Supplement Feature - February 2011
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The Right Safeguards

Protecting Pool Patrons, Reducing Risk

By Wynn St. Clair

What's in the Water?

Pools also don't want to earn a reputation as a place where people get sick. But that's a battle aquatic facilities all over the country are fighting on a daily basis.

Experts link about a dozen diarrheal outbreaks to swimming pools each year. While the number may seem small to pool operators, it's probably grossly underestimated because most diarrheal illnesses do not get reported to health-care providers and health officials.

Between 2005 and 2006, for example, a total of 78 recreational water-associated outbreaks affecting 4,412 people were reported to the CDC. It's the largest number of outbreaks ever reported in a two-year period.

In addition to the public health incentives for keeping a disease-free pool, there are financial ones as well. These outbreaks resulted, in many cases, in pool closures, bad publicity and attendance drops.

Hospitalizations for three common waterborne diseases cost the health care system as much as $539 million annually, according to research presented this summer at the International Conference on Emerging Infectious Diseases. Using data from a large insurance claims database between 2004 and 2007, the study estimated the hospitalization cost of three common waterborne diseases in the United States: Legionnaires' disease, Cryptosporidiosis and Giardiasis. For each case of disease, they calculated the cost paid by the insurer, the out-of-pocket cost to the patient and the total amount paid.

Total estimated costs for hospitalization for the three diseases was $154 million to $539 million, including $44 million to $147 million in direct government payments for Medicare and Medicaid. Estimated annual costs for the individual diseases were: Giardiasis, $16 million to $63 million; Cryptosporidiosis, $37 million to $145 million; and Legionnaires' disease, $101 million to $321 million.

Inpatient hospitalization costs per case averaged more than $34,000 for Legionnaires' disease, approximately $9,000 for Giardiasis and more than $21,000 for Cryptosporidiosis.

"When people think about these diseases, they usually think of a simple case of diarrhea, which is a nuisance but quickly goes away. However, these infections can cause severe illness that often result in hospital stays of more than a week, which can quickly drive up health care costs," said Michael Beach of the Centers for Disease Control and Prevention, an author of the study.