Tracynda Davis, M.P.H.,
Director of Environmental Health Programs, National Swimming Pool Foundation
MAHC Steering Committee
Centers for Disease Control and Prevention
Model Aquatic Health Code
CDC’s Model Aquatic Health Code (MAHC)

MAHC Genesis and Beginnings

MAHC Genesis
CDC-sponsored workshop, 2005
“Recreational Water Illness Prevention at Disinfected Swimming Venues”; Atlanta, Georgia
Recommendation #1
Create a national model code with broad input
Include disease, injuries, & drowning prevention
Make it data-driven, knowledge-based
Write for health jurisdictions to use as needed to create local code(s)
Update regularly based on new data
Give open access to all users

MAHC Vision and Objective
“
The MAHC is a user-friendly, knowledge-based, and scientifically supported document for reducing risk and promoting healthy recreational water use

Adoption of the MAHC transforms existing state & local codes into a uniform set of codes that ensure the health and safety of the swimming public

MAHC Scope

All areas of public health concern
Illness, injury, drowning
Public venues
Water, air, & facility exposures that impact the health of swimmers and facility users
Leave other areas to building codes, etc.

Facility types
Man-made, treated water venues
Health care-based pools
Therapy pools

MAHC Building Blocks
Data or best practices driven
Avoid prescription when possible
Free and accessible for all
Posted on CDC’s Healthy Swimming website
Implementable
Incremental change: “Evolution, not revolution"
Updated regularly
Model after the Conference for Food Protection, which regularly updates the model food code
Easy to understand
Code section accompanied by “Annex” that includes data and rationale for code requirements

MAHC Implementation

Create the MAHC as outlined
Federal, non-regulatory, non-enforceable model
Promote the MAHC to state & local health authorities
Support state & local health departments adopting all or parts of the MAHC into their codes
MAHC components spread into codes across U.S.
It won’t occur overnight
CDC fecal accident recommendations published in 2000 took about 5-10 years to be adopted into most codes in U.S.
MAHC creation facilitates fixing public health problems without the need for VGB-like legislation

Dispelling Myths: MAHC and VGB

MAHC and ICC/APSP Code Efforts
Where should pool code be written and enforced?
Public health (PH) or building code (BC) inspectors
PH already regulates pools so dual regulatory authority would be confusing for all
Don’t need to re-invent plumbing, fire, construction codes---MAHC refers to BC where appropriate
PH issues with hygiene, recirculation, ventilation, water quality should be written, reviewed, & enforced by PH
Enforcement requires that PH has full input and oversight into construction details via plan review
PH should have final voice in decisions that require ongoing enforcement

MAHC Outcomes:
Intermediate Term

Improved operations
Adoption of minimum standards across the U.S. (as with national food safety and building model codes)
Systems-based approach to facility design, operation, maintenance, policy
Reductions in code violations
Improved pool programs
Improved surveillance systems
Improved data collection
Data-based decision making

MAHC Outcomes: Long Term


Extensive research agenda
Prioritize data needed to drive MAHC changes
Drive fund raising efforts

Long-term outcome
Reductions in RWIs, injuries, drowning

MAHC Process

MAHC Steering Committee

Director: Douglas Sackett, New York State Dept. of Health
Michael Beach, Centers for Disease Control & Prevention
Chip Cleary, International Association of Amusement Parks and Attractions
Tracynda Davis, National Swimming Pool Foundation, representing NEHA
Jim Dunn, Aquatic Development Group
John Linn, SeaWorld Parks & Entertainment
Colleen Maitoza, County of Sacramento Environmental Management Department
Chuck Neuman, Water Technology, Inc.
Charles Otto, Centers for Disease Control & Prevention
Bob Vincent, Florida Dept. of Health

MAHC Technical Committees
Contamination Burden
Chairperson: Ellen Meyer
Disinfection & Water Quality
Chairperson: Jim Dingman
Facility Design & Construction
Chairperson: Carl Nylander
Facility Maintenance & Operation
Chairperson: Michael Beatty
Hygiene Facilities
Chairperson: Ralph Cordell
Lifeguarding/Bather Supervision
Chairperson: M. Kathryn Scott
Monitoring & Testing
Chairperson: Sung Choe

Operator Training
Chairperson: Dennis Berkshire
Recirculation Systems & Filtration
Chairperson: James Amburgey
Regulatory Program Administration
Chairperson: Frank Guido
Risk Management/Safety
Chairperson: Amy Duck
Ventilation & Air Quality
Chairperson: Franceen Gonzales
Forming 13th Committee: Implementation and Promotion

MAHC Process and Status
12 modules in various degrees of SC review
Post modules as ready for 60-day public comment
www.cdc.gov/healthywater/swimming/pools/mahc/structure-content
Revise modules based on public comments and post for viewing or adoption (not for public comment)
Following public comment & revision of all modules
Blend all 12 modules into complete MAHC
Post for another 60-day comment period to allow reviews to occur in the context of all other modules
Revise based on public comments
Post complete MAHC
Revise regularly through a new process like that used for U.S. model food code

MAHC: Status of Module Development

Modules released for public comment
Operator Training
Public comments addressed; updated & posted
Ventilation & Air Quality
Public comments received; TC addressing
Risk Management and Safety
Public comments received
Facility Maintenance & Operation
Public comments received
Hygiene Facilities
Public comments received
Regulatory Program Administration
Disinfection and Water Quality
Open for comments until 4/27/2012

MAHC: Status of Module Development

Modules undergoing final discussions between Steering Committee and Technical Committees:
Contamination Burden
Facility Design & Construction
Lifeguarding/Bather Supervision

Modules in final development:
Recirculation Systems & Filtration
Monitoring & Testing

Operator Training Module


Increased pool code violations have been linked to the lack of pool operator training

Violations may also be linked to an increased potential for health effects if a facility is not operated and maintained appropriately

The Operator Training Module is a first step towards assuring adequate training for all personnel who operate aquatic facilities

Operator Training Module
Key Elements

Operator Training contains requirements for:
Training course elements to be included in curricula
Instructor qualifications
Training certificate to be for 5 years maximum
The Regulatory Program Administration Module will require trained operators for all aquatic facilities (outlines facilities requiring on-site vs. off-site operators)

Ventilation & Air Quality Module

Health issues related to indoor pool use and associated poor water and air quality are increasingly being documented

The Ventilation & Air Quality Module is a first step towards improving air quality at indoor aquatic facilities and reducing associated health effects

Ventilation & Air Quality Module
Key Elements

The Ventilation & Air Quality Module has requirements for new or modified construction that include:
Properly designed air distribution system
Increased make-up air required above that required in the ASHRAE 62 standard for indoor pools
Determination of the extra make-up air needed is based on the indoor venue water use type (e.g., flat water, agitated water, or hot water) and venue or deck patron density (square feet/person)

Ventilation & Air Quality Module
Key Elements

The Ventilation & Air Quality Module has requirements for new or modified construction that include (continued):
Inclusion of additional make-up air from surge tanks or gutters that introduce fresh air
Development and implementation of plans to reduce combined chlorine in indoor facilities and inform facility patrons of the health impact

Ventilation & Air Quality Module
Key Elements

The Ventilation & Air Quality Module has requirements for new or modified construction that include (continued):
Design requirements for temperature & humidity:
System must maintain average relative humidity at <65% in a 24-hour period when occupied
System must maintain air temperature no more than 8°F above or 2°F below the average venue water temperature (not to include venues designed to exceed 90°F)

Risk Management & Safety Module

Increased vigilance is needed at aquatic venues to reduce injuries in the water, chemical storage room, and around the facility and pools

The Risk Management & Safety Module outlines steps to be taken to manage and reduce these risks and associated health problems

Risk Management & Safety Module
Key Elements

The Risk Management & Safety Module contains new guidelines covering:

Controlled access aquatic venues (e.g., lazy rivers) not requiring depth markers throughout
Expanded employee training to cover fecal- and vomit-related pathogen response and clean-up
Potential sources of glare and ways to prevent glare in aquatic venue design
Consideration of water temperature and patron use

Risk Management & Safety Module
Key Elements


The Risk Management/Safety Module contains new guidelines covering (continued):

Expanded chemical storage and handling
Use of remote monitoring systems
Employee illness policies
Inspection items for daily opening and closing of aquatic features or venues

Facility Maintenance & Operation Module

Aquatic facility operation and maintenance is a critical component of maintaining health and safety

Past outbreaks have commonly found operation and maintenance lapses to be critical contributors to disease outbreaks and injuries

Facility Maintenance & Operation Module
Key Elements

The Facility Maintenance & Operation Module lays the foundation for operational improvement by containing requirements for:

Closure and reopening guidance for long and short term closures
Comprehensive plans for preventive maintenance, equipment inventorying, and development of an operations manual to be maintained at the facility

Facility Maintenance & Operation Module
Key Elements

The Facility Maintenance & Operation Module lays the foundation for operational improvement by containing requirements for (continued):

Reducing and mitigating excessive glare and reflection on the pool surface through adjustments to windows and lighting equipment
Comprehensive daily records of pool operation & maintenance and of operational items inspected daily

Hygiene Facilities Module

Swimmer hygiene is a critical component that plays a role in documented waterborne disease outbreaks and poor water quality

The Hygiene Facilities Module is a first step towards improving swimmer hygiene and facility water quality to reduce the associated health effects

Hygiene Facilities Module
Key Elements

The Hygiene Facilities Module contains requirements for new or modified construction that include:
Minimum distances for hygiene facilities from aquatic venues
Diaper changing stations to include changing units, adjacent sinks, soap dispenser, handless trash receptacle, and disinfectant products for cleaning
Implementation of rinse vs. cleansing showers
Rinse shower: rinse by pool to reduce contaminants
Cleansing shower: in bathhouse with warm water and soap
Rinse showers can offset cleansing showers by 3:1 ratio

Regulatory Program Administration Module

Regulatory guidance forms the framework from which an effective model aquatic health code is built

The Regulatory Program Administration Module follows best practice and research-based protocol to ensure the aquatic facility is operating safely

The guidance reflected in this module ensures all parties are working together from the initial building permits to the health code enforcement process

Regulatory Program Administration Module
Key Elements

The Regulatory Program Administration Module contains requirements including but not limited to:
Establishment of an independent Aquatic Health Advisory Committee
Defining imminent aquatic health hazards and corresponding remediation and enforcement
Establishment of facility staffing requirements based on facility size and type
Trained operators required for all facilities
Outlines facilities requiring on-site vs. off-site operators

Regulatory Program Administration Module
Key Elements

The Regulatory Program Administration Module contains requirements including but not limited to (continued):

Guidelines for plans and permits
Recordkeeping requirements
Swimmer empowerment methods

Disinfection & Water Quality Module

Disinfection and water quality are critical components in maintaining bather health and comfort


Past outbreaks have often found that disinfectant levels and other water quality parameters were not maintained at proper levels

Disinfection & Water Quality Module
Key Elements

The Disinfection & Water Quality Module contains requirements for new or modified construction that include:
Primary disinfection: minimum chlorine/bromine levels required
Secondary disinfection (UV, ozone) for “increased risk” aquatic venues (new/modified construction)
Increased risk pools
Therapy pools, activity pools, interactive features, spray pads, wading pools, and other venues designed primarily for diaper-aged children

Disinfection & Water Quality Module
Key Elements

The Disinfection & Water Quality Module contains requirements that include (continued):

0.4 ppm: maximum level of combined chlorine of
Prohibition of cyanuric acid in:
Indoor facilities
“Increased risk” aquatic venues such as therapy pools, activity pools, interactive features, spray pads, wading pools, and other venues designed primarily for diaper-aged children

Lifeguarding & Bather Supervision Module

Lifeguarding and bather supervision are critical components of bather safety

The Lifeguarding & Bather Supervision Module will help assure adequate training for all personnel who supervise aquatic facilities and that the facility has the necessary equipment and procedures in place for bather supervision and emergency response

Lifeguarding/Bather Supervision Module
Key Elements

The Lifeguarding/Bather Supervision Module will contain requirements including but not limited to:

Lifeguarding training course elements defined
Lifeguard instructor qualifications
Safety training (CPR, AED, etc.)

Lifeguarding/Bather Supervision Module
Key Elements

The Lifeguarding/Bather Supervision Module will contain requirements including but not limited to (continued):

Staffing of lifeguards and attendants
Provision of lifeguard equipment and placement requirements
First aid equipment and facilities
Guidance for unguarded facilities

Facility Design & Construction Module

Design requirements for aquatic facilities vary at the state and local levels

The Facility Design & Construction Module will help bring uniformity to the nation’s aquatic facilities by providing current, science-based design guidelines

Design professionals who work in multiple jurisdictions that adopt the MAHC will be able to follow a single code

Facility Design & Construction Module
Key Elements

The Facility Design & Construction Module will contain requirements for new or modified construction that include:

Physical design and construction requirements of the pool and associated structural facilities, such as filter rooms and chemical storage areas that could impact public health in the future
Identifying typical building code issues (e.g., electrical, plumbing, and structural aspects) and deferring to building codes on these items

What Do We Need From You?
Participation!
Give public comment during 60-day periods
Follow instructions at www.cdc.gov/healthywater/swimming/pools/mahc/structure-content/#submit
Aggregate & synthesize comments within groups
Sending many copies of the same comment does not add value vs. create more work

Give feedback at MAHC@cdc.gov
Give ideas about direction, future needs, research
Ask questions. We will create a MAHC Q&A section

Conclusions: Planning for the Future with MAHC
Higher standards and expectations for operation
Improved technologies & systems-based solutions for:
Microbe inactivation
Chemical by-product reduction
Injury and drowning prevention
Increased scrutiny by public as health issues are highlighted in the media
Strategic planning for future transition and replacement of current MAHC structure
Structure/organization to be developed but likely to follow national Model Food Code example

"The findings and conclusions in this presentation have not been formally disseminated by CDC and should not be construed to represent any agency determination or policy."
Centers for Disease Control and Prevention
National Model Aquatic Health Code Program
More Information: Healthy Swimming Website
http://www.cdc.gov/healthywater/swimming/pools/mahc
Email: MAHC@cdc.gov