If going to work gives you a tense, nervous headache, you may need more than Anadin to cure it. It might not be the work, your colleagues, or the boss making you ill. It could be the building itself.

Sick Building Syndrome (SBS) may be a fad from across the Atlantic, but the World Health Organisation (WHO) has officially recognised it since 1982. It therefore has serious implications for employers, building owners, architects and builders – and for their insurers.

A WHO report suggests that up to 30% of new and altered buildings worldwide may have poor indoor air quality. According to the House of Commons Environment Select Committee, SBS costs British businesses more than £600m each year through a combination of absenteeism and reduced productivity.

In the US, there is increasing publicity about SBS. It is big business – and not just for the lawyers. Consultancy firms and manufacturers of corrective devices and monitoring equipment now generate more than $2bn (£1.5bn) each year.

In extreme cases, some buildings are known as “sick buildings” because they have such high levels of contaminants. A Florida courthouse, which cost $37m (£27m) to build in 1987, was so badly infested with microbes that a further $30m (£22m) had to be spent to put it right.

But what exactly is SBS? The US Environmental Protection Agency (EPA) describes SBS as a situation in which building occupants experience acute health and comfort problems that appear to be linked to a time spent in a building, but where no specific illness or cause can be identified. According to the Health and Safety Executive (HSE), these buildings are typically modern offices that have mechanical ventilation or air conditioning.

SBS contrasts with Building Related Illness, where symptoms of a diagnosable illness can be attributed directly to airborne building contaminants. The most notable example of this phenomenon was when hundreds of attendees at an American Legion convention in Philadelphia suddenly became ill. Twenty-nine died. As a result, legionnaires' disease was added to the medical lexicon.

Despite substantial research, the causes of SBS are not proven. However, most experts agree that certain factors play a key part.

No panacea
Following the 1973 oil embargo, national energy conservation measures called for a reduction in the amount of outdoor air provided for ventilation in order to minimise energy consumption. In many new or altered buildings, the ventilation rates were reduced by up to two-thirds. These rates proved to be inadequate to maintain the health and comfort of the occupants.

At the same time, the quantity of pollutants from indoor sources has increased. Photocopiers, synthetic carpeting and soft furnishings, chipboard furniture and cleaning agents can all emit toxic gases, including known carcinogens such as formaldehyde.

The explosion in the use of computer equipment has compounded the problem: it increases background radiation and static electricity, creates electromagnetic fields and disrupts the balance of negative and positive ions.

The Building Research Establishment identifies inadequate ventilation combined with bacteria and fungus from air-conditioning systems, chemical pollution and poor lighting as the likely major causes of SBS.

The symptoms of SBS vary according to the individual affected and the building. The HSE says the most common symptoms are headache; eye, nose or throat irritation; dry or itchy skin; stuffy or runny nose; lethargy and irritability or poor concentration. Most of the symptoms cannot be clinically defined and tend to dissipate soon after leaving the building. It may be difficult, therefore, to distinguish between a genuine sufferer and a crank or opportunist.

As the causes of SBS are complex and uncertain, the HSE stresses that it is not possible to identify a simple panacea to eliminate the problem. What works in one building may not work in another.

Increasing ventilation rates is an obvious possible solution. As a minimum, heating, ventilation and air-conditioning systems should comply with relevant building standards. However, heavily polluted areas, such as smoking lounges, may need up to three times as much fresh air as general areas.

Increasing the quantity of fresh air is not always the answer. Exhaust fumes and other contaminants can heavily pollute outdoor air. Air-cleaning devices may help, but they usually have limited application and can be expensive. Many air filters do not capture small particles (for example, from diesel exhausts) and mechanical filters do not remove gaseous pollutants.

Removing the source of the pollutant is generally an effective approach – when the sources are known and control is feasible. Such control includes rigorous maintenance of heating, ventilation and air-conditioning systems, replacement of water-stained ceiling tiles and carpeting and enforcing smoking restrictions.

Venting fumes from photocopying machines and printing facilities directly to the outside can also help. Paints, solvents, insecticides, adhesives and other pollutant sources should be used only during low or no-occupancy periods. Sufficient time for materials in new buildings to “off-gas” pollutants is also important.

Some experts stress the value of having plants in the office, as these can absorb some of the harmful pollutants.

The HSE recommends that, when SBS is mooted as a problem, employers should first investigate other possible causes of the symptoms, since they may simply be due to a common virus. When these causes are eliminated, the HSE suggests a four-pronged approach:

  • Determine whether symptoms are localised or widespread throughout the building. If the former, it may be easier to identify the cause.
  • Maintain heating, ventilation and air-conditioning systems and deal with any deficiencies.
  • Assess the cleanliness of the interior of the building and furnishings.
  • Seek the views of staff and investigate their complaints.

    Professor Alan Hedge, an expert on SBS, confirms the importance of diagnosing the cause before embarking on any remedial work: “All too often, remedial action is taken that is inappropriate, ineffective and uneconomical,” he says.

    Hedge points out that allowing employees more control over their local environment, together with keeping carpets, furnishings and air ducts clean, may be preferable to expensive, structural alterations.

    The EPA stresses the importance of education and communication. When building occupants, management and maintenance staff fully communicate and understand the causes and consequences of air-quality problems, they can work more effectively together to prevent problems from occurring, or to solve them if they do.

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