The sick building syndrome: a danger to your health.
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To examine the role of types of building ventilation in office buildings as a determinant of ocular, nasopharyngeal, skin, and general symptoms often denoted as the sick building syndrome, a cross-sectional study was carried out in March 1991 on 2,678 workers from 41 office buildings selected randomly from the Helsinki metropolitan area. The ventilation type and other characteristics of these buildings were recorded on a site visit, and a questionnaire directed to workers inquired about the symptoms, perceived air quality, and possible personal and environmental determinants (response rate, 81%). The outcomes were weekly work-related symptoms experienced during the previous 12 months and symptom groups defined either by their anatomic location or hypothesized mechanism. In logistic regression analysis adjusting for potential confounders, simple mechanical ventilation (mechanical supply and exhaust ducts) was related to a higher risk of ocular symptoms (odds ratio (OR) = 1.31, 95% confidence interval (CI) 0.76-2.26), nasal congestion (OR = 1.78, 95% CI 0.92-3.42) and discharge (OR = 1.44, 95% CI 0.72-2.88), pharyngeal symptoms (OR = 2.32, 95% CI 1.01-5.33), and lethargy (OR = 1.71, 95% CI 0.99-2.95) compared with natural ventilation. Air conditioning was related to a slightly higher risk of symptoms compared with simple mechanical ventilation (for any symptom, OR = 1.30, 95% CI 1.00-1.68). Steam and evaporative humidification as well as air recirculation acted also as determinants of these symptoms. The risk of the studied symptoms is related to the type of ventilation in the existing office building stock. Future studies should explore the typical functional problems and specific causes connected with the high-risk ventilation systems.
Environmental tobacco smoke is of serious concern in ventilated spaces both for comfort because of its odor properties and for health reasons. Although it has not been demonstrated as the primary cause in complaints, it is frequently seen as a contributing factor. Recirculation of air with ETS, without filtration or air-washing, may in fact lead to complaints, although at an unknown frequency. Finally, the contributions of ETS to the sick building syndrome is documented, although its extent is currently unknown.
BACKGROUND: The Office Illness Project in Northern Sweden, comprising both a screening questionnaire study of 4943 office workers and a case-referent study of Sick Building Syndrome (SBS) in 464 subjects was recently completed. Previously published results from the survey showed that female gender asthma/rhinitis, high psychosocial work load, paper and visual display terminal (VDT) work were related to an increased prevalence of SBS symptoms. METHODS: The case-referent study presented in this paper used data from the questionnaire supplemented with information from a clinical examination, a survey of psychosocial factors at work building data from inspection and measurements taken at the work sites. RESULTS: Personal factors such as atopy and photosensitive skin, psychosocial conditions and physical exposure factors influencing indoor air quality (IAQ), such as outdoor air flow rates and the presence of photocopiers were related to an increased prevalence of the reported SBS symptoms. The results were established using multivariate analysis. CONCLUSIONS: The rate response relationship between actually measured ventilation rates and the prevalence of perceived SBS symptoms presents strong evidence for the association between IAQ factors and health.
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METHODS: During a survey of building-related symptoms among 1355 employees working in 19 governmental office buildings in the Netherlands, we measured physical and chemical factors, airborne microorganisms, and endotoxin. Mechanically ventilated buildings were grouped as "healthy" or "sick" based on symptom prevalence (mean symptom prevalence < 15% or > or = 15%). We compared physical, chemical, and microbiological characteristics between mechanically ventilated and naturally ventilated buildings. RESULTS: Gram-negative rods were found in higher numbers in the "sick" buildings. The concentration of airborne endotoxin was six to seven times higher in the "sick" buildings than in the "healthy" buildings (254 vs 46 ng/m3); it was 35 ng/m3 in naturally ventilated buildings. No differences in physical characteristics of the buildings were found. Volatile organic compounds and carbon dioxide were present at higher concentrations in naturally ventilated buildings. CONCLUSION: Airborne microbial contamination, in particular with gram-negative rods and perhaps with endotoxin, may have a role in the causation of sick building syndrome.
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The growth of indoor molds and their resulting products (e.g., spores and mycotoxins) can present health hazards for human beings. The efficacy of chlorine dioxide gas as a fumigation treatment for inactivating sick building syndrome-related fungi and their mycotoxins was evaluated. Filter papers (15 per organism) featuring growth of Stachybotrys chartarum, Chaetomium globosum, Penicillium chrysogenum, and Cladosporium cladosporioides were placed in gas chambers containing chlorine dioxide gas at either 500 or 1,000 ppm for 24 h. C. globosum was exposed to the gas both as colonies and as ascospores without asci and perithecia. After treatment, all organisms were tested for colony growth using an agar plating technique. Colonies of S. chartarum were also tested for toxicity using a yeast toxicity assay with a high specificity for trichothecene mycotoxins. Results showed that chlorine dioxide gas at both concentrations completely inactivated all organisms except for C. globosum colonies which were inactivated an average of 89%. More than 99% of ascospores of C. globosum were nonculturable. For all ascospore counts, mean test readings were lower than the controls (P < 0.001), indicating that some ascospores may also have been destroyed. Colonies of S. chartarum were still toxic after treatment. These data show that chlorine dioxide gas can be effective to a degree as a fumigant for the inactivation of certain fungal colonies, that the perithecia of C. globosum can play a slightly protective role for the ascospores and that S. chartarum, while affected by the fumigation treatment, still remains toxic.
It has been difficult to confirm that a given building is responsible for allergic symptomatology, exacerbation of asthma, or immunological dysfunction. In fact, in most studies, few objective immunological parameters have been studied and only rarely has there been any quantitation of IgE or secondary mediators. Furthermore, although many studies deal with rhinitis or respiratory tract irritation, there is a misconception that all such symptoms are allergic in nature, and studies attempting to prove that allergies are caused by buildings frequently neglect to prove that these are indeed true allergic responses. In addition, many of the symptoms that people attribute to sick building syndrome (SBS) or building-related illness, such as headaches, dizziness, fatigue, nausea, cough, and eye irritation, are subjective, and studies often fail to take into account other possible causes that may be inherent in the subjects, such as sinusitis, hyperventilation syndrome, or psychosomatic illness. Unfortunately, most clinical studies on SBS pay little attention to the preexisting conditions that a subject may have and discount the possibility that the inciting agent does not cause symptoms, but merely exacerbates a preexisting condition. Moreover, they offer no information about the nature of the mechanisms of action or pathophysiological relationships. Clearly, further studies are necessary to further explain the complexity of complaints that currently exist. Indeed, SBS might properly be paraphrased as "what is it?--if it is!"
This study, which was conducted in central Italy, included (a) 525 office workers employed in an air-conditioned building that had fan coil units in every room (building B) and (b) 281 subjects who worked in three naturally ventilated buildings (building A) that were operated by the same public administration. The prevalence of work-related symptoms was assessed by a questionnaire that was administered by an occupational medicine specialist. The most frequent complaints of employees in building B were dry air, strong lighting, and high temperature. Employees who worked in this building experienced a statistically higher prevalence of symptoms that were characteristic of the sick building syndrome. This is the first time that this syndrome has been reported in Italy. Excessive illumination, a low relative humidity, and fiberglass on floors and furniture might have contributed to the symptoms. Inadequate maintenance of the building's air-conditioning plant and the employees' lack of information regarding self-regulation of the fan coil units may also have contributed to the prevalence of symptoms.
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In October 1985, six cases of legionnaires' disease were associated with a police headquarters building. Four were amongst staff who worked in or visited the communications wing of the headquarters and two cases occurred in the local community. A case-control study implicated the operations room of the communications wing as the main area associated with infection. This wing was air-conditioned and smoke tracer studies showed that drift from the exhaust as well as from the base of the cooling tower entered the main air-intake which serviced the air-conditioning system. Legionella pneumophila serogroup 1 subgroup pontiac was isolated from water and sludge in the cooling tower pond. Contaminated drift from the top of the cooling tower was probably responsible for the two community cases. An additional discovery was that symptoms suggestive of the sick-building syndrome were associated with working in this wing.
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