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

Estimating airborne trichloramine levels in indoor swimming pools using the well-mixed box model

Exposure to airborne disinfection by-products, especially trichloramine (TCA), could cause various occupational health effects in indoor swimming pools. However, TCA concentration measurements involve specialized analysis conducted in specific laboratories, which can result in significant costs and time constraints. As an alternative, modeling techniques for estimating exposures are promising in addressing these challenges. This study aims to predict airborne TCA concentrations in indoor swimming pools using a mathematical model, the well-mixed box model, found in the IHMOD tool, freely available on the American Industrial Hygiene Association website. The model's predictions are compared with TCA concentrations measured during various bather load scenarios. The research involved conducting 2-hr successive workplace measurements over 16- to 18-hr periods in four indoor swimming pools in Quebec, Canada. TCA concentrations were estimated using the well-mixed box model, assuming a homogeneous mixing of air within the swimming pool environment. A novel approach was developed to estimate the TCA generation rate from swimming pool water, incorporating the number of swimmers in the model. Average measured concentrations of TCA were 0.24, 0.26, 0.14, and 0.34 mg/m3 for swimming pools 1, 2, 3, and 4, respectively. The ratio of these measured average concentrations to their corresponding predicted values ranged from 0.51 to 1.30, 0.67 to 1.04, 0.57 to 1.14, and 0.68 to 1.49 for the respective swimming pools. In a worst-case scenario simulating the swimming pool at full capacity (maximum bathers allowed), TCA concentrations were estimated as 0.23, 0.36, 0.14, and 0.37 mg/m3 for swimming pools 1, 2, 3, and 4. Recalculated concentrations by adjusting the number of swimmers so as not to exceed the recommended occupational limit concentration of 0.35 mg/m3 gives a maximum number of swimmers of 63 and 335 instead of currently 80 and 424 for swimming pools 2 and 4, respectively. Similarly, for swimming pools 1 and 3, the maximum number of swimmers could be 173 and 398 (instead of the current 160 and 225, respectively). These results demonstrated that the model could be used to estimate and anticipate airborne TCA levels in indoor swimming pools across various scenarios.

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.

Swimming pool water disinfection by-products profiles and association patterns

The aim of this work was to determine and study the concentration of different groups of disinfection by-products (DBPs): trihalomethanes, haloacetic acids, haloacetonitriles, haloacetones and combined chlorine (as an indicator of chloramine levels), in the water of 175 public swimming pools in Gipuzkoa (Basque Country, Spain). The study included chlorinated and brominated pools, indoor and outdoor, used for recreational and sports purposes, and filled with water from calcareous and siliceous soils. The most abundant were haloacetic acids, followed by trihalomethanes, with chlorinated or brominated forms predominating depending on whether the pools were disinfected by chlorination or bromination, respectively. All the 75th percentiles of DBPs were below the limits established by the European Chemical Agency (ECHA), although the maximum values of trihalomethanes exceeded them. The same was true for dichloroacetonitrile in chlorinated pools and dibromoacetonitrile in brominated pools. All families of DBPs showed positive associations with each other, all being significant except for combined chlorine. Their mean levels were higher in outdoor pools than in indoor pools, significantly so in all except combined chlorine. Recreational pools showed higher levels of haloacetic acids and combined chlorine than sports pools. The concentrations of the different groups of DBPs were higher in the pools than in the mains water that fed them. This increase, especially that of the haloacetonitriles, as well as the high concentrations of brominated forms in the pools disinfected by bromination, make it necessary to focus on their toxicological implication. The differences in the DBP profiles of the filling network water were not transferred to the pool water.

Within-day variation and health risk assessment of trihalomethanes (THMs) in a chlorinated indoor swimming pool in China

Trihalomethanes (THMs) are the most common species of disinfection by-products (DBPs) in swimming pools and have received widespread attention due to their risk to public health. However, studies examining within-day variation and the carcinogenic health risks from exposure to THMs in indoor swimming pools are limited. Our study aimed to detect the within-day variation of four THMs categories and carcinogenic health risk in indoor swimming pool water in Taiyuan, China, and to examine the correlations between THMs and environmental parameters. Our results showed chloroform (TCM) was the most abundant component in THMs with median concentrations from 0.038-0.118 μg/m³. TCM and THMs were significantly positively correlated with FCl and significantly negatively correlated with the cumulative number of swimmers (CNS) in the swimming pool. The concentration of total THMs and TCM, lifetime average daily doses (LADD) of TCM, and the total lifetime cancer risks (ELCR) values of THMs declined with time with the highest level occurring at 8:00 am. ELCR values of THMs were in the range of 1.368 × 10^-5-1.968 × 10^-5, which exceeded the negligible risk level (10^-6) defined by US EPA. Our results suggest that THM occurrence and the carcinogenic health risks in pool water varied temporally. Exposure to pool water THMs may pose a carcinogenic risk to human health, especially at the pool's opening time.

Alternative Ecosorbent for the Determination of Trihalomethanes in Aqueous Samples in SPME Mode

A new sorbent material based on modified clay with ionic liquid immobilized into an agarose film was developed as part of this study. It was applied to determine organochlorine pollutants, like disinfection byproducts, through headspace solid-phase microextraction-gas chromatography-electron capture detection (HS-SPME-GC-ECD). The disinfection byproducts determined in this study were used as model molecules because they were volatile compounds, with proven severe effects on human health. Their presence in aquatic environments is in trace concentrations (from pg L^-1 to mg L^-1). They are classified as emergent pollutants and their determination is a challenge for analytical chemists. The parameters which affected the extraction efficiency, i.e., number and distance between SPME discs, salt concentration, the temperature of extraction, extraction time, and desorption time, were optimized. A wide linear dynamic range of 10-1000 ng mL^-1 and coefficients of determination better than 0.997 were achieved. The limits of detection and the limits of quantitation were found in the ranges of (1.7-3.7) ng mL^-1 and (5.6-9.9) ng mL^-1, respectively. The precision, expressed as relative standard deviation (RSD), was better than 8%. The developed sorbent exhibits good adsorption affinity. The applicability of the proposed methodology for the analysis of trihalomethanes in environmental and water samples showed recoveries in the range of 86-95%. Finally, the newly created method fully complied with the principles of green chemistry. Due to the fact that the sorbent holder was made of agarose, which is a wholly biodegradable material, sorbent clay is a widespread material in nature. Moreover, the reagents intercalated into the montmorillonite are new green solvents, and during the whole procedure, low amounts of organic solvents were used.

From trihalomethanes chronic daily intake through multiple exposure routes to cancer and non-cancer health risk assessment: Evidence from public Portuguese indoor swimming pools facilities using a probabilistic approach

This study aimed to estimate chronic daily intake (CDI) and to predict the attributable lifetime cancer risk (LCR) and hazard index (HI) from concurrent exposure to four trihalomethanes (THMs; chloroform, bromodichloromethane, dibromochloromethane and bromoform), via multiple exposure routes (oral ingestion, dermal contact and inhalation), among 238 non-competitive attendees of 10 Portuguese public indoor swimming pools (SPs), using a probabilistic approach based on Monte Carlo simulations. Exposure parameters of study participants were collected via questionnaires and THMs levels in SPs water were determined according the respective normative standards. The CDI for total THMs calculated for male and female participants considering all routes was 7.52 and 8.97 mg/kg/day, respectively. SP attendees presented higher CDI through inhalation than via the other two exposure routes, and chloroform was the compound contributing the most to total THMs CDI. The risk analysis indicated that the total LCR and HI from the targeted THMs were higher than the negligible risk levels (1 × 10^-6 and 1, respectively) in the scenarios examined (central tendency exposure and reasonable maximum exposure), and the health risk for females was slightly higher than for males. This study suggests that there are possible adverse health risks, thus, to protect pool attendees, adequate mitigation measures, and comprehensive regulatory guidelines on individual THMs concentrations are needed.

Eosinophil cationic protein (ECP) correlates with eosinophil cell counts in the induced sputum of elite swimmers

Introduction

Swimming practice has been associated with eosinophilic inflammation, however, the underlying mechanisms are not fully understood. The eosinophil cationic protein (ECP) in induced sputum may be used as a potential biomarker to assess airway eosinophilic inflammation among elite swimmers. The objective of this study is to characterize ECP levels in sputum supernatant in elite swimmers and evaluate ECP as an eosinophilic inflammatory marker.

Material and methods

Elite swimmers annually screened in our department (n = 27) were invited to participate in this cross-sectional study. Swimmers who agreed to participate (n = 24, 46% girls) performed lung function and skin-prick tests. Induced sputum was also collected and analyzed for differential cell counts and ECP measurements in sputum supernatant (ImmunoCAPTM 100, ECP, Thermo Fisher Scientific, Uppsala, Sweden).

Results

The median ECP level was 15.60 μg/L (6.02-38.75 μg/L) and higher levels were found among boys (27.90 (11.20-46.30) μg/L vs 6.65 (2.82-22.80) μg/L, P = .02). In addition, ECP levels in the sputum supernatant were positively correlated with eosinophil cell counts in the induced sputum (r = 0.583, P = .08).

Conclusions

ECP levels correlated positively with eosinophil counts in the induced sputum in elite swimmers. The measurement of ECP in sputum supernatant may be a useful marker to assess and manage eosinophilic inflammatory changes in the airways of elite swimmers.

Occurrence of Disinfection By-Products in Swimming Pools in the Area of Thessaloniki, Northern Greece. Assessment of Multi-Pathway Exposure and Risk

This study investigated the occurrence of disinfection by-products (DBPs) (trihalomethanes (THMs), haloacetic acids (HAAs), halonitriles (HANs), halonitromethane (TCNM) and haloketones (HKs)) in different type of swimming pools in the area of Thessaloniki, northern Greece by employing the EPA methods 551.1 and 552.3. Moreover, general water quality parameters (pH, residual chlorine, dissolved organic carbon, UV₂₅₄ absorption, total nitrogen, alkalinity and conductivity) were also measured. The concentrations of DBPs showed great variability among swimming pools as well as within the same pool between sampling campaigns. HAAs exhibited the highest concentrations followed by THMs, HANs, TCNM and HKs. Exposure doses for four age groups (3–<6 y, 6–<11 y, 11–<16 y and adults) were calculated. Route-specific exposures varied among DBPs groups. Inhalation was the dominant exposure route to THMs and TCNM (up to 92–95%). Ingestion and dermal absorption were the main exposure routes to HAAs (40–82% and 18–59%, respectively), depending on the age of swimmers. HANs contributed up to 75% to the calculated cytotoxicity of pool water. Hazard indices for different exposure routes were <1, suggesting non-carcinogenic risk. Inhalation posed the higher carcinogenic risk for THMs, whereas risk via oral and dermal routes was low. Ingestion and dermal contact posed the higher risk for HAAs. Risk management strategies that minimise DBPs exposure without compromising disinfection efficiency in swimming pools are necessary.

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.

Human exposure to air contaminants in sports environments

The aim of this review was to investigate human exposure to relevant indoor air contaminants, predictors affecting the levels, and the means to reduce the harmful exposure in indoor sports facilities. Our study revealed that the contaminants of primary concern are the following: particulate matter in indoor climbing, golf, and horse riding facilities; carbon dioxide and particulate matter in fitness centers, gymnasiums, and sports halls; Staphylococci on gymnasium surfaces; nitrogen dioxide and carbon monoxide in ice hockey arenas; carbon monoxide, nitrogen oxide(s), and particulate matter in motor sports arenas; and disinfection by-products in indoor chlorinated swimming pools. Means to reduce human exposure to indoor contaminants include the following: adequate mechanical ventilation with filters, suitable cleaning practices, a limited number of occupants in fitness centers and gymnasiums, the use of electric resurfacers instead of the engine powered resurfacers in ice hockey arenas, carefully regulated chlorine and temperature levels in indoor swimming pools, properly ventilated pools, and good personal hygiene. Because of the large number of susceptible people in these facilities, as well as all active people having an increased respiratory rate and airflow velocity, strict air quality requirements in indoor sports facilities should be maintained.

Study of the occurrence and multi-pathway health risk assessment of regulated and unregulated disinfection by-products in drinking and swimming pool waters of Mediterranean cities

The occurrence of a wide variety of regulated (four trihalomethanes (THM(4)), five haloacetic acids (HAA(5))) and unregulated (haloacetonitriles (HANs), halogenated ketones, chloropicrin, carbon tetrachloride, and other haloacetic acids) disinfection by-products (DBPs) was studied, in two hundred twenty-six finished drinking water samples collected in Barcelona (Spain, between 2008 and 2009), Athens (Greece, 2009-2010), Heraklion (Greece, 2009-2010), Nicosia (Cyprus, 2012-2013), and Limassol (Cyprus, 2011). The samples were analyzed by using liquid-liquid extraction, gas chromatography coupled with an electron capture detector or negative chemical ionization mass spectrometry. In addition, fourteen swimming pool water samples (from Heraklion and Athens) were also investigated regarding their DBPs content. The studied DBPs were determined concurrently with pH, total organic carbon (TOC), and bromide. Spearman's statistical analysis has shown statistically significant (p < 0.001) weak correlations between TOC, THM(4), HANs and HAA(5) but a strong correlation between THM(4) and HANs. Principal component analysis (PCA) on THM(4), HANs and HAA(5) provided a clear differentiation between the examined drinking waters, on the basis of their DBPs content. In the drinking water of coastal cities, the brominated DBPs dominated over the chlorinated ones, due to the higher bromide concentrations occurring in the corresponding raw waters. Lifetime cancer risk and hazard quotient by exposure to four THMs, dichlorocetic acid and trichloroacetic acid in drinking water and indoor swimming pools through multiple pathways were estimated. Total cancer unit risks in drinking water for Nicosia, Barcelona, Limassol and Athens exceeded in most cases the US EPA's regulatory threshold (1.0E-06). The total lifetime cancer risk evaluated for the studied indoor swimming pools was above the US EPA's negligible level for male, female, and junior swimmers.

Health risks and predictive modeling of disinfection byproducts in swimming pools

Disinfection is an indispensable water treatment process used to inactivate pathogens and prevent outbreaks of infectious diseases in swimming pools. However, toxic disinfection byproducts (DBPs) are inevitably formed during the process. To improve the supervision and regulation of DBPs in swimming pools, the reliability of using trihalomethanes (THMs) as the sole indicator of organic DBPs and the possibility of using easily detectable water quality parameters as predictors of DBPs were discussed based on the occurrence of 29 typical DBPs in swimming pools. Among the target DBP categories, THMs and haloacetic acids (HAAs) were the prominent species, and the concentrations of HAAs were the highest. The risk assessment results indicated that the total risk values in most pools were higher than the acceptable value (10^-6). Compared with nitrosamines and THMs, HAAs were the main contributors to the cancer risks posed by dermal absorption and ingestion. THMs (r = 0.619; p < 0.01) and HAAs (r = 0.989; p < 0.01) were both significantly correlated with total DBPs (the sum of 29 DBPs). A stepwise multivariate regression model was developed by analyzing the correlations between total DBPs and water quality parameters, and the relationship coefficient R² was 0.756. This study provides important information and perspectives for the improvement and implementation of standards for swimming pool water.

Can CO2 sensors in the ventilation system of a pool facility help reduce the variability in the trihalomethane concentration observed in indoor air?

Volatile and hazardous compounds are formed during the chlorination of pool water. Monitoring components in the air, such as the four trihalomethanes; chloroform, dichlorobromomethane, dibromochloromethane and bromoform (tTHM), is challenging. Carbon dioxide (CO₂) sensors are used for controlling air quality in different buildings and can be installed in ventilation systems for continuous surveillance and monitoring purposes. However, such sensors are not used in indoor swimming facilities. In this study, samples of tTHM and CO₂ were collected and analysed, along with other air and water quality parameters such as combined chlorine, to evaluate whether CO₂ sensors could be used to explain the observed variability in the tTHM concentration in an indoor swimming facility and thereby reduce the exposure of individuals utilising the pool to tTHM. Random intercept models were built for the tTHM and CO₂ concentrations, respectively, and the results show that the relationships between combined chlorine in the water, CO₂ in the air and number of occupants explain 52% of the variability in tTHM. The correlation between occupancy and CO₂ concentration (ρ = 0.65, p ≤ 0.01) suggests that CO₂ sensors should be used so that the air supply corresponds to the demand of the users.

Comprehensive assessment of the indoor air quality in a chlorinated Olympic-size swimming pool

Elite swimmers and swimming pool employees are likely to be at greater health risk due to their regular and intense exposure to air stressors in the indoor swimming pool environment. Since data on the real long-term exposure is limited, a long-term monitoring and sampling plan (22 non-consecutive days, from March to July 2017) was carried out in an indoor Olympic-size pool with a chlorine-based disinfection method to characterize indoor environments to which people involved in elite swimming and maintenance staff may be exposed to. A comprehensive set of parameters related with comfort and environmental conditions (temperature, relative humidity (RH), carbon dioxide (CO₂) and monoxide and ultrafine particles (UFP)) were monitored both indoors and outdoors in order to determine indoor-to-outdoor (I/O) ratios. Additionally, an analysis of volatile organic compounds (VOC) concentration and its dynamics was implemented in three 1-hr periods: early morning, evening elite swimmers training session and late evening. Samplings were simultaneously carried out in the air layer above the water surface and in the air surrounding the pool, selected to be representative of swimmers and coaches/employees' breathing zones, respectively. The results of this work showed that the indoor climate was very stable in terms of air temperature, RH and CO₂. In terms of the other measured parameters, mean indoor UFP number concentrations (5158 pt/cm³) were about 50% of those measured outdoors whereas chloroform was the predominant substance detected in all samples collected indoors (13.0-369.3 µg/m³), among a varied list of chemical compounds. An I/O non-trihalomethanes (THM) VOC concentration ratio of 2.7 was also found, suggesting that, beyond THM, other potentially hazardous VOC have also their source(s) indoors. THM and non-THM VOC concentration were found to increase consistently during the evening training session and exhibited a significant seasonal pattern. Compared to their coaches, elite swimmers seemed to be exposed via inhalation to significantly higher total THM levels, but to similar concentrations of non-THM VOC, during routine training activities. Regarding swimming employees, the exposure to THM and other VOC appeared to be significantly minimized during the early morning period. The air/water temperature ratio and RH were identified as important parameters that are likely to trigger the transfer processes of volatile substances from water to air and of their accumulation in the indoor environment of the swimming pool, respectively.

Assessment of the air quality in 20 public indoor swimming pools located in the Northern Region of Portugal

Air exposures occurring in indoor swimming pools are an important public health issue due to their popularity and regular use by the general population, including vulnerable groups such as children and elderly people. More comprehensive information on indoor air quality (IAQ) in swimming pools is thus needed in order to understand health risks, establish appropriate protective limits and provide evidence-based opportunities for improvement of IAQ in these facilities. In this context, twenty public indoor swimming pools located in the Northern Region of Portugal were examined in two sampling campaigns: January-March and May-July 2018. For each campaign, a comprehensive set of environmental parameters was monitored during the entire period of the facilities' operating hours of a weekday, both indoors and outdoors. In addition, four air (1-h samplings) and water samples were collected. Findings show that comfort conditions, ultrafine particles number concentrations and exposure to substances in the indoor air (concentration and composition) is likely to vary greatly from one public indoor swimming pool to another. Trihalomethanes (THM) and dichloroacetonitrile were the predominant disinfection by-products identified in the indoor air but other potentially hazardous volatile organic compounds, such as limonene, 1,2,4-trimethylbenzene, 2,2,4,4,6,8,8-heptamethylnonane, 2- and 3-methylbutanenitrile, acetophenone, benzonitrile, and isobutyronitrile were found to have relevant putative emission sources in the environment of the swimming pools analyzed. Furthermore, indicators of poor ventilation conditions (namely carbon dioxide, relative humidity and existence of signs of condensation in windows) and some water-related parameters (THM levels, conductivity and salinity) were found to be determining factors of the measured airborne THM concentrations that appeared to significantly potentiate the exposure. In summary, this work provides evidence for the need to establish adequate standards for the comprehensive evaluation of IAQ in public swimming pools, in order to guide further development of evidence-based prevention/remediation strategies for promoting healthy environments in swimming pools.