Background: Hotel indoor water parks are a burgeoning industry with 184 facilities in the US employing hundreds of lifeguards with several thousand patrons visiting these parks daily. In January 2007, a local health department requested NIOSH assistance to determine the cause of hundreds of reports of eye and respiratory irritation at a newly opened hotel indoor water park. Methods: Environmental tests included sampling for airborne chloramines and endotoxin, and water testing for a variety of chemical substances and microbes, including endotoxin, mycobacteria, and Legionella. A symptom questionnaire was administered to workers exposed (70/103 lifeguards) and unexposed (74/99 hotel employees) to the indoor water park environment. Prevalence ratios with 95% confidence intervals were calculated between exposed and unexposed groups, and repeated measures analyses compared lifeguard symptoms on days when chloramine concentrations were expected to be high and low, based upon hotel occupancy. Ventilation and water system designs were also reviewed. Results: Airborne trichloramine and endotoxin were found in the indoor pool area. No water microbes were detected, and water chemistry met Ohio standards. Lifeguards reported more work related cough (PR 10.2, 95% CI 4.3-24.2), wheezing (PR 9.7, 95% CI 2.4-40.2), shortness of breath (PR 6.7, 95% CI 2.5-18.2), chest tightness (PR 6.7, 2.1-21.4), and eye irritation (PR 9.0, 95% CI 4.1-19.6) than referents in the 4 weeks prior to questionnaire completion. Lifeguards reported more eye irritation (PR 2.0, 95% CI 1.2-3.2) and cough (PR 2.2, 95% CI 1.1-4.5) on days when hotel occupancy was high versus low. Conclusions: With the increasing construction of indoor water parks, more workers and patrons will be at risk for chloramine-associated health problems. Indoor water parks need to monitor and maintain water chemistry and ensure adequate air movement and distribution in the ventilation system to control airborne chloramine concentrations. Lilia Chen earned her Bachelors of Science from Tufts University and Masters of Science in Industrial Hygiene from the University of Illinois at Chicago. She currently works for the National Institute for Occupational Safety and Health (NIOSH) conducting health hazard evaluations (HHE) in the Health Hazard Evaluations and Technical Assistance Branch (HETAB). She was the lead project officer in investigating health symptoms reported at an indoor waterpark, in response to a technical assistance request from the local health department. Ms. Chen is also working on an HHE to investigate associations between employee symptoms and chloramine exposures at a poultry facility.
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