This study investigated adverse skin and eye effects in swimmers using pool
s with three different disinfection systems (chlorine, chlorine/ozone and b
romine/ozone) and monitored water quality parameters that may be related to
adverse health effects. A cross-sectional study of 770 children swimming i
n three school pools was carried out over a 4 week period in November 1994
using a postal questionnaire. Physico-chemical and bacteriological paramete
rs of water quality were monitored on a weekly basis. Responses were obtain
ed for 385 swimmers. Skin rashes with an onset less than 24 h after swimmin
g in the school pool were reported by 4-8% of swimmers. Compared with the b
romine/ozone pool, the odds ratio (OR) of having a rash that started less t
han 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. Adjustment for possible con
founders made no significant differences to these results. Eye redness, itc
h or irritation was reported by 23-33% of swimmers and 24% of non-swimmers,
and wearing swimming goggles had a protective effect (OR 0.40; CI 0.24, 0.
65). Disinfectant levels were more consistently maintained in the pools wit
h automatically controlled systems. The bromine disinfection system was not
associated with a greater risk of the development of skin rashes than othe
r disinfection systems, but the numbers were small, and need to be interpre
ted with caution.