Diving Into Health Codes

Dec. 16, 2019

The Model Aquatic Health Code aims to ensure health & safety at public aquatic facilities

About the author:

Derek DeLand is manager of environmental health programs in the regulatory affairs department of NSF Intl. DeLand can be reached at [email protected].

Millions of people each year head to waterparks, pools, and other public aquatic venues to splash and swim without thinking about waterborne illnesses and other dangers. Those of us who work in public health have been working for years to make recreational activities healthier and safer for all, but we still have work to do. 

In 2014, the U.S. Centers for Disease Control and Prevention (CDC) adopted the first Model Aquatic Health Code (MAHC), a set of guidelines for pool operators across the country to follow. The MAHC addresses everything from design and construction to management of public aquatic facilities. Statistics highlight the need for a uniform code for water-related activities at public pools, hot tubs and water parks, including those at private resorts and hotels. 

Hidden Threat

Injuries attributed to pool chemicals account for 3,000 to 5,000 emergency department visits across the U.S. every year. Nearly half of those patients are under the age of 18, according to the CDC. Disease outbreaks are not uncommon at public aquatic facilities. There were nearly 500 outbreaks linked to pools, hot tubs, spas, and water playgrounds between 2000 and 2014. The source behind most of the outbreaks was Cryptosporidium, a parasite that is chlorine-tolerant.

A third of the disease outbreaks traced to pools between 2000 and 2014 started in hotel pools and hot tubs, according to the CDC. A recent study showed one out of eight public pool inspections and one out of seven public hot tub and spa inspections prompted immediate closure due to at least one violation posing a serious threat to public health, cites a CDC fact sheet. Nearly 60% of public pool filter water samples contained Pseudomonas aeruginosa and E. coli, an indicator of contamination by feces, and 8.1% contained Cryptosporidium, Giardia or both, according to different studies noted by the CDC.

It is easy to see why bacteria and microbes flourish in some recreational water systems and not others. Without a uniform health code for public pools and spas, a pool in one state or county might be designed, operated and maintained in a different way than a similar pool across the country or just a few counties away.

The CDC hopes the MAHC will change that. Now on its third edition, adopted in July 2018, the guidelines provide state and local agencies with wording for the design, construction, operation, maintenance, policies, and management of public pools, spas and other water recreation facilities.

The goals of the voluntary guidelines are to ensure public health and safety, and to help prevent drownings, injuries caused by pool chemical splashes or fume inhalation, or outbreaks caused by bacteria and other pathogens that can contaminate swimming water. The code is recommended for pools, hot tubs, and spas in hotels, apartment complexes and neighborhoods, water playgrounds, and waterparks. It does not apply to residential hot tubs or backyard pools.

To stay on top of the latest science and best practices, the CDC updates the MAHC on a regular basis, much like the U.S. Food and Drug Administration (FDA) does with its Food Code. The CDC works with the Independent Council for the MAHC, which comprises of stakeholders from public health, industry partners, academia and consumers, to ensure the latest scientific and technological improvements are addressed. Recommendations for updates are sent to the CDC every three years.

The guidelines are similar in purpose to the FDA’s Food Code created decades ago. That model code was designed to be adopted by states and local jurisdictions to assist with the safety and protection of food sold on retail shelves and served in restaurants. So far, the FDA Food Code has been adopted by 63 of the 66 state agencies responsible for food safety. However, previously the regulations were individualized and lacked consistency.

Similarly, regulators, manufacturers and pool operators now face a difficult landscape as pool codes vary from jurisdiction to jurisdiction. Most health departments and agencies have researched and developed their own regulations to minimize risks, but many codes may be outdated and not based on the latest science and best practices. Until the MAHC was created, there was no comprehensive science-based reference for the safety and management of public pools and water recreation facilities.

Call to Action

It is up to each state or jurisdiction to adopt the MAHC, or portions of it, as their code. The time has come to encourage them to do so. The code also benefits the aquatics manufacturing sector by providing consistent criteria for the acceptance and use of filters, equipment and chemical-treatment products. With widespread adoption, manufacturers will have a single set of guidelines to follow from pool to pool across the country, enabling them to streamline their products for compliance.

Almost everyone takes a dip in a public pool or hot tub at some point in their lives, but without a uniform code there are few assurances the water has been treated and maintained according to science-based requirements and best practices, as outlined in the MAHC. 

State and local government officials save time and resources in developing or updating their own pool codes and benefit from the latest science and best practices available. Industry receives uniform requirements of compliance for pool equipment and chemicals, thereby reducing the burden of obtaining regulatory approvals for products by jurisdiction. Most importantly, the code helps protect swimmers from injury, illness and drownings at public pools, hot tubs, spas and waterparks. 

About the Author

Derek DeLand

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