Dr.MohamedNoweir

IndoorAirborneMoldManagement

Sources

HealthImpactsRemedia9onProgram

•  Background•  WhatisMold•  Typesof

Mold

•  Condi9onsFavoringGrowth

•  Sources

•  IndividualsatRisk

•  HealthImpacts

•  MoldInspec9on

•  Sampling•  Mold

Remedia9on

Background

2.  Indoorconcentra9onsofmostpollutantsarehigherthanoutside

3.  Increasingnumberofindoordiseases/healtheffects4.  Wekeepsensi9veequipment/preciousar9factsinside

•  Itisthephysical,chemical,andbiologicalcharacteris9csofindoorenvironmentwithnointernalindustrialprocessesoropera9onsthatcanaffectthecomfortorhealthoftheoccupant.

OR:•  “itisthenatureofindoorenvironmentthataffectsthehealthandwell-beingofoccupants”.

Agent Host

Environment

ClassicalEpidemiologicalTriad

• 

TheirAirbornefragmentsmaycauseeyeirrita4on,

allergies,eye-ears-nose-throatinfec4ons,asthmaa8acks,fa4gueanddepression.

Mold-WhatIsIt?•  TheKingdomfungiincludesmushrooms,

moldandyeast

•  MicroscopicFungi(living,naturallyoccurringorganism)

•  “Mold”and“fungi”termscanbeusedinterchangeably

WhatisMold?

v Thereareover30,000knownspeciesofmold

v Common“toxigenic”speciesinbuildingsinclude:

>Pennicillium

>Aspergillus

>Cladosporium

>Chaetomium

>Alternaria

•  Powerfulchemicalreleasedbyfungitohelpincompe99onforfood

•  Containedinthespores,viableornonviable•  E.g.Penicillin,Aflatoxins•  Explainsome,butnotallofhazardousproper9esofmoldv Knownallergensv Molds→mycotoxinsv Disease-Mycotoxicosis

Mycotoxins

Condi9onsFavoringGrowth

Leaks

Floods

Condensa9onSteam

HighHumidity>60%

Sinks HVACSystems

Dishwashers Outside Sprinklers Sprayingonthewall

LeakingroofsandPipes WashinganddryerMachines

Steam(Showers/Cooking)

IndoorPlants

SourcesofMoistureIndoor

IndoorVen9la9on

Natural

Infiltra9onWindowDoors

Mechanical

Note: Infiltration is air leakage through cracks and interstices, around windows and doors, and through floors and walls into a building

Inadequateven9la9oncausesMoldtogrow

HVACSystems

•  ItkeepsthetemperatureandhumidityindoorwithinThermalcomfortlevels.

•  Canberesponsiblefordistribu9ngMoldSporesthroughoutthebuilding

•  Canhavemoldyinstalla9oninside•  MustbeservicedbyanHVACspecialist

HeatVen9la9onAirCondi9oningSystemsDucts

WhatTypesOfMaterialsWillMoldGrowOn?

v Justaboutanythingv Primarilycellulosecontainingproductsv Ceiling9lesv Drywallv Woodv Glassv Metalv Concreteblockv Plas9c

Therearenocodesorstandardsregardingindoorfungalbioaerosolsorfungalloadinglevels.

•  GrowthinHVACsystemsandducts•  Whenasthma9cs,immune-compromisedandother

sensi9veoccupantsarepresent•  Serialepisodesofmoldcontamina9oninthesame

area/building,maybereasonforconcern•  Recommenda9onsforaddressingfungal

concentra9onsdetectedindoorhavebeendevelopedbyadiverserangeoforganiza9ons

•  Persistentpresenceofpoten9allypathogenicortoxogenicfungisuchasStachybotrysorFusariumspp.isunacceptableatanyconcentra9on

•  Themeasurementofanysinglespecies>50c.f.u./m3ofthesamespeciesotherthanCladosporiumorAlternariaaredetected,theremaybereasonforconcern

•  Oroverallmixedconcentra9on>500c.f.u./m3warrantsaddi9onalinves9ga9on.

&Na9onalHealthandWalefareCanadaguidelines

Comparisonbetweenthedifferentspeciesofisolatedfungalsporesinindoorsamplesbasedon thepercentageofeachspecies inPrimaryschools

Yeast Alterna Cladosporium Penecillium Aspergillus

93.8% 100% 53.1% 98.4% 81.2% less than 50 cfu/m3

6.2% 0% 46.9% 1.6% 18.8% more than 50 cfu/m3

•  RabauA,NoweirM.IndoorfungalsporeslevelsinDammamprimarySchools.FinalGradua9onproject2010.

Total fungal Counts cfu/m3

Less than 500 cfu/m3 92.2%

More than 500 cfu/m3 7.8%

comparison between sampled classrooms according to the total counts of Mixed isolated fungal spores in indoor samples

Anyoneexposedtoairbornemoldcanreacttovariousproper9esofviableandnonviablemoldspores.

•  IMMUNOCOMPROMISED•  INFANTS•  ELDERLY•  PREGNANCY•  SMOKERS•  ASTHMATICS•  CHRONICDISEASESTATES•  ATOPICINDIVIDUALS

Popula9onatRisk

•  AllergyduetoexposuretoFungalVOCsOR•  ToxicityduetoMycotoxinsexposure.•  Generalbeliefthatremovalofperson

frommold-infestedenvironmentalleviatedcondi9on

NOSOCOMIAL ASPERGILLOSIS A RETROSPECTIVE REVIEW OF AIRBORNE DISEASE SECONDARY TO ROAD CONSTRUCTION AND CONTAMINATED AIR CONDITIONERS JOSEPH R. LENTINO1,, MARI ANN ROSENKRANZ1 American Journal of Epidemiology .2000, Vol. 116, No. 3: 430-437

Infec9on

Signsandsymptoms

v Respiratorysystem–asthmaandpnuemoni9sv Impairedimmunesystemfunc9on–toxicosisv Severeheadaches,chronicfa9gue,musclepainv Skinirrita9onandderma99sv Coldandflu-likesymptoms

ControlofIndoorEnv.Pollu9onGeneralPrac9ces

SourceManagement

ContaminantControl

Improved Ventilation

1)  Sourceexclusion2)  Removal3)  Treatment

1)Natural2)Mechanical

ElementsofEffec9veMoldRemedia9onProgram

MoldAssessmentProtocol

Mold&MoistureSurvey

MoldTes9ng&

Inves9ga9on

Remedia9onProgram

PostRemedia9onVerifica9on

PhaseA:MoldandMoistureSurvey

•  Mold&MoistureSurveyshouldbeanon-invasivephysicalsurveyofallaccessibleareasinordertoiden9fypoten9almoldandmoistureproblems.Itshouldbedonebyhighlytrainedspecialiststhataretrainedtogatherdatausingtoolsincluding:

•  FactGathering•  VisualInspec9onofAccessibleAreas•  Noninvasiveprocedures

MoldInspec9on

•  Aninves9ga9onformoldgrowthbeginswithaninspec9onforvisiblemoldgrowth

•  Ifthereisnovisiblemoldimmediatelyno9ceable,aninspec9onforsignsofwaterdamageiscompletedandareaswithpossiblemoisturesourcesareinspected

•  Moldscanbefoundalmostanywhere;theycangrowonvirtuallyanysubstance,providingmoistureispresent.

MoldInspec9on

SignsofMoldGrowthorWaterDamage

Non-Invasivemeasurment•  FLIR-ThermalImagingandInfra-redCamerasscanning

•  NoninvasivewallMoisturemeter

MoistureMeasurement

Invasivemeasurement•  50%ofmoldproblemsmaybehiddenfromview

•  Concealedproblemswithinwallcavi9es,ducts,beneathcarpetsand9lesetc.

•  Holescanbecutforvisualinspec9on,airsamples,moisturemeterprobes

MoistureProblemsDifficulttoFind

PhaseB:MoldTes9ngandInves9ga9on

•  Toinves9gatepoten9alareasofconcernrevealedduringthePhaseASurvey,

•  Evaluatetheextentofthemoldproblemifoneisfound

•  Iden9fytheunderlyingmoistureproblem

•  Primarilytodeterminefungiiden99esandconcentra9oninbiologicalaerosols

•  Requiresanunderstandingofwhatisbeingmeasuredandafulldescrip9onofthecircumstancesduringsampling

Airsamples•  Viableor“Culture-based”

– EmploystheuseofanAndersen(orsimilar)sampler

– Resultsusuallyreportedas“colonyformingunitspercubicmeterofair”(CFU/m3)

•  Non-viableor“Non-culture-based”– Employstheuseofasporetrapsampler– Resultsusuallyreportedas“par9clespercubicmeterofair”(par9cles/m3)e.g.A-O-cellcassejes

TypesofBiologicalSamples

A.

B.

C.

A.ImpactorsamplerB.Sieveimpactorsampler(Anderson6

stage)C.  GlassimpingersamplerD.  A-O-cellsamplere.g.zofen

Types of Air Samplers

D.

Remedia9onandAbatement

•  Thekeytomoldcontrolismoisturecontrol–  Remembertoaddressthesourceofthe

moistureproblem.–  Remembertocheckforhighhumidityand

condensa9onproblemsaswellasactualwaterleaks,maintenanceissues,andHVACsystemproblems

PhaseC:Remedia9onProgram

•  Protectthehealthandsafetyofbuildingoccupantsandabatementworkers

•  Contractorsshouldbeusingpersonalprotec9veequipmentandcontainmentasappropriate

MoldCleanupsafeprac9ces

•  Thepurposeofaabatementshouldbetomi9gatemoldwhilepreven9nghumanexposureandminimizingdamagetobuildingmaterialsandfurnishings

•  Allmoldcontamina9onmustbecleanedup

•  Deadmoldiss9llallergenicandsomedeadmoldscanbetoxic

MoldCleanup

•  Duetothehealthrisksofbiocidesitshouldbeusedonlyasalastop9onforcontrollingfungalgrowthindoors

•  materialsvisiblycolonizedbymoldshouldberemoved

•  Nega9vepressuriza9onisrecommendedforremovalofmoldymaterialswithasurfaceareagreaterthanabout3msothattheflowofairisalwaysfromcleanareasintotheloca9onwherecleaningisoccurring.

•  Evacua9onofbuildingoccupantsshouldalsobeconsideredinlarge-scalefungalremedia9on.

•  Porousmaterialssuchaspaperfibergypsumboard,ceiling9lesvisuallymoldyshouldbediscarded

•  non-porousmaterialsassheetmetal,ceramic9les,glass,etc.,showsMoldgrowthisphysicallyremovedbycleaning.

•  Tapwaterwithdetergentsorsurfactantsshouldbeeffec9veformostcleanings.

PhaseD:PostRemedia9onVerifica9on

•  Atminimum,thesequalityassuranceindicatorsshouldbefollowedanddocumented:

•  Novisualand/orsensoryevidenceofmoldcontamina9onduringwalkthroughofthebuilding

•  Novisualand/orsensoryevidenceofmoldcontamina9onduringinspec9onofHVACsystem

•  Measurementsoftemp.,humidity,CO2,andCOwithinrecognizedguidelines/standards

•  Acceptableresultsfollowingsamplingandanalysesformold