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Investigation, remedies and prevention
For six years in the 1980s, members of the Civil and Public Servants' Association (CPSA) at the job centre in Milton Keynes suffered from working in a sick building. The job centre occupies two floors of a glittering mirror-glass building designed by the Development Corporation.
Soon after the sealed, air-conditioned building opened in 1980, staff began to complain about heating, lighting and ventilation. They suffered from the typical symptoms of sick building syndrome - itching eyes, chest problems, coughs, colds and sinusitis, and a general lethargy in the afternoons. A distinctive symptom was the 'three o'clock flush' - a reddening of the face experienced by many of the workers.
After four years of complaining, with no action by management, a union meeting held in March 1984 made demands for something to be done. Two years later, and after much struggle by union members, #10,000 had been spent on piecemeal repair-work to the air-conditioning system and on other alterations, but there was no improvement in workers' health. The CPSA members finally managed to persuade their management to commission a survey by a competent and independent heating and ventilation engineer. His main findings (in July 1986) were:
Management had no option but to accept in full the recommendations made in the report, which included complete replacement of the ceiling to allow air circulation and sealing in of the fibreglass insulation. Once this work had been carried out, conditions improved and the sickness level dropped dramatically. The final cost was estimated at #30,000.
These workers were organised but, despite walking out when conditions became intolerable and having to threaten industrial action to get things done, they were not taken seriously. Most importantly the management continuously refused an independent assessment of the situation which could have highlighted the problems at the outset. Such dragging of the feet is typical in cases of sick building syndrome, and a piecemeal approach to the problem without a proper diagnosis can mean that money is spent uselessly and that people's health continues to suffer needlessly.
A systematic approach for trade unionists
As the previous chapters have shown, the main factors contributing to symptoms of building sickness are:
A systematic approach is needed to determine which of these factors, or combination of factors, is likely to be responsible in a particular building. As the above example shows, it is easy to throw money at a building without improving things at all. Therefore, the following steps, which are discussed in more detail below, might be taken by trade unionists trying to solve sick building syndrome:
You may choose to set up a union working party to ensure that things get done as quickly as possible, involving ordinary members as well as committee members.
Case study: Ealing Council
In the summer of 1987, Ealing Council in West London moved 1,000 employees into the Great Western Centre, a prestige office development which promised a 'new era' of luxury for local authority workers. Within weeks, staff began to complain of headache, sore eyes, sore throats and stomach upsets.
It took several months of trade union pressure before the management commissioned London Scientific Services (an ex-GLC body) to conduct a survey of environmental conditions and a staff questionnaire. The survey was inconclusive but did find the bacterium responsible for legionnaires' disease in the air-conditioning system. Internal documents - describing pools of stagnant water in the ductwork and plant-room - pressed for cleaning and improved maintenance of the system. But these were ignored.
By 1989, two years later, the staff had had enough. Mass meetings were organised by the trades unions, and union members walked out when it was revealed that there were major defects in the building that breached fire regulations as well as hygiene standards.
The final straw came when the majority of staff in the switchboard room were struck down by severe allergic reactions, landing some in hospital. The cause turned out to be a breach in the internal ductings of the building that allowed a direct connection between a leaking sewage pipe, a laboratory where hazardous chemicals were used, a service duct contaminated with fungal growth and the room occupied by the switchboard staff.
Trade union reps demanded an immediate repair of these defects and an undertaking from management that the environmental problems would be investigated properly and immediately. These demands were met and a joint union-management committee was set up to monitor the progress of the investigations and repairs. Consultants were commissioned to design an effective maintenance programme.
Obtain information on sick building syndrome
You should obtain as much information as possible, particularly examples of other cases of sick building syndrome that your union has had to deal with. Talk to as many members as possible to elicit their opinions on the working conditions, symptoms and possible causes.
Provide members with information
Disseminate information to members by means of leaflets, newsletters, noticeboards, speakers at union meetings, etc. It is particularly useful to invite people who have been involved in combating sick building syndrome themselves to speak at a meeting.
As negotiations with management proceed, ensure that members are kept fully informed of objectives and progress - or lack of it - so that they can decide on appropriate action to take.
Conduct a questionnaire survey
In order for your case to be taken seriously by management, it is likely that you'll need some statistics in support. Appendix 1 gives a sample survey that can be adapted to suit your needs. It is based on a survey carried out in 1987 by the National Association of Local Government Officers (NALGO) in Kensington and Chelsea Town Hall in West London, a typical, municipal complex with air-conditioning, sealed windows, fluorescent lights and tinted glass. Workers there had suffered for many years with sick building syndrome, and the survey showed that the percentage of people who usually or always suffered from a particular symptom was: stuffy nose, 42; dry skin, 41; lethargy, 40; headaches, 30; eye irritation, 30; irritated throat, 30. A far higher percentage experienced problems on occasion.
A health and safety survey undertaken by the Manufacturing, Science and Finance Union (MSF) at the City and Guilds Institute in London in 1990 asked for members to rate the office environment. Fifty-eight per cent said that the temperature was usually unsatisfactory; 71 per cent criticised humidity levels; 81 per cent said that air circulation was poor; and a staggering 94 per cent did not get enough fresh air. The levels of headache (90 per cent), lethargy (74 per cent), dry eyes (61 per cent), sore throat (58 per cent) and other symptoms amongst these workers point to a major problem with ventilation in this six-storey, sealed, air-conditioned building.
Some members might prefer not to give their names in a survey. This doesn't matter, although it is useful to know who is experiencing problems. The most important thing is to get as high a response rate as possible, including people who say they find no problem with the environment. Make sure members understand that individual questionnaire forms are confidential and won't be shown to the management.
Inspect the building
If you are lucky, one of the building services engineers may be a sympathetic union member and happy to help you with your inspection of the air-conditioning/ventilation system. But, anyway, trade union safety reps have the legal right to carry out inspections (see Appendix 5). Appendix 2 provides a comprehensive checklist for building inspections. The whole building needs to be covered, so draw up a methodical plan and timetable for carrying out the inspection.
Obtain information from management
Some points on the checklist cannot be answered by inspection, but rely on information from management. Union safety reps have the right to this information under the Safety Representatives and Safety Committees Regulations (see Appendix 5). Ask any additional questions that have emerged so far. You might also ask management to check the comfort parameters of temperature, relative humidity and air speed at various specified sites in the office during working hours.
Determine objectives
By now, you should have a good picture of the extent and nature of the health problems experienced by members, the possible environmental causes, and whether the management is likely to be co-operative and assume its responsibilities under the Health and Safety at Work Act. You need now to determine both long-term and short-term objectives, and decide how these will be raised with the management - perhaps at a Safety Committee meeting if these operate effectively within your organisation, or at a regular union-management meeting. You also need to be clear about what action your members are prepared to take if management refuses the union's requests or takes no action.
Negotiate with management
Depending on what your investigations so far have shown and the objectives you have drawn up, you will have specific demands to make of the management. These obviously depend on so many factors that it is impossible to identify more than a few of the more obvious ones here:
You may need to keep reminding management of their obligation and duties under health and safety legislation (see Appendix 5), particularly if the solution to problems is likely to be an expensive one. If your management refuses to co-operate, call in the Environmental Health Officer from your local council who is legally responsible for ensuring that employers of people working in offices, shops and similar places do not neglect their duties under the Health and Safety at Work Act.
Re-survey the membership
If your inspection showed, for instance, that humidifiers were full of slime, filters were clogged up, and ductwork was dirty, the union's first demand might be for a complete overhaul of the system and the instigation of a regular cleaning and maintenance programme (see Appendix 3). After such work has been carried out the membership should be re-surveyed to see whether their health has been improved by this action. If not, you will need to negotiate with management for further action to be taken.
Relocation/new building
If your employer plans to relocate, you should use your rights under health and safety legislation to obtain information on the heating, ventilation and lighting systems in the new building and on other factors relating to sick building syndrome such as office layout/partitioning and furnishings. You might need to negotiate improvements to proposed alterations, refurbishments and installations.
Appendix 4 provides a checklist for those involved in planning an air-conditioning system for a new building or a new system in an existing building.
If there is no union
If there is no recognised union in your workplace, your employer still has a legal responsibility to provide a healthy and safe workplace (see Appendix 5). However, you will need to think carefully about the best way of approaching your management to get them to assume their legal duty. You might start by joining the appropriate trade union and seeking advice from the union's organiser. If you are unsure about which union to join, contact your local Trades Council, Regional TUC, or the Trades Union Congress (TUC, Congress House, Great Russell Street, London WC1. Tel: 071-636 4030).
No doubt people will have been complaining for some time about conditions at work: the building might for years have had a 'reputation' for causing sickness. Pass literature on sick building syndrome around the office so that as many people as possible become familiar with the causes and possible remedies - particularly those who are prone to develop symptoms. If you work in a building occupied by other organisations which share an air-conditioning system, ask these workers whether they are also suffering from ill-health. Some of you might then organise an informal meeting after work to discuss the issue. You can then decide which of the steps outlined above for trade union members you might take - setting up a working party, arranging a questionnaire survey, drawing up plans of the office, carrying out inspections, using the law, approaching the management, etc. But remember, unless you are an elected trade union safety rep you don't have any legal right to inspect the workplace and management doesn't have to give you information you ask for.
If a meeting of workers decides to inform management of survey results, do so in writing, making sure that the management is clear that the people presenting the results are representing all the workers. Never go alone to a meeting with management.
If your management ignores the problem, or you find the management impossible to approach, you could get the ball rolling by contacting the authorities responsible for enforcing the Health and Safety at Work Act - the local authority's Environmental Health Officer, who is responsible for offices. This can be done anonymously and EHOs have a duty to follow up any complaints made in this way.
Surveys and air monitoring
When negotiating with management for competent and independent consultants to be commissioned to carry out surveys, make sure you are calling in the right 'expert' for the job and that she or he is given the right brief. In the example of Camden Housing Aid Centre, described in Chapter 1, workers believed their symptoms were due to traffic exhaust fumes being drawn into the air-conditioning system. In an early survey an occupational hygienist was asked to assess the health risk from airborne lead and carbon monoxide and to make recommendations on the basis of his findings. The hygienist did just this and, not surprisingly, he measured levels well below recommended exposure limits and concluded that no action was necessary by the management to prevent ill-health amongst its employees. He failed to recommend that other causes of ill-health should be investigated, for instance that a thorough inspection of the ventilation system be undertaken to try to find the reasons for the complaints. It was another three years before NALGO members at this workplace managed to get their management to pay for the correct surveys to be carried out.
The occupational health and safety resource centre at Canada's University of Western Ontario has devised a routine five-point survey for occupational hygienists to follow when investigating air quality complaints (Ruhemann 1985). Features include:
From these measurements it may be possible to predict the health complaints of people working in the building; conversely, people's rating of environmental conditions usually correlates well with the measurements obtained with instruments (Wilson et al 1987). But this is not always the case: air monitoring tests may show nothing 'abnormal'. This doesn't mean, however, that people are not sick or that their symptoms aren't real! Instruments don't measure things in the same way as humans: they can only measure the 'here and now' and cannot provide a summary of the long-term performance of the building environment as humans can. Also, instruments cannot measure interactions between the various parameters that determine environmental comfort.
A major problem can arise when people look to instruments to validate health complaints (Vischer 1989). If people are too hot and the thermometer shows the temperature to be 25├C, then they are 'right' in complaining. But if a sound level meter gives a reading of only 32 decibels in an office where people complain about noise levels then they are 'wrong' and are told to stop complaining. The assumption is that the instrument tells the 'truth' and people's experience is dismissed as 'subjective' and 'unreliable'.
Instead of trying to relate people's judgements to instrument readings, the two should be treated as separate but equally valid measures. In her book Environmental Quality in Offices Jacqueline Vischer (1989) develops a new approach in which human judgements alone are used to diagnose problems in the building environment. Called 'building-in-use' assessment, this systematic, ongoing approach might be taken by managements who seriously want to improve the working environment.
Some of the techniques and instruments used to monitor the air are described below.
The thermal environment
To assess the thermal load on workers, temperature, relative humidity and air speed need to be measured. This is done by taking four different measurements: wet and dry bulb temperature, air speed and globe temperature.
Ambient temperature can be measured more accurately using the wet bulb-globe thermometer (WBGT) method than with an ordinary mercury or alcohol thermometer. Readings should be taken in various different parts of the office/building.
An instrument that is capable of measuring the moisture content of the air is called a hygrometer. Relative humidity can be measured by use of a whirling hygrometer (sling psychrometer), which consists of both wet and dry bulb thermometers, and psychrometric charts.
Air speed is often measured using a Kata thermometer (which allows air velocity to be measured by determining the cooling power of the air), although many other instruments are available for measuring air velocity. Air speed (movement) measurements should be made about 1 metre above the floor in positions where room occupants would normally be working. Attention should be given to those areas where circulation is likely to be blocked by partitions or other barriers.
Ventilation
To assess the performance of the ventilation system, the hygienist will need to measure air flow rates (the number of cubic metres of air that pass per second, or air changes that occur in one hour), air speed (the number of metres that the air travels in each second), air pressures inside ductwork and air flow patterns.
Air flow
Air flow rates inside the ducting deteriorate with time for a variety of reasons, but mainly because of dirt and other deposits on fan blades, duct walls and other parts of the system. If regular records are kept trends can be spotted and remedial action can be taken (Gill and Ashton 1982). Vane anemometers or heated head air meters may be used to measure air flow in ducts.
Pressure
A pressure difference needs to be maintained between the inside of ducts (negative pressure) and the outside room-space (positive pressure) so that air can flow. This is achieved by means of a fan with its suction and discharge effects. Pressure is absorbed by the ducting, fittings and obstructions such as dampers and filters, particularly when they are dirty. Routine pressure measurements can therefore indicate deterioration in the system. Manometers and diaphragm gauges are used to measure pressure.
Natural ventilation and circulation
In order to assess the rate of air infiltration in buildings without mechanical ventilation or to see how well the air is actually circulating in a mechanically ventilated space, a tracer gas such as nitrous oxide can be used. A known quantity of the gas is released into the room, and its distribution and dilution rate are measured.
Lighting
Sources of illumination deteriorate with time: windows and light fittings accumulate dirt which reduces the amount of light emitted, and surfaces become dirty so reducing the amount of light reflected from them.
The correct level of illumination does not necessarily mean that the workplace is properly lit: measurement of illumination takes no account of glare from unshielded lights or windows or of the position of the worker in relation to the light source.
Photometers are used in lighting surveys to measure illuminance levels, but a visual assessment of such factors as lighting adequacy, suitability to the work being done, shadows, reflections, glare, colours, cleanliness, flicker and light distribution is equally important. A person doing a thorough lighting survey should also talk to people occupying the room about what they feel about the lighting levels.
Noise
Sound level meters are used to measure the intensity of sound in units called decibels (dB). A reading in dB(A) cuts out those sound frequencies that the human ear is not sensitive to and boosts the sensitive frequencies. Even so, the use of sound level meters is a fairly crude way of measuring the experience of the human ear. The meter measures a sound between two points, assuming an emitter of sound and a receiver who hears it. A person sitting at a desk, however, has sound coming from all directions and the ear selects sound from a number of different directions at once (Vischer 1989).
Dust
Although the amount of dust in offices is unlikely to reach the 'nuisance' levels found in many industrial processes, the level can be considerable. If lots of paper is being used, paper dust is generated; new carpets shed particles of different sizes; movement stirs up the dust; cigarette smoking produces respirable particles; and asbestos and fibreglass particles may be shed from deteriorating insulation material. Large particles lodge in the nose and throat while smaller ones are deposited increasingly further down into the lungs as their size decreases.
There are two main methods for sampling airborne dust. Filtration sampling involves drawing a known volume of air through a pre-weighed filtering device by means of an air pump. The device is then weighed to determine the mass of dust collected during the sampling period (which may be the working day). The pore size of the filter will determine the size of dust particles that are collected. The second method involves direct reading of the dust concentration at a particular point in time, using bulky, expensive instruments.
Gases and vapours
There is such a vast range of gases and vapours that a wide variety of monitoring and detection techniques has been developed. Instruments can be used to measure directly the concentration of the airborne chemical or - more often - the air is collected from the workplace and examined in the laboratory. You need experience in analytical chemistry to carry out many of these assays, but anyone can use the simple detector tubes and paper type monitors relying on colour changes which have been developed for some chemicals, e.g. carbon monoxide.
Carbon monoxide, formaldehyde and ozone are three chemicals that are routinely monitored for in office surveys.
Air ions
Air ion analysers are available which can selectively measure ions of a particular size and mobility. Values are likely to be affected by the weather, time of day and fluctuations in air pollution levels, particularly outside the building.
Radiation
Electromagnetic radiation at either ionising or non-ionising frequencies is virtually impossible to measure accurately in the office and at the low levels concerned. Different frequencies need different methods of measurement, and at extremely low frequencies the instruments themselves can interfere with and distort the fields that they are measuring.
Microbiological contamination
More than 30 different types of organism have been identified in the water from one humidifier. The skills of a microbiologist are needed to sample, grow in the laboratory and identify microbial species such as bacteria, viruses, spores and amoebae.
Smoking in offices
When Volvo moved to a new building, it introduced a smoking ban for its 630 white-collar workers. British Telecom has introduced a piecemeal policy on smoking: workers can vote to designate their area 'no smoking' if they wish (Leadbeater 1989).
The contribution of tobacco smoke to indoor pollution was outlined in Chapter 4, and it is now indisputable that passive smoking causes ill-health in the short term, with effects on the respiratory system, and produces a likely increase in the risk of lung cancer in the long term. Over the past few years non-smokers have become increasingly vocal in their demands for the right to work in a smoke-free environment, and have pointed to the law to support their case. Under Section 2 of the Health and Safety at Work Act, employers are required to provide a safe and healthy working environment as far as is reasonably practicable. It is argued that the banning of smoking in the workplace or the restriction of smoking to designated areas away from workstations are actions that employers should, and reasonably could, take to comply with the law.
It is important for non-smokers to understand the enormous stress placed on smokers who are faced with the ultimatum: 'There's no smoking in this building from Monday morning'. Many smokers do want to give up their habit, but they need help in doing so. For this reason, designated smoking areas, ventilated so that tobacco smoke is not distributed around the building, offer the best compromise - as long as managers aren't allowed to smoke in their offices. A policy on smoking should be incorporated into the employer's safety policy (see Appendix 5).
Conclusion
An 18-month study into the causes of sick building syndrome, carried out by the government's Building Research Establishment and costing 'hundreds of thousands of pounds', is due to report at the end of 1990. The researchers hope to provide a method for studying sick buildings (Barrick 1989). Study is all very well, but there is plenty that can be done now to improve conditions for workers whose health is suffering, such as giving air-conditioning systems a thorough overhaul, checking the adequacy of the system, and increasing the amount of fresh air delivered per person.
One lesson that has already been learned is that sick building syndrome can result from placing too much emphasis on centralised efficiency and control, overlooking the individual and variable needs and responses of people to their environment. The best way to prevent sick building syndrome is for buildings and ventilation systems to be better designed in the first place so that people have plenty of natural light and individual control over heating and ventilation.
Sick Building Syndrome: causes, effects and control - Chapter 5
© 1990 London Hazards Centre, Interchange Studios, Hampstead Town Hall Centre, 213 Haverstock Hill, London NW3 4QP, UK