Health effects of disinfection by-products in chlorinated swimming pools

Understanding the fate of disinfection by-products in swimming pools: current empirical and mechanistic modeling insights

Disinfecting swimming pool water plays a crucial role in preventing the spread of harmful bacteria. However, the interaction between disinfectants and precursors can lead to the formation of potentially disinfection by-products (DBPs). Prolonged exposure to these DBPs may pose health risks. This review study investigates recent research advancements concerning the formation, exposure, and regulation of DBPs within swimming pools. It also provides an overview of existing models that predict DBPs generation in pools, highlighting their limitations. The review explores the mechanisms behind DBPs formation under different disinfectant and precursor conditions. It specifically discusses two types of models that simulate the production of these by-products. Compared to drinking water, swimming pool water presents unique challenges for model development due to its complex mix of external substances, human activities, and environmental factors. Existing models can be categorized as empirical or mechanistic. Empirical models focus on water quality parameters and operational practices, while mechanistic models delve deeper into the kinetics of DBPs generation and the dynamic nature of these compounds. By employing these models, it becomes possible to minimize DBPs production, optimize equipment design, enhance operational efficiency, and manage mechanical ventilation systems effectively.

Assessing the Health Impact of Disinfection Byproducts in Drinking Water

This study provides a comprehensive investigation of the impact of disinfection byproducts (DBPs) on human health, with a particular focus on DBPs present in chlorinated drinking water, concentrating on three primary DBP categories (aliphatic, alicyclic, and aromatic). Additionally, it explores pivotal factors influencing DBP formation, encompassing disinfectant types, water source characteristics, and environmental conditions, such as the presence of natural materials in water. The main objective is to discern the most hazardous DBPs, considering criteria such as regulation standards, potential health impacts, and chemical diversity. It provides a catalog of 63 key DBPs alongside their corresponding parameters. From this set, 28 compounds are meticulously chosen for in-depth analysis based on the above criteria. The findings strive to guide the advancement of water treatment technologies and intelligent sensory systems for the efficient water quality surveillance. This, in turn, enables reliable DBP detection within water distribution networks. By enriching the understanding of DBP-associated health hazards and offering valuable insights, this research is aimed to contribute to influencing policy-making in regulations and treatment strategies, thereby protecting public health and improving safety related to chlorinated drinking water quality.

Effect of exposure to disinfection by-products during swimming exercise on asthma-related immune responses

Swimming is a widely practiced exercise in modern society, where there is a heightened interest in health. The exceptional benefits of swimming are well-known, yet the issue of water quality management inevitably arises due to its nature as an aquatic exercise. Several studies reported that chlorine disinfectants commonly used in swimming pool water disinfection could degrade into toxic disinfection by-products (DBPs) and suggested that the DBPs might induce respiratory disorders, including asthma. Conversely, there were also reports that the DBPs had no significant effects on respiratory conditions. In this study, we investigated the influence of swimming exercise and DBPs on asthma. The decomposition products had little effect on the number of T cells in various immune organs. However, swimming exercise was found to increase the cell count in proportion to the exercise duration. Nevertheless, there were no significant changes in other immune cells and the secretion of asthma-related cytokines. These findings indicate that the effects of swimming pool DBPs on respiratory conditions during swimming exercise are either negligible or absent, and instead, the immunological benefits gained through consistent swimming exercise outweigh any potential drawbacks.

Electro-oxidation and UV irradiation coupled method for in-site removing pollutants from human body fluids in swimming pool

A comprehensive study was conducted to investigate how ultraviolet (UV) irradiation combined with electrochemistry (EC) can efficiently remove human body fluids (HBFs) related pollutants, such as urea/creatinine/hippuric acid, from swimming pool water (SPW). In comparison with the chlorination, UV, EC, and UV/chlorine treatments, the EC/UV treatment exhibited the highest removal rates for these typical pollutants (TPs) from HBFs in synthetic SPW. Specifically, increasing the operating current of the EC/UV process from 20 to 60 mA, as well as NaCl content from 0.5 to 3.0 g/L, improved urea and creatinine degradation while having no influence on hippuric acid. In contrast, EC/UV process was resilient to changes in water parameters (pH, HCO3-, and actual water matrix). Urea removal was primarily attributable to reactive chlorine species (RCS), whereas creatinine and hippuric acid removal were primarily related to hydroxyl radical, UV photolysis, and RCS. In addition, the EC/UV procedure can lessen the propensity for creatinine and hippuric acid to generate disinfection by-products. We can therefore draw the conclusion that the EC/UV process is a green and efficient in-situ technology for removing HBFs related TPs from SPW with the benefits of needless chlorine-based chemical additive, easy operation, continuous disinfection efficiency, and fewer byproducts production.

Perspectives and understanding on the occurrence, toxicity and abatement technologies of disinfection by-products in drinking water

Disinfection by-products (DBPs) are one of the significant emerging contaminants that have caught the attention of researchers worldwide due to their pervasiveness. Their presence in drinking water, even in shallow concentrations (in levels of parts per billion), poses considerable health risks. Therefore, it is crucial to understand their kinetics to understand better their formation and persistence in the water supply systems. This manuscript demonstrates different aspects of research carried out on DBPs in the past. A systematic approach was adopted for the bibliographical research that started with choosing appropriate keywords and identifying the most relevant manuscripts through the screening process. This follows a quantitative assessment of the extracted literature sample, which included the most productive and influential journal sources, the most widely used keywords, the most influential authors active in the research domain, the most cited articles, and the countries most actively engaged in the research field. Critical observations on the literature sample led to the qualitative assessment, wherein the past and current research trends were observed and reported. Finally, we identified the essential gaps in the available literature, which further led to recommending the course ahead in the research domain. This study will prove fruitful for young and established researchers who are or wish to work in this emerging field of research.

Water Flow-Driven Coupling Process of Anodic Oxygen Evolution and Cathodic Oxygen Activation for Water Decontamination and Prevention of Chlorinated Byproducts

Electrochemical advanced oxidation process (EAOP) is a promising technology for decentralized water decontamination but is subject to parasitic anodic oxygen evolution and formation of toxic chlorinated byproducts in the presence of Cl-. To address this issue, we developed a novel electrolytic process by water flow-driven coupling of anodic oxygen evolution reaction (OER) and cathodic molecular oxygen activation (MOA). When water flows from anode to cathode, O2 produced from OER is carried by water through convection, followed by being activated by atomic hydrogen (H*) on Pd cathode to produce •OH. The water flow-driven OER/MOA process enables the anode to be polarized at low potential (1.7 V vs SHE) that is lower than that of conventional EAOP whose •OH is produced from direct water oxidation (>2.3 V vs SHE). At a flow rate of 30 mL min-1, the process could achieve 94.8% removal of 2,4-dichlorophenol (2,4-DCP) and 71.5% removal of chemical oxygen demand (COD) within 45 min at an anode potential of 1.7 V vs SHE and cathode potential of -0.5 V vs SHE. To achieve the comparable 2,4-DCP removal performance, 4.3-fold higher energy consumption was needed for the conventional EAOP with titanium suboxide anode (anode potential of 2.9 V vs SHE), but current efficiency declined by 3.5 folds. Unlike conventional EAOP, chlorate and perchlorate were not detected in the OER/MOA process, because low anode potential <2.0 V vs SHE was thermodynamically unfavorable for the formation of chlorinated byproducts by anodic oxidation, indicated by theoretical calculations and experimental data. This study provides a proof-in-concept demonstration of water flow-driven OER/MOA process, representing a paradigm shift of electrochemical technology for water decontamination and prevention of chlorinated byproducts, making electrochemical water decontamination more efficient, more economic, and more sustainable.

Gastrointestinal Degradation and Toxicity of Disinfection Byproducts in Drinking Water Using In Vitro Models and the Roles of Gut Microbiota

Disinfection byproducts (DBPs) in drinking water are mainly exposed to the human body after oral ingestion and degradation in the gastrointestinal tract. The role of gastrointestinal degradation in the toxic effects of DBPs still needs further investigation. In this study, the degradation of five categories of DBPs (22 DBPs) in the stomach and small intestine was investigated based on a semicontinuous steady-state gastrointestinal simulation system, and 22 DBPs can be divided into three groups based on their residual proportions. The degradation of chloroacetonitrile (CAN), dibromoacetic acid (DBAA), and tetrabromopyrrole (FBPy) was further analyzed based on the Simulator of the Human Intestinal Microbial Ecosystem inoculating the gut microbiota, and approximately 60% of CAN, 45% of DBAA, and 80% of FBPy were degraded in the stomach and small intestine, followed by the complete degradation of remaining DBPs in the colon. Meanwhile, gastrointestinal degradation can reduce oxidative stress-mediated DNA damage and apoptosis induced by DBPs in DLD-1 cells, but the toxicity of DBPs did not disappear with the complete degradation of DBPs, possibly because of their interferences on gut microbiota. This study provides new insights into investigating the gastrointestinal toxic effects and mechanisms of DBPs through oral exposure.

Effects of disinfection by-products in swimming pool environments on the immunological mechanisms of respiratory diseases

Swimming in pools is a popular and healthy recreational activity. However, potential adverse health effects from disinfection byproduct (DBP) exposure in pool water are concerning. This study evaluated how such DBP exposure affects the respiratory system. DBP exposure was simulated with an animal-specific pool environment model. Experimental animals were exposed to DBPs for a specified duration and frequency over 4 weeks. The wet and dry weights of murine lungs were measured, with no significant differences observed. There were no significant differences in interkeukin (IL)-2/4/10, and interferon-γ levels. However, IL-6 expression decreased in the experimental group. To investigate the effects of DBP exposure on immune cell response, various samples, such as bronchoalveolar lavage fluid, lymph nodes, spleen, and thymus, were collected for T-cell isolation and fluorescence-activated cell sorting. Asthma-related blood cell distribution was analyzed using a complete blood count test; no significant differences were found. Thus, DBP exposure through this model did not induce substantial lung tissue damage, major alterations in cytokine expression (besides IL-6), significant immune cell responses, or changes in asthma-associated blood cell distribution. However, considering earlier results, future studies should focus on specific types, intensity, and duration of exercise that could affect DBP exposure-related immune-inflammatory responses.

Volatile Organic Compounds in Disposable Diapers and Baby Wipes in the US: A Survey of Products and Health Risks

Many thousands of diapers are worn by young children and the elderly, who have thin and sensitive skin that is highly vulnerable to chemicals, including volatile organic compounds (VOCs) that may be ingredients of these products or present as inadvertent or residual components. The levels and potential health risks of VOCs in diapers have not been reported previously. In this study, we collected 31 disposable hygiene products in the US market based on market share and analyzed 98 target VOCs using purge and trap sampling and thermal desorption/gas chromatography/mass spectrometer analysis. Exposures and risks were modeled using reasonable upper level exposure scenarios. Adult diapers contained the highest total target VOC concentration (median level of 23.5 μg/g), and the predominant VOCs were alkanes. In some diapers, the estimated noncancer risk from these VOCs was sometimes very large (hazard quotient of 1609) due to n-heptane. Baby diapers contained several known or suspected carcinogens, including benzene and 1,4-dioxane, and the lifetime cancer risk from some diapers approached 1 per million under a worst-case scenario. Store-brand products had higher levels of VOCs than generic brands, and products labeled "organic" or "for sensitive skin" did not necessarily have lower levels. Our results show that toxic VOCs were found in all tested disposable diapers and wipes at trace levels, and risks from using some diapers in high use exposure scenarios are high enough to warrant additional attention and possibly corrective measures. We recommend eliminating and monitoring toxic ingredients and disclosing all chemicals that may be in these products.

Cu(II) assisted peroxymonosulfate for antibiotic resistant bacteria inactivation: A potential disinfection technology in swimming pool

Alternative disinfection technology to chlorination is required to control the risk of antibiotic resistance in swimming pools. In this study, copper ions (Cu(II)), which often exist in swimming pools as algicides, were used to activate peroxymonosulfate (PMS) for the inactivation of ampicillin-resistant E. coli. Cu(II) and PMS showed synergistic effects on E. coli inactivation in weak alkaline conditions, obtaining 3.4 log inactivation in 20 min with 10 μM Cu(II) and 100 μM PMS at pH 8.0. Quenching experiments indicated that radicals (i.e., OH and SO₄^-) were not the main disinfectors for E. coli inactivation. Based on the structure of Cu(II) and density functional theory calculations, the Cu(II)-PMS complex (Cu(H₂O)₅SO₅) was recommended as the active species for E. coli inactivation. Under the experimental conditions, the PMS concentration had a greater influence on E. coli inactivation than the Cu(II) concentration, possibly because increasing PMS concentration accelerates ligand exchange reaction and facilitates active species generation. By forming hypohalous acids, halogen ions could improve the disinfection efficiency of Cu(II)/PMS. The addition of HCO₃^- concentration (from 0 to 1.0 mM) and humic acid (0.5 and 1.5 mg/l) did not significantly inhibit the E. coli inactivation. The feasibility of adding PMS to waters containing Cu(II) for the inactivation of antibiotic-resistant bacteria was validated in actual swimming pool waters, where 4.7 log inactivation of E. coli was achieved in 60 min.

Advances and research needs for disinfection byproducts control strategies in swimming pools

The control of disinfection byproducts (DBPs) in swimming pools is of great significance due to the non-negligible toxicity and widespread existence of DBPs. However, the management of DBPs remains challenging as the removal and regulation of DBPs is a multifactorial phenomenon in pools. This study summarized recent studies on the removal and regulation of DBPs, and further proposed some research needs. Specifically, the removal of DBPs was divided into the direct removal of the generated DBPs and the indirect removal by inhibiting DBP formation. Inhibiting DBP formation seems to be the more effective and economically practical strategy, which can be achieved mainly by reducing precursors, improving disinfection technology, and optimizing water quality parameters. Alternative disinfection technologies to chlorine disinfection have attracted increasing attention, while their applicability in pools requires further investigation. The regulation of DBPs was discussed in terms of improving the standards on DBPs and their preccursors. The development of online monitoring technology for DBPs is essential for implementing the standard. Overall, this study makes a significant contribution to the control of DBPs in pool water by updating the latest research advances and providing detailed perspectives.

Zwitterion and N-halamine functionalized cotton wound dressing with enhanced antifouling, antibacterial, and hemostatic properties

With emerging needs of wound care management, a multi-functional wound dressing is needed. To prevent infection and reduce patient suffering, antibacterial efficacy against a broad-spectrum of bacteria plus robust antifouling are among the most preferred properties. In this study, a wound dressing was created with antibacterial and anti-fouling capabilities is presented. The approaches used a synthesized tri-functional copolymer comprised of an N-halamine precursor moiety, a marine-inspired surface binding dopamine moiety, and a zwitterionic anti-adhesion moiety bonded onto a commercial cotton gauze. The resulting HaloCare™ wound dressing demonstrated >99.99 % inactivation within 5 min against E. coli and a panel of ESKAPE pathogens plus achieved 98.77 % reduction of non-specific protein binding. HaloCare was also shown to be compatible with hemostatic agents without impacting hemostatic efficacy. HaloCare shows great potential particularly in traumatic injury events as an infection preventing and hemostatic wound management system.

Chlorination of secondary treated wastewater with sodium hypochlorite (NaOCl): An effective single alternate to other disinfectants

The present study provides details about the usefulness of chlorination in the recovery effluents of sewage, and to make it useable for irrigation purposes. Chlorination is one of the effective simplified, and cost-effective traditional methods for disinfection. The study was done for the period of March, 2019 to February, 2020. The disinfection process was optimized by adding sodium hypochlorite to the secondary treated effluents with the help of jar apparatus at a mixing speed of 100 rpm. To optimize the various process variables such as dose, and contact time, several concentrations of NaOCl (0.5, 1, 1.5, 2, 2.5, 3.0) ppm were carefully chosen at different time intervals of 15, 30, and 60 min respectively, which were centered on the foregoing studies. The factors like seasonal variation on MPN index of total coliforms (TCs), C_R ∗ T concept, and effect of pH on log elimination of TCs, outcome of pH with rate constant (k), and results of pH against dilution coefficient (n) was also studied. The Chick–Watson, Rennecker–Marinas, Collin–Selleck, and modified Selleck models have shown good reliability to the experimental data of chlorine disinfection to be fit into these kinetic models for the treatment of sewage wastewater. The upgraded C_R ∗ T values were attained by using disinfection models. Among these four models, the kinetic modeling by Collin–Selleck, and Selleck–White was investigated as the best modeling to be fitted more finely to the chlorination experimental data to count for the effectiveness of NaOCl. The selected indicator organism in the optimization process of chlorine was Total coliforms (TCs). The residual chlorine and most probable number per log unit (Log) for TCs were measured before the start and after the termination of the disinfection process. The World Health Organization (WHO) standard for pathogenic removal from wastewater, and to irrigate the crops is 3- to 4-log and the chlorine residual under 1 mg/l limit was accomplished.

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Efficient removal of total coliforms (TCs) with sodium hypochlorite (NaOCl) at 1.5 ppm concentrations during the time period of 15 min. with one-step chlorination.

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The chlorine residual maintenance under target value 1 mg/l.

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C_R∗ T concept studied in detail.

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The effect of pH on log removal rate of TCs, on rate of constant (k), and on dilution coefficient (n) was evaluated.

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Seasonal variations of MPN discussed.

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The Chick–Watson, Rennecker–Marinas, Collin–selleck, and Whites’ modified kinetic modeling was applied to the secondary treated wastewater data for coliform removals, and to determine the effectiveness of the disinfectant.

NRF2-ARE signaling is responsive to haloacetonitrile-induced oxidative stress in human keratinocytes

Humans are exposed to disinfection by-products through oral, inhalation, and dermal routes, during bathing and swimming, potentially causing skin lesions, asthma, and bladder cancer. Nuclear factor E2-related factor 2 (NRF2) is a master regulator of the adaptive antioxidant response via the antioxidant reaction elements (ARE) orchestrating the transcription of a large group of antioxidant and detoxification genes. Here we used an immortalized human keratinocyte model HaCaT cells to investigate NRF2-ARE as a responder and protector in the acute cytotoxicity of seven haloacetonitriles (HANs), including chloroacetonitrile (CAN), bromoacetonitrile (BAN), iodoacetonitrile (IAN), bromochloroacetonitrile (BCAN), dichloroacetonitrile (DCAN), dibromoacetonitrile (DBAN), and trichloroacetonitrile (TCAN) found in drinking water and swimming pools. The rank order of cytotoxicity among the HANs tested was IAN ≈ BAN ˃ DBAN ˃ BCAN ˃ CAN ˃ TCAN ˃ DCAN based on their LC₅₀. The HANs induced intracellular reactive oxygen species accumulation and activated cellular antioxidant responses in concentration- and time-dependent fashions, showing elevated NRF2 protein levels and ARE activity, induction of antioxidant genes, and increased glutathione levels. Additionally, knockdown of NRF2 by lentiviral shRNAs sensitized the HaCaT cells to HANs-induced cytotoxicity, emphasizing a protective role of NRF2 against the cytotoxicity of HANs. These results indicate that HANs cause oxidative stress and activate NRF2-ARE-mediated antioxidant response, which in turn protects the cells from HANs-induced cytotoxicity, highlighting that NRF2-ARE activity could be a sensitive indicator to identify and characterize the oxidative stress induced by HANs and other environmental pollutants.

Effects of wearing swimming goggles on non-invasive tear break-up time in a laboratory setting

PURPOSE

The use of swimming goggles (SG) has demonstrated to alter different ocular parameters, however, the impact of wearing SG on the tear film stability remain unknown. The main objective of this study was to determine the short-term effects of wearing SG on tear film surface quality break-up time (TFSQ-BUT).

METHODS

Twenty-eight young healthy adults (14 men and 14 women) wore a drilled SG, and TFSQ-BUT was measured before, during and after SG use. Dynamic-area high-speed videokeratoscopy was used for the non-invasive assessment of TFSQ-BUT.

RESULTS

TFSQ-BUT was significantly reduced while SG wear in comparison to the baseline measurement (4.8 ± 4.5 s vs. 8.8 ± 6.9 s; corrected p-value = 0.017, d = 0.57, mean difference = 4.0 [0.6, 7.3]; 45% reduction). Immediately after SG removal, TFSQ-BUT rapidly recovered baseline levels (8.2 ± 5.9 s vs. 8.8 ± 6.9 s; corrected p-value = 0.744). The impact of wearing SG on TFSQ-BUT were independent of the gender of the participants (p = 0.934).

CONCLUSION

The use of SG induces a TFSQ-BUT reduction, with these changes returning to baseline levels immediately after SG removal. These data may be of relevance for the management of dry eye patients, who need to avoid circumstances that exacerbate tear film instability. Nevertheless, these results must be interpreted with caution since the experiment did not entirely mimic real-life conditions (e.g., eye cup piece drilled, time of exposure, environmental conditions). Future studies should consider the inclusion of dry eye patients and older individual in order to explore the generalizability of these findings.

Long-Term Monitoring of Water and Air Quality at an Indoor Pool Facility during Modifications of Water Treatment

Previous research has shown that volatile disinfection byproducts (DBPs) can adversely affect the human respiratory system. As a result, swimming pool water treatment processes can play important roles in governing water and air quality. Thus, it was hypothesized that water and air quality in a swimming pool facility can be improved by renewing or enhancing one or more components of water treatment. This study is designed to identify and quantify changes in water and air quality that are associated with changes in water treatment at an indoor chlorinated swimming pool facility. Reductions in aqueous trichloramine (NCl3) concentration were observed following the use of secondary oxidizer with its activator. This inclusion also resulted in significant decreases in the concentrations of cyanogen chloride (CNCl) in pool water. The concentration of urea, a compound that is common in swimming pools and that functions as an important precursor to NCl3 formation, as well as a marker compound for the introduction of contaminants by swimmers, was also reduced after the addition of the activator. Concentrations of gas-phase NCl3 did not decrease after the treatment processes were changed. The collection of long-term water and air quality measurements also allowed for an assessment of the effects of bather load on water and air quality. In general, the concentrations of urea (an NCl3 precursor), liquid-phase NCl3, and gas-phase NCl3 all increased during periods of high swimmer number.

Determination of chloroform concentration and human exposure assessment in the swimming pool

This cross-sectional study aimed to examine the concentration of the by-products of chlorination in the swimming pool and estimate human health risk for the swimmers of Shiraz University of Medical Sciences. In this study, the chloroform concentrations of 16 samples were measured using Gas Chromatography (GC). All the measured concentrations were less than the allowed amount announced by the World Health Organization (WHO). The results of the cancer risk (CR) and hazard index (HI) showed that the major exposure routes were found to be dermal during swimming and the 95 percentile of estimated CR and HI for the male group were 1.38 × 10^-10 and 1.82 × 10^-5 respectively, which is higher than the values of 5.48 × 10^-10 and 2.25 × 10^-5 respectively, for the women group. Sensitivity analyses indicated that the swimming exposure time (ET), and chloroform concentration were the most relevant variables in the health risk model. Therefore, knowledge about the sources of micro-pollutants in swimming pools might help promote the health methods of the pool environment.

Health effects of exposure to chlorination by-products in swimming pools

Concerns have been raised regarding the potential negative effects on human health of water disinfectants used in swimming pools. Among the disinfection options, the approaches using chlorine-based products have been typically preferred. Chlorine readily reacts with natural organic matter that are introduced in the water mainly through the bathers, leading to the formation of potentially harmful chlorination by-products (CBPs). The formation of CBPs is of particular concern since some have been epidemiologically associated with the development of various clinical manifestations. The higher the concentration of volatile CBPs in the water, the higher their concentration in the air above the pool, and different routes of exposure to chemicals in swimming pools (water ingestion, skin absorption, and inhalation) contribute to the individual exposome. Some CBPs may affect the respiratory and skin health of those who stay indoor for long periods, such as swimming instructors, pool staff, and competitive swimmers. Whether those who use chlorinated pools as customers, particularly children, may also be affected has been a matter of debate. In this article, we discuss the current evidence regarding the health effects of both acute and chronic exposures in different populations (work-related exposures, intensive sports, and recreational attendance) and identify the main recommendations and unmet needs for research in this area.

Association of blood trihalomethane concentrations with asthma in U.S. adolescents: nationally representative cross-sectional study

Background

Population studies show that the use of swimming pools is associated with the risk of asthma and allergic diseases among children. Our objective was to explore the associations between blood trihalomethane (THM) concentrations and asthma among US adolescents, and assess to what extent the association is modified by active tobacco smoke exposure.

Methods

We included 2359 adolescents aged 12–19 years with measured blood concentrations of chloroform (trichloromethane (TCM)), bromodichloromethane (BDCM), dibromochloromethane (DBCM) and bromoform (tribromomethane (TBM)) from the National Health and Nutrition Examination Survey 2005–2012. Logistic regression models were fitted to assess the odds ratios for the association of blood THM concentrations (three or four categories) with the risk of self-reported current and ever (lifetime) asthma.

Results

Blood DBCM concentrations were associated with a higher risk of ever asthma among all adolescents (OR 1.54 (95% CI 1.07–2.21), comparing the extreme exposure categories). The relationship was stronger among adolescents exposed to tobacco smoke (OR 3.96 (95% CI 1.89–8.30), comparing the extreme exposure categories). We also found positive relationships between blood brominated THM concentrations (sum of BDCM, DBCM and TBM) and risk of ever asthma and between blood DBCM and brominated THM concentrations and risk of current asthma among adolescents with tobacco smoke exposure. The relative excess risk of ever asthma due to the interaction between high blood DBCM and brominated THM concentrations and tobacco smoke exposure was 1.87 (95% CI 0.30–3.43) and 0.78 (95% CI 0.07–1.49), respectively.

Conclusions

Exposure to THMs is associated with a higher risk of asthma in adolescents, particularly among those exposed to tobacco smoke.

Among a representative sample of 2359 US adolescents, we found that exposure to THMs was associated with a greater risk of asthma, particularly among those who were co-exposed to tobacco smokehttps://bit.ly/3mpHxgq

Dynamic and quantitative characterization of antagonism within disinfectant mixtures by a modified area-concentration ratio method

The coexistence of various typical disinfectant pollutants has the potential to produce toxicity interaction towards organisms in the environment. A suitable model is necessary to evaluate the interaction quantitatively. Hence, the area-concentration ratio (ACR) method was modified (MACR) by combing confidence intervals to dynamically and quantitatively evaluate the toxicity interactions within disinfectant mixture pollutants. Disinfectant mixtures were designed by the direct equipartition design ray method using three guanidine disinfectants, chlorhexidine diacetate (CD), chlorhexidine (CHL), and polyhexamethylene biguanidine (POL) and one chlorine-containing disinfectant calcium hypochlorite (CAL). The toxicities of the four disinfectants and their mixtures towards Vibrio qinghaiensis sp.-Q67 (Q67) were determined by the time-dependent toxicity microplate analysis method. And the toxicity mechanism was analyzed by determining the effects of four disinfectants and their binary mixtures on the structure of cell, DNA and proteins (Pro) for Q67. The results show that the toxicities of CD and CHL to Q67vary little with time, but POL and CAL show the obvious time-dependent toxicity. The toxicities of CD, CHL and POL to Q67 are significantly stronger than that of CAL at the same exposure time. The toxicities of three binary mixture systems don't have significant difference in different exposure time. MACR can dynamically, quantitatively and accurately characterize toxicity interactions compared with ACR. According to MACR, the antagonism intensity dynamically changes with the prolongation of exposure time for binary mixture rays of three guanidine disinfectants and CAL, and linearly correlates with the components' concentration ratios. Four disinfectants all can destroy cell membrane and cause desaturation DNA of test organism, and CAL even can destroy the structure of DNA and protein. The probably reason for the antagonism within binary mixtures is the reaction between guanidine group and ClO^-, which is called chemical antaogism.

The Occurrence of N-nitrosodimethylamine (NDMA) in Swimming Pools: An Overview

The occurrence of several disinfectant byproducts has been investigated in swimming pools. Until now, there are only a few studies on nitrosamine, particularly N-nitrosodimethylamine in swimming pool water. This could be due to the lack of a suitable method that is sensitive enough for the measurement of N-nitrosodimethylamine in pool waters. Other disinfectant byproducts formed in pool water widely documented are trihalomethanes, haloacetic acids, halonitromethanes, and chloramines but inadequate information on N-nitrosodimethylamine. This paper provides a review of the nitrogenous disinfectant byproduct in swimming pools and its health implications. Anthropogenic substances introduced by swimmers such as sweat, lotions, and urine contribute to the formation of N-nitrosodimethylamine. The reaction of secondary amines such as dimethylamine with mono/dichloroamines produced dimethyl hydrazine and further undergo oxidation to form N-nitrosodimethylamine. The reaction of chlorine and other disinfectants with these anthropogenic sources in swimming pools cause cancer and asthma in human tissues. Thus, the assessment of N-nitrosodimethylamine in the swimming pool is less well documented. Therefore, the health consequences, mutagenic, and genotoxic potentials of N-nitrosodimethylamine should be the focus of more research studies.

Real-time confocal microscopy imaging of corneal cytoarchitectural changes induced by different stresses

Maintenance of the corneal refractive power and tissue transparency is essential for normal vision. Real-time characterization of changes in corneal cells during suffering stresses or wound healing may provide a way to identify novel targets, whose therapeutic manipulation can improve the outcome of this response induced by injury. Here we describe a novel user friendly and effective confocal real-time confocal microscopy attachment that monitors the effects of anisoosmotic stress on cell morphology and corneal thickness in situ. Corneal epithelial nuclei gradually became highly reflective in the isotonic group and the corneal stroma was slightly thickened as compared with that seen prior to 60 min exposure to a hypotonic solution. After 30 min of exposure to hypertonic stress, the corneal stromal cells became crenate and shriveled. The hyper-reflective area of the corneal stroma in the hypo-osmotic group was significantly larger than that in the other two groups, as demonstrated by 3D reconstruction imaging. The hypotonic fresh chlorinated pool water was observed to cause atrophy of corneal epithelial nuclei, while the isosmotic bee venom solution caused high reflection of the corneal stroma layer and corneal endothelial cell damage. With the microscopic attachment, the inward movement of corneal epithelial cells toward the denuded central region was detected in the serum-treated group. The microscopy attachment is an effective system for obtaining a more detailed understanding of the time dependent losses in the corneal cell structure and tissue architecture of full thickness corneas induced by osmotic stress or cytotoxic agents.

Human health risk estimation and predictive modeling of halogenated disinfection by- products (chloroform) in swimming pool waters: a case study of Dhanbad, Jharkhand, India

Disinfection is an important process to make the water free from harmful pathogenic substances, but sometimes it results in the formation of harmful by-products. Development of predictive models is required to define the concentration of THMs in pool water. Majority of studies reported inhalation to be the most significant THMs exposure route which is more likely to be dependent upon the concentration of THMs in pool water and in air. THMs concentration in the analyzed pool water samples and in air was found to be 197.18 ± 16.31 μg L-1 and 0.033 μg m3-1, respectively. Statistical parameters such as high correlation coefficients, high R2 values, low standard error, and low mean square error of prediction indicated the validity of MLR based linear model over non-linear model. Therefore, linear model can be most suitably used to pre-assess and predict the THMs levels in swimming pool water. Risk estimation studies was conducted by using the united states environmental protection agency (USEPA) Swimmer Exposure Assessment Model (SWIMODEL). The lifetime time cancer risk values related to chloroform exceeded 10-6 for both the sub-population. Inhalation exposure leads to maximum risk and contributed up to 99% to total cancer risk. Risk due to other exposure pathways like accidental ingestion and skin contact was found to be negligible and insignificant. Monte Carlo simulation results revealed that the simulated THMs risk values for the studied exposure pathways lies within ±3.1% of the average risk values obtained using SWIMODEL. Hence, the risk estimates obtained using SWIMODEL seemed to be appropriate in determining the potential risk exposure of THMs on human health. Variation in input parameters like body weight (BW) and skin surface area (SA) leads to difference in risk estimates for the studied population. Non cancer risk was found to be insignificant as represented by low hazard quotient (HQ < 1) values. Through monitoring and regulations on control of THMs in swimming pool water is required to minimize the risk associated.

Impact of swimming pool water treatment system factors on the content of selected disinfection by-products

Recommendations regarding disinfection by-products (DBPs) in pool waters consider the content of trihalomethanes (THMs) and combined chlorine (CC) as indicators of DBPs based on which the health risk for swimmers and staff of pool facility can be determined. However, the content of DBPs in swimming pools depends on many factors. In this paper, the influence of selected factors (physicochemical parameters of water and technological parameters) on the content of THMs and CC in pool water was determined. During the 6-month period, 9 pools of various functions were analyzed. The water in pools was subjected to the same method of treatment. The content of THMs and CC was compared against the content of organic matter, free chlorine and nitrates, pH, temperature, redox potential and turbidity, technological, and operational parameters. The THM content did not exceed the limit value of 0.1 mg/L. The content of CC varied significantly, from 0.05 to 1.13 mg Cl2/L. It was found that a very large water volume per person, in comparison to a very small one, contributed to the low content of CC and THMs. The high load expressed as m3 of water per person or m2 of water per person and the specific function of hot tubs (HT1 and HT2) led to the average concentration of CC in these pools exceeding 0.3 mg Cl2/L. The THM concentrations in hot tubs (especially in HT1) were also among the largest (0.038-0.058 mg/L). In terms of the analyzed microbiological indicators, the quality of the tested pool water samples was not in doubt. It was found that the purpose of the pool, its volume, and number of swimmers should be the key parameters that determine the choice of methods of water treatment. The research on the pool water quality in the actual working conditions of swimming pool facilities is necessary due to the need to preserve the health safety of swimmers and staff.

Pilot Test on Pre-Swim Hygiene as a Factor Limiting Trihalomethane Precursors in Pool Water by Reducing Organic Matter in an Operational Facility

Pool water must be constantly disinfected. Chlorine compounds used to disinfect pools react with organic substances such as sweat, urine, and personal care products introduced into pool water by users and results in the formation of disinfection byproducts. Trihalomethanes (THM), including chloroform and dissolved organic carbon (DOC) concentrations, were quantified using a two-stage process: determining initial THM and chloroform levels; then searching for a cheap and easy-to-use method to improve water quality. The method proposed here to limit THM and DOC concentrations in water is controlled showering. At three swimming pool facilities, chloroform concentrations (13.8 ± 0.33 µg/L, 15.5 ± 0.44 µg/L, and 13.9 ± 0.06 µg/L) were below the threshold concentration of 30 μg/L. At a fourth facility, however, the chloroform concentration exceeded that threshold (40.7 ± 9.68 μg/L) when showering was not controlled. Those conditions improved after the introduction of a mandatory shower; concentrations of DOC, THMs, and chloroform all decreased. The chloroform concentration decreased to 29.4 ± 3.8 μg/L, the THM concentration was 31.3 ± 3.9 μg/L, and the DOC concentration was 6.09 ± 0.05 mg/L. Pilot tests were carried out at real facilities to determine whether the control of pre-swim hygiene was possible. The introduction of proper pre-swim hygiene limited the concentration of DOC in water and can lead to a healthier environment for everyone attending the swimming facility.

Chlorinated Byproduct Formation during the Electrochemical Advanced Oxidation Process at Magnéli Phase Ti4O7 Electrodes

This research investigated chlorinated byproduct formation at Ti₄O₇ anodes. Resorcinol was used as a model organic compound representative of reactive phenolic groups in natural organic matter and industrial phenolic contaminants and was oxidized in the presence of NaCl (0-5 mM). Resorcinol mineralization was >68% in the presence and absence of NaCl at 3.1 V/SHE (residence time = 13 s). Results indicated that ∼4.3% of the initial chloride was converted to inorganic byproducts (free Cl₂, ClO₂^-, ClO₃^-) in the absence of resorcinol, and this value decreased to <0.8% in the presence of resorcinol. Perchlorate formation rates from chlorate oxidation were 115-371 mol m^-2 h^-1, approximately two orders of magnitude lower than reported values for boron-doped diamond anodes. Liquid chromatography-mass spectroscopy detected two chlorinated organic products. Multichlorinated alcohol compounds (C₃H₂Cl₄O and C₃H₄Cl₄O) at 2.5 V/SHE and a monochlorinated phenolic compound (C₈H₇O₄Cl) at 3.1 V/SHE were proposed as possible structures. Density functional theory calculations estimated that the proposed alcohol products were resistant to direct oxidation at 2.5 V/SHE, and the C₈H₇O₄Cl compound was likely a transient intermediate. Chlorinated byproducts should be carefully monitored during electrochemical advanced oxidation processes, and multibarrier treatment approaches are likely necessary to prevent halogenated byproducts in the treated water.

+Chlorination by-products in indoor swimming pools: Development of a pilot pool unit and impact of operating parameters

Chlorine addition in swimming pools ensures the microbiological quality of the water and the bathers' safety. However, water chlorination is associated with disinfection byproducts (DBP) formation and adverse health effects. The impact of operating parameters and innovative water treatment systems on DBPs levels has been reported in several studies, but sampling campaign in real pools remain difficult to carry out, mainly due to unexpected attendance variations. This study presents the development of a pilot pool plant allowing to perform experiments under controlled and reproducible conditions. Bathers inputs were simulated both for the organic load and for the mechanical agitation of water. Two sampling campaigns were performed during the building of the pilot, before and after the hall was closed. Key operating parameters such as chlorine dose, water temperature and attendance were controlled and monitored. DBP levels in the pilot plant were representative of French indoor swimming pools and the impact of bathers' activity was visible on volatile DBPs. Furthermore, correlations could be stated between operating parameters and DBP levels. Stripping effectively reduced volatile DBP concentrations in water. Moreover, energy consumption data, which are usually very scarce in experimental studies, showed the influence of heat pump consumption on the global energy consumption.

Influence of hydrotherapy pool water recirculation regime on Staphylococcus species concentration at subsurface: Preliminary experimental data from a pilot

Pools are prone to contamination from microbial pathogens from human external microbiota, including mainly Staphylococcus species. These bacteria originate mainly from the skin and rhinopharynx and tend to concentrate at the surface/subsurface. Being protected by films derived from mucus and sebum, they are markedly resistant to biocides. Our study aimed to evaluate the respective impact of mixed and reverse hydraulicity techniques on the concentration of Staphylococcus species at the subsurface following bathing by four individuals in an experimental pool. Disinfection, filtration and water renewal of the pool were stopped in order to study only the influence of the water recirculation regime. We found a significant reduction of 31.7% (Test 1), 50.9% (Test 2) and 41.9% (Test 3) in total Staphylococcus species counts at the subsurface when using reverse versus mixed hydraulicity. However, this reduction is not a pollution cut but a pollution shift, resulting from an increase in the outlet water flow rate by overflow channel from 49.3 to 100%. This experimental model was far removed from real life conditions and associated with a series of limitations. However, it seems that the type of water recirculation regime is a critical factor in the bacterial quality of pool water. These preliminary findings need to be confirmed in additional studies using more realistic conditions.

Evidence for alternative exhaled elimination profiles of disinfection by-products and potential markers of airway responses to swimming in a chlorinated pool environment

Chlorine-based disinfectants protect pool water from pathogen contamination but produce potentially harmful halogenated disinfection by-products (DBPs). This study characterized the bioaccumulation and elimination of exhaled DBPs post-swimming and investigated changes in exhaled breath profiles associated with chlorinated pool exposure. Nineteen participants provided alveolar-enriched breath samples prior to and 5, 90, 300, 510, and 600 minutes post-swimming. Known DBPs associated with chlorinated water were quantitated by thermal desorption-gas chromatography-mass spectrometry. Two distinct exhaled DBP elimination profiles were observed. Most participants (84%) reported peak concentrations immediately post-swimming that reduced exponentially. A sub-group exhibited a previously unobserved and delayed washout profile with peak levels at 90 minutes post-exposure. Metabolomic investigations tentatively identified two candidate biomarkers associated with swimming pool exposure, demonstrating an upregulation in the hours after exposure. These data demonstrated a hitherto undescribed exhaled DBP elimination profile in a small number of participants which contrasts previous findings of uniform accumulation and exponential elimination. This sub-group which exhibited delayed peak-exhaled concentrations suggests the uptake, processing, and immediate elimination of DBPs are not ubiquitous across individuals as previously understood. Additionally, non-targeted metabolomics highlighted extended buildup of compounds tentatively associated with swimming in a chlorinated pool environment that may indicate airway responses to DBP exposure.

Efficacy of eye drops containing crosslinked hyaluronic acid and CoQ10 in restoring ocular health exposed to chlorinated water

Purpose:

A prospective, open-label study in 20 professional swimmers evaluated the efficacy and safety of an ophthalmic solution containing crosslinked hyaluronic acid, coenzyme Q10, and vitamin E TPGS in releasing eye irritation and restoring ocular surface damages after prolonged exposure to chlorinated water.

Methods:

Individually, one eye was instilled with the ophthalmic solution and the other used as a comparator. Eye drops were self-administered three times a day for 2 months. Tear film breakup time (primary endpoint), Schirmer I test, beating of eyelashes/min, tear osmolarity, corneal and conjunctival staining with fluorescein, Ocular Surface Disease Index questionnaire, subject satisfaction, visual acuity (secondary endpoints), and Efron Grading Scale were evaluated at screening/baseline (V1), week 1 (V2), week 2 (V3), week 4 (V4), and week 8 (V5).

Results:

After 2 months, breakup time test significantly improved in the treated eyes (+1.67 s) compared to control (−3.00 s) (p = 0.0002). Corneal and conjunctival surfaces of treated eyes recovered significantly compared to control eyes when assessed by fluorescein staining (p < 0.0001), Ocular Surface Disease Index (p < 0.05), and visual analog scale (p = 0.0348) scores. Improvements were also observed with Schirmer I test, beating of eyelashes, and tear osmolarity, despite without statistical significance. Efron Grading Scale was consistent with the other tests. The ocular tolerability was excellent.

Conclusion:

The adequate combination of crosslinked hyaluronic acid, coenzyme Q10, and vitamin E TPGS, contained in the ophthalmic solution VisuXL^®, has been shown to protect ocular surface from potential damages originating from prolonged exposure to chlorinated water. VisuXL may represent a compelling treatment in other situations beyond dry eye syndrome.

Development of an automated system for the analysis of inorganic chloramines in swimming pools via multi-syringe chromatography and photometric detection with ABTS

Inorganic chloramines are disinfection by-products resulting from the unwanted reaction between chlorine used as disinfectant in swimming pools and nitrogenous compounds brought by bathers. This parameter (total chloramines or combined chlorine) is currently measured on site by a colorimetric method that does not allow to measure only inorganic chloramines. In this paper, a multi-syringe chromatography system combined with a post column derivatization is applied for the first time for the specific detection of the three individual inorganic chloramines (monochloramine, dichloramine and trichloramine). These latter ones are separated using a low-pressure monolithic C18 column, and separately detected after a post-column reaction with the chromogenic reagent ABTS (2,2'-azino-bis-(3-ethyl-benzothiazoline)-6-sulfonic acid-diammonium salt). Development of two ABTS reagents provides discrimination of chlorine and monochloramine that are not separated on the column. Optimization of the experimental conditions enables determination of inorganic chloramines with very good detection limits (around 10 μg eq.Cl₂ L^-1) without interferences from other chlorinated compounds such as organic chloramines or free available chlorine. The validation of the whole procedure has been successfully applied to real swimming pools samples.

Body fluid analog chlorination: Application to the determination of disinfection byproduct formation kinetics in swimming pool water

Disinfection by-products (DBPs) are formed in swimming pools by the reactions of bather inputs with the disinfectant. Although a wide range of molecules has been identified within DBPs, only few kinetic rates have been reported. This study investigates the kinetics of chlorine consumption, chloroform formation and dichloroacetonitrile formation caused by human releases. Since the flux and main components of human inputs have been determined and formalized through Body Fluid Analogs (BFAs), it is possible to model the DBPs formation kinetics by studying a limited number of precursor molecules. For each parameter the individual contributions of BFA components have been quantified and kinetic rates have been determined, based on reaction mechanisms proposed in the literature. With a molar consumption of 4 mol Cl₂/mol, urea is confirmed as the major chlorine consumer in the BFA because of its high concentration in human releases. The higher reactivity of ammonia is however highlighted. Citric acid is responsible for most of the chloroform produced during BFA chlorination. Chloroform formation is relatively slow with a limiting rate constant determined at 5.50 × 10^-3 L/mol/sec. L-histidine is the only precursor for dichloroacetonitrile in the BFA. This DBP is rapidly formed and its degradation by hydrolysis and by reaction with hypochlorite shortens its lifetime in the basin. Reaction rates of dichloroacetonitrile formation by L-histidine chlorination have been established based on the latest chlorination mechanisms proposed. Moreover, this study shows that the reactivity toward chlorine differs whether L-histidine is isolated or mixed with BFA components.

Advances in Legionella Control by a New Formulation of Hydrogen Peroxide and Silver Salts in a Hospital Hot Water Network

Legionella surveillance is an important issue in public health, linked to the severity of disease and the difficulty associated with eradicating this bacterium from the water environment. Different treatments are suggested to reduce Legionella risk, however long-term studies of their efficiency are lacking. This study focused on the activity of a new formulation of hydrogen peroxide and silver salts, WTP828, in the hospital hot water network (HWN) to contain Legionella contamination during two years of treatment. The effectiveness of WTP828 was tested measuring physical-chemical and microbiological parameters such as Legionella, Pseudomonas aeruginosa (P. aeruginosa), and a heterotopic plate count (HPC) at 36 °C. Legionella isolates were identified by serotyping and genotyping. WTP 828 induced a reduction in Legionella–positive sites (60% to 36%) and contamination levels (2.12 to 1.7 log₁₀ CFU/L), with isolates belonging to L. pneumophila SG1 (ST1 and ST104), L. anisa and L. rubrilucens widely distributed in HWN. No relevant contamination was found for other parameters tested. The long-term effect of WTP828 on Legionella containment suggest the easy and safe application of this disinfectant, that combined with knowledge of building characteristics, an adequate environmental monitoring and risk assessment plan, become the key elements in preventing Legionella contamination and exposure.

Impact of Different Combinations of Water Treatment Processes on the Concentration of Disinfection Byproducts and Their Precursors in Swimming Pool Water

To mitigate microbial activity in swimming pools and to ensure hygienic safety for bathers, pool systems have a recirculating water system ensuring continuous water treatment and disinfection by chlorination. A major drawback associated with the use of chlorine as disinfectant is its potential to react with precursor substances present in pool water to form harmful disinfection byproducts (DBPs). In this study, different combinations of conventional and advanced treatment processes were applied to lower the concentration of DBPs and their precursors in pool water by using a pilot-scale swimming pool model operated under reproducible and fully controlled conditions. The quality of the pool water was determined after stationary concentrations of dissolved organic carbon (DOC) were reached. The relative removal of DOC (Δc c_in^-1) across the considered treatment trains ranged between 0.1  ±  2.9% and 7.70  ±  4.5%, where conventional water treatment (coagulation and sand filtration combined with granular activated carbon (GAC) filtration) was revealed to be the most effective. Microbial processes in the deeper, chlorine-free regions of the GAC filter have been found to play an important role in the degradation of organic substances. Almost all treatment combinations were capable of removing trihalomethanes to some degree and trichloramine and dichloroacetonitrile almost completely. However, the results demonstrated that effective removal of DBPs across the treatment train does not necessarily result in low DBP concentrations in the basin of a pool. This raises the importance of the DBP formation potential of the organic precursors, which has been shown to depend strongly on the treatment concept applied. Irrespective of the filtration technique employed, treatment combinations employing UV irradiation as a second treatment step revealed higher concentrations of volatile DBPs in the pool compared to those employing GAC filtration as a second treatment step. In the particular case of trichloramine, results confirm that its removal across the treatment train is not a feasible mitigation strategy because it cannot compensate for the fast formation in the basin.

Predicting health risk from exposure to trihalomethanes in an Olympic-size indoor swimming pool among elite swimmers and coaches

Disinfection by-products (DBP) such as trihalomethanes (THM) are formed when chlorine and bromine interact with natural organic materials in chlorine-treated swimming pools. Epidemiological evidence demonstrated an association between exposure to swimming pool environment and adverse health effects. Therefore, this study aimed to assess carcinogenic and non-carcinogenic risk of long-term exposure of elite swimmers and their coaches. In an Olympic-size indoor chlorinated swimming pool, THM levels were determined in water (21-69 µg/L), in the boundary layer above the water surface (59-397 µg/m³), and in the air surrounding the pool (28-390 µg/m³). These values were used to predict multi-pathway chronic daily intake (CDI), cancer risk (CR) and hazard index (HI). Oral and dermal CDI for swimmers were 2.4 × 10^-6 and 2.0 × 10^-8, respectively. The swimmers' inhalation CDI (1.9 × 10^-3 mg/kg/day) was estimated to be sixfold higher than levels obtained for coaches (3.3 × 10^-4 mg/kg/day). According to guidelines, the HI was acceptable, but CR exceeded the recommended limit for both, coaches (CR: 5.5 × 10^-7-8.5 × 10^-5; HI: 6.5 × 10^-4-1 × 10^-1) and swimmers (CR: 1.4 × 10^-5-3.6 × 10^-4 HI: 1.6 × 10^-2-4.3 × 10^-1). Our findings provide further support to the need to develop comprehensive guidelines to safeguard the health of individuals involved in elite swimming.

Bench-scale assessment of the formation and control of disinfection byproducts from human endogenous organic precursors in swimming pools

In this study, a bench-scale system was utilized to assess the disinfection byproduct (DBP) formation from human endogenous organic matter. Perspiration and urine, constituting the main organic substances in swimming pools, were selected to represent the major human endogenous organics. Results revealed that the continuous input of body fluids into the reactor led to rapid accumulation of endogenous organic matter, which contributed to high concentrations of DBPs in the swimming pool. The increase in nonpurgeable organic carbon (NPDOC) concentration from the perspiration precursor was lower than that from urine during the operation. Moreover, the accumulation of swimmers' body fluids leads to increased DBP precursors, as well as increased chlorine demand and DBP formation in swimming pool water. The concentration of the trihalomethanes (THMs) and haloacetic acids (HAAs) consistently increased during the reaction. More THMs were generated in urine solution, whereas more HAAs were found in perspiration solution. To improve the water quality in swimming pools, ozonation, UV/Chlorine, and UV/H₂O₂ treatments were evaluated for their efficacy in reducing the DBP precursors. Results revealed that all of the three treatment processes can degrade the DBP precursors in perspiration and urine, eventually decreasing the DBP concentrations. However, only the UV/H₂O₂ treatment can decrease the formation of DBPs in perspiration and urine. In addition, the results revealed that UV/Chlorine and UV/H₂O₂ treatments should be operated for a sufficient contact time to prevent the increased production of DBP precursors in water at the early stage of the treatment.

Application of UVOX Redox® for swimming pool water treatment: Microbial inactivation, disinfection byproduct formation and micropollutant removal

Alternative disinfection technologies may overcome some of the limitations of conventional treatment applied in swimming pools: chlorine-resistant pathogens (e.g. Cryptosporidium oocysts and Giardia cysts) and the formation of chlorinated disinfection byproducts. In this paper, results of full scale validation of an alternative disinfection technology UVOX Redox^® (hereinafter referred to as UVOX) that combines ozonation and UV irradiation are presented. The performance was assessed in terms of microbial inactivation, disinfection byproduct formation and micropollutant removal. UVOX was able to achieve 1.4-2.7 log inactivation of Bacillus subtilis spores at water flows between 20 and 76 m³/h. Lower formation of trichloromethane and dichloroacetic acid was observed with UVOX followed by chlorination when compared to chlorination alone. However, due to the use of ozone and the presence of bromide in the pool water, the formation of trihalomethanes and haloacetic acids shifted to more brominated byproducts. Chlorine alone was able to remove the target micropollutants: acetaminophen, atenolol, caffeine, carbamazepine, estrone, estradiol, and venlafaxine (>97% removal) after 24 h, with the exception of ibuprofen (60% removal). The application of UVOX in chlorinated water enhanced the removal of ibuprofen. The application of UVOX could lower the usage of chlorine to the level that provides an adequate residual disinfection effect.

Variability of residual chlorine in swimming pool water and determination of chlorine consumption for maintaining hygienic safety of bathers with a simple mass balance model

Trial-and-error chlorination as a conventional practice for swimming pool water disinfection may fail to consistently maintain the pool's residual chlorine within regulatory limits. This study explored the variability of residual chlorine and other common water quality parameters of two sample swimming pools and examined the potential of using a mass balance model for proactive determination of chlorine consumption to better secure the hygienic safety of bathers. A lightly loaded Pool 1 with a normalized bather load of 0.038 bather/m³/day and a heavily loaded Pool 2 with a normalized bather load of 0.36 bather/m³/day showed great variances in residual free and combined chlorine control by trial-and-error methods due to dynamic pool uses. A mass balance model based on chemical and physical chlorine consumption mechanisms was found to be statistically valid using field data obtained from Pool 1. The chlorine consumption per capita coefficient was determined to be 4120 mg/bather. The predictive method based on chlorine demand has a potential to be used as a complementary approach to the existing trial-and-error chlorination practices for swimming pool water disinfection. The research is useful for pool maintenance to proactively determine the required chlorine dosage for compliance of pool regulations.

Application of Ultrafiltration in a Swimming Pool Water Treatment System

Swimming pool water was treated using an ultrafiltration process using ceramic and polymer membranes for comparison. It was determined that the efficiency of the process depended on the type of membrane used. The polymer membrane decreased the absorbance and concentration of combined chlorine in the pool water to a greater extent than the ceramic membrane. In the case of a ceramic membrane, the concentration of combined chlorine in the permeate exceeded the limit values. During the ultrafiltration process, the permeate flux decreased, causing the blockage of membrane pores. The extent of this phenomenon was similar for both tested membranes. In the case of the ceramic membrane, flushing it with water could significantly restore its initial performance. For both tested membranes, a high regeneration efficiency was observed during chemical treatment with an alkaline solution. SEM photos of the polymer membrane showed low resistance of this polymer to the chlorine present in the swimming pool water.

Exercise-Induced Bronchoconstriction and the Air We Breathe

An association between airway dysfunction and airborne pollutant inhalation exists. Volatilized airborne fluorocarbons in ski wax rooms, particulate matter, and trichloromines in indoor environments are suspect to high prevalence of exercise-induced bronchoconstriction and new-onset asthma in athletes competing in cross-country skiing, ice rink sports, and swimming. Ozone is implicated in acute decreases in lung function and the development of new-onset asthma from exposure during exercise. Mechanisms and genetic links are proposed for pollution-related new-onset asthma. Oxidative stress from airborne pollutant inhalation is a common thread to progression of airway damage. Key pollutants and mechanisms for each are discussed.

An exploration of disinfection by-products formation and governing factors in chlorinated swimming pool water

This paper investigates disinfection by-products (DBPs) formation and their relationship with governing factors in chlorinated swimming pools. The study compares concentrations of DBPs with WHO guidelines for drinking water quality recommended to screen swimming pool water quality. The statistical analysis is based on a global database of 188 swimming pools accumulated from 42 peer-reviewed journal publications from 16 countries. The mean and standard deviation of dichloroacetic acid and trichloroacetic acid were estimated as 282 ± 437 and 326 ± 517 μg L^-1, respectively, which most often surpassed the WHO guidelines. Similarly, more than half of the examined pools had higher values of chloral hydrate (102 ± 128 μg L^-1). The concentration of total chloramines (650 ± 490 μg L^-1) was well above the WHO guidelines in all reported cases. Nevertheless, the reported values remained below the guidelines for most of the studied pools in the case of total trihalomethanes (134 ± 160 μg L^-1), dichloroacetonitrile (12 ± 12 μg L^-1) and dibromoacetonitrile (8 ± 11 μg L^-1). Total organic carbon, free residual chlorine, temperature, pH, total nitrogen and bromide ions play a pivotal role in DBPs formation processes. Therefore, proper management of these governing factors could significantly reduce DBPs formation, thereby, contributing towards a healthy swimming pool environment.

Qualitative and health-related evaluation of point-of-use water treatment equipment performance in three cities of Iran

BACKGROUND

Application of the point-of-use water treatment (POU-WT) systems has consistently increased during the last decade in Iran. In this study, the qualitative performances of reverse osmosis-based POU devices in selected cities of Iran were investigated.

METHODS

This applied- descriptive study was conducted in three cities of Tehran, Rasht, and Ahvaz in 2016 (selected based on the level of POU devices sale index in three phases). After choosing the most popular five brands of six stages POU devices, 360 water sampling zones and POU consumer households of the selected cities were measured. Also, the awareness of the consumers about POU-WT systems selection and performance was investigated through a designed questionnaire.

RESULTS

The qualitative parameters in the three cities were acceptable (p < 0.05) for tap water (except for EC in Ahvaz), the output water were as follows: pH = 6.05-7.5, EC = 49.8-58.2 μs/cm, TOC = 0.01-0.23 mg/L and Nitrate = 0.52-4.5 mg/LNO₃ (lower or within the range of regulatory limits), Total Hardness = 33-41.5 mg/L and Fluoride = 0.01-0.23 mg/L (which were lower than the admissible limit, with p < 0.05), HPC values were in the range of 543-676 CFU/mL, which exceeded the regulatory level. Results of ANOVA analysis showed significant differences between the selected cities. The results of the questionnaire survey showed that the dissatisfaction of tap water quality and health-related concerns were the two main reasons for household POU-WT systems; awareness levels of 64% of these households about the performances of their POU systems were weak. Also, social media were mostly used by POU-WT users for brand selected.

CONCLUSION

Based on the results of the tap-water quality application of POU-WT systems are not recommended in Tehran and Rasht, and regarding the outputs of these systems, side effects of softened water, lack of Fluoride and a remarkable increase of the number of bacteria should be considered. In Ahvaz, application of POU-WT systems can decrease the health-related problems and it is necessary to increase the access to read POU-WT efficiency information for the consumers.

Health risk of swimming pool disinfection by-products: a regulatory perspective

While disinfection of swimming pools is indispensable for microbiological safety, it may lead to the formation of disinfection by-products. Most studies agree that inhalation exposure is the predominant pathway of the associated health risks, but assumptions are based on concentrations measured in water and evaporation models. Pool water and air were sampled in 19 swimming pools. Trihalomethanes were detected in all sites; chloroform being the most abundant species. Concentrations ranged between 12.8-71.2 μg/L and 11.1-102.2 μg/m³ in pool water and air, respectively. The individual lifetime carcinogenic risk associated with chloroform in swimming pools exceeded 10^-6 in all age groups for recreational swimmers and 10^-5 for elite swimmers and staff, even if the pool complied with the national standards. Inhalation exposure was estimated and found to be the most relevant, however, different mass transfer models from water measurements significantly under- or overestimated the health burden compared to direct calculation from the concentration in air. The observed health risks call for defining regulatory values and monitoring requirement of indoor air quality in swimming pools.

Regulation, formation, exposure, and treatment of disinfection by-products (DBPs) in swimming pool waters: A critical review

The microbial safety of swimming pool waters (SPWs) becomes increasingly important with the popularity of swimming activities. Disinfection aiming at killing microbes in SPWs produces disinfection by-products (DBPs), which has attracted considerable public attentions due to their high frequency of occurrence, considerable concentrations and potent toxicity. We reviewed the latest research progress within the last four decades on the regulation, formation, exposure, and treatment of DBPs in the context of SPWs. This paper specifically discussed DBP regulations in different regions, formation mechanisms related with disinfectants, precursors and other various conditions, human exposure assessment reflected by biomarkers or epidemiological evidence, and the control and treatment of DBPs. Compared to drinking water with natural organic matter as the main organic precursor of DBPs, the additional human inputs (i.e., body fluids and personal care products) to SPWs make the water matrix more complicated and lead to the formation of more types and greater concentrations of DBPs. Dermal absorption and inhalation are two main exposure pathways for trihalomethanes while ingestion for haloacetic acids, reflected by DBP occurrence in human matrices including exhaled air, urine, blood, and plasma. Studies show that membrane filtration, advanced oxidation processes, biodegradation, thermal degradation, chemical reduction, and some hybrid processes are the potential DBP treatment technologies. The removal efficiency, possible mechanisms and future challenges of these DBP treatment methods are summarized in this review, which may facilitate their full-scale applications and provide potential directions for further research extension.

Recreational Use of Spa Thermal Waters: Criticisms and Perspectives for Innovative Treatments

Natural spa springs are diffused all over the world and their use in pools is known since ancient times. This review underlines the cultural and social spa context focusing on hygiene issues, public health guidelines and emerging concerns regarding water management in wellness or recreational settings. The question of the "untouchability" of therapeutic natural waters and their incompatibility with traditional disinfection processes is addressed considering the demand for effective treatments that would respect the natural properties. Available strategies and innovative treatments are reviewed, highlighting potentials and limits for a sustainable management. Alternative approaches comprise nanotechnologies, photocatalysis systems, advanced filtration. State of the art and promising perspectives are reported considering the chemical-physical component and the biological natural complexity of the spa water microbiota.

Laboratory Efficacy and Disinfection by-Product Formation of a Coagulant/Disinfectant Tablet for Point-of-Use Water Treatment

Coagulant/disinfection products (CDPs) are a point-of-use (POU) water treatment technique that can improve microbial quality, reduce turbidity, and produce a free chlorine residual (FCR), serving as a potentially effective option for decentralized water treatment in a variety of contexts, including humanitarian emergencies. A novel CDP with a sodium dichloroisocyanurate-based disinfectant was evaluated with regard to its laboratory water treatment efficacy and generation of disinfection byproducts (DBPs). The CDP water treatment performance was assessed relative to bacteriological (E. coli) humanitarian water quality objectives, World Health Organization recommendations for evaluating POU water treatment options, and available DBP regulations and guidelines. At least 4 log10 E. coli reductions, for a “highly protective” status with regard to bacterial reductions, were attained in the tested conditions. Treated waters were consistently below 10 MPN/100 mL with regard to E. coli concentrations, with the majority of samples showing no detectable E. coli. For most conditions, target FCR values were not attained. Treated water turbidity levels were mostly between 5 NTU and 10 NTU. DBP levels were below the regulatory and health-based targets for both families of DBPs studied. This study has served to identify the performance envelopes of the CDP tested under challenging conditions.

Formation of trihalomethanes in swimming pool waters using sodium dichloroisocyanurate as an alternative disinfectant

Disinfection is essential to preventing infection caused by microbial pathogens in swimming pool water. The most commonly used disinfection methods are chlorine disinfectant, including sodium hypochlorite (NaOCl) and sodium dichloroisocyanurate (SDIC, C₃O₃N₃Cl₂Na) with characteristics of available chlorine formation and stability. In this study, we estimate the formation of trihalomethanes (THM₄) in indoor swimming pools filled with seawater that adopt these disinfection methods, and we investigated the factors influencing the formation of THM₄. Formation of THM₄ by free chlorine (FC) and SDIC respectively is 327.8 μg L^-1 and 307.6 μg L^-1; Br-THMs is 226.7 μg L^-1 for FC, 198 μg L^-1 for SDIC. SDIC has less THM₄ formation than FC in the same molar Br^- dosage (10 μM) and total chlorine dosage (20 μM), and bromoform is the main Br-THMs species. The occurrence of THM₄ is inhibited at high dosages of natural organic matter and Br^-. The total Br-THMs increase from 75 μg L^-1 to 189.7 μg L^-1 and from 64.6 μg L^-1 to 190 μg L^-1 by FC and SDIC at pH 5.0-9.0, both of which are highly dependent on pH. In real water, similar results were found in Br^--containing water (1 mg-Br^- L^-1).

Validation of a robust LLE-GC-MS method for determination of trihalomethanes in environmental samples

An analytical liquid-liquid extraction-gas chromatography-mass spectrometry (LLE-GC-MS) method was developed and validated for the determination of trihalomethanes (THMs) in environmental samples. The compounds studied were trichloromethane (TCM), bromodichloromethane (BDCM), dibromochloromethane (DBCM), and tribromomethane (TBM). The calibration curves for the THMs showed high linearity in the range of 1-1000 μg L^-1. Studies of intra-day and inter-day precision, limit of detection (LOD), limit of quantification (LOQ), accuracy, and recovery were performed with low (10 μg L^-1), medium (40 μg L^-1), and high (200 μg L^-1) concentrations of THMs. The intra-day and inter-day precision RSD varied in the ranges of 0.17-6.95% and 0.26-15.70%, respectively. No statistical differences were observed between the analysis of the concentration of certified reference materials (CRM 4M8140-U) and the values reported by CRM, indicating the good accuracy of the proposed method. The recovery was 88.75-119.21%. The LOD and LOQ were smaller than 0.13 and 0.40 μg L^-1. Compared with reported LLE-GC-MS methods, the validated method had similar LOD and enhanced LOQ, precision, accuracy, and recovery. Also, the method is robust, selective to THMs, and the total time for the extraction and GC separation of THMs is about 18 min. The method was useful for detecting and quantifying low concentrations of TCM (40-80 μg L^-1) formed by water chlorination in the presence of Microcystis aeruginosa cyanobacteria, thus demonstrating its applicability for monitoring THMs in real samples.

Water related ocular diseases

A number of ocular diseases can be attributed to contaminated water and we have coined a term "Water-related ocular diseases (WRODs)" to denote this wide-spectrum of conditions. WRODs are directly related to human contact with water and can occur through toxic, allergic, inflammatory or infective mechanisms. The non-infective causes can include chemicals used to clean swimming pools, oil spills and water-sport related injuries. Similarly, a number of infective organisms causing ocular diseases are transmitted through water. Since, these conditions can occasionally prove devastating, a review was done with the following aims: (i) To study the epidemiology of WRODs (ii) To assess the clinical presentation and current management of WRODs (iii) To highlight the future challenges and possible solutions to these problems. The online search was conducted utilizing search engines such as PubMed, Google Scholar, ClinicalKey and the Virtual Library of the Ministry of Health, Malaysia for relevant terms such as water-borne, swimming pool and eye infections.