Working Position Paper– WaterAid Nepal

WaterAid Nepal
Protective gear for Sanitary workers
to reduce risks posed by Covid-19
pandemic
May 2020

Sanitary workers are those who work in thesanitation and solid waste chains. Their jobs can
include cleaning toilets, emptying pits and septic
tanks, cleaning sewers and manholes, operating
pumping stations and treatment plants, andcollecting, transporting and disposing health careand household wastes. Sanitary workers provide
an essential public service but often at the cost of
their dignity, safety, and health. Often engaged in
the informal sector, as an invisible, discriminatedworkforce, they are some of the most vulnerable
workers, and exposed to occupational andenvironmental health hazards risking illness,injury, and even death.
Sanitary workers play a vital role to meet thesanitation targets for SDGs. Without protective
equipment, they are vulnerable to health hazards
within their job and have to cope with many
challenges, including those that have emergedwith the COVID-19 pandemic.
Transmission of COVID-19: COVID-19 spreads
primarily via tiny droplets that are generated
when an infected person coughs or sneezes oreven speaking. The virus in the droplets find its
way to a new host via two main ways. First, aperson can get the virus by breathing in those
droplets from an infected person in its proximity(2 metres), or the droplets may also land directlyin their eyes. The second is called contact
transmission, when the droplets reach the newhost via different vectors. These vectors start via
droplets landing on surfaces or in the infected
persons hands (when they cover their coughs orsneezes) and then passed to surfaces touchedwith the hands (eg a tap or coins). The virus canremain alive and contagious on surfaces for a few

hours or even days1. People can contract thediseases when, after touching contaminatedsurfaces or shaking contaminated hands, they
touch their own mouth, nose or eyes.
Approximately 2 to 10 percent of the confirmed
COVID-19 cases have diarrhoea, and several
studies have detected COVID-19 presence in the
faecal matter of patients and in wastewater, but
so far there is no evidence of faecal-oraltransmission.
The implications for sanitary workers are clearthat they face a risk of contagion. Their services
are vital and are unlikely to stop during the pandemic, but their activities expose them to contaminated surfaces such as the waste they collect,transport and sort, or the toilets and taps theyclean. Those cleaning and managing toilets, oremptying pits and septic tanks, have to interact inclose proximity with users and customers.
Measures need to be put in place to minimise
those risks.
The government and Nepal Medical Council, withthe reference of WHO standard, has developed
guidelines for the use of Personal Protective Equipment (PPE) for health care facilities in relation toCOVID-192. But it is silent about PPE use for sanitary workers, which reflects how they are neglected, even in a pandemic situation. However, interim
guidance produced by WHO and UNICEF on 19March 2020 for ‘Water, Sanitation, Hygiene, andWaste Management for the COVID-19 virus’, indicates the need for PPE (protective outerwear,gloves, boots, goggles or a face shield, and amask) to protect sanitary workers against possible
contamination.

Working Position Paper– WaterAid Nepal

It is necessary for sanitary workers to be recognized as key essential workers, to be provided
basic protection and training, given the hazards
that come with their job, and especially at timesof emergency like COVID-19.
What is needed? It is urgent that the authorities
immediately provide guidance on precautionary
measures on COVID-19 and allocate resources toensure regular supply of PPE for sanitary workers.
Equally important is to train and orient them on
how to handle PPE (put on, remove, dispose), howfrequently it needs to be replaced and, on theneed, to wash and disinfect PPE after every use infacilities adequate to each type of work. Hand
washing at critical moments is also vital, andequally needs adequate facilities and supplies. In
the long run, there is a need to establish a social
protection mechanism for the health, safety anddignity of the sanitary workers. WaterAid Nepal
will continue to advocate for PPE and hand hygiene measures for sanitary workers, while
demonstrating these aspects in its’ interventions.

Hand hygiene moments for SanitaryWorkersSanitary WorkersBefore putting on PPE and after removing it, when changing gloves and masks
After finishing sanitation activities
After contact with any respiratory secretions
After touching frequent-contact surfaces
or money,
Before eating and before touching theirface
After using the toilet

PPE recommended

Collecting, transporting anddisposing health care andhousehold wastes
Cleaning public/ community
toiletMask, thick gloves, wrist band, footwear covering whole foot/gum boots, face

Operating pumping stations
and treatment plants

Medical mask, rubber gloves, wrist band, hard sole shoes, appropriate clothing

Cleaning sewers and manholes

Medical mask, rubber gloves, wrist band, gum boots, liquid repellent protective

Emptying pits and septic
tanks

Medical mask, rubber gloves, wrist band, footwear covering whole foot or gum

shield or goggles, appropriate clothing (like long sleeved shirt and trouser), cap
Mask, gloves, wrist band, footwear covering whole foot, appropriate clothing(like long sleeved shirt and trouser)(like long sleeved shirt, long trousers and apron)outerwear, face shield or goggles, hard hat
boots, face shield or goggles, appropriate clothing (like long sleeved shirt, longtrousers and apron), cap

12Water, sanitation, hygiene, and waste management for the COVID-19 virus Interim guidance 19 March 2020, WHO and UNICEF
Guidelines for Use of PPE in Relation To COVID-19 in health care facilities (Key Extracts)-Government of NepalHealth Personnel engaged in suspected or confirmed cases of aerosol generating procedure: N-95 mask, Googles or visor, Gloves(loose gloves acceptable), Water resistant OR standard disposable gowns, Cap: Regular disposableHealth Personnel engaged in suspected or confirmed cases of non-aerosol generating procedure (seal the top edge with tape),Googles or visor, Gloves (loose gloves acceptable), Water resistant or standard disposable gowns, Cap: Regular disposable
Physicians examining the patients in the fever/screening clinics: Surgical mask (seal the top edge with tape), Googles or visor,Gloves (loose gloves acceptable), Water resistant or standard disposable gowns, Cap: Regular disposable
Escorts or Drivers: Surgical masks, Gloves, Gowns (if physical contact expected)
Laboratory Staff (depending upon the chance of splash): Surgical mask, Gown, Loose Gloves, Eye protection (if risk of splash)

All Staff, including Health Care Workers involved in any activity that does not involve contact with COVID-19 patients and working
in other areas of patient transit: No PPE required for everyone
References
https://www.who.int/water_sanitation_health/publications/health-safety-dignity-of-sanitation-workers.pdf
Tamil Nadu Urban Sanitation Support Program/Indian Institute for Human Settlement
WaterAid Nepal, JM Road 10, Pabitra Tole, Nakhipot – 14, Lalitpur, Nepal Phone No: +977 5230210 Web: www.wateraid.org/np