Differences between HVAC for

hospitals and that for other buildings :

1. The need to restrict air movement in and between the various departments (no cross
movement).
2. The specific requirements for ventilation and filtration to dilute and reduce contamination
in the form of odor. 
3. The different temperature and humidity requirements for various areas and the accurate
control of environmental conditions.

These requirements demand very high quantities of outside air along with significant treatment of
this ventilation air
Infection Control
• In a hospital environment, there tend to be high
concentrations of harmful micro-organisms. From an
infection control perspective, the primary objective of
hospital design is to place the patient at no risk for
infection while hospitalized. The special technical
demands include hygiene, reliability, safety and energy-
related issues.
Main routes responsible for
infections
• contact transmission
• droplet transmission (>5μm microorganisms)
• airborne transmission (<5μm microorganisms)
• Such as Covid-19 virus
1- Isolation rooms :
• The infected patient can contaminate the environment. A single room with appropriate air handling and
ventilation is particularly important to protect all residents . 
• Types of isolation rooms:
• 1.Airborne infection isolation (AII): refers to the isolation of patients infected with organisms spread via
airborne droplet nuclei <5 μm in diameter.

• 2.Protective environment (PE): is a specialized area for patients who have undergone allogeneic
hematopoietic stem cell transplant (HSCT). The patients whose immune mechanisms are deficient
because of immunologic disorders

• 3.Combined (AII/PE) rooms: are for patients suffering from a weakened immune system who also have
an airborne commun-icable disease. In this type of room, HVAC issues involve a combination of both AII
room and PE room considerations.
• 4. Contact isolation rooms: are for patients having a communicable disease that is not airborne.
Isolation rooms
requirements:

1- The protective environments (PE) are

set at POSITIVE air pressure relative to
adjoining spaces. These areas require
frequent air exchanges (>12 times per
hour) and require all supply air passing
through high efficiency particulate air
(HEPA) filters.
The isolation rooms housing
infectious patients (AII)

•must be maintained at NEGATIVE pressure. These

areas require frequent air exchanges (>12 times per
hour) and require all supply air to be exhausted
without recirculation.
• Continuous monitoring of pressurization with
alarms is required in AII/PE rooms. A differential
pressure indicator must be visible from outside
the room. Sensors and monitoring are required
from the patient room to the corridor and from
the anteroom to the patient room. Readings for
both monitoring arrangements should be
available in the corridor outside the combined
AII/PE room.
2- IMAGING ROOMS

• Imaging systems generally consist of an

assemblage of electronic devices that
perform diagnostic imaging and/or
patient treatment. They can generally
be grouped as four types of devices: X-
ray, ultrasound, magnetic, and
radioactive. As shown in Figure 8-9,
many of the systems, including
fluoroscopy and CT, are based on X-ray
If there is a
separate Equipment
Room, the airflow
required for that
space is determined
by the sensible heat
gain from the
devices in the
room.
IMAGING ROOMS

• In the Procedure Room, the required supply airflow is dictated by either

the cooling load or the airflow recommended by ANSI/ASHRAE/ ASHE
Standard 170-2008, whichever is greater. In most cases, the required
room air change is greater than the required air for cooling a Procedure
Room, where the required airflow is 12 to 15 ach. However, if all
electrical equipment is located in the Procedure Room, airflow may be
load driven. Sometimes, the control equipment is located in an area of
the Procedure Room separated by only a partition; thus, the load from
the control equipment is in the Procedure Room.
IMAGING ROOMS

• Exhaust systems are frequently provided to remove the helium and/or

chemical fire suppressants. Oxygen sensors are often installed, in case a leak of
helium displaces room oxygen. Sensor activation will result in the HVAC system
going into “purge” mode. These controls, dampers, indicator lights, etc., must
be carefully coordinated between the building automation system (BAS) and
the fire alarm system
• MRIs are supercooled magnets. The cooling is accomplished using liquid
helium. The overall system is usually cooled with chilled water, either from a
dedicated air-cooled chiller or from the house chilled water system. These
systems should be set up so that cooling can be provided by both cooling
sources; and occasionally using domestic water as a third cooling source.
3- Intensive care unit
(ICU)
• ICU is highly specified and sophisticated area of a
hospital which is specifically designed, staffed, located,
furnished and equipped, dedicated to management of
critically sick patient, injuries or complications.

• Suitable and safe air quality must be maintained at all

times. Air movement should always be from clean to
dirty areas.
standard of air required

a variable range temperature capability relative humidity of 30 ٪ minimum and For ventilation , a minimum of 6 ach is
of 70° F to 75° F [21.1° C to 23.9° C] 60 ٪ maximum. recommended , of which a minimum of
2 ach must be outdoor air.
 Pressure To protect the patient
from airborne
transmission of any

inside ICU
infection ,the pressure
must be positive.
The exhaust air
• Exhaust air is to be discharged to the outdoors.
• special consideration may be required for air exhausted to the
outdoors, such as from ICUs in which patients with
pulmonary infection are treated. In this case, the exhaust air
must be filtered to reduce the chances of spreading infection.
4- Emergency
Department
•The emergency room is an area of
particular risk because immune-
compromised, undiagnosed contagious
patient populations, all types of patients
and the medical staff often coexist there.

•This type of space has high air exchange

rates and all air is exhausted directly
outside.
The emer­gency department is generally the point of entry to a hospital for
undiagnosed patients, some of whom may be carriers of dangerous infectious
diseases like tuberculosis.
So, Preventing infections is a challenge in any emergency department. In
particular, communicable infections like tuberculosis, meales, and influenza
can be spread through airborne pathogens, putting patients at risk.
Emergency departments need to consider how their HVAC control systems
can combat these infections from spreading through proper HVAC design.
HVAC equipment serving emergency departments must be reliable and
minimize maintenance requirements to address the need for continuous
operation.
 IMPORTANCE Temperature and relative humidity affects the
OF .airborne survival of viruses, bacteria and fungi

CONTROLLING Thus, environmental control in hospitals is important

because of infectious disease transmission from the
TEMPERATURE .aerosol or airborne infection

AND Maintaining hospital premises at a certain

temperature and a certain relative humidity (%rh),
HUMIDITY IN likely to reduce the airborne survival and therefore
.transmission of influenza virus
HOSPITALS Temperature recommended range in the emergency
.room is 21°C-24°C
Relative humidity is in the
range between 40 and
60% minimises the
impact of bacteria and
respiratory infections.
Higher relative humidity
leads to proliferation of
bacteria and other
biological contaminant
(viruses, fungi, mould,
mites).
Pressure inside emergency room

Because the emergency room has a high risk of

airborne contagion so, pressure inside it would
be negative.
This can help limit the spread of contagions from
emergency rooms.
The Exhaust Air
•All air in emergency room is exhausted
•to the outdoors.
•Exhaust air should be cleaned because it contains airborne
contagion and contamination by viruses so, Fans placed on the
roof containing HEPA final filters to prevent recontamination.
•It is acceptable to mix a return air but HEPA fiters is a must in
this case.
 5- Operating Rooms
Recent History of HVAC Standards for Operating Rooms

The purposes of the HVAC system in an operating room (OR) are to minimize
infection, maintain staff comfort, and maintain patient comfort. As indicated in Table
1, the recommended air change per hour (ACH) value has been 15 to 25 for 40 years.
The current recom­mendation in the FGI Guidelines (AGI 2010) and ANSI/ASHRAE/
ASHE Standard 170-2008 is 20 ach supply air including 4 ach of outdoor air (20%
outdoor air). Note that 100% outdoor air systems have not been recommended since
the early 1980s, although until very recently the U.S. Veteran’s Administration has
required 100% outdoor air systems. Operating rooms must be designed for a positive
pressure differential of 0.01 in. of water [2.5 Pa]. As discussed above, this will require
a 200–400 cfm [94–189 L/s] offset. Although ANSI/ ASHRAE/ASHE Standard 170-2008
does not require continuous monitoring, various authorities having jurisdiction
(AHJs) frequently request or require monitoring of temperature, relative humidity
(RH), and dew point in ORs.
 Table (1) Recent
History of HVAC
Standards for ORs
 Classification of Surgeries
The surgical suite contains operating rooms as well as substerile rooms,
clean supply, sterile corridor, preoperative preparation, and postoperative
recovery care (postanesthesia care unit [PACU]). Common usage of the
term “OR” is often intended to include both the surgical room and these
support areas. In some hospitals, other spaces, such as locker rooms,
doctor ’s lounges, control desks, anesthesia workrooms, and even surgical
waiting areas, may be included in the general term. The OR special
environment, however, embraces only the restricted area of the surgical
suite. Surgeries may be classified as shown in Table 2.
 Table (2)
Classifi cation
of Surgeries
 Typical OR Layout
Figure 1 shows a schematic operating
room. As indicated, a typical internal
cooling load is 2 to 3 tons [7.0 to 10.6 kW].
With an air change rate of 20 and supply
air at 47°F to 50°F [8.3°C to 10.0°C], the
system can provide 6 to 7 tons [21.1 to
24.6 kW] of cooling, roughly twice the
actual load. Thus, in almost all operating
rooms, the required ACH drives the size of
the HVAC system, not the internal load.
 Typical Operating
Room (OR) Requirements
 Operating
Room Cooling
Loads
6- Outpatient clinic

•facility that offers treatment,

but does not admit patients
for overnight stays .
and Include ambulatory care:
outpatient treatment,
consultation, or intervention
that is performed on the
same calendar day as
registration and discharge .
standard of air required