Where Home and Health Intersect

Andrea Haugen, MPHHealthy Homes Program Chief

What hazards surround you at home?

Vermont Department of Health

Health issues related to housing conditions

Asthma Allergies Brain damage Behavior & learning problems Lung cancer Injuries Poisonings

Vermont Department of Health

“Mold” and “Mildew”

General terms used to describe fungus

There are many different types of fungi

Common throughout nature

Vary in color and appearance

There is no ‘black mold’

Just add Water

Mold is everywhere. All it needs to grow is:

Organic matter Food Furnishings, linens, clothing Building materials: carpet, wallboard, wood

Water / moisture Flood water Plumbing or roof leaks Relative humidity

Health Effects of Mold

Depends on the type of mold, and individual sensitivity: Irritation

Eye Nose Throat

Allergic symptoms Runny nose Congestion Sneezing

Asthma exacerbation Constriction of airways

Fungal infections – rare, but possible Refer to physician for all health

effects

Normal Airway

Constricted Asthmatic Airway

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Mold – What do you tell clients?

Fix leaky roofs, gutters, windows, and pipes.

Direct water away from the building foundation to keep it from seeping into the basement.

Use the right type and amount of insulation in areas above the ceiling and in exterior walls.

Vent clothes dryers and kitchen and bathroom fans to the outdoors.Rental Health Code Tip: Landlords

do not have to fix mold, but they do have to fix what is causing the mold.

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Mold – What do you tell clients?

Use kitchen and bathroom fans. Keep humidity levels at 40 –

60%. Use a dehumidifier to dry out

damp areas. Clean hard items and building

materials with soap and water Wash soft items that can be

laundered (such as clothes or linens)

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Pests

Most Common:Rats and miceRoachesFleasBedbugsHouse fliesMosquitoesDust mites

Health effects associated with pesticides include:

— Eye, nose, throat irritation

— Skin rashes, stomach cramps, nausea

— Trigger/Cause asthma and allergies

— Disease

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What all pests need

Food

Water

Shelter

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Integrated Pest Management

Keep them out and give them no place to hide Change surrounding landscape Block pest entries, passages, hiding places

Reduce food availability Practice proper food storage and disposal No dirty dishes in the sink overnight Clean crumbs, grease etc.

Knock down population Traps Appropriate pesticides

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PesticidesProblems with PesticidesPesticides that look like candyInsecticide chalk (aka Miraculous or Chinese chalk)Pesticide Poisoning

Almost half of all households with children under five stored pesticides within reach of children.

In 2003, Poison Control Centers reported 113,000 cases of pesticide poisoning.

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Pests - What do you tell clients?

Contact your landlord right away about pest problems. Clean up food or crumbs. Wrap food and put it in the refrigerator, or in a cabinet if tightly

sealed. Do not leave dirty dishes out overnight. Mop and vacuum regularly. Take garbage to the trash area at least once a week (or every

day if you have pests). Clean up clutter that provides hiding places for pests. Minimize pesticide use. If you use pesticides, make sure to follow

the directions on the label. Don’t use sprays or foggers. Seal holes in walls, floors and ceilings to prevent pests from

coming in. Use baits, traps, or gels to kill pests. Repair water leaks or damage.

Special Topic: Bed Bugs and You

If you discover bed bugs in the home during your visit, remain calm! Try to sit on hard chairs, not on beds or plush furniture.When you return to your vehicle, check your clothing. The back of your pants, tread of your shoes, shoe laces, socks, cuffs and collar. When returning home, if possible remove clothing before entering.Immediately place your clothes in the washer with hot soapy water. Place shoes in a hot dryer for 30 minutes. Your clothes, including shoes, can be tumbled in the dryer on high for 30 minutes.You should check the vehicle after treating your clothes and yourself.

Protect yourself and other clients by using:A fanny pack for holding personal items like your identification and cell phone A change of clothes and shoes (kept in your vehicle) A plastic storage container with a sealed lid that is large enough to contain the suggested items or items that you

might suspect to be infested

Vermont Department of Health

Lead: Sources of Exposure

Paint, interior dust, exterior dust or soil

1978: lead-based paint banned for residential use

Remains present in older homes 1970s – 1995: gradual

reduction/ removal from gasoline

Tap Water Corrosion in distribution

systems Household plumbing

Sources of Lead Exposure: VT Housing

Lead-based paint in housing is the primary source of lead poisoning in Vermont 34.5% of houses built prior to 1950 69% of houses built prior to 1978

More Sources of Lead Exposure

CPSC Recalls: Toys, jewelry, apparel,

coin purses, hockey sticks!

Vermont cases: Keys, fish weights, lead

shot, furniture, salvaged building materials

Other: ceramics/pottery; folk remedies; work sources

Why Children are at Risk

Increased hand-to-mouth behavior Lead dust on floors (crawling) and window sills Lead in soil Product exposure:

Toys Imported goods/candy

Absorb more lead than adults Children – 30-50% of lead Adults – 5-10% of lead

Consequences of Lead

“An overwhelming body of research shows long-term and irreversible cognitive and behavioral effects with even mildly elevated blood lead levels

in young children.” -Commissioner Harry Chen

March 2014 letter to health care providers

There is no safe level of lead in the body. Consequences of lead poisoning can range from lower IQ and learning disabilities to coma and death.

Department of Health Program Support

Provider OutreachAll children should be tested for lead at age 1 and again at age 2.

5-9 µg/dL OutreachInformation sent to families whose children test between 5-9 µg/dL (venous/cap)

Packet includes an offer for a free dust wipe kitPhone education when a child has a venous confirmed BLL at 5-9 µg/dL

Case Management and Environmental Investigation Services Offered when child has a venous confirmed BLL of 10 µg/dL Healthy homes assessment completed with lead investigation

Lead – What do you tell clients?

Leave your shoes at the door. Wet mop and wet clean. Use a HEPA vacuum. Wash children’s hands often, especially before meals

and naps. Run water until cold for cooking, drinking, and making

formula. Block access to chipping, peeling, cracked or disturbed

paint. Use lead-safe work practices such as wet sanding and

wet scraping.

Tips for Renters in pre-1978 Rentals: Under Vermont law, landlords should have a poster up with a number to call to report deteriorated paint and should give tenants an updated Essential Maintenance Compliance Statement once a year.

Asthma and Asthma Triggers

Vermont Department of Health

Asthma is now the number one cause of hospitalization for children

New England has the highest rate of diagnosed asthma of any region in the United States

1 in 8 adults in New England has asthma.The most common trigger for asthma in kids and adults is dust.

Asthma – What to tell clients?

Vermont Department of Health

Mop and vacuum regularly. Use a vacuum with a HEPA filter Use green cleaning products Dust and vacuum when asthmatic person is not present.

If possible replace and avoid curtains, drapes, and carpet to reduce dust exposure.

Use window treatments that can be wiped. Remove air fresheners and candles. Identify possible sources of moisture and mold

Avoid tobacco smoke Control pest infestations.

Minimize pesticide use. If have pets, do not allow in bedrooms.

Dust Mites and Asthma-What to tell clients?

Vermont Department of Health

Encase all pillows and mattresses of the beds with allergen impermeable encasings

Wash bedding weekly to remove allergen

Wash in HOT water (120ºF) to kill mites

For non-encased bedding (e.g. blankets and quilts) choose items that can withstand frequent hot water washing

Remove or wash and dry stuffed toys weekly

Avoid humidifiers

Homes with high humidity can have a lot of dust mites. With a drier house, dust mites are limited to things like blankets, pillows and stuffed toys.

Safety

Vermont Department of Health

What are the most common causes of home injury deaths?

1. Falls (particularly for the elderly)

2. Poisoning

3. Fires and burns

Safety

Vermont Department of Health

Are all the exits out of the building free of obstructions and able to be used?

Does each bedroom have a window that can be easily opened and is large enough for emergency rescue or escape?

Does each dwelling unit have 2 separate ways out?

Safety

Vermont Department of Health

Is there a working smoke alarm? On each level including the basement

Is there a working carbon monoxide alarm? In the vicinity of each bedroom In each room used for sleeping that

contains a fuel burning appliance

Health Hazard - Carbon Monoxide

Vermont Department of Health

What is Carbon Monoxide (CO)?Incomplete combustion of natural gas and carbonPoisonous, colorless, odorless, and tasteless gas.

Why is CO harmful?When breathed it displaces oxygen in the blood and deprives the heart, brain, and other vital organs of oxygen.

What are the symptoms of CO poisoning?HeadacheFatigueDizzinessDrowsinessNausea

Vermont Department of Health

Sources of COBack-drafting ChimneyWoodstoves and fireplacesGas water heaters Gas ovens and stoves Dryers not venting to the outside and clogged vents Kerosene or gas space heaters

Health Hazard - Carbon Monoxide

Carbon Monoxide – What to tell clients?

Vermont Department of Health

Use exhaust fans when cooking or bathing and check that they work properly.

Install a carbon monoxide alarm.

Check that smoke and carbon monoxide alarms work properly. Replace batteries twice a year.

Never use charcoal grills inside.

Open a window if you use unvented kerosene or gas heaters.Have dryers vent outside and keep

vents unclogged.

Safety

Is the home child-proofed?

Vermont Department of Health

Poisonings – What to tell clients?

Vermont Department of Health

Post the poison control number, 1-800-222-1222 near the phone or put it in your cell phone.

Lock up medicines in a location that is too high for young children to reach or see.

Children learn by imitation. Take your own medicines where children can’t watch.

Never leave medicine or vitamins out on a kitchen counter or at a sick child’s bedside, even if you are just going to answer the phone or the door.

Never tell children medicine is candy so they’ll take it.

Ask babysitters and guests to keep purses or bags that have medicines in them out of reach.

Safety

Vermont Department of Health

WaterIs the water able to come to non-scalding hot temperature?

Less than 120ºF

If on a private system, was the water tested within the last 5 years?

Total coliform bacterial test every year (Kit A) Inorganic chemical test every 5 years (Kit C) Gross alpha radiation screen every 5 years (Kit RA)

Rental Health Code Tip: Landlords are required to provide safe and potable water, but not ‘required’ to test

Questions?

Vermont Department of Health