An unhealthy building can lead to a mini epidemic among employees

Building-related illnesses are on the increase. Some, like legionnaires' disease, are caused by a recognisable bacterium. Others, such as those involving mould, or sick building syndrome (SBS), are more difficult to pin down. However, as the June 2003 UK Office of Fair Trading report on liability insurance says, the courts appear to interpret the law in a manner which entitles people to compensation.

There are no precise figures on the scale of building-related sickness. Surveys have not proved helpful, as the ill-defined nature of SBS and the common nature of the symptoms mean that sufferers may not associate their condition with their work environment. Some estimates suggest that the proportion of office workers showing symptoms that could stem from SBS is as high as 30% in the UK.

Legionnaires' disease
Legionnaires' disease is a type of pneumonia, caused by a germ called legionella pneumophila. People catch legionnaires' disease by inhaling droplets of water that contain the bacteria. Outbreaks occur from purpose-built water systems and cooling towers where temperatures are warm enough to encourage the bacteria's growth.

Legionnaires' disease affects men more frequently than women, and victims tend to be middle-aged or elderly. Smokers and people with bronchial problems are most vulnerable, and, since the symptoms are similar to those of flu, the disease is difficult to diagnose. However, outbreaks are relatively rare. In the three year period from 1999 to 2002, only 25 cases were reported to the Health and Safety Executive (HSE), although the true number was probably slightly more.

Employers are legally required to report cases of legionnaires' disease to the HSE, which publishes an approved code of practice. This includes a basic risk management framework for preventing outbreaks. Strategies include:

  • Risk Assessment of water systems

  • Remedial work in high-risk areas, including cleaning and disinfection

  • A regularly-monitored maintenance programme.

    Sick building syndrome
    SBS achieved international status in 1982 when the World Health Organisation formally recognised the condition. However, it cannot be diagnosed precisely, and the UK Industrial Injuries Advisory Council has not prescribed SBS as an industrial disease.

    Symptoms may include dry, itchy skin, dry eyes, nose or throat, stuffy nose, headaches and lethargy. Of course these common symptoms can have numerous different causes. However, you should suspect SBS when a number of people in the same workplace experience such symptoms, with these only occurring within the building, getting worse the longer the time spent there, and disappearing once employees leave.

    What causes SBS? No-one really knows, although the HSE suggests that a number of factors are likely to be involved. These include physical, environmental and job-related factors. Cases of SBS commonly occur in large, air-conditioned, open-plan offices where staff have little control over ventilation, heat and light. Poor design and maintenance and badly organised cleaning services contribute to the likelihood of SBS. Job-related factors include routine clerical work and working with display screens.

    It is likely that the incidence of SBS has grown because many office buildings are effectively sealed, with the intake of fresh air reduced to a minimum to save energy. This means that workers are breathing recirculated air, and possibly recirculated pollutants. Synthetic materials in buildings and furniture can release toxic chemicals such as formaldehyde. And there may be high levels of bacteria and fungi in ventilation systems. The result can be a polluted office with a high level of volatile organic compounds (VOCs) in the atmosphere.

    While the symptoms of SBS are rarely severe, high concentrations of VOCs can be carcinogenic, and no-one knows for sure what the long term effects of continuous periods of low-level exposure may be. Certainly, some insurers now regard SBS as having the potential for long-tail liability claims.

    The key to preventing SBS lies in good building design, and maintenance and monitoring to ensure that the building performs as intended. The US Lawrence Berkeley National Laboratory, Environmental Energy Technologies Division, suggests the following measures:

  • Maintain ventilation rates at or above 20 cfm per person

  • Avoid air conditioning, or at least keep air conditioning systems clean

  • Reduce sources of VOCs

  • Avoid temperature extremes outside the comfort zone.

    If you suspect SBS, the HSE's advice is to investigate promptly and systematically, starting with the most likely sources and taking action to remedy any faults that emerge. There are some more sophisticated strategies: research suggests that SBS can be treated by installing ultraviolet lights in ventilation systems, but it clearly makes sense to try the simple, cheaper approach first.

    Toxic mould
    Moulds are microscopic fungi that are present both inside and outside buildings. Problems occur when dampness, coupled with warm conditions and insufficient ventilation, cause excessive mould growth. Proving a connection between exposure to mould and symptoms of illness can be problematic, but this has not prevented a spate of successful lawsuits and claims in the US.

    With building-related sickness, prevention is generally far cheaper and easier than cure, and mould is no exception. Moulds cannot develop without a source of moisture. A recent edition of Adviser, published by Marsh, therefore suggests that the key to mould prevention is controlling moisture. Marsh recommends establishing a moisture incident procedure, which will describe steps for halting any moisture intrusion and for extracting moisture from the building. This type of preparation means that following a burst pipe or a flood you should be able to deal with the aftermath before mould has a chance to grow.

    Future claims?
    Should we be concerned about long-tail liabilities arising from SBS? In theory, the risk seems remote. Office workers tend to be a mobile breed, so, even if a serious illness in the future could be attributed to working in an unhealthy building, it might be difficult to pinpoint the offices and the employer involved. It could be equally difficult to show that a group of people who contract an illness all once worked in the same office at the same time.

    But the US mould claims explosion suggests there is no room for complacency. It appears that causal links are becoming less of a consideration for courts than the desire to compensate the afflicted. Science may eventually reveal firm links between conditions in a building and the long term health of those who work there. In any event, ensuring a healthy environment in which people can work well, has to be good risk management.

    Sue Copeman is editor, StrategicRISK

    INFORMATION SOURCES
    HSE
    Legionnaires' Disease - A guide for employers (
    www.hse.gov.uk/legionnaires/index.htm

    )Legionnaires' Disease - The control of legionella bacteria in water systems. Approved code of practice and guidance (HSE Books, PO Box 1999, Sudbury, Suffolk, CO10 2WA, Tel: 01787 881165, Fax: 01787 313995)Legionnaires' Disease - Controlling the risks associated with using spa baths (
    www.hse.gov.uk/legionnaires/index.htm

    )Legionnaires' disease - Essential information for providers of residential accommodation (
    www.hse.gov.uk/legionnaires/index.htm

    )An introduction to the control of legionella bacteria in water systems (video), £30.00 + VAT (HSE Books)Legionnaires' disease - Control of legionella bacteria in water systems: Audit checklists, £4.25 + VAT (HSE Books)Legionnaires' disease - Control of legionella bacteria in water systems, £8.00 (HSE Books)How to Deal with Sick Building Syndrome - Guidance for employers, building owners and building managers, £8.50 (HSE Books)Sick Building Syndrome - A review of the evidence on causes and solutions, £25.00 (HSE Books)Other
    The Health Protection Agency (
    www.phls.org.uk

    )Marsh Adviser March 2003 on Toxic Mould (
    www.marsh.co.uk/ToxicMoulds.pdf

    ).LEGAL RESPONSIBILITIES
    Employers have a legal responsibility to prevent work-related accidents and ill health - including SBS. There are general duties on all employers under the Health and Safety at Work Act 1974 and the Management of Health and Safety at Work Regulations to assess and reduce risks and ensure (so far as is reasonably practicable) the health and safety of employees, and others who may be affected by work activity.

    Other regulations apply in specific situations. For example, The Workplace (Health Safety and Welfare) Regulations 1992 will apply to any specific problem relating to inadequate ventilation, temperature control, lighting, cleanliness etc which can be associated with SBS symptoms.

    US 'MOuLD RUSH' CONTINUES
    Although leading US property/casualty insurers expect an improvement in profitability for 2003, a survey conducted by the Insurance Information Institute shows that only 38% believed that the mould crisis has peaked and that the pace of mould claims will decline. Certainly, the reduction of a 2001 landmark $32.1m award in Texas to just over $4m on appeal does not seem to have deterred claimants. Recent cases alleging illness from mould include:

  • 50 Tulare County, California, courthouse employees filing a suit against 20 contractors who built a wing of the courthouse which was found to have mould contamination
  • 30 former workers in the Investment Building office tower in Towson, Maryland, suing the current and former building owners and property managers
  • A class action suit against the City of Denver relating to alleged mould contamination at the Denver International Airport
  • four families suing two Connecticut school boards for alleged negligence in their handling of mould contamination and remediation.

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