They do the dirtiest work in the city -- fixing broken sewer pipes, wading into raw sewage at times to get the job done.
And at the end of the workday, that dirt follows Baltimore sewer workers home, where they wash soiled uniforms in the same machines that do the family laundry.
A city policy that requires workers to launder their uniforms threatens their health and that of their families, according to the employees and workplace safety experts, who also say a lack of shower facilities contributes to the problem.
"You have to bring this stuff home, and your family's there," said Earl Blackwell, a sewer worker who blames a bout with hepatitis A on his job. "I don't think they take seriously how dangerous and germy our job is."
Blackwell is one of 92 sewer workers who signed a union grievance this month demanding that the city start providing laundry service and showers at a west-side facility known as the Franklin Street Utility Maintenance Yard. About 140 people work there.
Department of Public Works officials acknowledge the workers need showers and say they will seek funds to add them to the facility. Last week, in response to the grievance, they gave workers permission to use showers at a public works building across the street from theirs.
"I think they have some legitimate and valid issues that need to be addressed," Public Works Director George L. Winfield said in an interview last week. "[With] the type of work that some of our employees are involved in in the day, there should be facilities where they could wash up before they leave the work site."
Winfield said he was studying the laundry complaint.
"I think it's a question of how we're going to address it," said Robert H. Murrow, a department spokesman. "It is going to be addressed one way or the other."
Laundry service and showers are available in Anne Arundel and Howard counties -- as they are to most sewer workers nationwide, according to the union that represents 40,000 of them.
Daniel Kaufman, a national spokesman for the American Federation of State, County and Municipal Employees, called it "fairly rare" for sewer workers to be responsible for washing their uniforms at home. If workers do their own laundry, he said, it's usually in workplace machines.
"That certainly would not be common practice," he said of Baltimore's arrangement.
However, Baltimore sewer workers are not the only ones in the area who must wash their uniforms at home. The same is true for those with Carroll County and the Washington Suburban Sanitary Commission, which serves Montgomery and Prince George's counties; workers with the latter agency receive $480 a year to cover laundry costs.
Nellie Brown, a certified industrial hygienist and author of the book, Health Hazards of Wastewater and Sewer Workers, said home laundering and the lack of showers could make workers and their families sick.
"That kind of stuff is really bad work practice," she said. "All that says to me, there's no real thought being given to the nature of this job."
Checking the rules
State and federal workplace safety rules do not require the city to launder sewer workers' uniforms. But experts at the Cincinnati-based National Institute for Occupational Safety and Health recommend it.
"I think there's definitely the potential for exposure to all sorts of things," said NIOSH epidemiologist Elizabeth A. Whelan.
Said Jeffrey P. Mozal, acting operations manager for the Howard County Bureau of Utilities: "If you're out traipsing around in sewage, you really don't want to take that stuff home and put it in your washing machine with your clothes."
Employers such as hospitals, whose workers routinely come in contact with blood, are required to clean their employees' "personal protective equipment" -- which can include uniforms -- under the Occupational Safety and Health Administration's Bloodborne Pathogen Standard.
According to many of the experts interviewed, that standard probably does not cover sewer workers because pathogens transmitted by blood, such as the human immunodeficiency virus and hepatitis B and C, do not survive very long in a sewer. But some say it could apply.
"In general, if they are exposed to human blood or body fluids, they are automatically covered under the OSHA Bloodborne Pathogen Standard," said Debbie Hunt, director of biological safety for Duke University and past president of American Biological Safety Association.
"There's human material," Hunt said. "Unless it's been decontaminated, that's how we would interpret it."
Officials with Maryland Occupational Safety and Health, which runs the state's OSHA program, declined to comment on the issue, saying that doing so could make it difficult for the agency to impartially handle future complaints from sewer workers.
Disease risks
The biggest health threats to sewer workers are gastrointestinal illnesses and possibly hepatitis A, which is spread through fecal matter, experts say.
No study has found that American sewer workers are at increased risk for contracting that form of hepatitis, which can cause flu-like symptoms, jaundice and severe stomach pains, said Dr. Douglas Trout, a NIOSH medical officer. But some studies have found they build up higher levels of hepatitis A antibodies, indicating increased exposure.
"It's hard to say if the risk is definitely high, but it's clearly not zero," said Brown, the Health Hazards author.
Blackwell , the sewer worker who contracted hepatitis A two years ago, said his doctor could not be sure of the cause but considered sewer work a strong possibility.
Murrow, the city public works spokesman, said he is not aware of any sewer workers contracting an illness at work and could not comment specifically on Blackwell's claim.
Blackwell, 55, said he suffered from jaundice and fatigue for months but is fine now. So are two preschool-age grandsons who live with him and underwent a series of shots as a precaution.
But he is worried about other health threats he might carry home on the brown pants and a tan, long-sleeved shirt he launders in his basement.
"It's 2002," Blackwell said. "You got AIDS, you got -- whew, I don't know all the diseases you got -- and we're in it."
City sewer workers are provided with lockers, but many wear uniforms home because there's no place to shower.
The Franklin Street yard, which houses 135 male and five female sewer workers, is a big garage lined with blue lockers. Public works officials couldn't say how old the facility is, but complaints about it are nothing new.
Workers say they've been upset for years over their laundry duties and the lack of showers at work. But it took the opening of a $6.5 million facility on the city's east side to spur the union grievance.
Some sewer workers thought the Haven Street Utility Maintenance Yard, with its showers and separate locker rooms for men and women, was being built for them.
But when the doors opened late last year, only 36 of the city's 176 sewer workers got to move in. The place is mainly used by storm drain and water maintenance workers -- "clear-water guys" in the lingo of workers on sewer duty.
While they do have shower privileges, the east-side sewer workers wash their own uniforms, too.
Laundering uniforms for workers is not cheap. Howard County spends $25,000 a year to wash work clothes for its 75 water and sewer workers, said Mozal, the acting operations manager. But he said no one ever suggests scratching what he calls a "common sense" service from the budget.
Doing the laundry
It is possible for workers to safely wash uniforms at home, said Brown. But they must follow strict procedures:
Change out of the uniform at work and bring it home in a bag that stays closed until it is time to wash.
Launder the items separately from other clothing, in the harshest conditions possible -- preferably with hot water and chlorinated bleach, to kill any disease-causing agents.
Run a rinse cycle in the empty machine afterward to flush it out.
Even so, Brown said, it's still safest for the worker and family members to keep the soiled uniform out of the house.
"I would prefer to see the clothing laundered at work," she said. "Why bring it home if you don't have to?"