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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
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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.
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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.
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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)”.
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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!
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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.
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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.
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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).
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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.
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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.
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VIII. LEGISLATIVE REQUIREMENTS (CONT.)
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
VIII. LEGISLATIVE REQUIREMENTS (CONT.)
II. Industry Code of Practice on Indoor Air Quality, 2010.
Key Provisions:
i. Complaints and Investigation
• Establishment of complaint procedures
• Investigation Process
• Assessment Report
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VIII. LEGISLATIVE REQUIREMENTS (CONT.)
II. Industry Code of Practice on Indoor Air Quality, 2010.
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
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VIII. LEGISLATIVE REQUIREMENTS (CONT.)
II. Industry Code of Practice on Indoor Air Quality, 2010.
Assessment Report must include the measurement of the specific physical
parameters and indoor air quality contaminants.
Acceptable Range for Specific Physical Parameters
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Parameter Acceptable Range
Air Temperature 23 – 26 ⁰ C
Relative Humidity 40 – 70 %
Air Movement 0.15 – 0.5 m/s
VIII. LEGISLATIVE REQUIREMENTS (CONT.)
Indoor Air Contaminants and Acceptable Limits
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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)
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VIII. LEGISLATIVE REQUIREMENTS (CONT.)
iii. Information, Instruction and Training
• Information
• Instruction
• Training
iv. Recordkeeping
• Keeping the Records
• Records to be Kept
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VIII. LEGISLATIVE REQUIREMENTS (CONT.)
v. Registration as an Indoor Air Quality Assessor
• Qualification
• Registration Procedure
• Registration Validity
• Renewal
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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.
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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!
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