[Legal and management issues of public health requirements for swimming pools in Regione Toscana]

In this paper we describe the laws and rules applying to swimming pools. Authorization activity title for recreational swimming pools is regulated according to articles 80 and 86 of the TULPS R.D.n°773/1931. In Regione Toscana periodic management of the hygienic requirements for swimming pools is regulated by Regional Decree 54R/2015. It requires the evaluation of physical-chemical and microbiological indicators. The law applies to structural and organizational requirements of swimming pools as well as defines responsabilities of managers.

Improving Pool Fencing Legislation in Queensland, Australia: Attitudes and Impact on Child Drowning Fatalities

Four-sided, non-climbable pool fencing is an effective strategy for preventing children from drowning in home swimming pools. In 2009, the Queensland Government introduced legislation to improve the effectiveness of pool fencing. This study explores community attitudes towards the effectiveness of these legislative changes and examines child (<5 years) drowning deaths in pools. Data from the 2011 Queensland Computer-Assisted Telephone Interviewing (CATI) Social Survey include results from questions related to pool ownership and pool fencing legislation. Fatal child drowning cases between 1 January 2005 and 31 December 2015 were sourced from coronial data. Of the 1263 respondents, 26/100 households had a pool. A total of 58% believed tightening legislation would be effective in reducing child drowning deaths. Pool owners were more likely to doubt the effectiveness of legislation (p < 0.001) when compared to non-pool owners. Perceptions of effectiveness did not differ by presence of children under the age of five. There were 46 children who drowned in Queensland home pools (7.8/100,000 pools with children residing in the residence/annum) between 2005 and 2015. While pool owners were less likely to think that tightening the legislation would be effective, the number of children drowning in home swimming pools declined over the study period. Drowning prevention agencies have more work to do to ensure that the most vulnerable (young children in houses with swimming pools) are protected.

[Some considerations on revision of legislation Hygiene-sanitary for the management of swimming pools for swimming-pool use and the National Consultation of the Ministry of Health]

After over a decade the Italian regulation on hygiene and surveillance in swimming pools is under revision based on WHO guidelines and current laws from other European countries. The Ministry of Health is proposing an update of the Annex 1 that contains physical, chemical and microbiological indicators for monitoring swimming pool hygiene. The authors review current regulations and the new proposal for updating surveillance. A comparison of Annex 1 as approved in 2003 and the new version as proposed in 2016 allowed to enlighten innovative improvements. The suggested updates underwent a public consultation through an online questionnaire involving citizens and stakeholders, following the required procedure for accessing the final approval of a new regulation. The updates include new requirements and changes involving several controls and microbiological parameters. Safety of recreational waters is presently under revision in different European countries. This updating process is a valuable opportunity to implement critical control points and improve monitoring. The final aim is an optimization of surveillance in terms of efficacy and costs, with an advantage for both the National Health Service as the swimming pool management.

Board Diving Regulations in Public Swimming Pools and Risk of Injury

Public session access to diving boards is one of the stepping stones for those wishing to develop their skills in the sport of diving. The extent to which certain dive forms are considered risky (forward/backward/rotations) and therefore not permitted is a matter for local pool managers. In Study 1, 20 public pools with diving facilities responded to a U.K. survey concerning their diving regulation policy and related injury incidence in the previous year. More restrictive regulation of dive forms was not associated with a decrease in injuries (rs [42] = -0.20, p = 0.93). In Study 2, diving risk perception and attitudes towards regulation were compared between experienced club divers (N = 22) and nondivers (N = 22). Risk was perceived to be lower for those with experience, and these people favored less regulation. The findings are interpreted in terms of a risk thermostat model, where for complex physical performance activities such as diving, individuals may exercise caution in proportion to their ability and previous experience of success and failure related to the activity. Though intuitively appealing, restrictive regulation of public pool diving may be ineffective in practice because risk is not simplistically associated with dive forms, and divers are able to respond flexibly to risk by exercising caution where appropriate.

Health-Related Behaviors in Swimming Pool Users: Influence of Knowledge of Regulations and Awareness of Health Risks

Background: Swimming pool attendance exposes users to infection and chemical risks that could be largely reduced with the adoption of healthy behaviors. This study aims to investigate if the knowledge of swimming pool regulations and awareness of health risks can be associated with users’ health-related behaviors. Methods: A cross-sectional study was conducted using self-administered questionnaires to collect data from two different target groups of swimming users: 184 adults and 184 children/adolescents. The association between specific variables and patterns of behaviors and knowledge was assessed through multivariate logistic regression models. Results: Although more than 80% of both groups declared they knew the regulations, compliance with healthy behaviors was often unsatisfactory, especially in adolescents and youth. In the children/adolescents group, healthy behaviors significantly increased with the frequency of attendance per week. In both groups, compliance increased with educational level (of parents for children/adolescents), while no positive association was observed between viewing the regulations and adopting appropriate behaviors. In the adult group, a higher knowledge/awareness of health risks was related to decreased odds of at least one unhealthy behavior. Conclusions: Guaranteeing the public display of regulations in swimming facilities is not sufficient to promote and change health-related behaviors. Much more attention should be given to educational interventions aimed to increase knowledge of health risks and the awareness that bathers are directly responsible for their own well-being.

Keeping recreational water facilities safe

(1) Outbreaks of diseases associated with aquatic venues have nearly quadrupled—to more than 40 per year. (2) The Cryptosporidium (Crypto) germ is the leading cause of diarrheal outbreaks related to swimming pools. (3) A national voluntary effort is underway to reduce the number of illnesses and injuries from recreational water facilities.

An overview of pool and spa regulations in Mediterranean countries with a focus on the tourist industry

The Mediterranean area is densely populated and a very popular tourist destination. This study aimed at gathering up-to-date information on current national pool and spa regulations. We formulated and duly distributed to 20 Mediterranean countries a questionnaire divided into two sections: for pool and spa facilities, respectively. The questionnaire was formulated in such a way that a positive answer would imply that the specific topic was addressed effectively. While all 20 countries responded to the swimming-pool-related questionnaire, only 11 of these countries reported the existence of spa-related regulations. When combining the response overall of all countries for pool and spa facilities together, of a grand total of 606 answers, 183 (30.2%) were positive. The positive answers in the pool section of the questionnaire were 29% of the total of 420 answers while positive answers in the spa section of the questionnaire were fewer (27.8% of the total of 176 answers). The countries were grouped by geographical area of the Mediterranean basin where they are situated. Also, the questions were grouped into broad thematic categories. The paper presents conclusions drawn on the basis of the data received according to these geographical and thematic groupings.

Regulations concerning natural swimming ponds in Europe: considerations on public health issues

Natural swimming ponds (NSPs) are a new type of recreational water facility characterized by the substitution of traditional disinfection with biodepuration. While this feature meets esthetic desires of users, specific concerns on public health issues have been raised by the scientific community and local authorities. The absence of a European directive applicable to these environments leaves each country without specific and harmonized indications. The present work describes the local/national policy situation, describing adopted parameters and monitoring activities. All documents underline the need for appropriate microbiological analysis and correct water management.

2013 environmental health legislation

The NEHA Government Affairs program has a long and productive association with the National Conference of State Legislatures (NCSL). The organizations have worked together on any number of legislative and policy areas that directly impact the environmental health profession. One of the keys to the successes of the NEHA/NCSL collaboration has been the recognition of the fact that often some of the most significant legislation and policy initiatives related to environmental public health occur in state legislatures. The states have, in a very real sense, been the innovators in developing new programs and practices. In recognition of this fact, we have asked NCSL to provide occasional overviews of state environmental public health legislative activity, covering topics that are of the most pressing public concern. Doug Farquhar, program director for NCSI's Environmental Health Program, has worked with NCSL since 1990. Mr. Farquhar directs development, management, and research for the Environmental Health Program. These projects encompass consultation and policy analysis of state and federal policies and statutes, regulations, and programs regarding environmental and related topics for state legislatures and administrative programs. Amy Ellis is a law clerk for NCSL within the Environment, Energy, and Transportation Group. As a law clerk she has researched a wide variety of environmental health policies. She is expected to obtain her JD from the University of Colorado Law School in 2015.

[New rules of the bathing water quality management]

Directive 2006/7/EC concerning the management of bathing water quality and repealing directive 76/160/ EEC, adopted in 2006, resulted in changes polish laws and regulations of this topic, which were necessary to comply with the new Directive. These included Water Act and three regulations: on bathing water quality surveillance, on bathing waters register and on bathing water profile. The main changes in the sanitary surveillance on bathing waters quality and their consequences for bathers has been discussed in the article. According to new regulations conducting bathing water quality monitoring was handed over to organizers of bathing sites and local government. Bathing water supervision and water quality assessment is in Polish Sanitary Inspection competence. Unique solution of polish law is division of bathing places into two categories: bathing sites and places used for bathing. In a consequence regulations "create" another category of such objects like places used according to custom for bathing by neighbourhood people, which will be left without any supervision. There is significant threat that new formal aspects combined with organisers burdened with supervision and finance responsibilities, will lead to decrease number of bathing sites in favour of growing number of places used for bathing. This can in consequence diminish bathers health safety.

[Nature-like swimming ponds and bathing: public health issues for congruous guidelines]

Nature-like swimming ponds represent an emerging approach to recreational waters. The substitution of traditional disinfection with biodepuration enhances environmental sustainability, but implies relevant public health issues. No European regulations are available while several countries delivered local guidelines. Appropriate microbiological analysis, user education, and correct water management based on HACCP approach, represent key points for the development of future guidelines.

Prevention of drowning in home pools – lessons from Australia

As an affluent and warm weather country, Australia faced an epidemic of drowning in children under five as the popularity of home pools increased in the late 1960s and early 1970s. In one state child drowning rose by 6.62 per 100,000 in the five years from 1968. Variation across jurisdictions in actions to regulate domestic pools has resulted in Australia representing an unfortunate natural experiment in interventions to prevent child drowning in pools. Mechanisms adopted by various authorities were analysed in detail to identify factors that contributed to success and failure in regulating domestic pools. Despite early identification of the problem and development of what were later demonstrated to be effective interventions, best practice solutions were not established in any jurisdiction until 2002, 25 years after identification of the problem. Key failures in intervention were found to be: failure to act in a timely way, flawed regulation, blockage of timely action and repeal of effective state regulation under political pressure, and blockage of effective standards. Lessons are identified as: inherent weaknesses in the standard setting process, failure of interventions to address major risk categories, failure to act before the hazard grew, failure to consider lesser interventions for tactical reasons, failure to pay attention to advocates, and the need for continuing effort. The paper argues that analysis of the identification of the problem, development of interventions and implementation of mechanisms of prevention illustrate where systemic changes are required and indicate lessons that should be applied in developing and implementing future interventions.

[Hygienic profile of the water in Milan swimming pools: a three-year comparative study]

The aim of this work was to determine whether swimming pool water quality in Milan from 2006 to 2008 was within the standards established by national and local Italian laws (Circolare Min. Sanità 128/71 and DGR 2552/2006). In 2006, 580 samples of water from public swimming pools were analyzed to determine the presence of heterotrophic counts at 37 degrees and total coliforms; pH, free chlorine and chloride of each sample were also measured. In the following years, water from both public and private swimming pools were examined to measure heterotrophic count at 22 degrees and 36 degrees, Escherichia coli, enterococci, Pseudomonas aeruginosa, Staphylococcus aureus, pH, free chlorine, and nitrates. The total number of analyses carried out in 2007 and 2008 was 2074 and 1532, respectively. In 2006, the extent of noncompliance of all swimming pools that was observed for both physical/chemical and microbiological parameters was 72.3%, which then decreased to 53.2% and 36.2% in 2007 and 2008, respectively. In particular with regard to the microbiological analysis, an increase of noncompliance based on at least one parameter was determined (7.1% in 2006 vs. 21.5% in 2007 and 22% in 2008). In contrast, a decrease of the extent of noncompliance based on at least one physical/chemical parameter was observed (from 68.1% in 2006 to 40.4% and 22.3% in 2007 and 2008, respectively). Interestingly, public swimming pools exceeded the legal limits of microbiological concentration more often than the private ones, whereas both types of swimming pools showed a decrease in noncompliance with regard to the physical/chemical parameters.

Centers for Disease Control and Prevention (CDC). Violations identified from routine swimming pool inspections--selected states and counties, United States, 2008

Swimming is the third most popular U.S. sport or exercise activity, with approximately 314 million visits to recreational water venues, including treated venues (e.g., pools), each year. The most frequently reported type of recreational water illness (RWI) outbreak is gastroenteritis, the incidence of which is increasing. During 1997--2006, chlorine- and bromine-susceptible pathogens (e.g., Shigella and norovirus) caused 24 (23%) of 104 treated venue--associated RWI outbreaks of gastroenteritis, indicating lapses in proper operation of pools. Pool inspectors help minimize the risk for RWIs and injuries by enforcing regulations that govern public treated recreational water venues. To assess pool code compliance, CDC analyzed 2008 data from 121,020 routine pool inspections conducted by a convenience sample of 15 state and local agencies. Because pool codes and, therefore, inspection items differed across jurisdictions, reported denominators varied. Of 111,487 inspections, 13,532 (12.1%) resulted in immediate closure because of serious violations (e.g., lack of disinfectant in the water). Of 120,975 inspections, 12,917 (10.7%) identified disinfectant level violations. Although these results likely are not representative of all pools in the United States, they suggest the need for increased public health scrutiny and improved pool operation. The results also demonstrate that pool inspection data can be used as a potential source for surveillance to guide resource allocation and regulatory decision-making. Collecting pool inspection data in a standardized, electronic format can facilitate routine analysis to support efforts to reduce health and safety risks for swimmers.

[Surveillance of the sanitary conditions of a public swimming pool in the city of Palermo (Italy)]

In a previous study we evaluated the microbiological quality of water of seven pools in the city of Palermo through evaluation of bacterial indicators of faecal contamination and of protozoa (Giardia and Cryptosporidium). In this study we also searched for the presence of fungi in two swimming pools of a public swimming facility in the same city. Samples were collected from both pools, their filtration systems and floor surfaces of the facility. Chemical-physical and microbiological examination of water of the two pools have shown that quality of water depends on the concentration of residual free chlorine and on the number of bathers in the pool. The values of four microbiological parameters (bacterial load at 22 degrees C and 36 degrees C, presence of coagulase-negative Staphylococci and Pseudomonas spp.) increased with diminishing chlorine concentrations and with increasing number of pool users. Faecal bacteria, Giardia and Cryptosporidium were not found. On the other hand, various fungi were isolated from floor surfaces and pool water even in the presence of optimal chlorine concentrations. This study confirms the importance of regular maintenance of pool disinfection systems and suggests the need to search for other micro-organisms not included in the current legislation (Giardia, Cryptosporidium and fungi).

[Hygienic risks in swimming pool: knowledge and behaviours of consumers of three structures in Crema, Parma and Naples]

The swimmers health's protection and the maintenance of good safety standards of structures can be guaranteed under observance of rules and the well management of the structures and activities. An anonymous questionnaire, with 38 items, was used in order to analyse and better understand the knowledge and behaviour of the users of three swimming pools in Crema, Naples and Parma. Socio-demographic features were similar in the three centres. One of the most important result was that the necessity of showers and foot-bath before entering the swimming pool is not well understood (77% and 78% respectively); caps and foot bath are, instead, almost always worn (98% and 97%). Knowledge on infection diseases transmitted by water is very poor, warts and mycosis being the best known. Sport structures are places where health and wellness can be affected. It is important to underline the role of behavioural rules as the use of showers, caps, and proper shoes. Authors recognize the swimming pool regulations as a valid tool for health promotion. It must be clear and easily understood and it has to be linked to a proper education pathway of all users and employees.

Backyard swimming pool safety inspections: a comparison of management approaches and compliance levels in three local government areas in NSW

ISSUE ADDRESSED

Since 1992, swimming pool fencing has been a legislative requirement in New South Wales (NSW), yet compliance with the NSW Swimming Pool Act is mixed. Local councils are responsible for the enforcement of the act. However, their approach to enforcement and the management of backyard swimming pool safety inspections is varied.

METHODS

A random sample of backyard swimming pools was inspected in Council A and existing compliance data for pools in two other councils (B and C) were obtained. Pool owners in Council A were surveyed regarding their attitudes to pool fencing and inspections. Semi-structured interviews were conducted with council employees.

RESULTS

Pool compliance rates across the three council areas varied. In Councils A and C, 51% and 54% of pools, respectively, were found to be non-compliant at the first inspection. Following re-inspection in Council A of 227 pools, a further 125 pools reached compliance. In Council B, 97% of the inspected pools were compliant.

CONCLUSIONS

This study provides evidence of poor backyard swimming pool safety compliance where local government inspection activity is minimal or non-existent.

[Applicability of the new law of State and Regional Agreement on management of swimming pools]

The Authors carried out a survey on private and public managers of 80 Italian swimming pools to evaluate the hygienic aspects and safety of the swimming pools. Participants were submitted to a set of questions about the modifications recently brought to the Act on management of the swimming pools during 2003. The study showed a poor knowledge about the hygienic-safety parameters, in particular of chlorine doses, range of temperature and frequency of daily turnover of the swimming pool water. The respect of chemical-physical parameters is necessary not only to assure an adequate microbial control of the water, but also to reduce the production of irritant and potentially toxic substances. The Authors pointed out the need of greater attention to hygienic aspects in order to reduce health risks, deriving from an uncorrected application of the laws, and to provide a greater comfort to the users of swimming pools.

[Hygienic quality of the water of public swimming pools--comments on a current German ordinance draft]

In April 2002, a new draft regarding the quality of the water of public swimming pools in Germany was published. This draft was adapted to the new regulations for drinking water in respect of its structure and regulations. Microbiological tests for assessing the quality of bathing water are given priority. With regard to basic differences in facilities for drinking water and such for bath water and to legal aspects, many data (n = 14,425 data) on the practical experience of public health authorities are presented, obtained during the last few years. With regard to the data and in respect of the great delay between sampling and obtaining the results it is concluded that microbiological methods are inappropriate parameters for rapid assessment of the quality of bath water. Hence it is recommended to implement the evaluation of disinfection by chlorination including pH as an indicator for the quality of a bath water, parallel to the guidelines on technical standards. A high frequency of chlorination testing can markedly reduce the number of microbiological tests. Additionally, microbiological tests of the filtrate before disinfection by chlorination are recommended. This procedure has proved successful in legionella control.

Childhood drowning: barriers surrounding private swimming pools

OBJECTIVE

To investigate the causes of child drowning and determine the need for changes in the legislation as well as improvements to the inspection and enforcement of current legislation related to barriers surrounding private swimming pools.

METHODS

There were 3 stages to the study: a retrospective review of coroner's data, an audit of swimming pool inspections, and in-depth interviews with swimming pool inspectors in Western Australia. The incidence of childhood drowning (per population) and compliance rates of swimming pools (per 1000 swimming pools) to the legislation were measured.

RESULTS

During the 12-year observational period (1988-2000) 50 children younger than 5 years drowned in private swimming pools in Western Australia with an overall incidence of drowning of 4.4 per 100 000 children per year. Sixty-eight percent of drownings occurred in pools that did not have 4-sided fencing with an almost 2-fold increased risk (incidence rate ratio: 1.78; 95% confidence interval: 1.40-1.79) of a child's drowning in a swimming pool with 3-sided versus 4-sided fencing. The compliance rate of swimming pools (compliance to the current legislation) at first inspection was approximately 400 per 1000 swimming pools.

CONCLUSIONS

Almost two thirds of the swimming pools in which children drowned had only 3-sided fencing. With a combination of a change in legislation, enhanced inspection processes, and public education, the incidence of drowning in private swimming pools in Western Australia could be reduced in the coming years.

Effects of pool-fencing ordinances and other factors on childhood drowning in Los Angeles County, 1990-1995

OBJECTIVES

This study estimated the effects of local pool-fencing ordinances and other factors on the rate of childhood drowning in Los Angeles County, California.

METHODS

Stage 1 was a retrospective dynamic cohort study of all drownings among children younger than 10 years that occurred in residential swimming pools in Los Angeles County between 1990 and 1995. Stage 2 was a matched case-control study that compared pools in which childhood drownings occurred (cases) with randomly selected pools in which drownings did not occur (controls).

RESULTS

The drowning rate was relatively high among toddlers (aged 1-4 years), boys, and African Americans and in areas with a high density of residential swimming pools. Pool-fencing ordinances were not associated with a reduced overall rate of childhood drowning.

CONCLUSIONS

Local ordinances enacted in Los Angeles County before 1996 do not appear to have been effective in reducing the rate of childhood drowning in residential pools. Possible reasons for this ineffectiveness are insufficient building codes for isolating pools from homes, inadequate enforcement of the ordinances, and inadequate operation or maintenance of fencing equipment by pool owners.

[Real and irrelevant risks of infection by swimming in recreational bodies of water]

Life-threatening infectious diseases associated with recreational water exposure are possible but occur very rarely. About eighty per cent of all infections due to bathing water produced gastroenteritis, the remaining were spontaneously healing infections of ear, nose and throat as well as eye and respiratory symptoms. They are caused by endogenic and exogenic agents. The risk, i.e. the mean frequency of such commonplace diseases associated with bathing or swimming is already doubled by endogenic infectious agents even without any etiological agents in the recreational water. The additional risk by exogenic infectious agents increases with the concentration of fecal markers. The prescribed limit E coli value of 200 CFU per 100 ml of the EU guidelines for bathing waters corresponds to a risk increased by the factor 7-8. The Bathing Water Committee of the German Federal Environmental Agency issued new recommendations prescribing severely lowered limit values. For example, the Committee called for 100 CFU of E. coli per 100 ml. However, there are economical and legal objections as well as doubts regarding the Committee's scientific competence. The lower limit values are associated with high expenses for communities and bathers without recognizable returns in terms of efficiency. Furthermore, they offend against the legal principle of equality because newly constructed pools are not different from bathing water regulated according to EU guidelines. Finally, the Bathing Water Committee holds scientifically incorrect views on infectious agents and on the risks in recreational waters.

[Comparison of European standards of swimming pool safety]

European countries follow different procedures to monitor the quality of the water of swimming pools open to the public: some use generally accepted technical standards, some officially recommended guidelines, some rules or regulations by local authorities and some have national laws or regulations. These agree insofar as in every country the water of swimming pools must be disinfected. The microbiological limits are to a certain extent identical with drinking water threshold values, e.g., no faecal coliforms must be present in 100 ml. Other microorganisms as for instance legionellae, staphylococci or Pseudomonas aeruginosa ar not uniformly considered. In all countries the water must be disinfected by chlorination. Big differences exist, however, in respect of the maximum admissible concentrations of free or total chlorine, haloforms and organic carbons. With regard to the common goals, harmonization of the regulations appears possible.

Achieving compliance with pool fencing legislation in New Zealand: a survey of regulatory authorities

OBJECTIVES

To identify the status of compliance and enforcement of New Zealand's Fencing of Swimming Pools Act (FOSP Act), 10 years after its introduction, and to identify methods for improving both compliance with the act and the process of enforcement.

METHODS

A postal questionnaire was sent to all 74 authorities in New Zealand in which they were asked questions about their enforcement of the FOSP Act. Semistructured telephone interviews were conducted with 12 authorities to supplement the data obtained in the postal survey.

RESULTS

Based on responses to the survey, it was estimated that there are over 59,000 domestic swimming pools in New Zealand, giving rates of 46 pools/1000 dwellings and 16 pools/1000 persons. The authorities reported that 44% of pools complied with the act, and a further 4% had been granted exemptions. Nineteen per cent of pools were reported to not comply with the act, and the compliance status of a further 33% was not known, or not stated by the authority. Only 9% of authorities had procedures for locating and inspecting pools, while 28% had a programme of reinspection to ensure that pools continued to comply. Pool owner resistance was considered to be the main difficulty with enforcing the act, and nearly half of the authorities believed publicity or education was needed to overcome these barriers. Fifty two per cent of authorities had publicized the act during the 12 months preceding the survey.

CONCLUSIONS

Due to ambiguities within the legislation, and differing levels of commitment by authorities to locate pools and monitor compliance, compliance with the FOSP Act is not consistent nationally. If the act were less ambiguous, there would be greater consistency and more enforcement.

Children's lives or garden aesthetics? A case study in public health advocacy

Following a decade of accumulating clinical reports on child drowning in domestic swimming pools, paediatricians began advocating legislation that would require all pools to be 'isolation' fenced. In 1990, the New South Wales Government introduced and then repeated such legislation following intense lobbying and media advocacy from a group of pool owners. This paper reviews the ways in which isolation fence advocates and opponents framed their public arguments. Five main areas of competing public discourse are identified: why pool drownings occur; the effects of fencing; expert views and community support; the role of the state in prevention; and personalised references to the value systems of those involved in the debate. Two factors seem likely to have contributed most to the overthrow of the legislation: fence opponents inhabiting the same noninterventionist ideological frame of reference as the government; and fence advocates' refusal to compromise on retrospective fencing seems likely to have inspired a commitment in opposition which would have been absent if an incrementalist, prospective fencing policy had been adopted.

[Draft of the swimming pool water regulation. Presentation, status: 17 September 1991, according to the federal hearing of 11 December 1991 in Bonn]

Comments are given on the present status of regulations concerning water in swimming pools and baths--1991--(in connection with the KOK regulations--1972--and the Federal German standard [DIN] No. 19643-1984-). Reference is made to microbiologic limits of Legionella pneumophila among others.

[Update of DIN 19.643--treatment and disinfection of swimming pool and bathing tub water]

German Standards Specification DIN 19,643 is at present under revision for health reasons and because of both negative and positive experiences gathered in practice. To enable adaptation of the standards specification to future developments, a Part I of the specification is being created comprising the demands to be made on the quality of the water and general demands on the construction and operation of swimming pools and tubs and basins in bath houses, e.g. in spas or municipal swimming pools. The subsequent parts of the new specification (Part 2 to Part n) concern the demands to be made on individual combinations of processes; these can be supplemented at any time in accordance with technical progress without requiring revision of the entire standards specification. Essential innovations are the reformulation of the required efficiency of disinfection, the introduction of the parameters Legionella pneumophila, trihalogen methane (THM) and the reduction of the limit value for chloramines. Technically speaking, the new features concern the automatic measurement of the auxiliary parameters of hygiene such as redox potential, pH value and free chlorine, automatic control of disinfectant additions, automatic filter rinsing with fluidization of the filter-bed to a prescribed minimum bed expansion, and the sight-glas at the filter container. The demands made on Jacuzzi and warm water spouted bed besins are integrated into the specification, thus obviating the need for German Standards Specification DIN 19,644.

Childhood drowning and near-drowning in the United States

More than 2000 children drown each year; in some states drowning is considered the leading cause of death for children under the age of 5 years. Many survivors of near-drowning have permanent neurologic disability. There are two distinct high risk groups: children under 5 years of age and boys aged 15 to 19 years. Most drownings in the former group occur in residential pools. Among survivors, the clinical course is bimodal; intact survival and survival with severe permanent disability are the most likely outcomes. The outcome of an immersion event is determined within a few minutes of the onset of immersion, mandating an emphasis on primary prevention. A requirement for pool fencing is the most promising such strategy and could be implemented soon. Training in cardiopulmonary resuscitation and (for older children) alcohol abuse prevention programs may be valuable adjuncts.

Is there a need for state health department sanitary codes for public hydrotherapy and swimming pools?

The Board of Health of the Commonwealth of Virginia has an outdated sanitary code for its public hydrotherapy and swimming pools. The code is restricted to pools in hotels and other lodging places. The absence of modern regulations for public hydrotherapy and swimming pools has permitted serious deficiencies in pool maintenance, which are highlighted in this report. The most notable of these deficiencies was the presence of high levels of bacterial contamination that could predispose to infect in the water of one public hot tub. The results of this study indicate that the Virginia Board of Health sanitary code for pool water must be revised immediately and should include all public hydrotherapy and swimming pools. Other states and communities may want to assess their codes for swimming pools and hydrotherapy tubs to avoid deficiencies that could be detrimental to public health.

Swimming pool owners' opinions of strategies for prevention of drowning

Training in cardiopulmonary resuscitation for pool owners and mandatory placement of a barrier around pools, two commonly suggested strategies for prevention of drowning, will depend, in part, on the support of pool owners to be successfully implemented. To measure this support, an equal probability sample of 795 Sacramento County households with pools was surveyed. An 80% response rate was achieved. A large majority (86%) favored voluntary cardiopulmonary resuscitation training, and a plurality (40%) favored required cardiopulmonary resuscitation certification for pool owners. However, 61% opposed a universal barrier requirement, and 49% objected to a barrier requirement for new pools only. Respondents with small children at home were more likely (P = .0001) to support a required barrier. The previous occurrence of a significant immersion event had surprisingly little effect. The results suggest some specific directions for programs to prevent swimming pool drownings.