Occupational illness in the hospitality industry: sick buildings and the bottom line.

[Guest guest]

Cornell Hotel & Restaurant Administration Quarterly

August, 1996

Occupational illness in the hospitality industry: " sick buildings " and the

bottom line.

, ; Teeters,

When the poor quality of the air inside a building results in the building's

inhabitants' becoming ill, the problem may be " sick-building syndrome. "

Over the last five years, the Las Vegas press has reported incidents of

indoor-air-quality problems in a number of major casino-hotels, an operating

room in a local hospital, the County Courthouse, and even the County

Health District's main building. Incidents similar to these have taken place

in community after community, and in hotel after hotel across this

country.(1) Many of these complaints fall under the heading of sick-building

syndrome (SBS). In this article we discuss some possible sources of SBS and

offer suggestions for remediating working complaints, as well as relating

the actual experiences of two Las Vegas properties.

According to the Occupational Safety and Health Administration (OSHA), " SBS

is not a well-defined disease with well-defined causes. It appears to be a

reaction. . .to a variety of chemical, physical, or biological stimuli. " (2)

In 1983, the World Health Organization (WHO) listed eight non-inclusive

symptoms that characterize SBS.

The symptoms include irritation of the eye, nose, and throat; erythema (skin

irritation or rash); mental fatigue and headache; respiratory infections and

cough; hoarseness of voice and sneezing; hypersensitivity reactions; nausea

and dizziness; and dry mucous membranes and skin.(3)

OSHA considers that SBS may comprise a number of overlapping syndromes.

Symptoms associated with chemical exposure might overlap with symptoms

associated with microbial exposure, making it difficult to distinguish

between microbial and chemical causes. Typically, SBS outbreaks occur most

frequently in recently constructed buildings that have central ventilation

systems. New, well-insulated facilities also have elevated levels of

particulates and volatile organic compounds (VOCs) from construction and new

furnishings. It is these elements that are thought to precipitate attacks of

SBS.(4)

Complicating matters is the rising incidence of chemically sensitive

individuals who are allergic to a range of man-made products. Workers with

an " environmental illness " affliction have difficulty tolerating a multitude

of diverse substances ranging from paints to perfumes. Exhibit 1 is a list

of common man-made chemical products that have caused mild to severe

reactions in chemically sensitive individuals. These persons' reactions may

involve joint pain, malaise, fatigue, skin rashes, headaches, dry and

irritated eyes, nausea, and dizziness.(5)

OSHA believes that women appear to have a much higher incidence of chemical

sensitivity than do men.(6) Even among women who were not defined as being

chemically sensitive, one study indicated that women were twice as likely as

men to report a productivity effect resulting from poor indoor-air quality.

Therefore, those departments (e.g., accounting, PBX, reservations, and front

office) that traditionally have a high proportion of women employees are

more likely to generate complaints of SBS. OSHA has also identified other

factors that can sensitize workers to concerns regarding SBS. " It is true

that poor management, boring work, poor lighting conditions, temperature

variations, poor ergonomic design, and noise may all lower the threshold for

complaint. " (7)

SBS [not equal to] BRI. SBS must also be distinguished from building-related

illness (BRI), which describes a specific medical condition with an etiology

that is known and can be documented.(8) The symptoms of BRI do not abate

when a person leaves the facility where the disease was contracted.

Legionnaires' disease, which was caused by a bacterium, is a classic example

of BRI, which can also be of chemical origin. Susceptibility to BRI is based

on a combination of factors including age and immune status.

Psychogenic Illness as a Contributing Factor

It is important to assess the contribution psychogenic illness might make to

SBS complaints, even though OSHA has held that SBS is not a synonym for mass

psychogenic illness, because psychological factors can " lower the threshold

for complaint. " OSHA concluded that " air quality complaints usually have

some basis, although they are difficult to assess with specificity. " (9)

Stress, anxiety, and psychological conflict have been found to cause

physical illness in individuals and groups. When this happens, the illness

is said to be psychogenic in origin. Mass psychogenic illness (MPI) is

defined by Colligan and as " the collective occurrence of a set of

physical symptoms and related beliefs in the absence of an identifiable

pathogen. " Once termed " assembly-line hysteria, " MPI was thought to be a

relatively rare occurrence in the workplace.(10) In 1976, however, research

psychologists at the National Institute for Occupational Safety and Health

(NIOSH) became convinced that the incidence of MPI was much higher than

previously reported.(11)

Victims of mass psychogenic illness are often subjected to common factors in

the work setting. " The spread of psychogenic illness seems most likely when

several people find themselves in a stressful situation, with no customary

way of coping with it. " (12) They are also involved in stationary work

settings and subjected to repetitive tasks - often with rising productivity

quotas. There is often tension between management and employees and no

avenue for the employees to voice their complaints to management. When an

incident of mass psychogenic illness occurs, employees tend to believe that

management knows there are " real " problems in their environment, but is

hiding the facts from them.

Since women are the most frequent victims of documented cases of MPI,

managers of certain hotel departments have a greater possibility of

receiving MPI-based complaints. Reservation departments, for instance,

employ a high ratio of women to men. Their environment may lend itself to

MPI, because efficiency standards are often stressed (for example,

reservation agents' call duration is typically monitored). The work is also

sedentary, meaning that the employee has no opportunity to relieve the

inevitable stress that comes from dealing with customers who may have

demands that cannot be met by the reservation agent. With no outlet, the

stress level will continue to mount and may cause a negative reaction (e.g.,

psychogenic illness) among employees. PBX operators, front-desk

receptionists, and accounting employees also share many of these same

working conditions - making the people in these areas predisposed to an

MPI-type complaint. Other departments in the hotel may also have stressful

working conditions (e.g., restaurants, bars, bell departments), but the

workers will typically have a means of venting this buildup of stress and

tension through physical activity.

MPI scenario. Mass psychogenic illness has three stages, according to NIOSH

psychologists. The fact that the syndrome is psychologically driven does not

make it any less real or serious than an illness caused by a bacterium or

virus. In stage one, known as " convergence, " two or more individuals

simultaneously experience vague physical complaints and muscular tensions,

but don't reveal them to their fellow employees. Stage two consists of a

stimulus (e.g., a strange odor) that would normally only make a person

flinch or grimace. In the already sensitized individuals, the stimulus

becomes a catalyst and provides an explanation for any discomfort that has

been experienced. According to NIOSH studies, an initiator (one person who

has had the vague physical complaints) eventually goes public with the

symptoms or becomes dramatically ill, inducing others who have similar

complaints also to become ill. In stage three, employees who have not

previously had any vague complaints will begin to experience the symptoms as

the tension and anxiety mount, a stage called " contagion. " The initiator and

others who were experiencing the same vague feelings of discomfort prior to

the introduction of the stimulus will probably be the most seriously

affected by the illness.(13) In a situation where there are numerous

intermittent complaints over time with no specific basis for the complaints,

the employees may be experiencing a combination of SBS and mass psychogenic

illness.(14)

First Step: Investigation

Whatever the basis for the illness, management must take immediate action to

mitigate the condition, especially considering OSHA's injunction that SBS

complaints generally have a demonstrable basis. The manager's first step is

to investigate the complaint, starting by documenting the day of the week,

date, and time of the occurrence.

Next, the manager must interview those who experienced or are continuing to

experience discomfort. Care should be taken in the interview process to

avoid " leading questions " that may influence the employee's response.

Questions should be open-ended and should not require the employee merely to

select a predetermined response. It is also wise to interview employees in

isolation so that the responses of one do not influence another's response.

The interviewer should display a neutral, but concerned and caring attitude.

Clearly, something has happened to cause workers to become ill. If the

interviewer projects an unfeeling or uncaring attitude or one of doubt or

disbelief, employees may become uncooperative and withhold critical pieces

of information.

Once the affected employees are interviewed, the investigator should take a

physical tour of the affected area; examine the heating, ventilation, and

air conditioning (HVAC) system servicing that area; and check on any other

areas that could have an impact on the affected area. Particular attention

should be paid to air-intake dampers and their proximity to exhaust

stacks.(15) Frequently, intake dampers that are designed to bring fresh air

into an area will also draw in exhaust from sewer stacks, smoke and flue

gases, and other pollutants that are being exhausted to the exterior of the

facility. A scenario like this caused the 1976 outbreak of Legionnaires'

disease, when water vapor from the building's HVAC cooling tower - laden

with deadly bacteria - entered an air intake for the building's ventilation

system.

The reason for noting the day, date, and time of the incident is that a

correlation can often be established between the onset of symptoms and

activities taking place in other areas, particularly the operation of

equipment and the performance of non-routine duties. Not only do ventilation

systems sometimes pull in outside contaminants, but they can act as a

conduit that moves pollutants from one part of a building to another.

Twenty-four-hour logs containing all reported incidents in the hotel should

be routinely maintained by security or the telephone department. Every

department, including engineering, food and beverage, and housekeeping,

should also keep a log of all activities that are not part of the daily

routine. Such activities include cleaning equipment, changing filters, and

remodeling and construction activities (e.g., painting, floor sealing).

Each person's threshold of complaint is different, and that threshold may be

affected on any given day by numerous other variables, including workstation

comfort, noise, use of computers, lighting and glare, changes in policies

and procedures, temperature levels, the nature of the work, and

organizational climate. Management must consider all of these factors. The

astute investigator should attempt to identify changes that have occurred in

areas with affected employees immediately preceding any incident.

Management should also enlist the outside assistance of public-health

agencies (e.g., OSHA, state occupational safety and health agencies) in the

investigation process. If preliminary investigations do not readily isolate

the origins of the illness, then management should also seriously consider

enlisting the aid of professional industrial hygienists. Finally, the air in

the area in question should be monitored for pollutants for as long as the

investigating authorities deem reasonable. Such continuous monitoring may

allow management either to pinpoint or rule out suspected pollutants.

Final Step: Remediation

The essential point regarding remediation is that management must take some

reasonable action. Simply investigating and monitoring the problem is

usually not the solution, and disregarding the complaints is out of the

question. Management is often reticent to take action when a problem falls

within the psychosocial realm, but it must be remembered that mass

psychogenic illness is just as real to its victims as an illness whose

origins are physical. Unfortunately, many hospitality managers may be

completely unaware of the existence of workplace disorders that are

psychological in origin.(16) If investigation indicates that the SBS is

augmented by psychogenic illness, action must be taken to mitigate the

tensions and stress that are affecting the employees. This may take the form

of enlisting the help of industrial psychologists and organizational

behaviorists, or at the very least, reviewing the working conditions that

may have precipitated the condition. Often, prior to a mass psychogenic

illness there may have been a change in management or a change in working

conditions that was negatively received by the employees in the

department.(17)

Because SBS is not a well-defined disease with well-defined causes, the

effectiveness of any single proposed remedy remains in doubt. When several

possible remedies present themselves, we recommend that the manager proceed

with the least costly first and implement more costly remedies if the

problem is not contained by the simpler, less-costly techniques. In many

cases experts have found that SBS problems can be remedied when revisions

are made to the HVAC system. Typically, incidents of SBS are eliminated when

one of the following corrective procedures is instituted: (1) air filtration

is increased either by changing and cleaning the existing system more

frequently or by augmenting the existing system with improved filtration

technology; (2) fresh air flow to the problem area is increased - thus

diluting any contaminants to a level acceptable to all; (3) the ventilation

system is cleaned and sanitized - thus eliminating any microbial pollutants

(e.g., fungi, mold, mildew, bacteria, viruses); and (4) ventilation patterns

are rearranged so that contaminants from other areas are not introduced into

the area under investigation.

Management must also realize that the HVAC system does not necessarily

always hold the solution to an SBS problem. The illness may be due to

chemicals or biological contaminants introduced into the work setting. New

furnishings, paints, construction materials, cleaning agents, floor and

furniture polishes, and deodorants, to name but a few, may be the problem's

source. In these cases, source reduction is the preferred way to eliminate

further incidents.

When any remediation takes place it is important that all employees be

informed of the steps being taken to rectify the situation. Imparting this

knowledge will help to build a climate of trust and mutual respect between

employees and management. Moreover, it will allow management to gain

feedback from employees on the effectiveness of the remedies.

To reemphasize, the single worst approach is for management to state that

the problem doesn't exist or that it is a product of overactive

imaginations.

Two Cautionary Tales

The following two indoor-air-quality incidents in the hotel-casino

environment illustrate the complications that management faces when

attempting to diagnose a sick-building complaint.

Classic Case of MPI?

In the summer of 1988, a PBX operator at a major Las Vegas hotel-casino

called in sick and another operator requested an early out. One week later

several of the PBX operators at this property complained of periodic

allergy-like symptoms that would abate as soon as they left their work area.

Approximately two weeks later, PBX operators on the early day shift

complained of congestion, sneezing, and burning eyes. The manager, however,

could detect no unusual odors or substances.

Six days later, at 5:00 PM, a chlorine odor was detected by this same group

of employees. One operator claimed to have had a severe reaction which

included a headache and a rash on her face. During the next day several

operators complained of skin and eye irritations.

For the next year, the incidents continued intermittently, while the

property's engineering department (with the aid of federal, state, and local

health officials) attempted to isolate and mitigate the sources of this

work-related illness. Investigators initially considered multiple

possibilities. First, the exhaust of a glass-washing machine in a laundry

area adjacent to the PBX room was thought to be the culprit. Next, engineers

found that the exhaust stack on the dry-cleaning equipment in the laundry

area was too close to an air-intake damper on the roof. Finally, an empty

barrel of perchloroethylene ( " perc, " the chief dry-cleaning chemical) was

found in the hallway adjacent to the PBX area. The PBX operators had removed

and reviewed the label, after which they exhibited symptoms indicating a

low-level exposure to perc. An industrial toxicologist hired as a consultant

concluded that the employees' symptoms were indicative of hysterical

disfunction brought on by actual low-level exposure combined with the

knowledge of the symptoms one " should have " from an exposure.

Treating the identified problems did not cause the complaints to disappear.

When they continued, management called for further testing for

microbiological pollutants, halogen compounds, and perc in the PBX area,

also measuring carbon-dioxide levels. Laboratory tests on the afflicted

workers' blood and urine were inconclusive.

Exasperated with its inability to identify the cause or causes behind the

complaints, management moved the entire department to another building

served by a completely separate air-handling system. Total costs associated

with the investigation were in excess of $ 50,000, not including the

relocation or the loss of worker productivity. By a conservative estimate,

the expense of lost productivity alone was at least equal to the cost of the

investigation.

The complaints continued after the move. Management was convinced that the

entire problem was psychogenic in origin. The employees would often complain

that strange odors were making them sick, but as soon as a manager or

engineer arrived those afflicted would state that the odor had dissipated.

At this point, management contacted the authors of this article to serve as

" arbitrators " with the PBX employees in the hopes of isolating and resolving

the stressors that were thought to be the actual culprits leading to the

complaints.

The employees of the department had become so agitated at management's

inability to resolve the problem, meanwhile, that they had decided to go to

the local press with their story. Just as emotions were coming to a fever

pitch, another complaint came into the chief engineer's office. This time,

the chief engineer rushed to the scene within seconds after the call came in

and was confronted with the unmistakable smell of sewer gas. He then hurried

to the air handler that served the PBX department.

This is what he found: Directly under the fan coils that chill the air that

is transported to the PBX department is a pan that catches water that

condenses on the cold fan coils. This water flows through a hole in the pan

into a p-trap similar to the trap found on toilets and sink drains. From

there the water flows down a pipe and drops to an open floor drain that also

has a p-trap to exclude sewer gas from the building.

The chief placed a piece of paper between the condensate drain line and the

floor drain. Instantly, the paper was sucked upward by a vacuum created by

the operating air handler.

He theorized that during periods of low relative humidity the water in the

p-traps in the condensate pan and the floor drain evaporated, leaving the

drain wide open and causing the condensate drain line to act like a straw

sucking up sewer gas into the building's air-handling system. When the

relative humidity increased, the p-traps would again fill with water and the

problem would disappear.

In the year since this problem was rectified, there has not been one single

air-quality complaint from the department.

Air-Quality Problems on a " Grand " Scale

During the first six months of 1995, employees at the MGM Grand casino-hotel

in Las Vegas made hundreds of indoor-air-quality complaints. Management was

perplexed by these reports because they involved widely disparate areas of

the hotel served by different ventilation systems. Furthermore, there were

virtually no complaints during the hotel's first year of operation, when

outgassing from new construction and decorative materials is most likely to

occur.

The hotel hired indoor-air-quality experts and industrial hygienists, who

were unable to isolate any substance as a potential culprit. Interestingly,

the complaints became so numerous that a local television station did an

in-depth feature on the problem. That feature appeared just two weeks before

the company shocked the community with the announcement of layoffs of

management and hourly wage personnel unequaled in the community's history.

Was all of this merely a coincidence, or was this a classic case of mass

psychogenic illness precipitated by a property's lackluster economic

performance, and the inevitable stressors that resulted? The answer may

never be known.

Take Action

With the increased interest and awareness of indoor-air-quality issues on

the part of employees, managers of hotels, restaurants, clubs, and casinos,

are likely to be increasingly confronted with outbreaks of SBS and other

workplace disorders (e.g., BRI and MPI). These incidents can prove to be

extremely costly in terms of lost employee productivity if management does

not proactively respond to the situation. Because many hospitality managers

may not be aware of (or believe in) the existence of such workplace

disorders, the managers may use the single worst possible tactic, which is

to ignore the situation and summarily dismiss complaints. Instead,

management should be aware of which departments are more prone to incidents

of SBS and mass psychogenic illness and apply a multidisciplinary approach

to investigate the cause of the occurrence. As and Morrow stated, " The

accurate diagnosis of sick-building syndrome, or any other workplace

disorder, requires a thorough industrial-hygiene assessment, a good medical

and neuropsychological evaluation, a timely (and complete) review of

symptoms, and a comprehensive examination of stresses and strains inside,

and outside, the workplace. " (18)

Finally, management must be aware of the resources available to remedy the

situation in a way that will be least costly to the organization, while

meeting the objective of providing a suitable work environment for all

employees.

Exhibit 1

Common products that may trigger allergic reactions

Air fresheners Disinfectants Dry-cleaning chemicals Fabric softener Glue

Hair spray Laundry soap Odors from hot plastic-coated wires Paint Perfume,

aftershave, and cologne Personal deodorant Plasticizers Rug shampoo Sealers

Soaps and shampoos Toilet cleansers

1 Jan Greene, " Quality of Indoor Air Has Some Choked Up, " Las Vegas

Review-Journal, July 23, 1995, pp. 1, 3.

2 Occupational Safety and Health Administration (OSHA), " Indoor Air Quality;

Proposed Rule (29 CFR [paragraph] 1910, 1915,-1926, and 1928), " Reproduction

Service No. 1202, Federal Register (Washington, DC: Commerce Clearing House,

1994), p. 15971.

3 OSHA, p. 15970.

4 K. Kreiss, " The Epidemiology of Building-Related Complaints and Illness, "

Occupational Medicine: State of the Art Reviews, Vol. 4 (1989), pp. 575-592.

5 OSHA, p. 15971.

6 OSHA, p. 15970.

7 Ibid.

8 C.M. and L.A. Morrow, " Dysfunctional Buildings or Dysfunctional

People: An Examination of the Sick Building Syndrome and Allied Disorders, "

Journal of Consulting and Clinical Psychology, Vol. 60 (1992), pp. 213-219.

9 Ibid.

10 M.J. Colligan and L.R. , " A Review of Mass Psychogenic Illness in

Work Settings, " in Mass Psychogenic Illness: A Social Psychological

Analysis, ed. M.J. Colligan, J.W. Pennebaker, and L.R. (Hillsdale,

N.J.: Erlbaum, 1982), p. 35.

11 M.J. Colligan and W. Stockton, " The Mystery of Assembly-Line Hysteria, "

Psychology Today, June 1978, pp. 93-94, 97-99, 114, 116.

12 Colligan and Stockton, p. 94.

13 Ibid.

14 H.S. Faust and L.B. Brilliant, " Is the Diagnosis of 'Mass Hysteria' an

Excuse for Incomplete Investigation of Low-Level Environmental

Contamination?, " Journal of Occupational Medicine, Vol. 23 (1981), pp.

22-26.

15 For example, see: Teeters, , and Joe F. Boatman,

" Smoke Gets in Your Eyes - Examining Air Quality in Casino-Hotels, " Cornell

Hotel and Restaurant Administration Quarterly, Vol. 30, No. 2 (April 1995),

pp. 69-78.

16 R.M. Bauer, K.W. Greve, E.L. Besch, C.J. Schramke, J. Crouch, A. Hicks,

M.R. Ware, and W.B. Lyles, " The Role of Psychological Factors in the Report

of Building-Related Symptoms in Sick Building Syndrome, " Journal of

Consulting and Clinical Psychology, Vol. 60 (1992), pp. 213-219.

17 Colligan and Stockton, p. 94.

18 and Morrow, p. 214.

, Ed.D., is an associate professor at the W.F. Harrah College of

Hotel Administration at the University of Nevada-Las Vegas, where

Teeters, M.B.A., is an assistant professor.