Managers at an apartment complex agree to relocate residents from moldy apartments after CBS Atlanta asks tough questions. A small fire last week in a top-floor unit of the Village Highlands Apartments activated the sprinklers in that unit and the two below it, forcing those residents to evacuate. Resident Sheena Bennett told CBS Atlanta News that the Red Cross offered her assistance, providing hotel vouchers for a few days. She said property managers promised to clean and dry the apartments while they were gone. But when she came back, mold was everywhere. “Everything in here from the back room to the front is molded,” Bennett said.  Bennett wore a mask as she pointed to mold and mildew growing on her windows, walls and floors. Bennett said property managers have refused to move the residents to other apartments, claiming there aren’t any available. “We pay our rent on time,” Bennett said. “And you can look at a board inside the rental office that says we have available spaces.” Bennett said she called the city. On Tuesday, East Point code inspectors condemned the three apartments, ordering residents to leave immediately. Brenda Ogburn lives in one of the now-condemned units. She is confined to a wheelchair. “I don’t have anywhere to go. I got to find somewhere to go,” Ogburn said. Ogburn’s daughter believes apartment managers don’t want to help them because their units are government-subsidized. Bennett wonders if managers are retaliating against them for reporting the problems to the city. “What she said was, ‘You should have thought about that before you called the city code out here,’” Bennett said.  No one in the management office would answer questions about the situation.  Members of the management team locked themselves inside the rental office and would not open the door.  On Wednesday Reddick Management, which runs the property, said they would relocate the tenants until the mold is cleaned. A representative, who did not give her name, admitted management should have been more compassionate and should have given tenants more options. Ogburn said she would be satisfied if management follows through with its offer. “If they do it, I’m very happy with what they’re telling me,” Ogburn said. Bennett said management told her apartments were available at other properties owned by Reddick. When asked if she’d move, Bennett said “if it’s available to us, yes.”

See video: http://www.cbsatlanta.com/story/16440411/east-point-residents-say-mold-in-apartment-is-making-them-sick

 Heating and air conditioning assumes a more important role than just the promotion of comfort. In many cases, proper air conditioning is a factor in patient therapy while in some instances it is a part of the treatment itself. However, the relatively high cost of air conditioning has led to inadequate and improperly designed systems with not enough care to factor in specific requirements for ventilation, filtration and cross-contamination.

Infection Sources and Air Quality in a Hospital

The basic infection sources in a hospital are:

Bacterial Infection – Examples of bacteria that are highly infectious and transported within air or air and water mixtures are Mycobacterium tuberculosis and Legionella pneumophila (Legionnaire’s disease). Since bacteria are normally present in colony forming units, they are usually taken care of by particulate air filters (HEPA). However, droplets or infectious agents of less than 5 micron size or less can remain in the air indefinitely.

Viral Infection – Examples of viruses that are transported by and virulent within air are Varicella (chicken pox/sledges), Rubella (German measles) and Rubeola (regular measles). Epidemiological evidence and other studies indicate that many of these airborne virus are submicron in size thus there is no known method to effectively eliminate 100 per cent of the viable particles. Therefore, isolation rooms with appropriate ventilation are the primary means to prevent the spread of airborne viruses in the hospital environment.

Moulds – Evidence indicates that some moulds such as Aspergilla’s can be fatal to advanced leukemia, bone marrow transplant and other immunocompromised patients.

Temperature and humidity play a vital role as they can inhibit or promote the growth of bacteria and activate or deactivate viruses. Some bacteria such as Legionella pneumophila are basically water borne and survive more readily in a humid environment.

Air Quality – A Key Factor

The advent of multidrug-resistant tuberculosis (TB), the increasing human immunodeficiency virus (HIV) population etc have focused awareness on the need to modify hospital ventilation design techniques. These factors have added greater urgency to effective sepsis control.

Infection-control problems frequently involve a bacteria or viral source within a hospital. Ventilation air dilutes the viral and bacterial contamination within a hospital. If ventilation systems are properly designed, constructed and maintained to preserve the correct pressure relations between functional areas, they remove airborne infectious agents from the hospital environment.

No area of the hospital requires more careful control of the aseptic condition of the environment than does the surgical suite. Ventilation with 100 per cent fresh air is the only means to keep the airborne organisms contamination low.

Postoperative recovery rooms used in conjunction with the operating rooms, should be maintained at a temperature of 75°F and a relative humidity between 50 and 60 per cent. The residual anesthesia odor sometimes creates an odor problem in recovery rooms. Hence, ventilation is important and a balanced air pressure relative to the air pressure of adjoining areas should be provided.

In protective isolation units, immunosuppressed patients (including bone marrow or organ transplant, leukemia, burn and AIDS patients) are highly susceptible to diseases. Therefore, air distribution of 15 air changes per hour is recommended. The sterile air is drawn across the patient and returned near the floor at or near the door to the room.

In cases where the patient is immunosuppressed, but not contagious, the room should maintain a positive pressure in relation to the adjacent room or areas.

Other areas that require high rates of ventilation include the radiology department, laboratories, infectious disease and virus laboratories, autopsy rooms and animal quarters.

Management and Improvement of Air Quality in Hospitals

Air quality can be improved in hospitals by designing systems that provide air virtually free of dust, dirt, odors, chemical and radioactive pollutants, bacteria, viruses and humidity buildup. Designers while planning air conditioning systems need to keep these design criteria in mind:

1.  The need to restrict air movement in and between various departments.
2.  The specific requirements for ventilation and filtration to dilute and remove contamination in the form of odors, airborne micro-organisms and viruses and hazardous chemicals as well as radioactive substances.
3. The different temperature and humidity requirements for various areas.
4. The design sophistication needed to permit accurate control of environmental conditions.

Though design specification regarding other aspects are adhered to, designers tend to compromise and accept substantial re-circulated air to conserve on energy; leading to air quality problems.

There is increasing need to bring about more awareness among the health professionals, AC&R engineers as well as equipment manufacturers on the very important aspect of increased ventilation standards for mitigation of airborne pollutants. The focus of all designers has to fundamentally shift to this all important aspect of new hospital ventilation design strategies.

Air Cleaning Options

There are basically two ways in which air quality can be improved in a hospital.

1. HEPA FILTRATION
2. VENTILATION

Generally speaking, air cleaners are not appropriate single solutions to indoor air quality problems but can be useful as an adjunct to effective source control and adequate fresh air ventilation. Air cleaning alone cannot adequately remove all pollutants typically found in indoor air.

However it has been seen that it is the increased fresh air ventilation which is responsible for mitigating the indoor air pollutants. Thus, the solution to pollution is dilution!

Increased Fresh Air Ventilation is the Key

The only solution to mitigate the unacceptable levels of airborne pollutants in the hospital is: addressing the source of pollution and addressing the level of contaminants in the air. These may be referred to as ‘source control’ and ‘removal’ respectively.

Source control is always the preferred approach however this may not always be a practical solution. Source control measures are pollutant specific and may include use of low formaldehyde emitting materials, banning of cigarette smoking, prevention of radon entry through sealing of foundations, eliminating use of asbestos and storing of paints and chemicals outside the occupied space. Controlling relative humidity will prevent microbial contamination.

Removal of contaminants from a building or reducing its concentration within a hospital can be accomplished by passive or active fresh air ventilation.

Passive ventilation refers to air exchanged through doors, windows or other openings by natural forces. In most air conditioned buildings, these openings have been reduced to the minimum to conserve energy.

Active ventilation systems provide continuous ventilation to which passive ventilation may add but not subtract when pollutants are evenly mixed throughout a space and the source rate is constant; the concentration of airborne pollutants will be inversely proportional to the ventilation rate, that is, doubling the ventilation will halve the concentration!

An existing ventilation system which is inadequate because of design flows, poor maintenance or expanded use of a building is often associated with poor indoor air quality. Mitigation can often require redesign or maintenance of the existing system. In cases where the outdoor air ventilation provision of an HVAC system is not being used, the remedy is very obvious – increase ventilation.

Indoor Air Quality with Energy/ Recovery Equipment

Higher fresh air ventilation needs translate into higher outdoor air changes per hour, which means more air conditioning loads and higher capacity plants to be installed. This leads to higher first cost and higher operating costs.

In fact, healthcare is an energy intensive, energy dependent enterprise. Hospital facilities are different from other structures, in that they operate 24 hours each day year round. Hence, they require sophisticated backup systems in case of utility shutdowns. They use large quantities of outdoor air to combat odors and dilute micro organisms, and must deal with problems of infection and solid waste disposal.

Hence, effective management of energy systems becomes imperative.

Increasing ventilation rates translates into two ways – an improved indoor environment and significant higher utility bills for the owners.

The solution is the use of energy recovery devices of which the energy/heat wheel is the most appropriate. The energy wheels which eliminate cross contamination of bacteria and airborne contaminates are most suitable for healthcare facilities.

The significance of IAQ in a hospital is phenomenal and far reaching for the physical as well as mental health of patients and healthcare workers.

Continual advances in medicine and technology necessitate the support of a property designed air-conditioning of hospitals and medical facilities for desired outcomes. It is said that five per cent of all patients who go to hospitals for treatment will develop an infection while they are there. The complex hospital environment requires special attention to ensure healthy IAQ to protect patients and healthcare workers against nosocomial infection and occupational diseases.

Good IAQ depends on adequate supply of fresh air, absence of pollutants and good distribution of air to the breathing zone of occupied spaces.

It is well established that a property designed, equipped, and maintained fresh air system in health care facilities use less energy and will be less costly to maintain.

The number one cause for lung cancer is from smoking, number two is radon exposure. Radon is a naturally occurring radioactive cancer-causing gas that seeps into the home through the soil from the lowest level up and into the home. Every home should be tested at least twice annually because radon may not show high levels at certain times.

 Be smart, get educated about radon, it is better to be safe than sorry.

For moreinformation contact Joe Maglio at: joe@rx4cleanairllc.com

Watch this video: http://www.youtube.com/watch?v=qFE7ijZZYV8

Have you have ever seen on TV the hit show doctor House? Either you love him or you hate him, either way he gets the job done and he is a perfect example of thinking outside the box. He goes beyond looking at the sick body and prescribing medicine, he has the living environment at home and at work if they indeed work investigated to see if there is a connection. If there is a connection this term is called building related illness and yes this is very common. Let me give you one example of this: In a home in the winter months the air becomes extremely dry the parent being concerned about her child’s dry skin, constant nose bleeds goes to the store and purchases a humidifier to add moisture to the air. This is reasonable and a good idea in-fact her child is sleeping better and the symptoms of dryness disappears and all seems well. Not exactly! You see every night mom would fill the humidifier using tap water and bacteria formed in the water tank that is now being aerosolized into the bedroom and the child became very ill. That was the reason why they saw the doctor in the case sited above, again the doctor prescribed the child’s sickness as Pneumonia prescribed the proper medicine, however the child went back into the environment which started the reoccurring nightmare all over again.  Here are some facts about Legionnaire’s disease:

1. Pneumonia is caused by bacteria from the Legionella genus.

2. Many cases of Legionnaires disease go undiagnosed according to the CDC because it is treated as a general pneumonia and never properly characterized. You can have the bacteria for 5-6 days in your system before you start developing a high fever, headache, nonproductive cough, malaise, etc.  which is a problem identifying where you where infected. In one case study when 22 people became infected with the Legionnaires disease it took several weeks before they could place all the infected people  at one restaurant that had a water fountain that tested positive for the bacteria.

3. This bacteria has the highest growth rate in stagnant water from 95-115 degrees and can survive chlorinated water. This is an opportunistic bacteria the immuno-suppressed, elderly, smokers and young ones are at greater risks.

4. Outbreaks of Legionnaires disease  (Also know as Legionellosis) have occurred after persons have breathed mists that come from a water source (e.g., air conditioning towers, whirlpool spas, showers, decorative water falls) and in this case sited a simple humidifier. (Alway’s empty the humidifier after each nigh’t use and use to refill distilled water….ONLY)

In conclusion do not expect doctors to make house calls or to check you indoor air quality…find a professional in that field and most importantly share this information with doctors. Ask this question first, do I feel better in my home or better when I am away…you and your body can only answer that.

So before you get another allergy shot, or if you are suffering form repeated relapses medically take this simple advice… find out the cause, masking the problem is not a long term solution, always remove the source. So get the health of you home checked because clean air is your best medicine for healthier living.

I will take your questions…email me directly at joe@rx4cleanairllc.com

Healthy regards,

Joe Maglio

• Assessment Protocols are protocols for evaluating existing conditions of concern and the potential for additional concerns that may arise from energy upgrade activities.
• Minimum Actions include critical actions that home energy upgrade contractors should take to help ensure their work does not introduce new indoor air quality
  concerns or make existing conditions worse.
• Expanded Actions include additional actions to promote healthy indoor environments that can be taken during many home energy upgrade projects. They can be performed by properly trained home energy upgrade workers who have sufficient resources. The protocols often refer to national standards and guidance; however, work should be conducted in compliance with state and local requirements as well. Supplemental guidance information is referenced. The document also includes appendices on worker protection and client education. The protocols are not intended to: 1) set new EPA regulatory standards, 2) provide guidance on diagnosing occupant health problems or building-related illness, 3) address emerging issues that have not been linked to adverse health effects, 4) make training or training documents unnecessary, 5) provide detailed guidance on how to achieve the intent of each recommendation in all situations or 6) identify funding availability or which programmatic funding sources should be used. How these protocols relate to other federal programs Recovery through Retrofit, November 9, 2010 Vice President Joe Biden announces three new initiatives that will help grow the energy-efficiency industry and help families make improvements that will help save money on their energy bills. Watch the video of the event. (42 min. 17 sec.) Read the White House Press Release

In May 2009, the Vice President’s Middle Class Task Force asked the White House Council on Environmental Quality (CEQ) to develop recommendations for federal action to lay the architecture for a self-sustaining home energy efficiency upgrade industry. In response, CEQ facilitated a broad inter agency process that resulted in the development of six recommendations described in detail in the report, Recovery through Retrofit. These recommendations were carefully crafted to stimulate the growth of a vibrant, private sector-led market for residential energy efficiency upgrades. They include establishment of a uniform set of national guidelines to promote high-quality, safe and healthy energy efficiency upgrades. The U.S. DOE is developing the Guidelines for Home Energy Professionals in response to this recommendation, in concert with EPA’s development of Healthy Indoor Environment Protocols for Home Energy Upgrades. The DOE Weatherization Assistance Program and the broader residential energy efficiency upgrade industry are experiencing significant growth as a result of investments made through the American Recovery and Reinvestment Act and increased public awareness of the economic, employment, and health benefits of reducing home energy consumption. DOE’s Guidelines for Home Energy Professionals contain standard work specifications and referenced technical standards for a wide range of energy efficiency upgrade measures. These standard work specifications define the minimum requirements for high quality energy efficiency upgrade work and the proper conditions necessary to achieve the desired outcomes of a given installation or upgrade measure. DOE’s Guidelines for Home Energy Professionals and EPA’s Healthy
Indoor Environment Protocols for Home Energy Upgrades have been developed in conjunction with one another and are complementary and mutually supportive.
Both are intended to provide a set of measures that the DOE Weatherization Assistance Program and other energy efficiency upgrade efforts can adapt to increase the quality of the work performed while maintaining or improving the health and safety of the occupants. DOE and the EPA have collaborated closely throughout the production of these two documents. In particular, the two agencies have strived to integrate the EPA minimum actions into the DOE Guidelines for Home Energy Professionals, so that upgrade workers following DOE guidance will inherently achieve the EPA minimum recommendations. Additionally, both DOE and EPA fully support the home energy upgrade industry going above and beyond the
minimum actions by adopting the EPA-recommended expanded actions, but both agencies also understand that financial or programmatic constraints may impede this in certain cases.

• Learn more about the DOE Guidelines at: www.weatherization.energy.gov/retrofit_guidelines How EPA recommends the protocols be used These protocols were developed to assist weatherization assistance programs and other home energy upgrade and remodeling programs to support their existing practices that improve the indoor environment and protect occupants. The protocols provide additional guidance for those able to go beyond minimum requirements and incorporate additional health oriented measures. EPA recommends that these protocols are voluntarily adopted, in whole or in part, for the following purposes:
• Develop or enhance standardized training program requirements.
• Refine and update program performance standards, materials, and resources to continue to protect occupant health.
• Inform revisions to program funding rules if and where needs are unmet (i.e., specify allowable expenses for health and safety as appropriate)

The majority of building-related illnesses are thought to be caused by bioaerosols, which are airborne particles of microbial matter which can be inhaled deep into the lung. Bioaerosols are bacteria, fungi, enzymes, hair – indeed all kinds of living organisms suspended in the air small enough in size that they are easy to inhale and get embedded in the lungs. They contain a mixture of particles from different origins (plants, animal and microbes) and constitute the most common indoor air pollutant worldwide. Having pets inside a household therefore increases the presence and the growth of fungi and fungal spores. “If the surroundings of the building are covered in piles of trash, and have no paved roads, the amount of outdoor pollution that will make its way indoors is obviously much higher than in a cleaner environment,” Awad explains, adding that in Egypt, “there is a particularly high count of micro-organisms indoors compared to other countries because the local temperature is very suitable for them to reproduce.” Micro-organisms need two optimum conditions to thrive: moisture and high temperature. Additionally, many buildings in Egypt are not maintained properly, to the detriment of indoor air quality. Leakages are frequent, prompting the speedy reproduction of microbes and molds, and when steps are not washed regularly, dust and particles are brought into houses and offices. “Sick building syndrome” describes a situation in which reported symptoms among a population of building occupants can be associated with their presence in that building. The most prevalent building-related illnesses are hypersensitivities, which include hypersensitivity pneumonitis, humidifier fever, building-related asthma, allergic rhinitis and infections. Headache, fatigue, difficulty concentrating, irritation and dryness of the mucous membranes, and skin problems are all symptoms which fade away when the person leaves the corrupt air quality of the “sick building.”

Building-related health issues pose many challenges to health professionals as it is a difficult task discovering the specific agent that caused a patient’s illness. “Doctors have a hard time relating a patient’s condition to indoor air quality specifically, because his condition is symptomatic of general exposure to environmental factors,” Awad explains, adding that the other challenge confronting indoor air quality studies is the lack of governmental standards to specify the acceptable concentration of indoor airborne fungi and bacteria. Also, each
individual will react differently according to his immune system, and while one will develop an acute allergy crisis, runny nose and irritated eyes, another will not respond physically to the presence of micro-organisms and bioaerosols. The Stachybotrys, a common filamentous fungus also known as “black mold” appears after fungal growth on water-damaged building materials and forms dark circles on ceilings and walls. Depending on the length of the exposure to this fungi and the amount of spores inhaled or ingested, symptoms can manifest as chronic fatigue or headaches; fever; irritation to the eyes, mucous membranes of the mouth, nose and throat; sneezing; rashes; and chronic coughing. In severe cases of exposure or cases exacerbated by allergic reaction, symptoms can be extreme, including nausea, vomiting, and bleeding in the lungs and nose. “These fungi, which develop in humid cracks indoors, can also trigger bleeding in infants,” explains Awad. There are basic solutions to limit the pollution inside a living environment, and this goes hand in hand with a change of habits, according to Awad. “Some people have wrong reflexes, they clean carpets indoors and enable all the particles to be released in the air and easily inhaled,” he says, adding that houses need to be more ventilated and better kept, hygiene-wise.

Here are some other precautions to take this winter:                                                                                 

• Generators — Never use a generator or grill or anything that emits carbon monoxide inside a space, in a home or too close to the home, Brown said. Fumes can seep into the
  house. Because carbon monoxide is colorless and odorless, you don’t know you are inhaling it until it is too late.

• Candles — “Candles are  pretty and they smell great, especially around the holidays,” Garriss said. But if you use candlesticks “make sure they are in a firm, solid base and use a globe around them so that when they melt down or if they fall over, the candle hits the globe,” he said. Never go to sleep while candles are burning. The Red Cross does not recommend using candles for lighting, Brown said. Use a flashlight instead and have an ample supply of batteries stored nearby.

• Fireplaces — Before using the fireplace this winter, have the chimney professionally cleaned, Garriss said. Make sure the fireplace has a screen so that people, especially children, can’t get too close, Brown said. And never leave a fire unattended for a period of time. Wood-burning stoves should have three feet of clearance, Garriss said, and are best used on ceramic floors rather than carpet or wood. Also, make sure your appliance is third-party tested.

• Stoves/ovens — “Cook outside, not in your garage,” Garriss said, noting the number of turkey-frying incidents that occur each Thanksgiving. If you are cooking in the kitchen (not frying turkey), do not leave food unattended, Brown said. If you leave the kitchen, even for a short time, turn the stove off. Keep anything that can catch fire such as potholders or clothing away from the stove. And never leave the oven door open as a way to heat a room.

• Space heaters — Garriss prefers ceramic disc heaters. “Any time you have a space heater there should be a three-foot clearance,” he said. If you have small children, use a cage guard for added safety.

The best way to determine if your HVAC system is clean is to perform a visual inspection. Before winter settles in, be sure to have these top issues that affect a home’s HVAC system checked:

1. Filtration – Low-efficiency filters, lack of a filter replacement program and improperly sized filters can allow particles and debris to flow into a home or building.

2. Duct work contamination – It is estimated that about 90 percent of HVAC systems more than 10 years old will have some level of insulation deterioration. Over time, the insulation fibers are distributed and blown into occupied spaces every time the blower turns on.

3. Dirty evaporator coil – Over time, evaporator coils become matted with dust and dirt. During cold months, the heated air can flow over the dirty coils and be distributed into your home’s interior space. Not all households are the same when it comes to how often their systems need cleaning, either. If any of these apply to your home, you might consider more
frequent cleaning:

*Smokers in the household.

* Pets that shed high amounts of hair and dander.

* Water contamination or damage to the home or HVAC system.

* Residents with allergies or asthma.

* Home renovations or remodeling.

The most effective way to clean air ducts and ventilation systems is to employ source removal methods of cleaning. This requires a contractor to place the system under negative pressure through the use of a specialized, powerful vacuum. For more information call Rx4 CleanAir at 770-521-0447.