Recreational Water Illnesses (RWIs)

Recreational Water Illnesses (RWIs)

What are Recreational Water Illnesses?

Recreational water illnesses (RWIs) are caused by germs spread by swallowing, breathing in mists or aerosols of, or having contact with contaminated water in swimming pools, hot tubs, water parks, water play areas, interactive fountains, lakes, rivers, or oceans.

Recreational water illnesses (RWIs) can be a wide variety of infections, including gastrointestinal, skin, ear, respiratory, eye, neurologic and wound infections. The most commonly reported RWI is diarrhea.

What are the common RWIs agents?

            The most common illnesses are caused by germs such as Cryptosporidium, Giardia, Shigella, norovirus and E. coli O157:H7.

Where are Recreational Water Illnesses (RWIs) Found?

            Recreational water illnesses (RWIs) are caused by germs spread through contaminated water in swimming pools, water parks, water play areas, hot tubs, decorative water fountains, oceans, lakes, and rivers.

How are Recreational Water Illnesses (RWIs) Spread?

            Swallowing water that has been contaminated with containing germs can cause Recreational water illnesses (RWIs)

Why Doesn't Chlorine Kill RWI Germs?

            Chlorine used in swimming pools and hot tubs kills the germs that cause Recreational water illnesses (RWIs), but the time it takes to kill each germ varies.

Below is a table which shows the time it takes for chlorine to be effective against common Recreational water illnesses (RWIs):

Agent	Disinfectant Times for Fecal Contaminants in Chlorinated Water
E. coli 0157:H7	less than 1 minute
Hepatitis A	approximately 16 minutes
Giardia	approximately 45 minutes
Cryptosporidium	approximately 15,300 minutes (10.6 days)

Notes:

• 1 mg/L (1ppm) free chlorine at pH 7.5 and 25° C (77° F)

Who is most likely to get Ill from a Recreational Water Illness (RWI)?

·        Children

·        Pregnant women

·        People with weakened immune systems (AIDS patients, organ transplants, or people receiving chemotherapy)

Cryptosporidium can cause life-threatening infections in people with weakened immune systems. These high risk individual should consult with their health care provider before they can participate in activities that would place them at a risk for contracting Recreational water illnesses (RWIs).

ILLNESSES:

Cryptosporidium:

            Cryptosporidium is a germ causing agent that causes diarrhea. Cryptosporidium is found in fecal matter of people who are infected by cryptosporidium. The germ has a tough outer shell that allows it to survive for a long time in the environment and also in properly chlorinated pools. The disease caused by infection with the germ cryptosporidium is called cryptosporidiosis. Cryptosporidium is microscopic, so it can’t be seen with the naked eye.

Giardia:

            Gardia is a germ that causes diarrhea. It is also found in the fecal matter of a person who is infected by Giardia. It can survive for up to 45 minutes in properly chlorinated pools. The disease caused by infection with the germ Giardia is called Giardiasis.

Hot Tub Rash (Pseudomonas Aeruginosa):

            Hot tub rash, or dermatitis, is an infection of the skin. Hot tub rash is often caused by infection with the germ Pseudomonas Aeruginosa. Hot tub rash can occur if contaminated water comes in contact with skin for a long period of time.

Legionella:

            Legionella a germ that can cause a type of pneumonia called legionellosis, more commonly known as Legionnaires’ disease. Commonly found in hot tubs and other place with hot water.

MRSA:

            MRSA is a germ that often lives in the nose or on the skin of healthy people. MRSA, short for methicillin-resistant Staphylococcus aureus, is a type of staph germ that is resistant to certain antibiotics. MRSA can be easily transmitted to other people through infected water. 

GENERAL PREVENTION:

According to the CDC the basic Six "Steps" for Protection against Recreational Water Illnesses (RWIs)

Don’t swim when you have diarrhea, this is especially important for kids in diapers.

Don’t swallow the pool water.

Practice good hygiene.

Take your kids on bathroom breaks often.

Change diapers in a bathroom and not at poolside.

Wash your child thoroughly (especially the rear end) with soap and water before swimming.

According to the CDC the basic three “Steps” for all swimmers for protection against Recreational Water Illnesses (RWIs)

Don't swim when you have diarrhea. You can spread germs in the water and make other people sick.

Don't swallow the pool water. Avoid getting water in your mouth.

 Practice good hygiene. Shower with soap before swimming and wash your hands after using the toilet or changing diapers. Germs on your body end up in the water.

12 Steps for RWI Prevention for Pool Staff

·         Lead your staff – Lead by example, make Recreational Water Illnesses (RWIs) an important part of the safety protocol. Make sure there is a strategic plan to counter Recreational Water Illnesses (RWIs).

·         Develop partnerships- Form a coalition with other important health agencies in your area, if there is an outbreak work together and combat the situation.

·         Educate pool staff- Educate the staff on the risks of Recreational Water Illnesses (RWIs) and proper pool maintenance.

·         Educate swimmers and parents- Educate swimmers and parents about Recreational Water Illnesses (RWIs), put up posters and fliers on how to prevent them and what they can do to stop the spread of Recreational Water Illnesses (RWIs).

·         Maintain water quality and equipment- Constantly check up on the water quality and your equipment.

·         Evaluate aquatic facility design- Make sure there aren’t any flaws in the aquatic facility’s design. Small flaws can also lead to the increase of the risk of Recreational Water Illnesses (RWIs).

·         Institute disinfection guidelines- Keep record of all incidents at the pool, including ph level and chlorine levels.

·         Evaluate hygiene facilities- Clean up the facilities properly. Stress the importance of a clean facility to your staff.

·         Develop a bathroom break policy- have some kind of bathroom break policy for little children, use bathroom break time as chlorine check time.

·         Create a special policy for large groups of young children- have a Recreational Water Illnesses (RWIs) awareness session for large groups of children.

·         Post and distribute health information- post information from the local health department or the CDC on information regarding Recreational Water Illnesses (RWIs) and other water borne illnesses.

·         Develop an outbreak/emergency response plan- have an effective plan in case of an emergency. Train your staff in this response plan.

Chlorine:

            People feel like chlorinated water will protect them from all diseases; this is not true as many diseases can survive in chlorinated water for many days. The recommended amount of available free chlorine is 2.0 parts per million in water and the recommended pH level is 7.5. Most bacterial causing Recreational Water Illnesses (RWIs) such as E. coli will die in under a minute under these conditions but some disease causing agents such as Cryptosporidium are highly chlorine resistant and live in recreational water for days. The effectiveness of chlorine is greatly reduced by the presence of feces; hence the water needs to be immediately treated if there is any incident.  

Testing for RWIs:

According to the CDC the following method can be used to test recreational water for Recreational Water Illnesses (RWIs):

Testing the strips at home before visiting the pool can help you learn how to properly use and read them.

In order to test at home, you will need:

• 3 containers
• 13 cups of regular tap water
• 3 drops of liquid chlorine bleach
• Allow tap to run for about 2 minutes

• Fill container 1 with 1 cup of water
• Fill containers 2 and 3 with 6 cups of water each
• Add 1 drop of liquid chlorine bleach to container 2
• Add 2 drops of liquid chlorine bleach to container 3
• Test each container of water utilizing the strips and the manufacturer's instructions
• Read test strips and compare to chart below

Chart for Using Free Chlorine Test Strips at Home
Amounts and Readings	Container 1	Container 2	Container 3
Amount of Tap Water	At least 1 cup	At least 6 cups	At least 6 cups
Amount of Bleach to Add	None	1 drop	2 drops
Amount of Free Chlorine Predicted	0 to <1 ppm	2-3 ppm	4-5 ppm
Your Average Reading

References:

1) http://www.cdc.gov/healthywater/swimming/rwi/

2) http://www.cdc.gov/healthywater/swimming/faq/index.html