Dr. Bob Grisdale, MSc, DC
Andrew Popadopoulos, MBA, CPHI(C)

The Canada Fitness Safety Standards & Recommended Guidelines were revised in 2004. The review process was open and transparent and carried out in consultation with the fitness community in Ontario in a unique manner appropriate to the Internet age[bg1]  — via an online forum. The resultant standards and recommended guidelines are a refinement and clarification of those previously published in the Fitness Safety Standards Guide Book, 2000.  The 6 categories (Fitness Related Personnel, Emergency Procedures, Communicable Diseases, Fitness Environment, Pre-Screening and Informed Consent, and Special Exercising Populations) were also considered in terms of their current relevance with respect to changes that have occurred since the 2000 Guide Book.

One category in particular, Communicable Diseases has undergone a remarkable ‘awakening’ in terms of its emergence into the public consciousness.  The terms Walkerton, West Nile virus, SARS and now Bird Flu have particular meaning in Ontario as they represent, in part, the challenges present in the delivery and consumption of services, both public and private.  Specifically, they have exposed the notions of duty and obligation on the part of service providers, as well as the pervasive repercussions of failure in that regard.  Those repercussions have legal and monetary features of accountability as well as a potentially devastating impact on public and individual health. 

The phrase “the new normal”, quite possibly with us for generations, seems to have emerged, in part, from the ashes of World Trade Center devastation and was expressed during the time that followed as a feeling that,[bg2]  although lives were returning to normal, ‘normal’ was now different. We have become aware of our vulnerability to the intended and even unintended actions of others.

The economic collapses characterized now by the terms “dot com”, “Enron” and others served to reinforce the notion of our vulnerability but they added another idea for affected individuals to consider.   They brought before us the notion of liability.  As jail terms began to redefine the margins of accountability for corporate executives, the terms compliance, accuracy and transparency began to characterize the temperament of business interactions.  People operating businesses, at every level, became more aware (or should have) of the repercussions of doing harm to others, even if inadvertently.

Finally, to a public that is now more aware of their vulnerability and demanding accountability in the case of a mishap, another ‘new normal’ has been introduced – the rapid emergence of infectious diseases in humans and animals.  Changing factors in our world such as international travel and commerce, microbial adaptation and change and a fiscally challenged public health system have made possible the scenario in which a person, living oceans away, could sneeze and then a few weeks later your neighbour falls very ill. Or it could be the person one treadmill to the left.

Given these changes it is not difficult to see how a sneeze at the gym can now be viewed in a very different context, by us all.  It is also not unreasonable for fitness service providers to wonder about their role in the management of communicable diseases in their fitness facilities, as if for the first time.  This is because, by definition, a new normal changes the context of standards, guidelines and operating procedures.

Compared to the Guide Book 2000, the new Fitness Safety Standards & Recommended Guidelines have pared what were previously one standard and three recommended guidelines into one single standard, in one sentence.  The trimming is an act of clarity, not simplicity.  Because clearly the impact of communicable diseases and the role of those charged with their management have become, and certainly will continue to be, a matter of focus and scrutiny.   At the same time the repercussions of mismanagement have implications in a much broader context and to a degree possibly even beyond the new normal

Ask Andy
Andrew Popadopoulos, MBA, CPHI(C)
Director, School of Occupation and Public Health
Ryerson University, Toronto

Questions and Answers; “Just the Facts, Maam”.

BG
What is the hierarchy of responsibility with regard to public health and communicable diseases in the province of Ontario?

AP
Communicable disease is a major focus of boards of health as they have the legislated responsibility to investigate any health hazard and mitigate its impact. They have the duty to inspect public places for the purpose of eliminating health hazards. They do so by ensuring that owners and operators of premises where the public is invited (such as fitness facilities) maintain their premises in a manner that is free from disease.

BG
What legislation speaks specifically to the operation and management of fitness facilities, in the context of public health issues?

AP
Fitness facilities are caught by various pieces of public health
legislation. The Health Protection and Promotion Act (HPPA
http://192.75.156.68/DBLaws/Statutes/English/90h07_e.htm) provides local boards of health with their duties and responsibilities. This includes the duty to inspect, the responsibility to be informed of hazards within their community and the mandatory investigation of communicable diseases.

Local boards of health are now enforcing the new Public Spa Regulation. In the past, public health inspectors were using guidelines and protocol to ensure whirlpools and spas were operating in a condition free from disease. They will continue to inspect public spas to ensure their safety and will now begin enforcing legislation specific to safety equipment and water chemistry and replacement among other specific requirements. The new regulation can be found at the link below.
Public Spas
http://www.e-laws.gov.on.ca:81/ISYSquery/IRLF0E2.tmp/3/doc

BG
Should fitness facility operational concerns (from a public
health /communicable disease context) include only the saunas and pools?

AP
Current fitness facility operational concerns from a public health
context mostly focus on communicable disease transmission. Pathogens can be transmitted in swimming pools, whirlpools, saunas, shower facilities, change rooms and through water coolers and floor mats and other fitness equipment.

BG
What are main areas of potential liability?

AP
The greatest of potential liability for fitness facility operators
can arise if they are found not be compliant with any regulations as it relates to the “Recommended Standards for the Operation of Public Spas” (Ontario Ministry of Health & Long Term Care Act, June 2001). Liability may also arise if the owner or operator of a fitness facility is found negligent in the maintenance of their facility, to the degree that their actions (or lack) may be the cause of a communicable disease outbreak.

It is critical for the owner or operator of a fitness facility to ensure that the swimming pool and whirlpool are operating in accordance with the regulations.  This includes regular testing of the free available chlorine and pH, and very importantly, ensuring the 150 mm black disc is visible from any point on the deck 9 m away.  It is the responsibility of the pool operator to close the pool to public access
if it is not compliant with the Public Pool regulation.

BG
Final Words?

AP
Communicable disease can be transmitted in many ways. New diseases are being discovered and their pattern of transmission may be unknown. It is therefore critical to use Universal Precautions at all times when dealing with body fluids or other material that may contain pathogens.

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