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Ocular and Respiratory Illness from Pool Chemicals

We already told you about how ozone for pool sanitation and water treatment is an ideal and chemical-free solution here. But why it is so importante to have a chemical-free water treatment for pools? It’s because of the risk of developing an ocular or respiratory illness.

Read the post below, and you’ll learn a new way to take care of your family’s health.

The use of chlorine has become very popular for the treatment of swimming pools, both for indoor and outdoor swimming pools. However, the lack of control over the quantities and frequency of application means that most pools are treated with chlorine levels much higher than those recommended, causing ocular and respiratory illness.

Whether by looking for a more efficient or a faster treatment, people forget that chlorine is a highly toxic chemical and often abuse the quantity and frequency of chlorine applied, thus causing damage to health, often not detected immediately. The use of chlorine also requires a period of rest and stabilization that is often not respected.

Most sensitive people show immediate symptoms, such as red and irritated eyes, tearing, burning, or even, red and irritated skin. A CDC (Centers for Disease Control and Prevention) publication reports on ocular and respiratory diseases associated with the use of indoor swimming pools in Nebraska in 2006.

“On December 26, 2006, the Nebraska Department of Health and Human Services (NDHHS) received a report of a child hospitalized in an intensive care unit for severe chemical epiglottitis and laryngotracheobronchitis after swimming in an indoor motel swimming pool. The pool was inspected the same day and immediately closed by NDHHS because of multiple state health code violations. NDHHS initiated an outbreak investigation to identify additional cases and the cause of the illness. This report describes the results of that investigation, which indicated that 24 persons became ill, and the outbreak likely was the result of exposure to toxic levels of chloramines* (1,2) that had accumulated in the air in the enclosed space above the swimming pool. This outbreak highlights the potential health risks from chemical exposure at improperly maintained pools and the need for properly trained pool operators to maintain water quality. (…)
*Disinfection by-products formed when free chlorine, a common disinfectant used in swimming pools, combines with nitrogenous human wastes (e.g., sweat, urine, or feces) in pool water. “

TABLE 1 – NUMBER AND PERCENTAGE OF PEOPLE WITH VARIOUS SYMPTOMS OF ILLNESS AFTER EXPOSURE TO AN INDOOR MOTEL SWIMMING POOL* – NEBRASKA, 2006

Symptoms

No.

(%)

Included in case definition

Burning eyes

Sore throat

Watery eyes

Coughing

Sneezing

Burning inside nose

Wheezing

Chest tightness

Shortness of breath


22

20

19

19

18

13

11

7

5


(92)

(83)

(79)

(79)

(75)

(54)

(46)

(29)

(21)

Not Included in case definition
Headache

Blurry vision

Dry mouth

Nausea

Diarrhea

Vomiting

Skin rash

Fever

Abdominal cramping

Photophobia


18

8

8

7

7

4

4

3

2

1


(75)

(33)

(33)

(29)

(29)

(17)

(17)

(13)

(8)

(4)

* N=24. A total of 20 persons entered the immediate pool area and became ill. In addition, four persons who became ill did not enter the immediate pool area but entered the larger, enclosed courtyard area in which the pool was located.

TABLE 2 – TIME FROM ENTERING THE IMMEDIATE AREA OF AN INDOOR MOTEL SWIMMING POOL UNTIL ONSET OF ILLNESS** – NEBRASKA, 2006

Time (min)

No.

(%)

< 120

≤ 29

30 – 59

60 – 89

90 – 119

≥ 120

14

3

4

1

6

6

(70)

(15)

(20)

(5)

(30)

(30)

** A total of 20 persons entered the immediate pool area and became ill. In addition, four persons (not included in this table) who became ill did not enter the immediate pool area but entered the larger, enclosed courtyard area in which the pool was located.
Read the full article here.

Some of the most common problems caused by chloride:

Red eyes and Conjunctivitis:

The most common eye problems caused by chlorinated water are:

  • Conjunctivitis – This infection can be either bacterial or viral and thrives in water because the tear film breaks down and germs get into the eye . It causes irritated, itchy eyes, severe redness and crusting;
  • Red eyes – Chlorine dries out the eyes and, as mentioned earlier, eliminates the tear film. When the tear film is stripped away, the vision may be temporarily blurred or distorted.

Dental enamel erosion and weaker teeth:

“Improperly maintained pool chlorination in swimming pools can cause rapid and excessive erosion of dental enamel,” warned Dr. Leila Jahangiri, a clinical associate professor and the Chair of NYUCD’s (New York University College of Dentistry’s) Department of Prosthodontics.

“If the chlorine levels are not properly maintained, the pool water can become overly acidic,” says Dr Jahangiri. “Regular contact with this acidic water as you swim can cause serious enamel erosion.”

Bladder cancer:

In a study published in the American Journal of Epidemiology, researchers linked bladder cancer risk to exposure to trihalomethanes (THMs). The study showed that swimmers who regularly swim in chlorinated pools have a 57% higher risk of developing bladder cancer.

The doctors thus established a link between bladder cancer and exposure to chlorine byproducts through inhalation and absorption through the skin.

Respiratory problems and asthma:

Respiratory symptoms such as nasal irritation, coughing, and wheezing. Asthma attacks may be triggered in people with asthma.

A study published by the Catholic University of Leuven ( Belgium) linked chloride to the development of asthma in children.

Regular attendance of chlorinated swimming pools by young children is associated with an exposure-dependent increase in the permeability of the lung epithelium and an increased risk of asthma, especially when combined with other risk factors.

Certain respiratory problems are caused by a byproduct formed in the chemical reactions between ammonia and chlorine: nitrogen trichloride (NCI).

Dry Skin:

Chlorine strips away essential oils from the skin and opens the skin pores, causing dry skin. Prolonged contact with chlorine may cause skin rashes, which may develop into blisters with further contact with chlorine.

Green Hair:

Hair dyed blond can turn grass green after being immersed in a chlorinated pool.

This hue does not come from the chlorine itself, but from the reaction of the chlorine with the copper contained in hair dyes.

Scientific Articles

Published: 2021

FATIMA EL-ATHMAN, LISA ZEHLIKE, ALEXANDER KÄMPFE, RALF JUNEK, HANS-CHRISTOPH SELINKA, DANIEL MEHRINGER, ANDREAS GRUNERT | October 1st | Pool water disinfection by ozone-bromine treatment: Assessing the disinfectant efficacy and the occurrence and in vitro toxicity of brominated disinfection by-products

Published: 2020
Published: 2017

WAQAS A. CHEEMA, KAMILLA M. S. KAARSHOLM, HENRIK R. ANDERSEN & OTHERS | March 1st | Combined UV treatment and ozonation for the removal of by-product precursors in swimming pool water

Published: 2016

YUE E., HUI BAI, LUSHI LIAN, JING LI, ERNEST R. BLATCHLEY | November 15th | Effect of chloride on the formation of volatile disinfection byproducts in chlorinated swimming pools

KAMILLA M. S. HANSEN, AIKATERINI PILIOTOPOULOU, WAQAS AKRAM CHEEMA, HENRIK R. ANDERSEN & OTHERS | April 1st | Effect of ozonation of swimming pool water on formation of volatile disinfection by-products – A laboratory study

Published: 2009

CLIFFORD P. WEISEL, SUSAN D. RICHARDSON, BENOIT NEMERY, GABRIELLA AGGAZZOTTI & OTHERS | April | Childhood Asthma and Environmental Exposures at Swimming Pools: State of the Science and Research Recommendations

Published: 2008
Published: 2007

CDC (Centers for Disease Control and Prevention), from the US Department of Health and Human Services – MMWR (Morbidity and Mortality Weekly Report) | September 14th | Ocular and Respiratory Illness Associated with an Indoor Swimming Pool – Nebraska, 2006

Published: 2006

CRISTINA M. VILLANUEVA, KENNETH P. CANTOR, JOAN O. GRIMALT & OTHERS | November | Bladder Cancer and Exposure to Water Disinfection By-Products throughIngestion, Bathing, Showering, and Swimming in Pools

Published: 2003

A. BERNARD, S. CARBONNELLE, O. MICHEL, S. HIGUET, C. DE BURBURE, J.-P. BUCHET, C. HERMANS, X. DUMONT, I. DOYLE | June | Lung hyperpermeability and asthma prevalence in schoolchildren: unexpected associations with the attendance at indoor chlorinated swimming pools

Published: 1988

J. HOIGNÉ | a chapter from the book “Process Technologies for Water Treatment” | The Chemistry of Ozone in Water

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