Automation

SERV PRO of ENCINO
18034 Ventura Blvd. #298
Encino, CA 91316
(818) 995-6444

SERV PRO of Canoga Park
6433 Topanga Cyn Blvd #597
Woodland Hills, CA 91303
(818) 991-6292

UNIQUE RESTORATION
Eton Ave.
Canoga Park, CA
(818) 348-6968

Controls are also reviewed to help determine if occupants should remain indoors or be removed from the workspace. As specified by OSHA in 29 CFR 1910.134 individuals who use respirators must be properly trained, have medical clearance, and be properly fit tested before they begin using a respirator.

New York Guidelines
The guidelines on assessment and remediation of fungi in indoor environments contains these primary subheadings, Executive summary, introduction, Health issues, environmental assessment, remediation, hazard communication, & conclusion. This panels of information was originally put together to address the contamination of Stachybotrys chratum. This article is put together for anyone concerned about fungal contamination.

Indoor Air Quality Organization
This organization was established in 1995 to promote standards in the industry. This organization and several others have been consolidated to establish a large authoritative body. The main organization is a well established are to read more about current mold problems and topics within the mold industry.

CDC
This article recommends source removal as an important way to deal with mold correctly. The elimination of moisture is an integral part of mold management states the CDC website. Those items that can be saved should be wiped down and those items that can not should be discarded. Occupants and workers should be protected from mold remediation activities.

New York Guidelines
The guidlines on assessment and remediation of fungi in indoor environments contains these primary subheadings, Executive summary, introduction, Health issues, environmental assessment, remediation, hasard communication, & conclusion. This panels of information was originally put together to address the contamination of Stachybotrys chratum. This article is put together for anyone concerned about fungal contamination.

Zeflon
This website combines information on pumps and products used by the daily mold inspector in you area. Items such as the Air-O-Cell cassette, Via Cell Products, sampling media & cassettes, sampling pumps & calibrators, potable instruments, gas detection equipment, laboratory supplies, protective clothing and respirators.

Health Effects Currently, there are no federal standards or recommendations, (e.g., OSHA, NIOSH, EPA) for airborne concentrations of mold or mold spores. Scientific research on the relationship between mold exposures and health effects is ongoing. Potential health concerns are important reasons to prevent mold growth and to remediate existing problem areas. Molds can also cause asthma attacks in some individuals who are allergic to mold. In addition, exposure to mold can irritate the eyes, skin, nose and throat in certain individuals. Symptoms other than allergic and irritant types are not commonly reported as a result of inhaling mold in the indoor environment. Remediation Plan Remediation includes both the identification and correction of the conditions that permit mold growth, as well as the steps to safely and effectively remove mold damaged materials. Before planning the remediation assess the extent of the mold or moisture problem and the type of damaged materials. If you choose to hire outside assistance to do the cleanup, make sure the contractor has experience with mold remediation. Check references and ask the contractor to follow the recommendations in EPA’s publication, “Mold Remediation in Schools and Commercial Buildings,” or other guidelines developed by professional or governmental organizations. The remediation plan should include steps to permanently correct the water or moisture problem. The plan should cover the use of appropriate personal protective equipment (PPE). It also should include steps to carefully contain and remove moldy building materials in a manner that will prevent further contamination. Remediation plans may vary greatly depending on the size and complexity of the job, and may require revision if circumstances change or new facts are discovered. If you suspect that the HVAC system is contaminated with mold, or if mold is present near the intake to the system, contact the National Air Duct Cleaners Association (NADCA), or consult EPA’s guide, “Should You Have the Air Ducts in Your Home Cleaned?” before taking further action. Do not run the HVAC system if you know or suspect that it is contaminated with mold, as it could spread contamination throughout the building. If the water or mold damage was caused by sewage or other contaminated water, consult a professional who has experience cleaning and repairing buildings damaged by contaminated water. The remediation manager’s highest priority must be to protect the health and safety of the building occupants and remediators. Remediators should avoid exposing themselves and others to mold-laden dusts as they conduct their cleanup activities. Caution should be used to prevent mold and mold spores from being dispersed throughout the air where they can be inhaled by building occupants. In some cases, especially those involving large areas of contamination, the remediation plan may include temporary relocation of some or all of the building occupants. When deciding if relocating occupants is necessary, consideration should be given to the size and type of mold growth, the type and extent of health effects reported by the occupants, the potential health risks that could be associated with the remediation activity, and the amount of disruption this activity is likely to cause. In addition, before deciding to relocate occupants, one should also evaluate the remediator’s ability to contain/minimize possible aerosolization of mold spores given their expertise and the physical parameters of the workspace. When possible, remediation activities should be scheduled during off hours when building occupants are less likely to be affected. If any individual has health concerns, doubts, or questions before beginning a remediation/cleanup project, he or she should consult a health professional. Mold Remediation/Cleanup Methods The purpose of mold remediation is to correct the moisture problem and to remove moldy and contaminated materials to prevent human exposure and further damage to building materials and furnishings. Porous materials that are wet and have mold growing on them may have to be discarded because molds can infiltrate porous substances and grow on or fill in empty spaces or crevices. This mold can be difficult or impossible to remove completely. As a general rule, simply killing the mold, for example, with biocide is not enough. The mold must be removed, since the chemicals and proteins, which can cause a reaction in humans, are present even in dead mold. A variety of cleanup methods are available for remediating damage to building materials and furnishings caused by moisture control problems and mold growth. The specific method or group of methods used will depend on the type of material affected. Some methods that may be used include the following: Wet Vacuum Wet vacuums are vacuum cleaners designed to collect water. They can be used to remove water from floors, carpets, and hard surfaces where water has accumulated. They should not be used to vacuum porous materials, such as gypsum board. Wet vacuums should be used only on wet materials, as spores may be exhausted into the indoor environment if insufficient liquid is present. The tanks, hoses, and attachments of these vacuums should be thoroughly cleaned and dried after use since mold and mold spores may adhere to equipment surfaces. Damp Wipe Mold can generally be removed from nonporous surfaces by wiping or scrubbing with water and detergent. It is important to dry these surfaces quickly and thoroughly to discourage further mold growth. Instructions for cleaning surfaces, as listed on product labels, should always be read and followed. HEPA Vacuum HEPA (High-Efficiency Particulate Air) vacuums are recommended for final cleanup of remediation areas after materials have been thoroughly dried and contaminated materials removed. HEPA vacuums also are recommended for cleanup of dust that may have settled on surfaces outside the remediation area. Care must be taken to assure that the filter is properly seated in the vacuum so that all the air passes through the filter. When changing the vacuum filter, remediators should wear respirators, appropriate personal protective clothing, gloves, and eye protection to prevent exposure to any captured mold and other contaminants. The filter and contents of the HEPA vacuum must be disposed of in impermeable bags or containers in such a way as to prevent release of the debris. Disposal of Damaged Materials Building materials and furnishings contaminated with mold growth that are not salvageable should be placed in sealed impermeable bags or closed containers while in the remediation area. These materials can usually be discarded as ordinary construction waste. It is important to package mold-contaminated materials in this fashion to minimize the dispersion of mold spores. Large items with heavy mold growth should be covered with polyethylene sheeting and sealed with duct tape before being removed from the remediation area. Some jobs may require the use of dust-tight chutes to move large quantities of debris to a dumpster strategically placed outside a window in the remediation area. Use of Biocides The use of a biocide, such as chlorine bleach, is not recommended as a routine practice during mold remediation, although there may be instances where professional judgment may indicate its use (for example, when immuno-compromised individuals are present). In most cases, it is not possible or desirable to sterilize an area, as a background level of mold spores comparable to the level in outside air will persist. However, the spores in the ambient air will not cause further problems if the moisture level in the building has been corrected. Biocides are toxic to animals and humans, as well as to mold. If you choose to use disinfectants or biocides, always ventilate the area, using outside air if possible, and exhaust the air to the outdoors. When using fans, take care not to extend the zone of contamination by distributing mold spores to a previously unaffected area. Never mix chlorine bleach solution with other cleaning solutions or detergents that contain ammonia because this may produce highly toxic vapors and create a hazard to workers. Some biocides are considered pesticides, and some states require that only registered pesticide applicators apply these products in schools, commercial buildings, and homes. Make sure anyone applying a biocide is properly licensed where required. Fungicides are commonly applied to outdoor plants, soil, and grains as a powder or spray. Examples of fungicides include hexachlorobenzene, organomercurials, pentachlorophenol, phthalimides, and dithiocarbamates. Do not use fungicides developed for outdoor use in any indoor application, as they can be extremely toxic to animals and humans in an enclosed environment. When you use biocides as a disinfectant or a pesticide, or as a fungicide, you should use appropriate PPE, including respirators. Always, read and follow product label precautions. It is a violation of Federal (EPA) law to use a biocide in any manner inconsistent with its label direction. Mold Remediation Guidelines This section presents remediation guidelines for building materials that have or are likely to have mold growth. The guidelines are designed to protect the health of cleanup personnel and other workers during remediation. These guidelines are based on the size of the area impacted by mold contamination. Please note that these are guidelines; some professionals may prefer other remediation methods, and certain circumstances may require different approaches or variations on the approaches described below. If possible, remediation activities should be scheduled during off-hours when building occupants are less likely to be affected.

Although the level of personal protection suggested in these guidelines is based on the total surface area contaminated and the potential for remediator or occupant exposure, professional judgment always should play a part in remediation decisions. These remediation guidelines are based on the size of the affected area to make it easier for remediators to select appropriate techniques, not on the basis of research showing there is a specific method appropriate at a certain number of square feet. The guidelines have been designed to help construct a remediation plan. The remediation manager should rely on professional judgment and experience to adapt the guidelines to particular situations. When in doubt, caution is advised. Consult an experienced mold remediator for more information.

Level I: Small Isolated Areas (10 sq. ft or less) - e.g., ceiling tiles, small areas on walls. * Remediation can be conducted by the regular building maintenance staff as long as they are trained on proper clean-up methods, personal protection, and potential health hazards. This training can be performed as part of a program to comply with the requirements of the OSHA Hazard Communication Standard (29 CFR 1910.1200). * Respiratory protection (e.g., N-95 disposable respirator) is recommended. Respirators must be used in accordance with the OSHA respiratory protection standard (29 CFR 1910.134). Gloves and eye protection should be worn. * The work area should be unoccupied. Removing people from spaces adjacent to the work area is not necessary, but is recommended for infants (less than 12 months old), persons recovering from recent surgery, immune-suppressed people, or people with chronic inflammatory lung diseases (e.g., asthma, hypersensitivity pneumonitis, and severe allergies). * Containment of the work area is not necessary. Dust suppression methods, such as misting (not soaking) surfaces prior to remediation, are recommended. * Contaminated materials that cannot be cleaned should be removed from the building in a sealed impermeable plastic bag. These materials may be disposed of as ordinary waste. * The work area and areas used by remediation workers for egress should be cleaned with a damp cloth or mop and a detergent solution. * All areas should be left dry and visibly free from contamination and debris. Level II: Mid-Sized Isolated Areas (10-30 sq. ft.) – e.g., individual wallboard panels. * Remediation can be conducted by the regular building maintenance staff. Such persons should receive training on proper clean-up methods, personal protection, and potential health hazards. This training can be performed as part of a program to comply with the requirements of the OSHA Hazard Communication Standard (29 CFR 1910.1200). * Respiratory protection (e.g., N-95 disposable respirator) is recommended. Respirators must be used in accordance with the OSHA respiratory protection standard (29 CFR 1910.134). Gloves and eye protection should be worn. * The work area should be unoccupied. Removing people from spaces adjacent to the work area is not necessary, but is recommended for infants (less than 12 months old), persons recovering from recent surgery, immune-suppressed people, or people with chronic inflammatory lung diseases (e.g., asthma, hypersensitivity pneumonitis, and severe allergies). * Surfaces in the work area that could become contaminated should be covered with a secured plastic sheet(s) before remediation to contain dust/debris and prevent further contamination . * Dust suppression methods, such as misting (not soaking) surfaces prior to remediation, are recommended. * Contaminated materials that cannot be cleaned should be removed from the building in a sealed impermeable plastic bag. These materials may be disposed of as ordinary waste. * The work area and areas used by remediation workers for egress should be HEPA vacuumed and cleaned with a damp cloth or mop and a detergent solution. * All areas should be left dry and visibly free from contamination and debris. Level III: Large Isolated Areas (30 –100 square feet) – e.g., several wallboard panels. Industrial hygienists or other environmental health and safety professionals with experience performing microbial investigations and/or mold remediation should be consulted prior to remediation activities to provide oversight for the project. The following procedures may be implemented depending upon the severity of the contamination: * It is recommended that personnel be trained in the handling of hazardous materials and equipped with respiratory protection (e.g., N-95 disposable respirator). Respirators must be used in accordance with the OSHA respiratory protection standard (29 CFR 1910.134). Gloves and eye protection should be worn. * Surfaces in the work area and areas directly adjacent that could become decontaminated should be covered with a secured plastic sheet(s) before remediation to contain dust/ debris and prevent further contamination. * Seal ventilation ducts/grills in the work area and areas directly adjacent with plastic sheeting. * The work area and areas directly adjacent should be unoccupied. Removing people from spaces near the work area is recommended for infants, persons having undergone recent surgery, immunesuppressed people, or people with chronic inflammatory lung diseases. (e.g., asthma, hypersensitivity pneumonitis, and severe allergies). * Dust suppression methods, such as misting (not soaking) surfaces prior to mediation, are recommended. * Contaminated materials that cannot be cleaned should be removed from the building in sealed impermeable plastic bags. These materials may be disposed of as ordinary waste. * The work area and surrounding areas should be HEPA vacuumed and cleaned with a damp cloth or mop and a detergent solution. * All areas should be left dry and visibly free from contamination and debris. Note: If abatement procedures are expected to generate a lot of dust (e.g., abrasive cleaning of contaminated surfaces, demolition of plaster walls) or the visible concentration of the mold is heavy (blanket coverage as opposed to patchy), it is recommended that the remediation procedures for Level IV be followed. Level IV: Extensive Contamination (greater than 100 contiguous square feet in an area). Industrial hygienists or other environmental health and safety professionals with experience performing microbial investigations and/or mold remediation should be consulted prior to remediation activities to provide oversight for the project. The following procedures may be implemented depending upon the severity of the contamination: * Personnel trained in the handling of hazardous materials and equipped with: o Full face piece respirators with HEPA cartridges; o Disposable protective clothing covering entire body including both head and shoes; and o Gloves. * Containment of the affected area: o Complete isolation of work area from occupied spaces using plastic sheeting sealed with duct tape (including ventilation ducts/grills, fixtures, and other openings); o The use of an exhaust fan with a HEPA filter to generate negative pressurization; and o Airlocks and decontamination room. * If contaminant practices effectively prevent mold from migrating from affected areas, it may not be necessary to remove people from surrounding work areas. However, removal is still recommended for infants, persons having undergone recent surgery, immune- suppressed people, or people with chronic inflammatory lung diseases. (e.g., asthma, hypersensitivity pneumonitis, and severe allergies). * Contaminated materials that cannot be cleaned should be removed from the building in sealed impermeable plastic bags. The outside of the bags should be cleaned with a damp cloth and a detergent solution or HEPA vacuumed in the decontamination chamber prior to their transport to uncontaminated areas of the building. These materials may be disposed of as ordinary waste. * The contained area and decontamination room should be HEPA vacuumed and cleaned with a damp cloth or mopped with a detergent solution and be visibly clean prior to the removal of isolation barriers. Personal Protective Equipment (PPE) Any remediation work that disturbs mold and causes mold spores to become airborne increases the degree of respiratory exposure. Actions that tend to disperse mold include: breaking apart moldy porous materials such as wallboard; destructive invasive procedures to examine or remediate mold growth in a wall cavity; removal of contaminated wallpaper by stripping or peeling; using fans to dry items or ventilate areas. The primary function of personal protective equipment is to prevent the inhalation and ingestion of mold and mold spores and to avoid mold contact with the skin or eyes. The following sections discuss the various types of PPE that may be used during remediation activities. Skin and Eye Protection Gloves protect the skin from contact with mold, as well as from potentially irritating cleaning solutions. Long gloves that extend to the middle of the forearm are recommended. The glove material should be selected based on the type of substance/ chemical being handled. If you are using a biocide such as chlorine bleach, or a strong cleaning solution, you should select gloves made from natural rubber, neoprene, nitrile, polyurethane, or PVC. If you are using a mild detergent or plain water, ordinary household rubber gloves may be used. To protect your eyes, use properly fitted goggles or a full face piece respirator. Goggles must be designed to prevent the entry of dust and small particles. Safety glasses or goggles with open vent holes are not appropriate in mold remediation. Respiratory Protection Respirators protect cleanup workers from inhaling airborne mold, contaminated dust, and other particulates that are released during the remediation process. Either a half mask or full face piece air-purifying respirator can be used. A full face piece respirator provides both respiratory and eye protection. Please refer to the discussion of the different levels of remediation to ascertain the type of respiratory protection recommended. Respirators used to provide protection from mold and mold spores must be certified by the National Institute for Occupational Safety and Health (NIOSH). More protective respirators may have to be selected and used if toxic contaminants such as asbestos or lead are encountered during remediation. As specified by OSHA in 29 CFR 1910.134 individuals who use respirators must be properly trained, have medical clearance, and be properly fit tested before they begin using a respirator. In addition, use of respirators requires the employer to develop and implement a written respiratory protection program, with worksite-specific procedures and elements. Protective Clothing While conducting building inspections and remediation work, individuals may encounter hazardous biological agents as well as chemical and physical hazards. Consequently, appropriate personal protective clothing (i.e., reusable or disposable) is recommended to minimize cross-contamination between work areas and clean areas, to prevent the transfer and spread of mold and other contaminants to street clothing, and to eliminate skin contact with mold and potential chemical exposures. Disposable PPE should be discarded after it is used. They should be placed into impermeable bags, and usually can be discarded as ordinary construction waste. Appropriate precautions and protective equipment for biocide applicators should be selected based on the product manufacturer’s warnings and recommendations (e.g., goggles or face shield, aprons or other protective clothing, gloves, and respiratory protection). in Indoor Environments. The purpose of the panel was to develop policies for medical and environmental evaluation and intervention to address Stachybotrys atra (now known as Stachybotrys chartarum (SC)) contamination. The original guidelines were developed because of mold growth problems in several New York City buildings in the early 1990's. This document revises and expands the original guidelines to include all fungi (mold). It is based both on a review of the literature regarding fungi and on comments obtained by a review panel consisting of experts in the fields of microbiology and health sciences. It is intended for use by building engineers and management, but is available for general distribution to anyone concerned about fungal contamination, such as environmental consultants, health professionals, or the general public.
Resources http://www.osha.gov/dts/shib/shib101003.html

Guidelines on Assessment and Remediation of Fungi in Indoor Environments
by The New York City Department of Health and Mental HygieneThe following are some unsolicited comments from our clients.

Executive Summary On May 7, 1993, the New York City Department of Health (DOH), the New York City Human Resources Administration (HRA), and the Mt. Sinai Occupational Health Clinic convened an expert panel on Stachybotrys atra in Indoor Environments. The purpose of the panel was to develop policies for medical and environmental evaluation and intervention to address Stachybotrys atra (now known as Stachybotrys chartarum (SC)) contamination. The original guidelines were developed because of mold growth problems in several New York City buildings in the early 1990's. This document revises and expands the original guidelines to include all fungi (mold). It is based both on a review of the literature regarding fungi and on comments obtained by a review panel consisting of experts in the fields of microbiology and health sciences. It is intended for use by building engineers and management, but is available for general distribution to anyone concerned about fungal contamination, such as environmental consultants, health professionals, or the general public.

We are expanding the guidelines to be inclusive of all fungi for several reasons:

• Many fungi (e.g., species of Aspergillus, Penicillium, Fusarium, Trichoderma, and Memnoniella) in addition to SC can produce potent mycotoxins, some of which are identical to compounds produced by SC. Mycotoxins are fungal metabolites that have been identified as toxic agents. For this reason, SC cannot be treated as uniquely toxic in indoor environments.

• People performing renovations/cleaning of widespread fungal contamination may be at risk for developing Organic Dust Toxic Syndrome (ODTS) or Hypersensitivity Pneumonitis (HP). ODTS may occur after a single heavy exposure to dust contaminated with fungi and produces flu-like symptoms. It differs from HP in that it is not an immune-mediated disease and does not require repeated exposures to the same causative agent. A variety of biological agents may cause ODTS including common species of fungi. HP may occur after repeated exposures to an allergen and can result in permanent lung damage.

• Fungi can cause allergic reactions. The most common symptoms are runny nose, eye irritation, cough, congestion, and aggravation of asthma.

• Many fungi (e.g., species of Aspergillus, Penicillium, Fusarium, Trichoderma, and Memnoniella) in addition to SC can produce potent mycotoxins, some of which are identical to compounds produced by SC.^{1, 2, 3, 4} Mycotoxins are fungal metabolites that have been identified as toxic agents. For this reason, SC cannot be treated as uniquely toxic in indoor environments.

• Fungi can cause allergic reactions. The most common symptoms are runny nose, eye irritation, cough, congestion, and aggravation of asthma.^{11, 12}

Fungi are present almost everywhere in indoor and outdoor environments. The most common symptoms of fungal exposure are runny nose, eye irritation, cough, congestion, and aggravation of asthma. Although there is evidence documenting severe health effects of fungi in humans, most of this evidence is derived from ingestion of contaminated foods (i.e., grain and peanut products) or occupational exposures in agricultural settings where inhalation exposures were very high.^{13, 14} With the possible exception of remediation to very heavily contaminated indoor environments, such high level exposures are not expected to occur while performing remedial work.¹⁵
There have been reports linking health effects in office workers to offices contaminated with moldy surfaces and in residents of homes contaminated with fungal growth.^{12, 16, 17, 18, 19, 20} Symptoms, such as fatigue, respiratory ailments, and eye irritation were typically observed in these cases.

Some studies have suggested an association between SC and pulmonary hemorrhage/hemosiderosis in infants, generally those less than six months old. Pulmonary hemosiderosis is an uncommon condition that results from bleeding in the lungs. The cause of this condition is unknown, but may result from a combination of environmental contaminants and conditions (e.g., smoking, other microbial contaminants, and water-damaged homes), and currently its association with SC is unproven.^{21, 22, 23}
The focus of this guidance document addresses mold contamination of building components (walls, ventilation systems, support beams, etc.) that are chronically moist or water damaged. Occupants should address common household sources of mold, such as mold found in bathroom tubs or between tiles with household cleaners. Moldy food (e.g., breads, fruits, etc.) should be discarded.

This document is not a legal mandate and should be used as a guideline. Currently there are no United States Federal, New York State, or New York City regulations for evaluating potential health effects of fungal contamination and remediation. These guidelines are subject to change as more information regarding fungal contaminants becomes available.

1. Health Issues 1.1 Health Effects
Inhalation of fungal spores, fragments (parts), or metabolites (e.g., mycotoxins and volatile organic compounds) from a wide variety of fungi may lead to or exacerbate immunologic (allergic) reactions, cause toxic effects, or cause infections.^{11, 12, 24}
There are only a limited number of documented cases of health problems from indoor exposure to fungi. The intensity of exposure and health effects seen in studies of fungal exposure in the indoor environment was typically much less severe than those that were experienced by agricultural workers but were of a long-term duration.^{5-10, 12, 14, 16-20, 25-27} Illnesses can result from both high level, short-term exposures and lower level, long-term exposures. The most common symptoms reported from exposures in indoor environments are runny nose, eye irritation, cough, congestion, aggravation of asthma, headache, and fatigue.^{11, 12, 16-20}
The presence of fungi on building materials as identified by a visual assessment or by bulk/surface sampling results does not necessitate that people will be exposed or exhibit health effects. In order for humans to be exposed indoors, fungal spores, fragments, or metabolites must be released into the air and inhaled, physically contacted (dermal exposure), or ingested. Whether or not symptoms develop in people exposed to fungi depends on the nature of the fungal material (e.g., allergenic, toxic, or infectious), the amount of exposure, and the susceptibility of exposed persons. Susceptibility varies with the genetic predisposition (e.g., allergic reactions do not always occur in all individuals), age, state of health, and concurrent exposures. For these reasons, and because measurements of exposure are not standardized and biological markers of exposure to fungi are largely unknown, it is not possible to determine "safe" or "unsafe" levels of exposure for people in general.

1.1.1 Immunological Effects

Immunological reactions include asthma, HP, and allergic rhinitis. Contact with fungi may also lead to dermatitis. It is thought that these conditions are caused by an immune response to fungal agents. The most common symptoms associated with allergic reactions are runny nose, eye irritation, cough, congestion, and aggravation of asthma.^{11, 12} HP may occur after repeated exposures to an allergen and can result in permanent lung damage. HP has typically been associated with repeated heavy exposures in agricultural settings but has also been reported in office settings.^{25,
26, 27} Exposure to fungi through renovation work may also lead to initiation or exacerbation of allergic or respiratory symptoms.

1.1.2 Toxic Effects

A wide variety of symptoms have been attributed to the toxic effects of fungi. Symptoms, such as fatigue, nausea, and headaches, and respiratory and eye irritation have been reported. Some of the symptoms related to fungal exposure are non-specific, such as discomfort, inability to concentrate, and fatigue.^{11, 12, 16-20} Severe illnesses such as ODTS and pulmonary hemosiderosis have also been attributed to fungal exposures.^{5-10, 21,
22}

ODTS describes the abrupt onset of fever, flu-like symptoms, and respiratory symptoms in the hours following a single, heavy exposure to dust containing organic material including fungi. It differs from HP in that it is not an immune-mediated disease and does not require repeated exposures to the same causative agent. ODTS may be caused by a variety of biological agents including common species of fungi (e.g., species of Aspergillus and Penicillium). ODTS has been documented in farm workers handling contaminated material but is also of concern to workers performing renovation work on building materials contaminated with fungi.^5-10

Some studies have suggested an association between SC and pulmonary hemorrhage/hemosiderosis in infants, generally those less than six months old. Pulmonary hemosiderosis is an uncommon condition that results from bleeding in the lungs. The cause of this condition is unknown, but may result from a combination of environmental contaminants and conditions (e.g., smoking, fungal contaminants and other bioaerosols, and water-damaged homes), and currently its association with SC is unproven.^{21, 22, 23}

1.1.3 Infectious Disease

Only a small group of fungi have been associated with infectious disease. Aspergillosis is an infectious disease that can occur in immunosuppressed persons. Health effects in this population can be severe. Several species of Aspergillus are known to cause aspergillosis. The most common is Aspergillus fumigatus. Exposure to this common mold, even to high concentrations, is unlikely to cause infection in a healthy person.^{11,
24}
Exposure to fungi associated with bird and bat droppings (e.g., Histoplasma capsulatum and Cryptococcus neoformans) can lead to health effects, usually transient flu-like illnesses, in healthy individuals. Severe health effects are primarily encountered in immunocompromised persons.^{24, 28, 29}

1.2 Medical Evaluation

Individuals with persistent health problems that appear to be related to fungi or other bioaerosol exposure should see their physicians for a referral to practitioners who are trained in occupational/environmental medicine or related specialties and are knowledgeable about these types of exposures. Infants (less than 12 months old) who are experiencing non-traumatic nosebleeds or are residing in dwellings with damp or moldy conditions and are experiencing breathing difficulties should receive a medical evaluation to screen for alveolar hemorrhage. Following this evaluation, infants who are suspected of having alveolar hemorrhaging should be referred to a pediatric pulmonologist. Infants diagnosed with pulmonary hemosiderosis and/or pulmonary hemorrhaging should not be returned to dwellings until remediation and air testing are completed.

Clinical tests that can determine the source, place, or time of exposure to fungi or their products are not currently available. Antibodies developed by exposed persons to fungal agents can only document that exposure has occurred. Since exposure to fungi routinely occurs in both outdoor and indoor environments this information is of limited value.

1.3 Medical Relocation

Infants (less than 12 months old), persons recovering from recent surgery, or people with immune suppression, asthma, hypersensitivity pneumonitis, severe allergies, sinusitis, or other chronic inflammatory lung diseases may be at greater risk for developing health problems associated with certain fungi. Such persons should be removed from the affected area during remediation (see Section 3, Remediation). Persons diagnosed with fungal related diseases should not be returned to the affected areas until remediation and air testing are completed.

Except in cases of widespread fungal contamination that are linked to illnesses throughout a building, a building-wide evacuation is not indicated. A trained occupational/environmental health practitioner should base decisions about medical removals in the occupational setting on the results of a clinical assessment.

2. Environmental Assessment The presence of mold, water damage, or musty odors should be addressed immediately. In all instances, any source(s) of water must be stopped and the extent of water damaged determined. Water damaged materials should be dried and repaired. Mold damaged materials should be remediated in accordance with this document (see Section 3, Remediation).

2.1 Visual Inspection

A visual inspection is the most important initial step in identifying a possible contamination problem. The extent of any water damage and mold growth should be visually assessed. This assessment is important in determining remedial strategies. Ventilation systems should also be visually checked, particularly for damp filters but also for damp conditions elsewhere in the system and overall cleanliness. Ceiling tiles, gypsum wallboard (sheetrock), cardboard, paper, and other cellulosic surfaces should be given careful attention during a visual inspection. The use of equipment such as a boroscope, to view spaces in ductwork or behind walls, or a moisture meter, to detect moisture in building materials, may be helpful in identifying hidden sources of fungal growth and the extent of water damage.

2.2 Bulk/Surface Sampling

Bulk or surface sampling is not required to undertake a remediation. Remediation (as described in Section 3, Remediation) of visually identified fungal contamination should proceed without further evaluation.

Bulk or surface samples may need to be collected to identify specific fungal contaminants as part of a medical evaluation if occupants are experiencing symptoms which may be related to fungal exposure or to identify the presence or absence of mold if a visual inspection is equivocal (e.g., discoloration, and staining).

An individual trained in appropriate sampling methodology should perform bulk or surface sampling. Bulk samples are usually collected from visibly moldy surfaces by scraping or cutting materials with a clean tool into a clean plastic bag. Surface samples are usually collected by wiping a measured area with a sterile swab or by stripping the suspect surface with clear tape. Surface sampling is less destructive than bulk sampling. Other sampling methods may also be available. A laboratory specializing in mycology should be consulted for specific sampling and delivery instructions.

2.3 Air Monitoring

Air sampling for fungi should not be part of a routine assessment. This is because decisions about appropriate remediation strategies can usually be made on the basis of a visual inspection. In addition, air-sampling methods for some fungi are prone to false negative results and therefore cannot be used to definitively rule out contamination.

Air monitoring may be necessary if an individual(s) has been diagnosed with a disease that is or may be associated with a fungal exposure (e.g., pulmonary hemorrhage/hemosiderosis, and aspergillosis).

Air monitoring may be necessary if there is evidence from a visual inspection or bulk sampling that ventilation systems may be contaminated. The purpose of such air monitoring is to assess the extent of contamination throughout a building. It is preferable to conduct sampling while ventilation systems are operating.

Air monitoring may be necessary if the presence of mold is suspected (e.g., musty odors) but cannot be identified by a visual inspection or bulk sampling (e.g., mold growth behind walls). The purpose of such air monitoring is to determine the location and/or extent of contamination.

If air monitoring is performed, for comparative purposes, outdoor air samples should be collected concurrently at an air intake, if possible, and at a location representative of outdoor air. For additional information on air sampling, refer to the American Conference of Governmental Industrial Hygienists' document, "Bioaerosols: Assessment and Control."

Personnel conducting the sampling must be trained in proper air sampling methods for microbial contaminants. A laboratory specializing in mycology should be consulted for specific sampling and shipping instructions.

2.4 Analysis of Environmental Samples

Microscopic identification of the spores/colonies requires considerable expertise. These services are not routinely available from commercial laboratories. Documented quality control in the laboratories used for analysis of the bulk/surface and air samples is necessary. The American Industrial Hygiene Association (AIHA) offers accreditation to microbial laboratories (Environmental Microbiology Laboratory Accreditation Program (EMLAP)). Accredited laboratories must participate in quarterly proficiency testing (Environmental Microbiology Proficiency Analytical Testing Program (EMPAT)).

Evaluation of bulk/surface and air sampling data should be performed by an experienced health professional. The presence of few or trace amounts of fungal spores in bulk/surface sampling should be considered background. Amounts greater than this or the presence of fungal fragments (e.g., hyphae, and conidiophores) may suggest fungal colonization, growth, and/or accumulation at or near the sampled location.³⁰ Air samples should be evaluated by means of comparison (i.e., indoors to outdoors) and by fungal type (e.g., genera, and species). In general, the levels and types of fungi found should be similar indoors (in non-problem buildings) as compared to the outdoor air. Differences in the levels or types of fungi found in air samples may indicate that moisture sources and resultant fungal growth may be problematic.

3. Remediation In all situations, the underlying cause of water accumulation must be rectified or fungal growth will recur. Any initial water infiltration should be stopped and cleaned immediately. An immediate response (within 24 to 48 hours) and thorough clean up, drying, and/or removal of water damaged materials will prevent or limit mold growth. If the source of water is elevated humidity, relative humidity should be maintained at levels below 60% to inhibit mold growth.³¹ Emphasis should be on ensuring proper repairs of the building infrastructure, so that water damage and moisture buildup does not recur.

Five different levels of abatement are described below. The size of the area impacted by fungal contamination primarily determines the type of remediation. The sizing levels below are based on professional judgement and practicality; currently there is not adequate data to relate the extent of contamination to frequency or severity of health effects. The goal of remediation is to remove or clean contaminated materials in a way that prevents the emission of fungi and dust contaminated with fungi from leaving a work area and entering an occupied or non-abatement area, while protecting the health of workers performing the abatement. The listed remediation methods were designed to achieve this goal, however, due to the general nature of these methods it is the responsibility of the people conducting remediation to ensure the methods enacted are adequate. The listed remediation methods are not meant to exclude other similarly effective methods. Any changes to the remediation methods listed in these guidelines, however, should be carefully considered prior to implementation.

Non-porous (e.g., metals, glass, and hard plastics) and semi-porous (e.g., wood, and concrete) materials that are structurally sound and are visibly moldy can be cleaned and reused. Cleaning should be done using a detergent solution. Porous materials such as ceiling tiles and insulation, and wallboards with more than a small area of contamination should be removed and discarded. Porous materials (e.g., wallboard, and fabrics) that can be cleaned, can be reused, but should be discarded if possible. A professional restoration consultant should be contacted when restoring porous materials with more than a small area of fungal contamination. All materials to be reused should be dry and visibly free from mold. Routine inspections should be conducted to confirm the effectiveness of remediation work.

The use of gaseous, vapor-phase, or aerosolized biocides for remedial purposes is not recommended. The use of biocides in this manner can pose health concerns for people in occupied spaces of the building and for people returning to the treated space if used improperly. Furthermore, the effectiveness of these treatments is unproven and does not address the possible health concerns from the presence of the remaining non-viable mold. For additional information on the use of biocides for remedial purposes, refer to the American Conference of Governmental Industrial Hygienists' document, "Bioaerosols: Assessment and Control."

3.1 Level I: Small Isolated Areas (10 sq. ft or less) - e.g., ceiling tiles, small areas on walls

Remediation can be conducted by regular building maintenance staff. Such persons should receive training on proper clean up methods, personal protection, and potential health hazards. This training can be performed as part of a program to comply with the requirements of the OSHA Hazard Communication Standard (29 CFR 1910.1200).

Respiratory protection (e.g., N95 disposable respirator), in accordance with the OSHA respiratory protection standard (29 CFR 1910.134), is recommended. Gloves and eye protection should be worn.

The work area should be unoccupied. Vacating people from spaces adjacent to the work area is not necessary but is recommended in the presence of infants (less than 12 months old), persons recovering from recent surgery, immune suppressed people, or people with chronic inflammatory lung diseases (e.g., asthma, hypersensitivity pneumonitis, and severe allergies).

Containment of the work area is not necessary. Dust suppression methods, such as misting (not soaking) surfaces prior to remediation, are recommended.

Contaminated materials that cannot be cleaned should be removed from the building in a sealed plastic bag. There are no special requirements for the disposal of moldy materials.

The work area and areas used by remedial workers for egress should be cleaned with a damp cloth and/or mop and a detergent solution.

All areas should be left dry and visibly free from contamination and debris.

3.2 Level II: Mid-Sized Isolated Areas (10 - 30 sq. ft.) - e.g., individual wallboard panels.

Respiratory protection (e.g., N95 disposable respirator), in accordance with the OSHA respiratory protection standard (29 CFR 1910.134), is recommended. Gloves and eye protection should be worn.

The work area should be unoccupied. Vacating people from spaces adjacent to the work area is not necessary but is recommended in the presence of infants (less than 12 months old), persons having undergone recent surgery, immune suppressed people, or people with chronic inflammatory lung diseases (e.g., asthma, hypersensitivity pneumonitis, and severe allergies).

The work area should be covered with a plastic sheet(s) and sealed with tape before remediation, to contain dust/debris.

Dust suppression methods, such as misting (not soaking) surfaces prior to remediation, are recommended.

Contaminated materials that cannot be cleaned should be removed from the building in sealed plastic bags. There are no special requirements for the disposal of moldy materials.

The work area and areas used by remedial workers for egress should be HEPA vacuumed (a vacuum equipped with a High-Efficiency Particulate Air filter) and cleaned with a damp cloth and/or mop and a detergent solution.

All areas should be left dry and visibly free from contamination and debris.

3.3 Level III: Large Isolated Areas (30 - 100 square feet) - e.g., several wallboard panels.

A health and safety professional with experience performing microbial investigations should be consulted prior to remediation activities to provide oversight for the project.
The following procedures at a minimum are recommended:

Personnel trained in the handling of hazardous materials and equipped with respiratory protection, (e.g., N95 disposable respirator), in accordance with the OSHA respiratory protection standard (29 CFR 1910.134), is recommended. Gloves and eye protection should be worn.

The work area and areas directly adjacent should be covered with a plastic sheet(s) and taped before remediation, to contain dust/debris.

Seal ventilation ducts/grills in the work area and areas directly adjacent with plastic sheeting.

The work area and areas directly adjacent should be unoccupied. Further vacating of people from spaces near the work area is recommended in the presence of infants (less than 12 months old), persons having undergone recent surgery, immune suppressed people, or people with chronic inflammatory lung diseases (e.g., asthma, hypersensitivity pneumonitis, and severe allergies).

Dust suppression methods, such as misting (not soaking) surfaces prior to remediation, are recommended.

Contaminated materials that cannot be cleaned should be removed from the building in sealed plastic bags. There are no special requirements for the disposal of moldy materials.

The work area and surrounding areas should be HEPA vacuumed and cleaned with a damp cloth and/or mop and a detergent solution.

All areas should be left dry and visibly free from contamination and debris.

If abatement procedures are expected to generate a lot of dust (e.g., abrasive cleaning of contaminated surfaces, demolition of plaster walls) or the visible concentration of the fungi is heavy (blanket coverage as opposed to patchy), then it is recommended that the remediation procedures for Level IV are followed.

3.4 Level IV: Extensive Contamination (greater than 100 contiguous square feet in an area)
A health and safety professional with experience performing microbial investigations should be consulted prior to remediation activities to provide oversight for the project. The following procedures are recommended:

Personnel trained in the handling of hazardous materials equipped with:

Full-face respirators with high efficiency particulate air (HEPA) cartridges
Disposable protective clothing covering both head and shoes
Gloves

Containment of the affected area:

Complete isolation of work area from occupied spaces using plastic sheeting sealed with duct tape (including ventilation ducts/grills, fixtures, and any other openings)
The use of an exhaust fan with a HEPA filter to generate negative pressurization
Airlocks and decontamination room

Vacating people from spaces adjacent to the work area is not necessary but is recommended in the presence of infants (less than 12 months old), persons having undergone recent surgery, immune suppressed people, or people with chronic inflammatory lung diseases (e.g., asthma, hypersensitivity pneumonitis, and severe allergies).

Contaminated materials that cannot be cleaned should be removed from the building in sealed plastic bags. The outside of the bags should be cleaned with a damp cloth and a detergent solution or HEPA vacuumed in the decontamination chamber prior to their transport to uncontaminated areas of the building. There are no special requirements for the disposal of moldy materials.

The contained area and decontamination room should be HEPA vacuumed and cleaned with a damp cloth and/or mop with a detergent solution and be visibly clean prior to the removal of isolation barriers.

Air monitoring should be conducted prior to occupancy to determine if the area is fit to reoccupy.

3.5 Level V: Remediation of HVAC Systems
3.5.1 A Small Isolated Area of Contamination (<10 square feet) in the HVAC System

Respiratory protection (e.g., N95 disposable respirator), in accordance with the OSHA respiratory protection standard (29 CFR 1910.134), is recommended. Gloves and eye protection should be worn.

The HVAC system should be shut down prior to any remedial activities.

The work area should be covered with a plastic sheet(s) and sealed with tape before remediation, to contain dust/debris.

Dust suppression methods, such as misting (not soaking) surfaces prior to remediation, are recommended.

The work area and areas immediately surrounding the work area should be HEPA vacuumed and cleaned with a damp cloth and/or mop and a detergent solution.

All areas should be left dry and visibly free from contamination and debris.

A variety of biocides are recommended by HVAC manufacturers for use with HVAC components, such as, cooling coils and condensation pans. HVAC manufacturers should be consulted for the products they recommend for use in their systems.

3.5.2 Areas of Contamination (>10 square feet) in the HVAC System

A health and safety professional with experience performing microbial investigations should be consulted prior to remediation activities to provide oversight for remediation projects involving more than a small isolated area in an HVAC system. The following procedures are recommended:

Personnel trained in the handling of hazardous materials equipped with:

Respiratory protection (e.g., N95 disposable respirator), in accordance with the OSHA respiratory protection standard (29 CFR 1910.134), is recommended.
Gloves and eye protection
Full-face respirators with HEPA cartridges and disposable protective clothing covering both head and shoes should be worn if contamination is greater than 30 square feet.

The HVAC system should be shut down prior to any remedial activities.

Containment of the affected area:

Complete isolation of work area from the other areas of the HVAC system using plastic sheeting sealed with duct tape.
The use of an exhaust fan with a HEPA filter to generate negative pressurization.
Airlocks and decontamination room if contamination is greater than 30 square feet.

Growth supporting materials that are contaminated, such as the paper on the insulation of interior lined ducts and filters, should be removed. Other contaminated materials that cannot be cleaned should be removed in sealed plastic bags. When a decontamination chamber is present, the outside of the bags should be cleaned with a damp cloth and a detergent solution or HEPA vacuumed prior to their transport to uncontaminated areas of the building. There are no special requirements for the disposal of moldy materials.

The contained area and decontamination room should be HEPA vacuumed and cleaned with a damp cloth and/or mop and a detergent solution prior to the removal of isolation barriers.

All areas should be left dry and visibly free from contamination and debris.

Air monitoring should be conducted prior to re-occupancy with the HVAC system in operation to determine if the area(s) served by the system are fit to reoccupy.

4. Hazard Communication When fungal growth requiring large-scale remediation is found, the building owner, management, and/or employer should notify occupants in the affected area(s) of its presence. Notification should include a description of the remedial measures to be taken and a timetable for completion. Group meetings held before and after remediation with full disclosure of plans and results can be an effective communication mechanism. Individuals with persistent health problems that appear to be related to bioaerosol exposure should see their physicians for a referral to practitioners who are trained in occupational/environmental medicine or related specialties and are knowledgeable about these types of exposures. Individuals seeking medical attention should be provided with a copy of all inspection results and interpretation to give to their medical practitioners.

Conclusion In summary, the prompt remediation of contaminated material and infrastructure repair must be the primary response to fungal contamination in buildings. The simplest and most expedient remediation that properly and safely removes fungal growth from buildings should be used. In all situations, the underlying cause of water accumulation must be rectified or the fungal growth will recur. Emphasis should be placed on preventing contamination through proper building maintenance and prompt repair of water damaged areas.
Widespread contamination poses much larger problems that must be addressed on a case-by-case basis in consultation with a health and safety specialist. Effective communication with building occupants is an essential component of all remedial efforts. Individuals with persistent health problems should see their physicians for a referral to practitioners who are trained in occupational/environmental medicine or related specialties and are knowledgeable about these types of exposures.

Notes and References

Bata A, Harrach B, Kalman U, Kis-tamas A, Lasztity R. Macrocyclic Trichothecene Toxins Produced by Stachybotrys atra Strains Isolated in Middle Europe. Applied and Environmental Microbiology 1985; 49:678-81.

Jarvis B, "Mycotoxins and Indoor Air Quality," Biological Contaminants in Indoor Environments, ASTM STP 1071, Morey P, Feely Sr. J, Otten J, Editors, American Society for Testing and Materials, Philadelphia, 1990.

Yang C, Johanning E, "Airborne Fungi and Mycotoxins," Manual of Environmental Microbiology, Hurst C, Editor in Chief, ASM Press, Washington, D.C., 1996

Jarvis B, Mazzola E. Macrocyclic and Other Novel Trichothecenes: Their Structure, Synthesis, and Biological Significance. Acc. Chem. Res. 1982; 15:388-95.

Von Essen S, Robbins R, Thompson A, Rennard S. Organic Dust Toxic Syndrome: An Acute Febrile Reaction to Organic Dust Exposure Distinct from Hypersensitivity Pneumonitis. Clinical Toxicology 1990; 28(4):389-420.

Richerson H. Unifying Concepts Underlying the Effects of Organic Dust Exposures. American Journal of Industrial Medicine 1990; 17:139-42.

Malmberg P, Rask-Andersen A, Lundholm M, Palmgren U. Can Spores from Molds and Actinomycetes Cause an Organic Dust Toxic Syndrome Reaction?. American Journal of Industrial Medicine 1990; 17:109-10.

Malmberg P. Health Effects of Organic Dust Exposure in Dairy Farmers. American Journal of Industrial Medicine 1990; 17:7-15.

Yoshida K, Masayuki A, Shukuro A. Acute Pulmonary Edema in a Storehouse of Moldy Oranges: A Severe Case of the Organic Dust Toxic Syndrome. Archives of Environmental Health 1989; 44(6): 382-84.

Lecours R, Laviolette M, Cormier Y. Bronchoalveolar Lavage in Pulmonary Mycotoxicosis. Thorax 1986; 41:924-6.

Levetin E. "Fungi," Bioaerosols, Burge H, Editor, CRC Press, Boca Raton, Florida, 1995.

Husman T. Health Effects of Indoor-air Microorganisms. Scand J Work Environ Health 1996; 22:5-13.

Miller J D. Fungi and Mycotoxins in Grain: Implications for Stored Product Research. J Stored Prod Res 1995; 31(1):1-16.

Cookingham C, Solomon W. "Bioaerosol-Induced Hypersensitivity Diseases," Bioaerosols, Burge H, Editor, CRC Press, Boca Raton, Florida, 1995.

Rautiala S, Reponen T, Nevalainen A, Husman T, Kalliokoski P. Control of Exposure to Airborne Viable Microorganisms During Remediation of Moldy Buildings; Report of Three Case Studies. American Industrial Hygiene Association Journal 1998; 59:455-60.

Dales R, Zwanenburg H, Burnett R, Franklin C. Respiratory Health Effects of Home Dampness and Molds among Canadian Children. American Journal of Epidemiology 1991; 134(2): 196-203.

Hodgson M, Morey P, Leung W, Morrow L, Miller J D, Jarvis B, Robbins H, Halsey J, Storey E. Building-Associated Pulmonary Disease from Exposure to Stachybotrys chartarum and Aspergillus versicolor. Journal of Occupational and Environmental Medicine 1998; 40(3)241-9.

Croft W, Jarvis B, Yatawara C. Airborne Outbreak of Trichothecene Toxicosis. Atmospheric Environment 1986; 20(3)549-52.

DeKoster J, Thorne P. Bioaerosol Concentrations in Noncomplaint, Complaint, and Intervention Homes in the Midwest. American Industrial Hygiene Association Journal 1995; 56:573-80.

Johanning E, Biagini R, Hull D, Morey P, Jarvis B, Landbergis P. Health and Immunological Study Following Exposure to Toxigenic Fungi (Stachybotrys chartarum) in a Water-Damaged Office Environment. Int Arch Occup Environ Health 1996; 68:207-18.

Montana E, Etzel R, Allan T, Horgan T, Dearborn D. Environmental Risk Factor Associated with Pediatric Idiopathic Pulmonary Hemorrhage and Hemosiderosis in a Cleveland Community. Pediatrics 1997; 99(1)

Etzel R, Montana E, Sorenson W G, Kullman G, Allan T, Dearborn D. Acute Pulmonary Hemorrhage in Infants Associated with Exposure to Stachybotrys atra and Other Fungi. Ach Pediatr Adolesc Med 1998; 152:757-62.

CDC. Update: Pulmonary Hemorrhage/Hemosiderosis Among Infants --- Cleveland, Ohio, 1993 - 1996. MMWR 2000; 49(9): 180-4.

Burge H, Otten J. "Fungi," Bioaerosols Assessment and Control, Macher J, Editor, American Conference of Industrial Hygienists, Cincinnati, Ohio, 1999.

do Pico G. Hazardous Exposure and Lung Disease Among Farm Workers. Clinics in Chest Medicine 1992; 13(2):311-28.

Hodgson M, Morey P, Attfield M, Sorenson W, Fink J, Rhodes W, Visvesvara G. Pulmonary Disease Associated with Cafeteria Flooding. Archives of Environmental Health 1985; 40(2):96-101.

Weltermann B, Hodgson M, Storey E, DeGraff, Jr. A, Bracker A, Groseclose S, Cole S, Cartter M, Phillips D. Hypersensitivity Pneumonitis: A Sentinel Event Investigation in a Wet Building. American Journal of Industrial Medicine 1998; 34:499-505.

Band J. "Histoplasmosis," Occupational Respiratory Diseases, Merchant J, Editor, U.S. Department of Health and Human Services, Washington D.C., 1986.

Bertolini R. "Histoplasmosis A Summary of the Occupational Health Concern," Canadian Centre for Occupational Health and Safety. Hamilton, Ontario, Canada, 1988.

Yang C. P&K Microbiology Services, Inc. Microscopic Examination of Sticky Tape or Bulk Samples for the Evaluation and Identification of Fungi. Cherry Hill, New Jersey.

American Society of Heating, Refrigerating and Air-Conditioning Engineers, Inc. Thermal Environmental Conditions for Human Occupancy - ASHRAE Standard (ANSI/ASHRAE 55-1992). Atlanta, Georgia, 1992.

Acknowledgments The New York City Department of Health would like to thank the following individuals and organizations for participating in the revision of these guidelines. Please note that these guidelines do not necessarily reflect the opinions of the participants nor their organizations.

Name		Company/Institution
Dr. Susan Klitzman		Hunter College
Dr. Philip Morey		AQS Services, Inc
Dr. Donald Ahearn		Georgia State University
Dr. Sidney Crow		Georgia State University
Dr. J. David Miller		Carleton University
Dr. Bruce Jarvis		University of Maryland at College Park
Mr. Ed Light		Building Dynamics, LLC
Dr. Chin Yang		P&K Microbiology Services, Inc
Dr. Harriet Burge		Harvard School of Public Health
Dr. Dorr Dearborn		Rainbow Children's Hospital
Mr. Eric Esswein		National Institute for Occupational Safety and Health
Dr. Ed Horn		The New York State Department of Health
Dr. Judith Schreiber		The New York State Department of Health
Mr. Gregg Recer		The New York State Department of Health
Dr. Gerald Llewellyn		State of Delaware, Division of Public Health
Mr. Daniel Price		Interface Research Corporation
Ms. Sylvia Pryce		The NYC Citywide Office of Occupational Safety and Health
Mr. Armando Chamorro		Ambient Environmental
Ms. Marie-Alix d'Halewyn		Laboratoire de santé publique du Québec
Dr. Elissa A. Favata		Environmental and Occupational Health Associates
Dr. Harriet Ammann		Washington State Department of Health
Mr. Terry Allan		Cuyahoga County Board of Health

We would also like to thank the many others who offered opinions, comments, and assistance at various stages during the development of these guidelines.

Christopher D'Andrea, M.S. of the Environmental and Occupational Disease Epidemiology Unit, was the editor of this document.

For further information regarding this document please contact the New York City Department of Health at 311.

http://www.nyc.gov/html/doh/html/epi/moldrpt1.shtml