Mold Concern Continues
The CDC now reports that the association between pulmonary hemorrhage and S. chartarum has not been proved, and further, that S. chartarum should not be treated differently than other types of mold.
Responding to the Hazard
Guidelines in New York City were revised in 2000 to cover not just S. chartarum, but all types of mold. According to the guidelines, moldy buildings need not be evacuated except in relatively uncommon cases where there is widespread illness because of contamination throughout a building.
Much current public health guidance indicates that common sense should prevail, with the focus not on mold but on returning the building to a dry condition. Mold can be taken as a warning of a moisture problem that needs to be fixed.
Most important is a visual survey to check for evidence of water damage and the extent of mold growth. Examples of moisture sources are defects in construction such as in windows, roofs, exterior siding, improperly laid foundations, and the absence of vapor barriers.
Unwanted water can also come from plumbing leaks and poorly designed or maintained components of the HVAC system. Good places to check are the outdoor air intake, filters, mixing chamber, heating/cooling coil area, spray humidifiers/evaporative coolers, air washers, and supplies and returns to the air handling unit.
The survey should be done before any samples are collected. The operative question before proceeding with sampling is, "Will the sampling you can afford be useful and could it hold up in court?"
It is not necessary to identify the type of mold in order to fix the problem. Money should never be spent on sampling mold that would be better spent correcting the moisture problem and thoroughly removing the mold.
However, for other purposes, such as for insurance claims or for evidence in lawsuits, or to document the effectiveness of cleaning, samples are often collected. Such sampling is the purview of the industrial hygienist.
Usually, air samples are collected in conjunction with bulk and swab samples of suspect source materials. During sampling, indoor air is compared with outdoor air. The significant presence of fungi in indoor air not present or as a minor component of outdoor air mycoflora is an indication of a problem source indoors. "Sticky tape" samples are often used to see if the mold is in fact growing, and not simply dormant or carried into the building.
It's important to be aware that fewer than a dozen laboratories are independently accredited to perform this specialized analysis, though many others claim to be able to serve this lucrative business.
How Dangerous is Mold?
There are no numeric standards for evaluating whether mold levels found in a building are "safe." All buildings have some form of moisture problem some time in their use. Everyone comes in contact with some mold in their daily life without evident harm. It is a question of degree and individual susceptibility.
While the most common health effects are minor sinus congestion, eye, nose, or throat irritation, coughing or difficulty breathing, some individuals are particularly vulnerable.
People with a chronic respiratory disease like asthma or sinusitis may experience difficulty breathing in moldy environments, and those with immune suppression may be at greater risk for infection. Infants, people recovering from surgery, those with immune systems weakened by HIV or cancer chemotherapy are also particularly vulnerable.
Lawsuits cite significant cases of deteriorating health, severe emotional distress, the loss of home, loss or damage to personal property, and a reasonable fear of developing cancer, brain dysfunction, memory loss, allergic and toxic reactions, and other physical injuries. Memory problems have been occasionally reported, but their cause is not well understood.
What to Do?
The most effective solution depends on the conditions in the building. Detective skills are important for understanding the extent of the damage and mapping out the best course of action. In general, the steps are:
1. Identify and stop the source(s) of moisture.
2. Inspect for mold growth. In many cases, mold grows inside walls or in other inaccessible locations. It is often necessary to pull up carpet, crawl under the building, and inspect ceiling spaces. Flashlights, mirrors, moisture meters, and borescopes are tools of choice. Borescopes have an eyepiece and internal lighting system which allows the investigator to check inside wall cavities for leaks and rot.
3. Clean and dry the moldy areas.
4. Bag and dispose of all moldy items.
It's important both to prevent contamination from leaving the cleanup area and entering the living space and to protect the health of people doing the work.
While limited areas of water damage and mold growth can be dealt with by building staff, often remediation contractors using asbestos abatement-type protocols are used instead. These protocols may include sealed work areas, negative pressure, airlocks, powered air purifying respirators, and protective clothing.
What We Can Expect
Concern about mold in buildings shows no sign of abating. Scientific research is lagging behind public demand for certainty about mold and its effect on health.
No single profession has as its duty the obligation to provide a building that is dry and free of mold growth. This is a shared responsibility among the building owner, homeowners' association, contractor, architect, maintenance company, and insurance or inspection company.
The field is rife for speculation and controversy as litigation pushes experts towards entrenched positions. Controversy should prevail for years to come while blame is assigned to contractors, designers, and others, and while our understanding of the health implications of mold continues to evolve.
Catherine Coombs, CIH, CSP is an industrial hygienist and director of environmental hazards research at Steven Winter Associates, Inc. (SWA), in Norwalk, Connecticut. She has led indoor environmental quality workshops for apartment owners and facility managers as part of a new energy management practices training program for the New York State Division of Housing and Community Renewal.