Question

Case Study There two sets of questions for this module, 1-4 and 5-8, for a total of eight questions. Using the concept of the epidemiological triangle to complete one of the following case studies: John J. is a school nurse at Jackson Elementary School, which was built in 1960. Nurse John has noticed that many students from Ms. Zee’s second grade class have come to the clinic complaining about coughing, sneezing, runny nose, and watery eyes. Nurse John has also observed that Steven Tea, the only asthmatic student in Ms. Zee’s class, has had more asthma attacks this year than he did last year. Because the rest of the school is not experiencing the same respiratory problems, Nurse John is concerned that something in Ms. Zee’s classroom is causing students to feel ill. Nurse John decides to visit Ms. Zee’s classroom. Upon entering the classroom, one of the few located in the school’s basement, John is struck by the powerful musty smell that inhabits the room. While talking to Ms. Zee, John learns that the classroom has “smelled bad for years,” and that students from previous years have complained about respiratory problems. Nurse John notes that Ms. Zee has stuffed a blanket at the base of the classroom’s small rectangular window near the ceiling because the window does not close completely. John suspects that Ms. Zee’s classroom walls are contaminated with mold. Upon further research, Nurse John learns that if water gets between the exterior and the interior of a building’s wall, mold can grow in the moist environment. This situation can occur as the result of construction defects in the building (e.g., leaky windows). Nurse John also learns that people who are exposed to extensive mold growth may experience allergic reactions, such as hay fever-like allergy symptoms, and that people who already have a chronic respiratory disease, such as asthma, may have trouble breathing when exposed to mold. Nurse John is concerned about the possible mold contamination effect on his asthmatic student, Steven.

1. Identify the agent, host, and environment in this case study, and describe how they interacted to bring about the occurrence of disease.

2. Is the mold contamination in Ms. Zee’s room a point-source pollutant or a non–point-source pollutant?

3. What can Nurse John do to learn more about indoor air quality (IAQ) and about what to do in case of mold?

4. What are some possible interventions that Nurse John could apply to address the mold contamination in Ms. Zee’s room?

This information is related to the primary care provider who orders a blood lead level, which comes back at 45 mcg/dL. On further investigation you discover that Billy’s home was built before 1950. At that time the home is tested, and the dust shows high lead levels. Due to Billy’s age and associated behaviors, such as hand to mouth activities, you determine that the lead dust in the home is a probable exposure, and that Billy should not return to the home. You must also consider multiple sources of exposures.

5.What other sources of exposure might exist?

6.What would you include in an assessment of this situation?

7.What prevention strategies would you use to resolve this issue? At the individual level? The population levels?

Answer 1

1. Agent :- The agent is the microorganism that actually causes the disease.In this case it is Mold ( Molds are a form of fungus Eg :Aspergillus)

Host   :- The agent infects the host,and get sick or carry an agent because some part of their physiology is hospitable or attractive to the agent.Here Students in the class room are the host.

Environment :- The environment includes any factors that affect the spread of the disease but are not directly a part of the agent or the host.In this case areas where leakages and flooding have occurred, places where the air does not circulate, and Wet cellulose materials are most supportive of mold growth.

            Mold growth is usually visible and often produces a musty odor . Mold can pose a health problem, especially   for people with an allergy, an existing respiratory problem, or a weakened immune system. As mold grows, spores, cells, fragments, and unstable organic compounds can enter the air. They can produce allergens, irritants, and mycotoxins. Some of these can be toxic, especially to individuals who have a sensitivity to them. Also, dampness encourages materials to break down, increasing the volume of particles, or dust, in the air. These particles can irritate the lungs, nose, and throat, especially in a person who already has a breathing problem, asthma, or a chronic lung condition

2.Point source pollution is defined as coming from a single point, such as a factory or sewage treatment plant.and Nonpoint-source pollution is the opposite of point-source pollution, with pollutants released in a wide area.

So the mold contamination can be considered as a non point source pollutant.

3. Indoor Air Quality (IAQ) refers to the air quality within and around buildings and structures, especially as it relates to the health and comfort of building occupants. Understanding and controlling common pollutants indoors can help reduce your risk of indoor health concerns.

Determination of IAQ involves the collection of air samples, monitoring human exposure to pollutants, collection of samples on building surfaces, and computer modelling of air flow inside buildings.

IAQ is part of indoor environmental quality (IEQ), which includes IAQ as well as other physical and psychological aspects of life indoors (e.g., lighting, visual quality, acoustics, and thermal comfort).^[1]

In our case ;-

* Assessing Exposure to Mold

        a. Exposure Assessment –

        b. Visual Inspection and Moisture Assessment

        c. Sampling for Mold,

        d. Assessment of Microorganisms.

4.Possible interventions - Removing mold problems requires a series of actions

• 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.

*Personal Protective Equipment and Respiratory Protection (dust masks etc)

*Application of physical method ( mechanical thermal , and electrical fields) to remove mold cells and spores)

*Application of antimicrobial products (chemical warfare)

* Ensure regular ventilation (complete opening of the windows for 5–10 min) and adequate heating (especially in winter) in order to keep the humidity as low as possible.

* Add mold inhibitors to wall paint