Self-reported health and comfort in 'modern' office buildings: first results from the European OFFICAIR study.

In the European research project OFFICAIR, a procedure was developed to determine associations between characteristics of European offices and health and comfort of office workers, through a checklist and a self-administered questionnaire including environmental, physiological, psychological, and social aspects. This procedure was applied in 167 office buildings in eight European countries (Portugal, Spain, Italy, Greece, France, Hungary, the Netherlands, and Finland) during the winter of 2011-2012. About 26 735 survey invitation e-mails were sent, and 7441 office workers were included in the survey. Among respondents who rated an overall comfort less than 4 (23%), 'noise (other than from building systems)', air 'too dry', and temperature 'too variable' were the main complaints selected. An increase of perceived control over indoor climate was positively associated with the perceived indoor environment quality. Almost one-third of office workers suffered from dry eyes and headache in the last 4 weeks. Physical building characteristics were associated with occupants' overall satisfaction (acoustical solutions, mold growth, complaints procedure, cleaning activities) and health (number of occupants, lack of operable windows, presence of carpet and cleaning activities). OFFICAIR project provides a useful database to identify stressors related to indoor environmental quality and office worker's health.

EPHECT III: Health risk assessment of exposure to household consumer products.

In the framework of the EU EPHECT project (Emissions, Exposure Patterns and Health Effects of Consumer Products in the EU), irritative and respiratory effects were assessed in relation to acute (30-min) and long-term (24-h) inhalation exposure to key and emerging indoor air pollutants emitted during household use of selected consumer products. A detailed Health Risk Assessment (HRA) was performed for five selected pollutants of respiratory health relevance, namely acrolein, formaldehyde, naphthalene, d-limonene and α-pinene. For each pollutant, the Critical Exposure Limit (CEL) was compared to indoor air concentrations and exposure estimates for the use of 15 selected consumer products by two population groups (housekeepers and retired people) in the four geographical regions of Europe (North, West, South, East), which were derived previously based on microenvironmental modelling. For the present HRA, health-based CELs were derived for certain compounds in case indoor air quality guidelines were not available by the World Health Organization for end-points relevant to the current study. For each pollutant, the highest indoor air concentrations in each microenvironment and exposure estimates across home microenvironments during the day were lower than the corresponding acute and long-term CELs. However, considerable contributions, especially to acute exposures, were obtained in some cases, such as formaldehyde emissions resulting from single product use of a floor cleaning agent (82% CEL), a candle (10% CEL) and an electric air freshener (17% CEL). Regarding multiple product use, the case of 30-min formaldehyde exposure reaching 34% CEL when eight product classes were used across home microenvironments, i.e. all-purpose/kitchen/floor cleaning agents, furniture/floor polish, combustible/electric air fresheners, and perfume, needs to be highlighted. Such estimated values should be evaluated with caution, as these may be attributed to the exposure scenarios specifically constructed for the present study, following a 'most-representative worst-case scenario' approach for exposure and health risk assessment.

EPHECT II: Exposure assessment to household consumer products.

Within the framework of the EPHECT project (Emissions, exposure patterns and health effects of consumer products in the EU), irritative and respiratory health effects were assessed in relation to acute and long-term exposure to key and emerging indoor air pollutants emitted during household use of selected consumer products. In this context, inhalation exposure assessment was carried out for six selected 'target' compounds (acrolein, formaldehyde, benzene, naphthalene, d-limonene and α-pinene). This paper presents the methodology and the outcomes from the micro-environmental modelling of the 'target' pollutants following single or multiple use of selected consumer products and the subsequent exposure assessment. The results indicate that emissions from consumer products of benzene and α-pinene were not considered to contribute significantly to the EU indoor background levels, in contrast to some cases of formaldehyde and d-limonene emissions in Eastern Europe (mainly from cleaning products). The group of housekeepers in East Europe appears to experience the highest exposures to acrolein, formaldehyde and benzene, followed by the group of the retired people in North, who experiences the highest exposures to naphthalene and α-pinene. High exposure may be attributed to the scenarios developed within this project, which follow a 'most-representative worst-case scenario' strategy for exposure and health risk assessment. Despite the above limitations, this is the first comprehensive study that provides exposure estimates for 8 population groups across Europe exposed to 6 priority pollutants, as a result of the use of 15 consumer product classes in households, while accounting for regional differences in uses, use scenarios and ventilation conditions of each region.

Ozone-initiated terpene reaction products in five European offices: replacement of a floor cleaning agent.

Cleaning agents often emit terpenes that react rapidly with ozone. These ozone-initiated reactions, which occur in the gas-phase and on surfaces, produce a host of gaseous and particulate oxygenated compounds with possible adverse health effects in the eyes and airways. Within the European Union (EU) project OFFICAIR, common ozone-initiated reaction products were measured before and after the replacement of the regular floor cleaning agent with a preselected low emitting floor cleaning agent in four offices located in four EU countries. One reference office in a fifth country did not use any floor cleaning agent. Limonene, α-pinene, 3-carene, dihydromyrcenol, geraniol, linalool, and α-terpineol were targeted for measurement together with the common terpene oxidation products formaldehyde, 4-acetyl-1-methylcyclohexene (4-AMCH), 3-isopropenyl-6-oxo-heptanal (IPOH), 6-methyl-5-heptene-2-one, (6-MHO), 4-oxopentanal (4-OPA), and dihydrocarvone (DHC). Two-hour air samples on Tenax TA and DNPH cartridges were taken in the morning, noon, and in the afternoon and analyzed by thermal desorption combined with gas chromatography/mass spectrometry and HPLC/UV analysis, respectively. Ozone was measured in all sites. All the regular cleaning agents emitted terpenes, mainly limonene and linalool. After the replacement of the cleaning agent, substantially lower concentrations of limonene and formaldehyde were observed. Some of the oxidation product concentrations, in particular that of 4-OPA, were also reduced in line with limonene. Maximum 2 h averaged concentrations of formaldehyde, 4-AMCH, 6-MHO, and IPOH would not give rise to acute eye irritation-related symptoms in office workers; similarly, 6-AMCH, DHC and 4-OPA would not result in airflow limitation to the airways.

Fitness for work in health care workers: biological risk.

The aim of this contribution is to propose good medical practice in formulating and managing fitness for work (FFW) for health care workers exposed to biological agents. A literature review was conducted, together with a critical analysis of available scientific evidence and presentation of practical examples taken from the Italian multicentric study in which the authors have been participating since 2008. Within the health care sector and with special reference to biological risk, making and subsequently managing a FFW for a specific job is in fact a particularly arduous task for the occupational physician and for the entire hospital management system. The process that leads to issuing a FFW needs to follow the appropriate guidelines and good technical and scientific practice and also take into careful consideration current legislation (national, regional, etc); it is the result of a well grounded balance between professional ethics, rights and duties of the worker and patient, but also of the employer and of all those involved. All these aspects need to be adapted to the single work situations, applying the principle of precaution and careful flexibility in management, with accurate evaluation of each individual clinical case with its peculiarities and referral, where necessary, to expert opinion. It is also indispensable to have in place a clear and jointly agreed hospital management policy where co-responsibility is taken by each single actor, always with due respect for specific roles, so that the Occupational Physician and employers are not left to manage the issue alone.

["Assessment of indoor school environment and identification of measures to protect the respiratory health of school children and adolescents" in a sample of schools in Milan]. / Valutazione dei fattori di rischio indoor in ambiente scolastico e definizione delle misure per la tutela della salute respiratoria degli scolari e degli adolescenti" in un campione di scuole di Milano.

The management of indoor air quality in schools needs special attention because it has a strong impact on respiratory health of children with effects also on performance and social development. In Italy a prevention program for indoor environments is provided in the "Guidelines for the prevention of indoor risk factors for allergies and asthma in the school", developed by the Ministry of Health (G.U n. 9 del 13.01.11). In this context, the Ministry of Health has promoted the "Indoor school" project (CCM2010). The main objective of the project is the implementation of these guidelines. In this paper we report the results of the first phase of the project which assessed the knowledge of school principals on issues related to IAQ and building characteristics of the school.

Airborne particulate matter and gaseous air pollutants in residential structures in Lodi province, Italy.

UNLABELLED: The province of Lodi is located in northern Italy on the Po River plain, where high background levels of air pollutants are prevalent. Lodi province is characterized by intensive agriculture, notably animal husbandry. This paper assesses indoor levels of selected airborne pollutants in 60 homes in the province, with special attention to size-fractionated particulate matter (PM). Indoor PM2.5 concentrations are frequently higher than current guidelines. PM10 and nitrogen dioxide also exceed the respective guideline recommendations in some cases, noting that 24-h nitrogen dioxide levels were compared with an annual limit value. All other studied pollutant levels are below current international guidelines. Among indoor PM size fractions, PM0.5 is predominant in terms of mass concentrations corresponding to 57% of PM10 in summer and 71% in winter. A strong seasonal trend is observed for all studied pollutants, with higher levels in winter corresponding to changes in ambient concentrations. The seasonal variation in PM10 is largely due to PM0.5 increase from summer to winter. Summer indoor PM levels are mainly from indoor-generated particles, while particles of outdoor origin represent the main contribution to winter indoor PM levels. On average, indoor concentrations of coarse PM are mostly constituted by indoor-generated particles. PRACTICAL IMPLICATIONS: This study presents a comparison between measured indoor concentrations in the study area and indoor air quality guideline criteria. Accordingly, particulate matter (PM) and NO2 are identified as key pollutants that may pose health concerns. It is also found that indoor PM in residential units is mainly constituted by particles with aerodynamic diameters <0.5 µm, especially in winter. Risk mitigation strategies should be focused on the reduction in indoor levels of NO2 and ultrafine and fine particles, both infiltrated from outdoors and generated by indoor sources.

[Assessment of comfort and health status of Call Center's workers]. / La valutazione del comfort e dello stato di salute in lavoratori di un Call Center.

BACKGROUND: Call Centers are workplaces in which there are a lot of occupational health hazards. METHODS: The aim of the study was to investigate Call Center operators' health status, using: "Ambiente/Salute" questionnaire, VHI questionnaire, health surveillance data analysis. RESULTS: "Negative" Microclimate rating: 68%; "negative" noise rating: 51%. "Negative" eye symptoms rating: 30%; "negative" postural disorders rating: 21%. "Negative" VHI value (over the limit of 30): 6%. CONCLUSIONS: It's necessary to develop and validate an appropriate health surveillance protocol

[Radon risk evaluation in a hospital context]. / Valutazione del rischio da Radon in una realtà ospedaliera.

Italian legislation imposes radon concentration in occupational, underground premises as to not exceed the annual action level of 500 Bq/m3. A survey in a hospital of Milan founded concentrations never exceeding the action level, distribute around the median concentration of 16 Bq/m3, ranging between 6 e 214 Bq/m3 (Cmean = 38 +/- 50 Bq/m3). However, a pavilion, characterized by higher levels (C = 103 divided by 214 Bq/m3), was better studied by short-term monitoring, during summer and winter, confirming concentrations not exceeding legislative level, even if not negligible. Results underlines the importance of a monitoring strategy as punctual as possible. Moreover, shortterm measurements can represent a valid tool for premises screening in radon monitoring.

[Focus on risk assessment in health environments: results and perspectives of a multicenter working group]. / Focus sulla valutazione del rischio negli ambienti sanitari: risultati e prospettive di un gruppo di lavoro multicentrico.

The hospital risk assessment (VdR) is certainly a relevant issue concerning the activities of prevention for the health of healthcare workers in relation to biological risk. The aim of this paper is to provide an up-date of the issue, based on the suggestions of recent literature about the rules ratified by the new legislative decree and data supplied by the Group of 10 Hospitals participated in this multicenter study. From the analysis of data on healthcare settings (HCS) participating in the project the following considerations can be formulated: i) All HCS considered VdR from biological agents. The method recommended in the Guidelines SIMLII 2005 is the most followed ii) To grading the risk, the use of invasive procedures for carrying out the analysis results is a necessary element iii) the operators classified as exposed to biological risk, and therefore subject to health surveillance, represent almost all of workforce in 7 out of 10 HCS. The subgroup believes that VdR must be conducted in close collaboration with the occupational physician and should represent a worthwhile investment with spin-off character on prevention, decision making, empowering. The presence of environmental requirements and organizational procedures should be considered, so that HCS is enabled for an effective risk management, without which risk assessments cannot be performed. The method of VdR mentioned in the guidelines MLIS 2005, besides being the most widely used by the company participating in the study, still has practical reasons and opportunities to justify its use. The HCS group felt the need to propose an implementation of the definition of invasive procedures and EPP, together with individual assessment. Flexibility was suggested in identifying different levels of risk with the involvement of occupational physicians, especially in the presence of EPP, also in order to plan content and frequency of health surveillance.

[Focus on health surveillance of health workers exposed to blood-transmissible biological agents: results and perspectives of a multicenter working group]. / Focus sulla sorveglianza sanitaria dei lavoratori della sanità esposti ad agenti biologici trasmissibili per via ematogena: risultati e prospettive di un gruppo di lavoro multicentrico.

The biological risk from exposure to bloodborne pathogens in health care environments represents a frequent and widespread risk, involving a large number of exposed workers. On the basis of the available scientific innovations, the recent legislation regarding health and safety of workers and the experiences of SIMLII guidelines on health surveillance (HS) workers exposed to biological risk, a multicenter study was carried out, involving nine relevant hospitals and about 32 000 healthcare workers (HCW). A review of the literature was performed, with particular reference to the last 10 years. For each hospital, protocols of HS have been examined according to tasks and biological risk from bloodborne viruses (HBV, HDV, HCV, HIV) as well as management of HCW infected with this pathogens. Differences of risk management in the hospitals, in relationship also with recommendations of the literature have been evaluated. The literature supplies important indications for HS management of HCW exposed to bloodborne pathogens, with relevant information also for patient safety. Preventive examinations are in line with the recommendations of literature and similar across the hospitals for HCV and HIV, while they are different for HBV. Periodic surveillance was different for the frequency, among the hospitals and also as compared to national SIMLII guidelines. As for management, no differentiation among the hospitals was detected as referred to different risk of exposure, while differences were observed around definitions of restrictions. Finally, good medical practices to support occupational physicians in the prevention and management of HCWs' exposed to biological risks are suggested.

[Tuberculosis. Focus on risk assessment and health surveillance in health workers: results and perspectives of a multicenter working group]. / La tubercolosi. Focus sulla valutazione del rischio e la sorveglianza sanitaria dei lavoratori della sanità: risultati e prospettive di un gruppo di lavoro multicentrico.

INTRODUCTION: Tuberculosis (TB) is still a threat for healthcare workers (HCW), due to the non decreasing incidence, the spread of drug-resistance, the introduction of new tests for the screening, the relevant costs of surveillance of exposed subjects. These issues implicate a revision of activities to prevent TB in health-care settings. METHODS: A multidisciplinary working group, led by occupational physicians, examined the activities to prevent TB performed in 9 Italian hospitals and reviewed the literature, with the aim to formulate evidence-based procedures. RESULTS: In the considered hospitals, 23.000 HCW are classified as exposed to TB, out of 32.000 HCW exposed to biological risks; yearly, about 6000 subjects are screened for preventive, periodical or post-exposure surveillance and 110-130 chemoprophylaxis are prescribed. A high proportion of HCW (54-75%) refused or interrupt to assume the drugs. In the period 2004-2008, 14 occupational TB were diagnosed (9/100.000 HCW exposed to biological risks). DISCUSSION: Critical issues are the availability of a specific, written TB control plan, including risk assessment, protocols for identifying, evaluating, managing infectious TB patients, health surveillance, education programs, specifically addressed to increase Standard Precaution adoption and compliance to the screening and to adequate risk perception. Risk assessment identify HCW to be included in TB testing (characterized by low positive predictive value), unrecognized TB and environmental control needed; TB risk classification should include no more than 3 or 4 classes and performed by assessing the issues suggested in the Italian guideline. Tubercolin skin test should be used for HCW screening, adding in vitro test in specific circumstances (for example, skin test positivity in BCG vaccinated HCW); the frequency of the screening should not exceed 2 years. Periodical revision of preventive activities should follow up to date scientific literature and need appropriate data computing.

[Exanthemic diseases (measles, chickenpox, rubella and parotitis). Focus on screening and health surveillance of health workers: results and perspectives of a multicenter working group]. / Le malattie esantematiche (Morbillo, Varicella, Rosolia e Parotite). Focus su screening e sorveglianza sanitaria dei lavoratori della sanità: risultati e prospettive di un gruppo di lavoro multicentrico.

BACKGROUND: Nosocomial transmission of varicella-zoster virus, certain paramixovirus and rubivirus might pose a risk of morbidity for varicella (V), rubella (R), mumps (Mu) and measles (Me) in health care workers (HCW), patients and coworkers. International literature and European legislation recommend preventive interventions to minimize the risk. METHODS: A literature review and a seroprevalence study were carried out in 9 hospitals located in north and central Italy, in order to evaluate risk assessment, health surveillance and fitness for work of HCW exposed to V, R, Mu and Me. Antibodies (Ab) against V, R, Mu and Me were determined. For a subgroup of 4 hospitals; sociodemographic, occupational data and sera were collected and analyzed. RESULTS: About 36000 tests on about 9000 HCW were analyzed. Differences in seroprevalence ratios (V 85.7-95.1%, R 47-96.8%, Me 71.4-97.8%, Mu 52.5-87.6%) were detected. In a subgroup, a relevant number of non immune HCW was also found among women infertile age and areas at higher risk. Statistically significant differences were detected only for selected variables and viruses. DISCUSSION AND CONCLUSIONS: Data of multicenter study confirm literature evidences and allow to define good medical practices for manage and minimize the risk of nosocomial transmission of V, R, Me and Mu. Recommendation are issued about serologic screening on HCW exposed to all 4 viruses thorough the modern analytical techniques, in order to assess risk on individual a group basis and to select priorities for intervention. Vaccination should be prescribed for those HCW non immune, selecting areas and HCW according to priorities.

[Biological risk. Relevant problems: risk to third parties]. / Il rischio biologico. Problematiche di rilievo: il rischio verso terzi.

Transmission of infections from healthcare workers to patients during clinical activities has been an issue for at least twenty years. Studies and general considerations on this topic have brought to consensus documents, guidelines and public health policies, that were sometimes different depending on which social and cultural backgrounds they referred to. Though crucial, this issue remains nowadays not completely resolved, especially if we consider that no agreement has been found on how to face the problem. In this complex framework a question arises about the potential role of the occupational physician. We are talking in fact about a risk that, though present in the working environment, does not directly involve the workers themselves, but rather the people the healthcare workers get in contact with. We may say it is not only a problem of occupational medicine, but rather an issue involving medicine in working environment. This is a real challenge for those who deal with job healthcare and security, even if it is fundamental to fully understand how to face it. After a synthesis of the problem in its conceptual and quantitative dimensions, we now offer some new food for thought and outline some operating clues for the occupational physician too, as a contribution for a common and effective solution.

[Focus on coverage and promotion of anti influenza vaccine in health workers: results and perspectives of a multicenter working group]. / Focus so copertura e promozione della vaccinazione antinfluenzale nei lavoratori della sanità: risultati e prospettive di un gruppo di lavoro multicentrico.

INTRODUCTION: The influenza illness is a concern for health care workers (HCW) due to the potential nosocomial transmission and sickness absenteeism. Immunization and Isolation Precautions might be effective preventive measures. AIMS: To formulate recommendations on vaccination in healthcare settings. METHODS: A multidisciplinary working group, led by occupational physicians (OP), examined the information on seasonal influenza immunisation campaign in 9 Italian hospitals in the period 2005-2009 and reviewed scientific evidence. RESULTS: Many health organizations recommend vaccination of HCW. The literature shows that seasonal influenza vaccination of healthy adult have a modest effect in reducing work day lost; there is no evidence that it affects transmission or it prevents the disease in elderly residents. These observations might be conditioned by methodological limitations. Further studies are required to avoid the risk of bias and in pediatric settings. The rate of flu vaccination among HCW is widely variable and it depends on individual risk perception and information about efficacy and side effects. In the considered hospitals, in the five-years period the vaccination rate ranged between 0 and 29%: the median value was 16-17% in 2005, 2008 and 2009 (only against H1N1 influence), 11% and 13% in 2007 and 2006 respectively. OP participation in the vaccination campaign seems to increase the immunization rate. DISCUSSION: Seasonal influenza immunization of HCW might be effective. We recommend to formalize written procedures in health care settings, to perform data computing and to periodically revise immunization activities and promotion and scientific literature, with the aim to appropriately address resources.

The management of the allergic child at school: EAACI/GA2LEN Task Force on the allergic child at school.

Allergy affects at least one-quarter of European schoolchildren, it reduces quality of life and may impair school performance; there is a risk of severe reactions and, in rare cases, death. Allergy is a multi-system disorder, and children often have several co-existing diseases, i.e. allergic rhinitis, asthma, eczema and food allergy. Severe food allergy reactions may occur for the first time at school, and overall 20% of food allergy reactions occur in schools. Up to two-thirds of schools have at least one child at risk of anaphylaxis but many are poorly prepared. A cooperative partnership between doctors, community and school nurses, school staff, parents and the child is necessary to ensure allergic children are protected. Schools and doctors should adopt a comprehensive approach to allergy training, ensuring that all staff can prevent, recognize and initiate treatment of allergic reactions.

[Evaluation of radon levels in bank buildings: results of a survey on a major Italian banking group]. / Valutazione delle concentrazioni di radon nel settore bancario: risultati di una indagine condotta in un gruppo bancario di rilevanza nazionale.

UNLABELLED: Radon, the second cause of lung cancer after smoking, is a natural, radioactive gas, which originates from the soil and pollutes indoor air, especially in closed or underground spaces. Italian legislation recommends an action level of 500 Bq/m3 per year for occupational exposure in underground premises. OBJECTIVES: Since banks usually use various underground premises (archives, safe-deposit room), a study was made of the radon levels on such premises with the aim of identifying useful monitoring strategies. METHODS: 134 branches of a major Italian banking group were examined using 1817 nuclear track dosimeters at ground level and underground level premises. The branches were located in 7 Italian regions in the north (Piedmont, Lombardy, Veneto), centre (Lazio) and south (Campania, Apulia, Sicily). Information on measurement points was recorded in a technical sheet and statistical analysis was carried out. RESULTS: Annual underground measurements gave an average concentration of 157 Bq/m3, with 5.1% for 400 < C < 500 Bq/m3 and 2.9%for C > 500 Bq/m3. Seasonal variability was reflected in a significant decrease in concentrations between winter and spring (delta(mean)% = -47.3%) and good stability between autumn and winter (delta(mean)% = 3%); moreover quarterly concentrations account for 85% of the variability of the corresponding annual level. A multiple linear regression model (R2 = 0.33) indicated geographic location as the principal factor in radon accumulation, followed by underground level, humidity, use, lack of windows, heating and natural ventilation, and direct contact of at least one wall with ground rock; whereas the safe-deposit room structure seems to protect from radon accumulation. Moreover, the ground level measurement results were significantly associated with the corresponding underground average concentrations (p < 0.001). CONCLUSIONS: The results could be a useful tool in planning a monitoring strategy for assessment of bank worker exposure, especially for banking groups with a large number of branches.

The INDEX project: executive summary of a European Union project on indoor air pollutants.

The prevalence of allergies, asthma and other respiratory diseases in large populations has increased in recent decades. Among other factors, this phenomenon has been connected to adverse health effects of air pollution. Although some causal links between occupational exposures and their health effects are shown, still little is known about the health risks of lifelong exposure to indoor air pollutants. To assess the health risks of indoor air pollutants at prevailing concentration levels in Europe, the Joint Research Centre of the European Commission carried out a project called "Critical Appraisal of the Setting and Implementation of Indoor Exposure Limits in the EU" (INDEX). The aims of the project were: (1) to assess health risks of indoor-originated chemical pollutants that might be regulated in the EU and (2) to provide suggestions and recommendations on potential exposure limits or other risk management measures. The results of the INDEX project should contribute to the development of an EU strategy for the management of indoor air quality. The highest priority was given in this study to: formaldehyde, nitrogen dioxide, carbon monoxide, benzene and naphthalene. Exposure limits, recommendations and management options were also given to minimize the health risks for these compounds.

[Management of "complicated" work fitness judgements among health care workers]. / La gestione delle "idoneità difficili" negli operatori della sanità.

The occupational physician, performing health surveillance within a hospital, may face to some difficulties due to the variety and complexity of the tasks and the health risk factors of the health care workers. One of the hardest issue for occupational physician is to provide judgement on worker's fitness. Moreover, this task could be more complicated when a impaired worker could represent an hazard for his patients and colleagues. The authors will illustrate three critical clinical cases examined in Occupational Health Unit of Luigi Sacco Hospital, Milan; furthermore, the authors will show the difficulties and the applied solutions in order to provide the judgement on worker's fitness.

Risk characterization and proposal of exposure thresholds to indoor chemical agents: the Index European project.

The European INDEX project was finalised to identify priorities and to assess the needs for an European Community strategy and action plan in the area of indoor air pollution. A list of 5 chemicals, with potential of high indoor concentrations, uncontested health impacts, and effective risk management, were selected to be regulated with priority: Formaldehyde, Carbon Monoxide, Nitrogen Dioxide, Benzene and Naphtalene. For each compound, guideline values and management options were suggested.