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 regulated at the provincial or territorial level with respect to design, construction, and operation (search www.canlii.org for most recent regulations). Despite this oversight, 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 or lack of life-saving devices that lead to injuries or drowning;
• Biological hazards due to the presence of pathogenic bacteria, viruses, and protozoa;
• Chemical hazards due to unsafe levels of chlorine or other chemicals routinely used to maintain water quality, or exposure to disinfection-by-products.

Although private, residential, or “backyard” pools have typically been outside the scope of environmental public health practice, the recent rise of the sharing economy means that private pools are becoming accessible to members of the public through platforms such as Airbnb and Swimply. In addition, Canadian children remain much more likely to drown in a private pool than a public pool with a lifeguard present. This demonstrates the need for continued risk communication and perhaps greater regulatory oversight of private pools, as has been attempted through a patchwork of municipal and provincial regulations.

The resources presented below provide information on guidelines and regulation of public pools and splash parks. We also provide some examples on how the provinces and territories are addressing risks from residential pools.

Guidelines, regulation, and best practices for public venues

• Canadian Drowning Prevention Plan 9th Edition (Drowning Prevention Research Centre, 2022)
  This guidance document drawing from recreational water and public health professionals emphasizes the importance of development of consistent regulations for public pools and waterfronts, and specifically fencing/enclosure requirements for private pools across Canada. This edition comes with a separate Resource Guide (French).

• Swimming Health and Safety Legislation(Canadian Red Cross, 2022)
  This webpage provides links to provincial and territorial regulations and guidelines for swimming pools and recreational facilities. The online database canlii.com can also be used to check for most recent legislation.

• Splash pads (US Centers for Disease Control and Prevention, 2022)
  This website provides information and risk communication resources regarding the safe use of splash pads, including a printable fact sheet in English and Spanish.

• Analyzing changes to municipal heat response plans during the COVID-19 pandemic (Jin and Sanders, 2022)
  This peer-reviewed article highlights the important role that outdoor, freely accessible splash pads played during extreme heat events when the COVID-19 pandemic had necessitated closure of other indoor cooling centers.  In a separate assessment of community preparedness for extreme heat events, Christenson et al. (2021) found that 47% of household surveyed visited pools or splash pads to cool off during hot weather.

• Leveraging informatics to improve environmental health practice and innovation: Final project report (Public Health Informatics Institute, Aug 2021)
  This report examines how several American jurisdictions use and share data to facilitate food and recreational water inspections. The report highlights numerous examples and approaches through which public health agencies can shift to data-driven inspection and improve information-sharing with other agencies, operators, and the public.

• The Model Aquatic Health Code (MAHC) (CDC, 2018)
  This webpage provides access to the current edition of the MAHC. The MAHC offers evidence based best practices on the design, construction, operation, and maintenance of swimming pools, hot tubs and other treated recreational water venues. The MAHC also offers extensive training resources and tools for pools and other forms of recreational water, including a free online course for Pool inspection training for environmental health professionals.
   
• Identifying and addressing the public health risks of splash parks (Russell and Eykelbosh, 2017)
  This NCCEH 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.
   
• Public pool safety standards for Canadian swimming pools (The Royal Lifesaving Society Canada, 2013)
  This guidance document focusses on how to avoid injuries and drownings in public pools by offering best practices on matters not covered by municipal or provincial regulations.

• Pool Chlorination and Closure Guidelines (National Collaborating Centre for Environmental Health, 2011)
  This NCCEH field inquiry provides an overview of the literature supporting pool closure guidelines based on a free available chlorine level >10 mg/L.

• 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. This resource is likely to be updated in the near future.

Addressing environmental health risks in private pools

• Backyard swimming pool rentals: Making a splash with some environmental public health risks (Lalonde, 2021)
  This NCCEH guest blog covers the key environmental public health concerns with backyard pool rentals and highlights the efforts of a few jurisdictions to regulate public access to private pools.

• Quebec to force all residential swimming pools to conform to safety standards (CBC News, 2021)
  This media article and the related legislation from the province of Quebec describe some of the most recent measures being taken to reduce the risk of pediatric drownings in pre-2010 private pools. The key component is pool enclosures, which are expected to be in place by 2025.

• Spatial analysis of paediatric swimming pool submersions by housing type (Shenoi et al., 2015)
  This peer-reviewed article disaggregates drowning data from residential pools into housing types, showing a markedly elevated risk of drowning from pools in multi-family complexes (like commercial, or semi-private pools) compared to private pools in single-detached homes.

• Backyard swimming pool safety checklist (Lifesaving Society, 2008)
  This checklist guides non-expert pool operators (homeowners) through the various potential hazards found in and around a backyard pool.

Recent research on recreational water venues

• Performance benchmarking model for sustainability of aquatic centres in cold regions: Development and implementation (Saleem et al., 2021)
  This peer-reviewed article developed a set of performance criteria for benchmarking aquatic centers, aiming for continuous improvement in the realms of 1) water management efficiency; 2) air quality; 3) energy efficiency; 4) health and safety; 5) quality of service and user satisfaction; 6) socioeconomic stability; and 7) operation and maintenance efficiency. The case study is based on five aquatic centers in British Columbia,

• Pathogen performance testing of a natural swimming pool using a cocktail of microbiological surrogates and QMRA-derived management goals (Shoults et al., 2021)
  This peer-reviewed article examines the effectiveness of the biological treatment processes used at Borden Park natural swimming pool, the first public pool operated without chemical disinfectants in North America. Further information on natural swimming pools can be found here.

• Hot weather and risk of drowning in children: Opportunity for prevention (Chauvin et al., 2020)
  This peer-reviewed article demonstrates that childrens’ risk of drowning in Quebec is increased six fold during periods of warm weather (>30°C). This increase was most strongly associated with non-pool water bodies, and was not impacted by new regulations in 2010 to limit unsupervised access to public pools.

• 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 peer-reviewed article 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.

Risk communication

• Health and safe swimming communications toolkit (US Centers for Disease Control and Prevention, 2022)
  This website provides information and materials to craft impactful risk communication campaigns around safe swimming, including suggestions for engagement/outreach, social media posts, and graphics.