Nine children contracted a painful skin disorder in a Bangor hotel’s pool hot-tub complex last winter when disinfectant levels dropped perilously low. The incident has raised questions about the adequacy of the public’s knowledge about health safety at pools, and the level of monitoring conducted by state inspectors.

The event received little publicity when it occurred in February. Nearly a year later, however, the federal Centers for Disease Control and Prevention has posted an analysis of the outbreak on its Internet site with details and warnings never provided in Maine by state health officials.

More pernicious problems such as the spread of deadly E. coli could have occurred. Fortunately, say public health officials, most of the infected children, who had come from the Houlton area for the state basketball tournament, suffered only Pseudomonas dermatitis-folliculitis, which is a severe rash. One got an ear infection as well.

The Bangor case caught the attention of the CDC in Atlanta, and on Dec. 8, it reported on the Maine situation and one in Colorado where 15 people contracted skin infections after using a hotel pool and hot tub. In addition to reporting more details of the Maine outbreak, the analysis urged that risks be better explained to bathers.

“Swimmers should be educated about the potential for waterborne disease transmission in pools and hot tubs, which could increase advocacy for improved maintenance and monitoring by pool operators,” concludes the report, which is posted on the CDC’s Web site.

“We make sure our hamburgers are well-cooked, but swimming in a pool can be as dangerous at times,” said Audrey York, school nurse in SAD 29 (Houlton area) who has a degree in public health.

She said some parents whose children had contracted the rash had trouble getting information from the state. “What I found disappointing was that they didn’t do the follow-up with the families,” she said.

York’s analogy between E. coli in food and in a pool is particularly apt. Maine has only 10 inspectors in the Department of Human Services charged with inspecting restaurants, pools, hot tubs, lodgings, tattoo parlors, electrologists’ offices and food concessions. They make restaurants the top priority – even though they don’t have time to ensure that each is inspected annually as required by law. There is no such requirement for pools, and inspectors mainly review maintenance records.

In the late 1980s, Maine had 19 inspectors. That was an adequate inspection force, said Clough Toppan, director of the Division of Health Engineering in DHS. But the scaled-back force is so small that inspectors spend most of their time “putting out fires,” Toppan said.

One of those fires was the outbreak of dermatitis among Houlton area children after their stay at The Fairfield Inn in Bangor during the last week of February.

The investigation found that several conditions likely contributed.

The pool was used heavily by children who, with their families, had descended on Bangor for the annual basketball tournament. Cyanuric acid, a chemical usually used in outdoor pools to prevent sunlight from lowering chlorine levels, was used in the indoor pool, and it may have contributed to decreased chlorine effectiveness. After the Feb. 25-26 weekend, chlorine levels “were very low to zero. No measurements were taken during the weekend,” said the CDC report.

“Luckily, nobody was seriously affected,” said Michael Walsh, president of Ocean Properties Ltd., which owns the hotel and 16 others in Maine and elsewhere. “It’s a rare occurrence. You had to have a couple of things happen at the same time.”

Walsh said the hotel doesn’t know for sure how many children packed into the pool, but the large number undermined the pool’s disinfectant system.

In addition, the bacteria had to be introduced into the water by one of the children, he said.

Still, the Division of Health Engineering sent Walsh a letter March 17 with a nine-point list of issues to address.

Since then the hotel has made changes. Now, just 25 people are allowed in the pool at any time. That is monitored by a surveillance camera wired to the front desk, he said. Procedures have been improved and the hotel has “a state-of-the-art system,” he said.

What has Walsh learned from the experience? Well, he said he wouldn’t let his children get into pools at facilities he doesn’t know.

“I would be more leery,” he said.

Houlton resident Laurine Wilson, a parent of one of the affected students, said The Fairfield Inn is a premier hotel to stay at in Bangor. Still, she said if a good-quality hotel has problems, it’s wise to be more cautious generally.

“As a citizen we just take things for granted that these facilities have to pass certain inspections,” she said. But state inspections aren’t done as often as many expect, she said.

Dr. Dora Anne Mills, director of the Bureau of Health, said the best inspection is one done when a pool is about to be used.

Water clarity is the first test. “I would not go swimming in a cloudy pool,” she said.

Parents and swimmers should also consider dirty pool decks, the number of people using the pool, and whether children in diapers are present. Some pool managers prevent diapered children from swimming, she said.

Mills, who said she’s not above asking for a kitchen tour before eating at an unfamiliar restaurant, said everyone should make such common sense checks. Just back to Maine Monday from a stay in Florida, she said she had checked before letting family members jump into the pool in the hotel where they stayed.

Hot tubs, given the water temperature, must also be maintained well to prevent bacteria growth. Larry Tonzi, a nurse practitioner who treated a patient with the rash at his office in Houlton, said he’s cautious with pools, and takes a hard line on hot tubs.

“I don’t get into hot tubs anymore,” Tonzi said. Private hot tubs, run without professional management, are even more risky, he said.

Freshwater beaches, only required to do bacteria tests once a year, are another area posing health risks, said Toppan of DHS.

Mills said the state could certainly use more inspectors. She asks for budget increases just about every year. But the idea hasn’t been politically popular. The program is funded by a fee that’s no more than $125 a year per facility. Many establishments fight higher fees and oppose more government regulation, she said.

But even if Maine had 100 inspectors, it wouldn’t eliminate risk, Mills said.

“We are able to help minimize the risk by what we always do, but people need to know that risk is out there,” she said.