Pools, hot tubs, and other treated recreational water venues

Public swimming pools, hot tubs, splash parks, wading pools, and other treated recreational water facilities are popular recreational water venues, which are regulated at the provincial or territorial level. In most provinces there is legislation specific to these facilities that provide criteria for their design, construction, and ongoing operation (www.canlii.org). Despite having these criteria, public recreational water venues still present some health risks to users that can result in injury, illness, or death if not identified and managed properly. These risks can be the result of:

• Physical hazards e.g., suction hazards resulting from poorly designed recirculation systems or entrapment hazards from floating play equipment (BC MOH, 2014).
• Biological hazards e.g., pathogenic bacteria, viruses, and protozoa.
  • Cryptosporidium, a protozoan parasite, is the most common cause of outbreaks associated with treated recreational water venues (CDC, 2015).
  • Legionella, a bacterium that can cause Legionnaires’ disease or a milder infection called Pontiac disease, can be found in water systems including hot tubs (CDC, 2017).
• Chemical hazards e.g., exposure to unsafe levels of chlorine gas or other chemicals routinely used to maintain water quality (CDC, 2011), or exposure to disinfection-by-products.

The resources presented below provide information on the design, construction, operation and maintenance design of treated recreational water venues. When these aspects are addressed using best practices, the risks to users are reduced.

NCCEH Resources

• Identifying and Addressing the Public Health Risks of Splash Parks (2017)
  This evidence review addresses many public health aspects specific to splash parks, including their contribution to the burden of illness, risk factors, and best practices in their design and operation.
   
• Pool Chlorination and Closure Guidelines (2011)
  These guidelines review the available literature with respect to closing swimming pools and similar venues when the free available chlorine exceeds 10 mg/L.

Selected External Resources

• Swimming Health and Safety Legislation (Canadian Red Cross 2019)
  This webpage provides links to provincial and territorial regulations and guidelines for swimming pools and recreational facilities.

• The Model Aquatic Health Code (MAHC) (CDC, 2016)
  This webpage provides evidence based best practices on the design, construction, operation, and maintenance of swimming pools, hot tubs and other treated recreational water venues, as well as educating users on these practices.

• Guidelines for safe recreational water environments: Volume 2, Swimming pools and similar environments (WHO, 2006)
  These guidelines provide a review of health hazards associated with swimming pools and similar venues, as well as information on monitoring, assessing, and mitigating hazards through design and construction, operation and maintenance, and user education.

Peer-Reviewed Articles

• Legionellosis Associated with Recreational Waters: A systematic review of cases and Outbreaks in Swimming Pools, Spa Pools, and Similar Environments. (Leoni et al. 2018)
  This article presents the results of a systematic review of the literature on cases and outbreaks associated with swimming pools, hot springs, hot tubs, whirlpools and natural spas.

• Occurrence of Cryptosporidium and Giardia and the relationship between protozoa and water quality indicators in swimming pools (Xiao et al., 2017)
  This primary research highlights the difficulty of monitoring Cryptosporidium in pool water because its presence does not correlate well with bacterial indicators.

• The risk of contracting infectious diseases in public swimming pools. A review (Barna and Kadar, 2012)
  This article provides a review of the pathogens that pose a risk of infection in a swimming pool or similar venue.

• Health impact of disinfection by-products in swimming pools (Villanueva and Font-Ribera, 2012)
  This article reviews the epidemiological evidence of the health impacts related to disinfection by products in swimming pools.

This list is not intended to be exhaustive. Omission of a resource does not preclude it from having value.