<s docid="LA122689-0070" num="54"> The World Health Organization has estimated that up to 30% of new and remodeled buildings may be plagued by indoor air quality problems -- an estimate borne out by widespread reports of "sick building" illnesses, including government workers at the EPA's own headquarters in Washington.</s>

<s docid="FR940405-1-00054" num="8"> These adverse health effects range from irritation effects to more severe, life-threatening building-related illnesses, such as Legionnaire's disease, and cancer.</s>

<s docid="FR940405-1-00054" num="9"> Ford Motor Company responded in docket comment 3-447, that ``[p]resently, at Ford, we investigate an average of two IAQ complaints per month which are predominantly classified as Sick Building Syndrome.</s>

<s docid="FR940405-1-00054" num="10"> We have seen Building-Related Illness, but these incidents have been rare and associated with specific contaminant episodes.</s>

<s docid="FR940405-1-00054" num="11"> The IAQ complaints we generally investigate are characterized by general malaise, headache, and flu-like symptoms that are said to disappear when the occupants leave the building * * * Of the IAQ problems investigated, about 20 percent can be attributed to PTS [passive tobacco smoke]/ETS.</s>

<s docid="FR940405-1-00054" num="12"> Upper respiratory irritation or eye irritation typically are associated with these complaints''.</s>

<s docid="FR940405-1-00054" num="14"> One comment [Ex.</s>

<s docid="FR940405-1-00054" num="15"> 3-433 reported that ``based upon approximately 30 IAQ investigations in a member company over the past two and one-half years, the following adverse health effects have been reported in office environments: eye, nose, and throat irritations; headaches, nausea, dizziness, fatigue; cough, shortness of breath, chest tightness.</s>

<s docid="FR940405-1-00054" num="16"> These so-called ``sick building syndrome (SBS)'' symptoms often disappear when the person leaves the building environment.</s>

<s docid="FR940405-1-00054" num="20"> Many are exposed to contaminants or other harmful substances; and, without ventilation, these sources linger and cause nausea, skin irritations and other unhealthy symptoms of illness.</s>

<s docid="FR940405-1-00054" num="21"> In severe cases, these contaminants and bacteria have been known to contribute to upper respiratory infections''.</s>

<s docid="FR940405-1-00054" num="26"> In conversations with various health care professionals, I have come to the conclusion that the diagnoses of chronic fatigue syndrome were actually sick building syndrome.</s>

<s docid="FR940405-1-00054" num="30"> Health problems experienced by workers in this building included chronic sinus infections; headaches; fatigue; eye, nose and throat irritations; difficulty breathing and congestion; allergies; and asthma.</s>

<s docid="FR940405-1-00084" num="38"> B. Indoor Air Quality Poor indoor air quality creates a variety of material impairments of health, two aspects of which are Building-Related Illness and Sick Building Syndrome.</s>

<s docid="FR940405-1-00084" num="39"> One of the most severe health effects associated with Building-Related Illness is legionellosis, a disease associated with microbial contamination of water sources which is commonly found in the water present in heating and cooling systems of buildings.</s>

<s docid="FR940405-1-00084" num="40"> Legionnaire's disease, caused by the Legionella organism, results in pneumonia which is fatal in approximately 20% of the cases.</s>

<s docid="FR940405-1-00084" num="41"> Even when not fatal, it is usually very severe, requiring substantial treatment or hospitalization.</s>

<s docid="FR940405-1-00084" num="42"> As many as 5% of those exposed to Legionella will get sick 1. Legionnaire's disease and other illnesses associated with microbial contamination due to poor indoor air quality are serious health effects that constitute material impairment.</s>

<s docid="FR940405-1-00084" num="50"> The upper respiratory symptoms associated with poor indoor air quality (sick building syndrome) include stuffy nose, runny nose, dry itchy eyes, nose and throat.</s>

<s docid="FT923-7392" num="7"> Since the early 1980s, almost half of the civil servants who work there, mainly for the Inland Revenue, have experienced the flu-like symptoms of the so-called sick building syndrome.</s>

<s docid="FT923-7392" num="8"> Sick building syndrome is an elusive illness.</s>

<s docid="FT923-7392" num="9"> It is difficult to diagnose, harder to pinpoint causes and few employers will admit to the problem for fear of bad publicity or being forced to make costly refurbishments.</s>

<s docid="FT923-7392" num="15"> The World Health Organisation estimates that the syndrome affects a third of European and North American offices.</s>

<s docid="FT923-7392" num="18"> At St John's House many of the 2,000 staff began complaining of sore throats, dry eyes, headaches and coughs in 1981 as soon as they moved there.</s>

<s docid="FT923-7392" num="19"> They said the symptoms came on at work and their families seemed immune.</s>

<s docid="FT923-7392" num="27"> Property Holdings stresses that the works will address several problems bedevilling such offices, not just sick building syndrome.</s>

<s docid="FT923-7392" num="30"> In 1984 the Public Records Office in Kew, west London, was closed for about four months for an overhaul after the syndrome was diagnosed.</s>

<s docid="FT923-7392" num="31"> Dr Leslie Hawkins, director of the occupational health service at Surrey University's Robens Institute and an authority on the syndrome, said the label 'sick building syndrome' was often misused.</s>

<s docid="FT923-7392" num="34"> He believes that where a higher-than-normal proportion of staff report symptoms ranging from irritated eyes, noses, and throats to menstrual disorders, and where those symptoms are triggered by office work, it is likely that the building is sick.</s>

<s docid="FR940405-1-00040" num="5"> 4-282]. The Air Force Procedural Guide [Ex.</s>

<s docid="FR940405-1-00040" num="6"> 4-199] on dealing with SBS takes a practical view: ``* * * in most cases the sick building syndrome does not have a clearly understood etiology and many of the SBS studies and investigations were inconclusive.</s>

<s docid="FR940405-1-00040" num="8"> In summary, SBS is not a well-defined disease with well-defined causes.</s>

<s docid="FR940405-1-00040" num="9"> It appears to be a reaction, at least in part due to stimulation of the common chemical sense, to a variety of chemical, physical or biological stimuli.</s>

<s docid="FR940405-1-00040" num="10"> Its victims display all or some of a pattern of irritation of the mucous membranes, and the worst affected individuals have neurological symptoms as well.</s>

<s docid="FR940405-1-00040" num="11"> B. Building-Related Illness Building-related illness (BRI) describes specific medical conditions of known etiology which can often be documented by physical signs and laboratory findings.</s>

<s docid="FR940405-1-00040" num="12"> Such illnesses include sensory irritation when caused by known agents, respiratory allergies, nosocomial infections, humidifier fever, hypersensitivity pneumonitis, Legionnaires' disease, and the symptoms and signs characteristic of exposure to chemical or biologic substances such as carbon monoxide, formaldehyde, pesticides, endotoxins, or mycotoxins [Exs.</s>

<s docid="FR940405-1-00040" num="15"> These illnesses are often potentially severe and, in contrast to SBS complaints, are often traceable to a specific contaminant source, such as mold infestation and/or microbial growth in cooling towers, air handling systems, and water-damaged furnishings.</s>

<s docid="FR940405-1-00040" num="16"> Symptoms may or may not disappear when the employee leaves the building.</s>

<s docid="FR940405-1-00040" num="17"> Susceptibility is influenced by host factors, such as age and immune system status.</s>

<s docid="FR940405-1-00040" num="18"> Mitigation of building-related illnesses requires identification and removal of the source, especially in cases involving hypersensitivity responses.</s>

<s docid="LA100690-0080" num="16"> Legal experts say the complex trial, expected to last as long as three months, could help set standards for allocating responsibility in cases alleging "sick-building syndrome".</s>

<s docid="LA100690-0080" num="17"> The term refers to buildings in which poor ventilation combines with a variety of fumes to create indoor air pollution.</s>

<s docid="LA100690-0080" num="18"> Environmental experts say the syndrome has become more common in recent years.</s>

<s docid="LA100690-0080" num="26"> "This building was a classic and severe case of sick-building syndrome," said attorney Helen Eisenstein, who represents two former tenants -- a software firm and an accounting firm -- and eight of the 10 individuals who are suing Prudential and its contractors.</s>

<s docid="LA100690-0080" num="27"> "A number of factors came together to make tenants sick here: Inadequate ventilation, construction fumes, improper operation of the ventilation system and poor choices of building materials," Eisenstein said.</s>

<s docid="FT924-15322" num="35"> There is the potentially fatal building-related illness which covers legionnaires disease as well as other dangerous bacteria which lurk in convenient recesses provided by modern air conditioning systems and elsewhere.</s>

<s docid="FT924-15322" num="36"> Then there is sick building syndrome, less dangerous but more difficult to tackle because it is hard to diagnose and no one really knows for sure what causes it.</s>

<s docid="FT924-15322" num="37"> It can affect staff in ways which even they do not recognise immediately but which can have a serious affect on both their health and the health of their businesses.</s>

<s docid="FT924-15322" num="38"> The World Health Organisation estimates the syndrome affects a third of European and North American offices.</s>

<s docid="FT924-15322" num="40"> A wide variety of symptoms range from sore throats, dry eyes (some staff have been unable to wear contact lenses), headaches and coughs through exacerbated menstrual disorders to lethargy, dizziness and depression.</s>

<s docid="FT924-15322" num="41"> Sufferers typically report that their symptoms only show up when they are at work and disappear as soon as they leave.</s>

<s docid="FT924-15322" num="42"> Their close friends and families appear to be immune.</s>

<s docid="FR940405-1-00098" num="37"> 1. Indoor Air Quality Health effects typically caused by poor IAQ have been categorized as Sick Building Syndrome (SBS) or Building-Related Illness (BRI).</s>

<s docid="FR940405-1-00098" num="38"> Some of the symptoms that characterize SBS include: irritation of eyes, nose and throat, dry mucous membranes and skin and coughs, hoarseness of voice and wheezing, hypersensitivity reaction, nausea and dizziness.</s>

<s docid="FR940405-1-00039" num="7"> Many individuals who believe the building they work in is implicated in SBS, have described similar effects.</s>

<s docid="FR940405-1-00039" num="8"> Symptoms usually include one or more of the following: mucous membrane (eye, nose, or throat) irritation, dry skin, headache, nausea, fatigue, and lethargy [Ex.</s>

<s docid="FR940405-1-00039" num="9"> 4-293]. These symptoms are generally believed to result from indoor air pollution.</s>

<s docid="FR940405-1-00039" num="10"> There is no secondary spread of symptoms to others outside the building who are exposed to the occupants (unlike the situation faced by many chemical and asbestos workers).</s>

<s docid="FR940405-1-00039" num="11"> Anderson [Ex.</s>

<s docid="FR940405-1-00039" num="12"> 4-10] suggested the possible causes for SBS as related to psychosocial, chemical, physical, or biological factors.</s>

<s docid="FR940405-1-00039" num="13"> Anderson [Ex.</s>

<s docid="FR940405-1-00039" num="14"> 4-10] distinguished SBS symptoms as different from mass psychogenic illness; although in general the causes of SBS are unknown, he suggested that most SBS symptoms could be explained by stimulation of sensory nerve fibers in the upper airways and the face (referred to as common chemical sense).</s>

<s docid="FR940405-1-00039" num="15"> Because these fibers can respond in only one way, SBS cases largely have the same symptoms irrespective of the cause [Ex.</s>

<s docid="FR940405-1-00039" num="31"> Some individuals who experience relatively mild and treatable symptoms such as headache, may be able to cope with the sick building environment for extended periods, although suffering from increased stress.</s>

<s docid="FR940405-1-00039" num="32"> Other individuals, more seriously affected, may find symptoms so severe that they may be unable to be in the building for extended periods, or at all.</s>

<s docid="FR940405-1-00039" num="33"> Still others may become temporarily or permanently disabled.</s>

<s docid="FR940405-1-00039" num="34"> It has been suggested that SBS may not be one syndrome but a number of sub-syndromes [Ex.</s>

<s docid="FR940405-1-00039" num="35"> 4-170]. This hypothesis suggests that the symptoms particularly associated with chemical exposure include fatigue; headache; dry and irritated eyes, nose, and throat; and sometimes include nausea and dizziness.</s>

<s docid="FR940405-1-00039" num="36"> Those symptoms most related to microbial exposures would result in itchy, congested, or runny nose; itchy watery eyes; and sometimes include wheezing, tight chest, or flu-like symptoms.</s>

<s docid="FR940405-1-00039" num="37"> The overlapping symptoms in each case are eye, nose, and throat irritation, perhaps making the two sub-syndromes, chemical and microbial, difficult to distinguish.</s>

<s docid="FR940405-1-00039" num="48"> There is little data on the perceptions of victims of SBS.</s>

<s docid="FR940405-1-00039" num="49"> Shapiro [Ex.</s>

<s docid="FR940405-1-00039" num="50"> 4-282] has complied a summary of 16 case-histories of SBS in the victims' own words.</s>

<s docid="FR940405-1-00039" num="54"> As a result of problems related to carpeting and other suspected causes, five workers were reported to have left the agency, 11 were relocated to alternative workspace or worked at home, and 100 reported to the agency's medical officer that they had SBS related problems.</s>

<s docid="FR940405-1-00039" num="55"> The range of self-reported symptoms included a variety of moderate and acute respiratory problems; headache; sore throat; burning of the eyes, lungs, and skin; rashes; fatigue; laryngitis; clumsiness; disorientation; loss of balance; nausea; numbness in extremities and face; and difficulty with mental tasks.</s>

<s docid="FT923-4291" num="6"> DUST from insulation used in most air-conditioned offices has been strongly linked to 'sick building syndrome', the flu-like symptoms which afflict thousands of office workers.</s>

<s docid="FT923-4291" num="9"> The World Health Organisation estimates that 'sick building syndrome' affects a third of offices in Europe and north America.</s>

<s docid="FT923-4291" num="16"> Dr Hedge said man-made mineral fibres were unlikely to be the sole cause of the symptoms of the syndrome, which include eye, nose, throat and skin irritation, as well as coughing, sneezing and breathing difficulties.</s>

<s docid="FT923-4291" num="18"> But he stressed that identifying a single cause or cure for the syndrome was unlikely.</s>

<s docid="FT923-4291" num="23"> He said the identification of insulation fibres as strongly linked to 'sick building syndrome' fitted the history of the syndrome which was first widely reported in the 1970s.</s>

<s docid="FT923-4291" num="25"> Computer operators report 'sick building syndrome' more often than other workers.</s>

<s docid="FT923-4291" num="26"> That may be because terminals attract dust which settles on the faces of the operators.</s>

<s docid="FT923-9638" num="6"> EXTENSIVE research has found no identifiable cause or cure for 'sick building syndrome', according to a report by the Health and Safety Executive, Catherine Milton writes.</s>

<s docid="FT923-9638" num="7"> An HSE review published yesterday says the cause of the syndrome - in which office workers blame buildings in which they work for symptoms such as headaches, dry throats, mental fatigue and dizziness - remains a mystery, and the syndrome is unlikely to go away in the short term.</s>

<s docid="FT923-9638" num="8"> The Institution of Environmental Health Officers said last year that local authorities had received a total of 500 sick-building complaints.</s>

<s docid="FT923-9638" num="11"> She said: 'Sick building syndrome is often associated with air-conditioned buildings and seems to affect women more than men, especially workers who are in a building for a long time'.</s>

<s docid="FT923-9638" num="13"> The report says the syndrome occurs in even the best-designed buildings.</s>

<s docid="FT923-9638" num="15"> The HSE is funding research at London University, which is comparing the sickness and absence data of more than 10,000 office-based civil servants with measurements of environmental factors and building maintenance records.</s>

<s docid="FR940405-1-00077" num="6"> OSHA's Risk Estimates_Indoor Air Quality Adverse health effects associated with poor IAQ are described as Building-Related Illness (BRI) and Sick Building Syndrome (SBS).</s>

<s docid="FR940405-1-00077" num="7"> SBS related conditions are not easily traced to a single specific substance, but are perceived as resulting from some unidentified contaminant or combination of contaminants.</s>

<s docid="FR940405-1-00077" num="8"> Symptoms are relieved when the employee leaves the building and may be reduced by modifying the ventilation system.</s>

<s docid="FR940405-1-00077" num="21"> On the basis of the information gathered in the individual studies, Mendell and Smith compared the prevalence of sick building symptoms in buildings with five types of ventilation: natural only; fans only; air conditioned with no humidification; air conditioned with steam humidification; and air conditioned with water-based humidification.</s>

<s docid="FR940405-1-00077" num="22"> Overall, they found the prevalence of work-related headache, lethargy, upper respiratory/mucous membrane, lower respiratory and skin symptoms significantly increased in buildings with any type of air conditioning as compared to buildings with no air conditioning.</s>

<s docid="FR940405-1-00077" num="23"> Thus, according to this analysis, a basic problem with SBS appears to reside in the air conditioning system or, in some building aspect associated with the presence of air-conditioning.</s>

<s docid="FR940405-1-00077" num="24"> Building-related illness (BRI) describes those specific medical conditions of known etiology which can often be documented by physical signs and laboratory findings.</s>

<s docid="FR940405-1-00077" num="25"> Symptoms may or may not disappear when the employee leaves the building.</s>

<s docid="FR940405-1-00077" num="26"> Currently, OSHA does not have any data on BRI related symptoms to conduct a quantitative risk assessment.</s>

<s docid="FR940405-1-00038" num="13"> Indoor air quality problems are generally classified as Sick Building Syndrome (SBS) or Building-related Illness (BRI).</s>

<s docid="FR940405-1-00038" num="21"> A. Sick Building Syndrome Typically, health effects caused by poor indoor air quality have been categorized as SBS or BRI.</s>

<s docid="FR940405-1-00038" num="22"> In 1983, the World Health Organization published a list of eight non-inclusive symptoms that characterize Sick Building Syndrome [Ex.</s>

<s docid="FR940405-1-00038" num="23"> 4-325]. These include irritation of the eyes, nose and throat; dry mucous membranes and skin; erythema; mental fatigue and headache; respiratory infections and cough; hoarseness of voice and wheezing; hypersensitivity reactions; and nausea and dizziness.</s>

<s docid="FR940405-1-00038" num="25"> Symptoms are relieved when the employee leaves the building and may be reduced or eliminated by modifying the ventilation system.</s>

<s docid="FR940405-1-00038" num="28"> In some instances, outbreaks of SBS are identified with specific pollutant exposures, but in general only general etiologic factors related to building design, operation and maintenance can be identified [Ex.</s>

<s docid="FR940405-1-00038" num="29"> 4-274]. In 1987, Woods et al.</s>

<s docid="FR940405-1-00038" num="33"> Based on this, Woods et al.</s>

<s docid="FR940405-1-00038" num="34"> [Ex. 3-745] hypothesized that 20% of U.S. office workers are exposed to indoor conditions which manifest as SBS.</s>

<s docid="FR940405-1-00038" num="35"> In fact, complaints about SBS have become so numerous that 37 out of 53 states and territories have designated a building complaints investigation contact person [Ex. 4-310].</s>

<s docid="LA112490-0149" num="15"> The new synthetic building products, dispensing a toxic soup of chemicals into airtight buildings, have created a new problem -- the "sick building syndrome" -- that can threaten the health of its occupants.</s>

<s docid="LA112490-0149" num="47"> "Sick building syndrome" is less of a problem here than in other areas of the country, because Southern Californians are not as reliant on heating and air-conditioning systems.</s>

<s docid="FR940405-1-00092" num="5"> Some of the published categories, in addition to the terms sick or well are: problem buildings and non-problem buildings, healthy buildings; buildings with high and low rates of IAQ related complaints; sick building syndrome (SBS).</s>

<s docid="FR940405-1-00092" num="6"> The SBS symptom complex is characterized by a range of symptoms including but not limited to, eye, nose and throat irritation, dryness of mucous membranes and skin, nose bleeds, skin rash, mental fatigue, headache, cough, hoarseness, wheezing, nausea and dizziness [Ex.</s>

<s docid="FR940405-1-00092" num="7"> 4-159]. Within a given building there will usually be some commonality among the symptoms manifested as well as temporal association between occupancy in the building and appearance of symptoms.</s>

<s docid="FR940405-1-00092" num="8"> Many people who work in buildings characterized as having SBS typically exhibit health symptoms that disappear when the person is no longer in the building.</s>

<s docid="FR940405-1-00092" num="9"> In most cases, a physical basis for the occurrence of the SBS can be found: lack of proper maintenance, changes in thermal or contaminant loads imposed during the building's life, changes in control strategies to meet new objectives (e.g.</s>

<s docid="FR940405-1-00092" num="10"> , energy conservation) or inadequate design.</s>

<s docid="FR940405-1-00092" num="11"> Building-related illnesses (BRI), on the other hand, are medically diagnosed diseases that present symptoms that can last for weeks, months, years or even a lifetime.</s>

<s docid="FR940405-1-00092" num="12"> Examples include nosocomial infections, humidifier fever, hypersensitivity pneumonitis, and legionellois.</s>

<s docid="FR940405-1-00092" num="13"> BRI can develop as a result of poor building systems operation and maintenance and uncontrolled point sources of contaminants.</s>

<s docid="FR940810-0-00155" num="42"> For example, the HEI-AR report discusses an asbestos abatement job at a college building with pre-abatement exposure levels of 0.0002 f/cc [HEI-AR, 1991, p.</s>

<s docid="FR940810-0-00155" num="43"> 5-37]. Shortly after abatement, exposure levels of 0.065 f/cc were measured.</s>

<s docid="FR940405-1-00114" num="30"> The term ``Building-related illness'' describes specific medical conditions of known etiology which can be documented by physical signs and laboratory findings.</s>

<s docid="FR940405-1-00114" num="31"> Such illnesses include sensory irritations when caused by known agents, respiratory allergies, nosocomial infections, asthma, humidifier fever, hypersensitivity pneumonitis, Legionnaires' disease, and the symptoms and signs characteristic of exposure to chemical or biologic substances such as carbon monoxide, formaldehyde, chlordane, endotoxins, or mycotoxins.</s>

<s docid="FR940405-1-00114" num="32"> ``Building-related illness'' defines the medical conditions that, if observed, require evaluation of the facility building systems to determine if they are functioning properly, and the taking of remedial action where warranted.</s>

<s docid="FR940405-1-00114" num="33"> Building-related illnesses are often potentially severe and are often traceable to a specific contaminant source such as ETS, microbial growth, and a host of other chemical or biologic substances which must be attended to mitigate degradation of indoor air quality.</s>

<s docid="FT931-14147" num="23"> Audubon and Croxton set about creating a healthy work place, since illnesses related to poor ventilation and airborne pollutants (known as sick building syndrome) are estimated to cost the US economy Dollars 60bn annually.</s>

<s docid="FT923-2548" num="6"> Sir, Catherine Milton quotes from a conference paper by Alan Hedge and colleagues suggesting that man-made mineral fibres are a cause of sick building syndrome ('The answer might just be blowing in the wind', September 8).</s>

<s docid="FT923-2548" num="13"> An alternative, proper statistical analysis shows no statistically significant association between sick building syndrome findings and the amount of settled man-made mineral fibre dust.</s>

