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Damp Indoor Spaces and Health (2004)

Chapter:2 Damp Buildings

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Suggested Citation:"2 Damp Buildings." Institute of Medicine. 2004. Damp Indoor Spaces and Health. Washington, DC: The National Academies Press. doi: 10.17226/11011.
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2 Damp Buildings Almost all buildings experience excessive moisture, leaks, or flooding at some point. If dampness-related problems are to be prevented, it is essential to understand their causes. From a technologic viewpoint, one must under- stand the sources and transport of moisture in buildings, which depend on the design, operation, maintenance, and use of buildings in relation to exter- nal environmental conditions such as climate, soil properties, and topogra- phy. From a societal viewpoint, it is necessary to understand how construc- tion, operation, and maintenance practices may lead to dampness problems. The interactions among moisture, materials, and environmental conditions in and outside a building determine whether the building may become a source of potentially harmful dampness-related microbial and chemical exposures. Therefore, an understanding of the relationship of building moisture to mi- crobial growth and chemical emissions is also critical. This chapter addresses those issues to the extent that present scientific knowledge allows. It starts with a description of how and where buildings become wet; reviews the signs of dampness, how dampness is measured, and what is known about its prevalence and characteristics, such as sever- ity, location, and duration; discusses the risk factors for moisture problems; reviews how dampness influences indoor microbial growth and chemical emissions; catalogs the various agents that may be present in damp environ- ments; and addresses the influence of building materials on microbial growth and emissions. The chapter does not review effects of building dampness that are unrelated to indoor air quality or health. However, dampness problems 29

30 DAMP INDOOR SPACES AND HEALTH often cause building materials to decay or corrode, to become structurally weakened or lose their thermal capacity, and thus to reduce their useful life. Dampness also causes building materials and furnishings to develop an unacceptable appearance. The societal cost of such structural and visual effects of dampness may be high. As discussed below, there is no single, generally accepted term for referring to “dampness” or “damp indoor spaces.” This chapter and the remainder of the report adopts the terminology of the research being cited or uses the default term “dampness.” MOISTURE DEFINITIONS1 Studies use various qualitative terms to denote the presence of excess moisture in buildings. These include dampness, condensation, building damp- ness, visible dampness, damp patches, damp spots, water collection, water ponding, and moisture problem. Dampness—however it is expressed—is used to signify a wide array of signs of moisture damage of variable spatial extent and severity. It may represent visual observations of current or prior moisture (such as water stains or condensation on windows), observed microbial growth, measurement of high moisture content of building materials, mea- surement of high relative humidity in the indoor air, moldy or musty odors, and other signs that can be associated with excess moisture in a building. Some studies make separate observations of dampness and mold, and both observed dampness and visible mold have been weakly associated with mea- sured concentrations of fungi (Verhoeff et al., 1992). Chapter 3 discusses the various signs and measurements of dampness, moisture, or mold that have been used in studies and lists several examples. Numerous technical terms are also used to describe characteristics of moisture and moisture physics, including absorption, adsorption, desorp- tion, diffusion, capillary action, capillary height, convection, dew point, partial pressure, and water vapor permeability. A complete discussion of all the terms is beyond the scope of this study, but some that are used in the report are defined below. The amount of water present in a substance is expressed in relation to its volume (kg/m3), or to its oven-dry weight (kg/kg). The former is referred to as moisture content (MC), and the latter as percentage moisture content (%-MC). MC is directly proportional to %-MC and to the density of the substance (Björkholtz, 1987). 1Material in this section and later in the chapter has been adapted or excerpted from a dissertation by Dr. Ulla Haverinen-Shaughnessy (Haverinen, 2002) that was written under the supervision of one of the committee members. It is used here with the permission of the author.

DAMP BUILDINGS 31 Relative humidity (RH) is the existing water vapor pressure of the air, expressed as a percentage of the saturated water vapor pressure at the same temperature. RH reflects both the amount of water vapor in air and the air temperature. For example, if the temperature of a parcel of air is decreased but no water is removed, the RH will increase. If the air is cooled suffi- ciently, a portion of the gaseous water vapor in the air will condense, producing liquid water. The highest temperature that will result in conden- sation is called the “dewpoint temperature.” “Humidity ratio” is another technical term used to characterize the moisture content of air. The humid- ity ratio of a parcel of air equals the mass or weight of water vapor in the parcel divided by the mass or weight of dry (moisture-free) air in the parcel. Humidity ratio, unlike RH, is independent of air temperature. The indoor– outdoor humidity ratio can be used to estimate the rate of interior water vapor generation, or more qualitatively to indicate if a building has sources. Water generation rate can be computed from a moisture mass balance equation; however, the rate of outdoor air ventilation must be known. If the building has a dehumidifier or an air conditioner that dehumidifies, the rate of water removal via this device must be factored. Sorption and desorp- tion of water and from indoor surfaces also complicates the estimation of the internal water vapor generation rate. Monthly mean water activity level has been proposed as a metric for evaluating whether mold growth will occur on surfaces of newly-designed buildings (TenWolde and Rose, 1994) but there is reason to be skeptical about its practicality because the level varies throughout a building and is not easily measured at all relevant locations (for example, in wall cavities). The temperature of air and materials in a building varies spatially; therefore, RH also varies spatially. In the winter for example, the tempera- ture of the interior surface of a window or wall will normally be less that the temperature of air in the center of a room. Air in contact with the window or wall will cool to below the central room temperature, increasing the local relative humidity. If the surface has a temperature below the dewpoint temperature of adjacent air, water vapor will condense on the surface, producing liquid water. Without a source to moisten building material continuously, the MC of the material depends on temperature and the RH of the surrounding air. The RH of the atmosphere in equilibrium with a material that has a par- ticular MC is known as the equilibrium relative humidity (ERH) (Oliver, 1997). Different materials have different distributions of pore size and degrees of hygroscopicity so materials that have the same ERH may have different MC. For example, at an ERH of 80%, the MC for mineral wool is about 0.3 kg/m3, for concrete can be 80 kg/m3, and for wood is about 90 kg/m3 (Nevander and Elmarsson, 1994).

32 DAMP INDOOR SPACES AND HEALTH MOISTURE DYNAMICS IN BUILDINGS— HOW BUILDINGS GET WET Water exists in three states: solid (ice), liquid, and gas (water vapor). The molecules in liquid water and water vapor move freely; molecules in ice are bound into a crystal matrix and are unable to move except to vibrate. Liquid water is a cohesive fluid; when it interacts with other materials, it is affected by forces that originate in the new material. If a drop attaches to a surface that has a strong affinity for water, like wood, it will spread out across the surface. The attraction may be great enough that water will run along the bottom of a horizontal material—a roof truss, for example—until it comes to an air gap or a downward projection where gravity pulls it away from the surface and it falls. Many building materials are porous, and the size of the pores affects their permeability. If the pores are small enough to keep both liquid water clusters and water vapor molecules from passing, the material is imperme- able; metal foils are examples of such materials. Materials with slightly larger pores (building papers like Tyvek and builders felt) will shed liquid water but be relatively permeable to water vapor. If the material has pores that are large enough for tiny clusters of liquid water to enter, it will be permeable to both liquid water and water vapor. As a result of intermolecu- lar forces, liquid water is drawn into the pores of such materials by capil- lary suction. Water drawn in that way is said to be absorbed by the porous material. Water migration through porous materials is a complex interac- tion of forces. Water molecules clinging to the surface of a solid material are bound to that surface by intermolecular forces. They cannot move about as freely as liquid water molecules or water vapor molecules and are in what is sometimes referred to as the adsorbed state. Water must accumu- late on surfaces to a depth of four or five molecules before it begins to move freely as a liquid (Straube, 2001). Adsorbed water cannot be removed by drainage. In the adsorbed state, water molecules are less available for chemi- cal and biologic purposes than they are in a nonadsorbed state. It does not take a great deal of moisture to cause problems with sensi- tive materials like paper or composite wooden materials. Moisture sources in buildings include rainwater, groundwater, plumbing, construction mois- ture, water use, condensation, and indoor and outdoor humidity (Lstiburek, 2001; Straube, 2002). The first three are sources of liquid-water problems, construction moisture may result in both liquid-water and water-vapor problems, and condensation associated with humidity involves water vapor as well as liquid water. Moisture problems begin when materials stay wet long enough for microbial growth, physical deterioration, or chemical reac- tions to occur. Those may happen because of continual wetting or intermit- tent wetting that happens often enough to keep materials from drying. As

DAMP BUILDINGS 33 discussed below, the important moisture-related variables in determining whether fungal growth occurs are those which affect the rate of wetting and the rate of drying (Lstiburek, 2002a). The most damaging water leaks are those which are large enough to flood a building or small enough not to attract notice but large enough to wet or humidify a cavity space or material for a long time. Thus, the “best” leak is one that is large enough to be noticed right away but small enough that the wetting does not promote microbial growth or affect materials. Both floods and slow leaks can result in large areas of fungal growth. Condensation sometimes occurs over a large area and can also result in extensive mold growth. Rainwater and Groundwater Placing a building on a site does not change how much rain falls each year—it changes the path that rainwater takes on its journey through the hydrologic cycle. When building designs work properly, rainwater is col- lected and redirected so that it does not intrude into the buildings them- selves. When collection and redirection fail, rainwater wets buildings. Build- ings have been protected from rainwater for centuries by using gravity, air gaps, and moisture-insensitive materials to direct and drain water away from other materials that can be damaged by water through corrosion, microbial contamination, or chemical reaction (Lstiburek, 2001). Weak- ness in rainwater protection can be found in the detailing of the roof, walls, windows, doors, decks, foundation, and site. Rainwater leaks may take a long time to become noticeable because the water often leaks into cavities that are filled with porous insulation. Insulation may retain the water, keeping materials wet longer than would empty cavities. Many roofing materials are impermeable to liquid water and can be repeatedly wetted and dried without damage. Wooden shingles and thatched roofs are exceptions. They drain the bulk of rainwater away from the interior but also absorb some of it. An air gap beneath then forms a mois- ture or water break and allows drying of the shingle or thatch by evapora- tion from inner and outer surfaces. Roof leaks typically occur at joints and penetrations; parapet walls, curbs for roof-mounted equipment and sky- lights, intersections between roofs and walls, and roof drains are common leakage sites. These leaks are often the result of failures in design or of installation of flashings and moisture or water breaks. In climates that receive substantial snowfall, water can intrude through roofs as the result of melting snow. Ice dams occur when there is snow on a roof and roof temperatures reach 33°F (1°C) or higher at times when the outdoor air temperature is below freezing. Snow on the warm part of the roof melts and then follows the drainage path until it reaches roofing that is

34 DAMP INDOOR SPACES AND HEALTH chilled below freezing by outdoor air. The water then freezes on this part of the roof and causes ice dams and icicles. Aggravating conditions for ice dams include sources of heat that warm snow-covered sheathing (air leaks and conductive heat loss from the building, recessed lighting fixtures in insulated ceilings, and uninsulated chimneys passing through attics) and valley roofs, which may collect water from a large surface area and drain it to one small location. Several design approaches are available for prevent- ing ice dams: • Air-seal and heavily insulate the top of the building so that escaping heat does not reach the roofing. • Ventilate the roof sheathing from underneath with outdoor air. (In combination with the air sealing and insulation, this keeps roofing cold, so melting does not occur or is minimized to rates that do not result in ice problems). • Avoid heat sources in the vented attic or vent bays (for example, do not use recessed lights in insulated ceilings). Rainwater protection in walls is accomplished largely with three basic methods: massive moisture storage, drained cladding, and face-sealed clad- ding (Lstiburek, 2001; Straube and Burnett, 1997). Historically, walls ca- pable of massive moisture storage have been built of thick masonry materi- als (such as stone in older churches). Exterior detailing channels rainwater away from entry through such walls. The walls are also able to store a large amount of water in the adsorbed state, and their storage capacity is suffi- cient to accommodate rainwater wetting and drying cycles without causing problems.2 Rainwater intrusion problems occur in these walls when a path- way wicks water from the exterior to the interior, where moisture-sensitive materials are. Wooden structural members in masonry pockets, interior- finish walls made of wood or paper products, and furnishings composed of fabrics, adhesive, or composites are typical materials that may be affected by rainwater transported through walls by bridging or capillary suction. Cladding (a protective, insulating, or decorative covering) with air gaps and a drain plane is another historical answer to rainwater intrusion. A drained-cladding wall has an exterior finish that intercepts most of the rainwater that strikes it but is backed by an air gap and water-resistant drainage material to keep any water that gets past the cladding from enter- ing the wall beneath. Wooden clapboard, wooden shingles, board and bat, brick or block veneer, and traditional stucco are examples of cladding used in some climates in the United States that has historically been backed by an 2Condensation is not typically a problem, because, unlike many composite structures, such walls have relatively even distribution of water-vapor permeability.

DAMP BUILDINGS 35 air gap and drainage layer. Asphalt-impregnated felt paper, rosin paper, and high-permeability spun-plastic wraps are examples of materials that are used as the drainage layer. Foam board and foil-faced composite sheath- ing have also been used as drain planes beneath cladding (Lstiburek, 2000). The most frequent problems in these walls occur when moisture-sensitive sheathings—such as oriented strand board (OSB), plywood, and low- density fiberboards—are not protected by a drainage layer. Face-sealed walls are made of materials that are impermeable to water and are sealed at the joints with caulking or gaskets (Straube, 2001). Struc- tural glazing, metal-clad wooden or foam panels, and corrugated metal siding are examples of face-sealed cladding. The intention is to seal the joints between the panels well enough to prevent rainwater entry. Rainwa- ter intrusion occurs when the seals fail. Seals on some face-sealed walls need to be renewed every 4–5 years. The unavoidable weakness in rainwater protection for any wall is at the penetrations—windows, doors, light fixtures, the roofs of lower portions of the structure, decks, balconies, and porches. Rainwater leaks through poorly detailed, designed or installed flashing are most common. Common errors include failure to provide detailed instructions for flashing in construction documents, providing two-dimensional details for situations that require three-dimensional flashing, installing head flashings on top of building pa- per rather than installed underneath, and ignoring leaks in the window itself. Wall drain papers for windows must be installed in the same way that a raincoat is worn: over, not tucked into rain pants. Pan flashing beneath windows can prevent leaks, even of poorly installed windows, from wetting the wall below (Lstiburek, 2000). Foundations are typically protected from moisture problems by being constructed of materials that are resistant to water problems (stone, con- crete, and masonry) and having rainwater diverted away from them (Lstiburek, 2000, 2001). (In some old buildings, foundation structures could be constructed of wooden piers, which might have to be kept wet.) Exces- sive moisture in foundations is often the result of poorly managed rainwa- ter, but it may also result from groundwater intrusion, plumbing leaks, ventilation with hot humid air, or water in building materials (such as concrete) or in exposed soil (for example, saturated ground in a crawl space foundation). Rainwater is diverted by sloping the finish grade away from the building; rainwater and groundwater are diverted with subsoil drain- age. Drainage systems use stone pebbles, perforated drain pipe, sand and gravel, or proprietary drainage mats. Stone pebbles and perforated pipe are typically enclosed in a filter fabric to prevent clogging by fine soil particles. Below-grade foundations are coated with dampproofing to provide a capil- lary break. Water problems occur if rainwater collected on the roof is drained to the soil next to the foundation. This may happen if the site is

36 DAMP INDOOR SPACES AND HEALTH inadvertently contoured to collect rainwater and drain it into the building or if paving does so. Other problematic scenarios include a drainage pipe that is missing, is installed improperly, or does not drain to daylight or a sump pump; a drainage system that fills with silt carried by water percolat- ing through the soil and that then clogs; and a failure to install a capillary break, which would keep water from being wicked through concrete prod- ucts to the interior. Foundations may be slab on grade (or near grade), full basements, crawl spaces, piers, or a combination of these types. A slab-on-grade foun- dation consists of a concrete slab that constitutes the first floor of the building. The perimeter of the slab may be thickened and reinforced, or it may be bound by a perimeter wall that extends some distance into the soil. The most common water problems with slab-on-grade foundations are caused when rainwater from the roof or site wets the foundation and the water is wicked up through concrete to wall or flooring materials. If air ducts are placed in or beneath the slab, these may flood with poorly man- aged rainwater. A basement is made by excavating a large, pond-like hole in the ground and constructing walls and a floor in the bottom of the hole. A basement floor slab is wholly or partially below grade. Some basement floors are at grade on one side and below grade on another. A drainage system is placed on the bottom of the hole around the perimeter of the walls, and a capillary break in the form of stone pebbles or polyethylene film is placed beneath the floor. Walls are coated with some form of dampproofing to make a capillary break. Free-draining material is placed against the walls to divert water from the foundation into footing drains. Many potential causes of dampness problems in full basements result from vagaries of weather and defects in design, construction, and maintenance. Rainwater from the roof or site can easily saturate the soil near the foundation and make it more likely for liquid water to seep or run into the basement. A more subtle problem occurs when water wicking through the walls or slab evaporates into the basement, leaving the walls dry but over-humidifying the space. Placing framing, insulation, paneling, or gypsum board against a basement wall creates a microclimate between finished wall and basement wall. In fact, if the outdoor-air dewpoint is higher than the temperature in this space, ventilating air will add moisture to the cavity, not dry it and this can result in conditions favorable for microbial growth. A solution to this problem is to insulate the foundation wall on the outside. If the foundation is insulated on the inside, a material with high insulating value and low water-vapor permeability should be used; this will keep the warm humid basement air away from earth-chilled walls. Plastic foam insulation meets this criterion. If the water vapor permeability of the insulation is low enough, it will reduce drying from the foundation wall into the basement.

DAMP BUILDINGS 37 Placing insulation beneath the floor slab can prevent basement floors from “sweating” during hot humid weather because it thermally isolates the concrete slab from the cool earth below. A crawl space is constructed in the same way as a basement foundation except that it is shorter and often the floor is not covered by a concrete slab. Many crawl spaces have air vents through the walls intended to provide passive ventilation. Because crawl spaces are not intended for occupancy, drainage detailing around them is often lacking or poorly implemented. Rainwater intrusion is common. In addition, the floor is often exposed soil, which creates the potential for evaporation into the crawl space. Vents placed too close to the ground sometimes become rainwater intakes. When the outdoor-air dewpoint is higher than the temperature of the soil and foundation surfaces, ventilating air wets the crawl space rather than drying it (Kurnitski, 2000). Pier foundations (concrete or crushed-stone footings for posts that con- stitute the major structural support for a building) are the most resistant to rainwater problems. Piers extend from the ground to above the surface of the soil to support the lower structure of a building. The most common water problem for this type of foundation occurs if a depression in the ground beneath the structure collects water and exposes the underside of the building to prolonged high humidity. Plumbing and Wet Rooms Most water intentionally brought into buildings is used for drinking, cooking, or cleaning. The bulk of this water passes harmlessly through drains to public or private treatment and is then released to the hydrologic cycle from which it was diverted. The pathway followed by such water consists of pipes, tubs, sinks, showers, dish and clothes washers, driers, and ventilating air. Most of the materials used in the pathway are moisture- insensitive—able to withstand dampness without decomposing, dissolving, corroding, hydrolyzing, or supporting microbial growth. Moisture prob- lems occur when water leaks from pipes or from sinks, tub or shower enclosures, washing machines, ice machines, or other fixtures and appli- ances that have water hookups. Pipes leak when joints are incorrectly made or fail, water freezes in them, the pipe material corrodes or decomposes, or a screw or nail is driven through them. Joints may not be correctly soldered, gasketed, cemented, or doped. Water lines lose integrity when they are exposed to acidic or caustic water or—in the case of rubber or plastic lines to washing machines—the polymers break down from oxidation or ultraviolet (UV) light exposure. Corrosive water may lead to mold growth if a large number of small leaks result. Pipes in exterior walls or unheated crawl spaces or attics may freeze

38 DAMP INDOOR SPACES AND HEALTH and crack during subfreezing weather. A screw or nail driven through a pipe may not leak for some time, because the fastener seals the hole it made; after thermal expansion and contraction and corrosion work for some time, the pipe may begin to leak. Drains and water traps are vulnerable to leaks. Overflows and careless installation and renovation practices also contribute to problems with fix- tures and appliances that use water. The materials that surround tubs and showers—typically ceramic tiles and fiberglass panels—receive regular wet- tings. They must be constructed, sealed, and maintained to protect the wall and floor materials beneath them. As with rainwater protection, most prob- lems occur at the joints. Grout between ceramic tiles often does not ad- equately serve as a capillary break and water wicks through to the base. In ceramic tile surrounds with paper-covered gypsum board as the base, mold growth may occur beneath the grout and on the backside of the gypsum board where water wicks through the paper facing the wall cavity. Depending on the detailing, water may also be wicked through the gaps where fiberglass panels overlap and meet tubs or shower pans. The shower pan in stand-alone showers is another weak spot. Essentially, these are basins that must hold a small depth of water. Leaks are most common at the drain penetration. Pans that are constructed on site have more joints to leak than prefabricated pans that are molded into a single piece. Poorly designed, incorrectly installed, and carelessly used shower curtains and doors are another source of problems. Tub surrounds and shower enclo- sures can be constructed of materials that are poor substrates for fungal growth; for example, fiber-cement board, rather than paper-covered gyp- sum board, can be used as the base for ceramic tile. Such steps reduce, but do not eliminate, the possibility of microbial contamination. Construction Moisture In newly constructed buildings, a large amount of water vapor can be released by wet building materials such as recently cast concrete, and wet wooden products (Christian, 1994). Manufactured products that were origi- nally dry can become extensively wetted by exposure to rain during trans- portation, storage, and building construction. Case studies have attributed microbial contamination to the use of wet building materials or to wetting during building construction (Hung and Terra, 1996; Salo, 1999). Large areas of mold growth may occur when a floor enclosing an earth-floored crawl space is installed because the soil may be a reservoir of rainwater; the humidity in such a crawl space quickly becomes high when the floor deck is applied over moist earth. Floor decks made from OSB or plywood are vulnerable to mold growth during extended periods (23 days for OSB, 42 days for plywood) of RH greater than 95% (Doll, 2002).

DAMP BUILDINGS 39 Condensation and High Humidity Condensation necessarily involves water-vapor transport. The two im- portant variables for condensation are chilled surfaces and sources of water vapor. Materials chilled below the indoor or outdoor air temperature accu- mulate water molecules in the adsorbed state and are at risk for condensa- tion; those chilled below the local dew point will begin to accumulate liquid water. Porous materials can hold more water vapor than impermeable ones before liquid water appears. The combination of high RH in indoor or outdoor air and cooled building materials increases the risk of dampness problems and microbial growth. Even without condensation, the local RH of air at the surface of cool material can be very high, leading to high mois- ture content in the material. Figure 2-1 illustrates how much air needs to be cooled before the difference between the air temperature and dewpoint temperature equals zero and condensation occurs. Regardless of the initial air temperature, when the relative humidity is very high only a few degrees of cooling will result in condensation. For example, if the bulk of the air in a room has a RH of 80%, condensation will occur on a surface that is only about 7oF (4oC) cooler than the bulk room air temperature. Therefore, whenever cool 90 80 70 60 Tair-Tdewpoint (°F) 90°F 50 70°F 50°F 40 30 20 10 0 5 10 20 30 40 50 60 70 80 90 100 Relative Humidity (%) FIGURE 2-1 The difference between air and dewpoint temperatures needed for condensation to occur, expressed as a function of relative humidity, for three in- door air temperatures.

40 DAMP INDOOR SPACES AND HEALTH surfaces are present due to cold outdoor temperatures or air conditioning of a building, high humidity poses a condensation risk. However, at present, there is no generally accepted upper limit for indoor RH level, based on the need to prevent dampness problems. Acceptable RH levels vary with cli- mate and building features. During periods of cooling in air-conditioned buildings, indoor materi- als are colder than the outdoor air. Ventilation is then a source of indoor moisture—not a removal process—unless the incoming ventilation air is first dehumidified (Harriman et al., 2001). If nonconditioned outdoor air is accidentally drawn across a surface that is chilled sufficiently by air-conditioned indoor air, condensation will occur. In the cooling season, that is most likely to happen when an exhaust fan or the return side of an air handler lowers indoor air pressure in rooms or depressurizes wall or ceiling cavities (Brennan et al., 2002). Outdoor air is drawn in by the lower air pressure and carries water vapor with it. Water vapor in this accidental outdoor airflow may condense on the backside of gypsum board or in cabinets that have holes for wire or plumbing. The backside of interior gypsum board and the underside of vinyl wallpaper on exterior walls are common locations for mold growth resulting from this process (Lstiburek, 2001). When buildings are air-conditioned, a combination of wind-driven rain and water-vapor transport can also result in condensation and mold growth beneath vinyl wallpaper, on the backside of gypsum board on an exterior wall, or on the backside of interior foam board (Lstiburek and Carmody, 1996). Those materials act as accidental vapor retarders on the cool side of the wall. Furnishings and wall decorations—such as pic- tures, cabinets, mirrors, and chalkboards—can also act as accidental vapor retarders. Materials may be chilled by outdoor air when it is cold outdoors (Bren- nan et al., 2002). Cold-weather condensation is often observed on the interior side of windows. Because windows usually have a lower insulating value than solid walls, the room-side surface of the glass is cooler than the surface of the surrounding walls. Indeed, if there is condensation or frost on the window, the glass temperature is necessarily below the indoor-air dew point. Condensation may also occur on cold pipes and on the bottom side of roof sheathing (the side facing the attic rather than the sky), the inside of exterior-wall sheathing, and the back side of claddings (clapboards, stone slabs, concrete panels, plywood panels, and the like). Foundations constructed of concrete, masonry, stone, and wood are often chilled by contact with the earth. If the indoor-air dew point is higher than the temperature of the earth-chilled surfaces, water will begin to con- dense (Brennan et al., 2002). As water condenses on capillary materials, such as concrete or wood, it is wicked away by capillary action. Hygro- scopic concrete and stone foundation materials can store moisture in a

DAMP BUILDINGS 41 relatively harmless state until they become saturated, at which time liquid water will appear. If the materials are coated with a vapor-impermeable material, such as sheet floor covering or many paints, condensation will immediately collect under the proper conditions. Water vapor in basements or crawl spaces may come from water passing through the foundation materials as liquid or vapor or from the ventilating air when outdoor-air dew points are high, or it may be dominated by water vapor from exposed soil (Kurnitski, 2000). Moisture-related problems become more likely when basement areas are finished (CMHC, 1996). Many of the materials used to finish base- ments allow water vapor to diffuse through them but are relatively good thermal insulators; thus, the materials inhibit heating of the foundation by warm indoor air but allow moisture to reach the cool surfaces. When a wooden stud wall with fiberglass insulation covered with gypsum board is placed against a concrete foundation and no vapor retarder is used, water vapor can easily pass through the wall section via the permeable materials and through gaps. However, there is very little drying potential under these conditions. Vapor pressure moves water vapor from the basement into the wall and sometimes from the outdoors into the wall. Very little air is moving behind such walls so drying by airflow cannot be achieved. The “microclimate zone” behind the stud wall stays moist throughout the cool- ing season, while wooden studs and paper-covered gypsum provide nutri- ent for mold growth. A vapor retarder in the wall will not prevent migra- tion through the gaps and holes but will reduce the drying potential of the wall and thus increase the importance of small rainwater or plumbing leaks. Carpet systems on floor slabs produce a similar phenomenon, unless there is an insulating, low-vapor-permeability layer in the system. Finished basements may have substantial mold growth because of those phenomena. Warming the surfaces of the earth-chilled materials, by insulating them or heating them prevents condensation. Insulating material placed inside the foundation must prevent vapor in the indoor air from reaching the chilled foundation materials and present a warm surface to the indoor air. As noted above, that is best accomplished by using a material with high insu- lating value and low vapor permeability. Insulating material placed on the outside of the foundation must resist biologic, chemical, and physical dete- rioration when exposed to soil and liquid water. Condensation on earth- chilled surfaces can also be avoided by dehumidifying the indoor air to lower the dew point to below the foundation surface temperatures. Occupants as Sources of Moisture High humidity indoors can originate in moisture emissions from cook- ing, washing clothes, bathing, and keeping living plants indoors. Respira-

42 DAMP INDOOR SPACES AND HEALTH tion and perspiration by building occupants contribute to humidity, as does the use of humidifiers. In improperly ventilated building spaces, those sources can account for substantial problems. In addition to plumbing leaks and flooding by water overflow, wicking along wall surfaces from poor wet-mopping practices is a problem in some indoor environments. The practices of cooking, bathing, and drying of clothes and the density of occupation vary among cultural and economic groups. In some homes, internal moisture is high because of nearly continuous simmering of foods or extensive indoor drying of clothes. Anecdotal evidence indicates that such activities can lead to high indoor humidity and associated microbial growth. In low-rise residential buildings, a damp foundation may contribute as much water vapor as all the rest of the sources combined (Angell, 1988). Moisture in Heating, Ventilating, and Air-Conditioning Systems Although relatively little attention has been directed to dampness and mold growth in heating, ventilating, and air-conditioning (HVAC) systems, there is evidence of associated health effects. Pollutant emissions linked to moisture and microbial growth in HVAC systems are one of several poten- tial explanations for the consistent association of air-conditioning systems with an increased prevalence of nonspecific health symptoms, called sick building syndrome, experienced by office workers (Seppänen and Fisk, 2002). The presence of air conditioning in homes has also been associated with statistically significant increases in wheezing and other symptoms of current asthma (Zock et al., 2002). Mendell et al. (2003) analyzed data on 80 office buildings where complaints had been made and found an in- creased prevalence of lower respiratory symptoms associated with poor draining of water from the drain pans beneath cooling coils of HVAC systems (OR 2.6; CI 1.3–5.2). In contrast, a preliminary analysis of data on a representative set of 100 large U.S. office buildings found that dirty cooling coils, dirty or poorly draining drain pans, and standing water near outdoor air intakes were not associated with reports of mucus membrane symptoms, lower respiratory symptoms, or neurologic symptoms (Mendell and Cozen, 2002). Liquid water is often present at several locations in or near commercial- building HVAC systems, facilitating the growth of microorganisms that may contribute to symptoms or illnesses. Outdoor air is often drawn from the rooftop or from a below-grade “well” where water (and organic debris) may accumulate. Raindrops, snow, or fog can be drawn into HVAC sys- tems with incoming outside air, although systems are usually designed to prevent or limit this moisture penetration. In both commercial and residential air-conditioning units, moving the supply-air stream in the direction of airflow leads it to the cooling coil

DAMP BUILDINGS 43 where moisture condenses (as a consequence of cooling the air or intention- ally for dehumidification). Ideally, that moisture drips from the surfaces of the coil into a drain pan with a drainage pipe. Drain pipes may become clogged with the remains of microbial growth. Occasionally, drain pans contain stagnant water because they do not slope toward the drain line. In drawthrough systems, drains may also be plugged or otherwise nonfunc- tional because air-pressure differences prevent drainage, sometimes causing the drain pan to overflow with water. If the velocity of air passing through the cooling coils is too high, water drops on the surface of the cooling coil can become entrained in the supply-air stream and deposit in the HVAC system downstream of the cooling coil. Air leaving the cooling coils is often nearly saturated with water vapor, and the high humidity of this air in- creases the risk of microbial growth. HVAC systems sometimes have a humidifier that uses steam or an evaporation process to add moisture. Humidifiers, used predominantly in colder climates, may have reservoirs of water or surfaces that are frequently wetted, or they may produce water drops that do not evaporate. Thus, there are many potential sources of liquid water and high humidity in HVAC systems. Microbial growth in HVAC systems can be limited by (Ottney, 1993) • Using sloped drain pans with drains at the low point. • Correctly trapping drains or using critical orifice drains that work against negative pressure in the system. • Providing easy access to coils, drain pans, and the downstream side of cooling coils for inspection and cleaning. • Making inner surfaces of the air-conveyance systems of materials that are impermeable to water penetration and are easy to clean. • Protecting the system from particle buildup by using filters with greater than 25% dust spot efficiency. Microbial contamination of HVAC systems has been reported in many case studies and investigated in a few multibuilding research efforts (Batter- mann and Burge, 1995; Bencko et al., 1993; Martiny et al., 1994; Morey, 1994; Morey and Williams, 1991; Shaughnessy et al., 1998). Sites of re- ported contamination include outside air louvers, mixing boxes (where outside air mixes with recirculated air), filters, cooling coils, cooling-coil drain pans, humidifiers, and duct surfaces. The porous insulating and sound absorbing material called duct liner that is used in some HVAC systems may be particularly prone to contamination (Morey, 1988; Morey and Williams, 1991). Bioaerosols from contaminated sites in an HVAC system may be transported to occupants and deposited on previously clean sur- faces, making microbial contamination of HVAC systems a potential risk factor for adverse health effects.

44 DAMP INDOOR SPACES AND HEALTH A 2003 study investigated the health impact of such contamination by examining the association between ultraviolet germicidal irradiation (UVGI) of drip pans and cooling coils in buildings ventilation systems and indoor microbial concentrations and self-reported symptoms in occupants (Menzies et al., 2003). The researchers systematically turned UVGI lamps installed in the HVAC systems of three office buildings on and off over the course of a year and collected environmental and occupant data. Fungi, bacteria, and endotoxin concentrations were measured, and building occupants who were unaware of the operating condition of the UVGI lamps filled out question- naires on their health. Other environmental data (temperature, humidity, air velocity, HVAC recirculation; and CO2, NOx, O3, formaldehyde, and total volatile organic compound concentrations) and occupant data (par- ticipants’ assessment of thermal, physical, and air quality; and demographic, personal, medical, and work characteristics) were also collected. Occupants reported significantly fewer work-related mucosal symptoms (adjusted OR 0.7; 95% CI 0.6–0.9) and respiratory symptoms (0.6; 0.4–0.9) when the UVGI lamps were on. Reports of musculoskeletal symptoms (0.8; 0.6–1.1) and systemic symptoms (headache, fatigue, or difficulty concentrating) (1.1; 0.9–1.3) were not significantly different. Although median concentrations of viable microorganisms and endotoxins were reduced by 99% (CI 67%– 100%) on surfaces exposed to UVGI, there were no significant decreases in airborne concentration. The results suggest that limiting microbial contami- nation of HVAC systems may yield health benefits, and follow-up research is recommended. PREVALENCE, SEVERITY, LOCATION, AND DURATION OF BUILDING DAMPNESS Prevalence Table 2-1 provides examples of published data on the prevalence of signs of dampness in buildings. The studies address a variety of locations and climates. Different dampness metrics were used; most data were col- lected with occupant-completed questionnaires. The reported prevalence of signs of dampness ranges from 1% to 85%. In most datasets, at least 20% of buildings have one or more signs of a dampness problem. But because moisture metrics and data-collection methods varied among studies, com- parisons of prevalence data from different studies can be only qualitative. Figure 2-2, which is based on the biennial U.S. Census American Hous- ing Survey, plots the prevalence of water leaks in U.S. houses by year. The data indicate that the prevalence of water leaks generally decreased over the period 1985–2001 and that more leaks are from external sources of wa- ter—for example, rain—than from internal water sources—plumbing leaks

TABLE 2-1 Examples of Reported Prevalence of Signs of Building Dampness Reference Country Population Dampness Metric Prevalence, % Residential buildings Brunekreef et al., 1989 United States homes of Questionnaire (city averages reported) 6,273 school Ever water in basement 11–42 children in 6 Ever water damage to building 12–23 cities Ever mold or mildew on any surface 21–38 Any of above 46–58 Dales et al., 1999 Canada homes of 3,444 Questionnaire children Dampness stains in last 2 years 24 Visible mold in last 2 years 15 Either of above 25 Engvall et al., 2001 Sweden 4,815 Questionnaire apartments Condensation on windows 7 High relative humidity in bathroom 9 Water leakage in last 5 years 13 Any of above 22 Evans et al., 2000 United 8,889 homes Questionnaire Kingdom of adults Damp or condensation a serious problem 1 Damp or condensation a minor problem 9 Haverinen et al., 2001a Finland 390 homes Inspections and 240 Grade 1, no to minor moisture damage 16 apartments Grade 2, intermediate moisture damage 18 Grade 3, high moisture damage 15 Jaakkola et al., 2002 Finland 932 adults Questionnaire about homes who were Water damage in last year 2 controls in Damp stains or peeling paint in last year 9 asthma case- Visible mold in last year 3 control study Kilpeläinen et al., 2001 Finland homes of Questionnaire (regarding any of the students’ 10,667 homes in the last year) university Visible mold 5 students Visible mold or damp stains 12 45 Visible mold or damp stains or water damage 15 (continued on next page)

TABLE 2-1 continued 46 Reference Country Population Dampness Metric Prevalence, % Nevalainen et al., 1998 Finland 450 private Inspections, surface moisture measurements, houses and questionnaire on previous or current damage Signs of moisture damage in roof 40 Signs of moisture damage in basement 25 Signs of moisture damage in walls 33 Plumbing-related moisture damage 25 Leakage from clothes washer or dishwasher 20 Leakage in ventilation ducts 20 Any of above 80 Norbäck et al., 1999 Sweden homes of 429 Questionnaire via interview subjects Water damage in last year 16 Floor dampness in last year 5 Visible mold in last year 9 Moldy odor in last year 6 Zock et al., 2002a 14 European 16,687 homes Questionnaire via interview countries, Water damage in last year 12 Australia, Water on basement floor in last year 2 India, New Mold or mildew in last year 22 Zealand, and United States Nonresidential buildings Jaakkola et al., 2002 Finland 932 adults Questionnaire about workplace who were Water damage in last year 6 controls in Damp stains or peeling paint in last year 12 asthma case- Visible mold in last year 3 control study Mendell and Cozen, 2002 United States 100 U.S. office Questionnaire buildings Past water damage in building 85 Current water damage in building 43 aIncludes data from Norbäck et al. (1999).

DAMP BUILDINGS 47 20 water leakage from OUTSIDE structure water leakage from INSIDE structure 18 16 Percent 14 12 10 8 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 Year FIGURE 2-2 Prevalence of reported housing water leaks during the preceding 12 months, 1985–2001. SOURCE: Biannual American Housing Survey for the United States, Bureau of the Census, U.S. Department of Commerce, http://www.census.gov/hhes/www/ahs.html. and the like. In 2001, 11.8% and 9.4% of houses had water leakage from exterior and interior sources, respectively. Most of the available data on dampness prevalence are related to houses and apartments, but some are related to other indoor environments. A study by Jaakkola et al. (2002) found that the self-reported prevalence of signs of dampness was similar in the workplaces and homes of subjects in the Finnish Environment and Asthma Study. In a study of 100 U.S. office buildings (Mendell and Cozen, 2002), 85% reported past water damage and 43% current water damage. Those prevalences are high relative to those typically reported in studies of homes; although localized water dam- age in a large office building may significantly influence exposures only of workers near the damage. Nonetheless, these data suggest that dampness in workspaces should not be ignored. The committee did not identify any large systematic surveys of damp- ness in U.S. classrooms,3 but anecdotal reports of dampness in classrooms 3Meklin et al. (2003) have assessed the occurrence of moisture damage, fungi, and airborne bacteria in schools in Finland, focusing on the impact of main building frame material (wooden vs concrete or brick). An earlier paper (Meklin et al., 2002) examined respiratory symptoms in the children attending those schools.

48 DAMP INDOOR SPACES AND HEALTH are common, and school data have been collected as part of broader char- acterizations of children’s exposures. A survey of the condition of U.S. schools by the General Accounting Office (GAO) did not contain a specific question about dampness or water leaks; however, the documentation of GAO’s visits to 41 schools included many references to water leaks (U.S. GAO, 1995). Daisey and Angell (1998) reviewed 49 health-hazard evalua- tions of educational facilities performed by the National Institute for Occu- pational Safety and Health in response to indoor air quality (IAQ) com- plaints; 28 of the evaluations reported water leaks in the building shell. Thus, the available evidence suggests that classrooms also commonly have dampness problems. Table 2-1 includes data from two studies (Haverinen et al., 2001a; Nevalainen et al., 1998) that used inspections by trained personnel to assess the prevalence of signs of dampness. Only a few studies have analyzed differences between occupant-reported and investigator-verified prevalence of moisture and mold observations in buildings. Douwes et al. (1999) found that occupant’s reports of damp spots or mold spots were better correlated with a measure of indoor mold than investigator’s reports of these visible signs. Bornehag et al. (2001) concluded that, although in most studies occupants had reported more dampness than investigators had, this was due to the occupants’ longer time perspective than the investigators’ “snapshot” observations. A conflicting study by Williamson et al. (1997) found that occupants reported dampness less often than trained surveyors. Nevalainen et al. (1998) reported similar results, suggesting that the expla- nation was a result of a trained eye and of knowledge of what represents a critical problem. Dharmage et al. (1999a) examined the validity and reli- ability of interviewer-administered questionnaires against observations and measurements made by an independent researcher. Among 44 items exam- ined for validity (defined as correspondence between occupant reports and independent observations or objective measurements), there was perfect or almost perfect agreement on 21 and substantial agreement on 19 others. Among 10 items examined for reliability (defined as correspondence be- tween interviews conducted 1 year apart), there was perfect or almost perfect agreement on nine items and substantial agreement on the other one. They concluded that the data collected with questionnaires were both reliable and valid. In another study, Dales et al. (1997) concentrated on the validity and determinants of reported home dampness and molds. They established associations between occupant-reported water damage, mold and mold odors, and objectively measured concentrations of viable indoor fungi in dust. However, they found little association between questionnaire responses and an objective measure of total airborne fungal matter (ergos- terol concentration) and there was evidence that—in the presence of low concentrations of viable fungi in dust—respondents reporting allergies were

DAMP BUILDINGS 49 more likely to report visible mold growth than asymptomatic respondents. The authors therefore recommended that objective exposure measures, not questionnaires, be used in studies of the health effects of indoor fungi. Information on the prevalence or severity of moisture damage reported by occupants is likely to be highly subjective. The validity and reliability of data gathered from questionnaires are affected by several survey factors, such as sample size, response rate, recall period, and factors related to the design of the questionnaire. Underreporting, overreporting, and systematic reporting bias that would not be corrected by increasing sample sizes are possible. But questionnaires are a relatively cost-effective method of collect- ing information on perceived indoor-air quality, especially if the sample is large, and questionnaire responses collected from the occupants themselves provide first-hand information; occupants’ perceptions are also important in assessing the condition of a building. Trained building inspectors have experience in observing and evaluat- ing structures and may also be more objective than occupants, who have a personal relationship with the building. Those advantages would not, how- ever, exclude the subjectivity of trained investigators. Thorough building investigations need both expert assessment of the building’s condition and occupant knowledge of its history and current problems to complement each other. Chapter 6 has further information on this topic, addressing the evalua- tion of moisture problems in the context of identifying sources and plan- ning remediation. Severity Most studies have not attempted to quantify the severity of dampness or of damage associated with dampness. It is clear that the severity of dampness varies widely, from occasional minor condensation on windows to the wetting of a large portion of a building during a flood. The evalua- tion of the severity or magnitude of moisture problems can use several criteria, most of which are subjective. Excess moisture in a building envi- ronment may induce physical damage, but it may also manifest biologic or chemical damage. Direct, immediate impacts include structural, microbio- logic, chemical, or aesthetic effects. Indirect consequences include health effects and remediation or repair costs. Because of the complexity of the evaluation, there is no agreed-on basis for determining the severity of dam- age from either the engineering or the health point of view. In buildings that have moisture-induced damage, people can be ex- posed to a complex mixture of microorganisms, organic and inorganic dust, and volatile chemicals (Husman, 1996). It is difficult to measure and distinguish between the various agents and their effects, and exposures have

50 DAMP INDOOR SPACES AND HEALTH often been defined indirectly and cumulatively as “damp housing” or living in a “water damaged” or “moldy” building. However, as noted in this chap- ter, there is no generally accepted definition of dampness or of what consti- tutes a dampness problem, and no generally accepted metric for character- izing dampness. Several factors might be considered in evaluating the severity of mois- ture damage. Four of these are discussed below: the size of the damaged area, the presence of visible signs of moisture damage, the duration of its presence, and the building material on which the damage is observed. The size or extent of damage is an important moisture-damage charac- teristic assumed to be related to source strength. It is reasonable to expect larger or more extensive damage to be associated with higher potential exposure. However, the literature does not provide much information on the estimation of damage size. Williamson et al. (1997) used a subjective grading of the extent of visible mold on a four-point scale: 0 = absent, 1 = trace, 2 = obvious but localized, and 3 = obvious and widespread. Subjectively, the extent of visible mold contamination on surfaces in buildings has been taken into account in guidelines for cleanup procedures issued by government and professional organizations. Chapter 6 discusses those guidelines and their recommendations. In a study intended to seek insights into the type of moisture damage that could be critical as a risk indicator for adverse health effects, a random sample of residential buildings was inspected for signs of moisture damage (Haverinen et al., 2001a). Trained building inspectors estimated the size of observed damage in square meters, and a dose-dependent association with respiratory infections and lower respiratory symptoms was observed. A later study used multivariate Poisson regression models to examine respira- tory symptoms (Haverinen et al., 2003); the relative importance of a vari- able characterizing the size of moisture damage appeared to be high, and the authors concluded that the size of the damage is an important charac- teristic related to the severity of damage. It should be remembered, how- ever, that estimation of the size of damage is difficult and that estimation accuracy varies because damage is often hidden. Location Intuition suggests that the location of moisture damage or mold growth might be important in evaluating exposure because it will be related to the amount of pollutants that may come into contact with a person. However, few studies have examined it in any detail. Some have concentrated on the more frequently or densely occupied locations within a home, such as bedrooms and living rooms (Dharmage et al., 1999b; Reponen et al., 1989; Su et al., 1992; Verhoeff et al., 1994; Wickman et al., 1992). Ross et al.

DAMP BUILDINGS 51 (2000) examined the association between asthma symptoms and indoor bioaerosols in an area where severe flooding had taken place. The study focused on locations on the basis of how they potentially influenced the exposure: bedrooms (location in relation to exposed people) and basements (location in relation to pollutant source). Little between-room variability was observed. Of the 44 homes evaluated, 26 showed no difference in concentrations between rooms; only eight of the remaining 18 had signifi- cantly higher concentrations in one room than the home average. Duration The period of or duration of moisture damage might also be expected to be important, but little research has investigated it. “Ongoing dam- age”—defined as damage resulting from either recent wetting or a lack of change in moisture conditions within 6 months of construction—has been associated with higher concentrations of culturable fungi in building mate- rials than “dry damage”—past damage due to high moisture conditions where the materials had subsequently dried without remediation (Pasanen et al., 2000a). However, the time-frame of the damage has not been associ- ated with health effects in a straightforward manner (Haverinen et al., 2001a). The definition of duration of damage and examination of its possible influence on occupant health deserves more consideration. Well-designed studies could allow important data to be gathered on whether time-related characteristics of moisture-induced deterioration of materials influence the manifestation of health effects. The resulting information could be used to guide prevention or remediation strategies. RISK FACTORS FOR MOISTURE PROBLEMS Building Characteristics Indoor moisture is linked with some building characteristics. Reported dampness has been associated with age of the building, lack of central heating, humidifiers, and pets (Spengler et al., 1994; Tariq et al., 1996). Low temperatures and high RH indoors can result from cold climatic con- ditions or from such building characteristics as the lack of thermal insula- tion and heating. Evans et al. (2000) found a linear association between reported indoor dampness and low temperature and adult health. Older buildings tend to be colder (Hunt and Gidman, 1982) and therefore to have higher RH. Thus, the age of the building can indirectly be associated with both indoor temperature and dampness, all else equal. Martin et al. (1987) found a relationship between damp housing and overcrowding, but not

52 DAMP INDOOR SPACES AND HEALTH duration of occupancy, household income, use of gas heating, or occupant smoking behavior. Microbial growth has also been associated with building characteristics. In residences, measures of microbial contamination have been found to be positively correlated with indoor temperature and humidity, age and size of buildings, use of wood stoves and fireplaces, absence of mechanical ventila- tion, and presence of pets and old wall-to-wall carpeting (Dharmage et al., 1999b, Lawton et al., 1998). Garrett et al. (1998) found airborne fungal concentrations and signs of moisture damage (including musty odor, water intrusion, and high RH) to be associated with smaller amount of thermal insulation, cracks in cladding, and poor ventilation. A factor analysis found an association between airborne concentrations of soil fungi and a dirt-floor, crawl space type of basement in residences (Su et al., 1992). The same study measured increased concentrations of water-requiring fungi in the air of residences where water accumulation was observed. Lawton et al. (1998) developed a “calculated internal moisture source strength” metric that was associated with high biologic contamination and age of houses but not with RH or number of occupants. Verhoeff et al. (1994) found an association between number of fungal propagules in settled dust and type of flooring; no association with other characteristics—such as ventilation and heating facili- ties, building materials, insulation, and observed dampness—was identified. In another study, Verhoeff et al. (1992) found that indoor viable mold propagules were weakly correlated with several risk factors for moisture problems (age of building, moisture-retaining building materials, and the presence of a crawl space) and observed dampness (damp spots, mold growth, wood rot, silverfish or sowbugs, stale odor, and wet crawl space). Barriers to Prevention Information on controlling moisture in residences and larger buildings has been developed and published (Lstiburek, 2001, 2002a,b; Lstiburek and Carmody, 1996; Rose, 1997), but the high incidence of indoor damp- ness suggests that it is not consistently applied by those designing, con- structing, or maintaining buildings. A number of institutional barriers hinder good practice. One may be that building professionals do not have the knowledge needed to design and build structures to minimize moisture problems. Systematic surveys of cur- ricula are lacking, but generally there is minimal instruction in moisture- control principles for architects and structural engineers4 and a lack of 4It must be noted that the broad array of subject competencies required of architects and structural engineers may leave little time for such focused training. Design teams might thus need specialists in moisture dynamics and control.

DAMP BUILDINGS 53 formal training in moisture-protective building techniques and materials for the construction workforce. Indeed, increased interest in dampness is- sues has resulted in workshops, continuing education, and new design tools that are addressing this need (Karagiozis, 2001; ORNL/IBP, 2003). Additional barriers result from building-code requirements that inad- vertently or indirectly increase the risk of moisture problems. Most codes require passive or active ventilation of crawl spaces. That requirement makes it difficult to construct a crawl space that is included as part of the conditioned space or simply inside the thermal envelope (Advanced Energy, 2001). If rainwater and groundwater are kept out, sealed insulated crawl spaces are often drier than ventilated ones. The entry of warm, humid outdoor air into ventilated crawl spaces, which are often cooler than out- doors, serves as a moisture source for the crawl spaces. Some codes, such as the 2000 International Residential Code, contain exceptions that provide a path to constructing sealed insulated crawl spaces (ICBO, 2000). Sealing crawl spaces can reduce moisture problems there, but sealing can increase concentrations of radon in a crawl space and the associated house. Because radon exposure increases the risk of lung cancer, sealed crawl spaces may be inappropriate in locations where radon concentrations tend to be high. Building-code requirements for vapor retarders on the interior side of exterior walls and ceilings may also have an impact on building dampness. Adherence to some codes may result in condensation problems when air conditioning is used and—in combination with low-permeability exterior sheathings—reduce the drying potential of a wall section. When a building is air-conditioned, the vapor-pressure gradient is from the exterior toward the interior, where condensation on the back side of the intentional vapor retarder may occur. The situation is aggravated if the building’s cladding is composed of a material, such as brick or split-face block veneer, that ab- sorbs rainwater, because the vapor-pressure driving force is greatly in- creased when the sun raises the temperature of the veneer to that of liquid water. A similar situation occurs when the building interior is depressurized relative to the outdoors; depressurization causes warm air to be drawn through the building envelope, and it washes the backside of chilled sur- faces with humid air from which water may condense. Such circumstances point to the need for building codes and design and construction recom- mendations that take climate into account. Lstiburek and Pettit (2000, 2001, 2002a,b), for example, have produced a series of books that offer design and construction advice specific to various housing types and cli- matic conditions found in the United States, including advice on avoiding water intrusion and excessive indoor dampness. Finally, building codes—which guide new construction—may some- times also apply to renovations. The advocacy group Smart Growth in America asserted that in the late 1990s there were conditions in which

54 DAMP INDOOR SPACES AND HEALTH even a simple repair could trigger requirements to bring an entire building up to code in Maryland (Smart Growth in America, 1999). Such circum- stances could make upgrades uneconomical and limit the funds available for remediation. Chapter 7 addresses other barriers to preventing and remediating mois- ture problems. FROM MOISTURE TO MICROBIAL GROWTH Dampness and other excess moisture accumulation in buildings are closely connected to observations of mold, mildew, or other microbial growth. The behavior of moisture and air movements can be characterized with physical parameters, but the biological phenomena take place accord- ing to a complicated network of regulating factors. Several phenomena make up the microbial ecology of an indoor environment. Buildings as Microbial Habitats In principle, common saprophytic environmental microorganisms5 and their spores are present everywhere and they start to grow wherever their basic needs for growth are met. They differ enormously in their needs for environmental conditions and some fungi or bacteria always do well in practically any indoor microenvironmental conditions. As previously noted, one important factor is the availability of moisture. Many environmental microorganisms easily start growing on any surface that becomes wet or moistened. The minimal moisture need for microbial growth may be char- acterized in terms of the water activity of the substrate, aw, which is the ratio of the moisture content of the material in question to the moisture content of the same material when it is saturated. In a situation where the material is in equilibrium with surrounding air that has a RH of 100%, aw = 1. The lowest aw at which the most tolerant, so-called xerophilic fungi may grow is 0.7, which corresponds to an ERH of 70%. A few species— such as Penicillium brevicompactum, Eurotium spp., Wallemia sebi, and Aspergillus versicolor—may start growing in these conditions. At higher moisture levels, such intermediate species as Cladosporium sphaerosper- mum, C. cladosporioides, and Aspergillus flavus may germinate and start their mycelial growth. Most fungi and bacteria require nearly saturated conditions; that is, aw of at least 0.85–0.90 (Grant et al., 1989). Examples 5The term “environmental microorganism” is used here to distinguish the microorganisms that are usually found in indoor or outdoor spaces from those more typically found in hu- mans or other living hosts.

DAMP BUILDINGS 55 of such fungi are Mucor plumbeus, Alternaria alternata, Stachybotrys atra, Ulocladium consortiale, and yeasts (Flannigan and Miller, 2001). Determinants of Microbial Growth Indoors Along the life span of a building, weather changes and other events often cause at least temporary wetting of some of its parts. Signs of micro- bial growth can thus be detected on many parts of a structure. Airborne spores and cells also accumulate in the parts of the structure that are in contact with soil or outdoor air, especially parts that act as sites of infiltra- tion of intake air. Accumulated spores may or may not grow in these sites, depending primarily on moisture conditions. Because their growth is regulated by the available resources, condi- tions, and competing organisms, the development of a microbial commu- nity may be slow in slowly changing conditions or fast whenever there is a sudden increase in one or more of the limiting factors. Examples of such incidents are floods, firefighting, and acute water damage (Pasanen et al., 2000b; Pearce et al., 1995; Rautiala et al., 2002). The time it takes for fungi to grow on a particular material depends on the material’s characteristics, the fungal species, and the amount of mois- ture (Doll, 2002). Molds are also capable of producing large quantities of spores within a short time. Rautiala et al. (2002) reported massive fungal growth within a week after firefighting efforts. According to Pasanen et al. (1992a), a fungus can grow and sporulate within a day in moist conditions and within a week on occasionally wet indoor surfaces. Viitanen (1997) modeled the time factor in the development of fungi and found that at RH above 80% for several weeks or months, mold can grow in wood when the temperature is 40–120°F (5–50°C). At RH above 95%, mold can be seen within a few days. In wetted gypsum board inoculated with spores, fungal growth started within 1–2 weeks (Murtoniemi et al., 2001). Chang et al. (1995) reported a latent period of 3 days for fungal growth on ceiling tiles, during which the germination and mold growth could be arrested. Besides water, microorganisms need proper nutrients and temperatures to grow; some also need particular light conditions.6 Those circumstances are usually met in buildings. Even if modern building materials do not appear to be readily biodegradable, they may support microbial action. Microbial nutrients may be carbohydrates, proteins, lipids and other biologic molecules and complexes, or they may be nonbiologic compounds. Nutrients are provided by house dust and available moisture and by many surface and construction materials, such as wallpapers, textiles, wood, 6Light is needed for the growth of many fungi and bacteria but the lack of light does not prevent microbial action. Thus, in general, light is not a critical factor in building microbiology.

56 DAMP INDOOR SPACES AND HEALTH paints, and glues. Even nonbiodegradable material, such as ceramic tiles and concrete, may support microbial growth (Hyvärinen et al., 2002) by providing a surface for colonies. That explains why fungal colonies may be found on mineral fiber insulation—a material that would not seem hospi- table to microbial growth (Wålinder et al., 2001; Hyvärinen et al., 2002). Prevailing temperatures in living spaces and other sections of buildings are usually 32–130°F (0–55°C), that is, greater than freezing and less than the temperature at which the denaturalization of proteins would start. That range permits the growth of most environmental microorganisms even if the temperature is not optimal for a particular genus or species. Many environmental microorganisms are not especially strict in their temperature demands, in contrast with many pathogenic microorganisms that need the human body temperature to be able to grow. Time is another integral element in the assessment of microbial growth in buildings. Growth may be slowed by decreasing or increasing tempera- tures or other limiting factors, and the time window that must be consid- ered in building microbiology is weeks, months, or even years. It is known that microbial degradation normally consists of a chain of events, in which different groups of microorganisms follow each other (Grant et al., 1989), but present knowledge of building microbial ecology does not allow accu- rate estimation of the age of microbial damage on the basis of the particular fungal or bacterial flora observed. MICROORGANISMS OCCURRING IN INDOOR SPACES AND ON BUILDING MATERIALS Microorganism is a catch-all term that refers to any form of life of microscopic size. This section focuses on fungi and bacteria associated with damp indoor spaces. Other microorganisms that may be found in such environments—notably, house dust mites—are not addressed here, although their presence may have important effects on occupants; the health effects of exposure to them and to others more generally related to indoor environ- ments are covered in detail in the Institute of Medicine (IOM) reports Clearing the Air (IOM, 2000) and Indoor Allergens (IOM, 1993) which discuss asthma and general allergic responses, respectively. Larger organ- isms, such as cockroaches, also inhabit damp spaces and may be respon- sible for some of the health problems attributed to these spaces; they are also addressed in the IOM reports cited above. Fungi and Bacteria in Outdoor and Indoor Air The fungi have (eukaryotic) cells like animals and plants, but are a separate kingdom. Most consist of masses of filaments, live off of dead or

DAMP BUILDINGS 57 decaying organic matter, and reproduce by spores. Visible fungal colonies found indoors are commonly called mold or sometimes mildew. This re- port, following the convention of much of the literature on indoor envi- ronments, uses the terms fungus and mold interchangeably to refer to the microorganisms. Filamentous fungi, yeasts, and bacteria are common in outdoor soil and vegetation, and outdoor air is an important transport route to the indoor environment for spores and other particles of microbial origin. Spores are often monitored outdoors with direct microscopic counting in- stead of culturable methods; when so measured, total spore counts may often reach an order of magnitude of 104 spores/m3 (Mullins, 2001). Micro- organisms from outdoor air often enter indoor environments through open doors and windows and through ventilation intakes. Spores of common molds, bacteria, and other microbial particles are regularly found in indoor air and on surfaces and materials—no indoor space is free of microorganisms. They are continuously deposited and removed by various mechanisms, such as gravitational settling on surfaces, by exhaust ventilation,7 and by diffusion to vertical surfaces and cavities. Deposited spores are also removed or released by cleaning, vibration, filtration, acciden- tal ventilation, fan-powered outdoor air (which may pressurize the building and squeeze air out rather than exhaust it), and thermophoresis. Those mecha- nisms depend primarily on the size of the particle: the larger the particle, the faster the gravitational settling. Small microbial particles (<5 µm) may not settle on surfaces before they are removed by ventilation. After settling on surfaces, microbial particles integrate with other house dust, and they may be removed by cleaning. Part of the settled house dust is resuspended into the air as a result of occupants’ movements and other mechanical disturbance (Butt- ner and Stetzenbach, 1993; Thatcher and Layton, 1995). Common fungal genera found in outdoor air include Cladosporium, Aspergillus, Penicillium, Alternaria, and Saccharomyces (yeasts) (Mullins, 2001), but the overall diversity of outdoor fungi is great. The genus As- pergillus, for example, has over 185 known species, including Aspergillus fumigatus, A. versicolor, A. flavus, A. penicilloides, and A. niger. Among the other fungal genera observed in outdoor air are Acremonium, Aureo- basidium, Cunninghamella, Curvularia, Drechslera, Epicoccum, Fusarium, Geotrichum, Hyalodendron, Leptosphaeria, Neurospora, Paecilomyces, Rhinocladiella, Trichoderma, Tritirachium, and such basidiomycete genera as Coprinus and Ganoderma (Mullins, 2001; Shelton et al., 2002). The concentrations and diversity of outdoor-air fungi vary with the geographic area, climate, season, weather conditions, and individual 7Chapter 10 of Clearing the Air (IOM, 2000) provides greater detail on building ventila- tion and air cleaning and their effect on exposure to indoor pollutants.

58 DAMP INDOOR SPACES AND HEALTH sources, such as agricultural activities. In temperate climates, the concentra- tions are usually highest in summer and fall and lowest in winter and spring (Shelton et al., 2002). Variation is also reflected in the counts and myco- flora of the indoor environment. Indoor concentrations of fungi are usually lower than the corresponding outdoor concentrations, but they vary con- siderably with the same range as outdoor air: 100–104 cfu/m3 (Shelton et al., 2002). Thus, it is difficult to give any “typical” counts of airborne fungi that would apply to more than a specific, defined set of conditions. Fungal contamination of the indoor environment creates a source of spores, fungal fragments, and other products that may become airborne and cause changes in the microbial status of the environment outside the range of “normal” conditions. Measurements of airborne fungi are often used to detect such contamination. However, even an actively growing mold mycelium does not release spores continuously; release depends on many physiologic and environmental factors, and it is not possible to detect the presence of such a source solely from the fungal-spore content of the indoor air. Sampling methods also cause variation in the data collected on fungal concentrations and speciation. For airborne fungi, the characteristics of the sampling device—such as its cutoff size and collection efficiency—influence the recovery of fungal particles (Reponen et al., 2001). Fungal counts are obtained either by direct microscopic counting or by culturing the spores into colonies, which are then counted and identified according to their morphologic features. Direct counting usually allows a rough genus- or group-level identification, although some species can be identified by mi- croscopic examination of spore trap plates or tape lifts (such as Stachybotrys chartarum, Cladosporium sphaerospermum, C. cladosporioides, Alternaria alternata, and Aspergillus niger). Instead, the culturing results depend on the growth media and conditions selected. Ren et al. (1999a) noted that the type and concentrations of fungi measured in house-dust samples were not representative of those isolated in indoor air. No sampling and analytic technique will cover all the fungi and allow their equal detection and iden- tification. Therefore, reported profiles also depend on the sampling, count- ing, and culturing methods used (ACGIH, 1999). Chapter 3 discusses sam- pling methods in detail. Table 2-2 summarizes studies that have aimed at differentiating build- ings with and without moisture damage by fungal counts of the indoor air. As can be seen, there is no general pattern whereby a characteristic fungal concentration is associated with either moisture-damaged or nondamaged homes, and the variation in measured quantities is large in both cases. Some studies have shown that increased airborne concentrations of fungi are associated with moisture damage in a building, and others have failed to show any such pattern. Taken together, the studies indicate that the fungal

DAMP BUILDINGS 59 counts alone provide little information about the microbial status of an indoor environment.8 However, information about the species found is useful in assessing whether the microbial constituents of a given indoor environment differ from what are considered typical in those particular conditions. Indoor concentrations of fungi are usually lower than outdoor concen- trations, but the indoor concentrations follow the outdoor ones (Shelton et al., 2002). The large variation in and sometimes dominating effect of out- door-air fungal concentrations cause difficulties in interpreting measure- ments made in indoor environments. It is common to use the indoor:outdoor (I/O) concentration ratios to reflect the presence of indoor sources of micro- organisms. Because fungal spores circulating in indoor air deposit on sur- faces and are caught by air filtration, I/O ratios are typically less than 1.0. However, if there is a strong microbial source indoors, the ratio can exceed 1.0. In a compilation of data from indoor air quality investigations in the United States, Shelton et al. (2002) found I/O ratios of 0.1–200. However, the ratios in most cases were well under 1.0. Species-level identification of the fungi allows even more accurate assessment. Where the I/O ratio of an individual species is repeatedly over 1.0, it suggests the presence of an indoor source of the species. It should be remembered, though, that where the numbers of both indoor and outdoor spores are low, ratios may yield misleading values. Most fungi found indoors come from outdoor sources, but bacteria have outdoor and indoor sources. Occupants of a building are a major source of bacteria, although the large majority of bacteria shed by people are not considered harmful to other people (Burge et al., 1999). Bacteria of human origin include gram-positive cocci, such as micrococci and staphylo- cocci. Among typical outdoor-air bacteria are Bacillus, Corynebacterium, Flavobacterium, Micrococcus, Pseudomonas, Streptomyces, and other acti- nomycetes. Like that of fungal flora, the genus and species diversity of outdoor-air bacteria is large. Environmental bacteria also grow in all wet spaces and are found in most cases where there is mold growth (Hyvärinen et al., 2002), but the profile of bacterial genera and species growing on moist building materials differs from that originating from humans. Fungi and Bacteria on Building Materials Most fungi and bacteria that grow on moistened building materials can also be found in outdoor natural habitats and air. However, the rank order 8The “Sampling Strategy” section of Chapter 3 also addresses the use of fungal counts in the assessment of indoor microbial contamination.

60 DAMP INDOOR SPACES AND HEALTH TABLE 2-2 Summary of Studies of Airborne Fungal Concentrations in Residences in Relation to Building Dampness Characteristics Number and Study Type of Sites Study Design Methoda Gallup et al., 1987 127 Moisture problem 6-stage impactor residences Non-problem Hunter et al., 1988 62 Monitoring complaint 6-stage impactor residences home (MEA) Miller et al., 50 Characterize RCS (rose 1988 residences concentrations of bengal malt fungi and fungal extract); metabolites in winter Filter (rose bengal malt extract, MEA + sucrose) Waegemaekers 36 Damp (24) 6-stage impactor et al., 1989 residences Reference (8) (MEA) [Unspecified (4)] Strachan et al., 88 Homes of children 6-stage impactor 1990 residences with wheeze (34) (MEA) Controls (54) Reynolds et 6 residential Monitoring complaint 2-stage impactor al., 1990 and office buildings (Sabouraud environments dextrose agar) Nevalainen et 48 Mold-damaged (30) 6-stage impactor al., 1991 residences Reference (18) (Hagem) Pasanen et 46 Damp (25) 6-stage impactor al., 1992b residences Reference (21) (Hagem) Pasanen, 1992 57 Urban (21) 6-stage impactor residences Damp urban (22) (Hagem/MEA) Rural (13): 7 old + 6 new [Unspecified (1)] Verhoeff et al., 130 Relation of fungal 1-stage impactor 1992 residences concentrations to (DG18) dampness

DAMP BUILDINGS 61 Fungal Concentrations in Relation Levels of Airborne Fungib,c to Building Characteristics Problem: AM 5,950 cfu/m3 Concentrations higher in problem Nonproblem: AM 716 cfu/m3 homes Visible mold: <12–449,800 cfu/m3 High concentrations associated with No mold: <12–23,070 cfu/m3 visible mold growth, construction work, and activity RCS: AM 345 cfu/m3 No conclusion on effect of moisture (0–3,125) or dampness Filter: AM 111 cfu/m3 Damp: GM 192 cfu/m3 Fungal concentrations associated Reference: GM 102 cfu/m3 with dampness Visible mold: <41,300 cfu/m3 Median concentrations of viable (MD 200–294) fungi associated with visible mold No mold: <38,600 cfu/m3 (MD 21–283) Indoors: <18,900 cfu/m3 High indoor:outdoor ratio and flora Outdoors: <1,090 cfu/m3 indicated indoor-air sources Damaged: 10–2,300 cfu/m3 Mean concentrations of viable fungi (GM 102) lower in damaged than reference Reference: 165–850 cfu/m 3 residences, but higher mean (GM 308) indoor:outdoor ratio in damaged residences (4.2/0.6) indicates indoor sources Damp: <2,291 cfu/m3 (GM 80) Concentrations not higher in damp Reference: <1,445 cfu/m3 (GM 78) houses Urban: <1,445 cfu/m3 Concentrations not higher in damp (GM 78) houses; concentrations higher in old Damp: 2–1,198 cfu/m3 rural houses (GM 69) New rural: 25–1,916 cfu/m3 (GM 70) Old rural: 98–5,730 cfu/m3 (GM 1012) Indoors: 62–43,045 cfu/m3 Fungal concentrations correlated (GM 640–822) weakly with dampness (continued on next page)

62 DAMP INDOOR SPACES AND HEALTH TABLE 2-2 continued Number and Study Type of Sites Study Design Methoda Beguin and 130 Monitoring patient RCS (HS medium Nolard, 1994 residences homes with rose bengal) DeKoster and 41 Health-based home 6-stage impactor Thorne, 1995 residences categories: (MEA) Noncomplaint (27) Intervention (10) Complaint (4) Li and 15 Homes of allergic (13) Samplair Kendrick, 1995 residences Homes of nonallergic (2) MK1/MK2 Rautiala et al., 7 buildings Monitoring of effect of 6-stage impactor 1996 mold-damage repair (MEA) filter Dill and 20 Homes of children RCS Niggemann, residences with allergic diseases (MEA + Czapek 1996 Dox) Garrett et al., 80 Homes of 1-stage impactor 1998 residences Asthmatics (43) (MEA) Nonasthmatics (37) Rautiala et al., 3 buildings Reducing microbial Filter cultivation 1998 exposure during (MEA, DG18) demolition of moldy structures Dharmage et 485 Homes of 2-stage impactor al., 1999a residences Random sample (349) (PDA) Asthmatics (139) [note: ∑ = 488] Johanning et 2 residences Mold-damaged (1) 1-stage impactor al., 1999 Control (1) (MEA) Filter Klánová, 2000 Residences A) no complaints + RCS + aeroscope and offices no mold (20) (YMA) 68 rooms B) complaints + no mold (20) C) no complaints + visible mold (10) D) complaints + visible mold (18)

DAMP BUILDINGS 63 Fungal Concentrations in Relation Levels of Airborne Fungib,c to Building Characteristics 375–3,750 cfu/m3 No conclusion on effect of moisture or dampness Noncomplaint: GM <1,290 cfu/m3 Indoor:outdoor ratios higher in Intervention: GM <1,100 cfu/m3 complaint homes; concentrations Complaint: GM <6,700 cfu/m3 higher in basement than main floor Damp: 2,727 spores/m3 Concentrations higher in damp Nondamp: 2,051 spores/m3 residences Before repairs: Demolition of moldy structures GM 370 cfu/m3 (<1,150) increases concentrations GM 59,000 spores/m3 (<500,000) remarkably; concentrations on After repairs: baseline after 6 months GM 200 cfu/m3 (<300) Visible mold: 64 to over 4,000 cfu/m3 Airborne concentrations not No mold: <13–1,652 cfu/m3 correlated with visible fungal growth <20–54,749 cfu/m3 (MD 812) No association between mean concentrations and visible mold; increased concentrations of fungi associated with musty odor, moisture or humidity, poor ventilation, and failure to clean indoor mold growth Before repairs: 860–1,300 cfu/m3 Local exhaust method most During repairs: <8 × 105 effective for control; personal protection still needed 37–7,619 cfu/m3 (MD 549) Higher concentrations in residences with visible mold Damaged: 1,993 to >7,069 cfu/m3 Higher concentrations in residence 1.8–6.6 × 10 5 spores/m3 with visible mold Control: 194–336 cfu/m 3 3.7–4.7 × 103 spores/m3 A) 0–230 cfu/m3 (AM 78) Concentrations of viable fungi B) 0–140 cfu/m3 (AM 58) higher in rooms with visible mold C) 60–3,190 cfu/m3 (AM 1033) D)120–17,930 cfu/m 3 (AM 2476) (continued on next page)

64 DAMP INDOOR SPACES AND HEALTH TABLE 2-2 continued Number and Study Type of Sites Study Design Methoda Miller et al., 58 Relation of air RCS (rose 2000 residences sampling and damaged bengal malt materials extract) Pessi et al., 88 Fungal concentrations 6-stage impactor 2002 residences in relation to microbial (MEA) growth in external walls aMEA = malt extract agar; RCS = Reuter centrifugal sampler; YMA = yeast and mold agar; PDA = potato dextrose agar. bAM = arithmetic mean; GM = geometric mean; MD = median. of the most prevalent species in indoor growth sites is generally different from that of species normally found in outdoor air, and otherwise unusual species may prevail indoors. Table 2-3 lists examples of fungal genera that have been isolated from “moldy” building materials or surfaces. Most fungal genera have several species, many of which occur on moldy building mate- rials. Therefore, the species diversity is far more extensive than the genus diversity shown in the table. Some fungi are considered “typical” or “indicators” of mold growth on building materials because they are often isolated from mold samples. How- ever, the mere presence of a fungus at a low concentration does not neces- sarily indicate mold damage. Instead, the simultaneous presence of several otherwise unusual or indicator fungi at concentrations that exceed the TABLE 2-3 Examples of Fungal Genera Found in Infested Building Materials Acremonium Gliocladium Scopulariopsis Alternaria Humicola Sphaeropsidales Aspergillus Mucor Stachybotrys Aureobasidium Oidiodendron Torula Botrytis Paecilomyces Trichoderma Chaetomium Penicillium Tritirachium Cladosporium Phialophora Ulocladium Doratomyces Phoma Verticillium Eurotium Rhinocladiella Wallemia Fusarium Rhizopus Yeasts Geomyces Rhodotorula SOURCES: Flannigan and Miller, 2001; Gravesen et al., 1999; Hyvärinen et al., 2002.

DAMP BUILDINGS 65 Fungal Concentrations in Relation Levels of Airborne Fungib,c to Building Characteristics 15 residences with lowest visible The mean levels were not associated growth: AM 214 cfu/m3 with severity of damage. More 15 residences with highest visible species different from outdoor air in growth: AM 329 cfu/m3 homes with severe damage Low growth: 9–516 cfu/m 3 Microbial growth in insulated (AM 112) external wall did not affect indoor Growth: 2–1,784 cfu/m3 air levels. (AM 121) cConcentrations reported in these studies cannot be used as reference values because of methodologic limitations in measurement techniques. Chapter 3 addresses this topic in greater detail. SOURCE: Excerpted and adapted from Hyvärinen, 2002. background concentrations in outdoor air or other reference samples can be regarded as an indication of indoor mold colonization. Although there is no general international consensus on which species should be regarded as indicators of the presence of mold, several fungi are often isolated from moldy areas. Table 2-4 shows examples of such fungi. Mold growth on materials is usually accompanied by bacterial growth (Hyvärinen et al., 2002). Such bacteria have been studied much less than fungi, but they are a part of the phenomenon of dampness and microbial growth on materials and therefore among the agents occupants may be exposed to, so they deserve attention. Bacteria that have been identified in samples of moldy-building materials are shown in Table 2-5. Components of Microbial Agents Some studies of fungi and bacteria examine specific microbial compo- nents found in damp indoor environments. Among the components charac- terized so far are spores and hyphal fragments of fungi, spores and cells of bacteria, allergens of microbial origin, structural components of fungal and TABLE 2-4 Examples of Fungi and Other Microorganisms Often Associated with Dampness or Mold Growth in Buildings Aspergillus fumigatus Phialophora spp. Wallemia spp. Aspergillus versicolor Stachybotrys chartarum Actinomycetes Aspergillus penicilloides Trichoderma spp. Gram-negative bacteria Exophiala spp. Ulocladium spp. SOURCES: Gravesen et al., 1994; Jarvis and Morey, 2001; Samson et al., 1994.

66 DAMP INDOOR SPACES AND HEALTH TABLE 2-5 Bacterial Genera Isolated from Moldy Building Materials Acinetobacter Dietzia Rhodococcus Agrobacterium Flavobacterium Spirillospora Arthrobacter Gordonia Streptomyces Bacillus Methylobacterium Streptosporangia Brevibacterium Microbacterium Thermomonospora Cellulomonas Mycobacterium Clavibacter Nocardia Corynebacterium Nocardiopsis SOURCES: Andersson et al., 1997; Peltola et al., 2001a,b. bacterial cells (such as β(1→3)-glucans of fungi, endotoxins produced by gram-negative bacteria, and peptidoglycans of bacteria), and such products as microbial volatile organic compounds (MVOCs) and toxic products of microbial secondary metabolism. Information on those agents is briefly summarized below. Chapter 3 discuss exposures to these agents in more detail. Spores and Fragments of Fungi Fungi produce and release spores that are cells with well-developed resistance to environmental stresses, such as desiccation and UV radiation. They are the essential means of distribution of filamentous fungi. The particle size of most fungal spores is roughly 2–10 µm, so they are easily transported by winds and air currents, and they may enter the respiratory system (Reponen et al., 2001). Fungal types vary remarkably in their capac- ity to produce and release spores. Penicillium and Aspergillus typically produce large numbers of spores that are easily released into the air. Stachybotrys and Chaetomium are examples of fungi that produce fewer spores and release them only occasionally. Penicillium and Aspergillus spores are regularly found in air samples, and Stachybotrys and Chaetom- ium spores are rarely found in the air, even in environments where they are growing (Andersen and Nissen, 2000). Fungi also release smaller particles (<1 µm) from the mycelium, as experimentally shown by Górny et al. (2002). The microbial origin of the small fragments was verified with antigen characterization. In the experi- mental study, the smaller particles were released in greater numbers than whole spores, but the concentrations of the small fragments in indoor environments have not yet been characterized. Their small size makes them capable of penetrating deeply into the alveolar region. However, their spe- cific role—if any—in adverse health outcomes has not been studied.

DAMP BUILDINGS 67 Spores and Cells of Bacteria Like fungi, spore-forming bacteria release spores from the growth site into the air. Among spore-forming bacteria are Bacillus spp. and actino- mycetes, such as Streptomyces. Bacterial spores are smaller than those of fungi—about 1 µm—but bacterial growth may release fragments smaller than the spores (Górny et al., 2003). Non-spore-forming bacteria may also enter the air as a result of various processes, but these bacteria have no specific mechanism that causes them to become aerosolized. As mentioned above, humans shed bacteria from their skin and respiratory system. Waterborne gram-negative bacteria may enter the air via aerosolization or other mechanical disturbances of stand- ing water. Gram-negative bacteria are also common in house dust, soil, and plants, and they are probably carried indoors on pets and dust. Allergens of Microbial Origin Fungi produce an enormous array of potentially allergenic compounds; each fungus produces many allergens of different potencies. Table 2-6 lists the major defined allergens isolated from fungi. Others have been identified but are clinically “minor” (few patients react to them); still others remain to be identified. Fungal allergen production varies with the isolate (strain), TABLE 2-6 Major Defined Allergens Isolated from Fungi Major Fungus Allergen Nature of Allergen(s) Reference Aspergillus fumigatus Asp f 1 18 kD; mitogillin Arruda et al., 1990 Asp f 3 Peroxisomal membrane Crameri, 1998 protein Aspergillus oryzae Alkaline serine protease Shen et al., 1998 Alternaria alternata Alt a 1 Yunginger et al., 1980 Alt a 2 Sanchez and Bush, 1994 Cladosporium Cla h 1 13-kD glycoprotein Aukrust and Borch, herbarum 1979 Penicillium chrysogenum 68-kD protein Shen et al., 1995 Penicillium citrinum 33-kD protein Shen et al., 1997 Psilocybe cubensis Psi c 2 23-kD protein; Horner et al., 1995 cyclophilin Malassezia furfur Mal f 1 36-kD protein Schmidt et al., 1997 Trichophyton tonsurans Tri t 1 30-kD protein Deuell et al., 1991 SOURCE: IOM, 2000.

68 DAMP INDOOR SPACES AND HEALTH species, and genus (Burge et al., 1989). Different allergen amounts and profiles are contained in spores, mycelium, and culture medium (Cruz et al., 1997; Fadel et al., 1992). In addition, the substrate strongly influences the amount and patterns of allergen production. Fungi, for example, release proteases during germination and growth, and fungal extracts contain suf- ficient protease to denature other allergens in mixtures. Microbial allergens are addressed in detail in the IOM reports Clearing the Air (IOM, 2000) and Indoor Allergens (IOM, 1993), which should be consulted for additional information. Structural Components of Fungi and Bacteria Some components of microbial cells have been investigated for their possible role in human health effects. Three have attracted particular atten- tion from researchers. Fungal cell walls are composed of acetylglucosamine polymer fibrils embedded in a matrix of glucose polymers formally referred to as β(1→3)- glucans. Potent T-cell adjuvants, the β(1→3)-glucans have been investi- gated as antitumor agents (Kiho et al., 1991; Kitamura et al., 1994; Kraus and Franz, 1991). They increase resistance to gram-negative bacterial infec- tion by stimulating macrophages and effecting the release of tumor-necrosis factor α mediated by endotoxin (Adachi et al., 1994a,b; Brattgjerd et al., 1994; Saito et al., 1992; Sakurai et al., 1994; Zhang and Petty, 1994). Soluble glucans have an effect in the lung similar to that of endotoxin (Fo- gelmark et al., 1994). Endotoxins—biologically active lipopolysaccharides—are components of some bacterial cell walls that are released when the bacteria die or the cell walls are damaged. They are responsible for some characteristic toxic effects of gram-negative bacteria. Endotoxin exposure has been associated with occupational lung disease among workers exposed at high levels (Douwes and Heederik, 1997; Milton, 1999). Rylander’s literature review (2002) notes that studies report both adverse and beneficial effects from low-level exposure to endotoxins, and suggests further research to clarify the role of other agents found in connection with them—β(1→3)-glucans in particular—in health outcomes attributed to endotoxin exposure. Peptidoglycans are the chemical substances that make up the rigid cell walls of eubacteria (bacteria with rigid cell walls, also called true bacteria). They are a major component of the cell walls of gram-positive bacteria and, like endotoxins, may be released into the environment when the cells die or are damaged. One study of classrooms in two elementary schools noted that high concentrations of a biomarker of the presence of peptidoglycans were associated with a teacher’s perception of the severity of indoor-air

DAMP BUILDINGS 69 quality problems (Liu et al., 2000). Their possible role in adverse health outcomes related to damp indoor environments is otherwise unexplored. Microbial Volatile Organic Compounds MVOCs are small-molecule, volatile substances that are typically re- leased by growing fungi and bacteria as end products of their metabolism. They are often odorous, causing the typical smell of “mold,” “cellar,” or organic soil. Chemically, they are usually alcohols, aldehydes, ketones, esters, lactones, hydrocarbons, terpenes, and sulfur and nitrogen compounds (Korpi, 2001). However, most of them have sources in addition to micro- bial growth, so their occurrence is not specific for damp indoor environ- ments with microbial growth. Among the several substances generally considered MVOCs are 3-methylfuran, 3-methyl-1-butanol, 1-octen-3-ol, 2-methylisoborneol, and geosmin (Smedje et al., 1996). Although the odor of mold has often been associated with respiratory symptoms in damp buildings, the specific role of individual MVOCs or their mixtures in adverse health outcomes has not been studied. Toxic Products of Microbial Secondary Metabolism 9 Many fungi and bacteria are able to produce compounds called second- ary metabolites. The compounds are not produced in all growth conditions but are often produced in cases of nutrient starvation, in the presence of other environmental stressors, or in the presence of competing organisms. Many secondary metabolites are toxic or otherwise biologically active. Commonly known microbial secondary metabolites are mycotoxins, bacte- rial toxins, antibiotics, and antimicrobial agents (Demain, 1999). Microbial toxins are not volatile, but they may be carried by spores (Sorenson et al., 1987). Numerous studies have examined the fungi and bacteria that may pro- duce toxins while growing on building materials (Andersson et al., 1997; Nielsen et al., 1998; Nikulin et al., 1994; Pitt et al., 2000; Tuomi et al., 2000). The same bacterial strain has been shown to express different de- grees of toxicity and inflammatory potential while growing on different building materials (Roponen et al., 2001); this supports the view that the substrate is important in the regulation of secondary metabolism. Production of secondary metabolites, including microbial toxins, may 9Chapter 4 addresses the toxic potential of fungi and bacteria found in damp indoor environments in greater detail.

70 DAMP INDOOR SPACES AND HEALTH vary within a single toxigenic strain (Jarvis and Hinckley, 1999; Larsen et al., 2001; Vesper and Vesper, 2002; Vesper et al., 2001). Variable produc- tion of toxins while microorganisms are growing on building materials has been shown experimentally (Murtoniemi et al., 2002, 2003a,b; Ren et al., 1999b). The identity of a mold species thus is insufficient information on which to predict its toxic potential. Mycotoxin production depends on a number of factors, including the availability of nutrients and water activity of the substrate on which the mold grows, temperature (Gqaleni et al., 1997), the sporulation cycle of the organisms (Larsen and Frisvad, 1994), and the presence of other organisms that are in competition for the moisture, nutrients, and other aspects of the growth environment (Wicklow and Shotwell, 1983). The presence of com- peting organisms appears to be important, and toxins seem to be produced to inhibit the growth of or kill competitors (Wicklow and Shotwell, 1983). Smith and Moss (1986) found that some molds stop making toxins after a few generations when grown in isolation; if generally true, this suggests that testing to determine whether a microorganism might have produced my- cotoxins is best conducted in the early stages of growth after isolation from their environment. The time in the organism’s life cycle also appears to influence toxin production. Aspergillus and Penicillium species are known to produce po- tent toxins with sporulation (Larson and Frisvad, 1994). The large energy demands of sporulation require an available supply of nutrients and precur- sors for structural molecules, such as proteins, nucleic acids, and lipids. Germination of spores likewise requires a large amount of energy. Reduc- ing competition for nutrients, water, oxygen, or other resources by inhibit- ing the growth of other occupiers of the mold’s ecologic niche gives a toxigenic mold a competitive edge toward survival of its offspring (Wicklow and Shotwell, 1983). One potentially toxigenic fungus found in water-damaged buildings is Stachybotrys chartarum, formerly referred to as Stachybotrys atra or Stachybotrys alternans. It is a cellulose-degrading fungus that grows well on wetted paper, gypsum board, and the paper liner and gypsum core of plasterboard (Hyvärinen et al., 2002; Murtoniemi et al., 2002; Nielsen et al., 1998). Stachybotrys may also occur on other types of materials, al- though less frequently (Hyvärinen et al., 2002). The cellulolytic properties of the fungus explain its occurrence on the wetted paper liner of plaster- board, but it is not fully understood why the gypsum core alone also supports the growth of Stachybotrys and its toxin production, as assessed by the in vitro cytotoxicity of the spores (Murtoniemi et al., 2002). A study did find a decrease in S. chartarum growth and sporulation (compared with a reference board) when desulfurization gypsum was used in the core and

DAMP BUILDINGS 71 when the liner was treated with biocide or starch was removed from the plasterboard (Murtoniemi et al., 2003b). The same study found that treat- ing plasterboard liner with biocide did not decrease growth and sporulation but did increase the cytotoxicity of the spores produced.10 Other possibly toxigenic fungi found in buildings or building materials include Aspergillus versicolor, A. fumigatus, A. flavus, and some species of Penicillium, Trichoderma, Fusarium, and Chaetomium (Gravesen et al., 1994). Their toxins have been isolated in mold-infested building materials (Nielsen et al., 1999; Tuomi et al., 2000) and in house dust or carpet dust of damp houses (Engelhart et al., 2002; Richard et al., 1999). However, toxin-producing fungal species produce toxins of varied potency (Abbas et al., 2002; Jarvis, 2002; Nielsen et al., 2002). Some bacteria found in damp indoor environments are also capable of producing toxins. Among the bacterial types that are potentially toxic while growing on building materials are species of Streptomyces, Bacillus, and Nocardiopsis (Andersson et al., 1998; Jussila et al., 2001; Peltola et al., 2001a,b). Although mycotoxins or bacterial toxins have often been shown to occur in mold-infested materials, as well as house dust in damp buildings, they have seldom been isolated directly from the air. Spores and fragments of toxigenic fungi may carry these toxins (Sorenson et al., 1987), and this speaks for possible airborne exposure, but little information is available on the degree to which the occupants might be exposed to them. That is partly because of methodologic problems of exposure assessment in general (see Chapter 3). Chapter 4 addresses toxins produced by microbial agents in greater detail. Gaps in Building Microbiology Science The great variations in environmental mycoflora in indoor spaces and the large number of variables that affect their occurrence and measurement are among the factors that make it difficult to set quantitative or qualitative guidelines or standards for the microbial quality of indoor air. However, there is evidence of clear differences in harmful potential between different microbes (Huttunen et al., 2003) and more such research would elucidate connections between agents and effects. Chapters 4 and 5 address those con- cepts in greater detail. 10When Murtoniemi et al. (2003c) examined growth of the bacteria Streptomyces califor- nicus on various plasterboards, they found that removal of starch from the liner and core inhibited growth and sporulation almost completely; spore cytotoxicity was not affected by the presence of a biocide.

72 DAMP INDOOR SPACES AND HEALTH Building Materials and Microbial Growth High moisture content is commonly observed in building materials (Haverinen et al., 2001b). That is not necessarily abnormal, nor does it necessarily mean that there will be microbial exposure. Care must be exer- cised in the interpretation of indications of high moisture content. Some signs of moisture may indicate old damage, already dried out, that may or may not still be a possible source of exposure. The signs may also indicate problems below the surface or periodic problems. Visible mold, although not a precise measure of exposure, is probably the clearest risk indicator for potential exposure. Building materials differ in the degree to which their constituents sup- port microbial growth. Below are brief descriptions of the characteristics of some common materials that influence microbial growth. Wood has a cellular structure, the cell walls being made up of two natural polymers, cellulose and lignin. Water in wood is present as free water in cell cavities and in combination with cellulose in the cell walls. Wood is hygroscopic and always tends to achieve a moisture content in balance with its environment (Oliver, 1997). Wood is also used in various composite products, which traditionally are poor at resisting moisture unless they are bound together with waterproof products, such as glues. The variability in the properties of those products is high; factors that affect their susceptibility to moisture include environmental conditions, component properties, manufacturing processes, preservative treatments, and chemical modification of raw materials (Wang, 1992). Many fungi use cellulose as a source of nutrients. However, they vary in their ability to degrade cell walls of wood. Fungal growth on wooden material depends on species, surface characteristics of the material, air humidity, and temperature (Viitanen, 1994, 2002). Pasanen et al. (2000b) studied microbial growth in wood-based materials collected from build- ings with moisture problems and found high median concentrations of viable fungi in all wood-based materials regardless of whether the damage was considered current or complete. Tuomi et al. (2000) analyzed the occurrence of mycotoxins in moisture-damaged material samples and found them in most of the material categories tested, but 82% of the mycotoxin-positive samples contained cellulose matter, such as paper, board, wood, or paper-covered gypsum board. Chang et al. (1995) evaluated growth of fungi on cellulose ceiling tiles and found that although dust deposited on old used tiles provided valuable nutrients, even new ceiling tiles could support growth when ERH was above 85%; fungal growth could be limited only if the wetted tiles were dried quickly and thoroughly. Doll (2002) did not observe growth on ceil- ing tile kept for 8 weeks in an environmental chamber at 85% RH and 72°F (22°C), but did see growth after 3–6 weeks at 95% RH. The samples

DAMP BUILDINGS 73 were not inoculated with fungi in the laboratory—contamination was from natural sources. Insulation materials include a wide array of wood-based, mineral, and organic materials. The wood-based materials are more hygroscopic than the mineral or organic materials; that is, their moisture content is much higher at a given ERH. Therefore, the moisture behavior may vary substan- tially among the materials (Nevander and Elmarsson, 1994). Pasanen et al. (2000a) studied the occurrence of microbial growth in insulation-material samples, including glass wool, polystyrene foam, and granulated cork. They observed a correlation between total spores and fungal concentration and the RH of the materials but usually not the %-MC of the materials. Ezeonu et al. (1994) observed no fungal colonization in fiberglass insulation below 50% RH and delayed colonization below 90% RH. Compared with wood-based materials, masonry and cementitious ma- terials are low in nutrients and biologically inert. That does not necessarily mean that they are immune to problems. Clay brick, for example, is a fast- wetting material because of its powerful capillary suction, and cementitious materials are hygroscopic and slow in drying. Therefore, if wetted, those materials may support microbiologic and chemical deterioration through their interaction with other materials (Oliver, 1997). Pasanen et al. (2000b) showed that the culturable fungal concentrations correlated with %-MC but not with the RH of the material in concrete, cement, mortar, and plaster-based finishing coating. Stone or mineral-based materials are com- monly used for interior finishing in facilities with high moisture loads. Those materials are resistant to microbial growth and are not biodegrad- able. However, nutrients from water and air can accumulate on them and support microbial growth. Polyvinyl chloride (PVC) materials are among the most frequently used wall and floor finishing materials because they provide inexpensive, easy- to-clean surfaces. They typically resist microbial growth, but (as discussed below) they may degrade in the presence of moisture. Paint, varnish, and similar materials are often used to protect other materials from water absorption, as well as for aesthetic reasons. Different types of paints differ in their water permeability and capacity to tolerate moisture (Oxley and Gobert, 1994). Peeling or blistering of a painted sur- face is often a sign of excess moisture in the structure underneath. DAMPNESS-RELATED PROBLEMS NOT ASSOCIATED WITH BIOLOGIC SOURCES Apart from mold, bacteria, and mite-related contaminants, moisture sometimes contributes to the release of nonmicrobial chemicals into the indoor air. It has been known for many years that the rate of release of

74 DAMP INDOOR SPACES AND HEALTH formaldehyde from composite building materials that contain urea-formal- dehyde resins, such as particle board, increases with the humidity of the surrounding air (van Netten et al., 1989). The emission of formaldehyde occurs, in part, as a consequence of hydrolysis of the resin. In chamber studies, Andersen et al. (1975) found that increasing the RH from 30% to 70% doubled the rate of formaldehyde emission from particle board. There have been numerous anecdotal reports of indoor odor and irrita- tion complaints associated with moist building materials, particularly plas- tic materials on moist alkaline substrates, such as concrete. The phenom- enon has also been investigated in a few scientific studies. Offermann et al. (2000) reported increased emission rates of potentially odorous and irritat- ing alcohols from the PVC backing of carpet tiles placed on a concrete slab that had a high water content. Lorenz et al. (2000) reviewed four case studies of health symptoms thought to be caused by chemicals that were emitted when high moisture content was combined with building materials that contained plasticizers. When materials were moistened and heated, they measured high emission rates of alcohols, phthalic anhydride, and other compounds thought to be irritating. In a study of four geriatric hospi- tals, dampness-related and moisture-related degradation of a plasticizer in PVC flooring was strongly associated with asthma symptoms (OR, 8.6; CI, 1.3–57) (Norbäck et al., 2000). In the same study, the dampness and degra- dation of the plasticizer were less strongly but still statistically significantly associated with increases in ocular symptoms, nasal symptoms, and lyso- zyme in nasal lavage (an indicator of inflammation) and with a decrease in tear-film stability (Wieslander et al., 1999). The degradation of the plasti- cizer was indicated by increased indoor airborne concentrations of 2-ethyl- 1-hexanol. Wålinder et al. (2001) also reported a higher concentration of 2- ethyl-1-hexanol in the air of a water-damaged office building with PVC flooring, relative to a control office building in the same complex. More recently, Sjoberg and Nilsson (2002) offered a theoretical analy- sis of how heating systems embedded in concrete slabs can exacerbate emissions from alkaline hydrolysis of floor coverings. Two problematic scenarios were identified. In the first, the heating system drives construction moisture out of the concrete slab to moisten the floor covering. In the second, moisture from the soil is driven through the concrete slab because of the temperature gradient that occurs when the heating system is turned off, for example, in the summer after an extended period of heating that has warmed the soil beneath the slab. It can be concluded only that dampness-related emissions of chemicals have been confirmed and linked in a few studies with health symptoms and odor complaints. The available data are too sparse to support conclusions about health implications of dampness-related emissions of chemicals from materials.

DAMP BUILDINGS 75 SUMMARY Moisture and microbial growth are present in all buildings, and there is no widely accepted definition of the conditions that constitute a “dampness problem.” Moisture-damage observations may include visual observations of dampness or microbial growth, readings of moisture measurements, and other signs that can be associated with excess moisture in building con- struction. The reported prevalence of signs of dampness in buildings varies widely. In most datasets, at least 20% of buildings have signs of a dampness problem. The available dampness data are primarily from studies of homes; however, some data suggest that dampness in workplaces, schools, and HVAC systems should not be ignored. The extent, location, and duration of building dampness are important for an understanding of its role in health problems, but there has not been much research to evaluate their influence. Water problems in buildings originate in rainwater, groundwater, plumb- ing, construction, water use by occupants, and condensation of water vapor. Moisture problems begin when materials stay wet long enough for microbial growth, physical deterioration, or chemical reactions to occur. The important variables are the rate of wetting and the rate of drying. A complex set of moisture-transport and air-transport processes related to building design, construction, operation, and maintenance and to climate determine whether a building will have a moisture problem. Below-grade spaces are particularly prone to moisture problems (Lstiburek, 2002a). Dampness has been associated with an array of building characteristics, including age of the building, lack of central heating, humidifiers, presence of pets, low temperatures, and crowding. During the life span of a building, weather changes and other events cause at least temporary wetting of some of its parts; signs of microbial growth can thus be detected on many parts of a structure. Microbial growth is regulated by the available resources, condi- tions, and competing organisms. Indoor microbial concentrations are also influenced by indoor temperature and humidity, building materials, type of foundation, and HVAC system characteristics. Environmental microorganisms are diverse. They differ enormously in their needs for particular environmental conditions, so there will almost always be some fungi or bacteria that do well in any microenvironmental conditions. In buildings, the general microbial needs of temperature, nutri- ents, oxygen, and light are usually met; therefore, the availability of mois- ture is the primary limiting factor in microbial growth. The materials used in the building determine both the amount of moisture needed to support growth and the type of microorganisms whose growth will be favored. Moisture may also trigger degradation of building materials and so contrib- ute to the release of nonmicrobial chemicals into the indoor air.

76 DAMP INDOOR SPACES AND HEALTH Research on the biologic and human health effects of microbial and other agents associated with damp indoor environments is discussed in the following chapters. It should be noted that there is very little docu- mentation of interactions of these various agents. While it is evident that various pollutants occur simultaneously in these environments, an overall risk assessment of the combined exposures is not possible with the present knowledge. FINDINGS, RECOMMENDATIONS, AND RESEARCH NEEDS On the basis of the review of the papers, reports, and other information presented in this chapter, the committee has reached the following findings and recommendations and identified the following research needs regard- ing damp buildings. The committee’s discussion of the public health re- sponse to damp indoor spaces (Chapter 7) provides additional observations on how some of the recommendations for actions might be accomplished. Findings • The term dampness has been used to define a variety of moisture problems in buildings, including high RH, condensation, and signs of ex- cess moisture or microbial growth. However, there is no generally accepted definition of dampness or of what constitutes a “dampness problem” and no generally accepted metric for characterizing dampness. • Dampness—as defined and documented in studies using a wide vari- ety of metrics—is prevalent in residential housing in a wide array of cli- mates. The prevalence and significance of dampness are less well under- stood in nonresidential buildings like office buildings and schools than in residential buildings. Relatively little information is available on the preva- lence and importance of dampness and microbial growth in HVAC systems. • Environmental microorganisms require moisture and nutrients to grow. The range of temperatures in buildings permits the growth of many microorganisms even if it is not optimal for a particular genus or species. • Dampness increases the risk of microbial contamination and can cause or exacerbate the release of chemical emissions from building materi- als and furnishings. • Dampness problems in buildings result from failures in design, con- struction, operation, maintenance, and use. The prevalence and nature of dampness problems suggest that what is known about their causes and prevention is not consistently applied in building design, construction, main- tenance, and use. • The prevalence of dampness problems appears to increase as build- ings age and deteriorate, but some modern construction techniques and

DAMP BUILDINGS 77 materials and the presence of air-conditioning probably increase the risk of dampness problems. Scientific studies have not, in general, provided data to confirm or refute this idea. • Changes in building design, operation, maintenance, and use are the key to preventing the manifestation of dampness-related building damage and microbial growth. Recommendations • Precise, agreed-on definitions of dampness should be developed to allow important information to be gathered about mechanisms by which dampness and dampness-related effects and exposures affect occupant health. More than one definition may be required to meet the specific needs of health researchers (epidemiologists, physicians, and public health practi- tioners) in contrast with those involved in preventing or remediating damp- ness (architects, engineers, and builders). However, definitions should be standardized to the extent possible. Any efforts to establish common defini- tions should be international in scope. • Increased attention should be paid to HVAC systems as a potential site for the growth and dispersal of microbial contaminants that may result in adverse health effects in building occupants. • Building professionals (architects, home builders, facility managers and maintenance staff, code officials, and insurers) should receive better training in how and why dampness problems occur and their prevention. • Current building codes should be reviewed and modified as neces- sary to reduce dampness problems. Research Needs As noted above, standardized dampness metrics and associated dampness-assessment protocols should be developed to characterize the nature, severity, and spatial extent of dampness. Using the standardized metrics, the determinants of dampness problems in buildings should be studied to ascertain where to focus intervention efforts and health-effects research. In addition, the committee identified the following research needs: • Economic research is needed to determine the societal cost of damp- ness problems and to quantify the economic impact of design, construction, and maintenance practices that prevent or limit dampness problems. • New and continuing research is needed to better characterize — The presence and health effects of bacteria that grow on damp materials indoors.

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Almost all homes, apartments, and commercial buildings will experience leaks, flooding, or other forms of excessive indoor dampness at some point. Not only is excessive dampness a health problem by itself, it also contributes to several other potentially problematic types of situations. Molds and other microbial agents favor damp indoor environments, and excess moisture may initiate the release of chemical emissions from damaged building materials and furnishings. This new book from the Institute of Medicine examines the health impact of exposures resulting from damp indoor environments and offers recommendations for public health interventions.

Damp Indoor Spaces and Health covers a broad range of topics. The book not only examines the relationship between damp or moldy indoor environments and adverse health outcomes but also discusses how and where buildings get wet, how dampness influences microbial growth and chemical emissions, ways to prevent and remediate dampness, and elements of a public health response to the issues. A comprehensive literature review finds sufficient evidence of an association between damp indoor environments and some upper respiratory tract symptoms, coughing, wheezing, and asthma symptoms in sensitized persons. This important book will be of interest to a wide-ranging audience of science, health, engineering, and building professionals, government officials, and members of the public.

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