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Ocular and Respiratory Symptoms Among Lifeguards at a Hotel Indoor Waterpark Resort

Dang, Bich MD; Chen, Lilia MS; Mueller, Charles MS; Dunn, Kevin H. MS; Almaguer, Daniel MS; Roberts, Jennifer L. BS; Otto, Charles S. MPS

Journal of Occupational and Environmental Medicine: February 2010 - Volume 52 - Issue 2 - p 207-213
doi: 10.1097/JOM.0b013e3181cf00d5
Original Articles

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.

From CDC/NIOSH, Cincinnati, Ohio (Dr Dang, Ms Chen, Mr Meuller), Division of Surveillance, Hazard Evaluations and Field Studies; (Mr Dunn, Mr Almaguer, Ms Roberts), Division of Applied Research and Technology; Division of Emergency and Environmental Health Services (Mr Otto), CDC/National Center for Environmental Health, Atlanta, Ga.

Dr. Dang is currently working at Baylor College of Medicine, Houston, Tex.

The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the National Institute for Occupational Safety and Health.

No competing interests.

Address correspondence to: Lilia Chen, MS, Centers for Disease Control and Prevention/National Institute for Occupational Safety and Health (CDC/NIOSH), 4676 Columbia Parkway, MS-R11, Cincinnati, OH 45226; E-mail:

©2010The American College of Occupational and Environmental Medicine