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The role sanitizers and bather hygiene play in healthy water

By Ellen Meyer

It is estimated an average of 140 mg (0.14 g) of fecal material is contributed to pool water by each swimmer—a minimum of 0.1 mg (0.0001 g) for adults to a maximum of 10,000 mg (10 g) for a child.

The primary goal of water treatment is to help protect swimmers from disease. Of course, it is important to protect the pool as well, but bather health is the first priority. This article will focus on the adverse health effects that can result from poorly treated pools and how to prevent them.

Before getting into the actual illnesses that can occur, the codes and laws referenced throughout this article that help prevent swimmer injury and illness should be reviewed first.

There are two main standards/codes that cover most pool and spa/hot tub care issues. In the U.S., the standard that addresses water quality is ANSI/APSP-11, American National Standard for Water Quality in Public Pools and Spas. The other standard, which is still relatively new to the industry, is the Centers for Disease Control and Prevention’s (CDC’s) Model Aquatic Health Code (MAHC). The MAHC does not cover residential pools and spas/hot tubs, but focusses on the design, construction, and operation of public facilities.

APSP standards and the MAHC are neither laws nor regulations that are enforced by any regulatory authority. Instead, they are standards/codes that not only serve as industry guidelines, but local public health authorities incorporate some of these standards/codes into laws.

Laws to regulate public pools come from the local and provincial/territory/state public health departments. Public pools are regulated and inspected by local public health authorities. These authorities, which could be city, regional/county, or provincial/territory/state public health agencies, write and enforce these health codes.

Laws used to regulate chemicals used in recreational water come from the Pest Management Regulatory Agency of Canada (PMRA) and the Environmental Protection Agency (EPA) in the U.S. PMRA and EPA regulate chemicals that kill pests. Pests can range from insects that damage crops to the bacteria that can be found in a pool. Any chemical that claims to sanitize a pool, kill bacteria or algae, or do anything else to prevent, destroy, repel, or mitigate any living organism in a pool or spa/hot tub must be registered with either agency in their respective countries. To obtain a registration, the manufacturer of the chemical must first provide data showing the product works and will not cause unreasonable adverse harm to people or the environment when properly used, stored, and disposed.

Now with that out of the way, it is time to talk about bugs and disease. These are not exactly pleasant topics, but they are important to understand.

Table 1

Group Species Typical Health Effect Outbreaks* Cases* Hospital*
Bacteria Pseudomonas aeruginosa
E. coli
Shigella sonnei
Legionella spp.
Respiratory illness
2 (4)
9 (2)
16 (56)
33( 52)
0 (0)
18 (1)
Parasites Cryptosporidium spp.
Viruses Norovirus Diarrhea 2 (2) 122 (21) 0 (4)
Chemical Chlorine/chloramine Respiratory/skin/eye irritation 3 (5) 57 (31) 0 (0)
* Values in parentheses are not confirmed to be the specific pathogen.
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