With the arrival of the May long weekend, the collective mentality changes from concerns of the cold of winter to the aspirations of the warm days of summer. People venture out of the home in search of locales where they can take in the sun and enjoy the warm breezes. Of all the places to which sun seekers migrate, none is as popular as the beach or swimming pool. For many, there is nothing quite like escaping the usual trials of daily activities and becoming one with the water.
Unfortunately, the escape comes with its own challenges, namely that of infections.
All microbes require water and many of the pathogens that cause us grief find a very happy home in the same waters we use to keep ourselves cool and refreshed. Studies have explored the risks associated with taking a dip either at the beach or at swimming pools and fountains and to no surprise, there is an increase in the prevalence of gastrointestinal infections, primarily stomach aches and diarrhea. The main culprits are familiar to us including E. coli, Campylobacter, and norovirus -- and are easily linked to the always infamous fecal-oral route. It's a standard means of spread and despite the fact that it may bring up some rather disgusting mental images, happens more often than many might think.
To prove this, the Centres for Disease Control and Prevention released a study this week where they examined the microbiological quality of swimming pool filters. They looked at 161 samples and found that well over half of them had evidence of E. coli and other infectious agents including the parasitic infections Giardia and Cryptosporidium. The overall risk was dependent on the rate of pool disinfection and bather density, which is based on the practices of the pool owners. However, there was one well-known factor that pointed the finger on the bathers themselves: their hygiene.
The CDC mentions in the paper that while many people do their best to keep their nether regions clean, without a proper shower and soaping before heading into the water, there can be an average of 0.14 g of fecal matter lingering around; that number could be quite higher if the bather is already suffering from diarrhea. That small amount can be washed off in the water, contaminating the pool. Depending on the level of infection, billions of pathogens could end up in the water. The concentration would no doubt be diluted but in the case of norovirus, Campylobacter and E. coli O157:H7, where only a handful of organisms are needed to cause infection, the results could be disastrous.
There are obviously ways to decrease the chances for infection. The first is fairly obvious: don't swim if you are sick. Another reasonable piece of advice is to avoid drinking the water. If ingestion of microbes is prevented, so is the infection. The others require a little more diligence on the part of the bathers to help protect themselves and others. The above-mentioned pre-bathing shower is highly recommended for anyone heading into the waters, even if they contain high levels of chlorine or antimicrobial salts. Also, a shower after a visit to the water is a good way to prevent any lingering germs from getting onto fingers and eventually into the mouth.
Despite the relative simplicity of these rules, they are obviously not being followed. Back in 2008, the State of Utah attempted to find out just how much the public knew about safe swimming. Not surprisingly, most understood the need to stay out of the water when sick and to take those showers before and after. But those numbers were reduced significantly when the questions turned to the nature of the pools themselves. In particular, almost half of the nearly five hundred people taking part believed that the responsibility for the prevention of infection lied squarely on facility management. This suggested that the participants were less likely to assume responsibility and assume that any deviations from personal hygiene would be taken care of by the pool owners.
As a result of these studies and complications, the CDC has developed an entire website devoted to healthy swimming. Their hope is that people will take these recommendations and put them not only to memory, but also to practice. Unfortunately, even the Utah study admitted many of the participants were most likely contravening the rules, even though they knew them. Call it summer brain or rugged individualism, there is little doubt that many of your fellow swimmers will continue to eschew the rules and act as if the swimming pool or beach is their own personal paradise for the enjoying and the polluting.
Yet, there is hope. By understanding the risks and then adhering to these rules, everyone can avoid the consequences of infection and enjoy their swim. More importantly, we can also be assured that those who follow will also have fun and stay safe.