Hygiene and Sanitation Monitoring of Refillable Drinking Water Depots in Jembrana District, Indonesia

doi:10.21203/rs.3.rs-3378318/v1

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Hygiene and Sanitation Monitoring of Refillable Drinking Water Depots in Jembrana District, Indonesia

https://doi.org/10.21203/rs.3.rs-3378318/v1

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Refillable drinking water has become an option to meet the hydration needs of the community, especially in Jembrana District, Bali. However, comprehensive monitoring of hygiene and sanitation has yet to be reported. This study aims to identify, evaluate, and describe the quality of hygiene and sanitation at the refillable drinking water depot in Jembrana District. The mixed-methods research design was used to monitor the hygiene and sanitation of 46 DAMIU in Jembrana District. Environmental inspections are conducted in the field, and water samples are taken for bacteriological analysis. All results are presented descriptively. The results showed that 82.60% had met the requirements to be free from coliform contamination, and 86.96% had met the requirements to be free of E. coli in the resulting refill water. A total of 17.40% coliformswere contaminated, and 13.04% E. coli were contaminated. Overall, improved monitoring of the hygienic characteristics of handlers, sanitary characteristics, and completeness of equipment should be applied, especially in replacing microfilter tubes, disinfecting equipment in the service life, and using tiered microfilters. A letter of guarantee for raw water management and water supply must be available. Hence, the hygiene and sanitation of refillable drinking water in Jembrana must be monitored according to established standards.

Hygiene

Jembrana

Monitoring

Refilled Drinking Water Depots

Sanitation.

Hygiene monitoring and sanitation of refillable drinking depots in Jembrana District should be carried out regularly.
Bacteriological contamination still occurs in the resulting refillable drinking water; 8/46 DAMIU is contaminated with coliforms, and 6/46 DAMIU is also contaminated with Escherichia coli.
Pathogenic contamination of refillable drinking water may be caused by operator hygiene behavior that does not apply applicable regulations, periodic replacement of microfilter tubes expired disinfectant equipment, and the lack of tiered microfilters.
Raw water management and the environment around DAMIU are essential to improve, and monitoring by relevant agencies is needed.

The refillable drinking water industry is an alternative to providing and supplying drinking water needs for rural and urban communities (Indasah 2018; Uddin et al. 2021). Refillable drinking water generally has passed several stages before being consumed by the community through purification, sterilization, and packaging processes (Morgan, Bowling, Bartram, & Kayser 2021; Wyasena, Sudaryati, Sudiartawan, & Adnyana 2022). Water that is suitable for consumption is expected to have met the criteria and standard sets to ensure the safety, content, and quality of the drinking water produced (Sari, Faisal, Raksanagara, Agustian, & Rusmil 2020; Sehol, Mangesa, & Loilatu 2020; Yao, Dal Porto, Gallagher, & Dietrich 2020). Based on data from the 2019 National Socioeconomic Survey, 89.27% of Indonesians have access to adequate drinking water, and 73.65% have access to clean water. According to 2019 National Socioeconomic Survey statistics, 89.27% of Indonesians have safe drinking water, while 73.65% have access to clean water.

According to the Ministry of Health of the Republic of Indonesia, the community's water classification for consumption and other purposes must follow the established quality standards. Four classes of water are used, including class I water, which is safe and suitable for consumption and must be free from disease-causing pathogens. In contrast, class II, III, and IV water is clean water that is not suitable for consumption or use as raw material for drinking water but is intended for water recreation infrastructure and facilities, freshwater fish farming, animal husbandry, irrigating crops, and other designations that require the same water quality as those uses. In 2018, data were obtained on 36.28% of people in urban areas who met their daily hydration needs by utilizing refillable drinking water. This figure has increased in recent years and is directly proportional to population growth and water needs, which vary from region to region (Maroneze, Zepka, Vieira, Queiroz, & Jacob-Lopes 2020; Slavik, Oliveira, Cheung, & Uhl 2020; Shen & Yao 2022).

Drinking water is a high priority to meet primary needs because water is the main source of life. The existence of growing diseases, including being able to pollute water, will cause unrest in the community. During the COVID-19 pandemic, everyone has tried to maintain and improve their health by consuming much water and living a healthy lifestyle (South Australia Health 2021). Because drinking water is expected to be pathogen-free, particularly coliform and Escherichia coli, special activities and handling are required to ensure the water's quality (Morgan et al., 2021). Hygiene and sanitation are critical indicators in monitoring, evaluating, and improving an industry's quality or replenishing a drinking water depot. Improving hygiene and sanitation has a beneficial effect on the quality of drinking water. Additionally, adequate knowledge, practice, and personal hygiene can help reduce pollutant contamination in the water (Cha, Fu, & Yao, 2021).

The community's growing need for refillable drinking water, particularly in Jembrana district, Bali Province, Indonesia, is being met by insufficient water management specialists and refillable drinking water. According to hygiene and sanitation data, the Jembrana district government received an environmental health inspection in 2020, with 83.1% of drinking water facilities satisfying regulations and the remaining failing to do so (Jembrana Health Department 2021). The preliminary studies show that business actors, managers, or depot operators do not use personal protective equipment when providing consumer services or during refills. This raises concerns about the quality of the drinking water produced. In addition, it was found that other activities at one depot included raising birds or other pets, selling LPG gas, and opening grocery stalls, which raised doubts regarding the quality of the water produced. Thus, it is essential to research, review, and direct depot owners or operators on reasonable refillable drinking water management procedures and implement the technical requirements of drinking water depots and their trade (Ministry of Industry and Trade 2004). Managers or owners of refillable drinking water depots that do not comply with the established standard criteria and norms will harm the quality of the drinking water produced (Kelly, Cronk, Fisher, & Bartram 2021). 2021). High pollution levels in the environment of DAMIUs will affect public health and become a source of disease (Ahmed et al., 2020; Kato, Maruyama, Merino, & Juban, 2021).

Previous research on pathogenic contamination of water bodies, especially refilled water, has been widely reported but limited to identifying the hygiene and sanitation of refillable drinking water in feasibility testing based on bacteriological parameters, namely, the presence or absence of coliform and Escherichia coli. However, comprehensive evaluation and monitoring following the indicators set by the Ministry of Health of the Republic of Indonesia, including cleanliness of DAMIU operators, environmental sanitation in DAMIU areas, equipment completeness parameters, and physical characteristics of drinking water and raw water, have not been widely reported, especially in Jembrana Regency, which has a water quality index of only 70%. This has never been carried out and reported, so evaluating the return of DAMIU registered with the Department of Industry and Trade, Jembrana Regency, is essential.

This study aims to identify, evaluate, and describe the quality of hygiene and sanitation of refillable drinking water depots (DAMIU) in Jembrana Regency, Bali, following the Regulation of the Minister of Health of the Republic of Indonesia Number 43 of 2014 concerning Hygiene and Sanitation of Drinking Water Depots. Hopefully, this research can provide essential information related to the quality of hygiene and sanitation of refillable drinking water depots in the Jembrana Regency area and serve as decision-making material for regional devices in the health office to ensure that public health is free from pathogen contamination in drinking water.

A mixed-methods research design was used in this study (Darwin et al., 2021). Qualitative data were obtained through structured interviews with operators, owners, or supervisors of refillable drinking water depots in the Jembrana District area and environmental inspections around DAMIU. In contrast, quantitative data were obtained from scoring "Yes" and "No" in the interview results, which were then summed to obtain percentages for each indicator. There are 46 refillable drinking water depots in Jembrana District, Bali, registered with the Health Office and the Office of Cooperatives, Small and Medium Enterprises, Industry, and Trade of Jembrana District in ten areas of work in public health centers. Each subdistrict in Jembrana District has two public health centers. The sampling technique in this study used total sampling or reviewing the entire study population, namely, refillable drinking water depots. The distribution of DAMIU in each subdistrict is presented in Fig. 1.

This study found the hygiene and sanitation factors of refillable drinking water depots by examining subvariables. These subvariables were the characteristics of the research respondents, the handlers' hygiene characteristics, the sanitation and completeness of the equipment, the physical characteristics of the refillable drinking water depots, the bacteriological production results, and the raw water. These variables are adopted from guidelines for implementing sanitation and hygiene in drinking water depots (Ministry of Health, 2014). The Denpasar Health Polytechnic's Health Research Committee gave the study ethical approval under the reference number LB/02.03/EA/KEPK/0237/2021 and approved it to run for two months (October–November 2021).

The characteristics of the research respondents were measured using nominal scales (gender and age) and ordinal scales (last education, position, length of work, and working hours), which were further presented in percentage form. The hygiene characteristics of the handler are measured based on their personal health, hygiene behavior, and hygiene knowledge, which are distinguished by a nominal scale (yes and no) and presented in percentage form. A two-part ordinal scale is used to measure sanitary characteristics and equipment completeness, characteristics of refillable drinking water depots, and physical and bacteriological characteristics of production results and raw water (Ministry of Health 2014).

Observations are made by providing a checklist on a physical questionnaire sheet, and then all the data are tabulated and analyzed descriptively. Refillable drinking water samples obtained in each DAMIU are evaluated at the Quantum Medical Facilities public health laboratory to obtain physical and bacteriological test results. In contrast, raw water sampling is done directly when raw water is brought to refillable drinking water depots. Bacteriological confirmation in refillable drinking water samples is based on the number of Escherichia coli and coliform (Feng, Weagant, Grant, & Burkhardt 2020), procedures for checking refillable drinking water, and requirements and supervision of drinking water quality by the Ministry of Health of the Republic of Indonesia number 907/Menkes/SK/VII/2002 (Ministry of Health 2022).

Presumptive testing, characterized by gas formation in the medium test tube, confirms coliform in water bodies. If the presumptive test is positive, affirmative testing follows. Escherichia coli contamination was confirmed in six steps with thioglycolic media, MacConkey media, TSIA (triple sugar iron agar) identification media, SCA (Simon citrate agar) identification media, SIM (sulfur iodide motility) identification media, and glucose, lactose, saccharose, maltose, and mannose identification media (Wyasena et al. 2022). The data that have been obtained are then tabulated, compared with quality standards set by the Ministry of Health of the Republic of Indonesia, and presented in the form of tables, figures, and narratives.

Based on the results of inspections of 46 refillable drinking water depots in the Jembrana district, data were collected on the characteristics of research respondents, handling hygiene, sanitation, equipment completeness, and the characteristics of DAMIUs. The characteristics and parameters of each variable are presented in Tables 1 through 5. Based on the results of the identification of respondent characteristics in Table 1, respondents in this study were dominated by male respondents (91.30%) in the age range of 19–35 years (93.48%) who were classified as productive age, had a position as DAMIU operators (93.48%), and the rest served as DAMIU owners who were directly managed without inviting other employees. The last education respondents, dominated by high school education (SMA) as much as 73.92%, had worked for 2–4 years (84.78%), and working hours in a day reached 9–11 hours per day (91.30%).

Table 1

Characteristics of research respondents
Characteristics of Respondents	Number of Respondents
Characteristics of Respondents	n = 46 (%)
Gender
Male	42 (91.30)
Female	4 (8.70)
Age
19–35 Years	43 (93.48)
36–45 Years	2 (4.34)
> 45 Years	1 (2.17)
Position
DAMIU owner	3 (6.52)
DAMIU Operators	43 (93.48)
Recent Education
No School	3 (6.52)
Elementary School or equivalent	2 (4.34)
Junior High School or equivalent	3 (6.52)
Senior High School or equivalent	34 (73.92)
Higher Education/collage or equivalent	4 (8.70)
Length of Work
< 1 Year	2 (4.34)
2–4 Years	39 (84.78)
5–7 Years	2 (4.34)
> 7 Years	3 (6.52)
Working Hours
6-8 hours	3 (6.52)
9–11 hours	42 (91.30)
> 11 hours	1 (2.17)

Table 2

Hygiene characteristics of handlers
Characteristic	Yes		No
Characteristic	N	Percentage (%)	N	Percentage (%)
Public Health
1. Healthy condition	45	97.82	1	2.17
2. Carry out regular medical check-ups (minimum once every month).	4	8.69	42	91.30
3. Have a history of chronic diseases	2	4.34	44	95.65
Handler behavior
4. Washing hands before work	6	13.04	40	86.95
5. Washing hands after work	1	2.17	45	97.82
6. Using a Mask	39	84.78	7	15.21
7. Using an Apron	1	2.17	45	97.82
8. Using Footwear	3	6.52	43	93.47
9. Using clean clothes	46	100	0	0
10. Using Handscone	5	10.86	41	89.13
11. Smoking while working	13	28.26	33	71.73
12. Food Consumption While Working	4	8.69	42	91.30
Handler hygiene knowledge
13. Have attended sanitary hygiene training or workshops.	2	4.34	44	95.65
14. Understand Standard Operating Procedures in the Workplace	17	36.95	29	63.04

Table 3

Sanitary characteristics and completeness of equipment
Characteristic	Meets Standard (MS)
Characteristic	N	Percentage (%)	N	Percentage (%)
Sanitization of the equipment used
1. Made of Tara food	46	100	0	0
2. Routine replacement of microfilter tubes	8	17.39	38	82.60
3. Closed reservoir and protected from direct sunlight.	46	100	0	0
4. Tandon in the net	46	100	0	0
5. Microfilters with in-life disinfection equipment	41	89.13	5	10.86
6. There are tiered microfilters	16	34.78	30	65.21
7. Gallons/water holders are cleaned before filling according to standard operating procedure	46	100	0	0.00
8. Filled gallons are not stored and are given directly to consumers.	46	100	0	0.00
Completeness of correction
9. Complete equipment	46	100	0	0.00
10. Disinfection equipment is in place and functioning properly	31	67.39	15	32.60
11. New bottle cap as available	46	100	0	0.00
12. Gallon washing and rinsing bins are available	46	100	0	0.00
13. Terseina sterilization equipment (ozonization/ultraviolet light)	46	100	0	0.00

Table 4

Characteristics of refillable drinking water depot (DAMIU) premises
Characteristic	Meets Standard (MS)			Does not meet the standard (TMS)
Characteristic	N	Percentage (%)		N	Percentage (%)
Refillable Drinking Water Production Site
1. Location free from pollution	46	100	0		0.00
2. Location of T PA/TPS (> 100 m)	40	86.96	6		13.04
3. The building is strong, safe, comfortable, sturdy, and easy to clean.	46	100	0		0.00
4. The floor is waterproof, the surface is flat, smooth, not slippery, not cracked, does not absorb dust, is easy to clean, and the slope is quite gentle.	38	82.60	8		17.40
5. The wall is waterproof, the surface is flat, smooth, not slippery, or cracked, does not absorb dust, is easy to clean, and the color is light and bright.	46	100	0		0.00
6. The roof and ceiling must be strong, rat-proof, easy to clean, not absorb dust, have flat surfaces and light colors, and have sufficient height.	40	86.96	6		13.04
7. The layout includes a processing room, storage, distribution, provision, and a visitor/consumer waiting room.	46	100		0	0.00
8. The lighting is bright enough to work, not dazzling, and evenly spread out	38	82.60		8	17.40
9. Ventilation ensures good air circulation and exchange.	40	86.96		6	13.04
10. Air humidity can provide comfort while doing work or activities.	46	100		0	0.00
11. has access to a bathroom and latrine	45	97.82		1	2.17
12. There are sewerage, smooth, and closed flows.	46	100		0	0.00
13. There are enclosed bins.	40	86.96		6	13.04
14. There is a sink for washing hands.	44	95.66		2	4.34
15. Free from vectors (mosquitoes, mice, cockroaches, house flies, etc.)	40	86.96		6	13.04
16. Not joined with other activities (stalls, grocery stores, LPG gas sellers, fish sellers, etc.)	38	82.60		8	17.40
17. No sources of pollutants (pets, birds, and farms)	38	82.60		8	17.40

Table 5

Physical characteristics, bacteriological production, and raw water
Characteristic	Meets Standard (MS)			Does not meet the standard (TMS)
Characteristic	N	Percentage (%)		N	Percentage (%)
Physical Analysis Results
1. Clear Water	46	100	0			0.00
2. Odorless Water	46	100	0			0.00
3. Water has no taste.	46	100	0			0.00
4. Unscented Water	46	100	0			0.00
Results of bacteriological analysis
5. MPN Coliform (negative)	38	82.60	8			17.40
6. Escherichia coli (negative)	40	86.96	6			13.04
Raw Water Analysis Results
7. Raw materials meet standard physical, chemical, and microbiological requirements.	46	100	0			0.00
8. There is a guarantee letter for raw water supply during transportation.	41	89.13	5			10.86
9. Water tank vehicles do not release toxic substances/must be tara food.	46	100	0			0.00
10. There is written evidence (raw water source certificate).	46	100	0			0.00
11. Transportation of raw water takes a maximum of 12 hours, and disinfection is carried out during the trip.	46	100	0			0.00
12. Personnel wearing personal protective equipment	40	86.96	6			13.04

Furthermore, the research findings in Table 2 related to the hygiene characteristics of handlers obtained in the personal health subsection found 1 (2.17%) DAMIU operator who experienced flu symptoms or unhealthy conditions. The identification results indicated that 91.30% of handling operators stated that they did not carry out regular health checks (at least once every month), and 4.34% of employees had a history of chronic diseases such as hypertension, asthma, diabetes mellitus, and chronic gastritis. In the subvariable of handler hygiene behavior, 86.95% of handling operators did not wash their hands before doing work, and 97.82% did not after providing consumer services. Furthermore, respondents were still found who did not use masks (15.21%), especially in depots near residential areas; 97.82% did not use aprons to protect themselves, and 93.47% did not use footwear.

Most operators expressed reluctance to use hands because the additional costs incurred were relatively high to buy handscones. Many DAMIU operators still smoked while working (71.73%) because most workers are men who tend to smoke. A total of 91.30% of operators, when handling the gallons of consumers, eat snacks while working. Thus, most hygiene behavior subhandlers still need to meet the requirements of the provisions. Finally, in the knowledge subvariable, 95.65% of DAMIU operators have never attended sanitary hygiene training or workshops at related agencies, and 63.04% need help understanding the applicable standard operating procedures in the workplace, so the knowledge subvariable still needs to meet the requirements.

The examination results of sanitary characteristics and completeness (Table 3) were obtained for the subvariable sanitation equipment used. Refillable drinking water depots could not replace microfilter tubes (82.60%), 10.86% of DAMIU found microfilters and disinfection equipment not in service life (expired), and 65.21% of DAMIU did not apply tiered microfilters. This is likely to be a source of disease transmission into water bodies. Furthermore, in the subvariable, the duration of the equipment obtained was still found to be 32.60% of the disinfection equipment that was present but

needed to be fixed.

In Table 4, which shows the characteristics of refillable drinking water depots with subvariables where refillable drinking water production is a diol, there are still 13.04 DAMIU next to the final garbage dump and temporary landfill, which means that contamination can occur when garbage trucks pass through DAMIU and dust or other polluting sources enter the water. Furthermore, 17.40% of DAMIU has conditions that do not meet the requirements in terms of waterproof standards: flat, smooth, but quite slippery surfaces; the presence of broken and cracked floors; a reasonably gentle slope; and 13.04% found that the roof and ceiling of the depot (ceiling) are damaged and perforated; there is water seepage due to rain; and some tiles are broken.

Another priority that must be considered is that 17.40% of DAMIU still needs more lighting because the light bulbs used are fairly dim, and the lighting needs to be evenly distributed. A total of 13.04% of the DAMIU still has ventilation relying only on the front door and one vent at the rear, which results in improper air exchange. Furthermore, 2.17% of bathroom access with DAMIU is still incorporated in one place in the same space, and 13.04% have uncovered bins that allow contamination due to vectors and insects in the bin. A total of 4.34% still found a sink with a leak that allowed mosquitoes to use it as a brooding place, and 13.04% of DAMIU still found mosquitoes and flies. Finally, the findings that must be highlighted are that 17.40% of DAMIU is still incorporated with other activities besides filling refillable water, including selling LPG gas, raising pets such as cats, birds, and poultry, and joining grocery stores and stalls in front of or beside DAMIU.

In Table 5, information is obtained related to physical characteristics, bacteriological production results, and raw water in terms of subvariables of the physical analysis of water as a whole. Clear, smelly, tasteless, and odorless are just a few of the physical quality standards that DAMIU's water meets. However, 17.40% of DAMIU was still coliform in the bacteriological subvariable, and 13.04% was contaminated with Escherichia coli. These results indicate that the water produced from each DAMIU needs to fully meet the standards and needs regular monitoring. In the raw water subvariable, 10.86% did not receive a guarantee letter for raw water supply when transporting to each DAMIU, and 13.04% found that the transportation officers did not use personal protective equipment, including smoking while carrying out water transfer activities to the reservoir.

According to a study on the hygiene and sanitation of DAMIU in the Jembrana district area, the productive age group dominates the age of operators. This age was chosen to consider excellent and adequate service capabilities and the need for labor that meets company standards. This is consistent with a prior study, which found that operators dominated DAMIU in Tanjung Pinang City when they were between 20 and 35 and transitioned into productive age (Enjelina, Purba, & Erda 2017). Most DAMIU recruited or hired in the Jembrana district already have work experience, making it more straightforward for managers to train before commencing work (Agista & Purwantisari 2020; Ellinda-Patra, Dewanti-Hariyadi, & Nurtama 2020; Thomas, Channon, Bain, Nyamai, & Wright 2020). However, some depot operating hours exceed the government-mandated maximum of eight hours; this may result in job fatigue and less productive employees managing DAMIU from an environmental, regulatory, and operational standpoint (Fajriah, Isamu, Mustafa, & Arami 2021). In addition, according to Table 2 of the study's findings, the subvariables for routine health checks were unmet, as neither employees nor operators believed routine health checks were necessary. Employees stated that they did not check their health at the health service if they did not have symptoms or signs of severe illness. It is a risk factor for disease transmission during the COVID-19 pandemic and may increase the likelihood of chronic disease owing to a lack of early screening (South Australia Health 2021).

Additionally, low income levels contribute to operators' need to understand the importance of routine health checks. The operator expresses that low income and noncompliance with the district's minimum wage for employees resulted in a lack of willingness to examine their health. It compromises the operator's hygiene and the surrounding environment. Depot owners must closely monitor operators because they can transmit infectious diseases through water. Monitoring the health of operators or depot officers is a priority to ensure the health of workers, DAMIU, and the quality of water produced. Suppose the depot owner needs to monitor this better. In that case, the DAMIU can be contaminated with infectious diseases such as tuberculosis via patient droplets, contaminated diarrhea from worker feces, hepatitis, which can be transmitted via touch and fluids, COVID-19, which can be transmitted via droplets, sneezing, coughing, and other diseases (Daniel, Gaicugi, King, Marks, & Ferrero 2020). Consequently, these subvariables necessitate additional monitoring and evaluation by related parties, particularly the local health department and community health center. In addition, operators with congenital and chronic diseases must constantly assess their health and guarantee that they are fit to operate on DAMIU. DAMIU owners monitor this to ensure the purity of the produced drinking water (Sofia, 2020; String et al., 2021).

The findings regarding the hygienic practices of subvariable handlers result from the filled drinking water depot (DAMIU) operators' lack of service cleanliness and water distribution maintenance. This subvariable must convey the operator's concern for the purity of refillable drinking water. Operators who fail to wash their hands prior to filling water gallons or assisting customers run the danger of transmitting sickness and contaminating DAMIUs. The liquid is moved from storage tubes to consumer gallons (Dreibelbis et al., 2018). Polluting and disease-carrying hands are significantly more likely to transmit disease than organs, the environment, or gallon consumers carry (Galindo et al., 2021). Water was tainted when contamination was transferred from the customer's gallons to the operator's hands. Additionally, a lack of operator hygiene threatens household-level public health (Weaver et al., 2016).

Operator DAMIU, who had never attended sanitary hygiene workshops, provided little knowledge of cleanliness. Some individuals must comprehend and adhere to standard operating procedures in the workplace. Relevant parties shall perform assessments to confirm community service providers' safety, cleanliness, and quality. The owner's lack of knowledge regarding the fulfillment of operational signs, such as the use of personal protective equipment such as aprons, footwear, and handscones, is a signal that must be improved to ensure the quality of DAMIU, the cleanliness of the product, and the production of refillable drinking water (Ellinda-Patra et al. 2020; Anthonj et al. 2021; Cha et al. 2021). In addition, smoking while working and serving clients while refilling water containers is inconsistent with acceptable handler standards. The presence of smokers among workers or operators who fill water into gallons has the potential to create pollution in the form of ash from burning cigarettes and contamination of gallon water with cigarette smoke, which could cause new diseases and reduce the quality of water consumed by the community (Novitasari 2020; Galindo et al. 2021; Kato et al. 2021).

The study's findings regarding the subvariable sanitary equipment utilized are still present at DAMIUs, which must replace microfilter tubes periodically. When DAMIUs cause the presence of dirt, they may contaminate it (Enjelina et al., 2017). Bacterial contamination of DAMIUs can result in diarrhea, cholera, typhoid, hepatitis, dysentery, and gastroenteritis (Galindo et al. 2021). Bacterial contamination of drinking water can result in diarrhea, cholera, typhoid, hepatitis, dysentery, and gastroenteritis (Saimin et al. 2020; French et al. 2021; Imtiyaz, Putri, Hartono, Zulkarnain, & Priadi 2021; Putra, Rozari, & Soetedjo 2022). In addition, the microfilters and disinfection equipment used did not meet the standards and had expired. The majority did not have tiered microfilters and only used 1–2 microfilters, following the standard guidelines established for microfilter criteria at refillable drinking water depots ranging from 0.5 µm, 0.3 µm, and 0.1 µm. If this is not done correctly, it will impact the water quality produced. The use of inappropriate microfilters will affect the cleaning quality of refillable gallons and pollute people's drinking water (Piccoli, Virga, Maucieri, & Borin 2021; Wyasena et al. 2022). DAMIU microfilters must adhere to food safety requirements and be updated regularly. It is anticipated that many microfilters with graduated diameters will be used to ensure the resulting cleanliness (Ministry of Health 2014).

In an earlier study conducted at the DAMIUs in Sidoarjo Park in 2018, the DAMIUs determined that people who do not employ backwashing systems to preserve microfilter cleanliness should maintain a routine replacement schedule for microfilter tubes (Oktaviani, 2018). A drinking water quality assessment at Pondok Pesantren An-Nuriyah Wonocolo Surabaya in 2020 showed that the low number of microfilters and not replacing microfilters regularly in DAMIUs helped reduce pollution and the number of bacteria in DAMIUs made from depots. Meanwhile, disinfection equipment did not function appropriately in fittings for subvariable equipment. It reduces sterilization's germ-killing capacity, which falls short of the minimal criteria for drinking water hygiene outlined in sanitation depot number 43 of 2014 (Ministry of Health 2014).

According to these findings, disinfection equipment must be routinely monitored, as it is the principal cause of bacterial contamination in refillable drinking water (Akhter et al., 2020; Novitasari, 2020). In contaminated containers or water, sterilization and disinfection equipment failures facilitate the growth and spread of pathogens. Consuming it causes fecal-oral illness, which lowers the standard of living regarding hygiene and public health (Ohorella & Endah, 2020; Piccoli, Virga, Maucieri, & Borin, 2021). A recent study indicated that in Pagan, Kusan Hilir District, Tanah Bumbu District, South Kalimantan, the poor quality and functionality of disinfection and sterilizing equipment at the DAMIUs led to a significant prevalence of diarrheal illnesses. It arises because bacteria and other pathogens cannot be successfully filtered; evidence includes microfilters that do not meet specifications (are not graded) and less-than-optimal disinfection and sterilization equipment. Bacteria and other pathogens are not UV-resistant; therefore, they will perish if their cell walls are exposed during sterilization or disinfection. Alternatively, if disinfection equipment is ineffective, pathogens can rapidly contaminate water, proliferate, and cause disease in those who consume contaminated water (Andiarsa, Setyaningtyas, Hidayat, Setianingsih, & Haryati 2018).

Moreover, findings on the characteristics of the DAMIU with subvariables where production was obtained still identified a DAMIU with a 100 m distance. They were adjacent to the permanent and temporary landfills. This causes contamination if, when the garbage carrier passes through DAMIU, in addition to contamination due to dust and other dirt, the resulting aroma can trigger the presence of vectors such as flies, which has implications for the slum environment due to unpleasant odors or other sources that generate flies in the depot area. In addition, proximity to permanent or temporary waste disposal facilities may result in disagreeable odors, influencing consumers' opinions of DAMIUs and water quality. This is detailed in depth in the section on the cleanliness of DAMIUs (WHO 2006; Ministry of Health 2014; Slavik et al. 2020). The distance between refillable drinking water depots is meant to meet predetermined quality criteria to reduce the number of pollutants entering bodies of water, especially during processing. Dust particles transported by garbage trucks to landfills or temporarily to the depot area can contaminate or transfer filling-process water and the surrounding environment. The foul odor near the DAMIUs had a detrimental impact on the community's reputation and clientele, decreasing the depot's earnings. Following health laws, the depot area must contain contaminants such as air, noise, and unpleasant scents that could impede customer service operations (WHO, 2006; Ministry of Health, 2014).

An, Bich, Yi-Ching, & Hien (2021) found that the floors of DAMIUs are not waterproof; have a smooth, nonslippery, noncracked surface that does not collect dust and is easy to clean; and have a suitable gentle slope that lets pollutant residues enter the DAMIU area. In refillable drinking water production facilities with nonwaterproof flooring, standing water can be built if water droplets leak and serve as nests or breeding grounds for vectors such as mosquitoes, flies, poisonous insects, and cockroaches. If this happens, DAMIUs become contaminated, jeopardizing the purity of the water and the environment (South Australia Health 2021). In addition, the roof ceilings of DAMIUs are insufficient or misaligned, resulting in rats and other rodents spreading disease and contaminating equipment. Environmental inspections conducted at 8 DAMIU must continue to be certified in illumination, which is crucial for operator safety. In addition, shaded areas and uneven lighting encourage the presence of lizards and vectors, such as mosquitoes and flies, to live and breed; therefore, replacing them with brighter and more uniformly distributed light bulbs will assist in reducing contamination in the DAMIU environment. A sink in a DAMIU is malfunctioning, and it is revealed that the water in the sink is always running, allowing mosquitoes and other vectors to lay eggs and nest there. Consequently, depot operators or owners must routinely monitor the cleanliness and health of the surrounding environment.

Additionally, it is detected in DAMIUs when mosquitoes seek to bite the handler; if the handler touches a portion of the body, the disease may be transmitted from the body to the DAMIUs. Additionally, some DAMIUs in the Jembrana district engage in additional activities, such as joining food stores or stalls, selling LPG gas, and selling betta fish. This results in a significant source of pollution at the DAMIUs. Additionally, the DAMIUs discovered a source of contamination in the depot area, including pet cats, birds, their nests, and small cages of pets capable of transmitting disease vectors (Ellinda-Patra et al., 2020; Health, 2021).

According to the research findings on the physical, bacteriological, and raw water characteristics obtained from the subvariables of physical analysis, all DAMIUs exceed the minimum standards for drinking water clarity, odorless ness, and tastelessness. However, the bacteriological analysis subvariable revealed the presence of refillable drinking water contaminated with coliform at 17.40% and Escherichia coli at 13.04%. Thus, DAMIU that does not meet these requirements must be monitored frequently and conducted under close supervision to ensure the high quality of the produced water (Batubara, Pohan, & Pasaribu 2021). According to Regulation Number 43 of 2014 issued by the Minister of Health of the Republic of Indonesia, if the quality of refillable drinking water produced by DAMIUs is contaminated with germs and bacteria despite meeting the minimum value of 70 percent in various aspects, the DAM in question does not meet health requirements. Assume that each DAMIU owner can only meet some established quality standards. In this instance, the depot will be closed temporarily or permanently until the DAMIU owner can implement and frequently monitor quality requirements (Ministry of Health 2014).

Research by Rahmitha, Utami, & Sitohang (2018) supports this finding, which states that there is still much bacteriological contamination in refillable drinking water in the Tembalang Regency (Rahmitha et al. 2018). Furthermore, Galindo et al. (2021) and Mostafa, Camacho-Galván, Castelán-Martínez, Galdos-Balzategui, & Reygadas (2021) revealed that bacterial and pathogenic contamination in refillable drinking water occurs due to various factors, such as operator hygiene, environmental hygiene, and the quality of the raw water produced. In the subvariable analysis of raw water, it is still found that DAMIU does not obtain and does not have a guarantee letter for the supply of raw water during transportation, which makes it possible to suspect that the water obtained does not have a permit and does not know the source of raw water used clearly and legally. Research by Serrem, Illés, Serrem, Atubukha, & Dunay (2021) reveals that the quality of the water consumed by the community must be maintained, and the source is known to detect contamination in drinking water; therefore, additional investigation and administration of water sources from related parties are needed. Meanwhile, a small percentage of transportation workers do not use personal protective equipment, so contamination can occur when delivering water from water sources to DAMIUs (Kelly et al. 2021; South Australia Health 2021; Spanoudi, Golfinopoulos, & Kalavrouziotis 2021).

Hence, providing information specifically to DAMIU business actors and knowledge transfer to DAMIU operators must be carried out to improve the quality of services and refill water produced as well as improve management. The environment around the depot and improving the skills of DAMIU operators or owners are needed to ensure that the actions and services provided have met the standards of the Regulation of the Minister of Health of the Republic of Indonesia Number 43 of 2014 concerning cleanliness and sanitation of water depots drinking and Decree of the Minister of Industry and Trade of the Minister of Industry and Trade of the Republic of Indonesia number 651/MPP/Kep/10/2004 concerning technical requirements of drinking water depots and their trade.

Policy implications

This study seeks to analyze and evaluate the hygiene and sanitation of refillable drinking water in each DAMIU in the Jembrana District area. Our current findings are expected to be used as a reference to regularly monitor the quality of refillable drinking water by the Jembrana District Health Office, which is integrated with community health centers in each subdistrict. The hope is that adequately maintained refillable drinking water quality will minimize unwanted events, especially water-sourced diseases. Our research recommends that relevant parties re-evaluate handlers' personal health and hygiene behaviours and the need for increased knowledge to understand the risks posed by services not following established operational standards. Sanitary monitoring and equipment completeness are expected to replace microfilter tubes regularly; disinfection equipment must be in new condition and have a long service life; and tiered microfilters and disinfection equipment must function properly to ensure water quality. DAMIU owners or operators must pay attention to the surrounding environment, which includes periodic repairs to refillable drinking water production sites and checking the quality of the water produced on bacteriological analysis to ensure that the water produced is free from coliform contamination and Escherichia coli. Local governments must enforce firm regulations for DAMIU owners to operate refillable drinking water businesses and ensure compliance with the requirements set according to the Ministry of Health guidelines.

Research limitations

This research is still limited to the hygiene and sanitation profile in depot areas and refillable drinking water products produced by DAMIU in Jembrana District. Research has not identified refillable drinking water products contaminated with coliform and Escherichia coli or whether they directly impact the health of the consuming public. The report is limited to observations of DAMIU owners and operators for information collection and only focuses on indicators set by the Ministry of Health of the Republic of Indonesia. The study area still focuses on one district and has yet to be generalized to the area of Bali Province due to limited resources.

Refillable drinking water has become an option to meet community hydration needs, especially in the Jembrana district, Bali. Hygiene and sanitation identification in 46 DAMIU was obtained: 38 DAMIU (82.60%) met the requirements to be free from coliform contamination in the resulting drinking water, and 40 DAMIU (86.96%) met the requirements to be free from Escherichia coli in the produced water. However, refillable drinking water contaminated with coliform was still found in 8 DAMIUs (17.40%), and 6 DAMIUs (13.04%) were contaminated with Escherichia coli in the refillable drinking water produced. Monitoring that must be thoroughly improved on the hygiene characteristics of handlers on the subvariables of personal health, hygiene behavior, and knowledge is classified as low. Sanitary characteristics and equipment completeness must be applied, especially when replacing microfilter tubes, disinfection equipment in its service life, and tiered microfilters. The DAMIU environment must be maintained hygienically and sanitized, especially in floor materials, atas, lighting, ventilation, and trash cans, and not combined with other activities and sources of pollution to minimize contamination in water bodies. Raw water management and water supply guarantee letters must be available. Thus, the hygiene and sanitation of refillable drinking water in Jembrana must be monitored according to established standards. In the future, identification is needed to be related to the quality of the DAMIUs in the Jembrana district area and analysis of pollutant factors that can cause problems in human health related to drinking water and mapped using GIS (Geographic Information System).

Acknowledgements

The authors thank the Health Office, Cooperative Office, Small and Medium Enterprises, Industry, and Trade of Jembrana Regency, and all parties who helped in this research.

Data Availability Statement

Data cannot be made publicly available; readers should contact the corresponding author for details

Conflict of Interest

The authors declare that there are no conflicts.

Funding

This research did not receive funding from any party.

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Hygiene and Sanitation Monitoring of Refillable Drinking Water Depots in Jembrana District, Indonesia

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