Exposure risk management from faecal pathogens for workers in container based sanitation systems

This thesis addresses the need for safely managed container-based sanitation (CBS) systems to contribute to the UN’s Sustainable Development Goal 6 and explores occupational exposure risk management to faecal pathogens in CBS systems in three Case Studies. A mixed methods approach undertook qualitative and quantitative risk assessment of exposure and associated risk management strategies. The risk assessment adapted and developed the WHO Sanitation Safety Planning (SSP) framework and identifies critical points where control measures are required to manage exposure. The risk assessments found tangible evidence of occupational exposure risks from hazardous events, such as spillages and blockages of the urine diverter, and subsequent transmission along the CBS system components. Hand and fomite transmission were identified as key exposure points to operators. Frequent handling of contaminated surfaces during collection increased hand contamination. Modelling of hand contamination during collection activities suggested that the operators might be involved in a chain of infection between households, although effective hand hygiene protocols managed the exposure risk. A Cross Case analysis highlighted four causal mechanisms of occupational exposure, namely (1) technical and equipment failures, (2) behavioural failures, (3) system safety failures and (4) environmental/seasonal failures. A formative analysis of the behavioural determinants of safe sanitation management highlighted emotional and ability factors as behavioural determinants that influenced operators’ behaviour. In conclusion, the Case Studies represent the most in-depth empirical study of occupational exposure risks in CBS systems at a level not detailed in the literature to date. The study highlights work-related activities in CBS systems that bring workers into contact with faecal matter and sets out how exposure risk management frameworks can achieve safely managed sanitation. The use of an adapted SSP and a safety performance management framework is demonstrated as an effective risk management tool of CBS systems in order to achieve SDG 6.