Transcript UCHC - Confex

IEQ and Respiratory Health in
School Buildings
Integrating 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
[email protected]
Co-authors:
Eileen Storey, MD, MPH
UCHC
William A. Turner, MS, PE
Turner Building Science, LLC
John E. Yocom, PE, CIH
Environmental consultant
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
UCHC Schools Team
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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
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
UCHC Pilot Research
Six schools study- more frequent respiratory
symptoms among asthmatics in “wet” buildings
Middle school pulmonary function testchildren’s 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
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
Building-related Respiratory
Disease
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Rhinitis
Sinusitis
Laryngitis
Asthma
Hypersensitivity pneumonitis (HP), and
Infectious diseases, i.e. legionella
Strategies to Evaluate Risks
and Health Effects
Epidemiological studies
questionnaires
physiological testing
Individual clinical assessment
medical history/physical examination
physiological testing
Industrial hygiene evaluation
contaminant levels
exposure assessment
hazard control recommendation
What Are the Roles Of:
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Medical evaluations
Epidemiological studies
Industrial hygiene investigations
Engineering assessments
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.
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.
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
intervention;and
• identifying priorities.
Medical and Epidemiological
Approach
• Occupational illness model and patient
treatment
• School nurse logs and interviews
• Questionnaire surveys
• On-site physiological testing
Epidemiological Approach
• Questionnaire surveys
– Describe the participants, their health status, and
their symptoms
– Explore factors in the occupant’s homes
– Help define occupants’ exposure to the building’s
environment
– Explore work-relatedness
– Provide guidance on intervention (correcting
building indoor environment problems)
– May identify individuals at risk
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
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
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
Engineering Focus
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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
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
A public middle school case
study
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~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
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
School District Response
1 District hires engineer as facilities manager to
manage IEQ problems and overall districtwide building project
2 Team approach adopted
3 Issues identified
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IEQ
Risk communication
Solution development
Financing building improvements
Further indications of IEQ
problem as work progresses
• Teacher diagnosed with occupational
respiratory disease, can’t 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
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)
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
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.