Mold Remediation in Wilkes-Barre, PA Mold Remediation

Mold Remediation in the Aftermath of Flooding in Wilkes-Barre, PA

Mold Remediation in the Aftermath of Flooding in Wilkes-Barre, PA

Pennsylvania was hit hard in September, first by Hurricane Irene and then by the remnants of Tropical Storm Lee (Huber, 2011). Close to 100,000 residents living in areas that were inundated in 1972 due to Hurricane Agnes were ordered to evacuate on Thursday, September 8, 2011 (The Times Leader, 2011) and were not allowed to return until Saturday afternoon or later (Olson, 2011). Fortunately, the levees built in the aftermath of Hurricane Agnes did their job and a comparatively low number of 5,400 homes were exposed to floodwaters (Huber, 2011). However, those residents whose homes were flooded will be faced not only with physical damage to their property, but also the threat of significant exposure to mold-generated bioaerosols if their homes were exposed to flood waters and remained damp for more than 48 hours (Brandt et al., 2006, p. 1). The number of residents at-risk for developing mold-related health problems therefore could be in the tens of thousands.

The flooding also affected sewage treatment plants and 14 were believed to have dumped raw sewage into the floodwaters (Huber, 2011). It should therefore be assumed that any property exposed to floodwaters represents a risk of exposure to protozoal and helminthic parasites (Brandt et al., 2006, p. 12). Other concerns include a population explosion for dust mites, cockroaches, rodents, and bacteria, which can cause and/or spread disease. Although there are a number of flooding-related threats to human health, this report will focus on exposure to molds since it probably represents the biggest threat to health.

Response Planning

Several excellent guides for approaching mold prevention, containment, and cleanup in the aftermath of flooding exist, including Damp Indoor Spaces and Health by the Institute of Medicine (Committee for Damp Indoor Spaces and Health [CDISH], 2004) and a relatively recent Morbidity and Mortality Weekly Report article by the U.S. Centers for Disease Control and Prevention (Brandt et al., 2006). Both of these articles outline the recommended responses to mold contamination problems related to indoor water exposure, based on epidemiological and laboratory evidence. These guides will be used as a foundation for constructing a response to the flooding crisis in Pennsylvania, but updated as necessary using more recent empirical findings.

Common Molds and the Associated Health Threats

The number of mold species that normally reside in our indoor and outdoor environments is quite large (Shelton, Kirkland, Flanders, and Morris, 2002). The prevalence of species-specific fungal-caused bioaerosols varies by season, with summer and fall having the highest concentrations. The buildings that were found to have the lowest indoor concentrations within the United States were located in the Northeast. The most common mold species detected both indoors and outdoors across the U.S. were Aspergillus, Cladosporium, and Penicillium. Most buildings that reported water damage were found to harbor all three of these molds, both through air sampling and by visible inspection (Shelton, Kirkland, Flanders, and Morris, 2002). Increased humidity and surface dampness fosters the growth of most molds, including these three, but efforts to generate empirical evidence linking specific types of molds with flooding and water damage have been inconclusive (CDISH, 2004, p. 58).

All three fungi, Cladosporium, Penicillium, and Aspergillus, produce small and lightweight spores that are released into the air in response to light air currents (Cabral, 2010, p. 4289). These spores alone can cause a number of respiratory problems because they remain airborne for extended periods and concentrations can increase over time in heavily contaminated structures. Fungi also produce a number of mycotoxins that can have a significant adverse impact on health. Aspergillus and Penicillium produce ergot alkaloids, aflatoxins, epipolythiodioxopiperiazines, and quinones (Brandt et al., 2006, p. 127). Penicillium produce substituted furans, lactones, and lactams. If airborne concentrations of spores and mycotoxins rise quickly enough, even healthy individuals may be unable to clear the respiratory tract of these contaminants fast enough to prevent an inflammatory response or hypersensitivity pneumonitis.

The prevalence of allergic reactions to Aspergillus, Cladosporium, and Penicillium in inner city children undergoing allergy skin tests was found to be 28%, 19%, and 13%, respectively (reviewed by Cabral, 2010, p. 4290). These prevalence rates were independent of flooding disasters, so this would represent the baseline prevalence of mold allergies in inner city children. More specifically, allergens produced by Aspergillus fumigatus have been linked to allergic bronchopulmnonary aspergillosis and the symptoms of this disease include breathlessness, bronchial infiltration, bronchiectasis, and pulmonary fibrosis. Hypersensitivity...

In addition to the above, immune-compromised individuals would be at an increased risk for developing acute sinusitis, mucormycosis, and brain abscesses if exposed to high concentrations of spores and mycotoxins produced by Aspergillus species. High concentrations of mold-produced bioaerosols can still overwhelm the immune systems of healthy individuals, resulting in chronic sinusitis, aspergilloma, and eye and tissue infections (Brandt et al., 2006, Table 5).
Information Dissemination

There is a critical need to get the most relevant information concerning the prevention and containment of indoor surface mold contamination to healthcare providers, as well as the signs and symptoms of mold exposure and recommended treatments, as quickly as possible. Mold is assumed to have established itself on surfaces exposed to water or dampness for more than 48 hours (Brandt et al., 2006, p. 21) so the incidence of mold-related medical problems will probably begin to occur almost immediately after the mandatory evacuation was lifted.

The Pennsylvania Department of Health (2011) maintains a Health Alert Network that provides a website for the most recent health bulletins and a structured communications network between the state health department and local health departments or agencies, hospitals, healthcare providers, and emergency management officials. This network would be activated locally to both disseminate information concerning the health threat that mold contamination represents and to collect case reports from healthcare providers.

The flooding of the Susquehanna River in the Wilkes-Barre region will pose additional problems, including power outages that will affect phone and internet access, and the physical isolation of communities due to washed out roads and bridges. Getting information into these areas will be more difficult, but radio communications and aircraft transport could be used to bring the necessary health information into and out of these locations.

Mold Contamination Remediation

The primary route of exposure to mold-generated bioaerosols is inhalation. The recommended personal protective equipment (PPE) for reducing airway exposure is an N-95 respiratory mask or better (Brandt et al., 2006, p. 22-23). The advantages of an N-95 respirator mask are that it filters out mold spores and mycotoxins, is relatively inexpensive, and comfortable to wear. The disadvantages are mainly related to proper donning of the mask and fit. A recent survey found that most participants from a post-Hurricane Katrina New Orleans failed to properly don an N-95 mask, while another 26% could not obtain a good fit despite donning the mask correctly (Cummings, Cox-Ganser, Riggs, Edwards, and Kreiss, 2007). Since there are at least 18 different N-95 models available, some individuals may have to try several different ones before a good fit is obtained.

Indoor air quality can be roughly estimated by collecting air samples. The biological contaminants thus collected can be either cultured or assessed using molecular biology techniques that determine the presence of specific species (Brandt et al., 2006, p. 4-5). Air sampling is considered more effective than sampling dust or surfaces; however, air sampling is still inaccurate enough that no guidelines have been established that define acceptable levels of mold bioaerosols in the U.S. In addition, the PPE and the methods used for mold remediation are the same regardless of which species is detected. The primary consensus is that if surfaces have been damp for more than 48 hours then it is assumed that mold has started to grow, whether it is visible or not.

The general recommendation for individuals returning to their home and business is to open all the doors and windows to begin airing the structure, thus reducing indoor humidity levels (Brandt et al., 2006, p. 6). Fans and dehumidifiers are also recommended to bring in outside air and lower indoor humidity. However, air currents will trigger the release of spores and mycotoxins from molds attached to surfaces and cause additional dispersal to other locations in the structure (Cabral, 2010, p. 4289), possibly exacerbating the contamination problem and the threat to health.

Talking Points

1. Assume all surfaces are contaminated with mold if they have been exposed to damp conditions for more than 48 hours. These surfaces should be cleaned with disinfectant solutions, HEPA filter vacuumed, or discarded.

2. Personal Protective Equipment (PPE) should be worn at all times when the risk of exposure is significant. The minimum recommended PPE include N-95 respirator mask, goggles without air vents, long sleeved shirts or jackets,…