government of liberia liberia water and sewer corporation ... · the ebola virus is an enveloped...

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Protocols for the safe collection and disposal of Ebola contaminated sewage

Government of Liberia

Liberia Water and Sewer Corporation

Protocols for the Safe Collection and Disposal of Ebola

Contaminated Sewage

Monrovia, Liberia January, 2015

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Acknowledgement

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Table of Content

Acknowledgement ........................................................................................................................................ 2

Table of Content ........................................................................................................................................... 3

I. Purpose/Aim ......................................................................................................................................... 5

II. Scientific Basis, Basic Assumptions, Design Criteria ............................................................................. 5

III. Understanding the Flow Process .......................................................................................................... 7

A. Collection .......................................................................................................................................... 7

B. Transportation .................................................................................................................................. 8

C. Discharge to Final Treatment and Disposal – FIAMAH Sewage Treatment Plant............................. 8

IV. Layout Principles of the Structures and Physical Facilities .................................................................. 8

A. Septic Tanks and Holding Tanks at the ETUs .................................................................................... 8

B. Transporting Route ........................................................................................................................... 9

C. Holding tank at Fiamah ..................................................................................................................... 9

V. Basic Requirement for Safety ......................................................................................................... 10

VI. Analysis of Risks .............................................................................................................................. 11

VII. Preparation for Operation .............................................................................................................. 11

VIII. Safety Protocols .............................................................................................................................. 11

A. Collection at ETU Septic Tanks and Holding Tanks ......................................................................... 11

B. Transportation from ETUs to Fiamah Digester Location ................................................................ 12

C. Discharging into Fiamah Detention Tank or Former Digester Tank ................................................ 12

IX. Health and Safety for Crew and Operators ..................................................................................... 13

X. Recommended Training for Crew ................................................................................................... 14

XI. Public Relations and Communication Plan ..................................................................................... 14

XII. Monitoring, Documentation and Reporting ................................................................................... 14

XIII. ANNEXES ......................................................................................................................................... 15

A. Maps of Dedicated Transportation Routes Showing ETU Locations .............................................. 15

B. LWSC Safety protocol and contingency plan in the event of an accident during transportation of

Ebola sewage from ETUs to Fiamah Digester location. .......................................................................... 18

C. LWSC Letter Requesting Road Privileges during Transportation to Avoid Traffic. ......................... 19

D. Preparation of Chlorine Solutions ................................................................................................... 21

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E. Worker Safety, Environmental and Social Impact Assessment for Management of Wastewater

from ETUs Monrovia-Liberia ................................................................................................................... 23

F. Procedures for PPE Donning ........................................................................................................... 29

G. Procedures for PPE Doffing ............................................................................................................. 30

H. Transfer Voucher of Sewage from Ebola Treatment Unit to Fiamah Digester ............................... 31

I. Public Relations and Communication Plan ..................................................................................... 32

J. A Step by Step Procedures for the Operation of Sewer Trucks ...................................................... 33

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I. Purpose/Aim The Ebola Virus Disease (EVD) pandemic has affected over 4,000 people in Liberia. One of the strategies

of the National Response is to detect cases and isolate the affected for treatment, as well as to prevent

further infection. To do this, the Government and its partners have constructed and continue to construct

a number of Ebola Treatment Units (ETUs) and Community Care Centers (CCCs), which are being used to

screen, detect and isolate Ebola patients for treatment. However, due to the high volumes of infectious

waste generated from these facilities, safety protocols for waste management need to be put in place.

Two broad types of waste are generated from the ETUs including solid and liquid waste. Protocols are in

place for infection prevention in hospitals1 and UNICEF has developed a document to guide the planning

of WASH packages for ETUs2. However, these documents offer limited information regarding waste

management and final disposal. While solid waste is basically segregated and disposed of in incinerators,

the main challenge lies with the collection and disposal of sewage, which including feces, and wastewater

from showers and laundry. The potential of contamination to the sanitation crew, the general community

and environment is of course, of critical concern.

The aim of this document is to offer safety protocols that would help to minimize potential hazards related

to the handling and management of sewage3 generated from the ETUs and the CCCs.

II. Scientific Basis, Basic Assumptions, Design Criteria Based on research and publications on the Ebola virus and its survival rates outside the body of an infected

person, the following informed the development of this document.

Known Science:

To date, there is no evidence for transmission of Ebola viruses via drinking-water contaminated by faeces or urine.

The virus is unlikely to survive for extended periods outside of the body. Higher temperatures (room temperature or above) are likely to increase the speed at which the virus dies-off in the environment.

However, the sewage from the infected person should be treated as a biohazard and must be

handled with care (i.e. all those handling fresh excreta should wear full Personal Protective

Equipment (PPE)).

The Ebola virus is an enveloped virus and therefore more fragile than many enteric, non-enveloped

viruses (i.e. poliovirus).

There is no published data on Ebola virus survival in sewage; however, general trends can be

deduced from what is known about virus survival in general in sewage. Virus inactivation in sewage

is facilitated by very high or very low pH, higher temperature (250C or greater), and time (in a matter

of days/weeks large declines occur).

1 Interim guidelines for hospital infection control while managing the suspect/case of Ebola Virus Disease (EVD) 2 WASH package for Ebola Care and Treatment Centres/Units – Guidance note, UNICEF Programme Division, 2014 3 Sewage in the context of this document refers to black water (excreta, vomit, blood spills) from the latrines and grey water (from showers, laundry, kitchen) but not storm water which is dealt with separately through a parallel drainage channel and connected to a soak away pit.

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In settled sewage at 250C, 99% of a similar structured virus (enveloped), coronavirus, was removed

in 7 days.

Although not specific for the Ebola virus, most viruses do not survive in a pH >11.5.

Assumptions:

The 5 % chlorinated water used for flushing the toilet and disinfection will contribute to the reduction

of the viral load and any other pathogens in the flushed toilet.

Assumption that the sewage is safely handled within the ETUs. As such this document considers its

handling and management from the septic tank, lined latrine, holding tank or poly tank to final

disposal site.

Minimum Design Criteria:

Sewage must be stored in a septic tank, lined latrine, holding tank or poly tank where it can easily be

desludged by sewer truck. (Note: For areas with low water table, a double pit latrine is preferred as

once one pit is full it can be left for several weeks to allow the virus to decline and then the second

pit used to collect fresh excreta).

As much as possible, the septic tank must be located in an area outside the red zone and fenced to

avoid unauthorized access, with clear unobstructed access. Septic tank can be located at the edge of

the red zone and accessible from the boundary fence.

The septic tank or the lined pit must have a PVC suction pipe (see Figure 1) to avoid opening the

manhole during the desludging process.

The suction pipe should be at least 3 (Storz) - 4 inches (Clamp) and inserted at least 6 inches from the

base of the septic tank. Outside of the septic tank, this fixed suction pipe should be equipped with a

Gate Valve and a “T” before the final Storz or clamp coupler. To prevent splashes to the crew, a Ball

Valve needs to be installed on the T (see Figure 2) to allow air suction before decoupling the pump’s

suction pipe.

Figure 1: Suction Pipe Figure 2: Ball Valve Installed on a “T”

Considering the above assumptions (with some scientific basis) that pH, quantity of chlorine, retention

time, and temperature will contribute to have a significant effect on reduction of the viral load in the

sewage. However, there are not enough scientific data on this specific area with the Ebola virus -

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additional environmental studies would be needed. For this reason, all operations around the

manipulation of the sewage will be considered as high risk and will require high level of safety.

III. Understanding the Flow Process In addressing the safety needs of handling and managing the sewage, the flow process is categorized

into three stages as illustrated in Figure 3 below.

Figure 3: Sewage Flow Process

A. Collection This process includes the removal of sewage from the various septic tanks, latrines, and holding tanks

located in the ETUs, and its corresponding material and equipment handling. It involves the right

positioning of the sewer truck at the designated area, connecting various suction hoses to the truck and

the septic tanks, the pumping or sucking the sewage and disconnecting the hoses upon completion. As

vacuum pressure is used in the collection process, there is the potential for waste to spill and splash when

the pump is stopped and the hose disconnected. To this effect, all septic tanks should be equipped with

a ball valve in order to prevent splashes. As some ETUs have more than one septic tank, the process will

need to be repeated for each tank. It is important to note that some septic tanks are serving only the staff

area and as such, may be considered “green”, or low risk. However, caution must still be applied. Proper

PPE donning and doffing should be performed under the supervision of Infection Prevention and Control

(IPC) staff4 to ensure occupational health and safety5 of workers.

4 Infection Control for Viral Haemorrhagic Fevers in African Healthcare Settings, CDC, 1998. 5 Ebola virus disease: Occupational safety and health. Joint WHO/ILO briefing note for workers and employers

(updated 5 September 2014).

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B. Transportation During the transportation process, the sewage is transferred by truck to the discharge point – FIAMAH

plant. This process has the potential to cause contamination along the transit route - possible leakage,

breakdown of the truck and traffic accidents. To minimize such risks, the LWSC has mapped dedicated

transportation routes, which provide locations of the ETUs, traffic flow patterns and time. Mapping the

routes helps to ensure that the sewage is transported during low-traffic time, using the least congested

route to minimize risks associated with road transport. The transportation process includes an escort

utility vehicle. This vehicle will be equipped with chlorinated water, PPE, drums, foot basin and buckets,

sprayers and various tools which can be used in case of an incident related to spillage.

C. Discharge to Final Treatment and Disposal – FIAMAH Sewage Treatment

Plant The final stage is the transfer or discharge of the sewage from the truck into the detention tank or former

digester tank, taking all necessary actions in such a manner as not to contaminate the crew, people living

in the direct vicinity of FIAMAH sewage plant or cause any environmental contamination.

To eliminate risks, the detention tank is located in a secured area preventing unauthorized access. The

tank is equipped with gate valves and a flange, which is fixed at the outlet to prevent discharge to the

ground. The on-site operator will inspect the tank, valves and flange on a regular basis. If a problem is

identified, the operator must immediately notify the Sewage Manager. The process also includes the

coupling and decoupling of the hose, the disinfection of the truck and crew and the disinfection of any

potential spill areas. Once the final discharge and the disinfection processes are completed, workers can

remove PPE and place in the bin specifically provided for contaminated PPE. An on-site dressing room,

equipped with a shower and toilet is available ONLY for the crew involved in the ETU desludging process.

IV. Layout Principles of the Structures and Physical Facilities

A. Septic Tanks and Holding Tanks at the ETUs Septic tank, latrines and holding tank sites should allow easy and safe assess for the sewage and

utility trucks.

All sites must be sealed and clearly labeled as danger zone to prevent unauthorized access.

Only the desludging crew and ETU supervisors are allowed access during the desludging process.

Tanks should have a suction pipe installed into it and capped to allowing easy access to suction

without opening the manhole.

The suction pipe should be at least 3 - 4 inches and inserted at least 6 inches from the base of the

septic tank. This fixed suction pipe should be equipped with a device to prevent splashes in order

to meet the minimum design criteria.

The sewer truck should be equipped with reductors from 3 (Storz) - 4 inches (Clamp) couplings as

is indicated in Figure 4 and 5 below.

Water should be connected from the ETU/CCC to the sewage area and a changing room provided.

Truck platform should be in concrete or gravel layer of at least 6 inches and connected to a soak

pit.

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Figure 4: Storz Coupling Figure 5: Clamp Coupling

B. Transporting Route LWSC has mapped the approved routes that are characterized by low traffic (see Annex A).

These routes will be traversed between the hours of 10:00 am to 3:00 pm. These are the hours

of minimum traffic along the routes. The two major routes are:

Unity Conference Center and Island Clinic ETUs: From ETU to main road to St. Paul Bridge (UCC

ETU) to UN Drive to Johnson Street Bridge to Johnson Street to Broad Street to Capitol Bye-pass

to Jallah Town along Cheesman Avenue to 20th Street to Fiamah STP.

ELWA, SKD and MOD ETUs: From ETU to Robertsfield Highway to S. D. Cooper Road (ELWA and

SKD) to Tubman Boulevard (MOD) to Airfield Road (back road) to 20th Street to Fiamah STP.

Sewer truck will be escorted by the utility truck that will contain equipment and supplies to

facilitate implementation of infection prevention and control measures in case of road accident.

LWSC safety protocol and contingency plan has been developed in the event of an accident during

transportation of Ebola contaminated sewage from ETUs to Fiamah Digester location (see Annex

B).

LWSC has requested road privileges during transportation in order to avoid traffic (see Annex C).

C. Holding Tank at Fiamah The detention tank or former digester area is fenced and secured.

Truck platform has been constructed with disinfection capabilities.

On-site LWSC security will be provided.

On-site changing room, shower and toilet facilities are provided.

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Figure 6: Holding or Retention Tank at Fiamah

V. Basic Requirement for Safety The minimal requirement for safety may be classified into 5 groups.

Physical Structures Equipment Human Resources Personal Protection

Equipment

Consumables

Changing room/ shower at Fiamah

Truck and crew disinfection areas at ETUs and Fiamah

Septic tank with 4 inch pipe inserted and capped

1 drum incinerator and ash pit at disposal site

Secured parking lot for sewer truck(s) at Fiamah

1 sewage truck

1 escort vehicle

2 No. 200 liter drum for 0.5% chlorine water

1 drum of clean water

1 backpack sprayer

2 hand sprayers

3 hand sanitizer

3 Footbath

2 Infrared thermometers

2 Mirrors

Sewer Manager

Technician

Sewer Truck Operator

Plumber

Driver

Laundry staff

Waste handler

Security guards

IPC supervisor

Sprayer

Monitoring team (EPA, MOH, LWSC, MPW, MCC, Fiamah Community)

Rubber boots

Reusable gloves

Water proof protective gown

Rubber apron

Goggles/eye shield

Face mask

Nose mask

Safety helmet

60 liter disposable plastic waste bags

HTH 70%

The recommended crew size per truck should be a maximum of 5 persons, comprised of 1 driver, 2

technicians, 1 operator and 1 sprayer. The escort vehicle must be equipped with safety equipment,

personal protective gears, and consumables, outlined in the table above. There must be at least 3 sets of

protective gear for the crew. These items must be replenished and are the responsibility of LWSC (for the

Fiamah disposal plant) and each ETU. All sanitation crew should be trained in the use of the safety

equipment, especially in its removal so as not to contaminate themselves during removal. The crew should

also be trained in the preparation of the 0.5 % and the 0.05 % chlorine solutions (see Annex D).

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VI. Analysis of Risks To understand the safety requirements for each of the stages, it is imperative to first identify the possible risks likely to occur at these stages. Annex E explains worker safety, environmental and social impacts or hazards and mitigation measures to be taken at the three critical steps in the process including the collection of sewage at ETUs, transport, and discharge into the detention tank of former digester tank.

VII. Preparation for Operation A trial run will be performed in order to enhance efficiency in desludging activities. After the

implementation of the trial run, the LWSC will organize a stakeholder’s meeting and share presentation

on the identified impacts (environmental and social), and mitigation measures to be taken at the three

critical steps in the process including the collection of sewage at ETUs, transport, and discharge into the

detention tank. Similar presentations will be conducted at the IMS and WASH Cluster meetings prior to

desludging operations.

VIII. Safety Protocols

A. Collection at ETU Septic Tanks and Holding Tanks Upon arrival at the ETU, these procedures must be followed:

1. Sewage truck must be parked on the designated platform, to ensure optimal connection and

safety in case of spills and splashes. (Platforms indicated in each ETU sketch as well as truck and

crew movement IN and OUT of the area).

2. Each ETU must have a fixed system in place before the first desludging operation takes place to

allow the pump truck to be coupled.

3. Crew should be prepared and dressed in the required safety gear under the supervision of the

ETU IPC (see Annex F for step-by-step details on PPE donning). This ETU IPC person will observe

and supervise the crew during desludging operation at the septic tank site.

4. Each fixed pipe to be connected to the suction pipe.

5. Disinfect6 the septic tank suction pipe and the end of the truck externally and internally.

6. Open the cap (cover) septic tank suction pipe and connect the suction hose.

7. Couple the suction hose to the sewer truck from the septic tank suction pipe. Add extra lengths

of hose if needed. Any extra length of hose needed should be disinfected.

8. Cross check all connections to be sure that they are tight and sealed.

9. Start the suction process and suck out the sewage from the septic tank.

10. After suction is completed, reduce suction pressure of vacuum pump and open the Ball valve

before the coupling. Close the Gate valve located before the T and let the truck’s pump suck the

air for 2 minutes. Stop the pump, close the Ball valve and loosen the connection to the septic tank.

This process will clear up any matter in the hose into the truck and avoid spillage when hose is

fully disconnected.

11. Close the valve on the truck and shut down the suction pump.

6 All disinfection must be done with the 0.5% chlorine solution. As much as possible use the facilities at the ETU to disinfect IPC equipment and LWSC crews.

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12. Disinfect the couplings and decouple the hose from the pipe by thoroughly spraying 0.5% chlorine

solution.

13. Insert end of hose into the chlorine solution in the barrel on the utility truck, start the vacuum

pump, open the valve and suck the solution into the sewer truck. This will clean the inside of the

suction hose. (Be careful, that the truck is not completely full so that the chlorine solution does

not enter into the truck).

14. Once suction is completed, close the valve, shut down the vacuum pump and remove hose from

barrel.

15. Spray to disinfect each section of the hose as it is being decoupled from the truck. Pack the suction

hose onto the truck and cap the suction end of the truck.

16. Disinfect the suction pipe on the septic tank and seal it off with the cover

17. Verify that all valves are secured without leakage and disinfect the truck and tires fully by spraying

with 0.5 % chlorine solution.

18. Wash away any splashes into the gravel drain.

19. Crew will return to the dressing room of the ETU.

20. Spray to disinfect each individual crew member while standing in the foot basin under the

supervision of the ETU IPC staff.

21. Remove protective gear as per removal protocols (see Annex G) and stack into the garbage bag

under the supervision of the ETU IPC staff.

22. Garbage bag will be collected and disposed of by the ETU solid waste team.

23. Wash hands with the 0.05% solution or soap and water.

24. Crew is ready to board the transport truck. The sewer truck driver and ETU manager must fill the

transfer voucher (see Annex H) prior to departure.

B. Transportation from ETUs to Fiamah Digester Location 1. The sewage truck leaves the ETU followed by the escort utility vehicle after ensuring that the gate

to the ETU area is closed.

2. Decontaminate parking platform after truck departs (by the ETU sprayer person).

3. The truck driver should follow the designated route as directed by LWSC management.

4. No stopping or transit for any reason other than spillage is permitted. Once the truck moves from

the ETUs, it must go directly to the discharge location. No stopping for any reason is permitted.

5. No eating or smoking during the transporting process.

6. The escort vehicle should be on alert for any leakage coming from the truck. In the event of

leakage, the truck should be stopped, access restricted and spill contained, area disinfected and

the leakage remedied before continuing the journey to the disposal site.

7. Obey all traffic rules, speed limits and road signs on the designated route.

C. Discharging into Fiamah Detention Tank or Former Digester Tank 1. This operation will follow the operational of sewer truck as for the case of collection at ETUs (see

Annex J).

2. Upon entry into the disposal site, the truck must be parked on the designated disposal platform.

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3. Crew under the supervision of the IPC adviser, must dress in a new set of PPE according to

protocol.

4. Disinfect the pump suction hose and sewage truck discharge pipe.

5. Couple the suction hose to the truck and the suction of the discharge pump. Ensure it is firmly

locked and sealed.

6. Start the discharge pump and gradually open the discharge valve on the truck.

7. After discharge is completed, and while the pump is still running, let the pump suck air and

residual matter into the storage tank for 2 minutes. Then, close the valve on the truck and loosen

the coupling on truck (extra care must be taken due to possible back pressure in the line - potential

for splashing).

8. Fully decouple and spray 0.5 % chlorinated water into the hose to be sucked by the pump for

about 2 minutes.

9. Shut down the discharge pump.

10. Slowly decouple the connection hose from the pump and disinfect it in and out into the sump of

the platform.

11. Disinfect both the couplings and the hoses on the truck and the pump.

12. Wash any spillage into the sump.

13. Disinfect the whole truck and the platform.

14. Crew should then disinfect themselves by standing in the footbath.

15. Crew removes PPE at the designated dressing/changing areas and in accordance to protocols. PPE

to be placed in the waste bag marked ‘hazardous’.

16. The used PPE in the waste bags will be disposed of in the drum incinerator.

17. Crew to wash hands and shower (shower, if end of shift).

18. Move the truck to the designated parking place or start the next journey.

IX. Health and Safety for Crew and Operators In order to ensure occupational health and safety the following measures are recommended:

1. Provision of proper personal protection equipment. All work clothing and equipment must remain

at the worksite and not brought home. Crew must follow safety protocols.

2. Regular health monitoring including daily temperature taking for all crew members.

3. Vaccinations for waste-related diseases including Polio, Typhoid, Tetanus, Hepatitis A and B.

4. Provision of hygiene supplies for crew and families.

5. Proper procedures on the management of splashes. Accidental exposure to splashes can occur

while working at ETU septic tanks, Fiamah site and during transportation. In case of any exposure

or unprotected contact with Ebola contaminated sewage, workers should be advised not to panic

but to remain calm and follow the following steps.

• Contact with the eyes: Immediately flush the affected eye with copious amounts of non-

chlorinated clean water, ringer lactate or sodium fluid.

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• Contact with the mouth or nose: Immediately rinse the mouth or nose with 0.05 %

chlorine solution. Do not swallow the chlorine solution. Rinse mouth or nose thoroughly with

clean water

• Contact with broken skin: Rinse the affected area with 0.5 % solution. Thoroughly was

the affected area with soap and clean water. Report to Medical Referent.

X. Recommended Training for Crew 1. Understanding how the Ebola Virus Disease is transmitted and individual prevention measures.

2. Use of PPE or other approved safety gear. See Annexes F and G for additional information on PPE

donning and doffing for the crew.

3. Preparation of the various chlorine solutions (see Annex D).

4. Respect of the desludging Safety Protocols.

5. Use of equipment such as the knapsack sprayer and hand sprayer.

6. Practical Simulation of a desludging operation with PPE to test run protocols prior to performing

the real operation.

7. Simulation of a spill and its management to ensure that crew know what to do in the event of

spillage.

8. Simulation of an exposure to splashes and its management to ensure that crew know what to do

in the event of splashes.

XI. Public Relations and Communication Plan Communication Action Plan has been established with Monrovia City Corporation (MCC). Community

awareness and sensitization campaign will take place during 6 months of desludging operations and it will

include radio talk shows, airing/broadcasting of radio jingles, community meetings, dissemination of flyers

and house to house awareness. Annex I describes the action plan for the Mini Communications Strategy

for public awareness and sensitization on safe collection and disposal of fecal matters from Ebola

Treatment Units to the former LWSC digester plant at Fiamah community in Monrovia, Liberia.

XII. Monitoring, Documentation and Reporting LWSC has formulated a multispectral monitoring team with members from governmental ministries, corporations, boards and Fiamah community in order to monitor the entire process of collection, transport and discharge of Ebola contaminated sewage from ETUs. The monitoring team will provide weekly and monthly monitoring reports to the LWSC. Similar reports will be shared with their respective entities. LWSC, monitoring team and partners will document and share the lessons learned. The monitoring team consist of the members from the following:

Ministry of Health (MOH).

Ministry of Public Works (OHS).

Ministry of Public Works (IPC/CHT).

Liberia Water and Sewer Corporation (LWSC).

Monrovia City Corporation (MCC).

Environmental Protection Agency (EPA).

Fiamah Community.

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XIII. ANNEXES

A. Maps of Dedicated Transportation Routes Showing ETU Locations

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B. LWSC Safety protocol and contingency plan in the event of an accident during

transportation of Ebola sewage from ETUs to Fiamah Digester location.

These protocols are to be strictly observed during the transportation of waste from the ETUs to

the Fiamah STP. The protocols identified measures to be taken in case of road accident.

1. The convoy will consist of a desludging truck (in front) and an escort pick-up (at the rear).

a. The truck crew will include a driver and a plumber;

b. The escort vehicle will include a driver and a stand-by operator;

2. No vehicle will be allowed to separate (drive between) these two vehicles.

3. Both vehicles will have clearly displayed Biohazard stickers.

4. The escort vehicle will at all times carry a knapsack sprayer and 400 liters (about 100 gallons) of

freshly prepared 0.5% chlorine disinfection solution.

5. The escort pick-up will drive behind the desludging truck and observe to ensure that there is no

leakage from the truck.

6. In case a leak is observed, the escort truck will immediately communicate with the desludging

truck to stop and correct the leak by the below procedure:

a. Stop both vehicles;

b. Use 0.5 % disinfecting solution to treat any spillage;

c. The plumber on the escort pick-up will close the point of leakage;

d. After verifying that the leak is sealed the journey will continue.

7. Mitigation for large spillage.

a. Clear all people from the affected area.

b. Secure the area quickly/Notify police.

c. Large scale disinfection with chlorine solution.

d. Mobilize a standby provision of additional 0.5 chlorine solution to spill.

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C. LWSC Letter Requesting Road Privileges during Transportation to Avoid

Traffic.

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D. Preparation of Chlorine Solutions

CDC (2014) Guidelines

Chlorine solutions that are correctly mixed and applied will damage Ebola on personal protective

equipment (PPE) and other surfaces to help prevent infection. Chlorine solutions are an important

component of cleaning and disinfection procedures and must be made daily to be effective.

Remember chlorine is very strong. Always wear gloves, face mask, and either goggles or a face

shield when handling chlorine granules and strong solutions.

Here are the items you need:

Gloves, googles and face mask for protection

Plastic or metal bucket. Plastic is preferred, as chlorine damages metal

Water

HTH also known as High Test Hypochlorite

A tablespoon or soupspoon (one tablespoon will hold about 14 grams)

A measuring cup or 1-liter bottle

A stick to stir the solution

To make a strong (0.5%) chlorine solution:

1. Fill the bucket with 20 liters of water.

2. Add 10 heaping tablespoons (1 tablespoon = 14 grams) of High Test Hypochlorite (HTH).

3. Stir the solution with a stick.

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To make a mild (0.05%) chlorine solution:

1. Fill the bucket with 20 liters of water.

2. Add 1 heaping tablespoon (1 tablespoon = 14 grams) of High Test Hypochlorite (HTH).

3. Stir the solution with a stick.

What you need to know

Wait 30 minutes before using any chlorine solution that is made from powder.

Chlorine solutions, depending on their use, should be transferred into bottles that have sprayers or

dispensers that have spigots.

Chlorine solutions need to be labeled with their correct strength. Label strong with (0.5%) and mild

as (0.05%).

Chlorine solutions do not work as well on heavily soiled surfaces. Clean first, then disinfect.

Keep the chlorine solution away from direct sunlight.

Chlorine solutions lose strength over time, so make a fresh batch every day.

0.5% Chlorine solution is used for disinfection of (body fluids, corpses, toilets and bathrooms;

gloved hands; floors; beds & mattress covers; footbaths; plates, cups and eating utensils.

0.05% Chlorine solution is used for disinfection of bare hands; skin and shoes; thermometers;

laundry.

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E. Worker Safety, Environmental and Social Impact Assessment for Management

of Wastewater from ETUs Monrovia-Liberia

Background information. Management of wastewater from Ebola Treatment Units (ETUs) and Community Care Centres (CCCs) is an important component in Ebola emergency response in Liberia. The Ebola wastewater management project is being implemented through Liberia Water and Sewer Corporation (LWSC) as a governmental agency responsible for the collection and disposal of wastewater in the country, with technical and financial support from UNICEF, ICRC, WHO, and IRC. Safety protocols have been developed with a view to providing safety measures for the collection of wastewater at ETUs, its transportation, and the ultimate discharging into Fiamah Digester tank for storage purposes. The protocols were developed in close collaboration with the WASH Cluster National Coordination, LWSC and its monitoring team, WHO, USAID/OFDA, UNICEF, ICRC, CDC, IRC, and adhere to the most recent WHO technical guidance on IPC and waste management, known science, and standard operating procedures. Extensive consultation on the contents of the protocols has been undertaken with stakeholders at country- level, as well as technical experts at regional and global level. Objective. The main goal of this project is intended to help avoid the potential of contamination to the sanitation workers, the general community and the environment during the desludging and discharging processes. The specific objective of this Worker Safety, Environmental and Social Impact Assessment is to systematically analyse the potential impacts of collecting, transporting and disposing wastewater from EVD treatment facilities at the Fiamah site and identify measures necessary to put in place to mitigate the risk of these impacts occurring. Multi-sectorial Stakeholder Participation. In effort toward addressing Environmental and Social Impact Assessment for collection, transport and storage of wastewater from ETUs; LWSC has since formulated a monitoring team with members from governmental ministries, corporations, boards and Fiamah community as is described below:

Ministry of Health (MOH) Through its Division of Environmental and Occupational Health, MOH is responsible for assessing and monitoring the occupational health of LWSC staff and environmental impacts resulting from the management of wastewater from ETUs.

Ministry of Public Works (MPW): The Ministry of Public Works is set to ensure proper installation of infrastructure required for waste management delivery services, including solid waste collection and disposal at ETUs and Fiamah site.

Liberia Water and Sewer Corporation (LWSC): The LWSC is responsible for the provision of storage and disposal facilities for wastewater from ETUs. Also, LWSC will ensure the implementation of safety protocols for the collection, transport and disposal of Ebola wastewater by LWSC crews.

Monrovia City Corporation (MCC): The MCC is intended to provide effective public awareness and sensitization on the safe collection, transport and disposal of faecal matter from ETUs. MCC has got municipal rights including the management of solid waste (used PPE) and provision of environmental health and sanitation.

Environmental Protection Agency (EPA): The EPA is an autonomous body established by EPA Act under the Executive Branch of Government. EPA is responsible for the management of the environment.

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Fiamah Community: The members of the community that live in the vicinity or neighbourhoods of Fiamah Ebola Waste Digester plant are essentially expected to take part in public awareness and sensitization programs, monitor the process, provide venue for communication campaign, and adhering to the health and safety measures.

More specific, the monitoring team, that is composed of one member from each of the named ministries, corporation, board, and Fiamah Community with technical support from UNICEF, WHO, ICRC and IRC, have been working to identify the environmental and social impacts or hazards and the mitigation measures to be taken at the three critical steps in the process including the collection of wastewater at ETUs, transport, and discharge into the digester tank. Methodology. This multi-sectoral monitoring group has participated in technical working sessions to develop and review safety protocols, as well as meetings with Fiamah community leaders. The activities extended to those of visiting the site to assess the suitability of sanitation and Infection Prevention and Control (IPC) facilities both at Fiamah and ETUs locations. The team was also taken through the PPE donning and doffing training of LWSC crews, inspection of sewer trucks, and mapping of clear routes to be used by sewer trucks and escort vehicles. Other similar activities included the team’s participation in IPC training of LWSC, and involvement in the trial run with non-Ebola wastewater. A table below summarizes the identified impacts (worker safety, environmental and social), and mitigation measures to be taken at each of the three critical steps in the process:

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Critical step in the process

Identified impact or hazard

Mitigation measures to be taken Mitigation measures Already in Place

Wastewater Collection at

ETUs

Excessive sweating due to PPE and direct exposure to the sun

- Monitor staff temperature before and after desludging.

- Rotate LWSC workers every 45 minutes of desludging process.

- Provide drinking water in the escort vehicles for use by workers after disinfection.

- 2 standby staff and 1 IPC staff allocated for each

desludging activity.

- Availability of drinking water for LWSC workers.

- Regular health monitoring including daily temperature

taking for all LWSC workers.

Splashes or staff contamination with Ebola sewage during coupling and decoupling

- Ensure the retention time of 10 days prior to desludging. - Proper use of PPE. - Implement IPC measures for management of splashes as

indicated in the safety protocols including decontamination with 0.5 and 0.05 chlorine solutions.

- Routine temperature monitoring of the workers for early detection in the event of transmission.

- Follow operational manual for proper coupling and decoupling to avoid splashes.

- Report any faulty couples and routine maintenance of sewer trucks.

- LWSC workers trained on PPE donning and doffing, IPC, management of splashes, and operational of sewer trucks.

- Availability of personal protective gears. - 1 IPC staff allocated for each desludging activity to

monitor the implementation of IPC measures by LWSC workers.

- Trial run on the management of splashes performed to enhance skills on exposure to splashes and its management.

- LWSC workers provided with hygiene kits.

Ground spillage due to mishandling, faulty seals, opening and closing of couples

- Proper use of PPE. - Contain the spills and decontaminate the area with 0.5

chlorine solution. - Follow operational manual for proper coupling and

decoupling to avoid spillage. - Report any faulty couples.

- LWSC workers trained on PPE donning and doffing, IPC, decontamination of ground surfaces, and operational of sewer trucks.

- Knapsack sprayers and disinfectants available for decontamination.

- 1 IPC staff allocated for each desludging activity to monitor the implementation of IPC measures by LWSC workers.

- Trial run on the management of ground spills performed to enhance efficiency in IPC measures during the decontamination process.

Leakage of septage from loose valves and joints

- Proper use of PPE. - Inspect the valves prior to desludging, report any loose

valves and perform routine maintenance of valves and joints (tightening of loose valves and joints).

- Contain the spills and decontaminate the area with 0.5 chlorine solution.

- LWSC workers trained on PPE donning and doffing, IPC, decontamination of ground surfaces, and operational of sewer trucks.


Table: Risk Assessment Matrix Summarizing the Identified Impacts and Mitigation Measures to be Taken

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- 1 IPC staff allocated for each desludging activity to monitor the implementation of IPC measures by LWSC workers.

Packing of suction hose - Use an air device to drain the hose by removing any remaining wastewater prior to its packing.

- Decontaminate the suction hose after desludging with 0.5 chlorine solution.

- Proper packing of suction hose into designated compartment.

- Air device installed at ETU septic tanks. - Knapsack sprayers and disinfectants available for

decontamination. - 1 IPC staff allocated for each desludging activity to

monitor the implementation of IPC measures by LWSC workers.

Transportation

Leakage from faulty or loose valves

- LWSC workers in an escort vehicle to stop the sewer truck, contain the leakage and decontaminate the area.

- The transportation process includes an escort utility vehicle equipped with chlorinated water, PPE, drums of chlorine solutions, foot basin and buckets, sprayers and various tools to be used in case of an incident related to spillage.

Contaminated sewer truck and tires

- Perform on-site decontamination of the sewer truck and tires after desludging and discharging processes.

- Concrete platform and gravel yards constructed to facilitate decontamination at Fiamah and ETU sites (monitoring team assessed the site and declared the parking lot at and gravel yards as safe facilities for decontaminating sewer truck including tires).

Road traffic accident and/or breakdown of sewer truck

- Transport Ebola sewage during low-traffic time, using the least congested route to minimize risks associated with road transport.

- Obey traffic rules, speed limits and road signs on the

designated route.

- LWSC has mapped dedicated transportation routes, which provide locations of the ETUs, traffic flow patterns and time for desludging and discharging activities.

- LWSC has submitted a letter to the national police officer requesting privileges during transportation to avoid traffic.

Stopping in town by crew to attend to other issues

- Implement supportive supervision during transportation. - Follow safety protocols.

- Staff supervisor made available for each transportation. - Waste “chain of custody” certification documentation

will track the time of the waste collection at the Ebola treatment center and the time of the discharge at the Fiamah site.

Excessive sweating due to PPE and direct exposure to the sun

- Monitor staff temperature before and after discharging. - Rotate LWSC workers every 45 minutes of discharging

activities.

- 2 standby staff and 1 IPC staff allocated for each discharging activity.

- Availability of drinking water for LWSC workers.


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Discharge into Fiamah

Digester Tank

- Provide drinking water in the escort vehicles for use by crews after disinfection.

- Regular health monitoring including daily temperature taking for all LWSC workers.

Splashes or staff contamination with Ebola sewage during coupling and decoupling

- Ensure the retention time of 10 days prior to desludging. - Proper use of PPE. - Implement IPC measures for management of splashes

including decontamination with 0.5 and 0.05 chlorine solutions.

- Follow operational manual for proper coupling and decoupling to avoid splashes.

- Report any faulty couples.

- LWSC workers trained on PPE donning and doffing, IPC, management of splashes and operational of trucks.

- 1 IPC staff allocated for each discharging activity to monitor the implementation of IPC measures including management of splashes.

- Availability of personal protective gears.

- Changing room and shower are available to enhance occupational health and safety (monitoring team assessed the site and declared it as a safe workplace for LWSC crews).

Occupational injured such as chemical burn by chlorine solution and fall by hitting obstacles (desludge/discharge pipes and suction hoses) during desludging processes.

- Follow procedures on the management of chemical burn. - Follow proper IPC measures to prevent exposure to

chemicals. - Provide warning signs on possible fall injuries due to

desludge/discharge pipes and suction hoses. - Verbal reminders by IPC supervisor.

- Proper layout of suction hoses.

- 1 IPC staff allocated for each desludging/discharging

activity to monitor the implementation of IPC measures

and remind the LWSC workers on possible fall injuries.

- LWSC workers trained on the management of chemical

burn.

spillage and leakages from loose joints and seals, poor handling of hose, offloading and packing after use

- Inspect the joints and seals prior to discharging, report and tighten any loose joints and seals.

- Contain the spills in the sump and decontaminate with 0.5 chlorine solution.

- Truck will be dedicated for Ebola Waste only - Truck will be parked in a secured area to avoid casual

contact with untrained persons or the general public


- 1 IPC staff allocated for each discharging activity to monitor the implementation of IPC measure.

- Spillage sumps in place to contain the spills for decontamination (monitoring team assessed the site and declared the 2 spillage sumps as safe structures to contain the spills for decontamination).

Accidental release of wastewater from the digester into the environment.

- Secured area that prevent unauthorized access with security.

- Routine inspection of the digester tank to detect any leakage.

- Plan to fence the entire compound with a solid fence (a wall) in order to enhance security measures.

- The Mayor met with community leaders and informed them about upcoming desludging activities.

- The main entrance to Fiamah facility currently locked to prevent accessibility by community members.

- Digester and disinfection areas are enclosed with chain-link fence with barbed wire on top, orange safety fence,


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and signs indicating “Keep Away - Treated Ebola Waste Safely Stored Here”.

- Digester tank has been dewatered and inspected for potential cracks in the structure or leaks in the piping system.

- Concrete digester tank equipped with gate valves and a flange to prevent discharge to the ground.

- Security provision on 24 hours basis. - Solid waste disposal facilities are available including .a

drum incinerator and ash pit (monitoring team assessed the site and declared ash pit as safe disposal facility).

Community members lose access to the digester tank and Fiamah compound which served as defecation area, farming areas, and pedestrian pathway for the surrounding community.

- Community awareness and sensitization campaign will take place during 6 months- including radio talk shows, airing/broadcasting of radio jingles, community meetings, dissemination of flyers, house to house awareness.

- Plan to provide sanitation facilities to enhance proper sanitation among communities living in the vicinity or neighbourhoods of Fiamah Digester plant.

- Provision of hygiene kits to Fiamah community. - Community awareness and sensitization on the

importance of proper sanitation.

- Communication Action Plan established with MCC. - Provision of hygiene kits to Fiamah community. - 6 influential community members informed the

community on the closure of the main entrance to Fiamah compound and access denial for open defecation.

Public vandalism or opposition to the use of the Fiamah Digester facility to receive Ebola waste.

- Community awareness and sensitization on the importance of proper storage and disposal of wastewater from ETUs.

- Plan to use the police escort in case of public opposition.

- Communication Action Plan established with MCC.

- Community awareness and sensitization through

community-based organization (CODES).

- Digester and disinfection areas are enclosed with chain-

link fence with barbed wire on top, orange safety fence,

and signs indicating “Keep Away - Treated Ebola Waste

Safely Stored Here”.

Turnover of the trained staff members at Fiamah.

- Motivate LWSC workers through provision of proper PPE, refresher trainings on the use of PPE and IPC measures, and hazard pay to LWSC workers performing desludging and discharging of wastewater from ETUs.

- Availability of proper PPE and hazard pay to LWSC workers performing desludging and discharging of wastewater from ETUs.


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F. Procedures for PPE Donning

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G. Procedures for PPE Doffing

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H. Transfer Voucher of Sewage from Ebola Treatment Unit to Fiamah Digester

Sewer Truck No: Volume of Sewage:

Departure from ETU: Arrival at Fiamah Digester Plant:

No. Infection Prevention and Control Measures

Implemented Y/N

Remarks

1 Proper PPE donning and doffing

2 Decontamination of hoses

3 Decontamination of truck and tires

4 Decontamination of truck parking lot/gravel yard

5 Proper collection and disposal of used PPE

I hereby certify that LWSC has desludged the

septic tank/holding tank

Certified by ETU Manager:

Desludged by LWSC:

Name:

(Contingent

Commander)

Driver’s Name :

ID Card No. ID Card No.

Signature Signature

Date Date

Liberia Water & Sewer Cooperation

Transfer Voucher of Sewage from Ebola Treatment Unit to Fiamah Digester

No: Transfer Date: ETU:

This form is used for the transfer of Sewage from Ebola Treatment Unit to Fiamah Digester Plant for

Storage. The LWSC must observe all procedures required by Infection Prevention and Control officer for

the de-sludging and discharging of Ebola Contaminated Sewage. Once the sewage is desludged, LWSC

will assume all responsibility in respect of accountability, proper handling, transfer, storage, and disposal.

Any accidental spillage during transportation should be reported under the remarks box. The original

signed copies of this document should be kept by LWSC and ETUs.

REMARKS:

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I. Public Relations and Communication Plan

ACTIVITIES Expected Outputs IMPLEMENTATION TIMEFRAME (MONTHS)

January 7 – June 6, 2015 Preparatory Activities

1 2 3 4 5 6 7

Stakeholders Meeting 1

Already held Oct. 28, 2014

Field Visit to LWSC Plant 1

Already held Oct. 28, 2014

Stakeholders Meeting 2

Already held Dec. 13, 2014

Stakeholders & Meeting 3 with the Mayor

24 community leaders and committee members attended and discussed issues relative to the success of the transport and storage of the Ebola fecal matters

Dec. 29, 2014

Community Meeting

12 community meetings held in Fiamah Community. Community leaders, youth, religious and women’s leaders, elders and entire community members educated and sensitized on the safe and harmless storage of Ebola’s fecal matters at the LWSC plant.

Training of Community Members

1 day training held and community members working with both the public awareness and monitoring committees trained on the processes taking before and during the transportation of Ebola fecal matters to LWSC digester plant.

Appearance on Radio Talk Shows

Community members and members of public awareness committee appeared on 6 radio talk shows to educate target audiences of the process and the harmless nature of the fecal matters.

Bill Boards 4 bill boards printed and planted at the digester plant to encourage residents of Fiamah and trespassers to keep away from the plant.

Preparation of Flyers

Safety protocols of LWSC relative to the process produced in flyers with graphics and words.

Distribution of Flyers

Produced flyers given to community members during community meetings, house –to-house and inter-personal discussions for more education & sensitization.

House to house engagements, interpersonal discussions and data collections

Inter-personal discussions held at homes of residents in the community and key information recorded.

Development and Production of Radio jingles

2 public education radio jingles on the process developed and produced.

Broadcasting of radio jingles

Produced radio jingles broadcast on three radio stations including the community radio in Fiamah.

Treatment and Transportation of Fecal Matters

Fecal matters treated and transported to LWSC digester plant for storage

Midline Report Activity reports prepared and submitted to all partners.

Final report Final reports prepared and submitted to all partners.

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J. A Step by Step Procedures for the Operation of Sewer Trucks

Inlet/outlet connections Pump mode (suction/pressure/gravity)

Control panel (pump on/off, emergency stop, power)

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Operational Procedures at ETU`s:

1. Check that the valves are closed.

2. Connect the hoses to the “inlet connector” and the air device. Make sure all connections are tight.

3. Set the pump in suction mode and start it.

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4. Open the “suction valve” and begin desludging by adapting the power of the pump - no more than 100 bars.

5. At the end of desludging, close the gate valve and open the ball valve and suck air for 1 minute to empty the hose.

6. Close the suction valve, switch off the pump and release pressure from the truck by setting the pump in gravity mode.

7. Decouple the hose from the septic/plastic tank and suck 200 litres of 0.5% chlorine from a drum and follow steps 2 to 4 and 6.

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8. Decouple hoses from the

truck, disinfect them and store them.

9. Make sure all valves are closed, the caps are on and the pump is turned off and put on gravity mode.

10. Inform the driver that

the truck is ready to move and proceed to undressing.

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Operational Procedure at Disposal Site (Fiamah):

1. Check that the valves are closed.

2. Connect the hoses to the

“outlet connector”. Make sure all the connections are tight.

3. Open the “outlet valve” and the ball valve and check for any leakages.

4. Put the pump on

“pressure mode” and start it.

5. Start to empty the truck and adapt the power of the pump - no more than 100 bar.

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6. Once the truck is empty, close the outlet valve, let pressure build into the tank for 30seconds.

7. Release the pressure by opening the valve, allowing the air to push all the liquid into the digester.

8. Turn the pump off and close the outlet valve and the ball valve.

9. Switch the pump to gravity mode.

10. Decouple the hose from the truck, dispose it to the basin and proceed to disinfection.

11. Make sure all the valves are closed, the caps are on and the pump is off and on gravity mode.

12. Inform the driver the truck is ready to move and proceed to undressing.

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Key Points in Operating Sewer Truck:

Before the coupling/decoupling of the hose ALWAYS make sure the inlet/outlet

valves of the truck are CLOSED.

Before any decoupling, release the pressure from the truck by setting the pump

on gravity mode

Before the desludging at the ETU check the valves of the air device and make

sure it is set for suction (gate valve open/ball valve closed).

After desludging/disposal, ALWAYS make sure the pump is off, set in gravity

mode and the caps are locked in the inlet/outlet connectors.

The operator of the pump must wait for the technician to give the green light

before starting the pump.

Once the pumping starts, each crew member will keep his position: one will

operate the pump, one will operate the air device and one will operate the

truck’s valve.

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LIBERIA WATER AND SEWER CORPORATION (LWSC) P.O.BOX 1079 SAO BOSO (FRONT) STREET MONROVIA, LIBERIA.

Meeting for the Validation of Safety Protocols for the Safe Collection and Disposal of Ebola Contaminated Sewage from Ebola Treatment Units (ETUs). January 22, 2015.

List of Participants

N0. Name Organization Phone Number Email

1. Frankie N. Cassell LWSC 0886453554 [email protected]

2. Clarence M. Momoh LWSC 0886533814 [email protected]

3. George K. Yarngo MPW 0777511171 [email protected]

4. James Kahia IRC 0775047451 [email protected]

5. Lucky Chikaura IRC 0775047451 [email protected]

6. Emilia Mmbando Raila UNICEF 0770267953 [email protected]

7. Abayomi B. C. Wingbah EPA 0886531903 [email protected]

8. Toru Yoshikawa WHO/OHS 0770496232 [email protected];

[email protected]

9. Lawrence A. Flomo Fiamah

Community

0886422497/

0776165093

[email protected]

10. Ronald Musiime WHO 0770496094 [email protected]

11. Seyeh S. Dulleh MCC 0777203197 [email protected]

12. Francis Michael Ndivo WHO 0770496221 [email protected]/

[email protected]

13. Bearford O. Weeks MPW/Consultant 0886514005 [email protected]

14. Dehwehn O. Yeabah MOH 0886669906 [email protected]

15. Samuel Levy ICRC 0777556000 [email protected]

16. Edward G. Wingbah EPA 0886576150 [email protected]

17. E. Sonie Zubah LWSC 0886520974 [email protected]

18. Korpo Jensen LWSC 0886593192 [email protected]

mailto:[email protected]












mailto:[email protected]/








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