War with RWIs: additional training for staff could prevent future recreational water illnesses.

There is a battle that continues to rage in the aquatics world--in fact, the war sometimes seems to be expanding. It isn't visible to the naked eye, but lurking in the water is an enemy that is tough for anyone to stop. After years of recruiting those who know how to fight, it appears that the effort to combat recreational water illness (RWI) outbreaks is paying off. But, if the tide is to be turned for good, more recruits need to be trained.

This past summer alone, 185,000 fell sick after an outbreak in Japan. Australia's Commonwealth Aquatic Games "crypto" scare that endangered the training of world-class athletes at one of the celebrated competitive swimming venues, the Melbourne Sports Aquatics Center. The current outbreaks worldwide prove once again to those skeptics that even well-managed pools are at risk of experiencing an RWI. One way to combat this is to initiate a "full press" attack educating at every level of operation, from the coach, operator, service technician and swim teacher.

Last year, when the article "Best Offense" was first published in the February issue of Aquatics International, a review of the literature and training materials used to certify and prepare aquatic professionals clearly showed that operators, lifeguards, service technicians, coaches and swim teachers critically lacked an education in RWI awareness before they were certified to enter their chosen aquatic profession. The article strongly suggested more training was needed to assist in stemming the rise in RWI contamination nationwide as reported by the Centers for Disease Control (CDC).

Notre Dame University Head Coach Tim Welsh, who also sits on the American Swimming Coaches' Association's (ASCA) Board of Directors, believes "RWI training is very important and appropriate."

In addition, organizations such as NRPA, Association of Pool and Spa Professionals (APSP), National Swimming Pool Foundation (NSPF), American Alliance for Health, Physical Education, Recreation and Dance (AAH-PERD), ASCA, and United States Diving all expressed an interest and a need for educating professionals about RWIs.

According to Dr. Roy Vore, with DuPont and APSP "The switch in getting the message out with a workshop module that provides a format that will be developed for the non-microbiologist in mind" should be a goal. The broad application approach is also attractive to Dr. Michael Beach, a leading scientist with the CDC who says, "I like the idea of this RWI training going out to courses (CPO, AFO, TECH service programs). It sounds like a great idea."

Educating aquatic professionals about the effects of RWIs is not new. What could be the dramatic shift in the industry is training every level of professional about the risks, just as a manager would train them about drowning. Kathleen (Katie) O. Moore, R.S., CPO, with the Texas Department of Health states, "This is 'education' in a broad sense and application at a facility level. The causes and effects of RWIs and the steps that can be taken to prevent them are not new. What is new is the placing of the risk of RWIs alongside the risk of other injuries that can be incurred in an aquatic environment."

The documented statistics available from the CDC are not new--they show that 60 percent of all RWI outbreaks occur in treated-water facilities. More recently, the aquatics industry was stunned when the state of New York became a defendant in a class action million-dollar lawsuit after a crypto outbreak sickened thousands at Seneca Lake State Park. The cruise line industry was also shaken by a million-dollar judgment resulting from an outbreak of Legionella.

After all this, why is the enemy gaining ground? Aquatic professionals don't have the proper information to fight RWIs. Providing the correct training could prove to be a turning point in the war.

It is a misconception to believe that pool and spa operators alone should bear the burden of combating RWIs. Even if you are stubbornly holding on to the belief that it is the responsibility of the operator, the question then becomes "who and what is an operator?" Let us again look at the facts based on the CDC's most current findings. The CDC's 2001-2002 study lists, five States: Texas, Florida, Pennsylvania, Michigan and Minnesota that have averaged at least four or more RWI outbreaks.

Next, after an examination of these states code for pools and spas, only Texas, Florida and Minnesota clearly state what an operator is and require posted proof of certification. The Pennsylvania and Michigan codes only site a "capable manager" or a "qualified person" with no clarification or definition as to the meaning these individuals and pool owners to supply water samples for analysis.

This line of thinking suggests that the term operator is becoming broader --no longer is only one individual responsible for cleaning a pool, but it could mean any person on staff at an aquatic facility.

The education of a coach, therefore, should not be limited to stroke or diving techniques, physiology or biomechanics. Basic course requirements necessary for aspiring coaches in swimming and diving clearly do not prepare the future coach to recognize disease transmission dangers. These courses should add a basic prerequisite to make it possible for coaches to become aware of the danger that RWIs present to the athletes under their direct control.

They also must understand the potential for an athlete's exposure to recreational water illnesses at the aquatics facility where they practice, the hotel or motel pool or spa where they travel, and the pool where they might compete. In other words, coaches are playing roulette with their athletes when they can't recognize the warning signs or dangers of waterborne transmission.

There is a groundswell developing to prevent RWIs. There is a growing acceptance that, while limited, this epidemic is unquestionably important to the health of patrons who use aquatics venues. Therefore, aquatic professionals should support the continued education to improve the level of awareness and understanding by everyone at every level. It is important to understand the dangers of RWIs as a prerequisite before becoming certified and by doing so create a broader base of understanding from which this menace can be vanquished and the war can finally be won.

Acknowledgments:

The author thanks the following individuals for their contributions to my study of RWIs which led to the creation of the RWI workshop module: Roy D. Vore, Ph.D. DuPont Chemical Solutions Enterprises, Alex Antoniou, Ph.D., Director of Educational Programs, National Swimming Pool Foundation; Michael J. Beach, Ph.D., Team Leader, Water and Environment Activity, Centers for Disease Control and Prevention Division of Parasitic Diseases; George Block, Assistant Director of Athletics, Northside Independent School District, ASCA Board of Directors; Martha Chapin, Senior Associate, Program Administration & Support Products, Health & Safety Services, American Red Cross, National Headquarters; Janet L. Gabriel, M.A., U.S. Diving Director of Education, Safety & Development, U.S. Diving, Inc; Pat Hogan, United States Swimming Director for Club Development, ASCA Board of Directors; Sharon Mannion, NRPA AFO Coordinator; Kathleen O. Moore, R.S., CPO, Policy, Standards & Quality Assurance Unit Division for Regulatory Services Department of State Health Services; Ken Suzuki, Director of Education, The Association of Pool & Spa Professionals; Tim Welsh, Head Swim Coach, Notre Dame, A.S.C.A. Fellows Coordinator, American Swim Coaches Association Board of Directors; Kent Williams, Founder of Professional Pool Operators of America, Aquatic International Advisory Board, NRPA Aquatic Facilities Operator Instructor, Jim Lauria, President, Team Chemistry LLC, Ellen Meyer, Ph.D. Arch Chemicals, Inc. John F. Whitmore, CPRP, Superintendent Denton Parks and Recreation.

By Louis "Sam" Fruia, M.Ed