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Newcastle April 23rd
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Poor water quality, what potential illness awaits you in the pool?

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“I regularly encounter patients during my after-hours house visits that present with allergic reactions, viral and bacterial infections causing problems with the ears, throat, lungs, eyes, skin, and overall wellbeing. Many of these patients have reported participating in swimming activities both recreational and organised lessons in the last 48 hours of my consultation”. Dr Molly Gorman, NSW Australia.

Dr Gorman also noted that she had recently examined a mature woman that presented with severe lung malfunction, and after several examinations, it appeared that the damage to her lungs was what is typically seen by that of a long-term chain smoker. When the woman was questioned further it was identified that in fact she had never been a smoker but had been a swim instructor for the past 20 years in an indoor swimming facility.

When swimming in a pool with poor water quality the potential for infections and the types of illnesses that can be contracted are listed below:

Parasites

Cryptosporidium

Symptoms include watery diarrhea, stomach cramps, nausea and vomiting, possibly leading to dehydration.

Millions of Cryptosporidium parasites can be released from an infected human or animal, according to the CDC.

According to Faculty of Medicine, Universiti Teknologi MARA, the reported prevalence of Cryptosporidium among patients with Gastroenteritis is 1% to 4% in Europe and North America and 1% to 37% in Africa, Asia, Australia, and South and Central America.

Giardia

This germ is found in the fecal matter of a person who has been infected by Giardia. It has a tough outer shell that allows it to survive for up to 45 minutes even in properly chlorinated pools. Giardia is a common cause of recreational water illness (disease caused by germs spread through pool water) in the United States and can cause prolonged diarrhea (for 1–2 weeks). It can make anyone sick.

Giardia is spread by swallowing water that has been contaminated with fecal matter containing Giardia.

Swallowing even a small amount of pool water that has been contaminated with the Giardia germ can make you sick.

During the past 2 decades, Cryptosporidium spp. and Giardia sp. have been associated with increasing outbreaks of swimming-associated gastrointestinal illness in the United States;

Bacteria

Escherichia coli (E coli)

Some kinds of E. coli can cause diarrhea, while others cause urinary tract infections, respiratory illness and Pneumonia, and other illnesses.

Escherichia coli (E. coli) bacteria normally live in the intestines of people and animals.

The time between ingesting the STEC bacteria and feeling sick is called the “incubation period.” The incubation period is usually 3-4 days after the exposure, but may be as short as 1 day or as long as 10 days. The symptoms often begin slowly with mild belly pain or non-bloody diarrhea that worsens over several days. HUS, if it occurs, develops an average 7 days after the first symptoms, when the diarrhea is improving.

Pseudomonas aeruginosa

Pseudomonas aeruginosa accounts for many episodes of infections associated with attendance at swimming pools. The genus Pseudomonas includes free-living bacteria that are highly versatile and able to adapt to different environments and conditions. It is responsible for a series of diseases ranging from skin and eye infections in healthy individuals to serious life-threatening illnesses in burn, surgical, or immunocompromised subjects, often sustained by multi-drug resistant strains.

Folliculitus and ear infections which are caused by Pseudomonas aeruginosa. This organism is responsible for skin (follicle) and mucous membrane infections and ear infections, particularly in kids, which tend to be difficult to treat. The organism proliferates very quickly in pools when the water temperature is greater than 26C and when disinfection levels are not maintained at all times. This organism also causes outbreaks in heated spa pools.

Due to its ability to form a biofilm on virtually all surfaces, Pseudomonas aeruginosa can survive in treated water with residual chlorine levels < 1 mg/L, in distilled water, and in disinfectant solutions, and it shows high resistance to mechanical cleaning processes.

Shigella

This is a type of Gastroenteritis (also known as ‘gastro’) caused by Shigella bacteria.

Only small numbers of Shigella bacteria are sufficient to cause an infection

Symptoms may include:

  • diarrhoea (sometimes with blood or mucus)
  • fever
  • vomiting
  • stomach cramps.

 

Viruses

Noroviruses

Noroviruses are a group of viruses that can cause Gastroenteritis (inflammation of the stomach and intestines) with diarrhoea, stomach pain and vomiting. Common names used for Gastroenteritis due to Norovirus are ‘gastric flu’ or ‘stomach flu’, ‘winter vomiting’ and ‘viral gastro’. Apr 9, 2018

Hepatitis A

Since this virus is primarily transmitted via fecal matter, this is the hepatitis strain that could become a problem in a swimming pool.

A self-limiting viral infection of the liver, hepatitis A typically does not cause chronic disease. While hepatitis A causes liver inflammation, most people’s livers can fully recover without any long-term damage. However, people already afflicted with chronic liver disease are more susceptible to serious illness as a result of hepatitis A infection. Since this disease is caused by a virus, it does not respond to antibiotics.

The most common symptoms of hepatitis A include:

  • Nausea, vomiting, diarrhea
  • Low-grade fever and loss of appetite
  • Rash
  • Fatigue
  • Jaundice and dark urine
  • Liver pain

 

Fungi

There are growing rates of people attending swimming pools for recreational, rehabilitative treatment or sport, especially in tropical area. Dermatophytosis, which is the most common fungal cutaneous infection, is a communicable disease mainly transmitted by human sources and swimming pools have high potential to transfer this infection.

Saprophytic fungi and yeast organisms have potential pathogenecity for Candidiasis, Otomycosis, Asthma and allergies (5914).

Although susceptible persons may be infected from different places it should be noted that pool environments contribute to the spread of these agents.

Additional Links

Outbreak of norovirus illness associated with a swimming pool

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2870624/

Pool party poopers: CDC warns of parasitic infection, toxic gas

https://edition.cnn.com/2017/05/19/health/cryptosporidium-chlorine-gas-pool-cdc/index.html

Cryptosporidiosis as threatening health problem: A review

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3793167/

Prevalence of Cryptosporidium spp. and Giardia intestinalis in Swimming Pools, Atlanta, Georgia

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2600305/

Facts About Giardia and Swimming Pools

https://www.cdc.gov/healthywater/pdf/swimming/resources/giardia-factsheet.pdf

Healthy swimming pools

http://www.health.nsw.gov.au/environment/factsheets/Pages/healthy-swimming-pools.aspx

E.coli (Escherichia coli)

https://www.cdc.gov/ecoli/index.html

Shigella infection – including symptoms, treatment and prevention

http://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/health+topics/health+conditions+prevention+and+treatment/infectious+diseases/shigella+infection/shigella+infection+-+including+symptoms+treatment+and+prevention

Norovirus-Health condition directory-Queensland Health

conditions.health.qld.gov.au/HealthCondition/condition/14/217/484/norovirus

10/09/2018

How healthy is the air you’re breathing around the swimming pool?

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Who is at risk?

Whether you are participating in swimming or just poolside providing moral support, the quality of the air around you is just as important for your health as the quality of the water you swim in.

On top of the myriad of exposure symptoms swimmers can suffer following a visit to an indoor pool, long term exposure to poor air quality can also cause hypersensitivities. Even professional swimmers have been hospitalised in the past thanks to severe exposure symptoms.

Does the air around the swimming pool you visit smell strongly of Chlorine?

If you answered ‘yes’ it’s important to know that the odour is not pure Chlorine, but rather a form of Chloramine (waste products combined with Chlorine), a by-product of Chlorine, called Trihalomethanes (THM).  THM are not only dissolved in the water where they can be absorbed through the skin or ingested but are also present in gaseous state that can be inhaled.

Chloramine gas is heavier than air, which means the bulk of the THM settle right where they can cause the most problems for swimmers. The level of THM in the air significantly rises as swimmer activity in the pool increases due to the surface tension of the water being broken, releasing the THM. A research paper by the Institute of Hygiene at the University of Heidelberg concluded that only 1/3 of THM uptake was by the skin while the remainder was via the respiratory pathway. A fact sheet from The Department of Environmental Services also reported short and long term affects to the central nervous system, bladder, kidneys and liver following exposure to THM.

The following video link provides a great explanation on the dangers of Chloramines: Pool Safety – Chloramines

In light of the above, swimmers, onlooking parents, swim instructors, lifeguards and site operators are all exposed to the health risks associated with a swimming pool. There are a couple simple things swimmers can do to help lower the risk of Chloramines forming such as showering before swimming and utilising the restrooms however the solution to removing the health risks lies with the facility owner/s taking action. Most facilities cannot afford losing customers or acquiring a bad reputation just because of air quality issues that can be resolved by using adequate equipment and maintenance techniques.

The expert team at Healthy Swim can certainly help educate your local facility on how to provide a safe and enjoyable environment for you and your family so why not suggest they contact us today – your health will be the ultimate beneficiary.

References:

https://www.ncbi.nlm.nih.gov/pubmed/21816450

https://www.ncbi.nlm.nih.gov/pubmed/15729838

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2974689/

https://www.des.nh.gov/organization/commissioner/pip/factsheets/ard/documents/ard-ehp-13.pdf

https://academic.oup.com/annweh/article/59/8/1074/2196152

https://www.ncbi.nlm.nih.gov/pubmed/15097021

https://www.sciencedirect.com/science/article/pii/S1438463905703230

https://www.swimmingworldmagazine.com/news/indoor-pool-air-quality-addressing-one-of-the-nations-most-underrated-issues/

 

25/05/2018

Welcome to Healthy Swim

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Hello and welcome to , an educational website dedicated to community health and water quality. Whether you’re a parent wanting to enrol your child in swimming lessons, a family looking for a healthy place to visit and cool off, someone who likes swimming at the local pool to keep fit or an owner/operator of a commercial swimming pool, you’ve come to the right place for information.

The team behind Healthy Swim are passionate experts in water quality and believe that everyone has the right to swim in safe, healthy water. We trust our local facilities with our health however unfortunately many commercial swimming pools around the country do not consistently meet the water quality standards set by the Australian Health Department and we want to help!

Our aim with the Healthy Swim website is to assist the general public to locate the healthiest pool in their area as well as assist swimming pool owners/operators to ‘get accredited’ and not just meet, but beat applicable health standards. Concerned members of the public can also anonymously nominate a swimming pool whose water quality they felt was poor. We will not name them on our website, we will simply contact them to ask how we can assist them to achieve the Healthy Swim accreditation and improve their water quality for your health and enjoyment.

Improving community health and safety is our aim therefore we will happily promote swimming pools who have taken the initiative of installing adequate secondary sanitation regardless of whose system they are operating. To achieve Healthy Swim accreditation and join the list of elite facilities on our website, continual water quality evidence must be provided. If you see the Healthy Swim accreditation sign at your local swimming pool, you know your health is in great hands!

Keep an eye out for the Healthy Swim accreditation sign at your local swimming pool.

07/12/2017

Choosing the right swim school/public pool

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Learning to swim is an extremely important skill, especially here in Australia where surf, sea and sand make up a huge part of our lifestyle. When choosing a suitable swim school/public pool most parents look for clean, safe and functional facilities, a good curriculum, staff credentials, class availability and pricing however often fail to consider the importance of water quality when making a decision.

We all have different priorities but I think it’s safe to say that every one of us finds the health of our family at the top of the list. With this in mind, let’s look at some reasons why you should also consider asking about the sanitation system in place and how facility management are active in their duty to meet health standards.

First and foremost, poorly maintained water can be hazardous to your childs health. Even a supportive parent cheering on the sidelines can be adversely affected with respiratory discomfort if adequate ventilation is not provided within indoor facilities. Does your child complain of red itchy eyes or dry skin following a trip to the pool? Do they have a strong ‘chlorine’ smell on their skin/bathers after swimming? This is not something you should ignore or accept as standard practice as it can be completely avoided. Sadly, not all public pools comply with regulated water standards and in a lot of cases just don’t have the adequate equipment to maintain those standards, especially those that have a high volume of bathers.

Primary Water Sanitation

It’s common knowledge that chemicals such as Chlorine are added to pool water to provide swimmers with protection against bacteria etc. The unfortunate nature of swimming pools however is that swimmers are a major source of pollutants (Ammonia from sweat and urine) which react with Chlorine to form chemical by-products known as Chloramines and Cyanogen Chloride (tear gas). Did you know that it is these Chloramines (not Chlorine) that are directly responsible for the distinct Chlorine odour as well as eye, nose, throat and lung irritations. Cyanogen Chloride adversely affects our lungs, central nervous and cardiovascular systems.

Basic primary sanitation systems don’t remove Chloramines/Cyanogen Chloride from the water and are also rendered useless against parasites such as Cryptosporidium and Giardia which have become immune to Chlorine at standard pool operating levels.

Chloramines are dissolved in pool water, however, Chloramine gas (Trihalomethane) can be released into the air when water surface tension is broken resulting in the strong ‘chlorine’ odour in the air. Staff and swimmers who experience long term exposure may develop allergic sensitivities and will react to even low levels of Chloramines which may force them to avoid the water altogether. Showers prior to swimming are encouraged to help lower the amount of Ammonia entering the water and minimise Chloramine build up risk.

Not only is regular maintenance and water balancing important to avoid health issues, adequate ventilation is also critical in maintaining clean air and a healthy swimming environment.

What else is swimming with you?

In addition to Chloramines and Cyanogen Chloride, the following ‘unintentional release’ material is typically swimming with you in a public pool:

.14 grams of faecal matter per bather;

6 million skin cells per bather after 15 minutes;

Minimum 30mls of urine per bather;

1 litre of sweat per bather, per hour; and

Inorganic products such as sunscreen and body lotions/moisturisers.

When you add the urine that is intentionally released you can certainly see how hard sanitation systems have to work to maintain water quality.

So what are your options?

Look for a swim school/public pool that has invested in a suitable ‘secondary’ sanitation system – particularly Ozone. If you are fortunate enough to live near a swim school/public pool that has, here’s a short explanation of why you are lucky!

Ozone

Ozone (O3), also known as ‘activated oxygen’ is composed of three Oxygen atoms and is a naturally occurring oxidiser that protects our planet in the atmosphere. If you drink bottled water, odds are it has been purified by Ozone.

How does it work?

Following injection into the water Ozone will safely oxidise organic material, impurities, Chloramines, Cyanogen Chloride, bacteria and viruses. Ozone will not create an unsafe chemical residual as once it has oxidised pollutants (3500 times faster than Chlorine) it breaks down into simple Oxygen which leaves the water noticeably softer and crystal clear. Ozone is also remarkable in the fact that it will effectively destroy Chlorine resistant parasites such as Cryptosporidium and Giardia which are known to cause severe gastric illness. At the very least, this means that you no longer need to worry about your family being exposed to high levels of Chlorine as when using Ozone, Chlorine levels can be dramatically reduced.

So if you are not 100% happy with the water at your local swim school/public pool, please feel free to let us know by nominating them on our website. We can definitely help them, and your families health will be the ultimate beneficiary.

07/12/2017

Chloramines – the hard truth

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Do you recall fond Summer memories when you get a whiff of Chlorine around a pool? Ever get off an elevator at a hotel and knew straight away that the pool was on that level? We all know that Chlorine is added to pool water as a disinfectant to protect our health but most of us don’t understand that the ‘Chlorine pool smell’ is not due to Chlorine, but to;

Chloramines (Combined Chlorine)

Chloramines are chemical by-products formed when Chlorine reacts with organic substances such as sweat or inorganic substances such as makeup and deodorant and can build up in pool water when improperly treated. These Chloramines come in various chemical forms called Monochloramine, Dichloramine and Trichloramine. Trichloramine, in particular, is considered quite toxic and exists 100mm under the water surface, releasing into the atmosphere as a gas when the surface tension of the water is broken, directly where swimmers are breathing.

Not only are Chloramines poor disinfectants, they irritate mucous membranes and cause exposed swimmers to suffer with stinging red eyes and itchy skin. Respiratory and Asthma problems related to Chloramine exposure are also common amongst regular swimmers.

Cyanogen Chloride (Tear Gas)

Cyanogen Chloride is a chemical by-product formed when urine reacts with Chlorine to form Cyanogen Chloride (CNCL – an unstable chemical structure). Cyanogen Chloride decomposes slowly with heat (heated water) to form Hydrogen Cyanide, Hydrogen Chloride and Nitrogen Oxide fumes. These fumes are highly toxic and corrosive and can be harmful to our lungs, heart, central nervous system and other organs if inhaled. These nitrogen based by-products have a greater tendency to cause cellular damage and Cancer. The Cyanide component is that found in CS gas (tear gas), used for riot control.

Solutions?

To limit the formation of Chloramines/Cyanogen Chloride, swimmers should always use the toilet and shower before entering the water to decrease the amount of contaminants entering the pool. This is particularly an issue for swim schools who have large numbers of infant swimmers that are not toilet trained.

Legally, to protect the health and safety of swimmers, combined Chlorine levels (Chloramines) must not exceed 1ppm in any public swimming pool or spa. If levels rise higher than this, Chloramines must be removed by adding very high amounts (up to 10x normal operating level) of Chlorine or by using Ozone, UV or a combination of the two technologies (Advanced Oxidation Process). When combining Ozone and UV the end result is Hydroxyl Free Radicals, one of the most reactive agents known to chemistry. These reactive species can oxidise virtually any compound found in water, maximising disinfection whilst killing all types of bacteria, fungi, virus and Chlorine resistant parasites such as Cryptosporidium. More importantly, these AOP systems will dramatically lower combined Chlorine levels to keep water well below health regulation limits.

Use your senses/common sense

Facility managers are responsible for maintaining adequate pool chemistry however you can also use your senses/common sense to decide for yourself if the pool is safe to swim in:

Is there a strong Chlorine odour? Does it irritate your sinuses or cause you to cough?

Does the water look clear or cloudy?

Do the pool surfaces feel slimy?

Always avoid getting water in your mouth and don’t swallow if you do!

Always shower before entering the pool to reduce the amount of contaminants that may enter with you.

Encourage kids to take regular bathroom breaks and do not go swimming if you have been ill or have Diarrhoea.

References:

https://www.cdc.gov/niosh/ershdb/emergencyresponsecard_29750039.html

http://www.purdue.edu/newsroom/releases/2014/Q2/swimming-pool-urine-combines-with-chlorine-to-pose-health-risks.html

https://pubs.acs.org/doi/abs/10.1021/es400273w?journalCode=esthag#/doi/abs/10.1021/es400273w?journalCode=esthag

https://www.google.com/amp/s/www.researchgate.net/publication/8153240_Stability_of_Cyanogen_Chloride_in_the_Presence_of_Free_Chlorine_and_Monochloramine/amp#ampshare=https://www.researchgate.net/publication/8153240_Stability_of_Cyanogen_Chloride_in_the_Presence_of_Free_Chlorine_and_Monochloramine

07/12/2017
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