During the COVID-19 pandemic, sanitation workers should be considered essential or key workers, and allowed to continue their work even if movement restrictions are implemented. COVID-19 related precautions are necessary to prevent person-to-person and surface transmission while this essential work continues. Examples of such precautions include practising physical distancing and hand hygiene at additional key moments such as after interacting with coworkers and clients.
The WHO (Guidelines on Sanitation and Health, section 3.4-3.6), the US CDC, provide general recommendations for reducing health and safety risks to sanitation workers and these recommendations should continue to be followed during the COVID-19 pandemic. The Pan American Health Organization (PAHO) and the Pan-African Association of Sanitation Actors/Centre for Affordable Water and Sanitation Technology provide some COVID-19 specific guidance for sanitation workers. A brief summary of these general and COVID-19 specific health and safety recommendations is provided below:
Staff training & preparation
Prior to starting work, all sanitation workers should receive training and information on the following topics to ensure a safe working environment:
The health risks of working with sanitation systems and contacting human waste. Human waste can contain numerous pathogens, not just SARS-CoV-2, and workers should be made aware of the health risks associated with contact with human waste. While no COVID-19 vaccination is currently available, sanitation workers should receive other setting-appropriate vaccinations before beginning work. Local health authorities can offer guidance on identifying necessary vaccinations.
General disease prevention strategies. Routine health and safety training may include information on the safe handling of human waste, the engineering and administrative controls used to limit exposure to untreated waste, facility cleaning and disinfection practices, worker hygiene practices, the proper use of PPE. Disease prevention strategies may vary depending on the context and type of sanitation systems commonly encountered. In all settings, workers should be trained on the engineering and administrative controls used to limit the frequency and duration of worker contact with sewage. In settings where some handling of untreated waste cannot be avoided (e.g. where on-site systems like pit latrines or container-based sanitation are common), training on safe handling procedures may also be prioritized.
COVID-19 specific prevention strategies. During the COVID-19 pandemic, health and safety plans for sanitation workers should be expanded to allow workers to physically distance from the people they serve. This may include adjusting shifts or working hours, limiting certain areas to essential personnel, and offering contactless payment options.
Standard operating procedures for proper use of machinery, equipment, and tools. The proper and effective use of appropriate equipment can help to reduce sanitation workers’ exposure to pathogens contained in human waste. Workers should be trained on the protocols for the safe cleaning and disinfection of equipment. During the COVID-19 pandemic, the frequency of cleaning high-touch surfaces may be increased to limit potential surface transmission.
Personal Protective Equipment
Workers should always wear appropriate personal protective equipment (PPE) including heavy-duty waterproof gloves, goggles and/or a face shield, face masks, rubber boots, and water-repellent clothing coverings (coveralls). During the COVID-19 pandemic, PAHO recommends that sanitation workers exposed to aerosol generating processes, such as certain cleaning processes in treatment facilities, wear N95 respirators (for more information see section ‘What is a N95 respirator and who should use one?’). Certain other processes performed by sanitation workers, such as the mechanized emptying of on-site systems, may also produce aerosols. Depending on availability, use of a N95 respirator may be appropriate during such procedures. The below infographic developed by the Pan-African Association of Sanitation Actors and CAWST illustrates the use of appropriate PPE during sanitation work.
Work clothing and PPE should be carefully removed and decontaminated immediately after use or stored in a sealable plastic bag until decontamination. Dirty work clothing should not be worn home. Heavy-duty reusable gloves, boots, and plastic or rubber coveralls/aprons should be cleaned with soap and water and decontaminated with 0.5% chlorine after use. Household bleach or sodium hypochlorite solutions (typically 5% chlorine) can be diluted to achieve a 0.5% chlorine solution (1 part bleach to 9 parts water). Work clothing should be machine laundered at 60-90°C with standard laundry detergent. Alternatively, soiled work clothing can be manually washed with soap and hot water (in a large container with a stick for stirring) and then soaked in a 0.05% chlorine solution for 30 minutes before rinsing and drying. Household bleach or sodium hypochlorite solutions (typically 5% chlorine) can be diluted to achieve a 0.05% solution (1 part bleach to 100 parts water). Greywater used for decontamination should be safely disposed of in drains connected to sewers, soak-away pits, or septic tanks.
Handwashing facilities should be provided in convenient locations to enable workers to frequently wash their hands with soap. Alternatively hand sanitiser with 70% ethanol can be used.
Sanitation workers should always be encouraged to wash their hands and other exposed areas of skin at the following times: after contact with human waste, after touching equipment used to contain human waste, before and after putting on PPE, before and after using the toilet, and before eating. During the COVID-19 pandemic, sanitation workers should also wash their hands after interacting with clients or the public, when entering or leaving buildings, and after contacting high-touch surfaces. See the infographic above which illustrates these important moments for hand hygiene and the description in the related report.
Workers should avoid touching their face, eyes, nose, mouth, and any open sores while handling waste. If waste contacts eyes, clean water should be used to flush eyes thoroughly. Keep wounds clean and covered. Headsets could be used to facilitate communication while limiting touching of the face.
Workers should never eat, drink, chew gum, tobacco, or any other substance, or smoke while handling human waste.
Contaminated work clothing and PPE should always be removed prior to eating, and eating should be done in areas away from waste handling procedures.
Other Health and safety considerations
Workers should be provided health checks, health care, and setting-appropriate vaccinations.
During the COVID-19 pandemic, workers should stay home from work if ill, have COVID-19 symptoms, or have a family member in the same household who has COVID-19 symptoms. If certain workers are considered ‘high-risk’ (60+ years old or have comorbidities), consider adjusting their duties or schedule to limit their exposure to colleagues and clients. Flexible sick leave policies will protect clients, workers, employers, and their families, limiting the risk of a localised outbreak and ensuring most sanitation workers remain available to continue their essential work.
Care should always be taken to avoid splashing, spraying, or aerosolizing waste during emptying, transport, treatment, and disposal. Only properly trained sanitation workers wearing appropriate PPE should be allowed in the area during waste handling procedures. In case of spills, immediately clean and disinfect the area. In the case of spillage of high-strength waste, the spill can be covered with lime prior to cleaning and disinfection.
Vehicles and equipment used for wastewater collection and transport should be cleaned and disinfected daily. During the COVID-19 pandemic, PAHO recommends cleaning the vehicle cabin with soap and water followed by 0.1% chlorine solution (1 part household bleach to 50 parts water) between uses. High touch surfaces (steering wheel, door handle, control panels, handles of push carts or other equipment) should be frequently cleaned and disinfected. Greywater used for cleaning and disinfection should be disposed of in drains connected to sewers, soakaway pits, or septic tanks.
Comprehensive worker protection includes more than a list of recommendations and extends beyond the COVID-19 pandemic. To read more about health, safety, and legal protection for sanitation workers, please see this WHO report.