Abstract
The objective of this cross-sectional study was to investigate the prevalence of self-reported respiratory, ocular and cutaneous symptoms in subjects working at indoor swimming pools and to assess the relationship between frequency of declared symptoms and occupational exposure to disinfection by-products (DBPs). Twenty indoor swimming pools in the Emilia Romagna region of Italy were included in the study. Information about the health status of 133 employees was collected using a self-administered questionnaire. Subjects working at swimming pools claimed to frequently experience the following symptoms: cold (65.4%), sneezing (52.6%), red eyes (48.9%) and itchy eyes (44.4%). Only 7.5% claimed to suffer from asthma. Red eyes, runny nose, voice loss and cold symptoms were declared more frequently by pool attendants (lifeguards and trainers) when compared with employees working in other areas of the facility (office, cafe, etc.). Pool attendants experienced generally more verrucas, mycosis, eczema and rash than others workers; however, only the difference in the frequency of self-declared mycosis was statistically significant (p = 0.010). Exposure to DBPs was evaluated using both environmental and biological monitoring. Trihalomethanes (THMs), the main DBPs, were evaluated in alveolar air samples collected from subjects. Swimming pool workers experienced different THM exposure levels: lifeguards and trainers showed the highest mean values of THMs in alveolar air samples (28.5 ± 20.2 μg/m3), while subjects working in cafe areas (17.6 ± 12.1 μg/m3), offices (14.4 ± 12.0 μg/m3) and engine rooms (13.6 ± 4.4 μg/m3) showed lower exposure levels. Employees with THM alveolar air values higher than 21 μg/m3 (median value) experienced higher risks for red eyes (OR 6.2; 95% CI 2.6–14.9), itchy eyes (OR 3.5; 95% CI 1.5–8.0), dyspnea/asthma (OR 5.1; 95% CI 1.0–27.2) and blocked nose (OR 2.2; 95% CI 1.0–4.7) than subjects with less exposure. This study confirms that lifeguards and trainers are more at risk for respiratory and ocular irritative symptoms and cutaneous diseases than subjects with other occupations at swimming pool facilities.
Highlights
There is growing concern about the onset of asthmatic conditions and other respiratory ailments in subjects attending indoor swimming pools
In subjects working at indoor swimming pools, such as hydro-therapists, recent evidence has shown a high frequency of skin diseases such as contact dermatitis [7]
It is well known that pool water chlorination can produce halogenated disinfection by-products (DBPs), most of which are potentially harmful to human health
Summary
There is growing concern about the onset of asthmatic conditions and other respiratory ailments in subjects attending indoor swimming pools. Recent epidemiological studies report unusually high prevalence rates of ocular and respiratory symptoms as well as asthmatic conditions—both in swimmers (mainly children) and in occupationally exposed subjects—as a consequence of their environmental exposure to chemical derivatives of pool water disinfection treatments [1,2,3,4,5,6]. Some volatile halogenated compounds can be found in swimming pool atmospheres as a consequence of the chemical reactions between chlorine, ammonia and amino-compounds from the sweat and urine of swimmers [8,9]. Chloramines, especially trichloramine, are considered the causal agent for irritated eye, nose and throat symptoms, as well as asthma, in swimmers and subjects working at indoor swimming pools [1,2,4,5,9,10]. The analytical method commonly used to detect trichloramine in the atmosphere is not considered specific enough to differentiate between inorganic and organic chloramines and other volatile DBPs with possible irritative effects [11]
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