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The importance of HVAC systems in hospitals

 Keyter Web

4 months ago
HVAC systems are playing a very important role in hospitals, not only by maintaining
comfortable climate conditions of temperature and humidity control, but also by maintaining a
clean, germ-free environment to contribute to the well-being of patients and to prevent the spread
of disease. These determining factors mean that the design of air conditioning systems for the
hospital sector must take into account a series of characteristics that, although important in other
sectors, must be given special attention in this sector.
There are different standards and application codes that are specific to the design, construction
and maintenance of air conditioning installations in hospitals, the most relevant in Spain being
UNE-100713: 2005, Air Conditioning Installations in Hospitals, UNE-EN ISO 14644, Clean
Rooms and Controlled Premises, and at the international level the HVAC Design Manual for
Hospitals and Clinics published by ASHRAE (American Society of Heating, Refrigeration and
Air Conditioning Engineers), or the Mechanical Systems Handbook for Health Care Facilities
published by ASHE (American Society for Hospitals Engineers).

Healthcare facility air conditioning plays a much more important role than simply providing
comfort to patients and employees. Medical equipment in hospitals and healthcare facilities is
sensitive to temperature and humidity levels and requires perfect air control to function
accurately. But also, the necessity of having rooms with very different use in hospitals, adds an
additional complexity to the design of these systems. It is necessary to zonify very clearly the
different spaces and their use. In a hospital, it is necessary to provide rooms where patients with
various pathologies will be treated and rested, among them a group will be exposed to infectious-
contagious diseases, which require a certain level of isolation, as well as rooms for patients with
depressed or weak immune systems (such as intensive care rooms, or neonatal rooms, operating
theatres), where it is necessary to prevent the arrival of pathogens that abound in hospitals.
Hospitals are therefore places where a much higher concentration of pathogens accumulates than
the average building, and most of these agents travel in the air currents, making air conditioning
equipment very sensitive to accumulating large quantities of pathogens and even serving as areas
for their cultivation, with the consequent risk to the health of users. All this must be avoided with
a correct design of the facilities, so that patients, hospital workers and visitors are protected from
exposure to these pathogens.

For this reason, in addition to providing for temperature control in air-conditioning systems
through heat and cold, and humidity control, in these systems, zoning in areas of over-pressure
and depression is particularly important, and therefore coherence when designing the zoning of
each area to be air-conditioned, as well as designing with elements that maintain a correct degree
of watertightness, but are at the same time accessible and built with clean materials, so that they
can be easily dismounted and cleaned regularly. It is also very important to design with an
adequate level of external air supply, often considerably higher than in other types of
installations, as well as a more exhaustive level of filtration, which allows for the maximum
retention of the micro-particles on which the bacteria, fungi and viruses causing the diseases
settle.

The most important considerations in the design of this type of system are the following:
– Filtration, classifying the premises and using HEPA filters in the most exposed premises.
Combination with biocide systems (ultraviolet lamps, etc.) but never substitution of the latter
with the first one.
– Ventilation systems with a significant supply of outside air. Precise study of the location of the
external air supply and air expulsion intakes to the outside, in order to avoid contamination
outside the building.
– Study of the premises that must be in overpressure and underpressure according to use, and
control of the direction of air flows according to specifications. Include odor control both in
filtration and in study of air flow directions.
– Monitoring of working pressures to detect when a failure happens and to check the
effectiveness of the maintenance service policy.
– Study of sound levels, installation of acoustic attenuators.
– Study of air flows and air speeds in critical rooms, taking into account the position of the
patients, design of grilles. Recommended in some cases to use hot/cold wall systems to minimize
draughts.
– Specifications of air handling units according to health requirements, including energy
recovery elements
– Design and construction of the duct network to facilitate disassembly and cleaning
– Consideration of pressure losses of fire control elements, such as shut-off dampers and
firewalls if they exist, in the calculation of air distribution.
UTAS/Handlers
AHUs (air handling units) used in air-conditioning systems for health centres and hospitals
require higher construction and quality characteristics than other types of installations. Generally
these units are classified in Europe according to the UNE EN 1886 regulation, where the
requirements of mechanical resistance, watertightness, thermal transmittance, thermal bridge
factor and filter bypass leakage are defined. We will not go into the definition of these aspects
because they are general for any installation. However, in the specific case of hospital units, it is
also necessary to comply with the requirements defined in UNE 100713.
 

In accordance with this standard, the units must have a hygienic finish, which hinders the
proliferation of microorganisms, contributes to the control of air quality, as well as facilitating
cleanliness. A uniform interior finish is required, with no gaps or folds that could lead to the
deposition of water condensate inside. In this way, interior surfaces must all be coated with
epoxy or polyester paint, or be made of stainless steel, completely smooth, and must be
constructed in order that the different elements (filters, dampers, heat exchanger batteries) can be
removed independently for total cleaning, being accessible to all interiors.

Condensate trays must be removable, made of stainless steel, covered with sufficient insulation
so that they do not produce additional condensate and with a slope so that the condensate water
is easily removed.
All panels must have inspection windows, with lighting so that the situation inside the unit can
be checked from the outside, and a differential pressure detection system to check that dirt is not
building up, causing increased pressure drop.
The panels must be sandwich, totally watertight and completely painted with M0 fireproof
insulation. They must be able to be completely removed from the structure to allow total access
to the interiors.
The heat exchange coils, which must be constructed in independent uprights so that they can be
completely removed for cleaning, must have no more than four rows or ranges of tubes, with a
minimum fin spacing of 3.2 mm (equivalent to 8 fpi fins per inch), with fin thicknesses of no less
than 0.12 mm, so that they are sufficiently rigid to be damaged during cleaning. The flow
velocity should not exceed 2 m/s (4000 feet per minute) [1] and they should be far enough away
from other elements to avoid dirt accumulation between them.
Filters shall be two or three stages, depending on the type of room the unit is intended for, easily
accessible also for maintenance and cleaning, resistant to humidity and rigid enough to avoid by-
pass. It is advisable to place a filtering stage before the battery and another after it, as well as
always placing a filtering stage behind each mixture, to prevent unfiltered air from being blown
into the room.

Fans should be plug-fan, with direct coupling. Couplings with belts and pulleys should always be
avoided because they release particles. Fans must also be mounted on a structure, with anti-
vibration plugs and with a flexible joint to the sheet metal to reduce vibrations and noise. They
must be dimensioned with a certain safety coefficient to be able to and with variable speed
system to ensure a constant drive flow, adapted to the filter contamination. It is important to
control this flow because its supervision will allow us to adapt the maintenance policy of the
unit.
Finally, the high level of filtration and ventilation means that the energy recovery aspects must
also be considered with special care.
The units incorporating heat recovery must have, in addition to the minimum efficiency required
by the standards, in the sense of avoiding the exchange of air flows, so that depending on the
country or region, only heat-pipe or dual coil type recuperators are accepted as the only systems
that avoid the crossing of air flows, and in other countries or regions the use of cross-flow plate
recovery exchangers is also allowed as long as the gas transmission rate is verified to be less than
1 per thousand.
Filtration
Filtration as a basis for maintaining air quality control at the appropriate standards is one of the
fundamental aspects to take into account in this type of installation. In general, according to most
regulations (e.g. Spanish standard UNE 100713), a distinction must be made between two types
of premises, class I premises with very high aseptic requirements, which require a minimum of
three levels of filtration, and class II premises, with the usual requirements, which require two
levels of filtration. In class I premises, the incorporation of the three levels of filtration meets the
objective of achieving maximum particle retention in the filter, the last level being a HEPA
(High Efficiency Particulate Air) type filter with a minimum filtration level of H13 (99.5%) or
H14 (99.95%) depending on the type of operating theatre. The recommendation of the standard
is to install F5 + F9 + H13/H14 for this type of premises, locating the HEPA filter in the impulse
if possible, or as close as possible to the impulse. In class II premises, the recommendation is to
install F5 + F9 filters.

In rooms or operating rooms, sick people have their immune system at its weakest, making your
body vulnerable to bacteria, viruses and other airborne infections. HVAC systems that use HEPA
filtration can capture infectious particles, control bacteria and prevent the spread of airborne
diseases to your most sensitive patients. However, without continuous monitoring and
maintenance, including filter replacement and cleaning of heat exchangers, pockets of infection
can occur. For this reason, the requirement to maintain the installation in perfect condition and
extend the life of these elements must also be taken into account. Such precise systems also
require adequate and continuous maintenance. Keeping the filters clean and in good condition,
verifying the watertightness from time to time, and checking the differential pressure
measurement elements between the different points, can be vital, because it would avoid that
areas that must be protected keep the heat exchange batteries clean and the implementation of
rigorous maintenance programs of cooling towers if they exist or of the ducts are only some of
the ways in which HVAC systems prevent the appearance of risks.

HEPA filters are very important elements of the system, so keeping them monitored by
monitoring pressure tapping before and after the filter elements is necessary to ensure proper
operation at all times. Detecting when they are no longer in the operating conditions
recommended by the manufacturer and must be replaced is vital to avoid taking unnecessary
risks. However, HEPA filters are expensive elements, so maintaining them correctly and
extending their life to the maximum is very important. Studies show that a low efficiency pre-
filter prior to a HEPA filter extends the life of the filter by up to 25%, while the insertion of a
medium efficiency element such as an F8 or F9 can extend the life of a HEPA filter by up to
900% [1]. By using this concept, called progressive filtration, HEPA filters can work under
optimal conditions for several years.

Ventilation
Ventilation is another fundamental element to consider in the design of air conditioning
installations in hospitals, mainly in the design of operating theatres [11], both from the point of
view of air quality control and from the energy point of view, since ventilation represents one of
the greatest energy costs in this type of system. It should be noted that operating rooms generally
have a considerably lower set point temperature than other rooms, so the energy cost of
ventilation in certain outdoor conditions is very high.
 From a preventive point of view against infections in operating rooms, and depending on the
type of operating room, a type of ventilation is recommended, unidirectional or turbulent, a
minimum number of renewals per hour, between 20 and 35 depending on the type of operating
room, and the possibility or not of recirculating air. These recommendations are included in the
UNE-EN ISO 14644 standard. 3] The classification of operating theatres is type A, high
technology operating theatres, for complex operations such as cardiovascular, organ transplants,
etc. Conventional operating rooms, type B, for conventional and emergency surgery, and type C,
for outpatient surgery and childbirth. In type A operating rooms, the unidirectional flow
ventilation system is recommended, and air recirculation is allowed. The air must be from the
same operating room and must be treated the same as the outside air, with a minimum of 35
renewals per hour. In Class B and C operating rooms, turbulent ventilation is allowed, and 20
renewals per hour for Class B and 15 for Class C. In both cases, it must be 100% outside air.
To complete the above considerations, the UNE 100713 standard indicates that although a good
air quality is obtained with three stages of filtration, a minimum external air flow of 1200 mc/h
must be promoted to maintain the concentration of anaesthetic and disinfectant gases within an
acceptable environmental level of less than 0.4 ppm. 2] It should also be noted that in operating
theatres with high requirements in terms of germs, a minimum of 2400 mc/h should be used
when the rooms are equipped with a mixed air diffusion system, with a minimum of 20 renewals
per hour.
These considerations are interesting specially when air handling units system is designed for this
kind of spaces.

Conclusion
This article has tried to list in a non-exhaustive way the different aspects to be considered in an
air conditioning installation for hospitals and in the equipment necessary to carry out the
installation in these singular buildings where some aspects which in other installations are not so
relevant, here obviously take a greater importance for safety reasons both of the people who
work there, as well as of the patients and the technical equipment and machinery that are
handled. The aspects related to UTAS machines/handlers, maintenance in general, filtration and
ventilation have been described in more detail, although it is necessary to remember how other
aspects such as acoustics, vibrations, odor control and energy efficiency are also essential and
should not be forgotten.

Article published in Climanoticias.com  | Date 03/12/2019

Resume

 UTAS/Handlers

 Filtration

 Ventilation

 Conclusion

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