ENV461: OCCUPATIONAL HEALTH

ASSIGNMENT 1
TITLE: SICK BUILDING SYNDROME

LECTURER NAME : MOHD SHUKRI BIN MOHD ARIS

NO NAME STUDENT ID

1 MOHD AZIZAN BIN ASROH 2023420644

2 MOHAMMAD NABIL BIN YUSRI 2023481448

 Part 1

1.0 Introduction

On April 27, 2024, there was a report that an increasing number of employees at

Company X complained of symptoms associated with frequent rhinitis, consisting of

rhinorrhea (RN), lightheadedness, itchy skin, and reddish eyes over the past 2

months. The frequent symptoms affected the employees, resulting in an increase in the

number of employees who required medical certificates (MC).

The Occupational Safety and Health Clinic in Hospital Z has received all the

cases for further examination. After proper history taking and physical examination, the

doctor suspected that frequent rhinitis symptoms in all cases might be due to

workplace-like sick building syndrome (SBS). The doctor was subsequently notified all

the cases to the Department of Occupational Safety and Health (DOSH). Subsequently,

after three days of notification received, the DOSH visited the Company X for a

workplace walkthrough survey to verify the workplace-related illness, identify risk factors

associated with the disease and also to suggest the prevention and risk control

strategies.

2.0 Workplace Assessment

2.1 Organization’s Work Environment

The Company X has a one-block building with four levels. This office operated

from 8am to 5pm during weekdays and close over the weekends or public holiday.

There was a total of 143 employees who work at the office. Upon verification of the

cases, there were a total of 33 cases with SBS-like symptoms, whereby 15 of the cases
work at Department A, 10 of the cases work at Department B, and 8 of the cases work

at Department C. All the departments are located at level 1. Department A is a human

resources department; Department B is a finance department; and Department C is an

information technology (IT) department. The main work activities for all the cases in the

departments are mostly secretarial, accounting, and computer work. Most of the time,

the main work processes include computer work and manual writing, as well as filing in

the respective personal rooms, cubicles, and main office. They were spending 7 to 8

hours in the office doing their duties.

The DOSH team managed to interview a total of 25 out of 33 cases on the day of

inspection. Every case presented with complaints of rhinitis and comparable symptoms

(itchy nose, occasionally watery and irritated eyes, runny nose, and sneezing) that were

frequently experienced upon reporting to work on normal working days. The onset of

symptoms occurred upon entering the workplace or office early in the morning, and they

were resolved upon returning home from work.

This office had adequate lighting and ventilation. The office was equipped with a

centrally controlled air conditioning system. Each member of staff has an allocated

personal cubicle and room. A number of rooms feature direct external window access,

whereas aisle-side rooms are devoid of windows and rely exclusively on the centralized

ceiling ventilation system. The air conditioning remains operational in nearly every room

during the inspection procedure.

2.2 Health risk at the workplace

 Upon workplace inspection, a section of the ceiling has been found to have a

problem with leaking pipes. Buckets are being used to contain the dripping water. There

was also increasing concern among the employees relates to the mould issue. There

were appearance of "mouldy" stains and patches on walls. The surfaces of the walls

were stained by whitish, creamy, and occasionally blackish stains and patches. Over

time, patches typically develop into progressively larger size.

Additionally, patches have also been observed on fabric surfaces, including sofas

in the meeting room, surfaces of filing cabinets and boxes. Although certain stools are

constructed from PVC, it has been observed that black patches appear on these

materials as well, and they also have a tendency to increase in size gradually.

Additionally, stained glass surfaces, including glass-doored cabinets, developed whitish

blotches. Furthermore, a mouldy odor was described. The employees also provide

descriptions of a cool environment attributed to air conditioning. Dampness or excessive

humidity may result from the lack of direct window access in cool indoor environments.

2.3 Occupational Health Hazard

Based on the results of the walkthrough survey conducted at the Company X, the

health hazard identified is the biological hazard caused by a specific fungi agent. Mould

or fungi, is prevalent in the environment. Fungi and moulds are composed of filaments

(hyphae) and a body (mycelium). Fungi multiply via spores and survive in media that

contains adequate nutrients and humidity. Fungi spores are present in all ambient air

(CDC, 2004). Airborne spores of fungi are capable of being transmitted via the air

(Ghajari et al., 2015). Aspergillus, Cladosporium, Cryptococcosis, Stachybotrys

(commonly referred to as black mould), and Penicillium are among the identified fungal
species and moulds that have the capacity to grow within an indoor environment (CDC,

2004; DOSH, n.d.).

Prefabricated gypsum boards and other inner wall materials utilized in buildings

are extremely conducive to the development of Stachybotrys chartarum. (Haleem Khan

& Mohan Karuppayil, 2012). Leaking pipelines within the wall is one of the factors that

contribute to the growth of the mould on the interior wall of a building. A pipe breach

within a building's wall will increase relative humidity, which in turn facilitates the growth

of mould as it travels to land via the air. Skin diseases affecting employees with

sensitive skin may also be induced by excessive exposure to mould growth. Persistent

cough is observed in infants whose mothers have asthma and are exposed to airborne

fungal spores (Haleem Khan & Mohan Karuppayil, 2012). Sinusitis is one of the

diseases that caused by the mould growth on the wall. These fungal can also grows on

a damp floor inside a building.

According to DOSH, in relation to Indoor Air Quality (IAQ) management identifies

several conditions that facilitate the growth of mould in indoor or built environments

include relative humidity more than 70%, the presence of oxygen, a temperature range

of 5 to 50 degrees Celsius that is relatively optimal, and the availability of fungal spores

in the air. High humidity is the primary factor that initiates mould growth (DOSH, n.d.).

2.4 Impact of the Occupational Health Risk

Mould has the potential to induce detrimental health consequences such as

hypersensitivity reactions, which may manifest as allergic symptoms including itchiness,

nasal itchiness, sneezing, redness and watery eyes, coughing or wheezing, and sore
throat (Health Problems Related to Dampness and Mold | NIOSH | CDC, 2023). This

collections of symptoms in the building are also known as Sick Building Syndrome

(SBS). The World Health Organization (WHO) classifies SBS as a collection of

symptoms with an unknown cause that can be attributed to exposure to building

variables, including indoor air quality, lighting, noise, and psychological effects (Mendes

& Teixeira, 2014).

People who have a genetic predisposition to hypersensitivity should take extra

caution around mould, especially those who are known to have asthma, due to the fact

that mould has the potential to induce severe allergic reactions and possibly

severe asthmatic reactions. Particular attention should be given to individuals with

compromised immune systems and chronic lung conditions, such as diabetic patients,

due to the increased risk of developing severe lung infections, including aspergilloma,

that can result from prolonged mould exposure (Ledoux & Herbrecht, 2023).

Occupational health risks and hazards not only result in SBS but also have

manifested as having significant adverse effects on other fields as well. One of these is

a decline in work productivity. This is evident in the individual performance of those

afflicted with SBS. Individuals who are affected by SBS will become distracted, resulting

in decreased work concentration. The workflow may be delayed, particularly in the case

of collaborative work. Moreover, individuals with SBS will be less motivated to work

because they will be disturbed by symptoms of SBS at all times.

Additionally, SBS may have psychological effects on the mental health of

employees, including but not limited to decreased motivation and fatigue, increased

workplace stress, depressive disorders, and anxiety (“Everything You Need to Know
About Sick Building Syndrome,” n.d.). Prolonged occupational-related stress and

anxiety, as well as the pressures of meeting work standards, may additionally contribute

to the development of SBS (Abdullah, 2019). The heightened irritability and anxiety

experienced by employees in such a setting can hinder teamwork, possibly leading to

duplicated efforts and reducing the free flow of ideas. Working environment filled

stressful atmosphere will cause everyone else who are working in the same room to get

stressed as well in which invites the negative vibe during working hours.

Furthermore, with the reducing of working productivity comes the economy

problem. Unhealthy building has led to the increased the rate of sick leaves. SBS would

cause employees to suffer from absenteeism. Employees with absenteeism can have a

negative influence to industrial economy. This will indirectly cause a major financial loss

to an industry. In the United States alone, productivity losses attributed to BRI (Building

Related Illness) are estimated to range from $20 billion to $70 billion (Awada et al.,

2021).

As for Health industry, SBS cause the increasing of healthcare costs as well as

the maintenance of the problematic buildings. According to a study by the National

Institute for Occupational Safety and Health (NIOSH), productivity losses due to poor

IAQ in the United States amount to approximately $60 billion annually ((16) The Cost of

Sick Building Syndrome | LinkedIn, n.d.). The implementation of air purification systems

and air monitoring has the potential to improve indoor air quality (IAQ). An air monitoring

system is utilized to detect airborne pollutants, whereas an air purifier is employed to

eliminate allergens, pathogens, and air pollutants from within a building. Investing in

these technologies, nevertheless, may result in significant long-term cost reductions.

Moreover, SBS may result in increased medical costs for employees. In contrast to

old and unhealthy buildings, buildings that prioritize health and safety can result in

increased cost savings on healthcare and reduced medical expenses for employees.

Part 2

2.1 Laws & Regulation

A legislative initiative in Malaysia, the Occupational Safety and Health Act of

1994 (OSHA 1994) seeks to guarantee the well-being, health, and safety of employees

in the workplace. It specifies regulations and guidelines to prevent health hazards,

injuries, and incidents in the workplace across a broad spectrum of industries and work

environments. Department of Occupational Safety and Health (DOSH) in Malaysia,

which is responsible with promoting workplace safety awareness, conducting

inspections, and enforcing occupational safety and health standards, was also

established within the framework established by OSHA 1994.

Under OSHA 1994, employers in Malaysia are obligated to ensure the health,

safety, and welfare of their employees by; providing and sustaining a safe and healthy

work environment; conduct risk assessment; identify and assess any risks to the safety

and health of their employees in the workplace. On the other hand, employees also

have general duties to ensure their own safety and health, as well as that of their

coworkers (OSHA 1994) by complying with safety and health procedures; cooperating

with investigation as well as taking care of their own health and safety.
 In this case, it is important for both employers and employees to take action to

control the mould or fungi infestation in the building to reduce the number of cases with

SBS. Firstly, development of specific SBS Regulations is really needed. It consists of

the drafting and implement regulations specifically targeting the prevention and

mitigation of sick building symptoms in workplaces. Also, acceptable indoor air quality

(IAQ) parameters, including limits for pollutants such as volatile organic compounds

(VOCs), carbon dioxide (CO2), particulate matter, and humidity levels should be

defined. DOSH may enforce regulations under the Occupational Safety and Health Act,

which requires employers to provide a safe and healthy workplace for employees based

on Occupational Safety and Health Act (OSHA) compliance.

Secondly, employers are required by OSHA's General Duty Clause to provide a

workplace free from recognized hazards that are causing or likely to cause death or

serious physical harm to employees. DOSH may use this clause to address SBS if it

determines that poor indoor air quality poses a significant risk to employees' health.

Thirdly, Indoor Air Quality Guidelines should be introduced. While DOSH may not

have specific regulations dedicated solely to SBS, it may adopt or reference indoor air

quality guidelines established by organizations such as the Environmental Protection

Agency (EPA) or the American Society of Heating, Refrigerating and Air-Conditioning

Engineers (ASHRAE). These guidelines can provide recommendations for maintaining

acceptable indoor air quality levels and preventing SBS-related symptoms.

Next, inspections and enforcement should be taken. DOSH inspectors may

conduct routine inspections of workplaces to assess compliance with applicable health

and safety regulations, including those related to indoor air quality and SBS prevention.
Non-compliance with regulatory requirements may result in enforcement actions, such

as citations, fines, or orders to correct deficiencies. Collaboration with other agencies

and stakeholders also can be done to solve these issues. DOSH may collaborate with

other agencies, such as environmental health departments or building code

enforcement agencies, to address SBS comprehensively. Engaging with stakeholders,

including employers, employees, industry associations, and health professionals, can

help identify best practices and develop effective strategies for preventing and

mitigating SBS.

2.2 Medical Surveillance Activities

Addressing sick building syndrome (SBS) through medical surveillance activities

requires a comprehensive approach that involves identifying, evaluating, and mitigating

potential health risks within the building environment. By implementing these steps, the

medical surveillance program can help identify and address SBS symptoms, improve

employees health and comfort, and create a safer and healthier indoor environment.

Here's a proposed action plan:

2.2.1 Initial Assessment

Assessment should be conducted as a thorough assessment of the building’ indoor air

quality (IAQ), ventilation systems, temperature control, humidity levels, and potential

sources of contamination at the office building. Survey by using questionnaire method

or any similar method should be carried out in order to gather information on symptoms

experienced, frequency, and perceived triggers mostly to the one that have complained

before.
2.2.2 Medical Surveillance Program Development

The Occupational Health and Safety Unit (OSH) should carryout medical surveillance

program in order to identify employee that currently developing sign and symptom of the

SBS symptoms. Establish a medical surveillance program tailored to the specific needs

and risks identified in the building. Role and responsibilities of medical personnel,

building management, and employee in identifying, reporting, and addressing symptoms

related to SBS should be handle by them. Protocols for symptom reporting, medical

evaluations, and follow-up actions are main item that should be inserted in the

surveillance.

2.2.3. Employees Education and Awareness

Education and training to all the employee on SBS symptoms, contributing factors, and

preventive measures should be held one or twice in a year. The employees also need to

understand that they are encouraged to reporting of symptoms and participation in

medical surveillance activities. Promote healthy habits such as regular handwashing,

proper ventilation, and maintenance of personal workspaces are the examples.

2.2.4 Environmental Monitoring

Implementation of a regular monitoring program to assess IAQ parameters, including

temperature, humidity, carbon dioxide levels, airborne contaminants, and microbial

growth from time to time should be highlighted. The use of both qualitative (e.g., visual

inspections) and quantitative (e.g., air sampling) mechanism to identify potential

sources of indoor pollutants are suggested.

2.2.5 Medical Evaluations

All the employees supposed to be offered medical evaluation either the basic screening

or the full medical checkup screening. Employees that experiencing SBS symptoms

should be prioritized to run the medical examination. The examination could be run

whether in the private clinic or the government clinic or the panel hospital and all

charges should be Paid by the the company. Document symptoms, medical histories,

and exposure histories to identify patterns and potential correlation add expect that

should be-distress when running the medical check up especially the one with sick

building syndrome symptom. After the medical examination carry out if the finding is

alarming the employee should be considered to get referral to any specialists (e.g.,

allergists, pulmonologists) for further evaluation and management of specific health

concerns.

2.2.6 Mitigation Strategies

Based on findings from environmental assessments and medical evaluations,

implement targeted mitigation strategies to address identified sources of indoor

pollution. This may include improving ventilation systems, controlling moisture and

humidity levels, remediation of mould or other contaminants, and reducing the use of

chemical-based cleaning products.

2.2.7 Follow-Up and Continuous Improvement

A systematic system should be developed for ongoing monitoring and evaluation of

IAQ, symptom reports, and effectiveness of mitigation measures. Periodically review

and update the medical surveillance program and mitigation strategies based on
emerging research, changes in building occupancy or use, and feedback from

occupants and medical personnel.

3.0 Strategies to Improve the Employee's Health Condition

Control refers to the process of eliminating or deactivating a hazard in a way that

ensures it no longer presents a risk to employees. The strategies to improve employees’

health condition are based on the Hierarchy of Control as in Figure 1:

 Figure 1: Hierarchy of controls (Source: https://www.cdc.gov/niosh/topics/hierarchy)

3.1 Control of Biological Hazard (Fungi)

Agent of Fungi; mould, which can be air-borne transmitted, and also containing

fungi spores in air. Substitution and isolation control are almost impracticable and

infeasible, as no indoor air is free from fungi spores (Health Problems Related to

Dampness and Mold | NIOSH | CDC, 2023).

3.1.1 Elimination control

During the inspection, it was observed that there is a section where the ceiling is

exposed and a bucket is being used for storing leaking water. This leak needed repair

as it had been continuous for some time. The presence of persistent moisture vapor

from a persistent water loss may have an impact on the relative humidity of the

environment. The impact of water damage caused by leaks can have an adverse effect

on the humidity of indoor air and worsen the growth of mould. Ceilings and roofs that
are leaking should be fixed and eliminate in order to maintain indoor air humidity below

70%. The sofa and other mold-infested materials, including glass-doored cabinets,

sofas, and filing cabinets, also require thorough cleaning. Mold can be eliminated using

common household items such as dish detergent and bleach (Mold Clean-Up After

Disasters, 2022). Mold-infested boxes also require removal.

3.1.2 Engineering control

Ventilation engineering may include the ACMV (Air-conditioned Mechanical

Ventilation), AHU (Air Handling Unit), and cooling tower.

This is to ensure that the indoor ventilation system is operating at its highest efficiency,

with functioning inlets and outlets, and that the airflow remains within the recommended

range of 0.15-0.5 m/s without becoming stagnant (Haleem Khan & Mohan Karuppayil,

2012). Additionally, the temperature should be maintained between 23 and 26 degrees

Celsius, avoiding any lower temperatures that could impact humidity. In order to visually

assess the capability of air movement, indicators such as ribbons may be applied to the

inlet and outlet channels. The absence of a visible or stationary ribbon indicator may

suggest an issue with the air inlet outlet, such as an obstructed channel.

Putting an air purifier to use could be advantageous. Particularly those who are

vulnerable might consider utilizing a personal portable air purifier in their area. As it is

equipped with a HEPA filter, the air purifier might help in removing indoor contaminants

and pollutants. However, as capacity and efficacy of air purifier are typically determined

by size and intended for residential use only, it may be inefficient to use every portable

air purifier on the market to cover each area. The implementation of an air purifier

designed for industrial purposes would be a more optimal solution as a whole. In

addition, it may be advantageous to utilize a dehumidifying agent or a dehumidifier

containing silica, such as those found in rooms and closets. While this approach may

only prove beneficial for small-scale usage, it can be conveniently placed within the

employee's room and effectively decreases humidity in the designated room.

3.1.3 Administrative control

Rotation and scheduling of employees is one method of administrative control.

Given that the majority of employees' work involves working on a computer, an

appropriate workplace modification could be "work from home (WFH)." However, WFH

may benefit from temporary measures. Nevertheless, working from home reduces

exposures, which is still advantageous for employees. Restricting WFH to once or twice

per week could potentially serve as a fair solution for those who are affected. When

employees are permitted WFH, a major cleansing process should occur once per month

or every two weeks. This is preferable to extensive cleaning procedures, which may

cause dust and debris to float, as rigorous cleaning techniques include blowing,

scrubbing, wiping, sweeping, and mopping. Additionally, administrative control can be

done by performing appropriate IAQ as required by the employer. Additional targeted

risk management and objective modification may be implemented in accordance with

the official IAQ report.

3.1.4 Personal Protective Equipment (PPE) Control

Appropriate PPE includes surgical or medical face masks that have been

specifically approved. The use of N95 provides more effective protection despite the fact

that it may induce shortness of breath and may not be suitable for longer periods of use.
Face masks should be provided to employees who are genetically susceptible

although they are the least effective method of hazard control.

4.0 Conclusion

The recurrent and high number of SBS symptoms among Company X employees

is associated with factors related to biological hazards, particularly mold or fungi

infestations. OSHA 1994 states that employers and employees should collaborate to

ensure a safe and healthy workplace environment. As the safety and health manager at

Company X, aggressive and quick risk control strategies should be implemented to

maintain the productivity of workers at the workplace.

References

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