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Keywords: INTRODUCTIONThe sick building syndrome (SBS) is used to describe a situation in which the occupants of a building experience acute health- or comfort-related effects that seem to be linked directly to the time spent in the building. No specific illness or cause can be identified. The complainants may be localized in a particular room or zone or may be widespread throughout the building.CLASSIFICATIONThe health conditions associated with buildings are commonly classified as:Building-associated symptoms.Signs and symptoms of the sick building syndrome are as follows[3]Headache, dizziness, nausea, eye, nose or throat irritation, dry cough, dry or itching skin, difficulty in concentration, fatigue, sensitivity to odours, hoarseness of voice, allergies, cold, flu-like symptoms, increased incidence of asthma attacks and personality changes.The cause of the symptoms is not known. It reduces work efficiency and increases absenteeism. Most of the complainants report relief soon after leaving the building, although lingering effects of neurotoxins can occur.
Signs and symptoms of the building-related disease are as followsCough, chest pain, shortness of breath on mild exertion, edema, palpitations, nosebleeds, cancers, pregnancy problems and miscarriages. Extrinsic allergic alveolitis, Legionnaire's disease, humidifier fever, pneumonia and occupational asthma are also known to occur.Legionnaire's disease is due to contamination of cooling towers by legionella organisms. Legionella is also responsible for Pontiac fever. Legionnaire's disease occurs predominantly in the middle aged and elderly adults whereas Pontiac fever occurs in young healthy adults, and has a very high secondary attack rate.Humidifier fever is caused by breathing in water droplets from humidifiers heavily contaminated with microorganisms causing respiratory infections, asthma and extrinsic allergic alveolitis. The disease is noninfective in nature. The patient may have flu-like symptoms. It is sometimes called Monday Fever. Permanent lung damage does not occur.The symptoms can be clinically defined and have clearly identifiable causes.
The complainants may require prolonged recovery time after leaving the building.It is important to note that complaints may also result from other cause like a preexisting illness or other allergies, job-related stress or dissatisfaction and psychosocial factors.[]ETIOLOGYThe following are some of the factors that might be primarily responsible for SBS:1. Biological contaminantsThe biological contaminants include pollen, bacteria, viruses, fungus, molds, etc. These contaminants can breed in stagnant water that has accumulated in humidifiers, drainpipes and ducts or where water has collected on ceiling tiles, insulation, carpets and upholstery.Insect and bird droppings can also be a source of biological contamination. Biological contamination causes fever, chills, cough, chest tightness, muscle aches and allergic reactions. In offices with a high density of occupancy, airborne diseases can spread rapidly from one worker to another. Air-conditioning systems can recirculate pathogens and spread them throughout the building e.g., Legionnaire's disease due to legionella organisms.
3. Inadequate ventilationIn 1970, oil embargo led building designers to make buildings more airtight, with less outdoor air ventilation, in order to improve energy efficiency.[7] The ventilation was reduced to 5 cfm/person. This reduced ventilation rate was found to be inadequate to maintain the health and comfort of building occupants. Malfunctioning heating, ventilation and air-conditioning systems (HVAC systems) also increase the indoor air pollution. In order to have an acceptable indoor air quality (IAQ) with a minimum energy consumption, The American Society of Heating, Refrigeration and Air-Conditioning Engineers (ASHRAE) recently revised ventilation standards to a minimum outdoor air flow rate of 15 cfm/person to avoid the problems related to inadequate ventilation. The standards are 20 cfm/person in office spaces and 60 cfm/person in smoking lounges.[1] Poor design and construction of buildings with more number of offices cramped in a building to increase the salable area also contribute to inadequate ventilation.4.
Electromagnetic radiationGadgets like microwaves, televisions and computers emit electromagnetic radiation, which ionizes the air. Extensive wiring without proper grounding also creates high magnetic fields, which have been linked to cancer.5. Psychological factorsExcessive work stress or dissatisfaction, poor interpersonal relationships and poor communication are often seen to be associated with SBS.6. Poor and inappropriate lighting with absence of sunlight, bad acoustics, poor ergonomics and humidity may also contribute to SBS.The symptoms of SBS are commonly seen in people with clerical jobs than in people with managerial jobs because professionals or managers have better working conditions. The symptoms are more common in females than in males probably because more females are in secretarial jobs, they are more aware of their health or a lesser dose of pollutants is required to manifest the effects. The symptoms are more common in air-conditioned buildings than in naturally ventilated buildings and are more common in a public sector building than in a private sector building [].
The occupational health and safety resource centre at Canada's University of Western Ontario has devised a routine five-point survey for occupational hygienists to follow when investigating air quality complaints (Ruhemann 1985). Features include:examination of the ventilation system for causes of poor distribution, including tests for biological organisms in any water in the system[9]PREVENTION AND CONTROLA field of study originating in Germany called Bau-biologie or Building biology has been initiated. The principles of Building biology are as follows:[11]FootnotesSource of Support: Nil Conflict of Interest: None declared.Indoor Air Facts No. 4 (revised) Sick building syndrome. Redlich CA, Sparer J, Cullen MR. Sick building syndrome. 7. IAQ fact sheet sick building syndrome, Environmental Health Center. Finnegan MJ, Pickering CA, Burge PS. The sick building syndrome: Prevalence studies. Sick building syndrome fact sheet indoor air facts no. 4 (Revised) Available from: http://www.epa.gov/iaq/pubs/sub.html-29k-