Design and Testing of

Unidirectional Air flow systems

for Operating Rooms.
Shankar Rajasekaran
M Tech (BITS, Pilani)
CAFS, (NAFA, USA), CTP (CTCBI, UK)
Subject Matter Expert – Air Cleaning & Contamination Control Engineering
Content
• Objectives of a HVAC system used in OR
• Contamination & Control
• HVAC system requirements for OR
• Airflow characteristics in OR
• Unidirectional Air flow design
• Unidirectional Airflow measurement
• Types of Unidirectional Airflow systems for OR
• Problems associated with Unidirectional Airflow systems
• No. of slides : 44
• Time duration : 45 minutes
Objectives of a HVAC system used in ORs

• Patient safety – Creation of an aseptic environment inside the OR to

minimise risks of Surgical site and other associated infections.
• Creating and maintaining a suitable environment for various surgical
procedures – ideal temperature and humidity levels.
• Comfort of the surgical team.
Chain of Infection
• Reservoir of the Infectious agent
In an OR, the requirement is to
• Human reservoirs
maintain the environment in such a
• Animal reservoirs way that it aids disruption of the
• Environmental reservoirs chain of infection spread.
• Portals of agent exit from the reservoir
• Modes of transmission
• Direct contact HVAC system acts as an important
• Vehicle borne tool to achieve this objective by
• Airborne applying various Contamination
• Vector borne Control techniques
• Portals of agent entry into the host.
• Susceptibility of the Host for the agent dose received.

Source : www.cdc.gov/ophss/csels/dsepd/ss1978/lesson1/section10.html
Contamination
Can be controlled by
- Stringent procedural protocols
Surface
- Regular & proper cleaning
CONTAMINANTS
Airborne Difficult to detect and remove

Viable (Bio Aerosols)

Gas Phase Solid Phase (Particles)
Non Viable

Note : Liquid phase contaminants suspended in air behave as Solid phase contaminants
Sources of Contaminant ingress in an OR
• Door, wall and ceiling gaps.
• HVAC system
• Personnel traffic
• Material traffic
• Internal generation from procedures
Basic concepts in Contamination Control
• Source limitation
• Personnel protocols
• Procedural protocols
• Primary (physical) barriers
• Layouts
• Anterooms
• Graded isolation
• Secondary (indirect) barriers
• Pressure differentials
• Air flow patterns
• Purging
• Removing internally generated contaminants
• Dilution
• Supplying clean air
Active part of the system
• Once the boundary structures are thoroughly cleaned, they are less
likely to generate contaminants immediately.
• Moreover, they cannot help in removing the internally generated
contaminants.
• It is the HVAC system that is capable of removing the internally
generated contaminants on a real time basis.
• Also the HVAC system is be capable of limiting the ingress of
contaminants into the OR.
Requirements of a HVAC system for OR
• Should maintain temperature and relative humidity requirements.
• Should add adequate amount of out side air to ensure gaseous
contaminants are kept under control.
• Should ensure that only negligible or insignificant levels of contaminants
are introduced –
• Adequate air filtration in the supply air circuit.
• Should be capable of removing the internally generated contaminants. –
• Providing streamlined air flow over critical area without eddies or swirls.
• Suitable positioning of supply and return air points
• Providing adequate air changes
• Should be capable of limiting the ingress of contaminants through door,
wall and ceiling gaps –
• Building adequate positive pressure
• By building adequate levels of primary barriers
Eddies / Swirls as a reservoir of contaminants
• Eddies in air flow have a negative pressure core.
• This negative pressure holds up contaminants and obstructs their
removal.
• Eddies do not have a precise and constant structure / size and hence
their capability to hold on to the contaminants is also not constant.

Negative
pressure
core
Streamlined air flow Turbulent air flow

Source: http://www.arch.ttu.edu/courses/2013/fall.htm
Laminar Air Flow
• Streamlined unidirectional flow
• Absence of eddies or swirls in the flow
• Represented by Reynolds number,
• Re < 2000 is laminar
• Re 2000 to 4000 is transitional
• Re > 4000 is turbulent
Reynolds number, Re
• Ratio of inertial forces to viscous forces.
• It is a dimension less number.
• If viscous forces are dominant, flow will be laminar and if inertial forces are
dominant, flow will be turbulent.
• Re = pVD / u, where,
p = Density of air V = velocity of air
D = Diameter of flow u = viscosity of air
• Lower velocity gives lower Re and hence laminar flow
• But Re is also proportional to D, which is the diameter of the duct or the pipe in
which the fluid flows
Unidirectional Air Flow (UDAF)
• IEST RP CC 002.3 – Unidirectional Flow Clean Air Devices
• Air flow in a single direction through a clean air device or a clean zone with
essentially parallel stream lines.
• Air flow characterised by deviation of not more than 14 degrees from the
straight line flow through the work zone
• Measured using Relative Standard deviation of air velocity normal to the
plane of air flow.
• RSD = (std dev / av ) x 100
• RSD less than 15% can be classified as unidirectional flow.
Unidirectional Air Flow
• ISO 14644 – 3 : 2003 - Cleanrooms & Associated controlled
environments
• Controlled air flow through the entire cross section of a critical zone with a
steady velocity and approximately parallel streamlines.
• This type of air flow results in a directed transport of particles away from the
clean zone.
• Air flow pattern in which the point to point readings of velocities are within a
defined percentage of the average air flow velocity (typically with +/- 10 %).
UDAF system Vs Turbulent flow system.
UDAF System Turbulent flow system
Low face velocity High face velocity
High level of velocity uniformity Low level of velocity uniformity
Non aspirating flow Aspirating flow
Low occurrence of flow vortices High occurrences of flow vortices
Smooth parallel flow lines Irregular and chaotic flow lines
Near constant velocity Fluctuating velocity
Non mixing flow Mixing flow
Benefits of using a UDAF Ultra Clean system
• Effective in removing away the contaminants generated from within
the critical work zone quickly.
• Protects the critical work zone against contaminant ingress from less
critical surrounding areas due to non aspirating character.
• Supplies clean air over the critical zone.
Turbulent Vs Unidirectional Air flow OR
Actual Site Values
Particle Average Particle Average Particle Maximum allowable
sizes in concentration concentration measured particle
micro measured on the on the Operating table concentration for
metres Operating table in a in a Unidirectional Air achieving ISO Class 5 ,
Turbulent Air flow OR flow OR in particles per ISO 14644-1 : 2015 in
In particles per cubic cubic foot particles per cubic
foot foot
0.3 60625 85 290
0.5 13111 45 100
1 3400 21 24
3 671 4 -
5 109 1 8
10 9 0 -
Components of a UDAF system
• Duct connecting collars
• Air flow controllers
• Air flow stabilisers
• Up stream plenum
• Air Filters
• Down stream plenum
• Diffusers
• Exit air pick up
 Volume control Upstream plenum
damper

Air flow stabilizer

Duct connecting Air filters

collar
Downstream
plenum

False ceiling Laminar flow Insulated chute for

diffuser Surgical light pendant
shaft
Surgical light
pendant shaft
 Creating UDAF
Bernouli’s conservation of energy equation
Potential energy remains nearly constant.

Ideally,

V1 << V2,
P1 >> P2
Consider
this as the V2 is a function of P1
discharge
plenum V2 not a function of V1.
side
This will provide laminar flow
Assume this constriction Consider this as
as the perforation in the the OR side
diffuser
Diffusers to achieve UDAF
• 2012 - ASHRAE Handbook – HVAC Systems & Equipment describes
• Defines Laminar Flow diffusers as those having a free area (open area of
perforation for air flow) of less than 35%.
• ASHRAE standard 170 : 2013 - Ventilation of Healthcare Facilities
• Advises use of Group “E” Non aspirating Diffusers for operating Rooms.
• HTM – 03 – 01 : 2007 – Specialised ventilation for Healthcare
premises
• Advises use of Plenum type laminar flow style diffusers. (Note : These are not
true laminar flow systems in the strict sense of the word, but produce
downward displacement parallel flow air distribution)
 Considerations for Laminar Air Flow Diffusers
Discharge plenum side Perforation Supply Air
X Diffuser
D

OR Side

5D

Negative pressure cone.

X = Diameter of the perforation
Higher velocities – Larger cone formation.
D = Distance between the two perforations
Lower velocities – Smaller cone formation
Measurement of Unidirectional Flow
• ISO 14644 -3 : 2005 – B.4.2.2 – Minimum number of measurement points
shall be equal to square root of 10 times the area in square metres, but not
less than 4 at a plane that is perpendicular to the air flow and at a distance of
150 mm from diffuser.
• HTM – 03 – 01 : 2007 - One measurement for every 280 x 280 mm square at
3 planes under the UDAF equipment, perpendicular to the air flow at – 150
mm from diffuser, 2 m from diffuser and 1 m from the floor.
• NABH : 2015 – At the supply grille face.
Target values for velocity in a UDAF system
• HTM – 03 – 01 : 2007 –
• Minimum Average velocity of 0.38 m/s at 2 m from supply air diffuser and minimum
of 0.2 m/s at 1 m from the floor level.
• Average air velocity of each quadrant should not vary more than +/- 6% from the
total average air velocity.
• NABH : 2010 –
• Velocity at the supply grille face should be between 90 to 120 fpm.
• NABH : 2015 –
• Recommended to be between 25 to 35 fpm at the supply grille face.
• ASHRAE 170 : 2017 – 7.4.1.a
• Air flow shall be unidirectional and downward flowing, with an average diffuser
velocity between 25 and 35 fpm.
Air Filters in a UDAF system
• ASHRAE 170 : 2017 – 6..4 - Ventilation of Healthcare facilities
• Specifies use of MERV 14 (ASHRAE 52.2) filters for operating rooms
• NABH : 2015 : Annex 5 – Revised guidelines for Air conditioning in
operation theatres
• HEPA filters shall be used at the terminal
• HTM – 03 – 01 : 2007 – 7.129 – Specialised ventilation for healthcare
premises
• Specifies use of H 10 (EN1822-1) filters for operating rooms
Size of the UDAF diffuser
• ASHRAE 170 : 2017 – 7.4.1.b - Ventilation of Healthcare facilities
• Should cover an area that extends 1 foot on each side of the operating table.
• NABH : 2015 : Annex 5 – Revised guidelines for Air conditioning in
operation theatres
• Should cover an area that extends 1 foot on each side of the operating table and the
surgical team
• NABH : 2014 : Revised guidelines for Air conditioning in operation theatres
• 8’ x 4’ for Super speciality OT & 6’ x 4’ for General OT.
• HTM – 03 – 01 : 2007 – 7.129 – Specialised ventilation for healthcare
premises
• 2.8m x 2.8m
Air flow movements in a UDAF OT

Source : National Air Filtration Association,

SCHEMATIC AIR FLOW IN AN OT
Positioning of Return air points
• NABH : 2015 – Return air points should be at a level of 75 to 150 mm
from the floor level.
• It is ideal to have at least 4 low level wall return air points at the 4
corners of the OR.
• Studies have proved that additional ceiling return air points near the
wall with low exit velocity helps to reduce stratification of air
Testing of a UDAF HVAC system in OTs.
• Temperature
• Relative Humidity
• Supply air velocity and uniformity
• Total air exchange rate
• Fresh air change rate
• Positive pressure
• Installed filter leakage test
• Particle concentration
Supply Air terminals for ORs

Source :
ASHRAE Journal
article Feb 2014 –
Improving
operating room
contamination
control
MULTIPLE ARRAY DIFFUSER
SINGLE LARGE DIFFUSER

40
SINGLE LARGE DIFFUSER

41
 RESULT FROM ASHRAE STUDY

Source :
ASHRAE Journal article
Feb 2014 – Improving
operating room
contamination control
Problems at site
• Damaged filters
• Improper filter installation
• Improper fitment of laminar diffusers
• Static charge build up on synthetic diffuser screens leading to
contamination build up.
• Air leakage through the Surgical pendent chute
• Improper insulation of the Surgical pendent chute
• Duct leakage
• Improper positioning and sizing of return air suction points
• Improper air balancing
• Improper testing methods
Thank you for your attention