By Chip Macdonald
If a worker is infected with disease from over contamination to mold, be
prepared and know how to handle the situation.
The ongoing research, litigation and debate concerning the health effects of
mold exposure continue to occupy the laboratories, courtrooms and the press.
The novelty of a new alarm in the trades is always intriguing and the
controversy will probably not end soon. Not every black stain bleeding
through the wall is necessarily a mold colony or even hazardous.
These days, however, just the slightest hint of mold can cause a real estate
deal to fold or a construction job to grind to an expensive halt. But talk
to someone who has actually been diagnosed with a mold-related respiratory
disease and it soon becomes clear that, for some individuals, molds can
change your life forever.
Symptoms
While fungus infections and related diseases may not disable a great number
of American construction workers, many cases undoubtedly go unreported or
are misdiagnosed as another upper respiratory tract infection. A recent
Harvard Medical study concluded that in 10,000 homes, mold exposure was
associated with a 50 to 100 percent increase in respiratory distress
symptoms. Other studies suggest that molds contribute significantly to a
300-percent or more increase in asthma diagnoses in the past 20 years.
Many people allergic to molds, mildew and fungus, exhibit a wide range of
irritating, acute symptoms, such as asthma, skin rashes, fatigue,
irritability and congestion. More severe symptoms may include coughing,
nausea, headaches, arthritic aches and joint pain. The initial exposure
symptoms are often flu-like and not until the diseases become advanced is a
diagnosis of a mold-induced disease even made. However mycotoxins (poisonous
mold byproducts) are very destructive and often produce chronic symptoms
such as impaired breathing, memory loss, hearing, speech and eyesight
degradation, loss of balance and even epileptic-like seizures and brain
damage.
Recently, there have been several mold-infested sick buildings in my own
rural upstate New York community that were discovered during either
renovation, demolition or re-roofing projects. Several of the local workers
involved were infected, diagnosed and are now recovering with some very
serious and long-term health effects of aspergilliosis. This respiratory
disease is caused by exposure to the black mold in the genus aspergillus.
I know of several other cases that may have been misdiagnosed or gone
unreported, as the symptomology can be misleading. While many species of
mold are tropical and subtropical in origin, many others are adaptable to
our northern climates as well, especially when an insulated envelope is
constructed and heated during the cold months. Warm, moist inside air
traveling against a cold surface condenses into liquid (usually within the
insulation envelope) and is trapped by various building materials preventing
evaporation. Most of us do not observe this trapped water vapor as it
condenses, freezes and thaws season after season. It is most often
discovered by the contractor during a renovation or repair project.
The tighter we envelope our homes and workplaces, the more difficult it
becomes to control moisture migration. Molds are colonial by nature and must
expand their limits to survive. Molds can grow nowhere unless a dependable
source of moisture is available.
Aspergillus (black mold)
While most molds and fungi are benign, slightly irritating or even
beneficial (penicillin and blue cheese), some are very toxic to humans. The
class of pathogenic molds that present the greatest hazard to workers
involved with additions and wall/ceiling penetrations, interior renovations,
and especially demolition are classified as black molds. This group
includes stachybotrys chartarum, cladosporium, aspergillus fumigtus (and
more than 50 other species), fusarium, trichoderma, penicillium and
memnoniella.
Of this group, the stachbotrys, penicillium and aspergillus are the most
common in residential, commercial and even industrial structures. Most large
municipality and state departments of health have researched and developed
public health protocols to address these indoor environmental contaminants,
including testing and assessment techniques, remediation procedures and
hazard communication policies. There are also federal agencies that are
concerned with the health effects of molds, such as OSHA, NIOSH, CDC and EPA
Most large universities also support widespread mold investigation and
research that can be accessed by way of their Web sites.
While some species may produce organ-specific physical reactions (eyes, ears
nose, throat and lungs), it is the fungal mycotoxins and volatile organic
compounds that are produced as metabolites, which pose the greatest harm to
the exposed worker. The fungus (or any fragment of mycelia) spore or
metabolite that is inhaled may prove invasive and quite infectious.
It is commonly assumed that airborne particles less than 50 microns in
diameter, which are inhaled may bypass the cilia in our trachea, our mucous
membranes in our nose and throat and travel down the brachial tubes to our
lungs air sacs (aveoli). Here, the transfer of oxygen and carbon dioxide
occurs through surrounding capillary cell walls. The diameter of most mold
spores is fewer than four microns (250,000 on a pin-head), which makes them
very aggressive.
These spores are also very opportunistic, as the lung is also a dark, warm,
moist and confined space. Molds may colonize from the brachial tree to the
aveoli, producing debilitating plugs consisting of mold hyphae and fibrin.
This typically causes a high chest pain and a non-productive cough, with
blood-tinged sputum, which often mimics tuberculosis. As with the inhalation
of asbestos fibers or silica particles, the body reacts to molds by sending
macrophages in the bloodstream to ingest and destroy these invaders.
When ingested by these cells, the mycotoxins destroy the marcophage and lung
scarring becomes a common defense. This eventually reduces the average 32
square feet of lung tissue capable of transmitting oxygen to the blood and
CO2 to the lungs. Less oxygen to the cells causes brain and tissue damage.
Acidic carbon dioxide builds up in the blood and tissues leading to fatigue
and potential collapse.
Diagnosis and treatment
A large volume inhalation of mold spores may cause a disorder known as
organic dust toxic syndrome or farmers lung. Acute symptoms may often
present within four to eight hours after exposure and include fatigue,
chills, shortness of breath, painful tight chest, headache, increasing
weakness, fever and sweating, suppressed appetite, and thick phlegm and
chronic coughing. Sometimes, repeated low-volume exposures to these spores
may cause hypersensitivity pneumonitis, which compromises the immune system
and may cause permanent lung damage. Pulmonary hemorrhages in the developing
lungs of infants has also been diagnosed from mold spores. Aspergiliosis is
a disease, which left untreated, may in some individuals even result in
cerebral hemorrhage and fatality. The disease may be segregated into three
separate diagnoses:
Disseminated Aspergillosis: This acute infection produces a range of effects
including septicemia, thrombosis and infarction of the lungs, heart,
kidneys and brain. It is diagnosed by chest X-rays, which reveal crescent
shaped radiodlucency surrounding a circular mass (mycelium). This
debilitating disease may also cause other infections, including pneumonia,
endocarditis (heart valve), dyspnea (gag response), lung abscesses and brain
abscess.
Allergic Aspergillosis: This is a hypersensitive asthmatic reaction to the
aspergillus antigens in the blood system. It is typically diagnosed by
sputum examination and laboratory culture (two weeks). This disease may lead
to opportunistic infections, including sinusitis and ear infections. It is
often accompanied with pleural pain and fever.
Aspergillosis Endopthalmitis: This infection of either the anterior or
posterior chambers of the eye, which may cause temporary or permanent
blindness if left untreated. Associated infections often include corneal
keratitis.
As aspergillosis is non-transmittable between individuals, it does not
require patient isolation or quarantine. Disseminated aspergillus is
typically treated by an aggressive antifungal course of intravenous
Amphotericin B for two to three weeks, local surgical excision of lesions
and chest physiotherapy (coughing) to improve pulmonary function. There are
hospitals and treatment centers (mostly located along populated river
valleys) that specifically diagnose and treat mold-related diseases and
disorders.
It has been noted by specialists that psychological depression is often
common with patients with mold-induced diseases as the treatment often
includes long and intense periods of hospitalization and rehabilitation. The
debilitating effects of respiratory distress and intoxification often extend
beyond the initial treatment period. Many mold-induced disease victims are
even considered at high-risk for re-infection at much lower spore
concentrations.
Regular, semi-annual cardio-pulmonary check-ups are strongly recommended for
mold victims for the first few years after treatment. In some states, this
is often legally considered an extenuating health-related circumstance,
keeping many workers compensation files open for the lifetime of the victim.
Sidebar
Mold testing and analysis
As a construction contractor, you are not expected to obtain a graduate
degree in microbiology or mycology in order to protect your employees or
your business. However, your written contract should contain a
non-disclosure clause that is adequately phrased to reduce your liability
and release your obligations to perform your contract when undisclosed
conditions involving hazardous materials (including biohazards) are
discovered or suspected.
You may even require the property owner or prime contractor to perform
definitive environmental testing and analysis prior and post to your
commencing work when any hazmat is suspected. At that point you may even
choose to abate the mold hazard yourself in the performance of your roofing
or demolition project. In the state of New York where I live, there is no
state-certification program for mold abatement contractors. While the
National Institute of Safety and Health and the Center for Disease Control
have a detailed protocol and policy for mold remediation, most state and
local governments have remained uncommitted to legislate in this area.
However, if another contractor or owner is undertaking the removal of black
mold infested materials from your project, before you start you should have
copies of the lab tests taken prior and post abatement. In most cases, if
the gross contamination of mold is observed (either a musty, anaerobic smell
dark black stain on building materials, etc.) and a worker is showing any
of the initial exposure symptoms, you may proceed as if there is a hazardous
mold exposure.
However, due to the cost and delay factors of abatement, the owner or prime
contractor may argue that these symptoms and observations do not
conclusively prove the presence of harmful molds. Therefore, testing may be
required. Testing may be either performed by bulk sampling or air test
procedures and follow these minimal, non-inclusive parameters:
Testing may be practiced when mold is suspected (smelled) but not observed
Testing (air or grab sampling) should not be practiced in a manner that
agitates the mold or unnecessarily exposes unprotected workers. Ventilation
shut off and windows closed for still-air conditions.
Tests may either be taken by individual test kits, which are mailed back
to a lab for testing or analysis, or else performed by a certified
industrial hygienist for a reputable environmental testing agency. In any
case, you should protect your workers and your firm, by thorough
documentation, photographs and daily work logs sufficiently detailed to
enable you to adequately reconstruct the work shift three years later.
Air monitoring may not be necessary, except in the diagnosis of either
aspergilliosis or stachybotriosis in a worker.
Air tests should be concurrently taken at any natural air inlet into the
affected space to eliminate the possibility of cross contamination.
Personnel performing the tests shall be:
a) Medically examined to ensure capable to enter area.
b) Thoroughly trained and evaluated in biohazard awareness and hazmat
decontamination procedures.
c) Fit-tested for and supplied with the appropriate personal protective
equipment for the hazard level assumed.
Analysis of test results must be made by either a professional accredited by
the American Industrial Hygiene Association or by a lab certified by the
Environmental Microbiology Laboratory Accreditation Program.
Sidebar
Remediation and disposal
If you choose to undertake mold remediation as part of a
renovation/demolition project, there are definitive actions that should be
taken. Special emphasis should be placed on comprehensive and hands-on
training of abatement personnel before exposing them to the health hazards.
Often, a simple exposure can produce medical conditions that affect their
lives for years to come. They should also have access to the best
professional equipment available, including fit-tested respirators, level B
protective clothing, and task-specific tools such as moisture meter, remote
cavity biohazard samplers, fiber optic scopes, cassettes for sampling
airborne aerosols, and decontamination supplies, just to name a few.
A written, site-specific mold abatement plan should be developed by the
employer and every member of the abatement team should be trained in its
specific procedures, as well as their own assigned tasks. Removal of
mold-contaminated materials (such as insulation, framing, plaster and gypsum
board) and post-demo handling methods, should be conducted using a
pre-determined set of safe work practices including engineering controls
(encapsulation, barriers, ventilation), administrative controls (training,
controlled access zones, shared exposures, decontamination, vapor proof
waste containers) and finally personal protective equipment (level B
clothing, respirators, supplied air).The species of the mold and the size
(volume) of the abatement area are crucial to determining an adequate
abatement plan. The reaction time is also crucial with molds, due to their
rapid and aggressive colonization patterns. The amount of exposure time and
extent of disturbance is critical. As with any poison, dosage is calculated
by multiplying the concentration (particles per cubic centimeter) times the
length of exposure. The ease with which we may be exposed by several
inhalations, emphasizes the need for writing and practicing an efficient
mold abatement plan.
Water leaks and accumulation should always be stopped immediately as
moisture is essential to growth and the production of spores. Relative
humidity should be tested and maintained below 60 percent (40 percent is
ideal) to inhibit mold growth. Always remember the goal of remediation is to
remove or clean contaminated materials by methods that prevent the emission
of fungi particles and spores that may contaminate clean areas or infect
workers.
Whenever gross fungal growth is observed, or even suspected, by anyone on
the job site, the property owner should be immediately notified. The owner
should then proceed according to hazard communication methods to notify all
affected employers on the work site. These employers, such as an interior
finish contractor, should likewise notify and evaluate his workers. If
remediation is required, then all affected employees should be included in
pre-abatement meetings with a disclosure of all the procedures in the mold
abatement plan.
A simple diagnostic mold culture test kit can achieve certified laboratory
analysis and species identification for approximately $30 in five to seven
days. A more expensive airborne particulate test will indicate the sample
concentration of mold (in spores/cc). This is a particularly important
post-mitigation test to determine the level of success of the abatement.
Knowledge and preparation is the best health defense for the contractor.
Medical records and symptomatic post-exposure records should be diligently
recorded. Any employees with persistent health problems related to
bioaerosols should be referred to a professional medical practitioner,
trained in mycological diagnosis and treatment. Thorough hazard
communication is the essential key to a biohazard, such as black mold.
Widespread mold contamination during construction demolition or inspection
can prove to be an aggressive and opportunistic source of infection from
just a brief exposure. For some individuals it appears a single exposure to
concentrated black mold or fungus colonies growing in confined spaces behind
the wall or ceiling during demolition may be dangerous. Training and
experience in mold awareness and identification, as well as the ability to
take prompt corrective measures, such as evacuating the affected area, are
the prerequisites for a competent person on the job.
Make sure your supervisors and job foremen are aware of the health hazards
of molds and fungi on their projects and are adequately trained to identify
potential conditions for mold growth. The odds of mold contamination on most
jobs are minimal but it only takes a single, deep breath of contaminated air
for some individuals to become infected. So, take the time to become trained
in mold hazards and the appropriate emergency action plan. Endeavor to keep
the lines of communication open from each worker, through site supervision,
straight to your office and the effects of black mold health hazards will be
minimized.
Sidebar
The basic recommended levels of mold and fungus remediation
LEVEL I: Small isolated areas (10 square feet or less) such as ceiling tiles
small area of wall gypsum board.
Abatement workers may be appropriately Hazard-Awareness-trained
maintenance personnel.
Provide NIOSH N95 respirators, gloves and protective clothing in
accordance to OSHA standards.
Evacuating non-essential personnel (with medical evaluations).
Dust suppression procedures (misting) by 100-percent containment is not
required.
Contaminated materials that cannot be cleaned should be removed in double
sealed plastic bags. Check state requirements for disposal of moldy
materials.
Visibly free from contamination/debris.
LEVEL II: Mid-sized isolated areas (10 to 30 square feet), such as several
pieces of gypsum wallboard.
Abatement workers may be appropriately hazard-awareness trained
maintenance personnel.
Provide NIOSH N95 respirators, gloves and protective clothing in
accordance to OSHA standards.
Evacuating non-essential personnel (with medical evaluations).
Cover work area with plastic sheet with taped seams to contain dust.
Dust suppression procedures (misting) is recommended.
Contaminated materials that cannot be cleaned should be removed in double
sealed plastic bags. Check state requirements for disposal of moldy
materials.
Areas used by workers for egress should be HEPA vacuumed and cleaned with
antimicrobial detergent, and left dry and visibly free from
contamination/debris.
LEVEL III: Large isolated area (30 to 100 square feet) such as several wall
board panels.
An experienced microbial-certified safety and health professional to be
consulted prior to remediation to develop abatement plan.
Abatement workers may be appropriately Hazard-Awareness-trained
maintenance personnel.
Provide NIOSH N95 respirators, gloves and protective clothing in
accordance with OSHA standards.
Evacuating non-essential personnel (with medical evaluations).
Cover work area with plastic sheet with taped seams to contain dust and
seal adjacent HVAC systems.
Dust suppression procedures (misting) is recommended.
Contaminated materials that cannot be cleaned should be removed in double
sealed plastic bags. Check state requirements for disposal of moldy
materials.
Work area used by workers for egress should be HEPA vacuumed and work area
cleaned with antimicrobial detergent and left dry and visibly free from
contamination/debris.
If abatement method is expected to produce a lot of dust, such as by
abrasive cleaning or demolition or the fungi is very visible in heavy
blanket or pocket concentrations, then Level IV remediation procedures
should be followed.
LEVEL IV: Extensive contamination (more than 100 square feet contiguous
area) or any exposure that resulted in a positive medical diagnosis of a
mold-related disease of condition.
An experienced microbial-certified safety and health professional to be
consulted prior to remediation to develop abatement plan.
Pre-entry and continuous air monitoring recommended.
Abatement workers should obtain advanced mold hazard and decontamination
training for experienced, professional abatement personnel.
Provide NIOSH N100 respirators, disposable gloves and protective clothing
that covers head, feet and hands in accordance to OSHA standards.
Evacuating non-essential personnel (with medical evaluations).
Completely isolate work area with plastic sheet with taped seams to
contain dust and seal adjacent HVAC systems.
Provide NIOSH approved exhaust fan with HEPA filter to generate negative
pressure to sealed work area.
Design and provide adequate airlocks and decontamination room.
Contaminated materials that cannot be cleaned should be removed in double
sealed plastic bags. Clean outside of bags in decon chamber with HEPA vacuum
(99 percent efficiency) prior to transport to uncontaminated area of
building. Check state requirements for disposal of moldy materials.
Contained work area used by workers for egress should be HEPA vacuumed and
work area cleaned with antimicrobial detergent and left dry and visibly free
from contamination/debris.
Post-abatement air monitoring prior to reoccupation is also recommended.
Chip Macdonald of Best Safety, Saratoga Springs, N.Y., offers safety program
implementation and management tailored to companies of all sizes.