Health
Assessment of
Polk
Juvenile Correctional Facility
Performed by
Polk County Health Department
Indoor Air Quality Program
Introduction
Because of concern about mold and moisture problems at the
Polk Juvenile Correctional Facility, two independent indoor air quality
investigations of this facility were performed. One was by S.E. McDonough &
Associates, Inc.,
Plan
An Indoor Air Quality Questionnaire for the workplace that
was originally designed by NIOSH (National Institute of Occupational Safety and
Health) was adapted for use as an assessment tool. Polk County Schools staff working in the
facility and G4S Youth Services staff who operate this facility for the state
will be asked to complete this questionnaire. A copy of the questionnaire is included
as Attachment 2.
The decision was made to individually interview a random
sample of 10% of the youth at this
facility. A Health Survey form was
developed for this purpose. A copy
of this form is included as Attachment 3.
In addition, an assessment of medical and sick call
procedures and a review of medical records will be performed.
Results
On April 14, 2006, Wesley Nall,
Environmental Supervisor for the Polk County Health Department administered the
Indoor Air Quality Questionnaire to 30 Polk County Schools staff who had worked
at Polk Juvenile Correction Facility.
Bob Valentine, Training Coordinator for G4S Youth Services presented the
questionnaire to facility staff during monthly training sessions on April 20,
2006. Ninety-nine individuals
attended the sessions with 80 questionnaires being completed. A sealed box was available for the staff
to drop the completed questionnaires into.
On April 17, 2006, Wesley Nall and Robert Ammons privately and individually interviewed 21 randomly
selected youth, and on April 27, 2006, Wesley Nall
performed an assessment of the medical and sick call procedures and records.
Questionnaire and Interviews
In response to the question, “Do you have air quality complaints?” 97% of the school staff and 71% of the facility staff said yes. The following graph shows this along with the number indicating each type of complaint.
The “stuffy” complaint that was indicated most often by both school and facility staff was also described as “lack of circulation” on the questionnaire. For school staff, “noticeable odors” was also indicated often with musty or moldy being the most prevalent description of the noticeable odor.
When asked, “What health symptoms have you
experienced? Select symptom(s)
which you have experienced more than 2 times per week while at
work.” 90% of school staff
and 71% of facility staff indicated experiencing one or more symptoms. The youth interviewed were also asked if
they experienced any symptoms a lot.
71% indicated experiencing one or more symptoms often. The following graphs show these results
with the percentage for each symptom.
The three most common symptoms reported by school staff were sinus problems, irritated eyes, and headaches. Facility staff reported headaches, sinus problems, and coughing most often. For the youth, congestion, runny nose, headaches, and coughing, were experienced most often.
School staff and facility staff were asked questions about
when these symptoms cleared up. 30%
of the school staff and 56% of the facility staff who experienced symptoms said
that they cleared up within 1—2 hours after leaving work. An additional 44% of school staff and
26% of facility staff indicated that the symptoms cleared up overnight or when
away from work for 2 days. The
remaining 26% of school staff and 18% of facility staff indicated that the
symptoms persist.
When asked, “Have you sought medical attention for
your symptoms?” 70% of the school staff and 28% of the facility staff
reporting symptoms said yes. 67% of
the youth reporting symptoms said they felt the need to seek medical attention
for the symptoms. The following
graph shows these results.
When asked, “Do you have allergies or other health
problems that may account for any of these symptoms?” 37% of school staff
and 48% of facility staff reporting symptoms said yes, with allergies being the
most common description from both groups.
For those school and facility staff who report working
primarily in one building, a determination was made of the percentage who
reported experiencing symptoms. The
following graph indicates the results with Bravo having the highest percentage
followed by Echo and Delta.
Medical Review
For the medical review the following tasks were performed with
the outcome described:
- Check
medical records of youth known to have asthma.
Presently three youth at this
facility have been diagnosed with asthma, have inhalers prescribed for use as necessary,
and are included on the Long Term Alerts and Special Needs Medical Alert
Log.
Youth A arrived at this facility
on 1/24/06. His medical records
show that at a previous facility, he was diagnosed on 12/23/05 with bronchitis
with wheezing. Since being at PJCF,
he has not used his inhaler.
Youth B arrived at PJCF on
8/19/05. His last asthma attack
occurred 3 months prior while at another facility. He has had no inhaler use since coming
to this facility.
Youth C came to PJCF on 10/31/05
with an inhaler. He was diagnosed
with asthma on 1/20/05 at a different facility. Since coming to PJCF he has experienced
four episodes resulting in the use of his inhaler—twice in December,
2005, once in January, 2006, and once in February, 2006. This youth was also one of the youth
randomly selected to be interviewed.
He reported having asthma and the use of the inhaler during the
interview. The health symptoms that
he reported experiencing a lot since being at PJCF were runny nose, sneezing,
congestion, coughing, cold-like symptoms, but he did not report shortness of
breath. He did state that these
symptoms diminish when leaving the building (dorm).
- Review the prescribed use of allergy medications
for youth over the past year.
This information was obtained from monthly reports submitted to the Department of Juvenile Justice.
Month
Number of Youth with Prescribed Allergy Medication
April, 2005
6
May,
2005
1
June, 2005
3
August, 2005
3
Sept., 2005
3
Oct., 2005
2
Nov., 2005
2
Dec., 2005
3
Jan.,
2006
2
Feb., 2006
4
March, 2006
3
- Compare
interview results for 5 youth with their medical records.
The information provided by the youth during the health survey interviews matched information in the medical records very closely.
- Review
sick call and medical emergency procedures.
The general review of procedures for sick call and medical emergencies including a review of the current Long Term Alerts and Special Needs Medical Alert Log and the Chronic Physical Condition List along with the specific review of medical records for youth with chronic pulmonary conditions and the records of a sample of youth interviewed indicate a system in place to adequately handle the medical needs of the youth at this facility.
Health Considerations
Building-related complaints or sick building syndrome has
been used to describe those symptoms that occur when an individual is in a
building and clear up within a few hours of leaving that environment. These
include symptoms related to irritation of mucous membranes, headaches, and
fatigue. Usually there are no
abnormal physical signs or laboratory tests for individuals with these
symptoms. There are numerous indoor
air contaminants such as volatile organic compounds from building materials,
furnishings, and cleaning materials, or other conditions such as job stress or
use of video display terminals that may cause these symptoms.
Building-related illness or disease is comprised of those
conditions that persist including infections and hypersensitivity
diseases. These symptoms are more
often accompanied by physical signs and laboratory findings. The main hypersensitivity diseases
related to building environments are allergic rhinitis, asthma, and
hypersensitivity pneumonitis. Allergic rhinitis symptoms include runny
nose, nasal congestion, and sneezing.
Symptoms of asthma include chest tightness, wheezing, coughing, and
shortness of breath.
Hypersensitivity pneumonitis is among the most
serious of the building-related illnesses, and is accompanied by potentially
severe respiratory problems.
The increased level of allergens in the indoor environment
can lead to increased hypersensitivity disease. Moisture intrusion and increased
relative humidity in the indoor environment are factors in promoting increased
levels of allergens such as dust mites and mold. There are two groups of individuals who
are potentially at risk:
·
Those individuals who are exposed to a level that is
sufficient to cause that person to become sensitized and begin to experience
symptoms;
·
Those individuals who are already sensitized and continue
to be exposed and develop symptoms.
In addition to the allergen health risk mentioned above, mold is also known to produce volatile organic compounds as a byproduct of metabolism. This provides the characteristic musty odor noticed with mold growth. These VOC’s readily become airborne and may adversely affect some individuals resulting in sick building syndrome symptoms similar to other volatile organic compounds in the indoor environment. Some molds are also known to produce toxins (mycotoxins). Inhalation or ingestion of materials containing these toxins is also a health concern.
Conclusion
Air Quality
Questionnaire results indicate a much higher percentage of staff with air quality complaints than normal. It is accepted that typically 25—30% of the occupants of a building will have complaints about the air quality. 97% of the school staff and 71% of the facility staff indicated a concern. The most common concern indicated—lack of circulation (stuffy feeling)—may be due to inadequate ventilation (intake of outside air) through the air handling systems. The next most common concern for school staff was noticeable odors and based on the descriptions provided, the main cause appears to be moisture in the indoor environment resulting in mold growth and musty odors. Noticeable odors may also result from inadequate ventilation.
Health Effects
The percentage of facility occupants who report experiencing
health symptoms on a regular basis is higher than normal and indicates a need
for concern about the indoor environment.
School and Facility Staff
30% of the school staff and 56% of the facility staff indicated that the health symptoms experienced in the workplace cleared up within 1—2 hours after leaving work. This group could reasonably be classified as having sick building syndrome. Even though the health symptoms experienced may not be as severe, their occurrence should not be discounted. They can affect the job performance of these individuals and may lead to more severe health effects for some.
An additional 44% of school staff and 26% of the facility staff indicated that the symptoms experienced cleared up overnight or after 2 days away from work. Depending on symptoms, some of these individuals may be classified as having sick building syndrome and some may have building-related illness. The main indication from the information provided by these groups is that certain symptoms occur in the workplace, clear up when away from work, and then reoccur after returning to work.
The remaining 26% of the school staff (7 individuals) and 18% of facility staff (10 individuals) indicate that their symptoms persist. Responses on the questionnaire indicate that these individuals believe that these health problems resulted from the workplace. These individuals could be classified with building-related disease.
Another indicator of the severity of experienced symptoms is the seeking of medical assistance. 70% of the school staff (19) and 28% of the facility staff (16) have sought medical attention. In addition, 12 of the school staff and 8 of the facility staff report taking medications for reported symptoms.
Individuals from both the school staff and facility staff have experienced or are experiencing hypersensitivity diseases that appear to be building (facility) related. The severity of their symptoms and /or advice from their physician should be considered in making decisions to continue to work in this environment.
Youth
Of the 21 randomly selected youth interviewed, 71% (15 individuals) indicated experiencing one or more health symptoms on a regular basis. Six reported that the symptoms occur daily with three others reporting that they occur often but not daily. Seven noticed a connection between the symptoms and a particular building with 6 indicating the dorm or room in the dorm. One responded with Bravo building. Two stated that the symptoms were better when out of the building (dorm).
The response from the youth with regard to experiencing health symptoms on a regular basis is similar to the response from the facility staff, however, a higher percentage 67% of youth, 28% of facility staff) reported seeking medical attention for the symptoms. Based on the interview description of treatment, sick call, and medical records, this higher level does not indicate a higher level of symptom severity.
In order to try to gauge the severity of symptoms experienced by the youth at this facility, the medical records of the three youth with previously diagnosed asthma were reviewed. In addition, one of these youth was among the random sample chosen for the health survey. The records indicate no asthma medication requirements for two of these individuals since arriving at PJCF. The third individual who was also interviewed has used an inhaler on four occasions since arriving about four months ago. In the interview this youth reported experiencing symptoms that diminish when outside the building, but did not report chest tightness, shortness of breath, or other symptoms requiring the use of his inhaler.
Another gauge used for the severity of symptoms was the number of youth with prescribed allergy medications. This number was obtained from monthly reports submitted to the Department of Juvenile Justice. A review of this report over the past year revealed nothing unusual.
This evidence indicates that youth are experiencing hypersensitivity diseases that are building (facility) related that appear to be less severe than school and facility staff. However, individual sensitivity may result in more severe symptoms and should be carefully considered in future medical treatment and placement.
Attachment 1
April 6, 2006
To: Dr. Shairi Turner, Chief Medical Director, Department of Juvenile Justice
From: Wesley Nall, Environmental Supervisor, Polk County Health Department
Subject: Environmental/Indoor
Air Quality Assessments of the Polk Juvenile Correctional Facility,
I have received and reviewed both indoor air quality
assessments performed at the Polk Juvenile Correctional Facility,
Conclusions drawn from both reports indicate that ongoing water intrusion and moisture problems in the buildings resulted in conditions suitable for mold amplification in the indoor environment. Air samples for fungi taken during both investigations indicate the likely presence of mold amplification in several areas, however, limited visible evidence of mold growth was noted. In addition, the total mold count measured in the indoor air samples, with the exception of one taken in Room B137 by Air Quality Consulting, did not exceed the outdoor air sample levels. This comparison, indoor levels to outdoor levels, is one of the primary tests for mold growth indoors. Indoor levels should be significantly less than outdoor levels. Another primary test looks at the types of mold present in the samples. A type of mold present indoors and not outdoors can be an indication of indoor mold growth. Air samples from both assessments indicated the presence of mold types indoors that were not found outdoors.
Our recommendations for remediation based on these reports are similar to those provided by the investigators. All moisture problems must be corrected and the affected materials handled according to standard protocol. In addition, we recommend that a building not be occupied during the mitigation process.
From our experience and the literature, we know that some sensitive individuals experience adverse symptoms when in a building where mold amplification has occurred in the indoor environment or air handling system. However, it is difficult to develop a positive link between the mold and the individual’s symptoms. It is more plausible to develop a link between the symptoms and being in the building. In general, we recommend that an individual’s decision to stay out of a building be based on the severity of these symptoms and/or consultation with a physician.
In situations like this where the presence of visible mold and the results of air testing do not indicate a definite need to close a building, a health survey of the building occupants may be a useful tool to determine the extent that individuals are being adversely affected by being in the building. We have performed similar surveys in other buildings including the Polk County Courthouse, and could assist in this area.