HVAC Design for Healthcare

Infection Control - Isolation Rooms

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HVAC Systems in Hospitals
An Effective HVAC System Controls Risk from Hospital-
Acquired Infections
Hospital, clinics and other medical
facilities pose several unique challenges that
aren't present in traditional HVAC situations.
As such, it's important for designers,
engineers, installers, maintenance personnel
and other HVAC professionals to be familiar
with installing HVAC systems for medical
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purposes.

Not only can simple comfort be on the line,

but patients can be put at risk by HVAC
systems that don't function properly. Here is a
brief introduction to HVAC systems for
medical facilities and How you can go about
designing a Isolation Room Within a Health
Care Facility.
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ROLE OF HVAC SYSTEMS IN INFECTION CONTROL
Hospital-acquired infections (HAIs, also referred to as nosocomial infections) have a significant
impact on patient care. Mortality rates from HAIs are significant and affect the overall cost of health care
delivery. In the United States, HAIs occur in an estimated 4% to 5% of admitted patients; at an estimated
annual cost approaching $7 billion. It is generally agreed that 80 to 90% of HAIs are transmitted by direct
contact, with 10% to 20% resulting from airborne transmission (representing 0.4% to 1% of admitted
patients) (Memarzadeh 2011a).

1.Contact, both direct and indirect, is the most common mode of transmission in health care
facilities and other indoor environments. HVAC has little impact on this mode of transmission.
2.Droplet transmission is characterized by dispersion of microorganisms from an infected
person over short ranges (3–6 feet). The aerodynamics of this results in microbes contained in fluids
that fall out of the air in rapid fashion.
3.Airborne transmission involves dissemination of microbes via droplet nuclei beyond short
ranges, such as via an HVAC system.

HVAC systems can affect the distribution patterns of airborne particles by

diluting or concentrating them, moving them into or out of the breathing
zones of susceptible persons, or by accelerating or decelerating the rate
of growth of airborne microbes. Improperly operated and maintained
HVAC systems can even become a reservoir for microorganisms.
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Let us Understand Hvac Design for Healthcare Facility

HVAC design for health care facilities is all about providing a safer environment for patients
and staff. The basic difference between air conditioning for healthcare facility and that of other
building types stem from:

AIR MOVEMENT DILUTION PATIENT COMFORT DESIGN PARAMETERS

The need to restrict air movement in and
between the various departments (no
cross movement).
The specific requirements for ventilation
and filtration to dilute and reduce
contamination in the form of odor,
airborne micro organisms and viruses,
and hazardous chemical and radioactive
substances. Ventilation effectiveness is
very important to maintain appropriate
indoor air quality.
The design sophistication to minimize
The different temperature and humidity
the risk of transmission of airborne
requirements for various areas and the
pathogens and preserve a sterile and
accurate control of environmental
healing environment for patients and
conditions.
staff.
HOSPITAL ISOLATION ROOM HVAC SYSTEM
DESIGN PRINCIPLES
 ISOLATION
ROOM
If your doctor wants you to be kept
away, or isolated, from other patients
while you receive medical care, you
may be in a special hospital room,
called an isolation room, to keep you
separate from other people.
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CODES/STANDARDS
TYPES OF ISOLATION REFERANCES
ROOMS
GUIDELINES

DESIGN
DESIGN CRITERIA
CONSIDERATION

EXAMPLE
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Codes/ Standards/ References
Codes:

International Mechanical Code (IMC)

Standard:

ANSI/ASHRAE/ASHE Standard 170 – Ventilation of Health Care Facilities (2017)

NFPA 101

Guidelines:

Facility Guidelines Institute (FGI) Guidelines (2014) – for ventilation refers to ASHRAE Standard 170 - 2017

“Guidelinesfor Environmental Infection Control in Health-Care Facilities”, Recommendations of CDC (centers for Disease
Control & Prevention )and the Healthcare Infection Control Practices Advisory Committee (HICPAC), 2014
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TYPES OF ISOLATION ROOMS

Airborne infectious isolation (AII)

Protective environment (PE)

Combined AII/PE

Contact isolation
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TYPES OF ISOLATION ROOMS

Airborne infectious isolation (AII)

 What is a Airborne Infection Isolation (AII) Room

• These rooms are for patients having an airborne communicable disease

• In this type of infection, patient is the source of infection

• The ventilation system functions as one of multi-levels of infection control system

• The purpose is to contain patient-generated infectious microbial within the room, to

prevent the spread of infection to other patients and staff.
DESIGN CONSIDERATIONS FOR AN
AII ROOM
 HVAC COMPONENTS

• AIR TERMINALS
• FILTERATION SYSTEM
• EXHAUST SYSTEM
• MOINTERING DEVICE
• ANTE ROOM REQUIREMENTS
 AIR TERMINAL TYPE TO BE USED IN AII ROOM

• FOR AII ROOM THE

TERMINAL TYPE IS
CEILING DIFFUSER
OF GROUP A & E
FOR SUPPLY AND A
RETURN DIFFUSER
OR GRILL OF
GROUP A OR E.
GROUP A TYPE OF DIFFUSER
 FIL

FILTERATION
SYTEM WITHIN
AHU
• FOR AN AII ROOM
ASHRAE STANDARD
REQUIRES THE AHU TO
BE INSTALLED WITH TWO
FILTER BANKS, ONE
MERV 7 UP STEAM AND
THE OTHER MERV 14 IN
THE DOWN STREAM.

• FRESH AIR SHOULD BE

TAKEN IN FROM A
HEIGHT OF 2 MTS ABOVE
GROUND LEVEL AND
ABOUT 10 MTS AWAY
FROM ANY EXHAUST.
Minimum Efficiency Reporting Value
 PLUME / STACK EXHAUST
• ALL AIR WILL BE
EXHAUSTED FROM AN AII
ROOM BY VERTICAL
EXHAUST

• ROOM EXHAUST MUST BE

ON EMERGENCY POWER
FOR AII ROOM

• AIR SHOULD BE
DISCHARGED AT A HEIGHT
OF 3MTS ABOVE ROOF
LEVEL @ ≥ 2500 FPM.
ANTEROOM : ANTE ROOMS ARE RECOMMENDED FOR AII ROOM AND
PE ROOM BUT NOT MANDATORY.

FOR COMBINATION ROOM

 MONITERING DEVICE
• AII rooms shall have a permanently installed
device and/or mechanism to constantly
monitor the differential air pressure :
--between the room (when occupied by
patients with a suspected airborne infectious
disease) and
–the corridor, adjacent spaces of the room
whether or not there is an anteroom

–A local visual means shall be provided to

indicate whenever negative differential
pressure is not maintained.

• A minimum of 0.01” of wg or 2.5 pa should be

achieved.
DESIGN PARAMETERS
FOR AN AII ROOM
 SOURCE ASHRAE STANDARD 170

---------------------------------------------------------------------------------------------------
 Calculate ACH based on exhaust flow
If not occupied pressure relationship is maintained and min ACH 6
Switching controls for reversible airflow (pressure relationship) shall 
not be permitted(note t)
 TOTAL
AII ROOM WITHOUT ANTE ROOM EXHAUST
250 CFM
Considering a room with dimensions :
Length : 10 ft
Width : 10 ft
And height : 10 ft
Volume of the room will become :10*10*10 = 1000ft3

FORMULA FOR ROOM AIR CHANGES PER HOUR (ACH)

ACH = (60*CFM)/VOLUME

CFM = (ACH * VOLUME)/60

WE HAVE MIN ACH : 12 as per ashrae standard 170.

CFM = (12*1000)/60

=200 CFM
 AII ROOM WITH ANTE ROOM
TOTAL
Volume of the room will become :10*10*10 = 1000ft3 EXHAUST
350 CFM
300
FORMULA FOR ROOM AIR CHANGES PER HOUR (ACH) CFM
50
ACH = (60*CFM)/VOLUME CFM
CFM = (ACH * VOLUME)/60

WE HAVE MIN ACH : 12 as per ashrae standard 170.

CFM = (12*1000)/60 200

CFM
=200 CFM

50
AIR CHANGES IN ANTE ROOM . CFM
CONSIDERING TOILET AND ANTE ROOM
VOLUME TO BE 240 FT3
MIN ACH FOR ANTE ROOM : 10 ACH
CFM = (10*240)/60
= 40 CFM
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TYPES OF ISOLATION ROOMS

Protective environment (PE) ROOM

 What is a PROTECTIVE ENVIRONMENT Room

These rooms are meant for patients with weakened immune system

These patients need protection against infectious airborne agents

In this case it is the patient who must be protected from infectious microbials

Also protection from opportunistic organisms that are not a threat to healthy individuals
DESIGN CONSIDERATIONS FOR AN
PE ROOM
 HVAC COMPONENTS

• AIR TERMINALS
• FILTERATION SYSTEM
• MOINTERING DEVICE
• ANTE ROOM REQUIREMENTS
 AIR TERMINAL TYPE TO BE USED IN PE ROOM

• FOR AII ROOM THE

TERMINAL TYPE IS
CEILING DIFFUSER
OF GROUP E,
NONASPIRATING
FOR SUPPLY AND A
RETURN DIFFUSER.
FILTERATION SYTEM AHU FIL
AND AT THE SUPPLY
TERMINAL

• FOR AN PE ROOM
ASHRAE STANDARD
REQUIRES THE AHU TO
BE INSTALLED WITH
FILTER BANK, ONE MERV
7 UP STEAM AND THE
OTHER HEPA AT THE
TERMINAL

• FRESH AIR SHOULD BE

TAKEN IN FROM A
HEIGHT OF 2 MTS ABOVE
GROUND LEVEL AND
ABOUT 10 MTS AWAY
FROM ANY EXHAUST.
Minimum Efficiency Reporting Value
ANTEROOM : ANTE ROOMS ARE RECOMMENDED FOR AII ROOM AND
PE ROOM BUT NOT MANDATORY.

FOR COMBINATION ROOM

 MONITERING DEVICE
• AII rooms shall have a permanently installed
device and/or mechanism to constantly
monitor the differential air pressure :
--between the room (when occupied by
patients with a suspected airborne infectious
disease) and
–the corridor, adjacent spaces of the room
whether or not there is an anteroom

–A local visual means shall be provided to

indicate whenever negative differential
pressure is not maintained

• A minimum of 0.01” of wg or 2.5 pa should be

achieved.
DESIGN PARAMETERS
FOR AN PE ROOM
SOURCE ASHRAE STANDARD 170
 Protective Isolation Room
Room Supply and Exhaust Design Considerations
Same requirements as AII room except:
o Location of supply diffusers and exhaust grilles
ASHRAE Standard 170 “Supply diffusers shall be above
the patient bed… Diffuser design shall limit air velocity at
patient bed to reduce patient discomfort
ASHRAE Standard 170 “Return/exhaust grilled shall be
locate near the patient door.”
o SA must be from AHU that has code‐required filtration:
Min MERV 7 prefilters and HEPA final filters (ASHRAE) or
MERV 14 final filters with terminal HEPA filter
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TYPES OF ISOLATION ROOMS

Combined AII/PE rooms are for patients suffering from a weakened

immune system who also have an airborne communicable disease. In this type of room,
HVAC issues involve a combination of both AII room and PE room considerations.
Combined AII/PE Rooms
•These rooms are for patients suffering from a weakened immune system and also having an air-
borne communicable disease
•The ventilation issues involved is combination of both AII and PE room
 Combination Airborne Infectious
Isolation/Protective Environment Rooms

PE requirements govern supply diffuser and exhaust

grille locations:

o ASHRAE Standard 170 “Supply diffusers shall be above the

patient bed.

o ASHRAE Standard 170 “Return/exhaust grilled shall be

locate near the patient door.”

Two permanently installed monitoring devices are required

o One between the AII/PE room and the ante room
o One between the ante room and the corridor
 Combination Airborne Infectious
Isolation/Protective Environment Rooms
For immune suppressed patients with a airborne infectious disease
CDC and ASHRAE 170 allow two options: positive or negative ante room
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TYPES OF ISOLATION ROOMS

Contact isolation rooms are for patients having a communicable disease

that is not airborne.
Contact Isolation
•The patients who are put in these rooms are not having communicable disease that is airborne
•Example of such cases are:
–Diarrhoea
–Draining wound
–Body lice and so on
Supply system:

•SA from PE to maintain 12 ach: 1,400 cfm

•SA to ante room: 250 cfm
•Constant volume box to maintain total SA / Total SA = 1,400 cfm + 250 cfm = 1,650 cfm
•Reheat coil to provide space temperature control

Transfer air from PE room to ante room and ante room to corridor

•Assume mid range in tightness – use 300 cfm transfer air (TA)

Return/Exhaust system:

•Air from ante room and PE room may be returned to AHU / RA from Ante Room: 250 cfm
•Toilet exhaust must be exhausted to outside / TE: 100 cfm
•PE room RA = PE room SA – TA to ante room – TA to toilet = 1,400 cfm - 300 cfm - 100 cfm = 1,000
cfm
•Constant volume box to maintain total RA
•Total RA = RA from PE room + RA from ante room = 1,000 cfm + 250 cfm = 1,250 cfm
 Thank You for attending this presentation
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collection area

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