A troubling news story out of San Diego prompts me to wonder if portable sanitation companies are doing enough to protect frontline service technicians from the spread of infectious diseases as they run daily restroom service routes.

Earlier this year, public health officials in Southern California were tracking an outbreak of the hepatitis A virus connected to poor sanitation throughout a growing homeless community. According to a news account, five cases of the virus and one death were concerning enough for the city to expand its offering of hand-wash stations, the type provided by portable restroom operators. Officials also called for more portable restrooms and more frequent servicing of the units.

This followed a more serious explosion of hepatitis A cases in the city from 2016 to 2018 that resulted in 600 cases and 20 deaths. All the San Diego outbreaks were traced to inadequate access to public restrooms and most often impacted the homeless population. This spring, a California Assembly bill was introduced requiring local governments to create an inventory of public bathrooms to address the shortage.

If many cases are now being found in and around the homeless community, your technicians who clean restrooms in urban centers are perhaps at risk of picking up an infection. Two types, A and B, would be the greatest concern for PROs. Hepatitis A is less serious for its long-term health effects. The risks of exposure to each differ, but they all cause inflammation of the liver. According to the U.S. Centers for Disease Control:

Hepatitis A is spread when someone ingests even microscopic amounts of the virus through close personal contact with an infected person, through eating contaminated food or drink, or contact with human waste. According to the CDC, hepatitis A symptoms — typically including vomiting, stomach cramps and diarrhea — can last from a few weeks to a few months, but most recover with no lasting damage. Deaths occur but are rare. Its spread can be largely prevented by good hygiene practices. There were about 20,000 reported infections in the U.S. in 2020.

Hepatitis B is more widespread and can develop into a serious lifelong illness. It is spread when even microscopic amounts of bodily fluids from an infected person enter someone who is not infected. While most remain asymptomatic, about 15% of adults who develop a chronic case die prematurely of cirrhosis or liver cancer. There were about 14,000 new infections in 2020 and about 880,000 adults in the U.S. have chronic Hepatitis B.

There are effective vaccines for both hepatitis A and B.

HOW DO YOU PPE?

What I have seen and experienced spending time with PROs on the job compels me to dive into this issue. When out on photo shoots or talking to portable sanitation contractors over many years, I have witnessed a wide spectrum safety practices, from careless to extremely careful.

Sometimes contractors are geared up with all of the recommended personal protective equipment and work hard to minimize contact with sewage while servicing restrooms. Other times I’ve been surprised to see technicians handling the suction hose with bare hands and doing little to avoid splash contact with waste. I have seen busy PROs eating in the truck between stops or holding cigarettes in the same hands that just pushed a hose into a full holding tank.

Many of these actions oppose the safety recommendations from the Centers for Disease Contro and advice from the technician training course of the Portable Sanitation Association International. Given what’s happening in Southern California, a refresher of best practices for technician safety is in order.

First, here is the CDC list of basic hygiene practices for workers who handle sewage:

• Wash hands with soap and water immediately after handling human waste; before eating or drinking and before using the toilet.
• Avoid touching face, mouth, eyes, nose or open sores and cuts while handling human waste.
• Keep open sores, cuts and wounds covered with clean, dry bandages.
• Use waterproof gloves to prevent cuts and contact with human waste.
• Wear rubber boots at the work site and during transport of human waste.
• Do not smoke or chew tobacco or gum while handling human waste.
• Flush eyes gently with safe water if human waste contacts eyes
• After handling human waste, remove boots and work clothes before leaving the work site; clean contaminated work clothing daily with 0.05% chlorine solution (1 part bleach to 100 parts water); before eating, remove soiled work clothes and eat in designated areas away from human waste-handling activities.

And use this PPE:

• Goggles to protect eyes from splashing of human waste.
• Face mask or splashproof face shield to protect nose and mouth from splashing of waste.
• Liquid-repellent coveralls to keep waste off clothes.
• Waterproof gloves and rubber boots to prevent waste exposure.

The CDC also says workers who handle human waste should be properly trained about disease prevention. This includes basic hygiene practices, proper disposal of PPE and collected waste, and symptoms of exposure to hepatitis. Further, employers should work with health officials to develop recommendations for providing preventive vaccinations for hepatitis A, hepatitis B, tetanus, among others.

INDUSTRY SPECIFIC

Many of these recommendations align with PSAI health, safety and professional excellence training, according to Joe Payne, a member of the group’s board of directors and training committee co-chair. Payne is also the operations manager at Terry’s Pumpin’ & Potties in Elko, Nevada, and his company follows recommended safety practices and also offers free hepatitis B vaccinations to protect frontline workers. The company has 13 employees and seven technicians.

“It’s something we offer to our employees. It’s completely voluntary and we do pay for that for our service technicians and anyone who’s going to be out there. If you really think about it, hepatitis is the most likely disease that you can get,” Payne says. “It’s not very likely if you’re using your gloves and your face shield and other personal protective equipment. But the possibility is there and if there’s a 2% chance of getting exposed to it, why not knock that down to zero by getting the vaccine?”

Payne’s company is a small sample size, but he estimates 50% to 60% of workers have taken the hepatitis B vaccinations, which are administered in three shots spread over several months.

“In my opinion, the vaccination is cheap insurance versus having an employee get hepatitis and having to go through all of that,’’ he says.

Payne’s experience serving restrooms used by homeless populations likely matches others in the industry, unfortunately. These units are commonly prone to being very messy and are often vandalized, he says.

TOUGH JOBS

“We service a homeless camp and it can be horrible. Those are the (units) that nobody wants to service,” he explains. He said users often “wreck the equipment, they fill the tanks full of clothing. Someone will come in and rip the toilet dispenser off the wall and take all the toilet paper. So the next 30 people who use it are ripping articles of clothing up and using that. They treat them like a garbage can.”

As you can either imagine or have seen for yourselves, units serving the homeless community could pose great risk for hepatitis exposure due to messy conditions and history of the disease spreading among this group. Payne stresses technicians never put a hand, even gloved, inside the holding tank, and always use a grabber to pull debris out and bag it. And workers should wear gloves, long-sleeved shirts and face shields to block splashing.

“Since COVID, everybody’s had a higher perspective on hygiene and protecting yourself personally. If we can continue that in our field, then that’s great,” Payne says. “Wearing personal protective equipment is your best defense against any type of disease or infection.”

Payne says he doesn’t have an idea of how many portable sanitation companies offer vaccines to employees or how the shots are accepted among workers in the industry. Please feel welcome to share your company policy on vaccines and PPE usage at editor@promonthly.com. I will be happy to compile a list and publish it in a future issue.