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Indian Journal of Occupational and Environmental Medicine, Vol. 12, No. 2, May-August, 2008, pp. 61-64 Review Article The sick building syndrome Joshi Sumedha M Department of Preventive and Social Medicine, Dr D. Y. Patil Medical College, Nerul, Navi Mumbai Code Number: oe08019 Abstract The sick building syndrome comprises of various nonspecific symptoms that occur in the occupants of a building. This feeling of ill health increases sickness absenteeism and causes a decrease in productivity of the workers. As this syndrome is increasingly becoming a major occupational hazard, the cause, management and prevention of this condition have been discussed in this article.Keywords: Building, sick, syndrome Introduction The sick building syndrome (SBS) is used to describe a situation in which the occupants of a building experience acute health- or comfort-related effects that seem to be linked directly to the time spent in the building. No specific illness or cause can be identified. The complainants may be localized in a particular room or zone or may be widespread throughout the building. [1]Classification The health conditions associated with buildings are commonly classified as: Signs and symptoms of the sick building syndrome are as follows [3] The cause of the symptoms is not known. It reduces work efficiency and increases absenteeism. Most of the complainants report relief soon after leaving the building, although lingering effects of neurotoxins can occur. Signs and symptoms of the building-related disease are as follows Legionnaire′s disease is due to contamination of cooling towers by legionella organisms. Legionella is also responsible for Pontiac fever. Legionnaire′s disease occurs predominantly in the middle aged and elderly adults whereas Pontiac fever occurs in young healthy adults, and has a very high secondary attack rate. [4] Humidifier fever is caused by breathing in water droplets from humidifiers heavily contaminated with microorganisms causing respiratory infections, asthma and extrinsic allergic alveolitis. The disease is noninfective in nature. The patient may have flu-like symptoms. It is sometimes called Monday Fever. Permanent lung damage does not occur. The symptoms can be clinically defined and have clearly identifiable causes. The complainants may require prolonged recovery time after leaving the building. It is important to note that complaints may also result from other cause like a preexisting illness or other allergies, job-related stress or dissatisfaction and psychosocial factors. [5] EtiologyThe following are some of the factors that might be primarily responsible for SBS: 1. Chemical contaminants 1.2. From indoor sources: The most common contaminant of indoor air includes the volatile organic compounds (VOC). The main sources of VOC are adhesives, upholstery, carpeting, copy machines, manufactured wood products, pesticides, cleaning agents, etc. Environmental tobacco smoke, respirable particulate matter, combustion byproducts from stove, fireplace and unvented space heater also increase the chemical contamination. Synthetic fragrances in personal care products or in cleaning and maintenance products also contribute to the contamination. 2. Biological contaminants Insect and bird droppings can also be a source of biological contamination. Biological contamination causes fever, chills, cough, chest tightness, muscle aches and allergic reactions. In offices with a high density of occupancy, airborne diseases can spread rapidly from one worker to another. Air-conditioning systems can recirculate pathogens and spread them throughout the building e.g., Legionnaire′s disease due to legionella organisms. [4],[6] 3. Inadequate ventilation 4. Electromagnetic radiation 5. Psychological factors 6. Poor and inappropriate lighting with absence of sunlight, bad acoustics, poor ergonomics and humidity may also contribute to SBS. Investigations 1. Evaluating the IAQ and identifying the contaminant by air sampling. The occupational health and safety resource centre at Canada′s University of Western Ontario has devised a routine five-point survey for occupational hygienists to follow when investigating air quality complaints (Ruhemann 1985). Features include: Prevention and Control 1. Increase the ventilation rates and air distribution. The heating, ventilation and air-conditioning systems should be designed to meet ventilation standards in the local building codes. The HVAC system should be operated and maintained properly to ensure that the desired ventilation rates are attained. If there are strong pollutants, the air may need to be directly vented to the outside. This method is especially recommended to remove pollutants that accumulate in specific areas such as rest rooms, copy rooms and printing facilities. The ASHRAE recommends a minimum of 8.4 air exchanges per 24 h. 2. Removal or modification of the pollutant source can be carried out by a routine maintenance of HVAC systems, replacing water-stained ceiling tiles and carpets, using stone, ceramic or hardwood flooring, proper water proofing, avoiding synthetic or treated upholstery fabrics, minimizing the use of electronic items and unplugging idle devices, venting contaminants to the outside, storing paints, solvents, pesticides and adhesives in close containers in well-ventilated areas and using these pollutant sources in periods of low or no occupancy. Allowing time for building material in new areas to off-gas pollutants before occupancy and smoking restrictions are some measures that can be used. 3. Air cleaning can be a useful addition to control air pollution. Air cleaning can be performed by ensuring uncongested interiors with open office designs, use of frosted glass and skylights that give access to natural light, terrace gardens, community spaces and indoor plants that absorb carbon monoxide and formaldehyde from the air. Air filters are also effective in removing some if not all of the pollutants. 4. Education and communication are important parts of any air quality management programme so as to work more effectively and efficiently to prevent and solve the health problems. 5. Legislation Banning of smoking in the workplace or restricting smoking to designated well-ventilated areas away from the work stations and creating no-smoking zones with the help of laws. In some European countries, workers have a statutory right to be involved with the employer′s plans for changes in the work place. 6. Research A field of study originating in Germany called Bau-biologie or Building biology has been initiated. The principles of Building biology are as follows: [11] 6.1. Site status The building site should be geologically undisturbed. Residential areas should be away from industrial centers and main traffic routes and housing should have sufficient green space and should be in harmony with the surrounding environment. 6.2. Construction concepts Natural, unadulterated and nontoxic building material should be used, walls, floors and ceilings should not be susceptible to mold or fungi, the basement should be waterproof and well -ventilated, the earth′s natural magnetic field should not be altered or distorted, production, installation and disposal of building materials should not lead to environmental pollution, building activities should not lead to exploitation of nonrenewable, rate resources. 6.3. Interiors Lighting and color must mix well with the surroundings and not jar the senses, man-made electromagnetic radiation must be reduced as much as possible, interiors should be done by using natural materials without toxic content and should be economically designed, there should be no toxic outgases or harsh smells, indoor humidity should be naturally regulated, air pollutants should be filtered and neutralized, thermal insulation should be balanced with heat retention, use of solar heating should be encouraged, moisture content in new buildings should be low, protective measures against noise pollution and harmful infrasonic and ultrasound radiation must be ensured, natural balance of atmospheric electricity and ion concentration should be maintained [Table - 2]. References
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