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Applying the Model Aquatic Health Code to Grade Swimming Pool Safety in a Large Metropolitan Area
Miguel A. Arroyo, Jr., MD Division of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital Jennifer L. Jones, MS Division of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital Antoine Nguyen University of Houston Rohit P. Shenoi, MD Division of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital
/@A?.0A The Model Aquatic Health Code (MAHC) provides voluntary guidelines that reduce the risk of disease, injury, and drowning at aquatic facilities. Its use varies across state and local jurisdictions. We sought to develop a swimming pool safety grading system in a metropolitan area by applying the MAHC to city swimming pool inspection data. We conducted a cross-sectional study that involved routine inspections of commercial aquatic venues in Houston, Texas, during 2016. We calculated the overall percentage of items in compliance with the MAHC. Next, we graded swimming pools by assigning points based on the MAHC to corresponding swimming pool violations and assigning a letter grade: A = 95–100%; B = 85–94%; C = 75–84%; and fail (F) = <75%. Graded pools were projected onto a map of Houston to geographically sort and visualize their location. There were 3,100 commercial aquatic venues in Houston that were inspected. Venues were graded for safety as: A = 40.2%; B = 0.5%; C = 0%; and F = 59.3%. Swimming pool enclosure violations were most frequent (18.0%). Most swimming pools, irrespective of the degree of pool safety violations, were located in the Southwest section of Houston. Overall, the MAHC can be applied to grade swimming pool safety in jurisdictions where it has not been adopted. The degree of safety violations can be spatially demonstrated to inform injury-prevention measures.
recommends multiple layers of protection to prevent drowning (Denny et al., 2021). Waterborne diseases, drowning, falling, div- ing, chemical use, and suction injuries are major recreational water illnesses and inju- ries (RWIs) associated with public aquatic facilities, particularly for young children. Between 2000–2014, there were 493 out- breaks of waterborne diseases associated with treated recreational water that resulted in at least 27,219 cases and 8 deaths (Hlavsa et al., 2018). Additionally, between 2003–2012 there were an estimated 4,247 emergency department visits for swimming pool chemi- cal-related injuries (Hlavsa et al., 2014). State and local agencies regulate safety at public aquatic facilities, as there is no fed- eral regulatory authority responsible for the design, construction, operation, mainte- nance, and management of public pools and hot tubs/spas. Public pool codes for prevent- ing and responding to RWIs are developed, reviewed, and approved by state and local public health ocials or legislatures and thus can vary among local and state jurisdictions. In 2007, the Centers for Disease Control and Prevention (CDC, 2023a) developed the Model Aquatic Health Code (MAHC) to provide guidance to local and state agencies regarding the design, operation, and main- tenance of public aquatic facilities to reduce RWIs. As a result, 25 jurisdictions located in the 5 states with the highest estimated counts of public aquatic venues—Arizona, Califor- nia, Florida, New York, and Texas—and a
Introduction Drowning is the leading cause of uninten- tional injury death in U.S. children 1–4 years (National Center for Injury Prevention and Control, 2018). In children, swimming pools account for 33% of fatal drownings (Clemens et al., 2021) and 65.7% of nonfatal submer- sions in the U.S. (Felton et al., 2015). During 2017–2019, an average of 6,700 pool- or spa- related nonfatal drowning injuries treated in
hospital emergency departments occurred each year in children <15 years; each year, an estimated 76% occurred in children <5 years (Yang, 2020). The risk of submersion is 2.7 times higher for a child at a multifamily residence com- pared with a single-family residence and 28 times more likely in a multifamily swimming pool than a single-family pool (Shenoi et al., 2015). The American Academy of Pediatrics
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