1. Humidity in Anesthetizing Locations Where Mechanical Systems and Compliance Collide Daniel Swanson | Project Director Healthcare | McKinstry Currently Acting Director of Facility Services & Construction UW-Northwest Hospital & Medical Center, Seattle, WA

2. Why is this a topic? Science! System Evaluation Why does this matter? What are the rules? How do you ensure compliance? Agenda

3. Why is this a topic? Lots of recent cases of “hits” on inspections Engineering and Clinical have different ways of measuring humidity Engineering has no good way to stay within standards mechanically There are no records of actions being taken Decisions being made aren’t following the patient when a “Tracer” is done Staying in compliance is a waste of energy Operations are being affected / shut down Just to pass inspection? Patient Safety Risk reduction

4. Humidity. (h)yoo ˈ midədē/ noun noun: humidity the state or quality of being humid. a quantity representing the amount of water vapor in the atmosphere or a gas

5. Science! Humidity vs Relative Humidity Water Warmer Air Air

6. Science! Latent Heat vs Sensible Heat Sensible Heat Changes Temperature Latent Heat Changes phase

7. Science! Dry Bulb Temp It’s what you think of when you think of temp Wet Bulb Temp It’s the temp you feel when you are wet

8. Science!

12. OK, that’s some great theory. Can my systems even do that? Mechanical System Evaluation

13. What systems are affected AHUs Cooling Coil Reheat Air flow Chiller Temp Capacity Flow From an FM perspective Can I meet my setpoints? How often? What are you doing?

14. Mechanical System Evaluation Iterative process Decide on a set of parameters for criteria Space temp, Design Day Evaluate current systems Coil performance (Using space temp, OAC, assumed load) Criteria met? Operational Evaluation Commissioning, cleaning, flow, controls system Redesign Coil size, static, Sensible vs latent, chw temp Cost? - Iterate Service Level Agreement / Budget

15. Mechanical System Evaluation

18. That’s Great. Why do we care about humidity again? Why does humidity matter?

19. Why does this matter? High Humidity Infection Control Surgical Site Infections (SSI) Wound Care Supports Mold Growth Operating Room Comfort Low Humidity Tissue impact Static Discharge Fire Potential ?

20. That sounds bad. Are there rules? Codes and guidelines.

21. Codes and Guidelines FGI 2010 ASHRAE 170 Table 7-1 Humidity and Temp Waiver AORN Perioperative Stds and Recommended Practices Safe Environment of Care - Recommendation V V.b and V.c NFPA-99 What’s DOH say? FGI standards What do the docs say? COLDER!!

22. ASHRAE 170 Table 7-1

23. AORN – Safe Environment of Care

24. NFPA 99 CMS currently adopts NFPA 101 – 2000 edition, which refers to an older version of NFPA-99 – which has a 35% rh low limit References to OR humidity have been removed from newer versions of NFPA 99 CMS intends to adopt the 2012 edition of NFPA 101, which would eliminate the NFPA driven 35% low limit. CMS issued a waiver

25. Categorical Waiver

26. Seriously? How do I follow all those rules? Compliance tools and ideas

27. Waiver How to accept waiver Where to put waiver letter Example waiver letter

28. Service Level Agreement Get all stakeholders to the table Determine which codes/standards/guidelines you will follow Know how frequently you can or cannot stay in standards Know what it will cost to stay within standards Determine what standard to meet and how it will be met Compliance vs being in standard

29. Work Orders Work Order System Setup How to reorganize How to close the loop Flagging work orders Paperwork trail What do you do as the Engineering Department High side humidity vs low side humidity

30. OK, got it. I think. Can you summarize? Summary

31. Science Codes Compliance Mechanical Evaluation Summary

32. Questions?

33. Thank you! Daniel Swanson (206) 762-3311 dans@mckinstry.com