environmental expert for black mold,bacteria,fungus home test kit

EPI-TOX AIRE® E-Z Home & Office Mold & Bacteria Test Kits

Areas of Expertise * Epidemiology Toxicology Industrial Hygiene Risk Assessment Risk Management Risk Communication Public Health Education
Indoor Environmental Quality HVAC Biological: Mould, Bacteria, Allergens, Parasites, Insects Chemicals: asbestos, lead, mercury etc. Physical Agents: Dust, electromagnetic fields,
radiation Emergency response services, natural and man made catastrophes Forensic Evaluation *Expert testimony and consultation
Building evaluations: Building damage, water damage, water tracking, and water mapping Residential / Home Services evaluations

Learn About Ground Vs. Air Testing

Bacteria, Mold, Fungi in the Indoor Environment

ALL Third Party Findings with all references located at the bottom of this page

Hazardous Bacteria are not just limited to Hospitals and Nursing Homes!

There is a great deal of discussion concerning the value of indoor testing for microbes (bacteria and fungi) and possibly followed by thoughtful
sampling, and subsequent recommendations for microbe remediation. Appropriately designed sampling protocols that test specific hypotheses
are required in environmental evaluations. This test does not replace a site evaluation by an indoor environmental quality
professional. However, we understand that some persons may want the information provided by this test. We will provide the bacteria and
fungi results, and an interpretation of the results. A site evaluation by an indoor environmental quality professional may be recommended if
the results warrant such action.

2        What do surface samples have to do with air testing for mold and bacteria?
During our ten years’ experience in evaluating indoor environments, we have found that tests that sample microorganisms collected from the
floor and other horizontal surfaces provide high quality information on the microorganisms that may be in the environment. Gravity causes
virtually all bacteria and fungi to fall to the floor and collect there. Microorganisms on the floor are available to be lifted into the
air by air currents flowing through the building or lifted by persons walking through the area. Microorganisms lifted into the air
are available for contact with persons in the building space.

We first started investigating indoor environments, using an impaction sampling instrument, the Andersen N6 cascade sampler.
We use the Anderson N6 sampler because it is a scientifically valued technique to identify and count bacteria and fungi in air
samples. The Anderson N 6 injects microbes onto a petri dish, and the samples are sent to the laboratory to be cultured,
identified, and counted. We did not use spore trap air sampling instruments very often because we want to measure
environmental bacteria and fungi. Spore traps can measure fungi’s spores but not bacteria, and the presence of bacteria is
important. Classic training in public health practice includes bacteriology because bacterial infections are more common in
humans than fungal infections.

Over time, we found that the cultured air sample results often did not reflect the environmental conditions we found. Some air
samples from significantly contaminated sites were extremely low in bacteria and fungi given the conditions. Some air samples
from very clean areas were much higher in bacteria and fungi than we anticipated and a reevaluation of the area did not indicate
unusual microbial growth. In a number of instances a first outdoor sample differed from the second outdoor sample by a factor
of hundreds to thousands of colony forming units. This variation of hundreds to thousands of colony forming units occurred
even though these outdoor samples were collected from exactly the same location and within minutes of the first sample.

To address these issues for indoor environments, we decided to collect dust samples from a large surface area in order to gain an
understanding of the bacteria and fungi loading in the building area. We recommend sampling from virtually the entire floor of
the space we are evaluating.

Mold exposure in the indoor environment is most frequently studied by counting culturable spores in settled dust or in the air, but this
approach has serious disadvantages. These include poor reproducibility, selection towards certain species, and the fact that dead molds or
mold components are not detected, even though they may have toxic/allergenic properties. Perhaps the most important problem, one that is
rarely discussed in the studies published to date, is that air sampling during a period of more than 15 minutes is often not possible, whereas
air concentrations usually vary a great deal over time. The few studies that included repeated exposure measurements of mold either in air or
in settled dust have shown considerable temporal variation in concentrations and organisms, even over very short periods of time (Hunter et
al., 1988, Verhoeff et al., 1994, Chew et al., 2001). We address a number of these concerns by collecting samples from a large surface area
rather than a small surface area and by analyzing for bacteria and fungi.

Verhoeff et al (1994) suggested that the within- and between-home variance of exposure, for indoor culturable molds, requires 27–36 mold
samples per home to estimate the average exposure in an epidemiologic study with less than 10 percent bias in the relation between a health
effect and the exposure (Heederik & Attfield, 2000, Heederik et al., 2003). This estimate suggests that unless many samples per home are
collected, culturable sampling will probably provide a very poor quantitative measure of exposure. This may explain why most studies with
culturable mold measurements did not find an association with symptoms. Most studies using surface samples collect from surfaces of 2 or 3
square meters. We collect samples from much larger surface areas, at least 12 square meters, to avoid potential bias from small sample
surface areas.

Indoor exposure assessment may use air and / or surface sampling. Swab, or tape lift samples can be collected but they are subject to
sampling bias. Their sampling bias limitations include collecting from very small surface areas and ensuring that a sufficient number of swab or
tape lift samples are collected. Sampling bias means you maybe selecting a surface that contains more or fewer organisms than are actually
present across the entire surface.   Ultimately, sampling bias means that you are not collecting a sample that represents the actual
environmental conditions.

In a small number of well-designed studies, dust samples were collected from floors or other surfaces and then analyzed for microbial content.
The advantage of dust sampling is the time integration that occurs when the microorganisms in the air settle on surfaces. Large area (>12m2)
surface sampling may be the most appropriate method for assessing associations between human exposure and health outcomes. The
method is fast, straightforward, and of modest cost. A vacuum cleaner is used, and filters or synthetic sampling bags are used to collect the
dust. It is important that the surface sampling procedure be standardized so that sample results may be compared between different sampling
areas. The standardization should include sampling location, surface area, vacuuming technique, vacuum suction, and the duration of the
sampling.

2.1                Bacteria Concentrations in the Indoor Environment
A few studies have reported concentrations of bacteria in indoor air. The bacteria concentrations are very variable and depend on climate
(temperature, relative humidity), season, building type, building construction, building age, building use, building ambient air parameters
(temperature, relative humidity), and building ventilation rates. Additionally, the reported bacteria concentrations depend on sampling and
analytical methods. The bacteria air values range from 36 CFU/m3 to 20,000 CFU/m3 (Institute of Medicine, 2004). The mean bacteria air
values of these studies ranges from 90 to 10,000 CFU/m3 (Institute of Medicine, 2004). These values provide some guidance; however,
because of the limitations described above, these data should be used as reference values with caution.

2.2                Fungi Concentrations in the Indoor Environment
A larger number of studies have reported concentrations of fungi in indoor air than the number of studies evaluating bacteria in air. The fungi
concentrations are very variable and depend on climate (temperature, relative humidity), season, building type, building construction, building
age, building use, building ambient air parameters (temperature, relative humidity), and building ventilation rates. Reported fungi
concentrations depend on sampling and analytical methods. A recent study by Sheldon et al., 2002, found airborne fungi values ( bioaerosols)
in the following ranges in the Northeast U.S. during the Summer: Indoor: range 10 - 2,200, 25th-75th percentile 10 - 400, median 100,
Outdoor: range 250 - 4,600, 25th-75th percentile 250 - 1,200, median 600 (Shelton, et al., 2002.) These values provide guidance, however,
because of the limitations described above, these data should be used as absolute reference values with caution.

It is important to remember that microorganisms (bacteria and fungi) are found everywhere in outdoor and indoor environments. Exposure
to microorganisms is unavoidable under normal conditions. Avoiding exposure to microorganisms is possible only through the
use of the most stringent air filtration, isolation, and environmental sanitation measures. There are beneficial microorganisms
and there are harmful microorganisms. Microorganisms, their spores, body parts, and metabolic products produce odors,
staining, deterioration, and human health problems. Microbes (bacteria and fungi) have four requirements for growth, moisture,
a carbon-based food source, temperature, and a receptive surface. Food sources include paper and wood building materials,
dust, and dirt. While the ambient air relative humidity in the building is important, it is the localized micro environment on
specific surfaces that is most important in promoting microbial growth. The moisture from natural or catastrophic water intrusions,
high relative humidity, or condensation when mixed with the nutrients that are available on virtually all surfaces provides an area conducive to
microbial growth. Microbes are very versatile and can grow in a wide range of temperatures. Temperatures above 65o F will allow growth and
above 80o F will allow rapid reproduction of many common problem causing species. Receptive surfaces are found on literally all building
materials, furnishings, equipment, and personal goods within a typical building.

3                Mold and Bacteria Health Impacts
It is fairly well understood that microorganisms cause health impacts including allergic effects, irritation effects, toxic effects, and infections.
Usually, we see these health impacts expressed as skin distress, eye distress, respiratory distress, throat irritation, cough,
headache, tissue intoxications and tissue infections. However, the specific functions of infectious microorganisms and
noninfectious microorganisms and their constituents on the health impacts related to indoor environments are not well
understood. Our lack of understanding of the role of microorganisms in the occurrence and development of these health impacts
is directly associated with our lack of valid, quantitative, exposure assessment methods for microorganisms. Additionally, we
also must consider lack of knowledge of the specific microorganisms that are responsible for specific health impacts. Indoor
environments have a complex blend of microorganism constituents including: live (viable) microorganisms, dead (nonviable)
microorganisms, their body parts, allergens, microbial volatile organic compounds (MVOCs), and other microorganism produced
chemicals.

Inhalation is presumed to be the most significant route of exposure for microorganisms (in this case bacteria and fungi). The majority of
fungal spores have aerodynamic diameters of 2-10 (micrometers) um (American Thoracic Society, 1997). Particles with these aerodynamic
diameters of 2-10 um settle out on surfaces within minutes for larger particles (10 um), and within hours for smaller particles (2um) (Hinds,
1982). Since the gravitational deposition rates for these large particles are greater than the ventilation and filtration rates in houses most
spores settle on indoor surfaces after being lifted in the air. These spores can be re-lifted into the air by turbulence such as walking
and cleaning (Thatcher & Layton, 1995). These particles can also be carried on a person, their clothes, and shoes and
belongings. These same dynamics also occur to transport microorganisms indoors from outdoors.

4                References

American Thoracic Society. 1997. American Thoracic Society Workshop, Achieving Healthy Indoor Air. American Journal of
Respiratory and Critical Care Medicine. 156(Supplement 3): 534-564.

Anderson, K., Morris, G.P., Kennedy, H., Croall, J, Michie, J., Richardson, M.D. & Gibson, B. (1996) Aspergillosis in immunocompromised
paediatric patients: associations with building hygiene, design and indoor air. Thorax, 51: 256-261.

Benensen, A.S. (1985) Control of Communicable Diseases Manual. Washington: American Public Health Association.

Burge, H.A. & Soloman, W.R. (1986) Sampling and analysis of biological aerosols. Atmospheric Environment Vol 21: 451-456.

Chew G, Douwes J, Doekes G, et al. Fungal extracellular polysaccharides, ß(1->3)-glucans, and culturable fungi in repeated sampling of house
dust. Indoor Air 2001;11:171–8.

Clark, S., Lach, V & Lidwell, O.M. (1981) The performance of the Biotest RCS centrifugal air sampler. Journal of Hospital Infection, 2: 181-186.

Cole EC, Cook CE (1998). Characterisation of infectious aerosols in health care facilities: an aid to effective engineering controls and
preventative strategies. Am J Infect Control 26: 453-464.

Gage, A.A. Dean, D.C. Schimert, G & Minsely, N. (1970) Aspergillus infection after cardiac surgery. Arch Surg, 101:384.

Goodley, J.M., Clayton, Y.M. & Hay, R.J. (1994) Environmental sampling for aspergilli during building construction on a hospital site, J. Hosp.
Infect., 26: 27-35.

Gustafson, T.L., Schaffner, W., Lavely, G.B., Stratton, C.W., Johnson, H.K. & Hutcheson Jr, R.H. (1983) Invasive aspergillosis in renal
transplant patients: correlation with corticosteroid therapy. J. Infect. Dis., 147:230-8.

Health Implications of Fungi in Indoor Environments (Eds. Sampson et al.). Elsevier, 1994, pp. 622.

Heederik D, Attfield M. Characterization of dust exposure for the study of chronic occupational lung disease: a comparison of different
exposure assessment strategies. Am J Epidemiol. 2000 May 15;151(10):982–990.

Heederik D, Douwes J, Thorne PS. Biological agents—evaluation. In: Perkins JL, ed. Modern industrial hygiene. Vol 2. Biological aspects.
Cincinnati, OH: American Conference of Governmental Industrial Hygienists, 2003:293–327.

Hospenthal DR, Kwon-Chung KJ, Bennett JE. (1998). Concentrations of airborne Aspergillus compared to the incidence of invasive
aspergillosis: lack of correlation. Medical Mycology 36: 165-168.

Hinds W.C. (1982). Aerosol Technology. New York. John Wiley & Sons.

Hunter CA, Grant C, Flannigan B, et al. Mould in buildings: the air spora of domestic dwellings. Int Biodeterior 1988;24:81–101.

Institute of Medicine, Committee on Damp Indoor Spaces and Health. Damp Indoor Spaces and Health. Institute of Medicine: The National
Academy Press. ISBN 0-309-09193-4. Washington, D.C. 2004, pp. 355.

Iwen PC et al. (1994). Airborne fungal spore monitoring in a protective environment during hospital construction, and correlation with an
outbreak of invasive aspergillosis. Infection Control and Hospital Epidemiology 15: 303-306.

Loo VG et al. (1996). Control of construction-associated nosocomila aspergillosis in an antiquated hematology unit. Infect Control Hosp
Epidemiol 17: 360-364.

Pennington, J.E. (1993) Aspergillus. In:Sarosi, G.A., Davies, S.F. (eds) Fungal Diseases of the Lung. 2nd edn. New York: Raven Press. pp133-
48.

Petherham,I.S. & Seal, R.M.E. (1976) Aspergillus prosthetic valve endocarditis. Thorax, 31: 380-90.

Philpott-Howard J (1996). Prevention of fungal infections in haematology patients. Infection Control and Hospital Epidemiology 17: 545-551.

Reponen T. (1995). Aerodynamic diameters and respiratory deposition estimates of viable fungal particles in mold problem dwellings. Aerosol
Science and Technology 22: 11-23.

Richardson, M.D. (1998) Aspergillus and Penicillium species. In: Topley and Wilson's Microbioogy and Microbial Infections, Volume 4: Medical
Mycology. Ajello, L. and Hay, R.J. (eds) London: Edward Arnold.

Richardson MD, Kokki M (1999). Aspergillus and aspergillosis. In: Clincial Mycology (Eds. Aniassie, Pfaller, McGinnis). Lippincott Williams and
Wilkins (in press).

Richardson MD, Kokki M (1999). Diagnosis and prevention of fungal infection in the immunocompromised patient. Blood Reviews 12: 241-254.

Richardson MD, et al (1999). Fungal surveillance of an open haematology ward. Journal of Hospital Infection (submitted for publication).

Rossi, G., Tortorana, A.M., Viviani, M.A., Pagona, A., Colledan, M. & Fassati, L.R. (1989) Aspergillus fumigatus infections in liver transplant
patients. Transplant Proc, 21: 2268-70.

Rotstein, C., Cummings, K.M., Tidings, J., Killion, K., Powell, E., Gustafson, T.L., Higby, D. et al. (1985) An outbreak of invasive aspergillosis
among allogenic bone marrow transplants: a case control study. Infect Control, 6: 347-55.

Seeliger, H.P.R. & Tintelnot, K. (1988) Epidemiology of aspergillosis. In: Vanden Bossche., H., Mackenzie, D.W.R. and Cauwenburgh, G.,
(eds). Aspergillus and aspergillosis. New York. Plenum.

Expert witness in biological, chemical, and
physical contaminants / indoor environmental
quality evaluations and remediation

Epidemiology and Toxicology Institute, LLC

SANDY VICTIMS and those who have been harmed by Natural or Man-Made Disasters
It pays in the long run to hire experts from the beginning. Remember you get what you pay for!
Always be careful of who you hire! Everyone claims to be an expert so make sure to check them out first!
Cleaning up right the first time is important! Your families health is at stake as is your pocket book!
Avoid having to do the work over a second time as so many have. It will cost more than doing it right from the start!
Dr. Gilbert is an Expert in biological, chemical, and physical contaminants. (mold, mildew,bacteria, poisons)
Indoor environmental evaluations and remediation is his specialty.
Dr. Gilbert does his own field work by day and teaches in the evenings plus EMT on weekends
Detailed test results by a certified Lab with a detailed report from an expert for your Insurance company or Attorney
Dr. Gilbert is an Expert witness in court giving Expert testimony, have your attorney call 631-868-3100

Google "expert in epidemiology and toxicology" or "expert epidemiologist and toxicologist" check us out first