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Public Health Column for the Times-News

Don't swallow the water

Published: Wednesday, July 1, 2015

Health Department columnist

Cool, clear, clean and refreshing. H2O in its liquid state entices us to a swimming pool or water park when the day is hot and muggy. Summer would be incomplete without a trip to a favorite lake, river or ocean. And who can ignore the squeals from excited children running in and out of an interactive water fountain located in the center of a hot city block?

Maybe one day I'll join them. What I don't want to interact with are recreational water illnesses, illnesses caused by germs and chemicals found in the water we swim and play in. According to the Centers for Disease Control and Prevention, RWIs are caused when germs are spread by swallowing, breathing in mists or having contact with contaminated water. They can also be caused by chemicals in water or chemicals that evaporate from water and then cause indoor air quality problems.

Think about what the average swimmer brings into a pool: microbes from hair, spit, hands, nose, mouth, skin, skin products, sweat, pee and poop. An adult brings an average of about 0.14 grams of feces on his or her bottom.

A kid brings 10 grams of feces — the weight of four pennies — with 10 trillion microbes. (This is why everyone, both adult and child, is asked to shower before getting in the pool.) Either amount when rinsed off in the pool can contaminate the water everyone is sharing.

A person who swims for 45 minutes in that same water could swallow one tablespoon of water if they're an adult and two and one-half tablespoons if they're a kid. That's enough to make you sick.

Unfortunately RWI outbreaks are on the rise. In fact, over the past two decades, RWI outbreaks associated with swimming have substantially increased. Some germs today are very tolerant to chlorine and were not known to cause human disease until recently. Once these germs get in the pool, it can take anywhere from minutes to days for chlorine to kill them. Swallowing just a little water that contains these germs can make you sick.

The most commonly reported RWI is diarrhea, which is caused by germs such as Crypto (Cryptosporidium), Giardia, Shigella, norovirus and E. coli 0157:H7. Crypto, which can stay alive for days even in a properly disinfected pool, has become the leading cause of swimming pool-related outbreaks of diarrheal illness. RWIs can also include skin, ear, respiratory, eye, neurologic and wound infections.

Children, pregnant women and people with weakened immune systems are most at risk for RWIs. Chlorine certainly helps protect us from germs, but it does not kill all germs instantly. Pool chemicals break down pee, poop, sweat, dirt and other gunk from swimmers' bodies. But this uses up the chemicals, leaving less available to kill germs.

If you're around a pool and think you smell chlorine, think again. You're actually smelling chemicals that form when chlorine mixes with gunk. These chemicals — not chlorine — can make your eyes red and sting, your nose run and make you cough.

Chemicals aren't the only weapon for battling germs in pools. In Henderson County, inspectors from the Department of Public Health work to ensure all public swimming pools in Henderson County operate in accordance to the regulations set by the Department of Environmental Health and Natural Resources.

Frequent inspections are conducted to ensure proper water quality, construction and safety standards are maintained. No pool can be open to the public unless an operations permit is obtained from an inspector.

Pools, however, are not the only recreational water where germs may be found. Even interactive fountains, splash pads and spray parks might make you sick. This water is typically recycled and might contain germs. Not all are chlorinated or filtered, and even with chlorination, not all germs are killed instantly.

Any pee in the water will weaken the germ-killing power of chlorine. When people, especially diaper-aged children, play in the water, they can contaminate the water with fecal matter.

Actually, swim diapers and swim pants might give users, parents and pool staff a false sense of security regarding fecal contamination. Even though they might hold in some solid feces, they are not leak proof. They can delay diarrhea-causing germs from leaking into the water, but they do not keep these germs from contaminating the water.

In larger bodies of water — lakes, rivers and the ocean — water can also be contaminated with germs from sewage spills, animal waste and water runoff following rainfall. Some common germs can also live for long periods of time in salt water.

The best advice is to avoid swimming for a day after heavy rain. Don't swim near storm drains. Stay away from trash and oil slicks in the water, which might indicate that germs have washed into the water.

This information is not pleasant to read, but it is not meant to keep you out of the water. The benefits of water-based activity outweigh the risks of illness and injury. Water is four times thicker than air, which means that a 400-yard swim is equal to a one-mile run. Water-based exercise puts little or no stress on joints and benefits and improves mental health.

Swimming is a great exercise for strength, stamina and technique. What a great way to get in shape. But knowledge about RWIs will help to protect yourself and others whenever you take a dip in the pool or head to the river.

The best steps for protecting everyone from RWIs are hygiene-related: shower before entering the water, stay out of the water if you have diarrhea, take kids on frequent bathroom breaks, change diapers away from the pool and don't swallow the water.

When at your favorite beach, watch for swimming advisories. Both North Carolina and South Carolina monitor coastal recreational waters and notify the public when high numbers of bacteria are found. If an advisory is issued, it means you shouldn't swim in that area.

Just remember that the pool or any body of water you swim in is only as clean as you are. Share the fun, not the germs this summer.


Kimberly Horton is the communications manager at the Henderson County Department of Public Health. She can be reached at khorton@hendersoncountync.org.

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Department of Public Health • 1200 Spartanburg Highway, Suite 100 • Hendersonville, NC 28792 • (828) 692-4223