GUIDELINES ON VENTILATION IN THE HEALTHCARE SETTING …

1 ANNEX 52. GUIDELINES ON VENTILATION IN THE. HEALTHCARE SETTING TO REDUCE. THE TRANSMISSION OF. RESPIRATORY PATHOGENS. First Edition Ministry of Health Malaysia &. University Malaya Medical Centre July 2021. GUIDELINES ON VENTILATION IN THE HEALTHCARE SETTING TO REDUCE. THE TRANSMISSION OF RESPIRATORY PATHOGENS. Table of Contents Acknowledgement .3. Abbreviations .. 5. Glossary ..5. 1. Scope .. 8. 2. Guideline 8. 3. 8. 4. VENTILATION .. 9. 5. Methods To Ventilate A Building .. 9. 6. Minimum Requirement For Airborne Infectious Disease Patient's Room .. 10. 7. Minimum Requirement For VENTILATION Rate .. 10. 8. Strategies To Improve VENTILATION .. 11. Strategies To Improve Natural VENTILATION .. 11. Strategies To Improve Mechanical VENTILATION .. 12. The Airflow Direction.

2 13. Strategies To Minimise The Risk Of Transmission Of Infection In Natural 13. Strategies To Minimise The Risk Of Transmission Of Infection In Mechanical 15. Exhaust Air .. 17. Evaluation And Assessment Of Existing Air Conditioning And Mechanical VENTILATION Systems With Recirculating Units .. 18. Non-Ducted ACMV System .. 18. Ducted Acmv System .. 21. Maintenance And Operation Of ACMV System .. 22. 9. Monitoring Of VENTILATION Performance .. 23. 10. Complementary Decentralized Air Cleaning Methods .. 23. Portable Air Cleaner With Hepa Filters .. 24. UVGI (Ultraviolet Germicidal Irradiation) .. 32. 11. Summary Of Recommendation To Improve Natural VENTILATION In HEALTHCARE Settings ..35. 12. Summary Of Recommendation To Improve Mechanical VENTILATION In HEALTHCARE Settings.

3 36. 13. Summary Of VENTILATION Specifications In Selected Areas Of Health-Care Facilities For Infection Prevention And Control.. 38. 16. Appendices Appendix 1: Airborne Infection Isolation Room (AIIR) .41. Appendx 2: Monitoring Of Air Pressure And Air Flow In HEALTHCARE SETTING .47. Appendix 3: Air Filter Category ..53. 2. First Edition: July 2021. MOH & UMMC. ACKNOWLEDGEMENT. ADVISORS. Tan Sri Dato' Seri Dr. Noor Hisham Abdullah Tuan Hj. Ir. Tauran Zaidi Ahmad Zaidi Director General of Health Director Ministry of Health Engineering Services Division Ministry of Health Dato' Dr. Norhizan Ismail Prof. Dr. April Camilla Roslani Deputy Director General of Health (Medical) Dean, Faculty of Medicine Ministry of Health University Malaya Datuk Dr. Hishamshah Mohd Ibrahim Dato' Prof.

4 Dr. Adeeba Kamarulzaman Deputy Director General of Health Professor of Medicine and Infectious (Research and Technical Support) Diseases, Department of Medicine Ministry of Health University Malaya Medical Centre Dr. Mohd Fikri Ujang Dr. Nor'Aishah Abu Bakar Director Deputy Director Medical Development Division Medical Care Quality Section Ministry of Health Medical Development Division Ministry of Health Prof. Dr. Nazirah Hasnan Ar. Saifuddin Ahmad Director Board Member University Malaya Medical Centre University of Malaya Dato' Dr. Mahiran Mustafa Senior Consultant Infectious Disease Physician & National Head of Infectious Disease Service Hospital Raja Perempuan Zainab II. CONTRIBUTORS. Prof. Dr. Sasheela Sri La Sri Ts. Dr. King Yeong Jin Ponnampalavanar President of ASHRAE Malaysia Chapter Infectious Diseases Consultant Lee Kong Chian Faculty of Engineering Head of Infection Control Department and Science University Malaya Medical Centre Universiti Tunku Abdul Rahman Assoc Prof.

5 Ir. Ts. Dr. Bernard Saw Lip Huat Dr. Suraya Amir Husin Chair of Centre for Sustainable Mobility Head of Infection Control Unit Technologies Medical Care Quality Section Lee Kong Chian Faculty of Engineering and Medical Development Division Science Ministry of Health Universiti Tunku Abdul Rahman 3. First Edition: July 2021. MOH & UMMC. Ir. Dr. Khairul Azmy Kamaluddin Ir. Jamilah Mahmood Senior Deputy Director (Services) Deputy Director Engineering Services Division Environmental Health Risk Sector Ministry of Health Indoor Air Quality Assessor (21). Engineering Services Division Ministry of Health Ir. Ts. Mohd Hisam Saat Ir. Dr. Abdul Malik Zainal Abidin Principal Assistant Director Senior Assistant Director Hospital Support Services Monitoring Sector Planning Branch Engineering Services Division Engineering Services Division Ministry of Health Ministry of Health Mohd Hafizi Mat Noor Ts.

6 Dr. Mohamad Dzulhelmy Amari Senior Principal Assistant Director Assistant Director Environmental Health Risk Sector Hospital Support Services Monitoring Engineering Services Division Sector Ministry of Health Engineering Services Division Ministry of Health Haidar Najiyah Ibrahim Mohammad Faizal Khalid Senior Assistant Director Principal Assistant Director Hospital Support Services Monitoring Sector Clinic Operation Sector Engineering Services Division Engineering Services Division Ministry of Health Ministry of Health Assoc. Prof. Dr. Sharifah Faridah Syed Omar Dr. Siti Zuhairah Mohamad Razali Head of the Infectious Diseases Unit Infection Control Department Department of Medicine University Malaya Medical Centre University Malaya Ir. Ts. En. Huzaidin Borhan Ts. En. Mohd Farid Isa Head of Engineering Department Senior Mechanical Engineer University Malaya Medical Centre Engineering Department University Malaya Medical Centre Sahrul Ridzuan Kamarulzaman Dr.

7 Shahnaz Md Nor Senior Assistant Director Principal Assistant Director Planning Branch Infection Control Unit Engineering Services Division Medical Care Quality Section Ministry of Health Medical Development Division Ministry of Health 4. First Edition: July 2021. MOH & UMMC. ABBREVIATIONS. ACH air changes per hour ACMV Air conditioning and Mechanical VENTILATION System (ACMV). AGP Aerosol-Generating Procedures AIIR Airborne Infection Isolation Room CADR Clean Air Delivery Rate CFM Cubic Feet per Minute HCW Health Care Worker HEPA High-Efficiency Particulate Air IPC Infection Prevention and Control MERV Minimum Efficiency Reporting Value OSHE Occupational Safety, Health and Environment UVGI Ultraviolet Germicidal Irradiation GLOSSARY. ACMV: Air Conditioning and Mechanical VENTILATION System.

8 The equipment, distribution systems, and terminals that provide, either collectively or individually, the processes of ventilating, or air conditioning to a building or portion of a building. Aerosol-generating procedures (AGP): Any medical procedures that can induce the production of aerosols of various sizes ( tracheal intubation, non-invasive VENTILATION , tracheostomy, cardiopulmonary resuscitation, manual VENTILATION before intubation, bronchoscopy, dental procedures). air changes per hour (ACH): VENTILATION airflow rate (m /hr) divided by room volume. It indicates how many times, during 1 hour , the air volume of a space is fully replaced with outdoor air. Air economizer: Duct and dampers arrangement with an automatic control system that together allow a cooling system to supply outdoor air to reduce or eliminate the need for mechanical cooling.

9 Air, exhaust: Air removed from a space and discharged to the atmosphere by means of mechanical or natural VENTILATION systems. Airflow direction: The airflow direction in a building, should be from clean zones to dirty zones. The air flow direction also depends on the type and functionality of the area requirement. Air distribution or airflow pattern: The external air should be delivered to each part of the space in an efficient manner and the airborne pollutants generated in each part of the space should be removed in an efficient manner. Air, recirculation: A part of extracted air which is not exhausted from the building, but it is recirculated back into spaces. The air can be treated before being recirculated (thermal, air quality). 5. First Edition: July 2021. MOH & UMMC.

10 Air, Supply: Air delivered by mechanical or natural VENTILATION to a space, composed of any combination of outdoor air, recirculated air or transferred air. Airborne Infection Isolation Room (AIIR): A single-occupancy room for patient care where environmental factors are controlled in an effort to minimize the transmission of those infectious agents usually spread from person to person by droplet nuclei associated with coughing or inhalation (Such rooms typically have specific requirements for controlled VENTILATION , air pressure, and air infiltration). Air-handling unit (AHU): Assembly consisting of sections containing a fan or fans and other necessary equipment to perform one or more of the following functions: circulating, filtration, heating, cooling, heat recovery, humidifying, dehumidifying, and mixing of air.