Occupational Exposure to Trichloramine and Endotoxins. Adverse Health Effects Among Personnel in Adventure and Rehabilitation Swimming Pool Facilities

Objective: To study occupational exposure to trichloramine and endotoxins in air at adventure and rehabilitation swimming pool facilities from an adverse health effects perspective. Methods: Air concentrations of trichloramine and endotoxins were measured in five adventure and 10 rehabilitation facilities. Respiratory and ocular symptoms were self-reported, and spirometry and fraction of exhaled nitric oxide (FENO) were measured. Results: Compared to rehabilitation facilities, the mean trichloramine concentrations in the adventure facilities were higher, both personal (80 μg/m3 (n = 41) vs 19 μg/m3 (n = 21)) and stationary (183 μg/m3 (n = 51) vs 23 μg/m3 (n = 32)), with higher frequency of ocular and respiratory symptoms. Low stationary endotoxin levels (<0.64 to 25 EU/m3) were found, compared to the reference value (90 EU/m3). Conclusions: Higher trichloramine concentrations in air and more ocular and respiratory symptoms in adventure facilities call for adequate occupational exposure limits.