Cste's Role in Promoting Health and Safety at Public Swimming Facilities: Engaging in the Update and Improvement Process for the New National Model Aquatic Health Code (MAHC)

BACKGROUND: A 2004 CSTE position statement requested CDC to convene an expert workshop to develop recommendations for reducing outbreaks associated with swimming pools and spas. The workshop recommended that CDC lead a national coalition of public health and aquatics industry experts to create a data-driven model national code that state and local health departments could voluntarily adopt. After 7 years of coalition work, the Model Aquatic Health Code (MAHC) was released in 2014 for voluntary state/local use. The MAHC is an open access, all-inclusive national model aquatic code that is data- and best practice-driven, knowledge-based, and written to provide the foundation for future disease, drowning, and injury risk reduction efforts. To keep the MAHC up to date with the latest public health data and industry changes, the non-profit, Council for the MAHC (CMAHC) was created to solicit national input on needed MAHC improvements for CDC consideration.

METHODS: The MAHC was developed by 12 Technical Committees and a Steering Committee; all included a mixture of public health, aquatic industry, and academic representatives.  The MAHC, which is all-inclusive and facility-based, covers outbreak, injury, and drowning prevention in chapters covering design and construction, operation and maintenance, and policies and management. Outbreak, surveillance, and other data were used to support criteria for: water quality (outbreak data); Cryptosporidium-specific elements (outbreak data, new inactivation data), chemical safety (surveillance data, patron/employee injury investigations), operational and emergency response plans (outbreak, injury data), and training (data showing training improves operation). CMAHC membership submitted and voted on >160 change requests at the first CMAHC update conference in 2015.

RESULTS: Two rounds of public comments on the MAHC garnered >4400 comments (72% accepted). The CMAHC change request process resulted in an improved product including new guidance on slip resistance; handrail dimension and gate latch height changes to reduce injuries based on child anthropometric data; and updates to fecal incident response guidance based on new Cryptosporidium inactivation data; the 2016 MAHC 2^nd Edition incorporates these successful change requests. 

CONCLUSIONS: The MAHC can serve as a national platform for data-based, multi-disciplinary, and multi-sectoral discussions aimed at improving aquatic health and safety. CSTE can engage in the CMAHC change request process to drive data-based improvements in the MAHC. Use of the MAHC should reduce state/local resource use and workloads, speed the resource intensive process of creating or updating state/local pool codes, and improve overall operation, health, and safety at public aquatic facilities.