Health effects of work at waste water treatment plants: A review of the literature with guidelines for medical surveillance

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Abstract
Potential health hazards associated with work at waste water treatment plants include bacteria, viruses and protozoa in domestic waste and heavy metals and other hazardous substances in industrial wastes. The primary exposure route for hazardous material is through inhalation of aerosols generated in the secondary phase of water treatment that contain pathogenic organisms. Although few epidemiological studies have investigated the health of waste water treatment facility workers, hazards noted have been limited to acute, self‐limited gastrointestinal illnesses. Due to the potential for long term or subtle adverse health effects, a medical surveillance program is proposed that includes attention to infectious diseases, such as hepatitis and to illness/absenteeism records.