Splash Pads: Understanding Risks and Creating Best Practices

WELCOME TO THE 2020 FRPA CONFERENCE! Splash Pads: Understanding Risks and Creating Best Practices

Presenter: Lauren Broom, B.S., R.S. About Your Instructor

• Certified instructor through the Pool & Hot Tub Alliance to teach the Certified Pool Operator Course (CPO)® • Attended University of Central Florida • B.S. in Biology • Florida Dept. of Health for 16 ½ years-Dec. 2003 to 08/2020 • Environmental Specialist II—public health inspector • Inspected public swimming pools • Recreational water outbreak investigations as part of the Epidemiology Dept. • Registered Sanitarian(R.S.)—certification in public health • Adjunct Instructor- Apartment Maintenance Technician Program • Valcencia College General

The popularity of splash pads have gained traction over the past decade. These facilities have inherent risks since the water is recirculated. The objective of this presentation is to identify the public health risks and create best practices to best manage these risks. LEARNING OBJECTIVES ▪ Recognize public health risks in splash pads. ▪ Identify best practices to control public health risks in splash pads ▪ List examples of recreational water illness outbreaks specific to splash pads ▪ Design & treatment equipment used to minimize the recreational water illness outbreak hazards Overview: Splash Pads

• Many names • Spray park, wet deck, splash park,spray-ground

• CDC Model Aquatic Health Code categorizes these as “Increased Risk Aquatic Venues”

• Water does not accumulate—reduces risk of drowning

• Increasing popularity • Little to no supervision compared to wading pool, spa, traditional pool • Cheaper to run for Parks & Rec since no supervision is required Design Re-Circulating System Non-Recirculating System

Higher Risk • Design often not indicated to the public Lower Risk • Presentation focuses on re-circulating splash pads • Re-circulating--higher risk of contamination and disease transmission that can be mitigated through proper design and operation Splash Pad Risk Factors:

• Behavior of people using it—mostly young and diapered children • Non-hygenic behaviors like exposing buttocks to spray features or drinking the water • One infective bowel movement can release enough oocysts of Crypto to contaminate 100 million gallons of water. • It is an open system outdoors—thus can get contamination from animals, birds, dust • Larger bathing load in relation to volume of water • Increase chance of fecal contamination • Increase turbidity in water—lower usefulness of disinfection • Reduced turnover rates • Areas that are constantly damp for prolonged periods of time—have higher levels of microorganisms compared to those submerged constantly in chlorinated water • Facility may use foggers or misters in the area • Water supply • Improper signage—bad messages or lack thereof • Greater dissipation of chlorine due to water being sprayed • High chlorine stabilizer(Cyanuric acid) levels • Lack of super-chlorination • Lack of properly trained staff that understand how to operate equipment • Irrigation systems that may overspray into the splash pad • Popular to use reclaimed water in Florida that contaminates the splash pad water • Studies performed found that it is often contaminated with crypto oocysts • People like to bring food and drinks into the fenced in area that could potentially contaminate water. • ORP monitoring system inoperable or in lock out • Lock out chlorine feeder and pH adjustment feeder • High pH levels that could lower % activity of chlorine concentration • Need ORP controller and pH adjustment feeder in most set ups • Irrigation systems that may overspray into the splash pad • Popular to use reclaimed water in Florida that contaminates the splash pad water • Studies performed found that it is often contaminated with crypto oocysts • People like to bring food and drinks into the fenced in area that could potentially contaminate water. • ORP monitoring system inoperable or in lock out • Lock out chlorine feeder and pH adjustment feeder • High pH levels that could lower % activity of chlorine concentration • Need ORP controller and pH adjustment feeder in most set ups • High levels of chloramines that cannot be removed by breakpt. Chlorination that can cause: • Pool odor • Eye, nose, throat irritation

Public Health Risks

• Recreational Water Illness Outbreak Risks • Cryptosporidium—protozoan parasite • Giardia—protozoan parasite • Salmonella-bacteria • Shigella-bacteria • Legionella-bacteria Who is at most risk??

• Young children • Pregnant women • People with weakened immune systems that have the following: • AIDS • Cancer • Other inherited diseases Recreatinal Water Illnesses (RWI)

• Can be transmitted in 3 ways: • Ingesting water • Contact with contaminated water • Air- aerosolized water droplets that are contaminated • Where do they come from? • From swimmers!! • Average person swallows 1 ounce of water for every 30 min. of swimming • GI illness is caused by swallowing food or water that is contaminated with feces. • Average person carries about 0.14 grams of feces on their rear end—babies carry more Anyone Here Have Diarrhea?

• Where do they come from? • From swimmers!! • Average person swallows 1 ounce of water for every 30 min. of swimming • GI illness is caused by swallowing food or water that is contaminated with feces. • Average person carries about 0.14 grams of feces on their rear end—babies carry more • Add up all the bodies using splash pad and you get fair amount of feces • If a person has an accident(formed or diarrhea) then the amount of feces in water goes way UP! • At some point concentration rises above the minimum for infection—and you get an outbreak! The germs that cause GI RWI have very low infective doses:

Organism Dose that will cause disease: E. Coli O0157:H7 10 cells Norovirus 10 particles Giardia 10-100 cysts Cryptosporidium 10 cysts

There is enough Cryptosporidium cysts in contaminated water if you lick your lips after going into the splash pad and ingest it to get you sick! Control of GI illness causing pathogens in splash pads:

Group Organism Killed by chlorine? Bacteria E. Coli O157:H7 Very quickly—all bacteria killed in Shigella ≤1 min @ 1 ppm FAC Parasites Giardia Quickly- <30 min @ 2 ppm FAC

Cryptosporidium Killed by 20 ppm FAC in 12.75 hours in absence of CYA

Crypto-800 pound gorilla of RWI’s

• Amounts for 75% of recreational water illness outbreaks • Thus well represented in outbreaks • Outbreaks become community wide and can spread through other ways like childcare centers and food establishments • Chlorine resistant • Requires additional(secondary) treatment to kill (use of UV or ozone) • Most common in treated recreational venues • Infective unit (oocyst) is built like a basketball with 2 little larvae inside the ball • Much larger than bacteria, • very difficult to kill with routine disinfectant levels • Effective filtration helps in removal • Best prevention is to discourage swimmers who have been ill • Do not swim until 2 weeks after symptoms have ended.

Crypto:

• Symptoms: • Diarrhea • Loose or watery stools • Stomach cramps • Upset stomach • Slight fever • Spread by fecal contamination of water from infected person • Factors that contribute to spread: • Inadequate animal waste removal • Inadequate filtration • Inadequate or interrupted disinfection • Contamination for other water source overspray

Hyper-chlorination & Crypto

• Different from routine super-shocking or breakpoint chlorination • Specific for inactivating Crypto • Must achieve contact time (CT) of 15,300 min The correct use of hyperchlorination for Crypto

15 correct incorrect 10

5 ppm chlorine of free

0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 time in hours

Keep the HOCl at 20 ppm for ENTIRE 13 hour period

Animals & Aquatic Venues—It does happen!

j Crypto Outbreak

• Location: • Water Park • Broward County, FL • 22 cases(16 confirmed) • Time period: July – August 1996 • Suspected index case: • 2 yr old child with diarrhea • Problems seen on inspection: • Grossly exceeded permitted bathing load of 118 persons • Water clarity was compromised • Ozonator for secondary disinfection not operational Crypto Outbreak/ Shigella RWI Outbreak

• Location: Volusia County,Florida– Splash Pad • Volume of water: 3380 gallons

• When: August 1999

• Number affected: 38 Environmental Assessment

• Contributing Factors to Outbreak: • No filtration system installed • Inadequate chlorine residual • Fountain water ingestion • Consumption of food/ water at splash pad • Many young children in swim diapers and they were standing over the spray nozzles • Chlorine levels not monitored • Results after closure of splash pad: • Cartridge filtration system installed • Chlorine monitor(ORP) installed to halt fountain operation automatically when chlorine residual levels fell below 3 ppm. • Signage advising: • Showering before entering fountain • Do not drink the water since it is recirculated • Change swim diapers in appropriate areas in bathrooms Crypto/ Giardia RWI Outbreak

• Where: Florida—Splash Pad

• When: 2006

• Number Affected: 49

• Contributing Factors to outbreak: • Inadequate chlorination • Other operational deficiencies Cryptosporidiosis Outbreak Florida, 2007 • Context • Child played in 2 interactive fountains while ill with diarrhea • Magnitude • 33 cases • 1 child care center • Multiple interactive fountains potentially contaminated

Source: C Dunn and G Schuessler, Indian River County Department of Health Inspection during Outbreak Investigation — Florida, 2007 • ~6,000 gallons • No lifeguards or attendants • Children drinking water, young children naked in water, parents changing diapers nearby, people walking through the fountain and nearby bird droppings, and joggers rinsing in clothes and shoes after run • Interviewed persons did not know water was recirculated • Reuse water for irrigating landscaping • Could overspray into fountain

Source: C Dunn and G Schuessler, Indian River County Department of Health Recommendations Florida, 2007 • Post sign warning patrons not to drink fountain water • Improve swimmer hygiene • Do not swim while ill with diarrhea • Change diapers in restroom or diaper-changing area • Wear swim diapers • Hyperchlorinate regularly • Switch to potable water for irrigating landscaping

Source: C Dunn and G Schuessler, Indian River County Department of Health Parasites in the Park: Investigation of a Cluster of Giardiasis and Cryptosporidiosis Cases Orange County, FL, 2006 Initiation of Investigation

• 9/1 Interviewed mother of a 22 mo male with Giardia and Cryptosporidium • Onset 8/21/06 • Daily exposure to Splash Park A

• 9/6 Pediatrician’s office reported 3 cases of giardiasis: 4 yo male, 2 yo female, 23 mo male • Onsets: 7/21, 7/22, 8/18 • Each visited Splash Park A Environmental Investigation of Splash Park A

September 8, 2006 Environmental Results • Major violation: concentration of chlorine <0.5 ppm

• Other observations • Non-functioning pH/ORP sensor unit • Paper cartridge filter (effective to 15 μm) • Not draining properly • No maintenance log • Bathrooms not clean • Algae build-up Environmental Actions

• Immediately closed Splash Park A and surrounded area with caution tape

• Homeowners association fired pool company in charge of maintenance

• Cleared for provisional reopening on October 11 Orange County Cases

Total Orange Cases Interviewed Primary Splash Park A County Cases* (% Total Cases) Cases (% Interviewed) Giardiasis 86 70 (81.4) 35 (50.0)

Confirmed 75 59 (78.7) 32 (54.2)

Probable 11 11 (100.0) 3 (27.3)

Cryptosporidiosis 45 38 (84.4) 8 (21.1) Confirmed 36 29 (80.6) 6 (20.7) Probable 9 9 (100.0) 2 (22.2) Co-infection 3 3 (100.0) 2 (66.6)

Confirmed 2 2 (100.0) 2 (100.0)

Probable 1 1 (100.0) 0 (0.0)

Total 134 111 (82.8) 45 (40.5)

*7 confirmed giardiasis cases and 5 confirmed cryptosporidiosis cases excluded from analysis because they were either severely immunocompromised or out of the country for the duration of their incubation period according to medical charts. Additional Cases • 6 Orange County secondary Splash Park A cases • 5 probable giardiasis cases • 1 probable co-infection case

• 6 Seminole County primary and secondary Splash Park A cases • 3 confirmed primary giardiasis cases • 1 confirmed primary cryptosporidiosis case • 2 probable secondary cryptosporidiosis cases

• 6 Orange County suspect cases identified through answering public inquiries Total Splash Park A Cases

Giardiasis Cryptosporidiosis Co-infection Total Cases Cases Cases Cases

Primary Cases 38 9 2 55 Confirmed 35 7 2 44 Probable 3 2 0 5 Suspect N/A N/A N/A 6 Secondary Cases 5 2 1 8 Splash Park A Case Demographics

• Age range (median age) • Primary cases: 2-38 years (4 years) • Secondary cases: 29-40 years (37 years)

• Sex • Primary cases: 65.5% male • Secondary cases: 62.5% male National Crypto Outbreaks

• Where: Illinois—splash pad

• When: 2001

• Number Affected: 358

• Contributing Factors to Outbreak • Inadequate chlorination • Where: Seneca,New York—splash pad

• When: 2005

• Number Affected: about 4000

• Contributing Factors to Outbreak: • Inadequate chlorination • Crypto was found in their holding tanks • Resulted in class action lawsuit against the state for monetary compensation Giardia

• Protozoan parasite • Symptoms: • Dirrahea (pale, greasy, malodorous) • Abdominal pain • Bloating • Nausea • Weakness • Vomitting • Dehydration • Fatigue • Loss of weight • Fever • Spread by fecal contamination of water • Factors that contribute to spread: • Inadequate or interrupted disinfection • Improper filtration • Contamination for other water source overspray Giardia/ Crypto RWI Outbreak

• Location: • Interactive Fountain Feature in Orange County, FL • When: May – December 2006 • 55 total cases associated with splash pad • 38 Giardiasis • 9 Crypto • 2 co-infections • 6 suspect • 8 known secondary infections—through food/school/ daycare • Problems seen from July 2005 to that outbreak time period: • Chronic maintenance occurred • Filtration problems • Water chemistry problems Challenges: Chlorine-Resistant

Chlorine Level (ppm) Disinfection Time 1.0 45 minutes Giardia 2.0 25 minutes 3.0 19 minutes

Chlorine Level (ppm) Disinfection Time 1.0 6.7 days Cryptosporidium 10 16 hours 20 8 hours

CDC. MMWR. 2001;50(20):416-417 CDC. MMWR. 2001;50(20):410-411 Shigella

• Bacteria • Symptoms: • Abdominal pain • Diarrhea—could contain blood/ pus/mucus • Spread by • Fecal contamination in water from infected user • OR contaminated water that infiltrated splash pad Shigellosis Outbreak

• Location: • Interactive Water Fountain (splash pad) • Volusia County, FL • 4 lab confirmed cases of Shigellosis late August 1999(age range 2-11) • Only common activity: playing in this splash pad • Fountain was installed prior to code update requiring health dept. approvals. Legionella

• Bacteria • Symptoms: • Loss of appetite • Body aches • Headache • Fatigue • Fever • Chills • Diarrhea • Abdominal pain • Non-productive cough • Pneumonia Respiratory disease: Legionella pneumophila

• Grows in biofilms • Thrives at 90OF to 106OF and neutral pH • Almost all infections from hot tubs. • WHO: 50+ outbreaks on cruise ships • Not resistant to chlorine • Infection: inhaled contaminated There are documented droplets, dose size unknown cases where individuals • Treatment: antibiotics (Legionnaire’s became infected simply by Disease) walking past a • Vacation and rental properties are contaminated hot tub with high risk the blowers on.

1. Legionella pneumophila becomes established in biofilm 2. Bacteria break free of the biofilm 3. Chlorine level <1 ppm allows Legionella pneumophila to survive in the water 4. Bubbles trap Legionella pneumophila 5. Air bubbles break the surface and burst 6. Fine droplets float in the breathing zone 7. Droplets are inhaled into the lungs 8. Bacteria enter White Blood Cells in the lungs 9. Bacteria reproduce inside the White Blood Cells 10. Outcome either Legionnaire’s Disease or Pontiac Fever

Legionellosis is not spread by person-to-person contact

• No documented cases of Legionella in splash pads at this time, but can happen if biofilm is allowed to form in fixtures or plumbing lines and if there is a lack of superchlorination routinely that will KILL it!

• There have been documented cases linked to decorative fountains which also recirculate water and spray water Salmonella

• Most people with a Salmonella infection experience: • Diarrhea (that can be bloody) • Fever • Stomach cramps • Some people may also have nausea, vomiting, or a headache.

• Easily killed by normal required disinfection levels by local regulatory authority

• Waterborne outbreaks of this organism are uncommon Samonella National Outbreak

• Where: Tennessee– splash pad • When: June 2014 • Info: splash pads not regulated in Tennessee • How many were ill: 10 • Risk factors that contributed possibly to outbreak: • No free chlorine in splash pad water • Children seen drinking splash pad water • Children putting their buttocks over the spray heads • Daily chemical log for pH and chlorine levels not being maintained • Prevention ideas given: • Regulate splash pads • Improved education of patrons Best Practices: Design

• Proper siting of the pad-minimizes potential sources of dust/debris/animals • Exclusion of animals-through signage and fencing • Adequately sized water reservoir • To allow with dilution and more effective disinfection • Minimize accumulation of disinfection by-products like chloramines • Assists with proper balanced water chemistry • Provisions for constant recirculation • Discharge of water when not in use • Spray features on separate pumps than filtration & disinfection system. • Feature pumps cannot operate when treatment pump is not operating • Discharge some water from reservoir while park is closed to obtain more fresh water • Provide adequate filtration to control turbidity so that disinfection systems operate as intended • Turbidity less than 3 NTU • Ability to drain the deck directly to waste • Chlorination at least 2 ppm • Second form of disinfection like UV or Ozone • Foggers and misters from potable water supply and properly disinfected against Legionella growth • Outfit feature with automatic shut-off device or audible alarm

Best Practices: Operation

• Flush pad surface prior to operation • Daily • Should be to direct waste • Inspections • Look for glass and feces • Regular sanitation • Deck • Feature • Routine Water testing with approved test kit • Daily chemical log maintained onsite for Chlorine/pH test readings

Best Practices: Operation

• ORP meters for chlorine activity(mV) and pH readings • Fountain to automatically cease if chlorine level is less than 3 ppm • Review equipment requirements to maximize filtration and removed of particulate matter • Review operational procedures to optimize filtration performance Filtration • Many different types of filters to choose from in aquatic industry-choose best micron size and filter with easiest maintenance • Most splash pads use due to ease of cleaning and time mgmt.: • Cartridge filter • Sand filter • Need to clean as needed to maintain proper flow rate • Need good filtration rate to reduce turbidity that will affect secondary disinfection

• Change cartridge filters monthly Challenges: Small Size

• Parasite sizes • Giardia cyst: 8 – 14 microns • Cryptosporidium oocyst: 4 – 6 microns

• Pool filter particle removal size • High rate sand: 25 microns • Paper cartridge: 15 microns • DE filter: 4 microns Disinfection Design

• Primary disinfection with chlorine disinfection

• Secondary disinfection with use of UV or ozone Primary Disinfection

• Use of disinfectant like chlorine that can: • Kill 99.9% of microorganisms • Oxidize and sanitize • Leave a residual in the water that can be read on pool test kit. • Must be fed by automatic feeder and works best with ORP controller Secondary Disinfection-Choices • Secondary disinfection required for “Increased Risk” aquatic venues with NSF/ANSI Standard 50 approval • These systems are required to provide minimum of 3 log(99.9%) inactivation of Crypto in full flow prior to return of the water to the aquatic feature at minimum flow rate.

• UV light

• Ozone

These are secondary disinfection systems because they do not leave a residual in the water that can be read by any test kit. UV • UV light inactivates microoganisms and breaks down chloramines with light energy. This happens while the water is in the UV chamber only, and as long as the water has no turbidity. No further process occurs once the flow leaves the chamber. UV provides no oxidation except as trace amounts. • UV water treatment for typical UV dose of 30 mJ/cm2 can provide sufficient disinfection since most pathogens are killed at relatively low UV energy for disinfection UV dose mJ/cm2 Required for 3 log(99.9%) inactivation of these RWI’s

RWI UV dose required for 3-log(99.9%) inactivation

Cryptosporidium parvum 12

Giardia Lamblia 11

Shigella 6.5

Legionella pneomphila 6.9 • Why used? • Ease of use • Reduced chemical consumption • UV-C is wavelength category used • 280-100 nanometers • Known as germicidal light • Disadvantages: • Service technicians lack background and training on maintaining system • Turbidity affects how water is disinfected since it is cloudy and lack of contact of water with UV light • Only water that makes it through the UV light gets disinfected, not always 100% of the water and hence why secondary disinfection • Over time UV light becomes less effective, need to factor in replacement of lamp to maintain disinfection rates Benefits of UV Systems

⚫ Increased Bather Comfort

⚫ Increased Employee Comfort

⚫ Reduced Need for Expensive Dilution

⚫ Reduced Corrosion of Steel Structures

⚫ Protection Against Cryptosporidium and Giardia

⚫ Increased Poolside Revenue $ Benefits of UV Systems

1) Destruction of Chloramines

2) Effective Primary Disinfection >99.9% Kill of Common Pathogens Effective Against Cryptosporidium and Giardia 3) Oxidation of Organic Contaminants 4) Clarification of Pool Water 5) TDS Reduction 6) No THM increase or any other change Chloramine Reduction Summit Health Club, Montana

1.20 1.10 1.00 0.90 0.80 0.70 0.60 Pre-UV 0.50 0.40 0.30

Bound Bound Chlorine (ppm) 0.20 0.10 Post-UV 0.00 UV Technology

Wavelength (m)

10-13 10-12 10-11 10-10 10-9 10-7 10-6 10-3 10 105 Visible Radio g Rays X-Rays Ultraviolet Infrared Frequencies

The Electromagnetic Spectrum

Ultraviolet is… A Type of Electromagnetic Energy Found Between X-Rays and Visible Light Wavelength Range: 5 nm to 400 nm Spectral Output of UV Lamps

UV exposure penetrates cell wall, disrupts DNA and prevents cell reproduction UV, The Mechanism

Effects of UV irradiation on DNA

DNA before exposure

DNA after exposure Primary Disinfection Dose Required to Kill 99.9% of Common Pathogens

Escherischia coli 16.2 mJ/cm² Bacillus enteritidis 12.0 mJ/cm² Hepatitus B Virus 33.0 mJ/cm² Mycobacterium tuberculosis 18.6 mJ/cm² Salmonella enteritidis 22.8 mJ/cm² Cryptosporidium parvum 17.7 mJ/cm²

Dose from Hanovia System >60 mJ/cm² Chamber Design - Medium Pressure

316L Stainless UV Monitor Steel Chamber

Quartz Sleeve Quartz Sleeve containing Arc containing Arc Wiper Motor Tube Tube UV Light Disinfection • UV light reactor been considered for disinfection of interactive water features

• UV dose of 8-14 mJ/cm2 inactivates at least 99.9% of Cryptosporidium oocysts

• UV dose of 12-20 mJ/cm2 inactivates at least 99.9% of Giardia cysts

Qian SS, et al. Water Research. 2004;38:317-326. Ozone

• Ozone is a gas that is dissolved in water to kill micooraganims, destroy organics and break down chlormaines by oxidation. This occurs immediately at the ozone gas injection point and continues as the side-stream remixes with the main return. • Ozone does provide the 3 log (99.9%) kill of Crypto in side-stream applied single pass at applied O3 dose of 1.6 ppm over the total pool volume in 24 hours. • Ozone Sizing Parameter for Splash Pad • 1.6 ppm/ 4 hr(240 min)

• Dissolved ozone is measured by an ORP controller • ORP can range between 700-850 mV • ORP of 800 mV is 0.2 ppm of dissolved ozone which equates to about 40 ppm of chlorine

Ozone Generators

These include: • Ultraviolet ozonators • Corona discharge Corona Discharge

• Corona discharge systems produce a much higher concentration and quantity of ozone as compared to the ultraviolet (UV) ozone generators

• Since an ozone residual is not maintained in pool or spa water, it is used to supplement disinfectants like chlorine or bromine Ultraviolet (UV) Ozone Generators

• A lower output of ozone and a lesser concentration than CD generators • Air is passed over UV lamps • The energy from these lamps splits the oxygen molecules in the air

Ozone vs. UV Comparison Summary ORP-Automatic Chemical Monitoring

• Test kits measure quanitatively(how much there is—ppm). ORP measures qualitative measure of chlorine’s work value in mV. • ORP tells us what will happen to disinfectant level 20 minutes from now

• ORP can be seen as predictor of the work that needs to be done in order to maintain water quality

• ORP measures the oxidizer, detractors and reducers simultaneously which makes ORP best possible control parameter for aquatic venues

• Research has shown that the amount of reducers (urine, swimmer wastes, organics, etc.) is changing constantly. Under these conditions, only ORP can be used to ensure the inactivation of RWI viruses and bacteria. Benefits of Chemical Automation

• Continuous maintenance of pH and sanitizer levels

• Reduction in partially oxidized organic matter

• Optimized sanitizer efficiency and reduced chemical consumption

• Increased compliance with Health Dept. operating

• Improved service life of splash pad equipment What is pH/ORP controller?

• Automated controller that monitors water chemistry, compares actual water quality readings to desired setpoint entered into controller and implements chemical feeding to automatically maintain pH and sanitizer levels “Brain” • Monitors pH and sanitizer effectiveness • Makes chemical feed decisions • Actuates chemical feed equipment • Maintain pH and sanitizer level • Many different types out there-all work on same technology

Best Practices: Education

• Signage : do not drink the fountain water, it is re-circulated. • Signage to show where diaper changing areas are located- so that not changed next to splash pad • Signage: do not swim while ill with diarrhea • Control bathing load—post signage • Shower before entering—post signage • Advocate use of swim diapers for diaper aged children(although not 100% effective)—pic of diaper • Signage in splash pad bathrooms on washing of hands prior to returning to pad • Signage on taking children on bathroom breaks

Tour of McKee Botanical Gardens IWF

Tour of Riverview Park Splash Pad

• Approved prior to requirement for secondary disinfection requirement

Lauren Broom, B.S., R.S. 321-726-8509 [email protected] FOR MORE INFORMATION ABOUT THE FLORIDA RECREATION AND PARK ASSOCIATION VISIT FRPA.ORG