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PubMed1992

[Update of DIN 19.643--treatment and disinfection of swimming pool and bathing tub water].

German Standards Specification DIN 19,643 is at present under revision for health reasons and because of both negative and positive experiences gathered in practice. To enable adaptation of the standards specification to future developments, a Part I of the specification is being created comprising the demands to be made on the quality of the water and general demands on the construction and operation of swimming pools and tubs and basins in bath houses, e.g. in spas or municipal swimming pools. The subsequent parts of the new specification (Part 2 to Part n) concern the demands to be made on individual combinations of processes; these can be supplemented at any time in accordance with technical progress without requiring revision of the entire standards specification. Essential innovations are the reformulation of the required efficiency of disinfection, the introduction of the parameters Legionella pneumophila, trihalogen methane (THM) and the reduction of the limit value for chloramines. Technically speaking, the new features concern the automatic measurement of the auxiliary parameters of hygiene such as redox potential, pH value and free chlorine, automatic control of disinfectant additions, automatic filter rinsing with fluidization of the filter-bed to a prescribed minimum bed expansion, and the sight-glas at the filter container. The demands made on Jacuzzi and warm water spouted bed besins are integrated into the specification, thus obviating the need for German Standards Specification DIN 19,644.

Disinfectants↗
PubMed2005

Novel use of a swimming pool biocide in the treatment of a rare fungal mastoiditis.

OBJECTIVE: To describe an extremely rare fungal mastoiditis caused by Lecythophora hoffmannii, its recalcitrant behavior to therapy, and eventual successful treatment with adjunctive therapy using polyhexamethylene biguanide (a common swimming pool biocide). STUDY DESIGN: Case report and review of literature of human Lecythophora hoffmannii infections. METHODS: Medline database was searched using the keywords Lecythophora and hoffmannii. All articles that described Lecythophora hoffmannii as the cause of human infection at any site were identified. Literature and patient's records were considered for complete data review and extraction. RESULTS: We present the second known case in the literature of a human infection with Lecythophora hoffmannii. We also present the process to definitively identify and then to successfully eradicate this unusual fungal infection using polyhexamethylene biguanide as adjunctive treatment. CONCLUSIONS: Successful treatment of a chronic Lecythophora hoffmannii fungal mastoiditis involved a combination of radical surgical removal of all apparent infected tissue along with local treatments with polyhexamethylene biguanide, a common swimming pool biocide agent under the brand name Baquacil (Avecia, Manchester, United Kingdom). Given the prolonged course of treatment, this report particularly stresses the importance of concurrent surgery combined with creative local antimicrobial therapy to eliminate an unusual fungal infection in an immunocompetent host.

Biguanides↗
PubMed2002

Formation of disinfection by-products in chlorinated swimming pool water.

The formation of five volatile disinfection by-products (DBPs: chloroform, bromodichloromethane, chloral hydrate, dichloroacetonitrile, and 1,1,1-trichloropropanone) by the chlorination of the materials of human origin (MHOs: hair, lotion, saliva, skin, and urine) in a swimming pool model system was examined. Chlorination reactions took place with a sufficient supply of chlorine residuals (0.84 mg Cl2/l < total chlorine < 6.0 mg Cl2/l) in 300 ml glass bottles containing either ground water or surface water as a reaction medium at 30 degrees C and pH 7.0, for either 24 or 72 h. A longer reaction period of 72 h or a higher content of organic materials led to the increased formation of DBPs. Of the DBPs formed by the reaction, chloroform was a major compound found in both ground and surface waters. The formation of chloroform and bromodichloromethane per unit total organic carbon (TOC) concentration was suppressed when all types of MHOs were added to the surface water that already contained DBP precursors such as humic substances. However, the formation of dichloroacetonitrile was promoted, probably due to the increased degradation reactions of nitrogen-containing compounds such as urea and proteins of human origin. In conclusion, the materials of swimmers' origin including hair, lotion, saliva, skin, and urine add to the levels of DBPs in swimming pool water, and any mitigation measures such as periodic change of water are needed to protect swimmers from elevated exposures to these compounds.

Acetonitriles↗
PubMed1974

Staphylococci in swimming pool water.

During a period of five years 1192 water samples from swimming pools were examined for staphylococci and 338 for coliform organisms only. Eighty-nine different pools were sampled.Numbers of staphylococci, estimated by the membrane filtration technique did not bear any significant relation to either bathing load or concentration of free chlorine.Wide variation in the staphylococcal count was observed when different parts of a pool were sampled on the same occasion.The only practicable standard for pool samples in relation to staphylococci would appear to be that these organisms should be absent from 100 ml. water when the pool has been out of use during at least ten hours before sampling if filtration and chlorination are adequate.

Chlorine↗
PubMed1980

[On the occurrence of staphylococci and pseudomonas in swimming-pool water (author's transl)].

1. Analyses made at a bath with an additional ozone processing stage showed that the bathers caused a marked bacterial contaminatin on busy days and that this contamination did not originate from the purification plant. 2. This finding and numerous individual analyses of water from various swimming pools yielded a spectrum of 14 micro-organisms, 4 genera being of frequent incidence: bacillus, staphylococcus, pseudomonas and flavobacterium. In general, bacterial contamination exists not only in the pool itself but also after filtering and even subsequent to the addition of chlorine. Staphylococci were found to be particularly invulnerable even to high chlorine contents, which is likely to be attributable to their enclosure in organic material. 5. Tenfold sampling demonstrated that the identification of Staphylococcus aureus in individual samples is unreliable despite its ubiquitous occurrence, probably due to their uneven distribution in the water, while the identification or exclusion of Pseudomonas aeruginosa proves sufficiently dependable even with only individual samples. 4. The general routine analysis of swimming pool water for the presence of staphylococcus aureus appears not justifiable, whilst testing for Pseudomonas aeruginosa appears justifiable, especially for identifying potentially dangerous filter contaminations.

Bacillus↗
PubMed1987

Community outbreak of adenovirus type 7a infections associated with a swimming pool.

In July 1982, an outbreak of pharyngitis caused by adenovirus type 7a occurred among children in a small town in western Oklahoma. Predominant symptoms were fever and sore throat (by case definition), headache (83%), abdominal pain (64%), and conjunctivitis (51%). At least 77 persons were identified whose symptoms met the case definition for illness. Onsets of illness peaked during the week of July 5 to 12, and the outbreak resolved within three weeks. A systematic telephone survey of the town revealed that persons who had swum at the community swimming pool were more likely to be ill than those who had not (P less than .001). A second survey of families with season passes to the pool showed that among swimmers, illness was directly related to average number of hours of exposure to the pool each week (P less than .001 by chi-square for trend). In addition, swimmers who reported swallowing pool water were more likely to be ill (29 of 56, 52%) than persons who did not (ten of 41, 24%) (P = .01). Throat-swab specimens from five of seven ill persons (71%) grew adenovirus 7a compared with one of 12 well persons (8%) (P = .01). The pool chlorinator had reportedly malfunctioned during early July. The outbreak resolved with proper operation of the chlorination system. Swimming pools continue to be a potential source of community-wide outbreaks of adenovirus infections.

Adenoviridae Infections↗
PubMed1999

Blocking in the Morris swimming pool.

Four experiments demonstrate that spatial blocking is governed by the same principles that govern blocking in Pavlovian conditioning. In the 2nd stage of each experiment, rats escaped from a Morris swimming pool by swimming to a submerged platform with a beacon attached to it. Test trials were then conducted in the absence of the platform and the beacon to assess the extent to which subjects had learned about the position of the platform with reference to the room cues. For the 1st stage of their training, rats either swam to the platform and beacon in the presence of curtains that prevented the room cues from being seen (Experiments 1 & 2), or they swam to the platform and beacon that were moved from trial to trial (Experiments 3 & 4). In each experiment, learning about the room cues in the 2nd stage of the experiment was blocked by the presence of the beacon. This blocking effect was disrupted by changing the appearance of the beacon for the 2nd stage of training or by restricting the amount of exposure to the beacon during the 1st phase of training.

Animals↗
PubMed1984

[Swimming pool granuloma--an atypical mycobacterial infection].

After an introduction on the problem of swimming pool or fish tank granulomas--chronic granulomatous skin infections with Mycobacterium marinum--we present two of our own cases. The disease is discussed and the signs and symptoms, histological changes, and therapeutic methodology presented.

Adult↗
PubMed2006

Identification of Mycobacterium marinum 65 kD heat shock protein gene by polymerase chain reaction restriction analysis from lesions of swimming pool granuloma.

BACKGROUND: Nontuberculous mycobacterium (NTM) had been reported to cause cutaneous infections which are difficult to interpret due to the variability of the clinical manifestations. Among NTM infections, Mycobacterium marinum (M. marinum) are mostly seen to cause skin infection. It is therefore important to establish a rapid approach for detection and identification of M. marinum from lesions of patients with suspected M. marinum infections. METHODS: Specimens were obtained from 5 patients with swimming pool granuloma. DNA was extracted and polymerase chain reaction (PCR) was performed. PCR products were digested with Hae III and BstE II, then analysed by pattern restriction analysis to detect heat shock protein (hsp) 65 kD gene. RESULTS: The 65 kD hsp gene was found in all specimens from patients with swimming pool granuloma. PCR restriction analysis (PRA) identified all 5 samples to be M. marinum infections, and the result was consistent with that of routine bacteriological identification. The lesions subsided or markedly improved upon treatment. CONCLUSIONS: PRA is a sensitive, specific and rapid method in identification of mycobacteria. Application of this method will be helpful for early diagnosis of mycobacterial skin infections.

Adolescent↗
PubMed2001

Protracted outbreaks of cryptosporidiosis associated with swimming pool use--Ohio and Nebraska, 2000.

Swimming is the second most popular exercise in the United States with approximately 400 million pool visits annually. During the summer of 2000, five outbreaks of cryptosporidiosis linked to swimming pools were reported to CDC. This report summarizes the investigations of two of these outbreaks involving approximately 1000 cases and provides recommendations to reduce the transmission of pool-related disease.

Adolescent↗
PubMed2006

Longitudinal monitoring of lung injury in children after acute chlorine exposure in a swimming pool.

RATIONALE: Acute exposure to chlorine gas results in respiratory impairment, but few data are available on the pathobiology of the underlying lung damage. OBJECTIVES: To assess lung function and potential lung damage pathways in the acute phase and longitudinally over a 15-mo follow-up after acute chlorine exposure. METHODS: Ten previously healthy children were accidentally exposed to chlorine gas at a swimming pool because of an erroneous servicing procedure. The fraction of nitric oxide in exhaled air (Fe(NO)), exhaled breath condensate compounds, and serum Clara cell-specific protein CC16 were repeatedly measured. MAIN RESULTS: In the acute phase, all patients had respiratory distress (one child required mechanical ventilation) and reduced lung function (median and interquartile range: FVC, 51 [43-60]% predicted; FEV(1), 51 [46-60]% predicted). This was accompanied by low Fe(NO) (4.7 [3.9-7.9] ppb), high exhaled breath condensate leukotriene B(4) (LTB(4)) levels (24.4 [22.5-24.9] pg/ml), and increased serum CC16 levels (mean +/- SEM, 23.4 +/- 2.5 microg/L). Lung function returned to normal in 15 d (FVC, 97% predicted [82-108], and FEV(1), 92% predicted [77-102]). Fe(NO) reached normal values after 2 mo (12.6 [11.4-15] ppb), whereas LTB(4) levels were still increased (12 [9.3-17.1] pg/ml). CONCLUSION: Children acutely exposed to chlorine in a swimming pool presented a substantial lung function impairment associated with biochemical exhaled breath alterations, represented mainly by an increase in LTB(4) and a reduction in Fe(NO). Although lung function and Fe(NO) improved within a few weeks, the increased levels of exhaled LTB(4) persisted for several months.

Accidents↗
PubMed2004

Pivmecillinam and adverse birth and neonatal outcomes: a population-based cohort study.

A previous study unexpectedly showed an increased, statistically imprecise, risk of low Apgar score in children of women redeeming prescriptions for pivmecillinam in late pregnancy. To improve statistical precision we extended the previous dataset with data for 5 more y, and in addition added more neonatal outcomes. We thus examined the risk of adverse birth and neonatal outcomes among pregnant users of pivmecillinam based on population-based registries in North Jutland County, Denmark. We included 63,659 women with a live birth, or stillbirth after the 28th week of gestation. 2031 had redeemed prescriptions for pivmecillinam any time during pregnancy, 559 in the first trimester and 371 within 28 d before delivery. Adjusted odds ratios were: birth defects 0.83 (95% confidence interval (95% CI) 0.53-1.32) for exposure during first trimester, preterm delivery 0.96 (95% CI 0.79-1.18) and low birth weight 0.79 (95% CI 0.52-1.20) for exposure any time during pregnancy, and stillbirth 1.19 (95% CI 0.30-4.80), low Apgar score 1.17 (95% CI 0.37-3.66), hypoglycaemia 1.03 (95% CI 0.53-2.00), and respiratory distress syndrome 0.79 (95% CI 0.38-1.68) for exposure within 28 d before delivery. Use of pivmecillinam during pregnancy did not appear to increase the risk of adverse birth and neonatal outcomes; however, statistical precision is still low.

Abnormalities, Drug-Induced↗
PubMed1979

Coliform status of domestic swimming pools.

An investigation of maintenance, usage, and coliform status of water in 104 domestic swimming pools in 13 Brisbane suburbs was made in January, 1978. The results showed that domestic pools are often imperfectly serviced, and are potential infection sources. The need for health education of pool owners, and for more reliable methods of pool sanitization is emphasized.

Escherichia coli↗
PubMed1995

[Juvenile palmar dermatitis acquired at swimming pools].

INTRODUCTION: We describe a new childhood mechanical dermatosis of the hands due to swimming pools. OBSERVATIONS: We report two cases of a dermatosis of the hands occurring in children characterized by symetric erythematous plaques on the convexities of the palmar zone of the hands and fingers. It is due to repeated rubbing of the palms on rough pool wall. It disappears spontaneously when stopping this activity. DISCUSSION: We propose the French appellation of "dermatite palmaire juvenile des piscines" to design this entity which has already been described in the English dermatologic literature under the name of "pool palms". Its characteristic aspect should allow a rapid diagnosis.

Child↗
PubMed1989

Immediate and long-lasting effects of MK-801 on motor activity, spatial navigation in a swimming pool and EEG in the rat.

In a series of experiments, rats received the noncompetitive N-methyl-D-aspartate (NMDA) antagonist MK-801 and measures were made of motor behavior, spatial navigation in a swimming pool, and electroencephalographic (EEG) activity. High doses (0.25-10 mg/kg IV) produced somnolence and akinesia, impaired food consumption, locomotion and swimming, and also impaired navigation to a hidden platform but complete recovery on all measures was obtained between 3 and 5 days postinjection. Lower doses (0.05-0.10 mg/kg, IV) impaired acquisition of a new place response in a swimming pool and produced hyperactivity but did not impair performance on a new cue response or on a well-learned place response. Two forms of hippocampal EEG activity, atropine-sensitive and atropine-resistant EEG were present with the low doses. The results demonstrate that a single dose of MK-801 causes changes in motor behavior and learning lasting a few days, but complete recovery occurs within 5 days of administration of even very high doses of MK-801. They further demonstrate that low doses of the drug selectively impair acquisition of new place responses. Although the general changes in behavior produced by MK-801 suggest that NMDA receptors are involved in many aspects of the control of behavior, the results additionally suggest that NMDA receptors are important for place learning.

Animals↗
PubMed2003

Lung hyperpermeability and asthma prevalence in schoolchildren: unexpected associations with the attendance at indoor chlorinated swimming pools.

AIMS: To study whether exposure to nitrogen trichloride in indoor chlorinated pools may affect the respiratory epithelium of children and increase the risk of some lung diseases such as asthma. METHODS: In 226 healthy children, serum surfactant associated proteins A and B (SP-A and SP-B), 16 kDa Clara cell protein (CC16), and IgE were measured. Lung specific proteins were measured in the serum of 16 children and 13 adults before and after exposure to NCl(3) in an indoor chlorinated pool. Relations between pool attendance and asthma prevalence were studied in 1881 children. Asthma was screened with the exercise induced bronchoconstriction test (EIB). RESULTS: Pool attendance was the most consistent predictor of lung epithelium permeability. A positive dose-effect relation was found with cumulated pool attendance and serum SP-A and SP-B. Serum IgE was unrelated to pool attendance, but correlated positively with lung hyperpermeability as assessed by serum SP-B. Changes in serum levels of lung proteins were reproduced in children and adults attending an indoor pool. Serum SP-A and SP-B were already significantly increased after one hour on the pool side without swimming. Positive EIB and total asthma prevalence were significantly correlated with cumulated pool attendance indices. CONCLUSIONS: Regular attendance at chlorinated pools by young children is associated with an exposure dependent increase in lung epithelium permeability and increase in the risk of developing asthma, especially in association with other risk factors. We therefore postulate that the increasing exposure of children to chlorination products in indoor pools might be an important cause of the rising incidence of childhood asthma and allergic diseases in industrialised countries. Further epidemiological studies should be undertaken to test this hypothesis.

Adolescent↗