Evaluation of indoor air quality concerns at an outpatient medical clinic in a shared-use building – West Virginia

Details

• Personal Author:
  Boylstein, Randy J. ; Hawley, Brie ; Martin, Stephen B. Jr. ; Mugford, Christopher
• Corporate Authors:
  National Institute for Occupational Safety and Health
• Description:
  NIOSH received a management request to conduct a health hazard evaluation at an outpatient medical clinic in West Virginia. The request cited concerns about indoor air quality in the building. Clinic employees reported nausea, headache, dizziness, confusion, fatigue, burning eyes, numbness of hands and fingers, tingling around lips, metallic taste, itching, and reduced work productivity. We held voluntary confidential interviews with individual employees who wished to discuss their symptoms and concerns in October and November 2014. We learned that employees' symptoms began on or after January 2014. Additional symptoms reported by employees included chest pain, amnesia, difficulty breathing, wheeze, asthma exacerbation, isolated coughing fits at work, paresthesias (a tingling or prickling feeling), taste disturbances, and burning throat. Many employees reported that most symptoms resolved within 1-2 hours of leaving work. We spoke with clinic health and safety management and learned that prior to this health hazard evaluation request, the clinic had been closed and employees had been relocated to another medical center on two separate occasions. In response to employee concerns, air sampling surveys were performed by health and safety consultants after the clinic first closed. The consultants sampled for volatile organic compounds (VOCs), total particulates, elements and metal compounds, carbon dioxide (CO2), and carbon monoxide (CO). No air levels were measured above any Occupational Safety and Health Administration (OSHA), National Institute for Occupational Safety and Health (NIOSH), or American Conference of Governmental Industrial Hygienists (ACGIH) exposure limits
  
  however, measured levels of VOCs and CO suggested that air was potentially being entrained from neighboring businesses into the clinic. As a result of the air sampling surveys, consultants recommended that management (1) seal openings in the firewall to reduce and eliminate air entrainment from neighboring businesses
  
  (2) reopen the air intake for the clinic to allow fresh, outdoor air into the clinic
  
  and (3) modify the heating, ventilating, and air-conditioning (HVAC) systems to ensure a positive pressurization of the clinic relative to neighboring spaces. Subsequently, clinic and building management made necessary repairs to implement these recommendations. However, when employees returned to the clinic, they continued to report symptoms. The clinic was closed a second time, and employees were relocated to another medical center off-site. Consequently, additional HVAC repairs were made and the employees returned to the clinic in early 2015. Despite the repairs made, employees continued to report respiratory and central nervous system symptoms. During an on-site assessment of the facility in March 2015, we collected area air samples in offices and in hallways shared by the clinic with neighboring businesses. We measured area air levels of formaldehyde, CO, CO2, other VOCs, and isocyanates. We also performed an assessment of the HVAC systems in place. We observed that the highest levels of CO, formaldehyde, and many other VOCs were external to the clinic in the adjacent shared hallway and break room and in the plenum space above the adjacent shared break room. Higher levels of CO, formaldehyde, and many VOCs in the shared hallways and plenum space suggests that the source(s) of CO, formaldehyde, and many other VOCs were external to the clinic. No CO was detected outside of the building which suggests that the CO was not from a source outside of the building. Our air samples highlighted several areas of the facility with formaldehyde air levels that approached or exceeded the NIOSH recommended exposure limit (REL). Our air sampling results indicated potential for entrainment of air from neighboring businesses into the clinic, despite the HVAC repairs made as of March 2015. As a result of our evaluation, clinic management decided to relocate the medical clinic to another location offsite.
  
  
• Subjects:
  Air Pollution Air Pollution, Indoor Carbon Dioxide Carbon Monoxide Environmental Exposure Environmental Monitoring Fatigue Formaldehyde Health Care Facilities Workforce And Services Hospitals Humidity Isocyanates Occupational Exposure Occupational Health Respiratory System Safety Temperature Ventilation Volatile Organic Compounds Workplace

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• Keywords:
  Air Conditioning Equipment Air Quality Air Samples Building Ventilation Carbon Dioxide Carbon Monoxide Employee Exposure Employee Health Employees Exposure Levels General Medical And Surgical Hospitals Heating Systems IAQ IEQ Indoor Air Quality Indoor Environmental Quality Medical Facilities Organic Compounds OSHA Region 3 Respiratory Sensory Temperature Effects Temperature Measurement Ventilation Systems VOCs Volatile Organic Compounds Work Environment Workers

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• Source:
  Morgantown, WV: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, HHE 2015-0011-3253, 2016 May ; :1-20
• Series:
  Health Hazard Evaluation Reports (HHE)
• DOI:
  https://doi.org/10.26616/NIOSHHHE201500113253
• Publisher:
  National Institute for Occupational Safety and Health
• Document Type:
  Text
• Genre:
  Field Study
• Place as Subject:
  West Virginia ; OSHA Region 3
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  RHD - Respiratory Health Division
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  28 pdf pages
• Contributor:
  LeBouf, Ryan F. ; McClelland, Tia L.
• NIOSHTIC Number:
  nn:20048001
• NTIS Accession Number:
  PB2016-103289
• Citation:
  NIOSH [2016]. Evaluation of indoor air quality concerns at an outpatient ; medical clinic in a shared use building – West Virginia. By Hawley B, Martin ; S, Mugford C, and Boylstein R. Morgantown, WV: U.S. Department of Health ; and Human Services, Centers for Disease Control and Prevention, National ; Institute for Occupational Safety and Health, NIOSH HETA No. 2015-0011- ; 3253,
• Federal Fiscal Year:
  2016
• Peer Reviewed:
  False
• NAICS and SIC Codes:
  622110 - General Medical and Surgical Hospitals - (NAICS)
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:fe5e490cb1b6e724a50c4276af00200eb692e19712a07edca4a833fe55fe984d613609c39ce6de3ae6ba395ead6e284b99783a345ff91e4c627a50cedb28b383
• Download URL:
  https://stacks.cdc.gov/view/cdc/172413/cdc_172413_DS1.pdf
• File Type:
  [PDF - 1.61 MB ]