An Assistant Health Officer Intervenes to Promote School Health

In 1996, a repair to the roof over several classrooms at a public school had not been completed before a heavy snowfall. Water seeped into and under the building, providing ample opportunity for the growth of mold. Three faculty members developed respiratory problems and were no longer able to work in their classrooms. Children who rotated through the classrooms were less severely affected.

After these illnesses were made known to the health department, a lengthy community process was begun, along with a series of requests for help from outside experts. Teachers, parents, school administrators, and townspeople were involved. Technical assistance was received from the Washington State Department of Health, the University of Washington Department of Envi¬ronmental Health field team, the Occupational Medicine Clinic, and the National Institute for Occupational Safety and Health (NIOSH).

In extensive public meetings, some argued for closing the school as unsafe, while others advocated repairing the building and drainage and replacing the air handling unit serving the classrooms of the affected wing of the school. (This unit drew its air from the crawl space where conditions had favored the growth of mold.)

Following two visits from NIOSH field teams, air sampling for microbes, repeated inspections by the Washington State Departments of Health and Labor and Industries, several remedial efforts were put into place. These included expenditures of more than $200,000 to replace the air handling units with individual classroom units; improvements to the building drainage; establishment of regular surveil lance for water incursions; and the development of clean-up procedures to be used in the event water was detected in the building or in crawl spaces under the building. These efforts were declared sufficient by all consulting agencies, and the process was commended by the Washington Department of Labor and Industries, whose job is to safeguard working conditions for all workers in the state.

Although no single cause of illness was identified, teachers were able to return to their classrooms in the affected wing of the school, and all school activities were resumed. Many of the participating parties expressed their appreciation for the patience and objectivity of the Assistant Health Officer who coordinated this process.

Where We Are Today
Our two current preventive medicine residents (sharing the rotation) have also become importantly engaged in the county. One is setting up a database and surveillance system for complaints and follow-up investigations for the more than 100 food establishments regularly inspected in the county, while the other has already investigated an outbreak of Norwalk-like viral gastroenteritis traceable to a fast-food restaurant in Ellensburg. An emergency room physician at the only hospital in Kittitas Valley recognized the outbreak and reported it to us. The restaurant staff and its owners were very cooperative, closing the restaurant immediately and assisting with the investigation. The outbreak, which affected an estimated 187 people, was traced to an ill food handler, who had presumably contracted his illness in the community. No other restaurants in the chain in Washington State reported outbreaks at that time.
In summary, this collaborative arrangement between Kittitas County and the University of Washington School of Public Health and Community Medicine has proven mutually beneficial over the 10 years of its existence. Its success has depended on the particular interests of the students and faculty involved as well as the willingness of health department workers to welcome and reorient new preventive medicine residents each year.