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SBS stands for Sick Building Syndrome. It covers a mixture of symptoms thought to be generated when a student at school spends time in a particular building. The symptoms range from itchy eyes, skin rashes, and nasal allergy symptoms, to more complicated symptoms such as fatigue, pains, and sensitivity to odours. On the other hand, it may be lead to more serious diseases like cancer and pneumonia.
SBS was first identified in the 1970s, and its identification at this time because of the increasing number of electronic equipment and other factors. The term SBS is used when a large number of people occupying a particular building develop symptoms associated with their presence in that building. Later on, the symptoms disappear. In most cases sick building syndrome occurs in office buildings, schools and apartment buildings.
Â SBS is suspected when the following circumstances are present:
Symptoms are temporary and associated with time spent in a particular building or place.
Symptoms disappear when the individual is not in the building.
Symptoms reappear seasonally (heating, cooling).
Symptoms and their severity are different from person to person.Â
The signs and symptoms of a diagnosable illness are easy to identify and can be directed to specific airborne building contaminants. On the other hand, the cause(s) of symptoms in cases of SBS are often difficult to pin down and in many cases different factors may lead to the situation. When a sick building is identified an investigation should be done. Once the causes are identified, corrective measures must be taken to ensure that any adverse reaction exhibited and cause(s) are isolated to make the area safe for the students and school personnel.
The prevalence of sick building syndrome is a problem, but statistics are limited. A World Health Organization (WHO) report from 1984 suggested that up to 30% of new and renovated buildings worldwide may generate excessive complaints related to indoor air quality (1). This high rate may be associated with modern mass produced construction materials that tend to off load gas irritating volatile organic chemicals (VOCs). In a U.S. report on office workers questioned at random, 24% reported air quality problems in their work place, and 20% believed this harmed their ability to do their job effectively (2) (http://www.houseofplants.co.uk).
Symptoms of SBS
People suffering from SBS present different symptoms, like other conditions such as:
Eye infections and irritations
Visual impairment tremors
Damage to the central nervous system
Running noses and throat irritations
Dry, itchy skin and rashes
Dizziness and nausea
Difficulty in concentrating
Fatigue and tiredness
Pneumonia and chest infections
Causes of SBS
The mechanism by which a building or anything within the building causes employees to become sick is unknown. Problem areas can be easily identified and curative action taken after an investigation.
Causes are listed below:
Building design, maintenance
Failure of ventilation system
Interior design factors
Levels of specific pollutants, humidity and temperature
Multiple chemicals acting in combination to cause sickness
Age of building
Type of materials used in building
SBS is associated with the presence of certain mechanisms and pollutants. Most of the symptoms appear because of known toxic effects of high levels of certain chemicals. Some symptoms are mainly allergic irritations which could result from various allergens in a building. Other symptoms are suggestive of those really experienced by sufferers of chemical sensitivity and many of the indoor pollutants.
Occurs in building with ventilation problems and may occur along with upper respiratory tract infection, Or with direct contact with chemicals, dust and gases.
Itchiness, soreness, redness, eye lashes drop and excessive tear production.
Tension, prolonged exposure to different irritant substances and long working hours.
Pain across the forehead, begins in the back of the head and upper neck as a band-like tightness or pressure and may end with vomiting.
Caused by breathing water droplets from humidifiers or from an air filter "ventilation system". Or exposure to chemicals that irritate the lungs and cause infection in the lung.
Productive cough, aching limbs, headache, tiredness, lethargy and abdominal pain.
Occurs in exposed areas because of the direct exposure to chemical and different irritant substances like painting materials and products.
Rashes, batches, itchy, dry skin and may end with chronic skin inflammation.
Physical changes: lack of sleep and new environment.
Headaches, digestive disorders, fatigue and lethargy, sleeping disorders, skin disorders and isolation from community.
Exposure to dust, ventilation problems and chemicals.
Cough, breathlessness, may end with lung cancer.
Dry mucous membranes, ventilation problems and chemicals.
Hoarseness, dry throat pain, recurrent throat infections and chronic Asthma.
Students spend most of their day in the school; it's their second house. From that aspect, the school environment should be physically and emotionally safe, well disciplined, and conducive to learning. Safety is an important issue, which may affect the students' physically and psychologically from this aspect, and there are important points that should be considered:
Structure of the school:
School building structures consist of columns, structural walls, beams, floors, and roof structures, which provide their stability. School buildings develop invisible cracks in concrete columns, structural walls, beams and floors. At the beginning, they are not an important issue. With time, the school building moves, creating stresses at joints in materials which ends in small cracks appearing. However, this is the normal process of a structure settling in its foundation. But, with the presence of other factors it makes the issue more serious. The idea is to be able to differentiate. In the event of a major structural problem in a school building, it should be evaluated by a structural engineer, and corrective measures should be made accordingly.
Special attention should be made to these aspects:
Bending in columns, beams, and roof structure
Rotting in wood structural components and floor structure
Rusting of metal structural components especially in high humidity weather
The roof protects the school building from rain, sun, wind, and keeps water from getting into the school building. The waterproofing system should be kept in a proper way. To prevent problems from happening, the roof should be kept in good shape and annually maintained.
Using different building materials in school buildings is common nowadays; for example, using fashion blocks in the walls and having exteriors as maintenance free as possible to lower costs. But new school buildings may feature concrete blocks or brick walls even though fashion blocks in some walls are kept. The school buildings' exteriors will still need annual maintenance plans to protect the materials. The plan will consider the type and quality of materials used and their current condition. Some school buildings are old, and the exterior may not be quite suitable for a maintenance free plan. The biggest threats to school buildings' exteriors are water, sun, wind, and being in areas near the coast.
The design of the inside of a building is an important issue. Paint maintenance should be paid special attention, because it plays a major roll in preventing the deterioration of the building, and usually cracks are invisible when they start to appear. Also, the paint should be good quality to avoid any irritation reaction.
The area around the school is made of concrete, but a pathway may be concrete, brick, stone, asphalt, or even wood. Such materials need good maintenance and must be watched for conditions that may cause major hazards such as slips and falls. Any major hazards should be eliminated through repair, ramping or clearing. Annual checkups and repairs must be done if the condition of the material deteriorates.
Healthy classrooms are ones that have adequate ventilation, lighting, an adequate number of students per class, and proper classroom temperature. All previous points which were discussed should be applied properly.
Proper Ventilation is important to the indoor air quality. Air-conditioning, the type of material used and maintenance also affect indoor air quality in order to optimise performance and prevent students becoming sick.
Many factors may affect indoor air quality and contribute to many health problems, the comfort, and the performance of students.
There are many causes of sick building syndrome like uncontrolled temperature (high or low). If there is a wide variation in temperature, it will affect other factors such as the increasing possibility of exposure to fever and throat infections. Therefore, maintaining adequate temperature inside classrooms will allow the students to perform butter. One must make sure that dangerous or offensive fumes are prevented from escaping into the classroom through the heating or cooling system.
Humidity can lead to different problems. It could vary from a simple one to a complicated one. For example, bacteria, fungi, and parasites live in places where humidity is above the normal levels, and they enter the body mainly through the respiratory system, resulting in some kind of respiratory infection. In classrooms, the range of controlled humidity is 40% to 70% in order to increase students' effectiveness. The range of relative humidity in warm classrooms should be less than 40%. Therefore, there should be annual checking of controls on a regular basis, and also, checking should cover the cleanliness of equipment for humidifying.
Ensure that there is adequate lighting in the classrooms and whole building to avoid a lot of problems.
'Surveys by the National Institute of Ophthalmology showed that around 38.8 percent of students at 260 schools in Ho Chi Minh City have refraction problems, short-sightedness, far-sightedness, and astigmatism. The ratio in the northern Hai Phong City was 60 percent, while in Hanoi, Da Nang and the central Ha Tinh Province, it ranged from 25 percent to above 30 percent. Doctors attributed the high incidence of weak eyesight to substandard classrooms in terms of size, area and light, as well excessive time spent working with computers'
To sum up, there are different factors that could affect the school environment, and some of them were discussed above. Some problems can be avoided by early detections and by finding proper solutions to avoid any health problems that arise. If a problem is detected earlier it can be solved during the design step or maybe later in order to maintain a safe school environment. SBS affects productivity, increases the rate of absenteeism, poor concentration and fatigue. It affects the well-being of the students and all school personnel and their performance. All the measures are directed to avoid and reduce the risk factors that affect student health.
BREEAM is a method used internationally to assess a building's surrounding area. It can be applied to asses both new and old buildings. 'There are several types of environmental assessment systems in use such as BREEAM, ESRSA, and CEEQUAL. Because it is used in two significant areas of the globe, BRE Global introduced two new geographical schemes that are use by BREEEAM International assessors which are BREEAM Europe and BREEAM Gulf. In addition to these two schemes, the BREEAM In Use and BREEAM Communities schemes are also available for use on international buildings and developments'.
Since BREEAM is widely used in Europe and as it used in the gulf, the BREEAM Gulf scheme can be used to assess the environmental impacts of any building located in the Gulf region. This will be explained later on in this paper.
BREEAM provides designers, planner and others with key factors:
It ensures the best environmental practice is included in a building
It finds solutions that help to minimise the environmental impact
It ensures the use of high standards and regulations
It reduces the costs and improves working and living environments
It reduces the time needed to finish the work
Steps of BREEAM assessment
There are two steps in BREEAM which can be used to evaluate the environmental effect secondary to building development:
1. Design Stage (DS)
2. Post-Construction Stage (PCS)
This step should be done before construction works start. Related information should be available to enable the BREEAM assessor to demonstrate, in a healthy manner, the building's performance against the reporting and evidential requirements of the technical guidance. The official assessment of DS will be carried out at the detailed design stages.
This step starts after construction work has finished. In this step, an evaluation and the BREMM rating are used before building occupation.
The post-construction stage is divided into two approaches:
1. A post-construction review of a design-stage assessment
2. A post-construction assessment
A post-construction appraisal aims to detect the BREEAM rating achieved at the design stage in accordance with the reporting and evidential requirements of the technical guidance. Where a formal DS assessment has not been carried out and a BREEAM assessment and rating is required, a full PCS assessment can be conducted.
BREEAM Gulf has been developed and established in collaboration with a variety of large organisations based in Qatar, Abu Dhabi and Dubai.
The purpose of the system is to bring all the new and used building types in the area into use. The available BREEAM system can be used to evaluate, demonstrate and improve the building environment.
The system has been developed in the Gulf region to resemble UK BREEAM system categories; it provides special assessment points in relation to environmental impacts associated with construction in the Gulf region.
The BREEAM Gulf system
The BREEAM system for the Gulf assessment point areas is as below:
Health and Wellbeing
Land Use and Ecology
During the assessment phase within each point from the above table, numbers of credits must be assessed to appraise the performance achieved by the development. This set of points is modified to fit the Gulf region's conditions and climate. They are applied to each point to enable the weighted scores to be added together to produce a single overall score for the building. Then, the score is translated into a 1-5 star rating and the highest level of environmental performance will score 5 stars.
'Unlike BREEAM in the UK which generally looks at building uses separately, a BREEAM assessment in the Gulf evaluates the performance of a whole building taking into account the different uses that are present (e.g. offices, retail, residential etc.). This approach reflects the construction market in theÂ region where mixed use buildings are the norm. The assessment, therefore, produces a single score for each assessed building based on an area weighted calculation'.
Differences with BREEAM in the UK
The purpose of BREEAM Gulf is to evaluate the construction industry in the region to achieve and maintain higher levels of sustainability. It also aims to identify local contexts and issues, and with this consideration, all of the codes and standards which should be maintained are described in the guidance.Â
Figure3: factors affecting indoor environment
Case study 1
The EPA (Environmental Protection Agency) has conducted a study about IAQ (Indoor Air Quality). William Blackstone Elementary School was one of three schools selected to pilot EPA Indoor Air Quality Tools for Schools (IAQ TfS) Kit and Program in 1999. The school is located in Boston's South End and is one of 120 schools in the Boston Public School System. The school was built in 1975, using the typical design of that time; brick walls, mostly flat roofs, Plexiglas windows, and visible duct work. It has a history of IAQ and health-related problems, specifically high rates of asthma among students. William Blackstone Elementary School was one of three schools selected to pilot EPA Indoor Air Quality Tools for Schools (IAQ TfS) Kit and Program in 1999. The school nurse noticed that the asthma rate was higher than the national average of two cases per classroom. Staff were also aware of serious problems with water intrusion during heavy rain, stained and collapsed ceiling tiles, peeling paint and stains on the walls, rust on support beams, and water damage to equipment and furniture.
Problems identified by the checklists and walkthrough included the following:
An above-average number of asthma cases and illnesses typically associated with indoor air quality problems (headaches, nausea, etc.).
Water damage, such as mold and mildew, missing, stained, and broken ceiling tiles, fungal growth on ceiling tiles, and damaged ceiling and wall plaster.
Thermal discomfort, such as widely fluctuating temperatures, too high or too low humidity levels, and cold drafts.
Ventilation problems, such as poor air circulation and lack of exhaust fans in some bathrooms.
Cleanliness problems, such as dust accumulation around the supply vents and surrounding ceiling tiles, infrequent dusting and vacuuming, and pest problems.
So, according to the findings, the IAQ team was formed and they established a meeting to list the causes of the problems and find solutions.
The IAQ team implemented some actions to improve the indoor air quality at Blackstone Elementary School. The EPA's IAQ TfS Kit gave the team the leverage it needed to persuade the school district to improve the environmental problems in the school. Once the Superintendent was informed of the school's IAQ issues and the team's recommendations, Blackstone Elementary was placed on a high-priority list for roof repairs and other renovations.
A number of improvements have been done, including roof repairs. There is a plan for installing new energy-efficient lighting and new ceiling tiles. Additionally, carpets will be replaced with tiles in the classrooms. The school nurse started to assess students' health and document any new asthma cases over the next year to establish a link between the indoor environment and children's health.
The surrounding environment plays a role in students' performance and affects their health directly. This means that attention must be given at some point during design stage or later to avoid unwanted risky problems that may affect students' health. Some problems can be detected easily like eye infections, but others like asthma will be treated but its effects are lifelong. Poor ventilation, lighting, humidity and temperature all can produce health problems; therefore, good ventilation, adequate lighting, and proper temperature should be maintained. High performance building features should be incorporated into the design process, and school building systems should be commissioned to ensure that they are operating according to design.
Case study 2
Mold in schools is getting a lot of attention at local, state and federal levels, the Houston Chronicle reported in 2002. Wide variations in temperatures and humidity levels in South Texas make it difficult to maintain internal atmospheric conditions to minimise the formation of mold or mildew.
Pharr-San Juan-Alamo School District's Memorial High School, three years after it was established, faced a toxic mold problem that reached crisis stage. There were complaints from teachers, staff and students that some staff and students were becoming ill, and as a result students left the school. As with many schools, the indoor air quality at the school was poor because of high ventilation, the high number of students per classroom, high intermittent ventilation loads and carryover from showers in gyms and locker rooms, and long periods where the building was vacant. There was an increase in heat, humidity, moisture, bad ventilation and filtration. The building had reached a saturation point. Leaks from the roof and windows contributed to the problem, and mold growth. Humidity inside the building was as high as 90 percent.
Instability of the weather (uncontrolled hot, humidity, moisture)
Bad ventilation and filtration
Leaks from roof and window
Cut off the source of moisture and mold removed
Fresh air from outside drawn to the building to regulate ventilation
Equipment fixed to supply dry air to the building via temporary desiccant dryers
Carpets exchanged for tiles
After three months the desiccant dehumidification system dried
The school is kept at 45 percent relative humidity and 75Â°F temp
The mold growth is inhibited.
Reduced absenteeism rate among students
Healthy environments in school settings empower students to learn more and increase their effectiveness. It also helps school personnel to meet their goals in teaching and other work. From the above case study it can be seen that any problem in the school environment affects students' health and learning ability. The problem can be easily detected by studying the causes and solving them. Many problems can be avoided by:
Choosing a good design of heating, ventilation, and air conditioning
Controlling moisture to prevent mold growth and preventing damage to building materials and systems
Maintenance of the roof and windows