Building codes, regulations and guidelines

Canadians spend much of their time indoors, and environmental sensitivities generally stem from aspects of the indoor environment. Construction, furnishing and maintenance of the indoor environment is therefore critical to addressing environmental sensitivities.

Described in this section are governmental initiatives addressing construction as it affects people with environmental sensitivities. Guidelines and the scientific background regarding indoor environmental quality are also described, and the implications of construction and renovation for people with environmental sensitivities are explored. Scents, moulds and pest control are discussed. Pollution prevention is preferable, but will not be sufficient indoors, so ventilation is important to ensure indoor air quality. Finally, electromagnetic phenomena and sensitivities are discussed.

Building codes

Building codes, the rule-books for construction of indoor environments, are the first place to look for standards that may address environmental sensitivities.

International initiatives

The need for improved laws, codes and initiatives affecting people with environmental sensitivities is being recognized and acted upon at the international level.

Table 8: International initiatives addressing environmental sensitivities in building

Canadian federal initiatives

Like the international community, various Canadian codes, regulations and guidelines recognize some form of environmental sensitivity. At the national level, these codes are not enforceable. They are, however, part of an overall framework that increasingly addresses the impact of environmental sensitivities on daily lives.

The Canadian Commission on Building and Fire Codes, with expertise from industry, the regulatory community and general interest groups, develops and updates six model national codes for buildings: the Model National Building Code of Canada, the Model National Energy Codes for houses and buildings, as well as model codes for fire, farm buildings and plumbing. Codes for electrical, gas and oil installations are developed by the Canadian Standards Association.¹⁷⁰ Model national codes provide guidance (much as the medical information published at the national level by the CIHI is advisory). They provide a minimum standard for structures and ventilation, and address fire and occupant safety, in the design and construction of buildings.¹⁷⁰

Table 9: Canadian national initiatives addressing environmental sensitivities in building

Provincial initiatives

Provincial building codes must adopt the model National Building Code of Canada under provincial legislation, and may include other standards to reflect location conditions and practices. The provincial codes are enforced by building codes officers, as provinces may delegate authority to lower tiers of government.¹⁷⁰

The Ontario Association of Architects has published guidelines addressing mould in construction and water penetration. They acknowledge that additional measures may be necessary to protect people with sensitivities.¹⁷³

Municipal measures and roles

Municipalities can go beyond provincial codes in regulating or implementing more stringent building or use requirements (e.g. restrictions on building materials and methods of construction, or the discharge of perfumes and fabric softeners in air from clothes dryers). Institutions such as governments, schools or universities may follow guidelines for environmental design or institute specific provisions for their own buildings (e.g. Lakehead University’s wireless-free policy).

Summary

Canadian statutes do not prescribe standards that are protective for people with environmental sensitivities. Building codes focus on topics such as strength of structures, but they are silent on many issues impacting indoor environmental quality such as building materials or commissioning of the structure (de-gassing before being occupied). Insofar as building codes and guidelines are perceived to be sufficiently protective of health and safety, they may constitute barriers to stricter guidelines, and to research and development of safer materials and methods.

Indoor environmental quality

Indoor environmental quality covers many concerns, including heat, light, air quality, noise and electromagnetic phenomena. A large scientific effort has been directed towards air quality. Internationally, there are disparate air quality guidelines for a variety of chemicals that may be found in indoor air. The World Health Organization recently published guidelines that apply to Europe,¹⁷⁴ but Canada does not have its own benchmarks for many of these same chemicals.¹⁷⁵ Canadian employers have a duty under provincial occupational health and safety acts to take reasonable precautions to protect workers from substandard environmental quality, including air contaminants exceeding workplace guidelines. Guidelines also exist for residential buildings, but these are not enforceable by law. Workplace standards and guidelines are typically not stringent, to avoid being considered too costly or impractical in industrial occupancies.

The following is an overview of some concerns regarding indoor air quality. The origin of possible contaminants, and strategies to avoid or remediate them are discussed, with particular focus on moulds, scents, pest control and electromagnetic phenomena.

Air quality

Indoor air quality is affected by many potential contaminants:

• gases such as carbon dioxide (CO2), carbon monoxide and volatile organic compounds (VOCs) (e.g. myriad chemicals from carpets, furniture, building materials and paints, or gases given off by microbes);
• particles that may include smoke, heavy metals and other chemicals, pollen, skin flakes, bacteria, and mould particles and spores.

Excessive CO2 impairs well-being and is generally controlled with the addition of fresh air. Measuring CO2 is useful to gauge the adequacy of ventilation in a fully occupied building, but it does not reflect the many other air contaminants arising from the building and contents. Generally, facilities are not fully utilized around the clock, so 24-hour average CO2 levels will underestimate actual exposures and are not helpful.¹⁷⁶ Health and well-being are related to the actual concentration of CO2, so real-time continuous monitoring over several days is necessary to determine peak concentrations. In office buildings without other sources of carbon dioxide (e.g. combustion appliances or air intakes close to sources of exhaust), CO2 measurement may also be a surrogate for occupant-generated pollutants. However, CO2 measurements cannot be usefully compared amongst buildings with different activities (e.g. cooking or combustion), concentrations of people, or practices with respect to scents or smoking.¹⁷⁷

VOCs originate from a multitude of sources, including the built environment (materials used in construction, furnishings and equipment), scents from cleaning and personal care products, odours from food preparation and incoming air. Ninety chemicals have been identified as priority substances amongst approximately 2,300 chemicals found in indoor air.^175,176,178 Canada does not have guidelines for many of them, but the issue is slated to be addressed under the Canadian Environmental Protection Act.¹⁷⁹

Dust can contain asbestos, pesticides, organisms such as fungi and bacteria, heavy metals (e.g. lead), fragments of material from plastic products (including plasticizers, flame retardants and stain repellents), or animal products (e.g. cat dander, dust mites, etc.). These may cause infections, provoke allergies or sensitivities, or have toxic effects.

Air quality guidelines are based upon toxicity testing in laboratory animals, and some workplace sampling to determine human exposures. This system has several weaknesses, which explains why guidelines may not be sufficiently protective to ensure no adverse health effects for people with environmental sensitivities:

• Rats have detoxification enzymes that do not exist in people, so toxicity conclusions may not apply to humans;¹⁸⁰
• Neurotoxicity (noted with the development of environmental sensitivities), particularly developmental neurotoxicity that might anticipate problems such as autism and attention deficit hyperactivity disorder in children, may not be studied;¹²⁹
• Research on workers is skewed by the "healthy worker effect." In other words, workers who cannot tolerate chemicals will find other work. Thus, the self-selected group of employees would not include people with a predisposition to chemical sensitivities. Furthermore, avoiding obvious toxicities in healthy adults will not translate into protection for the unborn; and
• Guidelines address toxicity of a single chemical at a time, whereas the workplace may contain many chemicals and biological agents from work processes, carpets and furniture, people wearing perfumes, moulds, contaminants from equipment such as copiers, etc. Combined and synergistic toxicities are not addressed under this system.

Building materials and finishing

The first priority in optimizing indoor air quality is to minimize the pollutants added to indoor air from the building and its contents. Several authorities, including the Canada Mortgage and Housing Corporation, the National Research Council of Canada and the American Society for Heating, Refrigeration and Air-Conditioning Engineers (ASHRAE)¹⁸¹ formally recognize this imperative.

A large number of chemicals in plastics, glues, paints, carpets, etc. may impair health, and formaldehyde is a particularly prevalent contaminant.^182,183 Tolerated products include materials such as natural fabrics, wallboard without pesticide additives, woods (this has to be assessed individually), metal, ceramic tiles and cement products (concrete, grout, etc.) without toxic additives.

Inexpensive materials and furnishings may be associated with increased toxicities (e.g. formaldehyde-containing composite wood products). More durable materials tend to be better tolerated, so over the longer term, both costs and maintenance may be reduced and indoor air quality improved.

There is no Canadian assessment of building materials specifically focused on low toxicity for people with environmental sensitivities. However, CMHC has many publications including "Building Materials for the Environmentally Hypersensitive" and "Research House for the Environmentally Hypersensitive." The Ecologo designates environmentally preferable choices for over 300 types of products. Health is not the primary focus of this initiative (for instance, products might include scents), and the program does not recognize that sometimes the environmentally preferable action would be not to produce or purchase certain types of products (e.g. air "fresheners").

Innovative interiors can be both aesthetically pleasing and good choices for the environmentally sensitive. However, every detail must be considered. For instance, in the case of cast concrete flooring in a housing project for people with sensitivities, the oil used to release the concrete from the forms was replaced with an alternative unscented lotion tolerated by individuals with sensitivities.

"Commissioning" involves a period of increased heating and ventilation to exhaust fumes from paints, wallboard filler, flooring and equipment. It is used to eliminate volatile materials to the greatest extent possible and should take place before spaces are occupied.¹⁸⁴

Furnishings and Equipment

Furnishings and equipment contribute significantly to VOCs in indoor air, and may off-gas for extended periods of time.^185,186 Equipment such as photocopiers, fax machines, laser printers and laminators also compromise the air quality in buildings as they emit dozens of air contaminants including VOCs, ozone and carbon black. Minimizing the toxic contaminants such as flame-retardants, plasticizers, heavy metals and solvents in electronics makes them both safer and easier to recycle.¹⁸⁷ Specifications for electronics should indicate that higher frequencies not be introduced into the electrical wiring.⁸

Scents

After tobacco smoke, perfumes are one of the most noticeable air contaminants in public places and the workplace, and they are reported to cause difficulties for most people with environmental sensitivities.^29,60,188 Fragrances are in personal care products, laundry and cleaning products, and can be in many other products such as tissues, wipes and other paper products. The ingredients may include any of approximately 4,000 plant or animal extracts or synthetic chemicals, with maybe 100 ingredients in a given fragrance.¹⁸⁹ Fragrances now contain more synthetic chemicals, and are stronger and more persistent. Some ingredients are respiratory irritants, asthma triggers and neurological toxins. Some are listed as potentially causing cancer and birth defects.^188-191 The ingredients are proprietary, and are not assessed for toxicity. Neither are they listed on labels, in the Workplace Health Information Management System (WHIMS), on Material Safety Data Sheets (MSDS) or under labelling requirements for personal care products.

"Scent-free" means that additional fragrance was not added to the product, but some cleaning products contain ingredients smelling of citrus or pine that can trigger sensitivity reactions and/or asthma. "Scent-free" products such as fabric softeners may contain neurologically active "masking agents," added to cover the unpleasant odour of the active ingredient or contaminants. People with environmental sensitivities may also react to the "softener" ingredients themselves, which coat clothes, evaporate slowly and contaminate dust.

A wide range of organizations promote no-scent workplace policies, including hospitals,^q universities^r and medical organizations, Health Canada and the Department of Justice, unions such as PSAC¹⁹² and CUPE, school boards, large facilities (e.g. the National Arts Centre) and the Lung Association.^s

Scent-free policies may help stem the influx of people into the group of those who are extremely sensitive to chemicals. Adherence to such a policy is necessary for people with sensitivities because scents can linger for several washings of clothes and hair.

Microbes - moulds and bacteria

Moulds are increasingly recognized as serious contaminants in buildings, contributing to "sick buildings" and to environmental sensitivities.^193-195 Moulds may also cause neurological and psychological disorders including depression.^114,116 Moulds have other diverse effects on health, and more research is needed into their toxic effects.¹⁹⁶ Spores and mycotoxins (toxic chemicals produced by moulds) cause inflammatory responses ¹⁹⁷ and may lead to asthma, allergies and environmental sensitivities.¹⁹⁴ Moulds may result in damage to the nervous system as they stimulate neural auto-antibodies, peripheral neuropathy, and neurophysiologic abnormalities.¹²⁸ Remediation of mould problems will improve workers health, attendance and well-being.^{34,86,198-203} Those with environmental sensitivities should be relocated during mould remediation work.¹⁷²

Greater awareness of bacteria in ventilation systems arose after Legionnaire’s Disease sickened 180 and killed 29 at a Philadelphia conference in 1976.²⁰⁴ Apart from their pathogenic potential, bacteria are a significant source of multiple adverse health effects and may be monitored along with moulds in indoor air.²⁰⁵

Moisture control is key to controlling microbes.^172,173 Design considerations for modern mould-free interior spaces include architectural details, materials selection, and moisture control with ventilation.^172,206 Information is available from the CMHC Healthy Home resource page, from the Canadian Construction Association ¹⁷² and the Ontario Association of Architects.¹⁷³ Following the hurricanes of 2005, the US Centers for Disease Control published a review concerning moulds and a summary of clean-up procedures regarding mould in buildings.²⁰⁷

Chlorine bleach is sometimes recommended to clean up residual mould.²⁰⁷ However, vapours may cause difficulties for people with allergies or environmental sensitivities,^208-212 and this is not recommended as a routine practice by the US Environmental Protection Agency.²¹³ A wire brush and trisodium phosphate or peroxide bleach (hydrogen peroxide) are effective. Another alternative approach that is less studied is to use beneficial organisms to eradicate moulds before final cleaning and renovations, and possibly to head off re-infestation.²¹⁴ Although ultra-violet (UV) light technology is proven to disinfect water, it is not effective for moulds in air.^u

Ventilation

Indoor air quality cannot be maintained without ventilation. Workplace materials and equipment produce various emissions; inhabitants emit carbon dioxide; and individuals and food give off odours. Ventilation is necessary to address these emissions, but it cannot supplant the overriding priority to minimize indoor air pollution arising from structures, fixtures, furnishings and equipment.

It is generally preferable to have natural ventilation with windows that open, but this is neither practical in inclement weather nor available in modern commercial buildings. Thus when air contaminants are generated from cooking, bathroom activities or photocopiers, a mechanical exhaust fan is the only effective method for removing the fumes. Furthermore, outside air will only enter a building if there is an air pressure difference between inside and outside, such as wind or "stack effect" (otherwise known as "chimney effect"). Therefore the design, operation and maintenance of heating, ventilation and air-conditioning (HVAC) systems are critically important.²¹⁵ Standards set in North America by ASHRAE²¹⁶ do not guarantee optimum health. Improvements in well-being have been observed when the ASHRAE standard for ventilation was exceeded,^{76,79,83,217,218} as recognized in an ASHRAE position paper.¹⁸¹

Ventilation, heating and air-conditioning systems are required to minimize condensation and collection of water (except in properly designed condensers for dehumidification). Maintenance of these systems is extremely important to prevent accumulation of dust and water, or growth of microbes.¹⁷²

Renovations can lead to compromised HVAC performance, if proper attention is not paid to vent connections and airflow through the new layout (newly created walls and doors, and arrangement of furnishings). Vents may also be blocked with equipment, or by employees who perceive a draught. As well, ventilation systems designed and installed at times when there were lower ventilation requirements may require attention in order to improve indoor air quality.

Indoor levels of pollution generally exceed outdoor levels, so outdoor air is usually relied upon for ventilation to control indoor pollutants. During cool weather moisture is also controlled with drier outdoor air. External sources of air contaminants include vehicle emissions (including from parking garages), pesticides, wood smoke and exhaust from adjacent buildings.

Air filtration

High efficiency particulate air (HEPA) filters are effective at removing dust and aerosols from ambient air, and may improve the health of people with allergies, asthma and environmental sensitivities.²¹⁹ Unfortunately there are no regulations to standardize what can be labelled as a HEPA filter. Activated carbon and other media such as potassium permanganate filters effectively remove many but not all volatile organic compounds.

Filtration of intake air and within air handling may improve air quality. However, filters that are not maintained become a contaminant source, particularly during humid weather when microbes grow more readily.^219-221

When supplied to many workers, multiple air filters can result in improved air quality and health parameters.⁸² During consultations, personal air filters within closed offices were identified as a common accommodation for office workers with environmental sensitivities in the UK.^v This is not as desirable as ensuring higher quality air for all workers and does not improve access to the rest of the premises and facilities such as washrooms; however, personal air filters are certainly worthy of consideration as an accommodation, along with other actions.

Pest control

Pesticides are frequently implicated in initiation and triggering of sensitivities.3,30 Low activity of the enzyme acetylcholinesterase (AChE), which is inhibited by common insecticides, is linked to neurological dysfunction and immune suppression.222 The Ontario College of Family Physicians has recommended that people take all possible steps to minimize exposure to pesticides,²²³ and Canada’s pesticide assessment system was criticized in light of the re-evaluation of the herbicide 2,4-D.⁵³

Fortunately, modern pest control does not require the use of most toxic chemicals. For instance, the experience in Ottawa hospitals is that aggressive, preventive maintenance and sanitation, non-toxic electronic insect monitoring and control, as well as traps with pheromones or baits have supplanted the spraying of toxic chemicals in food handling areas. Eliminating the conditions necessary for a pest to live and propagate (e.g. moisture and rotting wood), low-tech solutions (e.g. traps), and judicious and very limited use of least-toxic products that are approved for organic agriculture (e.g. borax or diatomaceous earth) have been sufficient. The most toxic chemicals such as organophosphate and carbamate insecticides are simply never used.^w

The Pesticides Code in Quebec prohibits the use of common toxic pesticides on Quebec greenspaces, and pesticide bylaws are currently in various stages of implementation in over 130 cities, towns and villages across Canada.⁶³ Many institutions, including hospitals and school boards, have also resolved not to use pesticides for landscaping. Scientific application of sound agronomic/horticultural principles results in healthy plants that resist diseases and insects, eliminating the need for pesticides.^x

Electromagnetic radiation and fields

"Electromagnetic radiation" covers a broad range of frequencies (over 20 orders of magnitude), from low frequencies in electricity supplies, radiowaves and microwaves, infrared and visible light, to x-rays and cosmic rays.²²⁴ Our limited understanding of the biological effects of the vast majority of frequencies gives reason for concern.^225-230 Although there is still debate in this regard,^231-233 tinnitus, brain tumours and acoustic neuroma are associated with cell phones and mobile phones. ^234-237

Communications and radar antennae expose those who live or work near these installations to their emissions. The radiation travels through buildings, and can also be conducted along electrical wires or metal plumbing. Wireless communications create levels within buildings that are orders of magnitude higher than natural background levels.²³⁸

The World Health Organization (WHO) acknowledges the condition of electromagnetic sensitivity, and published a 2006 research agenda for radio-frequency fields.²³⁹ The WHO recommends that people reporting sensitivities receive a comprehensive health evaluation. It states: "Some studies suggest that certain physiological responses of EHS individuals tend to be outside the normal range. In particular, hyperactivity in the central nervous system and imbalance in the autonomic nervous system need to be followed up in clinical investigations and the results for the individuals taken as input for possible treatment." Studies of individuals with sensitivities ought to consider sufficient acclimatization of subjects as recommended by Joffres for chemical sensitivities,⁷² as well as recognition of individuals’ wavelength-specific sensitivities. Reduction of electromagnetic radiation may ameliorate symptoms in people with chronic fatigue.²⁴⁰

It is worth noting that off-gassing of electrical equipment may also contribute to sensitivities.⁸⁴ Different sorts of technology (e.g. various medical equipment, analogue or digital telephones; flat screen monitors and laptop computers or larger older monitors) may vary significantly in strength, frequency and pattern of electromagnetic fields.²³⁸

Lighting

Visible light is a narrow range of electromagnetic radiation. Light affects hormone levels, including cortisol and melatonin,^241-244 which affects the ability to sleep, among other things. Seasonal affective disorder (SAD), wherein some people are increasingly depressed and fatigued during the winter months, may be alleviated with increased exposure to certain wavelengths of light in the blue end of the spectrum.²⁴⁵ People with environmental sensitivities may be unusually sensitive to light, reacting positively or negatively. Natural or full spectrum, non-flickering light is often best, but individuals ought to be consulted since they may be adversely affected by bright light.

Fluorescent lighting, which is increasingly common and is promoted to save electrical energy, may cause increased radiofrequencies in the electrical supply and harm people with electromagnetic sensitivities. The flickering may also exacerbate sensitivities.²⁴⁶

Electromagnetic radiation arising from the use of electricity

There are four phenomena that emerge from the use of electricity: ground currents; "electromagnetic smog" from communications equipment; magnetic fields from power lines and specialized equipment; and radiofrequencies on power lines or so-called "dirty electricity."

Ground currents

Ground current or "stray current" is electricity that is not contained in wiring; passing through the ground, building structures, plumbing, etc. Electrical current flows along the path of least resistance (e.g. through metal pipes or rods rather than through wood or concrete), with diverse health effects including behavioural, cardiovascular and reproductive problems (sterility and birth defects).^247-249

On October 19, 2006, the Ground Current Pollution Act unanimously passed second reading in the Ontario Legislature. The Bill defines "objectionable current,"^y establishes a time frame for utility companies to respond to and remedy complaints, and provides for the development and implementation of a plan to eliminate current that goes through the ground instead of through the neutral wire.

Low frequency electromagnetic fields

Extremely low frequency fields from high-voltage electrical supply lines have been associated with genetic damage²⁵⁰ and leukemia in children and may be considered an occupational carcinogen.²⁵¹

One clear example of health effects from magnetic fields involved workers on magnetic resonance imaging (MRI) machines. When electrical current flows, a magnetic field is created (measured in Gauss), and when conductors (including biological tissues) are moved within a magnetic field, electrical currents are induced. Workers experienced headaches and cognitive impairment at a greater rate and severity with increasing exposure time and magnetic field strength.²⁵² Workers with quicker movements, which would have caused greater induced currents, suffered greater health effects.

Telecommunications

The Royal Society of Canada reviewed the issue of health effects of radio-frequency transmissions for Health Canada in 1999, with updates in 2001 and 2004.⁵⁶ The latest report summarizes and is consistent with positions taken by many other authorities in Britain, Europe and the USA (e.g. California). Regulations for telecommunications are based upon avoiding heating of tissue as a result of exposure to electromagnetic radiation. However, other biological phenomena are both plausible and observed at much lower exposure levels.⁷ The Royal Society concluded that even if the evidence is not clear that adverse health effects from lower exposures to radiofrequencies exist, there is a need for further research.^55,56 There is growing evidence of cancers (particularly acoustic neuroma) associated with the use of mobile telephones.^{235,237,253,254} Given the seriousness of the adverse effects and the availability of alternative technologies, a precautionary approach is warranted.²⁵⁵

In 2006, based upon a comprehensive review of the scientific literature, the International Firefighters took the position that transmission facilities should not be located at fire stations.²⁵⁶ The growing plethora of wireless communication devices such as Internet, WiFi, cell phones, satellite radio, microwave transmissions, TV broadcasts, etc. are exposing the populace to more and stronger electromagnetic frequencies. Shielding may block electromagnetic radiation (but not magnetic fields). Buildings, geography, weathe r and immediate surroundings affect exposure from telecommunications by reflecting or focusing radiation, thereby creating elevated local levels. Measurements in Canadian cities are many times higher than the regulated levels.^z Canadian regulations do not require labelling of emissions from communications devices. Use of alternative technologies (wire or fibre data transmission) is the most straightforward, feasible and effective measure to accommodate workers with electromagnetic sensitivities.

Radiofrequencies on power lines

Some emerging research regarding electromagnetic sensitivities focuses on the radio-frequency "noise" on power lines. This arises from problems in the wiring and from "chopping" of the 60-cycle signal in modern power-efficient and sophisticated electronics. Remediation of wiring and addition of low-cost tuned circuits to electrical equipment are two steps to address this problem. As a "band-aid," Graham-Stetzer filters can be plugged into outlets to remove these high frequencies from the power lines. Using these filters to create an electromagnetically "cleaner" environment, improvements are reported for several health outcomes, including multiple sclerosis, behavioural problems and asthma in children in schools, and diabetes.⁸ 

Canadian standards for electrical equipment do not require testing for or limits on "dirty power." The CSA requires most products to be assessed only for shock and fire hazard. Electromagnetic compatibility testing is required for ballasts on fluorescent lights and medical equipment and can be carried out at the request of manufacturers.

There is a lack of consensus in research regarding the health effects of electromagnetic phenomena. This may be due to methodological limitations including unmeasured and uncontrolled parameters such as the quality of the electrical signal, radiofrequencies, locally elevated exposure levels and ground currents.

Summary

One of the most effective and economical strategies for achieving healthy indoor spaces and good air quality is to minimize potential pollutants during construction and renovation. This includes the use of low-maintenance surfaces that do not off-gas, design and construction that minimizes dampness and moulds, and an air intake system that avoids ground-level air. Energy conservation concerns create pressure to decrease ventilation in sealed buildings, reinforcing the need to use materials, finishings and furnishings with low toxic and volatile inputs and emissions. Least-toxic construction, maintenance and pest control, and infrastructure that minimizes exposure to electromagnetic phenomena all require attention to detail and might entail minimal additional costs. Minimizing on-going sources of environmental factors that initiate and trigger environmental sensitivities such as perfumes, dusts and vehicle exhaust require education and policies, and appropriate maintenance practices.

h. ANSI/ASHRAE Addendum c to ANSI/ASHRAE Standard 62.1-2004,  American Society of Heating, Refrigeration and Air-conditioning Engineers, Inc., Atlanta, Georgia.
i. Personal communication, Dr. Kartar Badsha, Environmental Law Centre, UK. (August 14, 2006)
j. “Considering the diversity of indoor air contaminants and the range of susceptibility in the population, compliance may not be acceptable for everyone.”  ASHRAE Standard 62, Ventilation for Acceptable Indoor Air quality. American Society of Heating, Refrigeration and Air-conditioning Engineers, Inc., Atlanta, Georgia.
k. ASHRAE® STANDARD, BSR/ASHRAE Standard 62.2P: Ventilation and Acceptable Indoor Air Quality in Low-Rise Residential Buildings, American Society of Heating, Refrigeration and Air-conditioning Engineers, Inc., Atlanta, Georgia.
q. Ontario hospitals with scent-free policies include:  Toronto General Hospital; Women’s College Hospital, Toronto; Wellesley Hospital, Toronto; Lyndhurst Spinal Hospital, Toronto; Middlesex Hospital Alliance, Middlesex; Leamington District Hospital, Leamington; Grand River Hospital, Freeport Health Centre, Kitchener; Ottawa Hospital Civic Campus; Ottawa Hospital General Campus; Children’s Hospital of Eastern Ontario, Ottawa; Queensway-Carleton Hospital, Ottawa; University of Ottawa Heart Institute, Ottawa Health Research Institute; Kingston General Hospital; Hotel Dieu, Kingston; Soldiers’ Memorial Hospital, Orillia; Niagara-on-the-Lake Hospital; North Bay General Hospital.
r. Including Dalhousie, McMaster, Acadia, Memorial, St. Mary’s, Thompson Rivers, Mt. Allison and  Malaspina Universities, and the Universities of Calgary, Toronto, Windsor, British Colombia, Prince Edward Island, Ottawa, Victoria, Saskatchewan, Waterloo and Guelph.
u. Unpublished tests conducted by Prof. Tang G. Lee, University of Calgary, April 1, 2001.
v. Personal communication, Dr. Kartar Badsha, Environmental Law Centre, UK. (August 14, 2006)
w. Doug Perkins, DPEnvironmental, pest management services for Ottawa hospitals,  personal communication, July 30, 2006
x. Frank Reddick, agronomist, Turflogic, personal communication, August 4,  2006
y. “objectionable current flow” means any steady state of electrical ground current for five seconds or more on a grounding conductor or any other conductor that normally does not carry electric current, except for any temporary flow of electrical fault current that is caused by a phase-to-ground fault condition and that results from the performance of a grounding conductor’s protective functions regarding faults or lightning
z. Dr. Andrew Michrowski, Ottawa, December 5, 2006  personal communication based upon his unpublished research completed for the CMHC.