Healthy recreational waters Physical hazards: drowning and injuries
16 October 2003 Drowning is one of the unequivocal dangers of recreational
New WHO guidelines should make
recreational waters safer
Recreational water activities can have
substantial benefits to health and well-
being. Swimming pools, beaches, lakes, rivers and spas
provide environments for rest and relaxation, physical
activity, exercise, pleasure and fun. Yet they also present
risks to health. Polluted and unsafe recreational waters can
lead to infections, exposure to chemicals, injuries and death.
New WHO Guidelines for safe recreational water
environments are aimed at reducing bathing-related death
and disability, and making beaches and recreational waters
safer places to relax, exercise and have fun.
Recreational waters for positive health
Water-based recreational activities have long been
recognized as having a positive influence on health and well-
being. Since ancient times, bathing in mineral waters has
been reputed to cure a variety of illnesses. While there have
been few scientific studies of these postulated effects, there
is no doubt of the benefits of warm water therapy in pain
relief, joint mobility and relaxation.
These days, more and more people are taking up
recreational activities in and around water, and these are an
important part of leisure and tourism around the world.
Swimming is recognized as one of the most beneficial forms
of exercise and is also an important therapy for
rehabilitation after operations such as hip replacements.
Hazards of recreational water use
Water-based recreation, however, can expose people to a
variety of health risks, which vary according to the type of
water, geographical location and local conditions. These are
linked to physical, microbial and chemical hazards.
- Display warnings and water safety instructions
- Improve pool design for safety
water use. An estimated 400 000 people drown each
year(1). In children, drowning is one of the leading causes of
accidental deaths (more information on drowning).
Most cases of drowning are
the result of drinking
alcohol or poor supervision.
In seas and rivers, tides and
currents are also important
hazards and can cause even
strong swimmers to drown. In spas and pools, drowning can
result from hair or body parts getting caught in inlets and
outlets. The clarity of the water can also be a factor. In
murky water, people may not see that someone needs help.
Overcrowded swimming areas present a similar problem.
Water-based recreational activities can also result in a
variety of injuries. Diving or jumping into waters of unknown
depth can lead to serious injuries, including spinal injury,
which may ultimately result in paraplegia or quadriplegia.
Diving into shallow water is the most common cause of
spinal injuries. More common, but usually less severe, are
injuries arising from discarded glass, cans and needles on
beaches or near bathing areas, or injuries from slipping on
wet surfaces around pools.
Reducing the risk of drowning and injuries – some
solutions
- Educate children and adults about the risks of water
activities, including basic life saving and first aid techniques
- Supervise children and weak swimmers at all times in or
near to swimming areas and water bodies
- Teach children to swim
- Keep beaches clean
- Install fencing around pools
Reducing the risk of drowning and injuries – some
solutions
:: Educate children and adults about the risks of water
activities, including basic life saving and first aid techniques
:: Supervise children and weak swimmers at all times in or
near to swimming areas and water bodies
:: Teach children to swim
:: Keep beaches clean
:: Install fencing around pools
:: Display warnings and water safety instructions
:: Improve pool design for safety.
Cryptosporidium oocysts
Microbial hazards: infections
Millions of litres of raw or
partially-treated sewage are
pumped into seas every day,
polluting the environment and resulting in an estimated 250
million cases of bathing-related gastroenteritis and upper
respiratory disease each year. Pathogenic viruses and
bacteria such as Escherichia coli O157 are commonly found
in untreated sewage, rendering swimmers, surfers, and
children, at risk from infection.
While the water quality in swimming pools and spas is
generally well-monitored, there may be outbreaks of
disease due to contamination. The majority of outbreaks are
caused by viruses or bacteria linked to faecal contamination.
An increasing number of infections are associated with
protozoa such as Giardia and Cryptosporidium, which are
resistant to commonly used pool disinfectants. Spas present
particular risks and require particularly stringent monitoring,
as the warm, nutrient-containing, aerobic waters provide an
ideal habitat for bacteria to proliferate.
Reducing the risk of infections – some solutions
:: Employ effective sewage discharge procedures
:: Implement beach management and award schemes
:: Set international norms, standards and limits for microbial
levels in seas, lakes and rivers
:: Apply appropriate levels of chlorine or other disinfectants
to pools
:: Empty, disinfect and clean pools, and filter pool water in
cases of accidental faecal release
:: Encourage pre-swim showering, toilet use and good
hygienic behaviour at pools and spas
:: Monitor pH, disinfectant levels and other parameters
frequently as part of a routine pool and spa maintenance
schedule
:: Clean spas and spa filters regularly.
Chemical hazards
Chemical contamination of seas and rivers arises principally
from direct waste discharge (e.g. industrial effluent) or
chemical spills, and is typically local or regional in nature.
Chemicals found in swimming pools and spas include those
related to water treatment (disinfectants and their by-
products), and those that come from swimmers (soap
residues, cosmetics, suntan oil). Disinfectant by-products,
such as chloroform, are produced from chemical reactions
between the disinfectants and organic or inorganic material
in the water. Little is known about the adverse effects of
exposure to chemical contaminants, although there is
concern about the possible long-term toxicological effects.
regulatory agencies, and the tourist industry. WHO’s
principal role in improving the safety of recreational water
Reducing the risk of chemical exposure – some solutions environments is to develop, publish and help implement
::Monitor and regulate industrial effluents guidelines for use by national and local authorities. Based on
::Develop damage limitation action plans in the event of a critical review of the available scientific evidence and
chemical spills representing views of world experts, the purpose of the
::Ensure good ventilation in rooms housing pools and spas guidelines is to ensure that recreational water environments
::Encourage pre-swim showering and good hygienic are as safe as possible in order for the most people to get
practices the maximum benefit.
::Monitor pH, disinfectant levels and other parameters Water is the essence of life. Without water, we cannot live
frequently as part of a routine pool and spa maintenance for more than a few days. The desperate need to improve
schedule. access to safe drinking water in many parts of the world
means that the recreational role of water is not seen as a
Tropical waters health priority. Yet children will play in water whether it is
safe or not, and the use of water for relaxation, exercise and
Recreational waters in the tropics and subtropics pose pleasure will continue to grow. It is essential, therefore, to
special hazards, not just from some of the local aquatic or ensure that recreational bathing becomes safer and
amphibious predators such as crocodiles, but also from a healthier.
number of tropical diseases. First and foremost is
(1) This number includes accidental drowning and
schistosomiasis or bilharzia, a disease caused by parasitic
submersion, but excludes drowning due to floods, water and
worms. The complex life-cycle requires the parasites to
other transport accidents, assaults and suicide.
spend part of their development inside aquatic snails found
in freshwater lakes and streams. Infectious larvae are shed
by the snails and penetrate the skin of people wading into or
bathing in the water. The parasites then lodge as adults in
people’s veins around the intestines and liver, or around the
bladder. Children and adolescents are particularly
vulnerable to schistosomiasis as they frequently play or
bathe in unsafe water in hot tropical climates (more
information on schistosomiasis).
Healthy recreational waters: WHO’s role
The health aspects of
recreational water use are
attracting increasing attention
by members of the public,
concerned professionals,
 12. What does it mean to have high or low alkalinity?

NAME OF RESORT: ___________________________

1. How many tourists visit the resort monthly?

2. How does the number of tourists affect the

environmental issues the resort will have?

3. How often do you change the water in your pool?

4. How would you control a pool's pH and total

alkalinity?

5. What substances or chemicals do you add to your

pool? Why?

6. What measures do you usually do in order to maintain

the water quality in your swimming pool?

7. How often do you check the pH and chlorine levels of

your pool?

8. How much chlorine do you put in your pool?

9. What tests do you usually do in order to know if your

pool is off balance?

10. What are your rules to maintain the cleanliness of

your facilities/pool?

11. What are the penalties if a customer or a visitor failed

to abide your rules and regulations?
 7. What improvements to the swimming pool and its 14. What improvements to the swimming pool and its
facilities do you suggest to be made? facilities do you suggest to be made?
________________________________________ ________________________________________

Name (optional):___________________ Name (optional):___________________ Name (optional):___________________

Age:______________ Age:______________ Age:______________
Address:__________________________ Address:__________________________ Address:__________________________

Please answer the following questions Please answer the following questions Please answer the following questions

1. How often do you visit this resort? 8. How often do you visit this resort? 15. How often do you visit this resort?

_ Once-Twice a month _ Once-Twice a month _ Once-Twice a month

_Thrice- 4x a month _Thrice- 4x a month _Thrice- 4x a month

_ Once a every 6 months _ Once a every 6 months _ Once a every 6 months

_ Once -Twice a year _ Once -Twice a year _ Once -Twice a year

2. What is the reason why you chose to visit this resort 9. What is the reason why you chose to visit this resort 16. What is the reason why you chose to visit this resort

and not other resorts? and not other resorts? and not other resorts?

_ Cleanliness _ Cleanliness _ Cleanliness

_Variety of pools _Variety of pools _Variety of pools

_ Location is near from home _ Location is near from home _ Location is near from home

State other reasons:__________________________ State other reasons:__________________________ State other reasons:__________________________

3. How likely are you to recommend this recreational 10. How likely are you to recommend this recreational 17. How likely are you to recommend this recreational

facility to other people? _1 _2 _3 _4 _5 facility to other people? _1 _2 _3 _4 _5 facility to other people? _1 _2 _3 _4 _5

4. Do you think that the pools have enough chlorine & 11. Do you think that the pools have enough chlorine & 18. Do you think that the pools have enough chlorine &

other disinfectants in them? _ Yes _No other disinfectants in them? _ Yes _No other disinfectants in them? _ Yes _No

5. Do the resort have staffs that filter the water when 12. Do the resort have staffs that filter the water when 19. Do the resort have staffs that filter the water when

there are floating things on the pool regularyly? there are floating things on the pool regularyly? there are floating things on the pool regularyly?

_ Yes _ No _ Yes _ No _ Yes _ No

6. On a scale of 1-10, how would you rate this resort 13. On a scale of 1-10, how would you rate this resort 20. On a scale of 1-10, how would you rate this resort

based on its cleanliness of water facilities? _____ based on its cleanliness of water facilities? _____ based on its cleanliness of water facilities? _____
21. What improvements to the swimming pool and its
facilities do you suggest to be made?
________________________________________