Double blind placebo controlled exposure to molds: exposure system and clinical results.

UNLABELLED: The objective was to develop an experimental setup for human exposure to mold spores, and to study the clinical effect of this exposure in sensitive subjects who had previously experienced potentially building-related symptoms (BRS) at work. From three water-damaged schools eight employees with a positive histamine release test to Penicillium chrysogenum were exposed double- blinded to either placebo, approximately 600,000 spores/m3 air of P. chrysogenum or approximately 350,000 spores/m3 of Trichoderma harzianum for 6 min on three separate days. A statistically significant rise in symptoms from mucous membranes appeared from the 9-graded symptom scale after exposure to T. harzianum or placebo. Dichotomizing the data, whether the participants experienced at least a two-step rise on the symptom scale or not, gave borderline increase in mucous membrane symptoms after exposure to P. chrysogenum. In conclusion this is, to our knowledge, the first study to successfully conduct a human exposure to a highly controlled dose of fungal material aerosolized directly from wet building materials. This short-term exposure to high concentrations of two different molds induced no more reactions than exposure to placebo in eight sensitive school employees. However, a statistical type II error cannot be excluded because of the small sample size. PRACTICAL IMPLICATIONS: In this double blind, placebo controlled study of mold exposure changes in symptoms, objective measurements and blood samples were small and mostly non-significant, and at the same level as after placebo exposure. The developed exposure system based on the Particle-Field and Laboratory Emission Cell (P-FLEC) makes it possible to deliver a precise and highly controlled dose of mold spores from water-damaged building materials, imitating realistic field exposure conditions. The present experiment is too small to rule out an effect of mold exposure; long-term experimental exposure studies on larger number of subjects are needed.

Determination of fungal spore release from wet building materials.

The release and transport of fungal spores from water-damaged building materials is a key factor for understanding the exposure to particles of fungal origin as a possible cause of adverse health effects associated to growth of fungi indoors. In this study, the release of spores from nine species of typical indoor fungi has been measured under controlled conditions. The fungi were cultivated for a period of 4-6 weeks on sterilized wet wallpapered gypsum boards at a relative humidity (RH) of approximately 97%. A specially designed small chamber (P-FLEC) was placed on the gypsum board. The release of fungal spores was induced by well-defined jets of air impacting from rotating nozzles. The spores and other particles released from the surface were transported by the air flowing from the chamber through a top outlet to a particle counter and sizer. For two of the fungi (Penicillium chrysogenum and Trichoderma harzianum), the number of spores produced on the gypsum board and subsequently released was quantified. Also the relationship between air velocities from 0.3 to 3 m/s over the surface and spore release has been measured. The method was found to give very reproducible results for each fungal isolate, whereas the spore release is very different for different fungi under identical conditions. Also, the relationship between air velocity and spore release depends on the fungus. For some fungi a significant number of particles smaller than the spore size were released. The method applied in the study may also be useful for field studies and for generation of spores for exposure studies.

'EUROPART'. Airborne particles in the indoor environment. A European interdisciplinary review of scientific evidence on associations between exposure to particles in buildings and health effects.

The relevance of particle mass, surface area or number concentration as risk indicators for health effects in non-industrial buildings has been assessed by a European interdisciplinary group of researchers (called EUROPART) by reviewing papers identified in Medline, Toxline, and OSH. Studies dealing with dermal effects or cancer or specifically addressing environmental tobacco smoke, house dust-mite, cockroach or animal allergens, microorganisms and pesticides were excluded. A total of 70 papers were reviewed, and eight were identified for the final review: Five experimental studies involving mainly healthy subjects, two cross-sectional office studies and one longitudinal study among elderly on cardiovascular effects. From most studies, no definite conclusions could be drawn. Overall, the group concluded that there is inadequate scientific evidence that airborne, indoor particulate mass or number concentrations can be used as generally applicable risk indicators of health effects in non-industrial buildings and consequently that there is inadequate scientific evidence for establishing limit values or guidelines for particulate mass or number concentrations.

Passive sampler used for simultaneous measurement of breathing zone size distribution, inhalable dust concentration and other size fractions involving large particles.

The particle size-dependent sampling velocity of the passive dust sampler developed by Vinzents (1996) is investigated under field conditions. Microscopical determination of the projected area equivalent diameter is used to quantify particles deposited on the sampler foils. Parameters for a semi-empirical model for particle deposition velocities on upward and forward facing foils are fitted to the data and it is shown that deposition mechanisms other than gravitational settling on the upward facing foil can be neglected. For calculation of airborne mass concentration no information on particle density is needed and only the ratio between the dynamic and volume shape factors needs to be known. Given the sampling velocity, the airborne mass per diameter interval is calculated from samples obtained in the wood industry, from which inhalable dust concentrations are calculated. The results are in line with parallel samples obtained with an inhalable dust sampler. A 'total' dust sampling characteristic can be fitted which reproduces measured 'total' dust with a closed face monitor. The results of this study demonstrate the validity of the passive dust sampling principle in environments involving even large (>100 microm) particles and the potential to predict the concentration of several size fractions.

Visual analogue scales for detecting changes in symptoms of the sick building syndrome in an intervention study.

OBJECTIVES: This study tested questionnaires using visual analogue scales (VAS) in a cleaning intervention study and attempted to find a simple way of analyzing the replies to the questionnaires. METHODS: A VAS questionnaire made up of 26 questions was developed and marked once a week for 28 weeks by the room occupants in 3 buildings. A total of 1248 questionnaires was used in the analysis of the results. A simple model based on the differences between a person's average responses during 2 different periods was used in the analysis. RESULTS: No clear effect of the cleaning was found. Several significant correlations between different questions were established. Estimates for the design of future studies are given. CONCLUSIONS: The VAS questionnaire proved to be feasible for this type of study. It is suggested that each intervention period should last 4 weeks if the questionnaire is used once a week. However, the length of the period also depends on the expected latency of the symptoms, on how long it takes for environmental conditions to be affected by the intervention, and on how quickly conditions return to "normal" during control periods.

Risk in cleaning: chemical and physical exposure.

Cleaning is a large enterprise involving a large fraction of the workforce worldwide. A broad spectrum of cleaning agents has been developed to facilitate dust and dirt removal, for disinfection and surface maintenance. The cleaning agents are used in large quantities throughout the world. Although a complex pattern of exposure to cleaning agents and resulting health problems, such as allergies and asthma, are reported among cleaners, only a few surveys of this type of product have been performed. This paper gives a broad introduction to cleaning agents and the impact of cleaning on cleaners, occupants of indoor environments, and the quality of cleaning. Cleaning agents are usually grouped into different product categories according to their technical functions and the purpose of their use (e.g. disinfectants and surface care products). The paper also indicates the adverse health and comfort effects associated with the use of these agents in connection with the cleaning process. The paper identifies disinfectants as the most hazardous group of cleaning agents. Cleaning agents contain evaporative and non-evaporative substances. The major toxicologically significant constituents of the former are volatile organic compounds (VOCs), defined as substances with boiling points in the range of 0 degree C to about 400 degrees C. Although laboratory emission testing has shown many VOCs with quite different time-concentration profiles, few field studies have been carried out measuring the exposure of cleaners. However, both field studies and emission testing indicate that the use of cleaning agents results in a temporal increase in the overall VOC level. This increase may occur during the cleaning process and thus it can enhance the probability of increased short-term exposure of the cleaners. However, the increased levels can also be present after the cleaning and result in an overall increased VOC level that can possibly affect the indoor air quality (IAQ) perceived by occupants. The variety and duration of the emissions depend inter alia on the use of fragrances and high boiling VOCs. Some building materials appear to increase their VOC emission through wet cleaning and thus may affect the IAQ. Particles and dirt contain a great variety of both volatile and non-volatile substances, including allergens. While the volatile fraction can consist of more than 200 different VOCs including formaldehyde, the non-volatile fraction can contain considerable amounts (> 0.5%) of fatty acid salts and tensides (e.g. linear alkyl benzene sulphonates). The level of these substances can be high immediately after the cleaning process, but few studies have been conducted concerning this problem. The substances partly originate from the use of cleaning agents. Both types are suspected to be airway irritants. Cleaning activities generate dust, mostly by resuspension, but other occupant activities may also resuspend dust over longer periods of time. Personal sampling of VOCs and airborne dust gives higher results than stationary sampling. International bodies have proposed air sampling strategies. A variety of field sampling techniques for VOC and surface particle sampling is listed.

Exposure assessment of airborne microorganisms by fluorescence microscopy and image processing.

The purpose of this study was to improve the exposure assessment of airborne microorganisms by means of image processing of fluorescence microscopy images. This technique reduces the analysis time and also offers the opportunity to measure the size distribution of the microorganisms. We developed and implemented an automatic focusing procedure in order to count and size evaluate the microorganisms in the sample. However, automatic focusing was not possible if there were any impurities such as larger particles present. Therefore, manual focusing of the microscope had to be applied in connection with automatic counting and size evaluation when assessing the exposure of workers handling materials containing microorganisms, for example. This is also an improvement as it is faster than the fully manual standard methods. The new methods developed in this study correlated (r2 > 0.85) with the standard method for samples of E. coli and for samples of generated airborne bioaerosols from household waste, although a correction factor is necessary. No correlation was found for samples of generated bioaerosols from composted waste. This work has established a possibility for improving exposure assessment of airborne microorganisms by means of image processing instead of manual counting.