MECHANICAL DESIGN CHALLENGES IN

HEALTHCARE FACILITY

Ir. Mohamed Azly Abdul Aziz

Jurutera Mekanikal Penguasa
Bahagian Rekabentuk Kesihatan,
Cawangan Kejuruteraan Mekanikal,
Ibu Pejabat JKR Malaysia
Content
Overview of Mechanical
Services in Healthcare
facility

Managing the ‘Needs’

Managing the Design

• Air Conditioning and
Mechanical Ventilation System
• Medical Gas Piping System
Overview of Mechanical Services in
Healthcare facility
Type of Healthcare Facility
Complexity

Special Major Specialist Minor Specialist

Health Clinics
Institution Hospital Hospital
• National • Above 200 • Less than 200 • KK2-KK7
Cancer beds beds • Klinik Desa
Institute • Permanent • Hospital • Klinik
• Regional Blood specialist Rembau, 1Malaysia
Centre • Hospital Hospital Parit
• National Serdang, Buntar
Forensic Hospital
Institute Selayang etc
Category
Medical Related
Mechanical System Equipment (Group 1)

Air Conditioning & Mechanical

Mortuary System
Ventilation System

Medical Gas Piping System Sterilizer

Fire Protection System Dental Chair

Cold Water and Sanitary

Reverse Osmosis System
System

Lift and Escalator Lab Equipment

Pneumatic Tube System Audiometry

Hot Water System

Kitchen Equipment
Groups of Medical Equipment / furniture
Supplied and installed by contractor. Major
items include Mechanical and Electrical
Group related (sterilizer equipment, autoclaves,
1 surgical lights, imaging equipment
including built-in furniture.)

Supplied by client and installed

by contractor. Equipments with
Mechanical and Electrical
Group
requirement (e.g. salvageable 2
from existing hospital)

Supplied and installed by client. (Plug

and play equipment requirement,
Group electrical outlets/water sources, loose
furniture and portable medical
3 equipment – occupy space).

Other items with

storage implication Group
(e.g. linen and 4
consumable.)
Managing the “Needs”
Managing the ‘Needs’

• The ‘Needs’ is expressed in the form of ‘Medical brief of

Requirement’
• Outline the specific requirements of each department and
space.
• Not standardized and tailor made to suit user’s
requirement. User centric.
• Preferred Equipment/system highly based on user past
experiences.
• Balancing cost and requirements.
• Solution- Rekabentuk Piawai
Managing the “Design”
Air conditioning and mechanical
ventilation system
• One of the most critical system in hospital.
• Stringent requirements.
• Health Technical Memorandum (HTM) frm NHS, UK
• ASHRAE
• World Health Organization (WHO)
Air Conditioning System Design Objectives

Temperature Humidity Pressure Noise control

•18oC to 26oC (depending •50% to 60% •2.5 Pa to 15 Pa (depends
on type of areas) on type of room)

Vibration control Air Cleanliness Maintainability Operability

(Filtration)
Airborne Contaminants
• Hospital-acquired infections (HAI) have a significant
impact on patient care.

• ACMV mitigates the spread of airborne contaminants

• Other factors include movement of patients, undiagnosed

patients, visitors, concentration of patients, and patient
susceptibility.

• Improperly operated and maintained HVAC systems can

even become a reservoir for microorganisms.
PATIENTS & ENVIRONMENT

• Patients with thyrotoxicosis do not tolerate hot, humid

conditions or heat waves very well.

• Cardiac patients may be unable to maintain the circulation

necessary to ensure normal heat loss.

• Clinical areas devoted to upper respiratory disease

treatment and acute care, as well as the general clinical
areas of the entire hospital, should be maintained at 30 to
60% rh.

Source: ASHRAE
ROLE OF AIR CONDITIONING IN DISEASE PREVENTION
AND TREATMENT

Preventing the
spread Dilution (by Air quality (by
(pressure ventilation), filtration),
control)

Exposure time
(by air change
Temperature, Humidity,
and pressure
differential),

Organism
viability (by
Airflow patterns.
ultraviolet [UV]
treatment), and
Design Challenges Low Temperature and
Humidity Control

Noise Level

Differential Pressure

Air Change
Application
Operation Theatre
Typical Operation
Room Layout
 HEPA Filter- Laminar Flow
Operation
Room Design
+ ++

Low Level
Exhaust
Cavity wall
construction to
prevent AHU c/w
condensation humidity
(including control
ceiling and floor Heat
slab) Recovery
Wheel
Design Low temperature and
Challenges humidity control
Operating Theatre Conditions
Parameter ASHRAE HTM 02-01
Temperature 20-24oC 18-25oC
Humidity 20-60 % 30-65%

• Cardiac and Orthopedic Operation theatre require operating temperature as

low as 16oC.
• Air change: ASHRAE allows recirculation. Min 4 ACH outside air.
• Typical RH: 50-60%.

For low room temperature and humidity, low

temperature chilled water and hence, more energy is
required.
Temperature and Humidity
• Design challenge to produce low room temperature
and humidity.

• Require low chilled water temperature and higher no

of rows to produce low Coil Apparatus Dew Point
(ADP) to achieve design room condition.
Coil ADP

Entering
Chilled Water
Temp
 Simulation in HAP
45 @ 25 ACH,
Temperature and Humidity HRW

Temperature/ Air Dew Point Coil ADP Required Entering

RH oC oC Chilled Water
Temp
oC

22oC/55% 12.5 11.5 9.9

20oC/55% 10.7 9.6 8.0
18oC/55% 8.9 7.7 6.1

16oC/55% 7.0 5.9 4.3

16oC/50% 5.6 4.3 2.7

Cooling coil approach temperature from 1.6oC to 5.5oC, a typical value for
HVAC applications is approximately 3.8oC.

Min chiller LCHWT is 4.4oC(albeit risky). Adding glycol (ethylene or propylene

glycol at certain concentration) will reduce min LCHWT to -9oC).
Temperature and Humidity
• Performance of cooling coil is governed by;
• Accuracy of estimated cooling load vs actual cooling
load.
• Under sizing will result in non achievement of
temperature and humidity condition.
• Over sizing will result in higher humidity level and higher
heater capacity.
• Sensitive to chilled water flow rate and temperature
stability.
• High energy consumption
Heat
recovery

Duct
installation
Difficulty
Design Differential Pressure
Challenges Control
Differential Pressure Control
• Requires tight envelope. Hard to estimate building air
tightness.

• Maintain a specific differential airflow rate between supply

and return/exhaust. Typically at 10-20%.

• The infiltration or exfiltration flow from a room is a function

of the leakage area and the pressure differential across all
surfaces of the room.

• Air pressure differential should be maintained at 0.01 in.

of water [2.5 Pa] relative to adjacent spaces. (ASHRAE)
or 25 Pa (HTM).
Differential Pressure Control

Parameter ASHRAE HTM 02-01

Differential Pressure (Pa) 2.5 HTM
25 03-01
 Double door : 22 cm2/m2 Source: ASHRAE Fundamentals
Ceiling Penetration: 21 cm2/each
𝑄𝑄 = 𝐶𝐶𝐴𝐴 𝐴𝐴 ∆𝑃𝑃
Design Air Change
Challenges
Air Change (ACH)

• One method of reducing the time and/or number of microbes to

which a person is exposed is by increasing the dilution rate of
clean air into a space.

• Low ACH below 6 ACH can generally contributed to

mold/fungus growth.

• This reduces the exposure time of microorganisms generated

within the room by objects, staff, or the patient.

• Effected by actual pressure drop of all ducted equipment, duct

construction quality.
Effect of Air Change
Time for 99% Particle Removal Efficiency
160

140
𝐴𝐴𝐴𝐴𝐴𝐴 × 𝑅𝑅𝑅𝑅𝑅𝑅𝑅𝑅 𝑉𝑉𝑉𝑉𝑉𝑉𝑉𝑉𝑉𝑉𝑉𝑉 (𝑐𝑐𝑐𝑐. 𝑓𝑓𝑓𝑓)
𝑐𝑐𝑐𝑐𝑐𝑐 =
120 60
Time (min)

100

80

60

40

20

0
2 4 6 8 10 12 15 20 50
Time for 99% Removal
138 69 46 35 28 23 18 14 6
Efficiency
Effect of High Air Change (ACH)

- Higher AHU capacity

Lower risk of contamination - Noisy
- Higher operation &
maintenance cost.

Parameter ASHRAE HTM 02-01

Air Change (total) 20 ACH 25 ACH

• ASHRAE allows recirculation. Min 4 ACH outside air.

Design Noise & Vibration
Challenges Control
 NOISE CONTROL
• High noise levels hinder patient healing largely through interference
with rest and sleep and effect the performance of critical activities.

Whose responsibility?
Noise level
criteria is inside
our Need
Statement

Require holistic/integrated design

 Noise Level Standard Comparison
Original Need
Statement CKM
ASHRAE HTM 08-01 Revised Need Statement
(based on
WHO)
Estimated A- Estimated A- Estimated
Function of A-Weighted Weighted Weighted A-Weighted
Space Room Noise Rating Noise Rating
Sound Pressure Sound Sound Sound
Criteria (RC) (NR) (NR)
Level Pressure Pressure Pressure
Level Level Level
dBA RC dBA NR dBA NR dBA

Operation
/Procedure 30-35 25-35 35-45 40-50 45-55 35-45 40-50
room

RC, taken into account low frequency band i.e 16 & 31.5 Hz up to 8000Hz
NC starts from 63 Hz, 125Hz, 250Hz, 500Hz, 1000Hz, 2000Hz, 4000Hz, 8000Hz
Noise pollution level during various surgeries

Reference: Giv, Masoumeh Dorri, et al. "Evaluation of noise pollution level in the
operating rooms of hospitals: A study in Iran." Interventional Medicine and Applied
Science 9.2 (2017): 61-66.
All Equipment Noise in Operating Theatre
Phase Noise Level (dBA)
Pre-operating phase 62-84
Operating phase 58-82
Post operating phase 45-84

Ref: Nilima shankar* and K. L. Malhotra , Noise in the operation theatre:

intensity and sources” Indian J Phyaiol Pharmacoi 1999; 43 (2) : 263-266
Noise Control Strategy

Source Transmission Receiver

Longer Internal duct

Select low speed fan Wall treatment
liner or Silencer
Aerofoil or backward
Longer duct run Floor treatment
curve
Lower diffuser NC rating Add elbows Acoustic ceiling
 • Minimize
fan speed

Bigger fan
- Expensive
- Bigger AHU
Lower
speed,
lower
Source: Kruger noise
Fan BDB 315
 Design Challenges
Internal duct Liner vs dBA
70
65
60
Room dBA

55
50
45
40
35
Internal Duct liner length (m)
30
0 2 4 6 8 10 12 14
dBA 64 60 54 51 50 48 47 45

Calculated using TAP Acoustic simulation software Based on simulation carried out with
• 4500 cfm Saiver AHU. Sound power
level data from manufacturer
 AHU-MOT
located at
upper floors

Longer duct run

-Higher insertion
loss
Design Challenges
• Internal finishes of hospital is generally “hard
surfaces” with low “Sound Absorption
Coefficient”. E.g No fabric allowed in ICU, no
carpet only vinyl flooring.
Sound
• The sound absorption coefficient is the ratio Absorption
Material
of absorbed sound intensity in an actual Coefficient
-α-
material to the incident sound intensity and can be
expressed as Acoustic tiles 0.4 - 0.8
Brickwork, painted 0.01 - 0.02
• α = Ia / Ii (1)
Carpet, heavy on
where 0.3 - 0.6
concrete
• α = sound absorption coefficient Floor, concrete or
0.02
terrazzo

• Ia = sound intensity absorbed (W/m2)

• Ii = incident sound intensity (W/m2)
Design Challenges
• Space constraints
• AHU Size
• Fan noise from AHU can be reduced by using low speed fan. For a
given flow, lower speed fan means bigger fan. Bigger AHU room is thus
required. AHU in hospital ideally shall be located far away from noise
sensitive area but will result in bigger fan (noise to adjacent area) and
energy cost.

• Congested ceiling plenum

• Congested ceiling plenum resulted in low duct aspect ratio. Minimum
shall be 1:4 and ideally should be 1. Low aspect ratio---higher
friction/noise/material cost.
Medical Gas Piping System
• One of the most critical system in hospital.
• Stringent requirements.
• Health Technical Memorandum (HTM) frm NHS, UK
• Type of gases/system
• O2
• MA4
• SA7
• VACUUM
• NO
• ENTONOX
• AGSS
Design Challenges
• Non standard requirements between hospitals
• No and type of Medical Gas.
• Height of bedhead panel.

• Difficulty in placement of AVSU in highly congested

critical areas (double circuits).

• Challenges in retrofitting works, particularly for 24hrs

department where interruption of medical gas supply is
not permitted.
• Shutting down of main plant is inevitable.
• Need to provide temporary supply via portable cylinder to AVSU.
 Design
Challenges

• HTM recommended height

Between 900-1600 mm
above FFL to centre of TU

• KKM requirement varies

from depending on user
preferences.

Source : HTM 02-01-Part A

Conclusions
• Mechanical Systems design of hospital is in fact
challenging with its complexity and critical interaction with
other building systems.

• Risk of failure or non performance of mechanical system

need to be mitigated at design stage followed by detail
supervision and commissioning at construction stage.
THANK YOU