This is a reposted article which we first posted in 2016. As it has now fallen in the Google rankings, we felt it was important enough that we reposted it with some newer pictures and information in order that it might be easily found.
Why would we suit people to clean up mold if if were not serious? We can assure you, the suits are not just for show!
Mold Illness and Your Health - ServiceMaster, Mobile, AL
How susceptible are you to mold? Some food for thought. ServiceMaster Advanced Mobile, AL (251) 653-9333. Although this article contains some information regarding our industry, it contains a ton of useful information for the consumer to consider as well.
How Many Remediation Customers are
Susceptible to Mold Illness?
It's important restorers understand the health
consequences some customers face in their homes.
April 27, 2016
One of the biggest challenges faced by people sick from mold is the fact that doctors,
friends, and other family members dismiss their symptoms simply because they,
personally, do not get sick when exposed to mold.
Many victims of mold sickness are labeled as hypochondriacs and are accused of not
being sick at all.
This is tragic because many people that get sick have no control over their sickness
because their bodies have a genetic pre-disposition to mold illness.
The purpose of this article is to explain why contractors, particularly mold remediation
professionals, should know why some of their customers get sick from mold and other’s
There is actually a scientific reason, and understanding of that science will not only help
you serve your customers more effectively, but also increase sales by addressing the
needs of mold sensitized individuals.
Lessons Learned From Interviews With Mold Sensitized Individuals
In 2015, Wonder Makers Environmental, a company based in Michigan, launched a new
website with the mission of educating consumers, contractors, and health professionals
on the health concerns caused by mold. The website’s goal is to be the ultimate resource
of mold information and contains many articles written by the CEO, Michael Pinto.
Since launching the website, numerous mold sensitized individuals have been
interviewed and many lessons can be learned from these interviews.
1. In general, there is a lack of appreciation among the medical community of the
impact mold can have on certain individuals.
2. The symptoms from mold sickness are broad, leading to multiple misdiagnoses of
patients by many doctors.
3. It is quite common for mold sensitized individuals to seek help from multiple
medical practitioners and still not get healthy.
4. Eventually, the individual learns mold has been the cause of the sickness.
5. Mold sensitized individuals frequently are forced to seek alternative shelters
because traditional remediation approaches are not adequate to address their
sensitivities, even assuming that the current standard of care is followed.
Anecdotal Data Versus Scientific Data On Mold Illness
For more than a decade, people have tried to use the courts to sue for compensation from
sicknesses caused by mold. During the early stages of these legal battles, the court system
tended to side with the defendants citing a lack of scientific evidence that mold actually
makes people sick.
Despite the lack of scientific evidence, anecdotal data from thousands of contractors
working with occupants of water-damaged buildings documented the health challenges
In the 1980s, the World Health Organization, coined the term “Sick Building Syndrome”,
which people believed was caused by poor indoor air quality caused by water damage to
According to Erik Johnson, a mold expert and survivor, it was not until the 1990s, that
the World Health Organization, acknowledged “Sick Building Syndrome” could be
caused by toxic mold.
The medical community is beginning to acknowledge the health impact that waterdamaged
buildings can have. This recognition was made very public in 2015 with the
release of the MOLDY documentary which featured health professionals and people who
have suffered mental and physical health issues after moving into moldy houses.
In a presentation at the PLR Expo in Toronto, Canada, in November, 2015, CEO of
Wonder Makers Environmental, Michael Pinto presented “13 Future Trends in the
Restoration Industry“ and has since also written an update to several of his points.
One of the most notable trends he cites is a “A Tighter Connection Between Medicine
Pinto cites new diagnosing techniques to identify an illness called Chronic Inflammatory
Response Syndrome (CIRS), which legitimizes the tie between water-damaged buildings
(WDB) and sickness. He also cited research that has identified a genetic component to
this condition, a screening test (VCS), and most importantly, a treatment regimen.
Pinto also believed the Environmental Relative Moldiness Index (ERMI) demonstrates
the important ties between medicine and the environment. ERMI is a scientific test that
analyzes dust samples for 36 mold species. This test provides base information to identify
CIRS because 26 of the mold species are considered to be water damage indicators.
This test is important because one sample can be analyzed to identify the extent of water
damage in the building that could make someone susceptible to CIRS sick. Importantly,
this test provides an ERMI score, i.e. a HERTSMI-2 score that can be given to physicians
and will help them assess whether a building will make their patient sick.
Because of growing medical awareness and the fact that there are now medical tests and
drugs to diagnose and treat mold illness, Pinto believes one of the other outcomes of this
acknowledgement will be a more active justice system where plaintiffs will now be able
to get compensation because they now have science to back up their claims.
25% of the Population is Susceptible to Mold Illness
The most interesting aspect of the research on the effect that Sick Building Syndrome has
on patients pertains to genetics.
One of the biggest problems with mold sickness is that it impacts everyone differently.
Some may experience minor allergies, and other health conditions like asthma and
chronic sinusitis, while other mold sensitized patients may suffer severe illnesses.
One physician documented the health symptoms of 227 patients who lived in waterdamaged
buildings during a three year period and found 98% of his patients had one of
the gene types where their immune systems were not able to effectively deal with
contaminants from water-damaged buildings.
As stated by Pinto:
“In layman’s terms, two different genes have been isolated, which keep some people’s
immune systems from functioning properly when they have been exposed to contaminants
from water-damaged buildings. Instead of properly identifying and eliminating the
foreign invader, those body defense mechanisms increase the problem. When viewed with
a basic understanding of genetic distributions, this research made it clear that up to a
quarter of the population (25%) is at increased risk from exposure to water-damaged
This research is very significant because it demonstrates that up to 25% of the population
has a genetic pre-disposition that makes them more susceptible to mold illness and the
condition known as Chronic Inflammatory Response Syndrome (CIRS).
Because of this research, the scientific community and legal system is now taking much
greater notice because diagnostic tests, lab tests and treatment tools are being developed
to help these patients. In short, the data is no longer anecdotal, but based on objective
What Is Chronic Inflammatory Response Syndrome (CIRS)?
According to Dr. Ritchie Shoemaker, CIRS is:
“An acute and chronic, systemic inflammatory response syndrome acquired following
exposure to the interior environment of a water-damaged building with resident toxigenic
organisms, including, but not limited to fungi, bacteria, actinomycetes and mycobacteria
as well as inflammagens such as endotoxins, beta glucans, hemolysins, proteinases,
mannans, c-type lectins and possibly spirocyclic drimanes, plus volatile organic
Listed below are the 37 symptoms associated with CIRS.
4. Muscle Cramps
5. Unusual Pain
6. Ice Pick Pain
8. Light Sensitivity
9. Red Eyes
10. Blurred Vision
12. Sinus Problems
14. Shortness of Breath
15. Abdominal Pain
17. Joint Pain
18. Morning Stiffness
19. Memory Issues
20. Focus/Concentration Issues
21. Word Recollection Issues
22. Decreased Learning of New Knowledge
25. Skin Sensitivity
26. Mood Swings
27. Appetite Swings
28. Sweats (especially night sweats)
29. Temperature Regulation or Dysregulation Problems
30. Excessive Thirst
31. Increased Urination
32. Static Shocks
36. Metallic Taste
For 75% of the population, when exposed to biotoxins caused by mold, the individuals’
immune system responds by binding with the invading poison that allows its cells to filter
the biotoxins through the liver, kidneys, and other organs.
In contrast, 25% of the population who have the genetic susceptibility to mold illness get
sick because their body’s immune system does not bind to the biotoxin, meaning it is not
eliminated and therefore continues to circulate, causing the many symptoms, documented
The “C” in CIRS refers to the term “Chronic” because individuals exposed to poisons
from mold are unable to eliminate the toxins from their body, resulting in on-going and
escalating sickness, particularly if the person is continually exposed to mold. This is the
primary reason that the first priority of medical practitioners treating mold sensitized
patients is to begin the detox process which also must coincide with movement away
from the building that is constantly exposing the person to the toxins.
The “I” in CIRS refers to the term “Inflammatory” because the constant exposure to the
toxins creates a cycle of sickness, meaning the individual’s immune system is constantly
trying to fight the toxins, leading to inflammation.
The “R” in CIRS refers to “Response” because the human body is designed to respond to
invading toxins. In the case of patients suffering from mold sickness, the immune system
is constantly trying to fight the toxins causing a stress on the complete immune system of
the individual, which in turn leads to other health conditions.
As stated by Pinto, the “S” in CIRS refers to “Syndrome” because:
“The symptoms are a result of many factors, including external exposures and internal
responses. The contaminants from water-damaged buildings should trigger the activation
of an immune response, but some people’s genetic structure does not allow the proper
recognition of the biotoxin. Since this combination of circumstances inhibits the
clearance of the poison from the body, these harmful substances continue to circulate and
create continual damage. With such individuals there is no linear dose/response
relationship, meaning that even trivial exposures can create severe problems.”
Is CIRS Life Threatening?
The major problem that individuals with CIRS face is their bodies immune systems
become severely compromised and weakened from the vicious cycle of invading poison,
immune response, and inflammation.
The end result is many of their bodies systems are damaged, leading to a wide range of
health conditions, some life threatening.
For this reason, many mold survivors have reported that they have abandoned the primary
residence that initially made them sick; instead, seeking shelter wherever they can find it,
especially very dry areas, with dessert like conditions where moisture is limited. These
drastic measures were taken by these individuals because their bodies have become so
sensitized to mold that even minor exposure triggers severe reactions.
Fortunately, the continued research on mold sickness is creating hope because treatments
been have developed that help individuals detox and eliminate the poisons, followed by
rebuilding the immune system so that it regains strength.
How Can This Knowledge Help Your Business?
At PLR Expo in 2015, Michael Pinto asked the audience of about 400 contractors if they
had heard of Chronic Inflammatory Response Syndrome? Very few raised their hand.
Honestly, I was a bit surprised. Keep in mind, one of the trends that Pinto identified was
“Growing Public Awareness.” If consumers are getting more educated, you should also.
One of the goals of this article is to explain why some of your customers are sick from
mold and others are not. Now you know the answer: 25% of the population has a genetic
pre-disposition to mold illness and may suffer from CIRS.
Learn about CIRS and know the symptoms. In fact, when you meet with a prospective
client who has health issues that could possibly be caused by mold, ask them how many
of the 37 symptoms of CIRS they have.
If you suspect they have CIRS, ask them to consult with a physician who can verify the
diagnosis and prescribe a treatment plan.
The next step is to work with your customer to properly remediate their home. It is no
longer just a matter of dealing with mold in just one part of the home when you are
dealing with a mold sensitized customer. You need to understand the big picture,
meaning you need to work on a plan that addresses spore deposition throughout the home
and also understand that the HVAC system could also be contaminated.
THE ARTICLE CONTINUES IN THE VEIN OF HOW MOLD REMEDIATION COMPANIES CAN PROFIT FROM CLEANUP OFFERINGS.
SINCE SERVICEMASTER DID NOT WRITE THIS, WE FEEL NO NEED TO REDACT THIS PORTION OF THE ARTICLE.
Addressing The Needs Of Mold Sensitized Individuals Will Increase Your Bottom
Recently, one of my clients began working on a mold project that was referred to them by
Wonder Makers Environmental. The mold sensitized homeowner was no longer living in
her home because her health kept getting worse as she suffered from CIRS and was
advised to move out until her home was properly remediated.
Wonder Makers referred this homeowner to a contractor who understood how to deal
with mold sensitized individuals. The mold remediator’s work plan addressed the source
of contamination, i.e. the moisture source. Once this problem was fixed, the scope of
work addressed the areas of the home that had mold growth. The work plan had three
1. Use proper standard of care, containment, negative air, air scrubbers, etc. to
remove porous mold contaminated content. The contractor also implemented
their mold prevention system backing it up with a 25 year guarantee.
2. Create a work plan to address the spore contamination in the HVAC system by
sub-contracting the clean up with a reputable firm
3. Address the spore deposition in the home by setting up a clean room where
contents could be cleaned with an effective solution, like Mold-B-Gone, and
HEPA vacuumed could be stored. It should be noted, the use of chemicals to
clean the contents is not necessary, though this contractor chose to use this
chemical because the ingredients are all natural, EPA approved, and on the FDA
The total price tag for this project was more than $20,000.
The customer is happy because the fungal ecology of her home is at normal levels and
she can live in her home again.
How many customers can you help if you simply ask the right questions?
How might your business grow if you position it as the expert on CIRS and begin
How many jobs will you win from competitors if your education efforts build more trust
Bottom line, there is a need for contractors that understand the needs of individuals
adversely affected by mold. The science of mold is advancing. The fact that up to 25%
of the population could be genetically pre-disposed to mold illness, means that
contractors that want to grow their businesses exponentially should begin preparing
themselves to service this market demand. How prepared are you?
Mold Overview - Types of Mold Explained - ServiceMaster ADVANCED - Mobile, AL
We are the original ServiceMaster Restore disaster restoration company operating in Mobile and Baldwin County in South Alabama, serving the area for over 30 years. We have handled some of the largest fire damage, water damage and mold remediation cleanup jobs ever performed on the Gulf Coast and we would be honored to serve you. (251) 653-9333, (251) 928-1028 and (866) 653-9333.
Below is an article posted on LinkedIn by Mr. Sanjay Gupta. it is an overview and gives the reader some basic information. Another great site is http://www.epa.gov/mold/. There is a link to his site included below.
Mold Facts and Information
Originally published on June 5, 2015. by Sanjay Gupta
The purpose of this article is to answer the following questions about mold:
1. What causes mold growth?
2. What are the most common types and species of mold?
3. Why should I be concerned about mold?
4. How can I detect mold?
What Causes Mold Growth?
Mold is a fungus, as are mushrooms and yeast, and has a biological purpose in our eco-system: to consumes dead organic material. Understanding it’s biological importance is essential to understanding why it poses health hazards.
Problems occur with mold when it begins growing in an enclosed environment such as a home. Mold found inside homes and buildings originates from the outside. Mold spores enter buildings and homes through open doorways, windows, heating, ventilation and air conditioning systems. Spores in the air outside also attach themselves to clothing, animals, shoes, bags and more!
The key ingredient mold needs to thrive and grow is moisture and a food source.
Sources of Moisture
Since mold is everywhere, it will only start growing when the spores settle on surfaces with excess moisture. The key to preventing mold growth is to control moisture. Maintaining an interior humidity level of between 30 to 40% will prevent mold growth.
Listed below are the most common sources of moisture. If you suspect mold growth, before the mold can be cleaned and removed, the sources of the moisture issues must be addressed first.
2. Backed-up sewers.
3. Leaky roofs and/or water leaks.
4. Humidifier which is not regularly cleaned and disinfected.
5. Damp basements or crawl spaces.
6. House plants and their debris.
7. Steam from cooking and showers.
8. Wet clothes hung to dry indoors.
9. Inadequate air exchange.
10. Excessive humidity.
11. Condensation, which is especially a problem during the winter, on poorly insulated surfaces.
Sources of Food
Mold is like a parasite because it will only grow if there is an ample mold source. Under the right conditions of temperature and moisture, mold will continue to feed. The problem with mold lies in the fact that most homes and buildings are made from dead organic material, which is the type of food that mold thrives on. Food sources for mold include the following:
1. Wood & wood products.
2. Paper and other paper products like cardboard and wallpaper
4. Fabric and upholstery
6. Painted walls.
8. Plaster (drywall).
9. Ceiling tiles
10. Insulation materials.
What Are The Most Common Types and Species of Mold?
Not all molds are the same; consequently, it is important to understand that identifying the types and species of mold is important because it helps you and the mold remediation professionals assess the potential health hazards that the growth poses.
Types of Mold
Of the 100,000 types of mold that have been identified, the three most common types have been identified as:
1. Allergenic Molds.
2. Pathogenic Molds.
3. Toxigenic Molds.
Allergenic molds are not usually life-threatening but do cause health concerns for individuals with allergies or asthma. Children and the elderly are most likely to experience health issues if there are allergenic molds present in the property.
Pathogenic molds are of particular concern if your immune system is weak or compromised because these can cause infections. This type of mold can cause hypersensitivity pneumonitis, an acute response resembling bacterial pneumonia. An example is Aspergillus fumigatus, which can grow in the lungs of immune-compromised individuals.
Toxigenic Molds (aka “toxic molds”)
Toxigenic molds are the worse types of molds because they produce mycotoxins that will make anyone exposed to them sick. Mycotoxins are chemical toxins present within or on the surface of the mold spore, which can be inhaled, ingested, or touched. An example of this is an aflatoxin, one of the most potent carcinogens known to mankind. Aflatoxins grow on peanuts and grains, and on some other foods.
Species of Mold
Mold inspectors and indoor air quality professionals use various methods to identify the mold species.
Testing could be done with a tape or swab sample on visible mold.
Air quality samples may also be recommended because air borne mold spores are not visible to the eye. Air quality samples are advantageous because they can identify the concentration of indoor spores.
Once samples are taken, they should be sent to accredited laboratories to analyze them to determine the exact species of mold.
The five most prevalent species of mold are:
Alternaria mold is commonly found in your nose, mouth and upper respiratory tract and can cause allergic responses.
Aspergillus mold is usually found in warm, extremely damp climates, and a common occupant of house dust. This mold produces mycotoxins which is a poisonous chemical compound. This mold variety can cause lung infections including aspergillosis.
Cladosporium mold is a very common outdoor fungus that can find its way indoors and grow on textiles, wood and other damp, porous materials. This mold triggers hay fever and asthma symptoms.
Penicillium mold is a very common species found on wallpaper, decaying fabrics, carpet, and fiberglass duct insulation. It is known for causing allergies and asthma. Some species produce mycotoxins, one being the common antibiotic penicillin.
Stachybotrys mold is extremely toxic “black mold” that produces mycotoxins that can cause serious breathing difficulties and bleeding of the lungs. This mold can be found on wood or paper.
We are the original ServiceMaster Clean (janitorial) & ServiceMaster Restore (disaster restoration) company operating in Mobile and Baldwin County in South Alabama, serving the area for over 30 years. We have handled some of the largest janitorial, fire damage, water damage and mold remediation cleanup jobs ever performed on the Gulf Coast and we would be honored to serve you. (251) 344-5105, (251) 653-9333, (251) 928-1028 and (866) 653-9333.
CERTIFIED Mold Remediation Requires Training & Knowledge
If you have a mold issue, make certain that you hire a CERTIFIED mold remediation professional. Ask to see their certifications. Ask to see their insurance. Mold can be a serious health hazard, and you shouldn't take a chance with anyone that says it can simply be torn out! The airborne spores left from the removal of affected drywall and contents, are typically the very thing that will cause health problems. If every square inch isn't properly cleaned and the air filtered, the resulting spores can be enough to cause serious health issues. We will not take a chance with your health. We only know one way to do the job - the right way. This involves total elimination and removal of all visible and airborne mold spores. - ServiceMaster Advanced - The Master of Disaster (251) 653-9333, (251) 928-1028.
ServiceMaster believes in doing mold remediation the right way. This means calling in an independent Industrial Hygienist and having the customer hire them to do “before and after” air sampling, and write a proper mold remediation protocol. Typically, collection of air and or tape samples will be done. Here is an initial report prior to remediation:
At this point, a proper mold remediation protocol will be written. This is an extensive, SPECIFIC document, detailing exactly what will be done. Specifically, which walls need to be removed, which areas can be cleaned, the duct work to be cleaned and where containment should be set up. Since these documents are quite lengthy (often several pages), we have elected not to include a sample document in this article. We will gladly provide one for a prospective customer.
After the protocol has been followed to the letter, and the remediation has been completed, then the structure is retested. Here is an example of the same structure as above, after mold remediation is completed:
Close examination of the air samples collected and the report issued, are indicative of nearly complete removal of all mold spores. in fact, the air inside is now cleaner than the outside air!
Not All Mold Remediation Is The Same (Part 1 of 3)
There is a growing awareness that when certain individuals become ill from the contaminants in a water-damaged-building (WDB), their bodies develop sensitivity to those specific pollutants, as well as to other compounds. In such cases “normal” remediation or cleaning does not result in an environment that is helpful or acceptable to the client. With new studies showing that up to 25% of the population could be genetically susceptible to this type of exposure ailment, it is crucial for both restoration contractors and the impacted people to know how to approach such problems so that any remediation or ancillary cleaning has the best chance of success.
Looking for Mold-Related Health Answers in all the Wrong Places
People who have been sickened by mold or who have been assisting in the restoration and repair of water-damaged buildings have seen it over and over again. The musty odor or visible fungal growth often produced by water damage can cause greatly varying problems from person to person, despite similar occupancy patterns. Some individuals become debilitated, and somehow know that it is the structure that is causing their problems. In contrast, a much greater number of similarly exposed people experience minor symptoms or none at all!
Such situations do not fit a typical risk assessment from a safety and health standpoint. Training in the arena of chemical exposures teaches that there is a dose/responserelationship. We are conditioned to expect that a higher dose of an offending compound is more likely to impact a greater number of individuals with more severe symptoms. However, when contamination situations do not fit that familiar pattern some investigators (and in this case, most of the mold control industry) fail to consider other possibilities and lazily fall back on the psychosomatic excuse for the sick people: “It’s all in their heads.”
This grip on the classic industrial hygiene approach to illness has led to a large number of narrowly focused research efforts that tried to force the “mold problem” back into the dose/response box. In particular, there have been extensive attempts to quantify occupant exposure levels to various mycotoxins. Although it has been known for centuries that various fungal organisms create chemical compounds that are poisonous to other organisms (think of toxic mushrooms and antibiotics derived from Penicilliummold that kills bacteria), many carefully controlled studies failed to show that occupants in water-damaged buildings could ever inhale or ingest enough of these toxic substances to reach a threshold of harm.
Sadly, that research was hindered by two assumptions that, even today, keep many mold remediation professionals from seeing the big picture of health effects from water-damaged buildings. The first supposition that impacted the data is the one that we mentioned previously—the dose/response expectation as the root of the symptoms. This was compounded by a narrow focus on mycotoxins as the serious culprit, almost to the exclusion of the irritant effects of fungus-generated gasses and the allergenic nature of microscopic spores and fragments. An even broader effort would look beyond mold and realize that any wet environment supporting fungal growth is also harboring bacteria and a host of other microorganisms.
Medical Science Explains Some Anecdotal Data that Occupants and Remediation Professionals Have Long Puzzled Over
What if the reaction of some people to a water-damaged building is not related to the standard dose/response model of exposure illnesses? To further complicate things, what if different organisms in wet environments affected people in a variety of ways? Once doctors and scientists moved in that direction, the search was on to identify mechanisms that trigger symptoms and to figure out what separates ill individuals from the majority that do not exhibit the same symptoms.
Taking a broader view led many researchers back to the idea that wet interior environments provide a suitable home for more than just mold. Research reports began filtering in that suggested that some symptoms reported by individuals in water-damaged buildings could be the result of combined exposure to both bacterial and fungal materials. In June of 2012 scientists participating in a long-term study of environmental health effects in the Cincinnati area reported that they identified two specific types of bacteria in water-damaged buildings that, in conjunction with mold, increase the negative health effects experienced by occupants.
A new look at the allergenic nature of mold exposure was also necessary when some physicians moved beyond the dose/response relationship and began investigating whether particular fungal contaminants could be sensitizers, in contrast to the typical approach where more exposure equates with worse symptoms. This alternate concept was supported by a 2012 study of items that impact indoor environments, which concluded with a list of 374 known asthmagens, identified by government agencies, third-party regulatory agencies, and academic sources. The report used the term “asthmagen” instead of “allergen” to emphasize a growing recognition that even contaminants that do not typically evoke an allergic response can be asthma triggers.
Occupant sensitization is now recognized as a significant problem by both government agenciesand the private sector.In essence, scientists and doctors now realize that sensitization can occur in situations where it was never anticipated in the past. Now, some of the puzzle pieces seem to be fitting together. Some individuals exposed to mold and other contaminants in water-damaged buildings will develop symptoms that conform to an allergic response. For those with an allergy to mold, elimination of exposure by either leaving the structure or remediating the problem generally results in self-healing and resolution of symptoms. However, individuals who become sensitized experience ever-increasing levels of symptoms even with smaller and smaller exposures. In the worst cases, even removal of the offending contaminants does not lead to an improvement in symptoms.
Once the idea of sensitization was validated, many of the difficult-to-explain symptoms made sense because they were the result of an innateimmune response illness (symptoms triggered by processes in the body itself) rather than an acquiredimmune response illness (symptoms triggered by an invader from outside the body). In layman’s terms, exposure to water-damaged buildings causes some people’s immune systems to go into overdrive and not shut off—even after the trigger contaminants are reduced to minute levels. Such responses have been labeled biotoxin illness, or more precisely, chronic inflammatory response syndrome (CIRS).
Finally, in the last few years DNA sampling has been instrumental in explaining why certain people in a water-damaged building will develop CIRS and others will not. There is now solid evidence validating the hypothesis that nearly a quarter of the population has a genetic susceptibility towards CIRS if they have a significant exposure to mold and other contaminants in water-damaged buildings. As a result, some people never get sick and others, who are genetically susceptible, get sick with seemingly trivial exposures.
What Does this Mean to Occupants and Remediation Contractors?
While these particulars about allergens, asthmagens, sensitization, CIRS, and WDB may seem inconsequential, they actually have a direct bearing on remediation contractors.One of the biggest issues is the realization that the standard classes of occupants thought to be most susceptible to mold probably are not. Training for fungal remediation routinely emphasizes that infants, the elderly, and those with pre-existing health problems are at greatest risk during a remediation effort. While those individuals should surely be protected, it can just as likely be healthy adults who develop a myriad of life-altering symptoms from exposures in a water-damaged building, simply because of their genetic makeup.
In these situations, professionals always look for a simple, inexpensive test to help identify who might be at the greatest risk. Incredibly, that hurdle may have been surmounted by the adaptation of a standard vision test called visual contrast sensitivity. Although the test was originally developed for identification of other diseases such as glaucoma, it was found to also be useful for diagnosing systemic illnesses such as diabetes. It has now been adapted to the point where many physicians claim that it can be an accurate assessment of the overall effect of neurotoxins on a patient’s system. According to multiple reports, for people who report potential exposure to water-damaged buildings, failing this test is a strong indicator of a biotoxin illness, with a diagnosis accuracy rate of about 92%.
This is one of the major reasons there is an evolving trend for restoration professionals to be responsible not only for removing contamination, but also for conducting complete structure cleaning, and even completing the repair/rebuild to minimize future problems. While it is true that many hygienists and contractors limit their scope of work based on cost factors and deal only with visible fungal growth, this tactic does not resolve the problem for sensitized individuals. In those cases, the contamination situation in a building that has been water damaged must be viewed as having four distinct components to be managed:
Sourcesof fungal contamination (both visible and hidden)
Transport mechanisms that allow spores to migrate from one area to another (with HVAC systems being the most important)
Contentssuch as clothing, furniture, and personal belongings that have become sources of contamination because they are supporting fungal colonies or have been cross contaminated with spores and other fragments
Reservoirsof fungal spores and fragments in the structure (carpets, walls, ceilings, and many other surfaces)
Unless all of these aspects of the fungal contamination issue are addressed, relief of symptoms by the occupants will often remain elusive. Continue reading Part Two…
Not All Mold Remediation Is The Same (Part 2 of 3)
This is part two of three, please read part one if you have not already so.
Proper Removal of Fungal Sources is Not Rocket Science—But Must be Science Based
Currently there are very few federal or state regulations that actually control the mold remediation process (Texas being the notable exception, but even in that state there is a current push to deregulate those activities). Therefore, true industry professionals must be aware that their efforts are subject to an industry standard of care. Unlike a regulation, a standard of care must be pieced together from a number of different documents. While there is some debate about which references really form the core of the mold control industry, the following seven documents are cited frequently:
1. American Conference of Governmental Industrial Hygienists; Bioaerosols: Assessment and Control; 1999
2. American Industrial Hygiene Association; Report of Microbial Growth Task Force; 2001
3. Environmental Protection Agency; A Guide for Mold Remediation in Schools and Commercial Buildings; 2001
4. Canadian Construction Association; Mould Guidelines for the Canadian Construction Industry; 2004
5. New York City Department of Health; Guidelines on Assessment and Remediation of Fungi in Indoor Environments; 2008
6. Institute of Inspection Cleaning and Restoration Certification; Standard and Reference Guide for Professional Mold Remediation S520; 2008
7. Occupational Safety and Health Administration; A Brief Guide to Mold in the Workplace; Safety and Health Information Bulletin, updated November 2013
Despite the fact that guidance for mold situations is coming from a variety of sources, there is a surprising consistency in the overall tone and approach. Since many mold remediation contractors come from a background of dealing with other hazardous contaminants such as asbestos or lead, all of the accepted reference documents emphasize understanding that mold is a biological agent. Since it has the ability to grow under the right conditions, isolation and deferred action to remove the source of the problem may not be possible, as it is with asbestos materials. With mold a delay may allow contamination inside a building to grow to a point where it poses a hazard greater than when initially discovered.
Another key point emphasized by all of the documents is that the presence of mold growth means that there is or has been moisture intrusion in the building. Removing surface mold contamination and not identifying and correcting the underlying moisture problem would be tantamount to a doctor treating symptoms rather than the disease that is causing them. This aspect of the mold remediation process has taken on even greater importance since we have recognized that other contaminants present in water-damaged buildings are also contributing to the problems experienced by occupants.
A third element that makes up the standard of care for the removal of fungal sources is that the work be done in such a way as to avoid cross-contamination. As is stated in bold type at the beginning of the remediation section of the New York City guidelines: The goal of remediation is to remove or clean mold-damaged materials using work practices that protect occupants by controlling the dispersion of mold from the work area and protect remediation workers from exposures to mold.
Even though it should not be necessary to add this warning, a word about chemical use is important. Too many advertisements related to mold remediation fall into the category of “spray and pray.” Despite the fact that the advertisements and sales pitches talk about how the product is “all-natural,” “developed by NASA for the space station,” “used by the military to decontaminate anthrax,” and a number of other impressive statements, such an approach does not fit the industry standard of care. More important, fogging, spraying, or atomizing chemicals into a structure occupied by a sensitized individual can be downright dangerous. Spraying such materials into a building and praying that they take care of the problem the first time, divert energy and financial resources away from the real work of physical removal of fungal sources and reservoirs.
The Basics of Source Removal When There are Sensitized Occupants
Proper isolation, engineering controls, and work practices must be employed on every project focusing on contaminant removal from water-damaged buildings because bad remediation can be worse than no remediation at all. Activities that disturb sources of biological growth and distribute bacteria, spores, fragments, and byproducts such as mycotoxins into the air where they can migrate to other areas of the structure must be done under controlled conditions. While failure to understand or follow this standard of care may create some problems for the average individual, conducting such work without proper controls can literally create a life-threatening situation for one who is genetically susceptible or previously sensitized to contaminants from water-damaged buildings.
Although entire books have been written on proper remediation, a typical project involving individuals who have known or suspected mold sensitization utilizes these sequential steps:
A. Isolation from the rest of the structure of the specific work area where visible or hidden contamination will be removed, utilizing sheet plastic or other materials sealed tightly against structural components.
B. Sealing off of supply and return air ducts for the duration of the remediation effort.
C. Installation of a decontamination chamber that acts as both a transition zone between the contaminated work area and the rest of the structure and a device that controls the amount of air flow into the workspace.
D. Creation of negative pressure inside the isolated workspace through the use of exhaust fans. In most cases the exhaust air is pushed through HEPA filters before being exhausted out-of-doors in order to create a pressure differential of 0.02” of water column (equivalent to 5 pascal).
E. Minimization of spore deposition through HEPA vacuuming or sealing of visible mold with adhesive plastic prior to disturbing the visible colonies.
F. Careful planning of the demolition aspects of the work so that sections of drywall or other finish material are kept small enough to fit into bags without having to be broken.
G. Requiring individuals working inside the isolated area to wear protective suits with hoods, slip-on safety boots, gloves, and respiratory protection is an important means of preventing cross-contamination. When the workers remove those items in the decontamination chamber it keeps contaminants from being carried into other areas of the building.
H. Utilization of dust free demolition techniques, such as panel saws with a dust collection cowl around the blade, connected to a HEPA-filtered vacuum for cutting of plaster or drywall.
I. A work sequence that follows the air flow, generally starting at the decontamination unit and finishing at the area closest to the negative air machine.
J. Immediate bagging of debris and careful attention to frequent cleanup of dust with a HEPA vacuum.
K. Wiping plastic bags of debris at the entry to the work area and then double bagging the material in the decontamination unit into bags that have never been inside the work area.
L. Transport of double bagged debris out through occupied areas of the structure in solid containers with tightfitting lids, such as Rubbermaid garbage cans.
M. Thorough cleaning of the isolated work area following the removal of all contaminated materials, using the “HEPA sandwich,” a three-step process consisting of HEPA vacuuming, damp wiping with an antimicrobial, and a second HEPA vacuuming.
N. Air scrubbing for 8 to 24 hours following completion of removal and cleaning activities. During this air scrubbing one HEPA-filtered unit should be used to maintain negative pressure, with a second unit set up inside the isolated work area with an exhaust tail to diffuse the air.
Dealing With the Often Forgotten Transport Mechanism
Although it seems difficult for the layperson to imagine, many remediation projects in water-damaged buildings emphasize sealing the supply and return vents in the isolated work area with poly sheeting and then simply allow the plastic to be removed after successful sampling results are received. No testing or cleaning of the register vents, ductwork, or mechanical components of the heating, ventilating, and air conditioning (HVAC) system is ever considered. Given that the microscopic particles that cause so many problems for sensitized individuals are present prior to the remediation effort, the default position should be to consider all HVAC mechanisms to be contaminated and in need of cleaning rather than being ignored.
Proper cleaning of HVAC systems is a sub-specialty, even in the remediation field. While many service providers claim to clean ductwork, few have the equipment and experience to do it well when the work is part of a remediation process in a water-damaged building with sensitized individuals. A thorough understanding of the cleaning guidelines put out by the National Air Duct Cleaners Association (NADCA) is a bare minimum starting point.
Above and beyond the basics, sensitized individuals require a thorough cleaning of the HVAC system that typically involves isolation of all supply and return points. Negative pressure is then installed at the mechanical unit, with the preferred method being a van- or truck-mounted filtration device connected to the HVAC unit by a long flexible duct. One at a time, starting at the supply and return vents farthest from the mechanical components, the grilles are uncovered and cleaning brushes, wands, or other specialized equipment is inserted into the ductwork. This process dislodges contaminants and pushes debris and microscopic impurities downstream, where it can then be sucked to the outside capture device in the specially-equipped vehicle.
Duct cleaning in the homes of sensitized individuals adds a number of complexities that are not present in the typical project. There is significant debate in the HVAC cleaning industry about the practicality and effectiveness of cleaning flexduct (polyethylene tubing that has spiral wire ribs in it—like a Slinky toy—that allow it to expand and contract). For occupants suffering from biotoxin illness or other sensitivities that are triggered by microscopic contaminants, it is best to remove and replace flexduct as part of the cleaning process. Such clients should also have the fan and coils actually disassembled from the unit. Although this requires the use of a licensed mechanical contractor, it allows those critical pieces to be taken outside and thoroughly cleaned, while enabling access to inspect and completely sanitize the drip pan and associated piping.
If the main trunk lines are constructed of fiberglass duct-board rather than sheet metal, a thorough cleaning will roughen the interior surface. Unless addressed at the time of the cleaning, the damaged interior will shed more particulates when the system is used and provide many more areas where moisture can be trapped and support future fungal growth. Therefore, as much as excess chemical use is avoided in homes with sensitized individuals, this is one situation where application of a low odor, EPA-approved coating inside the ductwork is imperative as part of the cleaning process.
The use of spray or gaseous sanitizers in ductwork as an adjunct to cleaning is also controversial. For sensitized individuals, the general industry preference is to avoid adding additional chemicals to the HVAC system—even those that are expected to quickly break down to inert materials. As noted in the remediation section, the focus of the cleaning should be on removing the small particulates to as low a level as practical, not on killing or inactivating the contaminants.
Not All Mold Remediation Is The Same (Part 3 of 3)
This is part three of three, please read part two if you have not already so.
The Contents Conundrum
Despite many statements to the contrary, most contents from water-damaged buildings can be salvaged and cleaned to the point where they are safe for even the most sensitized individual. Therefore, the more relevant question is not whether the contents can be cleaned, but, can the contents be cleaned thoroughly at a price that makes it financially feasible?
Two key pieces of information need to be reviewed when dealing with contents: the type of material to be cleaned, and whether the contamination is actual biological growth or rather deposition of spores and fragments. This means that sorting and inventory are the main tasks at this step in the remediation operation. The following table, summarized from a more detailed article (Wonder Makers Environmental; “Recommended Cleaning Practices for Materials Potentially Contaminated by Mold”; July 2001), describes many of the techniques currently available for addressing contaminated contents for sensitized individuals, and provides a great starting point for the sorting.
Type of Material
Porous: Fabric, paper, upholstered furniture, clothing, etc.
Air washing for documents, HEPA sandwich cleaning (HEPA vacuum, hot water extraction with drying and HEPA vacuum), dry cleaning (chemical residue may be a significant problem), specialized laundering such as Esporta
Disposal and replacement unless high value, then specialized restoration such as freeze drying papers and HEPA sandwich clean, specialized cleaning of furs, etc.
Semi-porous: Raw wood, furniture, etc.
HEPA sandwich cleaning, HEPA vacuuming with stiff bristle nozzle; may also include surface sealing after cleaning and inspection
Disposal and replacement if structural damage or significant rot; scraping, scrubbing, sanding, or abrasive blasting if surface contamination followed by HEPA sandwich cleaning
Non-porous: Metal, plastic, glass, sealed wood, etc.
HEPA vacuuming, wet wiping, washing, power washing, air washing, air blasting
HEPA vacuuming, scrubbing, immersion washing, ultrasonic cleaning, power washing, air washing, air blasting, steam cleaning
Specialty items: Paintings, photos, electronic goods, taxidermy displays, sculpture, artwork, oriental rugs, etc.
HEPA vacuuming in conjunction with air washing; disassembly, cleaning with deionized water, drying
Professional, specialized restoration
Cleaning of non-porous items is fairly straightforward. Soft goods pose a greater challenge because contaminants can become infused throughout the entire item. The more layers that make up the porous item or the bulkier the material, the more difficult cleaning and verification of the cleaning become. The ever-increasing variety of fabrics and materials that are used for soft goods compounds the problems because certain cleaning techniques are only appropriate or effective for specific materials.
Fortunately, there are some proven technologies for dealing with contaminated contents. One technique that has been demonstrated to be effective is known as the HEPA sandwich. This process involves three steps, with vacuuming being the first and last activity. In between, some form of wet cleaning is utilized, such as damp-wiping, washing, or hot water extraction. While this HEPA sandwich approach has been used extensively for cleaning non-porous or semi-porous building surfaces, it has also been employed successfully for a number of porous materials. For example, carpet that is impacted by deposition of mold spores but is not supporting visible colonies of fungal growth has been efficiently cleaned by HEPA vacuuming before and after a professional hot water extraction of the floor covering. Thousands of pieces of upholstered furniture have also been successfully saved using this method.
Removing the Reservoirs
Perhaps the most common error affecting sensitized individuals who go through a mold control process is the determination of whether or not cleaning is necessary in areas of the structure outside the isolated remediation work area. While detailed cleaning of an entire structure may not be necessary for individuals who are reacting to the water-damaged building with a typical allergic response, additional cleaning is almost always necessary for those who are suffering from biotoxin illness.
The fact that mold and other contaminants were growing in the structure to the point that it triggered or exacerbated a health problem, means that contaminants and reservoirs exist in other areas of the structure. This was graphically demonstrated by the EPA through the development of their Environmental Relative Moldiness Index (ERMI) sampling process. Their studies showed that a good indication of whether any structure had suffered water damage could be obtained from a single dust sample of the flooring.
Building on that government work, there is a growing body of evidence from carefully controlled medical studies that dust samples can be used to predict health concerns for sensitized occupants. One well-known physician, Dr. Ritchie Shoemaker, has even identified core components of an ERMI sample that specifically correlate with health. He compares ERMI-style dust sample results to a score sheet to provide his patients with information about whether a particular space is suitable for their occupation. This process is now migrating to an evaluation of the structure following remediation.
Despite not being high-tech, the primary method of removing reservoirs of contaminants from building surfaces is detailed cleaning. Every square inch of the surfaces in the structure are cleaned using HEPA vacuums (sealed and tested with a particle counter to ensure that they are not spreading dust around rather than collecting it), microfiber cloths, and carefully selected cleaning agents. This work is supplemented by air washing (directing compressed air across the surfaces toward an exhaust fan) and air scrubbing (recirculating air through a HEPA-filtered device). Sometimes fogging with water or non-toxic solutions is also utilized to help lift particles from surfaces and give them greater mass so that they are more easily captured.
A Word About Ozone
A number of contractors are now pitching the process of “treating mold in place” with high levels of ozone instead of removing contaminated materials in a controlled and careful way. They have expanded their promotion to include ozone flooding of structures after remediation as “insurance” against problems from hidden sources. This is bad for normal occupants and could be devastating for the sensitized individual. This approach is so far out of bounds that the New York City guidelines use this pretty clear language:
The use of gaseous, vapor-phase, or aerosolized (e.g., fogging) biocides for remedial purposes is not recommended. Using biocides in this manner can pose health concerns for people in occupied spaces of the building and for people returning to the treated space. Furthermore, the effectiveness of these treatments is unproven and does not address the possible health concerns from the presence of the remaining non-viable mold.
Other documents from the American Conference of Governmental Industrial Hygienists (ACGIH), the Restoration Industry Association (RIA), and the Institute of Inspection Cleaning and Restoration Certification (IICRC) say the same thing. Several of them specifically call out ozone as being inappropriate for mold remediation, particularly when it is used as a stand-alone technique.
Putting It All Together to Protect the Sensitized Person Who is Trying to Heal
There is no doubt that the relationship between water-damaged buildings and health effects is complicated. But this has been the case with every material that was eventually determined to be a hazardous contaminant. There will always be more to learn. Nevertheless, it is important to work intelligently with the existing information even as we strive for better data. This is especially true when many of the corrective action steps that can be employed have a proven track record with real-world success in helping sensitized individuals recover their health and lives.
At times, the process of trying to deal with a water-damaged environment that needs to be occupied by a sensitized person can seem overwhelming. In those moments both the occupants and the contractor chosen to assist them should drop back to the core concepts related to remediation for people with special sensitivities:
There is a connection between many significant health symptoms and contaminated environments that is not explained by the dose/response relationship.
Proper remediation must go beyond source removal and deal with residual contamination in the HVAC system, on contents, and on surfaces outside the isolated work area.
At a minimum, remediation practices must follow the standard of care and then plus-up from there to address the special needs of the occupants.
Attention to detail in all aspects of the work is crucial. A small gap in a barrier or an item missed in the cleaning process could trigger a significant reaction.
Everyone should be clear on a specifically-defined endpoint for each phase of the work before it begins.
Having a detailed project plan and an individual that acts as a central coordinator for the effort is one way to help such projects proceed smoothly. By the very definition of a sensitized individual, such projects that assist them are not routine. Even so, a thoughtful approach and a strict focus on completing each step properly can restore buildings to the point where medical intervention can be more effective in resolving health issues and giving these suffering people their lives back.
END OF ARTICLE
Our web site is loaded with informative articles and videos on mold remediation. Please view our site at: http://www.servicemastermobilealabama.com. It will give you a good idea of our standards. Also, please check the EPA guide on mold: http://www.epa.gov/mold/moldguide.htm. You will find that we absolutely adhere to the guidelines in this publication.
When you call us, we will assess your issue, direct you to an independent testing company if necessary, and immediately contain the affected area if necessary. We only know one way to do the job - the right way.
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