The War Against RWIs
Letters From the Front
By Louis "Sam" Fruia, M.Ed.
After two years, the ranks at the front are filling. The recruits are veterans of aquatics and captains of the industry. These recruits include the Association of Pool and Spa Professionals (APSP) and the National Swimming Pool Foundation (NSPF). Each has moved up to the line with the Centers for Disease Control and Prevention (CDC) and have troops in combat. But the ranks lack sufficient numbers, so the enemy continues to gain ground. We need more recruits if the tide is to be turned.
There has been a stream of news articles from around the world and industry monitoring the latest developments created to battle RWIs. This news has painted a vivid picture reflecting the true state of the battlefront. It is not pretty.
Published since 1983, the CDC's Morbidity and Mortality Weekly Report (MMWR) focuses on public health surveillance, reporting a broad range of risk factors and health conditions. The report revealed that 60 percent of all RWI outbreaks occur in treated water facilities. The 2001-2002 report revealed an astonishing 11 percent of spas and 8.3 percent of pools required immediate closure. The 2003-2004 report documented 62 waterborne disease outbreaks (WBDOs) in recreational water occurring in 26 states and Guam that affected 2,698 people, and resulted in 58 hospitalizations and one death.
These reports document the severity of RWI outbreaks and have indicated that they continue to rise year after year. The situation is so serious that the CDC recommended that people check pool and spa water with test strips before entering public venues. On the bright side, during this same two-year period, several improvements have made their way into the limelight, including the support for UV treatment and the development of PRS, an EPA-approved, patented, two-stage system that effectively traps Cryptosporidium in the filter. At Brownsville ISD, we have incorporated these methods into our layers of protection for our aquatic facilities.
After all this, why is the enemy gaining ground? The answer is quite simple: Aquatic professionals still do not have the proper information to fight RWIs. The industry must expand the current certification processes for aquatic professionals, including operators, lifeguards, service technicians, coaches and swim teachers to include RWI awareness and prevention. Every aquatic professional must have a practical understanding of waterborne pathogens.
Even the present best practices approach should include a low-tech solution broad enough for the masses to adopt and still afford to keep the pools and spas open. Breaking the material into modules is best. The key elements of the RWI training module could be injected into every training program. The idea is to include RWI training in the curriculum before a candidate is certified as an aquatic specialist by any professional organization.
This idea was presented to the organizations, and seminars were presented at conferences in 2006 and 2007. The Association of Pool and Spa Professionals (APSP) Recreational Water Quality Committee (RWQ) accepted the challenge and made the development of an RWI module one of its key goals.
The RWQ Committee sponsored the premier of the RWI module at the National Environmental Health Association's (NEHA) 71st annual Educational Conference and Exhibition and the 2007 International Pool and Spa Exposition. The information in the RWI module was included in the APSP's new Hot Tub Technician Manual. The APSP also has taken significant strides by providing this valuable information to public health officials (PHOs) in a new newsletter.
The American Swimming Coaches Association, with the largest competitive aquatic coaches' membership in the world, stepped up by publishing an Internet link to an abstract and main article on RWIs.
It is a misconception to believe that pool and spa operators alone should bear the burden of combating RWIs. The CDC's 2001-2002 WBDO summary lists five states with at least four or more RWI outbreaks where state codes define operators and require posted proof of certification. Some state codes only cite a "capable manager" or a "qualified person" with no clarification or definition as to the meaning. Clearly this method is not working, as outbreaks continue to occur in these states where there are "qualified operators." The CDC reports that over 97 percent of the data come from areas that require operators to be trained and certified, and only one in four had the proper training required by the local code. Also troubling, a published study revealed that many operators do not work over the weekends, the peak operation periods for many pools and spas.
It is a misconception to believe that pool and spa service technicians should bear the burden of combating RWIs. Class "C" facilities like hotels, where an outside service technician or service company operates the pool, are the source of many outbreaks. Sadly, most state codes make no mention of service technicians, who are therefore unregulated, leaving many unskilled technicians to deal with the dangers presented by RWIs. The owners and managers of these hotels and motels are nonprofessionals who conceptualize that service technicians are trained and knowledgeable aquatic professionals. Service techs do not necessarily have RWI knowledge, and many just have a truck, a bucket of sanitizer and a pole with a brush at the end.
It is a misconception to believe that coaches should not be responsible for combating RWIs because they do not operate aquatic facilities. We all agree that the coach is in charge of the team's physical safety while at practice. However, we don't often include chemical or microbiological safety in the coaches' responsibilities. This is nonsense. The coach is the "commander in chief," and to quote a very pragmatic and down-to-earth former Commander in Chief, President Harry S. Truman, "The buck stops here." Anyone who wants to be in charge has to accept the responsibilities that go with the job. This includes all the responsibilities, not just the easy ones.
The education of a coach must not be limited to stroke or diving technique, 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. They must understand the potential for an athlete's exposure to RWIs at any aquatics facility where they practice, as well as the hotel pool or spa where they rest on the road. Under the present system, coaches may be playing roulette with their athletes' health.
The image that a pool operator, coach, lifeguard or instructor needs to project to patrons, athletes and clients would be that of an aquatics professional, not a person who asks unskilled laypeople to do their job for them.
The first dispatch from the front two years ago, "Aquatics War with RWIs," hinged upon collaboration. The focal point was to rally this collaboration into a unified "plan of attack" against RWIs where organizations would mobilize training materials to include RWI awareness.
That collaboration, while progressing, is doing so slowly with assistance from groups and individuals in the aquatic industry. The product of this collaboration is the creation of a basic training module in RWI disease transmission. With continued interest from certifying organizations, this module will provide recruits from every program that trains operators, service technicians, swimming and diving coaches the knowledge base they need to fight RWIs. Only then can we muster sufficient recruits to win the war.
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