Disease Transmission and Swimming Pools
A decade ago, few people would have linked getting sick with swimming in treated swimming pools. Today, however, media reports from around the world frequently contain stories of outbreaks: 3,000 illnesses that spread to 36 New York counties in 2005; 185,000 falling ill after a 2007 outbreak in Japan; and that same year, 1,902 cases in Utah. Many more outbreaks have gone unreported or are of smaller scale and did not get worldwide media attention. All aquatic recreation facilities seem to be vulnerable—even those that are well managed. Outbreaks are often hard to identify quickly because it takes many people reporting an illness before a pattern can be established and it can be determined whether all the people had visited the pool. The consequences of an outbreak can be high: Several people have died, thousands have been hospitalized, facilities have been shut down for extended periods of time for expensive cleanup, and multimillion-dollar lawsuits have been filed. What is behind the surge of outbreaks? Is there a new “superbug”? Are we more aware because of better monitoring? Is it media hype? Are our immune systems weakening? Have our chemicals become less potent? Are people less careful of toilet habits? There are no simple answers to these questions, but this chapter explores how you can play a role in preventing exposure to potentially disease-causing pathogens.
Most bodily substances, especially blood, vomit, and fecal matter, can contain disease. The germs that can be transmitted through direct contact with blood and some bodily fluids are called bloodborne pathogens. The germs that can be transmitted by swallowing contaminated water are called waterborne pathogens. Let’s look at bloodborne pathogens first.
You may have contact with blood or bloody bodily fluids when you are involved in a rescue, performing first aid or CPR, or performing cleaning duties at the aquatic facility where you work. In these circumstances, you need to use infection control guidelines to minimize the risk of yourself and others becoming ill. The two primary diseases caused by bloodborne transmission are HIV and hepatitis.
HIV and AIDS are acronyms for human immunodeficiency virus and acquired immune deficiency syndrome. AIDS applies to the most advanced stages of HIV infection. By killing or damaging cells of the body’s immune system, HIV progressively destroys the body’s ability to fight off certain bacteria, viruses, fungi, parasites, and other microbes.
Hepatitis is the name of a family of viral infections that affect the liver. The most common types are hepatitis A (HAV), hepatitis B (HBV), and hepatitis C (HCV).
- HAV infection is primarily transmitted by the fecal–oral route, by either person-to-person contact or through consumption of contaminated food or water. Hepatitis A vaccination is the most effective measure to prevent HAV infection.
- HBV infection is transmitted through contact with infectious blood or bodily fluids and can cause acute illness and lead to chronic or lifelong infection, cirrhosis (scarring) of the liver, liver cancer, liver failure, and death. Hepatitis B vaccination is the most effective measure to prevent HBV infection.
- HCV is spread by contact with the blood of an infected person. Exposure sometimes results in an acute illness but most often becomes a silent, chronic infection that can lead to cirrhosis, liver failure, liver cancer, and death. Most HCV-infected people do not know they are infected since they have no symptoms. There is no vaccine for hepatitis C.
Reducing Exposure to Bloodborne Pathogens
You can prevent transmission of bloodborne pathogens by isolating yourself and others from contact. The first step in isolating a bodily substance is to use universal precautions, which means that whether or not you think the victim’s blood or other bodily fluid is infected, you act as if it is. The next step is to protect yourself from becoming exposed through the use of protective equipment.
Personal Protective Equipment
Because you cannot look at a bodily substance and know if it is infected, assume that all bodily fluids and feces could contain pathogens. Always use personal protective equipment (PPE) when you are at risk of exposure to any type of bodily substance. The minimum personal protective equipment available for your use while lifeguarding should include disposable gloves, protective eyewear, protective footwear, and a barrier mask for use during resuscitation.
Use disposable, single-use gloves to protect your hands. If a glove is damaged, don’t use it! Wearing two pairs of gloves can provide an additional barrier and further reduce the risk of transfer of bloodborne pathogens.
When taking contaminated gloves off, do it carefully. Don’t snap them. This may cause blood to splatter. See the skill guide on this page for the recommended technique.
Never wash or reuse disposable gloves. Make sure there is always a fresh supply of gloves in your first aid kit. If you find yourself in a first aid situation and you don’t have any gloves handy, improvise. Use a towel, plastic bag, or some other barrier to help you avoid direct contact.
Some people are allergic to natural rubber latex, which can be a serious medical problem. You may be at risk for developing latex allergy if you use latex gloves frequently. Allergic reactions may include skin rashes; hives; nasal, eye, or sinus symptoms; asthma; and (rarely) shock.
If you are allergic, take steps to protect yourself from latex exposure and allergy in the workplace. Taking simple measures such as using nonpowdered latex gloves and nonlatex gloves can stop the development of latex allergy symptoms and help you prevent new cases of sensitization.
It is difficult to put dry gloves onto wet hands, especially when you are in a hurry. If your hands are wet, and you are near the water, it may help to fill your glove with water and then slip your wet hand into the wet glove.