“Ventilation of Healthcare Facilities” Impact of the New ANSI/ASHRAE/ASHE Standard 170 Standard 170 Stephen W. Nicholas, CPMM, CAFS ASHRAE Boston Chapter Vice President May 5, 2011

S-170 Project Title Title –“Ventilation of Healthcare Facilities”

S-180 Project Purpose Purpose The purpose of this standard is to define ventilation system design requirements that provide environmental control for comfort, asepsis and odor in health care facilities. The purpose of this standard is to define ventilation system design requirements that provide environmental control for comfort, asepsis and odor in health care facilities.

S-170 Project Scope Scope The requirements in this standard apply to patient care areas and related support areas within health care facilities, including hospitals, nursing facilities, and out patient facilities. The requirements in this standard apply to patient care areas and related support areas within health care facilities, including hospitals, nursing facilities, and out patient facilities.

S-170 Project Scope Scope This standard applies to new buildings, additions to existing buildings, and those alterations to existing buildings that are identified within this standard. This standard applies to new buildings, additions to existing buildings, and those alterations to existing buildings that are identified within this standard.

S-170 Project Scope Scope This standard considers chemical, physical, and biological contaminants that can affect the delivery of medical care to patients, the convalescence of patients, and the safety of patients, health care workers and visitors. This standard considers chemical, physical, and biological contaminants that can affect the delivery of medical care to patients, the convalescence of patients, and the safety of patients, health care workers and visitors.

S-170 Project Standard falls under TC 9.6 Standard falls under TC 9.6 Standard will be placed under continuous maintenance Standard will be placed under continuous maintenance Addenda will be added to Standard and published on periodic scheduling Addenda will be added to Standard and published on periodic scheduling Appendix is not part of the mandatory requirements of the Standard Appendix is not part of the mandatory requirements of the Standard

S-170 Project Table 7.1 “Design Parameters” Table 7.1 “Design Parameters” Addendum (a) Clarifies four (4) items related to Table No. 1 Addendum (a) Clarifies four (4) items related to Table No. 1 Most notably Relative Humidity (RH) changed from 30-60% to 20-60% Most notably Relative Humidity (RH) changed from 30-60% to 20-60%

S-170 Project Table 7.1 “Design Parameters” Table 7.1 “Design Parameters” –Addendum (b) covers ten (10) issues –HEPA Filters on 0.3 micrometers are now specified eliminating the MERV-17 designation

S-170 Project “Design Parameters” “Design Parameters” Pressure Relationships Pressure Relationships For Critical Care For Critical Care For Wound Intensive Care For Wound Intensive Care –No Requirement (N/R)

S-170 Project The Rationale is Twofold The Rationale is Twofold 1. Prior FGI Guidelines had N/R for these types of rooms 2. Literature review determined no increased benefit from either a positive or negative pressurized rooms * Since HAI primarily are H2o/Moisture related microbes not airborne

S-170 Project “Design Parameters” “Design Parameters” OR Suites are required to have individual Temperature Controls OR Suites are required to have individual Temperature Controls Morgue & Autopsy Rooms require ” w.g or Pascals Morgue & Autopsy Rooms require ” w.g or Pascals Endoscopy Room – Classified as a Gastrointestinal Procedure Room now require a Total of 6 Air Changes per Hour (ACH) Endoscopy Room – Classified as a Gastrointestinal Procedure Room now require a Total of 6 Air Changes per Hour (ACH)

S-170 Project “Design Parameters” “Design Parameters” MERV – 7 filters are now required for re-circulating room HVAC units MERV – 7 filters are now required for re-circulating room HVAC units Subsequently revised in Addendum (h) Subsequently revised in Addendum (h)

S-170 Project Design Parameters” Design Parameters” Filter Blank-Off Panels & Seals are now required to minimize unfiltered air from by-passing filters Filter Blank-Off Panels & Seals are now required to minimize unfiltered air from by-passing filters

S- 170 Project The Title of the humidity column in Table 7-1, “Design Parameters” has been changed to “Design Relative Humidity” The Title of the humidity column in Table 7-1, “Design Parameters” has been changed to “Design Relative Humidity” It was discovered that certain regulatory agencies were interpreting the humidity ranges in this column as absolute; meaning no excursions above or below these ranges was acceptable It was discovered that certain regulatory agencies were interpreting the humidity ranges in this column as absolute; meaning no excursions above or below these ranges was acceptable

S-170 Project “Design Parameters” “Design Parameters” Note: Note: However the actual RH in a space may be outside these ranges when outside conditions exceed design conditions However the actual RH in a space may be outside these ranges when outside conditions exceed design conditions

S-170 Project “Design Parameters” “Design Parameters” Addendum (d) was published in July 2010 Addendum (d) was published in July 2010 Revised RH range for (8) short stay rooms Revised RH range for (8) short stay rooms to 20-60% … these rooms are listed in Table No. 1 to 20-60% … these rooms are listed in Table No. 1

S-170 Project-Surgery Critical Care Class B & C OR Rooms (m) (n) (o) pos. Class B & C OR Rooms (m) (n) (o) pos. Surgical OR-Cystoscopic (m) (n) (o) pos. Surgical OR-Cystoscopic (m) (n) (o) pos. Delivery (caesarean) (p) pos. Delivery (caesarean) (p) pos. Treatment Room (p) N/R Treatment Room (p) N/R Class A OR Procedure Room (o) (d) pos. Class A OR Procedure Room (o) (d) pos. Trauma Room Crisis or Shock (c) pos. Trauma Room Crisis or Shock (c) pos. Gastrointestinal-Endoscopy Procedure pos. Gastrointestinal-Endoscopy Procedure pos. Laser Eye Room pos. Laser Eye Room pos.

S-170 Project Addendum (e) published March 2011 Addendum (e) published March 2011 –Clarifies ventilation provisions for Airborne Infection Isolation (AII) rooms “Exhaust Discharges” –All exhaust ductwork from rooms such as AII, bronchocopy, emergency, department waiting rooms, etc. must be maintained at a negative pressure as it passes from these rooms to the exhaust fan. –If the exhaust fan is located in a mechanical room vs. the roof, the interior ductwork on the discharge of the exhaust needs to be sealed to SMACNA Seal Class A

S-170 Project Addendum (f) Addendum (f) Published March 2011 clarifies: Published March 2011 clarifies: “Combination Airborne Isolation/Protective Environment Room” “Combination Airborne Isolation/Protective Environment Room” Added to the Guidelines to address cases of an immunocompromised patient who also has an airborne infectious disease Added to the Guidelines to address cases of an immunocompromised patient who also has an airborne infectious disease

S-170 Project Addendum (f) To reduce energy use in Hospitals To reduce energy use in Hospitals - The minimum total ACH for an AII room may be reduced to (6) when the room is not being used for an infectious patient - The minimum total ACH for an AII room may be reduced to (6) when the room is not being used for an infectious patient –However the pressure relationship must remain negative –The addendum reaffirms that switching a room from negative to positive or positive to negative is strictly prohibited

S-170 Project Addendum (g) published March 2011 Addendum (g) published March 2011 Allows Type D diffusers for single patient rooms Allows Type D diffusers for single patient rooms Addendum (g) is based upon recent research* Addendum (g) is based upon recent research* * Healthcare Ventilation Research Collaborative 2009 Displacement Ventilation Research – Phase II Summary Report

ASGRAE/ASHE Standard 170 Summary Standard 170 remains under continuous maintenance. Standard 170 remains under continuous maintenance. The addenda are a result of committee member initiatives, proposed changes, and requests for interpretations The addenda are a result of committee member initiatives, proposed changes, and requests for interpretations This allows for the FGI Guidelines to be updated between the four-year revision cycle This allows for the FGI Guidelines to be updated between the four-year revision cycle

ASHRAE/ASHE Standard 170 Any ?

For Further Information Stephen W. Nicholas, CAFS, NCT II Stephen W. Nicholas, CAFS, NCT II 200 Sutton Street Suite Sutton Street Suite 230 North Andover, MA North Andover, MA