HVAC Systems Design for

Airborne Infection Control Spaces

in Health Care Facilities
Belgrade, Serbia April 28, 2017

Wei Sun, P.E.

ASHRAE
Distinguished Lecturer
Society Technology Transfer Committee Chair (12-13)
“Clean Spaces” Technical Committee (TC9.11) Chair (07-10)
“Healthcare Facilities” Technical Committee (TC9.6) Member
“Laboratory Systems” Technical Committee (TC9.10) Member
IEST (Institute of Environmental Sciences and Technology)
Society President
ISO 14644 Cleanroom Standards
USA Delegate
Engsysco, Inc.
Engsysco President
Ann Arbor, Michigan, USA
Web: www.engsysco.com Email: wsun@engsysco.com
 US Healthcare Facilities
Design Guidelines and Standards

2015 ASHRAE - Handbook Chapter 8

2013 ASHRAE - “Hospital and Clinics
HVAC Design Manual”
2010 FGI/AIA - “Guidelines for Design
and Construction of Hospital and Health
Care Facilities”
ASHRAE/ASHE Standard 170-2013 -
Ventilation of Health Care Facilities (with
addendums)
2006 CDC - “Infection Control
Guidelines”
2003 CDC - “Guidelines for
Environmental Infection Control in
Health-Care Facilities”
 US Healthcare Facilities
Design Guidelines and Standards
USP <797> Guidebook to
Pharmaceutical Compounding - Sterile
Preparations (2008)
Unified Facilities Criteria (UFC) - Design:
Medical Military Facilities (2009)
Unified Facilities Criteria (UFC) – Design
Build: Technical Requirements (2005)
VA HVAC Design Manual (2008)
NIH Design Requirements Manual for
Biomedical Laboratories and Animal
Research Facilities (2008)
WHO Interim Guidelines - Infection
Prevention and Control of Pandemic -
and Epidemic-Prone Respiratory
Diseases in Health Care
 US Healthcare Facilities
Design Guidelines and Standards

Aerobiological Engineering Handbook -

Airborne Disease Control Technologies
2012 NFPA Standard 99 - Standard for
Health Care Facilities
2012 NFPA Handbook - Health Care
Facilities Code Handbook
2012 IEEE, National Electrical Safety Code
(NESC)
 US General Building Codes

Architectural Design:
2012 International Building Code
Engineering Design:
2012 International Mechanical Code
2012 International Plumbing Code
2012 International Fire Code
2012 International Energy Conservation Code
 Airborne Infection Risk Management
An Critical Portion of Infection Control Risk Assessment (ICRA)

Source controls
• Patients with Tuberculosis, Chicken pox, Measles,
Smallpox, SARS, Monkey pox, antibiotic resistant
microbes..
• Cough etiquette and respiratory hygiene
Administrative controls
• Construction of infection control infrastructure
• Early detection, isolation, treatment and report
Personal protective equipment – primary barrier
Engineering controls – secondary barrier
• Patient placement (room layout, configuration)
• Space environmental control
Health-Care Settings with Special Environmental
Controls for Airborne Infections
(US CDC)

Operating Room (Operation Theatre)

Airborne Infection Isolation Room (AII)
Protective Environment (PE)
Critical and Intensive Care Unit
 Ventilation Requirements
(USA)

Function Space Standard Pressure Min. OA Min. All Air Air Relative Design
Basis Relationship ACH Total Exhausted Recirculated Humidity Temp.
to Adjacent ACH Directly to Within Room % °F
Areas Outside Units (Ex. w/
HEPA)
Operating Room AIA (06)
Positive 5 25 — No 45-55 62-80
(Re-circulating air ASHRAE(08) Positive 4 20 N/R No 30-60
20 68-75
system) CDC (03) Positive 3 15 N/R Yes 30-60 68-75
AIA(06) Negative 2 12 Yes No — 75
Airborne infection
ASHRAE(08) Negative 2 12 Yes No — 70-75
Isolation Room (03)
CDC Negative 2 12 Yes No — 75
Positive or 2 10 Yes No — —
AIA (06)
Negative
Isolation Positive or 2 10 Yes No — —
ASHRAE(08)
Anteroom Negative
Positive or 2 10 Yes No — —
CDC (03)
Negative
Protective AIA(06) Positive 2 12 — No — 75
Environment ASHRAE(08) Positive 2 12 — No — 70-75
Room CDC (03) Positive 2 12 — No — 75
AIA (06) N/A 2 6 — No 30-60 70-75
Critical and
ASHRAE(08) Positive 2 6 N/R No 30-60 70-75
Intensive Care
CDC (03) N/A 2 6 — No 30-60 70-75
Ventilation Requirements
(ASHRAE 170 – 2013 Std)
 Operating Room (1)
(Example - CDC Based)

Constant volume air handling systems are common in

operating rooms, variable systems are permitted for use “only
if” they continue to provide a positive room pressure
(normally 0.01-0.03 in. wg or 2.5-8 Pa differential) with
respect to the corridors and adjacent areas and the required
ACHs are maintained.

HEPA-filtered (99.97%) laminar airflow and UVGI (Ultraviolet

Germicidal Irradiation) as additional measures could reduce
SSI (Surgical-Site Infection) risk for certain operations.
Laminar airflow is designed to move clean air over the aseptic
operating field at a uniform velocity (0.3–0.5 m/s) (60-100
fpm), sweeping away particles in its path, and recirculated air
is passed through a HEPA filter.
Operating Room (2)
Operating Room (3)
(ASHRAE 170-2013)

Additional diffusers may be

located outside of the Primary
Supply Diffuser Array (Zone)
if needed to achieve required
environmental conditions or
air change rates, but no more
than 30% of the Primary
Supply Diffuser Array.
New definition of Procedure
Room is equivalent to Class A
ORs previously.
New definition of Operating
Room is equivalent to Class
B and C ORs previously.
 Airflow Effectiveness Improvement in OR

 Enlarged Clean Zone Area (3.2m x 3.2m)

 Higher ACH
 Foldable Air Curtain

Floor Mounted System

Airborne Infection Isolation Room (1)
(Example - CDC Based)

Use of negative pressure rooms with control of air flow

direction (normally - 0.01 to -0.03 in. wg or -2.5 to -8 Pa
differential), airflow volume differential at a minimum of 125
CFM (60 L/s) exhaust versus supply.
Seal room below 0.5 ft2 (465 cm2) of air leakage (called
Effective Leakage Area under 4 Pa pressure differential test)
Filtered (90%) supply air to the room. Air from negative
pressure rooms and treatment rooms is to be HEPA-filtered
(99.97%) and exhausted directly to the outside. Recirculation
is not allowed. Isolation rooms can be constructed ideally
with an anteroom. UVGI fixtures can be placed in upper room
or inside the ducts as an additional measure.
Personal protective equipment such as respirators (NIOSH
type N95 or powered purifier) for healthcare workers prior to
entering isolation rooms.
Airborne Infection Isolation Room (2)
(Example - CDC Based)

Cascading

Bubble

Sink
 Protective Environments (1)
(Example - CDC Based)

These rooms are to be designed for high-risk, immuno-

compromised patients (BMT, organ transplant, leukemia,
burn, late-stage HIV…) to minimize fungal spore counts
(measured in CFU) in air.
Ideally, incoming air by HEPA filters, supply air on one side of
the room across the patient, and exhaust out through the
opposite side of the room.
Positive room air pressure of 2.5 Pa (0.01" w.g.) relative to
the corridor, airflow volume differential at a minimum of 125
CFM (60L/s) supply versus exhaust.
Seal room below 0.5 ft2 (465 cm2) of air leakage.
Protective Environments (2)
Critical and Intensive Care Room (1)
(Example - CDC Based)

Based on the patient type and critical-care suite

configuration, positive, negative or neutral room
pressure (normally from -0.01 to 0.01 in. wg or -2.5 to
2.5 Pa differential) with respect to the corridors and
adjacent areas.

Filtered (90%) supply airflow, and recirculated air is

allowed.
Critical and Intensive Care Room (2)
Hospital Room Airflow, Pressure, Flow Direction,
Temperature and Humidity Requirements
(For Hospitals and Outpatient Facilities, FGI) (1)
Hospital Room Airflow, Pressure, Flow Direction,
Temperature and Humidity Requirements
(For Hospitals and Outpatient Facilities, FGI) (2)
 Example
Design Criteria – Operating Room
AHU Flow Diagram (With Possible Options)

Use only with

psychrometric
analysis!!!

Complex (multi-functional) AHU System (Discharge at 55°F year-around)

• Exhaust only
• Exhaust w./ heat pipe
• Exhaust w./ enthalpy wheel
• Dual Return paths
• 100% OA for purge
 ASHRAE Developing Cost Effective Solutions
Toward Low Energy Healthcare Buildings

Renewable Energy
Geothermal
Solar Panels
Wind Turbine
Energy Recovery
Cogeneration - Not only for Backup Power, but as Main Power.
Use Water-cooled Compressors (Large) to Recover Waste Heat
Energy Recovery - Heat Pipe, Thermal Wheel, Run-around Coils
Building
Building Envelope - Increase Air Tightness, Reduce Leakage through
Windows and Walls, Add Vestibules
Use Vertical Fenestration and Overhang in West, East & South Windows
Reduce or Eliminate of West-side Windows
Commissioning and Retro-commissioning – User friendly Software
 ASHRAE Developing Cost Effective Solutions
Toward Low Energy Healthcare Buildings

Lighting & Power

Sensor Controlled Natural Day Lighting
Building and Space (Section/zone) Metering through BMS
Reduce Plug Load: Use BMS Clock Control to Deactivate Non-Critical
Office Equipment during Night/Weekends, Can Be Overridden with Light
Switch.
Reduce Lighting Waste by Occupancy Sensor
LED Lights

Water
Collect Rain Water with Filtration for Irrigation and Underground Sprinkler
System
Cooling Condensate Collection (AHU over 5 Ton) for Cooling Tower
Make-Up Water
 ASHRAE Developing Cost Effective Solutions
Toward Low Energy Healthcare Buildings

HVAC
Logic Controlled Ventilation – Use Combination of Natural and Hybrid
Ventilation Automatically
CO2 Demand Controlled Ventilation, Air-side Economizers (Varies with
Climate Zones)
Enhanced Particle and Microbial Filtration Technology to Lower OA
Intake Quantify
OA Intake Shut down – Chemical and Multi-gas Sensing to Close OA
Damper when Chemical Concentrations in OA Above Allowable Limits
Decoupled Ventilation (DOAS), Improved Dehumidification for Latent
Removal
AHU Discharge Temperature - Dynamic Reset of VAV System
Sample View of US Hospitals 1
Sample View of US Hospitals 2
 Sample of Energy Saving Approaches

Rooftop Chillers Exterior Lighting

Direct versus Indirect Lighting Public Waiting Areas with Window Glazing
Sample of Energy Saving Approaches

Solar Panels on Roof

Logic Controlled Sun Shade

Use Exterior Lighting