Building Related Health Problems

Deerfield Beach, Florida
By Albert F. Robbins , D.O., MSPH-FAAEM-CIE

(Text of PowerPoint slideshow authored by Dr. Robbins)

BOARD CERTIFIED: OCCUPATIONAL/ENVIRONMENTAL MEDICINE

ALLERGYCENTER.COM

420 W. HILLSBORO BLVD., DEERFIELD BEACH, FL 33441

ALBERTROBBINS@AOL.COM

954-421-1929

BUILDING RELATED HEALTH PROBLEMS

OVERVIEW:

1)HEALTH EFFECTS OF POLLUTANTS

2)BUILDING DESIGN FLAWS

3)OCCUPANT FACTORS

4)BUILDING RELATED DISEASES

5)ENVIRONMENTAL MEDICINE APPROACHES & TREATMENTS

6)PUBLIC HEALTH GUIDELINES BUILDING RELATED HEALTH PROBLEMS

1. •UNTRAINED PHYSICIANS -don’t know that they don’t know
2. •BUILDING RELATED SYMPTOMS -usually nonspecific, multisystem
3. •INDUSTRIAL HYGIENISTS –multiple exposures, complex interactions
4. •BUILDING OWNERS -not recognizing potential health risks

SPECIFIC BUILDING RELATED AGENTS

1. •ALLERGENS
2. •IRRITANTS-VOC’S
3. •BACTERIA & VIRUSES
4. •TOBACCO SMOKE
5. •PESTICIDES

1. •WOOD DUST
2. •COPY PAPER, FIBERGLASS, LASER TONERS
3. •FORMALDEHYDE
4. •ASBESTOS
5. •RADON

BUILDING RELATED HEALTH COMPLAINTS

1. •DISCOMFORT
2. •IRRITATION
3. •HEADACHE
4. •FLU-LIKE
5. •SKIN RASHES
6. •FATIGUE

1. •ALLERGY
2. •ASTHMA
3. •COUGH
4. •INFECTION
5. •COGNITIVE

DYSFUNCTIONBUILDING RELATED SYMPTOMS

1. •TARGET ORGANS VARY –BASED ON OCCUPANT FACTORS
2. •A MULTIFACTORIAL CUMULATIVE THRESHOLD EFFECT
3. •INFLAMMATION

HIGH INFLAMMATORY MEDIATORS

1. •FOUND IN NASAL FLUIDS OF PERSONS IN DAMP BUILDINGS
2. •MITES, BACTERIA, MOLDS, ENDOTOXINS ALL CONTRIBUTE
3. •MINIMIZED BY HUMIDITY & MOISTURE CONTROL IN BUILDINGS

ENDOTOXIN-LIKEIRRITANTS

1. •(1-3 )B-D GLUCANS are ENDOTOXIN-like substances that may be irritating & stimulate the immune system
2. •Several studies have implicated GLUCANS as causal factors in SBS and NSBRI

CAUSES OF BUILDING RELATED SYMPTOMS

1. 1)CHEMICAL VOLATILES -VOC’s
2. 2)POOR VENTILATION & AIRFLOW
3. 3)POOR CLIMATE CONTROL
4. 4)AIRBORNE MICROORGANISMS
5. 5)ALLERGENS
6. 6)SYNERGISM of MULTIPLE POLLUTANTS & POOR VENTILATION

INDOOR vs. OUTDOOR AIR

1. •LOW VENTILATION RATE
2. •RECIRCULATED AIR
3. •BUILD-UP OF POLLUTANTS

1. •ULTRAVIOLET LIGHT
2. •TEMPERATURE EXTREMES
3. •DILUTED AIR

"An ounce of fresh air equals a pound of indoor air"INDOOR POLLUTANT CONCENTRATION FACTORS

1. •EMISSION RATES OF POLLUTANTS INDOORS
2. •VENTILATION RATE
3. •OCCUPANT BEHAVIOR

INDOOR HEALTHPROBLEMS

"No common air from without is as unwholesome as the air within a closed room that has been often breathed and not changed."

Ben FranklinSICK BUILDING SYNDROME symptoms

1. •NEUROTOXIC EFFECTS
2. •MUCOUS MEMBRANE IRRITATION
3. •RESPIRATORY
4. •SKIN
5. •CHEMOSENSORY CHANGES

…symptoms usually subside on leaving the building;NOT linked to any specific pollutant or illnessBUILDING RELATED ILLNESS

1. •SYMPTOMS DON’T always LEAVE when leaving the building
2. •SYMPTOMS can be LINKED to EXPOSURE to chemical, biological, allergic or toxic substances

BUILDING RELATED ILLNESSES

1. •INFECTIOUS DISEASES
2. •PESTICIDE POISONING
3. •CARBON MONOXIDE
4. •RHINITIS & SINUSITIS
5. •ASTHMA

1. •HYPERSENSITIVITY

PNEUMONITIS

1. •NOSOCOMIAL INFX
2. •CONTACT DERMATITIS

HEALTH EFFECTS OF POLLUTANTS

1. 1)IRRITATIONAIRWAY & NEUROGENIC INFLAMMATION
2. 2)ALLERGY-ASTHMA, RHINITIS, URTICARIA OR HIVES, ALLERGIC ALVEOLITIS (HP); MULTISYSTEM
3. 3)TOXIC REACTIONS-TARGET ORGANS VARY-MULTISYSTEM
4. 4)INFECTIONS

ALLERGY

1. •THE GREAT MASQUERADER
2. •THE LONG "COLD"
3. •INFLAMMATION ANYWHERE
4. •IMMEDIATE AND DELAYED REACTIONS

1. •CUMULATIVE THRESHOLD EFFECT
2. •INFECTION COEXISTS
3. •TOXICITY OVERLAPS

ALLERGIC TRIAD

1. •EDEMA
2. •MUCOUS PRODUCTION
3. •SMOOTH MUSCLE SPASM

*ANYWHERE IN THE BODY;SITE SWITCHING OCCURSTYPES OF ALLERGIC REACTIONS

1. •TYPE 1–IGE –RAPID;ANAPHYLAXIS
2. •TYPE 2–IGG -Minutes to hours
3. •TYPE 3–IGG -Immune complexes-Hours to days
4. •TYPE 4–IGG-Lymphocyte mediated -weeks to months

CHEMICAL ALLERGY

1. •HAPTEN INDUCED
2. •IGE-IMMEDIATE
3. •IGG-DELAYED
4. •MISDIAGNOSIS
5. •CONTROVERSY

1. •IRRITANT EFFECT
2. •MULTIPLE MECHANISMS POORLY UNDERSTOOD

FORMALDEHYDE

1. •CHEMICALLY INDUCED IMMUNE SYSTEM DYSREGULATION
2. •ALLERGY & TOXICITY MAY OVERLAP
3. •MOBILE HOME SYNDROME
4. •UFFI;PARTICLEBOARD;CLOTHING STORES

PERCHLOROETHYLENE

1. •ARRHYTHMIA
2. •SHORTNESS OF BREATH
3. •VAGUE NEUROLOGIC SYMTOMS
4. •SOLVENT LIKE ENCEPHALOPATHY

*DRY CLEANING STORESMETHYLENE CHLORIDE

1. •VARNISH REMOVER used in poorly ventilated spaces
2. •CONVERTED TO CARBON MONOXIDE
3. •CAUSES CORONARY ARTERY SPASM
4. •SYMPTOMS OF HEART ATTACK AND LOSS OF CONSCIOUSNESS

PARADICHLOROBENZENE

1. •AIR FRESHENERS
2. •PLUG INS
3. •CLEANING CHEMICALS

1. •INCREASES POLLUTANT LOAD
2. •VOLATILE ORGANIC COMPOUND

HEXACHLOROBENZENE

1. •ANEMIA IN 2 YEAR OLD
2. •POISONED BY DOG FLEA DIP
3. •CHEMICALLY INDUCED ILLNESS!
4. •HIGHER SUSCEPTIBILITY IN CHILDREN
5. •BUILDING RELATED!

VOLATILE ORGANIC COMPOUNDS-VOC’s

1. •CARPETS, PAINTS, CLEANING SOLUTIONS, AIR FRESHENERS, LYSOL, PLASTICS
2. •SOLVENTS AND PESTICIDES
3. •PERFUMES

MICROBIAL VOLATILE ORGANIC COMPOUNDS

CAUSE OCCUPANT DISCOMFORT

1. •VOC’S ARE MUCOUS MEMBRANE IRRITANTS
2. •CAN IRRITATE THE AUTONOMIC NERVOUS SYSTEM

MOLD VOC’S

1. •What SMELLS in a basement, closet or carpet
2. •the ODOR in a musty building or apartment
3. •More than 500 VOC's have been identified from many different FUNGI

MOLD VOC’s-ARE CHEMICALS!

1. •ACETALDEHYDE
2. •ACETONE
3. •HEXANE
4. •BENZENE
5. •STYRENE

1. •ETHANOLS
2. •CARBON DISULFIDE
3. •ISOPROPANOLS

MOISTURE increases risk of AIRBORNE DISEASE

1. •DUST MITES grow: bedding, upholstered & soft furnishings
2. •COCKROACH, ENDOTOXINS,AND MOLDS
3. •MOLD VOC’S
4. •MYCOTOXINS

CAUSES OF MOISTURE

1. •HVAC SYSTEM FAILURES
2. •ROOF LEAKS
3. •OPERATIONAL PERSONAL NEGLECT
4. •HURRICANES & FLOODS
5. •CONSTRUCTION FLAWS
6. •PIPE BURSTS
7. •SEWAGE WATER BACKUP

MICROBIAL AGENTS

1. •RECENT IAQ STUDIES SUGGEST -MICROBIAL CONTAMINATION UNDERESTIMATED -microorganisms 35% to 50% of cases
2. •VISUAL INSPECTION & SMELL-DIAGNOSTIC

(1000-10000 CFU’S VIEWED WITH CONCERN-SAMPLING?)MICROBIAL AGENTS

1. •WHEREVER DIRT, WATER, HEAT AND AIR COINCIDE
2. •AIR SAMPLING UNNECESSARY
3. •ERADICATE THE RESERVOIR THROUGH MOISTURE PREVENTION & CLEANING

VIABLE BACTERIAFOUND IN SICK BUILDINGS

1. •Actinomycetes
2. •Microspora faeni
3. •Staphylococcus
4. •Streptococcus
5. •Pseudomonas species

(ALSO LEGIONNELLA AND TB)

(Austwick et al, 1989 -SBS Studies)

NOSOCOMIAL INFECTION

1. •MRSA
2. •PSEUDOMONAS

HOSPITAL INFECTIONS IN IMMUNOCOMPROMISED PATIENTS

MOLDS & FUNGI

1. •Reproduce by producing spores which can easily become airborne

1-2

MOLDS OR FUNGI

1. •FUNGI include mushrooms, mildews, molds & yeast
2. •More than 1,000 different KINDS of molds have been identified indoors
3. •200 pathogenic species identified

MOLDS & FUNGI

1. •Typically grows slower than bacteria
2. •Spores size varies -1.5 microns to 200 microns
3. •Spore sizes in water damaged environments typically are 1.0 to 10 microns (particles 10 microns & below are respirable) 2-2

FUNGI –TWO BASIC TYPES OF SPORES

1. Dry spores
1. –Aspergillus
2. –Penicillium
2. •These spores are easily disturbed and become airborne (bioaerosol)

1-2FUNGI –TWO BASIC TYPES OF SPORES

1. Slimy spores
2. •Fusarium
3. •Stachybotris

(likes to grow on cellulose)

2-2STACHYBOTRIS:TOXIC MOLD

1. •Greenish black SLIME mold
2. •Requires VERY WET conditions to grow
3. •Hidden within building envelope
4. •Capable of producing a very potent MYCOTOXIN -TRICOTHECENE
5. •Not easily airborne until DRY

SOURCES OF MOLD IN BUILDINGS

1. •Wallboard
2. •Ceiling tiles
3. •Insulation
4. •Duct work
5. •Air handling units

1. •Carpeting
2. •Humidifiers
3. •Plants
4. •Outdoor air

MOLDS GROW ON

1. •Cloth
2. •Carpet
3. •Leather
4. •Wood
5. •Insulation
6. •Foods

…whenmoistconditionsexist

FUNGAL CONTAMINATED ITEMS

1. •Foods
2. •Books
3. •Papers
4. •Furniture
5. •Pianos
6. •Bedding
7. •Fabric Wallpaper
8. •Curtains
9. •Clothing
10. •Stuffed Animals
11. •Hair Pieces
12. •Carpets
13. •Plants
14. •Artificial Plants

1. •Bathrooms
2. •Closets
3. •TV’s
4. •Air Conditioners
5. •Humidifiers
6. •Dehumidifiers
7. •Ice Machines
8. •Dishwashers
9. •Stoves
10. •Drip Pans
11. •Refrigerators
12. •Machine Parts
13. •Old Motor Driven Equipment

MOLD IMPACT ON HUMAN HEALTH DEPENDS ON…

1. 1)The MOLD SPECIES involved
2. 2)Metabolic PRODUCTS produced
3. 3)Individual EXPOSURE amount & duration
4. 4)INDIVIDUAL SUSCEPTIBILITY

HUMAN EXPOSURE TO MOLDS & PRODUCTS

1. •TOUCH, BREATHE OR EAT IT (Surface contact, air or food)
2. •SPORES, MICROBIAL VOC’s, MYCOTOXINS

AEROBIOLOGIC EXPOSURE PATHWAY

1. 1)SOURCE: Can it SURVIVE & MULTIPLY?
2. 2)AEROSOL: Can it become AIRBORNE in sufficient QUANTITY?
3. 3)EXPOSURE: Can it remain VIABLE long enough to cause disease?
4. 4)RESPONSE: Can it be INHALED by a susceptible host?

INCREASED HEALTH RISK--The Susceptible Population

1. •IMMUNOCOMPROMISED
2. •INFANTS
3. •ELDERLY
4. •PREGNANCY
5. •SMOKERS
6. •ASTHMATICS
7. •CHRONIC DISEASE STATES
8. •ATOPIC INDIVIDUALS

ADVERSE REACTIONS TO ODORS REPORTED

1. •May be a time dependant sensitization of the brain mediated through the olfactory nerve-Iris Bell, M.D.
2. •ABNORMAL ODOR PERCEPTION IS REPORTED-IN NONSPECIFIC BUILDING RELATED ILLNESSES
3. •MULTIPLE CHEMICAL SENSITIVITIES

AIRWAY INFLAMMATORYDISEASES

1. •ALLERGIC RHINITIS
2. •SINUSITIS
3. •REACTIVE AIRWAYS DISEASE
4. •BRONCHITIS & ASTHMA
5. •ALLERGIC ALVEOLITIS (HP)

ASPERGILLOSIS:AN ALLERGIC DISEASE

1. •Pulmonary, sinuses, subcutaneous tissues targeted; may involve GI tract, & brain
2. •Cough, wheezing, & fever; Infiltrates seen on chest x-ray
3. •An immune response to fungi colonizing airways ; <1% pr. Gen. Pop.
4. •Allergy to molds/elevated eosinophils & IgE
5. •A.Fumigatus commonly implicated-Graveson, 1994

ORGANIC DUST TOXIC SYNDROME (ODTS)

1. •Can occur after ONE heavy exposure to dust contaminated with fungi and other agents –mycotoxins, endotoxins, glucans, bacteria
2. •INHALATION FEVER
3. •FOG OF PARTICULATES OR THICK AIRBORNE DUST–not found usually in home
4. •SYMPTOMS: Flu-like, ache, pain, headache, lethargic feelings

HUMIDIFIER FEVER

1. •Caused by ENDOTOXINS of bacteria and fungi; MOISTURE & WARMTH
2. •Flu-like symptoms --chills, fever, bronchospasm, chest tightness; onset 6 hours after exposure lasting 24 hours
3. •No treatment necessary
4. •MONDAY MORNING FLU in schools & offices

ASTHMA

"A lung disease-characterized by at least partially REVERSIBLE AIRWAY OBSTRUCTION, INFLAMMATION, and increased AIRWAY RESPONSIVENESS to a variety of environmental stimuli."

(PREVALENCE 5-10%)ASTHMA EXPOSURES

1. •
2. •WORK, HOME & SCHOOL EXPOSURES
3. •HOME, PERSONAL AND OFFICE CHEMICAL PRODUCTS & FOODS
4. •MICROBIAL AGENTS ON CARPETS, BEDDING, CONTAMINATED VENTILATION SYSTEMS

HYPERSENSITIVITY PNEUMONITIS

1. •Caused by inhalation of fungi & the body’s IMMUNE RESPONSE TO COLONIZATION OF AIRWAYS
2. •DELAYED SENSITIZATION -months to years
3. •FLU-LIKE symptoms, cough, shortness of breath, tight chest, fatigue, myalgia, fever
4. •ALLERGIC ALVEOLITIS <1% pr. 1-2

HYPERSENSITIVITY PNEUMONITIS

1. •ACUTE, CHRONIC, INDETERMINATE
2. •SERUM ANTIBODIES, HIGH RESOLUTION CT LUNG SCANS
3. •DIAGNOSIS : THE CLINICAL PICTURE
4. •MUST IDENTIFY SOURCE TO PREVENT FURTHER CASES

H. PNEUMONITIS

1. •MOST CASES FROM OCCUPATIONAL EXPOSURES-AGRICULTURE
2. •PET BIRDS, HUMIDIFIERS, CONTAMINATED HVAC SYSTEMS
3. •THERMOPHILIC ACTINOMYCETES

( A BACTERIA)

2-2

INFECTIONS FROM FUNGI

1. •At risk are IMMUNE COMPROMISED individuals-HOSPITAL PATIENTS
2. •Fungi can target multiple organs
3. •INFECTION & ALLERGY may coexist as in ASPERGILLOSIS
4. •Fungal colonization of sinuses-Most common cause of recurrent sinusitis –

(Mayo clinic -1996 study)Noninfectious INTERSTITIAL LUNG DISEASE

1. •MYCOTOXIN PRODUCING FUNGI
2. •"CLUSTERS SUGGEST THAT MOISURE, DIRT, AND BIOAEROSOLS ARE NOT AS HARMLESS AS PREVIOUSLY ASSUMED"

(Text Occ Med, Rosenstock,et al-2005)MYCOTOXIN HEALTH EFFECTS

1. •Neurological effects(penetrates blood brain barrier) -Tremors & Convulsions
2. •Synergistic effects-Organic Dust Toxic Syndrome (ODTS)
3. •Cardiovascular effects-Rapid Heartbeat, Hypotension, & Others

1-3ASPERGILLUS MYCOTOXIN HEALTH EFFECTS

1. FLAVUS
2. •Aflatoxin
3. Hepatotoxic
4. Carcinogenic

1. FUMIGATUS
2. •Furnitremorans
3. Tremorigenic

1. OCHRACEUS
2. •Ochratoxin-A
3. Nephro-& Hepatotoxic

*(Aspergillus Aflatoxins

is toxic to brain, liver,

kidney and heart)EFFECTS OF MYCOTOXINS ON HEALTH

1. •LOWEST OBSERVED ADVERSE EFFECT is on the IMMUNE SYSTEM
2. •Manifested as increased SUSCEPTIBILITY to infections -FREQUENT COLDS & BACTERIAL INFECTIONS

(Croft, 1986; JAKAB, 1994)

1. •Almost all mycotoxins have an IMMUNOSUPPRESSIVE effect, although the exact target within the immune system may differ

MYCOTOXIN-ILLNESS ASSOCIATION

DEPENDS ON:

1. 1)HEAVY MOISTURE CONTAMINATION of patient’s environment
2. 2)HIGH LEVELS OF MOLD SPORES in the AIR!
3. 3)SYMPTOMS CONSISTENT with known effects of exposure
4. 4)CLINICAL EVALUATION must be objectively supportive

CONFIRM DIAGNOSIS: EXAMINE BLDG

1. •DETAILED ENVIRONMENTAL & OCCUPATIONAL HISTORY
2. •PHYSICAL EXAMINATION
3. •SYMPTOMS & TEMPORAL EXPOSURE RELATIONSHIP DOCUMENTED
4. •IMMUNE AND ALLERGY TESTING
5. •X-RAYS, CT SCANS
6. •RULE OUT OTHER CAUSES OF DISEASE

Unless ENVIRONMENTAL CAUSATION is considered

1. •DIAGNOSIS may be MISSED
2. •Environmental causation LINK may be MISSED
3. •TREATMENT may be INAPPROPRIATE
4. •OPPORTUNITY is MISSED to alert others similarly affected
5. •ILLNESS may PROGRESS & become irreversible

ENVIRONMENTAL HISTORY AXIOMS (TARCHER)

1. •Effects of environmental exposure may develop only after a long LATENCY period
2. •Many illnesses of environmental origin become CHRONIC and thereby show NO variation with EXPOSURE PATTERNS
3. •Diagnosis of an Environmental Illness cannot always be made with certainty because many illnesses are MULTIFACTORIAL

1-2

ENVIRONMENTAL HISTORY AXIOMS (TARCHER)

1. •Vague NEUROBEHAVIORAL symptoms in children & adults may be the norm in some environmentally induced illnesses. This is a CLUE to search for an environmental cause
2. •The SENSITIVITY OF THE BRAIN to toxic substances may provide an early barometer of their adverse effects

2-2

BUILDING WALKTHROUGH

1. •When WIDESPREAD ILLNESS is reported
2. •If LITIGATION is anticipated
3. •When a question of HEALTH RISK arises
4. •When a DECISION to evacuate or stay is REQUIRED

* OCCUPATIONAL/ENVIRONMENTAL PHYSICIAN should be CONSULTED!ENVIRONMENTAL ASSESSMENT

1. •VISUAL INSPECTION -water damage, mold growth, odors, ventilation system
2. •BULK/SURFACE SAMPLING -may be required?
3. •AIR MONITORING –may be required?

(NYC GUIDELINES/ACGIH)CARBON DIOXIDE

1. •INDICATOR OF VENTILATION ADEQUACY
2. •A REASONABLE PREDICTOR OF SYMPTOMS
3. •LEVELS ABOVE 1000 PPM INDICATE PROBLEMS

NONSPECIFIC BUILDING RELATED ILLNESS

1. •ATOPIC INDIVIDUALS RESPOND TO IRRITANTS AT LOWER LEVELS AND HAVE LOWER IRRITANT THRESHOLDS!
2. •WORK STRESS A FACTOR
3. •NSBRI-40% VENTILATION SYSTEM ASSOCIATION!-DENMARK STUDY

1. •THE IDENTIFICATION OF ARCHITECTURAL & ENGINEERING DEFICIENCIES BY THEMSELVES SHOULD LEAD TO REMEDIATION STRATEGIES
2. •20 CUBIC FEET OF OUTSIDE AIR PER OCCUPANT PER MINUTE (ASHRAE) RECOMMENDED

ENVIRONMENTAL DESIGN & CONTROL

1. •A REVIEW OF BUILDING SYSTEMS SUGGEST THAT THE MAJORITY OF BUILDINGS IN THE U.S. SIMPLY DO NOT MEET PROFESSIONAL DESIGN STANDARDS AND THEREFORE CONTRIBUTE TO HEALTH CONCERNS & OCCUPANT DISCOMFORT

SPACE DESIGN HEALTH RISK

1. •PLACEMENT OF AIR VENTS, FURNITURE AND PARTITIONS MAY INFLUENCE THE DISTRIBUTION OF AIR FLOW LEADING TO AIR QUALITY COMPLAINTS

HEALTH RISK OF OFFICE MATERIALS

1. •IDENTIFY POTENTIAL SOURCES OF CONCERN
2. •VOC EMISSIONS & HEALTH EFFECTS
3. •SECONDARY SINKS: CARPET, UPHOLSTERY, DRAPES

MEDICAL SURVEILLANCE

1. •REVIEW objective DATA with team Members
2. •LEARN when, why, & how PROBLEMS began
3. •UNDERSTAND OCCUPANTS: Who affected, what symptoms, & where affected
4. •RISK ASSESSMENT COMMUNICATION

1-2MEDICAL SURVEILLANCE

1. •LIMITATIONS OF DATA -communicate
2. •DECISION MADE -to occupy or vacate
3. •INTERIM CONTROLS -put in place
4. •MONITOR EFFECTIVENESS of interim controls and remediation

(IAQA)

2-2INTERIM CONTROLS

1. •PROPER REMOVAL of mold contaminated materials
2. •COVER visible mold reservoirs where able
3. •Increase AIR FILTRATION efficiency at HVAC systems
4. •ENHANCED CLEANING using HEPA vacuums
5. •Install temporary DEHUMIDIFICATION
6. •Install local HEPA AIR CLEANERS

HAZARD COMMUNICATION

1. •OCCUPANT NOTIFICATION of presence of contaminants
2. •Description of REMEDIAL MEASURES & TIMETABLE for completion
3. •SEEK MEDICAL ADVICE if health problems exist
4. •Copy of all INSPECTION RESULTS & interpretation provided to physicians

(NYC GUIDELINES)INCREASED RISK OF -POLLUTANT EXPOSURE

1. •RELATED TO ACTIVITY IN A ROOM
2. •RENOVATING BUILDINGS
3. •CHANGING CARPETS
4. •REMEDIATION usually requires proper protection and occupant removal

OCCUPANT REMOVAL (Hodgson-PUBLIC HEALTH)

1. •The presence of PHYSIOLOGIC ABNORMALITIES usually warrants REMOVAL of that individual
2. •The presence of SYMPTOMS ALONE require further investigation. Usually may work or live in home
3. •If large numbers of individuals are symptomatic, one is forced to remove individuals anyways

PUBLIC HEALTH CLINICAL PRACTICE GUIDELINES

1. 1)DOCUMENT DISEASE
2. 2)DOCUMENT EXPOSURE
3. 3)PROVE OR DISPROVE LINKAGE
4. 4)INTERVENE
5. 5)COMMUNICATE

(M. J. Hodgson, M.D., MPH)

"PRUDENT PUBLIC HEALTH PRACTICE

WOULD ADVISE:

1. •Speedy cleanup of molds found indoors and treat as if they are toxin producing
2. •And/or removal of a heavily exposed population from exposure "

CDC-2002

CDC ADVISES

BIBLIOGRAPHY

1. 1)ACOEM IAQ CONFERENCE –2000
2. 2)ACOEM EVIDENCE BASED STATEMENT 10/27/02
3. 3)Is Indoor Mold Contamination a Threat to Health?-H. M. Ammann, PhD.
4. 4)NYC DOH "Guidelines on Assessment & Remediation of Fungi in Indoor Environment"
5. 5)Fungi & Bacteria in Indoor Environment,

E. Johanning, M.D. & Yang

1. 6)State of the Science on Molds & Human Health, CDC -2002, S. Redd, M.D.
2. 7)Principles & Practice of Environmental Medicine–A. Tarcher, M.D.
3. 8)Textbook of Clinical Occupational & Environmental Medicine, second edition,Rosenstock,et al,Saunders, Philadelphia,2005

Copyright, 2003