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PubMedDate not supplied

Swimming pool drownings and near-drownings among California preschoolers.

OBJECTIVE: To describe a significant but poorly understood public health problem, the authors compiled data on swimming pool drownings and near-drownings requiring hospitalization for California children ages 1 to 4. METHODS: Data from death certificates were used to analyze swimming pool drownings, and hospital discharge data were used to analyze near-drownings. RESULTS: Among California preschoolers in 1993, pool immersion incidents were the leading cause of injury death and the eighth leading cause of injuries leading to hospitalization. Rates per 100,000 population were 3.2 for fatalities and 11.2 for nonfatal incidents, with a fatality-to-case ratio of 1:3.5. Total charges for initial hospital stays (excluding physicians' fees) were $5.2 million for 1227 hospital days. CONCLUSIONS: Swimming pools remain a serious hazard for young children. Primary prevention continues to be an important public health goal. Public health officials should support the adoption of laws designed to protect children from drowning and near-drownings.

Age Distribution↗
PubMed1983

A survey of pathogenic and free-living amoebae inhabiting swimming pool water in Mexico City.

A survey of pathogenic and free-living amoebae in swimming pool waters of Mexico City was performed. Among the organisms isolated those which have public health importance were Naegleria fowleri Carter and Acanthamoeba castellanii Douglas. Amoebae of the genera Acanthamoeba, Naegleria, and Vahlkampfia were recovered in their cystic stage while those specimens of the genera Amoeba, Entamoeba, Thecamoeba, and Vanella were recovered only in their trophic stage during this study. Amoebae were concentrated through filtration procedures and subsequently cultured in different culture media. Nonpathogenic amoebae also isolated by culture included: Amoeba proteus (Pallas) Leidy, Amoeba striata Penard, Paratetramitus jugosus Page, Acanthamoeba astronyxis Ray and Hayes, Vahlkampfia avara Page, Vahlkampfia inornata Page, Thecamoeba verrucosa Ehrenberg, and Vanella mira Schaeffer. Trophozoites of Entamoeba gingivalis Gros, were also recovered, both directly and by culture. Most commonly found were amoebae of the species Naegleria gruberi Schardinger (59.02%), N. fowleri (16.77%), and A. castellanii (7.64%). Least-frequently found amoebae belonged to the species Thecamoeba verrucosa (0.12%). All isolated strains of N. fowleri and A. castellanii were thermophilic at 45 and 40 degrees C, respectively, and also pathogenic when inoculated into white mice. More populated by amoebae were those swimming pools of the indoor type with an inner side garden. It was also shown that the free residual chloride values of 0.50 to 1.5 mg/liter, ordinarily used in pool waters, are not adequate for elimination of amoebae.

Amoeba↗
PubMed2003

Outbreak of Pseudomonas aeruginosa folliculitis associated with a swimming pool inflatable.

On 18 February 2002, the Communicable Disease Unit was notified by the local Public Health Service Laboratory of a child with a positive skin swab for Pseudomonas aeruginosa. This child had attended the local swimming pool and played on an inflatable, subsequently presenting to a Primary Care Nurse Practitioner with folliculitis. A total of 35 cases was identified during the outbreak. This paper describes a case-control study and microbiological sampling of the cases, the suspected inflatable and a survey of 10 swimming pool inflatables in the local area. The odds ratio for developing folliculitis following use of the inflatable was 12 (95% CI 1.05-136.80). The strain of P. aeruginosa found on the inflatable was identical to that obtained from skin swabs of cases. Nine of 10 (90%) of the inflatables sampled were colonized by P. aeruginosa. Attention should be given to the problem of routine decontamination of swimming pool inflatables. P. aeruginosa folliculitis needs to be considered in the differential diagnosis of skin rashes in children, especially in Primary Care.

Case-Control Studies↗
PubMed1995

A comparison of rats and mice in a swimming pool place task and matching to place task: some surprising differences.

An ecological niche that requires competency in water has prepared rats for the swimming pool spatial tasks that they are administered in the laboratory. Their ability to eventually solve spatial tasks in a single trial makes them ideal subjects for evaluating neural contributions to spatial behavior and for addressing many other neuroscience problems. Swimming pool place tasks are also given to mice, but the spatial abilities of the animal has not been evaluated as extensively as have those of rats. In the present paper, place learning in a single place task and a matching to place task is comparatively assessed in groups of rats and mice. The rats were superior to the mice on both problems. Although the mice could learn a single place problem, their acquisition was slower and their asymptotic performance was inferior to that of rats. Mice also did not display one trial learning on the matching to place task as did rats. These species differences in swimming pool place learning are discussed with respect to both methodological considerations and to species differences in preparedness to learn. It is suggested that given the variability of the performance of mice across both strains and laboratories, rat performance could be used to provide a baseline for comparative purposes.

Animals↗
PubMed1981

Survey of bacteria in private swimming pools.

In a survey of the bacteria in swimming pools treated with either chlorine or Baquacil in private gardens in Melbourne, the water was frequently found to be at the incorrect pH and to contain biocides at suboptimal concentrations. The general bacterial flora count was commonly greater than 200 per mL; only 14% of chlorine-treated pools and 27% of Baquacil-treated pools consistently gave counts of less than 200 per mL. Coliforms were detected in 66% of chlorine-treated pools and in 22% of Baquacil-treated pools. Escherichia coli was detected in 32% of chlorine-treated pools and 8% of Baquacil-treated pools. Staphylococcus aureus was detected in 36% of chlorine-treated pools and in 8% of Baquacil-treated pools. Pseudomonas aeruginosa was detected in 7% of chlorine-treated pools, but not at all in Baquacil-treated pools. When the biocides were maintained at the correct concentration, the indicator organisms were well controlled by both biocides. This survey indicates that owners of pools need to be made aware that their pools can harbour potentially pathogenic bacteria unless biocides are constantly maintained at the correct concentration. Baquacil generally remains above the minimum recommended concentration for approximately 14 days between routine additions, whereas chlorine can dissipate from the pool within hours of addition on hot sunny days. This probably contributed to the superior over-all performance of Baquacil in this survey.

Biguanides↗
PubMed2006

Swimming pool drownings among US residents aged 5-24 years: understanding racial/ethnic disparities.

OBJECTIVE: We examined circumstances surrounding swimming pool drownings among US residents aged 5 to 24 years to understand why Black males and other racial/ethnic groups have high drowning rates. METHODS: We obtained data about drowning deaths in the United States (1995-1998) from death certificates, medical examiner reports, and newspaper clippings collected by the US Consumer Product Safety Commission. RESULTS: During the study period, 678 US residents aged 5 to 24 years drowned in pools. Seventy-five percent were male, 47% were Black, 33% were White, and 12% were Hispanic. Drowning rates were highest among Black males, and this increased risk persisted after we controlled for income. The majority of Black victims (51%) drowned in public pools, the majority of White victims (55%) drowned in residential pools, and the majority of Hispanic victims (35%) drowned in neighborhood pools (e.g., an apartment complex pool). Foreign-born males also had an increased risk for drowning compared with American-born males. CONCLUSIONS: Targeted interventions are needed to reduce the incidence of swimming pool drownings across racial/ethnic groups, particularly adult supervision at public pools.

Adolescent↗
PubMed1995

Environmental and biological monitoring of chloroform in indoor swimming pools.

The presence of chloroform as the result of disinfection with sodium hypochlorite was demonstrated in the water and ambient air of indoor swimming pools. Environmental monitoring was performed in 12 indoor swimming pools in northern Italy and the level of human exposure was assessed. Biological monitoring performed by gas chromatography on human plasma and alveolar air samples evidenced that the uptake of chloroform in swimmers varies according to the intensity of the physical activity and age. The elimination of chloroform in alveolar air in one subject showed a very short half-life (from 20 to 27 min) and a complete clearance within 10 h after the end of exposure.

Breath Tests↗
PubMed1985

Model studies on a membrane filtration method for the enumeration of coagulase-positive staphylococci in swimming-pool water using rabbit plasma-bovine fibrinogen agar.

The recovery of Staphylococcus aureus from swimming-pool water by membrane filtration was studied in model experiments. On the nonselective medium tryptone soya agar (TSA) there was no difference in counts of noninjured S. aureus with all membrane filters tested and with pour plates. Chlorine-injured S. aureus was enumerated most efficiently on TSA by Gelman Tuffryn HT-450 and Sartorius SM 13806 filters. Tuffryn filters were also most productive when used in combination with the selective medium rabbit plasma - bovine fibrinogen agar (RPFA). Other filters, particularly Gelman GN-6 and Millipore HAWP, when used on RPFA were shown to have a synergistic inhibitory effect on both noninjured and chlorine-injured S. aureus. This effect was not found on Baird-Parker agar. Using Tuffryn filters, counts on RPFA were equal to those on TSA for noninjured S. aureus and 0.1-2.0 log units less for chlorine-injured S. aureus. Despite this, the possibility for reading the in situ coagulase reaction for individual colonies on RPFA is considered such an advantage of this medium that its general use for enumeration of S. aureus in swimming pools is recommended. Further studies should be carried out to allow better resuscitation.

Animals↗
PubMed2005

Pseudomonas aeruginosa in public swimming pools and bathroom water of patients with cystic fibrosis.

INTRODUCTION: Acquisition of Pseudomonas aeruginosa (PA) in the lungs of patients with cystic fibrosis (CF) is a marker of poor survival. PA is a ubiquitous pathogen prevalent in humid conditions. This study aimed to identify the prevalence of PA in public swimming pools, as well as from water taps. METHODS: Water was collected from public indoor and outdoor pools in the area of St. Gallen, Switzerland. In addition, standing and running water was sampled from bathroom water taps of 50 patients with CF. RESULTS: Outdoor pools: In 2002, none of the 72 specimens from 28 pools revealed PA. In 2003, three specimens from 46 pools (7%) revealed PA, each were from a different paddling pool. Indoor pools: two of 128 specimens from 56 pools (4%) identified PA, both were from non-public hydrotherapy pools. Water taps: in winter, none of the 102 specimens was colonized with PA. in summer, only two out of 50 specimens of the standing water were positive for PA but none of the running water revealed PA. CONCLUSION: The prevalence of PA in public swimming pools and bathroom water taps in the eastern part of Switzerland is very low. On hot summer days, outdoor paddling pools and standing tap water can contain PA. This study does not support recommendations to avoid public swimming pools or running tap water if the water is maintained according to hygiene guidelines.

Colony Count, Microbial↗
PubMed2003

Aqueous photolysis of the sunscreen agent octyl-dimethyl-p-aminobenzoic acid. Formation of disinfection byproducts in chlorinated swimming pool water.

The photochemical behavior of the sunscreen agent octyl-dimethyl-p-aminobenzoic acid (ODPABA) was studied in different aqueous solutions and under different conditions. ODPABA photolysis was performed under laboratory conditions using a xenon light source and under natural sunlight conditions in sea, swimming pool as well as in distilled water. The influence of dissolved organic matter (DOM) on the degradation kinetics was also studied in the presence of various concentrations of humic acids (HA). The phototransformation was shown to proceed via pseudo-first-order reaction in all cases and the reaction rates followed the order: distilled water > swimming pool water > seawater, depending mainly on the presence of dissolved organic matter that retarded the photolysis reaction. Kinetic experiments were monitored with HPLC/UV-DAD and the half-lives (t 1/2) varied between 1.6 and 39 h in simulated solar irradiation and between 27 and 39 h in natural sunlight conditions. The product distribution during illumination was strongly dependent on the constitution of the irradiated media. Irradiation of the aqueous ODPABA solutions gave rise to several transformation products that were isolated by means of solid-phase extraction (SPE) and identified using GC-MS techniques. These were formed mainly through dealkylation and hydroxylation reactions and were detected in all aqueous solutions investigated. In the case of swimming pool water some additional byproducts were isolated and were tentatively identified as chlorinated intermediates, formed by the subsequent chlorination of the parent molecule as well as other intermediates.

4-Aminobenzoic Acid↗
PubMed2004

Pathways of trihalomethane uptake in swimming pools.

Chlorination of pool water leads to the formation of numerous disinfection by-products (DBPs), chloroform usually being most abundant. Bathers and pool guardians take up various amounts of DBPs by different pathways. Identification of different uptake paths is important in order to develop a technical strategy for swimming pool water treatment and to develop focussed technical solutions to minimize THM uptake. Basically, trihalomethanes (THMs) can be taken up by inhalation, by dermal absorption, or orally (swallowing of water). In our experimental study involving up to 17 participants we quantified the body burden resulting from exposure to three different concentrations of chloroform in water and air of an indoor swimming pool, during a 60 min exercising period. Chloroform concentration of the water was 20.7, 7.1, and 24.8 microg/l and was not influenced artificially. Corresponding air CHCl3 concentrations were measured at two different levels (20 cm and 150 cm) and ranged from to 85 to 235 microg/m3. To dissociate the dermal exposure route from that of inhalation, THM concentrations were measured in the blood of subjects practicing in an indoor pool with and without scuba tanks, as well as in the blood of subjects walking around the pool without swimming. Chloroform concentrations were measured in blood samples before and after each exercise period. Blood chloroform concentration of participants with scuba tanks was 0.32 +/- 0.26 microg/l, without scuba tanks 0.99 +/- 0.47 micro/l, and for persons walking around the pool 0.31 +/- 0.25 microg/l. Our results indicate that THMs are mainly taken up over the respiratory pathway. Only about one third of the total burden is taken up over the skin. We examined the relationship between blood concentration and environmental chloroform concentrations by using linear regression models. Blood concentrations are correlated to air chloroform concentrations; correlation to water concentrations is less obvious.

Adult↗
PubMed1983

[Germ transfer into swimming pool water by head hair].

The transmission of germs from the hair of the head to the swimming pool water was examined. It was found that between 6 x 10(6) and 10 x 10(6) germs are transmitted, depending on hair length. A sex-specific difference has been proved to exist. The 1,500 investigations based on different methods have demonstrated that the proportion of Staph. aureus carriers in the hair of normal persons without hospital contact is only 10 per cent and thus much lower than reported in literature. Even indicators of faecal contamination and pollution (E. coli, coliform germs) were detected in the hair less frequently than is reported in literature. Surprisingly, no correlation was found to exist between the cleanliness of the hair (interval between the last shampooing and swimming) and the transfer of germs. Rinsing of the hair has been found to liberate considerable quantities of germs which otherwise are produced by sebaceous secretions. Thus, in 52 per cent of cases, after shampooing the germ counts were found to be the same as before shampooing or higher. As a result, shampooing appears to be an unsuitable measure of germ reduction and the only possibility of diminishing the germ load in swimming pools is to wear bathing caps. This problem will be investigated by us in greater detail.

Bacteria↗
PubMed1981

A survey of fungi and some indicator bacteria in chlorinated water of indoor public swimming pools.

Fifty-four water samples, of volume 500 ml, originating from six public indoor fresh water swimming pools were examined for the presence of fungi and some indicator bacteria by a membrane-filter method. Sabouraud-dextrose agar and selective Candida albicans-medium were used for isolation and identification of fungi. In all but one of the samples the free chlorine content was above 0.40 mg/l. No Candida albicans were detected. Molds and unidentified yeasts were isolated from 29 of the samples. The following species were recorded: Acremonium spp., ALternaria sp., Aspergillus spp., Candida guilliermondii, Chaetomium sp., Cladosporium spp., Clasterosporium sp., Fusarium spp., Geotrichium sp., Penicillium spp., Petriellidium boydii and Phoma spp. Their occurrence was sporadic, each species mostly appearing as single colonies only, with a maximum of 5 colonies. Bacterial growth was noticed in 15 samples, but only in the sample of low free chlorine content did this reach significant proportions. The study indicates that the standard of chlorination is, at least in general, an adequate measure against fungal contamination of swimming pool water. However, the spectrum of mold species encountered encourages a further search for possible indicator species among these organisms.

Bacteria↗
PubMed1997

Prevention of spinal cord injuries that occur in swimming pools.

The purpose of this study was to determine the usual circumstances surrounding spinal cord injuries that occur in swimming pools so that appropriate primary prevention programs targeted at high risk persons, activities, and environments could be developed and initiated. A sample of 341 persons enrolled in the National Spinal Cord Injury Statistical Center database since 1973 whose injury was the result of a swimming pool mishap was identified. Medical records were reviewed retrospectively and a survey questionnaire was administered by telephone to 196 persons (57.5%) who were located and agreed to participate. Average age at time of injury was 24 years, 86% of injured persons were men, 95% were white, 70% were never married, 32% had less than a high school education, and only 7% were college graduates. Almost all injuries (87%) occurred in private/residential pools. Most injuries (57%) occurred when diving into less than 4 feet of water, while an additional 38% occurred at water depths between 4 and 8 feet. Depth indicators were not present in 75% of cases. There were no warning signs posted in 87% of cases. There was no lifeguard on duty in 94% of cases. There was self-reported alcohol involvement in 49% of cases, but drugs were involved in only 2% of cases. Almost half of all injuries (46%) occurred during parties. In 44% of cases, the injury occurred during the person's first visit to that particular pool. Ordinary dives accounted for 70% of cases, followed by unusual dives (17%), unintentional pushes (6%), and other circumstances (7%). Almost all injuries (88%) occurred between 1 pm and 1 am with the most frequent time of day being 6 pm, and 82% occurred during June, July or August. Over half (51%) of all injuries occurred on Saturday or Sunday. These results provide important clues to the development of a successful primary prevention program.

Adolescent↗
PubMedDate not supplied

Cryptosporidiosis outbreak in a recreational swimming pool in Minnesota.

On May 6, 1998, the Olmsted County Public Health Department initiated an investigation into an outbreak of diarrheal illness that had occurred among people who swam frequently at a local swimming pool. Interviews of swimmers and microbiological testing of stool samples and swimming pool filter material were conducted to determine the source of the outbreak. Twenty-six of 206 swimmers interviewed had illnesses that met the case definition. The most common symptoms were diarrhea (100 percent), abdominal cramps (81 percent), and nausea (77 percent). The median duration of symptoms was nine days. Four cases of cryptosporidiosis were confirmed by stool analysis. The outbreak was found to be associated with swimming at the pool. Public awareness-including an understanding that recreational water facilities should be avoided during diarrheal illness-and proper pool hygiene are vital in preventing cryptosporidiosis outbreaks. Health care providers also must consider testing specifically for cryptosporidiosis when a patient presents with persistent diarrhea.

Abdominal Pain↗
PubMed2004

Pulmonary epithelial integrity in children: relationship to ambient ozone exposure and swimming pool attendance.

Airway irritants such as ozone are known to impair lung function and induce airway inflammation. Clara cell protein (CC16) is a small anti-inflammatory protein secreted by the nonciliated bronchiolar Clara cells. CC16 in serum has been proposed as a noninvasive and sensitive marker of lung epithelial injury. In this study, we used lung function and serum CC16 concentration to examine the pulmonary responses to ambient O3 exposure and swimming pool attendance. The measurements were made on 57 children 10-11 years of age before and after outdoor exercise for 2 hr. Individual O3 exposure was estimated as the total exposure dose between 0700 hr until the second blood sample was obtained (mean O3 concentration/m3 times symbol hours). The maximal 1-hr value was 118 microg/m3 (59 ppb), and the individual exposure dose ranged between 352 and 914 microg/m3hr. These O3 levels did not cause any significant changes in mean serum CC16 concentrations before or after outdoor exercise, nor was any decrease in lung function detected. However, children who regularly visited chlorinated indoor swimming pools had significantly lower CC16 levels in serum than did nonswimming children both before and after exercise (respectively, 57 +/- 2.4 and 53 +/- 1.7 microg/L vs. 8.2 +/- 2.8 and 8.0 +/- 2.6 microg/L; p < 0.002). These results indicate that repeated exposure to chlorination by-products in the air of indoor swimming pools has adverse effects on the Clara cell function in children. A possible relation between such damage to Clara cells and pulmonary morbidity (e.g., asthma) should be further investigated.

Air Pollutants↗
PubMed2005

Swimming pool water--fractionation and genotoxicological characterization of organic constituents.

Swimming pool water treatment in general includes flocculation, sand filtration, and subsequent disinfection with chlorine. The continuous chlorination and input of organic material by bathers in combination with recirculation of the pool water leads to an accumulation of disinfection by-products (DBPs) in the water. Several DBPs have been identified as human carcinogens and are thought to cause allergic asthma. Therefore, the elimination of DBPs is one major aim of pool water treatment. Using membrane filtration as an alternative treatment technology, DBPs can be removed more efficiently than with conventional treatment. In this study membrane filtration and genotoxicity testing were applied for the characterization of pool water constituents and for the identification of the necessary molecular weight cut off of the membrane for an efficient elimination. Two-step membrane filtration revealed that most of the DBPs (as adsorbable organically bound halogen, AOX) were present in the molecular weight fraction below 1000 g/mol. The fraction below 200 g/mol contained more than 30% of the AOX. The distribution of the dissolved organic carbon (DOC) across the fractions was similar to that of the AOX. The genotoxicity was found to be strongest in the low-molecular weight fraction. Thus, considerable DBP removal by membrane treatment requires membranes with low-molecular weight cut offs down to 200 g/mol. The comprehensive elimination of the genotoxic compounds requires further treatment steps.

Adsorption↗