Healthcare Facilities:

Best Practices for HVAC Design and

Operations
Donald R. Burroughs, P.E., Member ASHRAE

ASHRAE Winter Conference, Tuesday Feb 7, 2023

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 Copyright
Copyright © 2020-2022 by ASHRAE. All rights reserved. No part of this presentation
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ASHRAE has compiled this presentation with care, but ASHRAE has not investigated
and ASHRAE expressly disclaims any duty to investigate any product, service,
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appearance of any technical data or editorial material in this presentation does not
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information in this publication is free of errors. The user assumes the entire risk of
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 AIA/CES Registered Provider

ASHRAE is a Registered Provider with The American Institute of Architects

Continuing Education Systems. Credit earned on completion of this program
will be reported to CES Records for AIA members. Certificates of Attendance
for non-AIA members are available on request.
This program is registered with the AIA/CES for continuing professional
education. As such, it does not include content that may be deemed or
construed to be an approval or endorsement by the AIA of any material of
construction or any method or manner of handling, using, distributing, or
dealing in any material or product. Questions related to specific materials,
methods, and services will be addressed at the conclusion of this
presentation.

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 Welcome

Instructor:
• Donald R. Burroughs, P.E.
• Vice President, Mechanical Chief Engineer
• Dewberry Engineers Inc., Raleigh, NC

Key Contributor :
• HVAC Design Manual for Hospitals and Clinics, ASHRAE
2013

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 Agenda
Morning Session, Tuesday, February 7, 2023
Time ET Topic
9:00 am –10:40 am Infection Control, Psychrometrics, Energy, Sequences
10:40 am – 11:45 am Adaptability, Renovations, Life Safety HVAC
Considerations, Boiler and Chiller Plants

11:45 am – 12:00 pm Q&A

12:00 pm – 1:00 pm Lunch Break and Instructor Available for additional
questions

Afternoon Session, Saturday, February 7, 2023

Time ET Topic
1:00 pm – 2:30 pm Surgery and Imaging
2:30 pm – 3:20 pm Isolation and patient rooms, SPD, Emergency
Department, Pharmacy, Pandemic Preparation
3:20 pm – 3:45 pm Lessons Learned: Controls
3:45 pm – 4:00 pm Q&A
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 Elements of HPHC HVAC Systems

• Performance - Infection control, comfort, patient outcome

• Safety - Fire, falls, injuries - employees, visitors, patients
• Reliability - Lost revenue
• Maintenance cost
• Energy cost
• Adaptability in design

IN THIS ORDER!
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 Major Codes and Standards
• Guidelines for Design and Construction of Hospitals Facilities
Guidelines Institute (FGI) Includes
ANSI/ASHRAE/ASHE Standard 170-2021
• Additional guidelines for Outpatient Facilities and for Residential Health, Care, and Support Facilities (Assisted
Living and Long Term Care)
• ASHRAE Standard 170 – 2021 Ventilation of Health Care Facilities
• NFPA 99 – 2021 Healthcare Facilities Code
• NFPA 101 – 2021 Life Safety Code (Chapters 18-21)
• Centers for Medicare and Medicaid Services (CMS) enforces to 2012 versions
• NFPA 90A – 2021 Standard for the Installation of Air-Conditioning and Heating Systems
• NFPA 70 – 2020 National Electric Code (Chapter 5, Section 517 – Healthcare Facilities
• State and Local Codes, often based on International Building Code (note special requirements for I2
Occupancies)
• US Pharmacopeia (USP) Standards 797 and 800 - 2019

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 Inspection and Review Agencies (for USA)
• State Healthcare Licensing Agency
• State and Local Building Inspections
• Centers for Medicare and Medicaid Services (CMS)
• Enforces to NFPA 101 – 2012 and other NFPA sections that were in place in 2012.
• Does not exempt issues that complied with older codes.
• CMS approved Accreditation Agencies
• The Joint Commission (TJC)
• Healthcare Facilities Accreditation Program (HFAP)
• Center for Improvement in Healthcare Quality (CIHQ)
• Community Healthcare Accreditation Program (CHAP)
• DNV GL Healthcare (DNV)
• Institute for Medical Quality (IMV)
• Accreditation Association for Ambulatory Healthcare (AAAHC)

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 Element #1
Performance = Infection Control + Comfort

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 What Makes a High-
Performing Hospital?
• Patient satisfaction
• Operate in the black

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 Hospital-Associated Infections (HAI)

• Kill ~75,000 people per year in the • Cost of each SSI ~$35,000
US (200 per day) • Estimated 5%–10% are airborne
• ~15 deaths per hospital per year (~ 35,000–70,000 incidents)

• ~722,000 non-lethal infections per • $500 million–$1 billion/yr cost of

airborne infections
year, 150/hospital/yr
• Major push by AHA and ACA, have
• 1 of 25 patients admitted to a dropped SSI 17% since 2008
hospital got HAI
• HAI rate continues to grow
• Surgical site infection in 1 of 50
• ~5,000/yr deaths from construction
operations (157,500 cases) caused infections
Source: CDC National and State Healthcare Associated Infections Progress Report, 2014, pub. 2016.

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 Science of Infection, Qualitative

Dose × Site × Virulence × Time

Infection =
Level of Host Defense

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 CDC 2003
AIRBORNE MICROORGANISMS

Fungus Bacteria Virus

• Aspergillus • TB • Measles • Ebola
• Mucorales • Acinetobacter • Varicella-zoster • Hantavirus
(Rhizopus)
• Brucella • Smallpox • Lassa
• Acremonium
• Staphylococcus • Influenza • “10-33% of all HAI
• Fusarium pathogens move through
• Adenovirus
the air at some point
• Norwalk between the initial source,
the reservoir, and the
• Corona
secondary patient”.
Source: Tang. J. 2009 “…..survival of airborne infectious agents”, J of Hosp Infection, 64:100e114

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 How People Get Infected

• Inhalation of aerosols
• Deposition of particles/droplets/spores,
especially on skin
• Contact with surfaces and other people
• Insects
• “Contact” exposure <6 ft to sneezes and
coughs, per CDC
• Water aerosols, incl toilet flushing

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 Inhalation

} Upper Respiratory
Tract

} Lower Respiratory
Tract

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 How Do Microorganisms Get into the Air?

• Disturbance especially during construction

• Outside air—infiltration
• Patient, staff, visitors
• Propagating spores, mold
• Linens
• Movement of “dirty” air within the hospital, including floor in OR
• Aerosolization, including toilets
• Sneezes and coughs

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 Infections Versus
OA Ventilation Rate

• Quanta generation rates for

average adult (p = 0.48m3/h)
• 8 hours in a 5400 ft2 office
building (V = 42,000 ft3)
• With one infected occupant
present the entire day

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 Dilution (Fly in Room)

Minutes required for Minutes required for Minutes required for

ACH
• CDC MMMWR removal of 90% removal of 99% removal of 99.9%
Guidelines 2005
2 69 138 207
Assumes: Perfect
Mixing W/ Perfectly 4 35 69 104
Clean Air. 6 23 46 69

• Fan Coil Units, PTAC, 8 17 35 52

And Chilled Beams Do 10 14 28 41
Not Provide Well 12 12 23 35
Filtered Air.
15 9 18 28
20 7 14 21
50 3 6 8

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 Droplets, Aerosols, Dry Nuclei

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 HAI in Amputated Finger

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 Deposition: Thermal Plume Theory

Limit velocity at
laminar diffuser

Buoyancy-driven, natural convection from the patient

Memarzadeh and Jiang ASHRAE RP 2001

Refuted by Zhang, John—University of Colorado ASHRAE RP 2015
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 Key Definitions

Definitions
• Ventilation = Outdoor Air
• Air Change = Filtered Supply Air Only
• Recirculated = No Filtration

ASHRAE/ASHE Standard 170

• Air Change = Any supply air including recirculated in “noncritical” areas i.e.,
chilled beams, FCU, fan box

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 Recirculating Systems
ASHRAE Standard 170-2021, Table 7-1 Footnote a.
Recirculating room HVAC units (with heating or cooling coils) are acceptable
for providing that portion of the minimum total air changes per hour which is
permitted by section 7.1.a.5. Because of the cleaning difficulty and the
potential for buildup of contamination, recirculating room units shall not be
used in areas marked “No.” [critical areas] Recirculating devices with HEPA
filters shall be permitted in existing facilities as interim….
Para 7.1.a.5: “..the portion of ACH > min OA, may be provided by recirculating
units…units shall filter OA, serve only one space, MERV 8 if condensing…..”

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 Particle-Based ACH

Source: Weiss Co Germany

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 Relative Humidity vs. Influenza Survival

Source: IBID. Noti, JD 2013.

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 Respiratory & GI Infections vs. RH

Source: Taylor, S., Nursing Home Study, ASHRAE Webinar, November 2019

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 Highest Correlation
to HAI’s was RH

• RH effects patient’s
defenses
• Humidity improves airway
cleaning (mucus)
• Effects rate of evaporation
of aerosols = size = settle
rate
• Concentration of salts
• Drying of mucus <40%

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 Filtration ASHRAE/ASHE Standard 170-2021
Function of Space Pressure Minimum Minimum All Room Air Air Recirculated by Unoccupied Minimum Filter Design Design
Relationship to Outdoor Total ach Exhausted Directly to Means of Room Units Turndown Efficiencies Relative Temperature
Adjacent Areas ach Outdoors (j) (a) Humidity (k), (l), °F/°C
(n) %

AII anteroom (e) NR 10 Yes No Yes MERV-8 NR NR

AII room Negative 2 12 Yes No Yes MERV-14 Max 60 70–75/21–24

Cesarean Delivery room Positive 4 20 NR No Yes MERV-16 20-60 68-75/20-24

Combination AII/PE anteroom (e) NR 10 Yes No No HEPA NR NR

Combination AII/PE room Positive 2 12 Yes No No HEPA Max 60 70–75/21–24

Continued care nursery N/R 2 6 NR No Yes MERV-14 30-60 72-78/22-26

Critical care patient care station N/R 2 6 NR No Yes MERV-14 30-60 70–75/21–24

Emergency department N/R 2 6 NR NR Yes MERV-14 Max 60 70–75/21–24

exam/treatment room
Emergency department human Negative 2 12 Yes No Yes MERV-14 NR NR
decontamination
Emergency department public Negative 2 12 Yes NR Yes MERV-8 Max 65 70–75/21–24
waiting area

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 Mold (fungi)

• Requires condensation
on surfaces below
dewpoint
• F(thermal resistance, dT,
permeance)
• Vapor drive calc

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 HVAC and Aspergillosis

• Avoid condensation in walls, ducts (inside and out)

• UV lights in AHU
• MERV 14+ filtration, tight fit
• Be very careful during construction/renovation
• Only 1 cfu/m3 is sufficient in high risk patients, dose/response shown.1
• A. fumigatus can produce aerosols, potentially transmitted.2
• Spores (conidia) are 2-3 microns
(1) Arnow, PM. “Endemic aspergillosis..in-hospital..”J Inf Dis 1991
(2) Engel, TGP, “Aerosol Transmission A. fumigatus,,,Netherlands”, Emerg Inf Dis, 2019 Apr

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 Filter Resistance,
MERV, FPM

• MERV 14 dP minimum ~
0.30 in.
• Less = leaks @ design
flow

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 Infections Versus Filtration Rate

Source: Stephens, B. HVAC Filtration & Wells Riley Approach. Built Environment. 3/1/12.

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 Cost of Filtration Versus MERV

Cost for 2 × 2 ft filter.

Source: Stephens, B. HVAC Filtration & Wells Riley Approach. Built Environment. 3/1/12.

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 Pressure Difference

Maintain pressurization 24/7: OR, Iso Room, SPD, Pharm, Lab

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 Ultraviolet (UV) Irradiation

Intensity × Time
UV Kill Effectiveness =
Virulence (k)
• Efficacy in ductwork becoming accepted
• Effective in AHU mold and mildew on filters, walls, coils, and pans
• Effective w/ sufficient intensity in air <500fpm
• Will degrade some filters, rubber, vinyl, etc.
• In rooms balance intensity for effectiveness and safety
• Ionization controversial

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 UV Lights Are Not Perfect

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 UV Design
Parameters
• Excellent on surfaces
• UVC 265 nm best
• K varies widely for different
organisms
− TB 0.004721
− Coronavirus 0.00377
− Influenza 0.00119
• ~35w/SF cross section in AHU
<500fpm
• Air temp & velocity effect
performance
• Lamp depreciation important
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 Monitoring of Pressure, Temperature, RH, ACH

• Sterile processing, Iso AII/ PE, • Generally AHJ accepts the

bronchoscopy: dP hospital’s plan for monitoring
• OR, Triage, morgue/autopsy: dP • Ball in tube or tissue where
• Operating room: Some CMS data not required
inspectors want ACH, T, RH
• Owner and AHJ requirements
• KISS
vary!
• Trend toward increasing
monitoring

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 Excerpt: ASHRAE/ASHE
Standard 170-2021
ASHRAE/ASHE Standard 170
Function of Space Pressure Minimum Minimum All Room Air Air Recirculated by Unoccupied Minimum Filter Design Design
Relationship to Outdoor Total ach Exhausted Directly to Means of Room Units Turndown Efficiencies Relative Temperature
Adjacent Areas ach Outdoors (j) (a) Humidity (k), (l), °F/°C
(n) %

Operating room (m), (o) Positive 4 20 NR No Yes MERV-16 (hh) 20-60 68-75/20-24

Operating/surgical cystoscopic Yes MERV-16

Positive 4 20 NR No 20-60 68-75/20-24
rooms (m), (o)
Delivery room (Caesarean) (m), Yes MERV-16
Positive 4 20 NR No 20-60 68-75/20-24
(o)

Substerile service area NR 2 6 NR No Yes MERV-8 NR NR

Recovery room NR 2 6 NR No Yes MERV-14 20-60 70-75/21-24

Critical and intensive care NR 2 6 NR No Yes MERV-14 30-60 70-75/21-24

Intermediate care (s) NR 2 6 NR NR Yes MERV-14 Max 60 70-75/21-24

Wound intensive care (burn unit) Positive 2 6 NR No Yes HEPA 40-60 70-75/21-24

Newborn intensive care Positive 2 6 NR No Yes MERV-14 30-60 72-78/22-26

Treatment room (p) NR 2 6 NR NR Yes MERV-8 20-60 70-75/21-24

Patient Room NR 2 4 NR NR Yes MERV-14 Max 60 70-75/21-24

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 Desired Performance 100%

Is ASHRAE 0.4% Good Enough?

• 35 h/yr system can’t meet conditions
• Acceptable in an acute care hospital?
• Actual max enthalpy in Raleigh 2015, 43 Btu/lb
• Actual max wb 79.7
• Actual high has increased each of past 4 years
• ASHRAE 0.4% condition for MCWB is 94.8/75.7 wb = 39 Btu/lb
• ASHRAE 0.4% wet bulb is 89.7/78.3 wb = 42 Btu/lb

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 Supply Air CFM

• Air flow is usually determined by code-required air changes, not

cooling load.
• Typical OR load = 2 ton 700 cfm
• Code = 20 ACH 1400 cfm
• 4 ACH OA 280 cfm

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 Engineer’s Role - How Can We Help?

• Maintain humidity in range 40-60%

• Maintain temperature in range desired by medical staff
• Avoid condensation where mold and spores grow
• Flush with fresh/clean (filtered) air
• Kill the microorganisms, esp. in AHU
• Minimize dispersion, esp. during construction
• Remove microorganisms from air
• Move air via pressure: clean to less clean

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 Infection Control Affects HVAC Design

16

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 Element #2 Reliability

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 C-Suite View of Reliability

• “What if a system goes down and

we have to call off a procedure?”

• Example: Power blips causing

shutdown of imaging systems

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 HVAC Reliability

• Reliability ∞ 1/complexity
• Maintenance ∞ complexity
• Complexity ∞ number moving of parts
• Complexity ∞ lines of code
• Complexity ∞ unintended consequences

•KISS

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 Equal Death

• Equal run time = all die same day

• Prius and Tundra—drive the Prius
• Greatly increases complexity of sequence
• Run the most efficient chiller the most
• Only 1 VFD chiller is needed

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 Complexity Can Be
Counterproductive

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 Quality Components: AHU

• If exterior, aluminum
or stainless steel
housing
• <0.5% leakage after
installation

Dual Fans with

Divider in AHU
or Fan Array

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 New Custom
AHU

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 Increase Reliability

• Design for redundancy, spare capacity

• Quality components
• Reduce parts inventory
• Parts and skilled service locally available
• Good and tested emergency operations procedures
• Regular tune-ups
• Emergency connections: DHW, chiller, generator, lift pumps

•KISS
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 Element #3 Maintenance

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 Maintenance Cost

• 0.2%–0.4% of operating cost

• 25,000–50,000/ft2 per zone mechanic at $75,000/yr gross salary cost
• Maintenance labor alone is $2–$3 /ft2/yr + parts
• AHA says $5/ft2/yr maintenance1
• One client with 1.8 million ft2
− $8 million maintenance $4.44/ft2
− $6 million utilities $3.33/ft2

• Fewer parts, simpler sequences, good access, redundancy, quality, PM

• KISS
(1) AHA/ASHE Benchmarking 2.0 Report

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 Element #4 Energy

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 Energy Metrics

• 0.2-0.5% of total hospital cost • Cape Fear Valley Hospital EUI = 165
• EUI = Energy Use Index = • Typical $4–6/ft2/yr
kBtu/ft2/yr (site) • Average Source EUI ~500
• National Average Site EUI ~ 250 • Source = 3X site electric
• EPA Energy Star® EUI ~ 170

* Interaction: You can save a given Btu only once

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 Breakdown of Energy Cost

Miscellaneous
HVAC Lighting
Steam and
65%
Misc. Equipment Kitchen Gas
18.0% 15.6%
1.1%

Fans Steam for Heating

25.9% 24.2%

Cooling Steam for

11.5% Domestic
HVAC Pumps Hot Water
2.6% 1.0%

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 Energy ~ 1/2% of Hospital’s Cost

450 5
Thermal Electrical
400

350 4

300

247
223
3
K BTU / FT2-YR SITE

250
154

182
140

202

161
187
134

162
200

143
126
130
132
134

111
150 2

84
98

30
100
158

158

158
147
135

135

127
122

116
115

114

112
111

111
109
106

50

95

84
0 69

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 Psychrometrics & Operations

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 OR Temperature/RH Quiz

What is the easiest way to lower the RH in the operating room?

1. Lower the temperature
2. Raise the room temperature
3. Install a desiccant system
4. Lower the CHW temp
5. Tune the AHU

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 OR Temperature/RH Answer

Raise the room temperature

• At a constant supply air dew point, raising the temperature a small amount
will lower the relative humidity a large amount
• No change in SAT @ AHU required
• Relative humidity is very confusing. It is amount of water vapor in the air
versus the max it could hold at that temp

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 Where Will You Get Condensation?

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 Sacto v. Houston, Condensation

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 Relative Humidity Is Confusing!

• Relative Humidity is the amount of water in the air relative to the

maximum amount of water that could be held in the air at that
temperature.
• Dewpoint changes very little throughout the day.
• Relative humidity changes dramatically as the temperature changes,
but the amount of water in the air remains constant.
• On the hottest, most humid days, 90°db, 65° dewpoint, the relative
humidity is only 44%.

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 Hot Air Holds a Lot More Water

Air @ Air @
68ºF/40% 80ºF/40%

42 DP° 54 DP°

Twice as Much Water

Use Dewpoint
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 Dewpoint v. RH Oakland May 24, 2021

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 Minimize OA,
Maintain Positive
Pressure
• Air monitoring stations 1000 cfm @ > Inside OR
>
80°F/63°F 65°F/60% rh
• OA = Exh + 5%, building >
>
DP
positive
• Accurate AMS sensors 5 tons, Summer
• Filtered RA is cleaner cfm of OA costs $2-4/yr
than OA & Expensive (Raleigh, NC)

• Use NOAA for OA

conditions
• DON’T return and relieve

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 Minimum OA Requirements
Excerpt: ASHRAE/ASHE Standard 170-2021
Pressure All Room Air
Minimum Air Recirculated by Design Relative
Relationship to Minimum Exhausted Design Temperature
Function of Space Adjacent Areas Outdoor ach
Total
Directly to
Means of Room Humidity (k),
(l), °F/°C
ach Units (a) %
(n) Outdoors (j)

SURGERY AND CRITICAL CARE

Operating room (m), (o) Positive 4 20 NR No 20-60 68-75/20-24

Operating/surgical cystoscopic rooms (m), (o) Positive 4 20 NR No 20-60 68-75/20-24

Delivery room (Caesarean) (m), (o) Positive 4 20 NR No 20-60 68-75/20-24

Substerile service area NR 2 6 NR No NR NR
Recovery room NR 2 6 NR No 20-60 70-75/21-24

Critical and intensive care NR 2 6 NR No 30-60 70-75/21-24

Intermediate care (s) NR 2 6 NR NR Max 60 70-75/21-24

Wound intensive care (burn unit) Positive 2 6 NR No 40-60 70-75/21-24
Newborn intensive care Positive 2 6 NR No 30-60 72-78/22-26
Treatment room (p) NR 2 6 NR NR 20-60 70-75/21-24

Patient Room NR 2 4 NR NR Max 60 70-75/21-24

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 Calculating % Outdoor Air by Temperature

% OA = 1 – (MA – OA)/(RA – OA)

Example: 22.2ºC (72ºF) return, 4.4ºC (40ºF) outside, 18.3ºC

(65ºF) mixed
= 1 – (65-40º)/(72-40º)
= 1 – 78%
OA = 22%

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 Quiz: OA Economizer in Spring

It’s 48°F and raining outside.

Should I bring outdoor air into my Operating Room AHU?

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 Answer: OA Economizer in Spring

YES, if OA 66°/50%
<50°F

OA 48°

66°
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 Outside Air Economizers
Relative Humidity, %
Only if dew point is 60% Max RH
between 35°F and 50°F,
~2,000 hr/yr Travis AFB,
2,500 hr/yr RDU
30% Min RH

50°F DP

35°F DP
68°F/30%/60%

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 Economizer Article Findings

• 4–25,000 cfm custom AHU in Raleigh, NC

• Added construction cost 100k
• Save 5k/year
• May be able to delete preheat coil
• Assuming economizer works perfectly and
requires zero maintenance then payback
20 years
• Add value for purge mode, still may not be
worth using daily

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 Do You Need a Preheat Coil?

• Main reason for PHC is failure of economizer

dampers or smoke purge when OA < 32°F
• Run cooling coil full flow during emergency
smoke purge
• Eliminate cost, dP, space, complexity
• Many PHCs freeze
• Weigh against air economizer

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 Waterside Economizer

• Can provide significant cooling whenever OA <45°F

• Water-cooled economizer system allows not using
air-cooled economizer
• Can have trouble starting chillers in cold weather
• Can pre-cool CHWR, series flow
• Must filter condenser water
• Difficult, expensive maintenance
• Maintenance on one flat plate
<< 40 AHU economizer systems
• Equip in mech room
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 Air-Side Energy Recovery

• SA, exhaust duct proximity or run-around

• Avoid cross contamination
• Bypass or HEPA contagious exhaust
• Good with 100% OA systems
• Good with DX
• Eliminates preheat
• Good with extreme OA temps
• Upstream of final filter
• Heat pipes great for sensible

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 Optimize Humidification

• Boiler steam OK with FDA-approved chemicals

• Steam/steam not required—cost, space, maintenance, heat
• Avoid terminal humidifiers
• Locate humidifier before cooling coil in AHU
• Keep RH sensors in calibration
• Use accurate instruments to test (sling)
• Large RH display but no control by user
• Adiabatic allowed with RO and UV, no storage, etc.

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 Terminal Humidifiers

• It’s raining in my OR
• Fast increase in temp setting causes humidifier operation
• 65F/50% = 46F dewpoint
• 75F/50% = 55F dewpoint
• 90F/80% = 83F dewpoint

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 Steam/Steam -
Complicated

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 Humidifier Control

• Problem: Humidity
Return Air From Various controls are typically
EXH/
Spaces unreliable and slow.
74° HW Significant swings in
Relief
humidity are
Typical common.
• Solution: Control to
STM 35°F dp in SA. Also
Alternative
use for high limit.
Locate ahead of
OA Supply 70° cooling coil.
55°/54°

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 Minimize Coil Face Velocity

• Low CHW temperatures

• DX: Adds another system, maintenance, electrical
• Glycol, air-cooled chiller: Adds another system, environmental
problems, electrical
• Desiccant wheel: Large, complicated, requires heat to
regenerate, good control
• Brine: Maintenance, requires heat and cooling, good control, can
also humidify

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 Minimize Coil Face Velocity

* Trane PRIMA-FLO 42°F/50°F CHW; 95°F/75°F EA; 8 Row, 8 fps, 13 fpi

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 Optimize CHW Flow

* Trane PRIMA-FLO 42°F/50°F CHW; 95°F/75°F wb EA; 8 row, 13 fpi, 400 fps
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 Direct Expansion (DX), Poor Humidity
Control

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 How About a Desiccant System?

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 Chilled Beam

• Sensible cooling only; you don’t want condensation on chilled

beam
• Supply 2 ACH cold air
• Recirculate 4 ACH across chilled beam
• CHW temp must be over room dewpoint
• CHW piping to each chilled beam
• Can 2 ACH dilute air to acceptable humidity with visitors?

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 Chilled Beam in Patient Room

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 SA Temp Reset

• Will raise space RH, if MAT dewpoint > 50°F

• Do not raise SAT unless OA dewpoint < 50°F
• Control CHW flow to meet SA setpoint, not CHW temp
• Higher CHW temp likely will cause higher dewpoint
• Saves energy by reducing reheat and cooling

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 Heating Water Temp Reset

• Reduce boiler and pipe standby losses

• Increase boiler efficiency
• High ΔT = less pumping, smaller pipes
• With constant SAT, reheat steady year round
• Hospitals are factories = internal load driven
• Be careful of need for fast warm-up
• Need 2-4 row RHC w/ lower HHW temp

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 Match SAT to Desired Space T/RH
Relative Humidity, %

SA 52°F/52°F DP
68°F/55%
Patient Room

66°F/50%
Operating/
Procedure Room
SA 47°F/
47°F DP

Dry-Bulb Temperature, °F
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 Best: Low Temperature, High dT CHW

• More tons in same size pipe

• Good humidity control
• Lower first cost than separate systems—equipment is smaller
• Lower ∆P in coil
• Lower cfm
• Less pump energy may offset chiller efficiency loss
• Avoid multiple systems – first cost and maintenance

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 So What?
• Set supply air at low temperature, or control SA on desired space
dewpoint
• Be very careful with energy saving strategies. Temperature and
humidity sensors must be very accurate and can get very
complicated.
• Use dewpoint in talking to staff
• Use sling psychrometer
• Try to align doctor’s expectations with system capability
• Don’t give staff humidity control
• Control humidifier from SA not RA
• Lower OR temp until RH = 60%
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 So What?

• Know psychrometrics, get comfortable via daily use

• Use real numbers: e.g., Hot day humidity is 50% @ 86°, DP = 63°
• Raise OR temp until RH ≤ 60%
• Run low CHW temp
• Minimize OA
• Verify control accuracy, setpoints and sequences

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 Element #5
Adaptability, Renovations

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 Plan for Change and Error

• Instrument and T&B error, internal loads—design for ~3°F and

5%–10% less than desired set point
• Size above minimum required air exchange rates
• Owner or Arch change minds late in design process
• Potential for future change of use
• Code changes
• Areas requiring pressurization may require higher offsets (more
EA or SA, especially negative pressure areas)

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 Plan for Change and Error

• Extra capacity
− Fan—system effect, higher SP, duct leakage, evaluate fan curve
− Motor—energy use determined by work, not hp, size electrical for next
highest hp
− Chiller
− Pumps
− Ducts—duct installation rarely like drawings
− Don’t reduce duct mains to minimums
− Spare breakers

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 Design Process for Existing Facilities
• Conduct Facilities Condition Assessment (FCA)
• As a minimum evaluate Infrastructure required, source location
and capacity.
• Pre-construction air system and water system testing
• Condition and potential code deficiencies
• Communicate with the facilities staff!
• Evaluate what the renovations/additions need in terms of
capacity and condition of existing systems.
• Evaluate the continuity of services to areas not being modified.

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 Design Process for Existing Facilities
• Determine uses of adjacent spaces including above and below
• Ensure that HVAC systems serving areas other than the construction zone
maintain adequate air flows and pressure relationships during construction.
• Ensure that air supplied to the construction zone is not recirculated to other
areas.
• Ensure that plans for remodeling include strategies to protect areas not
under construction from construction debris and dust. (Infection Control Risk
Assessment)
• Prepare for continuity of service. Plan for temporary HVAC equipment when
necessary. Phasing Plan.
• Integrate with Master Plan.
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 Typical Existing Problems

• Air filtration may not be up to current standards.

• Equipment lacks capacity to meet new loads.
• Equipment may be at the end of its life.
• Controls need upgrade or lacking in performance.
• Ductwork may be dirty or lined, especially return and exhaust
ducts.
• Hydronic systems may exhibit deterioration of piping and control
valves.
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 Typical Existing Problems

• Horizontal or vertical space for distribution may not be available

to permit addition of new systems or elements.
• Systems may be energy-intensive.
• There may be insufficient clearance for adequate maintenance.
• There may be significant “deferred” maintenance.
• Existing building envelope issues (insulation, air leaks, vapor
barrier) may affect HVAC performance.

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 Typical Existing Problems

• Systems may not be appropriate for changing functions or

technology, such as changing a patient room into a laboratory
space.
• Systems may have improper air or water flow.
• Systems may not have performed originally and are in dire need
of retro-commissioning.
• Central chiller plants may contain CFCs and/or need to be
upgraded due to age of equipment, lack of flexibility, or capacity.
• Original design may not be good.

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 Demolition

• Demolition Drawings must depict / describe the ICRA plan.

• Exhaust fans or HEPA-filtered fans are used to maintain negative
pressure in the construction zone. Exhaust to outside if possible.
• Hard barriers required in most cases
• Pressure gauges to confirm negative pressure in the work area
• Walk-off mats – wet or sticky
• Covered carts
• Documentation of daily activities and conditions

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 Demolition

• Preparations for demolition must also include:

• Ventilation control
• Air-handling systems that serve areas under construction should
be turned off if not serving other areas.
• Return air openings in the construction area should be sealed. If
this is not practical, provide filters over all return openings. Poor
choice!

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 Construction Phasing

• Renovation usually must be phased to ensure continuity of services,

Interim Life Safety requirements, patients and staff traffic.
• Indicate if work must be done during night time, weekends or other
unoccupied times.
• Show points of connection – new to existing – and show partial plans
with temporary systems or services and interim layouts as necessary
to reflect the work needed.
• May require portable AHU. Evaluate utilities required for temporary
equipment.

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 Infection Control Risk Assessment (ICRA)

• The FGI Guidelines for Design and Construction of Hospitals and

Health Care Facilities states:
“Early involvement in the conceptual phase helps ascertain
the risk for susceptible patient(s) and [the risk of] disruption
of essential patient services.”
• This consultation in the initial stages of planning and design is
termed an Infection Control Risk Assessment (ICRA).

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 ICRA

1. Coordination of construction preparation and demolition

2. Operating and maintaining facilities during construction
3. Post-construction cleanup
4. Monitoring during and after construction
5. Accountability and recordkeeping
6. Multi-discipline team including hospital infection control officer

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 ICRA

7. Which patient groups and employees are susceptible to risks

from the proposed construction process?
8. Which ventilation systems are involved and how close are they
to the construction?
9. What effect on space pressure?
10.Are current ventilation controls operating according to original
design intent?
11.Will supplemental ventilation be required during the project?

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 ICRA

12.Will fire code interim life safety requirements during

construction affect ventilation requirements?
13.Is special ventilation for infectious disease prevention
(tuberculosis or aspergillosis) affected during construction?
14.What impact will noise and vibration have on occupants,
sensitive procedures or equipment?
15.How will perceptions affect patients during various noisy or
odorous procedures?
16.Is there a history of water damage in renovated areas?

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 Infection Control Risk Assessment
STEP 1 - IDENTIFY THE TYPE OF CONSTRUCTION
PROJECT ACTIVITY

Inspection and Noninvasive Activities

Includes, but is not limited to:
• Removal of ceiling tiles for visual inspection only; e.g., limited to
one tile per 50 ft2
TYPE A • Painting (but not sanding)
• Wall covering, electrical trim work, minor plumbing, and activities
that do not generate dust or require cutting of walls or access to
ceilings other than for visual inspection

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 Infection Control Risk Assessment
STEP 1 - IDENTIFY THE TYPE OF CONSTRUCTION
PROJECT ACTIVITY

Small scale, short duration activities which create

minimal dust
Includes, but is not limited to:
• Installation of telephone and computer cabling
TYPE B • Access to chase spaces
• Cutting of walls or ceiling where dust migration can be controlled.

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 Infection Control Risk Assessment
STEP 1 - IDENTIFY THE TYPE OF CONSTRUCTION
PROJECT ACTIVITY
Work that generates a moderate to high level of dust or requires
demolition or removal of any fixed building components or
assemblies
Includes, but is not limited to:
• Sanding of walls for painting or wall covering
TYPE C • Removal of floor coverings, ceiling tiles, and casework
• New wall construction
• Minor duct work or electrical work above ceilings
• Major cabling activities
• Any activity which cannot be completed within a single workshift

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 Infection Control Risk Assessment
STEP 1 - IDENTIFY THE TYPE OF CONSTRUCTION
PROJECT ACTIVITY
Major demolition and construction projects
Includes, but is not limited to:
• Activities which require consecutive work shifts
• Requires heavy demolition or removal of a complete cabling system
• New construction.
TYPE D

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 Infection Control Risk Assessment
STEP 2 - IDENTIFY THE PATIENT RISK GROUPS

Low Risk Medium Risk High Risk Highest Risk

▪ Office areas ▪ Cardiology ▪ CCU ▪ Any area caring for
▪ Echocardiography ▪ Emergency room immunocompromised
▪ Endoscopy ▪ Labor and delivery patients
▪ Nuclear medicine ▪ Laboratories (specimen) ▪ Burn unit
▪ Physical therapy ▪ Medical units ▪ Cardiac cath lab
▪ Radiology/MRI ▪ Newborn nursery ▪ Central sterile supply
▪ Respiratory therapy ▪ Outpatient surgery ▪ Intensive care units
▪ Pediatrics ▪ Negative pressure isolation
▪ Pharmacy rooms
▪ Post-anesthesia care unit ▪ Oncology
▪ Surgical units ▪ Operating rooms including
C-section rooms

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 Infection Control Risk Assessment
STEP 3 - MATCH THE…

• Patient Risk Group (Low, Medium, High, Highest) with the planned…
• Construction Project Type (A, B, C, D) on the following matrix, to find the…
• Class of Precautions (I, II, III or IV) or level of infection control activities required.

Patient Risk Group TYPE A TYPE B TYPE C TYPE D

LOW Risk Group I II II III/IV

MEDIUM Risk Group I II III IV

HIGH Risk Group I II III/IV IV

HIGHEST Risk Group II III/IV III/IV IV

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 Renovations

• Exhaust construction zones to the outside if

possible, negative
• HEPA filter from construction zone to hospital
not recommended
• Remove all lined ducts and boxes
• Replace electric reheat
• Remove all abandoned equipment
• Maintain clean ductwork throughout
construction, verify!
• Clean walk-off mats, covered carts

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 Make Sure Clean Ducts

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 No Open Duct Returns
to AHU
• Returns in construction area should be
sealed shut or filtered if they cannot be
shut down.

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 Element #6
Life Safety HVAC Considerations

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 The Life Safety Approach for Hospitals

• Hospitals must rely on the building and building systems to protect

occupants while they remain in place. Corridor walls are built at a minimum
as smoke partitions, if not of rated construction, to protect patients in their
rooms.
• Additionally, hospitals are divided into Smoke Compartments separated by
smoke barriers. These compartments are intended to serve as protected
refuge zones for patients and staff during a fire/smoke event in adjoining
compartments.
• This is called a Defend-In-Place strategy, which works in stages.

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 Smoke Control and Life Safety
Defend-in-Place
• HVAC systems play a major role in the life safety of patients and staff.
Transport of fire or smoke via the HVAC system within the compartment or
between compartments can defeat the Defend-in-Place approach.
• Passive Smoke Control – AHU shutdown can be a key factor in patient
safety.
• Active Smoke Control – Smoke Ventilation Systems, Stairwell and Elevator
shaft pressurization, atriums, elevator lobbies.
• Under IBC hospitals (I2) have more stringent requirements
• CMS and TJC require hospitals to comply with all NFPA standards (101,
90A, 99, etc). CMS uses 2012 version, TJC uses most current.

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 Fire and Smoke Dampers
Critical Design Issues – Fire/Smoke Dampers & Smoke
Dampers
• Make sure adequate access is provided to actuator.
• Insist on access door immediately next to the damper for access.
• Access doors should be close to the same width as the duct width and at least 12-18 in. long in the
length of the duct. Use hinged or tethered doors. 12 x 12 is min allowed for FD.
• Make sure at least 24 in. of clearance is available in front of the access door.
• Access must be provided to the smoke detector; make sure the access panel is on the same side!
• Dampers MUST be inspected and tested periodically. JCAHO: At construction, within one year of CO,
and every six years after.
• Large dampers are difficult to reset without adequate access.
• If space permits, specify dampers with the blades outside the airstream.
• Label dampers on plans and dampers.
• Provide a schedule of dampers on drawings.

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 Passive Smoke Control Issues
• Passive smoke control barriers require inspection and ongoing
maintenance.
• An integral part is the shutdown of air handling systems and
related return and exhaust systems in the areas under alarm and
closely adjoining areas.
• In most cases, specialty exhausts (AII, Lab Hood, etc.) should
remain operating to ensure personnel and patient safety.
• The integrated systems (detectors, dampers, fire alarm, BAS,
AHU) must be tested regularly. Document sequence and results.
Design to minimize quantity of devices.
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 Active Smoke Control Issues
• Some local codes and jurisdictions require Active Smoke Control
designs.
• Most codes (NFPA, others) require that high-rise hospitals or clinics
(over 75 feet) have Active Smoke Control also buildings with atriums.
May be a legacy system of based on earlier codes or engineered
smoke control system.
• Earlier editions of NFPA 99 required all windowless anesthetizing
locations to have active smoke/purge evacuation systems. Many of
these systems remain although no longer required.
• Elevator shafts are difficult to pressurize with new requirement for
open doors. Use lobby separation instead.
• Consider a smoke control system evaluation/study
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 Central Heating Systems

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 Heating Loads

• Preheating • Absorption Cooling (limited)

• Reheating • Laundry (limited)
• Domestic Hot Water • Dietary
• Sterilization • Heating required ALL YEAR
• Humidification

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 Steam System Pressure Classifications

• Low Pressure: 15 psig

• Medium Pressure: 15-75 psig
• High Pressure: 75 psig and higher
• Higher Pressure = Higher system losses

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 Steam Pressure Requirements

• Laundry Equipment: 40-90 psig

• Steam Sterilizers: 40-75 psig
• Sterile Processing washers 40-75 psig
• Kitchen Dishwasher Booster Heating: 15-30 psig
• Kitchen Steam Kettles: 15-30 psig
• Kitchen Serving Line: 5-15 psig

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 Steam Pressure Requirements

• Steam-to-Steam Generators: 15-60 psig

• Direct Humidifiers: 5-15 psig
• Heating Water Heat Exchangers: 5-15 psig
• Domestic Water Heat Exchangers: 5-15 psig
• Double Effect Absorption Cooling: 100 psig
• Steam Heating Coils: 15 psig

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 Boiler Selection

• Fire tube life 15-25 years, water • May wish to size one boiler for
tube 25-50+ years reduced “summer loads”
− Process loads
• Vertical: small footprint, high − Reheat loads
efficiency. Operation issues.
• N+1 = Capacity to withstand loss
• Hot water or Condensing Boilers of largest boiler
• An excellent option is to use 3 • 96-hour fuel supply, natural gas
boilers: not considered standby fuel
− 50% / 50% / 50% of Peak Load • Full heating system on
− 75% / 75% / 25% of Peak Load emergency power

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 On-Site Fuel Supplies

• Most jurisdictions with significant heating requirements require an

alternative heating fuel source with one on site fuel
• Dual-fuel steam boilers are available in most sizes and configurations
utilizing both natural gas and some type of fuel oil; 96-hr supply
required
• Liquid propane / air mixing system can be used to produce an
equivalent backup to natural gas
• May allow Owner to purchase natural gas at favorable interruptible
rates
• Consider connection of boiler fuel oil tanks to generator tanks.
• UST and air quality permits required
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 Option 1
TRADITIONAL MEDIUM OR HIGH PRESSURE STEAM PLANT
• Two or more medium-pressure steam boilers and associated
boiler auxiliaries
• Steam pressure set to meet maximum requirement
• Pressure reducing required for lower pressure equipment
• Heat exchangers required for heating water and domestic water
heating
• Adjust system pressure based on most remote location

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 132
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 133
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 Option 2:
HOT WATER BOILERS WITH STEAM GENERATORS
• Hot water boilers are more efficient than steam boilers
• Can use condensing boilers (dual fuel now available)
• Condensing boilers can be teamed with heat recovery chiller
• Eliminates the need for higher maintenance steam and condensate
distribution systems
• Eliminates the need for hot water heat exchanger systems
• May reduce cost of boiler supervision
• Will require steam generators for remaining steam loads

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 135
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 Humidification

• Can be provided from central boiler steam, steam-to-steam generators, or

local electric or gas sources
• Studies have indicated no adverse effects of using central boiler plant steam
for humidification with careful use of FDA approved treatment chemicals
(Amines)
• Separate local steam generation for humidification is cost effective in
climates where little humidification is required or where humidification needs
are located far from the central steam sources

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 Sterilizers

• Can be provided from central boiler steam system or local gas or electric
generating sources
• Use of local steam generation is cost effective where sterilization loads are
low compared to other low-pressure heating requirements or where
sterilization needs are located far from the central steam sources.
• Local steam generation equipment room may be considered a “boiler room”
and subject to additional code requirements.
• Usually require 40-75 psi

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 Domestic Water Heating

• Can be provided through steam or hot water heat exchangers or through

separate fuel-fired equipment or heat recovery chiller up to 140°F
• Redundancy and EPS required
• Use storage capacity to handle large load fluctuations (laundry / kitchen)
• Instantaneous steam water heaters are very effective for domestic water
loads. These have the advantage of low standby losses compared to tank
type heaters and storage. Requires steam supply, mixing valves.
• Boosters for dishwasher and laundry
• Use flow limiters on recirculation loops to limit return/mixing

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 Typical Domestic Water Requirements

• Domestic hot water – washing / bathing, janitorial: 40°– 52°C

(105°– 125°F)
• Kitchen dietary: 60°C (140°F)
• Kitchen dishwashing final rinse: 83°C (180°F)
• Laundry uses: 60°– 72°C (140°–160°F)
• Max 48°C (118°F) delivery temperature

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 Central Cooling Systems

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 Cooling Requirements

• Space sensible cooling

• Humidity control in spaces
• Significant cooling due to reheat
• Outdoor air sensible cooling and dehumidification
• Equipment sensible cooling – radiology and other medical
equipment
• Most healthcare facilities require cooling all year

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 Unique Considerations for Cooling Loads

Carefully understand air change rates, space temperature and relative

humidity requirements for:
• Operating Suites • Administration
• Radiology Suites • Emergency Dept.
• Laboratories • Outpatient Services
• Patient Rooms • Morgue
• Dietary • Procedures
• Treatment Spaces

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 Low-Temperature Considerations

• Potential low temperature operating conditions: As low as 60°F – 50% RH

OR’s – other special spaces
• Review psychrometrics and required cooling coil discharge temperatures to
meet space requirements
• Select cooling coils for proper discharge temperature/ dewpoint conditions
at design entering chilled water temperature
• Consider separating air handling systems so areas with more extreme
cooling requirements are served by separate AHUs
• Low CHW temp

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 Low-Temperature Considerations

• Use DX re-cooling coils downstream of main air handling units to serve

specific high cooling requirement areas
• Re-cool coils could be served by a separate air cooled or water cooled
chiller or condensing unit
• Re-cool coils with CHW may not reduce dewpoint
• More detailed sequences of operation and control will be required
• More maintenance will be required and condensate handled in a remote
location
• Often needed for humidity control

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 Imaging Cooling Systems

• Review if separate chillers will be provided by equipment manufacturers to

cool equipment or if central chilled water can be used.
• Is cooling load inside the space or outside?
• Review chilled water temperature requirements for types of medical
equipment and determine if separate heat exchangers or mixing control will
be required.
• If central system, exchange or filter probably required.

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 Chiller Selection

• Redundancy – Minimum of two chillers should be used; each with enough capacity
to handle the minimum amount of load critical to the hospital or the entire hospital
load.
• An excellent option is to use 3 chillers:
− 50% / 50% / 20% Peak Load
− May wish to size one chiller for reduced “winter loads” or heat recovery chiller
• Number of chillers and type should be evaluated based on part-load and Life Cycle
Cost Analysis.
• Carefully evaluate peak coincident cooling loads and loads during different
seasons and during unoccupied periods before determining number and size of
chillers to be used.
• Size to accept loss of energy recovery equipment.
• Size piping to allow future expansion; leave taps with valves.

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 Auxiliary Components

• Chiller plant auxiliary components should be designed with

redundant backup equipment: chilled water pumps, some control
valves, controls, compressors, condenser water pumps, cooling
towers, condensing units, etc.
• Key – Evaluate which areas could be without cooling for a period
of time if any chiller fails: Admin? Outpatient Areas?
• Consider emergency chiller connection

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 Water-Side Economizer

• In many climates, a plate-and-frame heat exchanger is cost effective and

can provide for most cooling needs in the late fall, winter and early spring
seasons.
• A water-cooled economizer system allows the elimination of air-cooled
economizer, which is more costly and presents humidity and maintenance
challenges.

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 Water-Side
Economizer
• Plate-and-Frame Heat
Exchanger

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 Water-Side Economizer

• Payback: 3-5 years

• Need to be careful about maintenance – straining of condenser water
• Careful sequences and control needed to avoid conflict with chiller
operation – Condenser temps
• Usually operates below 42°- 45°F outdoor wet-bulb
• Careful cooling tower control must be employed, especially at switchover
from plate to chiller

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 Heat Recovery Chiller

• Size based on heating load not cooling load

• Use a stable base load with minimal variation
• Compressor head = condenser temp – evaporator temp
• Hot water limited to approximately 140 deg max.
• Higher hot water temp = higher chilled water temp
• Determine if in parallel or series with other chillers

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 CHW Pumping System

• Chilled water plant distribution can be designed in one of two different

arrangements:
− Primary/secondary pumping arrangement; either constant flow or variable flow
− Primary variable flow
• Primary variable flow has several control and energy conservation
advantages
• Use pressure-independent valves on coils
• Variable primary more sensitive – hard to control

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 CHW Temperature Selection

• Use highest “delta temp” possible:

− Chilled water: 14°– 16°F
− Condenser water: 12°– 14°F
• Difficult to obtain high temperature differences with existing AHU
cooling coils and maintain performance – existing cooling coils
may need to be replaced
• Low temperatures = more tonnage in same pipe size
• Low CHWS helps performance of existing coils

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 154
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 155
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 Surgery Suite Design

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 Operating Rooms

• Doctors will demand <68°F, 60% max

humidity
• Laminar flow diffusers required, minimum
12 inches beyond table
• Temperature control; not humidity with
large readouts
• Consider air curtains in very large
OR to get 20 ach
• SA <50°F
• 0.01 in. positive monitoring now required
• dP even when unoccupied

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 OR Room Design

• Tight for dP; beware of vapor transmission

• May use gasketed panels; integrated ceiling
• Structural ceilings allow attachment of booms
• Plenum supply improves laminar flow, reduces ductwork, saves space
above ceiling
• Interchangeable alum diffusers, panels, and lights
• Translucent diffuser panels are available
• Air curtains not proved to be superior
• Green light sometimes used, helps read monitors

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 Surgery Suite

• Operating Rooms (OR)

• Sub-sterile Room – typically between ORs for support use
• Clean Corridor
• Pre-Op/Holding/Recovery (Prep/Post)
• Post-Anesthetic Care Unit (PACU)
• Clean Supply
• Related: Sterile Processing Department (SPD)

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 Surgery Department

• Operating Rooms – often designated by service performed:

− General = general surgery
− Neuro = brain/spine surgery
− CV = cardiovascular surgery
− Transplant = solid organ transplant surgery
− Ortho = orthopedic surgery
• “Laminar Flow” OR – cleanroom-like supply air system
• Open Heart OR – Pump room for support equipment
• Hybrid = large OR with built-in CT or Fluoro

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 Characteristics of Operating Rooms

• Heart: low temp, fast reheat, large room

• Orthopedic: low temp, large room, extra filtration
• Cysto: med temp, floor drain?
• General: med temp
• Pediatric: high temp
• Neuro: low temp, large room
• Trauma: high temp
• Burn: high temp & humidity
• C-Section: med temp

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 OR Standards Recent History
AIA vs. DEW, NFPA

DATE SOURCE TEMP ºC RH% ACH OA

1974 USDEW 20°- 25°C (68°- 76ºF ) 50-60 25 / 25 25 / 5
1978 USDEW 20°- 25°C (68°- 76ºF) 50-60 15 / 25 15 / 5
1983 AIA 21°- 24°C (70°- 75ºF) 45-60 20 4
1987 AIA 21°- 24°C (70°- 75ºF) 50-60 15 3
1992 AIA 21°- 24°C (70°- 75ºF) 50-60 15 3
2001 AIA 20°- 23°C (68°- 73ºF) 30-60 15 3
2002 NFPA 99 20°- 23°C (68°- 73ºF) 50 25 5
2006(2) AIA/FGI 20°- 23°C (68°- 73ºF) 30-60 15 3
2010 FGI 68°- 75ºF 20-60 20 4

* From 2010 on, FGI includes Standard 170

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 OR Standards Recent History
ASHRAE

DATE SOURCE TEMP ºC RH% ACH OA

1971 Applications 20°- 25°C (68°- 76ºF) 50 25(1) 25

1987 Applications 20°- 25°C (68°- 76ºF) 50-60 15 / 25 (1) 15 / 5

1999 Applications 20°- 27°C (62°- 80ºF) 45-55 25 5
2003 Applications 20°- 27°C (62°- 80ºF) 45-55 25 5
2003 Manual for Hospital 20°- 24°C (68°- 75ºF) 30-60 25 5

2008 Std 170 Ventilation (FGI 2010) 20°- 24°C (68°- 75ºF) 30-60 20 4

2013
Std 170 (2021) and FGI (2022) 20°- 24°C (68°- 75ºF) 20-60 20 4
2021

(1)100% OA System
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 OR System Design

• Understand sequences of operation

• Pressurization
• Select quality components
• Most common system is CHW with HW reheat
• Year-round cooling load
• Low temp chilled water may meet desired Temp & RH
• Dedicated AHU for OR suite
• AHU must meet requirements of most critical OR
• 20 ACH SA, 4 ACH OA

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 OR Ceiling Layout

* Maximum 30%
of array may be
blocked by
lights, etc.

Return air on opposite sides

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 RCP on Floor

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 Integrated Ceiling, Hybrid OR

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 Operating Room Setpoints
Lower room temperature at night to reduce reheat

20%
67°/49°F DP

100%
80% RHC 50%
47°/46°F DP CFM 100%
0%
90°/64°F DP 65°/47°F DP
52% RH

20% of SA
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 Standard Process In Hospital OR

OA 90°/64°DP
MA 72°/53°DP RA 68°/49°DP

SA
47°/47°
OR
64°/60%
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 The Perfect Dew Point for OR Systems

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 Typical OR Cooling Load

48% 4%
10%

38%

Staff and Patient Lights and Equipment 25% OA Reheat

20% OA @ 86°/63° DP, inside 65°/50%

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 CFM Offset to Achieve Pressurization

Supply – (Return + Exhaust)

We recommend at least 400 cfm offset at all times

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 OR Temp/RH Suggested Policy

• “Normal Range” = 66-72F, 20-60%

• If out of range for > 30 min, call Engineering. Attempt to remedy
• “Action Range” = 64F or above 76F, or < 17% or above 65% for
30 min. Apply clinical policy re: cancel, reduce room use,
document
• Do not initiate surgery if in Action Range
• Physician to document requests for T/RH out of Normal Range

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 OR Airflow Setback

• Saves fan and reheat energy • Occupancy sensor with foolproof

~$2500/yr per OR override and status indicator
• Must maintain positive pressure at • Tie to BAS
all times • Provide adequate air during
• Requires RA boxes cleaning of room
• Filter ahead of box • Easier to lower temperature at night
to reduce reheat ~67% of savings
• Ensure system reaches full flow in
minutes • Fixed offset with tracking VAV or
direct pressure control

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 Must Filter Return Air before Coil or AMS

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 Need Tight Walls

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 Typical OR Design

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 Simplify

• Set supply air to 7.7°C (46°F)

• May require CHW coil @ 100%
• Control humidifier at 85% - 90% RH at AHU (41.5°dewpoint)
• Delete room humidifiers
• Delete RA humidity control
• Fix OA at 20% (except for smoke purge)
• RH readout in room, no user control
• Humidification in AHU ahead of CHW coil

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 Variables for Operating Rooms

• Temp/RH desired by the doctors

• Length of surgery
• Rate of temperature change
• 20 ACH, 4 ACH OA
• 17º- 24ºC (62º- 75ºF), 30% - 60%
• MERV 14 most ORs
• MERV 17 Ortho & Transplant optional
• Terminal HEPA optional (not required)

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 Heart and Vascular Hybrid OR

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 Congested Ceiling

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 Section Through Ceiling

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 Laminar Flow System Complete

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 Summary OR Designs

• Understand psychrometrics • Use dedicated chiller?

• Accurate temp/humidity sensors • Use dedicated AHU
• Minimize OA • Use boiler steam
• Increase CHW flow in coil • 2 low returns
• Reduce airflow across CHW coil • Temp & RH sensors in RA
• Minimize CHW temp • Set and forget supply air: 46ºDB,
85% RH
• Laminar diffusers (curtains?)
• HEPA optional most ORs
• 12” beyond table

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 Imaging Suite Design

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 The 10 Great Lies

1. It is just an equipment 6. The number of procedures does

replacement not matter
2. The manufacturers will do the 7. I’ll remember that I told you to cut
design corners
3. AHJ won’t care 8. Cost is more important than
performance
4. The contractor will design it for
free 9. They will never do that in this
5. Regulations are just like any other room
state 10. The check is in the mail

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 Departments / Modalities

• OB GYN – Ultrasound • Radiology – Fluoroscopy, MRI,

• ED – X-Ray, CT CT, Ultrasound, R&F, X-Ray

• Vascular – Fluoroscopy, • Nuclear Med – Nuclear

Ultrasound Camera, PET

• Surgery – Fluoroscopy, MRI • Cardiology – Fluoroscopy,

Ultrasound
• Oncology – Linear Accelerator,
Cyber Knife, PET • Urology – Fluoroscopy,
Ultrasound

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 Imaging Room Classification

• Class 1 (non-invasive) ----→ • Similar requirements to

Exam/Treatment Rooms
• Class 2 (mildly invasive)---→ • Similar requirements to Procedure
Room
• Surgery – Fluoroscopy, MRI
• Oncology – Linear • Cardiology – Fluoroscopy, Ultrasound
Accelerator, Cyber Knife, • Urology – Fluoroscopy, Ultrasound
PET

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 Modalities
TYPES OF IMAGING TECHNOLOGIES

• X-Ray (CT, Fluoroscopy)

• Ultrasound
• Magnetic (MRI)
• Nuclear / Energy Beams In (LINACC)
• Nuclear Out (PET)

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 What’s an Invasive Procedure?

• Done in aseptic (sterile) field

• Uses sterile instruments
• Enters sterile body cavity
• Insertion of indwelling device
• Excision and grafting of burns >20% of body
• Doesn’t start as invasive but there is high risk
• Doctor thinks it is invasive
Note: FGI 2018, ASHRAE/ASHE Standard 170 scrambling to catch up!

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 Non-Invasive Procedure Room

• Patient, exam, endo room

• Non-invasive—instruments enter normal body orifices, nasal, oral, GI
• Accessed from restricted or semi-restricted area, not done in OR
• 6 ach, standard diffusers

Note: may use sterile instruments or supplies

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 Procedure Rooms

• 15 ach SA, 3 ach OA • 70°F–75°F dB, 20%–60% rh is

• Positive pressure when occupied ASHRAE/ASHE Standard 170
regulation
• May drop pressure requirement
• But most doctors want 62°F–
when unoccupied, reset cfm
70ºF dB, 30%– 60% rh
• High supplies, laminar diffusers
• Cath lab, interventional, neuro
• Low returns on opposite sides of
• MERV 14
the room

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 ASHRAE / ASHE Standard 170-2021
IMAGING / PROCEDURE REQUIREMENTS

Pressure All Room Air Air Recirculated by Design

Minimum Minimum Unoccupied Minimum Filter Temperature
Function Relationship to Exhausted Directly Means of Room Relative
Outdoor ach Total ach Turndown Efficiencies (cc) °F/°C
Adjacent Areas (n) to Outdoors (j) Units (a) Humidity (k),%

Class A Procedure Positive 3 15 NR No MERV-14 20-60 70–75/21-24

Class 1 imaging room

N/R (jj) 2 6 NR NR Yes MERV-8 Max 60 72–78/22-26
X-Ray Diagnostic & Treatment

Class 2 imaging Room (d), (p)

Positive 3 15 NR No Yes MERV-14 Max 60 70–75/21-24
X-Ray (Surg, Critical Care, Cath)

Endoscopy N/R 2 6 MERV-14 20-60 68–73/20-23

Surgical Cystoscopy Rooms Positive 4 20 NR No Yes MERV-16 20-60 68-75/20-24

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 Diagnostic Imaging

• EKG / EEG (Electro Cardiogram /

Electro- Encephalogram)
• Ultrasound
• Radiology – X-ray
• CT (Computer Tomography )
• MRI (Magnetic Resonance Imaging)
• Nuclear Medicine
• PET (Positron Emission
Tomography )

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 Interventional Imaging

Highly complex space – is it in Surgery or Imaging?

• Shielded
• Support structure congests ceiling
• Review location of equipment within the various sub-rooms (procedure, equipment,
control)
• Separate thermostatic zones for scan, equipment, control rooms
• Cooling of equipment via chiller or chilled water system – continuous and reliable
• Fluoroscopy
• 15 ACH
• Check for Classification: Some IR rooms are Class 3 = OR requirements.
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 Imaging Procedure Rooms

• 15 ACH SA, 3 ACH OA

• Positive pressure when occupied
• May drop pressure requirement when unoccupied, reset cfm
• High supplies
• Low returns on opposite sides of the room
• 70º- 75º dB, 20-60% RH is Std170 regulation
• But most doctors want 62º- 70º dB, 30% - 60% RH
• Cath Lab, Interventional, Neuro
• MERV 14

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 Fluoroscopic
Unit Diagram

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 Fluoroscopy
• Treatment – Vascular, Angio, Cardiac Cath, EP, Ortho,
Endoscopy
• Continuous X-ray – diagnostic and procedure with injection, live
image
• Multiple components
• May have separate equipment room
• Lead shielding
• May have remote air cooled chiller (EWC)
• May require 6 or 15 ACH

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 Cath, EP, Angio
• Similar room, clinical use varies
• Equipment in various sub-rooms
(scan, equipment, control)
• Separate thermostatic zones for
scan, control rooms, equipment
• Rugged support structure for
equipment in ceiling
• Computer room type A/C unit for
equipment room/space
• Consider occupant count in
control room

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 Radiographic & Fluoroscopic (R&F)

• Treatment – Ortho, Endo, Neuro

• Combination of X-ray “snapshot” and continuous with injection
and real-time monitoring
• Multiple components
• May have separate equipment room
• May be procedure room
• 6 or 15 ACH

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 CT
• Diagnostic – Cardiology, Ortho, Internal,
Spleen, Brain/Neuro
• Can use CHW
• May be self-contained or have an
equipment room
• Injection assembly mounted on ceiling
• Multi-slice, 360º X-ray (photons)
• 6 ACH or meet load
• 20 ACH in Hybrid OR

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 Magnetic Resonance Imaging

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 MRI

• Water cooled • Wave guides in ductwork

• Aluminum & copper materials in • FM-200 - optional
room • Gauss lines affect area layout
• Large equipment, heavy • 6 ACH or meet load
• Continuous cooling load
• Liquid helium-cooled
superconductor – Quench vent w/
dielectric insulation

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 MRI

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 YouTube Video
MRI QUENCH

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 Gamma Knife
(RADIATION THERAPY
/ ONCOLOGY)
• Targeted radiation treatment
• Shielded space (typically
lead)
• Equipment in the various
sub-rooms (procedure,
equipment, control)
• Separate thermostatic zones
for scan, equipment, control
rooms
• 6 ACH or meet load

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 PET Scan
• Diagnostic – Oncology,
Neurology, Cardio
• Radioactive injection –
positron
emission/annihilation
• Gamma ray detection
• Real-time studies, early
diagnosis
• 6 ACH or meet load
• Hot lab adjacent – exhaust
• May be water cooled

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 Linear Accelerator
• Oncology, Radiation Therapy
• Emits radioactive particles
• Maze floor plan
• Low load in room
• Large equipment
• Adjacent simulator room with CT
• 6 ACH or meet load
• Heavily shielded space (lead or
thick concrete) limits duct, piping
routings within treatment space
• Equipment in the various sub-rooms
(procedure, equipment, control)
• Separate thermostatic zones for
scan, equipment, control rooms
• Water-cooled
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 Cystoscopy

• Treated as OR
• 20 ACH, 4OA
• Positive
• Optional floor drains

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 Anesthesia

• Level of sedation is important

• In Cath, Angio, EP
• If anesthesia, then WAGD
• Triggers many additional NFPA requirements

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 Auxiliary Rooms / Areas

• Film-based darkroom – rare now

• Scope cleaning
• Hot lab
• Simulator (CT) for linear accelerator prep
• Crash cart park / charge

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 Imaging Suite Details
• All equipment in the procedure • Hard ceiling?
room? • Lead lining, wave guides
• Separate equipment room? • Shielded control room?
• Water-cooled equipment – inside • Quench vent (MRI only)
air cooled, House CHW?
• Structure conflicts
• Dedicated chiller – air cooled
outside, e.g., MRI? • Emergency power
• Med gas, data, light, power in • Gauss lines
ceiling boom?

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 Engineering Systems Desired

• Med gas
• Anesthesia
• Emergency power
• Isolated power
• Lighting and controls
• Booms
• Temperature and humidity
• Hand wash
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 Mechanical Design

• Interface to FA
• Smoke purge
• Process cooling (inside/outside)
• MRI requirements
• Ceiling conflicts
• Load in each room
• Occupant load and temperature preferences
• FM-200?
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 Typical Imaging Suite

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 Typical Equipment Layout
CATH LAB

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 Cath Lab Equipment Heat Load

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 Process Cooling

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 Electrical Design

• Typically a single 100-200 amp, 3-phase, 480-volt power to a disconnect

provided by contractor
• Downstream usually by manufacturer’s installer
• Engineer to verify coordination
• Voltage required
• Power quality
• Emergency Power? Full?
• Isolated power?
• Who does detailed raceway layout

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 Electrical Load
CATH LAB #1 (HEART CENTER)

ASHRAE Research Project #1343-RP (Koenigshofer & Guevara June 2009)

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 Electrical Load
LINEAR ACCELERATOR

ASHRAE Research Project #1343-RP (Koenigshofer & Guevara June 2009)

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 Summary

• Hire an engineer/architect • Budget, ownership

• Verify existing conditions • Electrical requirements
• Obtain manufacturer’s final • Understand modality, Invasive?
drawings • Three zones for good temp &
• Understand user’s need humidity control
• Installation responsibilities • Test all systems; all scenarios
• Emergency Power not req’d

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 Isolation & Patient Room Design

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 Infectious Isolation, Aii

• Negative pressurization requires • 100% exhaust on emergency

~300 cfm offset power
• TB and other infectious disease- • Continuous pressure monitoring
carrying patients required including logging
information – 0.01 in.
• Anteroom desirable
• Oversize low wall grille to avoid
• 12 ACH (min. – 15 better), negative noise
room
• Filtration of exhaust is not
• 70°- 75°F / 30% - 60% RH required
• Tight construction

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 Airborne Infectious Isolation Suite

Per Std-170 intakes must be minimum 25’ from exhaust

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 Pressure Measurement

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 Air Leakage
DIFFERENTIAL
PRESSURE
• Door perimeter crack :
1/8 in. × 18 ft = 32 in.2
• Wall/deck perimeter
crack:
1/8 in. × 60 ft = 90 in.2
• Total crack area: 122 in.2
• Requires 240 cfm offset

Source: CDC MMWR 2005, Guidelines for Preventing the Transmission of Mycobacterium Tuberculosis in Health-Care Settings.
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 Protective Isolation

• Immunocompromised
patients
• 12 ACH, may return air
• MERV 17 (HEPA)
• Tight construction
• Continuous monitoring
• Anteroom highly
recommended
• Positive to adjacent spaces

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 Isolation Rooms
START-UP & ONGOING OPERATION

• Testing & balancing – really

• Start-up
• Training
• Monitoring
• Periodic testing
• O&M manual
• Real as-builts
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 Standard Details for Patient Rooms

• 4 ACH SA, 2 ACH OA • May have solar / envelope

• No pressure requirement load that dictates higher ACH

• 70°- 75°F, 30% - 60% • Recirculation system allowed

– not recommended
• MERV 14 Filtration
• VAV or to 2 ACH occupied

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 Patient Room Schematic
* 4 ACH and recirculation are allowed

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 ICU Department

• Intensive Care Unit (ICU) or Critical Care Unit (CCU)

• Often designated by the service it supports:
− SICU = surgery ICU
− CVICU = cardio-vascular ICU
− PICU = pediatric ICU
− Wound ICU = burn unit – requires humidity control
− NICU = neonatal ICU – low air velocity and noise!

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 ICU Rooms

• 6 ACH SA, 2 ACH OA

• No pressure requirement
• 70°- 75°F, 30% - 60% RH
• MERV 14 (90%) Filtration
• Some AHJs require 12 ACH
• Some AHJs require low returns

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 Labor
DELIVERY
• Special lighting may congest
ceiling
• Provide adequate cooling for high
activity and occupancy load
Nursery/ NICU
• Separate thermostatic zones for
staff and patient areas
• Avoid creating air drafts
• High humidity – condensation of
windows

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 Sterile Processing Department (SPD)

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 Sterile Processing Department (SPD)

• Clean instruments from surgery and • Sterilizers draw steam into

procedures decontamination room, canopy hoods
• Flow of materials from dirty to clean • Clean processing/supply needs low
temperature and humidity
• Flow of air from clean to dirty,
• AAMI, AORN guidelines—verify with
maintain dP at all times owner. Could require supplemental DX
• Decontamination dirty, wet work to dehumidify
area, hot, humid • Unique steam, water requirements incl
• Electric generator may be > 15 psi RO
• May affect room pressures nearby incl
OR

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 SPD Criteria
AORN/AAMI Guide

All Room Air Design Relative

Minimum # of Air Design Temperature
Functional Area Airflow
Exchanges Per Hour
Exhausted Directly
(l), °F/°C
Humidity (k),
to Outdoors (j) %

10 60°F to 65°F
Soiled/decontaminated Negative (in) Yes 20% to 60%
*(6) FGI (16°C to 18°C)
75°F to 85°F
Sterilizer equipment access Negative (in) 10 Yes 20% to 60%
(24°C to 29°C)
68°F to 73°F
Sterilizer loading / unloading Positive (out) 10 Yes 20% to 60%
(20°C to 23°C)
68°F to 73°F
Restrooms / housekeeping Negative (in) 10 Yes 20% to 60%
(20°C to 23°C)
68°F to 73°F
Preparation and packaging Positive (out) 10 (downdraft type) No 20% to 60%
(20°C to 23°C)
68°F to 73°F
Textile packaging room Positive (out) 10 (downdraft type) No 20% to 60%
(20°C to 23°C)
75°F
Clean / sterile storage Positive (out) 4 (downdraft type) No  70%
( 24°C)

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 ASHRAE/ASHE Standard 170 for SPD

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 Sterile Processing Department

• High heat, humidity; discharge

from sterilizers, washers
• Source capture – exhaust at
equipment
• Airflow from space to equipment
exhausts
• High heat from equipment jacket
losses; steam piping in sterilizer
equipment room

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 Field Testing Room
Pressure

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 Sterile Processing Department

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 Emergency Department, Pharmacy,
and Pandemic Preparation

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 Emergency Department

• Urgent care / Fast track / Acute care

− Pathways from walk-in or ambulatory entrance
• Waiting room/Registration – 100% exhaust, 12 ACH, filter RA?
• Triage
• Trauma / Resuscitation / Heart / Stroke
− Operating room-like space
• Exam rooms – each with thermostat?
• Procedure rooms / Radiology
• Nurse Station / Team area
• Emergency exhaust
• Decontamination area and retention tank

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 Emergency Department

• Seclusion / Holding / Psychiatric

− Generally a secured space
• Airborne Infectious Isolation (AII) Room
• Negative pressure waiting room
• Located near heliport (air intake)
• Located near ambulance entrance (air intake)

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 Pharmacy

• Automated systems
• Refrigerators – high load
• Walls/buffer area
• “Pharmacy in a box”
• Hoods, workbenches (“Primary Engineering
Control”)
• No night setback – maintain temperature for
meds

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 Pharmacy
USP 797 & 800
• Chemo hood exhausted, other hoods
recirculate via HEPA’s
• Confirm if compounding Hazardous
Drugs (HD)
• May be tight T/RH requests (68°F
typical)
• USP 797- ISO Class 7 (Class 10,000)
in Med Prep and Anteroom = HEPA
air at high ACH (approx. 30 ACH)
• Barrier isolator (glovebox) may
negate clean room requirement
• Std 170, 4 ACH, 2 OA, positive

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 USP 797 Pharmacy Plan

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 Pandemic Prep

• Verify performance of AII rooms, 12 • ID rooms/units/floors that could

ACH, 100% exh be isolated (single AHU, barrier
• Verify performance of ED Waiting walls)
(12 ACH, 100% exh) • Ensure key HVAC components
• Gather HEPA units and zip wall on EPS
isolation barriers
• ID AHU’s with OA economizer,
• Beware that most ICU’s are positive test performance
pressure, must modify
• Make a plan for “building”
negative pressure rooms/spaces
Source: http://tc0906.ashraetcs.org/

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 Design for Future Pandemics

• Purge dampers, sequence, • Treat/clean RA ductwork

monitoring • Avoid cross contamination at
• Dedicated OA unit energy recovery
• Oversize coils • Avoid re-entrainment
exhaust/intake
• Chiller capacity. Cooling triage plan
• UVGI in AHU
• Gasket RA/MA dampers
• Monitoring devices

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 Typical AHU Layout

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 Exhaust Grill in
Removed Window
Section

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 Ductwork To Centralized Exhaust

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 Patient Isolation Tent, Room with FCU

• Discharge via HEPA to RA

• Seal off remainder of RA grille
• SA diffuser inside tent
• Increases cooling load
• Best if room is close to AHU
• Keep room door closed
• Negative pressure in tent

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 Temporary Exhaust Hood
at Patient Head Space

Photo Courtesy: Amid the COVID-19 pandemic, B&I Contractors is working with Lee
Health on a concept that could help reduce the spread of the disease in hospitals.
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 Operating Room
COVID Patient

• Temporary Vestibule
• HEPA unit in vestibule to
create negative zone
• Seal other entries
• Verify with AHJ

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 Temporary Walls used for Ante Room or
other Pressure Barriers

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 Outdoor Tents for Triage

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 Lessons Learned: Controls
Why Am I Having These Problems?

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 Problems Pg 1
1. Building pressure, OA control
2. Incorrect readings, sensor calibration and setup
3. Insufficient or nonexistent pre-functional testing
4. Input and/or output devices don’t meet specifications
5. Service technicians won’t/can’t do custom programming
6. Finger pointing: engineer, service, sales, programming
7. “this is the way we always do it”; floating point v. analog
8. Strict standards for complex areas (pharmacy, SPD, OR) require more
complex controls. Exceeding tech’s capabilities.

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 Problems Pg 2
1. Proprietary soft and hardware
2. High prices
3. Inconsistent graphics across hospitals
4. Links to sequences & drawings don’t work
5. Non-response from mega company
6. No dashboards
7. Little training provided to owners, “can’t program”
8. Service technicians are not systems engineers but change SOP
9. Service technicians don’t know psychrometrics and S170

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 Owner Wants
1. Performance, Reliability, Flexibility, Low Op Cost
2. Audit trail of work performed
3. Documentation: what, when, why, who made changes.
4. BAS architecture diagram
5. One throat to choke
6. Minimal mgmt of service technicians
7. Calibration and functional testing
8. Consistent bids, equip, graphics, sequences
9. Plan for future

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 What you need

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 What you get

It Ain’t Broke; Or is It?

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 Check Psychrometrics
Use NOAA Weather Data

Rdg RA 79°F, 30% Calc 46°F Rdg SAT 55°F, 71% Calc % OA = 100% - (MAT-OAT) / (RAT-OAT) = 100%
Dewpoint That’s close. 46°F Dewpoint That checks. - (60-40) / (79-40) = 49% OA Too High

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 Training

• Assure operations and maintenance staff receives detailed

training on all systems and components
• Assure maintenance staff receives detailed basis of design
training from the design professionals
• Good manuals
• Good record drawings

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 Small Changes Have Big Effect on
Performance
• 1o F ∆ in CHW temp = 7% – 10% ∆ cooling
• 2o F ∆ supply air dewpoint = 6% ∆ RH at 72°
• 5o F ∆ in supply air setpoint = 25% ∆ cooling
• Tune-ups are cheap

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 267
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 Return Air System with Economizer
What is Wrong Here?

268
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 Values Don’t Make Sense
RA 13k, Exh 4k,OA 10k, SA 32k? MAT 59.9°, CHWV 100%, SAT 55.2°? SAT 38.6°F?

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 Chilled Water System
54.3oF
59.1%

644 Tons

38.0oFc
87.8oF
37.9oF
11.1 PSI

0.0%
On
45.3oF 62%
682 Tons 2166.0 GPM
45.0oF

0%
45.2oF
46.0oF

0.0 PSI
Off
78.7oF
77.8oF 51.4 0.0 GPM
1000 GPM
0 Tons
38.0oF
38.0oF

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 CHW System Issues

• Low ∆T 8°F, 3-way valves? • Evap flow too high @ 2.5 gpm/ton x
• Bypass open – short circuit 700 ton ~1750 gpm, chiller panel
says 3200 gpm, graphic shows
• Is ∆P loop optimized? Excess flow? ~2100 gpm
• ∆P sensor(s) locations correct? • Cond flow too high @ 3 gpm/ton x
• Actual OAT ~35°F, so WB reading 700 ton ~ 2100 gpm, control panel
is wrong @ 40°F 4260 gpm, not shown on graphic

• Per graphic, is this chiller 1&2 or

7&8?

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 Condenser Water System

86.3oF
0%
100%

79.2oF

0%
0%

46.0oF

%
80oF
82oF
70oF

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 Condenser Water System Issues
• CT fan speed?
• No CW gpm on graphic
• No OAT reading
• OA WB incorrect, convert to dewpoint
• Need time/date
• Reclaim water flow 2,600,000 gpm?
• CWR and CWS too high given low OAT
• Save energy with lower CW temp

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 Summary
HOW TO TUNE-UP?
• Double-check readings, verify psychrometrics
• Change setpoints and observe actual changes vs. expected
• Install metering
• Simple readouts, trends, alarms, dashboards
• Apply common sense
• Prius effect: Just knowing your instantaneous “mileage” results in
improvement

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 High-Performing Hospital HVAC

1. Performance—Infection control, comfort, patient outcome

2. Safety—Fire, falls, injuries—Employees, visitors, patients
3. Reliability—Lost revenue
4. Maintenance cost
5. Energy cost
6. Adaptability in design

In This Order!
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 Thank You!

Donald R. Burroughs, P.E., Member ASHRAE

Dewberry Engineers Inc.
[email protected]

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 References, Standards, Guidelines
• ASHRAE HVAC Design Manual for Hospitals and Clinics, 2013
• ASHRAE/ASHE Standard 170-2017, Ventilation of Health Care Facilities
• Pharmaceutical Compounding.
https://bakerco.com/communication/pharmaceutical-compounding/
• CDC MMWR 2005, Guidelines for Preventing the Transmission of Mycobacterium
Tuberculosis in Health-Care Settings
• Facility Guidelines Institute, Guidelines for Design and Construction of Hospitals
and Outpatient Facilities, 2018
• Healthy Hospital Initiative, www.healthierhospitals.org
• Koenigshofer, D. and J. Roberts. 2018. Do OA Economizers make “Cents” in
Hospitals? ASHRAE Journal (11).
• ASHRAE. Tech Committee 9.6 Health Care. http://tc0906.ashraetcs.org/

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 Securing Our Future

“Securing Our Future” examines how the crucial personal and professional
events of the past can help us leverage Relationships, Knowledge and Change
as the formula for making an impact and embracing our diverse world.

For additional details, visit:

https://www.ashrae.org/about/leadership/ashrae-president

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 Evaluation and Certificate

ASHRAE values your comments about this course.

• All course registrants will receive a separate email from ALI-Education
([email protected]) providing access to the Course Survey and
Certificate of Attendance. Once the Course Survey is complete, you
will be directed to the Certificate of Attendance. Please be sure to
check your spam/junk folder if it appears that you have not received
the ALI-Education email.
• Questions about the survey, certificate or ASHRAE courses should be
sent to [email protected].

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 Explore ASHRAE Learning Institute Courses

See all the ways to learn and grow with ASHRAE:

https://www.ashrae.org/professional-development/learning-portal

Find a specific topic for you:

➢ Commissioning
➢ Energy Efficiency
➢ Environmental Quality
➢ HVAC&R Applications
➢ Standards and Guidelines
➢ CoV-2 Mitigation
https://www.ashrae.org/instructor-led-courses

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 ASHRAE Certification

✓ More than 3,500 certifications earned to-date

✓ ASHRAE-certified Employers agree that “ASHRAE Certification is evidence
of the level of competence attained by a new hire prospect.” (90%)
✓ Digital Badging:

❑ Embedded metadata uniquely linked to you

❑ Shareable in electronic media, including LinkedIn and email
❑ Instant recognition with real-time, third-party verification

Visit www.ashrae.org/certification to learn more

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