HealthyPools Blog

Swimming is appreciated the world over as a healthful, fun-filled activity.  That was a solid point of agreement among international swimming pool experts who gathered in Portugal last month for the Fourth International Conference on Swimming Pools and Spas.  The researchers also agreed on another point:  Swimmer hygiene education is badly needed to reduce pool contaminants.  Most swimmers don’t realize they have an effect on the quality of pool water.

The first responsibility of the pool manager is to provide swimmers with recreational water that is safe from pathogens.  For example, Pseudomonas aeruginosa, the cause of painful swimmer’s ear infections, is obliterated in appropriately disinfected pool water.  By carefully maintaining pool disinfectant levels, most waterborne germs don’t stand a chance of infecting swimmers.

But disinfection is not without side effects:  An unintended consequence of chemical disinfection is the production of low levels of disinfection byproducts, also known as DBPs.  These are contaminants that may potentially cause health effects in swimmers, and are a subject of increasing research.  A common example of a DBP found in swimming pools is trichloramine.  It is the product of a chemical reaction between chlorine disinfectant and ammonia-containing substances introduced into pools by swimmers, such as body oils, lotions, saliva, perspiration, urine and feces.  Trichloramine is an eye and skin irritant with a pungent odor; it is the substance usually responsible for the red eyes and itchy skin that swimmers often mistakenly attribute to chlorine.  In fact, the harsh chemical odor of trichloramine is a sign of a poorly managed pool.

Researchers and public health officials predict that swimmers will play a more active role in reducing levels of trichloramine and other DBPs in pools when they understand their actions can make a difference.  In the case of DBP production, it helps to remember “it takes two to dance the ‘DBP tango’”:

Disinfectant + Bodily Substances → DBP Contaminants.

While pool managers cannot dispense with disinfectant without putting swimmers at risk, swimmers can shower away the substances that react with disinfectant to reduce the quality of pool water.  Families can take frequent bathroom breaks to avoid unfortunate “accidents.”  For their part, pool managers should ensure showers and toilets are accessible and in good working order.

I believe swimmer hygiene education should be included in all organized swim lessons and school health classes.  It’s time to raise awareness that swimmers are dancing partners in the “DBP tango.”

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.

During the 2010 Healthy Pools Campaign, more than 43,000 pool test kits were distributed to people who requested them from the Water Quality & Health Council Healthy Pools website.  Over the course of the summer, 747 participants from across the nation monitored and uploaded their pool chemistry data – pH and chlorine levels – to an online interactive map.  The Council, in partnership with the CDC, sponsored the summer campaign to raise awareness of the importance of proper pool chemistry.  Chlorine and pH are general indicators of the overall “health” of a pool, and according to the CDC, represent “the front line of defense against germs that can make swimmers sick.”

Why did we run this campaign? In May of 2010, the CDC issued a statement about pool inspections conducted in 13 states in 2008 that found one in eight public pools was closed immediately due to serious code violations, including inadequate pool chemistry. “Improper disinfectant and pH levels in the water can result in transmission of germs, such as Shigella and norovirus, which cause gastroenteritis.”  This report caught our attention, and we decided to enlist interested swimmers to conduct their own “unofficial” inspections.  With their help, we wanted to help supply people with the tools they need to ensure they are swimming in a healthy pool.  Swimmers were encouraged to approach pool staff with evidence of inappropriate pool water chemistry.  If that proved unproductive, swimmers were advised to contact local health departments.

The results are concerning:  More than 40 percent of swimming pools tested by swimmers had either unacceptable levels of chlorine or unacceptable pH readings. The CDC’s 2008 report showed more than 10 percent of pools exhibited improper pool chemistry.  It is difficult to compare these two studies directly, as the CDC data are limited to 13 states and the public survey lacks the rigors of scientific data collection.  Additionally, many of the pools tested in the Healthy Pools Campaign were backyard pools (60 percent), followed by the community adult pool (31 percent), hotel pools (5 percent) and community children’s pools (4 percent). The CDC report did not include backyard pools.  Nevertheless, both studies suggest the need for greater attention to managing water quality properly in swimming pools.

The connection between poor water quality in pools and illness in swimmers is well documented and definitive.  Yet every study has shown that there are still a substantial number of pools where two key indicators of safety, chlorine levels and pH, are not properly maintained.  Educating pool operators and the general public along with promoting water quality testing in pools are two methods the Council believes will result in safer pools and fewer illnesses.

The Council looks forward to running the campaign again in 2011, which happens to be the International Year of Chemistry.  What better time to work on getting pool chemistry right?

(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.)

Swimming is a fun and healthy activity for people of all ages. However, improperly chlorinated water puts swimmers at risk for recreational water illnesses like diarrhea and ear and skin infections. Misleading claims about saline pool systems can lead to confusion and potential public health risk. The introduction of saltwater pool systems has generated several myths and misconceptions that pool owners and operators need to be aware of.

Myth #1: Salt pools don’t require “harsh chemicals” or chlorine.

Controlling germs and algae requires a balance of germ killing chemicals – even in salt pools. Chlorine is the primary disinfectant used in most pools, and it is applied in several forms, including gas, liquid, tablets and sticks.

Many pool owners convert to saltwater pools because they are misled to believe that salt pools are chemical and maintenance free. Not true: saltwater pools disinfect water by means of an electrolysis cell that generates chlorine on-site utilizing the sodium chloride (the same compound that fills our salt shakers) that is dissolved in the pool water. Nevertheless, salt pools, like traditionally chlorinated pools, require monitoring and adjustment to maintain both an acceptable pH and an appropriate chlorine level.

Myth #2: Saltwater pools don’t require maintenance.

In addition to the regular pool chemistry maintenance, chlorine generation cells must be maintained. For example calcium builds up on the titanium plates (anodes) in the electrolysis cell and must be cleaned at proper intervals to ensure the unit is producing sufficient chlorine. As a reminder, it is important to monitor the chemical balance/ph of the pool as you would any pool because the success of any disinfection system is based in large part on maintaining the proper parameters for chemical and physical factors in the pool.

The bottom line is that swimming pool water must be disinfected if swimming is to remain a healthy, safe form of exercise. Whether added directly as chlorine disinfectant or generated from salt onsite, chlorine chemistry plays an essential role in protecting swimmers from waterborne disease.

In addition, it is important that saltwater pools also be continuously filtered, to remove algae, suspended particles, dirt, sunbathing oils, etc. Adequate filtration is necessary to maintain sparkling clear water. It also reduces the amount of chlorine that will have to be fed into the pool to maintain the desired chlorine residual for a healthy pool.

(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.)

So here I am sitting at the pool this past Saturday, enjoying a few hours (and by hours I mean maybe 1 hour and 15 minutes) away from the baby, and all of a sudden I hear the pool manager yell “Biohazard in the water, everybody out! Biohazard in the water, everybody out!”

Now, you want to clear out a pool with 30 people in it that is the way to go. So of course everyone is now staring at the pool manager and lifeguards wondering what is going on, and why are they staring so intently where some kids where swimming just a few moments before. Turns out, the biohazard was…you guessed it – poop! At least I’m pretty sure it was poop, they fished it out and tied it up in a plastic bag – just like when people curb their dogs, so I’m assuming it was poop.

As I was watching all of this go down, I couldn’t help but do 2 things – 1. laugh hysterically – hey it was funny! and 2. wonder if they were going to follow CDC guidelines for cleaning up such an incident. In full disclosure, I’m a bit more tuned in to this stuff because I’ve written for the American Chemistry Council’s Healthy Pools blog, so of course I HAD to observe what the lifeguards were doing to get the water back in shape. I mean, here was my job, literally coming to life in front of me.

So not only was everyone out of the water, lickity split, the lifeguards actually seemed to follow the guidelines for treating the water, keeping everyone out for a specific period of time (for this “biohazard” it was 1 hour) and luckily, for the kiddies, didn’t go around asking people who had done it. Whether or not the pool people would go around trying to figure it out I’m not sure, but if I was the offender (I wasn’t) I would be off somewhere, tail between my legs, contemplating never showing my face at the pool again.

Impressively enough, I used my test strips to check the water afterwards, and the pH and Chlorine levels were right in line with where they should be. Didn’t mean I was going to go swimming (I did have to get back to Baby R), but the moral of the story is … “Don’t poop in the pool!”

I’ll tell you this – as much as I COULD NOT stop laughing – I seriously had tears running down my face – apparently even at my age bathroom humor is funny – I hope that I never see or hear a person yell “Biohazard in the water, Everybody out!” Because when I do – it will be too soon.

(cross-posted from Sassing Me)

A new pool water study is being misrepresented in some media reports as linking swimming in treated pools to a potential cancer risk.  This suggested link is not backed by the research, according to an evaluation by the U.K. National Health Service (NHS).

To understand the issue, we must separate facts (those items accepted by scientists as proven to be true) and hypotheses (those items suggested as possibly being true but which remain unproven by scientific investigations).

1.      FACT: In properly managed pools, chlorinated swimming pool disinfectants help destroy waterborne germs that can cause diarrhea, swimmers’ ear and skin infections.

2   HYPOTHESIS: Chemical byproducts of disinfection may affect human health.

3.      FACT: Chemical byproducts of disinfection are formed when disinfectants react with organic compounds (e.g., urine, perspiration, perfumes, cosmetics, etc.) in swimming pools. The amount of disinfection byproducts formed is directly related to the quality of pool management. For example, chloramines, which can cause eye and skin irritation, are formed when nitrogen-containing compounds in urine and perspiration, etc. combine with chlorine.

In the new study, researchers concentrated disinfection byproducts from swimming pools, exposed mammalian (hamster ovary) cells to these concentrated disinfection byproducts and measured the resultant genotoxicity (i.e. damage or mutation to DNA). The authors examined pool and spa waters derived from a common tap water source, but treated using different water disinfectants and under different chemical conditions.

The study data reported by the authors demonstrate that every variable tested (i.e. type of disinfectant, amount of light, water temperature) produced more DNA damage to hamster ovary cells than tap water (which was the source water use for the pools and spas). The authors:

• STATE that “…disinfection of recreational pools is essential to prevent outbreaks of infectious disease.”
• SUGGEST that “…brominating agents should be avoided…in recreational pools…” and “…combining UV treatment with chlorine may be beneficial compared to chlorine alone.”
• The difference between what is STATED and what is SUGGESTED is the strength of the supporting scientific data.

In spite of cautions by the NHS and the study authors themselves regarding the limited meaning of these study results, some media reports have ignored these cautions and have ‘cherry-picked’ the information until all that is left is fear-mongering, a saleable commodity. These study related cautions, ignored by the media, put the results into the correct perspective and include:

1. The test (of genotoxicity) is one employed as an ‘early screen or prescreen’ because it is easy and inexpensive to perform (its advantages).  Its disadvantages are a) that its predictive validity to man (i.e. whether the results of the test have any meaning to predicting what might happen in man) is relatively unknown (this test is NOT accepted as definitive by either the FDA or EPA) and b) the test produces highly variable results in laboratories that do not routinely perform the assay (in other words, those labs that don’t normally do the test are expected to produce variable results)

2.      The materials tested (disinfection by products) were highly concentrated prior to testing. Whether the results obtained from tests using these enormous and non-natural levels of disinfection byproducts have any relationship to what might happen in a pool situation is outside the realm of current scientific knowledge.

3. The number of pools/spas evaluated in the study was very small making the data generated in this study inadequate for use in definitive human risk evaluation

4.      The NHS states: “This particular study did not directly examine [a link between chlorinated swimming pool water and a greater risk of cancer] or look at any other particular health outcomes in people…future research is needed to examine the genotoxicity of swimming pool water and its relationship with pool disinfectants, the environment and other particulates that are thrown into the mix, such as sun lotions and urine.”

The scientific ‘bottom-line’ at this point in time is:

Medical experts agree that swimming is an excellent form of exercise for people of all ages and the World Health Organization stated that it is important to consider the benefits of aerobic exercise and the proven significantly decreased health risks for infectious disease in a properly chlorinated pool versus the hypothesized and small potential risks from chlorinated byproducts.

For more information on Healthy Pools, please see www.healthypools.org.

(Bruce Bernard, Ph., is the Associate Editor of the Journal of Toxicology and a member of the Water Quality and Health Council)

Whether it’s for swimming lessons, swim meets, swim parties, water aerobics or just plain splashing around on hot day, your family will probably spend some significant time in a pool this summer.  As a research microbiologist specializing in water quality and public health safety, I’d like to correct four common swimming pool myths to help your family enjoy a “Healthy Pools” summer.

Myth #1:  The heavy chemical smell around the pool is a reminder that chlorine is present in the water for killing germs.

Fact: A properly disinfected swimming pool has no strong chemical smell, despite the presence of chlorine disinfectant to destroy germs.  That surprises most people.  In fact, the odor we notice around pools arises from the presence of chloramines in pool water.  Without turning this into a chemistry lesson, chloramines form when chlorine disinfectants react with contaminants brought into pools on the bodies of swimmers.  These contaminants include perspiration, urine, body oils and cosmetics.  Chloramines are irritants that can redden the eyes of swimmers and make their skin itchy.  Ironically, while many people think a pool chemical smell means there is too much chlorine in the water, more chlorine disinfectant may actually be needed to destroy the irritating chloramines.

Myth #2:  Chlorine in pool water turns your hair green.

Fact: Green hair is associated with swimming and blondes display this best, but don’t blame chlorine.  The green color comes from metals, such as copper, in the water, which are added to control algae or may be leached from pool plumbing and fixtures.   Now green hair looks good on some but here is a hint:  Wear a swim cap.  If you hate that idea, experts recommend a thorough hair-rinsing as soon as you leave the pool, followed by a gentle shampoo.

Myth #3:  Pool water is disinfected, so it’s alright if my children swallow some.

Fact: Teach your children to avoid getting pool water in their mouths.  Chlorine does kill waterborne germs, but chlorine levels fluctuate in pools, especially busy, crowded pools.  And germs are not equally susceptible to chlorine–some germs take longer to destroy than others.  Pool staff is responsible for keeping chlorine levels within an acceptable range, but, unfortunately, not all pools are carefully maintained.  It’s best to err on the side of caution and avoid swallowing pool water.  But if this sounds like rather passive advice, please read on.

Myth #4:  It’s up to only the pool operators to keep pools healthy.

Fact: There’s so much you can do, too!  To minimize irritating chloramines, shower before swimming and never pee in the pool.  Take young swimmers on frequent bathroom breaks and make sure they wash their hands.  Anyone with diarrhea must stay out of the water.  Learn to recognize the signs of a Healthy Pool, and notify pool staff if those signs are missing.  Finally, the Centers for Disease Control and Prevention (CDC) is encouraging swimmers to measure the pH and free chlorine level of pool water this year to make sure they are swimming in a Healthy Pool.  It’s a simple test done with a color-coded plastic strip, and you can even order a free test kit at www.healthypools.org/freeteststrips.  If you find unacceptable pool readings, inform pool staff, who should correct the pool chemistry.  If this does not happen, CDC recommends you notify your local public health department.  Finally, upload your results on the Healthy Pools site to see how your pool compares to others around the country.

Here’s to a great summer in only the healthiest of pools!

(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)

Swimming is a fun and healthy activity for people of all ages. However, improperly chlorinated water puts swimmers at risk for recreational water illnesses like diarrhea and ear and skin infections. Test strips are an easy way to check the water and maintain a healthy pool. When testing pool water, swimmers should be sure that the free chlorine level is between 1.0 and 4.0 parts per million (ppm) and the pH registers between 7.2 and 7.8. Please visit our website to order your free test strips.

The Centers for Disease Control and Prevention (CDC) reports a disturbing statistic: About 1 out of 8 public pool inspections conducted in 13 states in 2008 resulted in pools being closed immediately due to serious code violations. The venues that had the most disinfection violations were kiddie pools and water play areas. Unhealthy pools are more common than you may think. This new data underscores the importance of protecting yourself and your family at the pool this summer.

The CDC is encouraging all swimmers to be activists – check your pool water and immediately report any problems to pool staff. Test strips are a quick and easy way to measure if there is adequate chlorine to kill germs and if pH is in the proper range.

Last year’s survey by the Water Quality and Health Council found that one in five Americans pee in the pool. Urine, as well as sweat and even sunscreen, contains nitrogen that eats up some of a pool’s free chlorine, making it less effective in fighting off waterborne germs. To ensure on-the-spot protection, it is important to regularly adjust a pool’s chlorine levels.
Are you swimming in an unhealthy pool? The Water Quality and Health Council recommend you use your senses to recognize the signs:

o CANNOT SEE the floor drain in the deep end of the pool;
o SMELL a strong chemical odor; or
o FEEL sliminess on tile walls.

Free test kits are available on the Water Quality and Health Council website. For more information on preventing recreational water illnesses, please visit the CDC’s website.

(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.)