Cleaners may work in hospitals, schools-colleges-universities, factories, office buildings, government offices, hotels-restaurants to make these places tidy and clean; street sweepers keep the footpath-streets-roads-highways free from rubbish and debris to make walking and traveling pleasant and safe; garbage collectors remove wastes, litters and junks to help the city dwellers live hygienic and disease-free. These are vital functions for a sustainable city life -- however, these are occupations that are layered at the very bottom of the socio-economic hierarchy; neither are they paid anywhere close to a livable wage nor they receive any respect of any sort in a society that only worships family lineage, wealth and power -- political or muscle or bureaucratic. Most of us prefer to overlook folks in these occupations, we remain oblivious to their presence around us.
Our survival, thriving and breathing in a clean, healthy and safe environment depend largely on their jobs and operations, when and if done well. Do we care to know about the diversity, categories, severity, and regularity of hazards they face at work?
Cleaners, street sweepers and garbage collectors form a large and growing proportion of the total working population in any given city or country. For example, only cleaners make up 4 per cent of the working population in Finland and 10 per cent of the female working population in Spain. In the Canadian province of British Columbia, above 50,000 were working as cleaning personnel according to one report. Cleaners working in hospitals and healthcare facilities in Canada represent 30 per cent of all working in the cleaning industry. According to one newspaper report, more than 10,000 waste collectors work for the two Dhaka city corporations. If we had data and could include all the cleaners, street sweepers and garbage collectors -- both in the private and private sector -- together they would make a very large occupation group in Bangladesh.
These cleaning jobs have frequently been associated with multiple physical, chemical and biological hazards that greatly enhance their risk of occupational illness and injury. The ramifications of these illnesses and injuries include being falling sick, absence from work, gradual decrease in work productivity, working at compromised or reduced capacity. All of these consequently impact service delivery jeopardising the city dwellers' health, hygiene and safety. Furthermore, costs of treatment, pain and suffering, loss of health, wellbeing, and quality of life, care providing burden on family members, and earning loss from missed work create enormous burden for these workers and their families.
An extensive array of cleaning activities from sweeping and vacuuming to disposing of waste or cleaning toilets are accomplished in diverse work settings such as homes, offices, factories, schools, hotels, shops and hospitals. The categories of risks to which these workers are exposed to are not only specific to the type of cleaning tasks they do, but also specific to the sector and sites where they work.
PHYSICAL HAZARDS: Cleaning and associated jobs are physically demanding. They spend a considerable amount of time standing and lifting or pushing fixtures and equipment. Most of these tasks (e.g. dusting, sweeping and cleaning walls, furniture and bathrooms) require them to be in bending, stooping and stretching positions. They are also at risk of minor cuts, bruises and burns from machinery, hand tools they use and from handling refuse, debris, sharp and heated objects. In addition to these, they may work inside buildings which may not have adequate light, ventilation, humidity and temperature. They also work outdoors, and street sweepers and garbage collectors are at high risk of traffic accidents as no street signs are posted in Bangladesh to warn the inbound and passing traffic when they are on duty.
Mopping, brooming, and vacuum cleaning and prolonged standing and repetitive activities in general can cause musculoskeletal syndromes in hands/wrist and legs. Other high risk activities include reaching overhead; bending, kneeling and squatting for dusting and scrubbing; bending wrists; awkward lifting, bending, squatting to carry buckets; bringing, lifting and carrying a wet mop. During trash removal, high pushing and pulling forces are required. Moving, lifting, carrying, pushing and pulling furniture, appliances, stoves, ovens and microwaves also require a lot of force.
There is scientific evidence that the use of electrical cleaning machines and other hand-held powered equipment exposes cleaners to hand-arm vibrations leading to musculoskeletal problems. Malfunctioning electrical tools and equipment, appliances, wiring, switch panels and electrical outlets or transformers are sources of electrical hazards. Some cleaners have mentioned high noise as a nuisance at their work.
Slips, trips and falls are also frequent among them; the main risk factors identified are: poorly maintained stairways; working on a ladder; flooring with low slip-resistance; wet and dirty floors; worn grip of shoe sole; unexpected obstacles on the way (e.g. low furniture, wires of electrical or any other powered equipment); poor lighting; and lack of safety signs. Falls from a ladder when cleaning shelves or windows also happen.
CHEMICAL HAZARDS: Cleaning occupations work frequently with chemical cleaning products including toilet cleaning products, disinfectants, detergents, waxes, floor cleaners, soaps, preserving agents, surface/floor care products, glass cleaners, anti-corrosives, degreasing products and dissolving agents. These may contain: acids (sulphuric, citric, acetic, hydrochloric or phosphoric acid); alkaline agents (ammonium hydroxide, sodium hydroxide, silicates and carbonates); solvents (toluene, alcohols, glycol ethers, formaldehydes, ethanolamine); fatty acid salts, polishes (polyethylene, acryl polymers, wax), aldehydes, quaternary ammonium compounds. The health effects of these chemical hazards may include burns on skin, dermatitis, eye injury, corrosive action, irritation to skin, eye and mucous membrane, respiratory problems including asthma, sensitization, allergic reactions. Some of these agents may have neurotoxic properties or have adverse effects on the reproductive system.
BIOLOGICAL HAZARDS: Among biological agents, fungi, mold, vermin, cockroaches, mice, microorganisms contained in human excreta, blood and body fluids, bacteria (Staph aureus, E coli, Streptococcus) and viruses are common. The health outcomes include hypersensitivity, pneumonitis, asthma, lung mycoses, dermal allergies, HIV, hepatitis, tetanus, cystitis, inflammation of gallbladder, cholecystitis, allergic dermatitis, purulent infections, respiratory inflammation, food poisoning, angina, rheumatic disease, conjunctivitis.
Higher injury rates among these workers may also relate to a poor understanding of work processes and a lower awareness of the potential hazards. Experience has been shown to correspond with lower injury risk.
Previous research also showed a higher risk of injury among female workers that suggests that gender segregation occurs at work, with women often performing the more repetitive, routine and hazardous work. Women often have a heavy domestic workload in Bangladeshi tradition and family structure which may contribute to their work-injury rates (i.e. they have less opportunity to relax and exercise at home).
There are many other contributing factors that may elevate injury risk in these occupations, such as workplace culture --lack of support, heavy workload, high pace of work, long shifts, no training, not providing personal protective equipment (PPEs), not giving the correct tools and nor fitting these to their body height and strength etc. Research studies may have underestimated the real injury risk among them as underreporting of incidents is an issue in this sector, particularly when cleaners assume that such injuries are part of their job or that reporting would not change anything.
Preventative policies should be developed to reduce the hazards in the workplace and safer work practices can be promoted by offering them adequate and periodic training on ergonomics or body mechanics and ladder safety, providing them with adequate and fitting hand-tools, giving them sleep resistant shoes and reflective and fluorescent vest, ensuring posting of traffic signs on the streets when they are on duty. Preventive measures from chemical and biological agents include wearing respirators during work in a dusty area, ventilation improvements, wearing PPE, frequent hand washing, disinfection, sterilization and periodic pest control, replacing or substituting cleaning agents with less harmful or corrosive chemicals, and vaccination against blood-borne viruses (e.g., Hepatitis B).
Cleaners, street sweepers and garbage collectors deserve more attention, care and support from the people who greatly benefit from their services.
The writer is a Professor, Department of Pharmacy, East West University, Dhaka