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The Model Aquatic Health Code (MAHC)What it is and How it was Developed
International Health Regulators Forum for Establishments that
Handle Contact Water
June 6th-9th, 2017 Douglas Sackett
Executive Director, CMAHC
AGENDA
What is the MAHC?
Reasons for the MAHC
MAHC Development
Keeping the MAHC up-to-date
MAHC Adoption/Implementation
MAHC Outcomes
What is the MAHC?
Voluntary model public pool and spa code based on science and best practices created by the Centers for Disease Control & Prevention (CDC) 1st Edition released August 2014
2nd Edition released July 2016
Helps local and state authorities and aquatics sector make swimming and other water activities healthier and safer
States and localities can use the MAHC to create or update existing pool codes To reduce risk for outbreaks, drowning, and pool-chemical injuries
All-inclusive and addresses design, construction, operation, maintenance, policies, and management of public aquatic facilities.
MAHC Scope
All areas of public health concern
Illness, injury, drowning
Public venues
Water, air, & facility exposures that impact the health of swimmers and facility users
Leave other areas to building codes, etc.
Facility types
Man-made, treated, recirculated water venues
Health care-based pools
Therapy pools
MAHC Building Blocks
Data or best practices driven Avoid prescription when possible
Free and accessible for all Posted on CDC’s Healthy Swimming website
Implementable Incremental change: “Evolution, not revolution"
Updated regularly Current update cycle is every 2 years
Easy to understand Code section accompanied by “Annex” that includes
data and rationale for code requirements
MAHC Core Work Strategies
The core work strategies used for MAHC development included:
Use an “Evolution NOT Revolution” approach
Build a strong partnership between public health and the aquatics sector
Actively seek, listen to, and incorporate public input
Rationale
Incremental change is most likely to be adopted by state and local jurisdictions
Partnership will yield the best product, greatest buy-in, and will be most likely to be adopted
Incorporating public input improves overall quality and national buy-in
Why the MAHC?Support the Health Benefits of Swimming
One of top sports in the US – >300 million visits a year
Low impact exercise improves joint use with arthritis and cardiovascular health
Improves mood
Improves quality of life and reduces disability
Maintains bone health for post-menopausal women
For more information, see http://www.cdc.gov/healthywater/swimming/health_benefits_water_exercise.html:
Public Health Issues Detracting from Aquatics Benefits
Drowning 2nd leading cause of unintentional death from injury for ages 1-14 with ~3500/people/yr1
Spinal cord injuries; ~10,000 /year with ~4.5% (1995-2000) from diving (~450/yr)2
Indoor air quality issues due to di- and tri-chloramine and DBP production3
Pool chemical-associated injuries caused ~5000 people ED visits in 20124
Operational issues closed 12.1% of pools during routine inspections5
1 CDC. MMWR 2012;61:344-347; 2 DeVivo, 2003; 3 Weisel et al. Environ Hlth Perspect. 2009;117:500-507; 4 Hlavsa et al. MMWR 2014;63:427-430; CDC. MMWR 2010;59:582–7.
Current Pool Regulation Situation
Highest use, highest number of outbreaks
Little federal regulation, no federal jurisdiction
Disparate, variable regulation at state, local level
Little funding for public health research
What can be done to improve growing problem?
MAHC GENESIS AND BEGINNINGS
MAHC Genesis
CDC-sponsored workshop, 2005
“Recreational Water Illness Prevention at Disinfected Swimming Venues”; Atlanta, Georgia
Recommendation #1
Create model standards with broad input
Include disease, injuries, & drowning prevention
Make it data-driven, knowledge-based
Write for local and state health jurisdictions
Update regularly based on new data
Give open access to all users
MAHC Organization and Process
May 2007: NCEZID/NCEH organized Steering Committee
Federal/state/local PH, industry, academia included
Doug Sackett, NYS asked to be Director
Develop organizational plan, structure, and examples
Fall 2008: Organize Technical Committees
Appoint Chairs, recruit membership
Spring 2009: Initial Technical Committees start work
CDC clearance, public comment process (OGC-approved) Clear modules, posts on website for 60-day public comment
Revise modules based on comment and repost
Revised modules merged into single document and reposted for 2nd and final public comment
MAHC Process
Steering Committee
(Director, 9 members)
Coordinator, Assistant to Director,
& Technical Writer
Public
Comment X 2
New or Revised MAHC
12 Technical Committees
MAHC Steering Committee
Director: Douglas Sackett, New York State Dept. of Health
Michael Beach, Centers for Disease Control & Prevention
Chip Cleary, International Association of Amusement Parks and Attractions
Tracynda Davis, National Swimming Pool Foundation, representing NEHA
Jim Dunn, Aquatic Development Group
John Linn, SeaWorld Parks & Entertainment
Colleen Maitoza, County of Sacramento Environmental Management Department
Chuck Neuman, Water Technology, Inc.
Charles Otto, Centers for Disease Control & Prevention
Bob Vincent, Florida Dept. of Health
MAHC Technical Committees
Contamination Burden Chairperson: Ellen Meyer
Disinfection & Water Quality Chairperson: Jim Dingman
Facility Design & Construction Chairperson: Carl Nylander
Facility Maintenance & Operation Chairperson: Michael Beatty
Hygiene Facilities Chairperson: Ralph Cordell
Lifeguarding/Bather Supervision Chairperson: M. Kathryn Scott
Monitoring & Testing Chairperson: Vincent Hill
Operator Training Chairperson: Dennis Berkshire
Recirculation Systems & Filtration Chairperson: James Amburgey
Regulatory Program Administration Chairperson: Frank Guido
Risk Management/Safety Chairperson: Amy Duck
Ventilation & Air Quality Chairperson: Franceen
Gonzales
MAHC Development: Process and Timeline
14 Modules
Develop modules; Post for 1st round of
public comment10/2010-7/2013
Merge all modules;Post “Knitted” Version for 2nd
(final) round of public comment
3/20141428 comments
Revise-repost all modules.
2979 comments: 76% of comments asking for change accepted
14 Modules
Revised & postedMAHC 1st Edition
4,407 comments addressed with 72%
accepted
CompletedCompleted Completed August 29, 2014
MAHC: Key Points to Keep in Mind
Numerous opportunities for input and public comment >150 people from across PH, aquatics, academia
created modules Two rounds of public comment with over 4400
comments and >70% acceptance rate 3rd round of input if state/local adopting MAHC
Major design and construction elements primarily pertain to “new” or substantially altered construction” – not retrofitting except where specified
MAHCCODE LANGUAGE & ANNEX
What’s Inside?
1) Preface
2) User Guide
3) Glossary, Acronyms, Initialisms
4) Design and Construction
5) Operation and Maintenance
6) Policies and Management
7) MAHC Resources
8) Appendices
MAHC RENEWAL:KEEPING THE MAHC UP-TO-DATE
The Conference for the Model Aquatic Health Code (CMAHC)
What is CMAHC ?
501c(3) non-profit organization
Why does it exist ?
Established in 2013 to manage updates to the MAHC
Administration & Operation
Bylaws, Board of Directors, Executive Director
Committees include Technical Review Committee and Ad Hoc Committees
The Conference for the Model Aquatic Health Code (CMAHC)
Role
Conduit for funneling advice and data-driven, science-based information from public health and aquatic industry experts to CDC
Support use of MAHC
Vision
To keep the MAHC up-to-date, science-based, sustainable, easily understood and implemented by pool programs across the U.S. so as to support healthy and safe aquatic experiences for everyone.
The Conference for the Model Aquatic Health Code (CMAHC)
Mission
Collect, assess, and relay input on MAHC revisions back to CDC for final acceptance
Provide advocacy and needed support to health departments and other partners on using the MAHC
Solicit, coordinate, and prioritize research needs
CMAHC Biennial Conference
CMAHC Biennial Conference will be hosted every two years
Biennial CMAHC meetings: 2015, 2017, 2019, 2021, 2023, 2025, 2027, 2029
New MAHC Edition launches at CDC: 2016, 2018, 2020, 2022, 2024, 2026, 2028, 2030
CMAHC Working Structure: General Outline
InputChange Request
Technical Review & Discussion
CDC
Conference & Voting
Board of Directors
Standing Committees
DISINFECTION BY-PRODUCTS
MAHC ADOPTION
MAHC Features to Encourage Implementation
Voluntary science-based standards
Modular format allowing flexibility for jurisdictional needs
Design elements apply to new construction only
“Evolution, not revolution”
Diverse stakeholder involvement Public health partners
Coordination between building code officials and public health practitioners
User Guide under development
MAHC Adoption Status
Key considerations States must review and fit into regulatory process and timeframe:
adoption can take > 2 years; Food Code sped up after 3-6 years
Endorsements NACCHO 2015; NEHA imminent; CSTE 2017?
Adoption Full adoption: NM (08/01/2016 after 2+ years prep); Nova Scotia,
Canada
Partial adoption: DE, PWTAG/UK
In review for potential adoption: almost 30 jurisdictions such as CO; IA; IN; MD; NY; OH; Ontario, Canada; Colombia
Clear role for aquatics sector advocacy to speed adoption
Visible Groundswell Following MAHC Release: Becoming a Standard While Waiting for Adoption
Operational adoption: Use in operations, MAHC-compliant operational materials, and operational assistance
e.g., YMCA operations manual, Great Wolf Lodge operational guidance, Jeff Ellis & Assoc. guarding materials
Variances granted: MAHC-based variances/waivers given liberally to requestors while discussing adoption (e.g., FL, NY, CT)
Surrogate pool code: States without a pool code pointing to MAHC for design, operation, management guidance (e.g., MS)
Acceptance of design requirements: MAHC design features becoming accepted and not immediately removed from designs due to cost
Clients signing liability waivers if they require removal (e.g., UV disinfection on increased risk venues)
Standard of care: Being referred to as standard of care based on expert witness feedback
ANTICIPATED OUTCOMES
Short Term Outcomes: Immediate After Guidelines Adopted
Automated controllers and feeders
Chemical feeder-recirculation interlocks
Diaper changing station criteria
Training for pool operators
Performance-based lifeguarding
Preventive maintenance checks
Policies: employee illness, body fluid response, pool surface cleaning to reduce biofilm
MAHC Outcomes: Intermediate Term
Improved operations
Adoption of minimum standards across the U.S. (as with national food safety and building model codes)
Systems-based approach to facility design, operation, maintenance, policy
Reductions in pool closures due to imminent threats
Improved pool programs
Improved surveillance systems
Improved data collection
Data-based decision making
MAHC Outcomes: Long Term
Extensive research agenda
Prioritize data needed to drive MAHC changes
Drive fund raising efforts
Long-term outcome
Reductions in RWIs, injuries, drowning
CONCLUSIONS & FUTURE DIRECTIONS
MAHC and Pool Program Benefits
Saves state/local resources being used to essentially “reinvent the wheel” in separate jurisdictions
Scientifically or best practices based guidance
Renewed on biennial basis like model food code
Creation of toolkit with forms/guides to assist facilities
Will include “administrative code” guidance for pool programs with forms/guidance
Was initially in MAHC but is now separated because “can’t regulate the regulators” concerns
MAHC and Pool Program Benefits
Assist programs in more efficiently collecting data and analyzing it for use in decision making,
Assist with building uniformity across jurisdictions
Build relationships with building code inspectors
Build stronger relationships with aquatics industry since they have been involved from the beginning
Could be beneficial during state adoption
MAHCMore Information: Search on
“CDC MAHC” or visit the Healthy Swimming MAHC
Website: www.cdc.gov/mahcEmail: [email protected]
CMAHCMore Information: Search on “CMAHC” or visit the CMAHC
Website: www.cmahc.orgEmail: [email protected]
Contact Information
Doug Sackett
Executive Director, CMAHC
E-mail: [email protected]
Phone: 678-221-7218
QUESTIONS ?