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It still remains a mystery what caused a June 19 outbreak of illness at the Washington County Health Department in Fayetteville that sent 29 employees and 2 clients to the emergency room after they experienced nausea, dizziness and vomiting.

“I don’t think we are ever going to know exactly what happened in that building,” said Shirley Louie, associate branch chief for epidemiology, Arkansas Department of Health. “More than likely it was something in the air being inhaled, something people were being exposed to as a group.”

<b><i>Investigating the Cause</b></i>
Louie said investigators looked carefully at different issues, but were unable to determine the cause of the incident that resulted in closure of the health department for several days. There were early reports the illness might have been linked to the application of a pesticide, boric acid, or a floor stripping agent. They also investigated the plumbing system without finding any indication of a sewer gas leak. The building’s heating and air conditioning system was inspected.

Although there were no lasting health effects, nothing was found that could be positively identified as the cause of the problem for the 70 staff members or visiting clients at the facility.

“To think we will ever pin this down to one particular thing beyond a shadow of doubt, that may not happen,” Louie said. Plumbing, HVAC inspectors and physicians checked the building.

Boric acid is considered common and innocuous, and the floor stripping agent had been used in the past with no problem.
“It is a hospital-type environment, so it needs to be bright, clean, shiny and free of dust and dirt,” Louie said. “Clean, shiny floors are a part of that. The old wax was taken off, and the new wax put on. It was a routine thing that was done. ..And the floor stripping agent was put on sometime after some of these folks said they didn’t feel well.”

Since the source and the extent of the problem were unknown, it made sense to evacuate the building, according to Louie.
“Even if you don’t know what the problem is, the prudent thing to do is ask people to leave the building,” Louie said. “It is precautionary. Even if you aren’t 100 percent sure what it is, get them out until it is gone.”

It is not uncommon for there to be complaints about a building where people will smell something they consider unpleasant or unusual. Louie said odors are one of the most common complaints.

“Sometimes they aren’t unpleasant odors,” she said. “They are just odors people are not used to. Unpleasant odors and unknown conditions can cause real symptoms like nausea and eyes burning, and an upset stomach. People don’t want to be there any more because it is unpleasant.”

<b><i>Preventing Sick Buildings</b></i>
How can people avoid “sick building” problems? The most important thing is proper maintenance.
“You have to make sure the plumbing and heating and ventilation system work the way they were designed to work, and use the building in the manner it was designed,” Louie said. “For example, if it is designed for 10 people, don’t cram 50 people in there. Also, make sure all appliances in the building whether heaters and air conditioners, hot water heaters, stoves or refrigerators function and have good maintenance.”

Communication between building supervisors and employees within their building are key. She said if pest control, painting, or air duct cleaning is planned, let the employees know.

“If they begin to smell something unusual or see something unusual like powdery stuff on their desk, they know duct cleaning is happening and are not baffled by the dust,” Louie said. “Employees are better off knowing what is going on. Most employers don’t hide information. They just don’t think to communicate.”

Another good tip, she said, is to only use licensed pest control experts because they know how to mix and apply pesticides, what protective equipment is needed, where to spray and not to spray, and how to treat the environment after spraying.
Louie also recommends following directions on the label when using products such as floor stripping agents, paint and cleaning products, especially providing adequate ventilation according to label recommendations.

 “Mold is an issue that is almost universal, and almost always universally misunderstood,” Louie said. “As flippant as this may sound, mold is not some creature from outer space. It is just mold. The mold that grows inside a building is the same that grows outside in grass clippings or on bread left on the counter for too long. Mold is ubiquitous in the environment. There are mold spores clinging to the clothes you have on right now. The issue is you don’t want mold in a building because the only reason for it to grow is if there is moisture. Even if the mold didn’t make anyone sick, it means there is a problem with moisture. That in the long run either ruins your building or causes people to be ill.”

Louie said while mold is not as deadly as some people might fear, an environment that grows mold is sub-optimal. Find and correct any water leaks. Once you get rid of the moisture, you can take care of the mold. But if you clean up the mold without stopping the moisture problem, the mold will return.

“Mold is an allergen, and otherwise healthy people might be allergic to mold,” Louie said. “You need to deal with mold not as something so scary you need to burn down the building. But find out why it is growing, and how you can keep the environment from being conducive to mold growth.”

Common sense about health still applies, she said. Don’t assume health problems are caused by something in the indoor environment. Louie recommends seeing a physician who can diagnose the condition and recommend treatment.
When doing renovations, especially those that stir up dust and dirt, or result in fumes from glues or paints, be a good steward of your employees by giving them a clean environment in which to work. Do renovations after hours, if possible.

“Would you do renovation in your own home while your family members are there?” Louie asked. “If the answer is ‘no,’ you might not want to do a renovation while employees are there. It is just considering other people’s health and welfare and being a good employer.”

Be aware of the environment around you. If there is an unusual smell or change in temperature, don’t ignore it. But don’t automatically assume a new smell is going to be something harmful. 

“Be aware and don’t be afraid to ask questions,” Louie said.

Ed Barham, a spokesman for the Arkansas Department of Health, said what happened at the Washington County Health Department isn’t unusual. The state health department gets a similar complaint about once a month.

“In most cases it pans out just about like this,” Barham said. “They test the air and surfaces, and never do find out what has caused it. All that is pretty unsatisfying, but that is the best we have to offer… There aren’t any easy answers.”



August 2008

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