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Perfume, Fragrance and Odor Intolerance and Other Indoor Air Quality Complaints How Should They Be Handled

2/1/2012. 2. Introduction. Building Indoor Air Quality (IAQ) problems: Common and distressing to occupantsCause symptoms and illness in workers Disrupt productivity and staff moraleDealing with IAQ problems:Time consuming, costly and stressful. 2/1/2012. 3. Purpose of Presentation. Categorize IAQ problems and complaintsEmphasize distinction between odor effects and toxic effects of chemicals and substancesDescribe approach to evaluation and management of IAQ concerns .

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Perfume, Fragrance and Odor Intolerance and Other Indoor Air Quality Complaints How Should They Be Handled

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    1. 2/1/2012 1 Perfume, Fragrance and Odor Intolerance and Other Indoor Air Quality Complaints—How Should They Be Handled? Samuel W. Hall, MD Director, Occupational Health Services Veterans Affairs Medical Center Minneapolis, Minnesota

    2. 2/1/2012 2 Introduction Building Indoor Air Quality (IAQ) problems: Common and distressing to occupants Cause symptoms and illness in workers Disrupt productivity and staff morale Dealing with IAQ problems: Time consuming, costly and stressful

    3. 2/1/2012 3 Purpose of Presentation Categorize IAQ problems and complaints Emphasize distinction between odor effects and toxic effects of chemicals and substances Describe approach to evaluation and management of IAQ concerns

    4. 2/1/2012 4 Indoor Environmental Quality Function of: Air Quality Noise Lighting Comfort Ergonomic stressors Psychosocial stressors

    5. 2/1/2012 5 Indoor Air Quality IAQ refers to quality of air inside buildings and is related to: General ventilation Pollutant concentrations Thermal conditions (temp and humidity) that affect health, comfort and performance of building occupants.

    6. 2/1/2012 6 Indoor Air Quality Acceptable Indoor Air Quality (IAQ) Air in which there are no known contaminants at harmful concentrations as determined by cognizant authorities and with which a substantial majority (80% or more) of the people exposed do not express dissatisfaction.

    7. 2/1/2012 7 Magnitude of IAQ Problems NIOSH Data # IAQ evals of offices since late 70’s = 1300 1980—8% of total requests 1990—38% (150) of all requests Since 1990—52% of all requests

    8. 2/1/2012 8 Why IAQ Problems Increased? Changes in ventilation to conserve energy Changes in office work New equipment Ergonomic problems Organizational stress Increase in number of office workers Enhanced awareness of IAQ problems

    9. 2/1/2012 I-BEAM 9 EPA: I-BEAM Indoor Building Education and Assessment Model Computer software program integrating IAQ, energy efficiency and building economics into unique building management tool http://www.epa.gov/iaq/largebldgs/i-beam_html EPA/C-01-001V1.0

    10. 2/1/2012 I-BEAM 10 I-BEAM Enables You To Improve IAQ—within budget Refine maintenance program for IAQ Better manage housekeeping services for IAQ Conduct IAQ building audit Train management and staff in IAQ Provide IAQ building practice documentation Reduce liability for IAQ complaints Improve building and rental space marketability

    11. 2/1/2012 I-BEAM 11 I-BEAM Chapters Fundamentals of IAQ in Buildings HVAC IAQ Maintenance and Housekeeping Program Diagnosing and Solving Problems IAQ and Energy Efficiency Renovation and New Construction Managing for IAQ

    12. 2/1/2012 I-BEAM 12 Occupant Symptoms Associated with Poor IAQ Acute effects Discomfort effects Performance effects Chronic effects Building Associated Illnesses

    13. 2/1/2012 I-BEAM 13 Building Associated Illnesses Building Related Illness (BRI) Sick Building Syndrome (SBS) Idiopathic Environmental Intolerance (IEI) formerly known as Multiple Chemical Sensitivity (MCS)

    14. 2/1/2012 14 Building Related Illness Illness from known causative agent as a result of exposure to building air Hypersensitivity diseases—allergies Infectious diseases—Legionnaire’s disease Intoxications Acute—CO, metals, pesticides, VOC’s Chronic disease—asbestos, radon, ETS

    15. 2/1/2012 15 Sick Building Syndrome Nonspecific, largely subjective symptoms associated with building occupancy Headache Mucous membrane irritation Lethargy, fatigue Skin irritation Nausea and dizziness

    16. 2/1/2012 16 Building Factors Affecting IAQ Factors affecting indoor climate Temperature Relative humidity 30%-60% Airflow 15-20 cfm/person Factors affecting indoor air pollution Building fabric, furnishings and equipment Occupant-generated pollution Mechanical systems (HVAC) External sources

    17. 2/1/2012 I-BEAM 17 Types of Pollutants Environmental Tobacco Smoke Combustion Products Biological Contaminants Volatile Organic Compounds Formaldehyde Soil gases Pesticides Particles and Fibers

    18. 2/1/2012 I-BEAM 18 Contaminant Sources Indoor Sources Housekeeping and Maintenance Occupant-Related Building Uses as Major Building-Related HVAC System Moisture Motor Vehicle

    19. 2/1/2012 I-BEAM 19 Contaminant Sources Outdoor Sources Ambient Outdoor Air Motor Vehicle Commercial/Manufacturing Utilities/Public Works Agricultural Construction/Demolition

    20. 2/1/2012 I-BEAM 20 Contaminant Sources Outdoor Sources Building Exhaust Water Sources Birds and Rodents Building Operations and Maintenance Ground Sources

    21. 2/1/2012 I-BEAM 21 Diagnosing IAQ Problems General Diagnostic Process Characterizing Problems Checking Potential Causes Basic Measurement Techniques

    22. 2/1/2012 22 Major Reasons for Poor IAQ Indoor air pollution sources Poorly designed, maintained or operated ventilation systems Uses of building that were unanticipated or poorly planned for during design or renovation

    23. 2/1/2012 23 Terms and Definitions Odor: a smell, whether pleasant or unpleasant Fragrance: a pleasant odor Exposure: contact with a chemical agent Toxicity: ability to cause noxious effects It is a fixed property of a chemical

    24. 2/1/2012 24 Terms and Definitions Allergen: a substance capable of provoking an immune-mediated response Irritant: a substance capable of causing tissue inflammation Adverse Health Effect: any abnormal, harmful or undesirable effect on the well-being of a person that results from an exposure Hypersensitivity: any allergic response

    25. 2/1/2012 25 Key Concepts Some chemicals have no odor or toxicity example: nitrogen gas Some chemicals have an odor but no toxicity example: skunk musk Some chemicals have toxicity but no odor example: carbon monoxide Some chemicals have both an odor and toxicity example: hydrogen sulfide

    26. 2/1/2012 26 Key Concepts Working with or around a product, substance or chemical does not necessarily mean a person has been “exposed” to it. Even when someone has been exposed to a chemical, the exposure may not be biologically significant, i.e. no toxicity occurs.

    27. 2/1/2012 27 Key Concepts For toxicity to occur, a chemical has to be present at the biologic site of action in a sufficient concentration for a sufficient period of time. Most chemicals have an odor threshold hundreds of times lower than the level necessary for toxicity, i.e., smelling an odor does not equate to biologically significant exposure.

    28. 2/1/2012 28 Scented Products Personal Products perfumes, colognes, cosmetics, lotions, soaps, deodorants, hairspray Commercial Products cleaners, air fresheners, bleach, laundry detergent, candles, advertising inserts

    29. 2/1/2012 29 Chemical Sensitivity Prevalence 16% report allergy or unusual sensitivity to everyday chemicals 6% report doctor diagnosed multiple chemical sensitivity (MCS) 80% of the above say that fragrance is bothersome California Behavior Risk Factor Survey, 1995

    30. 2/1/2012 30 Adverse Reactions to Fragrances Skin Mucous membrane Respiratory Gastrointestinal Central nervous system Other

    31. 2/1/2012 31 Idiopathic Environmental Intolerances (IEI) Formerly known as MCS Proposed as new disease in 1950’s Adverse reactions from exposure to compounds under ordinary conditions Compounds: fragrances, detergents, solvents, pesticides, paints, dusts, drugs, etc. Symptoms: fatigue, headache, concentration + memory problems, nose + throat irritation, cough

    32. 2/1/2012 32 Epidemiology of IEI Age 40-50 yrs old Gender 80% female Education average 14 yrs Onset 1/3 cannot recall initiating event Symptoms CNS 90% GI 12-83% CVS 28-83% Endo 22% Fiedler: Env Health Perspect 1997;105(S2):409-415

    33. 2/1/2012 33 Theories Regarding IEI Physical illness from toxic exposure Psychological illness from toxic exposure Misdiagnosed psychological illness Culturally shaped illness behavior

    34. 2/1/2012 34 IEI Prognosis and Disability Symptoms distressing and often functionally disabling Large numbers of claims—health insurance, workers’ compensation, and disability Financial impact frequently significant Illness not progressive or fatal

    35. 2/1/2012 35 Evaluation of IAQ Complaint Clinical Evaluation History and physical examination Routine laboratory tests and medical imaging Psychosocial evaluation Environmental Evaluation Building engineer inspection Health and safety personnel inspection Industrial hygiene consultation/testing

    36. 2/1/2012 36 Clinical Evaluation Environment or Work-related Disorders Allergic disorders Irritant effects Intoxications Personal Health Conditions Metabolic-endocrine disorders Autoimmune diseases Neurological disorders Psychosocial Factors

    37. 2/1/2012 Institute of Medicine, 1988 37 Confirmation of Diagnosis of Illness from Exposure to Toxic Substance Are the subjective and objective findings explained by the suspected exposure? Is the chronological sequence appropriate? Is there confirmation of the exposure and quantification of the dose? Are there any other explanations for the illness?

    38. 2/1/2012 VA Knowledge Network Broadcast (03/02) 38 Management of IAQ Complaint Document disease Document exposure Document association (or lack of) Plan intervention Communicate Evaluate effectiveness Follow up

    39. 2/1/2012 39 Suggested Management for IEI Validate symptoms Provide appropriate treatment for organic disease Give physiologic explanation if possible Provide reassurance re diagnostic uncertainty, prognosis and disability Trial removal from biologically significant exp Trial of cognitive behavioral therapy Address coexistent psychosocial problems

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