Sick buildings, sick kids: facilities construction and management take on illness prevention.

An outbreak of norovirus resulted in some 60 vomiting students at Worcester Polytechnic Institute (Mass.) who were taken to the hospital in April. At the University of North Carolina, there were three confirmed and one suspected case of bacteria[ meningitis this year. Last fall, Franklin & Marshal[ College (Pa.) had to move 50 students out of a residence hall while facilities crews cleaned up a mold infestation.

A LexisNexis search of the words "college" and "outbreak" returns hundreds of similar stories, all with two themes: students are sick, and facilities management is critical to the process of ensuring clean air and dean surfaces inside campus buildings.

"The facilities group is very sensitive to these kinds of issues," says Christopher Ahoy, associate vice president for Facilities at Iowa State and president-elect of APPA: The Association of Higher Education Facilities Officers (www.appa.org). "The question is how do you solve these problems and what resources are there to address them?"

INDOOR GERM WARFARE 

When it comes to infectious diseases like influenza, meningitis, and gastrointestinal viruses like norovirus, building designers are increasingly asked to take health issues into account. At most colleges and universities this means bringing in more fresh but preconditioned air from outside, rather than constantly re-circulating inside air.

"One reason flu epidemics come through schools in the winter is that they're re-circulating all this air," says David Kromm, president of Kromm, Rikimaru & Johansen, a St. Louis-based architectural firm. "Having more fresh air allows you to get rid of some of the polluted air so you don't have a building full of germ-laden air."

And while the American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) standards were updated about five years ago to increase the amount of fresh air that new buildings must provide, older buildings are exempt from this standard. "Many of the older buildings on campuses don't even have a provision for ventilation of air," says Alex Wing, senior associate in the higher education group at Pittsburgh-based architectural firm Burr Hill Kosar Rittelmann Associates. "In buildings that are 100 years old, they just open the windows. We're finding that we have to retrofit those buildings with good AC units that provide a higher [eve[ of fresh air."

HOSPITAL STANDARDS

IHEs that are serious about controlling communicable illnesses might do well to adopt some design and maintenance practices regularly implemented in health care facilities, architects say.

"I believe the best way to address this problem is to model higher ed solutions after health care, where infection control is central to all facility design," says Wing.

Many new hospitals are installing HVAC systems that call for 100 percent air replacement, a standard far above the current norm of 20 percent per hour. While this extreme [eve[ would be prohibitively expensive in many higher ed settings, it gives rise to the question of how much fresh air is enough to have an illness prevention effect.

"Keep in mind that building codes, as a rule, provide the minimum standard, not the optimum or best practice," says Bruce Knepper, a principal in the health care group at Burt Hill.

Perhaps even more important than air, though, is preventing the spread of germs from human contact. In other words, follow your mother's orders and "Wash your hands!" In health care, it was education about the importance of hand washing that lead to dramatic reductions in the spread of disease. Wing suggests that IHEs worried about illness on campus undertake the same educational mission, and perhaps even go as far as to install waterless hand washing stations in strategic areas. Waterless systems typically use alcohol-based hand cleansers that reduce the amount of germs on hands without the need for a sink, soap, or towels.

SURFACE PATROL

After air quality and clean hands, indoor surfaces become the next major concern for facilities managers and custodial services on campus.

At the University of LaVerne (Calif.), the astute response of a custodian who noticed blood in vomit found in a bathroom helped ease campus concerns after a student was diagnosed with bacterial meningitis there in April. (Meningitis can't live outside the body for very long, and is primarily passed along through close contact with someone who is affected.)

"The custodian recognized the blood and went through the requirements of cleaning up for a possible blood-born pathogen," says Charles Bentley, director of public relations at the university.

At Worcester Polytechnic Institute (Mass.), when it became dear that dozens of students were falling ill at the same time, the school's food service vendor immediately implemented an emergency protocol, as though the outbreak were caused by food poisoning. (Noroviruses are typically transmitted through oral-fecal contamination and are highly contagious.)

"They wiped everything down in the dining hall and kitchen with a bleach solution, and immediately went to paper and plastic-wrapped everything," says Janet Richardson, vice president for Student Affairs at the school. "We also wiped down everything in the residence halls."

Having custodians properly trained in cleanup methods is essential, says Ahoy of APPA. "Our preventative maintenance program is evaluated on a quarterly basis to determine whether it's effective," he says. "Custodial service personnel are trained to take care of daily chemical treatments."

Just the same, most campuses don't apply the same cleaning rigor that health care facilities do. Knepper suggests that IHEs took at what happens in a hospital, or on a cruise ship, after an outbreak of a communicable disease.

Critical to the issue of how surfaces are cleaned, though, is the question of what the surfaces are made of.

Increasingly, colleges and universities are choosing surfaces that are easy to dean, and eliminating carpet and other building materials that are known or believed to emit pollutants that can affect vulnerable individuals.

MOLD MATTERS

Preventing and treating infectious diseases like norovirus calls for surface strategies--particularly in surface selection and regular surface cleaning. But preventing mold requires constant attention to water, whether you're dealing with new construction or 100-year-o[d buildings.

The good news about mold is that the Atlanta-based Centers for Disease Control (CDC) says, "There are very few reports that toxigenic molds found inside homes can cause unique or rare health conditions such as pulmonary hemorrhage or memory loss. These case reports are rare."

The bad news is it can make a lot of people with existing allergies or asthma uncomfortable, and afraid, and a lot of money will surely be spent combating both the mold and the public relations nightmare it causes. And from a facilities perspective, mow infestations are perhaps the most vexing, and costly, unforeseen expenses a facilities administrator might face.

WHY MOLD GROWS

Mold cases can fairly easy be grouped into four categories: bad building design, bad construction, poor maintenance, and the ill will of Mother Nature. The country's leading engineering expert on mold, who has toured the country speaking about the issue on behalf of the EPA, believes the bulk of the blame for the continued mold madness rests squarely on the shoulders of architects and engineers.

"None of these people have any idea about what it takes to design a building where it's hot and humid," claims Joseph Lstiburek of Boston-based Building Science Corp. "The U.S. is an air conditioning-dominated nation--no other industrialized nation in the world has the same prevalence of air conditioning, so the approach to construction in the U.S. should be air-conditioning dominant."

Mold needs a moist climate to grow, so preventing mold requires preventing excess moisture in a building or on surfaces. Dust off your physics knowledge--this is a straightforward application of the second law of thermodynamics, says Lstiburek.

"It's pretty simple: moisture flows from warm to cold," he says. "So in a hot climate, the inside is cold, thanks to air conditioning, and the outside is hot. So moisture flows from the outside in."

Many other mold infestations begin when a leaky roof is undetected, saturating layers of the building with moisture. Another common cause stems from excess moisture in the building materials as it was being built, says engineer Brian Runde, vice president at Michigan-based Peter Basso Associates.

THE REMEDIES

There was mow all over the science building on the Brandon campus of Florida's Hillsborough Community College in the fall of 2003. It was growing on classroom walls, dinging to file cabinets in faculty offices, and just about everywhere in-between. Some faculty members raised concerns about breathing issues, says Gary Golf, vice president of administration and CFO of the school

When it became apparent that the mold was reaching crises levels, Goff and his administration took a three-pronged approach to solving the problem. First, they brought in air quality analysts to evaluate whether the mold caused a health hazard. Next, they hired mechanical engineers to determine the cause of the infestation. Finally, they put cleaning crews to work to rid the building of at[ visible signs of mold.

The results of the air quality testing were surprising: there was no danger to the people working in the building, and the mold spore count was lower inside the building than it was outside. The engineers found the mold stemmed from an improperly installed air conditioning unit on the roof. The unit had no drip pan, creating a holding area for water on the roof that eventually seeped into the building, Golf says.

Before long, the facilities team took a look behind the sheetrock and found the walls were full of mold. Over spring break, they demolished the affected areas down to the metal studs, cleaned them with an anti-fungal solution, and re-built and re-carpeted the classrooms and offices. The last step was replacing the HVAC system on the roof, at a cost of $75,000.

"I spent over $140,000 cleaning it up," Goff says.

PREVENTION

After using his school's emergency procurement process to pay for the cleanup, Goff and his team wanted to make sure they wouldn't find themselves surrounded by mow again. They put in place some preventative measures that engineers say make sense for all campuses. Among these were mold and humidity sensors in all buildings.

An internal survey of the IHE's 1.3 million square feet of facilities found that three buildings had faulty HVAC controls that needed to be replaced. They also installed louvers on their roof-mounted AC units in an effort to prevent horizontal rain from entering the system.

And last year, when Florida was bashed by hurricanes, Hillsborough took some extraordinary measures to prevent mold. They sandbagged around low-lying facilities to try to keep the water out. And when one building experienced minor flooding they tore the carpet out and replaced the bottom three feet of wallboard that got wet.

"In the past, chances are we probably would have just dried it out," Goff says. "After the mold experience we decided to take action immediately instead of waiting to see whether mold was going to grow."

MITIGATING THE RISK

Think your insurance covers mold damage? You're probably wrong. Most policies now exclude coverage for mold-related claims, a trend that began several years ago when "insurers saw a wall of mold claims coming at them and did what insurance companies always do when there is a new source of loss they didn't see coming--they excluded it," says Dave Dybdahl, president of American Risk Management Resources Network.

Now, if you want coverage for mold-related toss you must find an insurance company that deals with environmental insurance. The problem, says Dybdahl, is there are only about 12 of them in the country.

"The issue is that for every place that you depend on insurance to either pay claims or back up an indemnity for someone, there's now a gap for mold-related claims," he says.

By the same token, IHEs should make sure the architects, engineers and builders also carry separate environmental insurance.

"People always tell contractors, 'You're not working for us without insurance,'" Dybdahl says. "But they're not paying attention to what's covered by that general liability policy."

When pricing environmental insurance, you can expect it to cost about one-fourth the amount you pay for fire insurance on the same facility, Dybdaht suggests.

Resources

American Risk Management Resources Network www.armr.net

ASHRAE www.ashrae.org

Building Science Corp. www.buildingscience.com

Butt Hill Kosar Rittelmann Associates www.burthill.com

Centers for Disease Control www.cdc.gov

Kromm, Rikimaru & Johansen www.krjarch.com

Peter Basso Associates www.pbanet.com

GREEN BUILDING=HEALTHY BUILDING?

Many IHEs are actively pursuing the sustainable building agenda, says architect Alex Wing, and that often means seeking certification via the leadership in Energy and Environmental Design (LEED) program of the U.S. Green Building Council (www.usgbc.org). Green buildings, which seek to conserve energy and water and are built to minimize environmental impact, are often among the healthiest buildings to live and work in because they pay special attention to indoor air quality and use products that don't emit pollutants.

"Buildings will have much less pollutants if people follow LEED's standards," says David Kromm, who is building a LEED certified "net-zero" building for Crowder College (Mo.), a process that means the building produces as much energy as it uses to operate.

The LEED certification process awards points for different aspects of a building that embrace "green" materials and techniques. Designing buildings that are meant to prevent the spread of disease could translate into points in the LEED system.

"One could argue, in the context of a LEED certification, that designing a building to be a healthier building from a disease perspective would warrant 'innovation' points," Wing says.

RECOMMISSIONING

To bring older buildings up to current indoor air quality standards, and mitigate the spread of illness and growth of mold, often requires new HVAC systems, or "recommissioning" older systems.

"It's not uncommon to see higher ed facilities with antiquated air handling systems that do not provide enough dean ventilation air," says Alex Wing of Burt Hill "This can be addressed by installing new systems using advanced filtration and sterilizing technology. System performance is also generally improved by commissioning and regular maintenance."

Many times, building systems are vulnerable to mold when they're used in ways outside of their original design specifications. Sometimes HVAC systems are adapted to new uses, or just poorly maintained over a long period of time. This often means that water and moisture are seeping and collecting in places where they shouldn't.

"Of all the mold problems I've been involved in, most have been in older buildings that were not being maintained or serviced properly," says Brian Runde of Peter Basso Associates. "We now recommend the recommissioning of systems--going back and making sure they are operating per the original design intent."

The idea of recommissioning buildings seems like a good one, unless the building was poorly designed in the first place.

"Recommissioning is making sure the same stupid building is operating the same stupid way it was designed to," counters Joseph Lstiburek of Building Science Corp. "Einstein's definition of insanity is doing the same thing over again and expecting a different result."

CRISIS COMMUNICATION

In mid-August 2003, about 10 days before school was scheduled to open, Sharon Saunders found out that North Carolina Central University had a major mold infestation that couldn't be cleaned up quickly. It meant closing two residence halls and sending 500 students to area hotels.

"We had to come up with a communications plan quick," Saunders says. "We announced to the public that this was the problem and this is what our plan of action is. Instead of being reactive, we were proactive."

Mold, meningitis, measles--they all mean that the media relations team has to work quickly, and in conjunction with the facilities department, health services and administration.

When the University of LaVerne (Calif.) had a single case of meningitis, Public Relations Director Charles Bentley quickly wrote a press release and had it reviewed by university administration, the local hospital and county health officials. When he sent it to local news outlets, it got little notice at first. Two days later he had six news trucks on his campus each looking for the best place to do a "stand up" without capturing the competition's equipment in the background.

"This is the kind of publicity I don't want," Bentley says. "But we looked at it as a community service, not just to our campus but to the community at large."

Janet Richardson, vice president for Student Affairs at Worcester Polytechnic Institute (Mass.), believes that the key to managing crises like these is having an emergency protocol in place before you need it. At WPI, everyone from the food service workers, to custodians, to campus police and administration had a specific course of action they followed when the mass of students started getting sick.

"When you're talking about health and responding to emergencies, being proactive and having emergency processes in place is crucial so you're not learning as you're going," she says.

In North Carolina, the proactive steps in the mold crisis didn't stop with a press conference. The school put forth a lobbying effort to get the state to pay for the mold cleanup.

And concerned that the negative publicity would hurt future enrollment, the communications team created a campaign they called "From Mold to Gold." It involved a 16-city tour of North Carolina, with meetings with newspaper editorial boards, alumni, businesses and prospective students in each city. The effort ended the next fall when it was noted that enrollment had increased 7.5 percent. The strategy won NCCU a Special Merit award in the public relations category from District III of the Council for the Advancement and Support of Education.

Rebecca Sausner is a freelance writer and can be reached at [e-mail].