Re: ERMI mold scale!

[Guest guest]

There are very definite advantages and disadvantages to the ERMI mold

scale. The advantages are so compelling that Dr. Shoemaker currently

uses the results as part of his diagnostic/treatment process. His

office has just asked me to have this test done, have the results

also sent to him and finally set up a telephone consultation with him

to discuss the results.

In an article posted at Mycometrics.com, Dr. Shoemaker asserts that

the ERMI test can even indicate a post-remediation number when a mold

illness relapse is likely to occur:

" Do high levels of mold, therefore, translate in genetically

susceptible patients into inflammation that reduces blood flow in

particular parts of the brain such that the brain doesn't work? Yes!

Even better, (i) following treatment abnormal brain metabolites are

reduced and (ii) the benefit of treatment maintained with re-

occupancy of the home provided the post-remediation ERMI is less than

2. Relapse occurs if the ERMI is higher.

http://www.mycometrics.com/articles/ERMI_Lin_Shoemaker.pdf

I also think that he finds the ERMI's DNA test results useful. The

test isolates the spore count for 36 specific species of mold, some

of which create mycotoxins (and others don't). I think he may use

this information in his diagnostic process, but I will know more

after I talk to him and will report back to the group.

I do know that the ERMI is only one tool in the toolbox of a

professional remediator, and that it is used to determine the overall

status of a water-damaged building. I also have heard that the ERMI's

breakdown of type of fungal spores present will help indicate WHERE

to look for specific mold species. Final confirmation of location can

be be done with additional tools of the toolbox. For instance, May

Indoor Air's website lists sophisticated techniques such as infrared

thermography to find hidden moisture and water leaks and also a

borescope to inspect walls and ceiling cavities. When mold spores are

discovered then final surface samples can be sent to a lab for

analysis to confirm the findings.

The ERMI is obviously not the only tool that is useful in analysis

for mold, but if Dr. Shoemaker thinks that it is helpful then I'm all

for it. It provides essential diagnostic information that otherwise

wouldn't be available, much like the many additional lab reports that

Dr. Shoemaker orders.

The major disadvantage that I can see is the cost, but it is worth it

to me if it helps me get well. Perhaps as it becomes more widely used

the cost will drop.

I am founding that getting well from mold illness is very, very

expensive, especially since I cannot work due to the illness. I am

grateful that the Internet provides access to the free support and

information provided to from this group. Thanx ya'll!

Pam

>

> Beware, the EPA mold scale ERMI is misleading. Please read the

truth

> about it here:

> http://molddetectionexperts.blogspot.com/2007/08/beware-epa-mold-

scale-e\rmi-is.html

[Guest guest]

More about the ERMI (including quotes from Dr. Shoemaker) at:

http://www.ieconnections.com/archive/june_07/june_07.htm

WHAT IS THE ERMI?

The 36 indicator species that make up the ERMI were chosen because

they can be found at relatively high concentrations in homes

throughout the United States. This is not to say that there are no

other species that are unique or important in different climates or

locations; rather, these 36 indicator species are common enough to be

predictive of the total mold burden. The goal is to measure enough

species to allow the laboratory to describe the relative mold burden

in homes anywhere in the country.

As shown in Table 1 on page ___, these 36 species were categorized

into two groups. The first group includes 26 species/clusters

associated with water-damaged homes. The other group is comprised of

10 common species or clusters not specific to water-damaged homes. In

HUD's survey, the ERMI was computed for each home by taking the sum

of the log-transformed concentrations of each of the Group 1 molds

minus the sum of the log-transformed concentrations of the Group 2

molds. (The concentration of the Group 2 species is subtracted from

the Group 1 species in order to adjust for variations in cleaning

habits.)

To produce the ERMI scale, the computed ERMI values for all 1,096

homes were assembled on a continuum from lowest to highest. The scale

ranges from about -10 to about 20, or even higher, as shown in the

sample ERMI report shown in Figure 1 on page ___. On the left-hand

side of the scale, the 25 percent of the homes with the lowest

concentrations of molds in the ERMI analysis have an ERMI value less

than -4. Homes within this low range have the lowest mold burden. The

homes in upper quartile have ERMI values of five or higher.

Generally, homes within this high range are considered to have the

highest potential risk of exposure to molds associated with water-

damaged indoor environments.

The ERMI scale is not meant as a method of making fine separations,

since the standard deviation for any ERMI value is plus or minus

three. For example, the 95 percent confidence interval for an ERMI of

14 would be from 11 to 17 – i.e., 14 plus or minus three. So, for

example, an ERMI value of 14 is not significantly different from an

ERMI value of 15, or an ERMI of two versus zero.

USING THE ERMI FOR MEDICAL QUESTIONS

The ERMI scale was derived from the analysis of the settled dust in

the common living room plus one bedroom of a home; for proper

comparison with the HUD survey data, the ERMI samples should be taken

in these same areas. However, dust samples can be taken anywhere for

analysis, and the inspector's expertise should direct that. There is

just more uncertainty as one moves away from the locations that were

used to build the ERMI scale. Here are some examples of how the ERMI

is being used.

" If a person is not feeling well and his or her doctor has determined

that sensitivity to mold is an issue to explore, then an ERMI

analysis of the patient's home is a good place to start, " explained

Dr. Ritchie Shoemaker, a family practice physician in land who

specializes in mold exposures. While the ERMI is a mold index and not

a health index, Shoemaker said that whenever the ERMI is

elevated, " you may suspect mold trouble. " If the ERMI is low and

there are people in the home with a typical mold illness, consider

repeating the ERMI in different areas. If the ERMI is low and no one

is ill, your sense of security increases.

An ERMI analysis might help you to determine if your home is safe for

visitors who might have a genetic susceptibility to mold. " If the

ERMI value [is above five, which] suggests the home is in the upper

25 percent of the scale, then an investigation for water damage could

be health-saving, " said Shoemaker.

He tells of " a Massachusetts mother who found that her home was

terribly contaminated, even without visible mold, musty smells or

abnormal air sampling from two prior mold inspectors. She says to

this day that ERMI saved her children's lives. Maybe that is too much

credit, but the truth is that her family only now is well. "

The Institute of Medicine's 2004 report " Damp Indoor Spaces and

Health " expressed the opinion that there was sufficient evidence of

an association between molds or other agents in damp indoor

environments with asthma symptoms in sensitized people. Each person

varies so much genetically that a level of mold burden for one person

may cause asthma symptoms but not affect another person at all.

Medical questions should always be left to the medical professionals.

The ERMI value is just one more piece of information that a physician

might use to help in a diagnosis.

For example, a study conducted of asthmatic children in Cleveland by

CASE Medical School used ERMI testing to document the mold burden in

each home. After remediation of the water damage and mold, the

children experienced a significant reduction in their need for

medical intervention for their asthma. In a prospective study of

atopic infants, measuring the mold burden with MSQPCR was found to be

a better predictor for development of wheeze/rhinitis than the visual

home inspection for mold.

USING THE ERMI TO LOCATE MOLD PROBLEMS

Derrick A. Denis, a Council-certified indoor environmental consultant

in Arizona, suggests that one should " consider what is your mold-

related question and which of the sampling methodologies and analyses

will most accurately answer your question. " He uses MSQPCR as one

more tool in his mold-inspection toolbox of sampling methodologies

for IAQ investigations. " Each of the sampling methods available has

strengths and weaknesses, as well as costs, " he said. " An ERMI

analysis can give a homebuyer a warning that there was an historic

unknown or undisclosed water problem with mold growth in the home, or

the ERMI can provide peace of mind that the relative mold burden in

the home does not indicate a history of water intrusion. "

" Some caution in the use of ERMI is necessary because of conditions

that can affect the outcome of sampling, " advised Greg Boothe, a

certified industrial hygienist in Tennessee who uses ERMI as an

effective screening tool to direct further investigation in both

residential and commercial settings. " Investigators must consider the

condition and activities related to the sampling surfaces in areas

selected for ERMI analysis, " said Boothe. New carpet and carpet that

has recently been professionally cleaned may not reflect the true

historical burden of mold in the building.

Gil Cormier, a certified industrial hygienist in Connecticut, has

used the ERMI for evaluating carpeting in schools. " We were able to

use the ERMI to evaluate carpeting and compare rooms with suspected

moisture problems with rooms with no known moisture problems, " he

said.

ADVANTAGES OF ERMI

Traditional air sampling has never been standardized; thus,

interpretations of the results are always problematic. The major

problem with traditional air samples are that they are necessarily of

a short duration. Often, air samples are taken for only a few minutes

because the recovery source, whether a Petri dish or a sticky slide,

is quickly overloaded. However, air samples can be useful and, if

properly taken, can also be analyzed by MSQPCR.

Air samples can be useful, especially in hospitals or in an effort to

pinpoint the location of a hidden mold problem, as Vesper and

others note in a 2004 paper published in the Journal of Hospital

Infection. In order to take air samples for MSQPCR analysis, the

collection medium is a 25 or 37 mm diameter polycarbonate filter with

either 0.45- or 0.8-micron pore size. The flow rate can range from

two to 16 liters per minute. The holder for the filter can be a

button, sampler, cassette, or any other holder suitable for the

filter. Sampling can be accomplished using either a personal or area

sampling pump. The great thing about MSQPCR analysis is that the

filter cannot be overloaded, meaning air samples can be taken for

prolonged periods such as many hours or even days. But the best part

is that you don't have to wait days to weeks for your results.

However, there is no ERMI scale for air samples.

SAMPLING FOR THE ERMI?

Sampling dust for the ERMI analysis is fairly simple. Start by

locating the most commonly used area in the living room. Using a tape

measure and masking tape, mark a three-foot by six-foot sampling area

on the floor. If the sample location cannot accommodate a sample area

of these dimensions, then adjust the dimensions accordingly. Record

these dimensions and note where you took the sample for later

comparison, if necessary. Next, do the same in the main bedroom.

Then take the protective caps off the holder and insert the filter

into the holder and attach it to the vacuum cleaner hose. Vacuum for

five minutes in each area, pull out the sampler and cap it. As a rule-

of-thumb, the filter should be generally about half full when you are

finished. If there is very little dust, then you will want to vacuum

for a longer time or over a larger surface area and note this on the

chain-of-custody form. Send each of the samples in a sealed bag for

an ERMI analysis to an EPA-licensed ERMI laboratory. Your results can

be ready in as little as 24 hours.

If the ERMI value is high, then you may want to analyze other areas

in order to help find the water damage that is the source of the

mold. A basement, if there is one, can be a common source of water-

damage molds, and a sample can be taken there. However, once it is

clear that there is water damage in the environment, other devices

like infrared cameras or moisture meters or even mold-sniffing dogs

may help to locate the problem.

When evaluating buildings other than homes, the difficulty is

deciding where to take samples. It may be that multiple samples will

be required. The experienced inspector will look at the HVAC system

and make an educated guess about where to sample. One should take

dust samples of an area equivalent to that used in the home

investigation. Collecting dust from other available surface areas

such as a shelf, cabinet, etc., with available settled dust can be an

alternative, if no appropriate floor surface is available.

Since no ERMI scale has been developed for other types of buildings,

one can only relate the analysis back to the home ERMI. Thus, an

office with an ERMI of 14 would be like saying the office environment

would be equivalent to a home in the top 25 percent of homes in the

United States for relative mold burden. Additional samples, even air

samples, may help pinpoint the mold's location.

Another time to use the ERMI is before and after remediation. After

fixing the water problem and removing the mold contaminated

materials, it is important that the entire home be thoroughly

cleaned. You can then repeat the ERMI sampling and analysis to ensure

post-abatement verification. There should be a significant reduction

in the ERMI value. However, it may take some weeks to months before

the ERMI returns to pre-water-damaged mold levels.

No sampling can replace the wisdom of experience in finding and

dealing with mold problems in buildings and ERMI can be a helpful

tool. As further research documents the ERMI's applications, it can

improve lives.

SUMMARY

We know that all indoor environments contain some mold, but not all

contain the same molds and definitely not at the same concentrations.

Identification and accurate quantitation of indoor molds to the

species level is now available using a DNA-based analysis, MSQPCR.

This automated analysis provides rapid, reproducible results that can

be reliably interpreted. For patients, prospective homebuyers,

industrial hygienists and remediators alike, ERMI shows great promise

to help us all.

King-Teh Lin is laboratory director for Mycometrics LLC. He earned a

doctorate degree from Wood Medical School and, soon

after his postdoctoral fellowship, continued as a faculty member

until being recruited by P & K Microbiology Services as a director of

research and development. There, he pioneered commercialization of

MSQPCR and invented the new DNA testing for wood-decaying fungi. In

2005, he established Mycometrics to provide microbiology testing

services. Lin can be reached by e-mail at kingteh@... or

by phone at (732) 355-9018.

[Guest guest]

Pam,

This is an extraordinary and clear statement of how ERMI can be used

by a professional and by a medical doctor such as Dr Shoemaker. As

you say, it is one tool in the tool box. Used properly with an

understanding of the strengths and limitations it can provide

valuable information that may assist in some of us healing.

The difficulty I found with the molddetectionexperts site is they

recommend air sampling analyzed by microscopy as better than ERMI.

Again, it is but one tool in the tool box and, in my opinion, one of

the least reliable.

I still caution users of ERMI that the sampling location and

technique is critical. If you sample an isolated hot spot the high

levels will not be representative of the house and could lead to

unnecssary costs. Contaminated equipment can be a problem. I have a

client using a similar technique that got higher readings after the

house was cleaned. The source was contamination on the equipment used

for the cleaning.

Again, there is more to mold (spore or DNA) than just collecting

something and getting numbers back from a lab. Thanks, again, Pam for

your experience and insight.

Carl Grimes

Healthy Habitats LLC

-----

> There are very definite advantages and disadvantages to the ERMI mold

> scale. The advantages are so compelling that Dr. Shoemaker currently

> uses the results as part of his diagnostic/treatment process. His

> office has just asked me to have this test done, have the results

> also sent to him and finally set up a telephone consultation with him

> to discuss the results.

>

> In an article posted at Mycometrics.com, Dr. Shoemaker asserts that

> the ERMI test can even indicate a post-remediation number when a mold

> illness relapse is likely to occur:

>

> " Do high levels of mold, therefore, translate in genetically

> susceptible patients into inflammation that reduces blood flow in

> particular parts of the brain such that the brain doesn't work? Yes!

> Even better, (i) following treatment abnormal brain metabolites are

> reduced and (ii) the benefit of treatment maintained with re-

> occupancy of the home provided the post-remediation ERMI is less than

> 2. Relapse occurs if the ERMI is higher.

> http://www.mycometrics.com/articles/ERMI_Lin_Shoemaker.pdf

>

> I also think that he finds the ERMI's DNA test results useful. The

> test isolates the spore count for 36 specific species of mold, some

> of which create mycotoxins (and others don't). I think he may use

> this information in his diagnostic process, but I will know more

> after I talk to him and will report back to the group.

>

> I do know that the ERMI is only one tool in the toolbox of a

> professional remediator, and that it is used to determine the overall

> status of a water-damaged building. I also have heard that the ERMI's

> breakdown of type of fungal spores present will help indicate WHERE

> to look for specific mold species. Final confirmation of location can

> be be done with additional tools of the toolbox. For instance, May

> Indoor Air's website lists sophisticated techniques such as infrared

> thermography to find hidden moisture and water leaks and also a

> borescope to inspect walls and ceiling cavities. When mold spores are

> discovered then final surface samples can be sent to a lab for

> analysis to confirm the findings.

>

> The ERMI is obviously not the only tool that is useful in analysis

> for mold, but if Dr. Shoemaker thinks that it is helpful then I'm all

> for it. It provides essential diagnostic information that otherwise

> wouldn't be available, much like the many additional lab reports that

> Dr. Shoemaker orders.

>

> The major disadvantage that I can see is the cost, but it is worth it

> to me if it helps me get well. Perhaps as it becomes more widely used

> the cost will drop.

>

> I am founding that getting well from mold illness is very, very

> expensive, especially since I cannot work due to the illness. I am

> grateful that the Internet provides access to the free support and

> information provided to from this group. Thanx ya'll!

>

> Pam

>

>

> >

> > Beware, the EPA mold scale ERMI is misleading. Please read the

> truth

> > about it here:

> > http://molddetectionexperts.blogspot.com/2007/08/beware-epa-mold-

> scale-e\rmi-is.html

[Guest guest]

Yes Pam, I agree with you 100% and you've said it very well.

As for me, I've been reading here for a couple hours, or more (!) a

day for almost three years, as well as other reading, and one thing I

have learned is that *any* test can be misleading all by itself - as

Carl has pointed out many times - and that we need a variety of tests

as well as good analytical thinking to figure out what the condition

of any building is, and how to fix it, if possible. I would agree

with new poster that it can be misleading if a mold inspector uses it

all by itself. As Carl pointed out, what if sample is taken in an

area where shoes drag in spores from outside!! Yet another thing I

have never heard or thought about!!! Thanks for explaining this so

well.

--- In , " Pam Gibbard " <pqgibbard@...>

wrote:

>

> There are very definite advantages and disadvantages to the ERMI

mold

> scale.

[Guest guest]

Barb,

When you say " any test can be misleading " do you mean ONE SINGLE TEST?

Carl, what do you think?

I went through that whole thing and I think the more information someone has

the better and the less chance there is that they

may be misled by any single nugget of information.. And its good to

understand the mechanics, the workings of how the test is done and the math

of how its read..

With ERMI, as Carl said, the sampling location is very important.. I think

its would be better to get an average sampling of dust than just a few spore

trap readings or even tape lifts..

ERMI has one advantage in that it isn't as time dependent as other methods,

I'd think..Did he say that? I bet he did..

The sampling averages the situation over the period of time the

mold detected in the sample was generated.. But with air spore testing, I

thinkthe moment of time the sample is taken is important.

With all kinds of spore testing, really, sampling locations and time are

important. Calm day vs windy day.. morning vs. afternoon. occupied space vs.

unoccupied.. (An unoccupied apartment is not a typical situations.. as its

much dryer.. no water is being used..

In California, dry season vs. wet season is very different...

Also, I think you have to look at the situation where you have positive

results and the situation where you have negative results VERY differently

as far as reliability. Positive results say MOLD WAS THERE..

Each negative result says no spores were found there THEN...Negative at that

time means there was no mold on that day, at that time. Its easy to have a

false negative, and by all accounts with spore testing it happens all the

time. It means a lot less than a strongly positive result.

So, does it seem accurate to say that its difficult to have a real major

false positive with a well thought out survey of a space (especially if its

done with spore testing)? (and not one of the newer methods like ERMI or

volume sampling for mycotoxins.. which have the potential to 'average' a

larger window of time..

I think that if you have a number of positive results that all say the same

or similar things its pretty strong evidence that you have a problem..The

likelihood of there not being a problem is very, very low. On the other

hand, I think its easy, especially with stachybotrys situations, to take two

or three or even four samples and not see spores from stachy even though a

place may have a stachy or a toxic problem.

It just didn't show up THEN...do you know what I mean? It may be old mold

thats lost its shape and isn't recognizable as stachy spores but its still

toxic..for a long time..

[Guest guest]

Yes.

--- In , LiveSimply <quackadillian@...>

wrote:

>

> Barb,

>

> When you say " any test can be misleading " do you mean ONE SINGLE

TEST?

>

[Guest guest]

Carl, Jeff...and other opinions please:

Where might good locations to collect dust for ERMI testing?

I was thinking perhaps of putting a small smooth material according

type filter like Filtrete Ultra partially over my cold air returns

and trying to collect there. Not sure I'd get enough though. I was

thinking also perhaps someplace you rarely can vacuum...due to it

not being a 'pathway' in the house that gets dirty from feet/shoes

so only dust would fall there and not shoe dirt. Jeff said in your

thermostate I believe since air goes through there to get

temperature readings? I don't see any around mine but maybe I have

a different type or I need to open it up further. I dusted entire

house including tops of door jams not long ago. Perhaps if I wait a

couple of months there will be enough then on top of door jams or

decorative objects.

--- In , " Carl E. Grimes " <grimes@...>

wrote:

>

> Pam,

>

> This is an extraordinary and clear statement of how ERMI can be

used

> by a professional and by a medical doctor such as Dr Shoemaker. As

> you say, it is one tool in the tool box. Used properly with an

> understanding of the strengths and limitations it can provide

> valuable information that may assist in some of us healing.

>