Sick Building Syndrome
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Treatment of almost all medical conditions has been affected by the COVID-19 pandemic. NICE has issued rapid update guidelines in relation to many of these. This guidance is changing frequently. Please visit https://www.nice.org.uk/covid-19 to see if there is temporary guidance issued by NICE in relation to the management of this condition, which may vary from the information given below.
Sick building syndrome (SBS) describes a situation whereby people experience symptoms of ill health that seem to be linked to spending time in a building but where no specific cause can be identified.
The term building-related illness (BRI) refers to recognised diseases, often infections (eg, Legionnaires' disease), caused by being in a building. The cause of SBS is thought to be at least in part due to changes in building and ventilation design triggered by the energy crisis in the 1970s.
One large study found no significant relation between most aspects of the physical work environment and symptom prevalence.
- Greater effects were found with features of the psychosocial work environment including high job demands and low support.
- The report concluded that the physical environment of office buildings appears to be less important than features of the psychosocial work environment in explaining differences in the prevalence of symptoms.
A subsequent study, found that whilst SBS was associated with poor supervisor support and perception of poor physical environmental conditions at work, an association with poor air quality was also present, even when allowances were made for the psychosocial environment.
Research has shown that SBS shares several symptoms common in other conditions thought to be caused be external factors. The umbrella term 'autoimmune (auto-inflammatory) syndrome induced by adjuvants' has been suggested. Other members of the suggested group include:
- Macrophagic myofascitis.
- The Gulf War syndrome
- Post-vaccination phenomena.
SBS is related to both personal and environmental risk factors. Risk factors for SBS include:
- Poor ventilation.
- High room temperature.
- Ineffective cleaning routines.
- Poor lighting.
- Smoking in the workplace.
- Air conditioning.
- Low humidity.
- Psychological factors such as stress or poor staff morale.
- Internal chemical contaminants: usually air pollutants:
- Initial emissions from components and fittings of a building - the 'new smell' generally dissipates over a short period but can last years.
- Volatile organic compounds, including formaldehyde, cleaning products, and manufactured plastic and wood products.
- Ozone from photocopiers and printers.
- Carbon monoxide, carbon dioxide and other inorganic oxides given off as combustion products in heating systems.
- Small fibres from furnishings, regularly agitated into the air by frequent sweeping. Also, asbestos in older buildings.
- Tobacco smoke.
- External contaminants - outside air entering a building:
- Vehicle exhaust fumes: from streets/underground car parks.
- Recycling of the building's own exhaust back in through poorly positioned vents/windows.
- Other external air pollution or airborne particles (eg, pollen, moulds) have been postulated but the evidence is unconvincing.
- The prime suspect in most cases is inadequate ventilation. The factors leading to poor ventilation include insufficient outside air, poor filtration of internal and external air, contaminated duct work, dirty heating, ventilating and air conditioning units, poor planning and placement of vents.
General tiredness is often the most common symptom. It usually starts within a few hours of arriving at work and improves within minutes of leaving the building. Symptoms may be worse in the winter months in northern climates:
- Headaches and dizziness; headaches are usually non-migrainous, rarely throbbing, and usually described as dull and often as a pressure on the head.
- Tiredness, loss of concentration.
- Eye problems.
- Skin problems - eg, dry or itchy skin.
- Coughing, shortness of breath, wheezing.
- Ear, nose or throat irritation.
- Guidance from the Health and Safety Executive (HSE) recommends that employers should:
- Carry out an employee survey to see if the occurrence of symptoms is higher than expected.
- Check the general cleanliness of the building, the state of all cleaning machinery (eg, vacuum cleaners) and the usage and storage of cleaning materials.
- Check the heating, ventilation and air conditioning system.
- After any initial steps to resolve the problem have been implemented, it may be necessary to repeat the employee survey and it may be necessary to carry out a more detailed assessment of the workplace environment.
Treating the underlying problem
- Education and recognition of the problem.
- Addressing relevant psychosocial issues - eg, high job demands and low support.
- Removal of the pollution source if possible.
- Improved planning of building ventilation.
- Maintenance of indoor air quality by regular servicing and quality measurements.
- Discouragement of smoking.
- Increasing the number of live plants in buildings.
Further reading and references
Jung CC, Liang HH, Lee HL, et al; Allostatic load model associated with indoor environmental quality and sick building syndrome among office workers. PLoS One. 2014 Apr 239(4):e95791. doi: 10.1371/journal.pone.0095791. eCollection 2014.
Sick Building Syndrome (SBS); Environmental Illness Resource
How to deal with sick building syndrome: Guidance for employers, building owners and building managers; Health and Safety Executive (HSE), 2012
Marmot AF, Eley J, Stafford M, et al; Building health: an epidemiological study of "sick building syndrome" in the Whitehall II study. Occup Environ Med. 2006 Apr63(4):283-9.
Runeson-Broberg R, Norback D; Sick building syndrome (SBS) and sick house syndrome (SHS) in relation to psychosocial stress at work in the Swedish workforce. Int Arch Occup Environ Health. 2013 Nov86(8):915-22. doi: 10.1007/s00420-012-0827-8. Epub 2012 Nov 11.
Israeli E, Pardo A; The sick building syndrome as a part of the autoimmune (auto-inflammatory) syndrome induced by adjuvants. Mod Rheumatol. 2011 Jun21(3):235-9. doi: 10.1007/s10165-010-0380-9. Epub 2010 Dec 29.
Norback D, Nordstrom K; Sick building syndrome in relation to air exchange rate, CO(2), room temperature and relative air humidity in university computer classrooms: an experimental study. Int Arch Occup Environ Health. 2008 Oct82(1):21-30. doi: 10.1007/s00420-008-0301-9. Epub 2008 Feb 2.
Terr AI; Sick Building Syndrome: is mould the cause? Med Mycol. 200947 Suppl 1:S217-22. doi: 10.1080/13693780802510216. Epub 2009 Mar 2.
Burge PS; Sick building syndrome. Occup Environ Med. 2004 Feb61(2):185-90.
Renner B, Mueller CA, Shephard A; Environmental and non-infectious factors in the aetiology of pharyngitis (sore throat). Inflamm Res. 2012 Oct61(10):1041-52. doi: 10.1007/s00011-012-0540-9. Epub 2012 Aug 14.