Oh, the power of suggestion of running water…the overwhelming sense of urgency elicited. The little boy in this year’s TaxACT Super Bowl XLVI commercial is in the family swimming pool when he realizes he has to go! He tries to do the right thing: He leaves the pool and dashes through the house in search of an open bathroom. But luck is not on his side. Every bathroom is occupied and to make matters worse, as he races from room to room, the little guy is tormented by the sight of water streaming from the washing machine and steam shooting from the tea kettle. Desperate, he plunges back into the pool where relief floods his face. Yes, he pees in the pool. But he tried valiantly to avoid it.

In 2009 the Water Quality & Health Council conducted a public survey that found one in five American adults admit to having peed in a pool. The news made headlines and focused attention on this unsanitary practice.

Peeing in the pool is a lose/lose proposition because:

• Swimmer urine depletes chlorine that would otherwise be available to destroy waterborne germs.
• Chlorine reacts with urine to produce compounds called chloramines that irritate the eyes and skin of swimmers.

At the end of the commercial, the boy appears smug with the knowledge that he has tainted the pool for his sister. The truth is that no one wins when pool water quality is degraded.

Speaking of winning, it is estimated that over 111 million people viewed the Super Bowl commercials as the Giants out-battled the Patriots in the big showdown. While fans were surely amused at the comical conclusion of the TaxACT commercial, let’s hope many of those viewers will be as motivated as our little protagonist was to get out of the pool the next time the urge strikes—and return only after using the bathroom.

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.

“Swimmers shouldn’t have to flip a coin to determine if the pool they are swimming in is healthy”. These words, from Chris Wiant, PhD, Chair of the Water Quality and Health Council, reflect the results of the Council’s 2011 Healthy Pools Campaign in which swimmers tested their pool waters for pH and free chlorine values. About half of the results uploaded to the Healthy Pools website this summer by 1,500 swimmers showed improper pH and free chlorine values. According to Wiant, “too many of the pools tested were out of the optimum range for protection against waterborne germs and swimmer comfort.”

With a generous contribution from the Hach Company, the Water Quality & Health Council distributed over 32,000 free pool test kits to the public. Swimmers used the kits to test for pH and chlorine levels in pools across the country.

The majority of data (78%) were submitted by backyard pool owners, pointing to a need for better public education on proper pool chemistry. In addition, data were submitted by swimmers at community adult pools (18%), community kiddie pools (3%), and hotel and motel pools (1%).

According to the Center for Disease Control (CDC), chlorine and pH represent the front line of defense against waterborne illnesses. Routine chlorination kills harmful microorganisms that can cause health-related problems, such as gastroenteritis and swimmer’s ear. A new study by CDC found that swimmer’s ear infections are responsible for 2.4 million health care visits every year and nearly half a billion dollars in health care costs.

In an effort to assist backyard pool owners with pool-related questions, this summer the Water Quality & Health Council included a popular “Ask a Pool Operator” feature on its Healthy Pools website. The public was treated to free expert advice on technical problems dealing with swimming pool maintenance. The Council also works to improve pool management education through its Healthy Pools blog series.

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.

As summer draws to a close, a recent Wall Street Journal article examines the popularity, costs and sales of various swimming pool disinfection technologies. The article compares traditional swimming pool chlorination with alternative germ-destruction technologies, including “saltwater pools,” ozone gas and ultraviolet radiation.

Some swimmers interviewed for the article expressed a preference for pools that use saltwater to generate chlorine over the traditional method of disinfection by the direct addition of chlorine products to the pool. These swimmers implied the two methods were vastly different. In effect, whether a pool is a “saltwater” pool or is treated with traditional chlorine disinfectants, germ destruction is achieved using the same chemistry—chlorine chemistry.

Chlorine is chlorine

Saltwater pools effectively generate chlorine on site from common sodium chloride salt.  A saltwater pool features a generator that applies electricity to salt, releasing dissolved sodium and gaseous chlorine. Chlorine then goes to work killing germs just as it does when chlorinated disinfectants are added to pools. Unfortunately, the Wall Street Journal article mistakenly asserts that chlorine from saltwater generators “…doesn’t allow the formation of itch- and stink-producing byproducts that conventional chlorine pools produce.” That is neither true nor possible.

In addition to killing germs, chlorine can react with low levels of impurities in the pool, including perspiration, body oils, urine and feces, to form “disinfection byproducts” such as chloramines, the irritants responsible for swimmers’ red eyes and itchy skin.  These can be minimized, however, by a combination of proper pool management and good swimmer hygiene.

Maintaining pool water quality

According to the Centers for Disease Control and Prevention (CDC), there should be no harsh chemical odor to a well-managed pool—public or private–in which pH and chlorine levels are maintained within appropriate ranges. In addition, CDC encourages swimmers to shower before swimming and avoid “peeing” in the pool; good swimmer hygiene helps reduce the presence of irritating chloramines in pool water.

Does a saltwater pool feel better on the skin? That might be attributed to the water softening effect of sodium in the saltwater pool.  Additionally, backyard pool owners particularly pleased with saltwater pools may be dealing with fewer swimmers and lower levels of impurities in the water than in the typical public pool, easing the task of pool maintenance. Nevertheless, whether it is added in the form of chlorinated pool disinfectants or generated in a saltwater pool, chlorine is chlorine and its chemistry does not waiver between conventional and alternative swimming pool applications!

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.

How cute is that? Little Jake over there is undergoing aquatic rehabilitation in an underwater treadmill after paralyzing his rear limbs in an unfortunate accident. One veterinarian’s initial prognosis was that Jake would not be able to walk again. But after physical therapy and the underwater treadmill, Jake is back on his feet and happier than ever.

Canines are not the only species that can benefit from aquatic therapy. Whether it is used to help people recover from acute injuries or to maintain health in the face of chronic disease, hydrotherapy is regarded as having “broad rehabilitative potential” that is relatively underused (Becker, 2009).

Water: An ideal medium for exercise.

Swimming is widely recommended by medical experts for its healthful benefits*. According to the American Red Cross, the buoyancy of water results in less stress on the joints, helping to reduce swelling and tissue damage. Warm water can increase circulation, decrease pain, and increase muscle relaxation and soft tissue flexibility.

Patients (and puppies) looking to strengthen muscles should exercise in pools with some turbulence.
Aquatic exercise: Benefits galore

• Lower risk of death In a 2009 Washington State University study of over 40,000 men, exercise swimmers had less than half the mortality risk of sedentary men, and exercise swimmers had half the mortality risk of exercise walkers and runners.
• Aids patients with COPD A 2009 study of patients with chronic obstructive pulmonary disease (COPD) found the swimming pool a “feasible and positive alternative venue for pulmonary rehabilitation”.
• Asthma Many studies have found swimming improves asthma symptoms; LaKind et al. cite Welsh et al. ¹, who reviewed the relevant scientific literature. According to LaKind et al., Welsh et al. note that most studies find “positive effects of swim training on fitness as measured by improved aerobic efficiency, physical working performance, and recovery heart rates.”
• Heart healthy Aquatic exercise strengthens the heart muscle and improves oxygen delivery to the muscles.
• Reduces water and sodium retention Animal data collected in Brazil ² indicate exercise in water might be prescriptive for patients with hypertension, obesity and/or mild renal disease as it reduces water and sodium retention.
• Hand eye coordination and balance According to a study done in Taiwan, swimming can improve hand eye coordination and balance in the elderly, which could lower a senior’s risk of a falling-related injury.
• Bone health Aquatic exercise can maintain or improve bone health in post-menopausal women.
• Better flexibility and range of motion According to the American Red Cross, when accompanied by good stretching habits, aquatic exercise can greatly improve flexibility and aid range of motion.
• Improved mood Swimming can improve the mental state of both men and women, the elderly and women with fibromyalgia, mothers, and parents of children with developmental disabilities.

Swimming may be the BEST and most enjoyable form of exercise, so give it a try!

*The American Red Cross recommends a health assessment from your health care provider before you begin an exercise program.

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

². Fabri et al.,(2010). Aquatic and Land Exercise Training Affects Renal Function in Rats Under Isosmotic Volume Expansion, Journal of Exercise Physiology, vol. 13, no. 2.

With high temperatures plaguing much of the country, the pool seems like the best bet to beat the heat. This blog highlights two interesting and entertaining resources recently found in the media that can help keep swimming healthy and enjoyable.

1. CDC’s Healthy Swimming 2011 Video Contest Winner’s Video!

This summer, the Centers for Disease Control and Prevention (CDC) challenged the public to create a short video to help educate swimmers about pool safety.  The winners, David and Aaron Mathews, worked with friends and family to develop “Recreational Water Illness Police,” a clip that uses humor to inform viewers about the most common recreational water illness—diarrhea. Roger that.

2. Quiz:  Is It Safe To Pee In The Pool … And Other Water Safety Questions

Want to test your water safety knowledge? A Huffington Post online quiz emphasizes key swimming safety issues, some of which are often overlooked, such as showering before entering the pool.  It is important that swimmers shower with soap (especially swimmer “bottoms”) before swimming so they do not introduce harmful bacteria into the pool.  This fact is lost on all but 25 percent of parents according to a recent report.  And no, it is not safe to pee in the pool.



It’s no secret that swimming pools, although fun and refreshing, are essentially communal bath tubs. To help keep water clean and safe, pool operators must adjust pool chemical levels. Maintaining proper pool chemistry can be a challenging task, especially in community pools where the number of swimmers fluctuates wildly from hour to hour.  Add to that the fact that many swimmers are unaware of the role of personal hygiene in keeping waters safe, and one begins to understand the magnitude of the pool operator’s responsibilities.

Chlorine and pH Get it Done

Chlorine is strongly associated with swimming in popular culture.  Although there are persistent myths about chlorine in swimming pools, chlorine is used as a disinfectant in the majority of pools to help prevent waterborne illnesses such as diarrhea, swimmer’s ear and skin infections.  Alternative sanitizers have been introduced in the marketplace over the last several years, but chlorine continues to offer the most effective and economical option to helping maintain safe pools.

Chlorine actually serves two purposes: it destroys algae and most waterborne germs, and it reacts with—oxidizes—small bits of organic debris and impurities introduced into pool water by swimmers.  Chlorine does this work in the form known as free chlorine, a combination of hypochlorous acid and hypochlorite ion.  Free chlorine is produced in pool water when chlorine disinfectant is added.  When free chlorine reacts with nitrogen-bearing or organic substances, the product is known as combined chlorine, a much weaker disinfectant and oxidant. The World Health Organization recommends free chlorine levels up to 3 mg/l be maintained in swimming pools.

As pool operators know, hypochlorous acid¹ is a more effective disinfectant and oxidant than the hypochlorite ion ², and their relative proportions fluctuate with the pH (acidity) of the water in the pool (low pH is more acidic and high pH is more basic).   To maintain optimal levels of hypochlorous acid for germ and algae destruction while at the same time keeping the water comfortable for swimmers, pool operators should maintain pH in the slightly basic range of 7.2 to 7.8.

Monitoring, Monitoring, Monitoring

One of the most important tasks of the swimming pool operator is vigilantly monitoring the pH and free chlorine level of pool water to ensure germs are being destroyed.  This is critical because chlorine may be depleted, for example, by a heavy “bather load”.  A crowded swimming pool adds more organic debris (e.g., perspiration, body oils, trace urine and fecal matter), which can lower the chlorine level or even deplete it, leaving little or no protection against waterborne germs.

A 2010 report from the Centers for Disease Control and Prevention (CDC) found one in eight public pool inspections conducted in 13 states in 2008 resulted in pools being closed immediately due to serious code violations, including insufficient disinfectant.  That is why CDC encourages swimmers to take matters into their own hands and (1) shower and thoroughly wash their bottoms before entering the pool and (2) use portable pool test strips to monitor for adequate free chlorine and pH.  As a public service, the Water Quality and Health Council is making these strips available free to the public this summer at www.healthypools.org/freeteststrips.  Swimmers will have to wash their own bottoms.

Fred Reiff, P.E., is a retired official of the Pan American Health Organization.

¹Hypochlorous acid is HClO.

²An ion is an atom or molecule with a net electric charge due to the loss or gain of one or more electrons. Hypochlorite ion is OCl-.

You are heading off to your community pool. The mental check list goes…

Sunscreen?  Yes.

Bathing suit?  Of course.

Shower?  Probably not.

Although the “shower before you swim” rule is consistently posted at community pools, a new University of Michigan report shows parents of young children do not appreciate the role showering plays in keeping swimming pools safe for the community (see video).  Whereas 64 percent of parents understand it is very important for children to avoid swallowing pool water, only 26 percent believe it very important to shower before swimming.  This study highlights the need to educate parents on swimmer hygiene.

The researchers polled 865 parents of elementary school children, aged 5 to 12 years old.  More than twice as many parents surveyed believe drowning at a water park is a significant risk compared to those who perceive a high potential risk of getting sick from the water in these settings.

Showering before swimming or visiting a water park is a must because it helps remove trace levels of fecal matter and associated pathogens on human skin.  Put bluntly, the most critical area of the body to wash is your bottom. Not surprisingly, young children and babies in diapers are very likely to contribute fecal matter to pools.  An ongoing shigellosis outbreak in northern Kentucky pools has caused the local health department to prohibit children who are not yet potty-trained from accessing pools (see blog).  Shigellosis causes diarrhea and is transmitted through inadvertent contact with fecal matter of infected individuals.

According to the Centers for Disease Control and Prevention (CDC), recreational water illnesses (RWIs) are on the rise. RWIs are caused by germs spread by swallowing, breathing in mists or aerosols or having contact with contaminated water in swimming pools, hot tubs, water parks, water play areas, interactive fountains, lakes, rivers, or oceans. More than 10,000 Americans are sickened annually by RWIs, which can cause diarrhea, vomiting, abdominal cramps and fever or skin, ear, respiratory and eye infections.

Sixty-five percent of parents polled agree that preventing RWIs is a shared responsibility between parents and pool staff; 28 percent believe that preventing infections is the sole responsibility of the water park staff. Chlorine and proper pool chemistry kill most of the germs that cause recreational water illnesses within an hour, and are essential to good pool management, but Cryptosporidium, a parasite that causes abdominal cramping, diarrhea and nausea, can survive for days even in properly disinfected pool.

The solution to preventing RWIs is a collaborative effort between park and pool operators and swimmers. The following simple preventive measures require the cooperation of informed parents:

• Shower or wash all parts of your body thoroughly with soap and water before swimming, paying special attention to the diaper areas of young children.
• Take children on bathroom breaks and check infant diapers often.
• Remind children to avoid swallowing water or getting water in their mouths.
• Do not swim if ill with diarrhea.

Healthy pools are a shared responsibility.  Parents, teach your children well:  Shower before swimming!

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

The health department’s response to the outbreak has been appropriately aggressive, including arming environmental inspectors with waterborne disease prevention messages.  In contrast, a similar outbreak in a state such as New Hampshire, which is currently entertaining the notion of eliminating pool inspections to save state dollars, could be much worse.

According to the Centers for Disease Control and Prevention (CDC) website, Shigella is a group of bacteria that can cause diarrhea (often bloody), fever and stomach cramps within a day or two of exposure.  The bacterial infection that results from exposure to this organism, shigellosis, is spread via contact with the stool of an infected person through contaminated hands, food and water.  It is especially common in toddler childcare environments.

Swimming pools in Kentucky likely became contaminated when swimmers with shigellosis shed fecal matter into the water, which uninfected swimmers inadvertently ingested.  In a June 2 press release, District Director of Health, Lynne M. Saddler, MD, MPH, said, “…the bacteria spread easily through water— infection can occur between the time a person with Shigella has an accident in a pool and the bacteria is killed by the chemicals in the pool water. Shigella can be spread after the symptoms end, so people who have had diarrhea recently should not swim, even if they feel better and the diarrhea has ended….Even if children are in plastic diaper pants or diapers designed for use in water, commonly called swimmies, you can’t guarantee that fecal matter will not escape into the pool water.”  Since April of this year, the number of shigellosis cases in Boone, Campbell, Grant and Kenton Counties in Kentucky are more than triple the annual average.

The operators of 350 pools have been given information and educational materials, including instructions to pool operators on the proper response (e.g., “hyperchlorinating” the swimming pool) to fecal accidents.  Tips from the CDC and the health department include a warning to swimmers to: avoid swallowing pool or water playground water; shower before swimming; wash hands after using the toilet and changing diapers; take children on frequent bathroom breaks; and change diapers in bathrooms, not poolside.

CDC’s website notes the past two decades have brought a substantial increase in the number of recreational water illness outbreaks associated with swimming.  New Hampshire, take a good look at Kentucky for evidence that de-funding pool inspections is simply penny wise and pound foolish for public health.

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.