title: Nasal and ocular symptoms, tear film stability and biomarkers in nasal lavage, in relation to building-dampness and building design in hospitals.
abstract: OBJECTIVE
  To study the relationships between dampness in concrete floors and building design on the one hand, and symptoms and medical signs of the eyes and nose in hospital workers, on the other.
  
  
  METHODS
  Four hospitals for geriatrics were selected to represent buildings with different ages and design, irrespective of symptom prevalence. The first building was built in 1925. The second, built in 1985, was known to have dampness in the floor. Conventional building techniques were used in the third building, built in 1993, and the last building was built in 1994, and was specially designed to include high ceilings, and minimal use of fluorescent lighting and interior plastic materials. The interior surfaces were painted with water-based beeswax glazing. All staff (n=95) working day shifts were invited to take part in a medical examination of the eyes and nose including acoustic rhinometry and nasal lavage, and a medical questionnaire, and 93% participated. Measurements of temperature, relative air humidity, air flow, illumination, volatile organic compounds (VOCs), molds, and bacteria were carried out in all buildings, together with measurements of formaldehyde, respirable dust, carbon monoxide (CO), carbon dioxide (CO(2)), nitrogen dioxide (NO(2)) and ozone. Statistical analyses were performed by bivariate analysis, and linear, ordinal, and logistic multiple regressions, adjusting for age, gender, tobacco smoking, atopy, and the perceived psychosocial work environment.
  
  
  RESULTS
  Dampness in the upper concrete floor surface (75-84%), ammonia under the floor [3 parts per million (ppm)], and 2-ethyl-1-hexanol in the air were detected in the two buildings built in 1985 and 1993. Increased occurrences of ocular and nasal symptoms, an increased concentration of lysozyme in nasal lavage, and decreased tear film stability were found in the subjects working in the damp buildings. Those in the specially designed building had fewer ocular and nasal symptoms, and increased tear film stability. All buildings had low levels of formaldehyde, molds, bacteria, ozone, and NO(2). The lowest total concentration of VOCs, and the highest concentration of specific VOCs of microbial origin, were found in the building with special design.
  
  
  CONCLUSIONS
  The study provides new evidence of the role of dampness-related alkaline degradation of di-(2-ethylhexyl) phthalate (DEHP) in polyvinyl chloride (PVC) building material. Emissions related to degradation of DEHP due to dampness in the floor, indicated by increased 2-ethyl-1-hexanol in the air, seem to increase both the secretion of lysozyme from the nasal mucosa and the occurrence of ocular and nasal symptoms. The indoor environment of the specially designed building with high ceilings and no fluorescent lighting or interior plastics seemed to have a positive influence on the nasal and ocular mucous membranes.
authors.affiliation: Department of Medical Sciences, Department of Occupational and Environmental Medicine, University Hospital, Uppsala University, S-751 85, Uppsala, Sweden. gunilla.wieslander@occmed.uu.se
authors.forename: G
authors.initials: G
authors.lastname: Wieslander
authors.forename: D
authors.initials: D
authors.lastname: Norbäck
authors.forename: K
authors.initials: K
authors.lastname: Nordström
authors.forename: R
authors.initials: R
authors.lastname: Wålinder
authors.forename: P
authors.initials: P
authors.lastname: Venge
mesh_terms: D000328:Adult; D016902:Air Pollution, Indoor / Q000032:analysis; D015415:Biomarkers; D005160:Facility Design and Construction; D005260:Female; D005430:Floors and Floorcoverings; D006761:Hospitals; D006801:Humans; D006813:Humidity; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017817:Nasal Lavage Fluid; D015995:Prevalence; D018877:Sick Building Syndrome / Q000453:epidemiology*; D013548:Sweden / Q000453:epidemiology; D013666:Tears
chemical_list: D015415:Biomarkers