Dermatologic evaluation of street sanitation workers.

Street sanitation workers (road sweepers) form the backbone of the civic cleaning system of any society. They are responsible for cleanliness maintenance in a society. In developed countries, most of the process of street cleansing is mechanized. In a developing country, such as in India, with limited resources, most of the cleaning process in urban localities remains manual. Brooms are the main and probably the only equipment utilized. With improper segregation of waste materials at the source and all types of garbage being disposed on the streets, these workers are exposed to dirt, infective organisms, and other hazardous materials like chemicals, animal excreta, and sharp objects. These factors subject the workers to skin, gastrointestinal, respiratory, and orthopedic problems.[12] Scarcity of health data in various occupational workers is a cause of great concern.[3]

A survey of these sanitation workers was conducted, which included a general dermatological evaluation and investigation of protective measures.

A total of 87 workers (male: 44, female: 43, age range: 20-65 years) were screened, only one of the 87 workers used gloves while working. None of the 87 workers used masks or properly covered footwear like boots during the work hours. The various dermatoses detected are enumerated in Table 1. Some of the workers had more than one dermatological problem.

Table 1

Various dermatoses detected in street sanitation workers

The incidence of disease for all occupations is not easily available. Street sanitation workers are especially prone to a range of dermatological problems considering their occupation. The potential sources of this issue ranges from prolonged outdoor activity and contact with potentially infective substances, chemicals, human and animal excreta, as well as sharp objects. In this study, a high incidence of fungal infections was noted, this may be due to high humidity and high temperatures in the tropics. Poor personal hygiene may be another reason. Detection of facial melanosis, melasma, and polymorphous light eruption stresses the need for the use of photoprotective measures because of the increased outdoor work in these workers. A significantly low incidence of use of personal protective measures such as gloves, masks, and proper footwear was noted among only one of the 87 workers reporting the use of any adequate protective measures. The low socioeconomic status of these workers may also be due to poor nutrition status of these workers, which makes them susceptible to various diseases.

Recommendations for improving the health status of street sanitation workers are as follows:

Development of a health monitoring system for sanitation workers with periodic health check-ups, especially dermatological

Awareness and education programmes regarding general health, hygiene, and protective methods

Providing and promoting the use of protective measures such as gloves, masks, work boots, and work clothes

Regular field checks regarding the use of protective measures

Segregation of wastes at the source in different color-coded bags

Utilization of machinery in the cleansing process