title: Immediate Closures and Violations Identified During Routine Inspections of Public Aquatic Facilities - Network for Aquatic Facility Inspection Surveillance, Five States, 2013.
abstract: Aquatic facility-associated illness and injury in the United States include disease outbreaks of infectious or chemical etiology, drowning, and pool chemical-associated health events (e.g., respiratory distress or burns). These conditions affect persons of all ages, particularly young children, and can lead to disability or even death. A total of 650 aquatic facility-associated outbreaks have been reported to CDC for 1978-2012. During 1999-2010, drownings resulted in approximately 4,000 deaths each year in the United States. Drowning is the leading cause of injury deaths in children aged 1-4 years, and approximately half of fatal drownings in this age group occur in swimming pools. During 2003-2012, pool chemical-associated health events resulted in an estimated 3,000-5,000 visits to U.S. emergency departments each year, and approximately half of the patients were aged <18 years. In August 2014, CDC released the Model Aquatic Health Code (MAHC), national guidance that can be adopted voluntarily by state and local jurisdictions to minimize the risk for illness and injury at public aquatic facilities.
  
  
  
  2013.
  
  
  
  The Network for Aquatic Facility Inspection Surveillance (NAFIS) was established by CDC in 2013. NAFIS receives aquatic facility inspection data collected by environmental health practitioners when assessing the operation and maintenance of public aquatic facilities. This report presents inspection data that were reported by 16 public health agencies in five states (Arizona, California, Florida, New York, and Texas) and focuses on 15 MAHC elements deemed critical to minimizing the risk for illness and injury associated with aquatic facilities (e.g., disinfection to prevent transmission of infectious pathogens, safety equipment to rescue distressed bathers, and pool chemical safety). Although these data (the first and most recent that are available) are not nationally representative, 15.7% of the estimated 309,000 U.S. public aquatic venues are located in the 16 reporting jurisdictions.
  
  
  
  During 2013, environmental health practitioners in the 16 reporting NAFIS jurisdictions conducted 84,187 routine inspections of 48,632 public aquatic venues. Of the 84,187 routine inspection records for individual aquatic venues, 78.5% (66,098) included data on immediate closure; 12.3% (8,118) of routine inspections resulted in immediate closure because of at least one identified violation that represented a serious threat to public health. Disinfectant concentration violations were identified during 11.9% (7,662/64,580) of routine inspections, representing risk for aquatic facility-associated outbreaks of infectious etiology. Safety equipment violations were identified during 12.7% (7,845/61,648) of routine inspections, representing risk for drowning. Pool chemical safety violations were identified during 4.6% (471/10,264) of routine inspections, representing risk for pool chemical-associated health events.
  
  
  
  Routine inspections frequently resulted in immediate closure and identified violations of inspection items corresponding to 15 MAHC elements critical to protecting public health, highlighting the need to improve operation and maintenance of U.S. public aquatic facilities. These findings also underscore the public health function that code enforcement, conducted by environmental health practitioners, has in preventing illness and injury at public aquatic facilities.
  
  
  
  Findings from the routine analyses of aquatic facility inspection data can inform program planning, implementation, and evaluation. At the state and local level, these inspection data can be used to identify aquatic facilities and venues in need of more frequent inspections and to select topics to cover in training for aquatic facility operators. At the national level, these data can be used to evaluate whether the adoption of MAHC elements minimizes the risk for aquatic facility-associated illness and injury. These findings also can be used to prioritize revisions or updates to the MAHC. To optimize the collection and analysis of aquatic facility inspection data and thus application of findings, environmental health practitioners and epidemiologists need to collaborate extensively to identify public aquatic facility code elements deemed critical to protecting public health and determine the best way to assess and document compliance during inspections.
authors.affiliation: Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infections Diseases, CDC.
authors.forename: Michele C
authors.initials: MC
authors.lastname: Hlavsa
authors.forename: Taryn R
authors.initials: TR
authors.lastname: Gerth
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Collier
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Dunbar
authors.forename: Gouthami
authors.initials: G
authors.lastname: Rao
authors.forename: Gregory
authors.initials: G
authors.lastname: Epperson
authors.forename: Becky
authors.initials: B
authors.lastname: Bramlett
authors.forename: David F
authors.initials: DF
authors.lastname: Ludwig
authors.forename: Diana
authors.initials: D
authors.lastname: Gomez
authors.forename: Monty M
authors.initials: MM
authors.lastname: Stansbury
authors.forename: Freeman
authors.initials: F
authors.lastname: Miller
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Warren
authors.forename: Jim
authors.initials: J
authors.lastname: Nichol
authors.forename: Harry
authors.initials: H
authors.lastname: Bowman
authors.forename: Bao-An
authors.initials: BA
authors.lastname: Huynh
authors.forename: Kara M
authors.initials: KM
authors.lastname: Loewe
authors.forename: Bob
authors.initials: B
authors.lastname: Vincent
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Tarrier
authors.forename: Timothy
authors.initials: T
authors.lastname: Shay
authors.forename: Robert
authors.initials: R
authors.lastname: Wright
authors.forename: Allison C
authors.initials: AC
authors.lastname: Brown
authors.forename: Jasen M
authors.initials: JM
authors.lastname: Kunz
authors.forename: Kathleen E
authors.initials: KE
authors.lastname: Fullerton
authors.forename: James R
authors.initials: JR
authors.lastname: Cope
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Beach
mesh_terms: D005161:Facility Regulation and Control; D006801:Humans; D011633:Public Facilities / Q000331:legislation & jurisprudence* / Q000592:standards; D011634:Public Health; D013551:Swimming Pools / Q000331:legislation & jurisprudence* / Q000592:standards; D014481:United States