31 de jan de 2014

Health officials implicate cooling towers in Legionella outbreak

The City of Milwaukee Health Department reported 58 clinically diagnosed cases of Legionnaires’ disease in Milwaukee County from June 1 to Sept. 30, 2013, according to a report in MMWR.
This is more than double the normal number of annual cases from the previous 5 years, according to the report. Most of the cases (78%) were in the city of Milwaukee. All but one of the cases in the county were hospitalized. The health department received one report of a death related to legionellosis.
The health department conducted environmental sampling for detection of Legionella at 11 sites throughout the city. They collected 39 swab and bulk water specimens. Three cooling towers were positive for L. pneumophila. Investigations using pulsed-field gel electrophoresis on lower-respiratory specimens from cases and tests at the 11 sites found six distinct strains of L. pneumophila, but no patient strains matched strains from environmental samples.
Thirty-one of the patients (53%) lived within 3 miles of one of the positive cooling towers. The investigators found an RR of 1.6 (95% CI, 0.9-2.7) for Legionella exposure within one of these towers, but the association was not significant. Investigators with the health department met with cooling tower contractors and identified a gap in maintenance due to weather conditions.
“This investigation underscores the need for local public health authorities to be prepared to rapidly enhance surveillance, deliver appropriate public risk messaging and coordinate with the private sector to mitigate environmental transmission of Legionella within a community,” they wrote.

29 de jan de 2014

LIVRO = LEGIONELLA NA VISÃO DE ESPECIALISTAS

Este pode ser o título do livro que vamos publicar possivelmente em março deste ano.
Este será o segundo livro que aborda o tema Legionella no Brasil, sendo que o primeiro foi da Dra Mirian Dilguerian " O MAL DOS LEGIONÁRIOS: DIÁLOGO ENTRE O DIREITO AMBIENTAL E O DIREITO SANITÁRIO".
No nosso livro, vamos contar com a colaboração de mais de 22 especialistas, médicos, juristas, advogados, biólogos, pesquisadores, avaliadores de risco, CDC (USA), Covisa entre outros.
O objetivo será promover o maior conhecimento desta bactéria para os responsáveis por sistemas que promovem a proliferação da mesma. Quais doenças são provocadas pela Legionella e medidas para minimizar os riscos. 
Lembramos que em 2013 já promovemos o primeiro seminário internacional sobre a Legionella, que foi sem dúvida o que nos motivou a trabalhar na publicação deste livro.

Seminário de ABRIL/2013

Saúde em edifícios Facility managers têm papel primordial na prevenção e combate à Legionella, dizem especialistas
O 1º Seminário Internacional sobre a Bactéria Legionella, realizado em 16 de abril último, em São Paulo, contou com a presença de importantes órgãos do setor da saúde, como a Agência Nacional da Vigilância Sanitária (ANVISA), a Coordenação de Vigilância em Saúde (COVISA/SP) e o Ministério da Saúde.
Durante o evento, foram apontados dados interessantes e preocupantes sobre a Legionella, bactéria que ataca o sistema respiratório (por meio de partículas de água contaminadas que são aspiradas) e que está presente em sistemas de água comuns em instalações prediais, como torres de resfriamento, chuveiros, aquecedores de água, fontes, transportes de água (caminhões pipa, por exemplo), caixas de água expostas, irrigação por aspersão, entre outros. A bactéria também pode ser encontrada em rios, lagos, represas e até mesmo no solo.
Segundo o Dr. Szymon Gartenkraut, Subgerente de Vigilância em Saúde do Trabalhador da COVISA/SP, a pneumonia é a quarta maior causa de óbitos no país, segundo dados do Sistema Único de Saúde. A legionelose, uma derivação atípica da doença, está inserida nesses números, porém não é possível ter o número exato de casos no país, pois o SUS não conta com dados específicos da doença. “Os óbitos por pneumonias atípicas vêm crescendo desde 2005”, afirma o Dr. Gustavo Graudenz, do Departamento de Ciências Médicas, Gestão Ambiental e Sustentabilidade da Universidade Nove de Julho.
“Não há desculpas, é fácil de se controlar a Legionella nos sistemas de água dos prédios”, destaca o Dr. William McCoy, membro do Comitê da ASHRAE. Para ele, o foco na prevenção é essencial e é papel dos Facility Managers criar uma equipe para combater os riscos da doença. Verificar como a água é processada e usada no prédio, analisar potenciais locais de infecção, determinar e combater pontos críticos são metas a serem cumpridas. O monitoramento da qualidade da água e dos resultados também são primordiais.
O encontrou serviu também para comemorar uma década da Resolução 09 da Anvisa, de 16 de janeiro de 2003, que estabelece padrões referenciais de qualidade do ar interno em ambientes climatizados artificialmente de uso público e coletivo. Também foi citada a Portaria 1429, do Ministério da Saúde, que apresenta um Plano de Segurança do Uso da Água, As duas medidas são de fundamental importância para oferecer um ambiente mais seguro e saudável aos usuários.

O Phygenics Validation Test (PVT), ação que conta com planos de segurança e métodos de diagnóstico da água, trazido pelo Dr. William McCoy, também pode ser uma ação importante para os gestores dos edifícios. Segundo McCoy, o método oferece maior precisão na detecção de bactérias, além de apontar os resultados até 80% mais rápido do que os métodos tradicionais e criar um histórico sobre os diagnósticos e resultados sobre a qualidade da água de cada instalação.

22 de jan de 2014

Hospital water taps contaminated with bacteria - Legionella

New research finds significantly higher levels of infectious pathogens in water from faucet taps with aerators compared to water from deeper in the plumbing system. Contaminated water poses an increased risk for infection in immunocompromised patients. The study was published in the February issue of Infection Control and Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America.
"Aerators are a reservoir for drug-resistant bacteria and a source of infection for patients at risk," said Maria Luisa Cristina, PhD, a lead author of the study. "Safe water is vital to ensuring patient safety where waterborne infections increase morbidity, mortality, treatment costs, compensation claims and prolong hospital stays."
Researchers from the University of Genova in Italy and collaborating universities studied cold and samples at two tertiary care hospitals for a year from faucets used by healthcare professionals for handwashing, surgical washing, and washing of medical equipment.
This study assessed growth of bacteria at both the faucet and deeper within the water distribution system. Cold and hot water sampling was carried out first with the aerators in faucets in place to assess the risk at each outlet point and then after disinfecting and flame-sterilizing the outlet point and letting the water run for two minutes to analyze the microbiological features of the plumbing system.
Researchers found the total microbial load was up to 10 times greater when aerators were in place than after they had been sterilized. Their findings show that opportunist micro-organisms like Legionella spp., Acinetobacter spp. and other Gram-negative bacteria were significantly higher at the faucet than in the plumbing system. Throughout the study, researchers consistently noted chlorine levels that were too low and hot water temperatures that were below the minimal temperature needed to prevent the growth of Legionella. Both of these factors promote the growth of waterborne pathogens.
In a commentary published alongside the study, Tara Palmore, MD, notes the need for additional research on the topic: "Hospitals tend to have large, complex waterworks with low-flow areas that produce stagnation and biofilm formation; hot and cold water temperatures that are not well regulated may be ideal for bacterial growth...the work of Cristina et al. is valuable in quantifying the frequency, magnitude, and location of the potential hazard to patients from hospital in their facilities. There is still a significant gap in our understanding of how and when such risk translates to patient infections."

17 de jan de 2014

Primeiro livro sobre o tema LEGIONELLA a ser publicado no Brasil




Com a iniciativa da SETRI, estamos trabalhando para publicar o primeiro livro (eletrônico) sobre o tema Legionella no Brasil.
Vários profissionais estão colaborando com esta iniciativa de vários segmentos:

Avaliador de Risco
Pesquisadores
Médicos
Jurista
Advogada
Biólogos
Microbiologistas
e convidados dos Estados Unidos, Inglaterra e Colombia

Nossa previsão que o livro esteja disponível a todos interessados em Março de 2014

14 de jan de 2014

LA Fitness spa reopens after Legionnaires' disease outbreak - Naperville, Illinois, USA



Spa amenities have reopened at LA Fitness in Naperville after an outbreak of Legionnaires’ disease shut down the facilities on Oct. 23, 2013, according to the DuPage County Health Department. Look below for the full release.
Spa facilities at LA Fitness in Naperville are set to re-open Jan. 10, 2014 after being closed by the DuPage County Health Department on October 23, 2013, due to two confirmed cases of Legionnaires’ disease associated with the spa. 
LA Fitness has worked cooperatively with the DuPage County Health Department and has followed State-recommended guidelines for appropriate remediation followed by clearance testing and continued monitoring.
Legionella bacteria are found naturally in the environment, usually in warm water. Keeping Legionella bacteria out of water is the key to preventing infection.  Most people with Legionnaires' disease will have pneumonia since the Legionella bacteria grow and thrive in the lungs.  The two reported cases associated with the LA Fitness spa were hospitalized and subsequently recovered and discharged to home. 


Síndrome do Edifício Doente

Artigo publicado em Junho de 2000

Is Your Office Killing You?
Sick buildings are seething with molds, monoxide--and worse 

Everything was running perfectly that spring afternoon at the courtyard-style Best Western Springdale in the suburbs of Cincinnati. Room service was humming along at a reliable clip. The floral-patterned comforters were getting fluffed. Kids were splashing in the pool. Then, suddenly, General Manager Jim Crane got an emergency call about a leak that was turning Room 529 into a virtual waterfall. Within minutes, he and the hotel's burly engineer were ripping apart the room's walls. Inside, they found something out of a B-grade horror movie: a deathly smelling mold so gooey and hairy it seemed like it was breathing.

Crane soon discovered that, like the Blob, the Aspergillus strain of mold was everywhere: swarming through bathrooms, sprouting out of ceilings, and creeping through the ventilation and vending machine areas. This was May, 1998, and for the next year Crane worked to rid the hotel of the mounds of black growth. He knew they were a disaster for guest relations, but what he didn't realize was that each time he took a breath, he was inhaling the mold's toxic fungal spores. These bioaerosols landed on the delicate mucous membranes of his airways and lungs, causing chronic inflammation and eventually leading to a medical diagnosis of hypersensitivity pneumonitis. The condition further scarred his lungs and eventually progressed into pulmonary fibrosis, a disease that is painful, debilitating, and sometimes even fatal. Slowly and invisibly, his workplace was killing him.

Today, Crane wheezes on his living room sofa--paying bills with his retirement savings and taking 17 different drugs each day. He filed a lawsuit in January against the hotel's owners, Laks Enterprises, which wouldn't comment on the suit. They lost the hotel through foreclosure to Bank of America in September after spending more than $2 million on an exhaustive remediation, and ''the hotel is now safe,'' says the hotel's director of sales, Karen Sullivan. Already, though, Crane has lost half of his lung capacity. Says Crane's physician, Dr. Eckardt Johanning, medical director of Eastern New York Occupational & Environmental Health Center in Albany: ''Lack of proper protection and maintenance in that building caused this tragedy.''

NO STANDARD. Crane's case may be an extreme example of what can happen when you work in a sick building, but he is hardly alone. Employees at Levi Strauss, US West, BP Amoco, even the Environmental Protection Agency, have claimed they suffered sick-building-related illnesses. Cases like these happen so often, in fact, that the World Health Organization estimates that one out of every three workers may be toiling away in a workplace that is making them sick.

The culprit: a stew of largely undetected dangers--from the carbon monoxide and other contaminants sucked into a building when air-intake vents overhang exhaust-filled loading docks and parking garages, to the volatile organic chemicals (VOCs) seeping out of building materials, furniture, office equipment, carpet, paint, and pesticides, to the molds and bacteria funneled through muck-filled heating, ventilation, and cooling systems (HVACs). Even the smoke from those puffing away at entrances gets sucked back into the building, chimney-style, because of the suction from revolving doors (what engineers call ''the stack effect'').

Putting in workaholic hours amid these contaminants is bad enough, but what makes it even worse is that, unlike at home, most of us can't even crack open a window at the office. Instead, we breathe yesterday's air and work in monotonous, uniform spaces under a forest of fluorescents, which can cause boredom, eyestrain, and lethargy. For those with robust immune systems, this may not matter much. But for 20% to 30% of the office population, the problems can range from the mild--headaches, nausea, dizziness, short-term memory loss, irritability, and itchy eyes and throats--to possible damage to the nervous and respiratory systems. Doctors also link the doubling of asthma rates since 1980 to bad indoor air.

Associated with sick-building syndrome is a controversial disease called multiple chemical sensitivity (MCS), which can make people allergic to almost anything containing a man-made chemical. This condition can sideline sufferers into surreal, boy-in-the-plastic-bubble worlds: Don Paladin, a former teacher, got MCS from pesticides sprayed at his school and is now forced to spend most of his time in his aluminum-sided ''sanctuary.'' Other MCS victims say they are forced to live outside or sport medical masks wherever they go. No wonder the EPA calls indoor air quality one of the top five environmental health risks of our time.

But even as the evidence mounts that sick-building illnesses are on the rise, the extent of the problem has been almost impossible to measure. Amazingly, the federal government has no effective standards for indoor air quality in offices. The Occupational Health & Safety Administration (OSHA) has standards that are supposed to protect workers against individual contaminants such as benzene and formaldehyde, both carcinogens. But those standards were set for industrial workplaces and have been force-fit to apply to white-collar offices. ''The OSHA standards don't always protect you from all kinds of exposures that people are having at the office,'' says Elissa Feldman, EPA's associate director of the Indoor Environments Div. ''There is no federally guaranteed protection from exposure to unhealthy air indoors.''

What's more, the chemical soup swirling through office air ''is a complex mixture that we just don't know that much about and no one has set standards for,'' adds Feldman. ''We're not [always] sure of the health effects.'' This, despite the fact that we spend 90% of our time inside--and more than half of that at work. What's also scary is that pollutant levels indoors are two to five times, and on occasion 100 times, more concentrated than outdoors, according to the EPA. ''There are offices in America that I've been in that were probably more dangerous to my health than a Superfund site,'' says William McDonough, former dean of the University of Virginia School of Architecture.

WORKER CLAIMS. Twenty years ago, sick-building complaints were often written off as the psychosomatic rantings of the disaffected--or just the whining of lazy boss-haters. Rare cases--like the shocking outbreak in 1976 of a mysterious lung ailment during an American Legion convention (now known as Legionnaires' Disease)--were considered medical aberrations that couldn't become commonplace. Today, those attitudes are fading in the face of new research buttressing the validity of sick-building syndrome, including new studies linking symptoms to buildings that are damp or freshly renovated.

Experts who study illnesses caused by buildings divide them into two categories. The first--building-related illness--is when readily identifiable microbes or fungi give people actual diseases, like the Legionnaire's outbreak in April from bacteria blown out of the Melbourne aquarium's air-conditioning system that killed four people and infected 99 others. The second--sick-building syndrome--is when people report symptoms that can't be traced to one cause. Local governments are now starting to legitimize these sick-building-related illnesses as a condition for social benefits. Nearly a dozen states from New Mexico to Maryland now recognize MCS as a bona fide claim for workers' compensation. MCS is also covered--on a case-by-case basis--under the Americans with Disabilities Act, obliging employers to make accommodations for sufferers.

U.S. companies could save as much as $58 billion annually by preventing sick-building illnesses and an additional $200 billion in worker performance improvements by creating offices with better indoor air, say researchers William J. Fisk and Arthur H. Rosenfeld of the Lawrence Berkeley National Laboratory in Berkeley, Calif. The researchers also found that the financial benefits of improving office climates can be 8 to 17 times larger than the costs of making those improvements. And the same VOCs that affect people can also harm expensive equipment. They create a film that covers computer circuit boards and telephone switches, causing them to blink or conk out, say Telcordia Technologies Inc. senior scientists Charles J. Weschler and Helen Shields. Just fixing those faulty phone wires has cost telecommunications companies more than $100 million over the past 10 years, they say.

Legal heat is also focusing attention on the issue. Last year, in a landmark case, the Ohio State Supreme Court awarded Joann Taylor an unprecedented $400,000 jury award from her former employer Centerior Energy Corp., now a part of First Energy. The charge: She was forced to keep working in her newly renovated office even after she had been rushed to the hospital with chest pains and vomiting from the chemical fumes in the new carpet. First Energy says no other employees had complaints and that Taylor had to keep working in that building in order to perform her job.

SKYLIGHTS. Indeed, sick-building cases are becoming more and more common--and are often filed against building owner/operators. While there were only a few such cases five years ago, today ''there are hundreds,'' says New York environmental consultant Wayne Tusa. It all adds up to indoor air becoming the next big environmental target, just as awareness of outdoor pollution led to the landmark Clean Air Act of 1970. Indeed, compared with European building standards, the U.S. seems stuck in the environmental Dark Ages (page 124).

But despite this growing climate of recognition, sick-building syndrome remains controversial. Many employers and building owner-operators say workers exaggerate illnesses. Doctors are often split on the issue, one camp dismissing many of the claims as hysterical, while the other sees them as the tip of the iceberg, foreshadowing a kind of chemical AIDS they say could be the scourge of the 21st century.

Even a company that does the right thing by being honest with employees about a building's dangers can be trapped in a legal quagmire. That's what happened to BP Amoco PLC after the company discovered a cancer cluster at its Naperville (Ill.) lab (page 128).

But a few businesses are taking action long before they get into trouble. At its Zeeland (Mich.) factory, furniture maker Herman Miller has created a virtual California. Workers sport Hawaiian shirts and blast the Beach Boys while working in an office that has 100% fresh air and daylight. After the factory opened, productivity improved by 1.5%, enough to pay off the building's $15 million mortgage. The place is so popular that 16 workers who quit last year for better-paying jobs all returned within two weeks because they said that they couldn't stand working in the dark. The U.S. Postal Service saw an even higher productivity gain--a stunning 16% jump--by simply installing skylights and improved lighting at its Reno (Nev.) postal sorting office. ''If any CEOs have half a brain, they would start to pay attention to the fact that their employees are their main cost-and-benefit center,'' says McDonough, now a consultant with Herman Miller and Steelcase. ''They can't afford not to do this.''

Blame the prevalence of sick buildings, in part, on the energy crisis of the 1970s. That's when office buildings began to be built as tight as tin cans, padded heavily with money-saving layers of insulation and equipped with hyperefficient HVACs. In many cases, these systems, run by operators looking to shave costs, suck in only five cubic feet of fresh air per minute per person. ''That is almost enough to keep people alive,'' quips New York architect Robert F. Fox Jr., whose firm designs environmentally friendly skyscrapers. Indeed, to save money, some operators shut down the fresh-air intakes altogether. The American Society of Heating, Refrigerating & Air Conditioning Engineers recommends that HVACs pump in 20 cubic feet of fresh air per minute per person--a level below which symptoms increase. But there is nothing compelling building operators to do so, says Mark J. Mendell, team leader for the indoor-air-quality research effort at the National Institute of Occupational Safety & Health (NIOSH).

Stagnant office air also circulates the residue of as many as 350 VOCs that are emitted by building materials, furnishings, and office machines. For example, most office paints contain solvents that can cause everything from eye, nose, and throat irritation to digestive and central nervous system damage. Carpeting sometimes contains PVCs that give off the carcinogen dioxin. Furniture is often made of particle board that is bonded with resins made with carcinogen-containing formaldehyde. That's not to mention the pesticides and cleaning products swabbed over offices that, according to the EPA, may also contain carcinogens that can be discharged into the office air.

No surprise, then, that sick-building-related symptoms are on the rise. Across the country, doctors who treat patients with sick-building-related illnesses say caseloads have mushroomed 40% in the past decade. ''There are more and more chemicals being introduced into the office environment through synthetic products, and ventilation systems have not caught up with being able to deliver fresh air,'' says sick-building specialist Dr. John B. Sullivan Jr. of the University of Arizona College of Medicine.

What makes it difficult for sufferers seeking remedies is that OSHA has no exposure limits for groups of chemicals that researchers believe might act synergistically. OSHA standards for acceptable amounts of benzene, for example, don't take into account the mixture of VOCs reacting with one another. This could be making building air even more dangerous, but because scientists don't yet know for certain how to measure for these combinations, the problems may be going undetected. That could also help explain, scientists say, why some buildings that are making people sick are getting clean bills of health. Or it may be that where standards do exist, OSHA's permissible exposure levels, which are often influenced heavily by politics and industry, are just too high. ''These exposure limits don't have any real bearing on what's happening in white-collar office buildings,'' says Alan Hedge, professor of human ecology at Cornell University. ''In terms of chemical irritation, we're seeing symptoms at levels way below OSHA's standards.''

''DEATH CUBE.'' An effort to enact sweeping indoor air standards stalled six years ago, when OSHA tried to issue a comprehensive smoking and indoor air-quality rule. The measure would have required all building operators to do basic, routine ventilation checks, change air filters regularly, and avoid using toxic cleaning substances. Not surprisingly, Big Tobacco went into overdrive behind the scenes to torpedo the move since the measure would have required all workplaces to be smoke-free. Shortly thereafter, in 1995, the 104th Congress was ushered in, and it fiercely opposed any new government regulations. The effort was squashed. ''Clearly, [sick-building syndrome] is a significant problem--though it is difficult to say how bad it is,'' says Charles N. Jeffress, Assistant Labor Secretary for Occupational Safety & Health. ''And it is very difficult to do something about it.'' That may be true at the federal level. But as states pass their own laws, Jeffress thinks it may be possible to learn which approaches work and which don't.

Until then, the stories are likely to mount, though they rarely make headlines. At Levi Strauss & Co., for example, internal memos obtained by Business Week show that for eight years, at least 60 employees complained about the air quality at the jeans maker's Stern office building in San Francisco. The workers were especially concerned about smoke from the wood-burning oven in the Il Fornaio restaurant on the ground floor. The mesquite-flavored fumes hung so heavy in the air that some employees rigged umbrellas over their desks to protect themselves from falling soot.

At least three people became disabled from acute asthma, severe allergies, and other environmental illnesses as a result of breathing in the carbon monoxide, the memos show. Things got so bad, employees say, that one office even got the grim nickname ''the death cube'' because three people who occupied it all died of cancer. Levi's took steps to revamp the building's ventilation system over the years, but the complaints persisted. ''It proved to be challenging to track the problem down and find the right steps to resolve it,'' says Linda Butler, Levi's senior manager for communications. Finally, the company raised the air intake vents in 1997 so that the fresh air wasn't commingled with the exhaust from the restaurant, and the problem was fixed, Butler says.

Sometimes, the trouble doesn't stem from an ongoing problem but from one simple renovation project. In 1991, at a former US West office in Walla Walla, Wash., some construction workers forgot to cover up the air-intake vents when they sprayed industrial-strength petroleum sealant on the building's facade as a part of a roofing and refurbishing project. Workers like clerk Juanita Johnson and telephone operator Rosie Gies, who had had a perfect attendance record during her first six years with the company, began suffering from nosebleeds and dizziness. ''I could barely breath at work because it hurt so much,'' says Gies, who eventually developed a case of reactive airway disease so debilitating that she says she couldn't lift her 3-year-old daughter. US West closed the office in late 1996 when it consolidated its directory centers. ''We did testing by independent consultants and found compounds well below OSHA's permissible exposure limits,'' says US West Communications Director Dana Smith.

Often, that's exactly what happens. Companies bat away complaints with test results showing that their workspaces meet OSHA standards. But when the standards clearly have been violated, lawsuits such as Celeste Morrell's can follow. Morrell was a case worker in the Social Services Dept. of New York's Onondaga County in 1988 when her department received a new shipment of wooden desks that had a foul, chemical odor. Turns out the double-pedestal desks, like much furniture, was made with particle board consisting of chips of wood glued together with formaldehyde. After breathing in the fumes all day, Morrell, a widowed mother of two, said she felt sick. When investigators scoured the office, they found formaldehyde levels in desk drawers that were up to five times OSHA's standard for short-term exposure. Morrell's physician diagnosed her with formaldehyde poisoning and ordered her not to work within 15 feet of the desks, but she soon developed multiple myeloma, a form of cancer her doctor linked to her office. Last September, just six months after her suit went to nonjury trial, Morrell died at the age of 51. A judge is still deliberating. ''Her desk killed her,'' says Morrell's attorney, Peter Littman of Ithaca, N.Y. Marc Violette, spokesman for the New York State Attorney General, says the state won't comment on the suit until after the judge has ruled.

HEAVY METAL. To make sure they never end up in court, some building owners, such as New York developer Durst Organization, are taking steps to erect greener and cleaner buildings on their own. Durst's newest building, the rocket-shaped Conde Nast tower, has solar panels, air intakes on every floor, and filters that screen out 85% of the city's contaminants (most buildings have filters that only keep out 35% of impurities). Some manufacturers, such as office furniture makers Steelcase and Herman Miller and office carpet maker Interface, are using materials in office furnishings that are less dangerous--a much needed move since many of the textile trimmings used in office fabrics, for example, are considered hazardous waste, a result of the heavy metal content of the dies and sealants used. Consider the office chair: ''Most people are sitting on chairs that are an amalgam of hundreds of chemicals that have never been defined in terms of their effects on human health, and the deeper we look, we find things that are cancer-causing chemicals,'' says the University of Virginia's McDonough.

Following the lead of these pioneers could well pay off for more companies. Time off from work due to illness can be cut by as much as 30% if workers simply have control over their office air, one study shows. Some states, such as New Jersey and California, are leading the way by enacting some indoor air standards. The EPA is also conducting its first-ever national assessment of the health of the country's office building stock, the biggest such study ever to be performed. Getting a better rating than the norm could be a marketing hook and might allow owners to charge even higher fees in today's helium-filled real estate market.

All this may signal the day when owner-operators make it a priority to choose building materials that are safer, companies demand air-quality reports before signing leases, and employees are as aware of their office's health as their own. Just like stock options and signing bonuses, workers are certain to start demanding fresh air and sunlight once they find out that other employees are getting them. Perhaps one day the office will even have its own annual checkup. If not, many American workers may not be around to complain. They'll be at home--sick.

Join an online discussion of sick buildings at www.businessweek.com/forums/

By MICHELLE CONLIN
With John Carey in Washington