Healthy Swimming Year-Round

Stay healthy and avoid recreational water illnesses (RWIs) when you swim or use the hot tub by following some simple steps.

Even though it is frequently associated with summer, swimming is a physical activity many people enjoy all year long. Indoor pools, hot tubs, and even outdoor pools in warm climates are popular year-round.

Swimming is a fun activity for people of all ages and offers numerous health benefits; however, recreational water (water from pools and hot tubs) can also spread germs that cause illnesses known as recreational water illnesses (RWIs). The germs that cause RWIs are spread by swallowing, breathing in the 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. RWIs can also be caused by chemicals in the water or chemicals that evaporate from the water and cause indoor air quality problems. The good news is that there are a few simple steps you can take to help protect yourself and your family from RWIs whenever you swim.

Stay Healthy in the Pool

The best way to prevent RWIs is to take an active role in stopping the spread of germs by following the Triple A's of Healthy Swimming: Awareness, Action, and Advocacy.

1. Awareness

Visit CDC's Healthy Swimming website. Learn how all swimmers can help protect ourselves and others from RWIs and follow the Steps of Healthy Swimming:

• Keep the poop, germs, and pee out of the water.
  • Don't swim when you have diarrhea.
  • Shower with soap before you start swimming.
    • Take a rinse shower before you get back into the water.
  • Take bathroom breaks every 60 minutes.
  • Wash your hands after using the toilet or changing diapers.
• Don't swallow the water you swim in.

Parents of young children should take a few extra steps:

• Take children on bathroom breaks every 60 minutes or check diapers every 30–60 minutes.
  • Change diapers in the bathroom or diaper-changing area and not at poolside where germs can rinse into the water.

**Remember that swim diapers and swim pants, even if required at a pool, are not a replacement for frequent diaper changing and regular trips to the bathroom while swimming. Swim diapers and swim pants are not designed to keep diarrhea (the most serious water contaminant) from leaking into the pool. Parents should never allow their children to enter the water when they are ill with diarrhea, even if they are wearing swim diapers or swim pants.

2. Action

• Check the free chlorine level and pH before getting into the water.
  • Pools: Proper free chlorine level (1–3 mg/L or parts per million [ppm]) and pH (7.2–7.8) maximize germ-killing power.
  • Hot tubs/spas: Proper disinfectant level (chlorine [2–4 parts per million or ppm] or bromine [4–6 ppm] and pH [7.2–7.8]) maximize germ-killing power.
  • Most superstores, hardware stores, and pool-supply stores sell pool test strips.
• Ask the pool operator the following questions:
  • Are the free chlorine and pH levels checked at least 2 times per day and more often when the pool is heavily used?
  • What is the latest pool inspection score?
  • Has he/she completed specialized training in pool operation?

3. Advocacy

• Encourage pool operators to take steps known to kill germs.
  • Add ultraviolet or ozone technology to pool water treatment.
  • Hyperchlorinate regularly; even the toughest germs, like Cryptosporidium (“Crypto” for short), can’t tolerate free chlorine levels at 20 ppm for 12.75 hours.
• Educate other swimmers about RWIs to promote healthy swimming.

Stay Healthy in the Hot Tub

The germs that cause RWIs can also be spread in hot tubs. To stay healthy while soaking in the hot tub, follow these HOT steps!

Heed… rules for safe and healthy use.

• Exclude children less than 5 years of age from using hot tubs.
• If pregnant, consult a healthcare provider before using hot tubs, particularly in the first trimester.

Observe... the hot tub and its surroundings.

• Hot tub temperature should not exceed 104°F (40°C).
• Check hot tub water; CDC recommends maintaining free chlorine at 2–4 parts per million [ppm] or bromine at 4–6 ppm, and pH at 7.2–7.8. Pool and hot tub test strips are available at local home improvement stores, discount retailers, and pool supply stores. If you want to practice using them at home, visit Pool and Hot Tub Test Strips Home Test Instructions.

Talk…to hot tub owners/staff and other hot tub users.

• Are chlorine or bromine and pH levels checked at least 2 times per day?
• Are these levels checked during times when the hot tub is most heavily used?
• Talk to hot tub staff and users about RWIs and share these tips with them.

Helpful Resources

To help spread the message about RWI prevention, CDC's Healthy Swimming Program has developed the following educational materials:

• Healthy swimming brochures available for free in English and Spanish.
• Fact sheets on frequently-asked RWI questions available in English and Spanish.
• Videos that remind swimmers to play it safe and stay out of the water when ill with diarrhea.
• Podcasts on preventing illness and injury while swimming.
• Posters on preventing recreational water illnesses and chemical injuries

For more in-depth information on healthy swimming, go to the Healthy Swimming Web site.

Remember, healthy swimming is no accident. Think Healthy. Swim Healthy. Be Healthy.