At a glance
Preventing swimming-related illnesses and injury at public pools, hot tubs, and splash pads requires participation from pool staff, swimmers, and health departments. Poor maintenance can result in low disinfectant levels that can allow the spread of a variety of germs that cause diarrhea as well as skin and respiratory illnesses. In addition to following all applicable local, state, tribal, or territorial pool codes, operators can also consult CDC's Model Aquatic Health Code (MAHC).
Operating and managing public pools
Although pool staff alone cannot completely prevent swimming-related illnesses, they play a key role keeping pool users healthy.
Follow the steps below to help protect pool users from germs
- Obtain state or local authority-recommended operator and chemical handling training.
- Ensure availability of trained operation staff during the weekends when pools are used most.
- Maintain free chlorine levels continuously between 1–3 parts per million.
- Maintain the pH level of the water at 7.0–7.8.
- Test pH and disinfectant levels at least twice per day (hourly when in heavy use).
- Maintain accurate records of disinfectant/pH measurements and maintenance activities.
- Maintain filtration and recirculation systems according to manufacturer recommendations.
- Ensure cleanliness and safety of restrooms, showers, and diaper changing areas.
- Enforce bather load limits.
- Scrub pool surfaces to remove any slime layer.
- Drain and replace portions of the water on a weekly to monthly basis, depending on usage and water quality.
- Treat the pool with a biocidal shock treatment on a daily to weekly basis, depending on water quality and frequency of water replacement.
- Institute a preventive maintenance program to replace equipment or parts before they fail (e.g., feed pump tubing, injectors, sensor probes).
- Provide disinfection guidelines for fecal accidents and body fluid spills.
- Develop employee policies for staff who are ill with diarrhea and a communication chain for reporting operation problems.
- Implement bathroom break policies for swimmers.
- Educate pool users and parents about swimming-related illnesses and prevention measures (i.e., don't swim when sick with diarrhea, don't swallow the water, etc. ).
Operating and managing public hot tubs
Low water volumes combined with high temperatures and heavy bather loads make public hot tub operation challenging. The result can be low disinfectant levels that allow the growth and spread of a variety of germs (e.g., Pseudomonas and Legionella) that can cause skin and respiratory illnesses. Operators that focus on hot tub maintenance and operation to ensure continuous water quality are the first line of defense in preventing the spread of swimming-related illnesses.
Follow the steps below to help protect hot tub users from germs
General maintenance measures
- Obtain state or local authority-recommended operator and chemical handling training.
- Ensure availability of trained operation staff during weekends when hot tubs are used most.
- Maintain free chlorine (3-10 parts per million or ppm) or bromine (4-8 ppm) levels continuously.
- Maintain the pH level of the water at 7.0-7.8.
- Test pH and disinfectant levels at least twice per day (hourly when in heavy use).
- Maintain accurate records of disinfectant/pH measurements and maintenance activities.
- Maintain filtration and recirculation systems according to manufacturer recommendations.
- Inspect accessible recirculation system components for a slime layer and clean as needed.
- Scrub hot tub surfaces to remove any slime layer
- Enforce bather load limits
- Drain and replace all or portions of the water on a weekly to monthly basis, depending on usage and water quality. Depending on filter type, clean filter or replace filter media before refilling the hot tub.
- Treat the hot tub with a biocidal shock treatment on a daily to weekly basis, depending on water quality and frequency of water replacement.
- Institute a preventive maintenance program to replace equipment or parts before they fail (e.g., feed pump tubing, sensor probes).
- Provide disinfection guidelines for fecal accidents and body fluid spills.
- Develop a clear communication chain for reporting operation problems.
- Cover hot tubs, if possible, to minimize loss of disinfectant and reduce the levels of environmental contamination (e.g., debris and dirt).
- Educate hot tub users about appropriate hot tub use.
Safety measures
- Prevent the water temperature from exceeding 104°F (40°C).
- Exclude children less than five years old from using hot tubs.
- Maintain a locked safety cover for the hot tub when possible.
- Recommend that all pregnant women consult a physician before hot tub use, particularly in the first trimester.
- Prevent entrapment injuries with appropriate drain design and configuration.
Operating and managing splash pads
CDC's Model Aquatic Health Code (MAHC) has the following guidance for splash pad operation and management to help prevent the spread of germs, including Naegleria fowleri, in water.
Follow the steps below to help protect splash pad users from germs
- Maintain adequate disinfectant level in the water:
- Minimum free available chlorine of 1.0 ppm (mg/L), if not using cyanuric acid (such as stand-alone cyanuric acid or stabilized chlorine, commonly known as "dichlor" or "trichlor")
- Minimum free available chlorine of 2.0 ppm, if using cyanuric acid
- Minimum total bromine of 3.0 ppm
- Minimum free available chlorine of 1.0 ppm (mg/L), if not using cyanuric acid (such as stand-alone cyanuric acid or stabilized chlorine, commonly known as "dichlor" or "trichlor")
- Maintain pH 7.0–7.8.
- Conduct daily inspection before opening to the public:
- Ensure disinfection, secondary disinfection (such as UV and ozone), and recirculation systems and filters are operating.
- Inspect for and remove biofilm on splash pad surfaces (such as the tank, spray nozzles, and drains) as required.
- Ensure disinfection, secondary disinfection (such as UV and ozone), and recirculation systems and filters are operating.
- Test free available chlorine or total bromine and pH before opening to the public each day and maintain adequate disinfectant level.
- Test free available chlorine or total bromine and pH every 2–4 hours while open to the public and maintain adequate disinfectant level.
- Maintain water turnover times at 30 minutes or less.
- Ensure drains prevent standing water from collecting in the water play area.
- Inspect tank regularly.
- Clean tank, as needed.
- Clean tank, as needed.
- Document operation and management activities such as water testing results, response to testing results, and equipment maintenance (such as tank cleaning) and repairs.
- Ensure all staff who handle pool chemicals (such as chlorine, bromine, and acid) are trained in pool chemical safety.
- Test the backflow preventers regularly to ensure they prevent backflow, or back siphonage, into the water distribution system serving the splash pad.
Naegleria fowleri infections—primary amebic meningoencephalitis (PAM)—linked to splashed water
Recommendations for regulating splash pads
Environmental health programs can consult CDC's MAHC to propose updates to their jurisdiction's code to ensure the design, construction, operation, and management issues of splash pads are addressed in a way that prevents injury and illness. CDC has the following guidance to help prevent the spread of germs, including Naegleria fowleri* in water:
- Ensure during plan review of splash pads that the
- Water is from a potable water source or other source approved by the authority that has jurisdiction.
- Size, number, and location of the drains prevent standing water from collecting in the water play area.
- Slope prevents surface water from draining into the splash pad system during rain events.
- Water is from a potable water source or other source approved by the authority that has jurisdiction.
- Inspect splash pads regularly to ensure code compliance.
- Educate operators about proper operation and management of splash pads and jurisdiction requirements.