Swimmer, protect thyself: cleaning up the pool environment.

Abstract

In 2006 a 6-year-old Nebraska boy was treated in a hospital intensive care unit for respiratory distress caused by chemical inflammation and swelling of his airways after spending three hours swimming in an indoor motel pool. Twenty-four other people who visited the pool in the same time period experienced milder eye and respiratory irritation. The pool was closed the next day. Inspectors found a broken ventilation system and a water level of chloramine—a respiratory and ocular irritant that forms when chlorine disinfectant combines with sweat, urine, or other organic matter1—that was eight times the state maximum. The free chlorine level in the pool was less than half the state minimum. The person who maintained the pool had no verifiable training in pool management and safety.2 This was no isolated incident. Two years later an analysis of data from more than 111,000 routine pool inspections in 13 states by the Centers for Disease Control and Prevention (CDC) showed that 12.1% of pools were immediately closed upon inspection for serious health or safety violations.3 As these examples demonstrate, the United States needs to do a better job of maintaining its public swimming pools. That task will involve standardizing pool codes, which currently are regulated at the state and local level and vary widely. Such an effort is under way, with the CDC sponsoring development of a science-based Model Aquatic Health Code (MAHC) that will serve as a guide.4 But part of the responsibility lies with swimmers, who can reduce their own risks and make the pool healthier and safer for others by remembering they’re really taking a communal bath and behaving accordingly. A new national model pool code can help, but swimmers also have to protect themselves.