HEATING, VENTILATION AND AIR-CONDITIONING …

1 NHMSFAP College of Physicians and Surgeons of British Columbia Page 1 of 8 December 30, 2017 A C C R E D I T A T I O N S T A N D AR D S Infection Prevention & Control heating , VENTILATION AND AIR-CONDITIONING SYSTEM (HVAC) Class 1 Facility: General Anesthesia heating , VENTILATION and AIR-CONDITIONING system standards are a primary infection prevention and control strategy whereby contaminants are diluted and expelled through the high-frequency replacement of standing room air with clean filtered air. The Canadian Standards Association (CSA) Special requirements for heating , VENTILATION and AIR-CONDITIONING (HVAC) systems in health care facilities (CAN/CSA ) standard is not based on the type of room but on the functions that are expected to occur within the room. Where several functions apply in a given area of a facility, the more stringent requirements take precedence. Both health-care facility classification and area classification, as per CSA, determine the design requirements.

2 The information contained in this document provides a general overview of the requirements. CAN/CSA Special requirements for heating , VENTILATION and AIR-CONDITIONING (HVAC) systems in health care facilities shall be referenced in addition to this document. CAN/CSA represents the detailed requirements for HVAC in non-hospital medical/surgical facilities. ABBREVIATIONS AIA American Institute of Architects CSA Canadian Standards Association DOP Dispersed oil particulate HEPA High-efficiency particulate air HVAC heating , VENTILATION and AIR-CONDITIONING MDR Medical device reprocessing MERV Minimum efficiency reporting value PAR Post-anesthetic recovery PD Pressure differential RH Relative humidity T Temperature ACCREDITATION STANDARDS Infection Prevention & Control heating , VENTILATION AND AIR-CONDITIONING SYSTEM (HVAC) CLASS 1 FACILITY NHMSFAP College of Physicians and Surgeons of British Columbia Page 2 of 8 December 30, 2017 DEFINITIONS CSA health-care facility classifications Class A-2 health-care facility A health-care facility in which patients are accommodated on the basis of medical need provided with continuing medical care and provided with supporting diagnostic and therapeutic services that can extend beyond 12 hours, and does not meet the other requirements of a Class A-1 health-care facility.

3 Examples include: outpatient surgical services cosmetic surgical offices dental surgical offices laser eye clinics other office surgical facilities Class C health-care facility A health-care facility in which ambulatory patients are accommodated on the basis of medical need provided with supportive, diagnostic, non-invasive interventions and treatment services and stay for no more than 12 hours, and remain capable of self-preservation. Examples include: laser eye clinics cosmetic surgical offices CSA area classifications Type I A patient care area where the invasiveness of procedures, the level of risk of morbidity and mortality to patients and the level of risk of adverse outcomes to care providers necessitate more stringent HVAC and environmental requirements. Examples include: minor surgical procedures endoscopy cystoscopy dental minor procedures room operating rooms recovery rooms ACCREDITATION STANDARDS Infection Prevention & Control heating , VENTILATION AND AIR-CONDITIONING SYSTEM (HVAC) CLASS 1 FACILITY NHMSFAP College of Physicians and Surgeons of British Columbia Page 3 of 8 December 30, 2017 Type II A patient care area of an area that is intended for the provision of services that provide direct support to patient care areas.

4 Examples include: decontamination/soiled room preparation and packaging/clean room sterilizer room scope reprocessing room sterile storage NHMSFAP Facility Classifications Class 1 Provides general anesthesia and major regional anesthesia (epidural, spinal nerve blocks) and may include use of IV sedation and/or analgesia, or local anesthesia only. Class 2 Provides use of IV sedation and/or analgesia where the patient remains responsive and breathes without assistance. Class 3 Provides local anesthesia only. May provide oral sedation but not IV sedation/analgesia or inhalants. New facilities, additions to existing facilities and/or replacement or addition of HVAC equipment in existing facilities are in compliance with CAN/CSA INDICATORS: HVAC system functions in accordance with design criteria HVAC system monitoring parameters are in accordance with design criteria Parallel air-handling units are present in CSA Class A-2 facilities for any areas that accommodate the following critical functions including but not limited to: surgery, operating rooms surgery, sterile core post-anesthetic care or recovery storage of sterile materials and supplies The position and type of supply and exhaust registers promote the movement of air within the rooms or spaces from clean to less clean areas Airflow is directed from supply to breathing zone to exhaust outlets1, 2 All filters are clean and sealed Air supply is from.

5 Non-aspirating ceiling outlets near the center of the work area1, 2 ACCREDITATION STANDARDS Infection Prevention & Control heating , VENTILATION AND AIR-CONDITIONING SYSTEM (HVAC) CLASS 1 FACILITY NHMSFAP College of Physicians and Surgeons of British Columbia Page 4 of 8 December 30, 2017 ceiling outlets3 Each operating/procedure room or area where anesthesia might be exhaled (PAR) has a minimum of two return air inlets1, 2 Return air inlets are placed: whereby the bottom of the return air inlet is 75 500 mm above the floor1 whereby the bottom of the return air inlet is at least 75 mm above the floor2 near the floor3 Rooms with inhalation anesthesia and/or inhalation analgesia have a scavenging system in compliance with ISO Z7396-21, 2 or CAN/CSA Minimum levels of HVAC are maintained for type I areas when the space is not occupied: Minimum of six air exchanges per hour of recirculated air1, 2 Pressure differential across separations is maintained ( Pa)1, 2 Temperature is maintained1 Relative humidity is maintained1 HVAC heating plant, cooling plant and controls are connected to the essential electrical system 1.

6 CAN/CSA 2. CAN/CSA 3. CAN/CSA Existing facilities are in compliance with the CAN/CSA at time of build INDICATORS: HVAC system functions in accordance with design criteria* 2010 present 2001 2009 1991 2000 M91 Before 1991 American Institute of Architects *Facilities not in compliance with CAN/CSA standards from time of build may be required to upgrade their existing system to be in compliance with current CSA Standards. HVAC system monitoring parameters are in accordance with design criteria The position and type of supply and exhaust registers promote the movement of air within the rooms or spaces from clean to less clean areas Airflow is directed from supply to breathing zone to exhaust outlets1, 2 All filters are clean and sealed Air supply is from: non-aspirating ceiling outlets near the center of the work area1, 2 ACCREDITATION STANDARDS Infection Prevention & Control heating , VENTILATION AND AIR-CONDITIONING SYSTEM (HVAC) CLASS 1 FACILITY NHMSFAP College of Physicians and Surgeons of British Columbia Page 5 of 8 December 30, 2017 ceiling outlets3 Each operating/procedure room or area where anesthesia might be exhaled (PAR) has a minimum of two return air inlets1, 2 Return air inlets are placed.

7 Whereby the bottom of the return air inlet is 75 500 mm above the floor1 whereby the bottom of the return air inlet is at least 75 mm above the floor2 near the floor3 Rooms with inhalation anesthesia and/or inhalation analgesia have a scavenging system in compliance with ISO Z7396-21, 2 or CAN/CSA Minimum levels of HVAC are maintained for type I areas when the space is not occupied minimum of six air exchanges per hour of recirculated air1, 2 pressure differential across separations is maintained ( Pa) 1, 2 temperature is maintained1 relative humidity is maintained1, 2 HVAC heating plant, cooling plant and controls are connected to the essential electrical system 1. CAN/CSA 2. CAN/CSA 3. CAN/CSA The HVAC system is maintained in accordance with CAN/CSA INDICATORS: Filters and seals are visually inspected monthly to verify the presence of the filter and seal and to ensure proper physical condition Primary filters with a MERV rating less than 9 are replaced every 12 months or when loaded (based upon measurements of pressure drop across the filter bank) Primary filters with a MERV rating greater than or equal to 9 are replaced every 24 months or when loaded (based upon measurements of pressure drop across the filter bank) Secondary filters are replaced every 24 months or when loaded (based upon measurements of pressure drop across the filter bank) HEPA filters are replaced every 36 months or when loaded (based upon measurements of pressure drop across the filter bank) whichever occurs first Fan coils, drain pans and induction and finned units are inspected and cleaned at minimum semi-annually (usually spring and fall)

8 Ducts are inspected at minimum annually Supply ducts are cleaned when deemed necessary by annual inspection ACCREDITATION STANDARDS Infection Prevention & Control heating , VENTILATION AND AIR-CONDITIONING SYSTEM (HVAC) CLASS 1 FACILITY NHMSFAP College of Physicians and Surgeons of British Columbia Page 6 of 8 December 30, 2017 Return ducts are cleaned every 10 years or when deemed necessary by annual inspection, whichever occurs first Exhaust ducts are cleaned every 10 years or when deemed necessary by annual inspection, whichever occurs first Diffusers (supply, return or exhaust) are cleaned every six months HVAC Design Criteria The information contained in this document provides a general overview of the requirements. CAN/CSA Special requirements for heating , VENTILATION and AIR-CONDITIONING (HVAC) systems in health care facilities shall be referenced in addition to this document. CAN/CSA represents the detailed requirements for HVAC in non-hospital medical/surgical facilities.

9 Minimum filter efficiency M91 Operating room Filter # 1 MERV1 8 Filter # 1 50%3 Filter # 1 30% Filter # 2 MERV 14 Filter # 2 90% Filter # 2 95% Procedure room Filter # 1 MERV 8 Filter # 1 50% Filter # 1 30% Filter # 2 MERV 14 Filter # 2 90% Filter # 2 95% Specialized operating room* Filter # 1 MERV 8 Filter # 1 50% Filter # 1 30% Filter # 2 MERV 14 Filter # 2 Filter # 2 95% Filter # 3 HEPA2 Filter # 3 N/A Filter # 3 N/A Endoscopy / bronchoscopy Filter # 1 MERV 8 Filter # 1 50% Filter # 1 30% Filter # 2 MERV 14 Filter # 2 90% Filter # 2 95% *Specialized operating room, transplants, orthopedics 1. Minimum efficiency reporting value (MERV) 2. High-efficiency particulate air (HEPA) 3. Dust spot efficiency 4. Dispersed oil particulate (DOP) Minimum outdoor air changes/total air changes per hour M91 Operating room 6/20 6/20 6/20 Procedure room 5/15 6/20 6/20 Recovery room 6/20 6/20 6/20 Endoscopy / bronchoscopy 5/(15/20) 6/20 6/20 Dirty room (MDR) 2/10 2/8 3/12 Clean room (MDR) 3/10 3/10 3/12 Sterile storage 0/4 0/4 3/12 ACCREDITATION STANDARDS Infection Prevention & Control heating , VENTILATION AND AIR-CONDITIONING SYSTEM (HVAC) CLASS 1 FACILITY NHMSFAP College of Physicians and Surgeons of British Columbia Page 7 of 8 December 30, 2017 Relative pressurization M91 Operating room Positive Positive Positive Procedure room Positive Positive Positive Recovery room Positive Positive Positive Endoscopy / bronchoscopy Negative Positive/Negative Positive/Negative Clean room (MDR) Positive Positive Positive Sterile storage Positive Positive Positive Dirty room (MDR) Negative Negative Negative Pressure-critical spaces.

10 Minimum pressure differential M91 Operating room + Pa + mm + Procedure room + Pa + mm + Recovery room + Pa + mm + Endoscopy / bronchoscopy - Pa + /- mm + / - Clean room (MDR) + Pa + mm + Sterile storage + Pa + mm + Dirty room (MDR) - Pa - mm - Pa = = mm of water pressure Temperature M91 Operating room 18 23oC 17 27oC 20 26oC Procedure room 18 22oC 17 27oC 20 26oC Recovery room 22 24oC 24oC 22 24oC Endoscopy / bronchoscopy 18 22oC 20 24oC 20 26oC Clean room (MDR) 18 23oC 20 23oC 22 26oC Sterile storage 20 23oC 20 23oC 22 26oC Dirty room (MDR) 18 20oC 18 20oC 22 26oC Relative humidity M91 Operating room 40 60% 45 55% 50 60% Procedure room 30 60% 45 55% 50 60% Recovery room 30 60% 50 60% 50 60% Endoscopy / bronchoscopy 30 60% 30 60% 50 60% Clean room (MDR) 30 60%* 30 60% 40 50% Sterile storage 30 60%* 30 60% 40 50% Dirty room (MDR) 30 60%* 30 60% 40 50% *As per the Ministry of Health Best Practice Guidelines for Cleaning, Disinfection and Sterilization of Critical and Semi-Critical Medical Devices relative humidity of 40 50% is preferred ACCREDITATION STANDARDS Infection Prevention & Control heating , VENTILATION AND AIR-CONDITIONING SYSTEM (HVAC) CLASS 1 FACILITY NHMSFAP College of Physicians and Surgeons of British Columbia Page 8 of 8 December 30, 2017 Parameter monitoring: monitored, alarmed central readout M91 Pressure differential (PD) Temperature (T) Relative humidity (RH) Parameter monitoring: local readout M91 OR/procedure room PD, T, RH T, RH T, RH Dirty room T, RH T, RH - Clean room T, RH T, RH - Sterile supply T, RH T, RH - Parameter monitoring.