Mold Removal

Mold Prevention Strategies

Information - Disaster Information

This is an excerpt from the CDC website detailing Mold Prevention Strategies and possible health effects after a major flood or hurricane. Please refer to the original website for a full detailed report. MJM Property Restoration has included this excerpt in order to better educate and provide information on the effects of mold in your home or business. Note that the CDC does not recommend that you attempt to remediate large complex issues your self, a professional company is needed, or you may face possible disease and long term health effects.

For small, simple problems, the entire list of tasks can be done by one person. Large, complex problems might require many persons from different professions and trades. For circumstances that fall between those extremes, some combination of occupant action and professional intervention will be appropriate. In general, no single discipline brings together all the required knowledge for successful assessment and remediation.

Summary

Extensive water damage after major hurricanes and floods increases the likelihood of mold contamination in buildings. This report provides information on how to limit exposure to mold and how to identify and prevent mold-related health effects. Where uncertainties in scientific knowledge exist, practical applications designed to be protective of a person's health are presented. Evidence is included about assessing exposure, clean-up and prevention, personal protective equipment, health effects, and public health strategies and recommendations. The recommendations assume that, in the aftermath of major hurricanes or floods, buildings wet for 48 hours will generally support visible and extensive mold growth and should be remediated, and excessive exposure to mold-contaminated materials can cause adverse health effects in susceptible persons regardless of the type of mold or the extent of contamination.

For the majority of persons, undisturbed mold is not a substantial health hazard. Mold is a greater hazard for persons with conditions such as impaired host defenses or mold allergies. To prevent exposure that could result in adverse health effects from disturbed mold, persons should 1) avoid areas where mold contamination is obvious; 2) use environmental controls; 3) use personal protective equipment; and 4) keep hands, skin, and clothing clean and free from mold-contaminated dust.

Clinical evaluation of suspected mold-related illness should follow conventional clinical guidelines. In addition, in the aftermath of extensive flooding, health-care providers should be watchful for unusual mold-related diseases. The development of a public health surveillance strategy among persons repopulating areas after extensive flooding is recommended to assess potential health effects and the effectiveness of prevention efforts. Such a surveillance program will help CDC and state and local public health officials refine the guidelines for exposure avoidance, personal protection, and clean-up and assist health departments to identify unrecognized hazards.

Mold: A Definition

Molds, mushrooms, mildews, and yeasts are all classified as fungi, a kingdom of organisms distinct from plants and animals. Fungi differ from plants and animals in several respects. Unlike animals, fungi have cell walls. However, unlike plants, which also have cell walls, fungal cell walls are made mostly of chitin and glucan. Fungi cannot produce their own nutrients as plants do through photosynthesis. Fungi secrete enzymes that digest the material in which the fungi are imbedded and absorb the released nutrients. Multicellular fungi do not differentiate into different organs or functional components the way plants and animals do (5).

Approximately 100,000 species of fungi exists; fewer than 500 fungal species have been described as human pathogens that can cause infections (5). Visible growth of multicellular fungi consisting of branching filamentous structures (mycelia) are known popularly as molds (5) and are referred to by that term in this report.

Molds are ubiquitous in nature and grow almost anywhere indoors or outdoors. The overall diversity of fungi is considerable. For example, the genus Aspergillus has at least 185 known species (6). Molds spread and reproduce by making spores, which are small and lightweight, able to travel through air, capable of resisting dry, adverse environmental conditions, and capable of surviving a long time. The filamentous parts of mold (hyphae) form a network called mycelium, which is observed when a mold is growing on a nutrient source. Although these mycelia are usually firmly attached to whatever the mold is growing on, they can break off, and persons can be exposed to fungal fragments. Some micro-organisms, including molds, also produce characteristic volatile organic compounds (VOCs) or microbial VOCs (mVOCs). Molds also contain substances known as beta glucans; mVOCs and beta glucans might be useful as markers of exposure to molds (7).

Some molds are capable of producing toxins (sometimes called mycotoxins) under specific environmental conditions, such as competition from other organisms or changes in the moisture or available nutrient supply. Molds capable of producing toxins are popularly known as toxigenic molds; however, use of this term is discouraged because even molds known to produce toxins can grow without producing them (6). Many fungi are capable of toxin production, and different fungi can produce the same toxin (6).

How Persons Are Exposed to Mold

Mold exposure can produce disease in several ways. Inhalation is usually presumed to be the most important mechanism of exposure to viable (live) or nonviable (dead) fungi, fungal fragments or components, and other dampness-related microbial agents in indoor environments. The majority of fungal spores have aerodynamic diameters of 2--10 µm, which are in the size range that allow particles to be deposited in the upper and lower respiratory tract (5). Inhalation exposure to a fungal spore requires that the spore be initially aerosolized at the site of growth. Aerosolization can happen in many ways, ranging from disturbance of contaminated materials by human activity to dispersal of fungi from contaminated surfaces in heating, ventilating, and air-conditioning (HVAC) systems. Fungal spores also can be transported indoors from outdoors. Overall, the process of fungal-spore aerosolization and related issues (e.g., transport, deposition, resuspension, and tracking of fungi to other areas) are poorly understood.

Persons can be exposed to mold through skin contact, inhalation, or ingestion. Because of the ubiquity of mold in the environment, some level of exposure is inevitable. Persons can be exposed to mold through contact with airborne spores or through contact with mycelial fragments. Exposure to high airborne concentrations of mold spores could occur when persons come into contact with a large mass of mold, such as might occur in a building that has been flooded for a long time. Exposure to mycelia fragments could occur when a person encounters a nutrient source for mold that has become disrupted, such as would occur during removal of mold-contaminated building material. Skin contact or exposure by inhalation to either spores or mycelial fragments also could occur in a dusty environment, if the components of dust include these fungal elements.

For the majority of adverse health outcomes related to mold exposure, a higher level of exposure to living molds or a higher concentration of allergens on spores and mycelia results in a greater likelihood of illness. However, no standardized method exists to measure the magnitude of exposure to molds. In addition, data are limited about the relation between the level of exposure to mold and how that causes adverse health effects and how this relation is affected by the interaction between molds and other microorganisms and chemicals in the environment. For this reason, it is not possible to sample an environment, measure the mold level in that sample, and make a determination as to whether the level is low enough to be safe or high enough to be associated with adverse health effects.

Persons affected by major hurricanes or floods probably will have exposure to a wide variety of hazardous substances distributed by or contained within the floodwater. This report does not provide a comprehensive discussion of all such potential hazards; such situations will of necessity require case by case evaluation and assessment. Guidance has been provided by CDC for such issues in a number of documents, including NIOSH Hazard Based Interim Guidelines: Protective Equipment for Workers in Hurricane Flood Response (9) and the CDC guidance: Protect Yourself From Chemicals Released During a Natural Disaster (10).

General Guidelines

Assessing Exposure to Mold

Exposure Assessment

Any structure flooded after hurricanes or major floods should be presumed to contain materials contaminated with mold if those materials were not thoroughly dried within 48 hours (15,16). In such cases, immediate steps to reduce the risk for exposure to mold are likely to be of greater importance than further exposure assessment steps presented below.

Assessing the level of human exposure to mold in flooded buildings where mold contamination is not obvious is often a central and ongoing activity in recovery related to hurricanes and floods. Understanding the strengths and limitations of the approaches that are available to assess such exposures is important. Buildings that were not flooded could also have mold. For example, buildings with leaking roofs or pipes, which allows water to penetrate into biodegradable building materials, or excessive humidity, particularly buildings built with biodegradable materials, are susceptible to mold growth (2).

Visual Inspection and Moisture Assessment

A visual inspection is the most important step in identifying possible mold contamination (17,18). The extent of any water damage and mold growth should be visually assessed. This assessment is particularly important in determining remedial strategies and the need for personal protective equipment (PPE) for persons in the contaminated area. Ceiling tiles, gypsum wallboard (sheetrockTM), cardboard, paper, and other cellulosic surfaces should be given careful attention during a visual inspection. Not all mold contamination is visible (9,16); with a flood, contamination in the interior wall cavities or ceiling is common. A common means of assessing the mold contamination of a building is to estimate the total square feet of contaminated building materials (9,18,19). However, professional judgment will necessarily play an important role in the visual inspection because less quantifiable factors (e.g., location of the mold, building use, and function) and exposure pathways are also important in assessing potential human exposure and health risks.

Ventilation systems also should be visually checked, particularly for damp filters, damp conditions elsewhere in the system, and overall cleanliness. To avoid spreading microorganisms throughout the building, HVAC systems known or suspected to be contaminated with mold should not be run. Guidelines from the U.S. Environmental Protection Agency (EPA) and CDC (20,21) provide useful information concerning this topic. Different algorithms for assessing and remediating mold-contaminated buildings are available. Examples of such algorithms are available from the U.S. Army (22), the New York City Department of Health (18), and OSHA (23).

Moisture meters provide qualitative moisture levels in building materials and might be helpful for measuring the moisture content in a variety of building materials (e.g., carpet, wallboard, wood, brick, and concrete) following water damage (9,17). Meters also can be used to monitor progress in drying wet materials. Damaged materials should be removed and discarded. Moisture meters are available from contractor tool and supply outlets. Humidity meters can be used to monitor indoor humidity. Inexpensive (<$50) models that monitor both temperature and humidity are available.

A borescope is a hand-held tool that allows users to see hidden mold problems inside walls, ceiling plenums, crawl spaces, and other tight areas (6,18). No major drilling or cutting of dry wall is required.

Sampling for Mold

Sampling for mold is not part of a routine building assessment (9,16,18,19). In most cases, appropriate decisions about remediation and the need for PPE can be made solely on the basis of visual inspection. If visible mold is present, then it should be remediated regardless of what types of microorganisms are present, what species of mold is present, and whether samples are taken. Other than in a controlled, limited, research setting, sampling for biologic agents in the environment cannot be meaningfully interpreted and would not substantially affect relevant decisions about remediation, reoccupancy, handling or disposal of waste and debris, worker protection or safety, or public health. If sampling is being considered, a clear purpose should exist. For example:

  • To help evaluate a source of mold contamination. For example, testing the types of mold and mold concentrations indoors versus outdoors can be used to identify an indoor source of mold contamination that might not be obvious on visual inspection.
  • To help guide mold remediation. For example, if mold is being removed and it is unclear how far the colonization extends, then surface or bulk sampling in combination with moisture readings might be useful.

 

Types of Samples

Types of samples used to assess the presence of mold and the potential for human exposure to mold in a water-damaged building include air samples, surface samples, bulk samples, and water samples from condensate drain pans or cooling towers. Detailed descriptions of sampling and analysis techniques have been published (6,17).

Among the types of samples, airborne sampling might be a good indicator of exposure from a theoretical point of view, particularly for assessing acute short-term exposures. However, in practice, many problems (e.g., detection problems and high variability over time) limit the usefulness of these types of samples for most biologic agents. If air sampling is conducted, personal measurements best represent the current exposure, although practical constraints might make personal sampling difficult. Therefore, area sampling is the most commonly performed type of air sampling used to assess bioaerosol exposure despite resultant uncertainty about how accurately the measurements reflect actual personal exposure.

One type of surface sampling is the sampling of settled dust. A theoretical advantage of settled-dust sampling is the presumed correlation of concentrations of fungi in the settled dust with chronic exposure to those fungi (17). However, surface sampling is a crude measure and will yield a poor surrogate for airborne concentrations (6,17). Results of surface sampling as a measure of exposure should be interpreted with caution. Bulk samples can provide information about possible sources of biologic agents in buildings and the general composition and relative concentrations of those biologic agents.

Assessment of Microorganisms.

Two distinct approaches are used for evaluation of the presence of specific microbes: culture-based and nonculture-based. The strengths and limitations of the different approaches have been published (6).

Instead of measuring culturable or nonculturable fungi or fungal components, constituents or metabolites of microorganisms can be measured as a surrogate of microbial exposure. Examples of such techniques include polymerase chain reaction (PCR) technologies and immunoassays (6,17). Methods for measuring microbial constituents (with some exceptions) are in an experimental phase and have not yet been routinely applied in clinical assessments, risk assessments, or epidemiologic studies.

No health-based standards (e.g., OSHA or EPA standards) or exposure limits (e.g., NIOSH recommended exposure limits) for indoor biologic agents (airborne concentrations of mold or mold spores) exist. Differences in season; climatic and meteorological conditions; type, construction, age, and use of the building and ventilation systems; and differences in measurement protocols used in various studies (e.g., viable versus nonviable microorganism sampling, sampler type, and analysis) make it difficult to interpret sampling data relative to information from the medical literature (6,17). If sampling is performed, exposure data can be evaluated (either quantitatively or qualitatively) by comparing exposure data with background data, indoor environments with outdoor environments, or problem areas with nonproblem areas. A quantitative evaluation involves comparing exposures, whereas a qualitative evaluation could involve comparing species or genera of microorganisms in different environments. Specifically, in buildings without mold problems, the qualitative diversity of airborne fungi indoors and outdoors should be similar. Conversely, the dominating presence of one or two kinds of fungi indoors and the absence of the same kind outdoors might indicate a moisture problem and degraded air quality. In addition, the consistent presence of fungi such as Stachybotrys chartarum, Aspergillus versicolor or various Penicillium species over and beyond background concentrations might indicate a moisture problem that should be addressed (17). Indoor and outdoor mold types should be similar, and indoor levels should be no greater than levels outdoors or in noncomplaint areas (17). Analytical results from bulk material or dust samples also might be compared with results of similar samples collected from reasonable comparison areas.

Other Issues

Biomarkers

For biologic agents, few biomarkers of exposure or dose have been identified, and their validity for exposure assessment in the indoor environment is often unknown. Testing to determine the presence of immunoglobulin E (IgE) to specific fungi might be a useful component of a complete clinical evaluation in the diagnosis of illnesses (e.g., rhinitis and asthma) that can be caused by immediate hypersensitivity (17,24). Testing is usually done by in vitro tests for serum specific IgE, or by skin prick or puncture tests. Detection of immunoglobulin G (IgG) to specific fungi has been used as a marker of exposure to agents that might cause illnesses such as hypersensitivity pneumonitis (17,24). However, the ubiquitous nature of many fungi and the lack of specificity of fungal antigens limit the usefulness of these types of tests in evaluating possible building-related illness and fungal exposure (17,24). Specific serologic tests (e.g., tests for cryptococcal antigen, coccidioidal antibody, and Histoplasma antigen) are useful in the diagnosis of some fungal infections, but these are the exception. The routine clinical use of immunoassays as a primary means of assessing environmental fungal exposure or health effects related to fungal exposure is not recommended. Health-care providers whose patients express concern about the relation between symptoms and possible exposure to fungi are advised to use immunoassay results with care and only in combination with other clinical information, including history, physical findings, and other laboratory results (24).

Mycotoxins

In recent years, increased concern has arisen about exposure to specific molds that produce substances called mycotoxins. Health effects related to mycotoxins are generally related to ingestion of large quantities of fungal-contaminated material (17). No conclusive evidence exists of a link between indoor exposure to airborne mycotoxin and human illness (6,25). Many molds can potentially produce toxins given the right conditions (6,11,17). Some molds that produce mycotoxins are commonly found in moisture-damaged buildings; research related to the importance of these findings is ongoing. Although the potential for health problems is an important reason to prevent or minimize indoor mold growth and to remediate any indoor mold contamination, evidence is inadequate to support recommendations for greater urgency of remediation in cases where mycotoxin-producing fungi have been isolated.

Summary

The interpretation of environmental sampling data generally requires professional judgment, and medical conclusions cannot be made based solely on the results of analysis of environmental sampling. In the context of mold growth following a major hurricane or flood, mold growth itself and the extent of growth based on a thorough visual inspection is sufficient to categorize a building as moldy or not moldy. This should provide sufficient information for action and no additional characterization is needed.

Clean-up and Prevention

The most effective way to eliminate mold growth is to remove it from materials that can be cleaned and to discard materials that cannot be cleaned or are physically damaged beyond use (9,18,19,26--30). Persons with respiratory conditions, allergies, asthma, or weakened immune systems should avoid mold cleanup if possible or seek the advice of their doctor and determine what type of personal protective equipment is appropriate. Appropriate PPE (e.g., tight-fitting NIOSH-approved N-95 respirator, gloves to limit contact of mold and cleaning solutions with skin, and goggles) (13,26--30) should be used when performing clean-up or other activities in mold-contaminated homes or buildings after a flood.

Clean-up

Removing mold problems requires a series of actions (6,9,16). The order of these actions is sometimes important (6), but might vary on a case-by-case basis. Typically, the following actions are taken regardless of whether a problem is small and simple or large and complex:

  • Take emergency action to stop water intrusion, if needed.
  • Determine the extent of water damage and mold contamination.
  • Plan and implement remediation activities.
    • If needed, establish containment and protection for workers and occupants.
    • Eliminate or limit water or moisture sources.
    • Decontaminate or remove damaged materials, as appropriate.
    • Dry any wet materials, if possible.
    • Evaluate whether space has been successfully remediated.
    • Reassemble the space to prevent or limit possibility of recurrence by controlling sources of moisture.

 

For small, simple problems, the entire list of tasks can be done by one person. Large, complex problems might require many persons from different professions and trades. For circumstances that fall between those extremes, some combination of occupant action and professional intervention will be appropriate. In general, no single discipline brings together all the required knowledge for successful assessment and remediation.

Returning to Mold-Contaminated Homes or Buildings After a Flood

When persons return to homes or buildings after a flood, they should take the following steps (6,9,16,26--30):

  • Clean up and dry out the building quickly. Open doors and windows and use fans or dehumidifiers to dry out the building.
  • Remove all porous items that have been wet for >48 hours and that cannot be thoroughly cleaned and dried. These items can remain a source of mold growth and should be removed from the home or building. Porous, noncleanable items include carpeting and carpet padding, upholstery, wallpaper, drywall, ceiling tiles, insulation material, some clothing, leather, paper, some wood and wood products, and food. Removal and cleaning are important because even dead mold can cause allergic reactions.
  • Clean wet items and surfaces with detergent and water to prevent mold growth.
  • Temporarily store damaged or discarded items outside the home or building until insurance claims can be processed.

 

Removing and Cleaning Up Mold in a Building

For cleaning mold covering <10 square feet in an area flooded by clean water, detergent and water might be adequate (9,16). However after hurricanes and major floods, flood water is likely to be contaminated and, in this setting, mold can be removed with a bleach solution of 1 cup chlorine bleach per 1 gallon of water (26--30). Never mix bleach or bleach-containing products with ammonia or ammonia-containing products. If water damage is substantial or mold growth covers >10 square feet, consult the EPA guide, Mold Remediation in Schools and Commercial Buildings (15).

 

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