Welcome to the Model Aquatic Health Code Network Webinar In Indoor Air ir Qualit ity and Swimmin ing Facili ilities Featured Presenter: : Ernest R. . Blatchley II III, I, Ph.D .D Tuesday, January 22, 2018 Join the MAHC Network! Email MAHCnet@naccho.org and request to be added to the mailing list. Please use your computer speakers to listen to today’s presentation. Questions may be submitted via the chat box. This webinar is being recorded. We will begin at 1:30 PM Eastern. Thank you for your interest and attendance!
MAHC NETWORK CMAHC UPDATES January 22, 2019 Douglas Sackett, Executive Director Council for the Model Aquatic Health Code
CMAHC UPDATES: ▪ CMAHC Ad Hoc Committee Update- ▪ Indoor Aquatic Facility Ventilation Design and Air Quality ▪ Membership
Indoor Aquatic Facility Air Quality ❑ Issue ▪ Poor indoor air quality has increasingly been linked to health effects ▪ Increased reporting of health events ▪ Large indoor facilities have proliferated ▪ Bather exposure times longer in these facilities ▪ Does not appear that ventilation standards are adequate to keep up with aquatics needs
CMAHC UPDATES Ad Hoc Committee ❑ Indoor Aquatic Facility Ventilation Design and Air Quality ▪ Chair: Ralph Kittler, Seresco ▪ Members: Michael Beach, CDC Douglas Sackett, CMAHC Chip Blatchley, Purdue University Jason Schallock, Anderson Poolworks Jeff Nodorft, Councilman-Hunsaker Stephen Springs, Brinkley Sargent Wiginton Architects James Harrison, GMB HVAC and pool water filtration designer Harry Milliken, retired from Desert-Aire Gary Lochner, Innovent Sandy Kellogg, Fairfax County Park Authority Don Baker, Paddock Pools
CMAHC UPDATES Ad Hoc Committee ❑ Indoor Aquatic Facility Ventilation Design and Air Quality ▪ Objectives and Outcomes ▪ Identify and assess the factors affecting air quality at indoor aquatic facilities, including: – Air handling/air distribution system design, effectiveness, and operation – Water quality/water chemistry – Pool water treatment operation and maintenance – Pool types (flat water, agitated water, water features, hot water) » Evaporation rate calculation. – Bather load – Spectator areas
CMAHC UPDATES Ad Hoc Committee ❑ Indoor Aquatic Facility Ventilation Design and Air Quality ▪ Objectives and Outcomes (continued) • Review and evaluate current Model Aquatic Health Code (MAHC) requirements to determine if identified factors affecting air quality are adequately addressed. • Develop revisions to the MAHC design and operational standard/best practice recommendations and corresponding Annex content to address ventilation/air quality design and operational criteria, as appropriate
CMAHC UPDATES Membership ▪ Renew your membership for the 2018-2020 Conference Cycle or join for the 1 st time! (memberships expired Nov. 2017) ▪ https://cmahc.org/membership-signup-form.php
MAHC CMAHC More Information: Search on More Information: Search on “CMAHC” “CDC MAHC” or visit the Healthy or visit the CMAHC Website: Swimming MAHC Website: www.cmahc.org www.cdc.gov/mahc Email: info@cmahc.org Email: mahc@cdc.gov
Contact Information Doug Sackett Executive Director, CMAHC E-mail: DouglasSackett@cmahc.org Phone: 678-221-7218
Indoor Air Quality in Swimming Facilities Ernest R. Blatchley III, Ph.D., P.E., BCEE, F. ASCE Lee A. Rieth Professor in Environmental Engineering Lyles School of Civil Engineering and Division of Environmental & Ecological Engineering Purdue University blatch@purdue.edu Presented as a Webinar for the Council for the Model Aquatic Health Code 22 January 2019 11
Overview • Background/motivation • Planned research • Scope of work • Why do we chlorinate pools? • Methods • DBPs in pools and their • Pool selection precursors • Modeling • Health effects of DBP exposure • Expected outcomes in pools • Relationship to other IAQ in • Effects of swimmers on indoor other facility types air quality (IAQ) • Q&A • Physics of DBP transfer from water to air 12
Swimming as Exercise, Recreation, Therapy • Second most common form of exercise in the U.S. • Benefits • Cardiovascular health • Fitness • Used as therapy for a wide range of medical conditions 13
Water Management Systems for Pools • Physical separation for particles • Filter • Membranes • Disinfection/Oxidation • Chlorine is most common • Alternatives • UV • Ozone • Monopersulfate • Combinations Image from: https://www.inyopools.com/Blog/how-a-swimming-pool-works/ 14
Chlorination of Swimming Pools Advantages Disadvantages • Effective against bacteria, • Ineffective against protozoa, viruses especially Cryptosporidium • Powerful oxidant • Disinfection Byproducts (DBPs) • Inexpensive, simple to use From: Hlavsa et al. (2015) E. coli O157:H7 Human Norovirus Cryptosporidium parvum Oocyst “Outbreaks of Image from: Image from: Kniel (2014) “The makings of Illness Associated with Image from: https://www.researchgat a good human norovirus surrogate,” Recreational Water – https://esemag.com/archive/0103/crypto. e.net/figure/E-Coli- Current Opinion in Virology , 4 , 85-90. United States, 2011-2012, html 15 CDC_fig1_311753193 MMWR , 64 , 24, 668-672.
DBPs in Pools • > 100 DBPs identified • Include volatile and non-volatile (polar and ionic) forms • Volatile DBPs • Inorganic chloramines (NH 2 Cl, NHCl 2 , NCl 3 ) • Organic chloramines (CH 3 NCl 2 ) • THMs (CHCl 3 , CHBrCl 2 , CHBr 2 Cl, CHBr 3 ) • Halogenated nitriles (CNCl, CNBr, CNCHCl 2 ) • Present in all chlorinated pools From: Weaver et al. (2009) “Volatile disinfection by -product analysis from chlorinated indoor swimming pools,” Water Research , 43 , 13, 3308-3318. 16
Inorganic Chloramines in Pools: Where Do They Come From? • Only trace quantities of NH 3 in pools • Reduced-N in pools • Urine • Sweat Urea Creatinine Uric Acid 343 mmol/d 12.9 mmol/d 3.0 mmol/d • Urea • Creatinine • Uric acid • Amino acids Arginine Histidine 0.025 mmol/d 1.10 mmol/d Glycine 1.80 mmol/d 17 Free Amino Acids: 5.7 mmol/d
Sources of DBP Precursors in Pools • Urine • 30-35 mL/Bather (Gunkel and Jessen, 1986) (0.6-0.7 g Urea/Swimmer) • 60-78 mL/Bather (Erdinger et al. , 1997) (1.3-1.7 g Urea/Swimmer) • Sweat • Production is Highly Variable • Competitive Swimmers: 1 L/Person/Hour (1.5 g Urea/Swimmer/hr) • Less for others • Natural Moisturizing Factor (NMF) – Skin • Attract and Retain Water from Atmosphere • Amino Acids, Urea, Lactate, … • Easily Removed from Skin with Water Image from: https://jezebel.com/5914953/an-anonymous- (0.2 g Urea/Swimmer) interview-with-a-grown-man-who-pees-in-the-pool Based on values reported by Institute of Sport and 18 Recreation Management (ISRM, 2009)
Health Effects Associated with Chemical Exposure in Chlorinated Pools Bernard et al. (2009) “Impact of Chlorinated Swimming Pool Attendance on the Respiratory Health of Adolescents,” Pediatrics , 124, 4, 1110-1118. “CONCLUSIONS. Our data suggest that infant swimming practice in chlorinated indoor swimming pools is associated with airways changes that, along with other factors, seem to predispose children to the development of asthma and recurrent bronchitis.” 19
Health Effects Associated with Chemical Exposure in Chlorinated Pools Bougault et al. (2009) “The Respiratory Fantuzzi et al. (2013) “Airborne trichloramine Health of Swimmers,” (NCl 3 ) levels and self-reported health Sports Med ., 39 , 4, 295-312. symptoms in indoor swimming pool workers: dose- response relationships,” Journal of “Although swimming is generally beneficial to a person’s overall health, recent data suggest that it may also Exposure Science and Environmental sometimes have detrimental effects on the respiratory Epidemiology , 23 , 88-93. system. Chemicals resulting from the interaction between chlorine and organic matter may be irritating to the “ In conclusion, this study shows that lifeguards and trainers respiratory tract and induce upper and lower respiratory experience ocular and respiratory irritative symptoms more symptoms, particularly in children, lifeguards and high-level frequently than employees not exposed. Irritative symptoms swimmers. The prevalence of atopy, rhinitis, asthma and become significant starting from airborne NCl 3 levels of 40.5 airway hyper-responsiveness is increased in elite swimmers mg/m 3 , confirming that the WHO-recommended value can compared with the general population.” be considered protective in occupational exposure to airborne NCl 3 in indoor swimming pools.” 20
Chiu et al. (2017), “Respiratory and Ocular Symptoms Among Employees of an Indoor Waterpark Resort — Ohio, 2016,” MMWR , 66 66, 37, 986-989. • July 2015: complaints of respiratory and ocular symptoms • January 2016: site visit • Survey of employees • Water, air quality measurements • Chloramines in water* • Endotoxin, microbial causes unlikely • HVAC system problems 21
Health Effects Associated with Chemical Exposure in Chlorinated Pools • Respiratory Problems • Research in US, Europe • > 100 Articles Since 1976 • Asthma, Other Adverse Respiratory Endpoints • Children • Elite Athletes • Swimming Instructors and Lifeguards • Swimming Often Prescribed for Asthmatics • Bladder Cancer (Villanueva et al. [2007] American Journal of Epidemiology , 165 , 148-156). • Linked to THM Exposure • Swimming Enhanced Risk • Eye Irritation 22
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