Introduction:

Fungi (mold) are present almost everywhere. In an indoor environment hundreds of different kinds of mold are able to grow wherever there is moisture and an organic substrate (food source). They can grow on building and other materials, including: the paper on gypsum wallboard (drywall); ceiling tiles; wood products; paint; wallpaper; carpeting; some furnishings; books/papers; clothes; and other fabrics. Mold can also grow on moist, dirty surfaces such as concrete, fiberglass insulation, and ceramic tiles. It is neither possible nor warranted to eliminate the presence of all indoor fungal spores and fragments; however, mold growth indoors can and should be prevented and removed if present.

The purpose of these guidelines is to provide an approach to address potential and observed mold growth on structural materials in commercial, school, and residential buildings. Mold growth in critical care areas of health-care facilities such as intensive care units or surgery suites may pose significant health concerns to patients. This document is not intended for such situations. Mold on bathroom tile grout, in shower stalls, and on bathtubs is a common occurrence. Occupants can control this growth through frequent use of household cleaners.

Water accumulation in indoor environments can lead to mold growth (and other environmental problems), which has been associated with human health effects (see Appendix A). Indoor mold growth can be prevented or minimized, however, by actively maintaining, inspecting, and correcting buildings for moisture problems and immediately drying and managing water-damaged materials. In the event that mold growth does occur, this guide is intended to assist those responsible for maintaining facilities in evaluating and correcting this problem.

Removing mold growth and correcting the underlying cause of water accumulation can help to reduce mold exposures and related health symptoms. Prompt remediation of mold-damaged materials and infrastructure repair should be the primary response to mold growth in buildings. The simplest, most expedient remediation that properly and safely removes mold growth from buildings should be used. Extensive mold growth poses more difficult problems that should be addressed on a case-by-case basis in consultation with an appropriate building or environmental health professional. In all situations, the source of water must be identified and corrected or the mold growth will recur.

Environmental Assessment:

The presence of mold growth, water damage, or musty odors should be addressed quickly. In all instances, any sources of water must be identified and corrected and the extent of water damage and any mold growth determined. Water-damaged materials should be removed or cleaned and dried. For additional information on cleaning water-damaged materials and personal belongings, refer to the EPA document "Mold Remediation in Schools and Commercial Buildings."

A trained building or environmental health professional may be helpful in assessing the extent of the moisture problem and mold growth and developing a site-specific work plan. The presence of a trained professional to provide oversight during remediation can also be helpful to ensure quality work and compliance with the work plan. According to the American Industrial Hygiene Association a trained professional should have, at a minimum, a relevant science or engineering degree and two years of full-time supervised experience in mold assessment.

Visual Inspection:

A visual inspection is the most important initial step in identifying a possible mold problem and in determining remedial strategies. The extent of any water damage and mold growth should be visually assessed and the affected building materials identified. A visual inspection should also include observations of hidden areas where damages may be present, such as crawl spaces, attics, and behind wallboard. Carpet backing and padding, wallpaper, moldings (e.g. baseboards), insulation and other materials that are suspected of hiding mold growth should also be assessed.

Ceiling tiles, paper-covered gypsum wallboard (drywall), structural wood, and other cellulose-containing surfaces should be given careful attention during a visual inspection. Ventilation systems should be visually checked for damp conditions and/or mold growth on system components such as filters, insulation, and coils/fins, as well as for overall cleanliness.

Equipment such as a moisture meter or infrared camera (to detect moisture in building materials) or a bore scope (to view spaces in ductwork or behind walls) may be helpful in identifying hidden sources of mold growth, the extent of water damage, and in determining if the water source is active.

Using personal protective equipment such as gloves and respiratory protection (e.g. N-95 disposable respirator) should be considered if assessment work might disturb mold. Efforts should also be made to minimize the generation and migration of any dust and mold.

Environmental Sampling:

Environmental sampling is not usually necessary to proceed with remediation of visually identified mold growth or water-damaged materials. Decisions about appropriate remediation strategies can generally be made on the basis of a thorough visual inspection. Environmental sampling may be helpful in some cases, such as, to confirm the presence of visually identified mold or if the source of perceived indoor mold growth cannot be visually identified.

If environmental samples will be collected, a sampling plan should be developed that includes a clear purpose, sampling strategy, and addresses the interpretation of results. Many types of sampling can be performed (e.g. air, surface, dust, and bulk materials) on a variety of fungal components and metabolites, using diverse sampling methodologies. Sampling methods for fungi are not well standardized, however, and may yield highly variable results that can be difficult to interpret. Currently, there are no standards, or clear and widely accepted guidelines with which to compare results for health or environmental assessments.

Environmental sampling should be conducted by an individual who is trained in the appropriate sampling methods and is aware of the limitations of the methods used. Using a laboratory that specializes in environmental mycology is also recommended. The laboratory should be accredited in microbiology by an independent and reputable certifying organization.

Remediation:

The goal of remediation is to remove or clean mold-damaged materials using work practices that protect occupants by controlling the dispersion of mold from the work area and protect remediation workers from exposures to mold. The listed remediation methods were designed to achieve this goal; however, they are not meant to exclude other similarly effective methods and are not a substitute for a site-specific work plan. Since little scientific information exists that evaluates the effectiveness and best practices for mold remediation, these guidelines are based on principles used to remediate common indoor environmental hazards. These guidelines are not intended for use in critical care facilities such as intensive care units, transplant units, or surgical suites.

Prior to any remediation, consideration must be given to the potential presence of other environmental hazards, such as asbestos and lead. These guidelines are based on possible health risks from mold exposure and may be superseded by standard procedures for the remediation of other indoor environmental hazards.

Moisture Control and Building Repair:

In all situations, the underlying moisture problem must be corrected to prevent recurring mold growth. Indoor moisture can result from numerous causes, such as: façade and roof leaks; plumbing leaks; floods; condensation; and high relative humidity. An appropriate building expert may be needed to identify and repair building problems. An immediate response and thorough cleaning, drying, and/or removal of water-damaged materials will prevent or limit microbial growth.

Relative humidity should generally be maintained at levels below 65% to inhibit mold growth. Short-term periods of higher humidity would not be expected to result in mold growth. However, condensation on cold surfaces could result in water accumulation at much lower relative humidity levels. Relative humidity should be kept low enough to prevent condensation on windows and other surfaces.

Emphasis should be placed on ensuring proper repairs of the building infrastructure so that water intrusion and moisture accumulation is stopped and does not recur.

Worker Training:

Proper training of workers is critical in successfully and safely remediating mold growth. Training topics that should be addressed include:

• Causes of moisture intrusion and mold growth
• Health concerns related to mold exposure
• The use of appropriate personal protective equipment
• Mold remediation work practices, procedures, and methods

For additional information, the National Institute of Environmental Health Sciences’ publication, "Guidelines for the Protection and Training of Workers Engaged in Maintenance and Remediation Work Associated with Mold" lists minimum training criteria for building maintenance and mold remediation workers that should be completed before addressing indoor mold growth.

Trained building maintenance staff can address limited and occasional mold growth. For larger jobs, more extensively trained mold remediation workers may be needed.

Cleaning Methods:

Non-porous materials (e.g. metals, glass, and hard plastics) can almost always be cleaned. Semi-porous and porous structural materials, such as wood and concrete can be cleaned if they are structurally sound. Porous materials, such as ceiling tiles and insulation, and wallboards (with more than a small area of mold growth) should be removed and discarded. Wallboard should be cleaned or removed at least six inches beyond visually assessed mold growth (including hidden areas, see Visual Inspection) or wet or water-damaged areas. A professional restoration consultant should be contacted to restore valuable items that have been damaged.

Cleaning should be done using a soap or detergent solution. Use the gentlest cleaning method that effectively removes the mold to limit dust generation. All materials to be reused should be dry and visibly free from mold. Consideration should also be given to cleaning surfaces and materials adjacent to areas of mold growth for settled spores and fungal fragments. A vacuum equipped with a High-Efficiency Particulate Air (HEPA) filter could also be used to clean these adjacent areas.

Disinfectants are seldom needed to perform an effective remediation because removal of fungal growth remains the most effective way to prevent exposure. Disinfectant use is recommended when addressing certain specific concerns such as mold growth resulting from sewage waters. If disinfectants are considered necessary, additional measures to protect workers and occupants may also be required. Disinfectants must be registered for use by the Canadian Environmental Protection Agency (CEPA). Any antimicrobial products used in a HVAC system must be EPA-registered specifically for that use.

The use of gaseous, vapor-phase, or aerosolized (e.g. fogging) biocides for remedial purposes is not recommended. Using biocides in this manner can pose health concerns for people in occupied spaces of the building and for people returning to the treated space. Furthermore, the effectiveness of these treatments is unproven and does not address the possible health concerns from the presence of the remaining non-viable mold.

Quality Assurance Indicators:

Measures to ensure the quality and effectiveness of remediation should be undertaken regardless of the project size. Evaluations during as well as after remediation should be conducted to confirm the effectiveness of remedial work, particularly for large-scale remediation. At minimum, these quality assurance indicators should be followed and documented:

• The underlying moisture problem was identified and eliminated
• Isolation of the work area was appropriate and effective
• Mold removal and worksite cleanup was performed according to the site-specific plan
• Any additional moisture or mold damage discovered during remediation was properly addressed
• Upon completion of remediation, surfaces are free from visible dust and debris.
• If environmental sampling was performed, the results of such sampling were evaluated by a trained building or environmental health professional.10
• Restoring Treated Spaces

After completing mold remediation and correcting moisture problems, building materials that were removed should be replaced and brought to an intact and finished condition. The use of new building materials that do not promote mold growth should be considered. Anti-microbial paints are usually unnecessary after proper mold remediation. They should not be used in lieu of mold removal and proper moisture control, but may be useful in areas that are reasonably expected to be subject to moisture.

Remediation Procedures:

Three different sizes of remediation and the remediation of heating, ventilation, and air-conditioning (HVAC) systems are described below. Currently, existing research does not relate the amount of mold growth to the frequency or severity of health effects. However, as the presence of moldy materials increases, so does the potential for exposure8 and the need to limit the spread of mold-containing dusts and worker exposures. As such, the size of the area impacted by mold growth as well as practical considerations was used to help define remedial procedures.

Since the following areas were arbitrarily selected, site-specific conditions must be considered in choosing adequate remediation procedures. For more information on the unique characteristics of building types and occupancies that may influence remediation procedures refer to the Canadian Industrial Hygiene Association’s publication, "Recognition, Evaluation, and Control of Indoor Mold.

1. Remediation can be conducted by trained building maintenance staff. Such persons should receive training on proper cleaning methods, personal protection, and potential health hazards associated with mold exposure. This training can be performed as part of a program to comply with the requirements of the OSHA Hazard Communication Standard
2. Respiratory protection (e.g., N-95 disposable respirator), in accordance with the OSHA respiratory protection standard is recommended.
   Gloves and eye protection should also be worn.
3. The work area should be unoccupied.
4. If work may impact difficult-to-clean surfaces or items (e.g. carpeting, electronic equipment), the floor of the work area, egress pathways, and other identified materials/belongings should be removed or covered with plastic sheeting and sealed with tape before remediation.
5. Efforts should be made to reduce dust generation. Dust suppression methods particularly during any cutting or resurfacing of materials are highly recommended. Methods to consider include: cleaning or gently misting surfaces with a dilute soap or detergent solution prior to removal; the use of High-Efficiency Particulate Air (HEPA) vacuum-shrouded tools; or using a vacuum equipped with a HEPA filter at the point of dust generation. Work practices that create excessive dust should be avoided.
6. Moldy materials that can be cleaned should be cleaned using a soap or detergent solution. Materials that cannot be cleaned should be removed from the building in a sealed plastic bag(s). Plastic sheeting should be discarded after use. There are no special requirements for the disposal of moldy materials.
7. The work area and areas used by workers for egress should be HEPA-vacuumed (a vacuum equipped with a High-Efficiency Particulate Air filter) or cleaned with a damp cloth and/or mop and a soap or detergent solution.
8. All areas should be left dry and visibly free from mold, dust, and debris. Check that other quality assurance indicators (see Quality Insurance Indicators) have also been met.

Medium-Sized Isolated Areas (10 – 100 square feet):

1. Remediation can be conducted by trained building maintenance staff. Such persons should receive training on proper cleaning methods, personal protection, and potential health hazards associated with mold exposure. This training can be performed as part of a program to comply with the requirements of the OSHA Hazard Communication Standard.
2. Respiratory protection (e.g., N-95 disposable respirator), in accordance with the OSHA respiratory protection standard (29 CFR 1910.134), is recommended. Gloves and eye protection should also be worn.
3. The work area should be unoccupied.
4. Cover the floor, egress pathways, and items left in the work area with plastic sheeting and seal with tape before remediation.
5. Seal ventilation ducts/grills and other openings in the work area with plastic sheeting. The HVAC system servicing this area may need to be shut down to properly seal vents.
6. Efforts should be made to reduce dust generation. Dust suppression methods particularly during any cutting or resurfacing of materials are highly recommended. Methods to consider include: cleaning or gently misting surfaces with a dilute soap or detergent solution prior to removal; the use of High-Efficiency Particulate Air (HEPA) vacuum-shrouded tools; or using a vacuum equipped with a HEPA filter at the point of dust generation. Work practices that create excessive dust should be avoided.
7. Moldy materials that can be cleaned should be cleaned using a soap or detergent solution. Materials that cannot be cleaned should be removed from the building in sealed plastic bags. Plastic sheeting should be discarded after use. There are no special requirements for disposal of moldy materials.
8. The work area and areas used by workers for egress should be HEPA-vacuumed and cleaned with a damp cloth and/or mop and a soap or detergent solution.
9. All areas should be left dry and visibly free from mold, dust, and debris. Check that other quality assurance indicators (see Quality Insurance Indicators) have also been met.

Large Areas (greater than 100 square feet in a contiguous area) – e.g. on separate walls in a single room:

Properly trained and equipped mold remediation workers should conduct the remediation. The presence of a trained building or environmental health professional (see Environmental Assessment) to provide oversight during remediation may be helpful to ensure quality work and compliance with the work plan. The following procedures are recommended:

1. Personnel trained in the handling of mold-damaged materials equipped with:
1. A minimum of half-face elastomeric respirators with P-100 filters used in accordance with the OSHA respiratory protection standard.
2. Full body coveralls with head and foot coverings
3. Gloves and eye protection
2. Containment of the affected area:
1. The HVAC system servicing this area should be shut down during remediation.
2. Isolation of the work area using plastic sheeting sealed with duct tape. Furnishings should be removed from the area.
   Ventilation ducts/grills, any other openings, and remaining fixtures/furnishings should be covered with plastic sheeting sealed with duct tape.
3. Consider using an exhaust fan equipped with a HEPA filter to generate negative pressurization.
4. Consider using airlocks and a clean changing room.
5. Egress pathways should also be covered if a clean changing room is not used.
3. The work area should be unoccupied.
4. Efforts should be made to reduce dust generation. Dust suppression methods particularly during any cutting or resurfacing of materials are highly recommended. Methods to consider include: cleaning or gently misting surfaces with a dilute soap or detergent solution prior to removal; the use of High-Efficiency Particulate Air (HEPA) vacuum-shrouded tools; or using a vacuum equipped with a HEPA filter at the point of dust generation. Work practices that create excessive dust should be avoided.
5. Moldy materials, that can be cleaned, should be cleaned using a soap or detergent solution. Materials that cannot be cleaned should be removed from the building in sealed plastic bags. The outside of the bags should be cleaned with a damp cloth and a soap or detergent solution or HEPA-vacuumed in the work area (or clean changing room) prior to their transport to unaffected areas of the building.
   There are no special requirements for the disposal of moldy materials.
6. Before leaving isolated areas, workers should remove disposable clothing to prevent the tracking of mold-containing dusts outside of the work area.
7. The work area and egress pathways (and clean changing room if present) should be HEPA-vacuumed and cleaned with a damp cloth and/or mop with a soap or detergent solution and be visibly clean prior to the removal of isolation barriers. Plastic sheeting should be discarded after use.
8. All areas should be left dry and visibly free from mold, dust, and debris. Check that other quality assurance indicators (see Quality Insurance Indicators) have also been met.

Remediation of HVAC Systems:

Mold growth in heating, ventilation, and air-conditioning (HVAC) systems can pose building-wide problems. Obtaining professional help should always be considered in addressing even small amounts of mold growth or moisture problems within an HVAC system. Recurring problems, regardless of size, may indicate a systemic problem and appropriate professional help should be sought.

Small Isolated Area of Mold Growth in the HVAC System (<10 square feet) – e.g. box filter, small area on insulation

1. Remediation can be conducted by trained building maintenance staff that is familiar with the design and function of the impacted HVAC system. Such persons should receive training on proper cleaning methods, personal protection, and potential health hazards. This training can be performed as part of a program to comply with the requirements of the OSHA Hazard Communication Standard.
2. Respiratory protection (e.g. N-95 disposable respirator), in accordance with the OSHA respiratory protection standard (29 CFR 1910.134), is recommended. Gloves and eye protection should be worn.
3. The HVAC system should be shut down prior to any remedial activities.
4. Efforts should be made to reduce dust generation. Dust suppression methods particularly during any cutting or resurfacing of materials are highly recommended. Methods to consider include: cleaning or gently misting surfaces with a dilute soap or detergent solution prior to removal; the use of High-Efficiency Particulate Air (HEPA) vacuum-shrouded tools; or using a vacuum equipped with a HEPA filter at the point of dust generation. Work practices that create excessive dust should be avoided.
5. The use of plastic sheeting to isolate other sections of the system should be considered.
6. Moldy materials that can be cleaned should be cleaned using a soap or detergent solution. Growth-supporting materials that are moldy, such as the insulation of interior-lined ducts, flexible ducts, and filters, should be removed and sealed in plastic bags. There are no special requirements for the disposal of moldy materials.
7. The work area and areas used for egress should be HEPA-vacuumed and cleaned with a damp cloth and/or mop and a soap or detergent solution. Any plastic sheeting should be discarded after use.
8. All areas should be left dry and visibly free from mold, dust and debris. Check that other quality assurance indicators (see Quality Insurance Indicators) have also been met.

Large Area of Mold Growth in the HVAC System (>10 square feet):

Properly trained and equipped mold remediation workers with specific training and experience in HVAC systems, should conduct the remediation. The presence of a trained building or environmental health professional (see Environmental Assessment) with experience and specific knowledge of HVAC systems, to provide oversight during remediation can be helpful to ensure quality work and compliance with the work plan. The following procedures are recommended:

1. Personnel trained in the handling of mold-damaged materials equipped with:
1. A minimum of half-face elastomeric respirators with P-100 filters used in accordance with the OSHA respiratory protection standard.
2. Full body coveralls with head and foot coverings
3. Gloves and eye protection
2. The HVAC system should be shut down prior to any remedial activities.
3. Containment of the affected area:
1. Isolation of work area from the other areas of the HVAC system using plastic sheeting sealed with duct tape
2. The use of an exhaust fan equipped with a HEPA filter to generate negative pressurization should be considered
3. Consider using airlocks and a clean changing room
4. Egress pathways should also be covered if a clean changing room is not used
4. Efforts should be made to reduce dust generation. Dust suppression methods particularly during any cutting or resurfacing of materials are highly recommended. Methods to consider include: cleaning or gently misting surfaces with a dilute soap or detergent solution prior to removal; the use of High-Efficiency Particulate Air (HEPA) vacuum-shrouded tools; or using a vacuum equipped with a HEPA filter at the point of dust generation. Work practices that create excessive dust should be avoided.
5. Moldy materials that can be cleaned should be cleaned using a soap or detergent solution. Growth-supporting materials that are moldy, such as the insulation of interior-lined ducts, flexible ducts, and filters, should be removed in sealed plastic bags. The outside of the bags should be cleaned with a damp cloth and a soap or detergent solution or HEPA-vacuumed prior to their removal from the isolated work area. There are no special requirements for the disposal of moldy materials.
6. Before leaving isolated areas, workers should remove disposable clothing to prevent the tracking of mold-containing dust outside of the work area.
7. The work area and egress pathways (and clean changing room if present) should be HEPA-vacuumed and cleaned with a damp cloth and/or mop and a soap or detergent solution prior to the removal of isolation barriers. Plastic sheeting should be discarded after use.
8. All areas should be left dry and visibly free from mold, dust, and debris. Check that other quality assurance indicators (see Quality Insurance Indicators) have also been met.