Indoor mold: management considerations

These first sections on background and exposure are a partial review and summary of some of the earlier sections on this website. Please refer back to those sections for additional information and more detail.

Brief Background:
Indoor mold problems can be found all over the world. Here in the United States, there are certain states that are more actively involved in the issue of indoor molds. These states include but are not limited to: California, Florida, Maryland, Michigan, New York, and Texas.

The issue of indoor molds has become even more of a problem since the 1970’s. This is due to changes in the materials and methods in construction, making homes and buildings more energy efficient and airtight. This prevents the moisture and humidity from escaping, allowing for the growth of mold. Therefore, this is a fairly new problem, explaining in part the lack of scientific evidence and understanding.

Risk Factors:
If there is indeed an association between indoor mold and health effects, people at increased risk include infants, the elderly, people recovering from surgery, immune suppressed people, and people with chronic inflammatory lung diseases, for example, asthma, hypersensitivity pneumonitis, sinusitis, or severe allergies. Again, if there is a link between the two, whether or not symptoms develop depends upon:

the nature of the fungal material
the amount and duration of exposure, which depends upon the setting, whether it be residential, occupational, or both
the susceptibility of the exposed person, which may be influenced by such things as genetic predisposition, age, state of health, or any concurrent exposures

Additive risks that may also cause health effects include smoking, fungal contaminants and other bioaerosols, and water damaged environments

Determining Exposure:
Several mold genera may be found in indoor environments. Some of the more commonly encountered genera include: Alternaria, Aspergillus, Cladosporium, Memnoniella, Mucor, Penicillium, and Stachybotrys.

There are four basic requirements for the survival of mold. These include:

a temperature range between forty and one hundred degrees Fahrenheit
a nutrient base
the presence of mold spores
and perhaps most importantly-MOISTURE

Each case needs to be assessed individually as all are different and may need to be dealt with in different ways. The first step of any assessment is to do a visual inspection. If mold is found to be present, the issue should be dealt with immediately. During the visual inspection, it is highly recommended that special attention be paid to ceiling tiles, sheetrock, paper, cardboard, and other surfaces that may contain cellulose.

Bulk or surface sampling should not be considered a required step in the process of remediation. If these techniques are going to be used, only appropriately trained personnel should complete this type of sampling. (For more information on these processes, please refer back to the section on methods for monitoring mold in the environment). If mold is detected with a visual inspection, action should be taken at that time, without any additional testing, in order to prevent further problems.

Air sampling is not a very efficient or accurate method for measuring fungi. The results from this type of sampling are prone to false negatives and therefore cannot rule out contamination. For these reasons, it is not recommended that air sampling be done as a routine part of assessments.

A boroscope may be used to help view and identify problem areas in ductwork, behind walls, or in other hard to get to places. Moisture meters can be used when it is probable that there are areas of hidden mold. The moisture meter can help to identify where excess moisture is located, possibly leading to a source of hidden fungal growth.

Recommendations for Remediation:
The primary aim for any remediation effort should be to identify and resolve the source of moisture. An immediate response (within 24-48 hours) should be taken when identifying any water damage in order to limit mold growth. For more information on preventive measures that can be taken, please refer to the section on strategies for preventing or controlling mold.

Different methods and precautions should be followed or taken depending on the size of the contaminated area. The New York City Department of Health and Mental Hygiene’s Bureau of Environmental and Occupational Disease Epidemiology separates areas into the classes described below. Included here are a brief summary of the various levels and different methods and precautions they recommend. Please refer to their website at www.ci.nyc.ny.us/html/doh/html/epi/moldrpt1.html for more detailed and additional information.
Level I: Small Isolated Areas (10 square feet or less)
Level II: Mid-Sized Isolated Areas (10 – 30 square feet)
Level III: Large Isolated Areas (30 – 100 square feet)
Level IV: Extensive Contamination (more than 100 square feet of contamination)
Level V: HVAC Systems Remediation

Refer to our section on strategies for preventing or controlling mold for recommendations on what measures one may take for cleaning small areas of mold. It is recommended that any attempted remediaton be completed by someone who is trained regarding proper cleaning techniques for mold, personal protection that should be used, and any potential health hazards. The minimum protection strongly recommended for work in a contaminated area includes gloves and eye protection, as well as a disposable respirator. The larger the area becomes, the more additional protective equipment is required. This additional equipment may include full face respirators with HEPA filters, and disposable protective clothing for both the head and feet. Depending on the size of the contamination, the area may require containment. For areas that are not in total containment, dust suppression methods are strongly recommended in order to prevent the transfer of mold spores or fragments to other parts of the building. Again, for a more complete description of methods for remediation, please refer to the NYC website listed above, as well as the additional references at the end of this section.

For occupational settings, whenever growth is detected and remediation efforts are going to be completed, it is recommended that all occupants be notified. Efforts should be made to have some type of effective communication so that people are made aware of the situation, what is being done to alleviate the situation and possible risks that they may be exposed to during the process.

It is strongly recommended that an environmental firm specializing in mold remediation be contacted for remediation of any extensive area of mold contamination. You may also contact the environmental division of your local health department for additional information, suggestions, and referrals.

Legislation/Regulation Efforts:
Because of the lack of scientific knowledge on the effects of indoor molds and human health, there currently are not any federal or state standards for measurement, remediation, or regulation. Not everyone is in agreement that mold is a serious health threat due to the lack of science to back up the claim. Even the government is not officially taking a stand on the issue at this time. The Environmental Protection Agency has suggested that excessive mold growth can have an effect on human health, but they have not yet been authorized by the government to regulate indoor mold. The Centers for Disease Control has been working with the Institute of Medicine reviewing the current literature in order to develop a report. Harriet Amman from the Washington State Department of Health has worked extensively on the issue of indoor mold and sits on the CDC panel. However, this report is not expected from the CDC until at least mid 2003.

Congressman John Conyers, Jr., a democrat from Michigan has currently proposed the bill H.R. 5040: The United States Toxic Mold Safety and Protection Act (Also known as the “Melina Bill”). The bill may be viewed in its entirety at www.house.gov/conyers/mold_Bill_Draft.pdf. This particular bill was set up to amend current legislation, such as: The Toxic Substances Control Act, The Internal Revenue Code of 1986, and The Public Buildings Act of 1959. The bill has multiple goals, focusing on ways to protect human health from toxic mold by such approaches as requiring continuing research on the topic, establishing educational programs to inform the public, and providing needed assistance to those falling victim to indoor molds. This bill also strives to establish guidelines for prevention and remediation. In addition the bill addresses the financial side of this issue by proposing a national insurance program in order to protect homeowners, authorizing tax credits for those that conduct inspection or remediation, and providing grants for removing mold from public buildings.

The major provisions of the bill include:
Title I: Research and Public Education
The bill requests that governmental agencies, such as the Environmental Protection Agency (EPA) and the Centers for Disease Control (CDC) address the issue of indoor molds and research out the hazards of indoor molds on human health and the effects that may result. In addition, it requests that the Department of Housing and Urban Development (HUD) and EPA address the issue of determining exposure and conditions that allow for mold growth. These agencies then are to setup guidelines for prevention, testing, remediation, and public education.
Title II: Housing and Real Property Provisions
The bill sets requirements for inspections for indoor mold on property that is funded by the federal government, as well as public housing. This section also addresses the issue of modifying building codes in new construction to prevent future problems related to mold growth.
Title III: Industry Standards Development
Title IV: Indoor Mold Hazard Assistance
This bill addresses the issue of funding mold remediation and removal efforts in public buildings by authorizing grants for such purposes.
Title V: Tax Provisions
This bill will authorize tax credits for remediation or inspection for indoor mold.
Title VI: National Toxic Mold Insurance Program
The bill proposes the establishment of a National Toxic Mold Insurance Program through the Federal Emergency Management Agency (FEMA) that will aid homeowners that are not covered for losses from their own insurance companies.
Title VII: Health Care Provisions
The bill allows individual states to provide Medicaid for people that do not have health care and are suffering from health effects due to exposure to indoor molds.

While it can be agreed that there is a need for legislative measures to be taken regarding indoor molds, there is significant criticism surrounding this bill, just as there has been for those presented in the past. Some of this criticism lies in the lack of any credible science about the issue of indoor molds and exposure or effects. There is no way to develop standards when there is no science and previous knowledge to help establish safe limits. There is also no way that the necessary research could be completed in the limited time frames allocated in the proposed legislation.

One of the issues addressed in Conyers’ bill is that of insurance companies not covering the costs of damage to property due to indoor molds. This is quite a controversial issue that has caused problems across the country. Some of the effects that have resulted from this controversy of who is responsible for the costs of damage due to mold have included delayed home sales, increases in insurance premiums, and the rise in mold related lawsuits. Insurance companies have asked state regulators to limit their mold liability, but no actions have taken place yet.

In California, legislators passed the Toxic Mold Protection Act to be enacted as of January 01, 2002, but the act is not yet enforceable until the California Department of Health Services develops limits for exposure. The department is investigating whether or not these limits can in fact be determined and enforced. The difficulty in indoor mold regulation is that we are trying to regulate a living organism. Under this act, the California Department of Health Services must finalize these limits by July 01, 2003. Other agencies and health departments across the nation are waiting on California’s results before adopting legislation and regulation themselves.

Costs Associated With Indoor Molds:
There are many costs associated with the issue of indoor molds. Some of these costs may be incurred during the detection phase. This may happen if further testing methods other than a visual inspection are taken. The bulk of economic costs occur during the remediation phase. These costs vary depending on the size and details of the actual job, as each situation is different. Remediation of extensive mold-damaged property can be quite pricey, especially if it is not covered by insurance policies. This is why there is so much controversy between the insurance companies and others. A Minnesota based firm estimated that typical commercial jobs fall within the range of $2000 to $500,000. The average insurance claim in Texas in 2001 was approximately $17,000, and it was estimated that in 2001 insurance companies in Texas paid out over $125 million in mold related claims.

If there is a link between human health and indoor molds, we can also add the costs of health care that may be needed. In such cases, additional costs may be incurred such as lost time from work or school etc. The quality of life for these individuals will also be compromised.

We also have to address the costs of the necessary research that must be completed in order to develop future policy, legislation, and regulations. This research will be extremely difficult and will require the highest quality professionals. There are also costs to continue public education and awareness through governmental agencies and health departments across the nation.

The purpose of this section was to raise awareness to our inability to develop a specific method for risk assessment or management of indoor molds. Instead, this section was set up to provide recommendations for management and remediation and also suggestions of where to gather additional information. Hopefully the work that is currently being undertaken will help to establish guidelines in the near future that will determine definitively if there are hazardous effects upon exposure to indoor molds and how to regulate this exposure to minimize one’s risk.

References:

* Congressman John Conyers, Jr. Introduces H.R. 5040: The United States Toxic Mold Safety and Protection Act (“The Melina Bill”). Available online at: http://www.house.gov/conyers/mold_Bill.pdf.

* Johnson, Kelly. Sacramento Business Journal. Mold Legislation seems to be Going Nowhere. 07/05/02. Available online at: www.bizjournals.com/sacramento/stories/2002/07/08/story8.html.

* MicrOscope, Inc. Feature/Florida May be Next Hotbed for Mold Legislation. 07/23/02. Available online at: http://biz.yahoo.com/bw/020723/232231_1.html.

* Minnesota Department of Health. Indoor Mold: Health Hazard Identification and Control. Available online at: www.health.state.mn.us/divs/eh/indoorair/mold/hazardid.html.

* Moldupdate.com. Minnesota: Mold Claims on the Rise: Regulation Under Review. Available online at: www.moldupdate.com/articles/0202f.htm.

* New York City Department of Health and Mental Hygiene Bureau of Environmental and Occupational Disease Epidemiology. Guidelines on Assessment and Remediation of Fungi in Indoor Environments. Available online at: www.ci.nyc.ny.us/html/doh/html/epi/moldrpt1.html.

* Sealey, Geraldine. ABCnews.com. The Fungus Among Us. 05/09/02. Available online at: www.abcnews.go.com/sections/us/DailyNews/toxicmold020509.html.

* Stutz, Terrence. The Dallas Morning News: Mold Policy may Delay Home Sales. 8/22/01. Available online at: www.hometest.com/News/TheDallas%20MonrningNews%20.html

* U.S. Environmental Protection Agency. A Brief Guide to Mold, Moisture, and Your Home. Available online at: www.epa.gov/iaq/molds.

* U.S. Environmental Protection Agency. Indoor Air-Mold/Moisture: Mold Resources. Available at: www.epa.gov/cgi-bin/epaprintonly.cgi.