Introduction
The mold remediation industry is lagging behind science. For years, it has failed to adapt to noteworthy scientific evidence highlighting the serious health risks associated with water-damaged buildings and the mold and other microbial contamination they can harbor. Additionally, the industry tends to overlook abundant evidence indicating that mold and its by products pose a bioaerosol problem with potentially significant health implications for a large percentage of the population. State-regulated and other unregulated water-damage remediation projects are currently limited to visibly contaminated or compromised areas, neglecting the impacts of water-damage contamination on the broader environment. In addition, verification standards post-remediation are insufficient, considering the health consequences.
Contaminated and improperly remediated water-damaged buildings negatively affect the health of millions in this country. By modernizing our approaches and techniques and listening to science, the industry can deliver infinitely more successful outcomes, including healthier spaces in every structure we treat. The impact of properly remediated buildings that support wellness cannot be overstated. The mold remediation industry is poised to revolutionize and transform indoor environments.
Decades of Scientific Evidence
Although a keener understanding of the contamination produced in water-damaged buildings is more recent, the science has been clear for decades. Water-damaged buildings are ubiquitous, and the contamination they produce is unhealthy.
According to data from the EPA’s Building Assessment Survey and Evaluation (BASE) Study, 85 percent of buildings surveyed showed signs of past water damage, and 45 percent had active leaks at the time of data collection. Furthermore, mold is the number one complaint for military families living in more than 700,000 privately run housing structures. In a letter to Senator Elizabeth Warren (D-Mass.) in 2023, then Secretary of Defense Lloyd Austin revealed that there were at least 4,588 reports of mold in Air and Space Forces privatized housing alone.1 Water-damaged buildings pose health risks to all occupants, but the impact on our military is particularly significant, considering their well-being is crucial to the safety of our nation. Should these or any family have to be fighting a war on two fronts? This data highlights the critical need for the industry to assess, remediate, and decontaminate water-damaged buildings properly.
The prevalence of aerosolized microbial contamination in indoor environments following water intrusion events has been extensively documented. These investigations highlight that both fungal and bacterial amplification occurs in such scenarios, alongside the production of harmful byproducts from microbial respiration, including mycotoxins, beta-glucans, and actinobacteria, to name a few.2 The heightened presence of these in water-damaged indoor settings is known to present significant health risks to building occupants. Moreover, it is essential to recognize that these contaminants extend beyond the immediate “affected” and contained areas.
It has been reported that 20-25 percent of the global population has a genetic predisposition (HLA DR|DQ) that increases their risk of mold-related illnesses. Furthermore, additional studies indicate that 10 to 15 percent of the population is immunologically sensitized to mold. Published in 2011, the Quest Diagnostics Health Trends Allergy Report is the most extensive analysis in the U.S. of allergy testing among patients undergoing evaluation for medical symptoms related to allergies. Quest’s study consisted of more than 1.5 billion patient encounters nationwide over 10 years in the United States. It documented confirmed allergies for various allergens such as pet, dust mites, etc., and included mold. The findings show an average of over 12% of the population are confirmed to have a mold allergy. Simply stated, tens of millions are either currently symptomatic or at risk, either genetically or immunologically. Dr. Neil Nathan notes in his book ‘TOXIC’ that “When it comes to the most sensitized patients, I have emphasized (and will continue to emphasize) that mold toxicity is the single most common contributing cause of that sensitivity. Mold toxicity is far more common than is currently recognized. Those knowledgeable in this field estimate that millions of people are wrestling with this problem but are entirely unaware of its existence”.3
Based on this data, the mold remediation industry should proceed with an assumption that occupants in water-damaged or damp buildings likely have some form of mold sensitivity, whether they realize it or not. Their remediation processes and protocols should certainly address the structural issues but also must resolve the whole environment’s microbial contamination. Adopting this assumption as a new best practice necessitates a paradigm shift in remediation protocols and strategies to elevate clearance criteria.
Water Damage Contamination Transmission in Indoor Environments
Current mold remediation processes largely stem from the best practices used for lead paint and asbestos removal in the 1970s. Establishing a containment barrier around the area of concern is a good practice, as it helps reduce cross-contamination during removal and reconstruction. However, lead paint and asbestos do not multiply or reproduce following a water damage event, nor do they produce mycotoxins and other microbial contaminants. Unlike fungi or bacteria, lead paint does not become aerosolized or redistribute through airflow within the indoor environment. Therefore, the approach to mold remediation should be guided by scientific research confirming microbial amplification and its transmission throughout indoor environments. Remediation efforts should be directed to the entire environment by integrating processes that not only tackle the moisture and structural compromise in the affected areas but also ensure comprehensive decontamination is properly performed throughout the structure. To mitigate health risks, it is crucial to address the whole environment.
Many factors influence the extent of environmental contamination, beginning with the type of water event and when “the leak” was discovered. The case study example provided at the end of this article shows that the water intrusion event cited went undetected for two years. If occupants do not notice water intrusions for days, weeks, or even months after they occur, microbial contaminants have already become airborne and migrated throughout the indoor space. Mold species such as Stachybotrys or Aspergillus/Penicillium or other contaminants such as endotoxins or mycotoxins are transported from one area—like the kitchen in this case—to different parts of the interior environment. Consequently, the source contamination is not contained to the original affected area, and the entirety of the building necessitates a thorough reversal of microbial contamination.
This transmission of contamination has been well-documented. Bench studies have identified species-specific variations in mold aerosolization from surfaces based on airflow patterns corresponding to regular human activity. “In the first ten minutes, the release of spores per square centimeter was lowest for *Cladosporium cladosporioides* (fewer than 500 spores) and highest for species like *Stachybotrys chartarum* (4,000 spores), along with *Aspergillus* and *Penicillium* species (10,000 spores each)”.4 This evidence further confirms other findings that fungal amplification on surfaces does not remain localized. Indoor airflow dynamics facilitate the migration of thousands of fungal spores throughout an environment. As previously stated, regulated and non-regulated remediation projects continue to be limited to visibly contaminated or compromised areas, oftentimes representing a fraction of the total indoor volume. The area affected by water damage contaminates other spaces to varying extents, contingent upon factors such as airflow and activities affecting air currents, such as walking past a contaminated wall or on settled contaminants on flooring.
Water Damage Contamination: It’s a Health Issue
The uncontained contamination produced by water-damaged buildings is known to impact human health negatively, and it is not just fungi. Thrasher and Crawley published an article in Toxicology and Industrial Health in September 2009, discussing nine types of bio-contaminants found in damp indoor environments due to microbial growth: (1) indicator molds, (2) Gram-negative and Gram-positive bacteria, (3) microbial particulates, (4) mycotoxins, (5) volatile organic compounds, including both microbial (MVOCs) and non-microbial (VOCs), (6) proteins, (7) galactomannans, (8) 1-3-β-D-glucans (glucans), and (9) lipopolysaccharides (LPS — endotoxins). They noted, “When mold species exceed those outdoors, contamination is deduced.”5 The harmful effects of mold particulates on human health are well-documented in both U.S. and Western medicine, with over 1,000 published articles in medical literature confirming the link between mold exposure and various illnesses.6
In a study published in Indoor Air in 2014, William W. Nazaroff summarizes findings related to the size- dependent deposition of particles in different areas of the human lung and cites evidence that airborne exposure to bioaerosols can cause diseases. He begins his discussion by stating, “Inhaling indoor air is the primary means by which humans are exposed to bioaerosols.”7
As we have discussed, water-damaged buildings can quickly amplify fungi and bacteria, along with their byproducts, even without observable growth. The particles that are predominantly smaller than two microns are particularly concerning, as studies have consistently demonstrated the ease at which they can be deposited directly into the lungs. Microorganisms thrive on damp or wet building surfaces, then become aerosolized, or “freely floating,” within indoor air currents. They settle out of the air onto surfaces, only to be re-aerosolized later. This ongoing cycle of aerosolized microbial contamination represents, in many ways, the environmentally sourced health risk. If one agrees that this is a foundational aspect of why water- damaged buildings are unhealthy, then one should advocate for an entire environmental decontamination with more stringent clearance criteria. Modern methods exist that can safely and effectively denature and remove microbial particulate, reducing adverse health impacts and the likelihood of reamplification while preserving the integrity of non-compromised building components.
Data Collection and Verification Criteria
Historically, industry data collection standards and testing are typically focused on mapping species and quantities of fungi, overlooking fungal viability and the previously mentioned types of contamination such as actinobacteria and endotoxins. This oversight may indicate incomplete environmental diagnosis, which is critical since these microorganisms are linked to various adverse health effects. A more comprehensive approach to diagnosing microbial contaminants in buildings is warranted before commencing any remediation activities. Then, the goal of remediation efforts should include thorough decontamination and removal of fungi and account for their viability, as well as other above-mentioned toxic contamination.
Otherwise, the environment will continue to harbor harmful biotoxins. Given what we understand today, merely reducing the quantity of fungal species is no longer sufficient. Dr. Ritchie Shoemaker, a recognized leader and change agent in the treatment of illnesses acquired in part from exposure to water-damaged buildings, states that “current recommendations for assessing exposure to fungi and methods of remediation based solely on fungi do not account for the fact that endotoxins and actinobacteria are now recognized as major contributors to human illness from exposure to water-damaged buildings.”8
Furthermore, Dr. Harriet Burge writes “Meanwhile, undoubtedly, a dead spore cannot germinate and therefore is unlikely to release allergens. This means that if you are trying to trace disease-causing exposures, culturable analysis or some other approach where viability is indicated is important”.9
We know mold only survives and reproduces in environments with adequate moisture. When moisture is insufficient, mold (fungi) becomes dormant, waiting for the next instance of moisture to restart its life cycle and produce byproducts. Even in its dormant state, mold remains viable. Therefore, if a remediation process leaves viable fungi and other biotoxins behind—despite good intentions—there is still a health risk. In the United States, agencies such as the EPA, CDC, and NIH have not yet published criteria regarding safe mold levels and spores inside buildings. This is despite the EPA’s previous statement that 50% of buildings are associated with some degree of indoor air quality (IAQ) contamination and that damp or water- damaged buildings are unhealthy without providing information to the public regarding why this is so. Hallak et al., in their peer-reviewed research, cite the World Health Organization’s guidelines, which indicate that an airborne fungal spore concentration above 500 CFU/m³ is considered hazardous for occupants. In comparison, levels exceeding 1000 CFU/m³ are deemed extremely hazardous (where CFU refers to colony-forming units), indicating the viability of spores.10 The WHO hazardous risk position is tied to viability. For example, in human testing, malignant cells can regrow if any viable cells remain after a dermatology procedure. The pathology report confirms that all malignant cells have been eliminated and cannot regrow. The mold remediation industry has its equivalent in viability testing as an adjunct to critical quantitative reduction confirmations. Thus, determining viability is relevant during the initial stages of data collection but more importantly, after abatement efforts. The goal should be to comprehensively reverse microbial contamination not only from a species and quantity standpoint, but confirmation of abatement efficacy should also include culturable analysis whereby no growth of whatever is left is an important outcome objective.
This represents a significant departure from the prevailing industry practice of “mapping,” which typically relies on only reducing spore counts from remediated contained environments to outdoor levels. Although this is very important, the sheer volume of those who are symptomatic warrants viability becoming an additional remediation benchmark. If experts think viability is relevant to disease-causing exposure and water-damaged buildings are universally acknowledged as unhealthy, then viability is applicable to comprehensive abatement assessments. Considering the scientific evidence that fungal spores, bacteria, and metabolic byproducts increase exponentially in damp-to-wet conditions, health risks increase exponentially in kind. For example, those diagnosed with mold-related sicknesses such as CIRS (chronic inflammatory response syndrome) and their physicians may not be satisfied with mathematical reductions in species in a pre- vs. post-analysis when the remaining contamination will continue to impact their health negatively. The good news is that diagnostic capabilities exist to do this, and contemporary technologies and methodologies are available that effectively denature microbial viability, both in the air and on surfaces throughout the entire environment.
A Holistic Approach to Solving the Problem
Incorporating modern best practices from both the healthcare and biotechnology industries—specifically high-level infectious disease disinfecting and comprehensive environmental decontamination—is long overdue. For instance, if we were to apply the current mold PRV (post-remediation verification) standards to the classification of malignant versus benign cancer cell cultures in humans, as mentioned previously, there would be an outcry from patients. It would be unacceptable to claim successful treatment because there are fewer cancer cells now than there were before. The standard assessment criteria for mold remediation success continues to be based on the idea that there is “less” contamination than there was previously. Considering the health consequences, this is insufficient, and the solution is available and accessible.
Advances in science, technology, and remediation methodologies have considerably evolved, allowing for the comprehensive reversal (and subsequent maintenance) of microbial contamination in indoor environments to levels either at or approaching zero viability. Referring to the biotechnology industry again, it is not uncommon for their decontamination processes to be confirmed at 5 or 6-log kill rates using a combination of sanitization cleaning and dry fog decontamination. One procedure does not supersede the other, but in combination, some of the healthiest environments from a microbial cleanliness standpoint are biotech cleanroom production facilities. Implementing these accessible modern techniques can significantly enhance the ability to reverse microbial-contaminated indoor spaces. In doing so, these enhanced processes deliver wellness-supporting environments, reducing the potential for re-emergence of illness or continued adverse immune response post-abatement efforts. Millions of individuals depend on the expertise of professionals in this field to elevate their practices and improve their standards.
Further Complicating Better Outcomes
Most states lack laws or certification requirements regarding mold assessment and remediation. As a result, remediation companies are ill-informed and lack the high-level expertise necessary to solve the complex problems associated with water-damaged buildings and their contamination. Significant funds are often spent on mold abatement and remediation with inadequate outcomes. Unfortunately, the factors that cause health issues in water-damaged buildings frequently remain unresolved, even though scientific and healthcare research has identified what we need to look for and how to address these problems. The solutions exist and are accessible, and until there is universal regulation mandating successful protocols, the industry must regulate itself and implement the processes and protocols shown to be effective, which will comprehensively solve the problem.
A Case Study
A client contacted us regarding a musty odor in their kitchen. The home, which is 4,343 square feet with five bedrooms and five bathrooms, had been completely remodeled just two years prior. During our investigation, we discovered significant fungal growth behind the Sub-Zero refrigerator. Upon recognizing the issue, we established a containment system to isolate the kitchen from the rest of the house and proceeded with our assessment. We determined that the ice maker’s drain line was improperly connected to the main drain within the wall cavity behind the refrigerator. Additionally, we found that the inspection cleanout drain cap had not been installed during the remodeling. As a result, every time the ice maker drained, it discharged water into the wall cavity and surrounding area for the past two years. We understand that this has likely led to the aerosolization of fungal spores, meaning the contaminants have spread beyond the kitchen. The family has four children, aged 5 to 13.
Best practices for drying, remediation, and reconstruction were implemented, along with strict adherence to the Gold Standard NORMI Sanitization Protocol. This protocol involves thorough, comprehensive techniques and sequencing high-level sanitation cleaning and dry fog decontamination of the entire indoor environment. Data shows that microbial contamination has been effectively reversed throughout the indoor space, including the air and surfaces, with no viable results found. This is our standard best practice and end result objective, and we achieve it in nearly 100% of our abatements.
Preliminary post-NORMI Sanitization/decontamination Protocol Lab Results:
Viability Results: Zero Growth
Conclusion
Understanding the health impact of the contamination caused by water-damaged buildings and the transmission of contaminants throughout affected indoor environments is critical to comprehensive water damage and mold remediation efforts. Current standards of identifying water intrusion promptly, employing proper dry-out methods, and repairing compromised components are essential. However, improved diagnosis, effective and comprehensive decontamination, and improved verification techniques must also be used.
It is imperative to establish a definitive, elevated standard within the industry as a whole and most definitely for confirmed sensitized/immune-compromised individuals. Achieving this will necessitate a commitment from professionals dedicated to understanding the underlying scientific principles of these challenges, equipping themselves with the necessary technology and expertise, and executing a comprehensive systematic process to reverse environmental source contamination. The remediation industry has the responsibility to elevate its standards based on scientific and healthcare conclusions and the sheer numbers of identified at-risk populations. The industry’s opportunity is immense to comprehensively transform contaminated environments into indoor environments that support wellness, allowing for the healing potential of millions.
References:
1 Kladzyk, Rene, Rolling Stone: ‘Operation Counter-Mold’: The Hidden Battle in Military Homes, (October, 24, 2024)
2 Al Hallak, M.; Verdier, T.; Bertron, A.; Roques, C.; Bailly, J.-D. Fungal Contamination of Building Materials and the Aerosolization of Particles and Toxins in Indoor Air and Their Associated Risks to Health: A Review. Toxins 2023, 15, 175. https://doi.org/10.3390/toxins15030175
3 Neil Nathan, M.D., Toxic: Heal Your Body from Mold Toxicity, Lyme Disease, Multiple Chemical Sensitivities , and Chronic Environmental Illness
4 Al Hallak, M.; Verdier, T.; Bertron, A.; Roques, C.; Bailly, J.-D. Fungal Contamination of Building Materials and the Aerosolization of Particles and Toxins in Indoor Air and Their Associated Risks to Health: A Review. Toxins 2023, 15, 175. https://doi.org/10.3390/toxins15030175
5 Thrasher, Jack & Crawley, Sandra. (2009). The Biocontaminants and Complexity of Damp Indoor Spaces: More Than What Meets The Eyes. Toxicology and Industrial Health. 25. 583-615. 10.1177/0748233709348386.
6 https://www.clearmybrain.com/mold-cirs-research
7 Nazaroff WW. Indoor bioaerosol dynamics. Indoor Air. 2016 Feb;26(1):61-78. doi: 10.1111/ina.12174. Epub 2014 Dec 27. PMID: 25483392; PMCID: PMC7165847.
8 Shoemaker R, et al. Shoemaker R1, Neil V2, Heyman A3, van der Westhuizen M4, McMahon S5, Lark D6. Medical Research Archives vol 9 issue 3. March 2021; Newer Molecular Methods Bring New Insights into Human- And Building- Health Risk Assessments from Water-Damaged Buildings: Defining Exposure and Reactivity, the Two Sides of Causation of CIRS-WDB Illness
9 Dr. Harriet Burge is recognized as one of the world’s foremost authorities in Indoor Air Quality and Aerobiology. March 2010 issue of Indoor Environment Connections.
10 Al Hallak, M.; Verdier, T.; Bertron, A.; Roques, C.; Bailly, J.-D. Fungal Contamination of Building Materials and the Aerosolization of Particles and Toxins in Indoor Air and Their Associated Risks to Health: A Review. Toxins 2023, 15, 175. https://doi.org/10.3390/toxins15030175
Skip Jankoski
Skip Jankoski is an environmental health innovator, author, and educator serving as President of Purified Environments, a Santa Barbara, California-based company specializing in advanced indoor environmental assessment, biotoxin burden reduction, indoor air quality management, and exposure-focused environmental intervention within water-damaged and environmentally compromised buildings.
He is the author of the PEPN-HEART™ Protocol (Health & Environmental Assessment for Recovery & Tolerance), a medically informed framework that applies principles of healthcare diagnostics, exposure science, contamination control, and environmental measurement to the built environment. The protocol views buildings as integrated exposure ecosystems in which air, dust, surfaces, contents, HVAC systems, moisture dynamics, and occupant interaction collectively influence environmental tolerability and human health.
As Co-Founder of PEPN™, an independent national governance alliance, Skip works to advance clinically aligned standards for environmental assessment, intervention, verification, and data integrity. Through PEPN™, environmental professionals, remediation providers, and healthcare practitioners collaborate within a framework designed to better understand and reduce biologically relevant environmental exposures.
With more than two decades of experience spanning medical therapeutics, implantable medical devices, laboratory diagnostics, biotechnology, and environmental health sciences, Skip brings a uniquely interdisciplinary perspective to the relationship between buildings and human health. Few professionals have worked across both healthcare and environmental disciplines at this depth, providing a perspective that connects environmental measurements with real-world exposure dynamics and occupant health considerations. His work focuses on microbial ecology, bioaerosol dynamics, particulate transport, and the role biologically active environmental agents—including microbial fragments, endotoxins,
actinobacteria, β-glucans, and fine particulate matter—play in occupant exposure.
Today, Skip is recognized for helping bridge the historical divide between environmental remediation and healthcare by translating exposure science, contamination-control principles, and aerosol physics into practical environmental health interventions. His work is helping define the emerging discipline of environmental health stabilization, where success is measured not simply by structural correction, but by the meaningful reduction of environmental exposure burden within occupied environments.
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