‘The water is recycled’: Splash pads reduce child drowning risk, boost diarrhea outbreaks
Click Here to Manage Email Alerts
Splash pads for children at water parks offer less risk for drowning, but inadequate disinfection and poor toileting/hygiene skills create a hub for gastrointestinal illness outbreaks, noted data in Morbidity and Mortality Weekly Report.
“Splash pads are popping up everywhere,” Michele C. Hlavsa, MPH, an epidemiologist and chief of the CDC Healthy Swimming Program, told Healio. “I suspect that the public doesn’t know that the water is recirculated and recycled. Sitting on jets, drinking water from jets — those are great ways to spread germs or transmit germs that cause diarrhea.”
Hlavsa and CDC colleagues were involved in a case-control study that identified 21 shigellosis cases and six norovirus infection cases that stemmed from a splash pad at a Kansas wildlife park in June 2021.
To identify those affected, the Kansas Department of Health and Environment and the involved wildlife park issued press releases and social media posts encouraging patrons who visited the park between May 28 and June 19, 2021, to complete a questionnaire that included questions on experiencing GI illness. Those who did not experience GI symptoms were considered controls.
Study findings
There were 404 respondents, and data analysis revealed two distinct outbreaks.
Of the 72 respondents who visited the park on June 11, illness experienced by 29% (n = 21; median age, 5 years; age range, 1-15 years; 62% female) was considered to be shigellosis, defined as three or more loose stools experienced within 24 hours with illness onset 12 to 73 hours from the park visit. While splash pad play was not linked to illness, getting splash pad water in the mouth was associated with illness (multivariate complete case adjusted OR = 10.2; multiply imputed aOR = 6.4; P = .036).
Of the 27 respondents who visited the park on June 18, illness experienced by 22% (n = 6; median age, 5 years; age range, 1-38 years; 83% female) was considered to be norovirus infection, defined as vomiting or three or more loose stools within 24 hours with illness onset 12 to 56 hours from the park visit. All six individuals got splash pad water in the mouth, which was associated with illness (multivariate complete case aOR = 24.1; multiply imputed aOR = 28.6; P = .006).
Three of the 21 children ill from shigellosis were hospitalized for an average of 3 days, whereas one child with norovirus was hospitalized for 1 day. No deaths were reported from either outbreak.
Water, equipment disinfection
According to the findings, the young children for which splash pads are intended have inadequate toileting and hygiene skills and are therefore more likely to contaminate the water. Ingesting water contaminated with feces from infected persons transmits the pathogens that cause GI illness.
In some splash pads, water is recirculated, with sprayed water draining into an underground tank. It goes through a filter and is disinfected with a germ-killing chemical, such as chlorine, before being sprayed again. However, these germs are not killed immediately.
According to Hlavsa, while most germs are inactivated and killed within minutes when chlorine is measured at 1 ppm, which is the level recommended by the CDC, others may take 10 to 15 minutes. Cryptosporidium, the leading cause of splash pad outbreaks according to Hlavsa, can survive for 7 days in a well-chlorinated splash pad.
“Chlorine doesn’t kill germs instantly,” Hlavsa said.
Additionally, since splash pads do not typically have standing water, they may be exempt under public health codes since they do not meet a jurisdiction’s definition of a treated recreational water venue, such as a pool. The researchers recommend reconsidering this exemption.
“[Splash pads] represent decreased risk of drowning because you don’t have standing water in the user area,” Hlavsa said, adding that the public then falls under the false assumption that splash pads are safe altogether, which is not the case.
“It’s really about getting that message across: If you have diarrhea, do not go into that splash pad. And in the future, do not drink that water,” Hlavsa said.
Raising awareness
According to the researchers, efforts to prevent GI illness outbreaks at splash pads need to target caregivers. “It’s about educating the public,” Hlavsa said.
Key points to remember include staying out of the water when sick with diarrhea, showering before getting in the water and taking children on bathrooms breaks (or checking diapers) every hour. The CDC also recommends caregivers remind children not to swallow water, not to defecate or urinate in the water and to not stand or sit on spraying jets, which could rinse feces into the water.
Hlavsa said the CDC hopes pediatric health care providers will help communicate this information and recommended visiting cdc.gov/healthyswimming for additional guidance.
“To raise awareness among providers, I think oftentimes when we have diarrhea, we worry about what we ate the day before,” Hlavsa said. “We don’t think about where we went swimming, and with Cryptosporidium, where have we been swimming in the last week.”
Going forward, Hlavsa explained that the CDC will take a multipronged approach to gathering additional data.
“We want to do more research and look at splash pad outbreaks overall — see what common things we find, where we see more opportunities to prevent these outbreaks,” Hlavsa said.
Researchers also will evaluate the CDC’s Model Aquatic Health Code, which provides guidance on how to experience safe and healthy swimming, to see how it can be improved.
“It’s OK to use these places,” Hlavsa said. “We just have to do it in a healthy and safe way.”
References:
- Healthy swimming. https://www.cdc.gov/healthywater/swimming. Updated July 25, 2022. Accessed Aug. 11, 2022.
- Make a healthy splash! https://www.cdc.gov/healthywater/swimming/materials/infographic-make-a-healthy-splash.html. Updated May 4, 2022. Accessed Aug. 11, 2022.
- Splash pads. https://www.cdc.gov/healthywater/swimming/swimmers/water-play-areas-interactive-fountains.html. Updated May 4, 2022. Accessed Aug. 11, 2022.
Perspective
Back to Top
I agree with the basic recommendations shared in the article around children and splash pads. Good and common-sense advice, such as avoiding splash pads if your child has GI symptoms and taking multiple breaks since toddlers don’t have good toilet habits. I would also emphasize that not drinking the water of splash pads is an important recommendation.
I think more research is needed to be able to make general assumptions, as this research was based on one cohort.
Collapse
Read more about
Click Here to Manage Email Alerts