 |
Suction-Drain Injury in a Public Wading Pool --
North Carolina, 1991
On June 16, 1991, a 3-year-old girl playing in a public wading
pool sat on the pool's uncapped suction drain. The child appeared
to be stuck on the drain, and the pool attendant quickly turned off
the pool's suction pump. As a consequence of sitting on the drain,
the child sustained severe internal injuries requiring surgical
repair. This report summarizes the investigation of this incident
by the North Carolina Department of Environment, Health, and
Natural Resources (DEHNR) and describes safety measures to prevent
injuries among children caused by pool suction drains.
Following the episode at the wading pool, the child was
examined at a hospital and had perianal bruising and prolapse of
the rectal mucosa. The prolapse was manually reduced, and a pelvic
computerized tomography scan showed no evidence of a rectal leak;
however, by June 17, she had evidence of localized peritonitis. An
exploratory laparotomy revealed a long anterior laceration of the
seromuscular layer of the rectosigmoid colon; the mucosal tube was
intact but ischemic and was separated circumferentially from the
outer layers of the bowel wall. The laceration was repaired and a
sigmoid colostomy performed.
The investigation by the DEHNR revealed that the wading pool
where this injury occurred had a three-quarter-horsepower suction
pump that was not linked to the adjacent adult pool or any other
outlet. At the time of the injury, the antivortex drain cover that
had previously covered the drain had been removed. Since the
incident, the antivortex drain cover has been secured to the drain
to prevent further suction injuries.
Reported by: NA Shorter, MD, Section of Pediatric Surgery, Duke
Univ Medical Center, Durham; JP Woodell, Durham County Health Dept;
TB Cole, MD, Injury Control Section, JA Hayes, MSPH, Div of
Environmental Health, JN MacCormack, State Epidemiologist, North
Carolina Dept of Environment, Health, and Natural Resources.
Unintentional Injuries Section, Epidemiology Br, Div of Injury
Control, National Center for Environmental Health and Injury
Control, CDC. Editorial Note
Editorial Note: The findings in this investigation are consistent
with those from previous reports of abdominal injuries among
children who sit directly on uncovered openings or vents capable of
forming a strong vacuum when covered (1). When a child sits on an
unprotected suction-drain vent, the child's perineum can form a
firm seal that creates a vacuum capable of relaxing the anal
sphincter. This negative pressure on the exposed rectal walls can
result in prolapse or intussusception; this, in turn, usually
produces a full-thickness anterior bowel tear, creating the
potential for evisceration of the mobile small intestine through
the laceration and the anal canal. Damage to the mesentery can
produce extensive irreversible small bowel ischemia requiring
resection.
Since May 1, 1991, North Carolina has required all newly
constructed public wading pools to be equipped with a surface
skimmer and with interconnected double drains to prevent
suction-drain injuries. However, pools constructed before May 1,
1991, have been allowed to continue operating with a single drain.
The public pool involved in this incident was built before the
standards became effective; however, the pool had been inspected 12
months before the injury occurred and had had an antisuction cover
in place over the drain opening at that time.
Because a child may be injured within seconds of sitting on a
drain, adult supervision alone does not effectively prevent
suction-drain injuries. Suction-drain injuries can be prevented
through interventions that prevent vacuums from forming when the
vents are covered. Existing pools that may have a single
suction-drain or multiple suction-drains that can be isolated by
valves should be equipped with antivortex covers or with grates at
least 12 inches by 12 inches over the drains to prevent the
possibility of a vacuum forming if a child sits on a suction-drain
opening (2). In addition, standards of the American National
Standards Institute/National Spa and Pool Institute and the
American Public Health Association specify that drain covers be
secured in a way to prevent removal without special tools (2,3).
Also, maintenance personnel should routinely inspect pool drains to
ensure covers remain secure. Pools should not be operated if a
suction-drain cover is missing, broken, or inadequately secured
(2).
For new pools, water circulation systems should be constructed
so that suction pumps are linked with more than one drain outlet;
for example, the pump may draw water from two drains in the deepest
part of the pool or from one drain and a surface skimmer, thus
preventing a tight seal from forming if one drain is covered. In
addition to these barriers, water-safety instruction courses should
include specific instructions on the prevention of injuries
involving pool equipment.
References
Cain WS, Howell CG, Ziegler MM, Finley AJ, Asch MJ, Grant JP.
Rectosigmoid perforation and intestinal evisceration from transanal
suction. J Pediatr Surg 1983;18:10-3.
National Spa and Pool Institute. American national standard for
public swimming pools. Alexandria, Virginia: American National
Standards Institute, National Spa and Pool Institute, 1991;
publication no. ANSI/NSPI-1 1991.
American Public Health Association. Public swimming pools:
recommended regulations for design and construction, operation and
maintenance. Washington, DC: American Public Health Association,
1981:16-7.
Disclaimer
All MMWR HTML documents published before January 1993 are electronic conversions from ASCII text into HTML. This conversion may have resulted in character translation or format errors in the HTML version. Users should not rely on this HTML document, but are referred to the original MMWR paper copy for the official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices. **Questions or messages regarding errors in formatting should be addressed to mmwrq@cdc.gov. Page converted: 08/05/98
|
|
