Preventing sick buildings.

IS INDOOR AIR CARRYING CARCINOGENS AND CONTAMINANTS throughout your facility poisoning your residents and staff? According to the U.S. Environmental Protection Agency (EPA), an increasing amount of scientific evidence points to indoor air more seriously polluted than the outdoor air of many large, industrialized cities. EPA findings based on human exposure indicate indoor air levels of many pollutants may be two to five times and, occasionally, more than 100 times higher than outdoor levels.

In bad indoor air, who's most at risk? EPA experts point to several groups: those who spend great amounts of time indoors, the chronically ill (especially those with respiratory or cardiovascular diseases), and the elderly--in other words, your residents.

Your building's indoor air quality (IAQ) or building air quality (BAQ) can trigger two significant types of health problems: sick building syndrome (SBS) and building-related illnesses. The EPA defines SBS as involving acute on-site discomfort among persons spending extended time in a building--likely a result of poor ventilation and/or maintenance. Building-related illnesses cover diagnosable ailments (Legionnaire's Disease and hypersensitivity pneumonitis among them) linked to specific airborne contaminants.

The good news: You can clean up your facility's air and keep it clean. Savvy owners, managers, and engineering staff can improve IAQ--and decrease associated risks and legal costs--through increased awareness of what affects it most. What are the culprits creating all the bad indoor air? They include furnishings, occupant activities, housekeeping practices, pesticide applications, and microbial contamination, along with under-performing or improperly maintained ventilation systems.

"Owners need to view indoor air quality as an ongoing task," explains Matthew Tendler, AIA. "They must realize the health of their residents is reliant on how they maintain their systems." Tendler, director of Sustainable Design Services for KS Consulting, a division of Kahler Slater Architects in Milwaukee, sees IAQ as twofold: keeping things clean and making certain heating, ventilating, and air conditioning (HVAC) systems are operating as they were intended.

"We're utterly dependent in modern buildings on the ventilation systems," explains Tendler. "These systems have to be running in optimal condition or we're slowly poisoning ourselves."

Besides providing thermal comfort, HVAC systems are designed to ensure buildings get enough fresh air. As a standard measure for tight, well-insulated buildings, engineers design systems to circulate 20 cubic feet per minute (CFM) of fresh air per person. Obviously, this allows for equal outgassing of interior building pollution. Toilet, soiled-linen, and kitchen exhausts are increased to take care of the extra pollutant load.

While air intake is governed by building code (10 feet from a discharge unit; rooftop units 10 feet from exhaust vents, for example), regulations do not cover, say, air intake proximity to a highway, freeway, or parking structure. Clearly, a combination of automobile emissions and wind could create unfavorable IAQ. "If someone's building a parking garage right next to your building, the owner should be aware of that," says Bob Heath, a Tampa engineer with 50 years of experience designing HVAC systems. (He recalls decades-old air intake standards of 5 CFM--when buildings breathed).

Optimal humidity levels hover between 30 and 50 percent, which typically requires adding or reducing moisture levels depending on climate and season. "Too much moisture will promote microbial growth," says Tendler. "Too little means the mucus membranes dry out and make people more susceptible to viruses."

Maintenance, maintenance, maintenance

Tendler advises routine, thorough inspection of building systems--a "regular, proactive schedule" --to maintain good IAQ. On his checklist:

* Keep air intakes free and clear of snow, bird droppings, debris, and trash. Keep dumpsters and waste receptacles away from intake areas. "If you're bringing in bad air in the first place, you're going to have problems," says Tendler.

* Monitor interior [CO.sub.2] levels. Readings higher than 800 to 1,000 parts per million (PPM) indicate a ventilation system that's not performing adequately.

* Replace HVAC filters and flush condensate drain pans (or drip pans) frequently--as often as every two weeks in hot, humid climates. Tendler suggests using drip pans pitched to drain and fabricated of stainless steel, which is easy to clean and less likely than galvanized steel to harbor moist residue where bacteria can thrive.

* Check and inspect biocide levels in cooling towers to help prevent growth of bacteria, including Legionella.

* Verify negative pressure in areas involving biological contaminant sources such as soiled-linen rooms and toilet areas.

* Balance your system and recalibrate humidistats at planned intervals to ensure your entire system is running at optimum levels.

Make IAQ everybody's business

"Everybody who maintains the facility should be aware of their role in IAQ," says Tendler, that is the goal. People just aren't trained to think about IAQ and the total building system and realize that everybody has a role to play in it."

Recognizing that basic maintenance issues (see "A clean routine: IAQ improvements to make now," page 13) and design and renovation affect IAQ, Tendler looks at building products and related offgassing, aiming to reduce VOC (volatile organic compound) emissions. Finishes, stains, sealers, and paints come in no- or low-emission formulas. Some carpet is certified as meeting the IAQ standards of the Carpet & Rug Institute (see [less than]www.carpet-rug.com[greater than]). And consider application and installation-related products (adhesives, for example) as parts of the IAQ mix.

Architects, interior designers, purchasers, facility managers, and contractors can play a role in improving IAQ. As part of his team approach, Tendler suggests that a maintenance worker or contractor charged with painting be responsible for partitioning work areas to contain dust and debris, for increasing ventilation and exhaust, and for ensuring that no- or low-VOC paints are used.

Maintaining good indoor air quality (IAQ) is the responsibility of every care provider. And the day is coming when a resident, guest, or family member will hold a palm-sized monitor and register your facility's IAQ to make certain you're doing your part.

Rachel Long is a regular contributor to CLTC.

A clean routine: IAQ improvements to make now

Taking immediate steps toward better air quality involves things such as routine housekeeping and pest control. Matthew Tendler, AIA, of environmentally driven KS Consulting, a division of Kabler Slater Architects in Milwaukee, explains where to begin. Among his tips:

Use greener cleaners. Switch to minimum-or no-toxicity cleaning products wherever possible. To minimize overall exposure, set limits on what areas require hazardous chemical disinfectants.

Rethink overuse. Indoor air quality may be compromised simply by overusing cleaning agents based on their methods of dispensing. Train housekeeping staff to mix concentrates correctly and to avoid dousing surfaces with cleaners; try pre-portioning hazardous cleaning products for given applications.

Check vacuuming equipment. HEPA (high-efficiency particulate air cleaning) vacuum systems--standard in many healthcare settings--filter and trap harmful bacteria. Otherwise, you're sucking everything in and spewing it out as exhaust.

Improve pest control. If pest extermination is routine at your facility, examine its methods. Reduce random spraying of pesticides near air intakes and at building entrances, where airflow will carry it indoors swiftly. Look at integrated pest management that involves less toxicity, for example, using rodent traps instead of poisons.