microbiological contamination affecting indoor air...

MICROBIOLOGICAL CONTAMINATION AFFECTING INDOOR AIR QUALITY

BYAZIZ NOOR

ZEEZY GLOBAL SDN BHD

SUNWAY HOTEL, SEBERANG JAYA

11 JULY 2017

CONTENT

I. INTRODUCTION

II. BACKGROUND

III. MICROBIOLOGICAL CONTAMINANTS THAT CAN AFFECT INDOOR AIR QUALITY AND HEALTH

IV. MICROBES IN THE INDOOR ENVIRONMENT

V. PREMISES WITH HIGH RISK

VI. HOSPITAL ACQUIRED INFECTIONS

VII. ACTUAL CASE SHARING

VIII. LEGISLATIVE REQUIREMENTS

IX. LEGISLATIVE REQUIREMENTS – KEY MESSAGES

X. CONCLUDING REMARKS

14/3/2017Zeezy Global Sdn Bhd 2

I. INTRODUCTION

Company background:

Zeezy Global Sdn Bhd (ZZG) is an environmental, health and safety consulting firm

based in Penang. The services we provide include:

• indoor air quality assessment

• microbiological sampling

• remedial action plan and implementation

• environmental, health and safety training


II. BACKGROUND

Purpose of this presentation:

• To share the microbiological aspects and impacts of indoor air quality

• To bring to the attention of the legislative requirements

• To share the premises at high risk and the potential consequences

• To provide recommendations to manage the risk

The intent is to provide awareness for an area of risk that is real, but less visible

and less publicized in the hope that more focus would be given to manage the

associated risk of microbiological contamination in buildings and premises to

safeguard the safety and health of the public.


III. WHY DO WE NEED TO BE CONCERNED ABOUT MICROBIAL CONTAMINATION ?

The presence of excessive amount of microbiological contamination in an indoor

environment has been known to pose health risks to the building dwellers or

occupants. Exposure to the contamination typically leads to health issues and

complications including, but not limited to:

• Allergic reactions

• Influenza/flu

• Pneumonia

• Asthma

• Respiratory track or other infections

• Exacerbation of existing condition14/3/2017Zeezy Global Sdn Bhd 5

IV. MICROBES IN INDOOR ENVIRONMENT

Typical microbes found in the indoor environment include the following:

• Bacteria

• Virus

• Mould/mold

• Fungus

These microbes generally thrive, grow and propagate in the presence of moisture

or dampness (damp condition), with favorable indoor temperatures and where

ventilation is poor.


V. PREMISES WITH RISK

Premises at risk are generally premises with high number of occupants, including:

• Hospitals and clinics

• Offices

• Kindergardens

• Schools, Universities

• Banks

In premises such as hospitals, the potential risk for infections and/or health effects

can be very high for a variety of factors, including a high number of dwellers, age

groups, existing medical conditions and impaired immunity. Microbial

contamination could result in “hospital acquired infections (HAI’s)”.


VI. HOSPITAL ACQUIRED INFECTIONS (HAI’s)…HAI’s are infections acquired in or from hospitals.

• It is estimated that there are some 2,000,000 healthcare infections annually in

the US alone.

• There is a 5% or greater chance of acquiring infections after being admitted to

hospitals.

• It’s the fourth leading cause of death in the US with about 100,000 deaths due

to HAI’s.

• HAI’s are huge financial burdens to the healthcare industries with cost estimated

to be $30-50 Billion annually in the USA.

• All countries have problems with HAI’s; some with greater infection and death

rates than the USA. (Source: Centers for Disease Control (CDC), USA)14/3/2017Zeezy Global Sdn Bhd 8

VI. KEY MESSAGES ON HOSPITAL ACQUIRED INFECTIONS (HAI’s)…

• Microbiological contamination and HAI’s issues are real and could affect the

health of dwellers, patients or inhabitants.

• The biggest hospital decontamination as of 2006, was in Malaysia, costing

RM11.5 million.

• All countries have problems with HAI’s – some to a greater extent.

• Malaysia is no exception. Estimates from the World Health Organization

showed that Malaysia has 400,000 of HAI’s comprising about 14% of the total

hospital admissions in 2010.

• It is one of the leading cause of death. Hence, it must be seriously addressed!


VII. ACTUAL “HAI” CASE SHARING

Below is an actual case sharing by a medical doctor…

Mr X, a local company director was noted to be very health conscious gentleman.

He was seen jogging daily. He would seek consultation at my clinic whenever he

had a medical concern, however trivial it may be.

One day when he walked in my consultation room, I was surprised to see him

reduced to 3/4 his usual size. He was slightly wobbly and spoke with a softer

voice than his usual. I asked him what actually happened to him.

He told be that after consulting me for his influenza, his fever doesn't get better,

so he went to see a physician at a local well-known specialist center who decided

to admit him for investigation. The physician ordered a chest X-ray and later

decided that he had a mild viral pneumonia.


VII. ACTUAL CASE SHARING (cont.)

While staying in the hospital, his condition deteriorated over the next few days

and he slipped into coma. They decided to managed him in the intensive care

unit. After a few days, he regained consciousness. The doctor told him that he

had viral carditis or infection of his heart muscle by virus. According to him, the

specialist told him that the virus was most likely picked up in the hospital or simply

a hospital acquired infection.


VII. ACTUAL CASE SHARING – SICK HOSPITAL (cont.)

Large Scale Hospital Microbiological Decontamination of Sultan Ismail Hospital, in

Johor Bahru.

• 740-bed, built at a cost of RM558 million. Had to be shut down after 2 months

of operation due to fungal outbreak.

• What followed was the largest bio-decontamination in the world (as of 2006)

with 10 million square feet of surface area decontaminated at a cost of RM11.5

million!

• The decontamination and remediation work took 4 months. The fungi

originated from the gardens in the hospital vicinity and spread inside the

building with favorable conditions. (New Sunday Times Online, Sunday, 12

February 2006).


VIII. LEGISLATIVE REQUIREMENTS

There are two parts of legislative requirements:

I. General Provisions of Occupational Health and Safety Act, 1994

(OSHA)

II. Industry Code of Practice on indoor Air Quality, 2010 by the

Department of Occupational Safety and health, Ministry of Human

Resources, Malaysia.


VIII. LEGISLATIVE REQUIREMENTS (CONT.)

I. General Provisions of Occupational Health and Safety Act, 1994 (OSHA)

i. Section 15 – general duties of employers and self-employed persons to

their employees.

ii. Section 17 – general duties of employers and self employed persons to

persons other than their employees

iii. Section 18 – duties of an occupier* of a place of work to persons other

than his employees.

Note* - An occupier is a person who has the management or control of the

place of work.



II. Industry Code of Practice on Indoor Air Quality, 2010 (ICOP-IAQ) by the

Department of Occupational Safety and health, Ministry of Human Resources,

Malaysia.

Purpose:

• To provide guidance on improving the indoor air quality

• To set minimum standard for selected parameters that will avoid discomfort and

and/or adverse health effects to employees and other occupants.

Scope

• Applies to all buildings or any part of the buildings or totally enclosed areas

served by a mechanical ventilation and air conditioning (MVAC) system.

Exception – domestic building, or any area/part built for industrial purpose.14/3/2017Zeezy Global Sdn Bhd 15


II. Industry Code of Practice on Indoor Air Quality, 2010.

Key Provisions:

i. Complaints and Investigation

• Establishment of complaint procedures

• Investigation Process

• Assessment Report




Assessment Report must be done during normal business activities with the

following consideration:

• Sources of air contaminants

• Occupant’s exposure to air contaminants – indoor or outdoor sources

• The prescribed activities

• Adequacy of mechanical ventilation

• Actions to be taken to improve the indoor air quality




Assessment Report must include the measurement of the specific physical

parameters and indoor air quality contaminants.

Acceptable Range for Specific Physical Parameters


Parameter Acceptable Range

Air Temperature 23 – 26 ⁰ C

Relative Humidity 40 – 70 %

Air Movement 0.15 – 0.5 m/s


Indoor Air Contaminants and Acceptable Limits


ppm mg/m3 CFU/m3

Chemical Contaminants

Carbon monoxide 10 - -

Formaldehyde 0.1 - -

Ozone 0.05 - -

Respirable Particulates - 0.15 -

Total Volatile Organic Compounds (TVOC) 3 - -

Biological Contaminants

Total Bacterial Counts - - 500

Total Fungal Counts - - 1000

Ventilation Performance Indicator

Carbon Dioxide (ceiling limit) 1000 - -

VIII. LEGISLATIVE REQUIREMENTS (CONT.)II. Industry Code of Practice on Indoor Air Quality, 2010. Key Provisions:

ii. Control of Indoor Air Quality

• Duty to Control

• Microbial Contamination

• Inspection and Maintenance of MVAC

• Control of Prescribed Activities

• Prevention and Control for Renovation Works

• Pest Control

• Housekeeping and Cleaning

• Environmental Tobacco Smoke (ETS)



iii. Information, Instruction and Training

• Information

• Instruction

• Training

iv. Recordkeeping

• Keeping the Records

• Records to be Kept



v. Registration as an Indoor Air Quality Assessor

• Qualification

• Registration Procedure

• Registration Validity

• Renewal


IX. LEGISLATIVE REQUIREMENTS – KEY MESSAGES

• The ICOP 2010 for IAQ is a comprehensive and valuable document for building

owners and management to manage the risks associated indoor air quality,

especially the risk of infection from microbes.

• ICOP 2010 is enforceable in the court of law. Enforcement efforts have been

relatively low. Regulatory attention and enforcement is expected to increase

moving forward.

• Self initiatives in managing and understanding the risk have been very minimal

and sporadic. Only a handful of premises comply to the ICOP.

• Public premises including hospitals/clinics, offices, schools, kindergardens are

considered high risks premises.


X. CONCLUDING REMARKS• Microbiological contaminants in the indoor environment could pose serious

health risks to the inhabitants particularly in high occupancy buildings such as

hospitals, offices, schools and kindergardens.

• HAI’s in Malaysia is relatively high with 400,000 cases or 14% of total hospital

admissions (2010).

• HAI’s is one of the leading cause of death (US CDC)

• Regulatory framework and guidance is available. Enforcement level for the ICOP

on IAQ 2010 has been low; therefore, the compliance level has been very low.

Enforcement effort in this area is expected to increase.

• This “silent” microbial risk in IAQ is real; the need to manage this risk is not only

prudent, but urgent!


Thank You


References

1. Occupational Safety and Health Act, 1994 (OSHA)

2. Department of Occupational Safety and Health, Ministry of Human

Resources, Malaysia, Industry Codes of Practice on Indoor Air Quality, 2010


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