Occupational hazards... Contact dermatitis and occupational asthma in therapists and instructors

High chloramine levels can cause illness in those who spend time in or near indoor swimming pools.

And, quite frankly, it can be the aquatic therapists, instructors and other staff who come down with the symptoms instead of the public.

Why? A typical aquatic therapy or aquatic exercise client may attend the pool 3x/week for 30-60 minutes sessions. In contrast, therapists and instructors often spend 4-6 hours (if not more) in the water each day of the week.

There are now products created to prevent skin irritation. Try Sprint Chimal Skin Shield or Kiefer SwimScreen (these are lotions which prevent skin irritation with prolonged immersion).

So how do you know if you are being exposed to high chloramine levels? One recent study showed common symptoms include cough and other respiratory symptoms (84%), eye irritation (78%) and rash (34%).

In another study of aquatic therapists, 44.4% reported the development of skin disease for the first time after the beginning of work at the swimming pool. The most common symptoms included pruritus and erythematous patches affecting mainly the extremities and trunk. Both smoking and increased exposure time increased the risk of acquiring a contact dermatitis.

The study concluded that contact dermatitis should be recognized as an occupational disease in aquatic therapists.

Of special note: The prevalence of contact dermatitis in pools chlorinated by gaseous chlorine was significantly higher than that in pools disinfected by other forms of chlorine compounds.

Additional Resources:

• To read research abstracts cited above about contact dermatitis.
  
• ePro Learning online training to learn more about rashes and other contact dermatitis risks.
• "Chemically Induced Rashes" article will help you decide if the rash you experience after pool time is due to chemical irritation or to a bacterial infection. In a nutshell, take a look at the chart below.
• "How long is too long" - article about length of time therapists should spend in the water.

Table 1 – Comparison of rashes

	Rashes caused by a chemical reaction	Rashes caused by a bacterial infection
Time to first symptoms	<24 hours, can be <10 minutes	>24 hours, often >2 days, occasionally up to 14 days
Duration of symptoms	Days to weeks	<14 days, usually 8 days
Typical appearance	Red itchy rash	Red rash (like bug bites if small or poison ivy if severe)
Reaction on re-exposure	Progressively worse	No change
Medical treatment	Not usually required	Not usually required