Ocular and Respiratory Symptoms Among Lifeguards at a Hotel Indoor Waterpark Resort
Abstract
OBJECTIVES: To determine the cause of eye and respiratory irritation symptoms among lifeguards at an indoor waterpark. METHODS: Investigators 1) performed environmental sampling for chloramine, endotoxin, and microbials; 2) administered symptom questionnaires; 3) reviewed ventilation system designs; and 4) reviewed water chemistry. RESULTS: Airborne trichloramine concentrations were found at levels reported to cause irritation symptoms in other studies. Some endotoxin concentrations were found at levels associated with cough and fever in previous studies. Exposed lifeguards were significantly more likely to report work-related irritation symptoms than unexposed individuals. The ventilation system may not have provided sufficient air movement and distribution to adequately capture and remove air contaminants at deck level. No water microbes were detected, and water chemistry met state standards. CONCLUSIONS: Indoor waterparks need to control water chemistry and ensure adequate air movement and distribution to control air contaminants and reduce health symptoms.
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Personnel in swimming pool facilities typically experience ocular and respiratory symptoms.
“Personnel in swimming pool facilities typically experience ocular and respiratory symptoms. [11,16 -19]”
From Occupational exposure to trichloramine and trihalomethanes: adverse health effects among personnel in habilitation and rehabilitation swimming pools (2019) · cites this paper as [17]
In waterpark lifeguards, work-related irritation was significantly more prevalent in throat (PR 12, 95% CI 2.9-48), nose (PR 3.5, 95% CI 1.9-6.6) and eyes (PR 9.0, 95% CI 4.1-20) than in unexposed employees.
“Lifeguards (37 men, 32 women) reported significantly more work-related irritation [prevalence ratio (PR), 95% CI] in throat (12, 2.9-48), nose (3.5, 1.9-6.6)and eyes (9.0, 4.1-20) than unexposed employees working outside the pool area (24 men, 50 women).”
From Inorganic chloramines: a critical review of the toxicological and epidemiological evidence as a basis for occupational exposure limit setting (2020) · cites this paper as Dang et al. 2010
In waterpark lifeguards, work-related symptoms were significantly more common during high-occupancy days than the low-occupancy day, including eye irritation (PR 2.0, 95% CI 1.2-3.2) and cough (PR 2.2, 95% CI 1.1-4.5).
“Work-related symptoms were significantly more common during the highoccupancy days than the low-occupancy day (PR, 95% CI), such as eye irritation ( 2.0, 1.2-3.2) and cough (2.2, 1.1-4.5)(adjusted for smoking habits, subjects with asthma not included).”
From Inorganic chloramines: a critical review of the toxicological and epidemiological evidence as a basis for occupational exposure limit setting (2020) · cites this paper as Dang et al. 2010
Several studies have demonstrated significantly more ocular and upper airway irritation in pool workers than in referents.
“Several studies have demonstrated significantly more ocular and upper airway irritation in pool workers than in referents (Jacobs et al. 2007;Dang et al. 2010, Chu et al. 2013;Fantuzzi et al. 2013;L€ ofstedt et al. 2016)”
From Inorganic chloramines: a critical review of the toxicological and epidemiological evidence as a basis for occupational exposure limit setting (2020) · cites this paper as Dang et al. 2010
The average concentration of trichloramine reported in the study by Dang et al. (2010) was 0.44 mg/m3.
“The average concentration of trichloramine reported in the study by Dang et al. (2010) was 0.44 mg/m 3 .”
From Inorganic chloramines: a critical review of the toxicological and epidemiological evidence as a basis for occupational exposure limit setting (2020) · cites this paper as Dang et al. 2010
Some studies showed higher prevalences of self-reported asthma-related symptoms in exposed pool workers and competitive swimmers compared to unexposed referents.
“Some studies showed higher prevalences of self-reported asthma-related symptoms in exposed pool workers and competitive swimmers compared to unexposed referents (L evesque et al. 2006;Jacobs et al. 2007;Dang et al. 2010).”
From Inorganic chloramines: a critical review of the toxicological and epidemiological evidence as a basis for occupational exposure limit setting (2020) · cites this paper as Dang et al. 2010
Exposure to trichloramine in the workplace air may aggravate asthma symptoms in individuals with existing asthma.
“Exposure to trichloramine in the workplace air may aggravate asthma symptoms in individuals with existing asthma (Thickett et al. 2002;Dang et al. 2010).”
From Inorganic chloramines: a critical review of the toxicological and epidemiological evidence as a basis for occupational exposure limit setting (2020) · cites this paper as Dang et al. 2010
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Exposure to trichloramine and respiratory symptoms in indoor swimming pool workers
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Occupational exposures of airborne trichloramine at indoor swimming pools in Taipei
Chu, T.-S., Cheng, S.-F., Wang, G.-S., & Tsai, S.-W. (2013) · Science of The Total Environment · doi:10.1016/j.scitotenv.2013.05.012 · Cited by 41 · see citing works
Westerlund, J., Bryngelsson, I.-L., Löfstedt, H., Eriksson, K., Westberg, H., & Graff, P. (2019) · Journal of Occupational and Environmental Hygiene · doi:10.1080/15459624.2018.1536825 · Cited by 33 · see citing works
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- Authors
- Dang, B., Chen, L., Mueller, C., Dunn, K. H., Almaguer, D., Roberts, J. L., & Otto, C. S.
- Affiliations
- National Institute for Occupational Safety and Health (US)
- Centers for Disease Control and Prevention (US)
- Corresponding author
- Chen, Lilia
- Venue
- Journal of Occupational & Environmental Medicine
- Published
- 2010-02
- Volume
- 52
- Issue
- 2
- Pages
- 207-213
- ISSN
- 1076-2752 (ISSN-L)
- OpenAlex
- W1989199588
- Cited by
- 29
- References
- 5
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 1 · 2022: 1 · 2021: 1 · 2020: 4 · 2019: 1 · 2018: 2 · 2017: 1 · 2016: 1 · 2015: 3 · 2014: 3 · 2013: 2 · 2012: 2
- FWCI
- 2.20
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Occupational and Environmental Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Indoor Air Quality and Microbial Exposure
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Occupational exposure and asthma
- Health Sciences › Health Professions › Occupational Therapy › Occupational Health and Safety in Workplaces
- Keywords
- lifeguards, eye irritation, respiratory irritation, trichloramine, chloramines, endotoxin, ventilation systems, water chemistry, occupational exposure, resort hotels, work-related symptoms
- MeSH terms
- Adolescent, Adult, Air Pollutants, Occupational, Chloramines, Endotoxins, Environmental Microbiology, Eye Diseases, Female, Health Resorts, Humans, Humidity, Male, Middle Aged, Occupational Diseases, Respiratory Tract Diseases, Swimming Pools, Temperature, Prevalence, Occupational Exposure, Young Adult
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