1

POST-REMEDIATION GUIDELINES

The lack of a single standard in the mold remediation industry can make answering the question, "How clean is clean enough?" difficult to answer. Experts have widely varying opinions on what is an acceptable level of mold in the air. The following table is a compilation of data from a large number of sources and studies, showing the conclusions of a variety of different scientists and researchers. The different units used in the various guidelines reflect the sample methods used. The unit cfu/m3 stands for "colony forming units per cubic meter of air." This means that the samples taken were viable samples, that is, they measured how many spores were in the air that could grow into colonies of mold. These spores are called colony-forming units. Numbers that refer to "spore counts" or that do not have the "cfu" reference are non-viable samples, meaning that they reflect a count of the total spores in the air, regardless of their ability to grow. Since only a small number of the spores might actually grow, these numbers are much larger than the viable sample numbers.

Date Source Guideline

Berk, et al. • Exposure of20 cfu/m3 to over 700 cfu/m3 with no ill effects

1979 •

Gravesen • 3,000 cfu/m3 Cladosporium, 100 cfu/m3 Alternaria threshold for evoking allergic symptoms

1979 •

Solomon, et al. • Domestic levels ttom 1-6,000 cfu/m3

1984 • Maximum levels usually <1,600 cfu/m3

Holmberg • <2200 cfu/m3 -mold-ttee environment

1984 • 10,000 to 15,000 cfu/m3-surface mold present

Morey, et al. • ≥105 bacteria or fungi/ml stagnant water-investigate 1984 • ≥1000 cfu/m3 -investigate

• ≥106 fungi/g dust-investigate

American Industrial • There is no safe level of an uncontained pathogenic organism

Hygienist Association 1986 (AIHA) Biohazards Reference Manual

1986 Morey, et al. • >10,000 cfu/m3 total fungi, >500 cfu/m3 one species in offices-investigate

*

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Post-Remediation Guidelines

1987 Burge, et al. • Indoor spore levels one third of outdoor, same species spectrum-recommended limit

1987 Ohgke, et al. • > 1 00 cfu/m3 indicates indoor fungal source-further investigation

World Health • Pathogenic and toxigenic fungi unacceptable in indoor aIr

1988 Organization (WHO)

IAQ: Biological Contaminants

• >50 cfu/m3 of one species-investigate • ≤150 cfu/m3 -acceptable if mixture of species • ≤500 cfu/m3 -acceptable if Cladosporium or other

common phylloplane 1988

Lacey, et al.

• 103 -104 spores/m3 of total fungi-normal in air

1988 Canada Mortgage &

Homes Corpo (CMHC) Determination of Fungal

Propagules in Indoor Air

• ≥200 cfu/m3 if several species-investigate • ≤400-500 cfu/m3 mainly Cladosporium and Alternaria-no

action unless indicated by inspection • ≥500 cfu/m3 mainly Cladosporium and

Alternariaetennine-determine reason

1988 Hunter, et al. • >5,000 cfu/m3 usually indicates surface mold growth

1988 Miller, et al. • Toxic/pathogenic-unacceptab1e • ≥50 cfu/m3 one species-investigate • ≤150 cfu/m3 -acceptable if mixture of species • ≤300 cfu/m3 -acceptable if common phylloplane fungi

1989

American Council of Governmental

Industrial Hygienists Guidelines for the

Assessment of Bioaerosoles

• <100 cfu/m3 –acceptable • Indoor/outdoor<l-acceptable if similar taxa • Complaint area/non-complaint> lOX-unusual

The Netherlands

Research Methods in Biological Indoor Air

Pollution

• 104 cfu/m3 total fungi-threat to health • >500 cfu/m3 of one species of a potentially pathogenic

nature- threat to health

1989 AIHA

The Practiitioner’s Approach to IAQ

Investigations

• Rank order assessment • ≥1000 cfu/m3 -indicates atypical situation • High indoor/outdoor ratio-indoor amplifier

1990 Burge • If indoor microbial aerosols qualitatively differ from outdoor, and indoor levels are consistently more than double the outdoor and exceed 1,000 cfu/m3 -investigate

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Post-Remediation Guidelines

1990 Reponen, et al. • >500 cfu/m3 (winter)-abnormal indoor source • Indoor/outdoor> 1 may indicate abnormal indoor levels

in summer • Applies only to urban and suburban subarctic homes

1990 Reynolds, et al. • >500 cfu/m3 -abnormal condition

• Significant indoor/outdoor differences indicate indoor source

• Speciation and rank ordering recommended 1991 Godish • > 1 ,000 cfu/m3 fungi-high levels; potentially significant

• contamination • < 100 cfu/m3 -mold-free environment

• Between figures above-subject to investigator's own interpretation

• Low recovery cannot confirm low airborne mold spore levels

Nordic Council • 10-104 cfu/m3 -typical in "sick buildings" and ambient air 1991 Criteria Documents

from the Expert Group CMHC (disclaimer) • >200 cfu/m3 variety of species other than Cladosporium and Testing of Older • Alternaria- investigate

1991 Houses for • >500 cfu/m3 including Alternaria and Cladosporium- Microbiological • investigate Pollutants

Miller, etal. • Indoor mycoflora qualitatively similar to outdoors-acceptable

1992 • Indoor mycoflora quantitatively lower than outdoors- • acceptable Occupational Safety • ≥1000 cfu/m3 -indicates contamination

and Health • ≥106 fungi/gram of dust-indicates contamination

1992 Administration • ≥105 bacteria or fungi/ml of stagnant water or slime-indicates contamination

(OSHA)

Technical Manual

Commission of the . For houses: European • > 104 cfu/m3 -very high Communities (CEC) • < 104 cfu/m3 -high Report #12: Biological • <103 cfu/m3 -intermediate

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Particles in Indoor • <200 cfu/m3 -low Environment • <50 cfu/m3 -very low

1993 Non-industrial indoor:

• >2,000 cfu/m3 -very high • <2,000 cfu/m3 -high • <500 cfu/m3 -intermediate • <100 cfu/m3-low • <25 cfu/m -very low

Yang,etal. • 200 cfu/m3 total fungi-upper limit

1993 • Critical analysis of opportunistic or toxigenic fungi detected

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6

AIHA • Rank order assessment The Industrial • Indoor/outdoor comparison recommended 1993 Hygienist's Guide to •

IAQ Investigations •

Russian Federation • Levels from 103 cells/m3 to 104 cells/m3 depending on specific

1993 MAC of Harmful • species

Substances • Some levels based upon metabolite or protein concentrations

National Health and • T oxigenic/pathogenic-unacceptab Ie Welfare, CanadaIAQ • ≥50 cfu/m3 if one species-investigate

1993 in Office Buildings: A • ≤150 cfu/m3 if mixture of species-acceptable

Technical Guide • ≤500 cfu/m3 if common tree/leaf fungi-acceptable in summer

Cutter Information • Indoor/outdoor ratios range from <.1 to <I-acceptable

Corp. IAQ Update: • Upper limits range from: 300 cfu/m3 of common fungi, 150

1994 Biocontaminants in • cfu/m3 of mixed species other than pathogenic or toxigenic

Indoor Environments • species, 200 cfu/m3 total fungi, 100 cfu/m3 unless immuno compromised population

OSHA • Levels of bioaerosols in the indoors would reflect those outdoors

Proposed IAQ • Rank order assessment 1994

Standard •

Healthy Buildings • ≤750 cfu/m3 total airborne bacteria and fungi-acceptable if

1994 International • species not infective or allergenic

ACGIH • <100 cfu/m3-10w

Air Sampling • 100-1000 cfu/m3 -intermediate

Instruments for • > 1 000 cfu/m3 -high 1995 Evaluation of Atmospheric Contaminants

IAQ Association Inc. • <300 cfu/m3 common fungi-acceptable

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IAQ Standard #95-1 • <150 cfu/m3 mixed fungi other than pathogenic or toxigenic-acceptable

1995 Recommended for Florida

New York City • Indoor/outdoor> I-indicates contamination

Department of Health • 103-104 cfu/m3 -immediate evacuation Guidelines on 1995 Assessment and Remediation of S. atm in Indoor Environments

Robertson • > 300 cfu/m3 total fungi, >50 cfu/m3 individual species (except Cladosporium )-investigate further

1997

8

Post-Remediation Guidelines

Godish .> 1 000 cfu/m3, > 1 0,000 spores/m3 -indicates contamination

2001 Indoor Environmental Quality AIHA Journal .Collected from a variety of sources, gives numbers for normal

background, possible contamination, and probable 2001 contamination for a variety of sample collection methods. See table below. Proposed Guidelines for Fungal Spores

Normal Possible Contamination Probable Type Contamination

Background* Source Source Air samples from <5,000 spores/m.! 5,000-10,000 spores/m.! >10,000 spores/m.!

residential buildings <500 cfu/m3 500-1,000 cfu/m3 >1,000 cfu/m3 Air samples from <2,500 spores/m.! 2,500-10,000 spores/m.! > 10,000 spores/m.!

commercial buildings <250 cfu/m3 250-1,000 cfu/m3 > 1 ,QOO cfu/m3 <100,000 spores/g 100,000-1,000,000 spores/g > 1,000,000 spores/g

<10,000 cfu/g 10,000-100,000 cfu/g > 100,000 cfu/g Dust samples <50,000 mycelial 50,000-100,000 mycelial > 1 00,000 mycelial fragments/g fragments/g fragments/g <100,000 spores/g 100,000-1,000,000 spores/g >1,000,000 spores/g

<10,000 cfu/g 10,000-100,000 cfu/g >100,000 cfu/g Bulk samples <50,000 mycelial 50,000-100,000 mycelial > 1 00,000 mycelial fragments/ g fragments/g fragments/g

<10,000 cfu/inL > 10,000 cfu/inL Swab samples <1,500 cfu/cm2 >1,500 cfu/cm2 NSFM or NSMB** Tape samples 1-5% 5-25% 25-100%

*Types and relative proportions of fungal spores should be similar to outdoors. **NSFM= no significant fungal material; NSFB= no significant fungal biomass

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STACHYBOTRYS MOLD AN OVERVIEW

Stachybotrys is a type of mold that has jumped into the public consciousness during the past few years. This awareness has been driven by media stories, legal cases, medical research, and a growing body of anecdotal stories. This document is a summary of information currently available from reputable sources. It is divided into sections to allow the reader with specific questions to quickly pick out an area of interest, while providing an overview for individuals that are just starting the education process. Description Stachybotrys is a specific family (genus) of mold that is present in the environment. Out-of-doors Stachybotrys molds help to decay organic matter. One particular species known as Stachybotrys atra (sometimes known as Stachybotrys chartarum) is prone to growth indoors. This mold is normally dark brown or black in color. It can look slimy, sooty, or even like grayish white strands, depending on the amount of moisture available and the length of time it has been growing. It is important to remember that many other common indoor molds can look similar to Stachybotrys (including Cladosporium, Aspergillus, Alternaria, and Drechslera), so testing is critical to conclusively identify Stachybotrys in a building. Stachybotrys mold needs the proper conditions in order to grow, including moisture, a nutrient source, temperature, and time. Standing water or a relative humidity of 90% or higher is necessary for Stachybotrys to start germination and grow. However, once the Stachybotrys begins to grow it can continue to propagate even if the surface water source dries up and the relative humidity falls to 70%.The nutrient sources that best support Stachybotrys are those with a high cellulose content. As such, Stachybotrys thrives on natural materials such as hay, straw, and wood chips, as well as building materials such as ceiling tile, drywall, paper vapor barriers, wallpaper, insulation backing, cardboard boxes, and paper files. Stachybotrys survives a wide variation in temperature and grows most proficiently in temperatures that humans consider warm to moderately hot. It tends to develop more slowly than many other molds—one to two weeks after moisture intrusion, as compared to one to two days for molds like Aspergillus, Penicillium, or Cladosporium. Despite its slow start, Stachybotrys usually develops into the dominant mold if the conditions are favorable, eventually crowding out other mold types that may have colonized the material first. It is often found in conjunction with, or is preceded by, Chaetomium. Like many other molds, Stachybotrys can spread both through the generation of spores and the growth of root-like tendrils called mycelia. Stachybotrys spores grow in clusters at the end of stem-like structures known as hyphae. The spores do not easily disperse into the air if the colonized material is wet, as the spores are held together by a sticky/slimy coating. Distribution through the air is possible when the mold dries out or is disturbed. Because of the danger of airborne dispersion of spores, all cleaning and removal of Stachybotrys mold should be done using appropriate controls.

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Health Effects In general, exposure to mold spores and pieces can result in allergic reactions, infections, or toxic (poisonous) effects. These health effects are the result of exposure by skin contact, ingestion, or breathing the mold. Stachybotrys has been studied for a number of years, with most of the early studies done on animals. Stachybotrys exposure is linked to allergic reactions. People in buildings with active Stachybotrys growthgenerally experience symptoms that include irritation and watering of the eyes and nose. Coughing and skin irritation are also allergic reactions commonly associated with Stachybotrys exposure. Animal studies clearly show that Stachybotrys exposure, even in low levels, suppresses the immune system. Anecdotal data clearly supports this immuno-suppressive capability in humans. As such, exposed individuals are often susceptible to bacterial and viral infections such as the flu. The reason Stachybotrys is of such concern is that medical evidence has proven that this mold has toxic properties. Stachybotrys produces a mycotoxin (i.e., poison from a fungus) named trichothecenes. When inhaled or ingested Stachybotrys can cause: • Sore/hoarse throat • Cold and flu symptoms (headaches, slight fever, and muscle aches) • Nosebleeds • Tingling or burning of nose, mouth, and perspiration areas (under the arms or between the legs) • Chronic fatigue • Dizziness • Nausea/vomiting • Memory loss • Attention deficit/concentration problems • Personality changes such as irritability or depression • Neurological disorders such as tremors • Hair loss • Coughing with blood • Bleeding in the lungs (hemosiderosis) • Damage to internal organs including blood, liver, kidneys, and lungs Although not supported by definitive studies at this point, there are some concerns about Stachybotrys exposure promoting cancer.The symptoms and health effects related to Stachybotrys depend on an individual's pre-existing health situation, length of exposure, and the amount of Stachybotrys in the environment. It has also been shown that the level of mycotoxins produced by Stachybotrys mold varies over time and depends on the environmental conditions present at the growth site. Because of this, different people in the same situation, even family members, may experience different sets and severity of symptoms.

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Medical Tests No single medical test can pinpoint the level of exposure or body damage caused by Stachybotrys. Proper medical care and professional decision-making are necessary to assure that the affected individual is treated properly. Many physicians believe that the following tests are appropriate in conducting a medical screening for Stachybotrys: • Complete medical exam • Chest x-ray • Pulmonary function test • Complete red and white blood cell count • Blood sedimentation rate • Stachybotrys specific RAST antibody test • Immunoglobulin panel • Immune competence tests Doctors should be encouraged to discuss the environmental situation with the industrial hygiene professionals who have conducted sampling in the building in question. Environmental Sampling Two primary methods of sample analysis can be used to detect Stachybotrys on surfaces or in the air.Samples can be cultured so that the material collected grows and can be identified. Other samples are examined microscopically and the material collected is categorized based on the color, size, and shape of the spores. Cultured samples are considered to be more definitive than those analyzed by microscopy alone, as the process not only allows identification of the general family (genus) of mold but can pinpoint the specific species as well. This “speciation” is not as critical when dealing with Stachybotrys since that genus of mold has one primary species that grows indoors. However, the distinction between species can be important when dealing with other indoor molds such as Aspergillus or Penicillium. Cultured samples do have some drawbacks. Since the process involves growing the mold, a seven- to ten-day turnaround time on samples is normal. Growing the mold also requires that the proper collection material (i.e., media or agar) be selected for the type of mold that is suspected. For Stachybotrys a selective agar such as cellulose or cornmeal is recommended. One laboratory has recently patented a Stachybotrys-specific agar (SSA) which is reported to significantly improve the collection efficiency of Stachybotrys from air samples. Another significant drawback for cultured samples in Stachybotrys contamination situations is the fact that only viable or living parts are counted. Hyphal fragments, sanitized spores, and other parts of the mold that can be contributing to health problems are not included in the count. Samples analyzed by microscopy can be advantageous in the case of suspected Stachybotrys contamination as the spores are easily identifiable. Faster turnaround time, including the possibility of on-site analysis, is a feature of microscopy samples. In

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addition to counting both the viable and nonviable mold, microscopic analysis can identify other allergens and contaminants such as pollen, dust mites, dust, and fibers. Regardless of the analysis method, mold samples can be collected in a variety of ways. Bulk samples can be sealed in a zipper-lock plastic bag or other sealed container and submitted to a laboratory. Clear cellophane tape is often used to lift a surface sample to be mounted on a microscope slide, although such samples may not be representative of the entire depth of material. Sterile sponges and swabs can be wiped across surfaces. Air samples are collected with a vacuum pump. The air is directed over a Petri dish with media (Anderson N-6 sampler), onto a greased slide or into a plastic cassette (Air-O-Cell). With the air cassette it is also possible to collect surface samples with a process known as micro vacuuming. Open dishes of nutrient media that are left exposed for one to four days, known as settled dust collectors, are not well respected in the inspection industry as a means of sampling for Stachybotrys. Generally, sampling for Stachybotrys involves a combination of surface sampling and air sampling. This is matched with a thorough visual inspection to search not only for mold but evidence of water intrusion as well. Many professionals start with bulk or swab samples, progress to cassette air samples, and follow with cultured samples where the media has been selected based on the bulk or cassette sample results.It is important to remember that air samples represent only a short window of time and that Stachybotrys spores do not become airborne as easily as other molds. Therefore the general consensus is that few, if any, such spores should be found in indoor air. Samples should be collected by, or under the direction of, knowledgeable professionals. Improper collection practices can endanger the individual conducting the sampling, spread the contamination, and lead to false results. Stachybotrys in particular is prone to a wide variability in measured airborne levels. Risk Assessment Providing general guidelines on interpreting medical tests or sample results is difficult due to the large variety of factors that influence Stachybotrys growth and spread, as well as the variability of symptoms between individuals. Because of its toxic potential most experts recommend that all Stachybotrys exposure be avoided by immuno-compromised individuals. This includes infants, individuals with significant lung disease, people undergoing chemotherapy or other cancer treatment, many of the elderly, and people who are HIV positive. Whatever the health status or symptom level, exposure to suspected Stachybotrys should be minimized as much as possible. While certain situations do demand building evacuation prior to corrective activities, oftentimes temporary solutions can be employed. When determining the best course of action in a Stachybotrys case the parties involved should consider the number of people involved, extent of the exposure, description of symptoms, sample results, history of the problem, location of the mold, type of activity in the building or area of contamination, type of air handling system, and public relations. In all situations the best information should be used to develop a plan of action that protects the building occupants without creating unnecessary panic until the mold and underlying source of moisture are corrected.

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Interim plans to reduce immediate risk until permanent repairs can be made may involve: • Isolation of the area or room where mold was found by shutting the door(s) and sealing around the jamb with painter's tape. • Isolation of the affected surfaces with plastic sheeting and tape. • Isolation of supply and/or return air vents in the area where mold is present. • Shut down of the heating, ventilation, and air conditioning (HVAC) equipment that serves the area impacted by Stachybotrys with necessary heating or cooling provided by alternate or temporary sources. • Rearrangement of work/leisure activities away from the affected areas. • Utilization of air cleaning devices that integrate high efficiency (HEPA) and activated charcoal filters. • General cleaning using a vacuum with HEPA filtration. • Installation of pleated filters on the heating or ventilation system. • Use of an N-95 filtering face piece when disturbing any items in the area where mold is visible (see next section for information regarding precautions for actual mold cleanup). • Temporary evacuation. The choice of any actions to deal with Stachybotrys on an interim basis should be made with the ultimate goal of mold cleanup also in mind so that duplicative or counterproductive actions can be avoided. Control Of Stachybotrys Contamination Currently no single set of regulations, rules, or even industry guidelines exist which clearly define mold remediation procedures. Nevertheless, there is considerable consensus in the healthcare community and restoration industry regarding the: 1. Importance of eliminating active mold growth inside buildings. 2. Necessity of using trained and experienced professionals for the remediation of extensive mold growth or mold contamination in high-risk situations such as hospitals, nursing homes, air conditioning ductwork, etc. 3. Need for work practices that minimize the spread of contamination during the cleanup/ removal process. 4. Removal of porous building materials (ceiling tile, drywall, etc.) that have been water saturated and now support mold growth. 5. Use of personal protective equipment by individuals conducting the cleaning or removal activities. 6. Isolation of the work area or removal of occupants while the remediation work is in progress. 7. Benefit of sophisticated engineering controls such as negative pressure enclosures, air filtering machines, isolated entry chambers, upgraded respiratory protection and the like for large scale mold remediation projects. 8. Importance of proper application of mold killing cleaners (fungicides) and encapsulants.

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9. Need for a complete cleaning of the work area so that it is visibly clean of all debris and dust. 10. Value of post-work visual inspection prior to the reinstallation of drywall or other finish components. Despite this general consensus of ideas, the specifics of implementation must be determined for each project. Before starting any mold control activity, particularly one that disturbs Stachybotrys, a number of important questions should be addressed: 1. Who will conduct the mold control project? 2. Are pre-work samples necessary? 3. What criteria will be used to determine a successful conclusion to the project? 4. What engineering controls will be employed? 5. What form of isolation, if any, will be used? 6. What cleaner will work effectively? 7. What materials are to be removed? 8. How is debris going to be packaged? Disposed? 9. What cleaning techniques will be employed? In what sequence? 10. What tools, supplies, and equipment are necessary?

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A COMPREHENSIVE OVERVIEW OF THE MOLD REMEDIATION

INDUSTRY Although not widely recognized in the public mainstream, dealing with mold contamination indoors has evolved into a specialty industry. This evolution, from common construction nuisance to specialty remediation service, has been noticed by many individuals in the cleaning, restoration, hazardous materials, and industrial hygiene fields. The legal community has not missed this progression toward a uniform treatment of mold contamination in buildings. One of the reasons that the general public is largely unaware of the transition going on in the mold remediation industry is that the changes have been occurring very rapidly. Five years ago there was very little recognition that mold exposure could pose a serious health threat, so there was little emphasis on treating mold as a unique contaminant. It was less than three years ago that mold exposure cases began to create a buzz in the legal community and a subsequent splash in the media. With few exceptions, mold remediation training courses have sprung into existence in the last two years. These have fueled a growth in technological advancements, impacting the industry. Despite all the technological advances the mold remediation industry today still resembles its earlier forms. Its basic components have served as the nucleus for development over the last few years. It is possible to use the analogy of a wheel to organize and describe the diverse factors that impact mold remediation. What is clear is that the many pieces of the mold remediation process have to interact smoothly to roll along. The wheel analogy can be stretched to fit mold remediation by remembering the experience of the Ford Explorer and Firestone tires. As that situation graphically demonstrated, under the right conditions the failure of a single component in a wheel assembly can have catastrophic consequences. That is why it is so important for individuals in the mold remediation field, or those contemplating entering the field, to have a good understanding of the major components that must work together during a remediation project. Though the wheel analogy is beneficial to conceptualizing the industry, it is important to make the distinction that a physical product is not being sold in the mold remediation business. Unlike the wheel assembly for a car, mold remediation is a service and expertise is the product. As such, anyone who enters the field must be vigilant in ensuring that the product continues to be of high quality. This point seems to be especially confusing to many currently involved in the mold remediation industry because there is no single federal or state regulatory standard that everyone can point to as the baseline for an organization’s performance. Nevertheless, contractors and service providers are in peril if they think that an absence of state or federal standards implies that there is no industry standard of care. One of the biggest misconceptions in the mold remediation field today is that liability issues and litigation are driving the industry. Although liability and litigation are important considerations, the legal community is not setting the standard of care.

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Lawyers are only clarifying and interpreting the standard of care that is already in place but scattered about in various scientific and industry documents. To emphasize this important point in our training class, a chart was put together which provides a summary of key areas of agreement in the mold remediation industry. These items were summarized from seven basic documents that are used throughout the industry, including technical publications from the American Conference of Governmental Industrial Hygienist (ACGIH), the Institute of Inspection, Cleaning, and Restoration Certification (IICRC), as well as local and federal documents such as the New York City Guidelines and the EPA Mold Remediation Guidelines for Schools and Commercial Buildings. Eight specific examples are given here to help the reader understand just how much overall agreement there is in the industry today. • Rapid drying of water intrusion is recommended to prevent mold growth (within 48 hours). • Fungal contamination of interior surfaces is unacceptable from a health/hygiene standpoint. • Interior fungal growth should be physically removed. • Respirators and other personal protective equipment should be used during all remediation projects. • Engineering controls should be progressively more stringent as the size of the remediation increases. • Large projects involve more than 100 square feet of fungal growth. • Containment barriers, negative pressure, HEPA air filtration, and decontamination areas should be used for large remediation projects. • Professionals should be used to interpret sample data. Even if individuals are aware of the many factors that impact mold remediation (the components of our wheel assembly) and understand the basic areas of agreement (similar to the underlying expectation that wheel assemblies have to be safe for use on a specific type of vehicle), an important connection still has to be made by the individual consultant or contractor. How does the mold remediation professional, whose product is their expertise, manipulate the various components to apply the standard of care to a particular project? Until there is more detailed guidance in the form of regulatory standards, it is clear that the mold remediation professional must make these individual project decisions based on education. This is why education serves as the hub of the wheel in Figure 1. It is important to note that in the context of this article, the term education is not limited strictly to formal classes or certification training. Education for the mold remediation professional must include a mixture of professional training courses, self study, communication with other professionals in the field, participation in industry conferences, and mentoring from more experienced consultants and contractors whenever possible. Anyone who is skeptical that such education forms the center of today’s mold remediation wheel need only look at the information provided by the American Conference of Governmental Industrial Hygienists, the American Industrial Hygiene Association, the EPA, Health Canada, and the New York City Department of Health. All

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of these organizations recommend the use of trained personnel for large mold remediation projects. An underlying tenet of the documents from all those organizations is not only that trained professionals understand the specifics of how to deal with mold remediation challenges, but that they are able to put mold remediation into proper perspective. For the mold remediation industry to continue to advance, professional practitioners must be knowledgeable enough to present compelling information that does not emphasize extremes. In our training classes, we characterize it as finding the center ground between the mold minimizers and the fungiphobics. In other words, mold remediation professionals should not downplay the potential health impacts of mold contamination, nor should they suggest in potential contamination situations that the occupants run screaming from the building. Once mold remediation professionals understand that the industry revolves around education and that they are being called upon to apply a somewhat general industry standard of care to specific situations, they quickly realize the value of comprehensive and effective training programs. This leads to questions about how to identify a training course or educational experience that will help an organization succeed in the industry and that isn't an infomercial for a specific laboratory, consultant, or system of engineering controls. Asking for detailed answers to the following four questions will help both newcomers and veterans choose appropriate mold remediation training: • Does the course focus on principles and techniques that can be adapted to a variety of situations as compared to specific recipes for how every single project should be completed? • Does the educational experience provide comprehensive information for continued self-study? • Does the class incorporate information from multiple recognized sources but do it in such a way that there is a coherent framework on which the information sources can build? • Does the educational experience infuse the proper philosophy of protecting crew members, occupants, and building structures in all aspects of the presentation? Of course there are a number of other questions that can help a person decide if a specific mold remediation course is for them (i.e., amount of hands-on activities, limitations on the number of students, etc.). However, even great training that emphasizes the wrong points will end up having a negative impact on individuals and organizations involved in the mold remediation business. To go back to our wheel analogy, remember that many of the same factors that can lead to wheel or tire failure are present in mold remediation projects. If the project is unbalanced (for example, too much emphasis on air sample results rather than visually clean areas), it can lead to a project that is not run safely. Everyone knows that tires have to be properly inflated. Similarly, mold remediation projects that are conducted under the pressure of unreasonable client expectations have a greater probability of failure, and projects conducted at excessive speed bring unforeseen and expensive problems. With all of these potential pitfalls, it may seem impossible to complete mold remediation work

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properly and cost-efficiently. The good news is that a mold remediation firm can be successful by keeping in mind four core principles: • Be able to see and understand the big picture. • Never be satisfied with the amount of knowledge you have. Continue your formal and informal education in this area. This is critical since new products and ideas are constantly evolving from the industry. • Effectively review project design, setup, and work efforts. • Be sure to have all aspects of the process balanced. It is comforting to know that Ford is still selling SUVs and Firestone is still selling tires. With proper diligence and common sense, mold remediation professionals can avoid a blowout on the road to success.

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DEFEATING THE FEAR FACTOR: AVOIDING THE SODOM AND

GOMORRAH APPROACH TO MOLD REMEDIATION

Recently, the issue of fungal contamination has gathered an increasing amount of media attention. Articles have appeared in major newspapers such as The Wall Street Journal. Newsweek and People magazines have addressed the dangers of fungal contamination in homes, particularly Stachybotrys contamination. Television has been getting into the act as well, with horror stories of fungal contamination being aired on 48 Hours, Primetime, and even Oprah. In one of these stories, a homeowner leads reporters through her contaminated house, showing them all of her possessions which she can “never take out” due to the fungal contamination. She then says that since the house “cannot be cleaned” she is going to let the fire department burn it for practice. While this “Sodom and Gomorrah” approach to mold remediation may make for interesting news, it is not an accurate or realistic approach to removing fungal contamination from a home. The reality is that in nearly every case, a home can be successfully cleaned of fungal contamination. In a few cases, individuals may become too sensitized to the conditions in the house, so that they cannot return to that house. However, even in these cases, most of their belongings can be decontaminated and used in their new residence. In the interest of making interesting stories, the media is spreading inaccurate information about the very real dangers of fungal contamination. The toxic mold scare that is beginning to form in this country is showing similarities to the fear of asbestos in the 1970's and 1980's. In both cases, the dangers posed were magnified, causing a good deal of concern in the public. With asbestos, this led to a rapidly growing demand for inspection and remediation services. Many of the companies that rushed to fulfill this demand had little or no experience or qualifications to work with asbestos. This is similar to what is happening in the mold remediation industry, as many companies that have little expertise or knowledge of toxic mold are hurrying to ride this new wave of consumer concern. The lack of knowledgeable consultants, however, can lead to bad advice, unnecessary expenses, and overreaction. Many of the losses caused by mold could be prevented if people knew about how mold begins, spreads, and the proper factors to consider when evaluating or cleaning a building with mold contamination. Since mold remediation is a relatively new field, there are many differences of opinion regarding the best methods of cleaning up mold. Some consensus is emerging, with the publication of the new EPA "Guidelines for Mold Remediation in Schools and Commercial Buildings". The EPA guidelines give some general methods for cleaning different surfaces and objects that have been exposed to possible mold contamination, but that may not have actual mold growth on them. Based on those guidelines, we at Caltex Environmental have developed some more detailed guidelines for most objects found in the house. For example, we recommend that pictures

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be HEPA vacuumed, along with whatever sleeves or frames that they were in. This removes any spores on the picture, so there is no risk of cross- contamination, and saves the picture, rather than simply throwing it away. For electronic devices like computers that have fans in them, we recommend blowing compressed air through the item, with a HEPA vacuum or negative air machine running nearby to remove any spores from the interior, then wet-wiping the exterior. Most items that do not have direct mold growth on them, especially if they are non-porous or semi-porous, can be successfully cleaned and returned to normal. In summary, finding mold growing in your house is not necessarily as bad as it may seem from the news reports. Make no mistake, there are many serious health risks associated with fungal exposure, and some of the effects can be permanent. However, if the problem is dealt with in a timely manner, using the appropriate techniques and careful work, it is possible to correct the situation. Remediation work can be time consuming and expensive, but it certainly is better than burning down the house with everything in it. Fire may have been God’s way of dealing with Sodom and Gomorrah, but it doesn’t have to be your way of dealing with mold. EXPLAINING MOLD CONTAMINATION SITUATIONS: PROPER

COMMUNICATION OF A COMPLEX SAFETY AND HEALTH ISSUE TO A DIVERSE AUDIENCE

Safety, health, and environmental professionals are often on the front lines of emerging issues that change the way we think about accident prevention or improved health. As such, it should be no surprise that safety managers, industrial hygienists, loss prevention specialists, and risk assessors are frequently being asked to explain mold contamination to building occupants, the media, and the public. While there were some warning signs in the last three to five years that mold was becoming a dominant concern in the indoor air quality arena the explosion of interest in the last two years has been fueled by media reports, liability concerns, and scientific research. Unfortunately, media reports are often significantly condensed sound bites; legal cases tend to emphasize the extremes of liability in an effort to win or fend off a claim; and scientific reports are often filled with either technical jargon which makes them difficult to understand or narrow limitations which restrict their application to the real world. Therefore it is important for those tasked with estimating risk or communicating the facts about a mold exposure situation to understand the big picture, make reasoned decisions, and communicate information clearly and convincingly. Clarifying the Big Picture The safety professional who addresses the mold topic from a compilation of media reports is woefully unprepared to present sensible information. While most media reports, either electronic or print, are not intentionally false, they often lead to incorrect interpretations of the data for two reasons. Time and space limitations mean that information must be condensed. Content limitations means that information must be

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simplified for the intended viewer or reader. This dual combination of condensing and simplifying is not conducive to understanding the nuances of complex situations where proper decision making involves the integration of many factors. As a result, many situations, such as those dealing with mold infestation, have the shades of gray edited away to something which is more black and white. In many stories, this problem is compounded by the reporter’s slant which effectively means that gray areas are not separated into black and white, but into black or white. This condensation and simplification feeds into a second trend of media reporting which also limits its usefulness to a safety professional trying to understand or explain the larger concept. Stories that involve controversy are generally considered to be better press material. As such, a predictable pattern develops for information related to emerging safety or health issues. This pattern has been played out hundreds of times with stories about such things as asbestos, the pesticide Alar, and now mold. In all these cases, Initial stories bring heightened awareness of a potential problem, but do so in a sensationalist way. This desire to highlight controversy in any particular area often results in mixed, or even contradictory, messages being presented by the same source over time. For example, the media focused almost exclusively on the dangers of asbestos for many years in its coverage of that subject. Then the tact of the majority of the coverage switched to proclaim that we had overreacted to it as a nation. This same pattern appears to be emerging with mold stories. For the last several years media reports emphasized the dangers and the reported health problems associated with this material. Now, however, some articles are keeping the subject alive by emphasizing problems with mold remediation projects or situations where the dangers were overestimated. Since it’s difficult to see the big picture by simply following stories in the popular press, safety and health professionals must dig deeper to get the “straight skinny” on mold issues. Articles in technical magazines, industry trade publications, science journals, and the like can provide much needed details to the outlines of the problems described in the television and newspaper reports. In addition, attendance at a variety of conferences where the subject is discussed will give safety and health professionals the range of opinions necessary for them to start developing their own approach to a mold contamination situation. By reviewing a variety of materials, including mold guidelines published by the EPA, New York City Department of Health, and the American Conference of Governmental Industrial Hygienists to name a few, the safety and health professional will quickly discover that the edges of the big picture are fairly well delineated. Some of these edge pieces that circumscribe the mold communication puzzle include: • The understanding that mold is a biological agent. Since it has the ability to grow under the right conditions, isolation and deferred action to remove the source of the problem may not be possible as it is with asbestos materials. In such situations, the delay may allow mold contamination inside a building to grow to a point where it poses a hazard greater than when initially discovered.

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• Mold growth means that there is or has been moisture intrusion in the building. Removing surface mold contamination and not identifying and correcting the underlying moisture problem would be tantamount to a doctor treating symptoms rather than the disease itself. • Exposure to mold spores and other byproducts (microbial volatile organic compounds, mycotoxins, connecting filaments, etc) does cause real health symptoms. These symptoms can range from mildly annoying allergic reactions to serious, and even life-threatening, ailments. • Individuals respond to mold exposure in a variety of ways. There is a large variation in individual susceptibility to the same exposure levels and the possibility of a person becoming sensitized to a specific specie of mold growing in a certain location. When added together this means that the range of potential responses to fungal exposure is greater than what is seen for most industrial chemicals. • There are a variety of guidelines currently available to assist in interpreting mold contamination situations, but no comprehensive federal regulations. A number of additional edge pieces which define the general consensus of thought regarding the bigger mold picture could be added, but the items above should be enough to convince safety and health professionals that their response to potential mold exposure should follow a pattern similar to that employed by the many organizations that deal with risk from potential radiation sources. The concept of ALARA is one which seems to transfer well from radiation protection to the current mold situations. Using the ALARA acronym would allow the safety and health professional to make decisions regarding potential mold exposure that would keep levels of the spores and byproducts “as low as reasonably achievable” (ALARA). Making Rational Decisions While considering the ALARA concept helps in understanding the big picture of mold contamination, it also leads directly to the second aspect of communicating mold information to a varying audience. Communication, no matter how clear, does not substitute for good decision making. It is generally counterproductive to explain the big picture of a mold contamination situation if the decisions that were made ignored the factors that make up the big picture. This is why decisions about mold should not be based strictly on the perceived risk of current liability. Many safety and health professionals have the mistaken impression that liability concerns, based on high profile lawsuits, are the driving force in the industry. In reality, the legal profession is only filling in the center pieces of the puzzle; the edges have already been laid in place. In the absence of federal or state regulations related to mold control, attorneys are clarifying the industry standard of care, not creating their own. By carefully examining generally available industry reference documents relating to mold, attorneys have been able to identify points of commonality which they correctly interpret as a de facto industry standard of care. Unfortunately, many safety professionals are asked to talk intelligently about the mold situation in general and/or make decisions about mold contamination conditions in their facilities without even understanding what the industry reference materials are, let alone the points of intersection between them. While

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there is some variation in which references really form the core of the mold control industry, the following seven documents are cited frequently. 1. American Conference of Governmental Industrial Hygienists; Bioaerosols: Assessment and Control; 1999 2. American Industrial Hygiene Association; Report of Microbial Growth Task Force; 2001 3. Environmental Protection Agency; A Guide for Mold Remediation in Schools and Commercial Buildings; 2001 4. Health Canada; Fungal Contamination in Public Buildings; 1995 5. Institute of Inspection Cleaning and Restoration Certification; Standard and Reference Guide for Professional Water Damage Restoration S500; 1999 6. Occupational Safety and Health Administration; Occupational Safety and Health Administration Technical Manual Chapter 6; 1995 7. New York City Department of Health; Guidelines on Assessment and Remediation of Fungi in Indoor Environments; 2000 Effective Communication Even if someone understands the big picture of mold contamination and has been able to make rational decisions in order to manage it, the proper communication of that information may ultimately turn out to be just as important as proper decision making. To communicate clearly and convincingly, a safety professional should emphasize that the subject of mold exposure and control is complex with a diversity of opinions. Despite this diversity of opinion, an industry standard of care is in place which stays away from the two extremes. In many of my discussions I have characterized these extremes as the mold minimizers (those individuals who are not willing to accept that mold exposure can be harmful) and the fungiphobics (people who call for the total elimination of mold spores from the indoor environment). Staying in the scientifically defensible center, emphasizing the protection of occupants, workers, and building structures, and emphasizing the goal of a safe environment rather than pristine or spore-free indoor air will help the safety and health professional to navigate the tricky terrain of mold discussions. Learn From History Safety and health professionals who feel overwhelmed by the flood of information relating to mold should take a deep breath and take heart. The profession has successfully wrapped its arms around complex issues in the past and become the moderating influence which allowed real change to happen. For example, we successfully dealt with the surge of interest in chemical exposures and the subsequent hazard communication standard. We have weathered the storm of media interest in asbestos, lead, confined spaces, and ergonomics. There’s no doubt that we can do the same with mold.

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FUTURE TRENDS AFFECTING INDOOR AIR QUALITY It seems curious to the HVAC equipment manufacturers, filter suppliers, industrial hygienists, laboratories, restoration contractors and duct cleaners who have seen a growing portion of their business coming in response to indoor air quality (IAQ) concerns that there is any question as to whether IAQ is a real, long term market. But there still is a major question mark in the minds of many insurance adjusters, building owners, property management firms, and maintenance supervisors about how much effort they should invest in learning about IAQ. Many people are trying to figure out which model of recent environmental issues IAQ is going to follow. Will IAQ be the next asbestos where the public interests, regulations and lawsuits grew for over a decade? The facilities that dealt with asbestos early had a competitive advantage over those that were forced to address it later under threat of regulatory mandate or extensive liability. Or is indoor air quality going to follow the pattern of lead paint control where successive rumblings and pronouncements from the regulatory agencies spark short-lived concerns but have not yet resulted in any real impact on business as usual? Even the IAQ industry itself contributes to this confusion and hesitancy with industry prognosticators arguing over the possible growth in services as compared to building equipment and components related to IAQ. Rather than just guess at whether interest in the IAQ area will continue to grow, thereby requiring a response from both building representatives and service/equipment providers, a careful analysis of general demographic and social trends can provide the basis for a more accurate prediction. Indeed, I believe that 9 critical factors are all currently aligned in the United States that will push this country toward increased IAQ activism. The primary trend that would seem to enhance IAQ as an important issue in the future is the fact that the United States is whirling into the information age. This trend has several spin-offs that closely impact indoor air quality. Computer usage both for work and pleasure will continue to grow. This activity is connected to indoor air quality in a variety of ways, with perhaps the most direct linkage being the condition dubbed "office eye syndrome" (i.e., a series of health symptoms such as headache, irritated eyes, fatigue, etc. associated with computer usage, humidity levels, dust concentrations, and extremely low levels of volatile organic compounds). The information age also implies that more people will be working in offices instead of factories. It is further characterized by increasingly accessible information on a variety of specific topics, including indoor air quality and its symptoms and causes. Overall, it is likely that the increased amount of office/computer work, as well as the increased ability to obtain information, will result in people being more knowledgeable and vocal in their complaints of indoor air quality. Two important trends that could have a strong impact on the growth of indoor air quality services are the continuing strong economy and tight labor market. The strong economy means that businesses will likely continue to expand, and to do so they will have to look at their existing or new infrastructure. To take advantage of this growth many office

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buildings are already positioning themselves as “green” office buildings that are environmentally friendly to the occupants. The tight labor market that has developed in conjunction with the strong economy means that there are increased efforts at employee retention and complaint resolution since businesses know that there are fewer roadblocks to job switching. Certainly office environment factors and long term nagging complaints have received greater attention in the last few years and will likely continue to command a priority position as companies try to cultivate improved personnel relations. Just as the economy and the labor market are tied together, the fourth and fifth major trends are also tied together. The aging of the overall population and the integration of generation X and nex-gen employees into the workplace will have a significant impact on the growth of indoor air quality services. Many aging baby boomers are work driven and have attained middle to upper management status within their careers and professions. However, they are also prone to more undermined health problems, some of which, ironically, are results of work stressors. Anyone with an underlying health concern is more sensitive to the indoor environment. Those individuals who have positions in management are more likely to exert effective pressure on an organization to deal with problems related to the quality of their indoor environment. While the nex-gen and generation X individuals in the work force may not have the same organizational clout to enforce change, neither do they have the same organizational loyalty as the baby boomers. Their willingness to job switch, even for reasons that seem trivial to other members of the work force, is another pressure point than can induce companies to pay attention to their indoor environment so they don’t lose important skilled and creative help. Trends six and seven that I see pushing indoor air quality concerns can be grouped together as well. There is a long term and continuing interest in the United States in general environmental consciousness and health consciousness even while there is a continuing argument at a national level over implementation of specific policies and goals. Widespread support is still standing among the American republic for clean air, clean water, and uncontaminated food. The public is concerned with outside air pollution and is growing in its recognition of the important role that inside air contaminants have on a person's health. The increasing prevalence of childhood asthma, adult allergies, chronic fatigue syndrome, and the impact of our physical environment on stress, all continue to lead people to consider indoor air quality as a parameter for correction. Eventually people’s health consciousness and the move to managed health care systems will make medical and insurance providers push the envelope to deal with environmental causes rather that repeatedly treating the symptoms that manifest themselves from an unhealthy indoor environment. While regulations do not appear to be a driving force in the near future for indoor air quality issues it seems clear that public information and consensus standards may substitute for government fiats. This eighth trend of public awareness is already supported by a number of programs. The EPA is involved in substantial outreach efforts with its Tools for Schools educational materials related to indoor air quality. Part of that

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effort encourages science teachers to develop student activities related to indoor air quality. Other high profile public information campaigns, including public service announcements on television and radio, are already in process by the American Lung Association and a host of other environmental groups and government agencies. The last notable item that should encourage continued attention toward indoor air quality is liability. My belief that liability and litigation, or the threat of possible litigation, will grow in significance in the IAQ arena is at odds with many observers who have stated that litigation only follows substantial regulatory input. As noted earlier, in the field of indoor air quality there has not been a strong regulatory presence exerted by the federal government. Therefore, many industry observers have discounted the impact of OSHA’s proposed IAQ regulations and the attendant litigation that often accompanies such standards. However, the adoption of voluntary standards as part of local building codes has produced a “bottom up” regulatory pressure. When local building codes, continuing research into the negative health effects caused by certain types of indoor environments, and high profile cases where whole buildings have to be evacuated are considered, it is no wonder that the IAQ field has caught the attention of some prominent attorneys. Currently most states have at least a handful of lawyers who specialize in indoor air quality cases. Water intrusion situations, sewage backflow, chemical exposures, inadequate air exchange, and suspected cancer clusters are all situations that are fodder for the legal system. When these sorts of situations are combined with aggressive marketing by attorneys who specialize in such cases, growing acceptance by individuals to resort to the legal community to address perceived wrongs, and sensationalization of major cases in the print and electronic media, it all seems to point to more litigation in the future regarding IAQ instead of less. Although there may be variations in some of these trends along the way (e.g., an economic downturn) the combined weight of the trends noted above is almost certain to give forward momentum to IAQ issues into the foreseeable future. As such, building owners, property managers, maintenance engineers, and safety/health/environmental professionals should begin now to build their knowledge base about this important subject. To do otherwise is to risk the possibility of having simple problems develop into complex issues. A person is then open to misleading advice of “instant experts” and charlatans which, unfortunately, are still part of the IAQ inspection and control industry.

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HOME IAQ REMEDIES: A LOGICAL PROGRESSION OF

CHOICES

Indoor air quality is an issue that has captured a lot of attention over the last few years. As a nation we are doing more and more to control our environment in the workplace, our vehicles, and our home. Indeed, the Environmental Protection Agency (EPA) estimates that many individuals spend over 90 percent of their time in conditioned environments. Although controlled spaces protect us from the extremes of weather and temperature they can also serve to trap pollutants around us. Another EPA study graphically illustrates this with measurements that prove that that indoor pollution levels can be a thousand times greater than outdoor levels of similar contaminants. Interestingly, however, despite the fact that people spend a much greater percentage of their time indoors at home than they do at work, the primary indoor air quality education and remediation efforts have been directed to the workplace. The emphasis of IAQ in the workplace is prompted by the fact that a large number of people are gathered in a single location, which makes it easier to document the common complaints and symptoms. However, by its very nature of being a workplace, such locations are gathering places for the fittest members of our society (with the exceptions of schools, nursing homes, and hospitals which serve as workplaces for the staff but have contact with a broad spectrum of our population). It is the home where groups that can be more easily and severely impacted by indoor air quality spend most of their time. It is at home where we find important subgroups of our population that are more suseptible to illnesses exacerbated by indoor air quality problems, including infants, children, the elderly, and individuals recovering from significant injuries or illnesses. Proper Identification Leads to Appropriate Control One of the difficulties with indoor air quality situations is that a large number of problems are all grouped under the same heading. Dirt, chemicals, mold, dust mites, bacterias/viruses, radon, pesticide residue, and hazardous building components such as asbestos insulation and lead paint are all possible contaminants that can fall under the IAQ heading. All of these items have been shown to negatively impact the health of building occupants and, therefore, should be considered during the IAQ investigations. A comprehensive investigation also has to look beyond contaminant sources to other environmental factors such as temperature, relative humidity, and airflow. Even the quality of light in a building may have to be evaluated to find answers for IAQ complaints or illnesses. With all these possible problem sources the most common mistake that we have observed with IAQ situations, in both homes and businesses, is that people want to move immediately to the corrective action stage before they have a good understanding of the situation. This frequently leads to a hit or miss approach where considerable resources are expended, oftentimes with marginal results. Such shortsighted corrective attempts serve

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to frustrate both the occupants that are suffering the symptoms and the individuals trying to correct the “problem”. This tendency to fix things before you know what you are fixing is enhanced not only by the wide range of potential problems incorporated into indoor air quality issues but also by the diffuse symptoms that such situations produce. In one dramatic case our organization was contacted by a homeowner who had spent four years bouncing between doctors, specialists, alternative care providers, and health food stores in an effort to deal with her problems. She was diagnosed at various points in time with fibermyalgia, chronic fatigue syndrome, sinusitis, recurring bronchitis, and asthma. In her desperation to feel better she spent over $50,000 on doctors and even went so far as to have the mercury amalgam fillings in her teeth removed and replaced. Based on a telephone conversation and description of her symptoms we suggested that mold contamination, particularly stachybotrys, could easily explain the variety of her symptoms. When a screening check of her home with a do-it-yourself kit turned up elevated spore levels, the specific detective work began. Incredible numbers of active mold colonies were discovered under her carpets and in the wall cavities from subslab moisture penetration. Within weeks of her home being properly cleaned, her symptoms diminished. In that particular case, and many others in both the residential and commercial sector, figuring out what the problem was turned out to be more difficult than actually fixing the problem. There are, however, a number of tips that are useful in identifying indoor air quality issues promptly and effectively. The first of these is to treat complaints seriously. If one member of the family has frequent headaches, constant sniffles, or recurring bouts with asthma-like symptoms, don’t just assume that it’s a cold or whatever happens to be “going around”. Observe and question other family members to see if the problem/symptoms are isolated to a single individual or are more widespread but just haven’t made it to the conscious level. An expansion of this tip about treating complaints seriously is to collect detailed information on the symptoms from each individual and write them down in columns so that an easy comparison can be made. Another positive aspect of writing down complaints and symptoms is that specific patterns of behaviors that trigger the symptoms and/or long term trends may become visible. Symptoms related to seasons, weather patterns, use of air conditioning, etc. may show up if complaints are tracked in written form. Another technique that is helpful in correctly identifying IAQ problems is a thorough investigation. Oftentimes we become too complacent, particularly in our own homes, about environmental factors that could be affecting our health. We know the roof leaks a little bit, but put off making a repair or replacement. While such a leak may not be enough to cause severe structural damage to the house, it can provide a moisture source to allow a significant colony of mold to get started in the attic or wall cavity. Ultimately, procrastination over such minor repairs may result in extensive renovation and cleaning being necessary. Other times our complacency is such that we don’t even

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recognize the source of a problem. Many pipe leaks in wall cavities or under cabinets go undetected for long periods of time until substantial damage has already occurred. In a similar fashion, homeowners may not look closely enough at shower or bathtub caulking or window glazing to notice that a gap has formed and a water leak is underway. A thorough annual inspection of the entire house is a good preventive measure, just as an annual medical check-up or car tune-up avoids problems in the long run. Checklists available from home improvement stores and internet sites help a homeowner break through the veneer of complacency to look at their dwelling with a critical eye for preventing structural and indoor air quality problems. The collection of samples is the last investigative technique that we recommend for homeowners. This recommendation of deferred sampling is at odds with many of our professional colleagues who encourage testing as a first step. A symptoms survey and critical visual inspection usually are enough to pinpoint problem areas which would allow more targeted sampling to be conducted if verification or quantification of a problem is necessary. At a minimum, enough investigation should be done so that a logical determination can be made about the sort of sampling that should be conducted: chemical, fungal, bacteriological, etc. In the complex cases where screening samples have to be collected we are fortunate that newer cost-effective techniques are now available for business and homeowners alike. Simple broad screen sampling for dust, mold, pollen, dust mites, and other particulates can be done with simple test kits (e.g. www.molddoctor.com and others). Several companies have chemical sampling devices that are as easy to use as radon canisters, but they collect more complex bacteria and virus samples from surfaces and ducts. Prioritizing Corrective Actions As noted earlier, the wide range of contaminants and conditions which fall under the general heading of indoor air quality problems makes it difficult to lay out an absolute list of corrective priorities that will work for every situation. Nevertheless, our experience with hundreds of homeowners shows that a number of trends are common and that certain activities have the best chance of having a positive impact on a family’s home and health. These priorities are also arranged in an order that accommodates cost considerations, with the less expensive corrective activities listed first: Do a thorough house cleaning. Use your survey to identify containers of old chemicals, pesticides, paints, fuels, deodorants, firewood, scrap lumber, and other materials that could harbor biological growth or become a source of chemical contaminants. Dispose of these items, but do it properly. Most communities have home hazardous waste collection places where unnecessary fuels, spray cans, and chemicals will be accepted for proper classification and disposal. Identify and correct all water intrusion problems. This can run the entire gamut from a simple spot of tar around a leaking chimney or replacement of a sink drain gasket to regrouting of bathroom tile or replacement of corroded and dripping pipes. More extensive corrections for water intrusion into the house include repair of gutters and downspouts, regrading of landscapes so that the earth and surface water slope

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away from the house, repair of drain tile, injection of betonite clay along the outside of the house, or installation of water collection systems and sump pumps. Check appliances for proper functioning. Furnaces, stoves, fireplaces, water heaters, and other appliances, particularly gas or propane fired appliances, should be checked on a regular basis by a trained professional. These checks should include measurements for carbon monoxide and natural gas/propane to minimize the chance of explosion or asphyxiation. With a recent reduction in price, the installation of carbon monoxide detectors near such appliances could also go a long way toward improving the indoor air quality at a reasonable cost. Improve filtration on furnace and air conditioning systems. Most standard furnaces use fiberglass filters that have a relatively low efficiency rating. Upgrading to pleated paper filters, combination paper and charcoal filters, or installing electronic air filters can dramatically improve air quality in a home. The improved filtration will not only stop particulate matters such as mold, dust, fibers, etc. but will also trap the bacteria and viruses that “hitch a ride” on such particles as they make their way through the air. Replace standard vacuums with high efficiency filtration models. Many vacuum manufacturers now have models that have HEPA filters. These high efficiency filters trap the finest dust particles that normally are propelled out of a bag or canister style vacuum after the heavy debris is deposited inside. Such vacuums are only marginally more expensive than their standard counterparts but have a significant impact on the overall cleanliness of the home’s air. Consider having your ductwork cleaned. The ductwork is the circulatory system for the home’s air. In new homes the ducts are often contaminated with debris from the construction process while older homes could suffer from buildup of contaminants over time. A duct cleaning does not have to be an annual event but if they haven’t been evaluated or cleaned in ten years, it’s time to look. Utilize portable room air cleaners for individuals that have asthmatic symptoms or significant allergies. The use of room air cleaners, particularly in the bedroom, can create a zone of relief for individuals that are sensitive to indoor and outdoor pollutants. Eight to ten hours of exposure to clean air in the bedroom is often enough time for many people’s bodies to recover from the assaults that occur outside, in school, or in the workplace. A word of caution is necessary as not all air-cleaning devices are the same. The safest models are those that pass the air through pleated HEPA and/or charcoal filters. Air filtration devices that add the extra feature of a negative ion generator (often referred to as an ionizer) often have a higher efficiency of filtration but many individuals react poorly to the abundance of negatively charged particles that fill a room where such devices operate. In the eyes of many indoor air quality professionals an even worse choice is an air filtration device that has an ozone generator incorporated into it. The ozone emitted from such units is an irritant and a number of studies have shown that such devices reduce odors by breaking long chain hydrocarbons into smaller molecules. This process may actually increase the overall level of pollutants in an area, even if it seems to smell better.

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Consider a professional inspection if symptoms persist and do-it-yourself measures are unsuccessful. Time and again it has been shown that people will spend whatever it takes to find the appropriate treatment for symptoms but are hesitant to spend any money investigating the potential cause of such symptoms. Part of this psyche may be a result of the lack of standardized credentials in the indoor air quality arena and the occasional history of unqualified or unscrupulous consultants preying on people’s fears. Great strides have been made in the field of indoor air quality investigations over the last few years. As a result, most inspections now provide cost-effective solutions to real problems. Indoor air quality is a problem that affects us all. Discussion of this invisible aspect of our environment should not be limited to workplaces, schools, or hospitals. Families everywhere can benefit from the advancements made in this industry to improve their health and the quality of their free time.

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MOLD 101: AN OVERVIEW FOR SAFETY PROFESSIONALS

In the last five to ten years, a body of scientific and anecdotal data has grown which points to interior mold contamination as a potentially serious health threat. In spite of this, many safety professionals do not concern themselves with mold contamination and indoor air quality (IAQ). Many safety professionals consider IAQ issues to be the business of industrial hygienists. However, there is an increasing amount of overlap between safety professionals and industrial hygienists on issues of mold contamination and remediation. Entry into confined spaces, formerly the exclusive domain of industrial hygienists, has been brought into the realm of safety professionals, and mold problems are poised to follow suit. In light of the growing concern about mold contamination and health issues, safety professionals should be prepared to deal with these issues. This article was written to provide safety professionals with the basic understanding they will need to answer those questions. However, please note that the information in this article is a simplification and compilation of information from several sources, meant to give a general overview of mold hazards and how to deal with them. The remediation industry is currently in a state of flux, and there are few true guidelines published. The authors have attempted to cull the best of the industry’s current standards in this article, but they may be subject to change as a consensus emerges. Some Basic Information In the common vernacular the terms mold and fungus are often used interchangeably. However, in the scientific community molds are just one of the categories of non-green plant-like organisms (along with mildew, mushrooms, yeast, rusts, and smuts) that fall under the heading of fungus. Since molds make up the largest component of the fungal classification with over 60,000 identified species, the two terms often are interchanged indiscriminately. Regardless of the type of fungal matter, they all share the characteristics of being able to grow without the benefit of sunlight. This means that the only things necessary for fungus to proliferate are a viable seed (known as a spore), a nutrient source, moisture, and the right temperature. This explains why fungal infestation is often found in damp, dark, and hidden spaces. Light and air circulation have a tendency to dry things out, making the area inhospitable for the fungus. Another trait of all fungal types is that they can grow both through physical expansion as well as through the spread of spores, a process scientists term “sporation”. A good analogy for this dual method of growth would be to think of dandelions. If the conditions are right for such weeds to grow in a lawn, they have a tendency to spread to the point where they will crowd out the grass. If the heads are plucked off the dandelion plants, the weeds will spread locally by expanding the size and number of stems. If the conditions are more favorable, the dandelions will grow their characteristic yellow flowers that ultimately turn into seedpods. At that point, the wind’s physical action can transport the

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individual seeds great distances where they start new plants if they land in an appropriate place. Most mold species act in a fashion similar to the dandelion. Once they get a foothold in a particular location rapid growth across the surface is possible if the moisture source is sufficient. This would be similar to the dandelion growing in size at the base during the spring rainy season. If the moisture source starts to decrease, many mold species will go into a sporation phase where they grow and release large numbers of microscopic spores into the air. Indeed, one researcher has estimated that a single round colony of penicillium mold 2.5 centimeters in diameter contains 400,000,000 spores, each spore so small that a microscope is needed to see it. In our analogy, the spores are the equivalent of light, fluffy dandelion seeds that so many children enjoy blowing off the stems, with the “stems” of mold referred to as hyphae. It is worth noting that certain analysis methods are able to identify hyphae as well as the individual mold spores. The Prevalence of Fungus and Hazard Assessment Many forms of fungus can be found throughout the natural world. People from the earliest of times have recognized not only the presence of fungus but have learned to distinguish between beneficial forms and harmful forms of these materials. The ancient Egyptians understood that the fungus called yeast was necessary if bread was to rise or beer and wine were to ferment. Many Asian nations have used dried black or green fungus for thousands of years as a seasoning for soups and sauces. There are types of mushrooms and truffles that have been known as delicacies since before the golden age of Greece. Blue cheese receives its characteristic marbling and taste from a mold. In the modern era, a common bread mold was manipulated to create the first class of disease-fighting antibiotics. However, just as mankind learned early on how to identify the good fungi, the bad ones were known as well. The book of Leviticus in the Bible contains some of the earliest known instructions for the proper procedures to deal with mold growth on interior surfaces. Ancient Roman texts document the dangers of eating moldy grain. The great potato famine of 1845-1847 was a result of a fungus called “Late Blight” and led to an estimated 750,000 deaths. A more recent occurrence of serious fungal destruction was the death of thousands of people in the former Soviet Union in the 1940s due to their ingestion of grain that was contaminated with the mold Stachybotrys atra. This is the same mold that some doctors link to the death of infants in Cleveland, Ohio, and around the country. Stachybotrys can produce serious injury after ingestion or inhalation through internal poisoning which causes hemosiderosis, bleeding in the lungs. Since mold, mushrooms and yeast can be beneficial or harmful it becomes crucial to have some understanding of the conditions that would result in a hazard due to a fungal contamination. In other words, if there’s a little bit of black mold in the corner of the shower stall, is it serious enough that people should run screaming from the building? What about a thick patch that covers half of a two foot by four foot ceiling tile and has gray spidery tentacles beginning to creep out of a black mass? Does it make a difference

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if these situations are in the crawlspace? The crawlspace of a factory versus the crawlspace of a school? Is the musty/mildew odor an indication of significant levels of contamination? What if you cannot find a visible source for the smell? While each situation of potential mold exposure has to be evaluated individually, there are several important items to consider in every case. All visible interior sources of mold, or the characteristic musty/mold odors, should be investigated carefully. A small amount of visible mold or transient odors can often signal greater infestation that is hidden above ceiling tiles, below carpet, inside HVAC systems or between wall components. Such visible mold also is a sure sign of a moisture source. The investigation/hazard assessment should identify possible causes of structural or plumbing leaks, or reasons for elevated humidity levels (i.e., inadequate air conditioning capacity, spraying, mixing or cooking processes, unvented shower rooms, etc.). The location of fungal contamination has a great impact on a hazard assessment. The most significant problems are cases where mold is in an air stream. Therefore, any mold contamination of an HVAC system, particularly the supply ductwork, needs to be addressed promptly. Mold in or near occupied spaces is the next priority. Even mold in less frequently entered areas, such as basements, crawlspaces, attics or service rooms, should be addressed as doors, floors, and walls usually do not create airtight barriers necessary to contain the microscopic spores. The amount of mold also factors into a risk assessment. While any mold should be cleaned up, larger quantities may require the use of safety equipment to protect the workers and engineering controls to protect the building occupants. Many organizations suggest that patches of mold smaller than 2-3 square feet can be cleaned with minimal precautions (NYCDH Section 3.3). Contamination up to 30 square feet requires personal protective equipment and controlled activities (OSHA 6-9). Mold infestation greater than 30 square feet normally demands site specific engineering controls such as dust partitions, air filtering devices, special cleaners, and fungicides (EPA Table 2). Although controversial, many mold remediation specialists treat certain species differently. Because of their ability to produce mycotoxins, molds such as Stachybotrys and Fusarium many times are approached from a more conservative standpoint—including the use of negative pressure enclosures fortheir removal. Measurements and Identification There are a number of ways to evaluate fungal contamination. Although there is a tendency in our society toward scientific precision and detailed quantification, the first step in evaluating the possible impact of mold contamination is to use three of our six senses (that’s right, six senses). Generally our visual sense, olfactory sense, and common sense are enough for us to distinguish between situations that are a nuisance the mold in the shower stall) and a potential hazard (mold growing inside HVAC ductwork). A couple words of caution are necessary any time the discussion involves the use of

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physical senses or common sense as the first step of an investigation for potential fungal contamination. It is important to remember hat there can be a large difference in the sense of smell from one person to the next. In general, women ave a more acute sense of smell than men, and non-smokers than smokers. A second consideration is the act that exposure to fungal contaminants, even at low levels, can sensitize some individuals so that they experience progressively greater symptoms even with decreasing exposure. Therefore, some people can experience symptoms when concentrations of spores in the air are low enough that no telltale musty or moldy smell is present. The variability in human perception of airborne fungal contaminants is one of the reasons why testing can be so important. Choosing the type of test you use, however, can be just as important as choosing to test. Whether it's air samples or surface samples for possible fungal contamination you can choose between direct analysis samples and cultured samples. Until a few years ago, especially for airborne samples, direct analysis samples were not well regarded. This was due primarily to sampling techniques that resulted in low collection efficiencies and them variability in collection media. With the advent of a commercially available cassette that standardized the collection medium and increased collection efficiency, the use of direct analysis sampling has grown tremendously. Many professionals in the IAQ field now use direct analysis samples as their initial screening tool because the results report both viable (i.e., spores that are capable of reproduction under the right conditions) and the non-viable spores. In addition to quantifying the spores in the air that can cause allergic reactions but might not grow because they are desiccated or have been altered in some fashion, the direct analysis system allows for the identification of hyphal fragments which helps determine if the spores are from an interior source. A faster turnaround time and simplified collection process are other reasons why the use of direct analysis samples has increased in popularity for investigations of possible fungal contamination. If more detailed analysis of the fungal contamination is necessary, cultured samples are used. In this sampling technique, air is impacted against petri dishes with specific types of sampling media. These dishes are then incubated under controlled temperature and humidity conditions and the resulting growth visually examined. By its very design the cultured samples do not identify non-viable spores even though such material can also contribute to allergic reactions, but the technique does allow a more precise determination of fungal types (species and sub-species levels as compared to genus level for direct analysis samples). There is a built-in waiting time of 3 to 7 days while the samples grow in an incubation chamber. Standards and Guidelines Regardless of which sampling technique is utilized, it is difficult to find definitive standards for comparison of fungal sample results. The instruction manual that OSHA uses for its inspectors has some recommendations for indicators of indoor contamination

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(these are noted in colony forming units per cubic meter of air [cfu/m3]). OSHA tells its inspectors that levels of 1000 cfu/m3 or greater indoors is a matter of concern for further investigation. The American Conference of Govermental Industrial Hygenists (ACGIH) has a relatively new manual on biological contamination, but even that doesn't have hard numbers for either cultured sample or direct analysis sample results. What most of the expert guidance documents do indicate is that comparisons should be made between out-of-doors and inside the building, and between complaint areas and non-complaint areas with the levels and types of biological organisms compared to determine whether indoor amplification is present. The wide range of natural spore levels is dependent on the season, the surrounding vegetation, and even time of day. This fact makes the collection of out-of-doors comparison samples critical. However, these sorts of comparisons are not very helpful in determining the effectiveness of mold cleanups or even doing the risk assessment for the building occupants who have complaints about the indoor environment. In an effort to deal more effectively with such cases, a number of scientists and consultants around the country, led by Dan Baxter of San Diego, California, have assembled large bodies of anecdotal information that relates fungal counts from direct analysis samples to complaints and symptoms of building occupants. This data has pushed a number of experts to adopt 2000 counts of mold spores per cubic meter of air (c/m3) as a maximum for a clean building. Just as important as the total count, these quasi-industry standards set limits for species that are known to generate more significant allergic reactions (i.e., Penicillium and Aspergillus at less than 1000 c/m3 each) as well as species that have toxigenic properties (i.e., Stachybotrys or Fusarium are not acceptable in indoor air at any level) (ETA Internal Document). There is some reason to be optimistic that continued studies of the relationship between airborne mold levels and health effects will eventually move the information from a quasi-industry standard to a fullfledged consensus standard and perhaps ultimately provide the basis for regulatory guidance. Cleaning Up and Controlling Mold Contamination Although fungus species are natural organisms found throughout the world, their presence in our houses, schools, and offices often creates health hazards that have to be dealt with in an effective manner. The key to controlling fungal growth is to remove the moisture, the nutrients, or the source of spores. In ancient times the technology was such that their only option was to try and remove the source of the mold contamination itself and pray that it didn’t return. This is illustrated quite clearly in the Biblical book of Leviticus. The priests were history's first known mold inspectors. Homeowners with mold growth on their walls were instructed to scrape it off and then have the area checked by the priest. If successive scraping or cleaning did not keep the mold from coming back, the house was to be destroyed and the debris dumped in an "unclean" place (Bible

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Leviticus 14:43-45). While this may seem harsh, it does graphically illustrate that the serious health consequences of indoor mold contamination were well known over 3,000 years ago. Source removal is an option that is used quite frequently today if visible mold growth is present on porous materials. Physical removal is still the best choice for plaster, drywall, ceiling tiles, cellulose insulation, cardboard boxes, and other such materials that harbor visible fungal contamination. In less extreme cases, removing the moisture source and cleaning the surface with a sanitizer/biocidal agent can be effective. If such techniques are employed it is essential that the sanitizing agent come in full contact with the fungal material for the required amount of time. Whether it is excess humidity, condensation or moisture intrusion as a result of roof leaks, pipe failures, or sub-grade seepage, the water intrusion must be controlled. To err in either one of these critical control activities is to invite recontamination. This is why the ACGIH guidelines call for porus materials that have been wet for longer than 48 hours to be removed regardless of whether the leak came from a clean or dirty water source. The cleanup and/or removal of fungal contamination requires appropriate work practices and personal protective equipment. Anyone who is going to intentionally disturb fungal contamination in any way should protect themselves with a respirator or filtering face-piece (minimum N-95 rating on the facepiece) (NYCDH, EPA, AIHA). Individuals engaged in a cleanup should not confuse a filtering face-piece with a dust mask, although both are now available at many hardware and discount stores. A standard mask for nuisance dust does not provide appropriate seals or filtration to minimize inhalation of disturbed spores. When advising individuals about mold cleanups our organization recommends surgical gloves underneath cotton or leather work gloves as critical for individuals who are involved in the removal of contaminated materials. If it is cleanup and sanitizaton, heavy duty rubber gloves are necessary to protect the worker from possible chemical exposures. Large scale removal or cleanup projects may require the use of disposable body coverings, hoods, and booties to minimize the cross-contamination from work areas to clean areas in the building. Depending on the type and amount of material to be dealt with, it may be necessary to isolate the work area from other areas in the building through the use of plastic sheeting to seal doorways, windows, vents, and other openings. If the potential for airborne dispersion of contamination is significant, it may be necessary to utilize large filtering fans to create negative pressure inside the specific work area. As such, many large mold remediation projects take on the appearance of an asbestos or lead abatement job site. Incorporating the techniques of separate decontamination stations, sealing of debris, and proper waste loadout from asbestos or lead types of projects can also be beneficial to large scale mold remediation activities. It should be noted that there are some consultants and contractors in the restoration and mold remediation industry that feel that the precautions of work area set-up such as decontamination chambers and negative pressure

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are unnecessary overkill which artificially inflates the price. One of the main arguments of the "set-up minimalist" is that the mold contamination does not have the same dangerous properties as asbestos, lead, or hazardous waste. Nevertheless, continued medical research, an increasingly high level of liability associated with such work, and the practical aspects of utilizing more extensive set-up to minimize the amount of post-remediation cleaning that needs to be accomplished to reach clearance levels are factors that are pushing more and more projects toward extensive set-up. To be sure, not every project needs full-scale asbestos-style precautions. Indeed, there are several products currently on the market that provide limited tools and supplies for homeowners and maintenance/custodial workers to properly deal with small sections of mold contamination. Even in such smaller projects the basic principles of isolation, limited dust generation during removal, thorough sanitization, encapsulation of residual mold, and proper disposal are useful. A Parting Word Although mold is a naturally occurring phenomenon, the presence of extensive mold growth indoors has been known as a source of concern since ancient times. Today, however, we do not have the benefit of priests trained and tasked to properly identify mold contamination and advise building owners of the proper techniques for dealing with the situation. Lacking priests to ask, many companies will be turning to their safety professionals for answers to their mold remediation questions. Hopefully this article has provided some of the necessary background to deal with those inevitable questions. For more in-depth information and advice about dealing with mold problems, safety professionals are urged to contact one of the growing number of businesses that deal with mold hazard assessment and remediation.

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POST-REMEDIATION GUIDELINES

The lack of a single standard in the mold remediation industry can make answering the question, “How clean is clean enough?” difficult to answer. Experts have widely varying opinions on what is an acceptable level of mold in the air. The following table is a compilation of data from a large number of sources and studies, showing the conclusions of a variety of different scientists and researchers. The different units used in the various guidelines reflect the sample methods used. The unit cfu/m3 stands for “colony forming units per cubic meter of air.” This means that the samples taken were viable samples, that is, they measured how many spores were in the air that could grow into colonies of mold. These spores are called colony-forming units. Numbers that refer to “spore counts” or that do not have the “cfu” reference are non-viable samples, meaning that they reflect a count of the total spores in the air, regardless of their ability to grow. Since only a small number of the spores might actually grow, these numbers are much larger than the viable sample numbers.

RECOMMENDED CLEANING PRACTICES FOR MATERIALS POTENTIALLY CONTAMINATED BY MOLD

Preparation Activities The cleaning of items that have been located in an environment with elevated levels of mold contamination is often an important part of a remediation project. Because of the serious health effects that can develop from mold exposure and the level of sensitivity to specific spores that building occupants often experience, proper decontamination of exposed items is essential. The first step of the cleaning process is to conduct a survey of the contaminated areas. Wearing appropriate personal protective equipment, the inspector should conduct a thorough visual or video inspection to determine the quantity and type of items that will have to be cleaned. This should include identifying porous (those that have tiny gaps or holes completely through them, such as cloth or paper), semi-porous (those that have some holes but are not completely permeable), and non-porous (those that have no gaps in the surface) surfaces. (For our purposes, hard objects that allow air to circulate through them, such as computers, or objects with many contours, such as carvings, are treated as semi-porous items.) Since it is often easiest to dispose of porous and semi-porous items, the owner should be consulted to identify items of high intrinsic value, such as art, historical documents, or photographs that should be cleaned rather than discarded. This type of cost/benefit analysis should be conducted with the owner after the survey has been conducted. All porous or semi-porous items with visible mold growth should be disposed of unless their value justifies specialized cleaning techniques, such as freeze-drying, use of an ozone chamber, or solvent washes. For paper items, it may be more cost effective to make copies of the contaminated items and discard the originals.

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Once it has been determined what will be cleaned, a containment setup should be designed that will best accommodate these items. This setup may be a two-stage or three-stage decontamination area, depending on the materials to be cleaned and the methods to be used. If water spray will be used, a three-stage decontamination chamber with a shower (figure 3) should be used; otherwise a two-stage chamber should be sufficient. The chamber should be constructed adjacent to the area where the contaminated items are currently located. If at all possible, contaminated items should not be removed from their original location prior to the cleaning process. If the items have already been moved to another location, they should be cleaned where they are. Once cleaned, the items should not be moved back into the original environment until that environment has been completely remediated. The design of the decontamination chamber will also depend on the items to be cleaned. If a large amount of compressed air or manual fanning of documents will be used, or if there are large objects that need compressed air cleaning, a special air-wash area should be built. This area will use two negative air machines to create a continual flow of air, negating the need for a HEPA vacuum during the cleanup of those objects (figure 2). If there are only a few items that will be cleaned with compressed air, a different design using a HEPA vacuum may be utilized (figure 1). ______________________________________ Items to Clean APPLIANCES (with exhaust fans) Item Suggested Cleaning Procedure

• Refrigerator HEPA vacuum the exterior; then blow compressed air through the fan exhaust.* • Microwave Use sanitizing wipes to thoroughly clean the exterior and interior.

Blow compressed air through the fan exhaust.* * Keep the nozzle of the HEPA vacuum within 3 inches of the air stream exiting the appliance or conduct the work within 12 inches of the face of an operating negative air machine to capture any dislodged particulates. APPLIANCES (without exhaust fans) Item Suggested Cleaning Procedure

• Washer/dryer Wipe all surfaces with sanitizing wipes. Replace the • cardboard backing, if any, and HEPA vacuum the area behind and between the

appliances. • Stove/oven Wipe all surfaces with sanitizing wipes. If possible, move the

appliance and HEPA vacuum the area where the appliance was stored. • Dishwasher Wipe all surfaces with sanitizing wipes. If possible, move the

appliance and HEPA vacuum the area where the appliance was stored. BEDDING Item Suggested Cleaning Procedure

• Sheets/blankets/comforters All bedclothes should be HEPA vacuumed and laundered.**

• Mattress/box spring HEPA vacuum thoroughly. • Pillows/stuffed animals HEPA vacuum thoroughly.

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**Most industry experts agree that dry cleaning is not an effective way of removing bioaerosols from clothing. For this reason, dry cleaning is not recommended. CABINETS/DRAWERS Item Suggested Cleaning Procedure

• File cabinets File cabinets should be opened and emptied. The cabinets • themselves should be wet-wiped. Any disposable contents should be discarded.

Other contents should be HEPA vacuumed and replaced. • Dish cabinets Each dish should be removed and wiped individually. The • cupboard should be HEPA vacuumed externally and wetwiped internally. • Drawers Drawers should be emptied and wet-wiped inside and out. • The contents should be HEPA vacuumed. Lazy Susan Wet-wipe all surfaces.

Anything stored there should also be HEPA vacuumed or wet-wiped. CLOTHING AND FABRICS Item Suggested Cleaning Procedure

• Fabric clothing HEPA vacuum thoroughly and launder. If manufacturer • recommends dry cleaning, replace or hand wash.** • Leather clothing Wipe with sanitizing wipes and HEPA vacuum.** For • further cleaning information, check the manufacturer’s guidelines. • Drapes HEPA vacuum and launder. Steam cleaning may also be • effective. Follow manufacturer’s cleaning instructions.** • Towels/washcloths HEPA vacuum and launder. • Rugs Rugs can be bagged and taken to an industrial cleaner to be • laundered. An alternative method would be to HEPA vacuum, perform hot water

extraction, and HEPA vacuum again after the rug dries. **Most industry experts agree that dry cleaning is not an effective way of removing bioaerosols from clothing. For this reason, dry cleaning is not recommended. COUNTERS AND CUPBOARDS Item Suggested Cleaning Procedure

• Formica/metal counters Wipe thoroughly with sanitizing wipes, scrubbing if • necessary. • Wooden counters Wipe thoroughly with sanitizing wipes, scrubbing if • necessary. If the exposure to mold was extensive, refinish the counter tops. • Wooden cupboards Wipe the exterior thoroughly with sanitizing wipes, • scrubbing if necessary. HEPA vacuum the interiors.

ELECTRONICS (with exhaust fans) Item Suggested Cleaning Procedure

• Computer towers HEPA vacuum the exterior of the tower; then remove the cowl. Use compressed air to blow into the computer, aerosolizing unreachable particulates.*

ELECTRONICS (without exhaust fans) Item Suggested Cleaning Procedure

• Television/computer monitor HEPA vacuum the exterior of the monitor; then use • compressed air to blow into the interior.* • Telephone Use compressed air to blow as much dust as possible from the exterior

and interior components of the telephone.*

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• Radio/stereo receiver HEPA vacuum the exterior; then blow compressed air into any openings.*

• Speakers Speaker covers should be HEPA vacuumed. Wet-wipe the speaker cabinet. Carefully wet-wipe the speakers themselves.

• Fax Use compressed air to blow any dust off the machine and out of any cracks.* • Answering Machine Wipe the entire machine with sanitizing wipes. • VCR/DVD Wet-wipe the exterior and blow compressed air into the tape/DVD

slot.* • Photocopier The exterior of the machine should be wiped with sanitizing wipes.

Compressed air should be blown into the interior.* Remove the toner storage tray and HEPA vacuum it.

• Remote Control Wipe with sanitizing wipes. * Keep the nozzle of the HEPA vacuum within 3 inches of the air stream exiting the component or conduct the work within 12 inches of the face of an operating negative air machine to capture any dislodged particulates. Recommended Cleaning Practices for Materials Potentially Contaminated By Mold Page 6 of 9 FOOD Item Suggested Cleaning Procedure

• Fresh Any exposed foodstuffs should be disposed of. • Canned The exterior of the container should be wiped with a sanitizing wipe. • Boxed Any boxed food that will be cooked before consumption, such as macaroni

and cheese, should be wiped with a sanitizing wipe. Any packages inside the box, such as seasonings or toppings, should be wiped off as well.

• Boxed foods that are not cooked, such as cereal, should be disposed of. FURNITURE Item Suggested Cleaning Procedure

• Upholstered chair/sofa/ottoman If the furniture has removable cushions, remove each cushion and HEPA vacuum all sides, as well as all surfaces of the furniture. If the cushions are not removable, vacuum all surfaces, paying special attention to the cracks between the cushions (this is especially important for reclining chairs).

Note: It is not possible to accurately gauge the extent of contamination in upholstered furniture. If the furniture has been heavily exposed to mold or spores, consider replacement. Leather or vinyl chair/sofa/ottoman If the furniture has removable cushions, remove each cushion and HEPA vacuum all surfaces, then wipe with sanitizing wipes. If the cushions are not removable, vacuum all surfaces, paying special attention to the cracks between the cushions. Wipe with sanitizing wipes wherever possible.

• Wood chair/sofa/ottoman If there is no visible mold growth on the surface and • exposure was minimal to moderate, HEPA vacuum all surfaces and clean the

surface with wood cleaner. If exposure was heavy, wipe the surface and then sand away the finish. HEPA vacuum the exposed wood and refinish.

• Wooden desk/shelves Treat the same as other wood furniture. • Wooden antiques Antique wood has not undergone the same treatment as modern

wood, making it more susceptible to mold. For that reason, any exposed antiques should be HEPA vacuumed, wiped down, and refinished.

• Plastic furniture HEPA vacuum and wipe all surfaces with a sanitizing wipe.

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LIGHT FIXTURES AND LAMPS Item Suggested Cleaning Procedure

• Florescent ceiling fixtures HEPA vacuum the plastic light cover, inside and out.Remove the bulbs and wipe with sanitizing wipes. Wipe the metal fixture as well.

• Incandescent ceiling fixtures Wipe any covering, bulbs, and fixtures with sanitizing wipes.

• Florescent and incandescent lamps Wipe the lamp and bulb with sanitizing wipes. HEPA vacuum the shade, inside and out.

• Incandescent chandeliers Wipe all surfaces with sanitizing wipes. This can be very time consuming but all pieces and bulbs in the chandelier must be wiped down.

PAPERS Item Suggested Cleaning Procedure

• Paperback and hardcover books Many times it is simply not worth the effort to clean cheap books; it may be easier to replace them. If cleaning is desired, the entire book should be HEPA vacuumed on all six sides or shaken out near the negative air machine. Freezing or freeze-drying may also be effective.

• Loose-leaf papers and notebooks Loose papers should be discarded unless the owner says otherwise (always check with the owner before disposing of anything). If it is necessary to clean papers, they should be individually HEPA vacuumed or shaken out near thenegative air machine. An alternative would be to place the papers in plastic bags, photocopy them, and then discard the originals. Freezing or freeze-drying may also be effective.

• Cardboard Cardboard should be discarded unless the owner says otherwise. If it is necessary to clean the cardboard, treat it as you would treat loose-leaf papers.

• Photos Photographs should be cleaned in the same way as papers. Photos in sleeves should be treated the same way but the sleeve should be HEPA vacuumed as well, or discarded and replaced. Framed photos or certificates that are covered by glass should have been protected from exposure and contamination but the frame should be wiped with a sanitizing wipe.

• Artwork Any pieces of art that would be saved should be cleaned in the same way as photos and papers.

TOILETRIES AND MEDICINES Item Suggested Cleaning Procedure

• Soap Soap that is no longer wrapped should be disposed of. • Shampoo Tightly capped bottles should be wiped off. Open bottles should be

disposed of. • Hairbrush/comb Rinse with a disinfectant and water. • Razors Electric razors should be wiped off with a sanitizing wipe and the blades

should be rinsed with a disinfectant and water. • Straight razors should be rinsed with a disinfectant and water. • Hair dryer Wet-wipe the exterior and change the filter. Blow compressed air

through any openings with a HEPA vacuum running to capture any dislodged particles.

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• Medicine bottles Capped bottles should be wiped off. Open bottles should be • disposed of. • Pills Any exposed pills should be discarded. Pills in bottles can be used after the

bottle has been wiped off. • Tubes/masks/respirators Any medical equipment should be wiped and rinsed with

a disinfectant, followed by a liberal amount of water. • Wheelchairs/walkers/canes All mobility aids should be wiped off with a sanitizing

wipe. • Any soft surfaces should be HEPA vacuumed.

TOYS Item Suggested Cleaning Procedure

• Metal and plastic toys Any metal or plastic toys should be wiped down with a sanitizing wipe.

• Wooden toys Wipe with sanitizing wipe. If exposure was heavy, sand down and refinish.

• Puzzles Puzzles should be treated like cardboard. • Rubber toys Rubber balls and toys should be HEPA vacuumed and wiped with a

sanitizing wipe. MISCELLANEOUS Item Suggested Cleaning Procedure

• HVAC ducts Ducts should be HEPA vacuumed or wiped with sanitizing wipes. • HVAC pans/coils HVAC components should be treated with an anti-fungal agent

and HEPA vacuumed. • Fans Wipe with sanitizing wipes. Any inaccessible parts should have compressed

air blown into them with a HEPA vacuum nearby to capture any released particles.

• Compact discs/records/cassettes Musical media should be removed from their cases, with both media and cases HEPA vacuumed.

• Vacuum cleaner Remove and replace the bag. All interior surfaces should be wiped with a sanitizing agent.

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THE COMPREHENSIVE, BUT COMMON SENSE, APPROACH TO

MOLD INDOORS In the last five to ten years a body of scientific and anecdotal data has grown which points to interior mold contamination as a potentially serious health threat. Foreign and U.S. studies have linked mold in homes to serious illnesses including severe respiratory and neurological problems. Industrial hygiene reports have connected lost time illness with drivers' exposure to mold-infested street cars. A steady stream of building evacuations have been documented because of symptoms traced to rampant but oftentimes hidden mold. Such reports made it first to the technical and medical journals, with the mainstream media subsequently translating it to the public consciousness. As the media reports grow and individual situations inevitably move toward litigation, many building managers, insurance professionals, medical practitioners and homeowners find themselves behind the curve on the issues of fungal contamination and are struggling to catch up. This article is designed to present an overview of the current situation regarding mold contamination and answer common questions such as: Is all mold contamination a hazard? Is such contamination more prevalent today than before, and if so, why? Are there effective ways to identify potential mold contamination? Do industry experts currently agree on any standards for addressing mold? How do you deal with it once you identify mold as a possible or actual contaminant in your building? Some Basic Information In the common vernacular the terms mold and fungus are often used interchangeably. However, in the scientific community molds are just one of the categories of non-green organisms (along with mildew, mushrooms, yeast, rusts, and smuts) that fall into the kingdom of fungus. Since molds make up the largest component of the fungal classification with over 60,000 identified species, the two terms are often interchanged indiscriminately. Regardless of the type of fungal matter, they all share the characteristics of being able to grow without the benefit of sunlight. This means that the primary things necessary for fungus to proliferate are a viable seed (known as a spore), a nutrient source, moisture, and the right temperature. This explains why you often find fungal infestation in damp, dark, and hidden spaces. Light and air circulation have a tendency to dry things out, making the area inhospitable for the fungus. Another trait of all fungal types is that they can grow both through physical expansion as well as through the spread of spores, a process scientists term sporation. A good analogy for this dual method of growth would be to think of dandelions. If the conditions are right for such weeds to grow in your lawn they have a tendency to spread to the point where they will crowd out the grass. If you pluck the heads off the dandelion plants, the weeds

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will spread locally by expanding the size and number of stems. If the conditions are more favorable, the dandelions will grow their characteristic yellow flowers that ultimately turn into seedpods. At that point, the wind’s physical action can transport the individual seeds great distances where they start new plants if they land in an appropriate place. Most mold species act like the dandelion. Once they get a foothold in a particular location rapid growth across the surface is possible if the moisture source is sufficient. This would be similar to the dandelion growing in size at the base during the spring rainy season. If the moisture source starts to decrease, many mold species will go into a sporation phase where they grow and release large numbers of microscopic spores into the air. Indeed, one researcher has estimated that a single round colony of Penicillium mold 2.5 centimeters in diameter contains 400,000,000 spores, each spore so small that a microscope is needed to see it. In our analogy the spores are the equivalent of light, fluffy dandelion seeds that so many children enjoy blowing off the stems, with the “stems” of mold commonly referred to as hyphae. It is worth noting that certain analysis methods are able to identify hyphae as well as the individual mold spores. The Prevalence of Fungus and Hazard Assessment Many forms of fungus can be found throughout the natural world. People from the earliest of times have recognized not only the presence of fungus but have learned to distinguish between beneficial forms and harmful forms of these materials. The ancient Egyptians understood that the fungus called yeast was necessary if bread was to rise or beer and wine were to ferment. Many Asian nations have used dried black or green fungus for thousands of years as a seasoning for soups and sauces. There are types of mushrooms and truffles that have been known as delicacies since before the golden age of Greece. Blue cheese receives its characteristic marbling and taste from a mold. In the modern era a common bread mold was manipulated to create the first class of disease-fighting antibiotics. But just as mankind learned early on how to identify the good fungi, the bad ones were known as well. The book of Leviticus in the Bible contains some of the earliest known instructions for the proper procedures to deal with mold growth on interior surfaces. Ancient Roman texts document the dangers of eating moldy grain. The great potato famine of 1845-1847 was a result of a fungus called “Late Blight” and led to an estimated 750,000 deaths. A more recent occurrence of serious fungal destruction was the death of thousands of people in the former Soviet Union in the 1940s due to their ingestion of grain that was contaminated with the mold Stachybotrys atra. This is the same mold that some doctors link to the death of infants in Cleveland, Ohio, although the Centers for Disease Control and Prevention (CDC) later downplayed that connection. Even so, it is well documented that Stachybotrys mold can produce serious injury after ingestion or inhalation, including internal poisoning which causes hemosiderosis, bleeding in the lungs. Since mold, mushrooms and yeast can be beneficial or harmful it becomes crucial to have some understanding of the conditions that would result in a hazard due to a fungal

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contamination. In other words, if there’s a little bit of black mold in the corner of the shower stall, is it serious enough that people should run screaming from the house? What about a thick patch that covers half of a two foot by four foot ceiling tile and has gray spidery tentacles beginning to creep out of a black mass? Does it make a difference if these situations are in the crawlspace? The crawlspace of a house versus the crawlspace of a school? Is the musty/mildew odor an indication of significant levels of contamination? What if you can’t find a visible source for the smell? While each situation of potential mold exposure has to be evaluated individually, there are several important items to consider in every case. All visible interior sources of mold, or the characteristic musty/mold odors, should be investigated carefully. A small amount of visible mold or transient odors can often signal greater infestation that is hidden above ceiling tiles, below carpet, inside HVAC systems or between wall components. Visible mold also is a sure sign of a moisture source. The investigation/hazard assessment should identify possible causes of structural or plumbing leaks, or reasons for elevated humidity levels (i.e., inadequate air conditioning capacity, spraying, mixing or cooking processes, unvented shower rooms, etc.). The location of fungal contamination has a great impact on a hazard assessment. The most significant problems generally occur where mold is in an air stream. Therefore, any mold contamination of a heating, ventilating, and air conditioning (HVAC) system, particularly the supply ductwork, needs to be addressed promptly. Mold in or near occupied spaces is the next priority. Even mold in less frequently entered areas, such as basements, crawlspaces, attics or service rooms, should be addressed as doors, floors, and walls usually do not create airtight barriers necessary to contain the microscopic spores. The amount of mold also factors into a risk assessment. While any mold should be cleaned up, require the use of safety equipment to protect the workers and engineering controls to protect the building occupants for contamination of any structural components (as compared to mold on a shower stall or refrigerator door seal). Many organizations suggest that patches of mold smaller than 2-3 square feet can be cleaned with minimal precautions. Contamination up to 30 square feet requires personal protective equipment and controlled activities. Mold infestation greater than 30 square feet normally demands site specific engineering controls such as dust partitions, air filtering devices, special cleaners, and fungicides. Although controversial, many mold remediation specialists treat certain species differently. Because of their ability to produce mycotoxins, molds such as Stachybotrys and Fusarium are many times approached from a more conservative standpoint—including the use of negative pressure enclosures for their removal. Measurements and Identification There are a number of ways to evaluate fungal contamination. Although there is a tendency in our society toward scientific precision and detailed quantification, the first step in evaluating the possible impact of mold contamination is to use three of our six senses (that’s right, six senses). Generally our visual sense, olfactory sense, and common

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sense are enough for us to distinguish between situations that are a nuisance (the mold in the shower stall) and a potential hazard (mold growing inside HVAC ductwork or wall cavities). A couple words of caution are necessary any time the discussion involves the use of physical senses or common sense as the first step of an investigation for potential fungal contamination. It is important to remember that there can be a large difference in the sense of smell from one person to the next. In general, women have a more acute sense of smell than men, and non-smokers than smokers. A second consideration is the fact that exposure to fungal contaminants, even at low levels, can sensitize some individuals so that they experience progressively greater symptoms even with decreasing exposure. Therefore, some people can experience symptoms when concentrations of spores in the air are low enough that no telltale musty or moldy smell is present. The variability in human perception of airborne fungal contaminants is one of the reasons why testing can be so important. Choosing the type of test you use, however, can be just as important as choosing to test. Whether it's air samples or surface samples for possible fungal contamination you can choose between direct analysis samples and cultured samples. Until a few years ago, especially for airborne samples, direct analysis samples were not well regarded. This was due primarily to sampling techniques that resulted in low collection efficiencies and the variability in collection media. With the advent of a commercially available cassette that standardized the collection medium and increased collection efficiency, the use of direct analysis sampling has grown tremendously. Many professionals in the mold inspection and remediation industry now use direct analysis samples as their initial screening tool because the results report both viable (i.e., spores that are capable of reproduction under the right conditions) and the non-viable spores. In addition to quantifying the spores in the air that can cause allergic reactions but might not grow because they are desiccated or have been altered in some fashion, the direct analysis system allows for the identification of hyphal fragments which helps determine if the spores are from an interior source. A faster turnaround time and simplified collection process are other reasons why the use of direct analysis samples has increased in popularity for investigations of possible fungal contamination. If more detailed analysis of the fungal contamination is necessary, cultured samples are used. In this sampling technique, air is impacted against petri dishes with specific types of sampling media. These dishes are then incubated under controlled temperature and humidity conditions and the resulting growth visually and/or chemically examined. By its very design the cultured samples do not identify non-viable spores even though such material can also contribute to allergic reactions, but the technique does allow a more precise determination of fungal types (to the specie level as compared to genus level for direct analysis samples). There is a built-in waiting time of 3 to 7 days while the samples grow in an incubation chamber.

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Standards and Guidelines Regardless of which sampling technique is utilized, it is difficult to find definitive standards for comparison of fungal sample results. The instruction manual that OSHA uses for its inspectors has some recommendations for indicators of indoor contamination (these are noted in colony forming units per cubic meter of air [cfu/m3]). OSHA tells its inspectors that levels of 1000 cfu/m3 or greater indoors is a matter of concern for further investigation. The American Conference of Govermental Industrial Hygienists (ACGIH) has a relatively new manual on biological contamination, but even that doesn‘t have “hard numbers” for either cultured sample or direct analysis sample results. What most of the expert guidance documents do indicate is that comparisons should be made between out-of-doors and inside the building, and between complaint areas and non-complaint areas. Both the levels and types of biological organisms should be compared to determine whether indoor amplification is present. The wide range of natural spore levels is dependent on the season, the surrounding vegetation, and even time of day. This fact makes the collection of out-of-doors comparison samples critical. However, these sorts of comparisons are not very helpful in determining the effectiveness of mold cleanups. Nor are they always accurate for a risk assessment for the building occupants who have complaints about the indoor environment and perhaps have been sensitized by long-term exposure. In an effort to deal more effectively with such cases, a number of scientists and consultants around the country, led by Dan Baxter of San Diego, California, have assembled large bodies of anecdotal information that relates fungal counts from direct analysis samples to complaints and symptoms of building occupants. This data has pushed a number of experts to adopt 2000 counts of mold spores per cubic meter of air as a maximum for a clean building. Just as important as the total count, these "quasi-industry" standards set limits for species that are known to generate more significant allergic reactions (i.e., Penicillium and Aspergillus at less than 1000 c/m3

each) as well as species that have toxigenic properties (i.e., Stachybotrys or Fusarium in indoor air at any level indicate a potential problem). There is some reason to be optimistic that continued studies of the relationship between airborne mold levels and health effects will eventually move the information from a quasi-industry standard to a fullfledged consensus standard and perhaps ultimately provide the basis for regulatory guidance. Indeed, California’s legislature has tasked that state’s health department with developing a permissible exposure limit for mold. While numerical standards are still much debated, there is little debate in the mold control area about the basic steps to correct and prevent mold contamination. A clear “industry standard of care” has been recognized by the courts. Although this standard must be put together from a number of reference sources (see end notes), it provides definitive boundaries for acceptable work in the mold comtanination cases. It blends realism in dealing with such situations with the caution that potential mold exposure demands.

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Cleaning Up and Controlling Mold Contamination Although fungal species are natural organisms found throughout the world, their presence in our houses, schools, and offices often creates health hazards that have to be dealt with in an effective manner. Them key to controlling fungal growth is to remove the moisture, the nutrients, or the source of spores. In ancient times the technology was such that their only option was to try and remove the source of the mold contamination itself and pray that it didn’t return. This is illustrated quite clearly in the Biblical book Leviticus. The priests were history's first known mold inspectors. Homeowners with mold growth on their walls were instructed to scrape it off and then have the area checked by the priest. If successive scraping or cleaning did not keep the mold from coming back, the house was to be destroyed and the debris dumped in an "unclean place". While this may seem harsh, it does graphically illustrate that the serious health consequences of indoor mold contamination were well known over 3,000 years ago. Source removal is an option that is used quite frequently today if visible mold growth is present on porus materials. Physical removal is still the best choice for plaster, drywall, ceiling tiles, cellulose insulation, cardboard boxes, upholstered furniture, and other such materials that harbor visible fungal contamination. In less extreme cases, removing the moisture source and cleaning the surface with a sanitizer/biocidal agent can be effective. If such techniques are employed it is essential that the sanitizing agent come in full contact with the fungal material for the required amount of time. Whether it is excess humidity, condensation or moisture intrusion as a result of roof leaks, pipe failures, or subgrade seepage, the water intrusion must be controlled. To err in either one of these critical control activities is to invite recontamination. This is why the ACGIH guidelines call for porus materials that have been wet for longer than 48 hours to be removed regardless of whether the leak came from a clean or dirty water source. Any cleanup and/or removal of fungal contamination requires appropriate work practices and personal protective equipment. Anyone who is going to intentionally disturb fungal contamination in any way should protect themselves with a respirator or filtering face-piece (minimum N-95 rating on the facepiece). Individuals engaged in a cleanup should not confuse a filtering face-piece with a dust mask, although both are now available at many hardware and discount stores. A standard mask for nuisance dust does not provide appropriate seals or filtration to minimize inhalation of disturbed spores. When advising individuals about mold cleanups our organization recommends surgical gloves underneath cotton or leather work gloves as critical for individuals who are involved in the removal of contaminated materials. If it is cleanup and sanitization, heavy duty rubber gloves are necessary to protect the worker from possible chemical exposures. Large scale removal or cleanup projects may require the use of disposable body coverings, hoods, and booties to minimize the cross-contamination from work areas to clean areas in the building. Depending on the type and amount of material to be dealt with, it may be necessary to isolate the work area from other areas in the building through the use of plastic sheeting

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to seal doorways, windows, vents, and other openings. If the potential for airborne dispersion of contamination is significant, the use of large filtering fans to create negative pressure inside the specific work area is recommended. Incorporating the techniques of separate decontamination stations, sealing of debris, and proper waste loadout from asbestos or lead types of projects can also be beneficial to large-scale mold remediation activities. As such, many large mold remediation projects take on the appearance of an asbestos or lead abatement job site. It should be noted that there are some consultants and contractors in the restoration and mold remediation industry that feel that the precautions of work area set-up such as decontamination chambers and negative pressure are unnecessary overkill which artificially inflates the price. One of the main arguments of the "set-up minimalist" is that the mold contamination does not have the same dangerous properties as asbestos, lead, or hazardous waste. Nevertheless, continued medical research, an increasingly high level of liability associated with such work, and the practical aspects of utilizing more extensive set-up to minimize the amount of post-remediation cleaning that needs to be accomplished to reach clearance levels are factors that are pushing more and more projects toward extensive set-up. To be sure, every project does not need full-scale asbestos-style precautions. Indeed, there are several products currently on the market that provide limited tools and supplies for homeowners and maintenance/custodial workers to properly deal with small sections of mold contamination. Even in such smaller projects the basic principles of isolation, limited dust generation during removal, thorough sanitization, encapsulation of residual mold, and proper disposal are useful. A Final Word of Caution Although mold is a naturally occurring phenomenon, the presence of extensive mold growth indoors has been known as a source of concern since ancient times. Today, however, we do not have the benefit of priests trained and tasked to properly identify mold contamination and advise building owners of the proper techniques for dealing with the situation. Without the benefit of comprehensive federal regulations or certification of contractors, individuals looking for assistance with such problems are left to sort through the competing claims and marketing hype on their own. Unfortunately, the number of inexperienced consultants and outright charlatans now promoting investigative or remediative services for indoor air quality means that the building owner has to understand some of these basics and use good judgement when selecting someone to assist them with indoor air quality problems.

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WATER-STAINED CEILING TILES MAY BE MORE THAN AN EYESORE: Proper Removal to Protect People and Property Values

Ceiling tiles in residential and commercial settings can be a source of biological contamination under a variety of conditions. If a moisture source is present, a ceiling tile may function better as a two-foot by four-foot petri dish, promoting biological growth, than a ceiling covering. Too often water-impacted ceiling tiles are left until they have become “pregnant”--bowed so severely from the weight of the moisture that they actually fall from the suspension tracks. In conducting hundreds of indoor air quality investigations and assessments, our organization has found that seventy to eighty percent of the stained ceiling tiles that were tested harbored active or former biological growth. In many cases, the ceiling tiles were determined to be contributing to elevated bioaerosol concentrations recovered from the interior air. One of three typical responses occur when water stained ceiling tiles are identified in a building. The first and most common response by maintenance personnel and building occupants alike is to ignore the stained tile. This is likely due to the lack of information available regarding the potential impact such materials have on indoor air quality. The second response is to hide the discoloration with a matching paint. This response follows the out-ofsight, out-of-mind theory. One of the problems with this approach is that the evidence of a leak or water intrusion is hidden and therefore the underlying problem is unlikely to be corrected. In addition, the application of paint seals and pushes the moisture to the top side of the ceiling tile. The end result is a tile that looks unaffected from the bottom side but can be promoting explosive growth on the top side as long as the moisture source is present. The third response is to change the tile in a less than expedient time frame. Water-damaged ceiling tiles are left until they take on the appearance of a pregnant tile in its third trimester. In many of these cases, the ceiling tile may not show heavy discoloration on the bottom side. However, the top side of a sagging ceiling tile may be supporting substantial biological contamination. Currently, many different agencies have approached this issue from a common sense point of view. Some agencies, which include Joint Commission on Accreditation of Healthcare Organizations (JCAHO), EPA: Mold Remediation in Schools and Commercial Buildings, and U.S. Public Health Service: Flood Response Guidelines, recognize that wet or water-damaged ceiling tiles should be removed. This approach is more feasible than analytical testing which is costly, time consuming, and usually brings about the same recommendation to remove biologically impacted materials. Although a number of groups agree that removal of water-damaged and/or fungal-harboring materials should be conducted, specific detailed methods have not been developed to perform this activity in a manner that controls and reduces the

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amount of exposure to workers and the environment. Disturbing the tile creates potential dispersal of contaminants, dust, and particulates. In situations where more than one ceiling tile removal is necessary, the amount of exposure and dispersal increases significantly. With this in mind, Caltex Environmental has adopted current industry guidelines and applied them to removal of water-stained ceiling tiles. The goal of ceiling tile removal is to do the most efficient job of removal without spreading fungal contamination and endangering the health of the workers conducting the removal or the people that inhabit the removal areas. This protocol for removing ceiling tiles is dependant on a number of factors: staining or discoloration of the tile, number of affected tiles in an area, and whether the tile is wet or dry. For clarification the following definitions will be used throughout the document. • Wet tiles--Any ceiling tile that has contained moisture for less than 72 hours • Dry tiles--Any ceiling tile that was previously wet, but has been dry for more than 72 hours Dry tile removal procedures are based on the number of stained ceiling tiles in a room or area. The classification of dry tiles falls into three categories: 1. 1 to 4 impacted ceiling tiles 2. 5 to 12 impacted ceiling tiles 3. 13 or more impacted ceiling tiles The quantity of tiles is counted by area. A single classroom or segment of hallway is considered one area. This should be determined before starting work. Protocol for Wet Tile Removal 1. Two people should conduct the removal. 2. Proper personal protective equipment (PPE) should be worn at all times. A minimum of goggles and latex gloves are required. 3. A sheet of polyethylene should be placed under the work area during the removal procedures. 4. A ladder that is the appropriate height should be used and placed on the polyethylene that has been placed under the work area. 5. Carefully remove the stained ceiling tile(s) and place the stained tile(s) into disposal bags without dropping or breaking the tile. 6. Inspect the top side of the adjacent ceiling tiles for contamination or discoloration. 7. If moisture, contamination, or staining is found, the same procedure should be followed to remove additional tile(s). 8. After removal of impacted tiles all bagged materials should be closed and duct taped using the gooseneck method. 9. Identify the source of the water and make plans for corrective actions in that area. 10. Wet wipe the track that the ceiling tile sits in using an EPA registered disinfectant such as Fiberlock’s IAQ 2500.

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11. Wet wipe the ladder using an EPA registered disinfectant such as Fiberlock’s IAQ 2500. 12. Carefully roll the drop cloth and place in a disposal bag and use the gooseneck sealing method. If further tiles are to be removed, the same piece of polyethylene may be used, but it must be cleaned before transferring to another area. Protocol for Removal of 1 to 4 Stained Tiles That Are Dry 1. Two people should conduct the removal. 2. Proper personal protective equipment (PPE) should be worn at all times. This includes goggles, gloves, Tyvek suit with hood, and either an N-95 or N-100 mask. 3. A sheet of polyethylene should be placed under the work during the removal procedures. 4. A ladder that is the appropriate height should be used and placed on the polyethylene that has been placed under the work area. 5. A HEPA vacuum should be used to vacuum the underside and the top side of the tile that is to be removed as well as tiles that are adjacent to the stained tile. 6. Carefully remove the stained ceiling tile, place the stained tile into disposal bags without dropping or breaking the tile. 7. Inspect the top side of the adjacent ceiling tiles for contamination or discoloration. 8. If contamination or discoloration is found, the same procedure should be followed for removal. 9. Identify the source of the water and make plans for corrective actions in that area. 10. HEPA vacuum the track that the ceiling tile sits in. 11. HEPA vacuum the ladder. 12. HEPA vacuum the polyethylene drop cloth. 13. HEPA vacuum each person working in the area. 14. Carefully roll the drop cloth and place in a disposal bag and use the gooseneck sealing method. If further tiles are to be removed, the same piece of polyethylene may be used, but must be cleaned before transferring to another area. Protocol for Removal of 5 to 12 Stained Tiles That Are Dry 1. Two people should conduct the removal. 2. Proper personal protective equipment (PPE) should be worn at all times. This includes goggles, gloves, Tyvek suit with hood, and either an N-95 or N-100 mask. 3. Isolate the work area from other areas of the building. 4. Critical barriers in that area should be constructed using polyethylene plastic and duct or painter tape. These barriers should seal doorways, air supply vents, and air return vents. 5. A sheet of polyethylene should be placed under the work during the removal procedures. 6. The surrounding area should also have polyethylene covering it. 7. A ladder that is the appropriate height should be used and placed on the polyethylene that has been placed under the work area.

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8. A HEPA vacuum should be used to vacuum the underside and the top side of the tile that is to be removed as well as tiles that are adjacent to the stained tile. 9. Carefully remove the stained ceiling tile, place the stained tile into disposal bags without dropping or breaking the tile. All bagged materials should be closed and duct taped using the gooseneck method. 10. Inspect the top side of the adjacent ceiling tiles for contamination or discoloration 11. If contamination or discoloration is found, the same procedure should be followed for removal. 12. Identify the source of the water and make plans for corrective actions in that area. 13. HEPA vacuum the track that the ceiling tile sits in. 14. HEPA vacuum the ladder. 15. HEPA vacuum the polyethylene drop cloth. 16. HEPA vacuum each person working in the area. 17. Carefully roll the drop cloth and place in a disposal bag and use the gooseneck sealing method. If further tiles are to be removed, the same piece of polyethylene may be used, but must be cleaned before transferring to another area. 18. Remove and discard critical barriers. Protocol for Removal of 13 or More Stained Tiles That Are Dry 1. Two people should conduct the removal. 2. Proper personal protective equipment (PPE) should be worn at all times. This includes goggles, gloves, Tyvek suit with hood, and either an N-95 or N-100 mask. 3. Isolate the work area from other areas of the building. 4. Critical barriers in that area should be constructed using polyethylene. These barriers should seal doorways, air supply vents, and air return vents. 5. A negative air machine or air scrubber should be set up and turned on in the work area. 6. A sheet of polyethylene should be placed under the work during the removal procedures. 7. The surrounding area should also have polyethylene covering it. 8. A ladder that is the appropriate height should be used and placed on the polyethylene that has been placed under the work area. 9. A HEPA vacuum should be used to vacuum the underside and the top side of the tile that is to be removed as well as tiles that are adjacent to the stained tile. 10. Carefully remove the stained ceiling tile, place the stained tile into disposal bags without dropping or breaking the tile. All bagged materials should be closed and duct taped using the gooseneck method. 11. Inspect the top side of the adjacent ceiling tiles for contamination or discoloration 12. If contamination or discoloration is found, the same procedure should be followed for removal. 13. Identify the source of the water and make plans for corrective actions in that area. 14. HEPA vacuum the track that the ceiling tile sits in. 15. HEPA vacuum the ladder. 16. HEPA vacuum the polyethylene drop cloth. 17. HEPA vacuum each person working in the area.

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18. Carefully roll the drop cloth and place in a disposal bag and use the gooseneck sealing method. If further tiles are to be removed, the same piece of polyethylene may be used, but must be cleaned before transferring to another area. 19. Remove and discard critical barriers. 20. Shut off and remove negative air machine.

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POST-REMEDIATION CRITERIA FOR MOLD CLEANUP

PROJECTS As concerns about mold contamination indoors become more prevalent, the need for standards within the industry grows at an increasingly rapid pace. Not only is it crucial to have mold remediation standards, but post-remediation standards, as well. Non-standardized post-remediation inspections cause a number of problems, including project failure, confusion for the contractor, increased liability for the whole industry, limited comparisons between projects, and a breakdown in the public's confidence. Although the post-remediation evaluation process includes many parts, including sample collection and analysis procedures, this article focuses on the importance of logical and effective post-remediation sample interpretation from a macro approach. We will leave the discussion of collection and analysis methodology to a future paper. Post-remediation evaluation is a critical component of any mold remediation project (AIHA 38). Oftentimes, due to the lack of concrete standards, the remediation work is done incorrectly or ineffectively. This can make the problem worse and the contamination widespread (ACGIH 15.2). If, for example, a proper decontamination unit is not correctly set up, the risk of contaminating clean areas increases dramatically. In other situations, there may be more than one mold source contributing to the problem. If all mold sources are not revealed and properly cleaned, mold will continue to be an issue even after remediation. A post-remediation evaluation process can identify shoddy remediation efforts or undiscovered mold sources that may continue to affect indoor air quality. Despite the obvious need for generally accepted criteria to use as a comparison for post-remediation samples, no universally recognized document currently exists. In fact, many industry professionals have adopted the mistaken opinion that such criteria is impossible to develop as there are too many variables (ACGIH TLV 2) (Tiffany, Bader, and Pratt 523). While it is important to recognize and address multiple impacts, being difficult does not make a project impossible. As such, the first step in the process is identifying and categorizing the critical variables to be addressed in the development of a clearance criterion. Why Don't We Have Standard Post-remediation Procedures? Take, for example, the number of different approaches and methodologies a hygienist or Indoor Environment Professional (IEP) can use to collect a sample. For surface samples, one might use swab, tape, bulk or dust collection methods to gather the sample. For air samples, gravitational sedimentation plates, air impact cassettes, spore trap on slides, collector sieves, liquid impingers, or agar impaction methods could be used to collect the sample. Now consider the number of ways to analyze and interpret the sample data: cultured, non-cultured (PCR), chemical (to identify mycotoxins or microbial volatile organic compounds), and others. Furthermore, consider diverse geographic locations that have very different spore levels as a normal part of their environment. In addition, many professionals argue that any post-remediation criteria must also take into account the considerable range in individual susceptibilities to mold (ACGIH TLV 2).

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Last, and most important, there is a wide variability in the way in which contractors conduct remediation, often failing to combine effective work practices with proper isolation and containment, engineering controls, decontamination procedures, and effective air flow and pressure management. Consequently, the difficultly in creating clear, concise mold remediation criteria comes as no surprise. Past Efforts Because mold spores are naturally occurring organisms and are found in all environments, it is very difficult to pin an exact number on exposure limits. Furthermore, selection of specific sampling locations has a direct impact on what spore levels might be found. While there is nearly universal agreement that mold growth indoors is unacceptable, what, exactly, constitutes appropriate levels of mold spores in indoor air or dust is vigorously debated . A large body of relevant data exists for post-remediation sampling. Personal research, guidance documents, peer reviewed studies, and papers all contribute to the wide range of information available. However, non-cultured air sample analysis has been used frequently in the recent past and has gained considerable acceptance in the industry. The resultant data has increased the debate about which method is most appropriate. With non-cultured air samples, analysis can be done directly with a microscopic exam, the results are reported in counts per cubic meter of air, and the turnaround time is faster. One drawback to the non-cultured samples is that the analysis is less detailed, producing identification only to the genus level. Cultured sample analysis, on the other hand, can identify to the species level, but has a longer processing time, media limitations, and difficult handling demands. Upon examining the tables, some common deficiencies among past studies and their approach to post remediation sampling were readily apparent: a small number of the approaches focus on post-remediation sampling, there is a heavy reliance on sampling, and a broad approach is lacking. In other words, most of the studies focus on trying to apply a single number to spore levels everywhere and anywhere, placing a heavy emphasis on sample results. These deficiencies convince us that, ultimately, the professionals within the mold industry need to realize that a variety of factors must be considered when conducting post-remediation clearance sampling. Past recommendations for post-remediation values include suggestions for reviewing data by comparing types of fungal spores and their relative proportion in a sample (called a rank/order review), comparisons to out-of-doors levels, and requirements that no pathogenic organisms be detected in post-remediation sampling (ACGIH 7.4.2). To apply rank/order values to a mold remediation project, one would collect an air sample from out-of-doors and another sample from the remediated area within the building. The analysis results of each sample would then be compared, listing the spore types from the most common ones observed to the least common. In a healthy environment, the most common spore types identified within the structure should also be the most plentiful in the out-of-doors sample.

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Building on this, the indoor sample should reflect similar spore type occurrences at a reduced level. If, for example, an unusually high count of an uncommon spore type is found on the indoor sample that is not prevalent on the out-of-doors sample, it is feasible to conclude that there is an active mold source indoors. The rank/order method seems logical because it accommodates the issue of different geographic locations having different naturally occurring types of spores. Interpreting the Data It is clear that the level of 1,000 colony forming units per cubic meter of air (CFU/m3) is considered significant. This amount was most frequently mentioned (the mode) as the appropriate indicator of background levels of mold (Burge, OSHA, etc.). Indeed, a tight range of numbers emerged from the statistical analysis with 1,341 CFU/m3 as the mean and 650 CFU/m3 as the median. According to the collective data, results below 1,000 CFU/m3 of common types of outdoor molds indicate no evidence of water intrusion and that no heath effects would be expected. However, target fungal types are discussed in many documents, with an overall agreement that further investigation should be conducted if fungal types do not mimic the variety seen in proximate outdoor samples. Many authors agree that significant consideration should be given to the presence of even small amounts of target organisms which have been found in conjunction with water-damaged or contaminated buildings. In particular, many authors suggest that elevated levels of Penicillium and Aspergillus mold species are not only health concerns, but coincide with water-damaged building materials. In addition, many mold types that are associated with elevated levels of mycotoxins (i.e., Stachybotrys, Fusarium, Memnoniella, etc.) are also tied to water-damaged buildings, even if they are detected only in small quantities. Historical interpretations of "normal" (background) levels for non-cultured air samples ranged from 2,000 counts per cubic meter of air (c/m3) as the mode, to 4,786 c/m3 as the mean. 2,500 c/m3 was the median value, and it's similarity to the mode give it increased validity as the dividing line between background levels and those found when contamination is present. Once again, many studies implied that no health effects are expected if fungal counts are at or below background levels as long as no target fungal types are present. Learning from History Despite the controversy over acceptable levels and numbers, post-remediation guidelines that include numbers are feasible. However, numbers are only part of the solution; process and interpretation must also be part of the guidelines. It is important to understand that initial post-remediation criteria will not be set in stone. Once any criteria gains substantial industry acceptance, it is prudent to expect that experience with those criteria will lead to future adjustments. Take, for example, historical issues concerning acceptable levels of asbestos, radon and lead. Initially, the

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exposure limits for these substances were controversial, but eventually the impacted industries adapted their work procedures to meet the criteria. As the acceptable control level became more commonplace, research was able to validate its effectiveness. Many substances that are considered contaminants in our buildings have gone through multiple cycles in which the acceptable level was adjusted based on continuing application and research. These same trends can be expected for the mold remediation industry. Seeing it from Our Perspective It is not unusual for post-remediation sampling to fail to meet clearance criteria. Communication problems, along with failure to follow specifications, have a significant impact on post-remediation clearance. Since many industry guidance documents recommend that a mold remediation work area be left free of visible dust, obvious visual problems are the first clue that something has not gone according to the specifications. For example, if visible dust is present within the containment, the isolated area has not been carefully cleaned and unacceptable levels of mold spores may still be present. There is no need to conduct clearance testing if it is obvious the area is not clean. In addition to identifying visual mold growth, it is imperative to consider hidden mold that may be impacting the area. Work plans must consider multiple aspects of a remediation project, specifically the possibility of hidden mold. Documents written by both the EPA and the AIHA contain warnings about hidden mold in remediation projects (EPA 8) (AIHA 8). Without careful reference to documents such as these, crucial information could be missed, potentially causing a multitude of problems farther along in the project. Improper setup of remediation projects also has a significant impact on post-remediation sampling results. Consider an isolation area without a decontamination chamber. Something that seems as trivial as a sheet or two of 6-mil plastic could cost the contractor several more days on the site (and substantial additional costs) after the post-remediation sampling failed due to an improper setup that caused recontamination of the project site. If care goes into creating and following remediation project specifications, small details can determine the success of a project. The easiest way to satisfy post-remediation evaluation criteria is to make the containment or work area a non-variable. If contractors approaching a remediation project consistently set up effective engineering controls such as isolation barriers and negative pressure enclosures, the surrounding environmental factors should not matter. Proper isolation of the work area will provide a uniform baseline between remediation projects regardless of the type of building. Professionals in the mold industry want clarity. Contractors, building owners and occupants, insurance adjusters, and industrial hygienists are all directly impacted by the lack of clarity often found in regulations. As such, it is crucial that contractors understand the expected end point before beginning any remediation project. When all parties understand that remediated areas are to be dust-free

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and meet a predetermined criterion for levels of fungal material, the communication process between the contractor and the client is drastically improved. Having a clear end point also reduces surprises at the end of a project and helps contractors and consultants work together with the same goals in mind, ultimately cutting costs. Knowing the end point before beginning a project is also an important concept that must be considered when developing the industry's standard of care. General Recommendations for the Post-Remediation Sampling Process It is important that contractors and independent hygienists take a macro approach to any job site before post-remediation sampling begins. Having a professional independent or third party consultant write specifications and aid in the inspection of the facility is usually a good idea (IICRC 4.2.1). In the event of legal action, having a third party consultant helps to ensure that actions taken during remediation are agreed upon and documented. The post-remediation process should always start with a visual inspection. Small indicators such as dust and debris should immediately alert the inspector that the specifications were not followed. Understanding that post-remediation samples would most likely not meet clearance criteria due to the unclean condition of the site, conducting post-remediation sampling would be senseless. To ensure that the data collected at a project site is valid, sampling and analytical techniques should be consistent. Using different techniques for post-remediation samples as compared to earlier project sampling may alter the results and ultimately cause additional problems, expenses, and frustration. Therefore, the same sample collection and analysis methods should be used at the beginning and the end of the project. The final general recommendation is to remember that people's health is involved. If there are concerns about the project, err on the conservative side to protect the occupants of the building. On any remediation project the contractors' primary concern should be protecting themselves, the work crew, and the occupants of the building. It is also important to recognize that mold remediation occurs in a wide variety of situations. The recommendations included in this document are designed to be applied to normal residential and business environments. Structures with immunocompromised occupants, or other at risk populations, may need to apply more stringent standards to fungal contamination clean-up efforts. Putting it All Together At some point all of the historical data and general concepts must be distilled into a workable process. Based on our ongoing research and extensive mold remediation project experience, we have developed Post-Remediation Evaluation Criteria for Mold Contamination, based on non-cultured sampling. All the procedures have been laid out for a post-remediation evaluation in a six-step chart. To start, a visual inspection (step 1) is conducted prior to the collection of any samples. The visual inspection is conducted to

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determine if the project specifications were followed, the moisture source was identified and corrected, and that the work area is dust free (white glove test). Only after the area passes a visual inspection are non-cultured samples collected. Initial interpretation of the sample data compares the total fungal spore concentration to the set number of 2,000 spore counts per cubic meter of air (c/m3)(step 2). This number is derived from the supporting reference in which the mode value is 2,000 c/m3. Several studies agree that this value is typical of an environment that is not impacted by adverse interior fungal growth, in essence, a "normal fungal ecology". The data also shows that very low total counts are possible based on seasonal variability or location. Our experience is consistent with that expressed by many other authors: when comparing samples from various areas the reliability of a gross comparison (i.e., total fungal spores) drops off considerably at low spore concentrations. Therefore, an exemption from step 3 is provided for samples from inside the contained area that have a total spore concentration of less than 800 c/m3. The evaluation of the remediation process continues with a comparison of the total spore count inside the work area to the total spore count in the makeup air source, based on the location of the containment entry point (step 3). Subsequently, a rank/order comparison of the fungal types (to the genus level only) and concentrations, including hyphal fragments inside the work area, are compared to the types and amounts naturally occurring in the comparison sample (step 4). At this point, we also recommend that the levels of hyphal fragments be reviewed. Hyphal fragment is a term that many laboratories use to describe fragments of fungal organisms that are not spores. Since hyphal fragments generally do not have enough characteristics to allow them to be correlated with a specific genus of fungi, they are recorded as a separate item. Our experience indicates that when concentrations of hyphal fragments found inside are higher than those found out-of-doors, an indoor source of fungal growth is usually present. As such, we have included this secondary comparison in step 4. The levels of fungal spores and hyphal fragments recovered in the work area sample(s) must be not more than 100 c/m3 higher than the levels of corresponding fungal spores or hyphal fragments in the comparison sample. This limit is based on the principle that all analytical methods have a limit of detection that must accommodate the limitations of the equipment used in the laboratory and for sample collection. In an indoor environment with a normal fungal ecology the ranking of the spores types found inside the work area should reflect the ranking of the comparison sample. For example, if Cladosporium was the most common spore type identified in the comparison sample, one would expect to find Cladosporium as the top ranking spore type inside the work area, only at a significantly lower level. At this point in the process, indicator fungal types are considered (step 5). Fungal types are designated as “indicator” if they are associated with water damage to building or indoor finish materials. Keep in mind that these fungi may also come from out-of-doors and make up a natural part of the existing flora.

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While several molds are discussed as potential indicators of water-damaged environments, Aspergillus/Penicillium types are mentioned frequently in the reference documents. Aspergillus and Penicillium spores are lumped together when analysis is performed by direct microscopy because the spores are indistinguishable from one another. Oddly, this turns out to be a benefit for the post-remediation evaluation process. Certain species of both Aspergillus and Penicillium are early colonizers of water-damaged materials that grow quickly and disperse many spores. When these growth properties are matched with the negative health effects associated with these spores, their value as an indication of acceptable mold remediation procedures is enhanced. Our experience at Caltex Environmental with post-remediation criteria and the documents referenced in the tables have led us to conservative but achievable criteria that indicator fungal types (e.g., Aspergillus/Penicillium) must be recovered at levels below 200 c/m3. The final step in evaluating a mold remediation project is to consider target organisms (step 6). Target organisms are identified by their characteristic need for high moisture content and/or water activity to grow, their ability to naturally produce toxins, and their common degradation of cellulose-containing materials. Spores from these target organisms are not typically found in clean indoor environments so the criterion for target organisms is zero tolerance. The presence of target organisms in a cleaned work area indicates ineffective remediation and can result in continued issues with the structure or ill-health effects for the occupants of the space. Any time one of the steps in the evaluation process exceeds the criteria, the area must be recleaned and retested as many times and as thoroughly as needed to meet the criteria for that step before moving on to the next step. When the work area has met the criteria in all six steps, it is considered to be clean with a normal fungal ecology, and the project has been successfully completed. Total spore counts are compared to an outdoor sample or, when they exist, to earlier air results. While both guidelines set a total spore count limit, U.S. Micro-Solutions proposes a more liberal limit of 3,000 c/m3 as compared to our 2,000 c/m3. Rather than a rank/order comparison, they add the condition that no one genera or spore type may exceed 75% of the total spore count. Their goal is a general decrease in the total spore count and a “marked” reduction in any predominant spore type. While both protocols indicate that no Stachybotrys conidia is acceptable on postremediation samples, ours proposes an enlarged list of zero tolerance indicator/target organisms. Our list includes species that grow in environments similar to Stachybotrys, are early colonizers of water-damaged materials, and/or produce toxins. P & K Microbiology Services have also developed an interpretation for fungal bioaerosol samples. Theirs is a twelve-step process, similar to ours in many aspects. Both set an acceptable total spore concentration, involve comparison samples (indoor to outdoor, complaint to non-complaint areas) and involve a rank/order comparison between samples. Many of the later steps in the P & K protocol are looking for indicator or “signature” fungi, similar to our indicator/target organisms in steps 5-6. The main difference in the two protocols is that P & K rely on culturable air samples. Rather than a limit, they set an upper range of 150 to 250 CFU/m3 for acceptable total spore counts.

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Their list of marker or “signature” fungi reflect cultured air sample results. We advocate using non-viable sampling which gives a broader look at what spores are in the environment and a quicker turnaround time for the client. Furthermore, the 12 step protocol can be a bit cumbersome. We feel our 6-step chart is more user friendly, and has the advantage of a clear pass/fail answer at each step. Key Points to Remember Throughout the effort of collecting and reviewing the historical data, developing the post-remediation criteria, and then field testing the process, several over-arching concepts continued to appear. A lack of standardization creates problems. Oftentimes projects fail due to incorrect or sub-par efforts to follow specifications. However, many projects are currently categorized as ineffective because there is no widely recognized verification protocol or criteria for comparison of post-remediation samples. As a result, the project becomes seemingly endless, costs skyrocket, and liability becomes an issue. Previous efforts have not focused on post-remediation as a separate subset of data. This leaves the field wide open. Much of the research has been related to identifying background levels or levels that can be linked to specific health effects. Few studies have focused on identifying post-remediation criteria whichm verifies the effectiveness of the remediation and cleaning techniques; even if those criteria cannot be clearly linked to health risk. History has shown that oftentimes a "best guess" has to be made so that research can validate the effectiveness of a particular level or criterion. Separating post-remediation criteria from the debate over background levels or other confounding issues would allow the industry to advance while further scientific data is collected. Developing post-remediation evaluation criteria for mold projects should be a process. Comparison numbers are only a small part of the big picture. However, in the absence of regulations, it is critical that the end point be clearly detailed and communicated before the project begins. Our recommendation for post-remediation criteria includes six steps. Failure on any single step means the evaluation process must start over from step 1. Incorporation of visual criteria and interpretation of sample data is imperative to the success rate of remediation projects. Conclusion Currently, there are many controversies surrounding indoor air quality, especially related to mold and its effects. Setting and using post-remediation evaluation criteria in all remediation projects is a surefire way to strengthen the industry and, in the long run, help define industry standards. Each mold remediation project should be viewed from a macro perspective, considering all related factors. The six-step Caltex Post-Remediation Evaluation Criteria is a valuable and effective tool for verifying the success of a project.

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Post-Remediation Mold Co Rank / Order Comparison Is the level of each fungal type (and hyphae) recovered inside less than 100 c/m3

above the level of the same fungal type (and hyphae) in the comparison sample?

4 Indicator Organisms Was Aspergillus/Penicillium on the inside sample less than 200 c/m3?

5 Target Organisms Was the inside sample free of target fungal types, both counted and observed? Zero tolerance of Stachybotrys sp., Fusarium sp., Trichoderma sp., Memnoniella sp., Chaetomium sp.

6 Comparison to Make-up Air Source Is the total spore concentration on the inside sample below that on the comparison sample? Comparison sample collected from out-of-doors or inside building but outside work area, depending on location of containment entry point.

3 Visual Inspection Were the specifications followed? Was the moisture source identified and corrected? Were the contents and debris removed? Was the work area white-glove dust free?

1 Total Spore Concentration Is the total spore concentration less than 2,000 c/m3 (typical of a normal fungal ecology)? If less than 800, go to Step 4.

2 Spore Trap Samples (Previously Affected Area) A spore trap sample will be collected in the area(s) of concern. These samples should show no Stachybotrys conidia. The total spore count should be below background (outdoor) air (certain exceptions apply to this guideline, particularly when outdoor spore counts can be negatively impacted by snowfall and other factors). On total spore counts over 3,000 no one genera or grouping may exceed 75% of the total spore count. Where prior air results exist, the total spore counts should be reduced by 70% where unusually high spore counts (greater than 10,000 spores per cubic meter) have existed in the past. Otherwise, a general reduction in total spore count is favorable with a marked reduction in any predominant spore type. Older buildings, with poor HVAC filtration or heavy outside air infiltration may be evaluated at the discretion of the site visitor. (Total sample volume should be 75 Liters on Air-O-Cell cassettes, 25 Liters on Micro5 cassettes or 60 Liters on Cyclex-D cassettes.) Areas corresponding to air samples not meeting these guidelines will be recommended for further remedial action.

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CLEANING CONTENTS FROM MOLD-CONTAMINATED ENVIRONMENTS

Mold growth and associated contamination in buildings continues to garner public attention. While the insurance industry is struggling to define payment restrictions, the need for professional, competent mold remediation continues to grow. Fortunately, the remediation industry is advancing to meet the evolving needs related to mold. Contractors and consultants who are knowledgeable about mold infestation in buildings understand that every mold clean-up project has two components. Much emphasis has been devoted to the remediation of visible mold from building components, including the removal of porous structural and finish materials that support mold growth. Considerably less attention has been given to methods of assessment and control for contents in mold-contaminated environments. However, an increasing awareness of the potential problems that are created when clothes and furnishings are not properly addressed as part of a mold remediation effort is forcing the industry to broaden its approach to mold cases. Two Bad Examples A short time ago, our laboratory received a lampshade from a woman who was in the middle of a mold remediation project. The fungal growth in her residence was severe enough that she had been advised tom find an alternate living space until the remediation project was completed. Unfortunately, nobody warned her that taking contents from the house to her temporary apartment without proper cleaning could cause cross contamination. Her continuing health problems led to additional research and concern about exposure to the items taken from the contaminated house. The owner’s fears were justified by our report. Although there was no visible mold growth on the shade, or even visible dust or dirt, the microvacuum sample revealed a high concentration of spores associated with water-damaged buildings, including Stachybotrys. An even more contentious case involved a contractor who engaged in a mold remediation project without proper assessment or subsequent testing of the contents. Since the entire interior of the house was being remediated, all of the movable items were packed out of the house. Evaluation, cleaning, handling and documentation of the process was so poor that after the contents had been moved to a storage facility our organization was asked to evaluate their condition. A visual inspection and sampling of the “cleaned” materials confirmed the presence of excessive levels of spores and fungal fragments. The overwhelming majority of mold types still contaminating the contents were targeted for removal from the house: Stachybotrys, Aspergillus, Chaetomium, and the like. This information helped to push the contractor toward a five-figure settlement. Guidelines Codify Field Experience Although there is no mandatory national standard for dealing with mold, there is a standard of care that can be understood by focusing on the points where various guidance documents intersect. Currently, six of the most important documents related to mold all

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confirm that mold-contaminated contents should be subject to specialized cleaning1. The most extensive information on contents is found in documents published by the EPA and IICRC. Most of the guidance documents favor the disposal of contents made of porous materials (e.g., drapes, clothes, upholstered furniture) that have visible mold growth. Several recent studies confirm the difficulty of removing the spores and growth structures from fabrics and other porous materials after growth is visible2. Contents that are contaminated by deposition of spores from adjacent growth can be cleaned. The IICRC’s S520 document refers to such contamination as Condition 2. The S520 notes that dust from impacted items does not reflect the “normal fungal ecology” in terms of amount or fungal types. It Starts With Assessment and Categorization Since proper handling of contents from a mold-impacted environment is based on the type of material and the type of contamination, an initial assessment and categorization is the first step of the cleaning process. Obviously, the key is to segregate items with actual mold growth from those impacted solely by spore deposition in order to minimize the possibility of further contamination. Once the initial segregation is completed a determination can be made on how the content cleaning will proceed. Thinking through answers to key questions will assist in the development of an effective plan. • What amount of contents is impacted? • What is the overall condition of the structure? • Are there security concerns at the site? • What cleaning techniques will be used? • Is there adequate space on-site to set up a decontamination work area? • Will a substantial portion of the items be processed off-site (e.g., laundry or dry cleaning)? • Is a general pack-out part of the overall job? • How long is the structural remediation expected to take? Determining If Content Cleaning Was Successful Perhaps the most vexing aspect of mold remediation projects in general, and content cleaning in particular, is determining an endpoint. What is clean enough? Does it depend on the situation and the occupants? The size of the project budget? Most knowledgeable industry professionals believe that it is crucial to evaluate and document the cleaning effectiveness3. But without an accepted standard endorsed by a regulatory agency or national standards group, the suggestions for post-cleaning criteria range from the thoughtful to the ridiculous. Some evaluation methods that have been suggested or used include: • Sensory verification – The owner conducts a visual and odor check. • Canine sensory verification – A trained mold inspection dog is brought in to sniff the contents and react to any mold.

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• Mycotoxin testing – Samples are collected and analyzed to determine if any residual poisonous chemicals are present. • Viable spore testing – Samples are collected and analyzed by culturing, which identifies residual spores capable of growing on a specific nutrient agar. • Total spore and fragment testing – Samples are collected by tape lift, microvacuum or air collection methods and fungal residue is identified under the microscope. Regardless of which method is employed, a comparison criteria needs to be established at the beginning of the project. It is also critical to establish at the beginning the number of samples that will be collected and the timing of their collection. We achieve content cleaning verification through a combination of visual inspection and total spore/fragment testing. Since visible growth on dust or contents signals improper cleaning, our first step in verifying content cleanliness is a white glove style visual inspection. We normally have the remediation contractor group cleaned items into batches. If a single item in a batch fails the visual inspection, the entire batch is recleaned. Once a batch of contents has passed the visual ninspection, a representative number of samples are collected4. Since the actual number of spores in the dust on an object is influenced by both the concentration of spores in the air and the time it has taken for the dust to collect, our organization began reviewing microvacuum samples to determine the percentage of spores. By recording the data from such samples as a relative number rather than an absolute count of spores, we were able to correlate analytical results with field conditions and, ultimately, with customer satisfaction. After years and hundreds of projects we have seen that fungal spore concentrations of one percent or less of the total sample constituents (absent target fungal types) are an indication of a normal fungal ecology. Fungal spore concentrations between one and three percent are an indication of an indoor environment contaminated with settled spores, dispersed directly or indirectly (Condition 2). Fungal spores recovered at three percent or more of the total sample constituents indicate an indoor environment contaminated with the presence of actual mold growth and associated spores (Condition 3). Recovery of target fungal spore types (including Memnoniella, Stachybotrys, Trichoderma, Chaetomium, and Fusarium) is further indication of fungal contamination. The total percentage of fungal spores recovered and the identification of target fungal spore types are two pieces of information used to determine if contents or surfaces have been impacted by mold sources in the environment, or whether they have been properly cleaned. Solving the Contents Conundrum Dealing with contents from a mold-contaminated building is complicated. As such, the work is fraught with technical and legal pitfalls. But traps can be avoided if remediation contractors follow these common-sense guidelines:

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1. Appreciate the risk to the occupants, the remediation crew, and the environment posed by mold-contaminated contents. 2. Understand the growing consensus that the ultimate goal is for the contents of a mold contaminated environment to have mold concentrations at levels consistent with, or less than, a normal environment. 3. Conduct a thorough assessment of contents, addressing fungal growth and spore deposition as well as the porosity of each item. 4. Implement appropriate cleaning practices and protective controls. 5. Select a defensible endpoint at the beginning of the project. This includes both the evaluation method (i.e., type of inspection, number and location of samples, timing of sample collection, etc.) and the comparison criteria. 6. Utilize the percentage of spores criteria described in this article in the absence of other technically supported data as a pre-defined endpoint for determining if contents are clean following a mold remediation project. Combining these guidelines with common sense and awareness that dealing with contaminated contents is an important aspect of each mold remediation project will protect the contractor and advance the industry as a whole.