Health and Safety Guide for Sewage Workers

What are the Main Hazards of Working with Sewage?

Working with sewage, including, for example, untreated sewage, sludge, septic tank waste or effluent water, can expose sewage workers to a variety of infection risks. Sewage workers most at risk include workers involved in sewer inspection and maintenance work, construction workers who repair or replace live sewers, and plumbers who may be exposed to sewage sludge.

There are a number of health risks associated with occupational exposure to sewage. The majority of illnesses are relatively mild cases of gastroenteritis, an infection of the gut (intestines) which is a very common condition that causes diarrhoea and vomiting caused when microorganisms have entered the body via contaminated tools or hand-to-mouth contact while eating, drinking or smoking, and by wiping the face with contaminated hands or gloves. Contact with other pathogens can cause diseases, a number of which are potentially fatal diseases that can pose a health risk to sewage workers, such as:

• Leptospirosis (Weil’s disease) – this is contracted from the urine of infected rats. The bacteria get into the body through cuts and scratches or through the lining of the mouth, throat and eyes after contact with infected urine or contaminated water. The risk of Weil’s disease is linked to areas where rats are or have been present. Work is considered higher risk where there is evidence of rat infestation and includes work linked to canals, rivers or sewers. More severe cases of Weil’s disease can lead to meningitis, kidney failure and other serious conditions and, in rare cases, the disease can be fatal.
• Hepatitis – hepatitis A is an infection of the liver that is generally uncommon in the UK. Initial symptoms are similar to flu and may lead to yellowing of the skin and eyes (jaundice), very dark coloured urine and pale faeces, abdominal pain and itchy skin. The symptoms usually clear up within two months, although may occasionally last up to six months. Older adults tend to have more severe symptoms. In most cases, the liver will make a full recovery. The risk of workers being exposed to hepatitis A is mainly when working in an area contaminated with raw, untreated sewage in the last 12 months. In particular, work in or near a sewer might lead to contamination of hands, clothing or PPE, or to splashes in the eyes and mouth.
• Hepatitis B – the incidence of hepatitis B is low, but people who work with untreated sewage are at risk of exposure.
• E. coli – this is spread by the faecal-oral route. Most strains are usually harmless. A few strains cause diarrhoea / bloody diarrhoea, vomiting and stomach pains and cramps. One strain can lead to kidney failure if not properly managed.

Sewage workers can be infected with parasites such as intestinal worms and Giardia duodenalis, also known as Giardia intestinalis, which can cause a variety of intestinal symptoms, including diarrhoea, stomach cramps or pain, nausea and dehydration.

Germs in sewage can cause skin infections if they enter a cut or abrasion, and they can also cause eye and ear infections.

Due to the fact that microorganisms are an innate characteristic of sewage, it is not possible to eliminate the hazard completely; however, measures should be in place to reduce the risk of infection and illness. Sewage workers should assume that everything, including equipment, clothing and themselves, that might be in contact with sewage in the course of their work is contaminated, and have effective decontamination procedures in place.

Sewage workers should always use safe systems of work and wear the protective equipment that is provided. We will look at PPE in more detail later in this guide. They should recognise the risks to health and safety and avoid becoming contaminated with sewage by:

• Avoiding breathing in sewage dust or spray.
• Changing out of contaminated clothing before eating, drinking or smoking and washing hands and face thoroughly with soap and water.
• Cleaning contaminated equipment on site and not taking contaminated clothing home – leave on site for cleaning or disposal.
• Cleaning all exposed wounds, however small, and covering with a sterile waterproof dressing.
• Seeking medical advice in the event of any flu-like fever or illness.

It is essential that a COSHH risk assessment is carried out when working with sewage as some workers will suffer from at least one episode of work-related illness each year.

The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR) places duties on employers, the self-employed and people in control of work premises (the responsible person) to report certain serious workplace accidents, occupational diseases and specified dangerous occurrences (near misses). Exposure to microorganisms that lead to diseases such as hepatitis is reportable under RIDDOR when a work activity causes accidental contamination sufficient to cause damage to the health of any person. Such situations are likely to arise when work is carried out without suitable controls, or where those controls fail.

Sewage workers may work on underground pipes and sewers, at reservoirs and water towers or at sewage treatment plants. Most of their time is spent working outside in all weathers. Conditions are often wet, dirty and smelly. They may work in confined spaces, which is governed by The Confined Spaces Regulations 1997. The various confined space hazards that pose a risk include toxic gases, oxygen deficiency, oxygen enrichment, flammable atmosphere, excessive heat and flowing liquids. Some of the other factors that should be taken into consideration during the risk assessment include lighting, communication methods and additional equipment needed for the task at hand. All workers must be equipped with the correct gas monitors, body protection, fall arrest and breathing devices, depending on the area that they are entering.

Manual handling injuries have a major impact on all workplaces and sectors, costing the economy hundreds of millions every year. Manual handling encompasses a wide range of actions including lifting, lowering, pulling, pushing, and carrying awkward and heavy objects. The risks are endless for sewage workers as the work can be quite physical, with lots of bending and lifting, and they may experience manual handling injuries such as:

• Back injuries
• Hernias
• Musculoskeletal disorders (MSDs) such as shoulder strain
• Repetitive strain injury (RSI) such as wrist strain
• Soft-tissue injuries to the wrists, arms, shoulders, legs or neck
• Long-term pain in the arms, legs or joints

Injury from poor, damaged or inadequate equipment – ensuring tools and equipment are in proper working condition is key to ensuring safety on a job. Inspect all equipment before use and only use if in good working order. Sewage workers should always use equipment properly, follow safe work policies and procedures, and attend any training required. Always ask for an explanation if something is unclear, or uncertain.

Slips, trips and falls are always a risk for sewage workers as they are often working on uneven surfaces and are exposed to all weather conditions. Each year slips, trips and falls cause thousands of preventable injuries. They can cause various injuries such as bruises, sprains, scrapes, broken bones and head traumas. Around 1,000 of these injuries involve someone fracturing bones or dislocating joints, so make sure footwear with a good grip is worn; we will look at PPE later in this guide.