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Department: … & more: HEALTH MATTERS

Do you have sick building syndrome?

Edwards, Gwendolyn RN, MSN

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doi: 10.1097/01.NURSE.0000327501.23866.39
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In Brief

IF YOU HAVE ALLERGY SYMPTOMS at work that clear up soon after you leave, you may literally be allergic to your work environment. Sick building syndrome (SBS) is defined as acute sickness or discomfort that appears to be linked to time spent in a building. Typically, staff and patients report similar symptoms.1

In this article, I'll discuss SBS as it pertains to health care facilities and provide steps you can take to avoid or alleviate problems.

It's in the air

Signs and symptoms of SBS include:

  • headaches
  • dry or itchy skin
  • dizziness and nausea
  • difficulty concentrating
  • fatigue
  • dry cough
  • eye, throat, and nose irritation.

They may be linked to a particular room or to the entire building, and they aren't associated with an identified cause or specific illness.

Don't confuse SBS with buildingrelated illness (BRI), which causes symptoms such as cough, chest tightness, fever, chills, and myalgia. These symptoms are clinically defined and have clearly identifiable causes. People who have BRI may need prolonged recovery times after leaving the building.1

Symptoms of SBS can be associated with poor indoor air quality (IAQ) caused by poor ventilation or poor air filtration with chemical contaminants from indoor sources such as carpeting, copy machines, and cleaning products; chemical contaminants from outdoor sources such as pollutants from motor vehicle exhausts; and biologic contaminants such as bacteria, molds, pollen, and viruses that may breed in stagnant water.1

According to the Environmental Protection Agency, SBS has been linked to 10% to 25% of all buildings in the United States. Over 5 million IAQ problems are reported per year in the United States alone.2

Tracking down common contaminants

Signs of SBS vary depending on who's exposed and what's in the air. Let's look at some common contaminants and the problems they cause.

Volatile organic compounds (VOCs). Many products found inside and outside a health care facility or office contain VOCs, which evaporate easily into the air. When they accumulate indoors, they're easily inhaled.3

VOCs can be found in carpeting, adhesives, glues, caulks, paints, disinfectants, cleaning supplies, and pesticides. This means that new carpeting, drapery, and office furniture may be causing your symptoms. The short- and long-term health effects of VOCs depend on the length of the exposure, VOC concentration, and individual susceptibility.

The lungs are the most common site of injury. Infants, older adults, and people with chronic disease are even more vulnerable to adverse reactions to VOCs.4

In a newly constructed building or unit with new carpeting and furniture, formaldehyde may be the biggest culprit. It can cause headaches and make eyes burn and water. An organic gas, formaldehyde may cause cancer. High levels of emissions can also trigger an asthma attack.5

Dust. Researchers have identified 30 different chemicals in dust samples, including many known to cause cancer in humans or animals.3 In fact, if truckloads of dust with the same concentration of toxic chemicals were deposited outside our homes, these areas would be considered hazardous waste dumps.3 Dust can also carry biologic contaminants.

Biologic contaminants. Often found in moist areas or near stagnant water, biologic contaminants include bacteria, mold, pollen, dust mites, and viruses. They may accumulate in carpeting, draperies, or anywhere dust accumulates.

If your facility has water leakage, mold could be causing your symptoms. Indoor mold grows in damp or wet areas such as bathrooms, basement walls, around windows, and near leaking water pipes. Moisture can also be caused by lack of maintenance, condensation, increased humidity, or climate change. Ceiling tiles, carpeting, drywall, and insulation can serve as food for molds, which require dead or decaying matter to survive.3

When molds are disturbed, they release spores into the air. When spores settle on wet surfaces, they grow quickly, digesting the surface and eventually destroying it. Strong odors are associated with some molds.3

Mold problems have increased as buildings have become more tightly sealed and energy efficient. Poor ventilation lets dampness collect on surfaces, which become reservoirs for molds. Heating and air conditioning systems can exacerbate mold growth by spreading spores throughout a building.3

Molds produce allergens, irritants, and, in some cases, toxic substances. Exposure to these substances can cause headaches, breathing difficulties, skin and eye irritation, allergic reactions, asthma exacerbations, and epistaxis.3

Now that we've considered contaminants at play, let's look at the solutions.

Need to ventilate

Properly maintaining ventilation systems is the key to improving IAQ and reducing exposures. If heating, ventilation, and air conditioning systems don't distribute air effectively throughout the building, IAQ deteriorates.1

Ventilating systems, humidification systems, cooling coils, or drain pans that aren't maintained properly may serve as reservoirs for microbes. Air intake vents may also be near sources of standing water or organic debris.4 All equipment that could be a reservoir for mold, fungus, or bacteria due to water condensation should be regularly maintained.6

Clearing the air

To improve IAQ, keep air supply vents uncluttered. Place computers and other equipment away from grilles and thermostats to improve room temperature control and prevent interruption of airflow. For instance, a hot, unventilated room can exacerbate symptoms. Besides temperature, other factors can affect how IAQ is perceived. These factors include odors, air velocity (drafts or stuffiness), lighting, crowding, aesthetics, and noise.6

Air pollution or pesticide particles can enter a building through its ventilation system or through spaces such as elevator shafts or stairwells. Facilities can opt for nonchemical methods when possible; for instance, using organic fertilizers for grounds maintenance and nonchemical techniques to remove pests whenever possible, then using the least toxic one if needed.3

Renovation and remodeling should be coordinated to reduce exposures to patients and employees. Encourage management to develop an IAQ program using the federal standards for guidance. Many IAQ problems can be prevented or corrected by applying knowledge about IAQ and sharing responsibility.6

Because anyone occupying a building can influence its IAQ, everybody should get involved. Even ordinary activities such as microwaving food or photocopying can contribute to poor IAQ, so keep them to a minimum. For more tips, see Take simple steps to improve IAQ.

Educating your colleagues and others can improve IAQ and reduce the toll of SBS. Assess your workplace for environmental hazards and intervene to reduce exposures to patients and staff.

Take simple steps to improve IAQ

  • Don't block air vents or grilles.
  • Comply with the facility's smoking policy.
  • Water and maintain office plants properly to prevent standing water.
  • Dispose of garbage promptly and properly.
  • Store food properly and clean and maintain refrigerators regularly to remove contaminants and prevent odors.
  • Avoid bringing products into the building or facility that could release harmful odors or contaminants; for instance, aerosols.
  • Notify your building or facility manager or IAQ manager immediately if you suspect an IAQ problem.3

What's the role of your building manager?

Work with your building or facility manager to improve your IAQ. Advise him to take these steps:

  • Designate an IAQ representative if your facility doesn't have one.
  • Routinely assess the IAQ and address existing or potential IAQ issues.
  • Educate building staff about IAQ management and their role in maintaining IAQ.
  • Establish policies for managing IAQ maintenance.
  • Respond to leaks, floods, or other accidents that may cause problems.
  • Manage pollutant sources such as smoking areas, renovation, housekeeping, pest control, and storage areas.
  • Keep records of reported health complaints to help solve IAQ issues.
  • Establish a preventive IAQ management program following guidelines issued by the Environmental Protection Agency and Occupational Safety and Health Administration.


1. Environmental Protection Agency. Indoor Air Facts No. 4 (revised) Sick Building Syndrome, 2007.
2. Mindel A. Mobilized healthcare for sick buildings. Facilities and Design Management. 21(9):12, October 2002.
3. Creating Safe Learning Zones: The ABC's of Healthy Schools. Center for Health, Environment and Justice, 2002.
4. Environmental Protection Agency. Indoor Air Pollution: An Introduction for Health Professionals, 2007.
5. Environmental Protection Agency. Indoor Air Quality (IAQ): Basic Information, Formaldehyde, 2007.
6. Environmental Protection Agency. An office building occupant's guide to indoor air quality, 2007. Web sites last accessed on July 1, 2008.
© 2008 Lippincott Williams & Wilkins, Inc.