Sick Building Syndrome

Persidangan Kesihatan Persekitaran

Pihak Berkuasa Tempatan
11-12 Jun 2013, PICC Putrajaya

Dr. Muhamaad Amir bin Kamaluddin

Pusat Penyelidikan Kesihatan Alam Sekitar, IMR
 Scope
• Introduction
• SBS and BRI
• Prevalence of SBS
• Indoor Air Quality Issues
• ICOP IAQ 2010
• Green Building
• Summary / Conclusion
 Introduction
• SICK BUILDING SYNDROME
• A phenomenon that occur when more
than 20% of the occupants of a building
complain about air quality or have definite
symptoms (ILO Encyclopaedia)
 Introduction
• In the late 1970s, it was noted that
nonspecific symptoms were reported by
tenants in newly constructed homes,
offices, and nurseries. In media it was
called "office illness”.
• The term "Sick Building Syndrome" was
coined by WHO in 1986
 SBS
• The term "sick building syndrome" (SBS)
is used to describe situations in which
building occupants experience acute
health and comfort effects that appear to
be linked to time spent in a building, but no
specific illness or cause can be identified.
• EPA: Indoor Air Facts No. 4 (revised)
Sick Building Syndrome 2010
 The most common Symptoms in Sick
Building Syndrome (WHO 1983)
• Irritation of the eyes, nose and throat
• Experience of dry skin and dry mucosa
• Skin flush
• Fatigue, headache, nausea, dizziness
• Hoarseness, wheezing, pruritus and non-
specific hypersensitivity

World Health Organization (WHO). Indoor Air Pollutants: Exposure and Health
Effects. Copenhagen: WHO 1983. EURO Reports and Studies,no 78.
 SBS
• Non specific symptoms
• Headaches
• eye, nose, and throat irritation
• a dry cough
• dry or itchy skin
• dizziness and nausea
• difficulty in concentrating; fatigue and
• sensitivity to odors.
 SBS
• Outcome = Non specific symptoms
• Exposure = Factors in the environment
 BRI
• BRI, distinguished by objective findings
underlying pathologic diagnoses, include
hypersensitivity, pneumonitis, asthma, and
infections such as legionellosis.
 BRI
• Less often, but often more serious & are accompanied
by very definite clinical signs & clear laboratory findings
• Hypersensitivity
- Hypersensitivity pneumonitis,
- Humidifier fever,
- Asthma
- Rhinitis,
- Dermatitis
• Infections
- Legionnaire’s disease and Pontiac fever
- Tuberculosis (TB),
- Common cold
 Prevalence of SBS
• The prevalence of sick building syndrome in
Malaysia is unknown.
• No country-wide based study has been
conducted using stratified random sampling of
buildings and their occupants,
• Published studies on SBS on sampled
occupants in limited selected buildings
conducted by local researchers.
• The reported SBS in 3 local studies reported a
pooled SBS prevalence ranging from 32.3 –
68.8 per cent.
 References
• Syazwan Aizat et al (2009). Indoor air quality and sick
building syndrome in Malaysian buildings. Global Journal
of Health Science, 1(2):126-136
• Z Sulaiman and M. Mohamed (2011). Indoor Air Quality
and Sick Building Syndrome at two selected libraries in
Johor Bahru Malaysia. Environment Asia 4(1), 67-74
• Nur Fadilah R and Juliana J (2012) Indoor Air Quality
and Sick Building Syndrome among office workers in
new and old building in UPM. Health and the
Environment Journal Vol. 3, No.2
 Preliminary results*
• N= 213
• Age
a) min-max = 22-57 years old
b) mean±sd= 35.5±9.6
• Mean work duration 7.3 years
• Prevalence of SBS 5.7%

*Jamilah et al 2011 (unpublished data)

 Indoor Air Quality
IAQ : Poor IAQ:
The air quality within • SBS
and around buildings • BRI
and structures, • Chronic diseases
especially as it relates
to the health and
comfort of building
occupants
 IAQ
• Indoor Air (ventilation system)
• Close system: natural
• Open system: mechanical
 IAQ
• Summary of US NIOSH Studies, 1990 (over
500 buildings investigated)
• Inadequate ventilation (52%)
• Contamination from inside building (16%)
• Contamination from outside building (10%)
• Microbial contamination (5%)
• Contamination from building fabric (4%)
• Unknown sources (13%)
 ICOP IAQ 2010
• Concerns for exposure to secondhand smoke led to a
code of practice on indoor air quality in 2005
• Compliance with the 2005 COP on Indoor air Quality is
voluntary
• However, the Industry code of practice (ICOP) is a legal
instrument provided for under the Occupational Safety &
Health Act 1994 (OSHA)
• Under OSHA, it is the general duty of an employer and
also the building owner and management to ensure the
safety and without risk to health of employees and
anyone at a place of work
ICOP IAQ 2010
 IAQ
Acceptable Range for Specific Physical Parameters:

Parameter Acceptable range

• Air temperature 23 – 26 oC
• Relative humidity 40-70%
• Air movement 0.15 – 0.50 m/s

1. Reference MS 1525 : 2001

2. Code of practice on energy efficiency and renewable energy for
non-residential buildings
Indoor Air Contaminants: Acceptable Limits
Chemical Contaminant
1. CO • 10ppm
2. Formaldehyde • 0.1 ppm
3. Ozone • 0.05 ppm
4. Resp particulates • 0.15 mg/m3
5. TVOCs • 3ppm
Biological Contaminant
1. TBC • 500 cfu/m3*
2. TFC • 1000 cfu/m3*
Ventilation Performance
Indicator
1. CO2 • C1000**
 Mould
• Growth of mould colonies - Wet and humid environment
• Mould growth can lead to a variety of health
issues, such as causing allergic reactions, irritations, and
in some cases, toxic actions (e.g. mycotoxins).
• Allergic responses include hay fever-type
symptoms, such as sneezing, runny nose, red eyes, and
skin rash.
• The standard set for humidity and temperature is for
comfort and to prevent mould growth
 VOCs

• Human bioeffluents, personal care products,

cleaning materials, paints, lacquer, varnishes,
pesticides, pressed wood products.
• Accumulation of VOCs play a major role in SBS
• Some VOC such as benzene is carcinogenic
 Ozone
• Colourless gas
• Produced in ambient air during
photochemical oxidation of combustion
products such as nitrogen oxides and
hydrocarbon
• Ozone concentration set at 0.05ppm to
prevent symptoms such as dryness of
upper respiratory tract and throat and nose
irritation
 Formaldehyde
• It is a VOC,
• used in bonding/laminating
agents, adhesives, paper & textile products, and
in foam insulation
• Also used in cosmetics & toiletries as
preservative
• New buildings, re-carpeting, ETS
• Levels exceeding 1-3ppm cause mucous
membrane irritation
• Suspected carcinogen
• Level set for comfort
 CO
• Incomplete combustion product
• Automobile exhaust, smoking, unvented
combustion appliances
• Asphyxiant
• The standard is set to provide a margin of
safety for people with cardiovascular
disease
 CO2
• Product of combustion
• Human respiration & ETS
• It is an asphyxiant
• At concentrations (>30,000ppm) may
cause headache, loss of judgment,
dizziness, drowsiness, and rapid breathing
• Level set to indicate adequacy of
ventilation rates or indicative of inadequate
mixing.
 Respirable particulates
• Less than 10 micron in diameter
• Sources are ETS, aerosols from air
fresheners or cleaning material
• Other sources
- dirt from carpets or
- dirt carried in from outdoor
- outdoor sources such as from haze
 Chronic diseases
• Lung cancer • Radon
• Mesothelioma • ETS
• Asbestos
 Common pollutants
• 2nd hand smoke
• Radon
• Molds
• CO
• VOC (e.g formaldehyde)
• Legionella
• Other bacteria (e.g TB)
• Asbestos fibres
• CO2
• Ozone
 IAQ ISSUES IN MALAYSIA
• Mouldy • Cold offices
building/offices • Low temperatures
• High humidity • Chemical emissions
• Pipe burst/leakage • Off-gassing from
• Flooding building materials
• Smoking indoors • Split unit air-
conditioners (no air
exchange)
 Green building
• Maintenance of HVAC system and regular
audit is one major method of reducing
SBS and the way forward is to adopt or
adapt the LEED Green Building
Certification System.
 LEED Green Building
Certification System
5 categories:
• Sustainable Sites (SS),
• Water Efficiency (WE),
• Energy and Atmosphere (EA),
• Materials and Resources (MR) and
• Indoor Environmental Quality (IEQ).

LEED - Leadership in Energy & Environmental Design is

an internationally recognized green building certification system
 SUMMARY

• Three factors the indoor air quality, the

physical comfort and the psychosocial
well-being are thought to contribute to
SBS.
 SUMMARY
• The control of moisture accumulation
(dampness) leading to mold growth and
the presence of bacteria and viruses as
well as dust mites and other organisms
and microbiological concerns.
• Water intrusion through a building's
envelope or water condensing on cold
surfaces on the building's interior can
enhance and sustain microbial growth.
 SUMMARY
• *Ventilation standard to provide a
minimum of 15 cfm of outdoor air per
person (20 cfm/person in office spaces).
• *Minimum of 8.4 air exchanges per 24-
hour period.

*ASHRAE
 SUMMARY
• Maintenance of HVAC system and regular
audit is one major method of reducing
SBS and the way forward is to adopt or
adapt the LEED Green Building
Certification System.
Duke University Press, 2006.