A procedure for evaluation of the indoor environment

Abstract

Exposure to substances found in the indoor environment is known totrigger respiratory illnesses such as asthma. Despite this knowledge,information on how to identify and remove these exposures is scarce. Toaddress this issue, we describe a program of environmental assessmentdeveloped at Children's Mercy Hospital in Kansas City, Missouri. Weevaluated buildings using a standardized assessment protocol. Thisprotocol included a combination of background information, visualinspection, volumetric air sampling, bulk sampling of suspicious areas,antigen measurement of housedust, and general measurements of the indoorclimate. We inspected a total of 63 buildings including 49 single unitstructures, 4 apartments, 4 town homes, 3 schools, 2 office buildings,and 1 mobile home. Most of these locations were identified because ofrespiratory ailments reported by the occupants. A screeningquestionnaire revealed factors that are known to be associated withfungal contamination such as leaks or flooding in 78% of thebuildings. Visual inspection confirmed these sources of contamination inthe majority of structures. Volumetric air sampling identified a highproportion of buildings with airborneAspergillus/Penicillium species. Stachybotrys wasfound in nearly 30% of these structures both in air and onsurface samples, and surprisingly, Stachybotrys spores werefound only in air in nearly 20%. Climactic factors were onlyweakly associated with fungal contamination. The homes of patients withrespiratory diseases often have significant fungal contamination thatcan be identified with a questionnaire. Using this standardizedapproach, factors associated with respiratory illnesses, usually fungalcontamination, frequently can be identified. Whether removal of theoffending exposure will lead to improve health remains to bedetermined.