Frequently Asked Questions about the MAHC for Potential Users

The MAHC

• Is guidance that government agencies and the aquatics sector can use to prevent drowning, injuries, and the spread of recreational water illnesses at public swimming pools and hot tubs.
• Integrates the latest knowledge based on science and best practices with specific code language and explanatory materials.
• Covers the design, construction, operation, and maintenance of swimming pools, spas, hot tubs, and other public disinfected aquatic facilities.

People in the United States swim more than 300 million times in pools and other bodies of water each year, making swimming one of the most popular recreational activities in the United States and the most popular recreational activity for children and teens ¹. However, over the past several decades, public aquatic venues have been associated with significant increases in disease outbreaks and the continued occurrence of drowning and injuries. Many of these illnesses can be prevented by proper maintenance and water treatment and by updated disease prevention practices (for example, supplemental treatment of water with ozone or ultraviolet light).

More information about Healthy Swimming

Reference

1. US Census Bureau. Statistical abstract of the United States: 2012. Arts, recreation, and travel: Participation in selected sports activities 2009 [XLS - 45 KB]

The MAHC is needed to help prevent outbreaks, drowning, and chemical poisoning and to reduce the need for public pools and spas to be closed for health hazards (for specific statistics related to these health issues, visit our General Information page). Many of these problems can be prevented by proper maintenance and water treatment and by updated disease prevention practices (for example, supplemental treatment of water with ozone or ultraviolet light).

However, in the United States, there is no federal agency that regulates aquatic facilities, so public pools and spas are typically regulated at the state or local government level. In fact, 68% of local health departments inspect public pools. State and local jurisdictions spend a great deal of time, personnel, and resources creating and updating their individual codes on a periodic basis. The MAHC is a tool to help government agencies and the aquatics sector reduce risk in their communities and stay up to date with the latest science.

The MAHC provides sample code language and explanatory text covering design, construction, operation, maintenance, and management standards. Most of the guidelines for facility design and construction pertain to new construction and substantial alteration only, not existing aquatic facilities. This guidance language can be used in whole or key components can be used individually. The MAHC Code wording is accompanied by an annex summarizing the scientific evidence base, research, and other materials used to inform the MAHC guidance.

List of key code provisions for new, existing, and substantially altered aquatic facilities

View the MAHC Code and Annex

Use of the MAHC is expected to help reduce the risk of diseases and injuries and promote healthy and safe swimming.

Short-term Outcomes: Use of the MAHC should help reduce the risk of diseases and injuries and promote healthy and safe swimming. We anticipate that the practices promoted in the MAHC will initially lead to the following system improvements:

• Fewer pool and facility closures
• Uniform inspection and surveillance data
• An established research agenda to drive future iterations of the MAHC
• Enhanced collaboration among stakeholders

Long-term Outcomes: By adopting the practices outlined in the MAHC, jurisdictions should also be able to improve the long-term health and safety at aquatic facilities. This should include a reduced risk of the following:

• Outbreaks of waterborne illnesses
• Drowning incidents
• Injuries from pool chemicals, disinfection by-products, and other causes
• Swimming-related emergency room visits

CDC is developing systems to track the impact and potential health improvements related to this national public health effort.

Creating the MAHC was a collaborative effort led by the Centers for Disease Control and Prevention and more than 140 volunteers from across the United States with expertise in aquatic venues, health, or safety. These experts included federal, state and local public health officials; researchers; and representatives of the aquatics industry, certification organizations, and not-for-profit aquatic associations.

Learn more about the creation of the MAHC.

Yes. Transparency and opportunities for stakeholder involvement has been a priority since the beginning. To learn more about the early process of creating the MAHC, visit Creating the MAHC.

Currently, updating the MAHC – including the public comment process – is managed through the Council for the Model Aquatic Health Code (CMAHC). CMAHC is a national partnership working to keep the MAHC up to date and current with the latest advances in the aquatics industry while also responding to public health reports of disease and injury.

Learn more about the MAHC’s update process.

View the MAHC.

The MAHC code language is accompanied by an annex that provides further information about the content of the MAHC and the scientific rationale for the guidance suggested in the MAHC.

The annexes:

• Give explanations, scientific data, and references to support why specific recommendations were made;
• Discuss the rationale for making decisions about code content;
• Provide a discussion of the scientific basis for selecting certain criteria;
• Explain why other scientific data might not have been selected (for example, inconsistencies in data);
• Highlight areas where additional research may be needed;
• Discuss and explain the terminology used; or
• Provide additional information, including summaries of scientific studies, charts, graphs, or other reference materials.

View the MAHC.

Cryptosporidium is a microscopic, chlorine-tolerant parasite that causes the diarrheal disease cryptosporidiosis. Both the parasite and the disease are commonly known as "Crypto." Outbreak investigations routinely show that many people continue to swim despite having a diarrheal illness. This is likely the cause of a massive outbreak of cryptosporidiosis that affected thousands of people and over 450 swimming venues in Utah in 2007. In 2009-2010, Crypto caused at least 27 outbreaks of diarrheal disease associated with recreational water, resulting in over 400 cases of illness. As a chlorine-tolerant parasite, Crypto can survive for days in even a well-chlorinated pool. The MAHC can help prevent Crypto outbreaks by highlighting evidence-based practices that can reduce the risk of disease spread. The MAHC recommends additional secondary disinfection safeguards such as ultraviolet light or ozone, which kills Crypto, particularly for increased-risk aquatic venues like children's wading pools.

The MAHC is a free, open-access resource developed to help jurisdictions ensure that their aquatic codes are based on the latest and most scientifically sound data available. The MAHC complements building-specific codes, such as the Uniform Swimming Pool, Spa and Hot Tub Code (USPSHTC) developed by the International Association of Plumbing and Mechanical Officials (IAPMO) and the International Swimming Pool and Spa Code (ISPSC) developed by the International Code Council (ICC).

To ensure that the various pool codes are complementary, CDC has signed agreements with both ICC and IAPMO. CDC has paid careful attention to avoid conflicts between the MAHC and building codes. The MAHC primarily addresses issues for which environmental public health officials have principal regulatory responsibility, including aspects of design and construction that impact public health and all aspects of management and operations. Codes like the USPSHTC and the ISPSC are intended primarily to address issues over which building code officials have principal regulatory responsibility, including most structural, mechanical, and electrical components.

In addition, the MAHC primarily addresses public pools and aquatic venues, whereas other codes may apply to residential pools.

The Virginia Graeme Baker Pool and Spa Safety Act (VGB) is a federal law passed in 2008 that requires public pools and spas to use unblockable drain covers or other specified devices or systems designed to prevent suction entrapment. Entrapment can occur when a body part or an object worn by the swimmer, such as jewelry, becomes entangled or stuck in the suction outlet cover, or when a body part forms a seal and suctions the swimmer to the outlet cover. The implementation of VGB is overseen by the Consumer Product Safety Commission.

There are several differences between the MAHC and VGB. While the VGB is a federal law requiring compliance, the MAHC is not a federal law and carries no regulatory authority unless adopted, in whole or part, by a state or locality. Rather, the MAHC is a resource that state and local agencies can use to update their own codes. The MAHC was created through a collaborative effort among public health and the aquatics sector, with opportunities for public review and comments. VGB targeted all pools; the MAHC design and construction elements pertain primarily to new construction or substantial alteration only (and only in those jurisdictions that adopt the MAHC). Finally, VGB only relates to unblockable drain covers. The MAHC covers a broad and complete range of public health concerns, including waterborne disease, drowning and other injuries, and chemical exposure.

The MAHC is not a federal law, so it will primarily affect aquatics businesses operating in jurisdictions that choose to adopt all or parts of the MAHC. For larger aquatics corporations operating facilities in multiple localities or states, the MAHC could lead to more consistent design, construction, operation, and maintenance guidance for pools and other aquatic facilities. In addition, expanded MAHC adoption would allow multi-state corporations to have a single, robust risk reduction effort that applies to locations across the United States.

By incorporating the MAHC guidance, aquatics facilities can reduce the risk of outbreaks of waterborne disease, drowning, and chemical and other injuries at their facilities. It is important to note that many MAHC provisions, particularly those related to design and construction, pertain primarily to new construction or substantial alteration only and will not require retrofitting of existing pools.

The aquatics sector has been heavily involved in the creation of the MAHC alongside public health experts. This helps ensure that the guidance proposed by the MAHC drives meaningful change while reflecting practical realities. CDC hopes that the design, maintenance, and operation of aquatic facilities become increasingly science-based through gradual changes that allow all parties to prepare. CDC shares the aquatics industry’s goal of making swimming healthy and safe.

The MAHC is intended to provide optional and voluntary language to make the design, construction, and operation of pools safer and healthier. States and localities that choose to adopt the MAHC will likely affect pool operations by incorporating science-based practices into pool operation and maintenance.

MAHC provisions relating to design and construction will pertain primarily to the construction of new or substantially altered aquatic facilities and will not require retrofitting of existing aquatic facilities. Over time, adoption of the MAHC guidance could drive greater consistency in aquatic facility construction and operation requirements.

In the United States, there is no federal regulatory authority responsible for design, construction, operation, and maintenance of aquatic facilities. State and/or local legislatures or agencies develop, review, and approve all pool codes. These codes are implemented by state and/or local public health officials and, in some cases, building code officials. Sixty-eight percent of local health departments have a pool inspection program.

As a federal agency, CDC tracks illnesses and injuries associated with recreational water nationally through reports it receives from state and local partners. When state and local public health agencies detect an outbreak associated with treated recreational water, they might ask CDC to investigate or help control the outbreaks. Data collected during outbreak investigations and through research are then used to inform CDC recommendations and policy decisions taken by state and local regulators. As part of the response to prevent future outbreaks, drowning, and injuries, CDC has been committed to aquatic health since the 1950s when it issued its first of a series of aquatic health and safety guidance documents to public health agencies and the aquatics industry. CDC has continued to issue assistance and guidance since that time culminating in the creation of CDC's Healthy Swimming Program in 2001 that currently leads the MAHC effort.

Each jurisdiction's aquatic health code is different and will have to be evaluated by stakeholders in that jurisdiction. The MAHC has attempted to identify keys areas for improvement based on scientific data and current best practices, learning lessons from outbreaks, and other data sources.

For example, hygiene is an important issue that is linked to the spread of disease at aquatic facilities. The MAHC is intended to help improve swimmer hygiene to reduce the risk of spreading illness at aquatic facilities that are associated with poor swimmer hygiene. Thus, the MAHC contains sample requirements for new or substantially altered construction that include the following:

• Minimum distances for hygiene facilities from aquatic facilities
• Criteria for diaper-changing stations
• Implementation of rinse showers in addition to cleansing showers

The MAHC is a guidance document and not a federal law and is only enforceable once adopted by a particular state or locality. The MAHC provides guidance on minimum standards for the design, construction, operation, maintenance, and management of aquatic facilities needed to protect public health and safety.

State or local stakeholders should evaluate the current laws and practical considerations in their jurisdictions to determine the most appropriate use of the MAHC in their communities. Jurisdictions may choose not to adopt the MAHC at all or may choose to adopt or revise all or parts of it to meet their needs.

No. The MAHC addresses a wide variety of aspects of aquatic health and safety. These aspects include operator training, risk management, ventilation and air quality, recirculation and filtration, facility design, and others.

Stakeholders should evaluate current laws and practical considerations in their jurisdictions to determine the most appropriate use of the MAHC in their community. Jurisdictions may choose not to adopt the MAHC at all, or may choose to adopt or revise key parts of the MAHC to meet their needs before adopting as regulation.

• The MAHC website
• MAHC Network
• The Council for the Model Aquatic Health Code (CMAHC) website
• Health Promotion Materials for the MAHC
• Training & Education for the MAHC
• Materials with information about recreational water illnesses (for public health officials, aquatics staff, and the public)
• Reports on recreational water-associated disease and outbreak tracking in the U.S.
• Publications about recreational water-associated outbreaks, injuries, and other aquatic issues
• Information about recreational water injuries