inappropriate safety equipment were identi- fied in 5.1% and 12.7% of pool inspections, respectively (Hlavsa et al., 2016). It is known that isolation swimming pool fences reduce the risk of drowning (Thomp- son & Rivara, 1998). As such, the American Academy of Pediatrics recommends a mul- tilayered approach to reduce drowning that includes functioning isolation swimming pool fencing and self-latching and self-clos- ing gates (Denny et al., 2021). We found that pool safety inspections in Houston, as currently conducted, captured 30% fewer swimming pool violations than if the MAHC criteria were used. Almost all of the safety violations observed were indi- vidual violations and <1% of the swimming pools that failed did so because of a low overall score. Many of the items that are not listed in the code used by Houston but that appear in the MAHC pertain to facility hygiene, record- keeping, and unauthorized alterations or replacement of equipment. Except for the lat- ter, which could be potentially dangerous, the first two items pertain to maintaining a clean facility to reduce the transmission of illness and disease and implementing proper aquatic management practices. Other reasons for not including these MAHC items could be that inspections are conducted based on the basic and common certification requirements and therefore these less common requirements might be neglected (National Association of County and City Health Ocials, 2015). Implications Our results have the following implications. Recreational water safety is regulated at the state or local level, and thus there is wide variation in implementing policy and safety practices across jurisdictions. Houston might need to update its inspection criteria to cur- rent MAHC standards and institute best prac- tices for pool safety. There has been a marked increase in rec- reational use of residential and public dis- infected water as leisure time around the pool has increased. Changes in the design of aquatic facilities have occurred and regulatory agencies need to keep abreast of these changes. A legislative approach that includes instituting updated versions of the MAHC would be one solution. There are fiscal implications, how- ever, that will also need to be evaluated.
TABLE 3
Swimming Pool Safety Grades by Establishment After Applying the Model Aquatic Health Code
Establishment
Swimming Pool Safety Grades # (%)
A
B
C 0 0 0 0 0 0 0
F
Total
Multifamily
951 117
14
1,491
2,456 (79.2)
Hotel or motel
1 0 0 0 0 0 0
206
324 (10.5)
Health or fitness facility
52 34 55 25
47 42 20 26
99 (3.2) 76 (2.5) 75 (2.4) 51 (1.6) 13 (0.4)
Club
City or public facility School or day care
Healthcare facility
8 4
5 2
Other
0
6 (0.2) 3,100 (100)
Total
1,246 (40.2)
15 (0.5)
0 (0)
1,839 (59.3)
Note. A = 95–100%; B = 85–94%; C = 75–84%; and F = <75% or noncompliance of a critical element regardless of the total score.
TABLE 4
Frequency of Observed Swimming Pool Violations
Item From the Model Aquatic Health Code (MAHC) Inspection Form Observed by the City of Houston
Observed Violations # (%)
Pool and spa
Enclosure in good repair
729 (18.0) 561 (13.8)
Self-closing/self-latching gates Protected overhead electrical wires
56 (1.4) 34 (0.8)
Grab rails, ladders secured; shell and deck in good repair
Float/safety line clearly present
0 (0)
Depth and no diving markers; stair stripes; in good repair and visible Skimmers: weirs and baskets installed; clean and operating; covers in good repair
136 (3.4)
24 (0.6)
Recirculation inlets functional
0 (0)
Main drain grate secured in place and in good repair
244 (6.0)
Water is clear, main drain visible
88 (2.2)
Starting blocks removed, covered, or access blocked Pool deck free from obstructions; emergency exit marked
5 (0.1)
1 (0.02)
Emergency phone or other communication device available and well-marked
151 (3.7)
First aid kit available
0 (0)
Appropriate safety equipment present and in good repair Signs: bathing load, rules, chemicals, and spa legible and in good repair
374 (9.2)
88 (2.2)
Spa temperature ≤104 ºF (40 ºC)
7 (0.2)
continued on page 14
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July/August 2023 • <B?;.9 <3 ;C6?<;:2;A.9 2.9A5
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