Public Health Professionals

Water-based physical activity, such as swimming, improves physical and mental health throughout life; however, it can put people at risk for recreational water–associated illness and injury. A recreational water illness outbreak is the occurrence of similar illnesses in 2 or more persons, epidemiologically linked by location and time of exposure to recreational water. For 1978–2012, 879 recreational water illness outbreaks have been reported CDC, and the number reported annually has increased significantly in recent years, especially the number of outbreaks associated with treated recreational water venues (e.g., pools and hot tubs/spas) reported annually. Drowning results in approximately 4,000 deaths each year, is a leading cause of injury death among children ages 1–4 years, and more than half of fatal drownings in this age group occur in a pool ¹. Nonfatal drowning also results in approximately 5,800 emergency department (ED) visits each year; more than half of these patients are children ages 1–4 years, and approximately two thirds of nonfatal drownings in this age group occur in a pool ². Pool chemical–associated health events (e.g., respiratory distress or burns) result in approximately 3,000–5,000 ED visits each year, and almost half of the patients are younger than 18 years of age ^3-5.

Public Aquatic Facility Inspections

Code enforcement through inspections of public aquatic facilities is an important tool in preventing recreational water–associated illness and injury. An inspection of a public aquatic facility is an assessment of whether its operation and maintenance meet the standards set in the jurisdiction’s public health code. During inspections, environmental health practitioners can serve as illness-and-injury-prevention advisors to pool operators. Immediate closures and violations offer an opportunity to educate operators about how to properly operate and maintain aquatic facilities and why these measures are necessary to prevent repeated violations of given operation or maintenance standards in public aquatic facility codes. By closing venues that pose a serious public health threat and by identifying violations to be corrected, environmental health practitioners play a vital role in minimizing risk for illness and injury at public aquatic facilities.

The pages below include information for public health professionals to use for outbreak response and prevention of water–related injuries, as well for regulation and inspection of public pools and hot tubs:

References

1. Xu J. Unintentional drowning deaths in the United States, 1999-2010. [PDF – 8 pages] NCHS Data Brief. 2014;149:1–8.
2. CDC. Drowning—United States, 2005–2009. MMWR Morb Mortal Wkly Rep. 2012;61(19):344–7.
3. Hlavsa MC, Robinson TJ, Collier SA, Beach MJ. Pool chemical-associated health events in public and residential settings – United States, 2003–2012, and Minnesota, 2013. MMWR Morb Mortal Wkly Rep. 2014;63(19):427–30.
4. CDC. Pool chemical—associated health events in public and residential settings—United States, 1983–2007. MMWR Morb Mortal Wkly Rep. 2009;58(18):489–93.
5. Hlavsa MC, Roberts VA, Anderson AR, Hill VR, Kahler AM, Orr M, Garrison LE, Hicks LA, Newton A, Hilborn ED, Wade TJ, Beach MJ, Yoder JS. Surveillance for waterborne disease outbreaks and other health events associated with recreational water— United States, 2007–2008. MMWR Morb Mortal Wkly Rep. 2011;60(SS12):1–32.