Sick Building Syndrome and Building Related Illness

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by Alex Stadtner

What is the difference between Sick Building Syndrome and Building Related Illness?

Sick Building Syndrome and Building Related Illness are two distinct diagnosis. People often use the term “sick building” when referring to a property, but buildings don’t get sick – people do. I believe if there are numerous people suffering from Sick Building Syndrome (SBS) it’s okay to refer to the building as “sick,” but that’s technically inaccurate. So what is the difference between SBS and Building Related Illness (BRI)?

Sick Building Syndrome (SBS)

Sick Building Syndrome includes the following symptomology:

  • complaints of acute discomfort (.e.g, headache; eye, nose or throat irritation; dry cough; dry or itchy skin; dizziness and nausea; difficulty concentrating; fatigue; and sensitivity to odors; rash)
  • unknown cause of symptoms
  • most symptoms vanish shortly after occupants leave the building

Another rule-of-thumb has been developed that states unless 20% or more of occupants are suffering SBS symptoms, it is not SBS. I think this is a terrible rule-of-thumb, and it really only benefits occupants in smaller buildings. For instance, if you were suffering these symptoms in a household of 3 – it’s automatically Sick Building Syndrome. But if you and 198 other occupants are suffering an office building of 1,000 – it’s automatically not SBS?!?!  That’s ridiculous. If 199 people are suffering in any building you better start to believe there’s a serious problem. The 20% rule just doesn’t add up.

Building Related Illness (BRI)

Building Related Illness is, by definition, different than SBS. BRI is generally allergic reactions or infections, and symptoms and patterns are as follows:

  • complaints of specific symptoms such as cough, chest tightness, fever, chills, and muscle aches
  • symptoms can be clinically defined
  • cause of symptoms in known
  • complaints can continue after having left the building

Unless you’ve lived under a rock, this sort of case should sound familiar.\

Humidifier fever, Legionnaires Disease, skin rashes, hypersensitivity pneumonitis, and other illness related to bacteria, fungus (mold), and viruses are often classified as Building Related Illnesses, not Sick Building Syndrome.

Often the words “malaise” and “lethargy” are used during BRI or SBS interviews. According to Managing Indoor Air Quality, “malaise is a vague feeling of uneasiness or physical discomfort,” and “lethargy is characterized by abnormal drowsiness or torpor, apathy, sluggishness and great lack of energy.”

 At the heart of every Sick Building Inspection is an occupant survey that helps the investigator understand symptoms and develop a hypothesis about what in the building could be causing these symptoms.

Indoor Air Quality and Sick Building Syndrome

Indoor Air Quality is almost always associated with SBS (and BRI). Whether from insufficient ventilation, excessive accumulation of indoor air pollutants, or a combination thereof, IAQ is almost always intimately tied to the symptoms of SBS or BRI.

Ventilation is a crucial element in maintaining good IAQ. Point-source exhaust for known sources of contaminants (e.g., combustion appliances, paint/chemistry hoods, etc.) and moisture (e.g., stove top, shower, indoor pool, etc.) is a relatively easy way to reduce indoor pollutants. But when these systems are broken or occupants don’t know to operate them… rapid accumulation of indoor pollutants can lead to SBS.

The other half of the ventilation equation is the introduction of outside air. As we continue building tighter and tighter buildings for energy efficiency, we must also ensure sufficient outside air delivery. If you have a carbon dioxide (CO2) meter and watch it as an unventilated room fills with occupants… you can see CO2 levels rise rather quickly. CO2 can be used as an indicator for measuring ventilation effectiveness, but there are more advanced methods involving flow hood measurements

Indoor and outdoor contaminants contributing to SBS or BRI may include any of the following (abbreviated list):

  • VOCs and formaldehyde from building materials or occupational environments
  • Microbial VOCs (MVOCs) from wet and actively growing colonies of mold or bacteria
  • mold spores and hyphae fragments
  • pesticides, fungicides and other biocides
  • fuel or refrigerant leaks
  • combustion byproducts
  • scented cleaning supplies or “air fresheners”
  • dander, insects and other biological allergens (e.g., cat, dog, mouse, rat, cockroach, dust mite, pollen, etc.)