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PubMed2000

Sick building syndrome. III. Stachybotrys chartarum.

Increasingly, physicians are being asked to evaluate patients with putative environmentally associated illnesses. These can include a variety of problems, including infectious illnesses (Legionnaire's disease), chemical exposure in the workplace, and sick building syndromes. The latter has been an issue particularly in asthma because of the association of mold and increased bronchial responsiveness. Recently, attention has been focused on the mold Stachybotrys in human disease. Stachybotrys was first identified more than 60 years ago following an epidemic of stomatitis, rhinitis, conjunctivitis, pancytopenia, neurologic disorders, and death in horses. Since then, Stachybotrys has been identified in several outbreaks of disease in animals. It has also attracted attention as a possible agent in idiopathic pulmonary hemorrhage in infants. Stachybotrys is a relatively uncommon fungus but has been isolated from a variety of sources, including contaminated grains, tobacco, indoor air, insulator foams, and water-damaged buildings with high humidity. This fungus is particularly important because it is one of a series of fungi that produces trichothecenes mycotoxins; these mycotoxins are biologically active and can produce a variety of physiological and pathologic changes in humans and animals, including modulation of inflammation and altered alveolar surfactant phospholipid concentrations. The presence of Stachybotrys in a building does not necessarily imply a cause-and-effect relationship with illness, but should alert physicians and healthcare professionals to do more vigorous environmental testing. Guidelines are presented herein for intervention measures in the maintenance of heating, ventilation, and air-conditioning systems.

Animals↗
PubMed2001

[Sick building syndrome should be treated more from a reasonable than an evidence-based point of view].

During the past decades, several non-specific syndromes have gradually appeared and eventually been given generic denominations such as "diseases of modern life". One of these is the so called Sick Building Syndrome (SBS), which consists of various combinations of common, non-specific symptoms as well as an absence of signs demonstrable by laboratory tests and other medical examinations or means. The lack of demonstrable biological correlates together with vague etiologic attributions make it unusually problematic to study, resulting in the production of a general, non-specific and sometimes contradictory fund of knowledge. This often transforms instances of SBS to theaters of conflict people by parties with divergent interests. Technical/scientific expertise can provide general advice but not unambiguously contribute to the resolution of the conflicts.

Concept Formation↗
PubMed1990

Influence of indoor climate on the sick building syndrome in an office environment. The Danish Indoor Climate Study Group.

The influence of indoor climate factors on symptoms of the sick building syndrome was investigated in Greater Copenhagen, Denmark. Altogether, 2369 office workers in 14 buildings, where indoor climate measurements were made, filled out a questionnaire. Multivariate logistic regression analyses of the multifactorial effects on the prevalence of work-related mucosal irritation and work-related general symptoms among the office workers showed that the concentration of macromolecular organic floor dust, the floor covering, the number of workplaces in the office, the age of the building, the type of ventilation, and two easily recognizable factors, the shelf factor and the fleece factor, were associated with the prevalence of symptoms.

Adult↗
PubMed2001

Sick building syndrome in relation to building dampness in multi-family residential buildings in Stockholm.

OBJECTIVES: The aim was to study relationships between symptoms compatible with sick building syndrome (SBS) on one hand, and different indicators of building dampness in Swedish multi-family buildings on the other. METHODS: In Stockholm, 609 multi-family buildings with 14,235 dwellings were identified, and selected by stratified random sampling. The response rate was 77%. Information on weekly symptoms, age, gender, population density in the apartment, water leakage during the past 5 years, mouldy odour, condensation on windows, and high air humidity in the bathroom was assessed by a postal questionnaire. In addition, independent information on building characteristics was gathered from the building owners, and the central building register in Stockholm. Multiple logistic regression analysis was applied, and adjusted odds ratios (OR) were calculated, adjusted for age and gender, population density, and selected building characteristics. RESULTS: Condensation on windows, high air humidity in the bathroom, mouldy odour, and water leakage was reported from 9.0%, 12.4%, 7.7% and 12.7% of the dwellings, respectively. In total 28.5% reported at least one sign of dampness. All indicators of dampness were related to an increase of all types of symptoms, significant even when adjusted for age, gender, population density, type of ventilation system, and ownership of the building. A combination of mouldy odour and signs of high air humidity was related to an increased occurrence of all types of symptoms (OR = 3.7-6.0). Similar findings were observed for a combination of mouldy odour and structural building dampness (water leakage) (OR = 2.9 5.2). In addition, a dose-response relationship between symptoms and number of signs of dampness was observed. In dwellings with all four dampness indicators, OR was 6.5, 7.1, 19.9, 5.8, 6.1, 9.4, 15.0 for ocular, nasal, throat, dermal symptoms, cough, headache and tiredness, respectively. CONCLUSION: Signs of high air humidity, as well as of structural building dampness, are common in multi-family buildings in Stockholm. Reports of building dampness in dwellings is related to a pronounced increase of symptoms compatible with the SBS, even when adjusted for possible confounding by age, gender, population density, and building-related risk factors.

Adolescent↗
PubMed1997

[Sanitary impact of air conditioning: what is the relation to sick building syndrome?].

Modern architecture is creating air-conditioned offices in our society. Various diseases have been associated with conditioned air exposure, and building-related diseases are distinct from sick building syndrome (SBS). Building-related diseases have a well-characterized aetiology, essentially infectious, compared to SBS, where the aetiology is not clear. This paper reviews these syndromes, their aetiologies and their discussion in order to treat and prevent their expression. Progress has been made in the conception of air-conditioning systems. Prevention of these syndromes is based on conception and cleaning of these systems, which allows the use of air-conditioning without any major sanitary problem.

Air Conditioning↗
PubMed1994

Effect of air humidification on the sick building syndrome and perceived indoor air quality in hospitals: a four month longitudinal study.

The sensation of dryness and irritation is essential in the sick building syndrome (SBS), and such symptoms are common in both office and hospital employees. In Scandinavia, the indoor relative humidity in well ventilated buildings is usually in the range 10-35% in winter. The aim of this study was to evaluate the effect of steam air humidification on SBS and perceived air quality during the heating season. The study base consisted of a dynamic population of 104 hospital employees, working in four new and well ventilated geriatric hospital units in southern Sweden. Air humidification raised the relative air humidity to 40-45% in two units during a four months period, whereas the other two units served as controls with relative humidity from 25-35%. Symptoms and perceived indoor air quality were measured before and after the study period by a standardised self administered questionnaire. The technical measurements comprised room temperature, air humidity, static electricity, exhaust air flow, aerosols, microorganisms, and volatile organic compounds in the air. The most pronounced effect of the humidification was a significant decrease of the sensation of air dryness, static electricity, and airway symptoms. After four months of air humidification during the heating season, 24% reported a weekly sensation of dryness in humidified units, compared with 73% in controls. No significant changes in symptoms of SBS or perceived air quality over time were found in the control group. The room temperature in all units was between 21-23 degrees C, and no significant effect of air humidification on the air concentration of aerosols or volatile organic compounds was found. No growth of microorganisms was found in the supply air ducts, and no legionella bacteria were found in the supply water of the humidifier. Air humidification, however, significantly reduced the measured personal exposure to static electricity. It is concluded that air humidification during the heating season in colder climates can decrease symptoms of SBS and perception of dry air.

Adult↗
PubMed2000

Resolution of sick building syndrome in a high-security facility.

The main objective of this article is to serve as a case study for other industrial hygiene (IH) professionals' review as a "real world" effort in responding to a facility perceived as "sick" by its occupants. As many industrial hygienists do not have extensive backgrounds in evaluating microbial air contaminants or the mechanical function of building HVAC units, the overall intent is to provide "lessons learned" to IH generalists who may be asked to participate in indoor environmental quality (IEQ) surveys. In September 1994, a suspected case of "sick building syndrome" was investigated (with significant airborne fungal loads confirmed) at a communications center after numerous occupants reported upper respiratory disease and/or allergy-type symptoms. The setting was a two-story structure approximately 30 years old, with a normal occupancy load of 350 to 400 persons. In addition to continual structural modifications, the central HVAC air conditioning systems had poor maintenance histories. Inspection of HVAC components revealed visible fungal growth on air filters and air ducts and in cooling fan condensate drip pans. Fungal air samples were collected with an Anderson N6 air sampler and Sabouraund dextrose agar media. Over a study period of 23 months, three rounds of 26 air samples were collected for 5 minutes each at 28.3 liters/minute airflow. Cultures exhibited fungi such as Aspergillus, Penicillium, Alternaria, and Cladosporium. Certain strains of these fungi produce mycotoxins that may cause a variety of deleterious health effects such as those described by occupants. Initial 1994 airborne fungal concentrations ranged from 85 to 6157 colony forming units (CFUs) per cubic meter of sampled air (CFU/m3). Some investigators have reported fungal concentrations as low as 245 CFU/m3 associated with complaint sites in other buildings. Remediation efforts involved hiring a dedicated mechanic to implement a HVAC preventive maintenance program (including regular replacement of all HVAC air filters and cleaning of accessible components with water/bleach solution). Post-abatement January 1996 re-sampling revealed a significant drop in airborne fungal colonies up to 97 percent (range = 21 to 1092 CFUs/m3)--which also coincided with physicians at the local hospital sensing a qualitative reduction in patient visits from facility workers. To address seasonal bias, a final August 1996 air sample round revealed a range of 14 to 500 CFUs/m3. Of the 21 workspaces sampled in all three rounds, nine continued to show a decline in CFUs/m3 from September 1994 baseline counts. These results demonstrate the critical role of an ongoing HVAC maintenance program for reducing potential reservoirs of fungal organisms in indoor work environments. Building renovations (especially those involving major changes to building layout and usage) can adversely affect IEQ if plans do not include coordinated updates and regular preventive maintenance of HVAC systems. Eventual negative outcomes can be reduced occupant productivity and deleterious health effects.

Air Pollution, Indoor↗
PubMed1999

Sick building syndrome in an office building formerly used by a pharmaceutical company: a case study.

In the past two decades, a group of health problems related to the indoor environment--generally termed sick building syndrome (SBS)--has emerged. We present an investigation of SBS in employees of a ministry working in a naturally ventilated office building that formerly had been used by a pharmaceutical company. A preceding environmental monitoring had failed to identify the cause(s) for the complaints. We conducted a questionnaire-based investigation and categorized the building sections and rooms according to their renovation status and their former use, respectively. The highest level of complaints was found among the employees working in rooms that in the past had been used for the production or storage of various pharmaceutical products suggesting that pharmaceutical odors may be a risk factor for SBS. Clinical laboratory tests did not show any unusual results. We conclude that the former use of a building for production and storage of pharmaceutical products should be considered as a possible risk factor for complaints about indoor air quality, e.g., when advising about or planning for renovations of buildings formerly used for production, handling, or storing of chemicals.

Adult↗
PubMed1997

Prevalence of the sick building syndrome symptoms in office workers before and six months and three years after being exposed to a building with an improved ventilation system.

OBJECTIVE: The prevalence of symptoms associated with the sick building syndrome (SBS) has recently been shown to decrease by 40% to 50% among office workers six months after they were exposed to a building with an improved ventilation system. The objective of the present study was to find whether the decrease in the prevalence of symptoms was maintained three years later. METHODS: Workers from the same organisation occupied five buildings in 1991 and moved during that year to a single building with an improved ventilation system. All buildings had sealed windows with mechanical ventilation, air conditioning, and humidification. Workers completed a self administered questionnaire during normal working hours in February 1991 before moving, in February 1992 six months after moving, and in February 1995, three years after moving. The questionnaire encompassed symptoms of the eyes, nose and throat, respiratory system, skin, fatigue, and headache, as well as difficulty concentrating, personal, psychosocial, and workstation factors. During normal office hours of the same weeks, environmental variables were measured. RESULTS: The study population comprised 1390 workers in 1991, 1371 in 1993, and 1359 in 1995, which represents 80% of the population eligible each year. The prevalence of most symptoms decreased by 40% to 50% in 1992 compared with 1991. This was similar in 1995. These findings were significant and remained generally similar after controlling for personal, psychosocial, and work related factors. CONCLUSION: In this study, the decrease of 40% to 50% in the prevalence of most symptoms investigated six months after workers were exposed to a new building with an improved ventilation system was maintained three years later. The results of the present follow up study provide further support for a real effect of exposure to a new building with an improved ventilation system on the prevalence of symptoms associated with the SBS.

Carbon Dioxide↗
PubMed2000

Associations between indoor CO2 concentrations and sick building syndrome symptoms in U.S. office buildings: an analysis of the 1994-1996 BASE study data.

Higher indoor concentrations of air pollutants due, in part, to lower ventilation rates are a potential cause of sick building syndrome (SBS) symptoms in office workers. The indoor carbon dioxide (CO2) concentration is an approximate surrogate for indoor concentrations of other occupant-generated pollutants and for ventilation rate per occupant. Using multivariate logistic regression (MLR) analyses, we evaluated the relationship between indoor CO2 concentrations and SBS symptoms in occupants from a probability sample of 41 U.S. office buildings. Two CO2 metrics were constructed: average workday indoor minus average outdoor CO2 (dCO2, range 6-418 ppm), and maximum indoor 1-h moving average CO2 minus outdoor CO2 concentrations (dCO2MAX). MLR analyses quantified dCO2/SBS symptom associations, adjusting for personal and environmental factors. A dose-response relationship (p < 0.05) with odds ratios per 100 ppm dCO2 ranging from 1.2 to 1.5 for sore throat, nose/sinus, tight chest, and wheezing was observed. The dCO2MAX/SBS regression results were similar.

Adult↗
PubMed2006

Adaptation of office workers to a new building - impaired well-being as part of the sick-building-syndrome.

AIM: The focus of our study was the assessment of the effects of spatial relocation on office staff. Our aim was to investigate whether psychosocial or personal factors are better predictors of the occurrence of impaired well-being. METHODS: Before relocation the administration of the university hospital of Ulm (Germany) was located in ten different buildings. Chemical and physical parameters of the indoor air were measured. The employees were surveyed with a questionnaire for their health status and psychosocial determinants. After moving to a new wide-spaced building, the same procedure was reapplied shortly afterwards and half a year later. Only respondents who had taken part in all three surveys are taken into account (n=84). The definition of impaired well-being as defined by the ProKlimA-study group was used as the criterion variable. RESULTS: The overall prevalence of impaired well-being rose from 24% to 36% after relocation. Contrarily, persons who were formerly accommodated in a wide spaced-building showed a reduced risk (OR(post1)=0.3). Affected persons had at all times a more negative response pattern. Chemical and physical parameters did not have any influence in this context. CONCLUSIONS: The adaptation to a new environment is influenced by the old "socialization" of the former buildings. Impaired well-being is not limited to bodily complaints, it rather has a systemic character in the form of a distinctive overall response pattern. For an adequate analysis of impaired well-being - and the sick-building-syndrome in consequence - the elucidation of individual and other potentially intervening factors is essential. Taking this into consideration, the search for norm values or a framework seems to be of limited value.

Air Pollutants, Occupational↗
PubMed2000

[Microbiological threat from buildings and rooms and its influence on human health (sick building syndrome)].

In buildings we can observe many different strains of bacteria, over 400 species of mould fungi, many strains of fungus causing the rotting of wood and wood like materials, many species of algae, aphids, and other types of growths and seed plants and also over 30 types of mites especially those seen in house dust. Buildings, especially their interiors have a very specific microclimate. Within it areas of so called ecological lows are formed in which conditions for settlement, growth and reproduction of these organisms take place. A building, which is a hazard to the health of its residents, is called a "sick building" from the term "sick building syndrome". The incidence and development of some types of mould fungus is associated with the production of very toxic metabolites which are called secondary metabolites i.e. mycotoxins. Long term human, especially in relation to children, contact with the species producing the most potent mycotoxins like aflatoxin--Apergillus flavus, ochratoxins--Aspergillus ochraceus, rubratoxins--Penicillium rubrum or strachybotrytoxins--Strachybotrys chartarum may even be the cause of death. Mould fungus or just mould is a saprophytic fungus derived from many different systemic groups (Mucor, Aspergillus, Penicillium, Fusarinum). Fungi can produce lethal mycotoxins such as: alternariol, aflatoxins, gliotoxins, ochratoxins, nivalenol, cytinine, dicumarol, rugulosine, trichoviridine and about 200 more which considering their mutagenicity are potentially dangerous to humans, animals, flora and microorganisms. Research which was begun by Prof. Julian Aleksandrowicz and Prof. Bolesław Smyk in 1970 and 1971 showed that the so called "leukaemia houses" of leukaemia victims had an abundance of toxinogenic fungus in them, particularly the most potent fungus which turned out to be Aspergillus flavus. Toxinogenic funguses are abundant in many living spaces and cellars in older and also in new housing. Mycotoxins have been shown to be very toxic and harmful and it is no wonder that many inhabitants of these living spaces are constantly ill, mainly upper respiratory tract infections, lethargy, constant headaches, nausea and a general ill feeling. Inhabiting these living spaces for a considerable period may lead to cancer.

Adult↗
PubMed2005

Sick building syndrome and perceived indoor environment in relation to energy saving by reduced ventilation flow during heating season: a 1 year intervention study in dwellings.

UNLABELLED: Ventilation in Scandinavian buildings is commonly performed by means of a constant flow ventilation fan. By using a regulated fan, it is possible to make a seasonal adjustment of outdoor ventilation flow. Energy saving can be achieved by reducing the mechanical ventilation flow during the heating season, when natural ventilation driven by temperature differences between outdoor and indoor is relatively high. This ventilation principle has been called 'seasonally adapted ventilation (SAV)'. The aim was to study if a 25-30% reduction of outdoor ventilation flow during heating season influenced sick building syndrome (SBS) and the perception of the indoor environment. This was done in a 1-year cross-over intervention study in 44 subjects in a multi-family building. During the first heating season (November to April), one part of the building (A) got a reduced flow during the heating season [0.4-0.5 air exchanges per hour (ACH)] while the other part (B) had constant flow (0.5-0.8 ACH). The next heating season, part A got constant flow, while part B got reduced ventilation flow. Reduced ventilation increased the relative air humidity by 1-3% in the living room (mean 30-37% RH), 1-5% in the bathroom (mean 48-58% RH) during heating season. The room temperature increased 0.1-0.3 degrees C (mean 20.7-21.6 degrees C), mean carbon dioxide (CO2) concentration in the bedroom increased from 920 to 980 p.p.m. at reduced flow. The indoor air quality was perceived as poorer at reduced outdoor airflow, both in the bedroom and in the apartment as a whole. There was a significant increase of stuffy odor (P = 0.05) at reduced outdoor airflow and the indoor air quality was perceived as poorer, both in the bedroom (P = 0.03) and in the apartment as a whole (P = 0.04). No significant influence on SBS symptoms or specific perceptions such as odors, draught, temperature, air dryness or stuffy air could be detected. In conclusion, reducing the ventilation flow in dwellings to a level below the current Swedish ventilation standard (0.5 ACH) may cause a perception of impaired air quality. Technical measurements could only demonstrate a minor increase of indoor temperature, relative air humidity, and bedroom CO2 concentration. This illustrates that it is important to combine technical measurements with a longitudinal evaluation of occupant reactions, when evaluating energy-saving measures. PRACTICAL IMPLICATIONS: It is important to combine technical measurements with a longitudinal evaluation of occupant reactions, when evaluating energy-saving measures. Reduction of outdoor airflow in dwellings below the current ventilation standard of 0.5 ACH may lead to a perception of impaired air quality, despite only a minor increase of bedroom CO2-concentration.

Adolescent↗
PubMed1994

Air recirculation and sick building syndrome: a blinded crossover trial.

OBJECTIVE: This study tested the hypothesis that recirculated air in mechanically ventilated buildings causes symptoms commonly referred to as the sick building syndrome and perceptions of poor indoor air quality. METHODS: A blinded, four-period crossover trial was carried out in two identical buildings, contrasting 70% return air (index phase) with 0% of return air (reference phase). Each period lasted 1 work-week. The study population comprised 75 workers who had reported symptoms related to the work environment or perceptions of poor indoor air quality. Participants reported their ratings of symptoms, their perceptions, and related information in a daily diary. The outcome criteria included aggregative symptom scores for mucosal irritation, skin reaction, allergic reaction, and general symptoms formed of ratings of component symptoms. Perceptions of unpleasant odor, stuffiness, or dustiness were additional outcome criteria. RESULTS: All 75 participants returned their diaries. For no symptoms did the scores differ between the two phases more than could be expected by chance. Mean rating of unpleasant odor was significantly smaller during the index phase, but mean ratings of dustiness and stuffiness did not differ materially between the two phases. CONCLUSIONS: Our results suggest that 70% recirculated air, when accompanied by an adequate intake of outdoor air, can be used without causing adverse effects.

Adult↗