Sick building syndrome (SBS) describes a situation whereby people experience symptoms of ill health that seem to be linked to spending time in a building, but where no specific cause can be identified.

The term building-related illness (BRI) refers to recognised diseases, often infections, e.g. Legionnaires' disease, caused by being in a building. The cause of sick building syndrome is thought to be at least in part due to changes in building and ventilation design triggered by the energy crisis in the 1970s.

One large recent study found no significant relation between most aspects of the physical work environment and symptom prevalence.¹

• Greater effects were found with features of the psychosocial work environment including high job demands and low support.
• The report concluded that the physical environment of office buildings appears to be less important than features of the psychosocial work environment in explaining differences in the prevalence of symptoms.

However, sick building syndrome usually occurs in those employed in buildings containing many people who are working closely together, especially in new buildings with sealed windows.

Risk factors

Sick building syndrome (SBS) is related to both personal and environmental risk factors.² Risk factors for sick building syndrome include:

• Poor ventilation.
• Air conditioning.
• Low humidity.
• Psychological factors such as stress or poor staff morale.

Causes

• Internal chemical contaminants: usually air pollutants.
  • Initial emissions from components and fittings of a building - the 'new smell' generally dissipates over a short period, but can last years.
  • Volatile organic compounds, including formaldehyde, cleaning products, manufactured plastic and wood products.
  • Ozone from photocopiers and printers.
  • Carbon monoxide, carbon dioxide³ and other inorganic oxides given off as combustion products in heating systems.
  • Small fibres from furnishings, regularly agitated into the air by frequent sweeping. Also, asbestos in older buildings.
  • Tobacco smoke.
• External contaminants: outside air entering a building.
  • Vehicle exhaust fumes: from streets/underground car parks.
  • Recycling of the building's own exhaust back in through poorly positioned vents/windows.
  • Other external air pollution or airborne particles, e.g. pollen, moulds.⁴
  • The prime suspect in most cases is inadequate ventilation. The factors leading to poor ventilation include insufficient outside air, poor filtration of internal and external air, contaminated duct-work, dirty heating, ventilating and air conditioning units, poor planning and placement of vents.

Presentation

General tiredness is often the most common symptom. It usually starts within a few hours of arriving at work, and improves within minutes of leaving the building. Symptoms may be worse in the winter months in northern climates.⁵

• Headaches and dizziness; headaches are usually non-migrainous, rarely throbbing, usually described as dull, and often as a pressure on the head.⁵
• Tiredness, loss of concentration.
• Eye problems.
• Skin problems, e.g. dry or itchy skin.
• Nausea.
• Coughing, shortness of breath, wheezing.
• Ear, nose or throat irritation.⁶

Workplace assessment

• Guidance from the Health and Safety Executive (HSE) recommends that employers should:
• Carry out an employee survey to see if the occurrence of symptoms is higher than expected.
• Check the general cleanliness of the building, the state of all cleaning machinery, e.g. vacuum cleaners, and the usage and storage of cleaning materials.
• Check the heating, ventilation and air conditioning system.
• After any initial steps to resolve the problem have been implemented, it may be necessary to repeat the employee survey and it may be necessary to carry out a more detailed assessment of the workplace environment.

Treating the underlying problem

• Education and recognition of the problem.
• Addressing relevant psychosocial issues, e.g. high job demands and low support.
• Removal of the pollution source if possible.
• Improved planning of building ventilation.
• Maintenance of indoor air quality by regular servicing and quality measurements.
• Discouragement of smoking.
• Increasing the number of live plants in buildings.

Document references

1. Marmot AF, Eley J, Stafford M, et al; Building health: an epidemiological study of "sick building syndrome" in the Whitehall II study. Occup Environ Med. 2006 Apr;63(4):283-9. [abstract]
2. Norback D; An update on sick building syndrome. Curr Opin Allergy Clin Immunol. 2009 Feb;9(1):55-9. [abstract]
3. Apte MG, Fisk WJ, Daisey JM; Associations between indoor CO2 concentrations and sick building syndrome symptoms in U.S. office buildings: an analysis of the 1994-1996 BASE study data. Indoor Air. 2000 Dec;10(4):246-57. [abstract]
4. Assoulin-Daya Y, Leong A, Shoenfeld Y, et al; Studies of sick building syndrome. IV. Mycotoxicosis. J Asthma. 2002 May;39(3):191-201. [abstract]
5. Burge PS; Sick building syndrome. Occup Environ Med. 2004 Feb;61(2):185-90.
6. Tsai YJ, Gershwin ME; The sick building syndrome: what is it when it is? Compr Ther. 2002 Summer;28(2):140-4. [abstract]

Internet and further reading

• Sick buildings syndrome, Health and Safety Executive (HSE); CRR 42/1992; A review of the evidence on causes and solutions
• Sick Building Syndrome: Causes, Effects and Control, London Hazards Centre
• Sick Building Syndrome (SBS) - Environmental Illness Resource
• USEPA; Indoor Air Facts No. 4 (revised): Sick Building Syndrome (SBS), US Environmental Protection Agency

Acknowledgements