This presentation covers an outbreak investigation initiated after the December 26, 2006 report of a child hospitalized in a pediatric intensive care unit for severe chemical epiglottitis and laryngotracheobronchitis after swimming in a state-licensed indoor, motel swimming pool managed by an uncertified operator with no verifiable training. After this complaint, the pool was inspected by the Nebraska Department of Health and Human Services and immediately closed on the basis of multiple violations. An outbreak investigation was initiated and the results indicated that at least 24 persons experienced illness and the outbreak was likely the result of exposure to toxic levels of chloramines that accumulated in the air in the enclosed space around the poorly managed pool. Chloramines are irritating disinfection by-products formed when free chlorine, a common disinfectant used in swimming pools, combines with human wastes (e.g. sweat, urine) that accumulate in pool water. This outbreak underscores the potential risks from chemical exposure at poorly maintained pools and the need for properly trained pool operators to maintain overall pool water quality and enhance swimmer safety. In response to the motel pool-associated outbreak that caused illness in at least 24 persons, the NDHHS Office of Epidemiology initiated a cross-sectional study to evaluate the associations between operator certification and chemistry violations on the basis of Nebraska state regulations. Simply stated, we asked the question, are public pools without a requirement for certified operators more or less likely to have chemistry violations than pools with a certification requirement? Previous studies have recommended standard, mandatory education for all public pool operators but substantiating data is limited. In Nebraska, certification is not mandated by law in 91 counties for operators of non-municipal pools such as those located in motels, hotels, and apartment complexes. Certification for similar pools is required in Douglas County and the City of Lincoln. Using 2005–2006 statewide pool-inspection reports, we evaluated water chemistry violations by comparing pools in these locations with and without certified operator requirements. Our results demonstrate with significance that pools without certified operators are more likely to have water chemistry violations than those with certified operators and might pose greater health risks as a result. Bryan F. Buss, DVM, MPH is a Lieutenant Commander in the United States Public Health Service assigned as an epidemiologist to the Center's for Disease Control and Prevention (CDC) Epidemic Intelligence Service (EIS). His duty station is the Office of Epidemiology in the Nebraska Department of Health and Human Services (NDHHS). Dr. Buss received a BS degree in Animal Science from the University of Nebraska-Lincoln in 1985 and his Doctor of Veterinary Medicine (DVM) degree from Iowa State University in 1989. After nearly 16 years of veterinary practice, he returned to college to pursue a new career direction in public health. In 2005, Dr. Buss earned a Master of Public Health (MPH) degree from the University of Iowa while working for the Center for Food Security and Public Health (CFSPH) at Iowa State University. Upon completion of his MPH, he continued his work with the CFSPH; he produced educational materials and provided information for both professionals and the general public to increase national preparedness for accidental or intentional introduction of disease agents that threaten both food production and public health in the United States. In July 2006, Dr. Buss began a two-year assignment as an officer in the CDC EIS Program, often called CDC's disease detective group. During his first year of EIS, he conducted field investigations in response to outbreaks of norovirus and MRSA in four Nebraska schools, and to case reports of cryptosporidiosis, fungal eye infections, and atypical skin illness associated with nail salons. In early 2007, he led an outbreak investigation of illnesses associated with a Nebraska motel swimming pool. The results of this investigation were published in the September 14, 2007 issue of the CDC Morbidity and Mortality Weekly Report (MMWR).
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