Building-Related Sickness: Causes, Effects, and Ways to Avoid It

Building-related Sickness Causes, effects, and ways to avoid it

Edited by Anu Palmer and Rosie Rawlings

TECHNICAL NOTE TN 2/2002 TECHNICAL NOTE ACKNOWLEDGEMENTS

BSRIA would like to thank the following sponsors for their contribution which has led to the production of this Technical Note.

The former Department of Transport, Local Government and the Regions

British Gas Properties Graham Powell Consultants Land Security Properties Ltd Lloyds Register of Shipping London Stock Exchange NatWest Group Price Waterhouse Royal Bank of Scotland Plc

This publication is an update of the BSRIA publication Sick Building Syndrome TN4/88. Further information was sourced from the BSRIA report Implementing HSE SBS Guidelines, 79110/1, issued in November 2000.

Dr Anu Palmer, Dr Rosie Rawlings, Nigel Potter and William Booth contributed from BSRIA. The publication was edited and produced by the Publishing and Information section at BSRIA.

This publication has been produced by BSRIA as part of a contract placed by the former Department of Transport, Local Government and the Regions. The contract was let under the Partners In Innovation programme, which provides part-funding of collaborative research. Any views expressed in it are not necessarily those of the Department.

The authors have sought to incorporate the views in the previously published reports, but final editorial control of this document rests with BSRIA.

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means electronic or mechanical including photocopying, recording or otherwise without prior written permission of the publisher.

©BSRIA TN 2/2002 June 2002 ISBN 0 86022 581 X Printed by The Chameleon Press Ltd BUILDING-RELATED SICKNESS 1

©BSRIA TN 2/2002 CONTENTS

1 INTRODUCTION 3

2 DEFINITION AND SYMPTOMS 5

3 SIGNIFICANT PARAMETERS 7

4 HEALTHY BUILDING ISSUES 8 4.1 Thermal comfort 8 4.2 Ventilation 11 4.3 Relative humidity 13 4.4 Lighting 14 4.5 Noise and vibration 18 4.6 Negative ions 20 4.7 Micro-organisms 21 4.8 Respirable particulates and filtration 23 4.9 Volatile organic compounds 25 4.10 Gaseous contaminants 27 4.11 Tedious work schedules 30 4.12 Occupant controls 30 4.13 Stress 31 4.14 Response to complaints 31 4.15 Productivity 32

5 PROTOCOLS AND CHECKLISTS 33

6 GLOSSARY OF TERMS AND ABBREVIATIONS 37

7 REFERENCES 39

FIGURES AND TABLES

Figure 1 Effect of clothing on sedentary comfort (from BSRIA TN 4/88)10 Table 1 Standard service illuminance for various activities/ interiors (from CIBSE Guide A)15 Table 2 Recommended noise levels (from CIBSE Guide A)18 Table 3 Typical ion concentrations for different outdoor environments 20 Table 4 Eurovent filter grades 24 Table 5 Filter applications 25 Table 6 Gaseous pollutants in indoor air (adapted from WHO) 27 Table 7 Some by-products of tobacco smoke and their occupational exposure limits 28 Table 8 Checklist for physical and air quality parameters 34 Table 9 Checklist for psychosocial factors 36

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©BSRIA TN 2/2002 INTRODUCTION INTRODUCTION 1

1.1 INTRODUCTION This publication is an update of BSRIA Technical Note TN 4/88 Sick Building Syndrome, which deals with the significant parameters, symptoms and ways to alleviate building-related sickness.

The phenomenon of building-related sickness (once known as sick building syndrome) has been reported since the early 1980s. It was recognised by the World Health Organisation in 1986. It results from a combination of physical, air quality and psychosocial parameters and leads to a decline of the well-being of occupants. The symptoms are interrelated, with sensory irritation often being one of the dominating complaints. It has been estimated that up to 30% of refurbished buildings and an unknown but significant numbers of new buildings may cause symptoms related to building-related sickness. While the actual number of cases is unknown, it can be concluded from the existing studies that the problem is widespread.

One of the changes over the past decade or so has been the development of health-related legislation. At the time of the previous report the Health and Safety at Work Act 1974 was in place in the UK, emphasising accident prevention. In contrast, the more recent work- related health regulations, which are made under the 1974 act and implement EC directives, take a different approach through arrangements following an incident and stricter control. The new legislation highlights the design of new buildings, changes for existing buildings and occupant behaviour.

The Management of Health and Safety at Work Regulations 1992 came into effect on 1 January 1993. They were revoked by the 1999 Regulations, which came into effect on 29 December 1999. These regulations implement the EC Directive 89/391, setting a requirement on all employers to carry out a risk assessment, which must be reviewed if necessary. The significant findings of the assessment must be recorded if there are five or more employees. Following the risk assessment, effective planning, organisation, control and review of measures and appropriate health surveillance must be provided. Employers must consider the possibility of building-related sickness an issue that should be subject to risk assessment.

The Workplace (Health, Safety and Welfare) Regulations 1992, which implement most provisions of the EC Directive 89/654, came into effect on 1 January 1993 to apply to new buildings. On 1 January 1996 the Regulations were modified to apply to all work places in existence. Currently a civil claim on the basis of a breach of the regulations cannot be made, with the specific exception of young persons and expectant mothers.

At present a revision is under consultation to allow civil claims to rely on the breach of the regulations. The regulations apply to building- related sickness in a number of ways: the workplace should be maintained in an efficient state; suitable and sufficient ventilation as well

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©BSRIA TN 2/2002 1 INTRODUCTION

as lighting must be provided; restrooms and rest areas must include suitable arrangements to protect non-smokers from discomfort caused by tobacco smoke (passive smoking).

In addition to the existing legislation, the Approved Code of Practice on Smoking in the Workplace (AcoP) is under development. It follows an example from California, where smoking is not permitted in public areas, and other states in the US where similar actions are being planned.

The Code will have a significant effect on pubs, restaurants, nightclubs and cafes. While most employers have already banned or seriously restricted smoking in offices, if the employers fail to provide a healthy (smoke-free) working environment they can be sued if the health of their staff deteriorates.

In 1995 the Health and Safety Executive (HSE) issued official guidance: How to Deal with SBS – Guidance for Employers, Building Owners and Building Managers1. The guidance was implemented in two office buildings, which BSRIA monitored very closely. The purpose of the monitoring was to evaluate the practical application of the guidance by two building owner/operators. The results entitled Demonstration Exercise Implementing HSE SBS Guidelines2 were published in 2000.

This report has identified the parameters most likely to play a role in building-related sickness. It also provides a discussion and guidelines on good practice for all significant aspects of building-related sickness. This is followed by a checklist that addresses the adequacy of the working environment based on a good engineering, maintenance and management practice.

Dr Anu Palmer and Dr Rosie Rawlings BSRIA, June 2002

4 BUILDING-RELATED SICKNESS

©BSRIA TN 2/2002 2 DEFINITION AND SYMPTOMS 2

2.1 DEFINITION AND The term problem building in relation to this publication can be used SYMPTOMS to describe any building in which occupants are dissatisfied with their indoor environmental conditions. The term building-related sickness should be restricted to multi-factorial problems, where no single factor exceeds the limits of generally accepted recommendations or thresholds.

There have been a number of studies in the UK of building-related sickness. The work, which covered a range of building types, concluded that the problem is widespread. However, BSRIA does not have information on the prevalence of symptoms in well-designed and maintained buildings, which means that the proportion of sick buildings within the problem building group cannot be evaluated.

It has been estimated that up to 30% of refurbished buildings, and an unknown but significant number of new buildings, may harbour symptoms of building-related sickness3. According to the World Health Organization (WHO), 25-30% of office personnel complain of building-related sickness symptoms4. The symptoms occur during working hours and diminish when people leave the building for weekends or holidays5.

It has been postulated that symptoms are more likely to occur in air- conditioned buildings than in naturally ventilated buildings3,6 and are related to the type of work and psychosocial aspects6. A number of risk factors have been identified:7,8

● a large number of workers per room ● a lack of environmental control (temperature, outdoor air supply) ● mechanical cooling ● humidification ● re-circulation of air ● rotary heat exchangers ● photocopiers and printers close to workstations ● paper and visual display unit work ● carpets and other fleecy materials ● allergen hyper-sensitivity (such as paints, chemicals and other materials) ● female gender ● low job category ● unfavourable psychosocial factors.

The symptoms are interrelated but can be divided into five groups:1,3,5

● sensory irritation of eyes, nose and throat, in the form of dryness, pain, stinging sensations, hoarseness, changes in voice and sounds from respiratory systems ● skin irritation such as blushing, pain, stinging or itching sensations ● neurotoxic symptoms in the form of headache, nausea, drowsiness, tiredness, lethargy, reduced mental capacities, fatigue

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● unspecified hyperactivity reactions, such as runny eyes, runny nose, asthma-like symptoms among non-asthmatic persons ● odour or taste sense, particularly changes in odour or taste and unpleasant odour or taste.

A building deemed to be sick has either some or all of the above complaints, with sensory irritation being one of the dominating complaints. Indoor air quality and pollution are the most important environmental factors9. When compared to other personal and occupational factors, use of computer screens is the most significant correlating factor in building-related sickness. Systemic symptoms, for example from lower airways or stomach, should not be dominant.

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3.1 SIGNIFICANT The important objective is to identify those parameters that can cause PARAMETERS discomfort, distress or even acute ailments broadly associated with the symptoms related to building-related sickness. This report, however, does not deal with specific diseases caused by legionella-type bacteria, potable water contamination or specific air contaminants entering buildings from, for example, nearby factories and exhaust fumes.

The parameters believed to be involved in the symptoms can be divided into the following groups.

Physical and indoor air quality parameters are:

● temperature and air velocity ● fresh air ventilation rates ● relative humidity ● lighting ● noise ● negative ions ● micro-organisms and biocides ● respirable particulates ● volatile organic compounds ● gaseous pollutants.

Psychosocial parameters are:

● tedious work schedules ● control of local environment by occupants ● stress ● identity and role factors such as job satisfaction, role, conflict and poor social relations ● response to complaints.

There are some direct links with fairly major individual faults associated with building services. One of these is the role of high temperatures in cases of chest tightness, headache, lethargy, ocular and nasal complaints. Another example is inappropriate lighting resulting in ocular or headache complaints.

In building-related sickness, the combined effect of several elements exceeds the sum of their individual effects. This is not the case when problems are related to reasons other than building-related sickness. It is fairly apparent that thermal comfort and lighting are significant factors but they should not be treated in isolation.

The fact that low ventilation rates can cause many of the symptoms should also be addressed. As research has not highlighted specific causes, the approach taken has been to address all the aspects listed above in the following section.

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