Pool & Spa
Policies
This information
provided by the Food,
Pool & Lodging Health and Safety Section of the Office of Public Health
Systems.
3 33-60-200, 333-62-165 #1
December 7, 1998 Review Date - July 1, 2000
POLICY AND INTERPRETATION MANUAL
FECAL ACCIDENTS/PROTOCOL/POOLS & SPAS
QUESTION: What should I do to handle fecal and vomiting accidents in the
swimming pool or spa?
BACKGROUND:
Swimming pools have been the subject of much public attention in recent years. E.
Coli O157 H7, Crytosporidia, Giardia and other organisms have been
making the news as people become ill from the organisms after swimming.
Swimming and bathing in swimming pools has become increasingly popular.
Unfortunately, in addition to providing fun, the water also washes away dirt,
oils, bacteria, perspiration, dead skin, and fecal material from our bodies.
These contaminants can accumulate to dangerous levels in the absence of
corrective measures. We have tried to reduce the risks by first providing
better dilution by constantly flushing water through the pool and, in more
recent years, by filtration and disinfection as clean water resources have
become more scarce.
Over time, public pools have come under stricter and more stringent rules
regarding pool water quality. We have reached the point where the public
expects pool water to be as clean and safe as their tap water. We can do a lot
to keep the water clean and healthy, but no one can totally eliminate
the risks associated with swimming.
Most organisms found in a pool are killed very quickly. Usually a few seconds
of disinfection is enough time to kill 99.9 % of the organisms. Recently,
however, we have begun to see organisms such as Cryptosporidia which are
very resistant to disinfection. Unfortunately, Crypto causes very watery
diarrhea, so these accidents are seldom noticed or reported. When contamination
does occur, it can only be identified after people start becoming ill, a week
or more after the contamination of the pool. Anyone entering the water can
contributeharmful organisms which could cause an infection. High-risk groups,
diaper-age children and immuno-compromised persons (cancer patients, persons
with transplants and persons with active HIV infections) are of special
concern. Diaper-age children are a greater problem because they are most likely
to have an accident, and they also ingest the pool water. Immuno-compromised
persons are more at risk because they cannot fight off the organisms.
This policy calls for a two-pronged approach. First, educate the public that
there are risks involved in swimming and what they can do to reduce the risks
involved. Secondly, treat identified fecal accidents as if they contain
the more easily killed organisms, because accidents containing Cryptospordia
are not often noticed nor reported before people begin to get sick.
POLICY / INTERPRETATION / GUIDELINE:
PREPARE A PLAN:
1. In the event that you are contacted by persons who are ill or who have
questions, How would you answer questions and complaints? To whom would you
refer these individuals? How would you manage press inquiries in the event of
an outbreak?
2. Prepare and implement a written fecal accident policy for your pool. Teach
this policy to all employees. Be sure that employees enforce your policy.
Instruct lifeguards and other personnel to monitor the pool area for fecal
accidents and behavior that can put others at risk (e.g., rinsing off the
soiled buttocks of an undiapered child in a pool, or rinsing the diaper.).
3. Unfortunately, fecal accidents that are caused by Cryptosporidium
infection are likely to be in the form of watery diarrhea, and therefore will
probably not be seen or reported. It is therefore important to:
A. Train staff (lifeguards and instructors) to report illnesses they experience
to the management and not to swim if ill with diarrhea or abdominal cramps.
B. Develop a policy for pool usage by diaper-aged and toddler children. These
children are at high risk for having fecal accidents in the pool. Require the
use of swim diapers.
C. Provide signage in a conspicuous location before the pool entry. The sign
shall state:
"PROTECT OUR WATER"
"If you have or have had diarrhea
in the past two weeks, please do not use the pool."
"Shower your child and yourself. Take a cleansing shower before entering
the pool or after using the toilet."
Bathers who are not toilet trained shall wear a swim diaper.
4. Develop a public education program to discuss the disease-transmission
risks, and inform the public what you are doing to reduce those risks. This can
include articles or interviews with the news media, newsletters, handouts at
the pool, and other activities.
HANDLING THE FECAL ACCIDENT:
The development of these guidelines was a cooperative effort of a committee
made up of pool operators, sanitarians, state swimming-pool program staff and
state epidemiologists.
We felt that over-treatment of the pool, in an effort to deal with every
accident as if it involved Crypto, was unrealistic. Reviewing reported
outbreaks indicate that the Crypto fecal accidents are not evident until
people become ill.
All fecal and vomiting accidents are handled basically the same way,
|
Well-formed Stools
/ Vomit |
|
Diarrhea |
|
1. Clear the area. 2. Check
for adequate disinfectant in the area. 4. Add additional
disinfectant as necessary. |
1. Clear the pool. 2. Add chlorine to
raise the pool to 5 ppm, or equivalent using other disinfectants. 4. Allow some time
for the disinfectant to spread and work on the extra organic material. In
addition we need to avoid "hot" spots of disin-fectant that
swimmers may swim through. Allow about an hour of total time down 6. Reopen
pool. |
Any material removed from the pool
should be disposed of in a biohazard waste bag. Clean your equipment and wash
your hands.
As the stool becomes less less-formed, the procedure would transition from the
well-formed procedure to the procedure for diarrhea.
For limited-use pools:
Follow the above procedures for the diarrhea, except allow additional downtime
and close the pool during the above process. Keep the pool closed at least an
hour, and up to one turnover of your pool for loose stools and diarrhea.
WHAT ELSE:
In addition to the above, it is also important that the pool and pool area be
kept clean and disinfected, this includes the dressing, toilet and shower
areas.
Maintaining your pool recirculation rates and proper functioning of filtration
systems, while frequently checking and maintaining proper disinfectant levels,
will also provide significant levels of protection from the risk of spreading a
disease-causing organism.
What if someone tells you he or she currently has an ongoing Cryptosporidia
infection and just had an accident in your pool?
In this unlikely event:
1. Clear and close the pool.
2. Inform patrons and staff of the situation. Have them contact the local
health department and their doctor if they become ill. It will usually take 7
to 10 days before anyone becomes ill. Young children should not attend daycare
if they develop a diarrheal infection.
3. Add disinfectant to bring the pool up to 20 ppm chlorine or equivalent. Remove
any pieces of stool and place them in a biohazard bag. Avoid handling the
stool, and wash well afterwards. Disinfect the net or other equipment. (The net
can just be thrown into the pool.)
4. Notify the local health department of the situation.
5. Maintain the disinfectant level for 12 hours and ensure the circulation flow
is at its maximum effective rate during this time. Balance the water chemistry.
6. Backwash the filters thoroughly.
7. Rebalance the water chemistry and adjust the disinfectant. Open the pool.
8. Monitor staff for illness and restrict ill staff from the water until they
obtain a negative stool sample for Cryptosporidia, or for two weeks
after the diarrhea ends.
9. Emphasize public education (especially for high-risk populations) and
increase your fecal-accident monitoring vigilance.
or Cryptosporidia, or for two weeks after the diarrhea ends.
9. Emphasize public education (especially for high-risk populations) and
increase your fecal-accident monitoring vigilance.