Transcript for CDC Telebriefing: Serious violations lead to closures of U.S. public pools & other aquatic venues

OPERATOR Welcome.  Thank you all for standing by.  At this time all lines are on a listen only mode.  At that time you will be allowed one question and one follow up question. I would like to inform all parties today’s conference is being recorded.  If you object to that, you may hang up at this time.  I will hand this over to the Senior Public Affairs Director.  You may begin.

TOM SKINNER: Thank you, Sydney.  Thank you all for joining us today for this telebriefing.  My name is Tom Skinner, Senior Public Affairs Officer at CDC.  Thank you joining us today for the release of the immediate closures and violations of public pools and other aquatic venues in five states.  Note that the information delivered here today is embargoed until 1:00 p.m.  Eastern Time today.  We are joined by Dr. Beth Bell, the director of CDC’s National Center for Emerging and Zoonotic Infectious Diseases, and Dr.  Michael Beach, the Associate Director for healthy water at CDC.  Both will provide opening remarks and then we will get to your questions.  I’ll turn the call over to Dr.  Bell.

BETH BELL: Good afternoon.  Thank you so much for joining us today to discuss a new report on health and safety violations at public pools, hot tubs, and water playgrounds.  This is a timely report as Monday, May 23rd marks the beginning of the 12nd annual healthy and safe swimming week.  As Memorial Day approaches and many of us are looking forward to spending time with our families and friends at the pool, it’s important to remember how to keep ourselves and our loved ones healthy and safe.  About 4,000 people die from drowning each year.  Drowning is the leading cause of injury to children 1–4 years old.  More than half of fatal drownings in this age group occur in a pool.

Additionally, almost 350 disease outbreaks linked to pools and other aquatic venues were reported to CDC during 2003–2012, and one outbreak can affect hundreds of people.  Proper operation and maintenance of public pools and other aquatic venues is critical to preventing injury and illness.  CDC looked at data on public aquatic venue operation and maintenance from almost 85,000 state and local inspections of almost 50,000 venues.  The inspections were done in 2013 in the five states with the highest numbers of public aquatic venues — Arizona, California, Florida, New York and Texas.  The data, which Dr. Beach will describe in more detail shortly, showed that 1 in 8 or 12 percent of the infections resulted in immediate closure due to serious health or safety violations.

Serious violations include not having adequate disinfectant, like chlorine, in the water to stop the spread of germs or not having appropriate safety equipment, such as a rescue ring with rope, to save swimmers who need help.  Over three-quarters of inspections found at least one violation.  We can and need to do better.  No one should get hurt or sick when visiting public pools, hot tubs, water playgrounds, or any other aquatic venue.  Good health and safety practices at aquatic venues include — having adequate disinfectant and pH in the water to prevent outbreaks linked to swimming in pools and other aquatic venues, and having lifeguards or  appropriate safety equipment available to prevent drowning.

Everyone has a role to play in making aquatic venues safer to swim in.  We rely on aquatic professionals to operate and maintain the facilities in a way that protects the health and safety of swimmers and staff.  on environmental health practitioners, or public health inspectors, to enforce health and safety requirements through inspections and through swimmers and parents of young children to take an active role in protecting themselves and their loved ones by checking for inspection results and doing their own inspection before getting into the water.  Parents and caregivers should also keep an eye on children at all times when in or around the pool.  Children can drown in seconds and in silence.  I’ll now turn this over to Dr.  Beach to provide more details on today’s report and steps we can all take to stay healthy and safe at the pool.  Dr. Beach?

MICHAEL BEACH: Thanks, Dr. Bell.  Thanks a lot for being here today as we approach Memorial Day and need to get these messages out to the public.  The results of the inspection data, 1 in 8 pools and hot tubs, 12 percent closed immediately, they’re clearly concerning.  As Dr.  Bell pointed out, we have a long way to go to lower the number of public aquatic venues with serious health and safety violations.  We need to protect the public.  Overall, state and local inspections most often identified safety equipment violations during 1 of 8 or 13 percent of inspections, disinfectant violations, and chlorine levels usually, during 1 of 8 or 12 percent, and pH violations during 1 of 8 or 12 percent.  pH is critical here because it determines how effective the disinfectant is at killing germs.  So you really need to have the disinfectant and pH being maintained.  More specifically, the data showed that more than 1 in 5 or 22 percent of kiddie or wading pool inspections resulted in immediate closure.  As you can imagine, this is especially troubling given that young children who are still learning their toileting skills are more likely to contaminate the water, more likely to swallow the water, both of which can lead to outbreaks of diarrheal illness.

While inspections are an important part of making sure that these aquatic facilities are clean and safe for swimming, almost one-third of local health departments do not regulate, inspect, or license public aquatic venues.  In those situations, it is generally up to the aquatic staff to properly operate and maintain these venues.  And inspections are usually conducted in locations only about one to three times per year, means the health and safety conditions can vary considerably between inspection dates.  So we really need a partnership to be built here.  Therefore, we really want to encourage swimmers and parents of young children to take an active role in protecting everyone’s health and safety in and around the water.

Check for the results of state or local public aquatic venue inspections online or onsite before getting in the water.  The results might be found on the health department’s website, but it varies state to state.  Ask your state, ask your pool operator what the results were.  We also recommend swimmers and parents of young children complete their own quick but effective four-step checklist before getting into the public or really a private pool.  Use test strips, available at most superstores or pool-supply stores, to check whether the pH and free chlorine or bromine levels in the water are correct.  Don’t forget to follow the manufacturer’s directions.  You’re essentially taking a strip, dipping it in the water and reading a color.  Make sure the drain at the bottom of the deep end of the pool is visible.  This means the water is clear enough for lifeguards and others to see swimmers underwater who may need help.  If you can’t see the main drain, the pool shouldn’t be open.  Check that the drain covers appear to be secured and in good repair.  Swimmers can get trapped underwater by a loose or broken drain cover. Finally, confirm that a lifeguard is on duty where required.  If not, make sure safety equipment, like a rescue ring or pole is available so you can help save lives.  Whether there is a lifeguard or not, parents should always keep an eye on their children, they’re a key asset to safety.  If you find any problems, don’t get in the water.  Tell the person in charge so the problems can be fixed.

With the summer swim season on its way, Memorial Day on its way, we hope we’ve given you some helpful tips to help keep you and loved ones healthy and safe.  Just about everyone knows someone or they do it themselves from a swimming standpoint.  So we need everyone to be a part of this.  Public health and aquatic staff should work together to make sure aquatic venues are safe for people to swim in.  And they all need to be partnering with the general public to get these messages out.  Every family can check for inspection results and do their own quick but effective inspection to help protect themselves and their loved ones this summer and year round.  It’s going to be another great swim season.  We want to make it healthy and safe.  Thanks.

TOM SKINNER: Thank you doctors Bell and Beach.  Sydney, I believe we’re ready for any questions that reporters may have.

OPERATOR: At this time if you do have any questions press star 1, say your first and last name and your affiliation.  Star 1, record your first and last name and affiliation.  It will take just a moment for questions to queue.  Please stand by.  Our first question will come from David Beasley from Reuters.

DAVID BEASLEY: Is this the first of its kind study?  Seems to be based on what I was reading?  With these stats from county health departments, et cetera?

MICHAEL BEACH: That’s correct.  This is Michael Beach.  That’s correct. We have done this and other groups have done this in a one-time deal to look at results, but this really is the launch of a national sentinel tracking system for these inspections where we’re working with the state and the local counties hand in hand to bring these results into a kind of a comprehensive picture of what we think is going on.

DAVID BEASLEY:  I also noticed there were 3,000 to 5,000 emergency room visits annually, nationally for things like skin and eye damage from pools and from breathing in fumes, that kind of thing?

MICHAEL BEACH:  Correct. So, again, it’s not part of this study, but we have those other data.  But those are really about issues with people coming to emergency rooms and as you said, it could be opening a bucket can and getting the chemical in your eyes, all sorts of pool chemical associated injuries that show up.  Really illustrating how we got to be extremely vigilant to reduce the injuries that are occurring here.  That actually goes not just for the public settings that we’re talking about but for the residential setting.  If you’re putting pool chemicals in your pool, you don’t take your toddler with you while you’re doing it.  This really led to some of the injuries we’ve seen.

TOM SKINNER: Next question, Sydney?

OPERATOR: Next question will come from LeighAnn Winnick of CBS News.  Your line is open. Please check your mute button or pick up your handset.

LEIGHANN WINNICK:: Hello.  Thank you.  There’s some fresh water and public pools, could the heavy rains in the south pose a problem for those facilities?  Also, are you expecting any uptick in any bug or virus this year?

MICHAEL BEACH: Sorry, you can repeat the last part?  Are we expecting something new?

LEIGHANN WINNICK:  Any uptick in any certain type of bug or virus in the water this year?  Anything in particular that might be going around in places where swimming season has started?

MICHAEL BEACH: Certainly not at this point in time.  But diarrheal diseases are present in a large part of the population and unfortunately pools are one of the places we spread those amongst us.  Nothing that we can see that is unusual here.  Fresh water pools, again, kind of fall outside the scope of this particular surveillance system.

LEIGHANN WINNICK: Okay.

MICHAEL BEACH:  We want to be very careful about what those are.  These are all chlorinated pools, just to correct that.

LEIGHANN WINNICK: Okay. Thank you.

MICHAEL BEACH:  Or brominated.  But they are all essentially disinfected pools.

OPERATOR: As a reminder, star 1 to ask a question.  The next question is from Dennis Thompson of Health Day.

DENNIS THOMPSON: Thanks for taking our questions.  I think you addressed this slightly already, if you could go into a bit more detail, what are the main contaminants that are needing to be sanitized in this water?  Where are they coming from?

MICHAEL BEACH:  Right.  I can start with where they come from.  This is called diarrheal incidents, where somebody ill with diarrhea has a release in the pool, it’s a common occurrence to swallow pool water while swimming.  So it’s a pretty simple way of spreading illness here.  That’s generally what we see, basically kind of two tiers of infections.  One is from the parasite, cryptosporidium, which is resistant to chlorine.  It kind of evades that main barrier we have in pools.  That accounts for three quarters of the outbreaks that we see every year.  We certainly have guidance for how we need to improve operation construction and disinfection to combat that particular parasite.

The other quarter of outbreaks that we see are traditional ones such as Shigella, Campylobacter, E. coli, that are quite chlorine sensitive.  That indicates to us that that is about very poor pool operation.  Generally the sorts of things we’re looking for in these inspections.  You don’t have chlorine, the pH is way off.  Those sorts of things where you can now spread a germ that should be taken care of by good pool operation.  That 25 percent of outbreaks indicates, again as this surveillance summary does, that we need to do a better job here.  That’s the — those types of outbreaks, the Campylobacter, Shigella, E. coli, those should not occur in a pool that’s operated properly.  We know that’s pointing out we have a ways to go from a training and operations standpoint.  Cryptosporidium is another issue, where in CDC’s voluntary guidance put out to the states last year, the Model Aquatic Health Code, we speak to implementing secondary disinfection and other methods that will combat cryptosporidium in America’s pools. This is something that has changed the paradigm of traditional pool operation where we rely on filters and chlorine to do everything.  Now we know we have to do more to combat this particular parasite.  Does that answer your question?

DENNIS THOMPSON:  Yes, it does.  Thank you.

TOM SKINNER: If there are no other questions, do you want to remind the callers one more time how to queue a question, if we do not get more questions, we’ll conclude the call.

OPERATOR If you do have a question, again, it is star 1.  Please record your first and last name as well as your affiliation at the prompt.  That is star 1, if you do have a question.  Please stand by.  Our next question will come from David Beasley of Reuters.  Your line is open.

DAVID BEASLEY: Thank you.  Could you talk about — were you surprised by these numbers?  Particularly nearly 80 percent, the pools and hot tubs and in these five states had at least one violation?  Was that — you were expecting it to be that high?

MICHAEL BEACH:   Glad you got back in the queue there.  It’s a good question.  Unfortunately we are not surprised. What we have seen in previous publications is similar results where we need to move forward.  Again, I think this is a multi-component system that we have to work on here.  But certainly training and education and new standards to put out there as far as how to combat cryptosporidium and other things that I’ve mentioned are really needed to be combated.  Eight years ago we started working with state and local partners and the industry asked us to develop on a national level the Model Aquatic Health Code which was released last year.  Sorry, in 2014.  We needed to work together to think about what the future was bringing, what is the data we were bringing to CDC and how could we put together a national package with those partners to address these issues.  We think this will take time and commitment from all parties.  But i think we’re moving forward on that as we go that many of these issues, newer issues and emerging issues will be addressed as state and local health departments start to think about taking some of this guidance and putting it into their own regulation.

DAVID BEASLEY:  Thank you.

TOM SKINNER: Sydney, do we have any more questions?

OPERATOR: We don’t have any more questions in queue at this time.

TOM SKINNER: We’ll conclude the call, I want to thank bell and beach for joining us today as well as all the reporters who dialed in.  A transcript of this call will be made available through the CDC media relations webpage later this afternoon.  Should reporters have follow-up questions, they may call the CDC press office at 404-639-3286 or they may e-mail media@CDC.gov.  Thank you once again for joining us.  This concludes our call.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES