Welcome to the Model Aquatic Health Code Network Webinar. Keep Up with the Model Aquatic Health Code: Featured Presenter: Michael Beach, PhD

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Welcome to the Model Aquatic Health Code Network Webinar Keep Up with the Model Aquatic Health Code: Featured Presenter: Michael Beach, PhD Tuesday, July 24, 2018 Please use your computer speakers to listen to today s presentation Questions may be submitted via the chat box We will begin at 1:00 PM Eastern Thank you for your interest and attendance!

Join the MAHC Network! MAHC Implementation Resources Webinar Updates Archived Webinars Email MAHCnet@naccho.org Stay tuned for more ways to network!

Featured Presenter Dr. Michael J. Beach Associate Director for Healthy Water National Center for Emerging and Zoonotic Infectious Diseases Centers for Disease Control and Prevention Deputy Director Division of Foodborne, Waterborne, and Environmental Diseases Centers for Disease Control and Prevention

Keep Up with the Model Aquatic Health Code: The 2018 MAHC 3 rd Edition is Out! What Has Changed? National Center for Emerging and Zoonotic Infectious Diseases NACCHO MAHC Network Webinar Michael J. Beach, PhD Centers for Disease Control and Prevention July 24, 2018

Outline MAHC introduction How did we get here? The CMAHC What changed? Next steps Resources

MAHC introduction

MAHC Vision Healthy and safe aquatic experiences for everyone

CDC Vision translation Public pools/waterparks/spas in every community Well operated and they remain open on inspection Everyone knows how to swim Everyone enjoys the health, social, and family benefits Healthy and safe aquatic experiences for everyone Improving swimmer ability, knowledge, and hygiene and improved pool operation leads to: Reducing drowning Reducing chemical and other injuries Limiting disease outbreaks The MAHC and CMAHC can achieve the long range vision using incremental change to move aquatics towards the vision

What is the Model Aquatic Health Code (MAHC)? Based on science and best practices Code / Annex (data and rationale) Resource for creating or updating pool codes Goals Reduce risk for outbreaks, drowning, and injury Outline uniform safety and operation standards Review and update cycle Advised by the Council for the Model Aquatic Health Code (CMAHC) Meets in October every 3 years to vote on change requests going to CDC Endorsed by NEHA, NACCHO, CSTE; awarded the 2017 Kelly Ogle Safety Award by the World Waterpark Association

MAHC Layout and Contents Code Language 1.0 Preface 2.0 User Guide 3.0 Glossary of Acronyms, Initialisms, and Terms 4.0 Aquatic Facility Design Standards and Construction 5.0 Facility Operation and Maintenance 6.0 Policies and Management 7.0 Appendices 8.0 References Chapter 4 primarily new construction or substantially renovated facilities or venues

MAHC Layout and Contents Annex language Scientific rationale for Code language Suggested best practices Regularly updated Superscript A in Code means Annex text available Used as resource across country

How did we get here? The CMAHC

The Council for the Model Aquatic Health Code (CMAHC) Operational Outline for Proposing MAHC Changes Input Change Request Technical Review & Discussion CMAHC Triennial Conference Presentations 7 Technical Support Committees Membership Voting Standing Committees Ad Hoc Committees CMAHC??? The aquatics equivalent of the Conference for Food Protection that works on the FDA Food Code Board of Directors CDC

2017 CMAHC Conference: Outcomes 2017 CMAHC Conference completed with >100 in-person attendees 179 Change Requests submitted Reviewed by Technical Review Committee with assistance by seven Technical Support Committees 68% (122/179) of CRs passed and sent to CDC Recommendations sent to CDC, discussed, MAHC edited, and cleared 2018 Edition released July 18, 2018 See track changes version of MAHC to see exact changes in context

What changed?

General Layout Code: 183 pages (vs. 289) Annex: 256 pages (vs. 371) All references: all cited by number in Chapter 8 vs. being in footnotes Section 3.3: updated to include full references, names, and years of referenced codes, standards, and laws

Disinfection and Water Quality: Legionella Contamination (NEW) Guidance for remediation and testing of aquatic venues suspected of and/or contaminated with Legionella Adapted from established CDC guidance at: https://www.cdc.gov/legionella/downloads /hot-tub-disinfection.pdf

Disinfection and Water Quality: Float Tanks (CMAHC Ad Hoc Committee) (New) Guidance for floatation tank regulation Written as stand alone unit: Plan submittal Materials Equipment standards Electrical systems and components Circulation system Disinfection Ventilation

Disinfection and Water Quality: Float Tanks (CMAHC Ad Hoc Committee) (NEW) Guidance for flotation tank regulation Operating permits Electrical, plumbing, disinfection, and ventilation systems Cleaning Fecal/vomit/blood contamination response

Disinfection and Water Quality: Disinfectant Feeders (CMAHC Workgroup) (New) Performance criteria for disinfectant feeder sizing Feeders shall be designed to maintain the minimum free chlorine concentrations specified in the MAHC at all times. Sizing based on the following examples of chlorine-demand factors: Aquatic venue - surface area, volume, use/space (e.g., agitated water), type (e.g., spa) Indoor vs. outdoor Anticipated maximum number of bathers per day Cyanuric acid/stabilizer used

Disinfection and Water Quality: Chemical Testing (New) Numerous pool chemicals (stabilizers, pool-grade salt, clarifiers, flocculants, defoamers, ph adjustment chemicals) must meet NSF/ANSI Standard 50 or 60 and/or EPA FIFRA registration (More flexible) Calcium hardness levels raised to 2500ppm (More flexible) Lowers secondary disinfection performance to a minimum 2-log reduction for all venues except interactive water play aquatic venues

Lifeguard and Bather Supervision: Other Changes (New) Requires lifeguards if alcohol served at aquatic venue (New) Requires lifeguard personal protective equipment to be on person or rescue tube (Strengthened) Clarifies glare assessment for lifeguard positions glare conditions are assessed from each lifeguard position as identified in the Zone of Patron Surveillance to determine if the AQUATIC VENUE bottom and objects in the POOL are clearly visible to QUALIFIED LIFEGUARD staff throughout operating hours

Risk Management and Safety: Noise Reduction (CMAHC Ad Hoc Committee) (New) Adds acoustic criteria to natatorium design to reduce noise levels Uses established specific design criteria and materials to reduce noise in indoor aquatic facilities (already used in other types of buildings) Requires sound absorbing materials be used to keep sound absorption coefficient to specific level New construction/substantial renovation

Risk Management and Safety: Chemical Release Injuries (Strengthened) Additional requirements to prevent chemical release events by improving chemical control and feed system interlocks and no/low flow deactivation Requirements to ensure chemical control and feed systems shut off when recirculation systems shuts down. Challenge testing of system required Mandatory bather evacuation (system shutdown, backwashing) Bathers cannot re-enter until >5 minutes after system turned on Visual alarm required if feeder is disabled through the electrical interlock for new and replacement installations

Risk Management and Safety: Other Changes (New) Adds certification for pool lifts All POOL lifts shall be CERTIFIED, LISTED, AND LABELED in accordance with UL 60335-2-1000, and be installed and used in accordance with the manufacturer s installation instructions and ICC/ANSI A117.1 (More flexible) Clarifies handhold wording for lazy rivers Example Bathers In or On Tubes Exception: Handholds shall not be required where BATHERS are required to be in or on a tube while in the LAZY RIVER (More flexible) More flexible requirements for closure and reopening

Next steps

Current MAHC Adoption Help us update the map! Tell us how you use the MAHC E-mail MAHC@cdc.gov Considering adoption or in process either in part or whole Partially adopted Fully adopted Counties considering 4 full adoptions, 4 partial adoptions by 4 states, 1 Canadian province, 3 U.S.G agencies, At least 18 states/counties in the process of, or considering, adoption. National Park Service Dept. of Defense Indian Health Service Nova Scotia, Canada PWTAG, UK

Ongoing CDC Work Posting MAHC check lists for routine use Mini-MAHCs Summary of code language to address specific problems Check out Cryptosporidium reduction (in clearance) Hygiene-diaper changing (in process) Chemical gassing/exposure events (in process) MAHC Aquatic Inspector ipad App (https://www.cdc.gov/mahc/app.html) Search for Aquatic Inspector from App Store on ipad MAHC inspector training (in collaboration with NEHA, coming soon)

Ongoing CMAHC Work CMAHC Committees in place Chlorine stabilizers Indoor aquatic facility ventilation design & air quality Coming soon: splashpad re-design Other issues: shell design Standing Committees in place Annex revision CMAHC/APSP Code Consistency

Get Prepared Join CMAHC and be part of ongoing work to improve aquatics CMAHC Change Requests for 2020 conference now accepted Start working with your professional group on what is needed 3-year cycle gives more time for thoughtful creation, writing, and vetting of new Change Requests (should translate to higher passage rates) Get involved in using the MAHC and/or the adoption process whether you are public health or aquatics sector

Resources

Resources Model Aquatic Health Code www.cdc.gov/mahc Search the MAHC www.cmahc.org/search-the-mahc.php

CDC Acknowledgments Ashley Andujar Michael Beach Maggie Byrne Elaine Curtis Vince Hill Michele Hlavsa John Kennon CDR Jasen Kunz CDR Joe Laco Jennifer Rutledge Pam Wigington

CMAHC Acknowledgments Doug Sackett: Executive Director Carl Nylander: Technical Review Committee Co-Chair Amanda Tarrier: Technical Review Committee Co-Chair Technical Review Committee CMAHC Board of Directors CMAHC Ad-Hoc & Technical Committee(s)

Contact Us Questions about the Model Aquatic Health Code? Email MAHC@cdc.gov

Next CMAHC Conference: October 2020 For more information, contact CDC 1-800-CDC-INFO (232-4636) TTY: 1-888-232-6348 www.cdc.gov The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.