NEHA May 2014 Journal of Environmental Health - page 10

Volume 76 • Number 9
Ayana R. Anderson, MPH
Division of Toxicology
and Human Health Sciences
Agency for Toxic Substances
and Disease Registry
Wanda Lizak Welles, PhD
Bureau of Toxic Substance Assessment
New York State Department of Health
James Drew
Bureau of Environmental
and Occupational Health
Wisconsin Department
of Health Services
Maureen F. Orr, MS
Division of Toxicology
and Human Health Sciences
Agency for Toxic Substances
and Disease Registry
The Distribution
and Public Health
Consequences of
Releases of Chemicals
Intended for Pool Use
in 17 States, 2001–2009
In 2009, swimming was the fourth most pop-
ular recreational sport in the U.S., with over
50 million individuals swimming at least six
times within the year (U.S. Census Bureau,
2012). Various chemicals are used to main-
tain pool water quality and protect against
the transmission of pathogens. These chemi-
cals include bromine-based disinfectants
(e.g., hypobromous acid), chlorine based-
disinfectants (e.g., chlorine gas), and chemi-
cals that adjust pH (e.g., soda ash) (De Haan
& Johanningsmeier, 1997). Pool chemicals,
which are safe when handled properly, can
cause injury when mishandled. Depending
on the severity, symptoms from exposure to
hydrochloric acid, bromine, hypochlorites,
and chlorine can include nose, eye, and
throat irritation; dermatitis; abdominal pain;
nausea; vomiting; headache; and dizziness
(National Institute for Occupational Safety
and Health, 2010).
Because the reporting of pool chemical inci-
dents is not universally mandated, completely
characterizing their public health impact is
difficult (Agabiti et al., 2001; Thomas & Mur-
ray, 2008). Three publications describe a series
of incidents involving various pool chemical
releases in the U.S.; however, the articles have
different measures and time frames. The first
article, using data from the National Electronic
Injury Surveillance System (NEISS), reported
an annual median of 4,120 emergency depart-
ment (ED) visits for injuries associated with
pool chemicals for 1998–2007 (Centers for
Disease Control and Prevention [CDC], 2009).
The second article, using data from NEISS
and the Sentinel Event Notification System
for Occupational Risk (SENSOR), reported
an annual average of 4,010 work-related ill-
nesses or injuries associated with pool chemi-
cals for 2002–2008 (CDC, 2011a). The third
article reported data from three databases: the
Hazardous Substances Emergency Events Sur-
veillance (HSEES) had 92 pool chemical inci-
dents that occurred at aquatic facilities during
2007–2008; NEISS reported a total of 4,574 ED
visits resulting from pool chemical incidents
for 2008; and the Waterborne Disease and Out-
break Surveillance System (WDOSS) reported
32 pool chemical incidents that occurred in
Michigan and Maryland with two or more per-
sons linked epidemiologically by time, location
of water exposure, and illness characteristics
and evidence implicating recreational water
(CDC, 2011b).
Our analysis used data from the Agency
for Toxic Substances and Disease Registry
(ATSDR) HSEES program to describe the dis-
tribution and public health consequences of
“pool chemical incidents,” which are defined
Abs t r ac t
To keep swimming pool water clean and clear, con-
sumers purchase, transport, store, use, and dispose of large amounts of
potentially hazardous chemicals. Data about incidents due to the use of
these chemicals and the resultant public health impacts are limited. The
authors analyzed pool chemical release data from 17 states that participat-
ed in the Agency for Toxic Substances and Disease Registry’s chemical event
surveillance system during 2001–2009. In 400 pool chemical incidents,
60% resulted in injuries. Of the 732 injured persons, 67% were members of
the public and 50% were under 18 years old. Incidents occurred most fre-
quently in private residences (39%), but incidents with the most injured
persons (34%) occurred at recreational facilities. Human error (71.9%) was
the most frequent primary contributing factor, followed by equipment
failure (22.8%). Interventions designed to mitigate the public health impact
associated with pool chemical releases should target both private pool
owners and public pool operators.
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