Mould: effects, remediation, management and prevention strategies

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Craig Lawrie: Good afternoon. Welcome to our teleconference. My name is Craig Lawrie and I'm a consultant with the Health Care Health and Safety Association in the Kingston regional office. On behalf of the Ontario Safety Association for Community and Healthcare, I would like to welcome all participants. Today our presentation is mould, its remediation, management and prevention strategies. Following the presentation we invite you to stay on the line for a question-and-answer period. Before introducing our speaker, I have a few reminders for the audience. Please eliminate all background noise or discussion during your call as this will affect the audio quality. Come to the microphone if you are conferencing in a large room, turn off all pagers and cell phones please, and finally, if your building has a PA system please turn it down or off if possible.

Well, it's time to get started, so let's proceed. Our speaker today is Dr. Om Malik, an Associate with the consulting firm, Occupational Health Management Consulting. Dr. Om Malik is a former Ontario public servant who after 25 years of service took an early retirement to be a consultant in occupational health management. He started his career as an occupational hygienist with the Ministry of Labor in 1975. In 1987 he was promoted to Chief Hygienist for the Province and in 1991 was again promoted to Provincial Coordinator for all professional services related to occupational health and safety. In 1999 Dr. Malik was Acting Director of Occupational Health and Safety Branch. Om has a PhD from the University of Saskatchewan, is a professional engineer, a certified industrial hygienist by the American Board of Industrial Hygiene as well as by the Canadian Board.

He is the recipient of the Hugh Nelson Award of Excellence in Occupational Hygiene awarded by the Occupational Hygiene Association of Ontario for his outstanding contributions to the profession. He is also an Adjunct Professor at the University of Toronto. Since retirement, he has been one of the Associates of the consulting firm, Occupational Health Management Consulting, and has been actively involved with issues surrounding indoor air and, in particular, moulds-related issues. Om is personally involved in two very high-profile mould remediation projects, one at the Newmarket Courthouse and the other at the Ministry of Transport buildings in Downsview. He brings to us a wealth of academic and real life experience in issues surrounding mould and indoor air quality. We're very pleased to have Dr. Malik with us today and welcome to Dr. Malik.

Dr. Om Malik: Thank you, Craig, and good afternoon to all of our participants. This afternoon I'll speak for about 40 or 45 minutes allowing you about 10 minutes at the end to ask any questions that you have. Any questions left over I'll be very happy to answer. My phone number and my e-mail address is in the first slide and you can send any questions to me.

Starting with a mould, it's the area I wish to cover and I hope most of you have the presentation that I prepared. It will cover mould hysteria, understanding a little bit about mould, what it is, how it is formed, how do we carry out investigations whether there is mould or mould exfoliate, how do we monitor for mould and some medical information with regard to the health effects of mould and I then would like to deal with the remediation of mould, once you find that there is mould how do we get rid of it, and how do we manage mould and prevent mould from reoccurring.

Let's start with the mould hysteria. You may not be able to see in the slide the finer detail, but as you can see that there's a first portion on that slide number 3 is the fire cure. In this particular case, somebody's house was found to have a lot of mould and they decided that instead of remediating mould they burned the house down. It's not an insurance fraud, it was done with the help of the Fire Department and they said it was cheaper for us to burn the house down than to live with mould. So that's the kind of... that's when people start acing in that fashion. That's when I call it hysteria. I don't mean to downplay the impact of mould, but when you have everybody getting sick and everybody talking about mould that's when it gets to the proportion of hysteria. And I've given you a few little more examples of mould showing up in the last few years. Last five years mould has been the cause of most of the reports in school portables. This portable found started in Oakville, Burlington, Toronto, that area, and now it has moved on and in the last two years it has been courthouse one, courthouse two, courthouse three and Newmarket having been called the capital of mould in the Toronto GTA.

So that's what I mean by the hysteria. Hysteria is not only here, it has gone on in big proportions, so much so that in the United States, California, Texas, they are the leading states where mould has become a big issue. Many of you I am sure have seen the movie "Erin Brocovitch". That was with regard to the chromium 6 being an environmental contaminant produced by the gas company. She, from that money that she made, she bought a $2-million house and found that house had mould in it and has now started a big crusade against mould. Now, when somebody with the profile of Erin Brocovitch leads a crusade, that creates the hysteria.

There's a famous Dallas case in Texas where the husband and wife indicates husband was an investment banker who was making good money. So, first of all, the child became sick, then the wife became sick and then the investment banker became so sick he was forgetting, he was not doing the things right so much so that he lost his job and that case did not get a court punishment but it was decided out of court and the settlement was pretty close to $22 million. So cases of that nature do bring in the high profile. There was the case of the Newmarket courthouse class action lawsuit for $50 million. The word on the street is that it has been denied but I can't be sure that it has been denied or not, but that's the level of mould hysteria that's around.

What is mould? Let's try to understand mould. Mould is everywhere. 23% of the earth's biomass is mould, it's fungus. Fungus that's found indoors we call it mould, outside it is called fungus. Now, is mould a plant? Is mould a bacteria, an animal or is it something else? There are basically three kingdoms: The animal kingdom, the plant kingdom and then the fungus kingdom and it's not... they all have a different role to play. What is the big role of fungus? The fungus' big role is to take care of the dead plant and the animal material. They just eat on it and destroy it. If we did not have fungus, we would be having havoc in terms of the leaves and the plants, they will not get disintegrated. So the mould has or the fungi does have a lot of role to play in keeping our environment clean and an environment worth living in.

They're found particularly in every ecological niche. It includes good mould, edible mould, inedible mould. Mushrooms are the good mould, we eat them. We start our morning with mould. Each one of us who does have breakfast, has a piece of toast, and the yeast that goes into making bread is a form of mould. So it's not we are surrounded by mould, mould is everywhere, outside, inside, but what we are talking about here is a mould that may have some harmful effects.

What does a mould look like? Can you see mould? Yes, I have seen it, it's growing in my bathroom. Yes, I have seen it, it's in my basement. Yes, I have seen it, it is on my carpet. No, we haven't. Mould we don't see - what we see is what gets excreted by that. So the mould is basically very, very fine, tiny, hair-like filaments which are anywhere between 1 and 1½ microns in diameter. To give you an idea, the best I can see, the smallest particle size, about 40 microns and we are dealing with 1 to 1½. Therefore, that's what I see. Then do you see mould? No, you don't. It doesn't mean it doesn't exist, but it is beyond the realm of the area where we can see mould.

These fine hair-like filaments, they are called the hyphae, and a mass of interwoven hyphae is what we call as a mycelium or one colony of mould. So the unit in which mould is normally expressed, how much mould is there, so many colony-forming units, so each unit that forms a colony is counted as a colony-forming unit. So we say so many colony-forming units per unit of air and the unit of air may be a cubic foot or a cubic meter. We in Canada, we are all dealing with meters and therefore our dealings are so many colonies per cubic meter of space. It's space we are dealing with.

In terms of colors, most of us have an idea that mould is that dark black, bluish-black slimy stuff that grows in the dark. No, mould comes in all colors. There's a yellow mould, there's brown mould, there's a black mould and a greenish mould and a gray mould. Look, leave your food out, leave your doughnuts out and you will see all kinds of different shades appearing on it. So it's really, mould has different colors. Black is the one that we have begun to hate and therefore we associate black as a mould. Mould does spirolate, does add one to the other. Either they do it sexually or by asexual means. So the reproduction is either by the nuclear fusion of two different spores or similarly breaking apart.

What do we need to develop a mould? Why, how is the survival and growth of the mould? Of course, you need spores. Spores are basically the bars that are given out during the spirolation order in the reproductive cycle. And that's what your spore is. So that's your seed, and so you should look at it from the plant point of view, it is a seed. If you look at it from the human anatomy point of view it is like the sperm, and you need that to start the growth. But as I mentioned before, there is mould everywhere. So mould seeds are everywhere, outdoors, indoors, so we clearly can't control mould from coming into our place.

What do they need to grow on? But the mould, unlike plants, do not have the facility or the capability of converting carbon dioxide and water and converting into food. It needs a food source, food itself, so it eats the substrate on which it grows and converts it into the glucose or the sugars that it needs to build the body substance. So its part is there to eat that food, so it needs seeds, it needs a food source. What else does it need? Now, you've got the seed, you've got the food. It needs water to grow. So most critical factor is the water. Because we can't control the food because there's food everywhere. Paint is a food, your wallpaper is a food, paper itself is a food, any glue that we put on the walls therefore is a food. Carpet is a food, carpet glue is a food. So there's nothing you can do about food.

What about water? Water comes in in many forms whether it is leaked into the workplace or it is moisture in the air, the so-called humidity. But what is critical about growing mould is the water and the contacts. So your humidity in the surface may be low but if your walls are sweating, if the walls are cold, it is the contact point between the air or between where the mould is growing and the walls. If the water content there is high, that is what is known as the water activity. So if the temperature is low, if the humidity is high, you have higher water activity. So given your little jug of water activity and you'll see that water activity as low as .6 if you have a scale from zero to one, it's enough to start the mould growth as long as you have other things. That's why you don't see mould growing on concrete or mould growing on steel plates, because they don't have the food. They have the water, they have the seed, but they don't have the food for them to grow on.

What is the impact of temperature? We are used to thinking oh, damp spaces, so damp, of course water is there. Does it have to be hot? No, but most mould does grow in warm places. We have three different types of mould categories. Mould that grow between 15 and 20 degrees. That's the type of mould that grows indoors. The mould that grow below zero degrees but their growth really gets stunted as you go toward 15-16 degrees. This is the mould that stays in the soil, so in the Winter time you would think that the mould is dead. It is not, it's still growing in the soil and grows below zero degrees. And then there are the mould type which grow only above 15 degrees... no, between 35 and 50 degrees, and that's the type of mould that you will find in very, very hot climates. So mould grows in all kinds of temperature, it is a different type that are there.

So when we talk of different types of mould, we have the two different things we have. We go to the genus and then we go to the species level. So it is like a lot of people are Maliks, but then the species is Om Malik, I am Om Malik, my son is somebody else Malik and my father is somebody else Malik. So we are all of the Malik family but we are all individuals within that. So we not only are a genuses, we are also down to the species level of who they are. So it is a different species of the same genus may survive with different temperatures or it may be only a few genuses that can... that can survive at a certain temperature.

Now, indirectly the temperature also controls the water activity. At higher temperatures the water activity goes down and therefore the mould growth is likely to be lower. So you have a direct effect and an indirect effect. Light is another one, because we think it's going to grow in dark places. That in large part is a myth. Mould grows both in light as well as in dark places. It is dark places... the myth started from the fact that a lot of mould is found in myths. Dark places are also... the damp places and because the air circulation is not there and that's why it has gone to be identified as dark. There are some species which do not like light and they might be preference to growing in dark places, but very few of them. In general, mould is not impacted by... the growth is not impacted by light. Spirolation on the other hand is. So mould do spirolate and the light may be a factor, but not in the growth fact.

As I talked about, where does it grow? Now, we have now said light has (inaudible) effect, temperature has some effect but indoors the temperature ranges such that it's pretty empty in that environment. Spores are everywhere, food is everywhere, so the only thing that we left to is the water. And for the growth sites are either plumbing leaks, whether they are slow leaks, drips, under and around sinks so that areas where there is water either leaking or the water condenses. Roof leaks, we have penetration in chimneys. Those are the areas where the water is likely to leak. Building envelopes are notoriously bad because the caulking gives up, the caulking cracks and there is a leakage there and it doesn't show on the indoors. So a lot of drywall may be getting wet over a period of time without us inside knowing that there has been a leak because the building envelope has been compromised. Roof doors in commercial buildings, whether you go onto the roof, if they are not properly sealed they are a constant source of envelope compromises.

One of the other areas that you want to look at and I'll come to that a little bit later also are... there are big holes, there are weeping holes around the windows in commercial buildings. That is for the air filtration. In poorly constructed places or places which are not maintained, these weeping holes, they get plugged and when they get plugged there are more prone to water penetration and leakage.

Let's move on from the mould sites to a little bit about what are the common moulds and I have given you a few varieties of common moulds that are found both indoors and outdoors. But we are interested more about the toxic moulds. What are the moulds that are of concern to us. And there are five genus that are indicated here: The Aspergillus, Penicillium, Stachybotrys, Fusarium and Acremonium. These names, it's importance of these names here is what does mould have that really is going to give us the problem? Mould have got three or four components... the hyphae as I talked about, hyphae walls, those walls by themselves, but then what does it contain? Mould is no different than other trees, other plants, other than human beings. They want to protect their own space. So if the invading party is a bacteria, then they develop poisons to kill those bacteria. And those poisons which kill bacteria, what do we call them? We call them antibiotics. And that is where the penicillium come from. The penicillium developed that antibiotic not for human use, they developed it to kill out the bacteria attacking their site where they were growing and we found it useful to extract out it, to make penicillin out of it.

Who are the other attackers of mould? The other attackers of mould are other moulds which want to grow in the same area because they also want to have food, so another species coming in with toxin that they developed to kill off other moulds, they are the mycotoxins and they developed those and so they get all absorbed on these small hyphae or on the spores as they're given out and we are then exposed to these poisons which were really not created for our use, they were created for their own protection. So some of the species, the toxic species, are because of the toxic components of those moulds and we have the five of them, Aspergillus, Penicillium and Stachybotrys. Stachybotrys is the one which is the black one which has got the big bad name, and one of the species of Stachybotrys calls it Stachybotrys Chartarum is the one that is really of concern these days at the indoors.

If you look at the next slide, I'm talking about marker species. What is so marker about them? These marker about them are that these are the species that generally grow in a wet environment indoors. They are the ones which are preferably growing on wet drywall or wet plywood, under the carpet. These are some... under ceiling tiles, these are the places, these are the species that grow in there. So they are marker. So if you find these species indoors, then they indicate that there might be a growth taking place. Not that they're never found outdoors. They are found indoors but the ability to survive and be caught onto a sample indoors is so low that if you get one or more than one... if you get up to one we can ignore it but if you get more than one spore in a slide then you start to look for it, where did it come from and that's what I mean by marker species. Aspergillus woticula (ph) is one of them, Aspergillus Fumigatus, and I say it is a... and it's a big deal for hospital settings because it's the one that causes most infections amongst people, the Stachybotrys Chartarum and the Fusarium.

Let's just look at the health effects a little bit. And I talk about it, there are four things that are really... one are the cell walls themselves, the antibiotic and the mycotoxins contained within them. Some of them are volatile organic compounds, others are not so volatile, so we're dealing with some of the volatile organic compounds giving out in the air and so you're affected by all of them. Maybe one thing is affecting you or all of them in combination because they are in the air. In large part, mould become very small amount get airborne. Sticky stuff, it stays where it is growing. Large-scale exposures take less when we disturb them either as a part of remediation or as part of... in a compost pile, maybe you are turning the compost pile or (inaudible) we turn them over.

What are the effects of these various parts of the mould structure? First is the allergic disorders or the mucous and thus reflect irritation. They are irritants, they cause all kinds of irritation to people. I might add right at the beginning, not everybody gets affected by them. There is a smaller proportion of people who get an irritant effect from mould than those who are not affected by it. If you compare it to the people who become allergic to cat dander or dog dander or to some of the spores in the air from the tree samples or the mites and cockroaches and some of the other ones, it ranks lower than those, those who are allergic to moulds. So it's not the only allergen that is around. A lot of us have cats. About 40% of the population becomes allergic to cats, whereas it's less than 15% who will become allergic to mould. So I'm just putting it in perspective where this allergic reaction is.

People suffer from hypotensive pneumonitis which is basically the similar type of infection as a bacterial pneumonia. In sections of colonization, and I'll go there in big detail, and then there are some toxic effects because of the viruses which stand for volatile organic compounds given out by the mould as the (inaudible) mycotoxins as I've explained to you. What effect they have on people and how much will depend on, as I talked about before, type of mould, whether it's a toxic mould or not a toxic mould. So different species have different reactions, have different toxicity, different ability to poison you. So the type of mould is one thing. Most allergic reactions are not straight dose response - higher the dose, higher the response. But the probability of your reacting to something increases as the exfoliate increases. So it may not have a direct correlation of those response, but higher the exposure, higher is the probability of that individual's reacting to it.

The age of the individual. It seems to be quite a dramatic impact for the age. The age between infant and six years of age seems to be particularly sensitive to mould infection and mould allergies. On the other end of the spectrum, elderly and sick are more impacted by the mould effect. Why it is - you've all heard that childhood asthma, people have childhood asthma and they will grow out of it. But does mould have an impact in it? Probably does. And then they get out of it because it seems to affect that age group considerably more than the other ones. If you are already allergic to something else, if you already sensitized to something else, then it seems that your system has already been weakened and things are likely to become worse if you already have it. So these are some of the factors that affect the severity of effect.

In the next few, three or four slides, I've given you the allergic reaction. There's no point in going, walking you through each one of them, and the allergic reactions are irritation of the eyes, skin, (inaudible) in the sensitive individuals. And an important part here is that people will talk about dead mould and live mould and the scientists call them viable mould and non-viable mould. The difference is the word dead or non-viable, alive and viable, basically are the words used for... if you put them in a damp spot will they grow or will they not grow? It's like a seed. Will the seed grow into a plant or will not grow into a plant? The seed that will not grow into a plant, something went wrong in there, is a dead seed, and the one that grows into a plant is a live seed. But their toxic effect on the body does not change because all the chemicals and everything has still to (inaudible) with the spores. So they call them... it's a word used for culturing the material in the plant to find out what species it is and if they can cultivate it they can let it grow, then it's a live or a viable one. But the health effects are not dependent on whether they are dead or alive.

Hypersensitive diseases, the diseases such as asthma, it can trigger asthma attacks in allergic individuals. Or worse and pretty interesting asthma in the non-allergic people. There is some evidence that the sensitization exposure of fungi increases the chance of a (inaudible). The other hypersensitivity is the hypotensive pneumonitis that I talked about which is the disease resembles that of the bacterial pneumonia and that can develop following an acute or a chronic exposure. And similarly you have the infection. A lot of people have heard of the infection which we never call (inaudible) or we cannot think in terms of mould is the yeast infection. Yeast infection is quite common amongst women and it's take care of and easily treated but that is basically a mould infection. Yeast is a mould.

So it can also create lung infection, lung again and the moist... whenever the spores land in lung and if they start to spirolate there and they start to grow there may be a lung infection. Not very common but it is common amongst people who are either immune-compromised or immune-suppressed. And most of you being in the health care industry know the difference between the immuno-compromised and immuno-suppressed system. Immuno-compromised are those because of some pre-existing disease such as HIV, their immune system has been compromised whereas immune-suppressed are those who are either undergoing an organ transplant or chemotherapy or radiation therapy where the immune system has been suppressed. And so those are the people at risk, much higher risk of infection.

Other infections I'd like (voice missing due to background noise) they're all mould infections. Then these mould that I talked about, the chemicals they produce, some are the volatile organic compounds. The type of volatile organic compounds released depends on the substrate that the mould is growing on, (inaudible) and it's keeping that up and it's a part of the metabolism that it creates the mycotoxins as a (inaudible) produces some of the organic compounds. So some of these compounds are the same as we have coming out of the paint or out of the carpet, some of them are a dander. A lot of research right now going on to find out if there are any markers for their ordinary compounds that may be only related to mould and may not be in any other products that we use indoors so that instead of going around looking for mould we could look for that chemical independently and say whether there is mould or not mould in that area.

Looking at the mycotoxins, mycotoxins are again also the metabolic product and their effect depends on what type they are and depends on the species from where they come from, and they also are dependent on the substrate. They seem to affect practically every part of the body. They affect the vascular system, the digestive system, the respiratory system, the cutaneous system, kidneys. They are everywhere and before we go on on the health effects, these are health effects which have been studied from exfoliate to very, very high levels of these moulds which are found in performing operations, whether you are operating a compost plant or you are operating a leaf pile or some of the other activities that goes on. These are not typical effects as seen as an exfoliate to indoor mould. So when I talk about it, it's not that any small amount of mould found indoors has these kind of (inaudible). And so we have to keep things in perspective that these are studies done on very, very high-exposure individuals.

Talking about mycotoxins and coming back into that is the mycotoxins B1. Many of you have heard that is probably the most potent of the carcinogens produced and it is used now as a reference against which the carcinogenicity of others of them compare to. They are found, people have peanut allergy and peanut allergy also comes from a lot of mould growth on the peanuts.

TAPE FLIP

Dr. Om Malik: ...be a mycotoxins. Some of the studies that have really put the focus on exposure to indoor mould, they were the two articles published of (inaudible) having bleeding lungs in an infant in Cleveland. There were three studies published about 10 or 12 kids, a very young infant, they cam back suffering, and when they found out that they had similar symptoms the investigators went to their homes and they together found that their homes were full of Stachybotrys growth, whether their basements or the bedrooms where they were. And for these studies then indicated that there was an association between the Stachybotrys exfoliate and the bleeding lungs which is the pulmonary hemosatrosis (ph) found. Those studies and one of them in particular was then studied in detail by the Center for Disease Control in Atlanta and they put out a warning and they said that the association was not as clear-cut as those published studies would indicate. There were some holes left in the study, people who were investigating when the people who went to their homes who knew about the outcome and so it was not a blind study and they have listed a few reasons for not really going full-blown with it and they are now carrying on further research to find out the association between Stachybotrys exfoliate and the pulmonary hemosatrosis.

The reason people jump to that conclusion is that animal studies have shown the similar impact of the Stachybotrys Cardarum exfoliate on rats and others to produce the pulmonary hemorrhage. So once they found the pulmonary hemorrhage in 10 kids, their home, that Stachybotrys, and that's what the animal studies show, it was quite easy to reach that conclusion. Now, I'll give you a couple of other studies of similar nature in which they found that the child was suffering from the disease and they found that when they went back and were removed from the exfoliate the child recovered.

So there are some associations and there are indications that heavy exposure to mould in an environment can also cause the same kind of effects that we have seen before with a heavy exposure and number two, it is restricted in large part to infants and that's why my comment was to infants and to the six-year-old.

How do we go about investigating a typical building? Basically what... we go back to where the mould grows and the mould grows in the damp environment so first thing you talk to anybody and everybody you can to find out the history, where have been the leakages, is this building prone to leakages? Enquire about all the so-called obvious sites of mould growth which are where there's no air circulation, which are damp, where there may be close to water stores, close to the windows - those are the areas where you will expect the leakage and find out more about it. Mycotoxins, volcanic organic compounds, they do have a distinct smell, so-called the musty smell or the (inaudible) odor.

I am investigating a building where as soon as you walk in - I haven't seen the mould yet - it smells like oatmeal and there are some of the other smells. Now, it's a workplace. If it was a home I would expect that they might have some mould but you walk in there and that is that distinct smell. But musty smells, everybody says oh that place smells musty. That's an indication that there might be mould growth. In large part, asthma gets worse mould by mould as it does by high humidity and dampness. So there may only be dampness and not mould and still be the asthma. So one has to go looking for it if there is really actually a mould growth or potential for mould growth.

Continuing with the typical building investigations, what you will look for is water stains and water stains are very easily seen on ceiling tiles. You will see on the carpet, okay. They're indications of a building that is prone to mould growth. Not every water stain will have a mould growth behind it but that's basically indicating you, the main tenants, that because of the building and the investigation needs to proceed further. Standing water - you will see that in commercial buildings largely in the basement in one corner or the other indicating to you the kind of sloping they have. What you also see, standing water is where the hallways are tiled and the corner is a drywall. When the cleaning is done the water stands in that corner between the drywall and the tiled floor with the effect that there is a capillary effect, the water starts moving up the drywall and it keeps getting wet, and what you have in the first three inches from the floor is the baseboard. So the water keeps seeping up the drywall and any growth that is there is being protected from being seen by the baseboard. So if you see any water standing around there then you can suspect that there might be a mould growth just behind the baseboard.

Sites of condensation. In how many places we've gone and we find that the cold water pipes, they are not (inaudible) and that's where the condensation takes place. But condensation also takes place in the heating and ventilation and air conditioning units. They are cooling coils and if the wells and the water pipes leading in and leading out of those ones are not properly insulated, become great pipes for water condensation. Hot water heaters closet generally are sites of a lot of humidity. Crawlspaces - again, crawlspaces don't have much of an air movement and if there's not much of an air movement that's where the water activity starts to become very high where your walls start to sweat because they're in contact with whatever water is there in the beginning. Again, it's not because they're crawlspaces, it is because there is not enough air ventilation. And then suspect wall cavities where you have a wet wall or you have wallpaper, if there is wallpaper and the wallpaper is... either it's a bad job of putting the wallpaper in or there has been a moisture in there.

HBSA (ph) system or the heating ventilation and air conditioning systems, look for in the condensation trays and heat exchanges coils. They are good sources where mould grows. Some of the ducts in the commercial buildings, they are lined inside for acoustical purposes as well as for the thermal insulation purpose. That practice is now discontinued. Most of them are now lined outside, but those which are inside and if the building has a moisture problem, then they provide a good source. They would provide a better... no, not a better force, I would say the commission would be worse if that insulation gets wet, then the growth will take place because we use a lot of glue in putting that fibreglass net together and that's food for to grow the mould. So that's an area you want to look for in the HBSA system.

Common wet and mould areas, kitchen areas. If you are looking at a home, whether it's a nursing home or it's a residential home, the kitchen area, the bathroom, the laundries. Laundries are very important to be looked at. Normally you find that the laundries are hot places and somehow the feeling is that you're in a hot place and therefore you are not going to have too much of mould. But the exhaust pipe coming out of there, they get disconnected from the dryer, and so you have a lot of moisture building up into the lodging again. So make sure that they're (inaudible).

These are sick building syndrome. The reason I bring that into it is that a lot of the symptoms experienced by a lot of people are similar when you don't have enough outdoor air coming in, if the humidity is too low or the humidity is too high and there may not be a mould growth. So when you're dealing with a building, symptoms alone are no different when the mould exfoliate was from a sick building or... heating and ventilation. A building that has mould in it is definitely also a building that does not have good air quality. It is the air quality which is... in more than 50% of the cases it is the air quality that is bad and mould may or may not be there.
Why do we sample for mould? Once we see that there is something growing, some black stuff, furry stuff, velvety stuff that's growing, first we want to be sure that it's mould and not something else. Secondly, we want to know is what the type of mould that is growing. It is not important to know what type of mould it is to the outcome of it. The outcome is we are going to remove no matter what type of mould it is. But what you want to know is what type of mould it is, it was because it's going to come back as a health issue and a personal injury issue. So when it comes to insurance, it comes to the health care, it comes to a legal cases, people are going to claim two types of damages, personal property damage and then personal injury damage, and so for that reason you want to know what type of mould it is. And then we take air samples to find out how much of mould exfoliate is there to know whether we are dealing with a big growth or a small growth.

In terms of the matter of sampling, first sample is a bulk sample and you just take a piece of the sample and send it to a (inaudible) laboratory and there are few (inaudible) laboratories in Toronto area as well as across Canada. Surface tape lift samples is the most scientific sample. You basically take a plain scotch tape and you put it over the mould and you remove it and put it on the slide and send to the laboratory. And then is when you don't want to pull too much out of it and it's inaccessible. Don't take the magic tape because that's already sort of translucent. It's not as clear. Take a very clear tape and send the samples in. Swab samples, easy. Again, take a Q-tip and pick up some samples and send it over.

Then the air monitoring. Air monitoring is done for two purposes. One is to find out the total quantity of mould and the samples that we take are samples which normally are looked under the microscope and we count the number of spores, both dead and alive, and because of that we only can identify sometimes up to the genus level. A good mycologist could go up to the genus level, otherwise they will tell you the total count. The other type of samples are samples which you take them onto a Petri dish where there's a (inaudible) solution which is to provide the food and you allow the sample to culture for up to two weeks and then look at it under the microscope and we can identify then down to the species level.

One of the other analysis that is done is the dust samples. Take a vacuum, vacuum dust out of a carpet, put the filters in between your filter bag and the nozzle and take those samples and send it in for analysis. When we deal with the air monitoring, the mould... so, as I mentioned, that we take both the volatile... the viable and the non-viable samples. What are the standards? There are no standards in Ontario for mould. There are some guidelines that the Ministry of Labor has put in and you may want to look at them, and basically they all recommend that we should take it out. But what is your responsibility as an employer? Your responsibility as an employer is given to you in the Occupational Hazards Safety Act. Section 25.2.8 of the Act states that you shall take all precautions necessary under the circumstances and therefore that's where you are... Health Promotion and Protection Act deals with the public safety and there you are expected to do it.
In terms of the protocols, there are at least three or four good protocols and you can find them on the Internet and these are the Health Canada, New York City Protocol and U.S. EPA which the Environment and Protection Agent. The most commonly followed protocol is that of the New York City. They have upgraded or upgraded that in year 2000 and they provide you guidance about remediation, different levels of remediation, different levels of personal protection. And the guiding principles of all of these protocols are the same, are no different.

In terms of developing your remediation plan, you should go into great detail in developing the plan, the procedures, the requirements, how are you going to isolate that area so that you don't spread this spore for the people who are in there, the type of personal protective equipment that has to be used by the people who are in the remediation business and how do you clear it. For clearance purposes you may want to look at is... what you want to look at in terms of the clearance is outdoor and indoor. Compare them indoor, must not be more spores indoors than outdoors. And the species mix, no more than 40% different than the outdoors. And no more than one to two spores of the toxic or the marker species indoors, as samples.

One of the questions that you are going to be dealing with is managing the risk, whether to evacuate the building or not to evacuate the building, and that's going to depend on the type of people you are dealing with. You have a difficult task especially in the health care industry where you are dealing with the sick, you are dealing with the elderly, you have children. Many of these protocols are based on office work, people are going there for eight hours, whereas you may have to deal with the people who are spending 24 hours in that environment. So whether to evacuate a facility or not would be dependent on the size of the mould growth, the type of occupant you have and the type of exposure that's likely to take. So there is no easy answer but there are professionals to help you in that.

Last but not the least, I would say is that communication is the most important component in whole (inaudible) You need to keep people informed of what you are doing, what is happening and what are the regular steps that are being taken. Do assure people that you are taking their concerns seriously, you are there to help them and keep them informed of your plan to take care of it. Information sessions for staff are very important, that they allay a lot of fears which they pick up from wherever they go. And in terms of a prevention tip, simple tip, the word moisture. The mould management - 'M' stands for mould, 'M' stands for moisture. Moisture prevention is mould prevention and that's where we need to go. I think I will stop now. Sorry for rushing it through but (inaudible) and we'll open it up for your questions.

Operator: Thank you. We'll poll for questions today using our quick queue polling feature. If you have a question, please press 1 on your touchtone telephone. If you're using a speakerphone, please lift the handset first and then press 1. And should you wish to cancel your question, please press the number sign. Please press 1 at this time if you have a question. And our first question will come from Pamela Garner of Royal Ottawa Health. Please go ahead.

Pamela Garner: I wonder if you could talk about how to clean up an area after you've identified the mould, and I know it sometimes involves taking down ceiling tiles and drywall. Does anything... I mean do you have to use bleach or how do you do it?

Dr. Om Malik: People used to use bleach but bleach is not even necessary. A detergent is probably all that you need to clean it. But after you clean it, the surface is going to become wet. Make sure that that is dried immediately. You have three types of water that comes out, the clean water, the gray water and the black water. Black water, if you have a sewer backup it's the gray water is in between and clean water and the tap water. So if you are going to use the tap water for cleaning it, if the surface stays wet for more than 48 hours mould will come back. So it's not only what you use to clean it, it is after cleaning you want to make sure it's absolutely dry and you use a dehumidifier or you have to put a heater in there. Do whatever it takes to dry it up in 48 hours.

Pamela Garner: Thank you.

Operator: Thank you. And the following question will come from Frances Reismann of Halton Health Care Services. Please go ahead.

Frances Reismann: Yes, I'd like to know what role that hand carriage has in the... hand carriage of yeast or moulds in the nosocomial transmission in the health care facility particularly where you're dealing with immune-suppressed or immune-compromised patients.

Dr. Om Malik: If you are not using your hands to deal with the mould, I don't think that there is any mould that gets transported through to hands. I really... my answer should be that I don't know but I don't think that there is any great impact of transmission through your hands.

Frances Reismann: So to patients that have invasive devices for instance, you don't see... in the... mould and/or yeast in the environment, a problem area then in caring for patients, for health care providers in caring for patients. You don't see hand carriage as being a considerable risk factor or a risk factor then?

Dr. Om Malik: The thing is that in an environment like that, good hand washing is probably a good practice anyways, and if you are dealing from patient to patient good hand washing is always recommended. However, when you're invasive testing, etc., whether you bring a lot of mould into the environment, I don't think so.

Frances Reismann: If I could ask one more question.

Dr. Om Malik: Sure.

Frances Reismann: Is there an environmental threshold level where you would see symptoms occurring in people? Is there a marker?

Dr. Om Malik: No, there is no marker in terms of the concentration but, as I said, that the higher the amount of growth you have the amount in the air and the higher the likelihood, but we have a marker that if you don't have any of the marker species, then approximately 1,000 colony-forming units per cubic meter of air is the marker for the indoor. If you have more than 1,000 colony-forming units, that's when you start to look around and say what's going on here.

Frances Reismann: Okay, thank you.

Operator: Thank you. Once again, if you do have a question please press 1 on your touchtone telephone. And we do have a question from Pamela Garner of Royal Ottawa Health. Please go ahead.

Pamela Garner: I wonder if you could comment on sort of health practitioners who treat clients for some kind of global yeast infection. You know, it's just that they see it as something they should clear up in people, so they put them onto various medications. Do you have a comment on that?

Dr. Om Malik: No, I really don't.

Pamela Garner: It's usually an alternative therapist kind of approach.

Dr. Om Malik: I really have no comment on that one.

Pamela Garner: Okay.

Operator: Thank you. And the following is a follow-up from Frances Reismann of Halton Health Care Services. Please go ahead.

Frances Reismann: My question is regarding the Health Canada protocols that you referred to.

Dr. Om Malik: Yeah.

Frances Reismann: Would that Health Canada protocol be the fairly new construction guideline...

Dr. Om Malik: No.

Frances Reismann: ...that you're referring to?

Dr. Om Malik: No, no. It's a guideline that they have developed over a period of time. It's still dealing with mould and how to deal with mould remediation as well as mould prevention. It's a good guide. It's not for construction only. You probably would benefit a lot also by reading the EPA guide or the Environmental Protection Agency's guide on mould in schools and commercial buildings. That has got some very good tips in terms of mould prevention.

Frances Reismann: Thank you.

Operator: Thank you. And at this time there are no further questions. I'd like to turn the meeting back over to you, Sir.

Dr. Om Malik: If any one of you needs references for these or e-mail addresses for any of the references that I have indicated, send me an e-mail and I'll send you a list of references.

Craig Lawrie: I'd like to thank Dr. Om Malik at this time for taking the time out of his busy schedule to speak to us today. I'm sure we all agree how informative it was, and thank you once again, Dr. Malik.

Dr. Om Malik: Yeah.

Craig Lawrie: This concludes our presentation today but before we end I would like to remind you that our next teleconference will take place on Tuesday, February 26th. We will be presenting blood-borne pathogens and our speaker with be Nora Boyd, President of CHICA Canada. Please check your safe-angle newsletter for more details or contact Susan Griffiths at our head office at 416-250-7444 for information. Thank you very much.