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If someone asked you to move all the water from one swimming pool to another, you would try to use the biggest hose and the most pressure you could find to make the transfer relatively quick and easy. Moving a video file from one computer to another is very similar to moving all that water: there's usually a tremendous amount of data (lots and lots of water) and very little bandwidth (the size of the hose).
As a result of the 1998 outbreak of infection with the chlorine-sensitive pathogen Escherichia coli O157:H7 at a waterpark in Georgia, many public health departments updated their guidelines for disinfecting pools following a fecal accident. Many of these guidelines recommended treating all fecal accidents as if they contained the highly chlorine-resistant parasite Cryptosporidium parvum, generally resulting in hyperchlorination and pool closures of up to a day. To determine whether fecal accidents commonly contained Cryptosporidium, the prevalence of this parasite and the moderately chlorine sensitive parasite Giardia intestinalis was assessed by asking swimming pool operators throughout the United States to collect formed stools from fecal accidents in their pools. This report summarizes the results of this study and provides recommendations for disinfecting pools following fecal accidents.
In August 1988 an increase was noted in the number of cases of cryptosporidiosis identified by the microbiology laboratory at Doncaster Royal Infirmary. By 31 October, 67 cases had been reported. Preliminary investigations implicated the use of one of two swimming pools at a local sports centre and oocysts were identified in the pool water. Inspection of the pool revealed significant plumbing defects which had allowed ingress of sewage from the main sewer into the circulating pool water. Epidemiological investigation confirmed an association between head immersion and illness. The pools were closed when oocysts were identified in the water and extensive cleaning and repair work was undertaken. The pool water was retested for cryptosporidial oocysts and found to be negative before the pool reopened.
Training in cardiopulmonary resuscitation for pool owners and mandatory placement of a barrier around pools, two commonly suggested strategies for prevention of drowning, will depend, in part, on the support of pool owners to be successfully implemented. To measure this support, an equal probability sample of 795 Sacramento County households with pools was surveyed. An 80% response rate was achieved. A large majority (86%) favored voluntary cardiopulmonary resuscitation training, and a plurality (40%) favored required cardiopulmonary resuscitation certification for pool owners. However, 61% opposed a universal barrier requirement, and 49% objected to a barrier requirement for new pools only. Respondents with small children at home were more likely (P = .0001) to support a required barrier. The previous occurrence of a significant immersion event had surprisingly little effect. The results suggest some specific directions for programs to prevent swimming pool drownings.
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SCUBA diving-induced pulmonary edema is a rare syndrome that has been previously reported to occur in cold water. We present a case of SCUBA diving-induced pulmonary edema in a 52-year-old man diving in a warm swimming pool. The pathophysiology of this syndrome is unclear, but it is unrelated to either barotrauma or decompression illness. This patient developed frank pulmonary edema while submerged, which resolved after surfacing. As with other patients who have had this syndrome, he did not have any cardiorespiratory disease. The presentation and pathophysiology of SCUBA diving-induced pulmonary edema are discussed.
When inhaled, chlorine is a highly irritating gas that can damage larger airways as well as distal lung structure. We examined the short-term respiratory effects of acute chlorine inhalation during a swimming pool accident. On October 22, 1998, an emission of chlorine vapours occurred in the chlorinating maintenance procedures room of a recreational center in Rome. A total of 282 subjects (134 children) inhaled hydrogen chloride and sodium hypochlorite. Most people received bronchodilators and cortisone at the emergency room; five children were hospitalised. A telephone follow-up was taken on 260 (92.2%) subjects to obtain information about duration of exposure (less than 3 minutes, 3-5 minutes, more than 5 minutes), intensity of exposure (not at all/a little, a fair amount, a lot), and acute respiratory symptoms. A total of 236 (90.7% of the target) individuals underwent clinical examinations, which took place 15-30 days after the accident. Lung function was measured in 184 people (82 children) after 15-30 days. A multiple linear regression was run to test the association between chlorine exposure and lung function, separately in adults and in children. Acute respiratory symptoms occurred among 66.7% adults and 71.6% children. The incidence rates were highest among those who had chronic respiratory disease and had a longer duration of exposure. In about 30% of the subjects, respiratory symptoms persisted 15-30 days after the accident. Lung function levels were reduced among those who reported high intensity of exposure in comparison to those who reported low exposure, both in children and in adults (forced expiratory volume in one second, FEV1, ml differences: -109 (CI 95%: -310, 93) and -275 (CI 95%: -510, -40). Given high prevalence of potential exposed people, findings from this study should alert public health authority about the possible clinical consequences.
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Chlorine is a potential respiratory hazard in both occupational and household settings. The clinical sequelae of inhalation are variable in severity and timing, and subacute presentation is a concern. We report the case of a 9-year-old girl who developed dyspnea, hypoxemia, and pneumonitis approximately 12 hours after exposure to chlorine released from aerosolized swimming pool purification tablets. Her course was characterized by improvement with supplemental oxygen and bronchodilator therapy. Follow-up pulmonary testing at 4 months after the episode revealed the presence of mild obstructive reactivity of the airways, but she was able to perform normal activities without requiring medications. We discuss the pathophysiology, symptoms, therapy, and long-term follow-up of chlorine inhalation injuries.
The authors describe the case of a highly stressed 36-year-old man who experienced ten or more painful episodes per year of recurrent oral-lingual herpes simplex virus 1, which were only partially responsive to acyclovir therapy for three years. A three-year diary of activities, personal stresses, concurrent infections, local trauma, and other possible psychogenic, somatogenic, and environmental events was used systematically to attempt to pair the stresses with the recurrent herpes episodes. Chlorinated swimming pool water seems to have been the triggering agent of the recurrent herpes simplex virus 1 episodes due to its temporal correlation and the greater than twenty-four-month asymptomatic period after the patient discontinued swimming in chlorinated water, but continued to swim in fresh and salt water, along with his normal pursuit of all other activities and habits.
In the period June 6--July 24, 1977, and outbreak of illness due to adenovirus type 3 (AV3) occurred in residents of a suburban community (Community A), Dekalb County, Georgia. Based on surveys, at least 105 cases occurred. The illness was primarily characterized by sore throat, fever, headache, and anorexia. Conjunctivitis affected only 34 of 105 (32%) of the individuals in two surveys. Frequent use of a private swimming pool was associated with illness in Community A residents. The outbreak coincided with a temporary defect in the pool filtration system which probably prevented maintenance of proper chlorine levels in the pool water, and suggested that the infection was spread by pool water. However, the predominant mode of transmission could not be shown conclusively to be waterborn rather than person-to-person.
The examination of 1950 different water samples showed that 21,5 percent of them were microbiologically not safe and had an high MPN of E. coli, 2,3 percent of these strains belonged to enteropathogenic groups. The percentage depended on the character of water establishment, and was in small water supplies as high as 8 percent, in swimming pools 11 percent. There were identified the following OK groups of EEC: O25:K11, O28:K73, O55:K59, O75:K80, O115, O126:K71, O146, which are well known as causes of acute enteric diseases of children and adults. In case of special epidemiological or other occasions, it would be useful to examine the E. coli strains, isolated from different water samples serologically, in order to identify them as enteropathogenic eventually.
On account of negative reactions encountered in their social environment, as well as unfulfillable aesthetic expectations they themselves hold concerning their physical appearance, persons with facial or other damages to the skin are weakened in their selfworth to a degree that they no longer dare to show their body. Repeated frustrations have entailed a level of sensitization that withdrawal into isolation appears the only course of action possible. In the Hornheide special clinic, an integrated rehabilitation model has been developed and tested, incorporating a special desensitization procedure by exposure to swimming pool situations, which is described in detail in the present article.
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A procedure was developed to study black versus white and horizontal versus vertical pattern visual discriminations in a swimming pool. The effects of central cholinergic muscarinic receptor blockade by atropine sulfate was then evaluated. The drug treatment impaired acquisition but not retention. Behavioral observations showed that the control rats used a number of strategies during the process of problem solving that facilitated acquisition of the discrimination. Through modifications of training procedures, the processes of strategy selection and discrimination learning were dissociated. Cholinergic blockade was found to impair strategy selection but not discrimination learning. The results question the widely held view that cholinergic systems are involved in learning and memory and suggest instead that cholinergic systems are involved in the selection of the movements or strategies that are prerequisite for learning.