3,107 public swimming pools, including spas and wading pools, in Houston during 2016. We defined a public swimming pool as one that is intended to be used collectively by people for swimming or bathing. This clas- sification included a swimming pool owned or operated as part of a multifamily dwelling project, nonprofit recreational facility, hotel, educational facility, or fitness center (Hous- ton Health Department, 2023a). In 2021, Houston had a population of 2.29 million (U.S. Census Bureau, 2021). The Houston Health Department regulates public pools and spas through enforcement of Chapter 43 of the City of Houston Code of Ordinances (City of Houston, 2023). The code was adopted from the Texas Administra- tive Code (Public Swimming Pools and Spas, 2023), Texas Health and Safety Code (Pool Yard Enclosures, 1994), and International Code Council, Inc. (2018). The ordinance ensures that aquatic facili- ties provide a clean, healthy, and safe envi- ronment for the public by protecting against waterborne illness and preventing drowning. The pool safety inspection consists of safety and administrative elements (Houston Health Department, 2019). All public pools, includ- ing multifamily and community swimming pools, require an annual inspection. More frequent inspections occur when safety viola- tions are discovered at the time of inspection or in response to a complaint. The city also lists critical violations that can result in immediate closure of the swim- ming pool (Houston Health Department, 2019). If uncorrected, these violations can be life-threatening. Private single-family resi- dential swimming pools are not subject to annual safety inspections by the city but can be inspected when requested by the owner. These pools were excluded from our study. Our study did not involve human subjects. Patients or the public were not involved in the design, conduct, reporting, or dissemina- tion plans of our research. Inspection Data Inspection data of all registered commercial swimming pools within the city limits of Houston were obtained from the Houston Health Department (HHD). Data included name and address of the property where the pool was sited, housing type (e.g., apartment, spa, city pool, club, condominium, commu-
TABLE 1
Comparison of the Model Aquatic Health Code (MAHC) and City of Houston Safety Codes and Violation Points
Safety Code
MAHC Violation Points
City of Houston Violation Points
Pool and spa
Enclosure in good repair
10 10 10
10 10 10
Self-closing/self-latching gates Protected overhead electrical wires
Grab rails, ladders secured; shell, deck in good repair
5 5 5 5
5 5 5 5
Float/safety line clearly present
Depth and no diving markers; stair stripes; in good repair and visible Skimmers: weirs and baskets installed; clean and operating; covers in good repair
Recirculation inlets functional
5
5
Main drain grate secured in place and in good repair
10 10
10 10
Water is clear, main drain visible
Starting blocks removed, covered, or access blocked Pool deck free from obstructions; emergency exit marked Emergency phone or other communication device available and well-marked
5 5 5
5 5 5
First aid kit available
5
5
Appropriate safety equipment present and in good repair
10 10
10
Adequate supervision of the facility
*
Signs: bathing load, rules, chemicals, and spa legible and in good repair
5
5
Spa temperature ≤104 ºF (40 ºC)
10
10
Water chemicals Approved NSF/ANSI Standard 50 DPD test kit
5
5
Proper disinfectant level pH between 7.2 and 7.8 Combined chlorine <0.4 ppm
10 10
10 10
5 5
* *
Cyanuric acid ≤100 ppm
continued on page 10
few other counties and states have adopted the MAHC (Hlavsa et al., 2016). The City of Houston, Texas, has not adopted the MAHC and instead uses a Code of Ordinances to reg- ulate the safety of city swimming pools (City of Houston, 2023). The primary aim of our study was to develop a grading system for swimming pool safety for Houston by applying the MAHC to city swimming pool inspection data. We hypothesized that by using a safety grading
system for public aquatic facilities, it would be possible to disseminate swimming pool safety information to guide injury-prevention measures and inform pool operators and the public about problematic pools.
Methods
Study Design and Setting We conducted a cross-sectional study of swimming pool safety inspection data for
9
July/August 2023 • <B?;.9 <3 ;C6?<;:2;A.9 2.9A5
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