Immediate Closures and Violations Identified During Routine Inspections of Public Aquatic Facilities - Network for Aquatic Facility Inspection Surveillance, Five States, 2013.

PROBLEM/CONDITION: Aquatic facility-associated illness and injury in the United States include disease outbreaks of infectious or chemical etiology, drowning, and pool chemical-associated health events (e.g., respiratory distress or burns). These conditions affect persons of all ages, particularly young children, and can lead to disability or even death. A total of 650 aquatic facility-associated outbreaks have been reported to CDC for 1978-2012. During 1999-2010, drownings resulted in approximately 4,000 deaths each year in the United States. Drowning is the leading cause of injury deaths in children aged 1-4 years, and approximately half of fatal drownings in this age group occur in swimming pools. During 2003-2012, pool chemical-associated health events resulted in an estimated 3,000-5,000 visits to U.S. emergency departments each year, and approximately half of the patients were aged <18 years. In August 2014, CDC released the Model Aquatic Health Code (MAHC), national guidance that can be adopted voluntarily by state and local jurisdictions to minimize the risk for illness and injury at public aquatic facilities. REPORTING PERIOD COVERED: 2013. DESCRIPTION OF SYSTEM: The Network for Aquatic Facility Inspection Surveillance (NAFIS) was established by CDC in 2013. NAFIS receives aquatic facility inspection data collected by environmental health practitioners when assessing the operation and maintenance of public aquatic facilities. This report presents inspection data that were reported by 16 public health agencies in five states (Arizona, California, Florida, New York, and Texas) and focuses on 15 MAHC elements deemed critical to minimizing the risk for illness and injury associated with aquatic facilities (e.g., disinfection to prevent transmission of infectious pathogens, safety equipment to rescue distressed bathers, and pool chemical safety). Although these data (the first and most recent that are available) are not nationally representative, 15.7% of the estimated 309,000 U.S. public aquatic venues are located in the 16 reporting jurisdictions. RESULTS: During 2013, environmental health practitioners in the 16 reporting NAFIS jurisdictions conducted 84,187 routine inspections of 48,632 public aquatic venues. Of the 84,187 routine inspection records for individual aquatic venues, 78.5% (66,098) included data on immediate closure; 12.3% (8,118) of routine inspections resulted in immediate closure because of at least one identified violation that represented a serious threat to public health. Disinfectant concentration violations were identified during 11.9% (7,662/64,580) of routine inspections, representing risk for aquatic facility-associated outbreaks of infectious etiology. Safety equipment violations were identified during 12.7% (7,845/61,648) of routine inspections, representing risk for drowning. Pool chemical safety violations were identified during 4.6% (471/10,264) of routine inspections, representing risk for pool chemical-associated health events. INTERPRETATION: Routine inspections frequently resulted in immediate closure and identified violations of inspection items corresponding to 15 MAHC elements critical to protecting public health, highlighting the need to improve operation and maintenance of U.S. public aquatic facilities. These findings also underscore the public health function that code enforcement, conducted by environmental health practitioners, has in preventing illness and injury at public aquatic facilities. PUBLIC HEALTH ACTION: Findings from the routine analyses of aquatic facility inspection data can inform program planning, implementation, and evaluation. At the state and local level, these inspection data can be used to identify aquatic facilities and venues in need of more frequent inspections and to select topics to cover in training for aquatic facility operators. At the national level, these data can be used to evaluate whether the adoption of MAHC elements minimizes the risk for aquatic facility-associated illness and injury. These findings also can be used to prioritize revisions or updates to the MAHC. To optimize the collection and analysis of aquatic facility inspection data and thus application of findings, environmental health practitioners and epidemiologists need to collaborate extensively to identify public aquatic facility code elements deemed critical to protecting public health and determine the best way to assess and document compliance during inspections.

Development of a preliminary relative risk model for evaluating regional ecological conditions in the Delaware River Estuary, USA.

Effective environmental management and restoration of urbanized systems such as the Delaware River Estuary requires a holistic understanding of the relative importance of various stressor-related impacts throughout the watershed, both historical and ongoing. To that end, it is important to involve as many stakeholders as possible in the management process and to develop a system for sharing of scientific data and information, as well as effective technical tools for evaluating and disseminating the data needed to make management decisions. In this study, we describe a preliminary assessment that was undertaken to evaluate the relative risks for the variety of stressors currently operating within the Delaware Estuary using a relative risk model (RRM) framework. This model was constructed using existing data and information on the ecological conditions and stressors in the main-stem Delaware River below the head of tide at Trenton, New Jersey, USA. A large database was developed with pertinent data from a variety of library, scientific, and regulatory sources. Data were compiled, reviewed, and characterized before development of the Estuary-specific RRM. Our primary goals and objectives in developing this preliminary RRM for the Estuary were to 1) determine if the RRM framework can be adapted to a large complex estuarine system such as the Delaware River, 2) identify the issues associated with adapting the model framework to the various management issues and regional areas/habitats of the River, 3) help identify data needs and potential refinements that might be needed to more specifically quantify relative stressor risks in various areas and habitats of the Estuary to better inform future management goals/actions by Stakeholders. The key conclusions of our preliminary assessment are 1) a diverse suite of stressors is likely affecting the ecological conditions of the Delaware Estuary, 2) chemical (toxicants/contaminants) and physical (sedimentation, habitat loss) stressors were found to be on par with regards to their ranking, and 3) the RRM, in its current form, made it difficult to effectively balance the inequality in the sizes of the study subareas considered in the assessment. Management objectives and related research activities should focus on collecting the necessary data and information to further refine the RRM and assess the relative impacts of these stressors at various scales in the Estuary. By having such a framework and tool available, we believe that stakeholders within the Delaware River watershed will be able to make more informed and risk-based management decisions regarding restoration options for the Estuary.

Sediment quality triad assessment of an industrialized estuary of the northeastern USA.

The lower Passaic River in northern New Jersey (USA) has been heavily industrialized since the mid-nineteenth century and its shoreline and aquatic habitats degraded or destroyed. Similar to other urban systems, Passaic River sediments, both surface and buried, historically have contained elevated levels of numerous contaminants that may pose risks to ecological receptors and humans. Sediments from 15 stations in the lower Passaic River and 3 reference stations in the Mullica River in southern New Jersey were sampled in 1999 and characterized for chemical contamination, toxicity, and impairment of the benthic community. The objective of this study was to determine the incidence, degree, and nature of degraded surficial sediments in the area to support subsequent plans for restoration of the system. Results demonstrated that Passaic River sediments had concentrations of many organic and inorganic contaminants at levels significantly greater than the reference area and effect-based guidelines. Sediments were toxic to marine amphipods at 11 stations and the benthic assemblages were impaired relative to the reference area at all stations. The weight-of-evidence of this sediment quality triad (SQT) assessment indicates that impacts from multiple contaminants are occurring throughout the lower Passaic River and, that these impacts must be evaluated further and addressed as part of ongoing restoration initiatives for the river.

Incremental ecological exposure risks from contaminated sediments in an urban estuarine river.

Estuaries in urban regions present unique environmental management challenges. Ecosystems in urban estuaries are typically impacted by habitat loss and degradation, watershed modification, and nonpoint and point sources of many chemicals. Restoring such systems requires an understanding of the relative contribution of various stressors to overall ecological conditions and an understanding of shifting patterns of stress over time. In this article, we present the results of a multiparameter environmental assessment of a quintessential urbanized waterway: the lower Passaic River in the vicinity of Newark, New Jersey, USA. To provide the foundation for effective management decision making, we quantified baseline conditions (habitat losses and degradation), chemical concentrations in sediment and biota relative to published toxic effect levels, direct toxicity of sediments to benthic organisms, and food-web mediated risks to fish-eating birds. Habitat losses have been severe (greater than 85% of wetlands, nearly 100% of the total length of tidal and nontidal tributaries, and 100% of natural shoreline habitat have been lost), resulting in substantial habitat constraints on biota. Despite this, biological communities are present in the lower Passaic. In general, concentrations of toxic chemicals in surface sediments have fallen with time, and natural recovery processes are proceeding. Chemical concentrations remain high enough to impair survival of amphipods, but not amphipod growth or polychaete growth or survival as measured in laboratory bioassays using field-collected sediment. Fish and blue crab body burdens of some metals, PCBs, and the pesticide, DDT, are at concentrations sufficiently high to exceed toxicity thresholds. The resident fish-eating bird--the belted kingfisher--is at exposure risk from some metals, PCBs, and polychlorinated dibenzo-p-dioxins and dibenzo furans (PCDD/Fs). Migratory waders--the herons and egrets--are not at risk from chemical exposure. These complex findings suggest that restoring the lower Passaic River to ecological health is a correspondingly complex task. Habitat constraints must be eased for biotic components of the ecosystem, and chemical effects must be reduced for those organisms that are present. Only a coordinated, multidisciplinary restoration program will succeed in this challenging environment.