Under Pressure

In a scene from the classic movie Caddy Shack, the staff is enjoying a day off in the water. Guests scatter as the wild staff members take over the pool and hilarity ensues.

Then, someone drops a Baby Ruth candy bar into the pool, which now looks like "doo-doo", the immortal word one of the surprised swimmers screams when he comes face to face with it.

Later, the Bill Murray groundskeeper character is shown standing in the deep end of the pool after it has been drained, busily disinfecting the floor and walls of the pool. I needn't tell you the rest, as the best punchline happens at this point. If you don't know what I'm talking about, rent the movie.

The imaginary scenario created in the film actually happens in pool complexes all over the country. Unfortunately, it's the real thing floating in our pools. With the increase of human defecation in our pools, by accident or on purpose, this incident has potentially profound implications for public safety at pools.

Invisible Enemy

The presence of E. coli bacteria in the water, no matter how small, is a clear and present danger to the public. Prompt action is critical to ensure the safety of people using the pool.

The infected pool or pools should be closed immediately. In cases where there are two pools sharing a common filtration system both pools should be closed. The closing of any pool for public health and safety has social, political and financial impacts on the community.

Recreational Water Illness (RWI), as defined by The Center for Disease Control, refers to some very serious infection that can be caused by particular strains of the bacterium Escherichia coli.

Hundreds of these strains of E. coli live within the digestive tracts of humans and animals without any ill effect, and are known as serotypes. The strain that produces a toxin that is harmful to humans is called enterohemorrhagic E. coli (EHEC) or verotoxin positive E. coli. The most commonly isolated EHEC strain is E coli 0157.H7.

Children under the age of five and adults over 65, when infected with the E. coli 0157.H7, are more likely to manifest complications than healthy adults.

The symptoms of EHEC infection usually consist of bloody diarrhea, fever and weakness, or passing small amounts of urine. In extreme cases kidney problems, such as hemolytic uremic syndrome (HUS), can lead to death. The public should always remember that pool water shared by everyone is not drinkable.

The germs associated with RWIs can be controlled by the proper use of chemicals within the pool environment. However chlorine doesn't always work right away. Chlorine in conjunction with proper pH levels can kill most bacteria, viruses and parasites. Germs like Crypto that cause RWIs sometimes live in pools for days. Pool operators must always remember that even the best maintained pools can spread illness.

When someone purposely defecates in a public pool, it is a criminal act that has a tremendous impact on the patrons and the staff. However, this can be very hard to diagnose and prove.

The most common fecal accidents are caused by leaky diapers that have not been properly fitted to the children and allow fecal matter to escape.

Manufacturer claims that these diapers are safe for public pool use are not supported by any governmental agency.

Any diaper that allows water to enter allows fecal matter to exit. Combining a pool diaper with rubber pants that have elastic around the legs and waist is probably the best solution to this problem.

How should your staff treat fecal accidents within your pool's environment? Proper training of your pool staff in handling a fecal accident is crucial to the operation and safety of your pool complex.

Procedures in place should be consistent with your local health department's codes or recommendations. Also, the CDC and EPA have promulgated recommendations for fecal accidents.

Step One -- Treating the Immediate Problem

1. Remove all patrons from the pool immediately and start emergency procedures for fecal accidents or contaminated pool water. This must be a published brochure available to all staff.

2. If the stool is firm, remove it immediately with a net and dispose of it accordingly.

3. Sterilize the net by immersing it into a chlorine solution in a bucket or slop sink and rinsing it thoroughly.

4. If possible, do not use the pool vacuum. Vacuums will sometimes disperse the fecal matter into the water, which can increase the chances of RWIs or contaminate this vacuum. In some cases a vacuum is the only means of removing fecal matter but it is not recommended. If you do use a vacuum the discharge hoses should be placed in an area that does not permit the water to return to the pool. After using a pool vacuum all parts should be soaked in a strong chlorine solution and rinsed well. Also, the filter elements should be soaked in chlorine and the entire system should be flushed with water.

5. In cases of diarrhea or extremely loose stools where extraction is virtually impossible the filtration system is the only solution.

Step Two -- Disinfecting contaminated areas and filtration systems

1. Pools chlorine levels should be maintained between 2 ppm and 3 ppm, and pH level should be kept between 7.2-7.5, throughout entire pool. (Note: 1.5-ppm chlorine level is the recommendation by the EPA for drinking water).

2. Pool chlorine levels should always be maintained in a consistent level regardless of the presence of fecal matter. By maintaining a strong, consistent level of chlorine and pH the pool operator ensures that the risk of RWIs, bacterium, and viruses is minimal

3. The CDC considers diarrhea the most dangerous form of fecal accidents that can happen in a swimming pool complex. The CDC recommends that you bring your chlorine up to 20 ppm for 8 1/2 hours to ensure proper sterilization of your water.

4. Pool filtration systems should be backwashed and cleaned thoroughly after any fecal accident within your complex.

Pool operators throughout the country handle fecal accidents within the guidelines of their state government. What is important is the fact the chlorine levels must be strong enough to prevent RWIs.

In an undercover operation, news media presented Inside Edition investigates bacterial levels and hotel pools; is the water as clean as it looks?, airdate Friday, September 7, 2001.

Inside Edition examined the water in hotels and motel pools in New Jersey and Orlando. Out of the 11 pools tested along the New Jersey shore more than half of them had no chlorine and several of them tested positive for fecal chloroform. As for Orlando, 17 pools and sports complexes were tested and eight had no chlorine at all. You can find this article at www.insideedition.com/investigative/dirty_pools.htm

How can you ensure that you have adequately sterilized your pool complex after a fecal accident involving diarrhea so it is safe for patrons? It is almost impossible to bring a pool level up to 20 ppm since most pH test kits only go up to 10. If a pool's chlorine level were brought up to 20 ppm for 8 1/2 hours, it would take hours or days to bring the level back down to 2 ppm. Although there are chemicals on the market to break down chlorine levels they are sometimes not easy to use.

Once again the pressure to reopen a pool complex on a hot weekend day can be tremendous on the staff and a financial burden on the complex. Education for your staff and the public is the best tool to control and defuse any situation.

Step Three -- Administrative Responsibilities

1. Pool rules and regulations must be clearly visible to all patrons using the facility and enforced by the staff.

2. Administrators must stand behind their pool operators and lifeguards to ensure that safety and health are top priorities.

3. Departments must be committed to preventing RWI within their aquatics complex by training and educating the staff.

4. Publicly announce that anyone purposely defecating in a pool can lead to legal action and will not be tolerated within your complex.

5. Develop a diaper policy for the pool, locker room, and deck areas that enables the changing and disposal of dirty diapers in a sanitary manner.

6. Stress the importance to staff that bathrooms should always be cleaned and disinfected routinely to prevent any fecal matter in the floors from entering the pool.

7. Consult with aquatic safety experts on establishing the regulations for your pools.

Education and training are the two most important tools that pool complexes can use to help ensure that recreational water illness is not a problem within their pool facilities.

Educating the public by signage can help eliminate fecal accidents involving diapers and young swimmers. Unfortunately, RWI can take hours and days before symptoms start. The correlation between swimming and ingesting water that has fecal matter in it and then becoming ill is sometimes overlooked.

Proper pool maintenance and chemical levels can only help prevent RWI but cannot guarantee that it will not occur. Social deviant behavior of purposely defecating in a pool may not be stopped, but it can be deterred through education within the community. Let the public know why you may close on that hot summer day, and ask for their help to keep their pools safe and open.

Jonathan L. Masone has 34 years of experience with public recreation. He is deputy commissioner with the Town of Hempstead, N.Y., Department of Parks and Recreation, which serves 750,000 residents. Masone has administrative responsibilities for 22 pool complexes and three and a half miles of ocean beach facilities. He holds a Bachelor of Science Degree in Recreation and Parks Administration from the University of New Hampshire and is presently working to complete his Masters Degree in Public Administration. He can be reached at jmasone@tohmail.org.