Sick building syndrome (SBS) is a common worldwide health concern.
Under the Sick Building Syndrome phenomenon, the people in a building suffer from symptoms of illness or become infected with chronic disease from the building they work in or reside in.
Many cases involving fatalities have been examined involving the deposition of infectious disease-bearing particles (vomit, feces, spittle, etc.) throughout a building or structure.
In all cases, the outbreaks are a direct result of inadequate cleaning, and maintenance, or defects with the construction materials or assembly process. In many cases, the building itself is too damaged to recover, as the materials themselves (wood structural members) are decaying from mold or rot.
The phenomenon is found worldwide in buildings with lower than adequate maintenance or other economic concerns. Health professionals recommend anyone living in an older building with medical conditions, to use HEPA air filters for indoor use to minimize airborne particulate introduced from outside the living space.
Many cases of Norwalk virus and Norovirus outbreak have been traced back to cruise ships and hotels with food service in unsanitary conditions or substandard restroom cleanliness protocols.
Certain symptoms tend to increase in severity with the time people spend in the building; often improving over time or even disappearing when people are away from the building. The main identifying observation is an increased incidence of complaints of symptoms such as headache, eye, nose, and throat irritation, fatigue, and dizziness, and nausea from exposure to harmful chemicals released by toxic black mold.
Some symptoms are linked to the average amount of time spent in a building, such as a mold spore and dust inhalation. SBS is also used interchangeably with “building-related symptoms“, which orients the name of the condition around patients’ symptoms rather than a “sick” building.
A 1984 World Health Organization (WHO) report suggested up to 30% of new and remodeled buildings worldwide may be subject to complaints related to poor indoor air quality. Sick building causes are frequently pinned down to flaws in the heating, ventilation, and air conditioning (HVAC) systems.
However, there have been inconsistent findings on whether air conditioning systems result in SBS or not. Other causes have been attributed to contaminants produced by outgassing of some types of building materials, volatile organic compounds (VOC), molds, improper exhaust ventilation of ozone (a byproduct of some office machinery), light industrial chemicals used within, or lack of adequate fresh-air intake/air filtration.
Signs and symptoms
Human exposure to bioaerosols has been documented to give rise to a variety of adverse health effects. Building occupants complain of symptoms such as sensory irritation of the eyes, nose, or throat; neurotoxic or general health problems; skin irritation; nonspecific hypersensitivity reactions; infectious diseases; and odor and taste sensations. Exposure to poor lighting conditions has led to general malaise.
Extrinsic allergic alveolitis has been associated with the presence of fungi and bacteria in the moist air of residential houses and commercial offices. A very large 2017 Swedish study correlated several inflammatory diseases of the respiration tract with objective evidence of damp-caused damage in homes.
The WHO has classified the reported symptoms into broad categories, including mucous membrane irritation (eye, nose, and throat irritation), neurotoxic effects (headaches, fatigue, and irritability), asthma and asthma-like symptoms (chest tightness and wheezing), skin dryness and irritation, gastrointestinal complaints and more.
Several sick occupants may report individual symptoms that do not appear to be connected. The key to discovery is the increased incidence of illnesses in general with onset or exacerbation within a fairly close time frame – usually within a period of weeks.
In most cases, Sick Building Syndrome symptoms will be relieved soon after the occupants leave the particular room or zone. However, there can be lingering effects of various neurotoxins, which may not clear up when the occupant leaves the building. In some cases – particularly in sensitive individuals – there can be long-term health effects.
One study looked at commercial buildings and their employees, comparing some environmental factors suspected of inducing SBS to a self-reported survey of the occupants, finding that the measured psycho-social circumstances appeared more influential than the tested environmental factors.
Limitations of the study include that it only measured the indoor environment of commercial buildings, which have different building codes than residential buildings, and that the assessment of building environment was based on layman observation of a limited number of factors.
Research has shown that Sick Building Syndrome shares several symptoms common in other conditions thought to be at least partially caused by psychosomatic tendencies. The umbrella term “autoimmune/inflammatory syndrome induced by adjuvants” has been suggested.
Other members of the suggested group include Silicosis, Macrophagic myofascitis, Gulf War syndrome, Post-vaccination phenomena.
Greater effects were found with features of the psycho-social work environment including high job demands and low support.
The report concluded that the physical environment of office buildings appears to be less important than features of the psycho-social work environment in explaining differences in the prevalence of symptoms. However, there is still a relationship between sick building syndrome and symptoms of workers regardless of workplace stress.
Excessive work stress or dissatisfaction, poor interpersonal relationships, and poor communication are often seen to be associated with SBS, recent studies show that a combination of environmental sensitivity and stress can greatly contribute to sick building syndrome.
Specific work-related stressors are related to specific SBS symptoms. Workload and work conflict are significantly associated with general symptoms (headache, abnormal tiredness, the sensation of cold, or nausea). While crowded workspaces and low work satisfaction are associated with upper respiratory symptoms.
Specific careers are also associated with specific SBS symptoms. Transport, communication, healthcare, and social workers have the highest prevalence of general symptoms. Skin symptoms such as eczema, itching, and rashes on hands and face are associated with technical work. Forestry, agriculture, and sales workers have the lowest rates of sick building syndrome symptoms.
Milton et al. determined the cost of sick leave specific for one business was an estimated $480 per employee, and about five days of sick leave per year could be attributed to low ventilation rates. When comparing low ventilation rate areas of the building to higher ventilation rate areas, the relative risk of short-term sick leave was 1.53 times greater in the low ventilation areas.
Work productivity has been associated with ventilation rates, a contributing factor to Sick Building Syndrome, and there’s a significant increase in production as ventilation rates increase, by 1.7% for every two-fold increase of ventilation rate.
Printer effluent, released into the office air as ultra-fine particles (UFPs) as toner is burned during the printing process, may lead to certain SBS symptoms. Printer effluent may contain a variety of toxins to which a subset of office workers is sensitive, triggering SBS symptoms.
Sick building syndrome can also occur due to factors of the home. Laminate flooring can cause more exposure to chemicals and more resulting SBS symptoms compared to stone, tile, and cement flooring.
Recent redecorating and new furnishings within the last year were also found to be associated with increased symptoms, along with dampness and related factors, having pets, and the presence of cockroaches.
The presence of mosquitoes was also a factor related to more symptoms, though it is unclear whether it was due to the presence of mosquitoes or the use of repellents.
- Regular inspections to indicate for the presence of mold or other toxins
- Adequate maintenance of all building mechanical systems
- Toxin-absorbing plants, such as sansevieria
- Roof shingle non-pressure cleaning for removal of algae, mold, and Gloeocapsa magma
- Using ozone to eliminate the many sources, such as VOCs, molds, mildews, bacteria, viruses, and even odors.
- However, numerous studies identify high-ozone shock treatment as ineffective despite commercial popularity and popular belief.
- Replacement of water-stained ceiling tiles and carpeting
- Only using paints, adhesives, solvents, and pesticides in well-ventilated areas or only using these pollutant sources during periods of non-occupancy
- Increasing the number of air exchanges; the American Society of Heating, Refrigeration, and Air-Conditioning
- Engineers recommend a minimum of 8.4 air exchanges per 24-hour period
- Proper and frequent maintenance of HVAC systems
- UV-C light in the HVAC plenum
- Installation of HVAC air cleaning systems or devices to remove VOCs, bio effluents (people odors) from HVAC systems conditioned air
- Central vacuums that completely remove all particles from the house including the ultrafine particles (UFPs) which are less than 0.1 μm
- Regular vacuuming with a HEPA filter vacuum cleaner to collect and retain 99.97% of particles down to and including 0.3 micrometers
- Place bedding in the sunshine, which is related to a study done in a high-humidity area where damp bedding was common and associated with SBS
- Increased ventilation rates that are above the minimum guidelines
- Lighting in the workplace should be designed to give individuals control, and be natural when possible
- Relocate office printers outside the air conditioning boundary, perhaps to another building
- Replace current office printers with lower emission rate printers
- Identify any products containing harmful ingredients and remove them
Some studies have shown a small difference between genders, with women having slightly higher reports of SBS symptoms compared to men.
However, many other studies have shown an even higher difference in the report of sick building syndrome symptoms in women compared to men. It is not entirely clear, however, if this is due to biological, social, or occupational factors.
A 2001 study published in the Journal Indoor Air, gathered 1464 office-working participants to increase the scientific understanding of gender differences under the Sick Building Syndrome phenomenon.
Using questionnaires, ergonomic investigations, building evaluations, as well as physical, biological, and chemical variables, the investigators obtained results that compare with past studies of SBS and gender. The study team found that across most test variables, prevalence rates were different in most areas, but there was also a deep stratification of working conditions between genders as well.
For example, men’s workplace tends to be significantly larger and have all-around better job characteristics. Secondly, there was a noticeable difference in reporting rates, finding that women have higher rates of reporting roughly 20% higher than men. This information was similar to that found in previous studies, indicating a potential difference in willingness to report.
There might be a gender difference in reporting rates of sick building syndrome because women tend to report more symptoms than men do. Along with this, some studies have found that women have a more responsive immune system and are more prone to mucosal dryness and facial erythema.
Also, women are alleged by some to be more exposed to indoor environmental factors because they have a greater tendency to have clerical jobs, wherein they are exposed to unique office equipment and materials (example: blueprint machines), whereas men often have jobs based outside of offices.
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 the WHO in 1986, when they also estimated that 10–30% of newly built office buildings in the West had indoor air problems. Early Danish and British studies reported symptoms.
Poor indoor environments attracted attention. The Swedish allergy study (SOU 1989:76) designated “sick building” as a cause of the allergy epidemic as was feared. In the 1990s, therefore, extensive research into “sick building” was carried out. Various physical and chemical factors in the buildings were examined on a broad front.
The problem was highlighted increasingly in media and was described as a “ticking time bomb“. Many studies were performed in individual buildings.
In the 1990s “sick buildings” were contrasted against “healthy buildings“. The chemical contents of building materials were highlighted. Many building material manufacturers were actively working to gain control of the chemical content and to replace criticized additives. The ventilation industry advocated above all more well-functioning ventilation. Others perceived ecological construction, natural materials, and simple techniques as a solution.
At the end of the 1990s came an increased distrust of the concept of “sick building“. A dissertation at the Karolinska Institutet in Stockholm 1999 questioned the methodology of previous research, and a Danish study from 2005 showed these flaws experimentally.
It was suggested that sick building syndrome was not really a coherent syndrome and was not a disease to be individually diagnosed, but a collection of as many as to a dozen semi-related diseases. In 2006 the Swedish National Board of Health and Welfare recommended in the medical journal Läkartidningen that “sick building syndrome” should not be used as a clinical diagnosis. Thereafter, it has become increasingly less common to use terms such as “sick buildings” and “sick building syndrome” in research.
However, the concept remains alive in popular culture and is used to designate the set of symptoms related to poor home or work environment engineering. “Sick building” is, therefore, an expression used especially in the context of workplace health.