IEQ and Respiratory Health in School Buildings Integrating epidemiology and engineering to better un

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IEQ and Respiratory Health in School
BuildingsIntegrating epidemiology and
engineering to better understand the relationship
and mitigate the problem

• Paula Schenck, MPH
• Division of Occupational and Environmental Health
• University of Connecticut Health Center (UCHC)
• 860-679-2368 schenck_at_nso2.uchc.edu

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• Co-authors
• Eileen Storey, MD, MPH
• UCHC
• William A. Turner, MS, PE
• Turner Building Science, LLC
• John E. Yocom, PE, CIH
• Environmental consultant

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UCHC Schools Focus

• Supported by
• Connecticut Departments of Labor and Public
  Health
• US Environmental Protection Agency
• National Institute for Environmental Health
  Sciences
• Oak Ridge Institute for Science and Education
  CDC/NIOSH
• UCHC

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UCHC Schools Team

• Eileen Storey, MD, MPH
• Angela Bermudez-Millan, MPH
• Robert DeBernardo, MD, MPH
• Anne Bracker, CIH, MPH
• Cande Pettigrew, BSN COHN
• Paula Schenck, MPH
• Engineering collaboration with Turner Building
  Science

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UCHC Experience

• Teachers evaluated with respiratory complaints,
  laryngitis, headaches, dizziness and vertigo in
  the occupational and environmental medicine
  clinic
• Industrial hygiene evaluations and intervention
  recommendations at school sites
• CT Resource Team support for Tools for Schools
  implementation throughout the state
• Involvement in Connecticut Academy of Science and
  Engineering (CASE) review of IEQ in CT schools
• Guidance to specific schools on IEQ

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UCHC Pilot Research

• Six schools study- more frequent respiratory
  symptoms among asthmatics in wet buildings
• Middle school pulmonary function
  test- childrens cohort showed declining trend in
  respiratory function in problem school
• Asthma in elementary schools-the difference in
  the prevalence of asthma across a group of
  schools may be attributable to building
  environment
• School environment and health - indoor air
  quality measures in school rooms reflected the
  relative level of health complaints

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Health and Quality of Life Concerns

• Health impacts
• Sick building syndrome
• Building related illness
• Allergic, irritant, toxic, infectious
  mechanisms
• Productivity
• Absenteeism
• Poorer student and teacher performance

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Building-related Respiratory Disease

• Rhinitis
• Sinusitis
• Laryngitis
• Asthma
• Hypersensitivity pneumonitis (HP), and
• Infectious diseases, i.e. legionella

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Strategies to Evaluate Risks and Health Effects

• Epidemiological studies questionnaires physiolog
  ical testing
• Individual clinical assessment medical
  history/physical examinationphysiological
  testing
• Industrial hygiene evaluation
• contaminant levels
• exposure assessment
• hazard control recommendation

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What Are the Roles Of

• Medical evaluations
• Epidemiological studies
• Industrial hygiene investigations
• Engineering assessments

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Medical and epidemiological approaches can help
by

• clarifying the individual health problem
• suggesting the type of agent
• guiding the industrial hygienist to probable site
  of exposure(s)
• bracketing the complexity and seriousness of the
  IEQ problem
• identifying individuals at risk
• supporting risk communication and
• monitoring the success of the intervention.

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Industrial hygiene assessments of schools

• link illness with environment
• assess agents and exposures
• define risk and support communication with school
  community
• provide guidance on intervention opportunities to
  reduce exposures and prevent respiratory illness.

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Engineering focus is critical to

• assessing the history and condition of the
  building
• finding the causes of IEQ problems
• formulating the options and costs for
  interventionand
• identifying priorities.

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Medical and Epidemiological Approach

• Occupational illness model and patient treatment
• School nurse logs and interviews
• Questionnaire surveys
• On-site physiological testing

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Epidemiological Approach

• Questionnaire surveys
• Describe the participants, their health status,
  and their symptoms
• Explore factors in the occupants homes
• Help define occupants exposure to the buildings
  environment
• Explore work-relatedness
• Provide guidance on intervention (correcting
  building indoor environment problems)
• May identify individuals at risk

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Epidemiological Approach

• Physiological testing
• Lung function measurements partially evaluate the
  health of the participant group while in the
  school (limited by power and difficulties of
  testing in a non-clinical setting)
• Comparison of spirometry results across a school
  week may indicate building-related effects

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Industrial Hygiene Investigation

• Qualitative
• review building history and past reports
• interview staff
• building assessment
• explore outdoor sources
• walk-through to characterize environment
• review sources
• presence of chemicals
• evidence of microbial growth
• use of equipment and other materials

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Industrial Hygiene Investigation

• Qualitative (continued)
• assess pattern of air movement and operation of
  HVAC
• identify exposure pathways
• Quantitative
• inventory materials used
• environmental measurements
• biological measurements
• difficulties and limitations
• establish need
• Hazard control recommendations

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Engineering Focus

• Building-science lens
• HVAC adequacy
• Control known sources of agents
• Stop all sources of moisture (as a surrogate
  for microbial contaminants)
• Identify and prioritize options

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Engineering and medical collaboration

• Developing investigatory tool
• useful in setting of health concerns
• uses qualitative assessment of moisture and dirt,
  odor, as an indicator of mold contamination
• preliminary experience in school
• School case study

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A public middle school case study

• 400 students----1999
• 40 staff----1999
• 97.6 attendance
• 20 students average class size
• 30 classrooms
• Built in 1950s with a major add-on 1960s
• District-wide building improvement program in
  planning stages

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A school with an IEQ problem, initial signs

• Staff with symptoms seeking care
• Active, vocal parents expressing concern
• IH surveys identify inadequate fresh air,evidence
  of microbial reservoirs and likely exposure
  pathways

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School District Response

• District hires engineer as facilities manager to
  manage IEQ problems and overall district-wide
  building project
• Team approach adopted
• Issues identified
• IEQ
• Risk communication
• Solution development
• Financing building improvements

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Further indications of IEQ problem as work
progresses

• Teacher diagnosed with occupational respiratory
  disease, cant tolerate being in the building and
  removed from the school.
• Building assessment
• moisture failed roof system, likely water
  incursion through walls and windows
• ventilation inadequacy confirmed
• bulk sampling confirms biological reservoirs, but
  chemical contaminants were not specifically
  identified
• likely paths of exposure identified

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Further indications-staff survey results

• Irritant and comfort symptoms widespread and
  more prevalent then respiratory symptoms among
  the occupants
• Occupant survey indicates patterns of respiratory
  disease corresponding to certain zones
• Responses to selected IUAT, and Arnow and Fink
  questions indicate individuals possibly at risk
  (broad screen)

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Developing a plan for solution

• Phase the approach realistically and address the
  financing challenge
• Identify what in the condition of the building
  has contributed to poor IEQ and incorporate
  actions into over building improvement project
• Implement improvements to reduce known exposures
  immediately
• Maintain IH oversight
• Increase outreach to staff and parents
• Monitor health of staff and students

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• The problem of IEQ in schools is complicated by
  many factors
• (increasing prevalence of respiratory disease,
  role of environment in schools, school systems
  pressures and challenges, and community
  priorities).
• Public health tools, environmental assessment
  and engineering have complementary strengths that
  work well together to address this issue.