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Final Guidelines for the Protection and Training of Workers Engaged In Maintenance and Remediation Work Associated with Mold 1 PREFACE This report is the product of two workshops each one attended by over sixty technical experts representing governmental agencies, industrial hygiene firms, abatement contractors, labor unions, universities, and trade associations. The first workshop, Mold Worker Protection Training Workshop was held January 27-28, 2004 in the city of New York. This workshop developed draft, experience-based guidelines for the health and safety training of mold hazard assessors, mold remediation workers, and workers who are exposed to mold in the course of maintaining building systems. The second workshop, Mold-related Health Effects: Clinical, Remediation Worker Protection, and Biomedical Research Issues, was held on June 28-29, 2004 in Washington, D.C. The need for these training guidelines has grown out of an increase in the population of mold- exposed workers and the absence of federal regulations or generally accepted professional guidance on appropriate training to protect these workers from mold exposures. Workshop deliberations benefited from the outcomes of an earlier companion meeting on Clinical Aspects of Mold Exposure held December 10-11, 2003 at the Johns Hopkins University Bloomberg School of Public Health. This workshop was comprised of an expert panel. Their findings relative to the evaluation, diagnosis, treatment and management of mold-related health problems were presented during the opening plenary session of the Mold Worker Protection Training Workshop and are found in Appendix A. The National Institute of Environmental Health Science (NIEHS) managed the workshops in co- sponsorship with the Society for Occupational and Environmental Health (SOEH), the Association of Occupational and Environmental Clinics (AOEC), the Urban Public Health Program of Hunter College of the City University of New York, the New York City Department of Health and Mental Hygiene, and the School of Public Health of the University of Medicine and Dentistry of New Jersey. The National Technical Workshop approach developed and refined since 1991 by the NIEHS Worker Education and Training Program provided the underlying framework for these workshops. The outcome of these workshops, presented here as minimum-training criteria, is intended to serve as initial guidance to governmental agencies, trade organizations, labor unions, and professional associations in the future development of mold worker protection training programs. The training recommendations are based on a review of all major existing guidance. The intent is for this guidance to be a "living document" to be revised in the future as our understanding of mold issues continues to grow and mature. Throughout the workshops the uncertainties were acknowledged regarding health effects of mold exposure and the nature and magnitude of mold exposures by the different target populations, which impacted related discussions on appropriate personal protective equipment (PPE), work practice controls, and, therefore, training. While the experts agreed that the uncertainties require additional research, it was recognized that certain adverse health outcomes are attributable to mold exposure and, even though there is clearly no dose-response data, thousands of workers are exposed to mold while removing and cleaning water-damaged materials and performing normal maintenance activities. The guidelines are based upon the need to protect these workers. Future research on mold health effects and exposures will undoubtedly require the content of this training curriculum to be modified.