The Model Aquatic Health Code

In recent decades, public health practitioners have seen a dramatic increase in waterborne disease outbreaks associated with public disinfected AQUATIC FACILITIES (e.g. swimming pools, water parks, etc.). As a result, public health investigations have revealed that many diseases can be prevented by proper maintenance and water treatment and by more modern disease prevention practices. Drowning and falling, diving, chemical use, and suction injuries continue to be major public health injuries associated with public AQUATIC FACILITIES, particularly for young children. In this context, the health and safety at public AQUATIC FACILITIES is regulated by state and local jurisdictions since, in the United States, there is no federal regulatory authority responsible for these public AQUATIC FACILITIES. All public pool codes are developed, reviewed, and approved by state and/or local public health officials or legislatures. Consequently, there is no uniform national guidance informing the design, construction, operation, and maintenance of public swimming pools and other public disinfected AQUATIC FACILITIES. As a result, the code requirements for preventing and responding to recreational water illnesses (RWIs) and injuries can vary significantly among local and state agencies. State and local jurisdictions spend a great deal of time, personnel, and resources creating and updating their individual codes on a periodic basic.

Based on illness tracking data, outbreak reporting, and stakeholder feedback, CDC believed further prevention-oriented planning and action were needed. CDC worked with the Council of State and Territorial Epidemiologists to get agreement on the need for a national workshop to develop guidance for preventing future RWI outbreaks. This CSTE position statement was passed in 2004 and CDC was tasked with organizing the national workshop, which was held in 2005.

This document does not address all safety or public health concerns associated with its use. It is the responsibility of the user of this document to establish appropriate health and safety practices and determine the applicability of regulatory limitations prior to each use.

In the absence of exceptions or further guidance, all fixtures and equipment shall be installed according to original manufacturer intent.

The MAHC refers to existing local codes in the jurisdiction for specific needs. In the absence of existing local codes, the authority having jurisdiction should specify an appropriate code reference.

Large numbers of recreational water-related outbreaks are documented annually, which is a significant increase over the past several decades.

Cryptosporidium causes a diarrheal disease spread from one person to another or, at aquatic venues, by ingestion of fecally-contaminated water. This pathogen is tolerant of CHLORINE and other halogen disinfectants. Cryptosporidium has emerged as the leading cause of pool-associated outbreaks in the United States.

Drowning and falling, diving, pool chemical use, and suction injuries continue to be major public health injuries associated with aquatic facilities. Drowning is a leading cause of injury death for young children and a leading cause of unintentional injury death for people of all ages.

Pool chemical-related injuries occur regularly and can be prevented if pool chemicals are stored and used as recommended.

All POOL CODES in the United States are reviewed and approved by state and/or local public health officials with no uniform national public health STANDARDS governing design, construction, operation, maintenance, policies, or management of public swimming pools and other public AQUATIC FACILITIES. The effort to create the MAHC stems from a CDC-sponsored national workshop called "Recreational Water Illness Prevention at Disinfected Swimming Venues" that was convened on February 15-17, 2005, in Atlanta, Georgia. The workshop assembled persons from different disciplines working in state, local, and federal public health agencies, the aquatics sector, and academia to discuss ways to minimize the spread of recreational water illnesses at disinfected AQUATIC FACILITIES. The major recommendation from this workshop was that CDC lead a national partnership to create an open access model guidance document that helps local and state agencies incorporate science and best practices into their swimming POOL CODES and programs without having to "recreate the wheel" each time they create or revise their POOL CODES. The attendees also recommended that this effort be all-encompassing so that it covered the spread of illness but also included drowning and injury prevention. Such an effort should increase the evidence base for AQUATIC FACILITY design, construction, operation, and maintenance while reducing the time, personnel, and resources needed to create and regularly update POOL CODES across the country. Since 2007, CDC has been working with the public health sector, the aquatics sector, and academic representatives from across the United States to create this guidance document. Although, the initial workshop was responding to the significant increases in infectious disease outbreaks at AQUATIC FACILITIES, the MAHC is a complete AQUATIC FACILITY guidance document with the goal of reducing the spread of infectious disease and occurrence of drowning, injuries, and chemical exposures at public AQUATIC FACILITIES. Based on stakeholder feedback and recommendations, CDC agreed that public health improvements would be aided by development of an open access, comprehensive, systematic, collaboratively developed guidance document based on science and best practices covering AQUATIC FACILITY design and construction, operation and maintenance, and policies and management to address existing, emerging, and future public health threats.

The Model Aquatic Health Code’s (MAHC) vision is “Healthy and Safe Aquatic Experiences for Everyone”. The MAHC’s mission is to incorporate science and best practices into guidance on how state and local officials can transform a typical health department pool program into a data-driven, knowledge-based, risk reduction effort to prevent disease and injuries and promote healthy recreational water experiences. The MAHC will provide local and state agencies with uniform guidelines and wording for the areas of design and construction, operation and maintenance, and policies and management of swimming POOLS, SPAS and other public disinfected AQUATIC FACILITIES.

The availability of the MAHC should provide state and local agencies with the best available guidance for protecting public health using the latest science and best practices so they can use it to create or update their swimming POOL CODES.

The MAHC development process created comprehensive consensus risk reduction guidance for AQUATIC FACILITIES based upon national interaction and discussion. The development plan encompassed design, construction, alteration, replacement, operation, and management of these facilities. The MAHC is driven by scientific data and best practices. It was developed by a process that included input from all sectors and levels of public health, the aquatics sector, academia, and the general public. It was open for two 60-day public comment periods during the process. It is national and comprehensive in scope and the guidance can be used to write or update POOL CODES across the U.S.

The MAHC is an open access document that any interested individual, agency, or organization can freely copy, adapt, or fully incorporate MAHC wording into their aquatic facility oversight documents. As a federal agency, CDC does not copyright this material.

The MAHC will be updated on a continuing basis through an inclusive, transparent, all-stakeholder process. This was a recommendation from the original national workshop and is essential to ensure that the MAHC stays current with the latest science, industry advances, and public health findings. To support this recommendation, CDC has supported creation of the Conference for the Model Aquatic Health Code (CMAHC; www.cmahc.org), a 501(c)(3) non-profit organization, to facilitate collecting, assessing, and relaying national input on needed MAHC revisions back to CDC for final consideration for acceptance.

Regulatory agencies like state and local governments have the authority to regulate AQUATIC FACILITIES in their jurisdiction.