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5 ‘tough talks’ with parents about preventing recreational water outbreaks

Issue: July 2016

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While adequate pool maintenance and disinfection measures are key to infectious disease prevention, individual swimmer behaviors and habits also play a critical part in fostering recreational water outbreaks. By outlining and emphasizing healthy swimming behaviors to parents at well-child visits this summer, pediatricians have an opportunity to reduce the risk of waterborne outbreaks both among their own patients and their larger communities.

1. Diarrhea-related illnesses from pools are typically introduced by infected swimmers accidentally shedding fecal matter into the water. Children, especially those in diapers, should shower before entering the pool and parents should focus on washing the perirectal area and under the buttocks to reduce the risk of diarrheal outbreaks.
2. Even asymptomatic swimmers can contribute to the spread of infectious diseases in pools; emphasize to the parents of your patients that they should wait at least a week after the resolution of symptoms before allowing their children to go swimming again.
3. While chlorine-tolerant Cryptosporidium is responsible for an estimated 75% of swimming pool outbreaks annually, the remaining outbreaks are usually caused by chlorine-susceptible pathogens, including Shigella, Campylobacter and E. coli, which indicate very poor pool management. Parents are advised to check the disinfectant level and the pH using testing strips before allowing their children to swim.
4. Healthier hygienic behaviors on the part of the parents at poolside can also significantly help in preventing the spread of infectious diseases in pools. When changing the diaper of a young child, parents should do it in the bathroom, or in a designated changing area, rather than at poolside as infectious organisms may still leak and contaminate the pool.
5. Pediatricians must remind parents to tell their children not to swallow the pool water. Even in pools with adequate disinfectant levels, the chemicals do not affect infectious organisms immediately, and can be readily swallowed before they are eradicated. Additionally, ingesting too much pool water can lead to chlorine poisoning.