Creating the Model Aquatic Health Code (MAHC)

NOTICE: This web page was archived for historical purposes once the MAHC was completed. The content is no longer maintained and might be out of date. For current information about the Model Aquatic Health Code, visit the Model Aquatic Health Code homepage.

The effort to create the MAHC stems from a CDC-sponsored national workshop called “Recreational Water Illness Prevention at Disinfected Swimming Venues” that was convened on February 15-17, 2005, in Atlanta, Georgia. The workshop assembled persons from different disciplines working in state, local, and federal public health agencies, the aquatics industry, and academia to discuss ways to minimize the spread of recreational water illnesses at disinfected swimming venues. The major recommendation from this workshop was that CDC lead a national partnership to create an open-access model guidance document that helps local and state agencies incorporate science-based practices into their swimming pool codes and programs without having to “recreate the wheel” each time they create or revise their pool codes. The attendees also recommended that this effort be all-encompassing so that it covered the spread of illness but also included drowning and injury prevention. Such an effort was intended to increase the evidence base for aquatic facility design, construction, and operation while reducing the time, personnel, and resources needed to create or improve pool codes across the country. Beginning in 2007, CDC worked with public health, industry, and academic representatives from across the United States to create this guidance document called the Model Aquatic Health Code (MAHC). Although, the initial workshop was responding to the significant increases in disease outbreaks at swimming pools, the MAHC is a complete aquatic facility guidance document developed with the goal of reducing the spread of disease and occurrence of drowning and injuries at public disinfected aquatic facilities.

A national consortium of public health officials, aquatics sector experts, and researchers worked for 7 years to create the 2014 MAHC (1st edition). This section includes all MAHC drafts, modules, and public comments and a description of the MAHC organization and development process.

MAHC Drafts and Modules

The MAHC Drafts page includes drafts of each MAHC module, the MAHC “knitted” version, changes made to it that resulted in the 2014 MAHC (1st Edition),and all public comments and responses from two public comment periods.

Process & Organization

The MAHC was initially developed as a set of 14 separate modules through a process involving a Steering Committee that guided the work of 12 Technical Committees that worked on specific areas of the MAHC. The linked Project Outline document describes the original MAHC vision, organization, goals, and objectives developed by the Steering Committee. The MAHC Process Diagram illustrates the sequence of events developed by the Steering Committee as part of the MAHC development process.

This draft MAHC outline or “strawman” provided a framework for discussing the MAHC content and helped the Steering Committee and Technical Committees identify where various parts fit within the overall MAHC. The “strawman” delineated cross-cutting issues requiring collaboration and deliberation by multiple Technical Committees. As with any “strawman,” the numbering format, organization, and structure changed as the MAHC progressed.

The MAHC was initially developed as a set of 14 separate modules. The initial drafts of these 14 MAHC modules were organized in a series of columns that contained a short keyword summary describing the information contained in the corresponding code language. Items deemed most critical to protecting public health were indicated in red font with an asterisk. The columns showed the section number and draft code language, and the far right column had a letter grade based on the perceived reliability and accuracy of the material presented. The grading system was divided into three levels:

  • Grade A: Practice supported by science/research/data
  • Grade B: Widely accepted practice not supported by science/research/data
  • Grade C: No widely accepted practice. Proposed language not yet supported by science/research/data

This format was changed when the modules were combined into a single document, the MAHC “Knitted” version. This MAHC “Knitted” version dropped the column format, the public health-specific red font designation, and the grading system.

The Technical Committees were responsible for the technical content of MAHC modules. As they developed the modules they periodically sent them to the Steering Committee for input to ensure that the content and format was consistent, integrated with the work done by other Technical Committees, and addressed the overall MAHC objectives. This process involved many drafts of the modules before completion. Once a Technical Committee finished a module and the Steering Committee approved it, it was forwarded to the MAHC Editor. The module was then formatted as needed. Additional annex information was added by CDC staff if further clarification was needed on the intent or direction of the MAHC and its associated code language. Following completion of this process, all modules were put through internal CDC clearance. CDC agreed to early and preliminary posting of the individual MAHC modules to maximize the opportunity for feedback on the Steering Committee’s thinking and direction. Upon completion of CDC clearance, each module was posted on the MAHC website, which was part of CDC’s Healthy Swimming website, for the first 60-day public comment period. After receiving almost 3,000 public comments, each comment was reviewed and addressed. The revised modules, as well as the public comments and responses, were then re-posted for public review although they were not open for further public comment. After all modules were revised and reposted, they were merged and duplications and discrepancies removed and fixed, respectively. This MAHC “Knitted” version was then reposted for a second 60-day public comment period, allowing for review of the wording again in the full context of the the entire MAHC. After addressing almost 1,500 additional comments, the MAHC “Knitted” version was revised based on public comment, put through CDC clearance again, and re-posted to the MAHC website as the 2014 MAHC (1st Edition).

The current status of the MAHC is summarized on the The MAHC Current Edition page.

MAHC infographic - decoding the MAHC

Message: Learn about the Model Aquatic Health Code and how it was developed to make swimming and other water activities healthier and safer.
Audience: Designed for state and local health professionals.

PDF: Decoding the Model Aquatic Health Code Cdc-pdf[PDF – 1 page] (Single-page printable version)
PDF: Decoding the Model Aquatic Health Code Cdc-pdf[PDF – 4 pages] (Multi-page printable version)

Page last reviewed: July 20, 2016