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Use the MAHC to Make Swimming Healthy and Safe

staff testing the pool chemicals next to diving platform

Government agencies and the aquatics sector can use the Model Aquatic Health Code (MAHC) to make swimming and other water activities healthier and safer.

The MAHC is a free, science-based resource to improve health and safety in

  • Public swimming pools
  • Pools and hot tubs/spas in hotels, apartment complexes, and neighborhoods
  • Waterparks

The MAHC guidelines address the design, construction, operation, maintenance, policies, and management of public aquatic facilities.

Help keep people healthy and safe by using the MAHC to reduce these health risks

  • 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
    A recent study found that 1 out of 8 (11.8%) public pool inspections and 1 out of 7 (15.1%) 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 over half of samples contained Pseudomonas aeruginosa (59%) and E. coli or feces (58%). Another study found 1 out of 12 (8.1%) pool filter water samples contained the parasites Cryptosporidium, Giardia, or both.

How can the MAHC be used?

The MAHC is a guidance document that government agencies can use to create or update existing pool codes.

It is not a federal law and only becomes law if adopted by a state or locality. This means government agencies can

  • Choose whether to adopt it at all
  • Choose to use all or only certain parts
  • Modify part or all of it to fit their needs
  • Use it as a data source

Aquatics sector leaders don’t have to wait for a government agency to adopt the MAHC. They can implement key MAHC elements now to start improving health and safety at their facilities.

Why is the MAHC important?

Swimming is one of the nation’s most popular sporting and leisure activities. People in the United States make more than 300 million trips a year to pools and other bodies of water. Most people have a safe and healthy time enjoying the water most of the time, but some places we swim in aren’t healthy or safe. Swimming in public pools or other aquatic facilities that aren’t healthy or safe can lead to drowning, injury from pool chemicals, or waterborne illness. Using the MAHC can help make swimming healthier and safer.

What does the MAHC include?

The MAHC includes model code language (code) and scientific explanations (annex). The MAHC addresses

  • Design and construction — such as secondary disinfection systems to kill chlorine-tolerant germs and reduce illness and outbreaks.
  • Operation and maintenance — such as lifeguarding standards to reduce drowning.
  • Policies and management — such as training for pool operators to reduce pool chemical injuries, pool closures, and other issues.
References
  1. CDC. Ten leading causes of injury deaths by age group highlighting unintentional injury deaths, United States – 2016. [PDF – 1 page]
  2. Gilchrist J, Parker EM. Racial/ethnic disparities in fatal unintentional drowning among persons aged ≤29 Years — United States, 1999–2010. MMWR Morb Mortal Wkly Rep. 2014;63(19):421-6.
  3. CDC. Drowning — United States, 2005-2009. MMWR Morb Mortal Wkly Rep. 2012;61(19):344-347.
  4. Spack L, Gedeit R, Splaingard M, Havens PL. Failure of aggressive therapy to alter outcomes in pediatric near-drowning. Pediatr Emerg Care. 1997;13(2):98-102.
  5. Hlavsa MC, Robinson TJ, Collier SA, Beach MJ. Pool chemical–associated health events in public and residential settings — United States, 2003–2012, and Minnesota, 2013. MMWR Morb Mortal Wkly Rep. 2014;63(19):427-30.
  6. CDC. Acute illness and injury from swimming pool disinfectants and other chemicals — United States, 2002-2008. MMWR Morb Mortal Wkly Rep. 2011:60(39):1343-1347.
  7. CDC. Pool chemical–associated health events in public and residential settings — United States, 1983-2007. MMWR Morb Mortal Wkly Rep. 2009;58(18):489-93.
  8. CDC. Microbes in pool filter backwash as evidence of the need for improved swimmer hygiene — Metro-Atlanta, Georgia, 2012. MMWR Morb Mortal Wkly Rep. 2013;62(19):385-88.
  9. Hlavsa MC, Cikesh BL, Roberts VA, Kahler AM, Vigar M, Hilborn ED, Wade TJ, Roellig DM, Murphy JL, Xiao L, Yates KM, Kunz JM, Aurdino MJ, Reddy SC, Fullerton KE, Cooley LA, Beach MJ, Hill VR, Yoder JS. Outbreaks associated with treated recreational water — United States, 2000–2014. MMWR Morb Mortal Wkly Rep. 2018;67:547-51.
  10. Shields J, Gleim ER, Beach MJ. Prevalence of Cryptosporidium spp. and Giardia intestinalis in swimming pools, Atlanta, Georgia. Emerg Infect Dis. 2008;14(6):948-50.
  11. CDC. Hlavsa MC, Gerth TR, Collier SA, Dunbar EL, Rao G, Epperson G, Bramlett B, Ludwig DF, Gomez D, Stansbury MM, Miller F, Warren J, Nichol J, Bowman H, Huynh B, Loewe KM, Vincent B, Tarrier AL, Shay T, Wright R, Brown AC, Kunz JM, Fullerton KE, Cope JR, Beach MJ. Immediate closures and violations identified during routine inspections of public aquatic facilities — Network for Aquatic Facility Inspection Surveillance, Five States, 2013. MMWR Surveill Summ. 2016;65(5):1-26.
  12. U.S. Census Bureau. Statistical Abstract of the United States: 2012. Arts, recreation, and travel: Participation in selected sports activities 2009. [XLS – 39.5 KB] 2012.
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