For persons working in contact with sewage BE SAFE Safety for Life
CONTENTS 1 P3 INTRODUCTION 2 P6 LEPTOSPIROSIS P7 TETANUS P7 POLIO P8 HEPATITIS A P8 HEPATITIS B P9 HIV/AIDS 3 P10 CHEMICAL HAZARDS P10 NOTES FOR THE DOCTOR 4 P11 Instructions to Employees Working in Contact with Treated Drinking Water 5 P12 First Aid Including Needlestick Injury Policy
1: INTRODUCTION This booklet provides need-to-know information relating to health and hygiene. Contractors who are employed on water treatment sites are now required to complete the National Water Hygiene training in order to obtain a National Water Hygiene card. This training has to be undertaken every five years from the date of the card s first issue. This ensures those within the industry are fully up to speed with the latest advice. It is your responsibility to take and renew your training and to report any relevant illness you may have to your manager or supervisor. Your Occupational Health Card This little card could save your life. Always carry your completed card with you, and show it whenever you need medical attention. It will ensure the attendant medical staff are aware of the hazards or restrictions of your work. This cards is available from AECOM s SH+E department. 3
1: INTRODUCTION What is Sewage? Raw sewage is mainly water containing excrement, industrial effluent and debris, such as sanitary towels, condoms, plastic etc. Excrement is the major source of harmful micro-organisms, including bacteria, viruses and parasites. What are the Health Risks? Exposure to sewage or its products may result in a number of illnesses. These include: Gastroenteritis, characterised by cramping stomach pains, diarrhoea and vomiting. Weil s Disease, a flu-like illness with persistent and severe headache, transmitted by rat urine. Damage to liver, kidneys and blood may occur and the condition can be fatal. Hepatitis, characterised by inflammation of the liver, and jaundice. Occupational asthma, resulting in attacks of breathlessness, chest tightness and wheezing, and produced by the inhalation of living or dead organisms. Infection of the skin or eyes. Rarely, allergic alveolitis (inflammation of the lung) with fever, breathlessness, dry cough, and aching muscles and joints. How do Micro-Organisms enter the body? Hand to mouth: The most common way for micro-organisms to enter the body is during eating, drinking and smoking, or when wiping your face with contaminated hands or gloves or by licking splashes on the skin. Skin contact: through cuts, scratches, or penetrating wounds, i.e. from discarded hypodermic needles. Certain organisms can enter the body through the surfaces of the eyes, nose and mouth. Breathing: Micro-organisms can be breathed in, as dust, aerosol or mist. 4
1: INTRODUCTION General Hygiene Good personal hygiene and hygienic working practices are important both in the prevention of contamination of drinking water supplies and in the maintenance of the health of those employed with sewage. 1. A habit of thorough hand and forearm washing is sufficient to prevent cross contamination. Hands should be washed :- - Prior to eating, drinking or smoking - After using the toilet - Before using the toilet where work involves sewage - After any contamination 2. Avoid rubbing your nose or mouth with your hands during work and avoid nail biting. 3. Smoking must be avoided. 4. Ensure that exposed, broken skin areas are covered with a waterproof dressing whilst at work. 5. Shower facilities are provided on all sewage treatment works for the use of all employees who work with sewage. This is to reduce the risk of cross contamination between work and home. 6. Protective clothing is provided for the tasks to be undertaken. These should be used whenever possible (especially gloves). Where relevant, on site laundry facilities are provided for the use of all employees who work with sewage. This is to reduce the risk of cross contamination. It is advisable to change personal clothing before going home. 7. Protective equipment is provided relevant to the tasks to be undertaken. This should be cleaned, maintained and appropriately stored by the user. Where it is damaged a replacement should be obtained. 8. Systems of work should be adhered to. These are designed to ensure the health and safety of the employee and the public. 5
2: DISEASES Leptospirosis (Weils Disease) (See HSE IND (G) 842) This is a serious and sometimes fatal bacterial infection which is transmitted to humans through the urine of infected rats. Transmission of infection occurs through cuts and abrasions or through the lining of the eyes, mouth and nose. The disease starts with a flu-like illness and a persistently severe headache, a rash and joint pain may occur, possibly followed by jaundice. Early detection is important in the treatment of the disease. Therefore, you should advise your doctor of your occupation and the possibility of this infection by showing your occupational health card. Precautions for Employees After coming into contact with anything that may have been contaminated by rodents, wash your hands and forearms thoroughly with soap and water. If your clothes and boots could have been contaminated, wash them and then wash yourself thoroughly after handling them. It is particularly important to do this before taking food or drink, or smoking. Wet protective clothing should be dried as soon as possible. Incidence In recent years, standards in personal hygiene and working practices have improved significantly virtually eradicating the incidence of this disease amongst water company employees. Leptospirosis is still a serious threat to Water employees; and continued awareness is necessary. 6
2: DISEASES Tetanus Tetanus, or lock-jaw, is a disease which can develop where wounds are contaminated with the tetanus bacillus, which is commonly found in soil. The condition produces muscle spasms and is difficult to treat once it has developed. Protection against tetanus is afforded by a complete course of immunisation and boosters. These are available from your GP. The primary course comprises of three doses at four weekly intervals. This is followed by two booster doses at 10-year intervals, giving lifelong protection. Polio Polio is a virus which affects the nerves leading to muscle wasting. It is excreted from infected persons thereby leading to possible contamination of the waterways. Protection against polio is afforded by a complete course of immunisation and boosters. These are available from your GP. A primary course comprises of three doses at four weekly intervals. This is followed by 10 yearly boosters. 7
2: DISEASES Hepatitis A (Infective Hepatitis) This infection is of faecooral transmission and can normally be prevented by good hygiene practices and working procedures. Where immersion in sewage occurs:- Expel any material from the nose and mouth; Copiously irrigate the eyes and mouth; Shower; Report the incident to your manager/supervisor and complete an accident report form; Visit your doctor or the nearest hospital casualty department immediately. You will be assessed to find out if treatment with Immunoglobin (antibodies against Hepatitis A) is necessary this prevents the onset of Hepatitis A infection. There is now immunisation available against Hepatitis A (Havarix Monodose). This is given as a single dose. In order to obtain more persistent immunity, a booster dose is recommended between 6 and 12 months after primary immunisation. This will give protection for up to 10 years. Vaccination is available through your GP. Hepatitis B (Serum Hepatitis) This is transmitted by infected blood, blood products and semen. Transmission of infection could potentially occur if infected blood enters the body through:- Needlestick injury Skin lesion Mucosa of eyes, mouth etc. See FIRST AID notes. The incidence of Hepatitis B infection in the UK is not high. Although there is a vaccination against Hepatitis B, it is restricted to certain high risk groups in the population as stipulated by the Department of Health. Sewage treatment workers are not considered to be at risk of contracting Hepatitis B through their normal working. Protective clothing and procedures are in operation to protect employees from all infections. 8
2: DISEASES HIV/Aids This is transmitted by infected blood and semen. Fortunately the virus is not robust outside the body, and cannot be transmitted by normal social contact. virtually non-existent; however, in the event of such an incident follow the procedure under FIRST AID. The presence of HIV infection in this country is low. Spillage of infected material is rapidly de-activated by household disinfectants/ bleaches. The virus is also de-activated by other organisms, the chemicals present in sewage and by ultra violet rays of sunlight. Employees who work with sewage are not considered to be at risk during the normal course of their duties. The risk of infection from a skin lesion or needlestick injury involving fresh infected material is 9
3: CHEMICAL HAZARDS* *Including Herbicides, Insecticides and Rodenticides Absorption of toxic chemicals may occur through inhalation, ingestion or skin contact, and may cause the following symptoms:- Nausea Headache Exhaustion and weakness, and possibly some mental confusion. Treatment In the event of accidental contamination or ingestion of a toxic compound, please take the following action:- Stop work Remove from further exposure Remove contaminated clothing Wash all exposed skin and hair If any chemical has entered your eye, flush thoroughly with sterile saline solution or clean running water holding the eye open Keep patient at complete rest If breathing ceases or weakens, start artificial respiration immediately making sure the breathing passages are clear. A resuci-aid should be used. Transport to hospital at once Where ingestion has occurred, dilute the chemical by drinking plenty of water. Do not encourage vomiting. Note: Always take details of the chemical to the hospital/doctor. Note for the Medical Practitioner: If the patient is thought to be suffering from absorption of these compounds, immediate hospitalisation is recommended. Advice concerning pesticides and herbicides may be obtained from: Poisons Information Drug & Therapeutic Centre Wolfson Unit Claremont Place Newcastle-upon-Tyne NE2 4HH Telephone: 0191 232 5131 10
4: INSTRUCTIONS TO EMPLOYEES WORKING WITH TREATED DRINKING WATER Whenever you go to your doctor or hospital on account of illness, please show your Occupational Health Card to make sure those attending know your occupation. Some infections can contaminate the water and pose a risk to water quality. Under the current National Water Hygiene Scheme, it is your responsibility to inform your manager/supervisor of any relevant illness you may have, such as stomach pains, prolonged fever, food poisoning, infective hepatitis and jaundice. You may return to work, but you must not work on restricted potable water operations until you have been given clearance by your GP. If you suffer from cholera, dysentery or typhoid, you will require three clear stool specimens before returning to work. You must be cleared to work with potable water if any of your household suffer from any of the above infections or if you or any of your party have nausea and/ or diarrhoea symptoms whilst travelling abroad or have been diagnosed with typhoid/paratyphoid or have a prolonged fever. Clearance to work with potable water can be obtained through your GP. 11
5: First Aid Including Needlestick Injury Policy 1. At the beginning of each shift cover any cuts or abrasions with a waterproof plaster. 2. In the event of any injury at work involving broken skin:- Squeeze the area to make it bleed (unless it is an artery in which case quickly stop the bleeding Wash the area with plenty of soap and water Dry thoroughly Cover with a waterproof plaster Complete an accident form DO NOT SUCK THE INJURED AREA 3. In the event of a needlestick injury:- Follow the above procedure Attend your local emergency department for immediate follow-up treatment (taking with you a copy of the Needlestick Injury Policy). 4. In the event of any contamination to the mucosa of the eyes, nose, and mouth:- Irrigate with plenty of water Complete an accident form 5. Contact your First Aider for further help. 12
CONTACT For further information please contact: michael.foulkes@aecom.com BE SAFE Safety for Life