Non-respiratory symptoms
Concerning self-reported ocular symptoms, indoor swimming-pools employees declared frequently having red (48.9%) and itchy (44.4%) eyes, mostly lifeguards and trainers13.
Regarding the skin, both water itself and CBPs have negative effects due to a dilution or flushing out of the natural moisturizing. An increasing risk of irritative skin symptoms was demonstrated dependent on the NCl3 concentrations21. Recreational swimming leads to transient but significant changes in skin surface properties of women with healthy skin22; skin dryness, itch and erythema are non-specific complains in swimming-pool attendants23,24. Additionally, both allergic contact dermatitis and contact urticaria due to chlorinated-pool water have been identified20,23,25,26. Swimming in public pools/spas in the current or previous week has been associated with dermal symptoms (rash, generalized itching, dermal infection)27. Besides, more verrucas, mycosis, eczema and rash have been identified in lifeguards and trainers compared to other workers at swimming pools13.
Three different disinfection systems (chlorine, chlorine/ozone and bromine/ozone) were investigated to assess adverse skin and eye effects28: compared with the bromine/ozone pool, the odds ratio (OR) of having a rash <24 h after pool use was 1.91 (CI 0.71-5.10) for the chlorine-pool and 1.88 (CI 0.61-5.81) for the chlorine/ozone pool. Gomà et al.29 reported the efficacy of a new disinfection method (based upon on replacement of the strong HCl by CO2, inclusion of a low concentration salt electrolysis system, and ultraviolet radiation phase) to markedly reduce the irritant substances levels in the pool atmosphere and significantly reduce eye, nose, skin and cough complaints, both in recreational and competitive swimmers.