Review report of Bule Hora referral hospital mechanical

ventilation and HVAC system design drawings and BOQ

General
The report is based on checking drawings and bill of quantity of bule hora referral hospital
project against local and applicable international standards.
1. EBCS 11 local code
2. ANSI/ASHRAE /ASHE Standard 170-2017, Ventilation of Health Care Facility.
3. ASHRAE HVAC Design Manual for Hospital and Clinics.(Second Edition)
4. ASHRAE Handbook HVAC Application 2015
5. 1999 – ASHRAE HANDBOOK FUNDAMENTALS
6. AAMI Standard 35Safe Handling and Biological Decontamination of Reusable Medical
Devices in Health Care Facilities and in Nonclinical Settings (AAMI 2003)
7. WHO KMC: practical guide 2003

It is realized that almost all of the rooms are connected with AHU. Some of the toilets are being
extracted through toilet extraction fans located at sixth floor; some through ducted twin toilet
extraction fan and other toilets are extracted by Ceiling mounted toilet extracting air fans
controlled by light switch. Kitchen is planned to be extracted through kitchen extraction fan.
Conference hall at six floor is air conditioned with packaged roof top unit.
 During the document review the major concerns are highlighted as follows
1. There are some areas which require HVAC&R but are left without any kind of HVAC&R
system.
2. No corridor ventilation is shown.
3. Duct layout needs revised attention.
4. There is discrepancy between bill of quantity and drawing.
5. Chiller and AHU connection is not shown.
6. There is riser shaft for each toilet in the ward it is recommended to collect all ward toilet
duct to one shaft to make the design economical and durable.
7. Toilet extraction system needs make-up air mechanism.
8. It is not clear what the “DUC” symbol in some toilets stand for.
9. Some of toilet exhaust systems with ceiling fans require back draught dampers.
10. What is the base behind using PVC pipes for some toilet extraction system?
11. The AHU system is suited for a single zone application; but it is applied to multiple zones
with multiple requirements which makes it inconvenient (incapable).
 12. Exhaust air lines from spaces which contains infectious airborne particles need HEPA
filters at their terminal units. The supply air lines of protective environment rooms also
need HEPA filters at their terminal units.
13. Outlet selection needs proper attention as they vary in application and level of care given
to them almost all hospital spaces require special attention on their supply and exhaust
terminal arrangement with in the room.(we highly recommend a revised attention)
Detail review
Semi basement
 Autopsy and post mortem are neither ventilated nor air conditioned. According to
ANSI/ASHRAE /ASHE Standard 170 it is recommended for an autopsy and post mortem
to have minimum of 12 air change per hour and laminar diffusers should be arranged in
the ceiling directly above the autopsy tables to produce a downward flow of air over the
occupants and autopsy table, and then to low-level exhaust grilles.(3)
 Morgue is neither ventilated nor air conditioned it is necessary for a morgue to have 20
air change per hour to keep the odor level down.(2)
 Exhaust intake should be located both at high level (in or near the ceiling) and at a low
level (in the sidewall). The high and low exhausts will help to minimize the chance of
stagnant air zones in the space or a buildup of gases and contaminants.(3)
 According to ANSI/ASHRAE/ASHE Standard 170 it is recommended that the pressure
differential between an Autopsy Room and surrounding areas be monitored and that there
be an alarm or some indication when the pressure differential is lost or, preferably, when
it starts to approach a neutral point.
 Cold rooms and deep cold room are not furnished with the system no indoor or outdoor
unit is shown on the design and nothing is mentioned on BOQ as well.
 Central drug store needs Air conditioning or cold room as required since drugs need
special care.
 Kitchen fan location is not specified; the exhaust flow-rate and kitchen hood size doesn’t
comply with 1999 – ASHRAE HANDBOOK FUNDAMENTALS and the duct shouldn’t
pass through occupied spaces.
 Toilet riser duct needs closure.
 According to the standard recommended kitchen hood size for single island hood type the
overhang shall be 12 inches in each side.
 The flow for the kitchen fan should be checked according to ASHRAE standard based on
the hood size.
 Laundry room is not ventilated according to ASHRAE HVAC Design Manual for
Hospital and Clinics ventilation design parameter minimum of 10 air change per hour
and negative pressure shall be maintained.
Ground floor
 Toilets at axis Z-Z2, 23-24 are not ventilated.
 Minor OR, MRI and recovery rooms are neither ventilated nor air conditioned.
  According to ANSI/ASHRAE /ASHE Standard 170, it’s recommended for MRI and CT
scan rooms to use linear diffuser made of non ferrous metal because metal interfere with
magnetic field used to create MRI image; And also for all equipments ductwork,
fastener hanger with in the radioactive range should be nonferrous.
 Clinical medical linear accelerator is not connected with the system it is recommended
to have a stand by air conditioning system since the machine heat gain from imaging is
large same goes for CT scan and MRI rooms.
 Psychiatric and rehabilitation patient-holding room is designed for patients who may
present a danger to others or themselves so these rooms should typically have security
diffusers, grilles, and registers installed for patient safety.(3)
First floor
 Kitchen and toilets at axis Z-Z2, 23-24 are not ventilated.
 In burn unit heating type air conditioning with temperature of about 37 oc is
recommended to keep the patient’s core temperature at least above 340c.(3)
 Transplant rooms must be considered as OR maintain positive pressure and prevent
surgical site infection.(3)
Second floor
 Neonatal ICU,KMR and CS OR are neither ventilated nor air conditioned according to
ANSI/ASHRAE /ASHE Standard 170-2017, Ventilation of Health Care Facility ICUs
and CS ORs need to maintain positive pressure; KMR shall have a heating type air
conditioning with temperature of 22-24°C to keep it warm for small babies.(7)
 According to ASHRAE HVAC Design Manual for Hospital and Clinics operating rooms
should use dedicated AHU one to one for each ORs; it’s not recommended to make OR
rooms dependent on the operation of a single unit; Using HEPA filter shall also be considered in
the supply air.
 Toilets at axis Z-Z2, 23-24 are not ventilated.
 Sound proof class room is not ventilated; according to ES-EBCS 11 standard class rooms
need to be ventilated at a minimum of 8 air changes per hour.
 Central sterile supply department(CSSD) is not ventilated since it’s composed of three
main section a dirty section, a clean section, and a sterile section Pressure should be
maintained from positive in the sterile section to negative in the dirty section.(3)
Temperatures in these areas (except for the equipment access room) should be controlled
between 60°F and 65°F [15.6°C to 18.3°C] with a relative humidity range of 30% to
60% (except for sterile storage, where maximum humidity is 70%).(6)
Third and fourth floor
 The function of mechanical vertical ducts at axis line J, S, O, 27, 26 are not clear the
toilets use different riser point.
 Patient day rooms and isolation rooms at axis I-H, 23-24 neither ventilated nor air
conditioned.
Fifth floor
 Toilets at axis Z-Z2, 23-24 are not ventilated.

Review of bill of quantity

 Volume dampers with different size are shown on the drawing but not on the bill of
quantity.
 Laminar flow panel, door grille and louver aren’t mentioned on the BOQ.
 On the drawing all the outlets are grilles except for linear slotted but on the BOQ grills
are not mentioned rather supply and return diffusers are listed.
 Quantity of air extraction fan and air handling unit vary from the drawing and some
additional AHU and EAF needed according to the design.
TYPE FLOWRATE Q CONTRACT DRAWING
(lps) QUANTITY (Pcs) QUANTITY (Pcs)
AHU 4,715 0 1
AHU 7,355 0 1
AHU 12,145 0 1
EAF 5525 0 1
EAF 13,095 0 1