Healthcare Ventilation, “High Consequence Spaces” - MISHE

1 Healthcare ventilation , high Consequence Spaces Healthcare EnvironmentsMiSHEC hapterDon MacDonald, Phoenix ControlsSeptember 28, 2017 Healthcare ventilation , high Consequence Spaces I. Industry ChallengesII. Standards and GuidelinesI. USP 800 updateIII. ApplicationsIV. Energy Management TrendsV. Optimizer Simulation Analysis Software VI. Case StudiesVII. SummaryPresentation OutlinePresented by:Don MacDonaldNorthern Regional ManagerPhoenix ControlsCell: 519 212 CHALLENGESP resentation and DiscussionEnergy Challenges Escalating Demand HVAC 44 % of cost 43% charged higher rates $ M per hospital per year $25 Electricity / bed / day 28% pay $3 to $4 per ft2 21% pay $5 to $6 per ft2 Cost to double in 20 years2011 Hospital Energy Management Survey, HFM MagazineEnergy Challenges HVAC Requirements Outside Air Demands Spaces with high ACH demand HEPA filtered ventilation Systems Emergency Power Temperature/Humidity Reluctance to setback ACHCSA 10 SpaceACH RequirementsOperating Rooms 20 Caesarean delivery 20 Fracture Room 12 Cardiac Cath20AI Isolation Rms 12 Diagnostic Imaging CT, MRI, X-Ray.

2 Ultrasound9-20 Burn unit15 Laboratory12 PharmaciesSee USPS ustainable DESIGN CHALLENGESP resentation and DiscussionVentilation Design Challenges Air Terminal Units VAV Boxes Commercial application engineering Component performance variances Low flow accuracy restrictions Extra duct length for accuracy Maintenance requirements Re calibration necessities Commissioning inconsistencies Energy wasteSizing VAV Boxes, Steven T. Taylor, PE, Fellow ASHRAE and Jeff Stein, PE, Member ASRAEVAV Box Controllers Have Limitations, Sutton Page Austin Air Balancing Corporation, 1106 West 6th Street, Suite 206, Austin, Texas 78703 (512) 447 7247 fax (512) 477 8152 ESL TR 04/10 01 Point to Point Verification of Monitored Sensors at Reynolds Army Clinic and Hospital Final ReportTurndown And Transducer Accuracy Chart: Paragon Controls, Tech Talk, August 16, 2002 VAV Sensors & Ductwork: Placement and Pitfalls Engineered Systems (Feb 2006)ASHRAE Research Project 1137 The problems with specifying VAV Boxes, Daniel IntHout, The Construction Specifyer, July 2004 ventilation Design Challenges Evidence.

3 Energy Waste Reynolds Army Hospital Final Report Pitottube assemblies clogged Blockage causing averaging sensor to send skewed signal to transducer Energy waste due to false signals causing supply and return fans to operate at maximum conditions Recommend ongoing maintenance and re calibration Current standards require that maintenance area be Point-to-Point Verification of Monitored SensorsSTANDARDS & GUIDELINESP resentation and DiscussionCodes and GuidelinesEnergy Efficiency Set energy efficiency goals strategies Consider total Life Cycle Cost Mechanical control systems should optimize consumption to the minimum needs of the building Use energy saving mechanisms such as variable air volume (VAV) systems and programmed controls for spaces in unoccupied periodsFGI 2014 Codes and GuidelinesEnergy Efficiency Energy Standard: Buildings Except Low Rise Residential Buildings Minimum requirements Energy efficient design and construction Mechanical equipment efficiencies Occupant sensing controls Expanded modeling requirements Energy demand efficiency.

4 Reduces consumption 30% over 2004 FGI 2010 ASHRAE , 2013 ASHRAE reduces energy consumption. Jeff McClain, CEM, LEED AP, Gregory Sifferlen, and Wayne H. Stoppelmoor Jr., CEM, CFEM edia LLC, 01/29/2011 Keeping up with Standard , Carol Marriott, PE, LEED AP, Carol Marriott Consulting, Maple Grove, Media, 01/18/2011 Overview of the currently adopted commercial energy code in each state as of September 2016 and GuidelinesEnergy Efficiency ASHRAE Table 7 1 Pressurized rooms: Air changes may be reduced when room is unoccupied. Number of air changes indicated must be re established when occupied. Pressure relationship must be maintained. Areas requiring no continuous directional control, ventilation systems may be shut down when unoccupied If any form of VAV system is used for energy conservation it shall not compromise the pressure relationships or the minimum air changes required by the tableFGI 2010 ASHRAE Standard , 2013 ASHRAE Standard 170 , 2013 Codes and GuidelinesEnergy Efficiency Night setback or Unoccupied setback OR s have high ACH rates (20 30) ACH may be reduced if pressure held OR s may be unoccupied 40% Staff usage profile Temperature setback?

5 Moderate Cost and Control strategy Airflow control: pressure independent air valves Supply and exhaust pair Controlled to set point to maintain offset Volumetric control to maintain pressure differential or direct pressure control Requires minimal maintenanceASHE Operating Room HVAC Setback Strategies HD Protection Overview Stored in negative pressure room. Ante rooms; one room to two room design. Sterile storage areas should have a positive pressure relationship to all adjacent areas except 800 Hazardous Continue to Implement USP 797 Criteria All compounded sterile preparations (CSP) to be in a Primary Engineering Controls (PEC) Device-Environment. Containment by HD Type. C-PECs: Containment Primary Engineering Control. C-SECs: Containment Secondary Engineering Control. ISO Class 5 enviro. ISO 7 buffer/ISO 8 ante areas must be separate rooms divided by walls and doors.

6 Environmental Performance Verification Certification of primary engineering controls performance. Testing the air quality of compounding area every six 800 Sterile CompoundingUSP <797> Comparison to <800>USP <797>PharmaceuticalCompounding Sterile PreparationsUSP <800>Hazardous Drugs Handling in HealthcareSettingsApplies to sterilecompounding onlyApplies to sterileand nonsterile compoundingApplies from receiptof inventory up to drug administrationWider continuumof time;Appliesfrom receipt of inventory through drug administrationAllHDs must be stored separatelyin area with 12 ACPH and negative to adjacent spaceAntineoplastic HDs must be stored separately from non HDs in an area with 12 ACPH and negative to adjacent space unless coated, final manufactured dosage forms are clearly labeled as HDs and safety strategies are detailed in SOPsExemption for low volume compoundingNo low volumeexemptionCopyright 2013-2017 CriticalPoint s Sterile Compounding Boot Camp - All rights reserved USP <797> Comparison to <800>USP <797>PharmaceuticalCompounding Sterile PreparationsUSP <800>Hazardous Drugs Handling in HealthcareSettingsCSTD use is a should CSTD use is a shall during administration aslong asdosageform permits and should for compoundingDefines PECsfor HDsterile compoundingDefines PECs for nonsterile & sterile HD compounding; allows manipulation of HDs that do not produce aerosols ( , coated tablets or capsules) outside of C PEC Prohibits SCA for HD compounding.

7 Requires BSC to be housedin ISO class 7 room air that is negative Permits C SCA for HDs provided CACI/BSC in areathat has 12 ACPH and negative; maximum BUD 12 hoursDoes not require environmentaland medical surveillanceRecommendsenvironmental and medical surveillanceCopyright 2013-2017 CriticalPoint s Sterile Compounding Boot Camp - All rights reserved USP 800 Storage and Compounding Iso 5, 6 and 7 Environment 800 Storage and Compounding Iso 5, 7 and 8 Environment ExamplesAirflow ControlCode Requirements Operation Maintenance Planning Operating Rooms (OR) Tested for positive pressure semi annually Preventative maintenance schedule Protective Environment Rooms (PE) Remain positive to adjacent space whenever an immuno compromised patient is present Tested daily when occupied Airborne Infection Isolation Room (AII) Remain negative to adjacent space whenever an infected patient is present Tested daily when occupiedASHRAE 170 Maintenance, Informative Appendix A O&M in Health Care FacilitiesVENTILATION APPLICATIONSP resentation and DiscussionOperating Rooms.

8 01 wcpositively pressurized space 20 ACH when in use 4 ACH minimum outside air typically runs at constant volume during surgery temperature range 68 75 F humidity 20 60% operates 24 hours a day Supply diffusers unidirectional downward and average velocity 25 35 cfm/sqft Area of diffusers shall extend a minimum of 12" beyond the surgical table Exhaust grills, at least 2 low level approx8" above floor as far apart as possibleOperating Room (OR) ventilation DesignASHRAE 170-2013 Operating Surgery RoomsSupply / Exhaust Tracking PairsRoom Pressure Monitor VAV or 2 Position Occupancy modes Temperature Humidity Pressure monitor Remote monitoring Duct temp sensor DecontaminationOperating SurgeryClean / Dirty CorridorSupply / Exhaust Tracking PairsCleanCorridorDirtyCorridorAII Airborne Infections Isolation room maintain continuous air pressure negative.

9 01 wc ensure rooms well sealed/no leakage 70 75 DegF design temperature 12 ACH, 2 ACH of minimum outdoor air Calculate ACH based on exhaust flow If not occupied pressure relationship is maintained and min ACH 6 Switching controls for reversible airflow (pressure relationship) shall not be permitted(note t) self closing devices on exit doors direct exhaust air outside, away from intakeIsolation Room ventilation DesignASHRAE 170-2013 AII Airborne Infections Isolation room Retrofit can use HEPA filtration recircsystem for ACH When AII room has an ante room: AII room negative to ante room, ante room negative to corridor Monitoring device between room and the corridor alarm when pressurization not maintained Exhaust grills located in ceiling or wall at the head of the patient Room ventilation DesignASHRAE 170-2013 Isolation Rooms w anteroomSupply / Exhaust Tracking Pairs CV, VAV or 2 Position high turndown APM2 pressure monitor Remote monitoring Occupancy modes Temperature control Duct temperature sensorAII Airborne Infectious Isolation room.

10 01 wcPE Protective Environment Isolation room Pressure positive .01 " wc. pa 12 ACH, 2 ACH of minimum outdoor air ACH for positive room calcon supply airflow Switching controls for reversible airflow (pressure relationship) shall not be permitted(note t) 70 75 DegF design temperature maintain continuous positive air pressure Ensure rooms well sealed/no leakage When PE room has an ante room: PE room positive to ante room, ante room positive to corridor Monitoring device between room and the corridor alarm when pressurization not maintained Supply diffusers located at the head of the patient bed. Exhaust grills located near the patient room Room ventilation DesignASHRAE 170-2013 Isolation Rooms w anteroomSupply / Exhaust Tracking PairsPE Protective Environment Isolation room+ .01 wcCombination AII/PE Isolation room 12 ACH, 2 ACH of minimum outdoor air maintain continuous positive air pressure ensure rooms well sealed/no leakage self closing devices on exit doors 70 75 DegF design temperature Monitoring device(s) between AII/PE room and the ante room and ante room to corridor alarm when pressurization not maintained Supply diffusers located at the head of the patient bed.