Sick Building Syndrome: Better building and maintenance techniques have spawned health problems stemming from poor IAQ

Public awareness over Indoor Air Quality was piqued in 1976 when a group of American Legionnaires was stricken by a mysterious illness. The level of concern has increased since then.

Public awareness over Indoor Air Quality (IAQ) was piqued in 1976 when a group of American Legionnaires was stricken by a mysterious illness while attending a convention in Philadelphia, leaving 29 dead.

The level of concern has increased since then, evidenced by terms and acronyms like IAQ, Sick Building Syndrome (SBS), Building Related Illness (BRI) and Volatile Organic Compounds (VOCs). More recently, the terms Microbial Volatile Organic Compounds (MVOCs) and Mycotoxins crop up routinely during discussions about building, building materials and indoor environments.

What do these terms mean and how do they affect building occupants? For the answer, Commercial Floor Care went to one of the country's leading experts, Ron Reese, CR, WLS, CMR of Hailey, Idaho (

"Each of the terms associated with Indoor Air Quality has a specific meaning," Reese said, "but generally they are related to a trend that has been occurring with more frequency since the 1970's. That trend is that a larger percentage of the population is complaining of health related problems that appear to be directly tied to the building that they work and live in."

Sick Building Syndrome
Where these complaints were shrugged off as unfounded just a few years ago, they are increasingly accepted as having a foundation in fact as more information is developed about the relationship between the quality of indoor air and the health of building occupants.

So what is SBS and should you as a building maintenance professional or facility manager care?

The short answer is a resounding 'Yes."

"SBS or Sick Building Syndrome is generally used to describe a sudden or acute onset of a wide variety of symptoms that don't have a readily identified cause, but are associated with a particular building or portion of a building," Reese explained. "Usually, the symptoms go away when the person leaves the building."

Why a problem now?
People have reported IAQ health problems since they began building shelter from the elements. There's a passage in the Old Testament (Leviticus) describing a mold remediation protocol to be conducted by the priest. The passage finishes by saying that if the problem cannot be corrected, the house is to be destroyed and the pieces hauled off to the dump.

So SBS is not new. Instead, it seems to become more pronounced while affecting larger percentages of the population as we become more successful in separating the indoor environment from the outdoor environment.

According to Reese, air conditioning, indoor plumbing, and better insulation and building techniques "have contributed to our comfort and likely to our building related health problems. If you were to try to tie the latest rise in complaints to one event, it would probably be the energy crisis of the early '70s and the changes in building practices that followed."

As most building maintenance professionals know, VOCs and MVOCs are the chemical gases given off by materials (glues, resins, fibers) and microbes (molds) that may be present in a structure. They may be the problem, leading to dramatic health consequences at certain concentrations in and of themselves (i.e., formaldehyde). Or, they may not be known to cause health problems but are merely the indicators of an associated problem as in the case of the MVOCs of mold.

According to Reese, national attention has focused like a laser on the effects of Mycotoxins associated with certain molds under some conditions. Chemical contaminants introduced into an indoor environment and concern over bacterial or viral sources like those associated with Legionnaire's disease may also be root and primary causes of SBS.

"Often these problems are a combination of contributing factors," Reese said. "Just as often, some seemingly minor change in the way a building works (i.e., application of a vapor retardant wall paint, closing of a foundation vent for winter or the addition of insulation) may be enough to trigger an event."

Changing standards
When national standards for air exchange between indoor and outdoor were cut from 15 cubic feet per minute (cfm) per occupant to 5 cfm, unforeseen consequences were realized as buildings became "airtight." Houses were wrapped, vapor barriers installed and stricter insulation standards implemented.

"Basically," Reese says, "building systems that had been teetering on the edge of 'working' went completely out of balance. Gases that had escaped to the outdoors with little effect on occupants and moisture that had passed relatively easily through structures with little serious consequence became trapped."

And people got sick. Accumulation was the primary culprit.

Taking note of SBS
Builders have taken note. The air exchange standard was recently returned to the previous minimum 15 cfm level by the American Society of Heating, Refrigeration and Air-Conditioning Engineers, with some conditions calling for up to 60 cfm per occupant.

In some cases, the consequences of new practices resulted in unacceptable outcomes. This has certainly been true in the case of the floor covering business. For years, that "new carpet smell" - analogous to that "new car smell" and associated with a fresh addition to the indoor environment - began to generate complaints by the building occupants.

"I'm sure this journal's readers are acutely aware of the changes that have taken place in suggested ventilation practices following a new installation and/or the changes that have occurred in the formulations of glues and adhesives used to install soft goods, vinyl and composite floor coverings," Reese said.

If it's too late to prevent the problem, what then?
If a problem has generated complaints but hasn't been traced to a specific source, it's important that some combination of an understanding of how building systems operate, interpretation of the complaints of the occupants, experience with successfully identifying and solving indoor air quality problems and, possibly, a dose of good luck are all facility managers and building maintenance professionals need for a diagnosis.

Rule out obvious things like a delivery truck parked and running next to the building air intakes or some equally obvious change in the building operation, like a furnace malfunction. Look for uncontrolled water from leaking pipes or roofs leaks.

"As is often the case," Reese says, "help from a professional in the field may be the best way to arrive at a successful conclusion to an indoor air quality problem. There is very little regulation of those who deal with these types of complaints, and finding the right combination of training, experience and investigative technique may take a little effort in and of itself."

Even the most educated, experienced and intuitive investigator may walk up a couple of blind alleys in developing a hypothesis, testing, confirming and evaluating the results before arriving at a workable solution. Referrals may mean as much as credentials as you look for someone to help solve an existing problem in your building.

The best defense? A good offense
When a combination of factors leads to an Indoor Air Quality (IAQ) problem, control of the individual components is the difference good IAQ and occupants suffering the consequences of Sick Building Syndrome (SBS).

According to Ron Reese, CR, WLS, CMR of Hailey, Idaho, "Increasing, improving and monitoring the rate at which the building exchanges indoor and outdoor air can be a relatively inexpensive way to see dramatic improvements in indoor air quality."

When new carpet or flooring is installed in a commercial facility or professional building, for example, simply opening windows or providing fans for mechanical assistance during initial off-gassing can lessen IAQ complaints. In an existing structure, such as federal building, facility maintenance professionals can provide outside make-up air to an HVAC system by working cooperatively with an HVAC professional.

That childhood admonition that "cleanliness is next to Godliness" speaks volumes about good IAQ. Air duct systems and furnace filters are prime candidates for regular cleaning or replacement, according to Reese, who also advises against "a chemical solution" to IAQ concerns.

Routinely spraying fragrances is not a solution, but instead can lead to a build up of chemicals in the indoor environment. Instead, Reese said facility managers and building maintenance professionals must prevent chemical contaminants from building up in the first place.

For more information, visit the Federal Environmental Protection Agency at

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