Multivariable Risk Assessment of Swimming Pool and Spa Exposures [Poster]

The reported number of Recreational Waterborne Illness (RWI) outbreaks in the U.S. has increased from the initial reporting year in 1978.

From 2005-2006, RWI outbreaks peaked at 78 and 74% of the outbreaks were associated with treated water venues, including swimming pools and spas. The risk of ingesting pathogens during swimming in pool/spa water is influenced by four variables: swimmer behaviors (submerging head, swallowing water, etc.), pool structure (recirculation rate, disinfectant method, etc.), facility operation (chemical balance, maintenance schedule, etc.), and water contamination levels (i.e. pathogen concentrations). A comprehensive assessment that considers and combines these variables will be completed to determine the risk of contracting a waterborne disease from swimming in pool/spa water. Twelve pools and spas in Tucson, Arizona will be evaluated on structure, operation and contaminant levels by testing chemical concentrations (chlorine/bromine, pH, alkalinity and cyanuric acid) at multiple depths, assaying water samples for fecal coliform, Pseudomonas aeruginosa and heterotrophic Bacteria, and recording other relevant data. Swimmer behaviors will also be monitored using video surveillance, and swimmer ingestion rates will be quantified by comparing cyanurate concentrations in urine and pool water. The research will evaluate swimming behaviors that increase the risk of ingesting pathogens, and the influence that pool characteristics have on that risk. Data from the assessment will be modeled to determine the risk of swimming in different exposure scenarios, like lap swimming or diving, with consideration of pool water ingestion, recirculation rates, and chlorine, cyanuric acid, fecal coliform, Pseudomonas aeruginosa and heterotrophic Bacteria concentrations during the exposure period. Results from the research will be available in May, 2012.

What's Hiding in Your Sandwich?

In this presentation, we will look at the history of Hazard Analysis Critical Control Points (HACCP) and its principles, FDA Defect Action Levels and the reasoning behind them, some of the latest technology to find defects and foreign material in food and then we'll see several actual real life examples of food adulteration. We’ll then discuss the types of contamination, the sources and how to prevent contamination and adulteration.

Tox in a Box: a Concise Training on the Health Assessment of Environmental Hazards [Learning Lab]

Have you had to interpret environmental data and make a public health determination? Have you been asked to give advice on how to reduce or eliminated exposure to a hazardous substance or condition?

Have you had to provide input on environmental sampling for an exposure investigation? If so, this 3-hour interactive session been designed for persons needing to learn how to apply exposure evaluation and risk assessment principles and methods to environmental health practice.

Attendees will learn how to evaluate environmental sampling data, discern exposure pathways, determine potential health hazards, and formulate methods to reduce or eliminate exposures. After covering basic hazard identification and exposure evaluation techniques, students will use case-studies of real environmental exposure situations to calculate health risks. The session is divided into four parts:

Part 1 – an overview of risk and public health assessment, including valuable tools of the field

Part 2 – estimating exposures including pathway identification and calculations

Part 3 – evaluating doses for potential responses using available guidelines and establishing guidelines when none are available

Part 4 – tying it all together with case studies

Rapid Evaluation and Improvement of Drinking Water Supplies in Africa

Sub-Saharan Africa presents environmental health professionals with opportunities to make meaningful public health impacts with modest investments of time and resources. UNICEF estimates that 43% of children in sub-Saharan Africa drink unsafe water. As a result, diarrheal illness is one of the leading causes of death and malnutrition for children under the age of five. It is estimated that each child in this region has five episodes of diarrhea per year. More than 800,000 of these children die annually from diarrhea and associated dehydration.

Environmental health professionals can make a significant contribution in Africa by conducting sanitary surveys and evaluating small water systems. Using simple, inexpensive biological testing methods, the safety of drinking water sources and the efficacy of water treatment devices can be evaluated in 48 hours or less. An environmental health professional can then recommend cost-effective, actionable steps to improve drinking water quality and prevent disease.

In some cases recommendations may focus on taking steps to protect the water source from contamination. In other cases, low-technology water treatment methods including the use of UV disinfection, bio-sand filters, ceramic filters, or solar stoves can be employed to significantly improve drinking water quality.

These environmental health skills can be easily taught to African nationals so that there is lasting change in drinking water quality and community health. Importantly, safer water supplies and better community health improve the standard of living, reduce deforestation due to the cutting of wood to build fires to boil water, and promote global sustainability.

Building an Aquatic Health Program of Excellence

In 2011, the Alexandria Health Department (AHD), in recognition of the excellence of their Aquatic Health Program, was honored as the winner of APSP’s Dr. Neil Lowry Memorial Award.

The key components of this highly successful program include:

• ¨ Program assessment
• ¨ Recruitment of excellent program leadership and staff
• ¨ A totally fee-supported program that enabled increased

o Staffing

o Equipment

o Outreach

• ¨ Use of seasonal EH staff positions to reduce the unit cost of pool evaluations (inspections)
• ¨ Frequent evaluations

o Every two weeks for seasonal pools

o Monthly for year-round pools

• ¨ Development of a risk-weighted measure of operational performance of pools and pool management companies (PMCs)

o 2008 - Began sharing data on PMC performance with all stakeholders

o 2010 – Began sharing annual rating data on operational performance of individual pools with pool owners

• ¨ Development of a new Aquatic Health Ordinance with stakeholder input

o Reflected most recent technology and environmental health science

o Required licensing of PMCs

o Enforcement mechanism for PMCs that repeatedly and flagrantly violate ordinance

o Adopted with no local industry opposition in March, 2010

• ¨ Outreach to stakeholders

o Web site information

o E-mails when tickets issued

o End of season deficiency letters

o Web posting of AHD evaluation reports

o Newsletter – published 3x per summer

o Semi-annual town hall-style meetings

o Awards for excellent performance by PMCs

As a result of these improvements:

• ¨ Consistency in the timeliness and quality of evaluations improved greatly

• ¨ Over a two year period:

o Health & safety violations per evaluation were reduced by 71%

o Ticketed violations were reduced by 59%

• ¨ Relations with pool owners and PMCs improved dramatically
• ¨ The best PMCs began using AHD’s data on their performance to market their companies
• ¨ Pool owners began choosing a PMC based on price AND performance, not just price
• ¨ Program became immune from budget cuts because it is self-supporting