Introduction
First, they suspected the food prepared for the birthday party to be the cause of the outbreak. It turned out that it was a waterborne disease, a norovirus. Waterborne disease can easily affect children who come in contact with the contaminated water.
The swim club manager seemed not very much cooperative during the initial outbreak; but the VHD investigators needed the cooperation of the swim club manager in identifying the real cause of the outbreak. Later, the manager told them that other persons not invited to the February 1 birthday party (members of an infant-mother swim class) got sick with ‘stomach flu’. From this information, VDH investigators came to know that 21 persons who had attended the swim club were reported being ill. The symptoms included vomiting, nausea, abdominal cramps, diarrhea, fever, and headache (Lee 2010). The victims got sick 8-62 hours after visiting the swim club. All patients reported being in the swim club on Saturday, January 31 or Sunday, February 1.
Primary cause of the outbreak
A virus contaminated the water in the pool that caused it to spread to anyone who came in contact with the water. The epidemiological dynamics of this particular virus had yet to be determined in the laboratory, and it would take time (Mpolya et al., 2009). Viruses a threat to the general public, especially children who are vulnerable when they play at entertainment swim clubs (Mermin et al., 2010).
Some parents reported that the water in the pool looked cloudy. A lifeguard reasoned that the cause of the cloudiness of the pool was a chemical added to the water. The initial findings of VDH investigators reported that the cause of the gastrointestinal illness was a norovirus infection which was spread by exposure to the pool on Saturday, January 31, or Sunday, February 1.
VDH investigators conducted a comprehensive assessment of the private swim club. The goal of the investigators was to gain a thorough understanding of the design features of the swim club.
Environmental factors
High staff turnover at the club shows that there was a problem of human resource management, which further affected employee performance. The swim club manager had entrusted some complicated pool decisions to the pool operator. Lifeguards, who received no formal or standardized training in pool maintenance, performed pool operations at the private swim club. The pool operator, who was in charge of the pool equipment, gave instructions to lifeguards regarding maintenance and water treatment. The lifeguards did not produce any record or documentation regarding testing. Water testing is an important part of pool operations and maintenance due to the changes of concentrations of chemicals as a result of chemical reactions, or when water is splashed out of the pool (Anderson et al. 2003). Testing should be done regularly to ensure safety for swimmers. Chlorine has to be measured and should be readily available to disinfect the pool water. Aside from chlorine testing, there are other chemical testing to be done at the pool (Bush 2002).
Lapses by occupational agents
Since information about water chemistry was unavailable due to failure of lifeguards to produce records in testing, staffs were made to recall water conditions on February 1, and the type of chemical solutions they used for the pool. They then reported the unusual color, or the cloudiness of the water in the pool (Podewils 2010).
Health codes of Vermont should be checked regarding regulations. CDC has regulations for chlorine level in a swimming pool, which should be 1.3 parts ppm, and 7.2-7.8 parts for pH.
The private swim club did not comply with local regulations since the free available chlorine and pH were tested as way below the recommended safe levels. Moreover, the swim club did not contingency plans regarding presence of abnormality in pool chemistries, in handling complaints from the public, responding to fecal complaints, vomiting and other emergencies (Lasker et al. 2001).
Mitigation of health and safety
At the outset, the incident occurred when the pool was at its highest activity; there was eating and drinking at the pool which increased risk factors for illness, particularly on children. Going into an unsafe swimming pool that is not-well managed can increase risks for children and adults. The risk was exacerbated by suspect fecal incident, which the VDH investigators later confirmed.
There were lapses in pool management and the actions of the pool staff. There was no public-private partnership, the club manager was too busy to attend to the emergency. Health and safety are global issues that should be addressed by a close cooperation by private and public agencies (Ford, Wells, & Capper 2003).
Quick action
Quick action of investigators in addressing the problem and in pinpointing the real cause could have prevented an outbreak. Cooperation from all possible stakeholders should have been obtained, but in this case not everyone gave their support in obtaining a successful outcome of the investigation of the outbreak. Health authorities have the responsibility for preventing the outbreak; this is not only the job of business (Allen-Scott, Hatfield, & McIntyre 2014).
Provide suggestions to prevent future waterborne disease outbreak.
Lessons learned from the Vermont case study can tell us that there should be proper management of the pool, the staff must be well trained and acquainted of the regulations, and the policies and procedures in running a pool. If these conditions are not met, a private swim club is a health and safety risk for the public, especially children.
The environmental factors, the facts involved and the actions by the VDH investigators allowed me to think of how public health should be safeguarded and delivered (Modell 2000). Public health is not a simple issue of some government agencies conducting investigation and providing recommendation. Policy is important in governance, and this should have been a primary concern of the state that cares for public health (Martin & Halachmi 2012).
Health agency on one side, and pool operator and club manager on the other should have close coordination to safeguard public health. In this case study, VDH investigators helped the private swim club, represented by the manager and the pool operator in developing a written policy in dealing with fecal incidents. This policy allowed the staff to document similar incident by writing in detail the date and time of the fecal incident, specifying whether it was a formed or diarrheal stool, including the amount of chlorine applied during the time it was detected.
References
Allen-Scott, L, Hatfield, J, & McIntyre, L 20124, ‘A scoping review of unintended harm associated with public health interventions: towards a typology and an understanding of underlying factors’, International Journal for Public Health, vol. 59, pp. 3-14, viewed 21 August 2016, via EBSCOHOST database.
Anderson, A, Heryford, A, Sarisky, J, Higgins, C, Monroe, S, Beard, R, Glass, R 2003, ‘A waterborne outbreak of Norwalk-like virus among Snowmobilers – Wyoming, 2001’, Journal of Infectious Diseases, vol. 187, no. 2, pp. 303-307, viewed 23 August 2016, via Academic Search Premier database.
Bush, G 2002, Preventing recreational water illnesses in chemically treated swimming water: an intervention measuring knowledge and behaviour using the stages of change model, PhD Thesis, Middle Tennessee State University, viewed 23 August 2016, <http://ezproxy.sothebysinstitute.com:2195/pqdtft/docview/305552213/previewPDF/BF3F18261D40410APQ/1?accountid=13958>.
Ford, E, Wells, R, & Capper, S 2003, ‘High performance public health: assessing agencies’ strategic management capabilities’, Journal of Health & Human Services Administration, vol. 25, no. 4, pp. 383-407, viewed 23 August 2016, via Academic Search Premier database.
Lasker, R, Weiss, E, & Miller, R 2001, ‘Partnership synergy: a practical framework for studying and strengthening the collaborative advantage’, The Milbank Quarterly, vol. 79, no. 2, pp. 179-205.
Lee, K & Harmer, A 2010, ‘Ten years of the Global Alliance for Vaccines and Immunisation’, British Medical Journal. Vol. 341, pp. 58-59, viewed 21 August 2016, via Academic Search Premier database.
Martin, M & Halachmi, A 2012, ‘Public-private partnerships in global health: addressing issues of public accountability, risk management and governance’, Administration Quarterly, vol. 32, no. 2, pp. 189-237, viewed 22 August 2016, via Business Source Elite database.
Mermin, J, Villar, R, Carpenter, J, Roberts, L & Samaridden, A 2010, ‘Typhoid in Tajikistan’, Centers for Disease Control and Prevention, Atlanta, Georgia.
Modell, S 2000, ‘Integrating management control and human resource management in public health care’, Financial Accountability & Management, vol. 16, no. 1, pp. 33-54, viewed 23 August 2016, via Business Source Elite database.
Podewils, M, Blevins, L, Hagenbuch, M, Itani, M, Burns, A, Otto, C,Widdowson, M 2010, ‘Norovirus in Vermont: a classroom case study’, U.S. Department of Health and Human Services, Atlanta, Georgia.
This health issue, involving an outbreak first identified as coming from contaminated food, required health investigators to conduct an extensive study, including laboratory tests to determine the cause and circumstances in the fecal incident, along with an epidemiologic investigation (Phillips & Goodman, 2004).
VDH investigators had to convince the club manager to help in the investigation by providing data and information surrounding the operation of the swim club. The manager later on cooperated and the investigation went smoothly. This aspect of the case study should have been avoided if there was a mechanism, or regulation, for the stakeholders of a health outbreak to form a team to jointly conduct investigation. However, this did not happen, allowing for a slow result of the investigation. The VDH investigators conducted interviews and laboratory tests; the victims were children, as young as 5-7 years old, who were in contact with the contaminated water (Podewils et al., 2010).
It can be concluded that while there were lapses in maintenance and management, the authorities at Vermont only made recommendations when the incident already occurred. This could have been avoided if regulations were properly in place and implemented for private swim clubs to follow.
References (for Reflection Journal only)
Phillips, C 2004, ‘The missed lessons of Sir Austin Bradford Hill’, Epidemiologic Perspectives & Innovations, vol. 1, no. 3, viewed 23 August 2016, via EBSCOHOST database.
Podewils, M, Blevins, L, Hagenbuch, M, Itani, M, Burns, A, Otto, C,Widdowson, M 2010, ‘Norovirus in Vermont: a classroom case study’, U.S. Department of Health and Human Services, Atlanta, Georgia.
