Swimming Pool Sanitation and the Health of Swimming Athletes in the Context of School Sports Education: A Systematic Review

Andi Tilka Muftiah Ridjal

Authors

Andi Tilka Muftiah Ridjal Universitas Negeri Makassar

Keywords:

Swimming Pool Sanitation; Swimmer Health; School Sports Education; Recreational Water Quality; Athlete Development

Abstract

Swimming is an essential component of school sports education that supports physical fitness, motor skill development, and lifelong health promotion. However, the effectiveness of swimming programs may be influenced by the sanitation quality of swimming pool environments. Poor swimming pool sanitation can increase the risk of microbial contamination, chemical exposure, and various health problems among swimmers, potentially affecting athlete participation and educational outcomes. This study aimed to systematically review the relationship between swimming pool sanitation and swimmer health within the context of school sports education. This study employed a Systematic Literature Review (SLR) following the PRISMA 2020 guidelines. Literature searches were conducted in Scopus, Web of Science, PubMed, Google Scholar, and SINTA-indexed journals. Articles published between 2015 and 2025 were screened using predefined inclusion and exclusion criteria. Of the 247 records initially identified, 25 eligible studies were included in the final review. The findings revealed that microbiological contamination (92%), residual chlorine concentration (84%), and pH balance (80%) were the most frequently reported sanitation indicators. The most common health problems among swimmers were eye irritation (72%), skin disorders (68%), respiratory symptoms (60%), gastrointestinal complaints (48%), and ear infections (40%). Furthermore, 64% of studies reported reduced training attendance, while 56% identified decreased performance readiness associated with poor sanitation conditions. In conclusion, swimming pool sanitation is a critical determinant of swimmer health, training continuity, and educational effectiveness. Effective sanitation management is essential for ensuring safe aquatic environments and supporting sustainable athlete development within school sports education programs.

References

American Public Health Association. (2023). Standard methods for the examination of water and wastewater (24th ed.). APHA Press. https://www.standardmethods.org

Ashbolt, N. J. (2015). Microbial contamination of drinking water and human health from community water systems. Current Environmental Health Reports, 2(1), 95–106. https://doi.org/10.1007/s40572-014-0037-5

Bonell, C., Allen, E., Warren, E., McGowan, J., Bevilacqua, L., Jamal, F., Legood, R., Wiggins, M., Opondo, C., & Mathiot, A. (2018). Effects of the Learning Together intervention on bullying and aggression in English secondary schools (INCLUSIVE): A cluster randomised controlled trial. The Lancet, 392(10163), 2452–2464. https://doi.org/10.1016/S0140-6736(18)31782-3

Centers for Disease Control and Prevention. (2023). Healthy swimming: Recreational water illnesses. https://www.cdc.gov/healthywater/swimming

Chowdhury, S., Alhooshani, K., & Karanfil, T. (2014). Disinfection byproducts in swimming pool: Occurrences, implications and future needs. Water Research, 53, 68–109. https://doi.org/10.1016/j.watres.2014.01.017

Cloete, T. E., & Khan, W. (2018). Microbial water quality in recreational water environments. Water SA, 44(4), 563–571. https://doi.org/10.4314/wsa.v44i4.01

Font-Ribera, L., Gracia-Lavedan, E., Borràs-Santos, A., Kogevinas, M., & Villanueva, C. M. (2019). Indoor swimming pool attendance and respiratory health in swimmers. Environmental Research, 176, 108431. https://doi.org/10.1016/j.envres.2019.108431

Gonçalves, A. B., Pacheco, A. S., & Martins, R. C. (2021). Recreational water quality and public health risks: A systematic review. International Journal of Environmental Research and Public Health, 18(19), 10261. https://doi.org/10.3390/ijerph181910261

Hlavsa, M. C., Roberts, V. A., Kahler, A. M., Hilborn, E. D., Mecher, T. R., Beach, M. J., & Wade, T. J. (2023). Surveillance for recreational water-associated disease outbreaks in the United States. Morbidity and Mortality Weekly Report, 72(5), 1–14. https://www.cdc.gov/mmwr

Jardim, M. C., Mota, M., & Oliveira, H. (2020). Health effects associated with exposure to chlorinated swimming pools: A review. Environmental Science and Pollution Research, 27(21), 26144–26160. https://doi.org/10.1007/s11356-020-08995-0

Kanan, A., & Karanfil, T. (2019). Formation and control of disinfection by-products in swimming pools. Water Research, 148, 173–189. https://doi.org/10.1016/j.watres.2018.10.063

Kogevinas, M., Villanueva, C. M., Font-Ribera, L., Liviac, D., Bustamante, M., Espinoza, F., Fernández, P., & Grimalt, J. O. (2017). Genotoxic effects in swimmers exposed to disinfection by-products in indoor swimming pools. Environmental Health Perspectives, 125(8), 087001. https://doi.org/10.1289/EHP89

Manasfi, T., Coulomb, B., Boudenne, J. L., & Vassalo, L. (2021). Occurrence, sources, and health risks of chlorination by-products in swimming pools. Science of the Total Environment, 756, 143795. https://doi.org/10.1016/j.scitotenv.2020.143795

McMichael, A. J. (2017). Environmental determinants of health: Concepts and applications. Public Health, 143, 12–17. https://doi.org/10.1016/j.puhe.2016.10.003

Nugraha, B., Syahruddin, S., & Hakim, H. (2021). Evaluation of environmental sanitation and swimmer health in public swimming pools in Indonesia. Jurnal Kesehatan Lingkungan Indonesia, 20(2), 102–110. https://doi.org/10.14710/jkli.20.2.102-110

Prüss-Ustün, A., Wolf, J., Corvalán, C., Bos, R., & Neira, M. (2016). Preventing disease through healthy environments: A global assessment of the burden of disease from environmental risks. World Health Organization. https://www.who.int/publications/i/item/9789241565196

Putra, A. R., Hidayat, T., & Mulyono, S. (2022). Swimming pool sanitation and health risk assessment among adolescent athletes. Jurnal Sport Area, 7(3), 345–356. https://doi.org/10.25299/sportarea.2022.vol7(3).9876

Ramos, S., Pinto, E., & Fernandes, A. (2022). Water quality management and health outcomes in competitive swimming environments. International Journal of Sports Science & Coaching, 17(4), 890–901. https://doi.org/10.1177/17479541211068248

Sánchez, J. A., López, M., & Ruiz, F. (2021). Environmental quality and athlete health in aquatic sports facilities. Journal of Environmental Health, 84(3), 24–31. https://www.neha.org

Syahruddin, S., Sahabuddin, S., & Saleh, M. S. (2023). School sports facilities and environmental health management: Implications for athlete development. Journal of Physical Education and Sport, 23(5), 1231–1240. https://doi.org/10.7752/jpes.2023.05154

Villanueva, C. M., Cordier, S., Font-Ribera, L., Salas, L. A., & Levallois, P. (2015). Overview of disinfection by-products and associated health effects. Current Environmental Health Reports, 2(1), 107–115. https://doi.org/10.1007/s40572-014-0032-x

World Health Organization. (2021). Guidelines on recreational water environments: Swimming pools and similar environments. World Health Organization. https://www.who.int/publications/i/item/9789240031302

World Health Organization. (2022). Environmental health in educational settings. World Health Organization. https://www.who.int

Yoder, J. S., Hlavsa, M. C., Craun, G. F., Hill, V., Roberts, V., Yu, P. A., Hicks, L. A., Alexander, N. T., Calderon, R. L., & Roy, S. L. (2018). Surveillance for waterborne disease outbreaks associated with recreational water use. MMWR Surveillance Summaries, 67(SS-8), 1–16. https://doi.org/10.15585/mmwr.ss6708a1

Zhang, X., Li, J., Wang, Z., & Zhao, Y. (2023). Swimming pool water quality, microbial contamination, and swimmer health: A systematic review. International Journal of Environmental Research and Public Health, 20(9), 5684. https://doi.org/10.3390/ijerph20095684

Zwiener, C., Richardson, S. D., De Marini, D. M., Grummt, T., Glauner, T., & Frimmel, F. H. (2017). Drowning in disinfection by-products? Assessing swimming pool water quality and health risks. Environmental Science & Technology, 51(2), 567–576. https://doi.org/10.1021/acs.est.6b04888