Internet search tools are making it easier individuals to gain access to a range of information available on water quality, recreational water illnesses and the like. With help and information she had obtained from APSP, the mom was able to make a big difference in the water quality at the local pool.
Not only that, but she has become so enthusiastic she’s advocating within her state for better recreational water quality practices. She wants not only her children, but all children to be protected from unsanitary pool water. And she has embarked on a letter-writing campaign to make sure other parents have access to the information she has obtained.

Michael Beach of the Centers for Disease Control and Prevention in Atlanta has been predicting and advocating such “activist swimmers” in checking up on pool operators (see the September issue of Aquatics International). Careless practices and inadequate operator education have pointed to a need for consumers to get involved and hold recreational water facility operators accountable, he says.

Health inspectors can’t be at every facility every day they’re open. But the patrons can be there — with their eyes open, their questions ready, their water test strips at hand. Front-page news stories on RWI outbreaks, Web traffic at sites such as the CDC’s Healthy Swimming, newspaper cartoons and, yes, the activist mom mentioned earlier are all indicators that the public, at least some of it, is becoming much more aware and involved.

How aware? To find out, PPG’s Accu-Tab Chlorination System Business unit just completed a survey of more than 1,000 waterpark patrons concerning their habits and practices while visiting these facilities. Some of these results appear throughout this article. For instance, visitors to waterparks rank RWIs second only to injuries among their water-related safety concerns at waterparks.

Shared responsibility
Certainly, operators need to take responsibility to ensure healthy air and water. But in paying more attention to how waterpark operators are doing their jobs, consumers shouldn’t lose sight of their own responsibilities.

Careless patrons, not just careless operators, can be devastating for water and air quality in waterparks. Patrons need to be informed of the impact their own practices could have. Failing to shower with soap before entering pools and spraypads, or changing diapers at poolside can create serious water quality issues, and even air quality issues. Waterparks need to be designed and operated in such ways as to encourage safer behavior on the parts of the patrons.

While some of the public is becoming more keenly aware of at least some aspects of water and air quality, others appear to be blithely ignorant of even the basics. A 2004 USA National Consumer League poll indicated that 14 percent of the population believes pool water is actually sterile. And their actions often reflect this misperception. It goes beyond just accidental ingestion and the generally discouraged (but all too often seen) practice of oral water-spouting in pools.

In the wake of the 2005 cryptosporidiosis outbreak at Seneca Lake in New York, Doug Sackett (assistant director of the NYS Department of Health) observed an example of such a misperception. A person was filling a drinking water bottle at a spraypad frequented by diaper-age children. Nearly one-fourth of the people we polled had observed such water bottle filling, and 4 percent had actually done it themselves.

Our survey indicated that 12 percent of the waterpark-visiting public still views recreational spray water as safe for drinking. Few people have grasped the concept that spraypad water is generally recycled and pool water is communal bath water. The message of the CDC’s Healthy Swimming Web site, as well as similar messages by APSP and NSPF — “don’t drink the water” — just isn’t getting through. Signs and other reminders at more pools and waterparks would help.

Sick behavior
Swimming while ill is another concern. The Consumer League poll indicated that 18 percent of the population thinks it is OK to swim while ill with diarrhea. In 2003 an outbreak of cryptosporidiosis in Kansas spread from county to county, as ill swim team members continued to swim. Swimming while ill with diarrhea appears to have played a role in crypto outbreaks in Ohio and Nebraska in previous years.

In 2004, three waterpark employees along with 16 patrons — again swimming while ill — were on the leading edge of (and likely contributing causes to) an outbreak affecting more than 250 persons. Our survey shows that 58 percent of the public would resume swimming within days after a bout of diarrhea. They clearly remain unaware of the fact that a person may continue to shed oocysts for a couple of weeks.

Changing diapers on pool decks and at spraypads, and the temptation to use pool or spray water for washing infants during these changes, constitutes a similar concern. More than one-third of the patrons we polled had at least observed diaper changes in such locations in waterparks, and 6 percent even observed the recreational water at hand being used for washing the infant during the change. One factor may be that (according to nearly half of the respondents) there were no conveniently placed diaper-changing areas, areas where a parent could change a diaper while keeping an eye on their older children.

In the water
The CDC reported a fairly steady growth from 1978 to 2004 in gastrointestinal illness associated with recreational water use. Due to an unusual chlorine resistance, cryptosporidium seems to account for about two-thirds of these. Ninety percent of the consumers we polled expressed at least moderate confidence that chlorine can prevent waterborne illness.

It certainly does play an important role, but even chlorine-susceptible organisms continue to contribute to outbreaks. This is a sign that chlorination is not as consistent as it should be. And such outbreaks make news and put operators in a bad light. An outbreak of E. coli O157:H7 at a waterpark in Marietta, Ga., captured news headlines in 1998.

Failing to shower with soap before entering the water is another risk we examined. Only 27 percent of patrons consistently do this before entering pools or spraypads. Failure to shower was attributed to a lack of privacy much more often than either forgetfulness or being in a hurry. Failure of the waterpark to provide soap in the shower rooms was cited by 45 percent as contributing to their reason for not showering with soap while there.

Inadequate cleansing before entering recreational water can create problems in two ways: (1) germs on the skin get into the water (2) sweat and other nonliving body waste increase chlorine demand and contribute to the formation of combined chlorine (or chloramines) in the water.

Airing concerns
Chloramines not only contribute to odors in the area, but also have been linked to serious respiratory issues. Recent studies from Belgium and the Netherlands have suggested a correlation between asthma and indoor pool use, with nitrogen trichloride (the most notoriously volatile and irritating of chloramines) being suggested as the causative agent. It is interesting to note that the reports of respiratory issues linked to chloramines in swimming pools comes from continental Europe, where chlorine doses tend to be significantly lower than in the United States. One has to suspect that a failure to achieve breakpoint chlorination in many European pools may be involved.

Failure of patrons to shower before entering pools may contribute to the problem, but facilities often catch the blame.

The asthma research reported in Europe is hitting the newspapers here. Major papers such as The Chicago Tribune and The Washington Post have picked up the stories.

Some of this may be resonating with waterpark visitors. One-fourth of the patrons we polled reported noticing unpleasant odors at a recent waterpark visit.

Ten percent reported that the odor had a fairly significant or significant impact on their waterpark experience. Three percent indicated that they had experienced respiratory discomfort or disease at, or after, visiting a waterpark.

Getting misty
Indoor waterparks also could be at risk for other air quality issues, many of which could be amplified by the mists created by spraying or splashing water. Among these are “lifeguard lung” and bacterial respiratory infections.

There were reports in 1998 of lifeguard lung, or hypersensitivity pneumonitis, among employees of an indoor waterpark in Colorado. The malady appeared to have come from repeated inhalation of allergens of bacterial origin. The water spray features allegedly were generating respirable mist containing the allergens.

There do not appear to have been many, if any, outbreaks of lifeguard lung since 1998, but Legionnaires’ disease occasionally is associated with recreational water settings. A well-publicized lawsuit resulted in an initial judgment of $193 million against a spa filter manufacturer (it was reduced to $15 million in July). The suit grew out of a 1994 outbreak of Legionnaires’ disease. The outbreak was associated with spa use on the cruise ship Horizon.

With inadequate chlorination, warm spa water is ideal for the growth of Legionella bacteria. The mist created by the bursting air bubbles can get the Legionella into respirable droplets. The bacteria are abundant in nature. While they multiply best in warm water, they survive at lower, pool and spraypad, temperatures. The risk may not be on quite the same level as with warmer water from a shower, air-injected hot tub, or cooling tower. However, waterpark features such as spraypads that can generate fine mists could be at risk if the water is not adequately treated.

Water spray features have been growing in popularity. spraypads often are considered a welcome, safer alternative to pools, by parents who are concerned about small children drowning. Drowning was listed as a concern for 84 percent of the waterpark visitors we polled.

But while offering these benefits, the facilities should minimize the mist risks. Good filtering and consistent sanitization (even supplementary sanitizing systems) will help. Designing spray and splash features to minimize formation of fine mists also would be beneficial. Air handling and air exchange are major considerations for indoor waterparks.

Risks and benefits
Waterparks, especially indoor facilities, constitute a rapidly growing industry. When contrasted with society’s sedentary tendencies and weakening family units, the wholesome family activity and vigorous exercise associated with aquatic recreation are encouraging changes. The rapid growth trends for waterparks should be welcome to those outside and inside the industry. But it is apparent that alarms also are being raised.

Somehow we will need to bring together divergent attitudes and awareness levels. As the research indicates, some patrons are becoming more alert to water and air quality issues.

But some remain blithely unaware of even the role personal hygiene practices play in all of this. Waterpark operators and designers need to be involved, not just in the water treatment itself, but also in communicating best practices for improving water and air quality, including best practices for park visitors. Waterparks also need to be designed to encourage these habits as much as possible.