The World Health Organization estimates that up to 30 percent of all new and remodeled buildings worldwide have significant indoor environmental quality (IEQ) deficiencies. According to the Environmental Protection Agency (EPA), medical costs for serious illnesses caused by indoor air pollution total more than $1 billion annually while lost productivity from those illnesses costs between $4.7 billion and $5.4 billion a year. Add sick leave time to that lost productivity, and illnesses caused by indoor air pollution can cost businesses up to $60 billion a year.

The National Institute for Occupational Safety and Health (NIOSH) uses the term, "indoor environmental quality” to describe a range of comfort and health problems affecting adults and children in today's office buildings and schools. While for many years IEQ was seen as only an industrial problem, recently organizations have focused on recognizing, evaluating, and controlling chemical, physical, and biological stressors in non-industrial environments.

"The U.S. Environmental Protection Agency consistently ranks indoor air pollution as one of the top five risks to public health. The effect of air pollution upon occupants is a variety of maladies ranging in severity from chronic to acute. In the past two decades, the National Institute for Occupational Safety and Health experienced a 69 percent increase in requests to conduct air quality investigations."
Occupational Health & Safety, 10/01/04

Over the past 20 years, media scrutiny, increased regulatory activity, workers’ compensation claims, and litigation have brought more attention to non-industrial IEQ. Terms such as "tight building syndrome," "sick building syndrome," "buildingrelated illness," and "moldy building" have become part of the language spoken by building owners, facility/real estate managers, employers, contractors, Occupational Safety and Health Administration (OSHA) compliance officers, workers’ compensation claims adjustors, and attorneys.

One of the primary components of IEQ is indoor air quality (IAQ). While IAQ is associated with chemical contaminants such as organic vapors and irritant gases, and biological contaminants such as mold spores, bacteria, and toxins, the broader field of IEQ also includes consideration of comfort parameters, noise, vibration, lighting, and ergonomic stresses. It is not unusual for tenants and employees to attribute any actual or perceived discomfort, irritation, and/or illnesses to IEQ, regardless of the actual causes.

"Nationally, more than 21 million people in 1.4 million buildings are affected by indoor respiratory problems each year, according to federal environmental data."
Tampa Tribune, 01/23/05

Mold Not Always the Culprit
In recent years, the attention given to mold has resulted in an inordinately large number of discomfort complaints, illnesses, and reports of unpleasant odors often blamed on fungal growth within buildings. In many cases, the assertions that IEQ deficiencies stem from mold growth are unfounded or inadequately substantiated. Although mold growth within buildings presents the potential for adverse health effects, especially for individuals with compromised immune systems, mold growth should not automatically be assumed to be the source of most IEQ problems and complaints. Nonetheless, mold should be prevented and remediated when it is detected.

IEQ started to become an issue in the 1970s, during the energy crisis. The desire to conserve energy resulted in more tightly closed and more heavily insulated buildings, and the greater recirculation of conditioned air within these buildings. As a result, removal and dilution of any contaminants generated within structures or introduced into buildings from outside became much more problematic. In fact, the most frequently diagnosed source of IEQ deficiencies was and continues to be the lack of adequate, fresh air provided by heating, ventilating, and air conditioning (HVAC) systems.

Adverse health effects associated with poor IEQ can range from fairly non-specific complaints of eye and respiratory tract irritation, headaches, and fatigue to potentially fatal illnesses such as Legionellosis. According to the U.S. Centers for Disease Control and Prevention (CDC), there are between 8,000 and 18,000 cases of Legionellosis in the United States annually. However, because fewer than 10 percent of cases are diagnosed and reported, this total may be just the tip of the iceberg.

Legionella bacterium thrive in warm, stagnant water, and while most high-profile outbreaks are associated with air conditioning chilling towers and other large pieces of mechanical equipment, many cases result from such mundane equipment as hot tubs, showers, etc. Protocols for testing, maintaining, and operating mechanical systems are being adopted by an increasing number of building owners and managers. Given the potentially fatal outcome of Legionnaires' Disease, facility owners and/or managers cannot afford to be complacent about identifying and managing exposures.

In addition to potentially significant health implications, building owners, facility managers, employers, contractors, building materials manufacturers, engineers, architects, and insurers routinely confront and manage the adverse financial and legal ramifications of IEQ deficiencies.

"Hospitals are particularly vulnerable to [Legionnaires’] outbreaks. But Dr. Victor Yu, the chief of infectious diseases at the Pittsburgh Veterans Administration Health Care center, who is an expert on Legionnaires' disease, said that few test their water supplies routinely. Dr. Yu said that about 70 percent of hospitals in New York State would find the bacteria if they looked for it and that many patients probably die from the disease without anyone knowing."
New York Times, 5/03/05

Are You Prepared to Handle IEQ?
In considering their IEQ exposures, facility owners, managers, and employers should be asking the following questions:

• Do we know what the potential IEQ exposures are for our facilities?
• Do we know what our historical IEQ complaint, claims, and litigation history has been?
• Have we assigned formal responsibility to a competent team for managing IEQ and preventing IEQ deficiencies?
• Have we developed a standardized IEQ deficiency prevention plan incorporating facility maintenance, regular facility inspections, and assessments?
• Have we developed and implemented a standard procedure for identifying, documenting, and responding to IEQ deficiencies?
• Have we addressed existing IEQ deficiencies?
• Have we educated personnel about IEQ and their roles in maintaining good IEQ?
• Have we developed and implemented protocols for activities presenting significant potential for producing adverse IEQ impact (construction, painting, pest control, etc.)?
• Have we identified competent outside resources capable of assisting in the assessment and remediation of IEQ deficiencies?
• Have we implemented an adequate documentation system for IEQ issues, activities, and outcomes?

Managing IEQ
It has become extremely important for organizations to recognize the potentially adverse effects IEQ deficiencies can have on people, resources, image, and business success and to develop proactive processes for preventing, reducing, and/or managing IEQ deficiencies.

Lack of response to IEQ questions and/or complaints will often be perceived as an attempt to hide deficiencies, increasing the likelihood of adversarial scenarios and escalation of concerns. Such escalation can result in the often unnecessary involvement of physicians, union representatives, OSHA compliance officers, and attorneys.

"Because everything in our homes and workplaces have grown increasingly dependent on chemicals and technologies (some 700,000 chemicals are used in manufacturing everyday products, and everything from appliances to computers to children's toys uses electricity), living and working in airtight buildings often constructed from an assortment of toxic products has meant that we stew in chemical soups all day and all night and rarely consider the consequences."
San Francisco Chronicle, 01/21/05

Every building owner and/or manager should develop and implement a formal, documented IEQ management plan. The plan should communicate the IEQ management vision, delineate IEQ deficiency prevention and response procedures, and identify the individual/individuals responsible for performing or managing those procedures. Key plan elements should include:

• Training/education of key personnel
• Facility preventive maintenance (structural, mechanical, plumbing, etc.)
• Periodic visual inspections and quantitative IAQ evaluations
• Solicitation of IEQ-related questions, complaints, and comments from occupants (maintenance of IEQ complaint log)
• Analysis of deficiencies and determination of appropriate responses
• Performance and documentation of IEQ interventions
• Occupant/tenant communication
• Identification of competent, outside resources (industrial hygienists, engineers, etc.)
• Periodic plan evaluation and revision

Marsh can assist organizations in the identification of IEQ risks, the prioritization of responses, and the development and implementation of IEQ prevention and management plans. By creating a plan of action, organizations can mitigate their IEQ risk and manage issues appropriately as they arise.

If you have any questions or would like additional information, please contact us.