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Poolside guide to recreational water illnesses

By Diane Griffith, Staff Writer, myOptumHealth

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As refreshing as your local pool may seem on a sweltering summer day, there may be hazards hiding inside. Pools, hot tubs and water parks can all harbor bacteria that could make you physically ill.

Recreational water illnesses (RWIs)
Swallowing, breathing or having contact with contaminated water can make you sick. These illnesses are known as recreational water illnesses (RWIs). The most commonly reported RWIs are diarrheal illnesses that are caused by such germs as Cryptosporidium, Giardia, Shigella and E. coli.

A swimmer who has such an illness can carry germs into the water and easily contaminate a pool or water park. Everyone should shower before entering a pool. Those with diarrheal illnesses should not enter the pool at all.

Lakes, rivers and even the ocean can also be contaminated by sewage spills, animal waste and water runoff after a rainfall.

In the pool or hot tub, disinfecting agents must remain at correct levels or respiratory infections or illnesses to the eyes, skin or ears can occur. And while chlorine can kill most germs in less than an hour, others can survive in pools for days – even when chlorine is used.

Hot tub rash
Hot tub rash is a skin infection common in hot tubs and spas. It can cause itchy skin, a bumpy red and tender rash, and pus-filled blisters. The rash may be worse underneath a bathing suit. It usually goes away without treatment in a few days. If it doesn’t, though, you should see a doctor.

Because of the high temperatures in the tubs, chemicals like chlorine evaporate more quickly than in pools and disinfectant levels need to be checked more frequently. Hot tub rash can also occur in pools and at the lake or beach.

Who is at risk?
Those who suffer most severely from RWIs are children, pregnant women and people with compromised immune systems. When recreational water is contaminated with human or animal waste containing Cryptosporidium, it can be life-threatening to those with weakened immune systems.

Rules for hot tub use:

  • Shower before and after using the hot tub.
  • Don’t exceed the number of bathers allowed.
  • Don’t exceed a spa temperature of 104 degrees F.
  • If you’re pregnant, avoid using a hot tub at all. The high temperature could put your baby at risk.
  • Don’t allow children under age 5 in the hot tub.
  • Don’t allow pets in the hot tub.
  • Don’t swallow water.
  • Follow spa maintenance guidelines.
  • Do not use a hot tub if you have diarrhea.
  • Wash your bathing suit after swimming.

Rules for pool use:

  • Shower before you enter the pool.
  • Don’t swim if you’re sick.
  • Don’t swim if you have open wounds or sores.
  • Don’t swallow pool water.
  • Don’t change diapers near the pool. Put swim diapers on babies and toddlers.
  • Encourage children to take bathroom breaks. Do not allow children to relieve themselves in the pool.
  • Don’t allow pets in the pool.

The only way to avoid RWIs is to stop germs from getting in the pool in the first place. Educating your family and others about healthy swimming behaviors is your best and only defense.

View the original Poolside guide to recreational water illnesses article on myOptumHealth.com 


  • Centers for Disease Control and Prevention. Healthy swimming: questions and answers.


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