Lentis/Sick Building Syndrome

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Because sick building syndrome is a fairly recent issue, any professionals currently involved in design of buildings should be aware of the problem. Engineers and architects will play a key role in the future of designing buildings with the occupants in mind. By beginning to think about the building occupants before construction, it may be possible to decrease the number of people affected by sick building syndrome.

Although sick building syndrome was not recognised before 1980.[1]. Today it is defined by the Environmental Protection Agency (EPA) as a situation where a building’s occupants experience acute health effects that seem to be linked to time spent in a building, but no specific cause can be identified[2]. Symptoms include headaches, eye, nose or throat irritation, coughing, itchy skin, dizziness, nausea and fatigue and most sufferers report relief soon after leaving the building. What makes sick building syndrome an interesting phenomenon is the fact that it is defined by its lack of explanation and once a specific cause has been identified, it is no longer a sick building.[1].


Case Study: Sick Building Syndrome at the EPA HeadquartersEdit

In the United States, the first, most influential case of sick building syndrome occurred in the EPA’s headquarters in southwest D.C. The building was originally built for apartments in 1970 but converted to an office building for the EPA in 1971. Working conditions were poor with tiny offices, few windows, roaches, mice and clogged ventilation grills that left a black powder on surfaces. In 1987, the building owners installed new carpet to try and improve conditions.

EPA Headquarters at Waterside Mall

Many EPA employees reported sickness starting in 1988, a year after the Waterside renovations. Senior attorney, Amy Svoboda, worked in the EPA headquarters in SW DC. In 1988, she began to develop flu-like symptoms, as well as experiencing hearing loss, swollen joints, burning lungs, nausea, welts, and a loss of coordination. Amy, 35 years old at the time, played soccer and ran the stairs in the office for exercise during her lunch breaks, but the symptoms she experienced at work prevented her from continuing to do so and eventually remained with her even at home.

Amy was not the only one feeling ill-effects from work. Kirby Biggs, an analyst for the EPA, found that he could no longer read spreadsheets because, he says, it felt like he was making a paper cut across his eyeballs. Two hundred twenty five EPA employees reported burning eyes, headaches or other symptoms to an EPA nurse shortly after the renovations.[1]. The sick workers were from all over the building, so many thought that their illness was unique. Amy said that it was not until a survey was sent around inquiring about health symptoms that she connected her maladies to the building.[3].

After many complaints, the facilities management performed an air quality test of the building. They found 68 airborne chemicals but at no higher concentrations, they say, than in your home living room. . [1]. Not everyone working at Waterside experienced health symptoms while at work. One employee said he never felt ill. He remembers a pungent smell the day the roof was re-tarred, but it had no physical effect on him.[3].

Nineteen people sued S.E.W. Investors, the building owners, for permanent brain damage caused by the building. At first, the 19 were awarded $250,000 each ruling that it did not matter if the causes of their poor health were physiological or physical. Later, this ruling was overturned and the court declared that the owners were not responsible for the “psychogenetic illnesses.[1].

Probable CausesEdit

The US National Institute for Occupational Safety and Health has cited (in 1988) poor ventilation systems, microbial contamination, strong indoor pollution sources, and pollutants from outside as possible contributors to sick building syndrome[4].

Since 1988 further experience has identified additional sources that can contribute to sick building syndrome. Allergens can play a large part in the symptoms experienced by individuals. Allergens can cause true allergies, but most often individuals experience varying degrees of sensitivity. Allergens such as animal droppings (some examples include cockroach feces, rat urine and feces, fly feces) and human and animal dander. Dander and dust are by far the most common allergen found in indoor environments.[5]. Due to the nature of allergens, population sensitivities, genetics, age, health, diet, time being exposed and dose, people experience health symptoms in various ways. It is common for only a small part of a population to have symptoms from sick building syndrome or indoor air pollutants. This in no way reduces the validity of claims from individuals that they have symptoms.

Sick building syndrome has two variants: sick or tight building syndrome and building related illnesses. [6].

Sick building syndrome is a condition associated with complaints of discomfort including headache; nausea; dizziness; dermatitis; eye, nose, throat, and respiratory irritation; coughing; difficulty concentrating; sensitivity to odors; muscle pain; and fatigue. The specific causes of the symptoms are often not known but sometimes are attributed to the effects of a combination of substances or individual susceptibility to low concentrations of contaminants. The symptoms are associated with periods of occupancy and often disappear after the worker leaves the worksite.

Building-related illnesses are those for which there is a clinically defined illness of known etiology and include infections such as legionellosis and allergic reactions such as hypersensitivity diseases and are often documented by physical signs and laboratory findings. A more thorough description of these illnesses can be found in the American Conference of Governmental Industrial Hygienists (ACGIH) guidelines on evaluating bioaerosols.[7].

Inadequate VentilationEdit

During the oil crisis of the 1970’s, a need for energy conservation led to a reduction in the amount of outdoor air provided for ventilation. However, it was later found that these reduced ventilation rates were not adequate to maintain the comfort of the building’s occupants and contributed to the effects of SBS[2]. Inadequate ventilation may also be a source of micro-organisms and enhance the effects if indoor pollutants[4].

Microbial ContaminantsEdit

Microbial contaminants includes viruses, fungi, mold, bacteria, nematodes, amoeba, pollen, dander, and mites. Microbial contaminants can breed in stagnant water that accumulates in ducts, humidifiers, carpeting, insulation or other areas. Other areas include air handling system condensate, cooling towers, water damaged materials, high humidity indoor areas, damp organic material and porous wet surfaces, humidifiers, hot water systems, outdoor excavations, plants, animal excreta, animals and insects, food and food products. [6].

Acute health effects: Allergic reactions such as hypersensitivity diseases (hypersensitivity pneumonitis, humidifier fever, allergic rhinitis, etc.) and infections such as legionellosis are seen. Symptoms include chills, fever, muscle ache, chest tightness, headache, cough, sore throat, diarrhea, and nausea.

Indoor Contaminant SourcesEdit

Major Indoor Air Contaminants identified by U.S. OSHA include: [6].

1. Acetic Acid Sources: X-ray development equipment, silicone caulking compounds. Acute health effects: Eye, respiratory and mucous membrane irritation.

2.Carbon Dioxide Sources: Unvented gas and kerosene appliances, improperly vented devices, processes or operations which produce combustion products, human respiration. Acute health effects: Difficulty concentrating, drowsiness, increased respiration rate.

3.Carbon Monoxide Sources: Tobacco smoke, fossil-fuel engine exhausts, improperly vented fossil-fuel appliances. Acute health effects: Dizziness, headache, nausea, cyanosis, cardiovascular effects, and death.

4.Formaldehyde Sources: Off-gassing from urea formaldehyde foam insulation, plywood, particle board, and paneling; carpeting and fabric; glues and adhesives; and combustion products including tobacco smoke. Acute health effects: Hypersensitive or allergic reactions; skin rashes; eye, respiratory and mucous membrane irritation; odor annoyance.

5.Nitrogen Oxides Sources: Combustion products from gas furnaces and appliances; tobacco smoke, welding, and gas- and diesel-engine exhausts. Acute health effects: Eye, respiratory and mucous membrane irritation.

6.Ozone Sources: Copy machines, electrostatic air cleaners, electrical arcing, smog. Acute health effects: Eye, respiratory tract, mucous membrane irritation; aggravation of chronic respiratory diseases.

7.Radon (not a traditional pollutant, but included for completeness as a contaminant). Sources: Ground beneath buildings, building materials, and groundwater. Acute health effects: No acute health effects are known but chronic exposure may lead to increased risk of lung cancer from alpha radiation.

8.Volatile Organic Compounds (VOC's). Volatile organic compounds include trichloroethylene, benzene, toluene, methyl ethyl ketone, alcohols, methacrylates, acrolein, polycyclic aromatic hydrocarbons, and pesticides. Sources: Paints, cleaning compounds, moth-balls, glues, photocopiers, "spirit" duplicators, signature machines, silicone caulking materials, insecticides, herbicides, combustion products, asphalt, gasoline vapors, tobacco smoke, dried out floor drains, cosmetics and other personal products. Acute health effects: Nausea; dizziness; eye, respiratory tract, and mucous membrane irritation; headache; fatigue.

9.Miscellaneous Inorganic Gases. Includes ammonia, hydrogen sulfide, sulfur dioxide. Sources: Microfilm equipment, window cleaners, acid drain cleaners, combustion products, tobacco smoke, blueprint equipment. Acute health effects: Eye, respiratory tract, mucous membrane irritation; aggravation of chronic respiratory diseases.

10.Asbestos Sources: Insulation and other building materials such as floor tiles, dry wall compounds, reinforced plaster. Acute health effects: Asbestos is normally not a source of acute health effects. However, during renovation or maintenance operations, asbestos may be dislodged and become airborne. Evaluation of employee exposure to asbestos will normally be covered under the OSHA Asbestos standard.

11.Synthetic Fibers Sources: Fibrous glass and mineral wool. Acute health effects: Irritation to the eyes, skin and lungs; dermatitis.

12.Tobacco Smoke Sources: Cigars, cigarettes, pipe tobacco. Acute health effects: Tobacco smoke can irritate the respiratory system and, in allergic or asthmatic persons, often results in eye and nasal irritation, coughing, wheezing, sneezing, headache, and related sinus problems. People who wear contact lenses often complain of burning, itching, and tearing eyes when exposed to cigarette smoke.[8].

Tobacco smoke contains several hundred toxic substances including carbon monoxide, nitrogen dioxide, hydrogen sulfide, formaldehyde, ammonia, benzene, benzo(a)pyrene, tars, and nicotine.

Outdoor Contaminant SourcesEdit

Outdoor air pollutants such as vehicle exhaust can enter buildings through air intake vents, windows or other openings. These pollutants then become a form of indoor air pollution and can cause discomfort. [2]. The location of fresh air intake to the building in relationship to sources of outdoor pollutants is an area to investigate. Where outdoor contaminants can be taken up by the fresh air supply there can be an increase or buildup of contaminants indoors.

Investigation GuidelinesEdit

These guidelines have been developed by the U.S. Department of Occupational Health and Safety in their Technical Manual. [6].

Employer and Employee InterviewsEdit

1.Employer Interview

a.What is the magnitude and distribution of employee complaints or illnesses? Are any employees obtaining medical care? b.What are the design and operational parameters of the heating, ventilating, and air-conditioning (HVAC) system, such as source and amount of fresh air per occupant delivered to the breathing zone; adjustable or local HVAC controls; type of humidifier and how controlled; recent ventilation changes; and areas serviced by various units? c.Does the frequency and type of maintenance performed on the HVAC systems, such as cleaning and oiling, meet the HVAC manufacturer's recommendations: filter change; prevention of bacterial buildup by use of biocides; repair and cleanup of water leaks; operating fresh air intake damper; and system balance checks? d.Is smoking allowed in the office, in adjacent areas or in areas serviced by the same ventilation system? Are there designated smoking areas that have separate, nonrecirculating exhaust systems? e.What type of copying machines, signature machines, spirit duplicators, blueprint machines and other office machines are used in the vicinity of complaints or in areas serviced by the same ventilation system? f.Has there been any recent renovation or maintenance that can be a source of contaminants, such as painting, carpet installation, air conditioning repairs, use of acid drain cleaners, carpet cleaning, disinfecting of HVAC system, pesticide application? g.Has there been any recent renovation or maintenance that can alter air flow patterns such as installation of partitions or relocation of air intakes or exhausts?

2.Employee Interviews

a.What are the complaints and associated symptoms experienced; when do they occur (season, time, days, frequency); where do they occur; how long do symptoms last; do they clear up after leaving work (how soon); have the symptoms been triggered by any specific event or in any specific area; what is the source of symptoms; was any medical diagnosis or care rendered? b.What are the workers' characteristics, such as smoker, allergies, pre-existing illnesses and disabilities; are they taking any medication; what are the occupational contributors?

Walk-around InspectionEdit

NIOSH has determined that inadequate ventilation is the main problem in 52% of their IAQ investigations. Therefore, ventilation surveys should be initially conducted. During the walkaround inspection, the investigator could determine the building characteristics, discuss with knowledgeable personnel the proper operation of the HVAC systems, verify information obtained from the employer and employee interviews, perform ventilation-system testing, and, if appropriate, collect screening samples to identify potential causes of the problem.

Evaluation and testing of the HVAC system should follow the procedure established in the Ventilation Investigation chapter of the OTM. Investigators may need to discuss the operation of the ventilation system with building engineers and perform ventilation testing to determine proper fresh air intake. A simple traverse of the fresh-air intake duct may provide adequate information to determine the fresh-air flow. Measurements should be made under maximum and minimum air-flow conditions to determine the range of fresh-air intake.

The walkaround inspection should cover all the affected areas. Factors to be evaluated include inside and outside contamination sources; the HVAC system, e.g., location of air source, contamination, and proper operation; and occupational contributors.

1.Potential Problem Areas.

The following is a compilation of specific concerns in past investigations but may not apply in every situation.

a.Are there sources of indoor contaminants that could lead to employee complaints (e.g., copy machines, signature machines, blueprint copiers, paints, cleaning compounds and disinfectants, tobacco smoke, adhesives and glues, off-gassing of construction material and building fabric, contaminants generated by construction or renovation, positive- or negative-pressure work areas, improperly vented gas appliances, air fresheners, pesticides)? b.Are there sources of outdoor contaminants that lead to employee complaints (e.g., vehicle exhaust, roofing materials, cooling towers, dust, or other contaminants from construction activity, industrial plant, or building exhaust; gasoline vapors, pollen, biological contaminants, atmospheric pollutants)? c.Are heating, ventilating, and air-conditioning systems being operated and maintained properly with respect to location of air intakes and exhausts, pressure differentials between rooms that may account for influx of contaminants, design for supplied outdoor air, flow and distribution of air, position of dampers, local exhaust ventilation, air-cleaning equipment, HVAC operating times, regular operation checks, equipment cleaning and disinfecting, presence of water leaks or standing water, water-damaged building materials, and bacteriological contamination?

2.Sample Collection

a.During the walkaround inspection, professional judgment must be exercised to determine if samples should be collected to evaluate potential sources and potential contaminants including gases, vapors, and particulates. b.Initial sampling will normally consist of collecting environmental data using grab or screening samples with direct reading equipment such as detector tubes, particulate monitors, air velocity measuring instruments, and psychrometers. Screening samples for airborne contaminants should be collected for formaldehyde, carbon dioxide, carbon monoxide, and VOC's which are common potential sources of contamination. c.Samples may be collected to monitor the possible buildup of contaminants during the workday. Detector tube samples can be collected for carbon dioxide early in the day and again toward the end of the day; direct reading instruments can monitor continuously using a strip chart recorder to obtain a hard copy of contaminant variations during the day. d.To evaluate thoroughly, collect samples at fresh-air intakes, near return-air ducts, adjacent to both indoor and outdoor potential sources of contaminants, and in employee work areas both for complaint and noncompliant areas. Sampling methods and equipment are covered in Section IV.

Environmental EvaluationEdit

Based on initial sampling, further investigations may be performed using standard OSHA sampling procedures listed in the OSHA Analytical Method Manual.

1. Microbiological Evaluation a.NIOSH found that 5% of its investigations of indoor air quality involved some type of microbiological contamination. The ACGIH Bioaerosols Committee's guidelines for assessing the role of bioaerosols[7] contains information on sampling, analysis, and recommendations for remedial actions. Air sampling should be initiated only after medical or clinical reports indicate the existence of workplace-related illnesses, such as hypersensitivity and allergic disorders, that are likely due to bioaerosols. The Office of Occupational Medicine should be consulted before initiating any sampling.

Sampling Instrumentation and MethodsEdit

A. Low Contaminant Levels

1.Choose sampling procedures that can determine concentrations of toxic materials that are much lower than are normally found in industrial investigations. Few procedures have been validated for these lower level contaminants.

2.Present OSHA sampling and analytical procedures were developed to meet precision and accuracy requirements for airborne contaminants in the range of OSHA Permissible Exposure Limits (PEL's) and American Conference of Governmental Industrial Hygienists (ACGIH) Threshold Limit Values (TLV's). These procedures are used for sampling 8-hour Time-Weighted Averages (TWA's) and Short-Term Exposure Limits (STEL's) of 15 or 30 minutes.

3.In many IAQ investigations, extensive air monitoring may not be warranted because inadequate introduction and/or distributions of fresh air may be the main problem.

B. General Screening

Use screening techniques to determine the potential sources that may require more sensitive and accurate evaluation or may require action as described in Section E, depending upon professional judgment.

1.Collect screening samples using detector tubes or direct reading instruments. For increased sensitivity, higher flow rates or longer sampling times may be used. Low range detector tubes are available from manufacturers. Appendix III:2-2 contains a table of screening methods, concentration range, validated testing methods, and contaminant types.

2.Based on screening results, validated sampling procedures may be required to further quantify employee exposures. Much of the information on validated sampling and analytical methods is contained in the OSHA Chemical Information Manual or in the OSHA Analytical Methods Manual.

C. Optional Screening For Common Indoor Air Contaminants, Based Upon Professional Judgment

1.Acetic Acid. Use detector tubes (0-10 ppm) to evaluate complaints of eye, nose, and throat irritation. Low levels of acetic acid have been found from off-gassing of silicone caulking compounds and in hospitals where x-ray developing equipment is improperly ventilated.

2.Asbestos. Screening is not a routine procedure. Any requested screening should be done in accordance with the proper OSHA Standards.

3.Carbon Dioxide. Use low level detector tubes (0-2000 ppm) or portable infrared spectrometers to screen for indoor carbon dioxide levels. Carbon dioxide measurement is a useful screening technique which is often helpful in determining whether adequate quantities of outside fresh air have been introduced and distributed into the building.

NIOSH recommendations: ◾ 250-350 ppm - normal outdoor ambient concentrations ◾ 600 ppm - minimal air quality complaints ◾ 600-1,000 ppm - less clearly interpreted ◾ 1,000 ppm - indicates inadequate ventilation; complaints such as headaches, fatigue, and eye and throat irritation will be more widespread; 1,000 ppm should be used as an upper limit for indoor levels

These levels are only guidelines. If carbon dioxide levels exceed 1,000 ppm it does not necessarily indicate that the building is hazardous and should be evacuated. Rather this level should be used as a guideline that helps maximize comfort for all occupants.

4.Carbon Monoxide. Low-level detector tubes (2-200 ppm). Direct-reading CO monitors.

5.Formaldehyde. Use low-level (0.04-1 ppm) detector tubes to evaluate complaints of eye, nose, and throat irritation which may be due to off-gassing from insulation, building materials, carpets, drapes, or glues and adhesives.

6.Nitrogen Oxides and Ozone. Detector tubes. Also collect outdoor samples since ambient levels of ozone may reach levels that are 1-3 times the PEL of 0.1 ppm during air-temperature inversions. If a more accurate or continuous ozone evaluation is required, a chemiluminescent monitor that is specific for ozone and can measure in the range of 0.01 to 10 ppm is available from the HRT.

7.Radon. A rapid, easy-to-use screening method for measuring radon gas concentrations is available. It is used for deciding if additional measurements are required or remedial actions should be undertaken. Additional longer-term quantitative procedures are available.

8.Airborne Particulates. Use a particle counting instrument capable of measuring concentrations as low as 2,000 particles/cubic centimeter (cc) of air for comparing particulates in various areas. The investigator may be able to determine where additional ventilation or air filtration is necessary to eliminate or minimize employee complaints.

For example, if employee complaints are more prevalent in an area where the particulate concentration is 40,000 particles/cc, and other areas are below 15,000 particles/cc, the investigator may recommend that a high efficiency filter be installed or, if the area has a separate ventilation system, that the ventilation rate be increased.

9.Airborne Microorganisms. The ACGIHrecommends a pre-assessment of the extent of microbial contamination prior to initiation of air sampling..[7].

Before biological sampling, several precautions must be taken including making arrangements for preparing culture media for sampling, specialized shipping procedures, and making arrangements for analysis by a laboratory familiar with the handling and processing of biological samples.

Legionella pneumophila is often present in hot water tanks, washing systems, and pools of stagnant water, but health effects are not observed until the contaminants become aerosolized within the building confinements.

The identification of predominant taxa, or at least fungi, is recommended in addition to determining the number of colony-forming units/m3 of air (cfu/m3). During growing seasons, outdoor fungus-spore levels can range from 1,000 to 100,000 cfu/m3 of air.

Contamination indicators:[9].

◾1,000 viable colony-forming units in a cubic meter of air ◾1,000,000 fungi per gram of dust or material ◾100,000 bacteria or fungi per milliliter of stagnant water or slime

Levels in excess of the above do not necessarily imply that the conditions are unsafe or hazardous. The type and concentrations of the airborne microorganisms will determine the hazard to employees.

Miscellaneous Airborne ContaminantsEdit

1.Use a portable infrared spectrometer to evaluate a wide variety of potential air contaminants including acetic acid, ammonia, carbon dioxide, carbon monoxide, nitric oxide, nitrogen dioxide, sulfur dioxide, and a number of volatile organic compounds. It can be connected to a strip chart recorder to obtain a hard copy showing variations of concentration during the day.

2.Take care in interpreting the results since the instrument is not always specific for one compound.

Recommendations for the EmployerEdit

The following are general recommendations which, where relevant, should be standard procedure. If followed, they may prevent or alleviate many indoor air-quality problems.

Engineering RecommendationsEdit


a.Includes the use of natural, dilution, local exhaust, or increased ventilation efficiency. The most effective engineering control for prevention of indoor air quality problems is assuring an adequate supply of fresh outdoor air through natural or mechanical ventilation.

b.ASHRAE in its 62-1989 standard recommends 20 cubic feet per minute (CFM) of outdoor air per occupant for offices. For smoking lounges, up to 60 CFM of outdoor air per occupant should be provided.

c.When possible, use local exhaust ventilation and enclosure to capture and remove contaminants generated by specific processes. Room air in which contaminants are generated should be discharged directly outdoors rather than recirculated.


a.Ventilation efficiency can be improved by:

◾Ensuring that outdoor air-supply dampers and room air-vents are open; ◾Removing or modifying partitions or obstructions that block fresh-air flow; ◾Rebalancing the system to prevent inflow or outflow of contaminated air due to pressure differentials between rooms; ◾Preventing poor distribution of make-up air by proper placement of air inlets and exhausts; and ◾Using room fans to improve mixing and dilution of pollutants.

b.Outside air intakes should not be located in close proximity to potential sources of contamination (automobile garages, cooling towers, building exhausts, roadways).

3.Air Treatment. Air treatment is the removal of air contaminants and/or the control of room temperature and humidity. Recommendations for air treatment include: ◾The use of filtration, electronic cleaners, chemical treatment with activated charcoal or other sorbents; ◾Humidity control in the range of 20%-60%; and ◾Temperature control in the range of 68-76 F.

4.Source Controls. Source controls include substitution, removal, encapsulation, local exhaust ventilation, and use of physical barriers.

Administrative and Work Practice RecommendationsEdit

Recommendations include programs that change the behavioral patterns of occupants.

1.Preventive Maintenance (PM). Preventive maintenance plans for humidifiers, water spray, and other HVAC system components should include: ◾Checking damper positions and functioning belts, baffles, ductwork, and system balance; ◾Measuring airflow and performing necessary adjustment if necessary to meet ASHRAE recommendations; ◾Replacing filters on air handling units at regular intervals; ◾Cleaning air distribution ducts and dampers; and ◾Replacing damaged insulation.

2.Microbial Contamination a.Eliminate or control all known and potential sources of microbial contaminants by prompt cleanup and repair of all areas where water collection and leakage has occurred including floors, roofs, HVAC cooling coils, drain pans, humidifiers containing reservoirs of stagnant water, air washers, fan coil units, and filters. b.Remove and discard porous organic materials that are contaminated (e.g., damp insulation in ventilation system, moldy ceiling tiles, and mildewed carpets). c.Clean and disinfect nonporous surfaces where microbial growth has occurred with detergents, chlorine-generating slimicides, or other biocides and insuring that these cleaners have been removed before air handling units are turned on. d.Maintain indoor air relative humidity below 60% (50% where cold surfaces are in contact with room air). e.Adjust intake of outdoor air to avoid contamination from nearby soil, vegetable debris, cooling towers, or sanitary stacks unless air is adequately conditioned. f.Adjust combustion sources such as furnaces or water heaters to assure proper burning and exhaust to an area where re-entrainment will not occur. g.Minimize exposure by limiting occupancy of contaminated airspace, limiting use of offending sources to specific areas or times, or evacuating contaminated areas until they can be ventilated adequately. h.Isolate, if feasible, areas of renovation, painting, carpet laying, pesticide application, etc., from occupied areas that are not under construction. If possible, perform this work during evenings and weekends. If ventilation is turned off during weekends or other periods, ensure that system is on so that contaminant concentrations are sufficiently diluted prior to occupancy. i.Supply adequate ventilation during and after completion of work to assist in diluting the contaminant levels. j.Personnel affected with hypersensitivity should be thoroughly evaluated and the problem identified and corrected before returning them to the workplace. If, after the remedial action, the illness persists in the workplace, the affected personnel should be considered for permanent reassignment to another area. k.Eliminate or reduce contamination of the air supply with cigarette smoke by banning smoking or restricting smoking to designated areas which have their air discharged directly to the outdoor rather than recirculated.


Investigations of office related complaints using industrial hygiene techniques often fail to identify the source of these problems. The combined effects of multiple, low-level air contaminants have not been investigated thoroughly and may be a cause of the problem.

In a recent NIOSH document, Stress Management in Work Settings, occupational stress is discussed in terms of assessment methods, stress management, and programs and training necessary to reduce occupational stress. The synergistic effect of multiple stressors appears to indicate that building-related problems may be more than an air quality problem. The combined effect of these multiple stressors may interact with employees and could result in acute adverse emotional or physical reactions. In the short term, these reactions may lead to decreased productivity, absenteeism, and high turnover rates and if prolonged may lead to a variety of illnesses including hypertension, coronary heart disease, ulcers, alcoholism and mental illness.

These office-related health problems can be evaluated by a consultant through employee interviews, analysis of job demands, and training employees. The following potential problems may need to be addressed: ◾Physical hazards including noise from nearby sources such as air conditioning systems and printers, inadequate lighting, stress from the operation of video display terminals (VDT's), vibration sources, extremes of heat, cold and humidity, drafts, and poor air circulation. ◾Ergonomic problems such as carpal tunnel syndrome or inflammatory disorders of the tendons and joints of keyboard operators due to tasks requiring repetitive motions. Proper design of fixed work stations where employees are required to perform repetitive tasks includes proper lighting to prevent glare, maintaining temperature and humidity in a comfortable range with minimum temperature variations, maximum flexibility in work station design including adjustable chair, keyboard, and screen height, and a work-rest regimen that allows breaks to reduce psychological distress. ◾Reduction of job stress by: (a) adequate flow of information from management to employees; (b) explanation of any changes introduced into the workplace including new chemicals, ventilation, production modification, and work schedules; (c) maximizing employee participation in planning and implementing changes; (d) stress reduction techniques including exercise, biofeedback, and assertiveness training; and (e) training workers to understand chemicals they may be working with and their health effects, dose/response relationships, and results of environmental evaluation.

Psychological AspectsEdit

Often many probable causes exist and symptoms cannot be traced to a specific origin. Symptoms have also been shown to increase along with factors such as job stress, time spent in front of a computer screen, and decreased job status[4]. In fact, in every study in which work stress has been considered as a factor, it was clearly correlated with SBS symptoms[4]. This suggests that sick building syndrome may be exacerbated by physical and psychological stressors.

Building OwnersEdit

At the other end of the spectrum, building owners are now potentially liable for the adverse health effects caused by their buildings. Owners must be concerned for the health of their building occupants, because many sick building syndrome lawsuits have occurred between building occupants and owners. Personal injury lawyers have become increasingly common in sick building syndrome cases, some even listing sick building syndrome as a specialty[10].

Green Building Council Comfort RecommendationsEdit

US Green Building Council’s (USGBC) Leadership in Energy and Environmental Design (LEED) standards express concerns about ventilation in buildings. It is possible to gain additional credits toward a certified building by providing increased ventilation, in addition to what is required. Emphasis is also placed on the comfort of the building occupants, by providing credits toward certification for allowing occupants access to temperature and lighting controls. The measures taken by USGBC illustrate the importance that is now being placed on the comfort and safety of building occupants[11].

The US Environmental Protection Agency (EPA) has also issued information on Federal Facilities Indoor Air. They provide tips on how to create a healthy indoor environment, saying a building occupant’s surroundings should “contribute to productivity, comfort, and a sense of well-being”[12]. They have also created a list (Building Air Quality Action Plan) of preventative measures that can be taken in order to prevent building occupants from experiencing sick building syndrome symptoms. A large emphasis in this list is put on communication between building occupants, managers and owners. It encourages getting everyone involved in making buildings healthy and safe environments[12].


  1. a b c d e Murphy, Michelle. (2006).Sick Building Syndrome and the Problem of Uncertainty: Environmental Politics, Technoscience, and Women Workers. Durham: Duke University Press.
  2. a b c U.S. Environmental Protection Agency. (2010). Indoor Air Quality (IAQ). Retrieved November 14, 2010, from http://www.epa.gov/iaq/pubs/sbs.html.
  3. a b Pratt, Sarah.(1996, December). Every Breathe She Takes.Spin, 12, 110-181.
  4. a b c d Stellman, Jeanne. (Ed.). (1998). Encyclopaedia of Occupational Health and Safety". Switzerland: International Labour Organization.
  5. Web MD Article, Indoor Allergy Triggers retrieved March 29, 2017 from http://www.webmd.com/allergies/features/indoor-allergies-triggers.
  6. a b c d U.S. Department of Occupational Safety and Health. (2016) Technical Manual, Chapter 2, Indoor Air Quality Investigations. Washington DC, US OSHA. Retrieved March 29, 2016 from https://www.osha.gov/dts/osta/otm/otm_iii/otm_iii_2.html.
  7. a b c ACGIH Committee on Bioaerosols, American Conference of Governmental Industrial Hygienists(1987). Guidelines for Assessment and Sampling of Saprophytic Bioaerosols in the Indoor Environment.
  8. National Institute for Occupational Safety and Health (NIOSH) Guidance for Indoor Air Quality Investigations. Cincinnati, OH (1987).
  9. Brief, R. S. and T. Bernath.Indoor Pollution: Guidelines for Prevention and Control of Microbiological Respiratory Hazards Associated with Air Conditioning and Ventilation System. Applied Industrial Hygiene. 3(1):5-10.(1998)
  10. Cook, J. R. (2003). Personal-Injury.com. Retrieved November 14, 2010, from http://www.personal-injury.com/
  11. U.S. Green Building Council. (2010). LEED. Retrieved November 14, 2010, from http://www.usgbc.org/DisplayPage.aspx?CategoryID=19
  12. a b U.S. Environmental Protection Agency. (2010). Federal Facilities Indoor Air. Retrieved November 14, 2010, from http://www.epa.gov/region1/enforcement/fedfac/iaqbroc.html