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�������� 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 .
Introduction Drowning is the leading cause of unintentional 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 submersions in the U . S . ( Felton et al ., 2015 ). During 2017 – 2019 , an average of 6,700 pool- or sparelated nonfatal drowning injuries treated in
Applying the Model Aquatic Health Code to Grade Swimming Pool Safety in a Large Metropolitan Area
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 compared 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
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
recommends multiple layers of protection to prevent drowning ( Denny et al ., 2021 ). Waterborne diseases , drowning , falling , diving , chemical use , and suction injuries are major recreational water illnesses and injuries ( RWIs ) associated with public aquatic facilities , particularly for young children . Between 2000 – 2014 , there were 493 outbreaks 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 chemical-related injuries ( Hlavsa et al ., 2014 ).
State and local agencies regulate safety at public aquatic facilities , as there is no federal regulatory authority responsible for the design , construction , operation , maintenance , and management of public pools and hot tubs / spas . Public pool codes for preventing and responding to RWIs are developed , reviewed , and approved by state and local public health officials 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 maintenance 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 , California , Florida , New York , and Texas — and a
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