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What causes recreational water illness and who it affects most

This is an excerpt from StarGuard With Web Resource-4th Edition by Jill White.

Recreational Water Illness and Waterborne Pathogens

If vomit or fecal matter gets into the water, there is a slight possibility that germs may remain long enough, before being killed by the sanitizing agent such as chlorine, for a patron to become ill by swallowing contaminated water. Although incidents of transmitting serious disease in this manner are rare, you must understand how the risk for transmitting these diseases can be reduced.

A recreational water site is anywhere people enter the water such as a pool, water park, hot tub, lake, river, or ocean. Recreational water illnesses (RWIs) are caused by germs spread by swallowing, having contact with, or breathing in mists or aerosols of contaminated water in swimming pools, hot tubs, water parks, water-play areas, interactive fountains, lakes, rivers, or oceans. RWIs encompass a wide variety of infections, including gastrointestinal, skin, ear, respiratory, eye, neurologic, and wound infections. Patrons who are most at risk for getting very sick from an RWI include children, pregnant women, and those who have an immune system deficiency caused by HIV, chemotherapy, or other conditions.

Germs that cause RWIs generally enter the water when a swimmer has a fecal incident while in the water. When swimmers are ill with diarrhea, their stool can contain millions of germs and contaminate the water. In addition, on average people have about .14 gram of feces on their bottoms that, when rinsed off, can contaminate recreational water. Germs are less likely to be present in a small amount of vomit, which is a common occurrence when a child swallows too much water, especially right after eating. Viruses are more likely to be present in vomit when it contains more than just regurgitated pool water, which may indicate that a person is sick. Germs that may be present in blood don’t survive in chlorinated water and do not pose a threat.

The most common RWI is diarrhea, which can be caused by germs such as the following:

  • Crypto (KRIP-toe, which is short for Cryptosporidium)
  • Giardia (gee-ARE-dee-uh)
  • Norovirus
  • E. coli (ee-CO-lye, which is short for Escherichia coli)

There are other germs and chemical compounds that naturally occur in the environment. If disinfection, oxidation, or pH levels of the water are not maintained appropriately, these germs can multiply and cause other types of RWIs that affect the skin, eyes, ears, or respiratory tract.


Learn more about Starguard: Best Practices for Lifeguards, Fourth Edition.

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Disease transmission in swimming pools and reducing your exposure to them
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.
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During an emergency, certain legal principles apply regarding what you are expected to do in the United States.


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StarGuard With Web Resource-4th Edition
The fourth edition of StarGuard: Best Practices for Lifeguards presents the essentials of lifeguarding, helping lifeguard candidates become skilled and proactive. This resource contains the latest research in lifeguarding and lifesaving, including the most current CPR/AED and first aid content.
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