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The sick making syndrome

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 .deckingcarshalton Signs and symptoms of the sick building syndrome are as follows[3]
Headache, dizziness, nausea, eye, nose or throat irritation, dry cough, dry or itching skin, difficulty in concentration, fatigue, sensitivity to odours, hoarseness of voice, allergies, cold, flu-like symptoms, increased incidence of asthma attacks and personality changes.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
Cough, chest pain, shortness of breath on mild exertion, edema, palpitations, nosebleeds, cancers, pregnancy problems and miscarriages. Extrinsic allergic alveolitis, Legionnaire’s disease, humidifier fever, pneumonia and occupational asthma are also known to occur.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]

The following are some of the factors that might be primarily responsible for SBS:From outdoor sources: Contaminants from outside like pollutants from motor vehicle exhaust, plumbing vents and building exhausts (bathrooms and kitchens) can enter the building through poorly located air intake vents, windows and other openings. Combustion byproducts can enter a building from a nearby garage. Radon, formaldehyde,
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.The biological contaminants include pollen, bacteria, viruses, fungus, molds, etc. These contaminants can breed in stagnant water that has accumulated in humidifiers, drainpipes and ducts or where water has collected on ceiling tiles, insulation, carpets and upholstery.

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]In 1970, oil embargo led building designers to make buildings more airtight, with less outdoor air ventilation, in order to improve energy efficiency.[7] The ventilation was reduced to 5 cfm/person. This reduced ventilation rate was found to be inadequate to maintain the health and comfort of building occupants. Malfunctioning heating, ventilation and air-conditioning systems (HVAC systems) also increase the indoor air pollution. In order to have an acceptable indoor air quality (IAQ) with a minimum energy consumption, The American Society of Heating, Refrigeration and Air-Conditioning Engineers (ASHRAE) recently revised ventilation standards to a minimum outdoor air flow rate of 15 cfm/person to avoid the problems related to inadequate ventilation. The standards are 20 cfm/person in office spaces and 60 cfm/person in smoking lounges.[1] Poor design and construction of buildings with more number of offices cramped in a building to increase the salable area also contribute to inadequate ventilation.¬†Electromagnetic radiationGadgets like microwaves, televisions and computers emit electromagnetic radiation, which ionizes the air. Extensive wiring without proper grounding also creates high magnetic fields, which have been linked to cancer. Psychological factorsExcessive work stress or dissatisfaction, poor interpersonal relationships and poor communication are often seen to be associated with SBS.

 

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:a walk-through inspection to look for sources of contamination, such as photocopiers, insulation and cleaning materials,measurement of temperature, humidity, air movement and other comfort parameters,measurement of carbon dioxide to assess the ventilation efficiency,measurement of formaldehyde, carbon monoxide, ozone and respirable particles andexamination of the ventilation system for causes of poor distribution, including tests for biological organisms in any water in the system[9]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.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.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.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 problBanning 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.

 

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