11/12/2014

VentilationforHealthcareFacilities
Presentedto
WisconsinHealthcareEngineeringAssociation
November13,2014

Needideastomakethisfirstpageinteresting;picture?Hennemanlogo?

TopicstobeCovered

Relevantcodesandstandards
Airhandlingunits
Spaceventilationrequirements
HVACdistributionsystems
Realworldexamplesofspacesfocusingon
challenges,particularlypressurerelationshipsand
pressurecontrol

Patientrooms
Operatingrooms
Airborneinfectiousisolation(AII)rooms
Pharmacies

11/12/2014

RelevantCodesandStandards
WisconsinDepartment
ofHealthService:

AIA2006HealthcareGuidelineswhichreferences:
ASHRAE170B VentilationofHealthcareFacilities

JointCommissionon
Accreditationof
Healthcare
Organizations(JCAHO)

FGIGuidelinesforDesignandConstructionofHospitalsand
OutpatientFacilities2010whichreferences:
AmericanSocietyofHeating,RefrigeratingandAir
ConditioningEngineers(ASHRAE)Standard170Ventilation
ofHealthcareFacilities2008

ASHRAEStandard170

2013ismostrecentversion

ASHRAEStandard170
AHUs OutsideAirIntakes
25ft fromcooling
towers,exhausts,
vents
6ft abovegrade
3ft aboveroof
ASHRAE170for
Areaways:Bottomof
theairintake6above
grade,intakeat
bottomofareaway3
abovebottomof
areaway.

3-0

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ASHRAEStandard170
AHUs Filters
FilterBank1
shallbe
upstreamof
coils
FilterBank2
shallbe
downstreamof
coilsandsupply
fan.Bank2
mustbesealed
andairtight

ASHRAEStandard170
MinimumFilterEfficiencies
FilterBank1
ASHRAE/AIA
(MERV)

FilterBank2
ASHRAE/AIA
(MERV)

OperatingRooms

7/7

14/14

InpatientCare

8/7

14/14

Protective
EnvironmentRooms

7/8

HEPA/17

13/13

NR/NR

Administrative

8/7

NR/NR

NursingFacilities

13/7

NR/13

PsychiatricHospitals

7/8

NR/14

SpaceFunction

Laboratories

Comments

Includes patientrooms

Nursinghomes

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TypesofMERV14FinalFilters

Bagfilters
Supportedmediafilters
Lowpressuredropgreenfilters
Electronicfilters

MERV14FinalFilters
ExamplesofPressureDrops
FilterType

Initial Pressure
Drop*
(inchesw.g.)

Bag

0.60

FinalPressure
Drop*
Comments
(inchesw.g.)
1.0

24x24x30

RigidMedia

0.60

1.0

24x24x12

LowPressureDrop Green

0.41

1.0

24x24x30

Electronic

0.25

0.75

SecureAire ACS

*Basedon500fpmfacevelocity

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MERV14Standardversus
ElectronicFilterLoading(1)

(1)SlideCourtesyofTemperatureEquipmentCorporationandSecureAire

FilterTypeSummary
Newdevelopments
infilters low
pressuredropfilters
andelectronicfilters
warrantan
economicanalysis
Thereisnoone
rightfiltertype

Replacingfilterswith
lowerpressuredrop
filtersonanexisting
systemcanhelpyou
findsomeextraair.

Healthcare
facilitiesrequire
moreandhigher
levelsoffiltration
thanothertype
ofbuildings.

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ASHRAEStandard170
Humidifiers
Steamhumidifiersmust beused;noreservoirtypeorevaporativepan,etc.
ChemicaladditivesforhumidifiersteamshallcomplywithFDA
requirements.
Directboilersteamisacceptablewithgoodchemicaltreatment.
ROsystemonboilermakeupwillreducechemicalusage

Ifunabletouseboilersteamneedsteamtosteamcleansteamhumidifier.
Locationofhumidifier?
Beforecoolingcoil reducesriskofwettingfinalfilters
Candoaftercoolingcoilifcarefulwithabsorptiondistance.

TypicalHospitalAirHandlingUnit

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TypicalHospitalAirHandlingUnit

13

SpaceDesignCriteria
VentilationRequirements
AIA2006
ACH

ASHRAE170
ACH

NR(2)

4or6

Protectiveisolation

Positive

12

12

Airborne infectious
isolation(AII)

Negative

12

12

Operatingroom (OR)

Positive

15

20

Caesarian deliveryroom

Positive

Procedure(minorsurgery) Positive

15

15

Emergencyroomwaiting

Negative

12

12

Allairexhaustedtooutside

Radiology roomwaiting

Negative

12

Allairexhaustedtooutside

FunctionofSpace

Pressure(1)

Patientroom

1.
2.

PressureRelationshiptoAdjacentAreas
NR=NoRequirement

Comments
6forsinglebedpatient room
servicebyaspiratingdiffusers
Allairexhaustedtooutside

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SpaceDesignCriteria
VentilationRequirements
AIA2006
ACH

ASHRAE170
ACH
Comments

FunctionofSpace

Pressure(1)

XRay(treatment/ diagnosis)

NR

XRay
(surgery/catheterization)

Positive

15

Lab(general,cytology,
histology,andothertypes)

Negative

Labs(sterilization andglass
washing)

Negative

10

10

Bronchoscopy,sputum
collection

Negative

12

12

Allairexhaustedtothe
outside

Pharmacy

Positive

USP<797>governs,if
applicable

1.

PressureRelationshiptoAdjacentAreas

15

SpaceDesignCriteria
NursingFacilityVentilationRequirements
AIA
2006
ACH

ASHRAE170
ACH
Comments

FunctionofSpace

Pressure(1)

Residentroom

NR

Resident gathering/dining

NR

Physicaltherapy

Negative

Occupationaltherapy

Negative/NR(2)

1.
2.

PressureRelationshiptoAdjacentAreas
NR=NoRequirement

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SpaceDesignCriteria
HumidityLevels

RecentlyASHRAEhasloweredthewinterhumiditylevelrequirements
insomespaces,includingORsfrom30%RHto20%RH:

FunctionofSpace
Patientroom

AIA2006
%RH

ASHRAE170
%RH

NR

Max60%

Newborn nursery

3060

3060

Operatingroom (OR)

3060

2060

Procedureroom

3060

2060

Criticalandintensive care

3060

3060

SpaceDesignCriteria
Implementing20%RHinORs:
CMSisallowingawaiver organizationmustdeclarewaiveratthe
beginningofaCMSconductedsurvey.
MustcheckhumidityrequirementsofequipmentusedinORs.AAMI,
theAssociationfortheAdvancementofMedicalInstrumentation,has
issuedcaution:
SuppliesandmedicaldevicesusedintheORsmaybesensitivetolowerhumiditylevels.
Electrodes,forexample,aresensitivetohumidity,asareotherdeviceswithsensors.
Legacymedicaldevicesstillareinuseandhavenotbeentestedinthelowerhumidity
range.Deviceswithtemperaturecontrolsorelectronicsareparticularlysensitiveto
humidity.

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PatientRoomHVACPlan
A common
patient room
HVAC layout
VAV with
reheat supply
and radiant
panel
perimeter
heat
19

PatientRoomsandChilledBeams
Active chilled beams are induction units
in the ceiling.

20

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PatientRoomsandChilledBeams
Activechilledbeamscanandhavebeenusedin
patientrooms
Questionhasbeentheneedforfiltersatthe
chilledbeams somejurisdictions
required/othersdidnot
ASHRAEStandard170 2012hasclarified:
ProvideaminimumMERV6filterforairflowpassingoveranysurfacethatis
designedtocondensewater.Thisfiltershallbelocatedupstreamofanysuch
coldsurface,sothatalloftheairpassingoverthecoldsurfacesisfiltered.

PatientRoomsandChilledBeams
Onemanufacturerwithfilters:

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11/12/2014

PatientRoomHVACPlanwithChilledBeam

23

PatientRoomsandChilledBeams
Advantages:

Thermalcomfort
Canhavelowsoundlevels
NeedlessceilingheightthanallairVAV
system
Possibleenergysavings:
movingonlyminimumventilationair
withAHU lowerfanenergy
DedicatedOAunitwithheatrecovery

Disadvantages:

PhotoCourtesyofTrox,USA

Mustchangefiltersinpatient
rooms/overbed
Riskofcondensation
A2nd pipingsystemtoroom,CHW
Possibleenergyadds
Limitedairsideeconomizer
Possibleincreaseinpumpingenergy

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OperatingRooms
DesignCriteria
20achwith
4achOA

Recentlylow
endreduced
for30%RH

Humidity
levels:20%to
60%RH

68Fto75Fbycode
(lowerasrequiredby
procedure/doctor)

Positive
pressureto
adjacentareas
25

OperatingRooms
TypicalVentilationSystem

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11/12/2014

OperatingRoomsAirDistribution
AIA 2006 and ASHRAE 170-2012 Agree
Supply
unidirectional
downwardsover
patientand
surgicalteam

Primarysupply
diffusersshall
extenda
minimumof12
beyondthe
surgicaltable

Supplydiffuser
velocityof25to
35cfm/sf

Roommusthave
atleast2low
sidewallreturn
grills

Nomorethan
30%ofsupply
diffuserarea
shallbeusedby
nondiffusers

Additional
returngrilles
maybeplaced
highonwalls

27

OperatingRoomsAirDistribution

28

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ORSystemChallenge#1
LowTempOR&HumidityLevel
IfallORsat72Fand35%
OneORtemploweredto65F57%RH
OneORtemploweredto63F64%RH
OneORtemploweredto60F75%RH

IfallORsat72Fand20%
OneORtemploweredto65F37%RH
OneORtemploweredto63F43%RH
OneORtemploweredto60F54%RH

ORSystemChallenge#2
LowTempOR&HumidityLevel
LessonLearned
Ifimplementinga
newlow
temperatureOR,
analyzethe
psychometricsof
thespecific
situation.

Ifcontrollingto
30%rh,consider
20%rh orlower
to20%rh when
highhumiditylevels
occurinlowtemp
OR

Mayneedbooster
humidifiersatall
ORs
ControlAHUhumidifier
totheroomthatneeds
theleastamountof
humidity(lowtemp
OR).
Boosterswilltrimother
roomsrequiredrh

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11/12/2014

OperatingRoomChallenge#2
UnoccupiedAirflowSetbackandPressurization
Why unoccupied shut-back of airflow?
Energy savings
Reduction of facilitys carbon footprint
For more information, ASHE has a booklet
available online entitled Operating Room
HVAC Setback Strategies
31

OperatingRoomChallenge#2
UnoccupiedAirflowSetbackandPressurization
Estimated annual energy dollars saved for one OR
Savingsbasedon

$2,023
$2,846
$3,260

$2,027
$2,597

$2,378

Chicagoweather;
$0.11/kWhfor
electricityand
$0.65/therm for
gas,13unoccupied
hoursperday

10 ORs annual savings is $20,000 to $32,000

32

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OperatingRoomChallenge#2
UnoccupiedAirflowSetbackandPressurization

Per AHSRAE Standard 170:

ORs must be positive, at least +0.01 at all times
ACH can be reduced when unoccupied provided
the pressurization is maintained

33

OperatingRoomChallenge#2
UnoccupiedAirflowSetbackandPressurization
Occupancysensorortimescheduleindicatesunoccupied
conditions

SupplyVAVboxclosesandreturndamperorVAVboxcloses

IfsupplyVAVboxclosesfasterthanreturndamperorVAVbox,the
ORmaygonegative
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11/12/2014

OperatingRoomChallenge#2
UnoccupiedAirflowSetbackandPressurization
Example:
OccupiedMode:ORat+0.023to+0.014
UnoccupiedModeInitiated
After1
minute:
0.028

After10
minutes:
0.009

After17
minutes:
0.001

After18
minutes:
+0.001

After25
minutes:
+0.01)

ORwasnegativelypressurizedfor17minutes
andlessthan+0.01for25minutes
35

OperatingRoomChallenge#2
UnoccupiedAirflowSetbackandPressurization
LessonLearned

Ifimplementingan
unoccupiedairflow
setbackinan
operatingroom

Recommendthe
samecontroldevice
onsupplyand
return eitherVAV
boxesorairvalves

Speedofresponse
ofaircontrol
devicesmustbe
commissionedand
adjustedsoroom
remainspositive
whenswitching
fromoccupiedto
unoccupiedmode
andback

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11/12/2014

AirborneInfectionIsolationRooms
Used to reduce the spread of airborne
infectious diseases (TB) from the patient
in the AII Room to the rest of the
hospital.
In addition to ASHRAE Standard 170 and
AIA Guidelines:
Guidelines for Environmental Infection Control
in Healthcare Facilities, Recommendations of
CDC and the Healthcare Infection Control
Practices Advisory Committee (HICPAC), 2003
37

AirborneInfectionIsolationRooms
CodesandStandards
CDC

AIA2006

Temp/humidity not
addressed
Min12achexhaustfor
roomsconstructedsince
2001
Min0.01H2Opressure
differentialtoachieve
airflowintoroom
Allairexhaustedto
outsideawayfromair
intakesandtrafficor
exhaustedafterHEPA
filtration

75F
30%60%rh
12achminimumtotal
airflow/2achoutsideair
Allairexhaustedto
outside
Min0.01H2Opressure
differentialtoachieve
airflowintoroom

ASHRAE
Standard1702013
(incorporatesCDC)
70F75F abilityto
maintainatalltimes
60%rh(nominimum)
12achminimumtotal
airflow/2achoutsideair
Allairexhaustedto
outside
Negativepressure
relativetoadjacent
spaces

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11/12/2014

AirborneInfectiousIsolationRoom
ArchitecturalDesignConsiderations
Anteroomnot
requiredbutperAIA
Eachroomshallhave
anareaforhand
washing,gowning,
andstorageofclean
andsoiledmaterials
locateddirectly
outsideor
immediatelyinside
theentrydoortothe
room.
Anteroomwithhand
washsinksatisfied
theserequirements

AirborneInfectiousIsolationRoom
ArchitecturalDesignConsiderations
AII roomconstructed
tominimizeleakageareas

LessonLearned

Walls slabtoslab
Ceilings plasterordrywall
Selfclosingdoorswithdoorsweeps
Slidingdoorspreferred
Finishesshouldbesmoothand
cleanable
Sealallpenetrations

Roomwillnotremainpressurized
orwillneedalotofairtostay
pressurizedifroomisleaky.

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11/12/2014

AirborneInfectiousIsolationRoom
PressurizationDesignConsiderations
AII roomnegativetoante
room/anteroomnegative
tocorridor(ASHRAE)

MinPbetweenAII room
andadjacent
rooms/corridor0.01wg
(ASHRAE)

Minof10%moreEAthan
SAbutnolessthan50cfm
Newtightconstruction 200cfm
to300cfmdifferential
Poorlyconstructed 300cfmto
500cfm

PermanentlyinstalledP
monitoringdevice(ASHRAE)

AirborneInfectiousIsolationRoom
RoomSupply&ExhaustDesignConsiderations
Locationofsupplydiffusersandexhaustgrilles CDC2003
andASHRAEStandard170disagree
CDC2003:Supplyabovepatient,exhaustlowonwall
ASHRAEStandard1702008/2013:Exhaustgrillesorregistersshallbe
locateddirectlyabovethepatientbedontheceilingoronthewallnear
theheadofthebed

Designermayconsiderdiscussingdiscrepancywithhospital
infectioncontrol
Ifchosetosupplyabovepatient,usenonaspiratinglaminar
flowtypediffusers

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AirborneInfectiousIsolationRoom
AirflowDiagram
DiagramfromCDCGuidelines

AirborneInfectiousIsolationRoom
RoomHVACDesignExample
Exhaustsystem:
EAfromAHIItomaintain12ach:1,400cfm
Toiletexhaust:100cfm
EAfromanteroomtomaintain10ach:250cfm
ConstantvolumeexhaustboxtomaintainEA/TotalEA=1,400cfm+100cfm+250cfm=1,750cfm

TransferairfromcorridortoanteroomandanteroomtoAII room
Assumemidrangeintightness use300cfmtransferair(TA)

Supplysystem:
AII SA=EATAfromanteroom+TAtotoilet/AII SA=1,400cfm 300cfm+100cfm=1,200cfm
ConstantvolumeboxtomaintaintotalSA/TotalSA=1,200cfm+250cfm=1,450cfm
SAtoanteroom:250cfm(Anteroomneutral)
Reheatcoiltoprovidespacetemperaturecontrol

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11/12/2014

AirborneInfectiousIsolationRoom
RoomHVACDesignExample

AirborneInfectiousIsolationRoom
RoomPressureMonitors
Locateoutsideofanteroomdoorincorridor
Alarmsvisuallyandaudiblyifnegativepressureisnot
maintained
Tieinalarmtobuildingautomationsystem
LessonLearned:
Toavoidnuisancealarms,controltoa
higherPthantotheP
atwhichthealarmisset
Controlto0.03andalarmat0.01.

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11/12/2014

AirborneInfectiousIsolationRoom
HVACDesignExample
ExamplesimplifiedAII roomsequenceofoperation
ModulatesupplyCAVairterminalunitdampertomaintainsupply
airflowsetpoint.
Modulateexhaustairterminalunitdampertomaintainexhaust
airflowsetpoint.
Modulatereheatvalveandradiationvalvetomaintain
temperaturesetpoint.
Coordinatewithuserstosetuptimedelaytoallowentrance/exit
tothepressurizedspacewithoutaudiblealarm.
Ifanexhaustfanfailurealarmisreceivedatthefrontend,close
thesupplyairterminaldamperoperator.

Pharmacies
US Pharmacopeial Convention
(USP) <797> Pharmaceutical
Compounding Sterile Preparations
applies to:
Facilities in which sterile products are prepared and where
manipulations are performed during the compounding of sterile
products which increase the potential for microbial contamination
of the end product.
Facilities where products are compounded using devices or
ingredients which are not sterile to prepare products which must
be sterilized prior to use.

Many hospitals have upgraded - upgrades and

renovations typically exceed of $1M.
48

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Pharmacies and <USP 797> Requirements

Apositiveornegative
pressurecleanroomwith
ISOClass7airquality

Airlocksorpassthroughs
formaterialmovement

AnISOClass7Anteroomfor
entryfromtheoutsideareas

AnISOClass7BufferZone
(andCompoundingRooms)

Handwashingfacilities

LaminarAirFlow
Workbench(es),Biological
SafetyCabinet(s),orBarrier
Isolator(s)inwhichsterile
compoundingtakesplace

49

Pharmacy Compounding Equipment

LaminarAirflowWorkBenches(LAFWs)
ISOClass5(Class100)cleanliness.
Provideslaminarairflowacrossthework
surface
HEPAsupplyfilterwith99.99%minimum
efficiencyincapturing0.3micrometer
particulates

Applications:

IVadmixturepreparation
Drugcompounding
Mediapreparation
Pharmaceuticalprocedures
Electronicassembly

Usedincleanworkroomanddoesnotrequire
ductedexhaustair
50

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11/12/2014

Pharmacy Compounding Equipment

BiologicalSafetyCabinet(s),(BSCs)
DownflowofairandHEPAtreatmentofrecirculatedair
Dependingontype,someorallairisexhausted
Inflowsanddownflows certifiedatsashvelocities(90105fpm),perASHRAE

Types:A1,A2,B1,B2
A1&A2 exhaust30%ofair
B1 exhaust40%ofair
B2 exhaust100%ofair

UsetypeB2forchemo
compoundingunlessglove
boxused
Caution requiresabout
1,000cfmat2.0atinlet
51

PharmacyCompoundingEquipment
Barrier Isolators (Glove
Boxes)
Leak tight negative
pressure work area
HEPA filtered air better
than ISO 5
Exhaust volumes typically
300-500 cfm at -2.0 w.g.
(50% of type B2 BSC )
52

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PharmaciesandUSP<797>
ISOClasses

MaintainingISOClass7and8
requiresHEPAfiltersandthe
followingairchangesperhour:
ISOClass7:30to60

53

PharmacyPlan
FanFilterUnitsforCleanRooms
HEPA filter and small fan in ceiling tile
ECM Speed Control
Filters changeable from room-side

54

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PharmacyPlan
SeparateCleanRoomforChemo
How are high airflows and static pressures for
terminal HEPA diffusers cleanrooms
achieved?
Can use central AHU
but frequently existing
AHU does not have
adequate capacity
Additional recirculation
only fan coil units
Ceiling mounted fan
filter units
55

PharmacyPlan
SeparateCleanRoomforChemo

AnteRoom

ChemoPrep
Cleanroom
where
hazardous
drugsare
prepared

CleanCompounding
Cleanroom
wherenonhazardous
drugsareprepared

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PharmacyHVACPlan
Chemo Hood
Exhaust Duct
Constant
Volume VAV
Box
EA

Fan Filter Unit

Low Exhaust
or Return

57

PharmacyHVACSystemChallenge
Fan filter units are in line with the CV boxes
CV boxes dampers will modulate in
response to a change in pressure in the
duct
Fan filter units ECM motors modulate as
the filters load up
Two modulating devices in series fight each
other and leads to hunting
One device must be fixed ECM motors
can be set fixed
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11/12/2014

Thank you for you time

Questions?

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