virus outbreaks based on modeling studies1 and well-publicized outbreaks in Brazil and other areas of Latin America. Although there have been over 5,000 travel-related cases reported2 in the US since 2015, local transmission of the virus in the continental US occurred in just 224 cases in two geographic “pockets” last summer: Miami-Dade County, Florida (218 cases) and Brownsville, Texas (6). What does this summer hold for those of us on the lookout for Zika virus?

Zika: State of Play

Globally, the World Health Organization (WHO) reports Zika virus continues to spread to areas where mosquitoes are present that can transmit the virus. For example, the WHO recently reported three laboratory-confirmed cases of Zika virus in the Gujarat State of India. Because of the potential health effects on infants of infected mothers, the Centers for Disease Control and Prevention (CDC) tracks the number of pregnant women with any laboratory evidence of possible Zika virus infection in the US and US Territories (1,845 and 3,795, respectively, as of May 9, 2017). As of May 9, 2017, of 1,471 completed pregnancies reported to the US Zika Pregnancy Registry, there have been 64 liveborn infants with birth defects and 8 pregnancy losses with birth defects (approximately 5 percent birth defects).3

Currently, CDC data show nearly two-thirds of the 50 states have reported laboratory-confirmed cases of Zika virus in 2017. For the period January 1 – May 24, 2017, all 120 reported Zika virus cases were in travelers returning from affected areas. Many more cases, 498, were reported in US territories, with the majority in Puerto Rico. CDC presumes that all cases in US Territories were acquired through local mosquito-borne transmission. Meanwhile, Miami-Dade County and Brownsville are currently designated by CDC as “cautionary areas” to which pregnant women should consider postponing travel. In Florida, where I work at the Department of Health, none of the more than 90,000 mosquitoes tested to date have been found to be infected with the Zika virus, evidence that the virus has not “overwintered” here. We have a team of over 20 epidemiologists placed around the state to monitor Zika virus, and $20 million in state funds has gone to “skeeter control” districts for their spraying/larvaciding/eradication efforts. We are also aware that some cities and counties are planning to use genetically modified sterile mosquitoes to reduce mosquito populations.

Hope for a Vaccine

In a September 2016 interview, CDC director, Dr. Tom Frieden, noted that “Zika is likely to become endemic in this hemisphere. That means it will continue to spread at some level for years to come.” On the positive side, government scientists at the National Institute of Allergy and Infectious Diseases have developed an experimental vaccine that is being tested on human volunteers. According to the March 31, 2017 announcement, the trial is expected to conclude in 2019, but initial results could be available by the end of 2017. An effective vaccine will be critical in controlling the spread of Zika virus. Meanwhile, it’s important to implement the many known strategies that can help reduce our exposure to mosquitoes and Zika virus.

Tips from the Frontline of the Zika Virus Battle

The following tips include information from the Florida Department of Health’s “Drain and Cover” program, and can help control the risk of Zika virus and other mosquito borne illnesses:

  • Drain water from garbage cans, house gutters, pool covers, coolers, toys, flower pots, or any other containers where sprinkler or rain water has collected.
  • Discard old tires, drums, bottles, cans, pots and pans, broken appliances and other items that aren’t being used.
  • Empty and clean birdbaths and pets’ water bowls at least once or twice per week.
  • Protect boats and vehicles from rain with tarps that do not accumulate water.
  • Maintain appropriate pool chemistry (chlorine level and pH) of swimming pools. Empty plastic swimming pools when not in use and store in a way that avoids accumulating water.
  • Repair broken screens on windows, doors, porches and patios.
  • If you must be outside when Aedes mosquitoes are active (daytime), cover up. Wear shoes, socks, long pants and long sleeves.
  • Apply mosquito repellent to bare skin and clothing. Follow label directions. Repellents with DEET, picaridin, oil of lemon eucalyptus, para-menthane-diol, and IR3535 are effective and safe for pregnant and breast-feeding women, when used as directed. Use netting instead of repellents to protect children younger than two months.

Although it is difficult to predict how Zika virus will affect the US this summer, taking reasonable precautions to prevent exposure to mosquitoes is prudent, especially for those of us in vulnerable areas. Forewarned is forearmed!

Bob G. Vincent is an Environmental Administrator in the Florida Department of Health. He manages Department of Health programs for Healthy Marine Beaches, Safe Drinking Water, Water Well Surveillance and Public Pools and Bathing Places.

 

Click here to download this article.


1 These regions included the Gulf Coast and much of the Eastern Seaboard of the US.

2 Travel-related cases of Zika virus are those in which people are infected by mosquitoes while visiting countries in which the virus is endemic (regularly found). CDC reported 61 of these in 2015, 4,830 in 2016 and 119 as of May 19, in 2017.

3 CDC notes: “Although these outcomes occurred in pregnancies with laboratory evidence of possible Zika virus infection, we do not know whether they were caused by Zika virus infection or other factors.”

 

Responding to Dengue Fever

Friday, October 9th, 2015
Responding to Dengue Fever

The female Aedes aegypti mosquito is the “vector” that transmits dengue fever from person to person.Image reprinted from the US Centers for Disease Control and Prevention website.

In the wake of recent monsoons and flooding, mosquito-borne dengue fever is once again on the rise in the Asia Pacific Region.  According to the US Centers for Disease Control and Prevention (CDC), worldwide, dengue fever cases number over 50 million annually.  The World Health Organization (WHO) estimates1 that globally 2.5 billion people, over one-third of the world’s population, live in areas that put them at risk for the viral disease, and about 70 percent of them (1.8 billion) live in the Asia Pacific Region.

Dengue is rare in the continental US, but endemic in Puerto Rico, where the CDC maintains a center of expertise and a diagnostic laboratory in its San Juan Dengue Branch.  It is also endemic to the Caribbean, Mexico and Central America.  According to the Gates Foundation website, dengue fever incidence has increased 30-fold worldwide since the 1960s.  Increasing urbanization and global travel contribute to ongoing outbreaks globally.

Dengue Fever Symptoms

Dengue fever symptoms range from mild fever to incapacitating high fever, with severe headache, pain behind the eyes, muscle and joint pain and rash, according to the World Health Organization.  Symptoms appear 3 -14 days after the infective bite.   The CDC advises patients to go immediately to an emergency room or closest health care provider if any of the following warning symptoms appear:

  • Severe abdominal pain or persistent vomiting
  • Red spots or patches on the skin
  • Bleeding from nose or gums
  • Vomiting blood
  • Black, tarry stools (feces, excrement)
  • Drowsiness or irritability
  • Pale, cold, or clammy skin
  • Difficulty breathing

Dengue hemorrhagic fever is a severe, potentially lethal form of the disease that generally requires hospitalization.  Children usually have a much milder form of dengue fever than adults, but those who survive the disease have a much greater chance of dengue hemorrhagic fever if they are subsequently infected as adults with a different serotype of the virus.

Avoiding Mosquitoes to Avoid Dengue Fever

Dengue fever is spread by the bite of infected Aedes aegypti mosquitoes, which are endemic to the southeast sector of the US among other world regions.  Humans are the reservoir of the disease, and there are at least four dengue viruses.  A person bitten by an infected mosquito may or may not develop symptoms.  That person cannot transmit the illness directly to others, but if a mosquito bites that person after he/she becomes infected, that mosquito can spread dengue fever to others through ongoing biting. According to the CDC, the Aedes aegypti bites primarily during the day. This species is most active for approximately two hours after sunrise and several hours before sunset, but it can bite at night in well-lit areas.

There is neither a vaccine for dengue fever nor specific antiviral medicines to treat the illness.  Preventing dengue is a matter of avoiding mosquitoes and their bites. Strategies include:

  • Eliminate standing water in flower pots, buckets, barrels, old tires, untreated kiddie pools and other containers that can serve as breeding grounds for mosquitoes.
  • Ensure good drainage of water around homes.
  • Maintain a chlorine residual of about 1 mg/l in stored treated drinking water; drinking water storage is common in developing countries that lack central water distribution.
  • Make sure backyard pools are appropriately chlorinated as mosquitoes will not breed in chlorinated water.
  • Inspect and repair window and door screens.
  • Apply an insect repellent to exposed skin and/or clothing when spending time outdoors. Products containing DEET, picaridin, IR3535, and some products containing oil of lemon eucalyptus and para-menthane-diol may provide long-lasting protectionfollow label directions for use.2
  • Apply insect repellent to skin after applying sunscreen, if sunscreen is to be used.
  • When you are outdoors, air movement around your body (from fans or natural breezes) disrupts mosquito flight and reduces your risk of being bitten.

The Indian Government is Activated

The Indian Express reports the current Dengue Fever outbreak is the worst one in five years, and notes other diseases with similar symptoms are also on the rise, including typhoid and B. coli.  The newspaper reports government inspectors go house-to-house in New Delhi in search of standing water, for even a few milliliters of clear water can become the breeding grounds of mosquitoes. Steep fines are imposed on residents who harbor standing water.  Fumigation is practiced in some areas.  Children are advised to wear full-sleeved shirts.

Government doctors have been told they will be on the job with no leave until the outbreak subsides and the number of hospital beds has been increased.

A High-opportunity Target

As flooding in the Asia Pacific region subsides, dengue cases are expected to decline.  Nevertheless, the disease remains one of the “most widespread vector-borne viral infections in the world,” according to the WHO.3  The Gates Foundation calls dengue fever a “high-opportunity target” because several potential vaccines are in development. The foundation supports efforts to develop a dengue vaccine, which it estimates could prevent more than 500,000 hospitalizations and 3,000 deaths annually, most of these among children (see press release).

An effective vaccine against dengue fever is the response we would most like to see to this global scourge.

Click here to download this article.

For more information on dengue fever and the Aedes aegypti mosquito, please see this CDC resource.

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


1See: World Health Organization, Regional Office for South-East Asia, Asia-Pacific Dengue Strategic Plan (2008-2015)

2For more information on insect repellents and their effectiveness, please see http://cfpub.epa.gov/oppref/insect/.

3WHO.  Dengue hemorrhagic fever:   Diagnosis, treatment, prevention and control. Geneva. World Health Organization, (1997): 12-23

West Nile Virus: A Seasonal Epidemic in North America

Friday, August 21st, 2015


West Nile Virus Activity by State – United States, 2015 (as of August 11, 2015)
Map courtesy of the US Centers for Disease Control and Prevention

This summer North America is once again experiencing a “seasonal epidemic” of West Nile virus that is expected to last through the fall.  According to the Centers for Disease Control and Prevention (CDC) website, the mosquito-borne virus has been reported in 42 US states as of August 11, 2015.  Fortunately, most people who are infected with the virus show no symptoms; about 20 percent of people infected develop mild symptoms (e.g., headache, body aches, joint pains, vomiting, diarrhea or rash) after three to 14 days.  Less than one percent of those infected become seriously ill (e.g., high fever, muscle weakness, neck stiffness, stupor, and potentially permanent or fatal neurological disease).  There are no medications to treat West Nile virus, nor vaccines to prevent human infection1Avoiding West Nile virus is primarily a matter of avoiding mosquito bites.

West Nile Virus Transmission

According to the Centers for Disease Control and Prevention (CDC) website, the West Nile virus cycles between mosquitoes and birds.  Mosquitoes become infected with the virus by biting infected birds; they then pass the virus to humans and other mammals through mosquito bites.  West Nile virus is believed to have been in the US since about 1999 when it was first detected in New York City, but human infections have been reported in many countries for over 50 years.  According to the World Health Organization website, the virus is found in Africa, Europe, the Middle East and West Asia, in addition to North America.

West Nile virus can kill some host birds when the virus concentrates in their blood.  Sightings of multiple dead birds could be a sign that the virus is circulating in the vicinity.  CDC notes reporting dead birds to county and state health departments may be helpful to West Nile virus monitoring activities.  Additionally, some health departments monitor mosquitoes for the West Nile virus, which may be supplemented by monitoring sentinel chickens and dead birds.  According to the CDC report, “West Nile Virus in the United States:  Guidelines for Surveillance, Prevention, and Control,” “Research and operational experience shows that increases in WNV [West Nile virus] infection rates in mosquito populations can provide an indicator of developing outbreak conditions several weeks in advance of increases in human infections.”  (The report is linked to this CDC website.)

Reducing Your Risk of West Nile Virus is a Three Step Process

  • First, know your inherent risk level. People over 50 years of age have a greater chance of developing serious symptoms of West Nile virus than those younger than 50.
  • Second, know when to expect the “enemy.” Many mosquitoes are most active from dusk to dawn; these are the hours during which special precautions may be warranted, including avoiding being outdoors.
  • Third, take steps to avoid mosquitoes and their bites.
    • When outdoors, use effective insect repellents; those containing DEET,  picaridin, IR3535, and some oil of lemon eucalyptus and para-menthane-diol products may provide longer-lasting protectionfollow label directions for use (For more information on insect repellents and their effectiveness, please see http://cfpub.epa.gov/oppref/insect/.)
    • Wear long sleeves and long pants of tightly woven fabric; tuck pant legs into socks for extra protection
    • Inspect and repair screens on windows and doors
    • Remove standing water in flower pots, buckets, barrels, old tires, untreated kiddie pools and other containers that can serve as breeding grounds for mosquitoes
    • Make sure backyard pools are appropriately chlorinated; mosquitoes will not breed in chlorinated water
    • When you are outdoors, air movement around your body (from fans or natural breezes) disrupts mosquito flight and reduces your risk of being bitten.

Your local health department may provide additional information about protecting against mosquito-borne diseases in your area.

What to do if You Think You Have West Nile Virus

According to CDC, mild symptoms of West Nile virus will improve on their own without medical intervention.  Severe West Nile virus symptoms may require hospitalization.  West Nile virus is not spread from casual human contact, such as touching or kissing.  If you have severe symptoms and think you may be infected with the West Nile virus, seek medical attention immediately.

For more information on West Nile virus, please see www.cdc.gov/westnile.

Click here to download this article

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.


*WNV human disease cases or presumptive viremic (“viremic” is defined as the presence of a virus in the blood) blood donors. Presumptive viremic blood donors have a positive screening test, which has not necessarily been confirmed

† WNV veterinary disease cases, or infections in mosquitoes, birds, or sentinel animals.

1According to the World Health Organization, vaccines are available for use in horses.

 

Swimming Pool Myths Busted over the Airwaves

Friday, June 19th, 2015

We recently completed our annual Healthy Pools “radio media tour” of 23 radio stations across the US, during which we dispelled common swimming pool myths and promoted tips on staying healthy in the pool this summer.  Here are some highlights from the tour:

MythThere is a dye that is used to identify swimmers who pee covertly in the pool.

There is no dye in pool water to indicate the presence of pee (pockets of warm “water” may be an immediate, but fleeting give-away).  Rather, swimmers are on the “honor system” when it comes to getting out of the pool to use the bathroom.  We highly recommend doing this (see below).

Myth:  Swimmer’s eyes turn red when there is too much chlorine in the pool.

Too much chlorine in the pool would be irritating to the eyes, but chlorine itself is not the common cause of swimmer “red eye.”  Swimmers’ eyes redden from irritants–known as chloramines–produced when urine and sweat in the pool combine chemically with chlorine pool disinfectant.  To quote Dr. Tom Lachocki of the National Swimming Pool Foundation, “Swimmers’ eyes are the real color indicator that someone might have peed in a pool.”

For a healthy experience in the pool: shower before swimming to remove sweat, dirt, cosmetics and trace fecal matter (yes, we all carry some, so please shower thoroughly).  The pre-swim shower and frequent bathroom breaks can go a long way toward letting chlorine carry out its critical role of killing germs in the pool instead of having to bind with the various impurities swimmers add to pool water.

Use Your Senses and Use Pool Test Strips

Over the course of our interviews, we repeated these simple tips on using your senses to evaluate the “health” of a swimming pool:

Sight:  Make sure you can see clearly through the water to the floor of the pool.

Sound:  If you are near the mechanical room, you should be able to hear the pool pumps operating to circulate the pool water.   For larger pools, pumps might not be as audible.  In that case, you should be able to feel water being pumped into the pool in various locations, especially near the bottom of the pool.

Smell:  A properly maintained pool should have NO HARSH CHEMICAL odor.

Touch:  Tiles on the sides of the pools should feel smooth and clean, NOT SLIMEY.

Taste:  Avoid getting water in your mouth and swallowing it.

Finally, pool test strips are a simple tool swimmers can use to check the pH and free chlorine level of pool water. Order a free pool test kit at www.healthypools.org

Happy Swimming in Healthy Pools.  Over and out!

 Click here to download this article.

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

Safe Fun in the Kiddie Pool

Friday, May 29th, 2015

A Word to the Wise: If you plan to leave the end of a garden hose submerged in the pool, remember that not all states require backflow preventers on hoses. Without a backflow preventer, it is possible that tainted pool water will flow back into the drinking water system when the hose is turned off. 

Kiddie pools can bring hours of delight to young children on a hot summer day.  But unlike larger pools, small plastic and inflatable kiddie pools are normally not equipped with water filters or treated with chemicals that remove germs and balance pH.  Add to this the fact that hygiene is not a strong suit of the kiddie pool set, and a few helpful tips are in order for safe fun in the kiddie pool:

  • Fill the pool with fresh water before each use:  Without the benefit of chemical treatment, kiddie pools must be refilled with fresh tap water before each use.  When my children were small, I would fill the pool with water early in the morning and let it warm up for a few hours before letting the children go in.  Naturally, adult supervision is needed around the water-filled pool.
  • Bathe children before they enter the pool: This may sound counterintuitive, but without bathing children first, the risk of their contaminating the pool with pathogens rises.  Without getting too graphic, the diaper and underpants area are the source of most of the pathogens that can make kids sick.  Change diapers as needed, and keep in mind that swim diapers or swim pants are not leak-proof.  If your little swimmer is potty trained, build in some bathroom breaks to avoid “accidents.”
  • Sick children should not be in the pool with other children: A child who is experiencing diarrhea or vomiting must not be allowed in the pool with other children. If a child becomes sick in the kiddie pool, a quick exit of everyone from the pool is in order.  The pool must be emptied of water, cleaned and disinfected before being used again (see the next tip). 

Do You Bathe Your Children Together?

The Centers for Disease Control and Prevention website notes children from the same family or household who are often bathed together are unlikely to be at increased risk of spreading diarrheal illness to each other when using the same inflatable or plastic pool. Allowing larger numbers of children from different families to use these pools, however, is likely to increase the risk of spreading diarrheal illnesses.

  • Clean and disinfect the kiddie pool after each use: Drain or empty the pool after each use. Leaving the pool full overnight is unsafe, both because it is a potential drowning risk and a potential waterborne disease risk.  (Did I mention there are no disinfectants in the water?)  The Centers for Disease Control and Prevention (CDC) recommends cleaning the pool after it has been used, and once dry, leaving it in the sun for at least four hours.  The ultraviolet rays of the sun can be effective at destroying pathogens.  Alternatively, if manufacturer’s directions agree, the kiddie pool interior can be cleaned and then disinfected with a simple chlorine bleach solution.  For example, the “How to Clean Stuff” website1 recommends using a solution of one part bleach to five parts water. Rinse the pool well after this treatment. 
  • Don’t drink the kiddie pool water: Discourage children from drinking pool water from kiddie pools or from any pool, for that matter.  After all, we know from a 2009 Water Quality & Health Council survey that approximately one in five adults admit to having peed in the pool–a habit that might have started in the kiddie pool.  Distracting young children with a “sippy cup” of a favorite beverage may help, but don’t be surprised if the beverage ends up poured over somebody’s head! 

Here’s to a happy, healthy and safe fun in the kiddie pool.

Click here to download this article.

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


1 Although the “How to Clean Stuff” website recommends draining kiddie pools only once per week, I strongly recommend draining the pool immediately after use.

Staying Healthy in the Hot Tub

Friday, May 30th, 2014

 

What is a hot tub? A stress-free, aqueous haven, or a water barrel brimming with bacteria? That was the essence of the question addressed in a recent Huffington Post interview with Centers for Disease Control and Prevention (CDC) epidemiologist Michele Hlavsa and University of Arizona Professor Charles Gerba. Although the headlines asserted, “This Will Make You Never, Ever Want to Get in a Hot Tub Again,” these two experts provide the kind of straight talk that can help you enjoy a healthy hot tub experience. As usual, knowledge is power.

Hot Tub Rash and More

In the interview, CDC epidemiologist Michele Hlavsa discussed “hot tub rash,” a condition that may result from using an inadequately disinfected hot tub. Levels of the bacterium

Pseudomonas aeruginosa1 may increase when hot tub disinfectant levels, such as chlorine and bromine, fall. Bacteria in water-soaked bathing suits can cause an infection of the hair follicles of the skin to which wet bathing suits cling. The infection is technically known as Pseudomonas folliculitis. Fortunately, hot tub rash—which may follow the shape of a person’s bathing suit—normally disappears within a week.

Another potential condition associated with inadequately disinfected hot tubs is Legionnaire’s disease, a severe type of pneumonia, and its milder counterpart, Pontiac Fever which according to Ms. Hlavsa, causes flu-like symptoms. These illnesses are transmitted by the inhalation of mists or tiny airborne droplets containing the Legionella bacterium. Senior citizens, smokers and those with weakened immune systems are most susceptible to these illnesses.

Download the following tip sheet for staying healthy in the hot tub:

Tips for a Safe Soak in the Hot Tub

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.


1Pseudomonas aeruginosa is the bacterium that is the common cause of swimmer’s ear. According to a 2011 CDC report, “swimmer’s ear” accounts for 2.4 million doctor visits and nearly $500 million in health care costs annually.

Click here to download this article.

A “How to” Video on Pool Chemical Safety

Friday, May 16th, 2014

A new report1 by the US Centers for Disease Control and Prevention features statistics on pool chemical incidents during the period 2003-2012.  The highlights include:

  • An estimated 4,247 people2 per year went to emergency departments for injuries associated with pool chemicals; nearly half of these were younger than 18.
  • The most frequent diagnosis was poisoning stemming from inhalation of vapors, fumes or gases.
  • More than one-third of pool chemical related incidents occurred at a residence.
  • Over 70 percent of incidents occurred over the summer swim season; over 40 percent of incidents occurred on a Saturday or Sunday, a time of increased pool use and decreased likelihood of a trained operator being on duty.

Chemicals are added to pools to maintain healthy conditions for swimming. Disinfectants, for example, inactivate waterborne germs that spread illnesses such as diarrhea, swimmers’ ear and skin infections.  Many pool chemical incidents are preventable through operator training.  In an attempt to help reduce pool chemical-related incidents, the American Chemistry Council and the Chlorine Institute collaborated to produce a training video featuring guidelines and recommended practices on the safe storage and use of pool chemicals.  For example, to prevent chemical inhalation injuries, the video recommends, among other tips:

  • Reading and following chemical manufacturers’ directions and relevant safety data sheets.
  • Storing chemicals in a well-ventilated, dry and secure area, away from children and animals.
  • Separating incompatible chemicals in storage.
  • Never mixing acids and chlorine-based chemicals; avoiding cross-contaminating chemicals with common scoops or other equipment.
  • Always adding pool chemical to water; never adding water to pool chemical.
  • Using personal protective equipment such as goggles and plastic gloves when handling pool chemicals.

The video, available on YouTube and accessible to both commercial pool operators and backyard pool owners, includes safety messages based on information from the CDC.

As the pool season starts, share the video and help make a dent in pool chemical incident stats!


1 Hlavsa, M.C. et al., “Pool Chemical-Associated Health Events in Public and Residential Settings—United States, 2003-2012, and Minnesota, 2013,” Morbidity and Mortality Weekly Report, May 16, 2014/63(19);427-430.

2 (95% Confidence Interval = 2,821-6,930)

How can a Parent Help Maintain the Fun and Decrease the Risks Associated with Water Parks?

Friday, May 10th, 2013

How can a Parent Help Maintain the Fun and Decrease the Risks 
Associated with Water Parks?
Interactive spray fountains, splash parks and splash pads are popular summertime venues where kids can cool off and have fun in “zero-depth” or very shallow water. Many urban areas feature these venues; families discover they can beat the heat inexpensively without leaving the city. They are also found in amusement parks and as part of municipal pool complexes. But as enjoyable as interactive water features can be, they can also make kids sick when certain risky behaviors are practiced (and these risky behaviors are observed frequently).

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

How to Reduce Your Child’s Risk of Illness from Water Park Venues

  • Shower or bathe children with soap before attending water parks, paying special attention to their bottoms.
  • Discourage risky behaviors like sitting on water spouts or placing mouths over them.
  • Do not drink water from water park play area.
  • Change diapers only in designated areas.
  • Do not permit children who have diarrhea to attend water parks.

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.

Reducing the Risk of Pool Chemical Accidents

Friday, July 6th, 2012

Pool Chemical Safety: Storage

Pool Chemical Safety: Use

The summer swim season is here, and unfortunately so are the pool chemical-related health events. One event made national headlines in late June when about 70 people were taken to local hospitals and eight were hospitalized. However, many more of these events never make the headlines. In fact, the Centers for Disease Control and Prevention (CDC) recently reported that as many as 5,200 emergency room visits per year are due to pool chemical–related injuries. Almost half of these injuries take place at a residence.

Pool chemicals help protect swimmers from bacteria and other germs that can lead to recreational water illnesses (RWIs). However injuries can occur in or out of the pool when critical safety rules for storing and using pool chemicals are ignored. Inhaling fumes when opening pool chemical containers, mixing pool chemicals, attempting to pre-dissolve pool chemicals, and splashing chemicals in the eyes can cause injuries.

Fortunately, most of these injuries can be prevented by following safe chemical storage and handling practices. Be sure to:

  • Read entire product labels before storing and using pool chemicals;
  • Dress for safety by wearing appropriate safety equipment (for example, safety goggles, gloves, and mask) before storing and using pool chemicals;
  • Lock chemicals up to protect people and animals;
  • Never mix chlorine products with each other, with acid, or with any other substance; and
  • Only pre-dissolve pool chemicals when directed by the product label
    • – If product label directs pre-dissolving, add pool chemical to water; NEVER add water to pool chemical.

While CDC’s Healthy Swimming Program continues to focus on preventing RWI’s caused by contaminated water, the Program is stepping up its efforts to prevent injuries caused by pool chemicals. To help spread the word to pool operators and backyard pool owners alike, we have developed poster-sized check-lists, which pool owners and operators can read or download by visiting Healthy Swimming Posters. This is another important tool to promote healthy swimming, and with the generous financial support of the American Chemistry Council we are in the process of printing and laminating 35,000 copies of each poster in English and Spanish. Remember, healthy swimming is no accident!