Trihalomethanes in Lisbon indoor swimming pools: occurrence, determining factors, and health risk classification

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.

Surveillance of Legionella pneumophila: Detection in Public Swimming Pool Environment

The bacterium Legionella pneumophila is a ubiquitous microorganism naturally present in water environments. The actual presence of this opportunistic premise plumbing pathogen in recreational swimming pools and hot tubs in the northwestern part of Croatia has not been investigated. This study aimed to analyze the presence of the opportunistic pathogen L. pneumophila in public swimming pool water in Primorje-Gorski Kotar County (N = 4587) over a four-year period (2018-2021). Additionally, the second aim was to investigate the connection between the presence of L. pneumophila and pool water physicochemical parameters using mathematical predictive models. The presence of L. pneumophila was detected in six pool samples. Five positive samples were found in the water of indoor hot tubs filled with fresh water, and one positive sample in an outdoor recreational saltwater pool. A predictive mathematical model showed the simultaneous influence of chemical parameters dominated by the temperature in saltwater and freshwater pools, as well as the significant influence of free residual chlorine and trihalomethanes. Our results pointed out that keeping all physicochemical parameters in perfect harmony is necessary to reach the best disinfection procedure and to avoid the optimum conditions for L. pneumophila occurrence.

Potential cancer risk estimates from trihalomethanes in peri-urban settings of Kawama East of Mufulira, Zambia

In this study, we report the formation and cancer risk estimation of trihalomethanes (THMs) emanating from 'ex-situ' chlorination of shallow hand-dug well water obtained from a peri-urban area of Mufulira District, Zambia. The aim of the study was to evaluate the potential cancer risks for people in this area where chlorine water disinfection at the household level is commonly practiced. Water samples from 13 randomly selected hand-dug wells (4-8 m deep) were collected and analyzed for pH, turbidity, and dissolved organic carbon before chlorination. Then another set of water samples from the same 13 wells was chlorinated using the methods commonly practiced in this area, consistent with WHO recommended doses. The chlorination degradation products, THMs, trichloromethane, bromodichloromethane (CHCl₂Br), dibromochloromethane (CHClBr₂), and tribromomethane, were determined at three different times of 60, 180, and 300 min after chlorination, while residual chlorine was determined immediately after chlorination and at 60 and 1,440 min after chlorination. THMs were determined using gas chromatography (GC), while residual chlorine was determined colorimetrically. Then cancer risk estimation from ingestion, inhalation, and dermal routes was carried out. All water samples from the 13 wells showed elevated amounts of THMs, which also increased with increasing contact time. For instance, the concentrations of THMs at 60 min after chlorination ranged from 24.3 ± 2.0 to 61.3 ± 1.0 μg/L, while at 180 and 300 min, ranged between 85.6 ± 4.3-146.9 ± 2.5 μg/L and 188.1 ± 7.1-250.1 ± 7.1 μg/L, respectively. It was observed that tribromomethane was not detected at all in all samples, while CHCl₂Br and CHClBr₂ were only detected at 180 and 300 min post chlorination. The lifetime cancer risk estimation results showed negligible risk at 60 min post chlorination. However, at 180 and 300 min post chlorination, the results were far above negligible, but within the regulatory US EPA limits. The overall risk, however, could not be ignored, given a multiplicity of exposure to various other contaminants, raising concerns over additivity and synergistic interactive effects, particularly for non-cancer hazard indices.

Assessment of exposure of children swimmers to trihalomethanes in an indoor swimming pool

This study aimed to understand the exposure levels of trihalomethanes (THMs) in an indoor swimming pool and calculate the risks of exposure to THMs, based on the presence of each THM species, of children swimmers aged 6-17, in Beijing, China. We obtained exposure factors for the children through questionnaires and measured THM concentrations through laboratory tests, and we combined the results with an exposure model to calculate the risks, with consideration of different exposure routes (oral ingestion, inhalation and dermal absorption). In terms of exposure factors for the swimmers aged 6-17, the average body weight, exposure duration, exposure frequency, swimming time, shower time, changing time, warm-up exercise and rest time, skin surface area and ingestion rate of pool water were 40.46 kg, 2.70 years, 96 events/year, 64.03 min/event, 17.04 min/event, 15.31 min/event, 12.71 min/event, 1.37 m² and 48.93 ml/event, respectively. The THM concentrations in swimming pool water, shower water, swimming pool air and locker room air were 67.17 μg/L, 12.64 μg/L, 358.66 μg/m³ and 40.98 μg/m³, respectively. The average cancer risk of THMs was 5.44 × 10^-6, which is an unacceptable risk according to the United State Environmental Protection Agency (USEPA) Guidelines. The average hazard index was 0.007, i.e., less than 1, indicating that the noncancer risk was acceptable. Chloroform (TCM) was the main substance in four species of THMs and inhalation exposure was the main exposure pathway. The risk of cancer and noncancer from inhalation exposure to THMs accounts for 97-99% of the total risk. As a result, the disease control authorities and administrative department should pay attention to the health and safety of swimming facilities and, at the same time, establish standards for THMs in the air through further research.

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.

Occurrence and formation of disinfection by-products in the swimming pool environment: A critical review

Disinfection of water for human use is essential to protect against microbial disease; however, disinfection also leads to formation of disinfection by-products (DBPs), some of which are of health concern. From a chemical perspective, swimming pools are a complex matrix, with continual addition of a wide range of natural and anthropogenic chemicals via filling waters, disinfectant addition, pharmaceuticals and personal care products and human body excretions. Natural organic matter, trace amounts of DBPs and chlorine or chloramines may be introduced by the filling water, which is commonly disinfected distributed drinking water. Chlorine and/or bromine is continually introduced via the addition of chemical disinfectants to the pool. Human body excretions (sweat, urine and saliva) and pharmaceuticals and personal care products (sunscreens, cosmetics, hair products and lotions) are introduced by swimmers. High addition of disinfectant leads to a high formation of DBPs from reaction of some of the chemicals with the disinfectant. Swimming pool air is also of concern as volatile DBPs partition into the air above the pool. The presence of bromine leads to the formation of a wide range of bromo- and bromo/chloro-DBPs, and Br-DBPs are more toxic than their chlorinated analogues. This is particularly important for seawater-filled pools or pools using a bromine-based disinfectant. This review summarises chemical contaminants and DBPs in swimming pool waters, as well as in the air above pools. Factors that have been found to affect DBP formation in pools are discussed. The impact of the swimming pool environment on human health is reviewed.

Concentrations of disinfection by-products in swimming pool following modifications of the water treatment process: An exploratory study

The formation and concentration of disinfection by-products (DBPs) in pool water and the ambient air vary according to the type of water treatment process used. This exploratory study was aimed at investigating the short-term impact of modifications of the water treatment process on traditional DBP levels (e.g., trihalomethanes (THMs), chloramines) and emerging DBPs (e.g., Halonitromethanes, Haloketones, NDMA) in swimming pool water and/or air. A sampling program was carried to understand the impact of the following changes made successively to the standard water treatment process: activation of ultraviolet (UV) photoreactor, halt of air stripping with continuation of air extraction from the buffer tank, halt of air stripping and suppression of air extraction from the buffer tank, suppression of the polyaluminium silicate sulfate (PASS) coagulant. UV caused a high increase of Halonitromethanes (8.4 fold), Haloketones (2.1 fold), and THMs in the water (1.7 fold) and, of THMs in the air (1.6 fold) and contributed to reducing the level of chloramines in the air (1.6 fold) and NDMA in the water (2.1 fold). The results highlight the positive impact of air stripping in reducing volatile contaminants. The PASS did not change the presence of DBPs, except for the THMs, which decrease slightly with the use of this coagulant. This study shows that modifications affecting the water treatment process can rapidly produce important and variable impacts on DBP levels in water and air and suggests that implementation of any water treatment process to reduce DBP levels should take into account the specific context of each swimming pool.

Assessment of air and water contamination by disinfection by-products at 41 indoor swimming pools

This study was aimed at assessing the profiles (occurrence and speciation) of disinfection by-product (DBP) contamination in air and water of a group of 41 public indoor swimming pools in Québec (Canada). The contaminants measured in the water included the traditional DBPs [i.e., four trihalomethanes (THMs), six haloacetic acids (HAAs)] but also several emergent DBPs [i.e., halonitriles, halonitromethanes, haloketones and nitrosodimethylamine (NDMA)]. Those measured in the air comprised THMs and chloramines (CAMs). Overall, extremely variable DBP levels were found from one pool to another (both quantitatively and in terms of speciation). For instance, in water, among the four THMs, chloroform was usually the most abundant compound (37.9±25.7µg/L). Nevertheless, the sum of the three other brominated THMs represented more than 25% of total THMs at almost half the facilities visited (19 cases). In 13 of them, the levels of brominated THMs (66±24.2µg/L) even greatly outweighed the levels of chloroform (15.2±6.31µg/L). Much higher levels of HAAs (294.8±157.6µg/L) were observed, with a consistent preponderance of brominated HAAs in the swimming pools with more brominated THMs. NDMA levels which were measured in a subset of 8 pools ranged between 2.8ng/L and 105ng/L. With respect to air, chloroform was still the most abundant THM globally (119.4±74.2µg/m(3)) but significant levels of brominated THMs were also observed in various cases, particularly in the previously evoked group of 13 swimming pools with preponderant levels of brominated THMs in water. CAM levels (0.23±0.15mg/m(3)) varied highly, ranging from not detected to 0.56mg/m(3). Overall, the levels were generally relatively high compared to current guidelines or reference values from several countries, and they point to a relatively atypical presence of brominated compounds, and to significant levels of emergent DBPs for which health risk is less documented.

Dynamic real-time monitoring of chloroform in an indoor swimming pool air using open-path Fourier transform infrared spectroscopy

This study used open-path Fourier transform infrared (OP-FTIR) spectroscopy to continuously assess the variation in chloroform concentrations in the air of an indoor swimming pool. Variables affecting the concentrations of chloroform in air were also monitored. The results showed that chloroform concentrations in air varied significantly during the time of operation of the swimming pool and that there were two peaks in chloroform concentration during the time of operation of the pool. The highest concentration was at 17:30, which is coincident with the time with the highest number of swimmers in the pool in a day. The swimmer load was one of the most important factors influencing the chloroform concentration in the air. When the number of swimmers surpassed 40, the concentrations of chloroform were on average 4.4 times higher than the concentration measured without swimmers in the pool. According to the results of this study, we suggest that those who swim regularly should avoid times with highest number of swimmers, in order to decrease the risk of exposure to high concentrations of chloroform. It is also recommended that an automatic mechanical ventilation system is installed to increase the ventilation rate during times of high swimmer load.

Health-Related Behaviors in Swimming Pool Users: Influence of Knowledge of Regulations and Awareness of Health Risks

Background: Swimming pool attendance exposes users to infection and chemical risks that could be largely reduced with the adoption of healthy behaviors. This study aims to investigate if the knowledge of swimming pool regulations and awareness of health risks can be associated with users’ health-related behaviors. Methods: A cross-sectional study was conducted using self-administered questionnaires to collect data from two different target groups of swimming users: 184 adults and 184 children/adolescents. The association between specific variables and patterns of behaviors and knowledge was assessed through multivariate logistic regression models. Results: Although more than 80% of both groups declared they knew the regulations, compliance with healthy behaviors was often unsatisfactory, especially in adolescents and youth. In the children/adolescents group, healthy behaviors significantly increased with the frequency of attendance per week. In both groups, compliance increased with educational level (of parents for children/adolescents), while no positive association was observed between viewing the regulations and adopting appropriate behaviors. In the adult group, a higher knowledge/awareness of health risks was related to decreased odds of at least one unhealthy behavior. Conclusions: Guaranteeing the public display of regulations in swimming facilities is not sufficient to promote and change health-related behaviors. Much more attention should be given to educational interventions aimed to increase knowledge of health risks and the awareness that bathers are directly responsible for their own well-being.

Chemical contaminants in swimming pools: Occurrence, implications and control

A range of trace chemical contaminants have been reported to occur in swimming pools. Current disinfection practices and monitoring of swimming pool water quality are aimed at preventing the spread of microbial infections and diseases. However, disinfection by-products (DBPs) are formed when the disinfectants used react with organic and inorganic matter in the pool. Additional chemicals may be present in swimming pools originating from anthropogenic sources (bodily excretions, lotions, cosmetics, etc.) or from the source water used where trace chemicals may already be present. DBPs have been the most widely investigated trace chemical contaminants, including trihalomethanes (THMs), haloacetic acids (HAAs), halobenzoquinones (HBQs), haloacetonitriles (HANs), halonitromethanes (HNMs), N-nitrosamines, nitrite, nitrates and chloramines. The presence and concentrations of these chemical contaminants are dependent upon several factors including the types of pools, types of disinfectants used, disinfectant dosages, bather loads, temperature and pH of swimming pool waters. Chemical constituents of personal care products (PCPs) such as parabens and ultraviolet (UV) filters from sunscreens have also been reported. By-products from reactions of these chemicals with disinfectants and UV irradiation have been reported and some may be more toxic than their parent compounds. There is evidence to suggest that exposure to some of these chemicals may lead to health risks. This paper provides a detailed review of various chemical contaminants reported in swimming pools. The concentrations of chemicals present in swimming pools may also provide an alternative indicator to swimming pool water quality, providing insights to contamination sources. Alternative treatment methods such as activated carbon filtration and advanced oxidation processes may be beneficial in improving swimming pool water quality.

Formation of THMs and HANs during bromination of Microcystis aeruginosa

Bromine-contained disinfectants and biocides are widely used in swimming pools, recreational waters and cooling towers. The objective of this study was to evaluate the formation of thrihalomethanes (THMs) and haloacetonitriles (HANs) and their cytotoxicity in algae solutions during free bromine disinfection. Disinfection by-products formation potential experiments were conducted using model solutions containing 7 mg/L (as total organic carbon) Microcystis aeruginosa cells. Effects of free bromine dosage, pH and ammonia were investigated. The results showed that brominated disinfection by-products were the major products when free bromine was applied. The total THMs formed during bromination was much as that formed during chlorination, whereas HANs were elevated by using bromination instead of chlorination. Dibromoacetonitrice (C2H2NBr2) and bromoform (CHBr3) were the only detected species during free bromine disinfection. The production of C2H2NBr2 and CHBr3 increased with disinfectant dosage but decreased with dosing ammonia. CHBr3 increased with the pH changing from 5 to 9. However, C2H2NBr2 achieved the highest production at neutral pH, which was due to a joint effect of variation in hydrolysis rate and free bromine reactivity. The hydrolysis of C2H2NBr2 was base-catalytic and nearly unaffected by disinfectant. Finally, estimation of cytotoxicity of the disinfected algae solutions showed that HANs formation was responsible for the majority of toxicity. Considering its highest toxicity among the measured disinfection by-products, the elevated C2H2NBr2 should be considered when using bromine-related algaecide.

Environmental toxin-linked nonalcoholic steatohepatitis and hepatic metabolic reprogramming in obese mice

Obesity is associated with strong risks of development of chronic inflammatory liver disease and metabolic syndrome following a second hit. This study tests the hypothesis that free radical metabolism of low chronic exposure to bromodichloromethane (BDCM), a disinfection byproduct of drinking water, causes nonalcoholic steatohepatitis (NASH), mediated by cytochrome P450 isoform CYP2E1 and adipokine leptin. Using diet-induced obese mice (DIO), mice deficient in CYP2E1, and mice with spontaneous knockout of the leptin gene, we show that BDCM caused increased lipid peroxidation and increased tyrosine nitration in DIO mice, events dependent on reductive metabolism by CYP2E1. DIO mice, exposed to BDCM, exhibited increased hepatic leptin levels and higher levels of proinflammatory gene expression and Kupffer cell activation. Obese mice exposed to BDCM also showed profound hepatic necrosis, Mallory body formation, collagen deposition, and higher alpha smooth muscle actin expression, events that are hallmarks of NASH. The absence of CYP2E1 gene in mice that were fed with a high-fat diet did not show NASH symptoms and were also protected from hepatic metabolic alterations in Glut-1, Glut-4, phosphofructokinase and phosphoenolpyruvate carboxykinase gene expressions (involved in carbohydrate metabolism), and UCP-1, PGC-1α, SREBP-1c, and PPAR-γ genes (involved in hepatic fat metabolism). Mice lacking the leptin gene were significantly protected from both NASH and metabolic alterations following BDCM exposure, suggesting that higher levels of leptin induction by BDCM in the liver contribute to the development of NASH and metabolic alterations in obesity. These results provide novel insights into BDCM-induced NASH and hepatic metabolic reprogramming and show the regulation of obesity-linked susceptibility to NASH by environmental factors, CYP2E1, and leptin.