12 Steps for Prevention of Recreational Water Illness and Injury

Protecting swimmers from recreational water illnesses (RWIs) is very important. There are many preventative measures you can take without restricting pool access and enjoyment. Pool operators, lifeguards, and swimmers need to be educated about the behavior changes they need to make in order to reduce the spread of RWIs. Here’s a list of 12 Steps for RWI prevention:

Step 1: Lead your staff.
Take the lead, outline your vision, show your commitment to your staff, and put yourself at the forefront of the aquatics field. 

Step 2: Develop partnerships.
Building a communication bridge to your health department and other aquatic facilities is a great way to get information about other outbreaks occurring in your community. 

Step 3: Educate pool staff.
Ensure pool operators and lifeguards have taken part in a standardized training course given by aquatic professionals.  Also make sure your staff knows the critical role of water testing, the importance of dual chlorine and pH control, and how to respond if disinfectant levels are not adequate.

Step 4: Educate swimmers and parents.
Consider implementing a short safety and RWI orientation for parents and their children.

Step 5: Maintain water quality and equipment.
Keep chemical feed equipment and chemicals at optimal levels within state and local government regulations. Make sure your entire staff knows poor pH control can compromise chlorine’s effectiveness as a disinfectant.

Step 6: Evaluate aquatic facility design.
Look at your filtration system, your form of disinfection and your locker rooms. If your kiddie pool filtration system is connected with other pools, fecal contamination can be dispersed from the kiddie pool to the other pools. There are many new technologies that disinfect pool water such as ozone, ultraviolet (UV) irradiation, and mixed oxidants. Make sure locker rooms and restroom facilities are safe and close to where they are needed. 

Step 7: Institute disinfection guidelines.
Even if you’re not required to do so, have a written fecal accident response policy and keep records of all fecal accidents, chlorine and pH level measurements, and any major equipment repairs or changes.

Step 8: Evaluate hygiene facilities.
Ask yourself the following questions: Do you have an adequate number of facilities? Are they safe? Are the facilities close to the pool? Are the facilities well maintained? Would you walk around barefoot in them as your patrons do? Are the diaper-changing facilities usable, safe, and close to hand-washing facilities? Do you have showers with warm water?

Step 9: Develop a bathroom break policy.
Schedule an hourly break for disinfectant testing and bathroom use. Staff should tell swimmers and parents that this break provides optimal timing for bathroom use. 

Step 10: Create a special policy for large groups of young children.
If you allow large groups of children in the pool consider requiring RWI orientation training for the parents and make sure they understand that your pool, just like any school, excludes ill children.

Step 11: Post and distribute health information.
Consider posting a sign near pool entry stating: Don’t swim when you have diarrhea. Don’t swallow the pool water. Shower before entering the pool. Take your children on bathroom breaks often. Change diapers in the bathroom and not at poolside. 

Step 12: Develop an outbreak/emergency response plan. 
Most pool staff already have a risk management plan for injuries and drowning, but many do not have plans for managing a recreational water illness outbreak. Make sure you are prepared.