NIOSH to study spa mold in nationwide research

Health hazards include respiratory problems

A case of being in the right place at the right time — or perhaps, more accurately, the wrong place at the right time — led to an on-site visit by the National Institute for Occupational Safety and Health (NIOSH) at the Grove Park Inn Resort Spa in Asheville, NC, and a plan to mitigate a health hazard that had been causing employees to complain of conditions including pneumonia, head-aches, sore throats, and burning and watery eyes.

Such complaints might more typically be handled over the phone, but they happened to coincide with the criteria for a national research study planned by NIOSH centering on Stachybotrys chartarum, a fungus often found in the indoor environment.

"We have a health hazard evaluation program through which we can be asked for assistance by employers or employees, or an organized group like a union," explains Ken Wallingford, CIH, indoor environmental quality research coordinator in the Morgantown, WV, laboratory field office of NIOSH. "Typically, they are handled by phone, as we get about 150 a year. But they had a working population that was relatively large — about 32 employees who seemed like they had potentially been exposed to Stachybotrys chartarum. So we paid them a visit, collected bulk samples, had them analyzed, and they came back positive. So we asked them if they wanted to be involved in our research study."

The initial health-related complaints came from three spa employees. It is not so surprising that an environment like this could be the source of such a problem, as Stachybotrys chartarum is known to grow in areas with excessive humidity, water damage, flooding, and condensation. The spa features several underground waterfalls, pools, and massage treatment rooms.

Impetus for the study

What led NIOSH to undertake this study? "Back in 1994, there was an outbreak of young children’s deaths in Cleveland from pulmonary idiopathic hemorrhage," Wallingford recalls. "Researchers from the CDC had hypothesized this had been due to the mycotoxins produced by Stachybotrys chartarum. This created a toxic mold scare not unlike what happened in the ’80s with asbestos."

A subsequent CDC review by internal and external expert panels, however, concluded there was not enough information in the original study to make a definite link. "It’s still an open question: Do mycotoxins really cause considerable health risks at the levels at which they are seen indoors?" There are usually huge exposures in an agricultural, or outdoor, setting.

This is an important occ-health question, Wallingford continues, "because we’ve never been able make a direct link between health symptoms of workers exposed to this mold and the mycotoxins produced by this mold."

One of the goals of the study is to determine whether stachylysin, a blood protein, is related to mold exposure. A NIOSH medical officer took blood samples from 32 inn workers to test for the protein.

"Now that researcher have blood proteins that are thought to be produced from exposure to specific molds, if it proved that this is a good bio-marker of exposure, it may be one sure way to link exposure to a particular mold and maybe to determine if the symptoms are caused by a particular mycotoxin," Wallingford explains.

At really high doses, such as found in agriculture, mycotoxin does cause internal hemorrhage, says Wallingford. "At lower levels, there is a variety of different conditions that have been suggested, but never proved."

Benefits for Grove Park

While it is far too early in the process for any answers to be given, the Grove Park resort already has benefited. "Since this came to us as a health hazard request from employees, we didn’t just do a research study," says Wallingford. "There was enough environmental data there to help them identify where the problem was and to take proactive steps to fix it — which they’ve done."

NIOSH told the spa specifically where the problem areas were and suggested they be cleaned up and that the water damage be repaired. "We told them where their moisture problems were and, through an outside consulting group, they developed their own proactive remediation," says Wallingford. "We did not specify what they needed to do — just what the problem was and where it was."

As for the nationwide study, it currently is just in the pilot phase, reports Wallingford. "I think we can get enough people — 100 or so individuals who’ve been exposed and [a like number of] controls — to give us a good idea of whether this a viable biomarker of exposure," he notes. "Then, if the answer is yes, we can go on to a larger study."

In this phase, Wallingford adds, he is looking for five or six facilities, which he hopes to sign up by September. "We are actively recruiting," he asserts, noting that worksites that are interested in participating can contact him directly.

The results of the study could be of great benefit to employers and employees, Wallingford says. "It would be a very quick, easy, and inexpensive way to determine if a worker has been exposed to a mycotoxin-producing mold," he asserts.

[For more information or to volunteer your worksite for the NIOSH study, contact:

  • Ken Wallingford, CIH, Indoor Environmental Quality Research Coordinator, NIOSH Laboratory Field Office, Morgantown, WV. Telephone: (513) 841-4327. E-mail:]