General Information

Pools Can Be Fun

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Whether you dog paddle or have an elegant butterfly stroke, swimming can be fun and we all know it’s good for you. Also, when your muscles are tight and you’re tense, a nice sit in a hot tub/spa can be very relaxing. Water translates to fun, relaxation, and good exercise for many of us. In fact, did you know that people in the United States swim more than 300 million times in pools and other water bodies each year?

However, in some places, swimming and other water-related activities can lead to injuries and illness, including:

  • Drowning. Drowning is a leading cause of unintentional injury-related death for children ages 1–14 years. Non-fatal drowning can cause brain damage resulting in learning disabilities or even permanent loss of basic functioning.
  • Injuries and emergency department (ED) visits. Injuries linked to pool chemicals accounted for 3,000–5,000 emergency department visits each year. Almost half of the patients are under 18 years of age.
  • Waterborne illness outbreaks. Nearly 500 disease outbreaks linked to pools, hot tubs/spas, and water playgrounds occurred from 2000 to 2014. The leading cause of these outbreaks is Cryptosporidium. This parasite is chlorine tolerant and can cause outbreaks that sicken thousands.
  • Public pool and hot tub/spa closings because of public health hazards. A recent study found that 11.8% (1 out of 8) of public pool and 15.1% (1 out of 7) of public hot tub/spa inspections resulted in immediate closure because of at least one identified violation that represented a serious threat to public health.
  • Evidence of pool water contamination. Sampling of public pool filter water found 59% (95/161) of samples contained Pseudomonas aeruginosa and 58% (93/161) of samples contained E. coli, an indicator of contamination by feces. Another study of pool filter water found 8.1% (13/161) of samples contained Cryptosporidium, Giardia, or both.

The Model Aquatic Health Code (MAHC) is a set of voluntary guidelines published by CDC. This document brings together the latest science and best practices to help state and local government officials save time and resources when they develop and update pool codes. Pool codes are specific rules that designers, builders, and managers of pools, hot tubs/spas, and waterparks must follow to keep the fun going and reduce risk of injuries and illnesses. Pool codes are similar to codes for restaurants to tell them how to keep food safe to eat. Codes are developed or updated by local or state governments and might cover such things as how water quality is tested, how aquatic facilities are built and managed to help ensure swimmers and aquatics staff stay healthy and safe, and how chemicals should be used safely to stop the spread of germs in the water.

Keeping People and Pools Healthy and Safe: the Model Aquatic Health Code (MAHC)

The Model Aquatic Health Code Helps Prevent Injury and Illness

The Model Aquatic Health Code contains guidelines to help prevent injury and illness at public pools, hot tubs/spas, and waterparks. This includes drowning; injuries caused by pool chemical splashes or inhaling fumes; or outbreaks caused by bacteria and other germs that can contaminate the water we swim in. The Model Aquatic Health Code does not apply to pools or hot tubs/spas in people’s homes or backyards. The Model Aquatic Health Code does apply to

  • Pools and hot tubs/spas in hotels, apartment complexes, and neighborhoods
  • Water playgrounds
  • Waterparks

New Guidelines Keep Pools Safe

Why is the Model Aquatic Health Code important? Most health departments and related agencies must develop programs to help ensure swimmers and aquatics staff stay healthy and safe. Previously, agencies had to start from scratch and had to do their own research to develop or update pool codes. This meant that the pool codes also varied a lot from one jurisdiction to another. That is because no overall science-based reference existed, until the Model Aquatic Health Code, which was first released in the summer of 2014. Government agencies can now use this model code to save time and reduce resources used to develop or update existing pool codes to reduce risk for drowning, chemical injuries, and outbreaks.

Partners Come Together To Make the New Code

The Model Aquatic Health Code was created by CDC at the request of health departments, the aquatics sector, academic partners, and others because no overall science or best practices–based guidelines existed at a national level. The Model Aquatic Health Code is a tool for government agencies and the aquatics sector to use in efforts to prevent injury and illness. It is not a federal law and only becomes law if voluntarily adopted by a state or locality. This means government agencies can

  • Choose whether to adopt it
  • Choose to adopt all or only certain parts
  • Modify part or all of it to fit their needs

The Model Aquatic Health Code is intended to save time and resources spent by individual jurisdictions developing and updating codes across the country, while giving agencies the benefit of the latest science and best practices to help keep swimmers and aquatics staff healthy and safe.

Keeping the Code Up To Date

Keeping the code up to date is a very important, ongoing task. That’s why CDC is working with the Council for the Model Aquatic Health Code (CMAHC) to ensure the Model Aquatic Health Code stays current. The CMAHC works with its members from public health, the aquatics sector, academic partners, and the general public from across the country to ensure the latest scientific and technological improvements are addressed by the MAHC. Resulting recommendations to improve the Model Aquatic Health Code are sent to CDC every 3 years to help CDC to update the MAHC.

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Page last reviewed: July 18, 2018