[Legal and management issues of public health requirements for swimming pools in Regione Toscana]. / Inquadramento giuridico e gestione delle attività svolte al fine del mantenimento dei requisiti igienico-sanitari negli impianti natatori nella Regione Toscana.

In this paper we describe the laws and rules applying to swimming pools. Authorization activity title for recreational swimming pools is regulated according to articles 80 and 86 of the TULPS R.D.n°773/1931. In Regione Toscana periodic management of the hygienic requirements for swimming pools is regulated by Regional Decree 54R/2015. It requires the evaluation of physical-chemical and microbiological indicators. The law applies to structural and organizational requirements of swimming pools as well as defines responsabilities of managers.

[Some considerations on revision of legislation Hygiene-sanitary for the management of swimming pools for swimming-pool use and the National Consultation of the Ministry of Health]. / Alcune considerazioni sulla revisione della normativa igienico-sanitaria per la gestione di piscine ad uso natatorio e la Consultazione Nazionale del Ministero della Salute.

After over a decade the Italian regulation on hygiene and surveillance in swimming pools is under revision based on WHO guidelines and current laws from other European countries. The Ministry of Health is proposing an update of the Annex 1 that contains physical, chemical and microbiological indicators for monitoring swimming pool hygiene. The authors review current regulations and the new proposal for updating surveillance. A comparison of Annex 1 as approved in 2003 and the new version as proposed in 2016 allowed to enlighten innovative improvements. The suggested updates underwent a public consultation through an online questionnaire involving citizens and stakeholders, following the required procedure for accessing the final approval of a new regulation. The updates include new requirements and changes involving several controls and microbiological parameters. Safety of recreational waters is presently under revision in different European countries. This updating process is a valuable opportunity to implement critical control points and improve monitoring. The final aim is an optimization of surveillance in terms of efficacy and costs, with an advantage for both the National Health Service as the swimming pool management.

Board Diving Regulations in Public Swimming Pools and Risk of Injury.

Public session access to diving boards is one of the stepping stones for those wishing to develop their skills in the sport of diving. The extent to which certain dive forms are considered risky (forward/backward/rotations) and therefore not permitted is a matter for local pool managers. In Study 1, 20 public pools with diving facilities responded to a U.K. survey concerning their diving regulation policy and related injury incidence in the previous year. More restrictive regulation of dive forms was not associated with a decrease in injuries (rs [42] = -0.20, p = 0.93). In Study 2, diving risk perception and attitudes towards regulation were compared between experienced club divers (N = 22) and nondivers (N = 22). Risk was perceived to be lower for those with experience, and these people favored less regulation. The findings are interpreted in terms of a risk thermostat model, where for complex physical performance activities such as diving, individuals may exercise caution in proportion to their ability and previous experience of success and failure related to the activity. Though intuitively appealing, restrictive regulation of public pool diving may be ineffective in practice because risk is not simplistically associated with dive forms, and divers are able to respond flexibly to risk by exercising caution where appropriate.

Keeping recreational water facilities safe.

(1) Outbreaks of diseases associated with aquatic venues have nearly quadrupled­to more than 40 per year. (2) The Cryptosporidium (Crypto) germ is the leading cause of diarrheal outbreaks related to swimming pools. (3) A national voluntary effort is underway to reduce the number of illnesses and injuries from recreational water facilities.

An overview of pool and spa regulations in Mediterranean countries with a focus on the tourist industry.

The Mediterranean area is densely populated and a very popular tourist destination. This study aimed at gathering up-to-date information on current national pool and spa regulations. We formulated and duly distributed to 20 Mediterranean countries a questionnaire divided into two sections: for pool and spa facilities, respectively. The questionnaire was formulated in such a way that a positive answer would imply that the specific topic was addressed effectively. While all 20 countries responded to the swimming-pool-related questionnaire, only 11 of these countries reported the existence of spa-related regulations. When combining the response overall of all countries for pool and spa facilities together, of a grand total of 606 answers, 183 (30.2%) were positive. The positive answers in the pool section of the questionnaire were 29% of the total of 420 answers while positive answers in the spa section of the questionnaire were fewer (27.8% of the total of 176 answers). The countries were grouped by geographical area of the Mediterranean basin where they are situated. Also, the questions were grouped into broad thematic categories. The paper presents conclusions drawn on the basis of the data received according to these geographical and thematic groupings.

Regulations concerning natural swimming ponds in Europe: considerations on public health issues.

Natural swimming ponds (NSPs) are a new type of recreational water facility characterized by the substitution of traditional disinfection with biodepuration. While this feature meets esthetic desires of users, specific concerns on public health issues have been raised by the scientific community and local authorities. The absence of a European directive applicable to these environments leaves each country without specific and harmonized indications. The present work describes the local/national policy situation, describing adopted parameters and monitoring activities. All documents underline the need for appropriate microbiological analysis and correct water management.

2013 environmental health legislation.

The NEHA Government Affairs program has a long and productive association with the National Conference of State Legislatures (NCSL). The organizations have worked together on any number of legislative and policy areas that directly impact the environmental health profession. One of the keys to the successes of the NEHA/NCSL collaboration has been the recognition of the fact that often some of the most significant legislation and policy initiatives related to environmental public health occur in state legislatures. The states have, in a very real sense, been the innovators in developing new programs and practices. In recognition of this fact, we have asked NCSL to provide occasional overviews of state environmental public health legislative activity, covering topics that are of the most pressing public concern. Doug Farquhar, program director for NCSI's Environmental Health Program, has worked with NCSL since 1990. Mr. Farquhar directs development, management, and research for the Environmental Health Program. These projects encompass consultation and policy analysis of state and federal policies and statutes, regulations, and programs regarding environmental and related topics for state legislatures and administrative programs. Amy Ellis is a law clerk for NCSL within the Environment, Energy, and Transportation Group. As a law clerk she has researched a wide variety of environmental health policies. She is expected to obtain her JD from the University of Colorado Law School in 2015.

[New rules of the bathing water quality management]. / Nowe zasady zarzadzania jakoscia wody w kapieliskach.

Directive 2006/7/EC concerning the management of bathing water quality and repealing directive 76/160/ EEC, adopted in 2006, resulted in changes polish laws and regulations of this topic, which were necessary to comply with the new Directive. These included Water Act and three regulations: on bathing water quality surveillance, on bathing waters register and on bathing water profile. The main changes in the sanitary surveillance on bathing waters quality and their consequences for bathers has been discussed in the article. According to new regulations conducting bathing water quality monitoring was handed over to organizers of bathing sites and local government. Bathing water supervision and water quality assessment is in Polish Sanitary Inspection competence. Unique solution of polish law is division of bathing places into two categories: bathing sites and places used for bathing. In a consequence regulations "create" another category of such objects like places used according to custom for bathing by neighbourhood people, which will be left without any supervision. There is significant threat that new formal aspects combined with organisers burdened with supervision and finance responsibilities, will lead to decrease number of bathing sites in favour of growing number of places used for bathing. This can in consequence diminish bathers health safety.

[Nature-like swimming ponds and bathing: public health issues for congruous guidelines]. / Biopiscine e balneazione: considerazioni igienico sanitarie per lo sviluppo di adeguate linee guida.

Nature-like swimming ponds represent an emerging approach to recreational waters. The substitution of traditional disinfection with biodepuration enhances environmental sustainability, but implies relevant public health issues. No European regulations are available while several countries delivered local guidelines. Appropriate microbiological analysis, user education, and correct water management based on HACCP approach, represent key points for the development of future guidelines.

Violations identified from routine swimming pool inspections--selected states and counties, United States, 2008.

Swimming is the third most popular U.S. sport or exercise activity, with approximately 314 million visits to recreational water venues, including treated venues (e.g., pools), each year. The most frequently reported type of recreational water illness (RWI) outbreak is gastroenteritis, the incidence of which is increasing. During 1997--2006, chlorine- and bromine-susceptible pathogens (e.g., Shigella and norovirus) caused 24 (23%) of 104 treated venue--associated RWI outbreaks of gastroenteritis, indicating lapses in proper operation of pools. Pool inspectors help minimize the risk for RWIs and injuries by enforcing regulations that govern public treated recreational water venues. To assess pool code compliance, CDC analyzed 2008 data from 121,020 routine pool inspections conducted by a convenience sample of 15 state and local agencies. Because pool codes and, therefore, inspection items differed across jurisdictions, reported denominators varied. Of 111,487 inspections, 13,532 (12.1%) resulted in immediate closure because of serious violations (e.g., lack of disinfectant in the water). Of 120,975 inspections, 12,917 (10.7%) identified disinfectant level violations. Although these results likely are not representative of all pools in the United States, they suggest the need for increased public health scrutiny and improved pool operation. The results also demonstrate that pool inspection data can be used as a potential source for surveillance to guide resource allocation and regulatory decision-making. Collecting pool inspection data in a standardized, electronic format can facilitate routine analysis to support efforts to reduce health and safety risks for swimmers.

[Hygienic profile of the water in Milan swimming pools: a three-year comparative study]. / Profilo igienico-sanitario dell'acqua delle piscine milanesi: tre anni a confronto.

The aim of this work was to determine whether swimming pool water quality in Milan from 2006 to 2008 was within the standards established by national and local Italian laws (Circolare Min. Sanità 128/71 and DGR 2552/2006). In 2006, 580 samples of water from public swimming pools were analyzed to determine the presence of heterotrophic counts at 37 degrees and total coliforms; pH, free chlorine and chloride of each sample were also measured. In the following years, water from both public and private swimming pools were examined to measure heterotrophic count at 22 degrees and 36 degrees, Escherichia coli, enterococci, Pseudomonas aeruginosa, Staphylococcus aureus, pH, free chlorine, and nitrates. The total number of analyses carried out in 2007 and 2008 was 2074 and 1532, respectively. In 2006, the extent of noncompliance of all swimming pools that was observed for both physical/chemical and microbiological parameters was 72.3%, which then decreased to 53.2% and 36.2% in 2007 and 2008, respectively. In particular with regard to the microbiological analysis, an increase of noncompliance based on at least one parameter was determined (7.1% in 2006 vs. 21.5% in 2007 and 22% in 2008). In contrast, a decrease of the extent of noncompliance based on at least one physical/chemical parameter was observed (from 68.1% in 2006 to 40.4% and 22.3% in 2007 and 2008, respectively). Interestingly, public swimming pools exceeded the legal limits of microbiological concentration more often than the private ones, whereas both types of swimming pools showed a decrease in noncompliance with regard to the physical/chemical parameters.

Do traditional measures of water quality in swimming pools and spas correspond with beneficial oxidation reduction potential?

OBJECTIVES: Oxidation reduction potential (ORP) is a more direct measure of water quality in swimming pools and spas than free chlorine. However, ORP is not considered in some state pool codes, including Minnesota's. This study examined whether compliance with the Minnesota Pool Code assured an ORP > or = 650 millivolts (mV), a value defined in the literature as adequate to kill viral and bacterial pathogens within seconds. We also examined predictors of ORP. METHODS: Water samples from public swimming pools and spas in Hennepin County, Minnesota, were collected during routine health inspections from May through August 2004 and assessed for compliance with the state pool code. ORP values were also recorded. A Chi-square test was used to evaluate the association between code compliance and ORP. Analysis of covariance (ANCOVA) and logistic regression models were used to determine predictors of ORP. RESULTS: The study included 132 pools and 30 spas. Compliance with the Minnesota Pool Code did not assure an ORP > or = 650 mV (p < 0.01). Outdoor pools had significantly lower ORP values than indoor pools (p < 0.001). ANCOVA and logistic regression models showed that ORP decreased with increasing cyanuric acid, increasing pH, and decreasing free chlorine. CONCLUSIONS: Compliance with the Minnesota Pool Code did not coincide with adequate ORP values, particularly for outdoor pools and spas. Therefore, it may be appropriate for states to include a minimum ORP standard of > or = 650 mV in their swimming pool regulations. Doing so would likely benefit the health of swimmers.

[Surveillance of the sanitary conditions of a public swimming pool in the city of Palermo (Italy)]. / Sorveglianza igienico-sanitaria di una piscina di uso pubblico della città di Palermo (Italia).

In a previous study we evaluated the microbiological quality of water of seven pools in the city of Palermo through evaluation of bacterial indicators of faecal contamination and of protozoa (Giardia and Cryptosporidium). In this study we also searched for the presence of fungi in two swimming pools of a public swimming facility in the same city. Samples were collected from both pools, their filtration systems and floor surfaces of the facility. Chemical-physical and microbiological examination of water of the two pools have shown that quality of water depends on the concentration of residual free chlorine and on the number of bathers in the pool. The values of four microbiological parameters (bacterial load at 22 degrees C and 36 degrees C, presence of coagulase-negative Staphylococci and Pseudomonas spp.) increased with diminishing chlorine concentrations and with increasing number of pool users. Faecal bacteria, Giardia and Cryptosporidium were not found. On the other hand, various fungi were isolated from floor surfaces and pool water even in the presence of optimal chlorine concentrations. This study confirms the importance of regular maintenance of pool disinfection systems and suggests the need to search for other micro-organisms not included in the current legislation (Giardia, Cryptosporidium and fungi).

[Hygienic risks in swimming pool: knowledge and behaviours of consumers of three structures in Crema, Parma and Naples]. / Rischi igienico-sanitari in piscina: conoscenze e comportamenti degli utenti di tre impianti delle città di crema, Parma e Napoli.

The swimmers health's protection and the maintenance of good safety standards of structures can be guaranteed under observance of rules and the well management of the structures and activities. An anonymous questionnaire, with 38 items, was used in order to analyse and better understand the knowledge and behaviour of the users of three swimming pools in Crema, Naples and Parma. Socio-demographic features were similar in the three centres. One of the most important result was that the necessity of showers and foot-bath before entering the swimming pool is not well understood (77% and 78% respectively); caps and foot bath are, instead, almost always worn (98% and 97%). Knowledge on infection diseases transmitted by water is very poor, warts and mycosis being the best known. Sport structures are places where health and wellness can be affected. It is important to underline the role of behavioural rules as the use of showers, caps, and proper shoes. Authors recognize the swimming pool regulations as a valid tool for health promotion. It must be clear and easily understood and it has to be linked to a proper education pathway of all users and employees.

Improving Pool Fencing Legislation in Queensland, Australia: Attitudes and Impact on Child Drowning Fatalities.

Four-sided, non-climbable pool fencing is an effective strategy for preventing children from drowning in home swimming pools. In 2009, the Queensland Government introduced legislation to improve the effectiveness of pool fencing. This study explores community attitudes towards the effectiveness of these legislative changes and examines child (<5 years) drowning deaths in pools. Data from the 2011 Queensland Computer-Assisted Telephone Interviewing (CATI) Social Survey include results from questions related to pool ownership and pool fencing legislation. Fatal child drowning cases between 1 January 2005 and 31 December 2015 were sourced from coronial data. Of the 1263 respondents, 26/100 households had a pool. A total of 58% believed tightening legislation would be effective in reducing child drowning deaths. Pool owners were more likely to doubt the effectiveness of legislation (p < 0.001) when compared to non-pool owners. Perceptions of effectiveness did not differ by presence of children under the age of five. There were 46 children who drowned in Queensland home pools (7.8/100,000 pools with children residing in the residence/annum) between 2005 and 2015. While pool owners were less likely to think that tightening the legislation would be effective, the number of children drowning in home swimming pools declined over the study period. Drowning prevention agencies have more work to do to ensure that the most vulnerable (young children in houses with swimming pools) are protected.

Backyard swimming pool safety inspections: a comparison of management approaches and compliance levels in three local government areas in NSW.

ISSUE ADDRESSED: Since 1992, swimming pool fencing has been a legislative requirement in New South Wales (NSW), yet compliance with the NSW Swimming Pool Act is mixed. Local councils are responsible for the enforcement of the act. However, their approach to enforcement and the management of backyard swimming pool safety inspections is varied. METHODS: A random sample of backyard swimming pools was inspected in Council A and existing compliance data for pools in two other councils (B and C) were obtained. Pool owners in Council A were surveyed regarding their attitudes to pool fencing and inspections. Semi-structured interviews were conducted with council employees. RESULTS: Pool compliance rates across the three council areas varied. In Councils A and C, 51% and 54% of pools, respectively, were found to be non-compliant at the first inspection. Following re-inspection in Council A of 227 pools, a further 125 pools reached compliance. In Council B, 97% of the inspected pools were compliant. CONCLUSIONS: This study provides evidence of poor backyard swimming pool safety compliance where local government inspection activity is minimal or non-existent.