GUIDELINES FOR SAFE RECREATIONAL-WATER ENVIRONMENTS

1. GUIDELINES FOR SAFERECREATIONAL-WATERENVIRONMENTS SWIMMING POOLS, SPAS AND SIMILAR RE1CREATIONAL-WATER ENVIRONMENTS

3. Aim of the Guidelines Protection of public health. Ensure that swimming pools, spas and similar recreational-water facilities are operated as safely as possible To be used as the basis for the development of national approaches to controlling the hazards that may be encountered in recreational-water environments. To be used as reference material for industries and operators preparing to develop facilities containing swimming pools and spas, as well as a checklist for understanding and assessing the potential health impacts of projects involving the development of such facilities.

4. The Guidelines for Safe Recreational-water Environments are published in two volumes: Volume 1: Coastal and Fresh Waters Volume 2: Swimming Pools, Spas and Similar Recreational-water Environments

6. The hazards associated with the use of recreational-water environments Those concerning injuries and physical hazards (leading, for example, to drowning or spinal injury); Microbiological hazards; and Those concerning exposure to chemicals.

7. Types of pools and spas Private (domestic), Semi-public (e.g., hotel, school, health club, condominium, cruise ship) or Public (municipal or governmental). A �spa� Hot tubs (domestic), whirlpools (commercial/facility) and natural mineral baths.

8. Pool usage The daily opening hours; The peak periods of use; The anticipated number of users; and Special requirements, such as temperature, lanes and equipment.

9. Types of users The type of pool reflects the users, which may include: the general public; children/babies in small teaching groups; hotel/motel guests; tourists on board cruise ships; health club members; medical patients in therapy pools; competitive swimmers; clients of outdoor camping parks; leisure bathers, including clients of theme parks; and specialist sporting users, including scuba divers and water polo participants.

10. Types of hazard encountered Drowning and near-drowning; Major impact injuries (e.g., spinal injury); Slip, trip and fall accidents; Cuts, lesions and punctures; Infection arising from inhalation of, ingestion of or contact with pathogenic bacteria, viruses, protozoa and fungi that may be present in water as a result of faecal contamination, carried by participants using the water or naturally present; and Adverse effects relating to toxic chemicals, with exposure arising from inhalation, ingestion and dermal exposure.

11. Table 1.1: Examples of negative health outcomes associated with hazards encountered in swimming pools, spas and similar recreational-water environment

12. Table 1.1: Examples of negative health outcomes associated with hazards encountered in swimming pools, spas and similar recreational-water environment

13. Data on risk take four main forms: National and regional statistics of illness and deaths; Clinical surveillance of the incidence of illness and outbreaks; Epidemiological studies and surveys; and Accident and injury records held by swimming pool owners/managers and local authorities.

14. The use of quantitative microbiological risk assessment in assessing risk Hazard assessment; Exposure assessment; Dose�response analysis; and Risk characterization.

15. Degrees of water contact encountered � No contact � for example, outdoor pools where sunbathing may be the primary reason for visiting the facility. � Meaningful direct contact � involves a negligible risk of swallowing water, such as wading and the use of spas, hydrotherapy pools, etc., where the body is immersed but the head is not. � Extensive direct contact � with full body immersion and a significant risk of swallowing water, e.g., swimming, diving.

16. Strategies to minimize health risk. Design and construction of facilities (including licensing and authorization, as appropriate); Operation and management (including lifeguard training and certification and pool safety operating procedures); Public education and information; and Regulations and good practice (including licensing of equipment, chemicals, etc., available for use in swimming pools and spas).

17. Drowning?! Drowning can generally be defined as death by suffocation due to immersion in water. It may be classified as either �wet� � where the victim has inhaled water � or �dry� � a less common condition, but one that involves the closing of the airway due to spasms induced by water. The actual physical action of drowning depends on the circumstances

18. Contributory factors Swimming in deep water Drain suction excessive Falling unexpectedly into water Not being able to swim Breath-hold swimming and diving Alcohol consumption High water temperatures Easy illicit access to pools Inadequate pool and spa covers

19. Preventive actions Teaching not to swim beyond skill level Teaching to stay away from water Parental/caregiver supervision of children Diving only under suitable conditions Education/public awareness Suction outlet cannot be sealed by single person, and at least two suction outlets per pump Accessible emergency shut-off for pump

20. Preventive actions Grills/pipes on drain gates preclude hair entrapment Wearing bathing caps Maintaining water temperature in hot tubs and spas below 40 �C Isolation fences around outdoor pools, and locked doors for indoor pools Locked safety covers for spas and hot tubs

21. Summary of viral waterborne outbreaks Etiological agent Source of agent Disinfection Adenovirus 3 Possible faecal contamination None Adenovirus 7 Unknown Improper chlorination Adenovirus 4 Unknown Inadequate chlorine Adenovirus 3 Unknown Failed chlorinator Adenovirus 7a Unknown Malfunctioning chlorinator Hepatitis A Accidental faecal release Suspected None Hepatitis A Cross-connection to sewer line Operating prop. Norwalk virus Unknown Chlorinator disconnected Echovirus 30 Vomitus Operating properly�

22. Faecally derived Pathogens Shigella-related outbreaks E. coli O157-related outbreaks Giardia Cryptosporidium

23. Non-faecally derived Bacteria Legionella spp. Pseudomonas aeruginosa Mycobacterium spp. Staphylococcus aureus Leptospira interrogans Non-enteric viruses Molluscipoxvirus Human papilloma virus Amoebas Naegleria fowleri Acanthamoeba spp. Fungi Trichophyton spp. Epidermophyton floccosum

24. Disinfectants and disinfecting systems for swimming pools Disinfectants used most frequently in large, heavily used pools Chlorine - Gas Calcium/sodium hypochlorite Sodium dichloroisocyanurate Electrolytic generation Ozone/chlorine in combination Chlorine dioxide Chlorine dioxide/chlorine in combination

25. Disinfectants used less frequently Bromine Liquid bromine Bromochlorodimethylhydantoin (BCDMH) Sodium bromide + hypochlorite

26. Disinfectants used infrequently; mainly for small-scale and mainly for small-scale and private pools � Bromine chloride UV UV�ozone Iodine Hydrogen peroxide Silver/copper Biguanide

27. Recommended disinfectant residuals (mg/litre) in swimming pool water Disinfectant UK EC USA Free chlorine 1�2 1.0�3.0 Bromine 1.5�3.5 2�4 Chlorocyanurates 2.5�5.0 free Chlorine dioxide 0.2�0.3 Ozone 0 <0.1 0.1 (0.05 mg/m3 air) BCDMH 4�6 (as Br) 200 (max. as BCDMH) Copper 1 BCDMH bromodichloromethaneBCDMH bromodichloromethane

28. MANAGING WATERAND AIR QUALITY Controlling clarity to minimize injury hazard, Controlling water quality to prevent the transmission of infectious disease, and Controlling potential hazards from disinfectant by-products.

29. Challenges factors: Treatment (to remove particulates, pollutants and microorganisms); Disinfection (to destroy or remove infectious microorganisms so that the water cannot Transmit disease-producing biological agents); Pool hydraulics (to ensure optimal distribution of disinfectant throughout the pool); and Addition of fresh water at frequent intervals (to dilute substances that cannot be removed from the water by treatment). Pre-swim hygiene

30. Choosing a disinfectant Safety Compatibility with the source water supply (matching the chemical characteristics of the disinfectant, such as its effect on pH, with the source water contributes to minimizing cost); Type and size of pool (disinfectant may be more readily degraded or lost through evaporation in outdoor pools); Bathing load (sweat and urine from bathers will increase disinfectant �demand�); and Operation of the pool (i.e., supervision, management).

31. Complying criteria: Effective, rapid, inactivation of pathogenic microorganisms (including, ideally, viruses, bacteria and protozoa); Capacity for ongoing oxidation to assist control of contaminants during pool use; Wide margin between effective biocidal concentration and concentrations resulting in adverse effects on human health

32. Complying criteria: Availability of a quick and easy determination of the disinfectant�s concentration in pool Water (simple analytical test methods and equipment); and Potential to measure the disinfectant�s concentration electrometrically to permit automatic control of disinfectant dosing and continuous recording of the values measured.

34. Suggested turnover periods for different types of pool Pool Type Turnover period Competition pools 50 m long 3�4 h Conventional pools up to 25 m long with 1-m shallow end 2.5�3 h Diving pools 4�8 h Hydrotherapy pools 0.5�1 h Leisure water bubble pools 5�20 min Leisure waters up to 0.5 m deep 10�45 min Leisure waters 0.5�1 m deep 0.5�1.25 h Leisure waters 1�1.5 m deep 1�2 h Leisure waters over 1.5 m deep Spas 5�15 min Teaching/learner/training pools 0.5�1.5h Water slide splash pools 0.5�1 h

35. Bathing load formulae used in the United Kingdom Shallow water (under 1 m) � 1 bather per 2.2 m 2 Standing depth water (1�1.5 m) � 1 bather per 2.7 m 2 ; and Deep water (over 1.5 m) � 1 bather per 4 m 2 . The bathing load obtained using these formulae: Is the maximum bathing load of the pool at any one time (instantaneous bathing load); should not be exceeded; and should be used when designing a pool and working out the circulation rate, etc.

36. Prevent faecal release into pools No child (or adult) with a recent history of diarrhoea should swim. Parents should be encouraged to make sure their children use the toilet before they swim. Thorough pre-swim showering is a good idea, and parents should encourage their children to do it � preferably by example. At the other extreme, washing babies� bottoms in the pool should be discouraged. Young children should whenever possible be confined to pools small enough to drain in the event of an accidental release of faeces or vomitus. Lifeguards should be made responsible for looking out for and acting on AFR/vomitus incidents.

37. Guidelines Free chlorine residual level of at least 1 mg/litre throughout the pool, or equivalent disinfection efficiency Disinfectant residuals should be checked by sampling the pool before it opens and after closing. The frequency of testing while the swimming pool is in use depends upon the nature and use of the pool. Testing may need to be done as often as once every 2 h at a heavily used public pool.

38. Guidelines The pH of swimming pool water must be adjusted to ensure efficient disinfection and because coagulants may be less effective if the pH value is outside of the recommended range. In order to maintain the pH within the recommended range, regular measurements are essential, and either continuous or intermittent adjustment is usually necessary. pH testing is generally undertaken at the same time as disinfectant residual testing.

39. Guidelines Oxidation�reduction potential Continuous control of the oxidation�reduction potential (ORP) is considered useful by many experts. Together with pH and free chlorine, the ORP value gives an indication of the disinfection efficiency. In chlorinated pools, ORPs of 750 mV (for pH 6.5�7.3) and 770 mV (for pH 7.3�7.8), measured against a silver/silver chloride reference electrode with potassium chloride electrolyte are required to guarantee the safe inactivation of microorganisms

40. Guidelines Notes: 1. Samples should be taken when pool is heavily loaded. 2. Sampling frequency should be increased if operational parameters (e.g., turbidity, pH, disinfectant residual, continuous filtration) are not maintained within target ranges. 3. Sample numbers should be determined on the basis of pool size and complexity and should include point(s) representative of general water quality and likely problem areas.Notes: 1. Samples should be taken when pool is heavily loaded. 2. Sampling frequency should be increased if operational parameters (e.g., turbidity, pH, disinfectant residual, continuous filtration) are not maintained within target ranges. 3. Sample numbers should be determined on the basis of pool size and complexity and should include point(s) representative of general water quality and likely problem areas.

41. Guidelines

42. Guidelines