Wastewater Treatment Plant Workers Research Articles

Global diversity of airborne pathogenic bacteria and fungi from wastewater treatment plants

Wastewater treatment plants (WWTPs) have been recognized as one of the major potential sources of the spread of airborne pathogenic microorganisms under the global pandemic of COVID-19. The differences in research regions, wastewater treatment processes, environmental conditions, and other aspects in the existing case studies have caused some confusion in the understanding of bioaerosol pollution characteristics. In this study, we integrated and analyzed data from field sampling and performed a systematic literature search to determine the abundance of airborne microorganisms in 13 countries and 37 cities across four continents (Asia, Europe, North America, and Africa). We analyzed the concentrations of bioaerosols, the core composition, global diversity, determinants, and potential risks of airborne pathogen communities in WWTPs. Our findings showed that the culturable bioaerosol concentrations of global WWTPs are 102–105 CFU/m3. Three core bacterial pathogens, namely Bacillus, Acinetobacter, and Pseudomonas, as well as two core fungal pathogens, Cladosporium and Aspergillus, were identified in the air across global WWTPs. WWTPs have unique core pathogenic communities and distinct continental divergence. The sources of airborne microorganisms (wastewater) and environmental variables (relative humidity and air contaminants) have impacts on the distribution of airborne pathogens. Potential health risks are associated with the core airborne pathogens in WWTPs. Our study showed the specificity, multifactorial influences, and potential pathogenicity of airborne pathogenic communities in WWTPs. Our findings can improve the understanding of the global diversity and biogeography of airborne pathogens in WWTPs, guiding risk assessment and control strategies for such pathogens. Furthermore, they provide a theoretical basis for safeguarding the health of WWTP workers and ensuring regional ecological security.

Using Quantitative Microbial Risk Assessment (QMRA) of SARS-CoV-2 to understand possible exposure to health risks in selected wastewater treatment plants located in the Eastern region of South Africa

In the past two years, Covid-19 has emerged as the most severe and pressing public health issue, causing a great deal of damage to societal and economic welfare, as well as causing illness and mortality. The operators in wastewater treatment plants (WWTPs), particularly those employed in rural communities, appear to often exhibit a lack of adherence to proper safety protocols by not utilizing sufficient protective equipment while handling unprocessed sewage samples throughout the different phases of wastewater treatment and disposal. This study aimed at examining the potential health risk of infection among WWTP operators, as a result of unintentional ingestion of wastewater during routine duties in facilities that receive influent containing Severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) from various areas. This study examined the prevalence of SARS-CoV-2 in grab samples of untreated wastewater samples using the real-time quantitative polymerase chain reaction (RT-qPCR) technique and quantitative microbial risk assessment (QMRA) model was employed on three probable exposure of SARS-CoV-2 scenarios that are expressed as moderate, aggressive and extreme (2 mL, 10 mL, 20 mL) to evaluate the probability of infection to WWTP workers based on the 6 h that the workers spent in WWTPs performing their daily activities which exposed them to potential health risk of various pathogens. At the highest SARS-CoV-2 genome of 266.23 × 102 gc/mL, the findings indicated that there was no statistically significant difference in the probability of infections with respect to seasonal differences because the P(i) value was greater than 0.05 (p > 0.05). Overall, P(i) was highly significant across all volumetric scenarios in the study with p value that was p < 0.001. The probability of getting infected during the different seasons is assumed to be low since there was no statistically difference in P(i) with respect to season however it can be assumed that there is a high chance of getting infected regardless of volumetric intake. Our study suggests that the risk of accidental occupational exposure to SARS-CoV-2 in raw wastewater is negligible to workers whereby workers would perform their daily activities without wearing protective gear. Nevertheless, the importance and work of WWTPs by workers should not be overlooked. Regardless of the situation, it is widely recognized that residential wastewater poses a potential risk of infection due to the presence of several enteric pathogens, therefore, it is crucial to ensure that those who are occupationally exposed to untreated wastewater are well equipped with suitable personal protective equipment (PPE).

Assessing environmental exposure to viruses in wastewater treatment plant and swine farm scenarios with next-generation sequencing and occupational risk approaches

Occupational exposure to pathogens can pose health risks. This study investigates the viral exposure of workers in a wastewater treatment plant (WWTP) and a swine farm by analyzing aerosol and surfaces samples. Viral contamination was evaluated using quantitative polymerase chain reaction (qPCR) assays, and target enrichment sequencing (TES) was performed to identify the vertebrate viruses to which workers might be exposed. Additionally, Quantitative Microbial Risk Assessment (QMRA) was conducted to estimate the occupational risk associated with viral exposure for WWTP workers, choosing Human Adenovirus (HAdV) as the reference pathogen. In the swine farm, QMRA was performed as an extrapolation, considering a hypothetical zoonotic virus with characteristics similar to Porcine Adenovirus (PAdV). The modelled exposure routes included aerosol inhalation and oral ingestion through contaminated surfaces and hand-to-mouth contact.HAdV and PAdV were widespread viruses in the WWTP and the swine farm, respectively, by qPCR assays. TES identified human and other vertebrate viruses WWTP samples, including viruses from families such as Adenoviridae, Circoviridae, Orthoherpesviridae, Papillomaviridae, and Parvoviridae. In the swine farm, most of the identified vertebrate viruses were porcine viruses belonging to Adenoviridae, Astroviridae, Circoviridae, Herpesviridae, Papillomaviridae, Parvoviridae, Picornaviridae, and Retroviridae.QMRA analysis revealed noteworthy risks of viral infections for WWTP workers if safety measures are not taken. The probability of illness due to HAdV inhalation was higher in summer compared to winter, while the greatest risk from oral ingestion was observed in workspaces during winter. Swine farm QMRA simulation suggested a potential occupational risk in the case of exposure to a hypothetical zoonotic virus.This study provides valuable insights into WWTP and swine farm worker's occupational exposure to human and other vertebrate viruses. QMRA and NGS analyses conducted in this study will assist managers in making evidence-based decisions, facilitating the implementation of protection measures, and risk mitigation practices for workers.

The resistome and microbiome of wastewater treatment plant workers – The AWARE study

Urban wastewater treatment plants harbor a large collection of antibiotic resistant enteric bacteria. It is therefore reasonable to hypothesize that workers at such plants would possess a more diverse set of resistant enteric bacteria, compared to the general population. To address this hypothesis, we have compared the fecal microbiome and resistome of 87 workers at wastewater treatment plants (WWTPs) from Romania and the Netherlands to those of 87 control individuals, using shotgun metagenomics. Controlling for potential confounders, neither the total antibiotic resistance gene (ARG) abundance, nor the overall bacterial composition were significantly different between the two groups. If anything, the ARG richness was slightly lower in WWTP workers, and in a stratified analysis the total ARG abundance was significantly lower in Dutch workers compared to Dutch control participants. We identified country of residence, together with recent antibiotic intake in the Dutch population, as the largest contributing factors to the total abundance of ARGs. A striking side-finding was that sex was associated with carriage of disinfectant resistance genes, with women in both Romania and the Netherlands having significantly higher abundance compared to men. A follow up investigation including an additional 313 publicly available samples from healthy individuals from three additional countries showed that the difference was significant for three genes conferring resistance to chemicals commonly used in cosmetics and cleaning products. We therefore hypothesize that the use of cosmetics and, possibly, cleaning products leads to higher abundance of disinfectant resistance genes in the microbiome of the users. Altogether, this study shows that working at a WWTP does not lead to a higher abundance or diversity of ARGs and no large shifts in the overall gut microbial composition in comparison to participants not working at a WWTP. Instead, other factors such as country of residence, recent antibiotic intake and sex seem to play a larger role.

Role of MTHFR 677C>T and 1298A>C gene polymorphisms on renal toxicity caused by lead exposure in wastewater treatment plant workers

Environmental and occupational lead (Pb) exposures continue to pose major public health problems. Wastewater treatment plant (WWTP) workers proved are exposing to high Pb concentrations in sludge departments. The aim of the work was to investigate the role of MTHFR C677T and MTHFR A1298C gene polymorphisms on alteration of oxidative stress and homocysteine levels in WWTP workers exposed to high Pb concentrations, and study its relations with renal functions. The study included 90 WWTP workers from Abu-Rawash WWTP. Homocysteine, creatinine, urea, malondialdehyde (MDA), and total antioxidant capacity (TAC) were measured. Polymorphisms of MTHFR C677CT and MTHFR A1298C genes were studied using PCR/RFLP. Urine Pb concentrations were also measured. About 32.2% of the workers were with detectable Pb levels. Pb, homocysteine, and MDA levels were significantly higher among workers carrying TT polymorphism compared to other MTHFR C677T gene polymorphisms, while TAC was significantly lower among them compared to other polymorphisms. The same results were found among workers carrying CC compared to other MTHFR A1298C gene polymorphisms. WWTP workers carrying MTHFR 677TT and MTHFR 1298CC are more susceptible to elevation of homocysteine and the urinary Pb compared to the workers with the other polymorphisms. Furthermore, those workers were found to have increase in urea and creatinine. Therefore, MTHFR C677T and MTHFR A1298C gene polymorphisms could be used for prediction of the susceptibility to the risk of kidney impairments among WWTP workers in the sludge departments caused by their exposure to high Pb in their workplace.

A novel approach to biological risk surveillance in occupational hygiene: A case study on the use of quantitative microbial risk assessment to determine occupational risks for wastewater treatment plants workers in Costa Rica

Wastewater treatment is essential for preventing infectious diseases and water pollution. To perform this process, workers operate and maintain wastewater treatment plants (WWTPs); thus, they are exposed to the many pathogens in domestic wastewater. Consequently, it is necessary assess occupational exposure to pathogens in WWTPs. Quantitative microbial risk assessment (QMRA) is an approach for estimating the risk posed by a specific pathogen which can be useful for occupational hygiene assessments of biological risk. In this study, we applied QMRA, informed by occupational field surveillance, to estimate the potential risk for WWTP workers. Furthermore, we used simulations to test additional control strategies such as personal protective equipment (PPE). The QMRA was conducted for three WWTPs in Costa Rica with data collected between May 2020 and May 2021. Observation in each workplace showed a need for more consistent application of risk reduction strategies in the work environment, especially in behavior, infrastructure, and use of appropriate PPE. Cryptosporidium sp., Giardia sp., norovirus, and enterovirus genus were measured and detected in the WWTPs, and the treatment performance was unsatisfactory. As a result, the total health disease burden was higher than the benchmark for drinking water recommended by WHO (1.00 × 10−6 DALY per person per year) by between one and three magnitudes orders in all WWTPs for the three exposure scenarios (operation, maintenance, and visitors). The simulation demonstrated that using PPE could reduce the estimated disease burden by nearly two orders of magnitude. Still, this control measure did not reach a level below the benchmark risk (less than 1.00 × 10−6 DALY per person per year) for the WWTP workers. This study highlights the importance of using PPE with other control measures, such as automation or barriers, to isolate exposure sources. However, this study employed an uncommon approach in occupational health and hygiene, which combined field inspections, survival analysis, and QMRA, using field surveillance to understand the occupational environment and potential exposure routes, which is crucial for hazard identification and risk assessment. In addition, exposure modeling and QMRA were used to simulate different control scenarios, providing a robust estimate of potential risks associated with occupational exposure.

Ciprofloxacin- and azithromycin-resistant bacteria in a wastewater treatment plant

The occurrence of antibiotic-resistant bacteria (ARB) in wastewater treatment plants (WWTPs) has become an occupational and environmental concern. WWTPs are engineered systems that treat wastewater to meet public health standards before release into the environment. The residuals, as either effluent or solids, are then discharged or beneficially recycled into the environment. Since these wastes contain a diverse array of microorganisms, some of which are resistant to commonly used antibiotics, there is a potential for these organisms to spread in the environment via residual recycling and effluent discharge. Human infections with ARB are increasing, and it is not well known how the interaction between humans and the environment plays a role in this process. WWTP workers, who are on the front lines, may come into direct contact with materials containing these microbes. This study aimed to determine the number of ARB present in both air and sewage sludges in a WWTP using nonselective media supplemented with two antibiotics (ciprofloxacin and azithromycin). The densities of total heterotrophic bacteria, ciprofloxacin-resistant bacteria, and azithromycin-resistant bacteria were 7.82 × 105 − 4.7 × 109, 7.87 × 103 − 1.05 × 108, and 2.27 × 105 − 1.16 × 109 CFU/g, respectively. The prevalence [(concentration on medium with antibiotics/concentration on medium without antibiotics) × 100] of ciprofloxacin-resistant bacteria in treated sludge was twice as low as in digested sludge and approximately three times lower than in raw sludge. For azithromycin, the prevalence of resistant bacteria in treated sludge was about the same in digested and nearly twice lower than in raw sludge. Despite a marked reduction in the mean prevalence of resistant bacteria in dewatered treated sludge for both antibiotics, these differences were not significant. The highest prevalence of antibiotic resistance was observed for azithromycin. Similarly, the prevalence of airborne azithromycin-resistant bacteria inside the belt filter press room (BFPR) was nearly seven times higher than the prevalence of airborne ciprofloxacin-resistant bacteria. These concentrations of ARB were not negligible and may represent an exposure pathway for some workers in WWTPs.

Potential Exposure to Respiratory and Enteric Bacterial Pathogens among Wastewater Treatment Plant Workers, South Africa

Wastewater handling has been associated with an increased risk of developing adverse health effects, including respiratory and gastrointestinal illnesses. However, there is a paucity of information in the literature, and occupational health risks are not well quantified. Grab influent samples were analysed using Illumina Miseq 16S amplicon sequencing to assess potential worker exposure to bacterial pathogens occurring in five municipal wastewater treatment plants (WWTPs). The most predominant phyla were Bacteroidota, Campilobacterota, Proteobacteria, Firmicutes, and Desulfobacterota, accounting for 85.4% of the total bacterial community. Taxonomic analysis showed a relatively low diversity of bacterial composition of the predominant genera across all WWTPs, indicating a high degree of bacterial community stability in the influent source. Pathogenic bacterial genera of human health concern included Mycobacterium, Coxiella, Escherichia/Shigella, Arcobacter, Acinetobacter, Streptococcus, Treponema, and Aeromonas. Furthermore, WHO-listed inherently resistant opportunistic bacterial genera were identified. These results suggest that WWTP workers may be occupationally exposed to several bacterial genera classified as hazardous biological agents for humans. Therefore, there is a need for comprehensive risk assessments to ascertain the actual risks and health outcomes among WWTP workers and inform effective intervention strategies to reduce worker exposure.

A cohort study of wastewater treatment plant workers: Association between levels of biomarkers of systemic inflammation and exposure to bacteria and fungi, and endotoxin as measured using two methods

Work in wastewater treatment plants (WWTPs) can be associated with exposure to airborne microorganisms and endotoxin from the working environment. The aim of this study was to obtain knowledge about whether serum levels of the markers of systemic inflammation, C-reactive protein (CRP) and serum amyloid A (SAA), are associated with personal exposure to endotoxin, measured using the Limulus (endotoxinLimulus) and the rFC (endotoxinrFC) assays, as well as bacteria and fungi in a cohort of WWTP workers. Exposure and blood samples were collected for 11 workers over one year. Exposure to endotoxinLimulus-day and endotoxinrFC-day correlated significantly (r = 0.80, p<0.0001, n = 104), but endotoxinLimulus-day was 4.4 (Geometric mean (GM) value) times higher than endotoxinrFC-day (p<0.0001). The endotoxinLimulus-day, endotoxinrFC-day, bacteria, and fungal exposure as well as serum levels of CRP-day (GM=1.4 mg/l) and SAA-day (GM=12 mg/l) differed between workers. Serum levels of SAAday correlated significantly with CRPday (r = 0.30, p = 0.0068). The serum levels of CRPday were associated significantly with exposure to endotoxinLimulus-day. Exposure, SAA and CRP data were also analyzed as av. of each season, and SAAseason was associated positively and significantly with endotoxinLimulus-season and endotoxinrFC-season and negatively with fungalseason exposure. In conclusion, CRPday was associated with the endotoxinLimulus-day and SAAseason with endotoxinLimulus-season and endotoxinrFC-season exposure. Thus, we hereby document that WWTP workers are exposed to airborne endotoxin which seems to have a negative impact on their health.

Protecting Wastewater Workers by Categorizing Risks of Pathogen Exposures by Splash and Fecal-Oral Transmission during Routine Tasks

Quantitative microbial risk assessments (QMRAs) present an opportunity to systematically assess risk to wastewater treatment plant (WWTP) workers and mitigate work-related infectious diseases. However, while QMRAs often explore the impacts of aeration or treatment mechanism, or the use of controls to mitigate risk (e.g., ventilation, personal protective equipment (PPE)), fewer studies address other variables, such as differing tasks across plants, time spent conducting these tasks or size of plant. QMRA approaches also vary substantially in their findings and recommendations. The objective of this paper is to provide a risk-based wastewater worker task characterization for urban, municipal and industrial WWTPs along with mitigation measures. Routine tasks fell into five categories in ascending order of exposure and risk, Type A being the lowest and Type E being the highest. Percentage of full-time equivalent time spent on each task category was estimated, along with amount of wastewater exposure (mL) and inhalation duration (h). Estimates differed between urban and municipal plants but were similar in industrial and municipal systems. Finally, a checklist was developed to identify potential mitigation measures and prioritize H&amp;S solutions for eight inspected WWTPs. The present work provides practical information for job safety assessments, H&amp;S policies and QMRA method refinement.

Dispersion of SARS-CoV-2 RNA across a wastewater treatment plant and its workers.

Within urban and suburban sewersheds, SARS‐CoV‐2 released through faeces is transported through sewage systems into municipal wastewater treatment plants (WWTPs). Studies have shown that viral RNA is detectable in untreated wastewater but not in WWTP effluent. In this study, we investigated treatment steps between the influent and final treated effluent to identify the point at which viral RNA is below detection. Additionally, we examined air surrounding high turbulence treatment steps to test for the presence of SARS‐CoV‐2 RNA in WWTP‐generated bioaerosols. To examine potential worker exposure to SARS‐CoV‐2, WWTP workers were tested for the presence of viral RNA. The data show that despite high viral RNA concentration in the influent, SARS‐CoV‐2 RNA concentration decreased significantly (p < 0.02) in the main treatment steps and was below detection in the effluent. Additionally, SARS‐CoV‐2 RNA was below detection in air samples (n = 42), and the worker rate of infection was not significantly different (p = 0.99) from the rate of infection in the surrounding community. These results suggest that WWTP workers may have minimal exposure to SARS‐CoV‐2 during routine outdoor work procedures and that the WWTP successfully reduces the amount of viral RNA entering effluent receiving waters, providing a vital public health service to communities.

A Review of the Presence of SARS-CoV-2 in Wastewater: Transmission Risks in Mexico.

The appearance of SARS-CoV-2 represented a new health threat to humanity and affected millions of people; the transmission of this virus occurs through different routes, and one of them recently under debate in the international community is its possible incorporation and spread by sewage. Therefore, the present work’s research objectives are to review the presence of SARS-CoV-2 in wastewater throughout the world and to analyze the coverage of wastewater treatment in Mexico to determine if there is a correlation between the positive cases of COVID-19 and the percentages of treated wastewater in Mexico as well as to investigate the evidence of possible transmission by aerosol sand untreated wastewater. Methodologically, a quick search of scientific literature was performed to identify evidence the presence of SARS-CoV-2 RNA (ribonucleic acid) in wastewater in four international databases. The statistical information of the positive cases of COVID-19 was obtained from data from the Health Secretary of the Mexican Government and the Johns Hopkins Coronavirus Resource Center. The information from the wastewater treatment plants in Mexico was obtained from official information of the National Water Commission of Mexico. The results showed sufficient evidence that SARS-CoV-2 remains alive in municipal wastewater in Mexico. Our analysis indicates that there is a low but significant correlation between the percentage of treated water and positive cases of coronavirus r = −0.385, with IC (95%) = (−0.647, −0.042) and p = 0.030; this result should be taken with caution because wastewater is not a transmission mechanism, but this finding is useful to highlight the need to increase the percentage of treated wastewater and to do it efficiently. In conclusions, the virus is present in untreated wastewater, and the early detection of SAR-CoV-2 could serve as a bioindicator method of the presence of the virus. This could be of great help to establish surveillance measures by zones to take preventive actions, which to date have not been considered by the Mexican health authorities. Unfortunately, wastewater treatment systems in Mexico are very fragile, and coverage is limited to urban areas and non-existent in rural areas. Furthermore, although the probability of contagion is relatively low, it can be a risk for wastewater treatment plant workers and people who are close to them.

Impact of mannose-binding lectin gene polymorphism on lung functions among workers exposed to airborne Aspergillus in a wastewater treatment plant in Egypt

In this study, the risk of Aspergillus (Asp.) positivity and its respiratory health impacts on wastewater treatment plant (WWTP) workers were studied. In addition, it identified the geno-susceptibility role of mannose-binding lectin 2 (MBL2) gene polymorphisms and the mannose-binding lectin (MBL) serum levels on the pulmonary functions of the Asp.-positive workers. Pulmonary function tests (PFTs) were performed for 89 workers from a selected WWTP, after exclusion of the smokers. Molecular identification of Asp. blood positivity was done by 18S rRNA sequencing. Determination of MBL2 gene polymorphism and estimation of MBL serum levels were done. PFTs revealed abnormalities in 49.2% of the workers. Asp. was positive in 42.5% of the workers with different species. Among the Asp.-positive workers, 6.5% of the workers were with obstructive PFTs, 12.9% with restriction, and 22.6% with combined PFT abnormalities. MBL2 genotyping showed that wild genotype AA was common (68.5%) among Asp.-positive workers compared to the other genotypes. This allele, whether homozygous or heterozygous, was significantly associated with decline in PFTs of the exposed workers. MBL serum levels were significantly lower in workers with obstructive, restrictive, and combined PFT abnormalities compared to those with normal PFTs, and in the workers with Asp.-positive species than the Asp.-negative workers. Moreover, it was significantly lower in workers with Asp. fumigatus compared to that in the workers with other Asp. species, and in the Asp.-positive workers with homozygous or heterozygous A allele compared to that in the Asp.-positive workers with homozygous B allele. Working in a WWTP can be associated with impaired PFTs due to exposure to airborne fungi. MBL2 genotyping showed that Asp.-positive workers with homozygous or heterozygous A allele were at risk to develop decline in their PFTs.

Multiple infections with hepatitis A virus and development of rheumatoid arthritis among waste water treatment plant workers.

In the present work, we studied the association between multiple exposure of waste water treatment plant workers to infection with existing hepatitis A virus in waste water and development of rheumatoid arthritis, taking in consideration number of working years as an indicator for frequency of exposure to infection, compared to non waste water treatment plant workers. A total of 105 waste water treatment plant workers and 48 NWWTPWs were included in the study. Exclusion criteria were positivity for HBV and/or HCV IgG, negativity to HAV IgG and suffering from rheumatic diseases other than rheumatoid arthritis. 96.2% of waste water treatment plant workers were anti-HAV-IgG positive, of whom 5 had high antibody titer indicating ongoing infection and were anti-HAV-IgM negative excluding primary infection. These 5 samples were further subjected to quantification of liver enzymes, glutamate oxaloacetate trasaminase and glutamate pyruvate transaminase and HAV-RT-PCR to check viremia and results showed increase of glutamate oxaloacetate trasaminase and glutamate pyruvate transaminase as well as viremea in all of them. Rheumatoid arthritis diagnosis was carried out by detection of C-reactive protein, rheumatoid factor and anti-cyclic citrullinated protein. Rheumatoid arthritis development was 19% in the waste water treatment plant workers with >10 working years and 8% for < 10 working years. Also, disease development started earlier (Age 30-40 years) among the waste water treatment plant workers compared to non waste water treatment plant workers (age: 40-50 years). Multiple exposures of waste water treatment plant workers to HAV might be one of the etiological stimuli of rheumatoid arthritis.

714 Evaluation of risk of occupational disease biotransmission of SARS-COV2 in wastewater treatment plant workers

714 Evaluation of risk of occupational disease biotransmission of SARS-COV2 in wastewater treatment plant workers

Carriage of ESBL-producing Enterobacterales in wastewater treatment plant workers and surrounding residents - the AWARE Study.

To investigate whether wastewater treatment plant (WWTP) workers and residents living in close proximity to a WWTP have elevated carriage rates of ESBL-producing Enterobacterales, as compared to the general population. From 2018 to 2020, we carried out a cross-sectional study in Germany, the Netherlands, and Romania among WWTP workers (N = 344), nearby residents (living ≤ 300 m away from WWTPs; N = 431) and distant residents (living ≥ 1000 m away = reference group; N = 1165). We collected information on potential confounders via questionnaire. Culture of participants’ stool samples was performed with ChromID®-ESBL agar plates and species identification with MALDI-TOF–MS. We used logistic regression to estimate the odds ratio (OR) for carrying ESBL-producing E. coli (ESBL-EC). Sensitivity analyses included stratification by country and interaction models using country as secondary exposure. Prevalence of ESBL-EC was 11% (workers), 29% (nearby residents), and 7% (distant residents), and higher in Romania (28%) than in Germany (7%) and the Netherlands (6%). Models stratified by country showed that within the Romanian population, WWTP workers are about twice as likely (aOR = 2.34, 95% CI: 1.22–4.50) and nearby residents about three times as likely (aOR = 3.17, 95% CI: 1.80–5.59) to be ESBL-EC carriers, when compared with distant residents. In stratified analyses by country, we found an increased risk for carriage of ESBL-EC in Romanian workers and nearby residents. This effect was higher for nearby residents than for workers, which suggests that, for nearby residents, factors other than the local WWTP could contribute to the increased carriage.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10096-021-04387-z.

Relationships among Perceived Control, Safety Attitude, and Safety Performance: A Case Study on Wastewater Treatment Plant Workers

Wastewater treatment plants (WWTPs) are an indispensable part of the infrastructure of modern cities. However, because of the existence of many confined working spaces in them, they also pose significant risks of occupational hazards for workers. Therefore, this study was conducted on WWTP workers in Kaohsiung, Taiwan to explore the connections among the perceived control, safety attitude, and safety performance of WWTP workers. In total, 123 valid questionnaires were returned for descriptive statistical analysis, variance analysis, correlation analysis, and hierarchical regression analysis. According to the analysis results, the WWTP workers in this study indicated a mid to high level of perceived control, and they generally believed they were also responsible for industrial safety management. The variance analysis results showed that workers of a different gender, age, service unit, and seniority had significantly different safety attitudes. The hierarchical regression analysis results indicated that the perceived control of the WWTP workers had a significant influence on their safety performance through their safety attitude, which served as a mediator between perceived control and safety performance. It is hoped that these findings can provide references for WWTP managers and workers in their daily communication, operation, and safety management system introduction to ensure better safety.

Novel Coronavirus and the Wastewater Treatment Plants Workers

Novel Coronavirus and the Wastewater Treatment Plants Workers

Seasonal fluctuation of aerosolization ratio of bioaerosols and quantitative microbial risk assessment in a wastewater treatment plant.

Wastewater treatment plants (WWTPs) play a vital role in public health because it can emit a large quantity of bioaerosols. Exposure to bioaerosols from WWTPs is a potential health risk to WWTP workers and surrounding residents. In this study, the seasonal fluctuation of aerosolization ratios of several bioaerosols and quantitative health risks of the WWTP workers and the surrounding residents exposed to total coliform, fecal coliform, and enterococcal bioaerosols were analyzed. Results showed that the aerosolization ratio of airborne bacteria was higher in the cold seasons and lower in the warm seasons, whereas the aerosolization ratio of airborne fungi was the highest in summer. The aerosolization ratio of airborne fungi was evidently higher than that of other bioaerosols. Moreover, the aerosolization ratio under the inverted umbrella aerator mode was generally higher than that under the microporous aerator mode. For each exposure scenario, the health risks of males were generally 7.2-26.7% higher than those of females. The health risks of the exposure population exposed to total coliform and enterococcal bioaerosols were generally higher in warm seasons, whereas those of the population exposed to fecal coliform bioaerosol were the highest in winter. Additionally, the health risks of exposure population without masks under the imprudent/conservative estimate all exceeded the benchmarks. However, when equipped with masks, all the exposure populations' health risks decreased 1-2 orders of magnitude and approached acceptable levels. This research methodically provides new scientific data on the aerosolization ratio of microorganism bioaerosols in a WWTP and promotes the comprehension of their quantitative health risks under imprudent/conservative estimates.

Antibiotic Resistance in Wastewater Treatment Plants and Transmission Risks for Employees and Residents: The Concept of the AWARE Study.

Antibiotic resistance has become a serious global health threat. Wastewater treatment plants may become unintentional collection points for bacteria resistant to antimicrobials. Little is known about the transmission of antibiotic resistance from wastewater treatment plants to humans, most importantly to wastewater treatment plant workers and residents living in the vicinity. We aim to deliver precise information about the methods used in the AWARE (Antibiotic Resistance in Wastewater: Transmission Risks for Employees and Residents around Wastewater Treatment Plants) study. Within the AWARE study, we gathered data on the prevalence of two antibiotic resistance phenotypes, ESBL-producing E. coli and carbapenemase-producing Enterobacteriaceae, as well as on their corresponding antibiotic resistance genes isolated from air, water, and sewage samples taken from inside and outside of different wastewater treatment plants in Germany, the Netherlands, and Romania. Additionally, we analysed stool samples of wastewater treatment plant workers, nearby residents, and members of a comparison group living ≥1000 m away from the closest WWTP. To our knowledge, this is the first study investigating the potential spread of ESBL-producing E. coli, carbapenemase-producing Enterobacteriaceae, and antibiotic resistance genes from WWTPs to workers, the environment, and nearby residents. Quantifying the contribution of different wastewater treatment processes to the removal efficiency of ESBL-producing E. coli, carbapenemase-producing Enterobacteriaceae, and antibiotic resistance genes will provide us with evidence-based support for possible mitigation strategies.