Fauber Peter H. Langowski Gordon P. Sharp Steven D. Friedman Michael D. Mead Andrew J. Streifel Frederich E. Emmerich, Chair Roger L. Hedrick David Robin Donald M. Brundage, Vice-Chair Rick M. Stanke Michael D. Corbat Srinivas Katipamula Wayne H. Stoppelmoor, Jr. Drury B. Swierczyna Julie M. Ferguson Larry Kouma Jack H. Zarour Michael W. Gallagher Arsen K. Melikov Lawrence C. Grondzik R. Lee Millies, Jr. Gupta Karl L. Peterman Susanna S. Hanson Erick A. Phelps Stephen C. This signifies the concurrence of more than a simple majority, but not necessarily unanimity.
Consensus requires that all views and objections be considered, and that an effort be made toward their resolution. ASHRAE obtains consensus through participation of its national and international members, associated societies, and public review.
Every effort is made to balance the concerned interests on all Project Committees. In referring to this Standard or Guideline and in marking of equipment and in advertising, no claim shall be made, either stated or implied, that the product has been approved by ASHRAE.
This foreword is not part of this standard. It has not been pro- Standard will be included in the Hospitals and Out- cessed according to the ANSI requirements for a standard patient Facilities books.
Unresolved objec- Due to timing constraints, these three sections in the stan- tors on informative material are not offered the right to dard are identical.
The refor- mat was included in this edition to simplify the incorporation Standard originated with an agreement between of these upcoming changes. The requirements for spaces that do not exist in any Facilities that an ASHRAE standard would provide the best given facility type may be ignored. The committee also ASHE was also included in this process, which resulted in appreciates the feedback received from the addendum public the initial edition of this standard—the first standard review and continuous maintenance proposal processes.
Additional future input from the public is welcome. This edition to the standard includes a number of significant improvements to the edition. As a continuous 1. The purpose of this standard is to define ventilation system This standard does not constitute a design guide. Rather design requirements that provide environmental control for it comprises a set of minimum requirements intended for comfort, asepsis, and odor in health care facilities. This change allows for easier coordination according to the requirements of this standard and that is between the standard and FGI documents, which, as of the intended to provide airborne infection isolation.
Rou- tial Health, Care, and Support Facilities tine maintenance and service shall not constitute an alteration. Accepted standards of patient care are used to average velocity: the volumetric flow rate obtained by divid- determine where an invasive procedure is performed. For the purposes of this document, the term is building: a structure that is wholly or partially enclosed limited to the above description. The intent is to differentiate within exterior walls and a roof, or within exterior and party those procedures that carry a high risk of infection, either by walls and a roof, and that affords shelter to persons, animals, exposure of a usually sterile body cavity to the external envi- or property.
In this standard, a building is a structure intended ronment or by implantation of a foreign object into a nor- for use as a hospital or health care facility. These patients include but are not limited to fusers generally have very low average velocity. For the allogeneic stem-cell transplant patients and intensive chemo- purposes of this standard, the performance of these diffusers therapy patients. Informative Notes: 1. Examples of chronic diseases include diabetes, can- An aseptic field is required for all procedures performed in an cer, emphysema, or cardiac failure.
Any form of anesthesia may be administered in an OR if 3. Examples of immunosuppressive therapy include proper anesthesia gas administration devices are present and radiation, cytotoxic chemotherapy, antirejection waste anesthesia gas disposal systems are provided. For more information, see CDC in Appen- clinical care to patients. Such care includes monitoring, eval- dix B. Local anesthesia and minimal and moderate seda- inpatient: a patient whose stay at the health care facility is tion may be administered in a procedure room as long as spe- anticipated to require twenty-four hours or more of patient care.
The restricted access is primarily intended to sup- locations suitable to the technical requirements of the proce- port a high level of asepsis control, not necessarily for security purposes. The informative appendices to 4. New buildings shall comply with the this standard and informative notes located within this stan- provisions of this standard. Additions shall 4. This standard often specifies a range of comply with the provisions of this standard. Portions of a standard.
Any new mechanical in each space, and any special clinical needs for temperature, equipment installed in conjunction with the alteration as a humidity, and pressure control. This program shall be prepared direct replacement of existing mechanical equipment shall in the planning phase of design.
Alterations to spaces listed in Table 6. Any alteration but also with ventilation to dilute and remove contaminants, to existing health care space in a building that will continue to provide conditioned air, and assist in controlling the transmis- treat patients during construction shall comply with Sections sion of airborne infection. In order to meet these require- Administrative require- 6.
The exemption, approved calculation methods, rights of approved space ventilation and pressure relationship requirements of calculation methods, and rights of appeal are specified by the Tables 7. AII rooms 4. Compliance documents are those plans, b. PE rooms specifications, engineering calculations, diagrams, reports, c. Operating rooms ORs , including delivery rooms Cae- and other data that are approved as part of the permit by the sarean AHJ.
Compliance documents shall 6. The capacity of the 4. Positive-pressure exhaust ductwork located within mechanical equipment rooms shall be 6. All airstream sur- b. Exhaust discharge outlets from AII rooms, bronchoscopy and sputum collection exhaust, pharmacy hazardous-drug 6. Outdoor air intakes for AHUs shall be exhausted enclosures, and laboratory work area chemical located a minimum of 25 ft 8 m from cooling towers and all fume hoods shall additionally be arranged to discharge to exhaust and vent discharges.
Outdoor air intakes shall be the atmosphere in a vertical direction with no rain cap or located such that the bottom of the air intake is at least 6 ft other device to impede the vertical momentum and at 2 m above grade. New facilities with moderate-to-high risk least 10 ft 3 m above the adjoining roof level.
All intakes shall be designed b. Exhaust discharge outlets from AII rooms, bronchoscopy Exception to 6. Standard Relief air is exempt from the 25 ft 8 m air intake but with the exhaust discharge point above the separation requirement.
Relief air is defined as the Class 1 air top of the air intake may be used. The submitted reen- that could be returned to the air-handling unit from the occu- trainment analysis shall demonstrate that an exhaust dis- pied spaces but is being discharged to the outdoors to maintain charge outlet located at a distance less than 25 ft 8 m building pressurization such as during air-side economizer horizontally provides a lower concentration of reentrain- operation.
Intakes on top of buildings shall 6. Filter banks shall be provided in accordance be located with the bottom of the air intake a minimum of 3 ft with Table 6.
Each filter bank with an efficiency of greater 1 m above roof level. In the case of an areaway, the bottom ter or differential pressure measuring device that is readily of the air intake opening shall be at least 6 ft 2 m above accessible and provides a reading of differential static pres- grade.
The bottom of the air intake opening from the areaway sure across the filter to indicate when the filter needs to be into the building shall be at least 3 ft 1 m above the bottom changed. All of the air provided to a space shall be filtered in of the areaway. Sections 7. Additional prefilters may be used to reduce maintenance for filters with efficiencies higher than MERV 7. Filter Bank No. Gravity-type heating or cooling units, such as radiators mixed air is filtered.
Cooling towers shall be located so ply fan. All second filter banks shall have sealing interface that drift is directed away from AHU intakes. They shall meet surfaces. Filter-bank blank-off 6. When outdoor humidity and internal mois- panels shall be permanently attached to the filter-bank frame, ture sources are not sufficient to meet the requirements of constructed of rigid materials, and have sealing surfaces equal Tables 7. Steam or adiabatic bank frame. Filter frames shall be durable and 6.
All joints between filter segments and enclosing a. Locate humidifiers within AHUs or ductwork to avoid ductwork shall have gaskets or seals to provide a positive seal moisture accumulation in downstream components, against air leakage.
A humidity sensor shall be provided, located at a suitable 6. Cooling coils and distance downstream from the injection source. If radiant cooling panels d. Humidifier control valves shall be designed so that they 6. If radiant heating is pro- remain off whenever the AHU unit is not in operation. Chemical addi- wound intensive care unit burn unit , an OR, or a procedure tives used in the steam systems that serve humidifiers shall room, either flat and smooth radiant ceiling or wall panels with comply with FDA requirements 3.
Surgeons may require alternate air distribution systems for some specialized surgeries. Such systems shall be considered acceptable if they meet or exceed the requirements of this standard. Air distribution systems using Group D diffusers shall meet the following requirements: 1. The supply diffuser shall be located where it cannot be permanently blocked Informative Note: e.
The transfer grille to the toilet room shall be located above the occupied zone. Humidifier water shall be treated with a reverse osmosis 6. All air distribution devices process, a UV-C sterilization light source, and a submi- shall meet the following requirements: cron filter. Surfaces of air distribution devices shall be suitable for b.
Treated humidifier water shall be continuously circulated cleaning. Supply air outlets in accordance with Table 6. All valves, head- shall be used. The supply diffusers in ORs shall be designed and drain completely when not in use.
Ports suitable for testing water quality shall be provided in c. Psychiatric, seclusion, and holding patient rooms shall be the treated humidifier water piping system. Moisture eliminators shall be provided as required to pre- 6. Where smoke barriers are required, vent moisture accumulation in ductwork.
Maintain the pressure relationships required 6. Spaces that have required a. Maintenance access shall be provided at all dampers. All damper locations shall be shown on design drawings. The following addi- c. Air-handling systems shall be arranged such that damper tional surgery and critical-care patient care areas that do not activation will not damage ducts.
Ducts that penetrate construction served by fully ducted return or exhaust systems: recovery intended to protect against x-ray, magnetic, radio frequency rooms, critical and intensive care areas, intermediate care interference RFI , or other radiation shall not impair the areas, and wound intensive care units burn units.
In inpatient effectiveness of the protection, nor shall the treatment of these facilities, patient care areas shall use ducted systems for penetrations impair the ventilation of the space served. Where space pressure relationships are required, the air distribution system design shall maintain 6. Energy recovery systems shall be located loading, heating-season lower airflow operation, and cooling- upstream of Filter Bank No.
If energy recovery systems are season higher airflow operation. Airstream surfaces of the air used, the systems shall not allow for any amount of cross- distribution system downstream of Filter Bank No.
Spaces shall be ventilated according to Table 7. Airborne infectious isolation room exhaust systems 1. If used for energy recovery. The ventilation rates in this table are intended to pro- exhaust airstream components are fully separated by an vide for comfort as well as for asepsis and odor control air gap of adequate distance to prevent cross-contami- in spaces of a health care facility that directly affect nation that is open to the atmosphere e.
Ventilation rates for spaces not specified pumped coils. Where spaces with prescribed rates in both If energy recovery systems with leakage potential are used, Standard Energy 3.
Energy recovery systems with leakage potential rooms. Spaces that are required in Table 7. Controls ment room, and any other space identified by the AHJ or the intended to switch the required pressure relationships infection control risk assessment ICRA team.
Air change rates in excess of the minimum values are expected in some cases in a. An exterior vapor barrier shall be provided for insulation order to maintain room temperature and humidity con- on cold surfaces. A vapor barrier is not required for insu- ditions based on the space cooling or heating load. The entire minimum outdoor air changes per hour b. Existing insulation and duct lining accessible during a required by Table 7.
Duct lining shall not be used in ductwork located down- 5. For spaces where Table 7. Duct lining with an imper- lated by room units, the portion of the minimum total vious cover may be allowed in terminal units, sound air changes per hour required for a space that is greater attenuators, and air distribution devices downstream of than the minimum outdoor air changes per hour Filter Bank No.
This lining and cover shall be factory required component may be provided by recirculating installed. Such recirculating room HVAC d. Duct lining shall not be installed within 15 ft 4. This filter shall be located upstream odor in hospital health care facilities. However, because they of any such cold surface, so that all of the air pass- are minimum requirements and because of the diversity of the ing over the cold surface is filtered.
For air-handling systems serving multiple spaces, sys- these requirements do not provide assured protection from tem minimum outdoor air quantity shall be calculated discomfort, airborne transmission of contagions, and odors. The following general require- i. HVAC units with heating or cooling coils are acceptable for provid- n.
If pressure-monitoring device alarms are installed, allowances shall ing that portion of the minimum total air changes per hour that is per- be made to prevent nuisance alarms.
Short-term excursions from mitted by Section 7. Because of the cleaning required pressure relationships shall be allowed while doors are mov- difficulty and potential for buildup of contamination, recirculating ing or temporarily open. The design of either portable or fixed systems should prevent that exceed the minimum indicated ranges.
The design of such systems p. Treatment rooms used for bronchoscopy shall be treated as bronchos- shall also allow for easy access for scheduled preventative mainte- copy rooms. Treatment rooms used for procedures with nitrous oxide nance and cleaning. Pharmacy compounding areas may have additional air change, differ- q.
In a recirculating ventilation system, HEPA filters shall be permitted ential pressure, and filtering requirements beyond the minimum of instead of exhausting the air from these spaces to the outdoors, pro- this table, depending on the type of pharmacy, the regulatory require- vided that the return air passes through the HEPA filters before it is ments which may include adoption of USP , the associated introduced into any other spaces.
The entire minimum total air level of risk of the work, and the equipment used in the spaces. When these areas are open to larger, nonwaiting spaces, the c. Informative Note: The intent here is to not require victims.
The OR within the trauma center that is routinely used for the volume calculation to include a very large space e. Pressure relationships need not be maintained when the room is r. See NFPA 99 10 for further requirements. See Section 7. Higher ventilation rates above the total ach listed shall be used when ing and cooling, baseboard heating, etc. The protective environment airflow design specifications protect the of the potential contaminants in each laboratory work area.
This white paper provides a protocol for perioperative care areas when mechanical systems are unable to maintain relative humidity RH within the desired range that has been established by the facility for their specific operations. For the purpose of this paper, a humidity control event occurs when the RH is above or below the established facility RH range. Download the White Paper. Learn more.
The second edition provides in-depth, up-to-date design recommendations based on best practices from consulting and hospital engineers with decades of experience in the design, construction, and operation of health care facilities.
It presents solutions that are proven, cost effective, and reliable; solutions that provide low maintenance cost and high reliability, with a focus on presenting what's different about health care HVAC. For "standard" mid- to large-size hospital, typically at least , ft 2 , but the strategies apply to all sizes and classifications of large hospitals.
Addendum a to Standard Addendum b to Standard Addendum c to Standard Roger Lautz, Dr. Fred Betz, Dr. Ehsan Mousavi. The requirements in this standard apply to patient care areas and related support areas within health care facilities, including hospitals, nursing facilities, and outpatient facilities.
It does not present official positions of the Society nor reflect Society policy. Contact the The revised edition incorporates 12 addenda to the standard andincludes the following significant changes:. Public Review Draft Standards.
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