1. Bioaerosols & Indoor Air Quality
Demonstration components of this lecture involve showing and providing and overview of indoor air quality monitoring equipment. The Andersen Bioaerosol Sampler, monitors that can evaluate CO2, CO, Temperature and % Relative Humidity. A Dust/particulate monitor. A Photoionization Detector (PID) for monitoring select organic vapors. A multigas meter to monitor Oxygen, Methane, Carbon Monoxide and Hydrogen Sulfide.
Sampling plates for the bioaerosol sampler can be brought in an students can gain practice loading and calibrating the Bioaerosol sampler. This is good practice before the field exercise where students will monitor a location in order to assess the levels of airborne or surface contamination.
An additional instructor (industrial hygienist) from the EH&S Office may be recruited to assist with the course lecture, interactive exercise or field sampling exercise if needed.
The scheduled tours associated with this lecture are usually difficult to schedule during lecture time or the instructor may decide to use lecture time for one of the tours. Building Services Personnel (those responsible for maintenance of the HVAC – Heating Ventilation and Air Conditioning Systems) can be contacted in advance to arrange for about a 45 minute tour of the HVAC system for one of the big buildings at your institution. The air intake and exhaust ducts, the filtration system, the heating and cooling coils, humidification systems, drainage systems, etc. The Building Services group can also discuss their preventive maintenance program for the system (filter changes, efficiency of the filters, checks for stagnant water, changes of fan belts, etc.)
A tour of a cooling tower (large or small) should be scheduled due to their association with the growth and dissemination of Legionella. If possible a representative from the water management company responsible for application of the biocides should also be asked to provide a tour and walkthrough of a cooling tower, and describe to the students how it works, what the risks are, and how they are controlled. One student project could be monitoring cooling towers that have a biocide program and those that do not to see if there is a difference in the levels of microoganisms found in bulk water samples.

2. Bioaerosol
Mixture of solid or liquid particles in air containing whole or parts of biological materials.
Biological materials include human pathogens, toxic or allergic pieces of microorganisms, dust mite parts or feces, animal dander, fur, dried saliva, and animal waste products

3. Bioaersols (Examples)
Human pathogens
fungi, bacteria, parasites, viruses
Endotoxin (LPS from gm neg. bacteria)
Mites, animal dander (other allergens)
Fungi
mold
spores
mycotoxins

4. Sick Building Syndrome (SBS)

5. Sick Building Syndrome (SBS)
Acute health and comfort effects experienced by building occupants that are apparently linked to time spent in the building. (EPA)
No specific illness identified
symptoms appear 2-6 hours after entry
symptoms disappear shortly after leaving or overnight (fresh air)

6. Symptoms of SBS headache fatigue shortness of breath sinus congestion
cough
sneezing
eye, nose, and throat irritation
skin irritation
dizziness, nausea

7. Building Related Illness (BRI)
Illness brought on by exposure to building air.
Symptoms of diagnosable illness identified.
Linked to agents in the air
Examples (Legionnaire’s Disease, Pontiac Fever, Humidifier Fever, Hypersensitivity)

8. Hypersensitivity Diseases
Antigens stimulate antibody response
Hypersensitivity Pneumonitis (IgG produced, Farmer’s Lung)
chills, fever, cough, shortness of breath (4-8 hours post exposure)

9. Humidifier Fever Flu-like symptoms (4 - 8 hours post-exposure)
no prominent respiratory symptoms
symptoms dissipate w/in 24 hours
related to cold-aerosol humidifiers in an enclosed space
empty water daily, disinfect after use

10. Allergic Rhinitis Hay fever pollen, mold spores, dust, dander
nasal obstruction, discharge, post-nasal drip
sneezing, itching, tearing eyes
cough
pollen, mold spores, dust, dander

11. Asthma
Triggers at work
pollen
mites
fungi
insects/arthropods

12. Allergens Dust mites Cats, dogs (pets) Dander (animal facilities)
Cockroaches
Pollen

13. Susceptible Building Occupants
Allergies, asthma
Respiratory disease
Immunosuppressed (patients)
Contact lens wearers
Others?

14. Infectious Diseases Legionnaire’s Disease Legionella bacterium
growth in water sources F
associated with algae
cooling towers, evaporative condensers, spas, plumbing systems, humidifiers
severe pneumonia (5 - 30% mortality)
immunosuppressed, those with respiratory conditions at much higher risk
1976 outbreak at American Legion Convention
182 cases, 29 deaths
10,000+ US cases estimated annually

15. Psittacosis Chlamydia psittaci (bacterium)
fever, chills, headache, muscle aches, fry cough
pneumonia
infection of other organs, can be fatal
< 50 cases/year in US
inhalation of dried secretions from infected birds

16. Aspergillosis Pneumonia related to inhalation of Aspergillus spores
with fever, cough, chest pain
opportunistic infection in immune suppressed and those with lung disease
Aspergillus fumigatus, A. flavus most common causes
important nosocomial infection
release during construction/renovation work

17. Other Fungal Pathogens
Cryptococcus
Cryptococcus neoformans
isolated from soil worldwide (bird droppings - pigeons)
inhalation of spores
85% of infections among immune deficient
meningitis, permanent neurological damage
12% mortality rate

18. Other Fungal Pathogens
Histoplasmosis
Histoplasma capsulatum
flu-like illness in most (pulmonary involvement of disseminated infection in severe cases)
contaminated soil (bird or bat droppings)
inhalation of spores
immunocompromised at high risk

19. Mycotoxins Over 200 known Inhalation, ingestion, skin contact
Aflatoxin B1 (liver cancer, lung cancer?)
Trichothecen mycotoxins
T-2 (inhibits RNA and protein synthesis, toxic to dividing cells, damages variety of organs, tissues, immunosuppressive)
Yellow rain (russian military )

20. Fungal Wall Cell Components
Beta (1 - 3) - D- Glucans
small cell wall pieces
inflammatory lung and airway reactions
impair immune system
flu-like illness from high exposures (Organic Dust Toxic Syndrome)

21. Building Assessment Building History date of construction
renovations, upgrades
new furnishings
meet with building management
list of building activities
previous floods, water damage, leaks

22. Energy Efficient Buildings
1970’s - Arab oil embargo
construction of “tight” buildings
less use of fresh outdoor air, more re-circulation of treated air
40% energy cost savings
99% of requests to NIOSH for air quality investigations occur after 1978

23. Building Assessment Review of occupant complaints
building location, number of reports
time of complaints (daily or seasonal pattern)
type of complaint
health symptoms (acute/chronic)
comfort (thermal, odor, noise, lighting)
NIOSH 80% rule
input from healthcare professional(s)

24. Building Assessment Building walkthrough with building manager
with some occupants (union representation)
complaint areas and non-complaint areas
housekeeping
visible fungal growth (sources of moisture)
overcrowding
fans, blocked diffusers, heaters, humidifiers

25. Hidden Sources of Mold back side of drywall
top of ceiling tiles (roof leaks)
underside of carpets (carpet below filing cabinets)
pipe chases, utility tunnels
elevator shafts (building syringe)
drain pans in HVAC system
insulation within ductwork

26. Building Assessment Monitor CO2, dust Temperature, %RH
Smoke test (airflow)
Amount of fresh air
ASHRAE
20 CFM/person
Odors (volatile chemicals in air)

27. Building Assessment Review HVAC system type of system
plenum or ducted system
insulation in ductwork?
dirty mechanical room?
preventive maintenance?
% of re-circulated air
time HVAC turned on/off
blocked airflow
odors, stagnant water?
biocides in system?

28. Building HVAC System Outdoor Air Intake location (downstream of…)
work in vicinity
pollutants in vicinity
bird droppings, decaying matter
vehicles, fuel-powered equipment
exhaust stacks, toilet exhaust stacks
cooling towers, puddles, garbage, etc.
Screens, filters, BIOSECURITY!
Air intakes can be used for terrorism events

29. Building HVAC System Air filtration filter location % efficiency
pre-filters?
Maintenance schedule (changes)?
Appearance (excessive dirt/debris)
Fit (leaks around filters - bypass system)

30. Building HVAC System Supply fan percentage of fresh air
supply diffusers in rooms (dirt/debris)
air patterns within room (location of supply and exhaust diffusers)
short circuiting of air?
Poor mixing?

31. Building HVAC System Heating/cooling coils condensation drip pans
stagnant water (blocked drains)
sloped toward drain
biocides in use?

32. Building HVAC System Humidification system
cold water humidification
potable, drained off well
Exhaust Fan (discharge from building)
normal, hazard, toilet (separate)
50 ft from supply intakes
at height and velocity to remove from building
no discharge out side of building

33. Bioaerosol Sampling Develop hypothesis (plan)
Find source and remediate
Sample to assess building, confirm findings
assess occupant exposures

34. Bioaerosol Sampling Select sampling locations (numbers of samples)
complaint areas, non-complaint areas, outdoors, time of day, year
Sampling method?
Contact (direct microscopic examination)
bulk (bag pieces of suspect material, water)
swab (swipes of suspect surfaces)
air (viable, non-viable methods)

35. Bioaerosol Sampling Air sampling
non-viable methods (spore traps, filter cassettes)
Air-O-Cell
viable methods
AGI-30 (all glass impinger - air pumped through liquid medium - good for bacteria)
sieve impactors (Anderson Sampler, RCS)
Flow rates, calibration critical

36. Bioaerosol Sampling Select Environmental Microbiology Laboratory
accreditation/certification, selection of media
incubation temperature for samples?
Sampling Media
viruses, bacteria, parasites, mites, endotoxins
TSA, blood agar for bacteria
fungi
psychrophyllic, mesophyllic, thermophyllic
nutrient requirements (wet, normal conditions)
DG-18 (wet), MEA (general)

37. Bioaerosol Sampling Collection/Transport Protocols
instrument calibration
sterility of media, containers, swabs
disinfection between each use
chain of custody forms
identification of samples
field blank, control blank, coded samples
prompt shipment/delivery to lab
bacteria samples on ice

38. Bioaerosol Sampling Enumeration of data
quantity per ml, gm, liter of air, m3 of air, square cm, m2 of surface
quantity of organisms numerator
quantity of media sampled denominator
time (min.) x flow rate/min. = total volume
(1000 liters per m3 of air)

39. Bioaerosol Sampling Analysis of data (only snapshot in time)
identification of genus and species
concentration of each per location sampled
rank order indoors vs. outdoors
indoor to outdoor ratio
low yield outdoors in colder months
complaint vs. non-complaint areas
immediate notification from lab of serious results
pathogens, positive anthrax, elevated levels in hospitals

40. Standards and Guidelines for Fungi in Indoor Air
No Standards!
Yet
too many variables (personal susceptibility and variation among individuals - what levels for sensitized?)
paradichlrobenzene example at Peabody Museum
latex allergy in BWH OR
Standards = must
Guidelines = should

41. Standards and Guidelines for Fungi in Indoor Air (Rao et al)
Comprehensive review of literature
ACGIH
<100 CFU/m3 = low
CFU/m3 = intermediate
>1000 CFU/m3 = high
AIHA
>1000 CFU/m3 atypical

42. Standards and Guidelines for Fungi in Indoor Air
General statements
levels indoors should compare with levels outdoors
pathogenic organisms not acceptable in indoor air (WHO, Canada, AIHA)
indoor:outdoor > 1 may (investigate potential indoor source)

43. Remediation Water = problem! remove water, dry, clean, disinfect
completely remove mold and dry water-damaged areas
address the source of water or humidity problem
Options
discard and replace, wet vacuum, drying (if <24-48 hours), dehumidification, freezing,

44. Remediation Cleaning can disperse contaminants
don’t sweep, vacuum w/out filtration
damp mop, disinfectant wipe (wet collection methods)
HEPA filtered vacuum cleaners

45. Containment during Remediation or Construction in Sensitive Areas
Sample before project (baseline for clean and contaminated areas)
Communicate to personnel in adjacent areas
scope of work
potential hazards
control measures
Ongoing sampling during project
Final clearance samples (to baseline of clean areas)

46. Containment during Remediation or Construction in Sensitive Areas
Schedule work after hours (evenings, weekends)
Consider closing facility if very sensitive population within/nearby
YPB Medical Oncology
Hire/assign objective, independent project monitors
ensures all workers adhere to protocol
reports problems, breaches immediately
can shut job down on site if necessary

47. Containment during Remediation or Construction in Sensitive Areas
Containment barriers
solid gypsum barriers built (temporary construction)
polyethylene sheeting
anteroom for clothes change
HEPA filtered exhaust fan in contaminated zone
create negative pressure gradient within space
exhaust only purified air out of space

48. Containment during Remediation or Construction in Sensitive Areas
Personal Protective Equipment
Full jump suits, booties, hood
PAPR or N-100 Disposable respirator or higher
Full face shield (cover all exposed skin)
Tape wrists ankles, etc
Spray contaminated areas with disinfectant before removal
suppress aerosols
decontaminate mold

49. Containment during Remediation or Construction in Sensitive Areas
Collect and seal waste in bags
decontaminate exterior of waste bags
transport out of space in covered cart (exterior also decontaminated)
HEPA vacuum all surfaces after each shift
Disinfect surfaces after shift
Remove and bag PPE after each exit
YPB pizza party

50. Containment during Remediation or Construction in Sensitive Areas
Extensive clearance samples taken
Keep area closed until clearance samples verified clean (below acceptable set point and absence of pathogenic organisms)
Don’t forget to get sanity back after project!