Using the Model Aquatic Health Code to Grade the Safety of Swimming Pools in Houston, Texas




Nguyen, Antoine
Arroyo, Miguel
Jones, Jennifer
Shenoi, Rohit


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Purpose: Drowning and submersion injuries in the pediatric population are responsible for many unintentional deaths. Moreover, there are other associated injuries in young children such as water-borne diseases, falling, and diving injuries. The Model Aquatic Health Code (MAHC) developed by the CDC issues guidelines aimed to decrease disease, injury, and drowning events at aquatic facilities. Since no federal regulatory authority currently exists, there is wide variation in the inspection of aquatic facilities and implementation of the MAHC guidelines across state and local authorities. The aim of this study was to devise a grading system for swimming pools across the city of Houston by applying the MAHC guidelines to pool inspection data. The results may then inform measures to strategically provide pool operators and the public with safety information regarding swimming pools.

Methods: A cross-sectional study of commercial swimming pools and spas in Houston was conducted in 2016 using routine inspection reports. Each public pool in Houston is required to undergo annual inspections. Private residential pools are not required to be inspected annually and such reports were excluded. The MAHC was used to develop a grading system that assigned points to commercial swimming pools and spas based on violations as detailed in inspection reports. Letter grades were assigned 95-100% (A); 85-94% (B); 75-84% (C); <75% (F-Fail) based on overall percentage of compliance with MAHC and projected onto a map of the city of Houston.

Results: A total of 3107 commercial aquatic venues were inspected in Houston during 2016 with 3100 of these being located within the city of Houston. Each venue was graded for safety and had the following grade distribution: (A): 40.2%; (B): 0.5%; (C): 0%; and (F): 59.3%. The most frequent violations were related to swimming pool enclosures (18%) followed by self-closing gates (13.8%). The majority of swimming pools inspected were concentrated in southwest Houston.

Conclusions: The MAHC guidelines may be used to appropriately assess and grade swimming pool safety in jurisdictions in which they have not yet been endorsed. Many jurisdictions vary in their regulation and implementation of policies regarding swimming pool safety. There may be a need for more jurisdictions to update their pool inspection criteria using MAHC guidelines. Further, injury prevention measures can be used to devise injury prevention measures based on the spatial distribution of safety violations.