NOVA unravels baffling cases of bad air in buildings all over the world. Even hospitals are on the "sick building" list – along with offices, schools, homes and just about any enclosed space.
Category
📺
TVTranscript
00:00Tonight on NOVA.
00:03Within about four hours of being at work, I just was covered with a rash.
00:08Sick building syndrome.
00:10I kept saying, what is wrong with me?
00:12Could you be at risk?
00:14The place smelled like vomit, and I wouldn't work in the building.
00:18Follow our cameras behind the scenes for a glimpse at what may be lurking in the air you breathe.
00:24I can't do this anymore. I just can't do this.
00:27Can buildings make you sick?
00:29Funding for NOVA is provided by Raytheon.
00:43Through sophisticated satellite imaging systems, Raytheon will help to preserve the Amazon Basin's natural resources.
00:51Raytheon. Expect great things.
00:55And by Merck.
00:58Pharmaceutical research.
01:00Improving health.
01:02Extending life.
01:03Merck. Committed to bringing out the best in medicine.
01:07Major funding for NOVA is provided by the Corporation for Public Broadcasting
01:12and by annual financial support from viewers like you.
01:20The contemporary skyline is marked by towering buildings.
01:24Each a self-contained, carefully controlled environment.
01:28The modern air-conditioned towers should be an ideal place to work, tailored to human comfort.
01:41But now people are discovering that their familiar surroundings are not as benign as they appear.
01:47Behind the walls and ceilings of high-rise offices, local government agencies, and even hospitals, there is a mysterious threat that no one yet understands.
02:03You or I shouldn't have to worry about the hidden life of a building, but as an occupant, sometimes you start noticing the dirt that's around the air diffuser or the water stain on the tiles.
02:17Or maybe you start picking up these strange odors that are wafting through the building and your sensory awareness says, gee, something isn't right here.
02:27Something wasn't right at Norfolk House, a local government agency in Northern England.
02:32When the employees moved in, instead of enjoying their new surroundings, they complained that the building was making them ill.
02:45Buildings like this are commonly called sick buildings, but no one here could figure out what might be causing so many puzzling symptoms.
02:54Two doctors were asked to investigate, Sherwood Burge and Alistair Robertson.
03:05Yes, there we are.
03:06These are the right ones?
03:07Yes.
03:08Good morning, Gordon Craig.
03:10Good morning, Sherwood Burge and Alistair Robertson.
03:12Good morning.
03:13For several years, these doctors have been part of an international research effort to examine health problems that may be caused by modern buildings.
03:21It's about six years ago now.
03:23In sick buildings like this, the reported symptoms are relatively mild, but widespread.
03:29The definition of sick building syndrome is basically a whole lot of very common complaints, which are much more common in some buildings than others,
03:38and which get better when people go away from that building.
03:41And the commonest complaints are feeling very tired and sometimes getting headache.
03:45And the headache is often across the forehead here and behind the eyes.
03:49And it's certainly not typical of migraine.
03:52Burge's first step is to interview some of the victims.
03:55In the past 12 months, have you had more than two episodes of dryness of the eyes?
03:58Yes.
04:00Do you have this on most days, most weeks, most months or less often?
04:03Most days.
04:05Did this first start or become worse since starting work in this building?
04:08Yes, it first started when I came to this building.
04:11I've not suffered having had contact lenses for 10 years before that.
04:14Have you had more than two episodes of lethargy and or tiredness?
04:17Yes.
04:18Do you have this on most days, most weeks, most months or less often?
04:23Most working days.
04:24How long after coming to work do the headaches usually take to start?
04:28A couple of hours.
04:30How long after leaving work does it usually last?
04:33It wears off within a couple of hours.
04:36These interviews seem to provide conclusive evidence that the building is to blame.
04:41But it may be the subjects are describing symptoms they think the doctor wants to hear.
04:46This classic trap is called the Hawthorne effect.
04:49The Hawthorne effect is where people behave in the way that the investigator wants them to behave
04:55because of the presence of an investigator.
04:57And this could have been one of the factors in sick building syndrome
05:01because people were investigating the workplace
05:03that could have directed the attention of people towards their workplace.
05:07So that there could have been a Hawthorne effect.
05:09Alan Hedge worked with Burge and Robertson to design a self-administered questionnaire.
05:15All right. Yes, sir.
05:17It is now a standard tool in sick building investigations.
05:21We ask about ten symptoms.
05:23First of all, eye symptoms, dryness of the eyes and watering of the eyes.
05:27And we ask specifically whether these symptoms have occurred more than twice in the past twelve months
05:32and whether the symptoms get better on days away from work.
05:34And it's by asking that sort of question that we work out whether they're work-related symptoms or not.
05:39When the questionnaires were analysed, it was clear.
05:42Norfolk House had some real problems.
05:45Seventy-nine percent of the employees suffer from lethargy at work.
05:52Sixty-six percent from headache.
05:55Sixty percent from nose and throat symptoms.
05:58And fifty percent had trouble with their eyes.
06:02Overall, a staggering ninety-four percent reported one or more symptoms that occurred only at work.
06:09Yet to all appearances, the building seemed perfectly normal.
06:13There was no obvious cause of ill-health.
06:15The doctors decided to look at an earlier investigation.
06:18The case of the two Five Ways buildings in Birmingham.
06:24Five Ways House is a rather drab office block built in the 1950s.
06:29Connected to it by a walkway is Five Ways Tower, a modern air-conditioned building.
06:35They both contain government offices with staff doing similar jobs.
06:40The really interesting finding in that study was that the symptoms people reported varied by the kind of building people were in.
06:47Sick building symptoms were three times higher in the air-conditioned Five Ways Tower.
06:52Which led us to believe that it was something in the ventilation system of the buildings that was causing the problems people were reporting.
06:58The older Five Ways House was in fact the healthier place to work.
07:03Its major physical difference is it has windows that opened.
07:07It is naturally ventilated.
07:10Outside wind pressure makes the air circulate inside.
07:13Air also rises as it is warmed.
07:17In contrast, Five Ways Tower has sealed windows isolating it from the outside.
07:23The interior is fully air-conditioned.
07:26A central air-handling unit under the roof draws air into the building.
07:32Within this unit, the air passes through filters and then through heating and cooling coils.
07:38Sometimes a humidifier is used to spray water into the air to raise the humidity.
07:45The conditioned air is distributed through duct work.
07:48And stale air is extracted and expelled.
07:54To save energy, a portion of this exhaust air is sometimes recycled through adjustable dampers.
08:01Energy efficiency was a major concern when Norfolk House was designed in the late 70s.
08:06Like Five Ways Tower, it was constructed as a tight building.
08:10Its walls and windows sealed so that any air entering the building passes through the ventilation plant.
08:20Sick building syndrome most often strikes buildings with air conditioning.
08:26But not every air-conditioned building has a problem.
08:30I think that one of the great classical definitions of air conditioning was that it would provide within the building
08:35the conditions on a warm spring day.
08:38You might feel that that's somewhat optimistic.
08:40But it was that sort of a definition.
08:43The two normal causes of failure were one, that the system was never properly commissioned.
08:48Or indeed during the design of the building, the design of the system was altered to cope with alterations in design of the building.
08:55And therefore mistakes were made.
08:57And thirdly, when the building was fitted out, when it was occupied, air inlets and air outlets were covered over with full ceilings.
09:06Furniture was put in positions where it was never intended.
09:09People, if you like, sat in positions where they were never intended.
09:12The space planners got to work and started cramming the people in.
09:16Perhaps at a higher density than the buildings were intended for.
09:20It was a combination, I think, of those sort of effects.
09:27This building was never designed to accommodate as many employees as ended up working here.
09:33As the numbers grew, the space was rearranged to fit everyone in.
09:38Could a source of the problem simply be an inadequate air supply?
09:42That's where we have the main heat loss.
09:44A ventilation expert was brought in to help.
09:47There are variable air volume units, such as the white ones you see.
09:51Philip Jones is from the Welsh School of Architecture.
09:54The air finally for suppliers.
09:56His first impression was that something indeed was amiss.
09:59At the moment it looks as though we've got some areas where there are high velocities and complaints of draft.
10:07In other areas the supplier seems to have been closed down somewhat and we get very low velocities and possibly then complaints of stuffiness.
10:17It's early to tell yet because we've only just started the measurements.
10:22To get more precise measurements, they brought a set of sensitive air movement and temperature probes.
10:28Space to move it around.
10:29Okay.
10:34One of the first steps is to measure how the carbon dioxide, exhaled by the people working here, builds up during the day.
10:45This will show whether enough fresh air is being pumped in.
10:50After several days, the results are analyzed.
10:54Through the week, the temperature is between 19 and 22 degrees Celsius, 66 and 71 degrees Fahrenheit.
11:01This meets the accepted standards.
11:04The relative humidity is also stable at about 35%, slightly dry but not excessively so.
11:13The carbon dioxide measurements are high, 900 parts per million, suggesting the air is getting quite stale.
11:20But aside from the CO2, could there be other substances in the air causing people to react?
11:35A clue comes from a strange condition known as humidifier fever.
11:41Humidifier fever is a flu-like illness, which in its most severe form is associated with quite mild breathlessness.
11:51It's normally seen in an industrial setting such as a printing works.
11:56Because paper shrinks if it gets too dry, humidifiers are used to raise the moisture content of the air.
12:02But whenever they were in use at this factory, people began to feel ill.
12:09The problem started having had a weekend away from the factory and on the Monday afternoon, mid-afternoon, almost without question, we got aching limbs and feeling very tired.
12:23By the time you got home in the evening, this developed into a severe flu symptom.
12:29A physician specializing in lung disease, Dr. Tony Pickering was called in to investigate and advised them to change their humidifiers.
12:38This is the type the factory used to have.
12:41The water is drawn from a reservoir contained within the machine.
12:45Hidden from view, the stagnant water was a perfect breeding ground for microorganisms.
12:50You find a whole variety of bacteria, dusts, fungi, insects, amoebae.
12:59We know that the cause lies in the water because if we get affected individuals to inhale that water,
13:06we're able to reproduce their symptoms in exactly the same form as they experience at work.
13:12The factory then installed new humidifiers without a water reservoir.
13:17The system we have now runs directly off the mines.
13:21There's nobody in the factory that has had any problems since the system's been installed.
13:26Humidifier fever occurs mainly in factories, but it's suggested that common microorganisms in the air can make office workers ill.
13:36Back at Norfolk House, another team has arrived to investigate whether microorganisms could be the culprit.
13:43This equipment will be left to sample the air, absorbing any contaminants that come floating by.
13:57It'll be analyzed later to see if it catches anything harmful.
14:02A bit of low-tech housecleaning picks up dust which may have settled out of the air.
14:10Some people are allergic to dust mites, tiny creatures that feed off human skin cells.
14:16It is actually their excrement that is the allergen, the cause of the allergic reaction.
14:23To see if there's any in the vacuum cleaner dust, there's a handy kit to do a spot check.
14:28It shows almost none here.
14:31That idea is dismissed.
14:34The dust is also examined for irritating particles such as fiberglass.
14:41They find low levels of these microscopic cellulose fibers from paper.
14:47But not any microorganisms.
14:52They look next at the humidifier in the air conditioning plant.
14:56The reservoir is the most likely place for the microorganisms to be found.
15:01All types of reservoirs are now doused with biocides to prevent microorganisms from growing,
15:07including the lethal bacteria which causes Legionnaires' disease.
15:12An airborne microorganism count will show how affected this treatment has been.
15:17This device blows air over a nutrient gel.
15:22Any fungi or bacteria will stick to this gel and grow to form a colony.
15:30A week later, the results are ready.
15:34The culture strips have been incubated and the colonies can be counted.
15:39Each dot marks a fungal or bacterial colony and the machine adds them up.
15:55Overall, there are fewer growths than would be expected in an office with so many people.
16:07It would seem from these results that many assumptions were wrong.
16:12Dust and microorganism levels are lower than average and provide no explanation for the high level of sick building symptoms.
16:19The medical opinion from Dr. Tony Pickering confirms this view.
16:28Following his work on humidifier fever, he has been researching air pollution in sick buildings.
16:34We've just recently completed some work looking at 15 buildings of which four were naturally ventilated
16:42and the remainder were a mixture of mechanically ventilated and air conditioned buildings.
16:46Each building was assessed in terms of its sickness and then measurements were made of bacteria, fungi and airborne particulates.
16:55His results show that in naturally ventilated buildings, symptoms are low but levels of microorganisms and airborne dust are high.
17:08With air conditioning, the environment is cleaner with low levels of microorganisms and dust but higher levels of symptoms.
17:17I think that they effectively rule out bacteria and fungi and airborne particulates on their own at any rate as being a cause of the symptoms that people experience in air conditioned buildings.
17:33Another surprising contrast between air conditioned and non-air conditioned offices emerged when scientists re-examined Five Ways Tower.
17:42We found that all workers disliked fluorescent lighting but that those people in the air conditioned building disliked it more than those in the naturally ventilated building.
17:51And I think this is for a number of reasons.
17:53Firstly, the amount of daylight getting into the air conditioned building was considerably less than the naturally ventilated building and that leads to a problem with glare.
18:01And the level of the ceilings in the air conditioned building was lower than the natural ventilated building and therefore the fluorescent lights were much more within the line of sight in the air conditioned building.
18:12Norfolk House doesn't have low ceilings but the fluorescent tubes are exposed and the employees find the lights harsh.
18:24Arnold Wilkins, an illumination expert, believes lighting may be a key factor.
18:34Thoracent lighting along with other forms of gas discharge lighting fluctuates in brightness continuously twice with each cycle of the AC electricity supply.
18:45So that in Europe it's pulsating 100 times a second and in America 120 times a second.
18:51Now these pulsations are far too rapid to be seen as flicker but they can be registered electronically.
18:58I have here a photodiode and if I turn the screen on and direct the photodiode at the tube you can quite clearly see the waveform the tube generates.
19:09It's varying in brightness between a maximum and about 60% of that maximum 100 times a second.
19:17If one looks through a shutter spinning slightly faster than the rate of fluctuation the whole interior space of Norfolk House can be seen to be pulsating.
19:30This normally happens 100 times a second considered too fast to be recorded by the human eye.
19:37But Arnold Wilkins suspected that this assumption was wrong.
19:41He decided to experiment using a new kind of fluorescent light.
19:50Instead of the conventional pulsation of 100 times a second, high frequency units pulsate 20,000 times a second.
19:59He compared these two types of light to see if the human eye performed differently under high and low frequency illumination.
20:06I'm going to ask you to just read a passage of text here.
20:13For example, a corporal in the army wears two stripes on his sleeve and a sergeant wears three.
20:18When we read, the eye makes a series of rapid jerks from word to word.
20:23Pulsating light might disrupt the accuracy of this movement.
20:27I just want you to bite on this bar to keep your head really still.
20:31No.
20:32Okay.
20:33Are you getting in a comfy position?
20:34Is that right?
20:35Mm-hmm.
20:36Now, these are the glasses that measure your eye movements.
20:44These glasses have small infrared sensors attached to them.
20:48That's right.
20:49The subject is asked to scan between two words on the page at a given cue, and the size of the eye movement is measured.
20:56First, the conventional tube, pulsating at 100 hertz.
21:06And now, the high frequency tube.
21:09Under conventional low frequency lighting, the movements were slightly longer.
21:17It suggested that the pulsation was causing the eye to overshoot the target.
21:22This could be causing eye strain and headaches.
21:27Wilkins decided to test his theory in a real office.
21:31For the trial, he secretly switched the lighting between low and high frequency,
21:36and asked the office staff to record the number of headaches they had.
21:40Under the high frequency lighting, the number dropped by half.
21:45But could lighting alone explain the problems at Norfolk House?
21:51I think the answer is probably going to be looking at the total load on an individual.
21:57That's both the total environmental load and the total occupational load.
22:01You might call it the total stress load on a person,
22:04where what you have to consider are the chemicals in the building,
22:08the thermal conditions in the building, the acoustics in the building,
22:12the lighting in the building, and also the work that people are doing
22:16and the nature of that work and how stressful it is.
22:19Investigators are now convinced that for Norfolk House,
22:23sick building syndrome cannot be attributed to a single cause.
22:27People vary enormously in their sensitivity.
22:30Some are affected by inadequate ventilation.
22:34Others by artificial light.
22:37Social and psychological stress can increase the level of reported symptoms
22:41until it is significantly higher than in other buildings.
22:45It is this combination of factors that makes the building sick.
22:49In the United States, where constructions of steel and glass have been elevated to an art form,
23:05indoor air quality is now a major public issue.
23:08Building managers are looking into their ventilation systems with concern.
23:14Real mess.
23:16Okay, we've got excessive rust here on the chill coil frames.
23:20I would say that the frames are getting ready to fall apart and drop the coils on the floor.
23:30The humidifier reservoir is dry.
23:34Large pieces of rust in the reservoir itself.
23:40This is bound to be adding to the particulate levels of the supply air being supplied to the occupied areas of the building.
23:46See if I can find a duct here?
23:50Yep.
23:51I think there's one up here, Greg.
23:53Got the drill?
23:54State-of-the-art techniques using endoscopes are available for more in-depth investigation.
23:59These tools are exposing many badly maintained ventilation systems.
24:04Quite a bit of debris on the turning veins.
24:07And a large piece of paper.
24:09This anatomical view of a ventilation duct is probably not for the squeamish.
24:20It is teeming with mold, fungi, dust and insects.
24:24Or worse, all wafting pollutants into the circulated air.
24:32Any problem resulting from poor maintenance can often be made far worse by crude attempts to conserve energy.
24:39We've got 100% recirculation on this unit, Dennis, with the fresh air dampers closed and the return air dampers open all the way.
24:49To save money on heating and cooling costs, building managers recirculate as much air as possible.
24:55But finding the right balance between fresh air, recycled air and energy costs is not easy.
25:08Today, even newly constructed offices can find themselves with air quality problems.
25:14As the state of Massachusetts was surprised to discover.
25:17Just how bad is the air inside the new Registry of Motor Vehicles building in Roxbury?
25:22An employee union says it's bad enough that they're demanding Governor Weld to evacuate the building immediately.
25:29The problems began the day the Registry of Motor Vehicles moved into this new building in April 1994.
25:36I've been coming to work, you know, to do my job and I've been getting sick.
25:42You get severe headaches, dizziness. Your scanner's tight and dry. My throat is dry.
25:49And we have headaches at least five days a week.
25:52Most employees continued to work despite their symptoms.
25:56But when samples indicated high levels of latex in the air, the sixth floor had to be evacuated.
26:02Six months after the building opened, 51% of employees had health complaints and desks were emptying out.
26:10With few clues as to what was happening, frustrated employees asked for assistance from their congressman, Joe Kennedy.
26:22How many of you are uncomfortable with going back into that building today?
26:25You all are.
26:27You all are.
26:28But the problems only seem to intensify.
26:31I have actually had people who have quit and left due to the conditions of this building.
26:37And under normal circumstances, they loved the job, they would not have left, but have found for themselves that they could no longer tolerate it.
26:47As the number of sick workers increased, registry officials began systematically tracking all of their symptoms.
26:54The sheer volume was staggering.
26:57But more important, the complaints were consistent throughout the building.
27:02It was time to seek help from the Department of Public Health.
27:06At that point in time, I sent two of our regular indoor ear staff, monitoring staff, over to do a preliminary walkthrough and evaluation.
27:18And I recall them coming back to me and saying, Suzanne, this is different.
27:25What had changed was the appearance of severe illnesses, like occupational asthma.
27:32The registry hired Dr. William Patterson, an occupational health physician.
27:39That's the total amount of air in your lungs.
27:41He began charting the breathing patterns of employees with asthma to determine if their condition was worsening as they worked in the building.
27:50As a physician, I worry about the people here.
27:53Most physicians and even most laypeople think about occupational asthma as being related to chemicals in the workplace.
28:00And that usually is where you see it.
28:03Chemical factories, where they may be exposed to isocyanates, for example.
28:07Electronics factories with solder or bakeries.
28:10It's actually quite uncommon to have outbreaks of occupational asthma in an office building.
28:16At the same time, the registry started to investigate the building, beginning with the ventilation system.
28:23Consultants, including Joseph Striebeck of Building Sciences Corporation, suspected there were flaws in the way the system handled outside air.
28:38Now, that air from the outside is introduced into a space just below the ceiling.
28:47And this space is a mixing box that we call a plenum.
28:52The bottom of this mixing box is the drop ceiling tiles.
28:56So the outside air from the roof is taken and dumped into this space.
29:01The outside air mixes with the air already in this chamber.
29:06And then heat pumps pull it into the work area below.
29:09But this system had problems.
29:11The air could pick up any contaminants in the space.
29:14And the outside air was too humid for the system to handle.
29:20And any school child will tell you if you take hot, humid air and you cool it down, you're going to get condensation.
29:32Well, all of that humidity caused all kinds of odor problems to occur with the ceiling tile and the heat pump units themselves.
29:44The ceiling tiles are made out of cellulose, perlite, a clay filler, and one of the cheapest industrial adhesives known, which is starch.
29:55Well, when that ceiling tile is exposed to a high humidity, the starch ferments.
30:01And the fermentation byproduct of starch happens to be butyric acid.
30:07So the place smelled like vomit.
30:10To lower the humidity of the outside air, the landlord installed a large air conditioning unit called a chiller.
30:19But its effectiveness remained to be seen.
30:22It needed to be tested throughout the humid summer.
30:28Excessive humidity seemed to explain the intolerable odors.
30:32But what about the health complaints, such as skin irritation and asthma?
30:38Registry officials feared there might be something else in the plenum causing problems.
30:47The undersides of all the structural beams were coated with the commonly used fireproofing material.
30:53And some of it appeared to be eroding into this space, the air supply for the entire building.
30:59This substance was also highly irritating, as investigators discovered when they sampled it.
31:06When we sent the samples off to the Harvard School of Public Health for analysis, the scientist who did the analysis on the samples also got a rash.
31:18And she had never been in the building.
31:21It was pretty obvious to me at that point in time that the fireproofing was the likely culprit.
31:30Further testing showed that the fireproofing was literally coming through the ceiling.
31:36When investigators micro-vacuumed surfaces throughout the office, they found the fibers everywhere.
31:43I don't believe that it's a carcinogen because the fibers in the particles aren't small enough to get into the lower respiratory system.
31:53But it's not a happy state of affairs.
31:56I know from my own health effects, I was stuffed up for many hours.
32:01I had a headache.
32:03My eyes were puffy and watery.
32:06And I had a rash.
32:07And I can tell you, it wasn't fun.
32:10And I wouldn't work in the building.
32:12But hundreds of employees were working in the building, pushed to the breaking point.
32:22I think I've had it.
32:24I think I'm going to ask for a transfer.
32:26I think we're just hanging in there and hoping that they're going to rectify the situation here.
32:33But it's been almost a year and it is making it more difficult.
32:37I just know that I'm feeling like I can't be effective anymore.
32:42After arduous negotiations, plagued by endless bureaucratic delays,
32:46the building's developer finally agreed to make some changes to the ventilation system.
32:55His plan would install ducts to isolate the fresh air from contaminants in the plenum.
33:01But it would not treat the eroding fireproofing material.
33:06To implement these repairs, modular units had to be brought to the site.
33:15They would house the staff temporarily while the ventilation system was being rebuilt.
33:21But none of this ever happened.
33:23At the end of June, approximately 80% of the employees reported symptoms.
33:29The Department of Public Health ordered the building to be evacuated.
33:33We hope to have the majority of the people located by the end of July
33:38and perhaps another 30 days to relocate those people to work within the data center.
33:43On July 31st, 1995, after 15 months of debate, the building was closed.
33:50It's long overdue. Overdue. And a lot of people have been getting sick for a long time.
33:57And it's just about time.
33:59Ironically, the registry employees returned to the very same dilapidated quarters they had left little more than a year before.
34:07Once the pride of an inner city neighborhood, the new building now stands vacant.
34:15It is an open question whether it will ever be occupied.
34:19And who will pay the millions to fix it will be decided by the court.
34:22This is the headquarters of the EPA in Washington, D.C.
34:32A place you would think would be free of sick building contaminants.
34:37But the EPA had its own problems.
34:39We had a major renovation and thousands of square yards of new carpeting were installed.
34:51And as a result, 60 people got sick and about 10 had to be hospitalized.
34:58Some of them with quite serious symptoms such as loss of voice, extreme fatigue, debilitation and that sort of thing.
35:05It was assumed that volatile chemicals from the new carpet materials were to blame.
35:13Tests show that fumes are released from these products when they're new.
35:17Could pollution levels at the EPA have exceeded the safe exposure limits?
35:23Oh, heavens no. They were in the low parts per billion range.
35:26And that's what astounded everyone that such small quantities of chemicals could produce such large reactions in so many people.
35:38I think mainstream medical opinion today would tell you there's no evidence that such low concentrations will cause adverse reactions in people.
35:46However, I think a moment's consideration will tell you that people differ in their response to environmental stimuli by many orders of magnitude.
35:56And some people are going to react at extremely low concentrations.
35:59And I think this is what we're seeing in many of these sick building episodes.
36:03And surprisingly, some of the most puzzling episodes are turning up at hospitals all across the country.
36:12I had worked a long weekend, a Friday, a Saturday and a Sunday night.
36:17And there were three nurses working and a nurse's aide and all three of us were sick.
36:21We all had chest pain, shortness of breath, very bad headaches, sinus pain.
36:25We were exhausted. We felt awful, very, very bad. But we kept coming back. We had to come back.
36:32Our patients needed us. We went back to work. And for three nights, we were very sick.
36:36And Monday morning, I went to employee health and said, I can't do this anymore. I just can't do this.
36:42At Brigham and Women's Hospital in Boston, mysterious symptoms were suddenly sending many employees off the job.
36:48The largest number of complaints seemed to be coming from operating room personnel.
37:02The situation worsened through the winter of 1993.
37:08Brigham and Women's, a Harvard teaching hospital, became alarmed when the number of serious complaints rapidly escalated.
37:14In July, they closed down five operating rooms and called in an environmental consultant.
37:22They'd had a number of people that had developed rashes, that had experienced various types of allergic reactions.
37:29They had a wide variety of reports that were being made in the operating rooms under different shifts and under different circumstances.
37:36So we were brought in really to start looking at specific causes that could be really contributing to the potential exposures that people may be having.
37:45It took months of effort to check out an enormous number of potential culprits.
37:55This required a thorough look at anything and everything brought into this sterile world.
38:00After a series of investigations which involved looking at particulates in the air, looking at all of the chemicals that are used in the workplace, looking at the equipment, and looking at the glove products, we identified that for a number of employees, latex allergy was the primary source of the exposure causing them problems.
38:26The presence of latex has increased dramatically in the last few years.
38:32Along with AIDS has come a staggering rise in glove use.
38:36So much so that manufacturers took shortcuts to keep up with demand.
38:45Speeding up the rinse cycle prevented the latex allergen, a rubber tree protein, from washing off the gloves.
38:51The hospital's investigations showed unexpectedly that the source of latex exposure was not just from skin contact.
39:08It turns out when gloves are removed, latex particles are released into the air and drift down onto exposed surfaces.
39:15And once you understood that, you then had to institute a very rigorous cleaning program.
39:20And that was really done for all the materials, all the cots, all the beds that are used, all the gurneys that are carried up and down the hallways and the OIs, as well as the walls and the areas above the ceilings.
39:33It took weeks of meticulous effort to remove the latex allergen from this unit.
39:42But the hardest task was making sure this allergen would not be reintroduced.
39:48Most hospitals could use as many as ten different brands of gloves in their operation, from exam gloves to surgeon's gloves to procedure gloves, all different kinds of gloves.
39:59We took this step that outlawed basically all kinds of gloves except for the ones that we felt were the very absolute lowest in latex.
40:07It was a tough step for us to take. It was a tough move just to get the other ones out of the institution.
40:12That was a few hundred thousand dollars of new expense that we had to bear because of the situation with latex.
40:18The latex was a huge issue that I think hit the fan overnight to us as well as other hospitals.
40:33Brigham and Women's was widely recognized for its efforts to control latex.
40:37The operating rooms reopened.
40:44Yet the hospital was soon to discover that the latex allergen was not the only problem.
40:51Despite several test reports showing that the ventilation system was meeting all current environmental guidelines,
40:59employees in other areas of the hospital, including many nurses, were becoming ill.
41:04I went to work one morning and within about four hours of being at work, I just was covered with a rash.
41:13My face, my neck, my arms. I didn't know what it was.
41:17I am definitely allergic to latex, but I hadn't been near any latex.
41:23I don't wear the latex gloves anymore and hadn't for some time.
41:25I was having numbness in my extremities that I found out later was, went along with a lot of other symptoms that I was experiencing.
41:35And I was short of breath. I was having, the chest pain was actually my airway reacting to whatever chemicals I had been exposed to.
41:43By January, I had had three episodes of bronchitis and three trips to the physicians.
41:50They put me on antibiotics.
41:52They had increased a steroid inhaler.
41:54They had given me an epinephrine pen.
41:57But I still had shortness of breath at work.
41:59I'd also started developing rashes on my forearms.
42:01I had headache. I had a lot of GI symptoms.
42:03I would be fine one minute and the next minute my throat would be on fire and I would feel like I couldn't swallow.
42:11And I kept, I kept saying, what is wrong with me?
42:15You know, I kept wondering, do I have cancer? Do I have some, some terminal disease? Do I have AIDS?
42:22Why am I getting so sick all the time?
42:25Over 47 nurses were placed on disability leave, no longer able to work in the hospital's environment.
42:31One nurse who remained at work was Denise Garlick.
42:36She suffered from recurring hives and breathing difficulties and decided to take a short leave until she could see a specialist.
42:46I went to see the occupational health physician three weeks later.
42:50In the course of that three weeks, while I had been out of work, I had had two more episodes of hives.
42:55I had had an episode of angioedema where I got massive swelling of my throat and of my face and of my lips and my voice changed.
43:06My husband and I sat up through that night because, of course, I was aware that at some point I could have such difficulty breathing that I would not be able to breathe.
43:14And I then returned to see the allergist. Needless to say, at that point he gave me an EpiPen because each reaction I was having was more severe.
43:27It was hard to tell where this was going to stop.
43:31After extensive testing, doctors were finally able to find what was causing Denise so much difficulty.
43:42Normally, when a foreign substance enters the body, the immune system quickly responds.
43:48Certain blood cells manufacture antibodies to defend against invaders.
43:55If the invader is an allergen, the antibodies called immunoglobulins precipitate a range of symptoms identified as an allergic reaction.
44:06It is these immunoglobulins in Denise's blood that establishes the diagnosis of an allergy.
44:12She is allergic to glutaraldehyde, a sterilizing agent commonly used in hospitals.
44:19It's somewhat ironic that a hospital which is dedicated to public health and to improving people's health problems could be the source of other kinds of problems.
44:27Obviously, sanitization and keeping the hospital germ-free involve using a number of chemicals, biocides and other chemicals, which in fact could be causing chemical sensitivity.
44:40Hospitals are veritable chemical factories.
44:44There are an enormous number of chemicals which are used in laboratories, in therapies, in medicines, in operating theaters.
44:52The chemicals are endemic to the hospital setting.
44:58Brigham and Women's began searching for new ways to minimize exposure to all kinds of chemicals.
45:03Workers began pouring cleaning disinfectants instead of spraying them whenever possible.
45:15This would maintain the same level of germ control while preventing the cleaning agent from getting airborne and into the ventilation system.
45:21To reduce the use of glutaraldehyde, they began sterilizing some equipment with hydrogen peroxide, a more benign disinfectant.
45:34And for certain equipment that needs more intense treatment, they completely enclosed the sterilization process and expelled the fumes directly outside.
45:48Environmental consultant John McCarthy installed sensors to monitor the presence of chemicals in the air.
46:01A central computer would warn the staff of any elevated levels.
46:04These efforts to eliminate airborne chemicals far exceed any legal requirements.
46:12But could existing guidelines be inadequate for such a complex environment?
46:17Regulations are a very good place to start.
46:21What you want to be able to do is meet that as kind of your basic achievable requirements.
46:25However, what you have to look at is, is it really meeting the demands of each specific area?
46:32Each area in which a person is as a microenvironment.
46:36And that's what you need to understand in order to really understand potential exposures that the people may have.
46:41This also becomes very important as you start thinking of the ventilation system that exists in a hospital.
46:46Is that doing the job you want it to do?
46:47It may be meeting all the codes and all the specifications that are laid out for it.
46:52But is it really impacting the individual's microenvironment as you would want it to?
46:58The hospital as a whole was making an effort to address these environmental concerns.
47:03But were there individual treatment areas where chemical exposure was still a problem?
47:09Some nurses felt they did not have adequate information to understand the warning signs.
47:15I did not know that hand rash and sinus symptoms could cause for me to cross the threshold to angioedema,
47:23which is what those symptoms are called.
47:25And I did not know that I would now be living in isolation.
47:28I did not know that the people that went out on air quality a year or months before me were living in isolation.
47:34And I feel that if I had known that, quite possibly if I was put out of the environment,
47:39I may not have crossed the threshold to where I am now.
47:41Once an active person who could do anything, Marie Mannion's world has shrunk dramatically.
47:49She is now convinced she and many of her colleagues suffer from a new and little understood syndrome called multiple chemical sensitivity.
47:56This syndrome is thought to proceed through a two-step process.
48:03The initiating event usually comes about as a result of a chemical exposure.
48:09It can be a one-time exposure to a sensitizing chemical, like a neurotoxin, like a pesticide.
48:15Or it can be continuous exposure to moderate levels of that particular substance.
48:19And the hypothesis is that this sensitizing chemical may affect the brain.
48:27But what the brain might do with this information, and how it might impact the rest of the body, is barely understood.
48:34But no matter what the mechanism, Marie's life has been irrevocably altered.
48:42Marie and others like her are so sensitive that they can't walk down the aisle of a supermarket,
48:50lined with common brands of household products.
48:52She cannot enter a clothing store where plastics and synthetic materials give off fumes.
49:00She can no longer wear cosmetics without fear of having a violent reaction.
49:05It is as if our man-made environment has turned against us.
49:09The human body has evolved to cope with its environment over millions of years.
49:14And yet, in the span of one and two or three generations, we have created new compounds, new chemical formulations,
49:24that have never existed in nature before.
49:27And we find these things in our foods.
49:30We find them as pesticides.
49:32We find them in plastic formulations.
49:35All sorts of new chemical formulations that have never been present before.
49:38One has to wonder whether there are effects in our immune system, in our endocrine system, in our nervous system,
49:47that we have no natural analog for.
49:51In other words, the body doesn't quite know how to handle these chemicals.
49:56The blood from a chemically sensitive person does not always have the tell-tale marker usually associated with allergies.
50:02This makes it difficult for doctors to diagnose chemical exposure as the basis of a patient's symptoms.
50:12And their participation is key.
50:15Physicians are taught in medical schools that the more symptoms that a patient complains about,
50:21the more you should be inclined to regard the problems as psychogenic.
50:25And here we have patients whose problems seem to get worse and spread as the physician attempts to treat them.
50:32The process is complicated.
50:33One has to understand the multiple effects that a chemical can have on the system.
50:38With research on chemical effects still in its infancy,
50:43doctors at this time can only recommend that people who appear sensitized avoid the environments that make them ill.
50:50For some of the nurses at Brigham and Women's, this has meant giving up their lifelong careers.
50:56I have been a nurse for 18 years and I've worked on the labor floor for 14 years.
51:02But I think I've come to the decision that I have to leave work.
51:06I don't want to do that.
51:08I love what I do.
51:10It's a very happy place.
51:12I take care of women in labor.
51:14It's a great job.
51:16And I don't want to leave.
51:17The hospital is, of course, very concerned about anybody who's not able to return to the environment.
51:27There is a rehab process set up for them if they elect to pursue further education or other careers or anything that they would really like to do at this point.
51:39The hospital is prepared to support them.
51:42But for the nurses, these official efforts are not enough.
51:47More than 50 hospital employees have filed lawsuits seeking compensation for their ill health.
51:56These nurses claim that increasing numbers of their co-workers are also ill.
52:01And they now have concerns about the health of their patients.
52:03None of our experiences today indicate that any patient has been affected by any of this environmental issue.
52:12And that we've gone to great pains in all of our efforts as we improve the environment.
52:19That we've not interrupted patient care in any way or interfered with patient care in any way.
52:24In light of these experiences, Brigham and Women's has been forced to make indoor air quality a top priority.
52:31Now in the midst of a large expansion project, the hospital has hired an environmental consulting firm to oversee construction of the new ventilation system.
52:43No decisions are made without input from both hospital management and environmental specialists.
52:52At the same time, the hospital is involved in a multimillion dollar upgrade of its existing ventilation system.
52:58Attention is focused on avoiding the problems of the past.
53:05The indoor environment of a skyscraper is a fragile equilibrium.
53:12Sick building symptoms can come about suddenly by changes as basic as rearranging interior office space.
53:19A promising approach for the future is to consider air quality from the earliest stages of design to final construction.
53:30The indoor environments we have created are taking their human and economic toll.
53:37Evidence is mounting that it simply doesn't pay to compromise the air we breathe.
53:44Educators, educational institutions and organizations can purchase this and many other NOVA programs for $19.95 plus shipping and handling.
54:00To order call 1-800-255-9424.
54:07An M8-138-24.
54:15An M8-133.
54:17An M8-131.
55:50Next time on NOVA, a passenger jet with .47 on board crashes into a remote jungle.
55:57In just seconds, a routine flight turns into tragedy.
56:02Investigators pick through debris spread across several miles.
56:05Look at this piece here, guys.
56:07Why did this plane fall out of the sky?
56:10Can they find the clue to what caused the mysterious crash of Flight 201?
56:14That's next time on NOVA.
56:16For more information about NOVA, visit the PBS homepage on the World Wide Web at www.pbs.org.
56:32For transcripts of NOVA programs, call 1-800-831-9000.
56:38End.