Health Care Facilities

Healthcare Facilities: Best
Practice Design & Applications

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Architects Continuing Education Systems. Credit earned on
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members. Certificates of Attendance for non-AIA members are
available on request.
• This program is registered with the AIA/CES for continuing
professional education. As such, it does not include content that
may be deemed or construed to be an approval or endorsement by
the AIA of any material of construction or any method or manner of
handling, using, distributing or dealing in any material or product.
Questions related to specific materials, methods and services will
be addressed at the conclusion of this presentation.
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Part 1-1: Welcome & HFDP Exam
Agenda
8:00 - 8:10 Part 1-1 Function of HVAC In Healthcare
8:10 - 8:25 Part 1-2 Role of HVAC in Infection Control
8:25 - 8:35 Part 1-3 General Terms & Design Overview
8:35 - 9:05 Part 1-4 Psychrometrics Applied to Healthcare
9:05 - 9:15 Questions and Answers
9:15 - 9:25 Part 1-5 Emergency Preparedness
9:25 - 9:35 Part 1-6 Life Safety and Fire Protection
9:35 - 9:50 Part 1-7 Construction in Existing Facilities
9:50 - 10:10 Part 1-8 Central Heating Systems
10:10 - 10:30 Part 1-9 Central Cooling Systems
10:30 - 11:00 Part 1-10 Energy Conservative Design
11:00 - 12:00 Lunch
*Breaks on your own
5
Learning Objectives – Design
• Explain the relationship of infection control to HVAC design
• Explain how Psychrometrics is applied to healthcare
• Explain the implications of Life Safety, Fire Protection and
Emergency Preparedness on HVAC design
• Describe the fundamentals of healthcare heating and cooling
systems
• Explain HVAC design for Isolation Rooms, Operating Rooms,
Intensive Care Units and Imaging Rooms
• Explain how healthcare HVAC systems can be designed with
energy conservative strategies
6
What’s Unique About Healthcare HVAC
• Infection Control
• Patient Comfort
• Humidity Control – Reheat Systems
• Heavy Regulation
• Stakes are High
• Generally Design is Not Load-Driven
• Medical “Office” Building = Healthcare
• Fire: Defend in place
• Ongoing maintenance, verification, inspections
• 24/7 Operation
• Owner Occupied – long life
7
Role of Good Healthcare Engineer
• Know Facility
• Know Engineering & Maintenance Personnel
• Know Their Preferences
• Know Their Procedures
• Know Codes
• Contribute to Design Process Early
• KISS
8
Typical Healthcare Organization Structure
VP Support
Services
Director Director
Const. & Design Eng & Op
Architect Maintenance
Systems Upgrades &
Engineer Repairs
New Construction &
A/E Renovations
9
Elements of HPHC HVAC Systems
1. Performance – Infection Control, Comfort, Patient
Outcome
2. Safety – Fire, falls, injuries – employees, visitors, patients
3. Reliability – Lost Revenue
4. Maintenance Cost
5. Energy Cost
6. Sustainability
IN THIS ORDER!!
10
HVAC Reliability
• Reliability ∞ 1 / complexity
• Maintenance ∞ complexity
• Complexity ∞ # of parts
• Complexity ∞ lines of code
• Complexity ∞ unintended consequences
11
Cost of Down Time – Lost Income
• Knee/Hip Replacement: 3-4 Hours – $20,000 - $40,000
per case
• Heart Valve Replacement: 3 Hours – $50,000 - $100,000
per case
• PET Scan Machine: $40,000 per day
• MRI: $50,000 - $100,000 per day
• C-Section: 1 Hour – $18,000 per case
www.health.costhelper.com
12
Maintenance Cost
• 25,000 - 50,000/ft2 per Zone Mechanic @ $75,000/yr
Gross Salary Cost
• Maintenance labor alone is $2-$3 /ft2/yr + parts
• AHA says $5/ft2/yr maintenance*
*AHA Benchmarking 2.0 Report
13
National
Average
14
EPA Star
$/SF
2
3
4
5
161 127
111 112
Electrical
162 116
182 135
Energy ~ 1% of Hospital’s Cost
143 122
126 114
Thermal
84 84
130 111
30 95
98 69
202 115
247 158
223 158
140 147
154 158
132 109
134 106
187 111
134 135
100
450
400
350
300
250
200
150
0
50
K BTU / FT2-YR
Healthcare Design Professional Exam
• Sponsors
 ASHRAE
 ASHE – American Society of Healthcare Engineers
• Purpose
 Demonstrate a well-rounded understanding and
knowledge of medical terminology and facility operations
as they affect HVAC&R design in healthcare facilities.
www.ashrae.org/certification
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Suggested Resources
• ASHRAE HVAC Design Manual for Hospitals, 2013
• This Class
• NFPA 101 Life Safety
• NFPA 110 Emergency Power Systems
• NFPA 99 Healthcare
• ASHRAE Handbook-Applications, Chapter 7
• ASHRAE Standard 170-2013, Ventilation of Health Care Facilities
• ASHRAE Standard 62.1, Ventilation for Acceptable Indoor Air Quality
• IBC Mechanical Volume
• IBC Volume 1 General
• FGI (AIA) Guide for Design of Healthcare 2014
• CDC Guides for Infection Control
• The Joint Commission 2010 Accreditation Manual
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Part 1-2:
Infection Control & Physiology
Key Terms
• Hospital Acquired Infection (HAI) – Infections contracted inside the
hospital; 50,000 deaths/year in USA in 2006 (nosocomial)
• Major/Minor – usually relates to type of procedure or operation and
anesthesia
• Triage – selecting who to treat first and last
• Epidemiology – study of health outcomes and statistics
• Immuno-compromised – patient who has very weak immune system,
easily and severely infected
• ACH – Air Changes per Hour (filtered?)
• Squame – Skin particle
• Airborne Infection – diseases that might be transmitted via micro-
organisms in the air
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Hospital Acquired Infections – Cost
• HAI ~$30-$45 Billion a year
 Top 5 HAIs
• Pneumonia ~ $28,508 per case
• Bloodstream (central line) ~$29,156 per case
• Surgical site ~$34,670 per case
• Gastrointestinal (C. difficile & MRSA) ~$9,124
• Urinary Tract ~$1007 per case
• Average cost of a Hospital Acquired Infection ~$25,903
• ~$500 Million per year are airborne
Scott, R.D., II. The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits
of Prevention. U.S. Centers for Disease Control and Prevention, Mar. 2009.
19
Science of Infection, Qualitative
Dose x Site x Virulence x Time

Infection =
Level of Host Defense
20
Methods of Infection
1. Related to HVAC Design
• Inhalation
• Deposition
2. Unrelated to HVAC
• Water Mist (Legionella)
• Insect Bite
• Contact (largest cause)
• Sneezes and Coughs
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HVAC Infection Control Methods
• Filtration
• Irradiation, UV
• Pressure difference (clean to dirty)
• Reduce impingement (air velocity @ wound)
• Evaporation of droplets (RH)
• Scientific bases of code-required ACH are weak
• Scientific bases for humidity requirements are weak
22
Where Germs Come From
• Staff
• Patient
• Utensils
• Air
• Water
• Insects
23
Sources of Infection
< 1 mm Squame
Aspergillus 2 – 4 mm
Curvularia Fungus 10 – 30 mm
Virus < 0.3 mm
24
Surgical Site Infection
• Approximately 14% – 16% of all HAI are SSIs
• Air flow is an important route of infection
• Staphylococcus Aureus is common on the skin of many
people
• Approximately 1.15 x 106 – 0.9 x 108 squames shed
during surgery (1)
1. Mangram, AJ, TC Horan, ML Pearson, LC Silver, and WR Jarvis. 1999. Guideline for Prevention
of Surgical Site Infection, 1999. American Journal of Infection Control 27 (2):97-134.
2. Lidwell, OM. 1988. Air, antibiotics and sepsis in replacement joints. Journal of Hospital Infection
11 (Supplement 3):18-40.
25
Inhalation
Nose
} Upper
Respiratory
Tract
}
Alveoli
Lower
Respiratory
Tract
26
Small Particles Reach Lower Tract
Percent Captured
N = Nose U = Pharynx-Bronchi M = Bronchioles

L = Alveoli
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Filtration Efficiencies
MERV 0.3 - 1.0 1.0 - 3.0 3.0 - 10 micron
Category E-3 -
6 - - 35-50%
7 - - 50-70%
8 - - 70-85%
9 - 85% +
Category E-2
10 - 50-65% 85% +
11 - 65-80% 85% +
12 - 80% + 85%+
Category E-1
13 < 75% 90% + 99% +
14 75-85% 90% + 99% +
15 85-95% 90% + 99% +
17 99% 99% 99%
Minimum Filter Efficiencies – S170-2013
Filter Bank Filter Bank
Space Designation (According to Function) #1(MERV)a #2 (MERV)a
Operating rooms (Class B and C surgery); inpatient and ambulatory diagnostic and therapeutic
7 14
radiology; inpatient delivery and recovery spaces
Inpatient care, treatment, and diagnosis, and those spaces providing direct service or clean
7 14
supplies and clean processing (except as noted below); All (rooms)
Protective Environment (PE) rooms 7 HEPAc,d

Laboratories; Procedure rooms (Class A surgery), and associated semirestricted spaces 13b NR
Administrative; bulk storage, soiled holding spaces; food preparation spaces; and laundries 7 NR
All other outpatient spaces 7 NR
Nursing facilities 13 NR
Psychiatric hospitals 7 NR
Resident care, treatment, and support areas in inpatient hospice facilities 13 NR
Resident care, treatment, and support areas in assisted living facilities 7 NR
*N/R = not required
a: The minimum efficiency reporting (MERV) is based on the method of testing described in ANSI/ASHRAE Standard 52.2, Methods of Testing General Ventilation
Air-Cleaning Devices for Removal Efficiency by Particle Size ([ASHRAE 2012] in Informative Appendix B).
b: Additional prefilters may be used to reduce maintenance for filters with efficiencies higher than MERV 7.
c: As an alternative, MERV-14 rated filters may be used in Filter Bank No. 2 if a tertiary terminal HEPA filter is provided for these spaces.
d: High-Efficiency Particulate Air (HEPA) filters are those filters that remove at least 99.97% of 0.3 micron-sized particles at the rated flow in accordance with the 29
testing methods of IEST RP-CC001.3 (IEST[2005] in Informative Appendix B).
MERV Rating Chart
MERV DUST SPOT CONTAMINANT APPLICATION TYPE
PE and Ortho Bag or
17 N/A Smoke
Rooms Box
OR and Patient Bag or
14 90-95% Most Bacteria
Care Box
8 30-35% Over 3 micron Pre-filters Pleated
High
7 25-30% Mold Spores Pleated
Residential
* None of these filters control organic gases
30
Contaminant Removal Rates
Minutes required Minutes required Minutes required
ACH for removal of for removal of for removal of
90% 99% 99.9%
2 69 138 207
4 35 69 104
6 23 46 69
8 17 35 52
10 14 28 41
12 12 23 35
15 9 18 28
20 7 14 21
50 3 6 8
CDC MMWR 2005, assume perfect mixing (imperfect can be 10 times)
31
Significant Ventilation is Required
Pressure All Room Air
Air Recirculated Design Relative Design
Relationship Minimum Minimum Exhausted
Function of Space to Adjacent Outdoor ach Total ach Directly to
by Means of Humidity (k), Temperature (l),
Room Units (a) % °F/°C
Areas (n) Outdoors (j)
SURGERY AND CRITICAL CARE
Operating room (Class B and C)

Positive 4 20 NR No 20-60 68-75/20-24
(m), (n), (o)
Operating/surgical cystoscopic
Positive 4 20 NR No 20-60 68-75/20-24
rooms, (m), (n) (o)
Delivery room (Caesarean) (m),
Positive 4 20 NR No 20-60 68-75/20-24
(n), (o)
Substerile service area NR 2 6 NR No NR NR
Recovery room NR 2 6 NR No 20-60 70-75/21-24
Critical and intensive care NR 2 6 NR No 30-60 70-75/21-24
Intermediate care (s) NR 2 6 NR NR max 60 70-75/21-24
Wound intensive care (burn unit) NR 2 6 NR No 40-60 70-75/21-24
Newborn intensive care Positive 2 6 NR No 30-60 70-75/21-24
Treatment room (p) NR 2 6 NR NR 20-60 70-75/21-24
Excerpt: ASHRAE Standard 170-2013

32
Deposition: Thermal Plume Theory
Forced convection
from laminar diffuser
Buoyancy driven, natural convection from the patient
Memarzadeh & Jiang

34
Univ of Colorado Research – OR Suites
Findings:
• Shape of air pattern is hourglass
• Constriction / speed highly affected by SAT
• No evidence of thermal plume
35
Ultraviolet (UV) Irradiation
Dose x Time
Kill Effectiveness =
Virulence
• Not practical in ductwork

• Effective for stationary mold and mildew on filters, walls,
coils and pans
• Effective in rooms? Beware of human exposure and
materials degradation
36
Pressure Difference
• Maintain proper pressurization 24/7
 Operating Rooms
 Isolation Rooms
 Sterile Processing Departments
IN
OUT
Super CLEANEST CLEAN GENERAL DIRTY
Clean
+ + + + + + + + + + - - -
37
Effect of Infection Control on HVAC Design
HUMIDIFER
% RETURN EXHAUST %
(SMOKE PURGE)
CHW TEMP • AIR DISTRIBUTION PATTERNS/LOCATION

SA TEMP • PRESSURE DIFFERENCES
HUMIDITY • AIR CHANGE RATE
FILTRATION
Variables Determined by Use of Space

38
Part 1-3:
General Terms & Design Overview
Departments
• Emergency Department (ED)
• Imaging/Radiology Departments
• Surgery Departments (In-Patient and Ambulatory)
• Post-Anesthesia Care Unit (PACU)
• Intensive Care Unit (ICU)
• Intermediate Care Unit
• Patient Rooms
• Isolation (AII) and Protective Environment (PE) Rooms
• Support Services – Central Sterile, Pharmacy, Lab, Dietary,
Materials Mgmt, Admin, Central Energy Plant (CEP)
40
Preliminary Design
• Major medical equipment
• Room-specific equipment installation drawings and data
• Shielding
• Lighting
• Power distribution
• Emergency power
• Room name/use
• Medical gas
• Booms
• Applicable codes
41
HVAC Design – Helpful Hints (1)
• Ensure air distribution arrangement in patient/staff mixed
spaces is from clean to less clean (i.e., Triage, Registration,
PE, AII, ICU)
• Peg air change rate on supply, not on exhaust, except
bathrooms
• Calc loads with high glass areas
• Occupant activity level and gowning impacts comfort
• Generally code ACH exceeds load
42
HVAC Design – Helpful Hints (2)
• Coordinate AHU zoning with architectural life safety plan
• Provide separate exhaust systems for different use areas
• Get equipment books/cut sheet data
• Develop “rules of thumb” air quantity estimates (cfm/ft2)
• Build “templates” to ease/simplify computerized cooling/heating
load calculations; e.g., RHC gpm
• Start with room air flows and build back to AHU
43
Room Pressure Monitoring
• Required at AII, PE, Bronchoscopy
• Recommended at Triage, Morgue/Autopsy
• Often in ORs
• AHJ requirements vary widely
44
Medical Equipment
• Manufacturer information
• “Hidden” equipment:
 UPS
 Transformers
 Power conditioners
 Water coolers
• Diversified or undiversified?
45
Fresh Air Intakes – AVOID
• Cooling towers • TB Isolation rooms
• Trash compactors • Bathroom exhausts
• Loading docks • Biological safety cabinet
• Roads exhausts
• Diesel generators • Ethylene oxide sterilizers
• Heliports • Incinerators
• Plumbing vents (25-30 ft)
Cautionary note: Architects may
locate them where they look best
46
Specify Quality Components
• Controls (LON, BACNET)
• AHU – fan, coil, dampers, instruments
• Humidifier
• Filter
• Terminal Unit
• Ductwork
47
Quality Components: Final Filter
48
Quality Components: Ductwork
49
Quality Components: AHU
No Thru Joints
SS Coil Casing & Frame
Double Wall W/ Foam

Metal Interior VFD VFD
SS Drain Pan
Easy access to BOTH sides Multiple Fans

of all components w/ Divider in
AHU or Fan
Good Doors & Gaskets
Array
• If exterior, aluminum or stainless steel housing

• < 0.5% leakage installed
50
Quality Components: Terminal Box
GOOD ACCESS FOR
CONTROL PANEL
120V TO EACH BOX
51
Part 1-4:
Psychrometrics Applied to Healthcare
Psychrometrics Makes My Head Hurt!
Have You Ever Had Problems With?
• Condensation on iced tea glass
• Condensation inside of a wall – winter or summer
• Complaints about temp / RH in operating rooms
• Water in pneumatic lines
• When to operate an outside air economizer
• When to operate a flat-plate economizer
54
Have You Ever Had Problems With?
• Poor chilled beams
• Comfort in areas served by DX unit
• Chilled water or supply air reset
• Humidifiers
• Excess condensate from chilled water coil
55
Psychrometrics Definition
Measuring mental traits, capacities and processes:
a branch of psychology dealing with the measurement of
mental traits, capacities, processes, intelligence, skill and
learning
56
Understand Fundamentals
Psychrometrics is the science of the heat and water vapor
properties of air, based on the Perfect Gas formula.
Commonly used psychrometric variables are temperature,
relative humidity, dewpoint temperature and wet-bulb
temperature.
Heat Transfer is energy transit from hot to cold because of
temperature differential.
Applications – Meteorology, HVAC design and operation,
fishing, golf and HUMAN COMFORT!!
57
Heat Transfer Basics
Q=dT/R = dT * C
BTU = °F/ HR-SF-°F = °F x BTU
HR-SF BTU HR-SF-°F
T2
T1 T3 T2
T4 T5
T1>T2>T3>T4<T5
HIGHER dT FASTER HEAT TRANSFER LOW CHW TEMP
MORE SF MORE HEAT TRANSFER LARGE COIL SFC
HIGHER CONDUCTIVITY CLEAN COIL, TURBULENT WATER
58
Where Will You Get Condensation?
59
Answer: Both Locations
60
Iced Tea
NC
AZ
61
Don’t See Condensation In Arizona?
• Iced Tea temperature is below
dewpoint in both states
• Condensation in both states
• Condensation evaporates
quickly in Arizona due to high
temp and lower relative humidity
• That’s why you feel cooler in
Arizona – evaporation
62
Relative Humidity Is Confusing!
• Relative Humidity is the amount of water in the air
relative to the maximum amount of water that
could be held in the air at that temperature.
• Dewpoint changes very little throughout the day.
• Relative humidity changes dramatically as the
temperature changes, but the amount of water in
the air remains constant.
• On the hottest, most humid days, 100°db, 75° dewpoint,
the relative humidity is only 45%.
63
Relative Humidity Is Confusing!
Air @ Air @
68ºF/40% 80ºF/40%
42 DP° 54 DP°
Twice as Much Water

Use Dewpoint
64
See The Pattern?
65
Diurnal Pattern
MORNING: 65°F AFTERNOON: 80°F

Relative Humidity: 100% Relative Humidity: 60%
Dewpoint: 65° Dewpoint: 65°
• Overnight temperature usually will not drop below dewpoint

• Dew on grass
• No dew on asphalt
66
Perfect Gas Law
PV = nRT
• Pressure increases, temperature increases
• Temperature increases, volume increases
• Pressure increases, volume decreases
• Temperature increases, the number
of molecules decreases
67
Psychrometric Effects in
Healthcare HVAC Systems
• Compressed air expands when released into the pneumatic control
system, causing the temperature to drop, reaching the dewpoint.
This causes condensation in controls lines.
• Air compressor gets hot. Pressure Temp
• Pressurizing air in AHU raises SA temperature.
• Refrigeration cycle: Refrigerant is compressed, then cooled, then
expands rapidly = lower pressure lower temperature.
• Each type of refrigerant has its own psychrometric chart including
pressure, temperature, dewpoint.
68
Quiz: OA Economizer in Winter
It’s 40°F outside. Should I bring additional outdoor air
into my OR system to save energy?
69
Answer: OA Economizer in Winter
Maybe, if the dewpoint is > 26°F; otherwise you must
humidify.
70
Quiz: OA Economizer in Spring
It’s 48°F and raining outside. Should I bring outdoor air
into my Operating Room AHU?
71
Answer: OA Economizer in Spring
YES, if OA
<50°F 66°/50%
OA 48°
66°
72
Quiz: Condensation on Coil
20,000-cfm OA @ 90°/75° dewpoint is cooled to
46°/46° dewpoint. About how much water is produced?
A. 0.1 gpm
B. 0.5 gpm
C. 2 gpm
D. 10 gpm
73
Answer: Condensation is A BIG DEAL!
2 gpm condensate = 2,880 GPD
Fills a swimming pool in 5 days!
74
Quiz: OR Temp / RH
What’s the easiest way to lower the RH in the Operating
Room?
A. Lower the temperature
B. Raise the temperature
C. Install a desiccant system
D. Lower the CHW temp
E. Tune the AHU
75
Answer: OR Temp / RH
• Raise the temperature
• At a fixed dewpoint, raising the temperature a small
amount will reduce the relative humidity a large amount.
76
Temperature / RH Change At Fixed DP
SA 46°/46°DP
77
Humidifier Control
Return Air From Various Spaces
EXH / 74°
Relief HW RA 74°
Typical
STM
Alternative
OA Supply
70°
55°/54°
• If humidifier is set for 50% in RA, it will maintain 74°/50%  54° dewpoint.
This will cause condensation on surfaces below 54°.
• Humidity controls are typically unreliable and crude. Significant swings in
humidity are common.
• Solution: Set humidifier to minimum 35° dewpoint in SA.
78
What’s Wrong with DX Systems?
79
DX – What’s The Problem?
• Controlled by dry bulb thermostat
• Air cools to saturation
• Thermostat satisfied
• CPR turns off
• Water on coil evaporates
• Unconditioned OA enters
• Dewpoint and RH rise quickly in room
• Clammy feeling until CPR turns back on
80
How About A Desiccant System?
81
Desiccant – Science
• Pre-heat to protect chilled water coil in winter.
• Outside air is pre-cooled using chilled water to remove as much
moisture as possible.
• Desiccant wheel rotates (think cotton candy).
• Wheel absorbs moisture from incoming air.
• Steam heats and dries out the desiccant.
• Hot, dry air (Arizona) is introduced to the air handler where the dry
bulb temperature is reduced at the normal chilled water coil.
• Complicated, large, sensitive
• Requires good psychrometric knowledge
82
Chilled Beam
• Sensible cooling only; you don’t want condensation
on chilled beam
• Supply 2 ACH cold air
• Recirculate 4 ACH across chilled beam
• CHW temp must be  Room dewpoint
• CHW piping to each chilled beam
• Can 2 ACH dilute air to acceptable humidity with
visitors?
83
Chilled Beam in Patient Room
84
So What?
• Set supply air at low temp, or control SA on desired space
dewpoint
• Be very careful with energy saving strategies. Temp and
humidity sensors must be very accurate and can get very
complicated.
• Use dewpoint in talking to staff
• Use sling psychrometer
• Try to align doctor’s expectations with system capability
• Don’t give staff humidity control
• Control humidifier from SA not RA
85
So What?
• Know psychrometrics, get comfortable via daily use
• Use real numbers: e.g., Hot day humidity is 50% @ 86°,
DP = 63°
• Raise OR temp until RH ≤ 60%
• Run low CHW temp
• Minimize OA
• Verify control accuracy, setpoints and sequences
86
Resources
• iPhone Apps
 Psychrometric L.T. App
 Munters Psychro App
• http://www.noaa.gov/ Weather/Government
• www.WeatherUnderground
87
Questions?
Part 1-5:
Emergency Preparedness
Emergency Preparedness
Catastrophic Events
• Internal and external catastrophic events may affect the ability
of an institution’s HVAC systems to provide the intended
services.
• An earthquake, train wreck, chemical spill, bio-terrorism, or
infectious epidemic presents an added set of design
considerations.
• Example: the designation of emergency spaces to serve
larger than usual numbers of victims.
90
General Principles of Emergency
Preparedness (1)
1. Design several spaces as alternative diagnostic and treatment
areas for use when ordinary hospital areas are overrun or out
of commission.
2. Install additional exhaust capability in several areas. These
areas can then be used to treat people in an epidemic or
catastrophe. This is especially important in areas accessible to
the general public.
3. Design additional large areas with ventilation isolation that
could be used for triage or treatment, such as lobbies, waiting
areas or dining areas.
91
General Principles of Emergency
Preparedness (2)
4. Design for external wash/decontamination capability.
5. Design existing smoke-control and ventilation pressurization
systems and defend-in-place procedures so they can be
used in cases of internal chemical or biological
contamination.
6. Provide security for hospital air intakes, mechanical
equipment, and entrances for people and material.
92
Disaster Classification
An Internal disaster affects the hospital itself, its
patients, systems, personnel, and/or its spaces;
(e.g., a fire within the hospital, outbreak of nosocomial
infection)
An External disaster (e.g., hurricane) might affect
internal hospital systems such as the power supply or
might add many more patients than the hospital’s normal
capacity (chemical spill, epidemic)
93
Planning For Internal Disaster (1)
1. Fire
2. Power Disruption (Emergency Power)
3. Water supply disruption or contamination (Alternate Source)
4. Ventilation System failure or contamination
(Relocation/Redundancy)
5. Heating system failure (Redundancy)
6. Fuel supply disruption (Alternate Source)
7. Nosocomial infection outbreaks (Pressurization Control
Strategy)
94
Planning For Internal Disaster (2)
8. Structural failure (earthquake, flood, tornado, explosion)
(Relocation)
9. Terrorist attack on the hospital itself (chemical, biological,
explosive) (Ventilation Design - Outdoor Intakes -
Pressurization)
10. Elevator failure (Alternate procedures/ Redundancy)
11. Steam system failure resulting in lack of sterilization capacity
(Alternate sources of sterilization - Redundant Systems)
95
External Disasters (1)
• Multiple trauma disasters
a. Accidental (vehicular pile-up, hurricane, tornado, fire,
earthquake)
b. Terrorist (explosion)
• Chemical disasters
a. Accidents (wreck involving chemical tank car)
b. Terrorist (water supply contamination, airborne/explosive,
food contamination)
• Evacuation disaster
a. Accommodation of patients and staff from an evacuated
healthcare facility
96
External Disasters (2)
• Biological disasters
a. Unidentified severe illness, possibly infectious
b. Epidemic (waterborne, airborne, insect vector)
c. Terrorist (water supply contamination, airborne/explosive,
food contamination)
• Nuclear disasters
a. Accidental (industrial)
b. Terrorist
97
Planning For External Disasters (1)
1. Trauma Events
(Boston Marathon bombing, massive automobile disaster, tornado)
• Additional spaces designed to become triage areas,
treatment areas or convalescing areas
• Design for additional sterilization and
ventilation/humidification during emergency
• Plan for additional water and medical gases during
emergency
98
Planning For External Disasters (2)
2. Chemical / Nuclear Events
• Design for additional provisions for decontamination;
perhaps outside the facility
• Design for additional provisions for ventilation isolation
3. Biological Events (Epidemics)

• Spaces designed to become isolated from a ventilation
standpoint in an emergency
• Design for spaces to become isolation wards in an
emergency
99
Physical Security
• Prevent access to outdoor air intakes
• Relocate outdoor air intakes
• Special filtration / treatment of outdoor air
• Establish a security zone around air intakes
• Prevent public access to mechanical areas
• Prevent public access to building roofs
• Implement security measures, guards, alarms, cameras
• Isolate lobbies, mailrooms, loading docks and storage
• Secure return air grilles
• Restrict access to building operating systems
• Restrict access to building information
100
Outdoor Air Intakes
101
Outdoor Air Intakes
102
Outdoor Air Intakes
103
Decontamination Areas
Decontamination facilities can be located outside the
facility. Can be permanent or portable; e.g., collapsible
tent-like enclosures.
104
Emergency Decontamination Corridor System
105
Alternative Isolation Spaces
• A space other than the triage area and the general hospital
can be designated for isolation of patients thought to be
infectious.
• The designated isolation area should have total exhaust and
negative pressurization.
• Additional ventilation components/controls will be required.
106
Alternative Treatment Spaces
• Emergency rooms and operating rooms serve as treatment
areas and can serve as disaster treatment areas, unless they
are damaged by the disaster.
• Delivery rooms can be taken over as disaster treatment and
operating rooms.
• If the hospital medical staff is large (more available doctors
than existing treatment rooms), auxiliary areas can be
designated as disaster treatment areas and should be
equipped with appropriate ventilation and emergency power.
107
Alternative Sterilization Spaces
• Sterilization can become a problem if the hospital’s steam
generation capability is interrupted. Autoclaves that use an
alternative energy source are required. Sterilization is
necessary for surgical instruments, fluids, linens and
reusable equipment.
108
Part 1-6:
Life Safety and Fire Protection
The Life Safety Approach for Hospitals
• Hospitals must rely on the building and building systems to
protect its occupants while they remain in place. Corridor
walls are built smoke-tight, if not of rated construction, to
protect patients in their rooms. Smoke compartments are a
key facet of fire protection.
• This is called a Defend-In-Place strategy, which works in
stages.
110
Terminology
• Smoke Compartment = sub-division of building into areas
• Smoke-tight (resistant) = sealed construction to prevent
smoke passage, typically at corridor walls
• Fire-rated = designated walls and floors constructed to UL
listing criteria; use of fire caulk and listed penetrations; i.e., at
storage rooms, elevator shafts, mechanical / electrical
chases, etc.
• Smoke-rated = designated walls and floors constructed to UL
listing criteria; typically surround the smoke compartment
111
Smoke Control and Life Safety
Defend-in-Place
• HVAC systems play a major role in the life safety of patients
and staff. Transport of fire or smoke via the HVAC system
within the compartment or between compartments can defeat
the Defend-in-Place approach.
• Passive Smoke Control – AHU shutdown can be a key
factor in patient safety.
112
Stage 1 – Fire in a room can be extinguished and smoke
controlled. Only those occupants in the immediate fire
area would have to be evacuated from their rooms.
Stage 2 – Fire occurs in a smoke compartment; the nursing

staff closes the doors to all patient rooms, allowing
patients to remain in relatively clean environments, even
though there is a fire in the same general area.
113
Stage 3 –
• If evacuation of patient rooms becomes necessary, relocate
occupants of the smoke compartment where the fire originated
into another compartment on the same floor.
• Relocate patients horizontally and provide a safe holding area on

the floor where a fire originates, so that patients can be wheeled
or otherwise relocated without using stairs or elevators.
114
Stage 4 –
• Elevators or stairs can be used to evacuate patients from the
building. If the fire protection systems work as designed, this
evacuation stage should never be necessary.
• HVAC systems play a major role in the life safety of patients
by reducing the movement of smoke.
115
Smoke Compartment (1)
• NFPA 101 and the model building codes require separating a
hospital building into smoke compartments. Smoke
compartments must not be larger than 22,500 ft2, and must
limit the travel distance to a required smoke barrier from any
point within a room to 200 feet.
• Some codes limit the dimensions of smoke compartments
rather than limiting the travel distance to reach a
compartment.
• By code, Ambulatory Surgery Centers will have a minimum of
2 smoke compartments.
116
• A smoke compartment is intended to limit the number of
people who need to be relocated and allows the transfer of
beds or gurneys from (and into) adjacent compartments. It is
constructed of 1-hour fire/smoke-rated walls and has self-
closing doors at barrier walls.
• The architect will depict this sub-division of the space and
designation of fire and smoke walls on the Life Safety plans.
• The HVAC design must be coordinated with the Life Safety
plans and the HVAC smoke control provisions (passive or
active), automatic sprinkler design, and fire alarm system
design.
117
• Ducts penetrating smoke compartment walls or barriers require
Fire/Smoke Dampers.
• HVAC system zoning should match smoke compartment, and duct
routings should avoid multi-crossings of the compartment walls.
• If an HVAC system serves multiple compartments, minimize ducts
crossing the fire/smoke walls.
• Don’t use small F/S dampers; oversize the duct, because pressure drop
will be high. Verify actuator capacity required.
• Approved fire-stopping materials must protect piping and other
penetrations of these walls.
• Be sure to specify smoke damper for design velocity of air.
• Label rated walls
118
Fire and Smoke Dampers
Critical Design Issues – Fire/Smoke Dampers
& Smoke Dampers
• Make sure adequate access is provided to actuator.
• Insist on access panels immediately next to the damper for access.
• Access panels should be close to the same width as the duct width and
at least 12-18 in. long in the length of the duct.
• Access must be provided to the smoke detector; make sure the access
panel is on the same side!
• Fire dampers MUST be inspected periodically.
• Large dampers are difficult to reset without adequate access.
• If space permits, specify dampers with the blades outside the airstream.
• Label dampers on plans and dampers.
119
Passive Smoke Control
• As with any life safety system element, passive smoke control
barriers require inspection and ongoing maintenance. The
barriers must be maintained at a level that can resist the
passage of smoke and contain smoke in the area of fire origin.
• An integral part of Passive Smoke Control effectiveness is the
shutdown of air handling systems and related general exhaust
systems in the areas under alarm and closely adjoining areas.
• In most cases, specialty exhausts (AII, Lab Hood, etc.) should
remain operating to ensure personnel and patient safety.
120
Active Smoke Control – When Applicable
• Defend-In-Place is the primary concept for fire protection and
life safety in healthcare facilities.
• Some local codes and jurisdictions require Active Smoke
Control designs.
• Most codes (NFPA, others) require that high-rise hospitals or
clinics (over 75 feet) have Active Smoke Control.
• Verify amp draw of smoke dampers vs. fire alarm system.
121
Active Smoke Control – Special Cases
• Defend-In-Place is the primary concept for fire protection and
life safety in healthcare facilities.
• Most codes require Active Smoke Control for Atrium spaces.
• Authorities Having Jurisdiction (AHJ) may require that
operating rooms have the capability to prevent smoke
recirculation from a fire within the OR suite – referred to as
Smoke Purge. See NFPA 99.
• Usually accomplished by moving dampers to provide 100%
OA intake and 100% exhaust
122
Part 1-7:
Construction in Existing Facilities
Issues
• Initially, the HVAC systems installed represented the best
technology available at the time.
• Afterwards, most hospitals go through extensive remodeling,
upgrading and additions.
• This results in a wide variety of HVAC system types, ages
and conditions of equipment – and usually physical space
limitations.
124
Guiding Principles
• Meet program intent
• Fix existing infrastructure problems
• Document construction procedures
• Infection control risk assessment
• Commissioning
125
Design Process for Existing Facilities (1)
• Conduct Facilities Condition Assessment (FCA)
Code / Condition / Capacity
• Evaluate what the renovations/additions present in terms of
capacity and condition existing systems.
• Evaluate the continuity of services to areas not being
modified.
126
The following steps are essential:
• Pre-construction air system and water system testing
• Ensure that plans for remodeling include strategies to
protect areas not under construction from construction
debris and dust
• Determine uses of adjacent spaces including above and
below
• Determine source and capacity of utilities
127
• Ensure that HVAC systems serving areas other than the
construction zone maintain adequate air flows and pressure
relationships during construction.
• Ensure that air supplied to the construction zone is not
recirculated to other areas.
• Prepare for continuity of service. Plan for temporary HVAC
equipment when necessary.
• REPLACE, REPLACE, REPLACE!
128
Typical Existing Problems (1)
• Air filtration may not be up to current standards.
• Older equipment may not have the capacity to meet new
loads or may be at end of its life cycle.
• Controls may be older – in need of upgrade or lacking in
performance.
• Ductwork may be dirty or lined, especially return and exhaust
ducts.
• Hydronic systems may exhibit deterioration of piping and
control valves.
129
• Horizontal or vertical space for distribution may not be
available to permit addition of new systems or elements.
• Systems may be energy-intensive.
• There may be insufficient clearance for adequate
maintenance.
• There may be significant “deferred” maintenance.
130
• Systems may not be appropriate for changing functions or
technology, such as required to change a patient room into
a laboratory space.
• Systems may have improper air or water flow.
• Systems may not have performed originally and are in dire
need of retro-commissioning.
• Central chiller plants may contain CFCs and/or need to be
upgraded due to age of equipment, lack of flexibility, or
capacity.
131
Demolition (1)
• HVAC Demolition Drawings must include the ICRA solution
depicted on demo HVAC drawings
• Exhaust fans or HEPA-filtered fans to maintain negative
pressure in the construction zone
• Pressure gauges to confirm negative pressure in the work area
• Walk-off mats – wet or sticky
• Covered carts
• Documentation of daily activities and conditions
132
Demolition (2)
Preparations for demolition must also include:
• Ventilation control
• Air-handling systems that serve areas under construction
should be turned off
• Return air openings in the construction area should be
sealed. If this is not practical, provide filters over all return
openings.
133
Construction Phasing
• Renovation usually must be phased to ensure continuity of
services, Interim Life Safety requirements, patients and staff
traffic.
• Work may have to be done during night time, weekends or
other unoccupied times.
• Show points of connection – new to existing – and show
partial plans with temporary systems or services and interim
layouts as necessary to reflect the work needed.
• May require portable AHU.
134
Infection Control Risk Assessment (IRCA)
The AIA Guidelines for Design and Construction of
Hospitals and Health Care Facilities states:
“Early involvement in the conceptual phase helps

ascertain the risk for susceptible patient(s) and
[the risk of] disruption of essential patient
services.”
This consultation in the initial stages of planning and design
is termed an Infection Control Risk Assessment (ICRA).
135
ICRA (1)
1. Coordination of construction preparation and demolition
2. Operating and maintaining facilities during construction
3. Post-construction cleanup
4. Monitoring during and after construction
5. Accountability and recordkeeping
136
ICRA (2)
6. The ICRA should be carried out by a multidisciplinary
planning group that should involve, at minimum,
representatives from the Infection Control / Epidemiology
Department, design architects/engineers, facilities
engineers, contractors, environmental services and
administration.
137
ICRA (3)
7. Which patient groups and employees are susceptible to
risks from the proposed construction process?
8. Which ventilation systems are involved and how close are
they to the construction?
9. What effect on space pressure?
10. Are current ventilation controls operating according to
original design intent?
11. Will supplemental ventilation be required during the project?
138
ICRA (4)
12. Will fire code interim life safety requirements during
construction affect ventilation requirements?
13. Is special ventilation for infectious disease prevention
(tuberculosis or aspergillosis) affected during construction?
14. What impact will noise and vibration have on occupants,
sensitive procedures or equipment?
15. How will perceptions affect patients during various noisy or
odorous procedures?
16. Is there a history of water damage in renovated areas?
139
Infection Control Risk Assessment
Step 1 – Identify the Type of Construction Project Activity
Inspection and Non-Invasive Activities
Includes, but is not limited to:
• Removal of ceiling tiles for visual inspection only; e.g.,
limited to 1 tile per 50 ft2
TYPE A • Painting (but not sanding)
• Wall covering, electrical trim work, minor plumbing, and
activities that do not generate dust or require cutting of
walls or access to ceilings other than for visual
inspection
140
Step 1 – Identify the Type of Construction Project Activity
Major Demolition and Construction Projects
Include, but are not limited to:
• Activities that require consecutive work shifts
• Heavy demolition or removal of a complete cabling
TYPE D system
• New construction
141
Step 2 – Identify the Patient Risk Groups
Low Risk Medium Risk High Risk Highest Risk
 Office  Cardiology  CCU  Any area caring for
areas  Echocardiography  Emergency Room immunocompromised
 Endoscopy  Labor & Delivery patients
 Nuclear Medicine  Laboratories  Burn Unit
 Physical Therapy (specimen)  Cardiac Cath Lab
 Radiology/MRI  Medical Units  Central Sterile Supply
 Respiratory Therapy  Newborn Nursery  Intensive Care Units
 Outpatient Surgery  Negative pressure
 Pediatrics isolation rooms
 Pharmacy  Oncology
 Post-Anesthesia Care  Operating rooms
Unit including C-section
 Surgical Units rooms
142
Step 3 – Match the…
Patient Risk Group (Low, Medium, High, Highest) with the planned…
Construction Project Type (A, B, C, D) on the following matrix, to find the…
Class of Precautions (I, II, III or IV) or level of infection control activities
required.
Patient Risk Group TYPE A TYPE B TYPE C TYPE D

LOW Risk Group I II II III/IV
MEDIUM Risk Group I II III IV
HIGH Risk Group I II III/IV IV
HIGHEST Risk Group II III/IV III/IV IV
143
Part 1-8:
Central Heating Systems
Heating Loads
• Preheating
• Reheating
• Domestic Hot Water
• Sterilization
• Humidification
• Absorption Cooling (limited cases)
• Laundry
• Dietary
• Heating required ALL YEAR
145
Key Considerations
• Ratio of process load (laundry, dietary, sterilization,
humidification, domestic water heating) to space heating /
reheating load
• Location of users to central heating plant and each other
(laundry, dietary, central sterile preparation)
• Redundancy / reliability requirements
• Operational requirements, maintenance and life-cycle cost
effectiveness
• DHW piped from CEP?
146
Steam System Pressure Classifications
• Low Pressure – Less than 103.5 kPa (15 psig)
• Medium Pressure – 103.5 - 517 kPa (15 - 75 psig)
• High Pressure – Greater than 517 kPa (75 psig)
• Higher Pressure = Higher system losses
147
Steam Pressure Requirements (1)
• Laundry Equipment: 276 - 621 kPa (40 - 90 psig)
• Steam Sterilizers: 276 - 217 kPa (40 - 75 psig)
• Kitchen Dishwasher Booster Heating: 104 - 207 kPa
(15 - 30 psig)
• Kitchen Steam Kettles: 104 - 207 kPa (15 - 30 psig)
• Kitchen Serving Line: 35 - 104 kPa (5 - 15 psig)
148
Steam Pressure Requirements (2)
• Steam-to-Steam Generators: 104 - 414 kPa (15 - 60 psig)
• Direct Humidifiers: 104 kPa (15 psig)
• Heating Water Heat Exchangers: 35 - 104 kPa (5-15 psig)
• Domestic Water Heat Exchangers: 35 - 104 kPa (5-15 psig)
• Double Effect Absorption Cooling: 689 kPa (100 psig)
• Steam Heating Coils: 104 kPa (15 psig)
149
Boiler Selection
• Fire tube life 15-25 years, water tube 25-50+ years
• Vertical: small footprint, high efficiency reported
• Can use condensing boiler for small HW loads; burn gas only
• An excellent option is to use 3 boilers:
 50% / 50% / 50% of Peak Load
 75% / 75% / 25% of Peak Load
• May wish to size one boiler for reduced “summer loads”
 Process loads
 Reheat loads
• N+1 = Capacity to withstand loss of largest boiler
• 96-hour fuel supply, natural gas not considered standby fuel
• Full heating system on emergency power
150
Central Plant
• It is often advantageous to dedicate one boiler to laundry due
to higher steam pressures
• All auxiliary components redundant and on EPS: boiler feed
water pumps, condensate pumps, steam traps, control valves,
etc.
• Heating water components redundant and on EPS:
exchangers, pumps and control valves
• Emergency water supply; impacts cooling
• DHW redundancy
151
Option 1: Medium-Pressure Steam Plant
• Two or more medium-pressure steam boilers and associated
boiler auxiliaries
• Steam pressure set to meet maximum requirement
• Pressure reducing required for lower pressure requirements
• Heat exchangers required for heating water and domestic
water heating
152
Medium-Pressure Steam Plant
153
Option 2: Medium- & Low-Pressure Boilers (1)
• Medium-pressure steam boilers and associated boiler
auxiliaries dedicated to medium-pressure process loads
(laundry, sterilizers, clean steam generators)
• Low-pressure boilers dedicated to space heating/ reheating,
domestic hot water, humidification
• Evaluation based on proportion of process loads to total
heating requirements and load profile hours
154
Option 2: Medium- & Low-Pressure Boilers (2)
• Life cycle cost evaluation needed
• Appropriate where process loads are small relative to heating
or are of short duration (laundry operates for only one shift –
sterilizers provided with steam with local generators)
• Reduce costs of continuous supervision by licensed boiler
operator – usually at 104 kPa (15 psi)
155
Medium-Pressure/Low-Pressure Central Plant
75-100
psi
30 psi header
156
Option 3: Medium & Steam Plant
With Hot Water Boilers
• Medium-pressure steam boilers for process loads (laundry,
sterilizers, clean steam generators) or local steam generators
• Hot water boilers for space heating/reheating and domestic hot
water
• Evaluation based on proportion of process loads to total heating
requirements and load profile hours
• Best in climates with low heating requirements or smaller facilities
• Can take advantage of higher efficiency heating water boilers
• Reduce cost of boiler supervision
157
Medium-Pressure Boiler Plant/
Heating Water Boilers
60-100 psi
HW Header
158
Option 4: Dedicated Heat Recovery Chiller
for Space Heating/Reheating or Domestic
Water Heating (1)
• May be used in conjunction with any of the previous three options for an
overall plant
• Requires continuous reheating and domestic water heating loads
• Requires continuous cooling load
• COP of 2.5 - 4.0 compared to COP of 0.70 for a normal heating system
• Sizing should be accomplished based on average heating load
requirements, not cooling load
• May be provided in as small as 30-ton modules to fit into smaller
mechanical room spaces
159
Option 4: Dedicated Heat Recovery Chiller
for Space Heating/Reheating or Domestic
Water Heating (2)
• Reheating and heating coils should be sized to operate with
55°- 60°C (130°- 140°F) entering temperature instead of 80°C
(180°F) traditional.
• In cold climates or in retrofit applications, the main heating
systems are required to boost the temperatures in cold
months.
• Use to pre-cool chilled water return temperature in warm
months – may be only chiller in winter months.
160
Typical Current Cooling System
161
Dedicated Heat Recovery Chiller
(Water/ Water Heat Pump) –
Return Chilled Water / Heating Water
162
Effectiveness of Heat Recovery
• Coefficient of Performance (COP) = Energy Input Out / Energy
Input In
• Traditional Boiler – Thermal Eff 80% = COP 0.8
• Traditional Boiler – System Eff 70% = COP 0.7
• High Efficiency Boiler – Thermal Eff 88% = COP 0.88
• Heat Recovery Chiller – Heating COP 3.5-4.8 depending upon
operating temperatures
• FOUR TO SIX TIMES THAT OF A TRADITIONAL
BOILER
163
Effectiveness of Heat Recovery
• Heat Recovery Chiller – COP 3.8 – Input: 210,520 Btu/h
(61.6 kWh)
• Average Cost per kWh: $0.05 (Could average less
depending on demand effect)
• Cost for 800,000 Btu – $3.08 HR Chiller
• There are also additional significant water consumption
savings for using the heat in the building
164
(Water / Water Heat Pump)
• Dedicated Heat Recovery Chillers (DHRCs) can be used
in various sizes to fit physical space constraints and
heating needs
• Should be considered as heating devices with cooling
capacity as a beneficial by-product
• Sized based on average heating load
165
(Water / Water Heat Pump)
• Ideal candidates for winter chillers for smaller radiology or
other non-economizer cooling loads
• Economically beneficial to eliminate air-side economizer
sequences in some cases
166
Dedicated Heat Recover Chillers – ROI
Northeast Major Medical Center
Example: Partners Healthcare
Dedicated Heat = Mass
Recovery Chiller General
DHRC Savings Hospital
Zone Current DHRC DHRC Heat Pump
Reheat Reheat Energy use DHRC Energy Cost ($) Energy Use Savings Total Savings $
BTUHs 106 Cost ($) (kWh) (MMBTU) (MMBTU)
2112 $32,739 0 $0 0 0 $0
2015 $31,237 0 $0 0 0 $0
2112 $32,739 0 $0 0 0 $0
2064 $31,988 0 $0 0 0 $0
2112 $32,739 56325 $7,886 192 1920 $24,854
2064 $31,988 55033 $7,705 188 1876 $24,283
2112 $32,739 56325 $7,886 192 1920 $24,854
2112 $32,739 56325 $7,886 192 1920 $24,854
2064 $31,988 55033 $7,705 188 1876 $24,283
2112 $32,739 56325 $7,886 192 1920 $24,854
2064 $31,988 0 $0 0 0 $0
2112 $32,739 0 $0 0 0 $0
12576 $388,363 335368 $46,952 1145 11432 $147,981
3-50 Ton Modules and Accessories Cost $ 446,670 - 3 Year Payback
167
168
Flue Gas Heat Recovery – Boiler Stacks
169
Flue Gas Heat Recovery (1)
• Flue gas heat recovery systems may be effective in
healthcare applications due to constant need for heating
• Normal payback of 2-3 years
• Best used to heat boiler feed water
• Separate condensing heat exchanger may be used to heat
space heating water
• Tricky to heat condensate return
• Care must be taken to control the flue gas temperature to
avoid condensation (flue gases less than 137°C; 280°F)
170
Flue Gas Heat Recovery (2)
• Corrosion-resistant materials must be carefully specified
depending on the nature of the fuel source
• Induced draft flue gas fan may be required
• Provide accessibility to the heat exchange surfaces for
cleaning and a method to operate the boiler during
maintenance (bypass around flue gas heat exchanger)
• Increases maintenance and complexity
• Avoid producing steam
171
On-Site Fuel Supplies
• Most jurisdictions with significant heating requirements
require an alternative heating fuel source
• Dual-fuel steam boilers are available in most sizes and
configurations utilizing both natural gas and some type of
fuel oil; 96-hr supply required
• Liquid propane / air mixing system can be used to produce
an equivalent backup to natural gas
• May allow Owner to purchase natural gas at favorable
interruptible rates
• UST and air quality permits required
172
Domestic Water Heating
• Can be provided through steam or hot water heat exchangers or
through separate fuel-fired equipment or heat recovery chiller up to
140°F
• Redundancy and EPS required
• Use storage capacity to handle large load fluctuations (laundry /
kitchen)
• Instantaneous steam water heaters are very effective for domestic
water loads. These have the advantage of low standby losses
compared to tank type heaters and storage. Requires steam supply,
mixing valves.
• Boosters for dishwasher and laundry
• Use flow limiters on recirculation loops to limit return/mixing
173
Dedicated Heat Recovery Chiller (Water /
Water Heat Pump) – Domestic Water Heating
174
Control of Legionella
• Storage should be at 60°C (140°F) or greater, or separate

treatment methods must be employed
• Recirculate
• Dead-ends should not exceed 20 ft
• Mixing valves on each fixture or zone with 140°F supply
• 118°F at faucet
175
Typical Domestic Water Requirements
• Domestic hot water – washing / bathing, janitorial: 40°– 52°C
(105°– 125°F)
• Kitchen dietary: 60°C (140°F)
• Kitchen dishwashing final rinse: 83°C (180°F)
• Laundry uses: 60°– 72°C (140°–160°F)
• Max 48°C (118°F) delivery temperature
176
Humidification
• Can be provided from central boiler steam, steam-to-steam
generators, or local electric or gas sources
• Studies have indicated no adverse effects of using central
boiler plant steam for humidification with careful use of FDA
approved treatment chemicals (Amines)
• Separate local steam generation for humidification is cost
effective in climates where little humidification is required or
where humidification needs are located far from the central
steam sources
177
Sterilizers
• Can be provided from central boiler steam system or local
electric self-generating sources
• Use of local steam generation is cost effective where
sterilization loads are low compared to other low-pressure
heating requirements or where sterilization needs are located
far from the central steam sources
• Usually require 276-517 kPa (40-75 psi)
178
Part 1-9:
Central Cooling Systems
Cooling Requirements
• Space sensible cooling
• Humidity control in spaces
• Significant cooling due to reheat
• Outdoor air sensible cooling and dehumidification
• Equipment sensible cooling – radiology and other medical
equipment
• Most healthcare facilities have need for some mechanical
cooling ALL YEAR, even in winter months
180
Unique Considerations for Cooling Loads
Carefully understand air change rates, space
temperature and relative humidity requirements for:
Operating Suites Treatment Spaces
Radiology Suites Administration
Laboratories Emergency Dept.
Patient Rooms Outpatient Services
Dietary Morgue
Sterile Supply Procedures
181
Low-Temperature Considerations (1)
• Potential low temperature operating conditions: As low as
16°C (60°F) – 60% RH OR’s – other special spaces
• Review psychrometrics and required cooling coil discharge
temperatures to meet space requirements
• Select cooling coils for proper discharge temperature/
dewpoint conditions at design entering chilled water
temperature
• Consider separating air handling systems so areas with more
extreme cooling requirements are served by separate AHUs
182
Low-Temperature Considerations (2)
• Use DX re-cooling coils downstream of main air handling
units to serve specific high cooling requirement areas
• Re-cool coils could be served by a separate air cooled or
water cooled chiller or condensing unit
• Re-cool coils with CHW may not reduce dewpoint
• More detailed sequences of operation and control will be
required
• More maintenance will be required and condensate handled
in a remote location
• Often needed for humidity control
183
Imaging Cooling Systems
• Review if separate chillers will be provided by equipment
manufacturers to cool equipment or if central chilled water
can be used.
• Is cooling load inside the space or outside?
• Review chilled water temperature requirements for types of
medical equipment and determine if separate heat
exchangers or mixing control will be required.
• If central system, exchange or filter probably required.
184
Chiller Selection
• Redundancy – Minimum of two chillers should be used; each with
enough capacity to handle the minimum amount of load critical to the
hospital or the entire hospital load
• An excellent option is to use 3 chillers:
 50% / 50% / 20% Peak Load
 May wish to size one chiller for reduced “winter loads” or heat recovery chiller
• Number of chillers and type should be evaluated based on part-load
and Life Cycle Cost Analysis
• Carefully evaluate peak coincident cooling loads and loads during
different seasons and during unoccupied periods before determining
number and size of chillers to be used
• Size to accept loss of energy recovery equipment
• Size to allow future expansion
185
Auxiliary Components
• Chiller plant auxiliary components should be designed with
redundant backup equipment: chilled water pumps, some
control valves, controls, compressors, condenser water
pumps, cooling towers, condensing units, etc.
• Key – Evaluate which areas could be without cooling for a
period of time if any chiller fails: Admin? Outpatient Areas?
186
Water-Side Economizer
• In many climates, a plate-and-frame heat exchanger is cost
effective and can provide for most cooling needs in the late
fall, winter and early spring seasons.
• A water-cooled economizer system allows the elimination of
air-cooled economizer, which is more costly and presents
humidity and maintenance challenges.
187
Plate-and-Frame
Heat Exchanger
188
189
• Usually a good payback: 3-5 years
• Need to be careful about maintenance – straining of
condenser water
• Careful sequences and control needed to avoid conflict with
chiller operation – Condenser Temps
• Usually operates below 42°- 45°F outdoor wet-bulb
• Careful cooling tower control must be employed
190
Chilled/Condenser Water Temp Setback
54.3oF
59.1%
37.9oF 2029.9 GPM
2166.0 GPM
46.0oF
191
CHW Pumping System
• Chilled water plant distribution can be designed in one of two
different arrangements:
 Primary/secondary pumping arrangement; either constant flow
or variable flow
 Primary variable flow
• Primary variable flow has several control and energy
conservation advantages and should be evaluated on a Life
Cycle Cost basis
• Use pressure-independent valves on coils
• Variable primary more sensitive – hard to control
192
CHW Temperature Selection
• Life cycle cost effectiveness and first-cost will be improved
by using as high a “delta temp” as possible:
 Chilled water: 14°- 16°F
 Condenser water: 12°- 14°F
• These temperature differences cannot be applied to an
existing building with existing AHU cooling coils and maintain
performance – existing cooling coils will need to be replaced
• Low temperatures = more tonnage in same pipe size
193
194
195
Part 1-10: Energy Usage and
Energy Conservation in
Healthcare Facilities
Energy Usage in Healthcare Facilities
• Average healthcare facility uses 3-5 times the annual energy
consumption/area (ft2) of a typical commercial facility
• Average consumption ranges from 2870 to 3785
(MJ/m2)/year (250,000 to 330,000 Btu/ft2 /year)
• Average utility costs range from $4.00 to $9.00/ ft2 /year)
• Why do healthcare facilities consume so much energy?
197
Healthcare Energy Metrics
• EUI = Energy Use Index = kBtu / ft2 / year
• National Hospital Average: 250 kBtu / ft2 / year
• EPA Energy Star: 170 kBtu / ft2 / year (32% Red)
• Labs 21 laboratory average: 330-400 kBtu / ft2 / year
• Recent high-performance healthcare facilities: 125-150 kBtu /
ft2 / year (50% Red)
198
Healthcare Energy Metrics
• One average-sized hospital produces 18,000 tons of carbon
dioxide (CO2) annually
• Hospitals in the USA use 836 Trillion Btu of energy annually
• Average hospital produces 30 lbs. of CO2 per square foot
199
Current Healthcare Business Model
• Currently, most healthcare systems’ profit margins are only
2%-3% (many are less).
• These margins mean the institution must generate $33-$50
in annual revenue to make $1 in margin.
• Healthcare systems must increase their margins to provide
funding for future challenges.
• Annual energy and water expenditures are about 1%-2% of
annual healthcare facility operating costs – equal to the
current margin.
200
Factors Resulting in High Energy Usage in
Healthcare Facilities Include:
• Supply air change rates
• Outdoor air requirements
• Humidification
• Dehumidification
• Significant filtration and fan energy requirements
• Extremely high reheating requirements due to air change rates
greater than required to meet sensible loads
• 24 hour/day - 7 day/week operation
• Wide range of space comfort conditions:
 OR’s cooling as low as 16°C (60°F) @ 60% RH
 Nurseries: 24°– 27°C (75°– 80°F)
201
Where is the Energy Used in a Healthcare Facility?
• Review of a General Regional Hospital – 29 270 m2 (315,000
ft2) (Davenport, Iowa)
• All healthcare functions:
 Critical & Out-pt. Surgeries  Recovery Suites
 Labor/Del./C-Section Suites  Nursery
 Radiology Suites (Crit./Out-pt.)  Emergency Department
 Laboratory  Cardiac Catherization
 Dietary  Nursing Floors (Med, ICU, CCU)
 Support Services  Administration
 Lobbies/Waiting Areas  Outpatient Treat/P-T
202
Effect of Weather is Small
DOE Modeling of a general regional hospital for:
• Boston • Philadelphia
• Atlanta • Miami
• St. Louis • Chicago
• Minneapolis • Houston
• Tucson • Los Angeles
• Seattle
203
Electrical Energy Usage (kWh)
204
Thermal Energy Use (Btu)
205
Breakdown of Energy Cost
Misc. Steam &

HVAC Kitchen Gas
1.1%
Misc. Equipment Lighting
65% 18.0% 15.6%
Fans Steam for Heating

25.9% 24.2%
Cooling
11.5%
Steam for Domestic

HVAC Pumps Hot Water
2.6% 1.0%
206
Monthly Thermal Energy Usage
100,000
90,000
Total Usage = 434,685 MMBtu Annually
80,000
70,000
60,000
MMBtu/Month
50,000
40,000
30,000
20,000
10,000
0
January February March April May June July August September October November December
207
Major Energy Users
• Ventilation fan energy
• Ventilation air cooling
• Reheating/Space heating
• OA Heating/Cooling/Dehumidification/Humidification
These items account for approximately

59% to 64% of the Annual Energy Cost
in a typical healthcare facility –
no matter its location!
208
Typical OR / Cooling Load
48% 4%
10%
38%
Staff & Patient Lights & Equipment * Minimum OA Reheat

20% OA @ 86°/63 DP, inside 65°/50%
209
How Can We Design More Energy Efficiently?
• Use variable air volume (VAV) control in most areas
• Use larger AHU and ductwork
• Reduce OA and SA during unoccupied periods (normally
25% of occupied requirement is allowed by most AHJ)
• Reduce air flow to minimum space ventilation requirements
during occupied periods when load is low
• Reduce reheat in unoccupied times
• Supply air temperature reset
210
Healthcare Space Occupancies
SPACES TYPICAL OCCUPIED HOURS/WEEK
80% normally occupied
Patient Rooms (occupied)
24 hours 7 days/week
75% normally occupied
ICU Rooms (occupied)
Nurses Stations (significant %) 24 hours 7 days/week
Emergency Room Areas/Exam Rooms 24 hours 7 days/week
Lab Areas (normally 50% of total areas) 24 hours 7 days/week
Emergency Radiology Areas (normally 15% - 25% of total areas) 24 hours 7 days/week
Emergency Surgery/Recovery Areas (normally 15% - 25% of total
areas)
Autopsy 24 hours 7 days/week
Central Sterile Supply 24 hours 7 days/week
Nursery 24 hours 7 days/week
Corridors/Waiting Areas 24 hours 7 days/week
Medical Records 24 hours 7 days/week
Receiving 60 hours/week
Clean Linen Storage 50 hours/week
Hours of Occupancy
• Most Surgeries-occupied hours/week – 65
• Most Recovery Area/Surgery Prep-occupied hours/week – 65
• Most Outpatient Treatment/Phys/Occupational Therapy-
occupied hours/week – 65
• Most Radiology Areas-occupied hours/week – 65
• Most Support Areas/Office Areas-occupied hours/week – 65
• Only about 15% of the hospital is constantly occupied!!!
• Even areas constantly occupied have minimum air change
requirements frequently above load
212
VAV and Pressurization
• Use variable air volume (VAV) control in all areas where it is Life Cycle
Cost effective
• Use variable return air flow tracking on spaces with directional
pressurization control requirements
• Reduce code-required minimum OA and minimum space ventilation air
requirements during unoccupied periods (normally 25% of occupied
requirement is allowed by most AHJ)
• Reduce air flow to minimum space ventilation requirements during
occupied periods when sensible load is low
• Reduce airflow to lowest minimum ventilation to meet Std 62.1 in other
areas – airflow can be almost zero at night
• Lower discharge air temperature setpoint to reduce reheat
213
Considerations for Airflow Setback
• Evaluate hours of occupied operation of the space
• Consider amount of air setback (25%)
• Maintain pressure requirements for continuous directional
air flow control (positive or negative)
• Fail-safe override with status indicator
• Adequate exhaust for room cleaning
• Time delays
• Shut off terminal humidifiers during unoccupied periods
• Maintain corridor pressure
214
Key Design Considerations: VAV in
Clinical Pressurization Control Areas
• Use return air flow tracking terminals or return control dampers to maintain
airflow offset in spaces requiring directional pressurization control.
• Return air flow terminals should be provided with hot wire anemometer air
flow sensors or with filters if normal air flow monitoring is used. Control
dampers may be a simpler solution in some applications.
• Control must be provided to bring the space quickly back to occupied air flow.
• Air handling units should be provided with minimum outdoor air (OA) flow
stations and controls. Reduce OA to 25% or whatever is required for
pressurization.
• Air handlers should be provided with variable frequency controllers for supply
and return or exhaust fans.
215
Key Design Considerations: VAV in
Clinical Pressurization Control Areas
• Minimum terminal supply airflow setpoint will be set to 25% of
occupied periods.
• Return air flow terminals will have a supply airflow setpoint
equal to the supply airflow, plus or minus an offset for
pressurization control.
• Offsets are normally 300-400 CFM for an OR.
• Supply and return fans will control speed, based on measured
airflow quantities based on airflow setpoints.
• Terminal humidifiers will be off.
216
VAV in Critical Care
217
OR Air Flow Setback
218
Areas Requiring Pressure Differentials
• Operating suites
• C-Section
• Radiology treatment
• Procedure spaces
• Recovery
• Therapy
• Bronchoscopy/Endoscopy/GI
• Some laboratory areas
219
Considerations: VAV in Spaces
Without Pressurization Control
• Return air tracking not required.
• Minimum airflow setpoint can be reduced to that required for
ventilation by Standard 62.1 or exhaust requirements.
• Reduce minimum OA to only that required for exhaust and
pressurization during unoccupied periods.
• Air handling units should be provided with minimum outdoor
air flow stations and controls.
• Air handlers should be provided with variable frequency
controllers for supply and return or exhaust fans.
220
Considerations: VAV in Spaces
Without Pressurization Control
• General patient rooms / Nursing stations
• General exam rooms
• Dining areas / Kitchen
• Atrium meeting rooms
• Some laboratory spaces
• Offices / Support areas / Meeting spaces
• Some of these spaces have minimums, but no
pressurization control requirement
• Some spaces may require minimums for exhaust
221
Considerations: Scope of Work to
Accomplish VAV Control
• New variable frequency controllers – Supply/return/ exhaust fans
if not already provided
• New motors for supply/return/ exhaust fans
• New airflow measuring stations for supply/return/ exhaust fans
• New DDC controls for air handling units if not already provided
• New DDC controls for supply terminals if not already provided
• New DDC controls for return or exhaust terminals
• New return or exhaust terminals in existing ductwork
• Ceiling work and infection control measures
• Testing and balancing
• Commissioning
222
Savings Calc:
Surgery Suite AHU System (11 ORs and Support)
1. Code-Required Occupied Air Changes – 30,500 CFM
2. Actual Occupied Period – 4,390 Hrs/Year
3. Actual Unoccupied Period – 4,370 Hrs/Year
4. Unoccupied Air Changes – 8,900 CFM
5. Reheating Savings/Year – 1,735 MMBtu/Year – $29,580/Year
6. Cooling Savings/Year – 252,370 Tons/Hours/Year – $23,500/Year
7. Fan Energy Savings/Year – 13,650 kWh/Year – $11,360/Year
8. OA Heating/Humidification Savings/Year – 1,480 MMBtu/Year – $25,230/Year
9. Total Savings – $89,678/Year Implementation Cost – $323,960
10. Payback – 3.6 Years
223
Similar Savings For:
• Delivery rooms
• C-Section rooms
• Trauma/procedure rooms
• Radiology space
• Cardiac catherization
• Some laboratory areas
• Bronchoscopy
• Other spaces with significant unoccupied hours
224
Reset Discharge Air Temp To Save Energy
• Reduces CHW flow and cooling required
• Especially convenient if on air side economizer
• Control based on dewpoint temperature and
make sure RH is not too high
• Reduces reheat energy significantly
• Can be employed in any areas in the hospital
• Quick payback
• Tune to desired T/RH of each space
225
Match SAT to Space Conditions
66°/
70%
OR
SA 46°/46°DP
66°/50% OR
226
Achievable Cost Reductions
• Electrical energy consumption 30% – 33%
• Thermal energy consumption 53% – 68%
• Overall annual utility cost reduction 39% – 44%
• Simple payback – retrofit design 3 – 4 Years
• Simple payback – new design 1.5 – 2 years
227
Energy Considerations for Architects
• Generous duct sizes
• Space for rounded transitions
• Metering
• Commissioning (designer or 3rd party)
• Reduce glass area
• Shading
• East-West orientation
• Space for maintenance: mechanical room, ceiling, shafts
• Lighting controls
• Water-cooled imaging equipment
• Radiant heat 228
Effects of Static Pressure on Energy
• 100,000 cfm system with VAV
• 2 in. static pressure reduction
• Saves $18,200/year
229
Required Cooling vs. Window Area
4.5 4.2
4.0 3.6
3.5
3.0
3.0
2.5
CFM/ft2
2.5
1.9
2.0
1.5 1.2
1.0
0.5
0.0
4 6 8 10 12 1.25
Vertical Feet of Window
*Data Points are at Peak Cooling (November), RDU, NC
230
Ratio of Solar Gain in Winter to Peak
Heat Load at 20°F Outside Temperature
500%
Cooling Peak Load/Heating Load
450%
381% 386%
400% 364%
350% 330%
300% 276%
250%
200%
150% 109%
100%
50%
0%
4 6 8 10 12 1.25
Vertical Feet of Window 231
Heating vs. Window Area
1400
1200
1000
Btu/h
800
600
400
200
0
4 6 8 10 12 1.25
Vertical Feet of Window
RDU, NC Weather
232
Questions?
Healthcare Facilities: Best
Practice Design & Applications
Agenda
12:00 - 12:40 Part 2-1 Surgery Suite Design
12:40 - 1:10 Part 2-2 Imaging Suite Design
1:10 - 1:30 Part 2-3 Isolation / Patient Room Design
1:30 - 1:45 Part 2-4 Special Use Space Design
1:45 - 2:00 Questions and Answers
2:00 - 2:50 Part 2-5 Commissioning and
Retro-Commissioning
2:50 - 3:00 Closing / Questions and Answers
* Breaks on your own
235
Part 2-1:
Surgery Suite Design
Understand The Big Picture
• Patient outcome is #1 objective.
• Performance is more important than energy conservation.
• Air flow rate is determined by code, not cooling load.
• Codes are established for infection control.
• Temperature and humidity are usually dictated by the
surgeons.
• Heavily regulated design and operation.
237
Surgery Department
• Operating Rooms (OR)
• Sub-sterile Room – typically between ORs for support use
• Clean Corridor
• Pre-Op/Holding/Recovery (Prep/Post)
• Post-Anesthetic Care Unit (PACU)
• Clean Supply
• Related: Central Sterile
238
Surgery Department
• Operating Rooms – often designated by service performed:
 General = general surgery
 Neuro = brain/spine surgery
 CV = cardiovascular surgery
 Transplant = solid organ transplant surgery
 Ortho = orthopedic surgery
• “Laminar Flow” OR – cleanroom-like supply air system
• Open Heart OR – Pump room for support equipment
239
Know Applicable Regulations
• Use and name of room
• Confirm it’s an OR
• FGI / ASHRAE STANDARD 170 or other code?
• Equipment in room
• User’s preferences (on temp, RH, setback)
• Classification of surgeries
• Life Safety Requirements
• Discuss ceiling conflicts and requirements
240
Classification of Surgeries
Class A: Minor procedures under topical, local or regional
anesthesia w/o preoperative sedation. Excluding
intravenous, spinal & epidural procedures.
Class B: Minor or major procedures with oral, parenteral or
intravenous sedation or analgesic or disassociative drugs.
Class C: Major procedures with general or regional block
anesthesia & support of vital bodily functions.
241
Characteristics of Operating Rooms
• Heart: low temp, fast reheat, large room
• Orthopedic: low temp, large room, extra filtration
• Cysto: med temp
• General: med temp
• Pediatric: high temp
• Neuro: low temp, large room
• Trauma: high temp
• Burn: high temp
• C-Section: med temp
242
Recent History of OR Standards:
AIA vs. DEW, NFPA
DATE SOURCE TEMP ºC RH% ACH OA
1974 USDEW 20-25°C (68-76ºF ) 50-60 25 / 25 25 / 5
1978 USDEW 20-25°C (68-76ºF) 50-60 15 / 25 15 / 5
1983 AIA 21-24°C (70-75ºF) 45-60 20 4
1987 AIA 21-24°C (70-75ºF) 50-60 15 3
1992 AIA 21-24°C (70-75ºF) 50-60 15 3
2001 AIA 20-23°C (68-73ºF) 30-60 15 3
2002 NFPA 99 20-23°C (68-73ºF) 50 25 5
2006(2) AIA/FGI 20-23°C (68-73ºF) 30-60 15 3
2010 FGI 68-75ºF 20-60 20 4
243
Recent History of OR Standards, ASHRAE
DATE SOURCE TEMP ºC RH% ACH OA
1971 Applications 20-25°C (68-76ºF) 50 25(1) 25
1987 Applications 20-25°C (68-76ºF) 50-60 15 / 25 (1) 15 / 5
1999 Applications 20-27°C (62-80ºF) 45-55 25 5
2003 Applications 20-27°C (62-80ºF) 45-55 25 5
2003 Manual for Hospital 20-24°C (68-75ºF) 30-60 25 5
S170 Ventilation
2008 20-24°C (68-75ºF) 30-60 20 (2) 4
(FGI 2010)
(1) 100% OA System

(2) 20% MIN, May 2010
244
OR System Design
• Understand sequences of operation
• Pressurization
• Select quality components
• Most common system is CHW with HW reheat
• Year-round cooling load
• Low temp chilled water may meet desired Temp & RH
• Dedicated AHU for OR suite
• AHU must meet requirements of most critical OR
• 20 ACH SA, 4 ACH OA
245
Psychrometric Processes
In Your OR HVAC System
246
Standard Process In Hospital OR
MA 72°/53°DP
OA 90°/64°DP
RA 68°/49°DP
SA 47°/47°
OR 64°/60%
247
The Perfect OR Dew Point 27ºC
(80°F)
21ºC
(70°F)
Higher Dew Point
DEW POINT Acceptable Requires Terminal
16º C
Range Humidifiers
(60°F)
30-60% RH
10ºC Can Reach w/ 3.8ºC
16.6ºC
(50°F) (62°F), 60% (39-40°F) CHW &
7.2ºC
Humidifier In AHU Only
(45-46°F)
4.4ºC
(40°F)
23.3ºC
(74°F), 40%
Lower Dew Point
16.6ºC (62°F), 19.4ºC (67°F),
30% Requires DX, Glycol,
50%
or Desiccant
4.4ºC 10ºC 16ºC 21ºC 27ºC
(40°F) (50°F) (60°F) (70°F) (80°F)
DRY BULB 248
Typical OR / Cooling Load
48% 4%
10%
38%
Staff & Patient Lights & Equipment * Minimum OA Reheat

20% OA @ 86°/63 DP, inside 65°/50%
249
Terminal Reheat Box
• Cool air to remove water via condensation on chilled water coil
• Constant temperature & dewpoint supply air sent to reheat coil
• Air is reheated, to desired room temperature
• Dewpoint constant
250
Reheat Coil
SA 46°/46°DP
Reheat Anywhere on This Line 251

Supply Air CFM
• Air flow is usually determined by code-required air
changes, not cooling load.
• Typical OR load = 6048 kCal/hr [2 ton] 330 L/s
[700 cfm]
• Code = 20 ACH 660 L/s [1400 cfm]
• 4 ACH OA 280 cfm
252
Calculating ACH
Room Dim.: 6m x 6m x 3m = 108 m3 = 108 000 L
20 ft x 20 ft x 10 ft = 4000 ft3
AIR RATE = ACH x Room Volume

Unit Time
= 20 x 4000 ft3 = 20 x 108 000 L

60 min 3600 s
= 1333 CFM = 600 L/s
253
CFM Offset to Achieve Pressurization
Supply – (Return + Exhaust)
We recommend at least 190 L/s (400 cfm)

offset at all times.
254
NEED TIGHT WALLS 255
Calculating % Outdoor Air by Temperature
% OA = 1 – (MA – OA)/(RA – OA)
Example: 22.2ºC (72ºF) return, 4.4ºC (40ºF)

outside, 18.3ºC (65ºF) mixed
= 1 – (65-40º)/(72-40º)
= 1 – 78%
OA = 22%
256
Minimize Coolant Temp and/or
Dehumidify at Low Temps
CHW: Most relatively new chillers can provide 4°C (39°F)
CHW if load allows.
DX: Via glycol, can reach 0°C (32°F) “CHW,” lose
efficiency and capacity with glycol.
Desiccant: Excellent humidity control, reduce CHW coil
load, large equipment, requires heat, expensive,
complicated
257
Typical OR with Air Flow Setback
258
Evaluate Economizer Cycle
• Economizers rarely work perfectly
• Economizers often waste energy in practice
• If dampers leak ~30%, then 0 energy saved (in SE)
• Do evaluation and sensitivity analysis (% error = break even)
• Preheated coils often freeze
• Add first-cost, maintenance, energy use of PHC, RAF, need
for humidifier in winter
• Flat plate often better choice
259
Set OA to Minimum Required
AMS
1000 cfm @ > Inside OR
>
80°/63° DP > 65°/60% RH
>
5 tons, Summer
Winter Steam Humidifier,
15°F/10°F dewpt to 50°F/35°F
• Air flow monitors dewpt ,~ 56 pph steam
• Calibrate sensors, especially humidity

• More OA not better
• Use NOAA for OA conditions
260
Simplify
• Set supply air to 7.7°C (46°F)
• May require CHW coil @ 100%
• Control humidifier at 85% - 90% RH at AHU (41.5°dewpoint)
• Delete room humidifiers
• Delete RA humidity control
• Fix OA at 20% (except for smoke purge)
• RH readout in room, no user control
• Humidification in AHU ahead of CHW coil
261
Maximize CHW Coil Performance
* Trane PRIMA-FLO 5.5°/10°C CHW; 35°/23.8°C EA; 8 Rows, 2 m/s, 5 Fins per cm
42°/50°F CHW; 95°/75°F EA; 8 Rows, 400 FPM, 13 FPI
262
Maximize CHW Coil Performance
* Trane PRIMA-FLO 5.5°/10°C CHW; 35°/23.8°C EA; 8 Rows, 2 m/s, 5 Fins per cm
42°/50°F CHW; 95°/75°F EA; 8 Rows, 400 FPM, 13 FPI
263
Optimize Humidification
• Use boiler steam with FDA-approved chemicals
• Select criteria to eliminate humidifier at each OR
• Place final filter after humidifier
• Keep RH sensors in calibration
• Simplify sequence, control on SA dewpoint
• Use accurate portable instruments to test
• Large RH display in OR but no control
264
Terminal Humidifier Issues
• Possible carryover or misting in OR
• Condensation & leaking from duct
• Noise
• High RH
• Low RH
• Pipe & valve leaks
• Terminal clean steam systems
 Have all the issues listed above
 Requires electricity
 Requires water
 Requires sewer
 Very large, causing coordination conflicts
AVOID TERMINAL HUMIDIFIERS WHERE POSSIBLE

265
Variables for Operating Rooms
• Temp/RH desired by the doctors
• Types of surgeries (A, B, C)
• Length of surgery
• Rate of temperature change
• 20 ACH, 4 ACH OA
• 17º- 24ºC (62º- 75ºF), 30% - 60%
• MERV 14 most ORs
• MERV 17 Ortho & Transplant optional
• Terminal HEPA optional (not required)
266
Hybrid OR Layout
Return Air on Opposite Sides 267

HEART & VASCULAR
HYBRID OR
268
269
CONGESTED CEILING 269

270
MEDICAL GAS ON BOOM
270
Section Through Ceiling
271
272
LAMINAR FLOW
SYSTEM COMPLETE 272
Summary OR Designs
• Understand psychrometrics
• Use accurate temp/humidity instrument (sling psychrometer)
• Keep economizers calibrated, minimize OA
• Increase CHW flow in coil
• Reduce airflow across CHW coil
• Minimize CHW temp
• Use dedicated chiller
• Use dedicated AHU
• Use boiler steam
• Keep humidity sensors in calibration
• Temp & RH sensors in RA
• Set and forget supply air: 46ºDB, 85% RH
273
Part 2-2:
Imaging Suite Design
Modalities – Types of Imaging Technologies
• X-Ray (CT, Fluoroscopy)
• Ultrasound
• Magnetic (MRI)
• Nuclear / Energy Beams In (LINACC)
• Nuclear Out (PET)
275
Diagnostic Imaging
• EKG / EEG (Electro Cardiogram / Electro- Encephalogram)
• Ultrasound
• Radiology – X-ray
• CT (Computer Tomography )
• MRI (Magnetic Resonance Imaging)
• Nuclear Medicine
• PET (Positron Emission Tomography )
276
Interventional Imaging
• Fluoroscopy (Cath)
• Gastro-Intestinal (GI)
• Endoscopy
• CT
• Vascular
• Neuro
277
The 11 Great Lies
1. It is just an equipment replacement
2. The manufacturers will do the design
3. AHJ won’t care
4. The contractor will design it for free
5. The check is in the mail
6. Regulations are just like any other state
7. We will use the manufacturer’s Btu/h
8. The number of procedures does not matter
9. I’ll remember that I told you to cut corners
10. Cost is more important than performance
11. They will never do that in this room
278
Department Names
• OB GYN – Ultrasound
• ED – X-Ray, CT
• Vascular – Fluoroscopy, Ultrasound
• Surgery – Fluoroscopy, MRI
• Oncology – Linear Accelerator, Cyber Knife, PET
• Radiology – Fluoroscopy, MRI, CT, Ultrasound, R&F, X-Ray
• Nuclear Med – Nuclear Camera, PET
• Cardiology – Fluoroscopy, Ultrasound
• Urology – Fluoroscopy, Ultrasound
279
Room Names
• Cardiac Catheterization Lab
• Angiography, Specials
• Vascular and Interventional
• CT (Computer Tomography)
• MRI (Magnetic Resonance Imaging)
• PET Scan (Positron Emission Tomography)
• Lin Acc (Linear Accelerator)
• X-ray
• R&F (Radiography and Fluoroscopy)
• Endo (Endoscopy)
• Cysto (Cystography)
280
Procedure vs. Operating Room
Uses & Classifications
• Class A: Minor procedures under topical, local or regional
anesthesia w/o preoperative sedation. Excluding
intravenous, spinal & epidural procedures.
• Class B: Minor or major procedures with oral, parenteral or
intravenous sedation or analgesic or disassociative drugs.
• Class C: Major procedures with general or regional block
anesthesia & support of vital bodily functions.
281
S-170-2013 Imaging / Procedure Req’mts
OA SA
FUNCTION PRESSURE FF RH% TEMP F
ACH ACH
Class A Procedure + 3 15 14 20-60 70-75
X-Ray Diagnostic &
N/R 2 6 14 Max 60 72-78
Treatment
X-Ray (Surg, Critical
+ 3 15 14 Max 60 70-75
Care, Cath)
Endo N/R 2 6 14 20-60 68-73
Surg Cystoscopic + 4 20 14 20-60 68-75
282
Imaging Procedure Rooms
• Positive pressure when occupied
• May drop pressure requirement when unoccupied, reset cfm
• High supplies
• Low returns on opposite sides of the room
• 70º- 75º dB, 20-60% RH is Std170 regulation
• But most doctors want 62º- 70º dB, 30% - 60% RH
• Cath Lab, Interventional, Neuro
• MERV 14
283
Fluoroscopic Unit Diagram
284
X-Ray
• ED, MOB – Diagnostic
• Single snapshot
• Often small, mobile units
• Self-contained – all load in room
• Not procedure room
• 6 ACH or meet load
285
Fluoroscopy
• Treatment – Vascular, Angio, Cardiac Cath, EP, Ortho,
Endoscopy
• Continuous X-ray – diagnostic and procedure with injection,
live image
• Multiple components
• May have separate equipment room
• Lead shielding
• May have remote air cooled chiller (EWC)
• May require 6 or 15 ACH
286
ANGIO / VASCULAR 287
Cath, EP, Lab, Angio
• Similar room, clinical use varies
• Equipment in various sub-rooms
(scan, equipment, control)
• Separate thermostatic zones for
scan, control rooms, equipment
• Rugged support structure for
equipment in ceiling
• Computer room type A/C unit for
equipment room/space
• Consider occupant count in control
room 288
Interventional Imaging
Highly complex space – is it in Surgery or Imaging?
• Shielded
• Support structure congests ceiling
• Review location of equipment within the various sub-rooms
(procedure, equipment, control)
• Separate thermostatic zones for scan, equipment, control
rooms
• Cooling of equipment via chiller or chilled water system –
continuous and reliable
• Fluoro
• 15 ACH
289
Radiographic & Fluoroscopic (R&F)
• Treatment – Ortho, Endo, Neuro
• Combination of X-ray “snapshot” and continuous
with injection and real-time monitoring
• Multiple components
• May have separate equipment room
• May be procedure room
• 6 or 15 ACH
290
OPERATING ROOM WITH CT 291
CT
• Diagnostic – Cardiology, Ortho,
Internal, Spleen, Brain/Neuro
• Can use CHW
• May be self-contained or have an
equipment room
• Injection assembly mounted on ceiling
• Multi-slice, 360º X-ray (photons)
• 20 ACH in Hybrid OR
292
MRI 293
Magnetic Resonance Imaging (MRI)
• Diagnostic – Ortho, neuro, internal, cardio, breast
• Giant Magnet – Non-ferrous materials in scan/shielded area;
for HVAC, plumbing, fire, electrical, etc.
• Review location of equipment within the various sub-rooms
(MRI scan, equipment, control) and magnetic field
• Separate thermostatic zones for scan, equipment, control
rooms – different occupancies, different needs
294
MRI
• Water cooled
• Aluminum & copper materials in room
• Large equipment
• Continuous cooling load
• Liquid helium-cooled superconductor –
Quench vent w/ dielectric insulation
See MRI: Quench
http://www.bing.com/videos/search?q=youtube+mri+quen • Long procedure
ch&FORM=VIRE4#view=detail&mid=1C86B900851D6B997
DFD1C86B900851D6B997DFD • HVAC zoning
• Wave guides in ductwork • Emergency power?
• FM-200 • O2 sensor / He alarm
• Gauss lines affect area layout • Manual exhaust, optional
• 6 ACH or meet load • Emerg pressure hatch
295
MRI
GAMMA
KNIFE 299
Gamma Knife (Radiation Therapy / Oncology)
• Targeted radiation treatment
• Shielded space (typically lead)
• Equipment in the various sub-rooms (procedure,
equipment, control)
• Separate thermostatic zones for scan, equipment,
control rooms
298
PET SCAN 299
PET Scan
• Diagnostic – Oncology, Neurology, Cardio
• Radioactive injection – positron emission/annihilation
• Gamma ray detection
• Real-time studies, early diagnosis
• Hot lab adjacent – exhaust
300
LINEAR ACCELERATOR 301
Linear Accelerator
• Oncology, Radiation Therapy
• Emits radioactive particles
• Maze floor plan
• Low load in room
• Large equipment
• Adjacent simulator room with CT
• Heavily shielded space (lead or thick concrete) limits duct, piping
routings within treatment space
• Equipment in the various sub-rooms (procedure, equipment, control)
• Separate thermostatic zones for scan, equipment, control rooms
• Cooling of equipment via chiller or chilled water system – continuous
and reliable
302
CYSTOSCOPY
303
Cystology
• Treated as OR
• 20 ACH, 4OA
• Positive
• No floor drains
304
Anesthesia
• Level of sedation is important
• In Cath, Angio, EP
• If anesthesia, then WAGD
• Triggers many additional NFPA requirements
305
Auxiliary Rooms / Areas
• Film-based darkroom
• Scope cleaning
• Hot lab
• Simulator (CT) for linear accelerator prep
306
Infrastructure
• Measure air change rates (ACH)
• Verify HVAC controls, zoning
• Does room meet current MEP codes
• Filtration
• Power available, voltage, amperage, location
• Voltage, amperage required, normal/emergency
• Lighting (if to remain)
• Med gas availability
• Neighbors, Gauss lines
• Plumbing
• Weight, size
307
Imaging Suite Details
• All equipment in the procedure room?
• Separate equipment room?
• Water-cooled equipment – inside air cooled, House CHW?
• Dedicated chiller – air cooled outside, e.g., MRI?
• Med gas, data, light, power in ceiling boom?
• Hard ceiling?
• Lead lining, wave guides
• Shielded control room?
• Quench vent (MRI only)
• Structure conflicts
• Emergency power
• Gauss lines
308
Engineering Systems Desired
• Med gas
• Anesthesia
• Emergency power
• Isolated power
• Lighting and controls
• Booms
• Temperature and humidity
• Hand wash
309
Mechanical Design
• Interface to FA
• Smoke purge
• Process cooling (inside/outside)
• MRI requirements
• Ceiling conflicts
• Load in each room
• Occupant load and temperature preferences
310
Typical Imaging Suite
10kW
5kW
311
Typical Equipment Layout – Cath Lab
312
Cath Equipment Heat Load
313
Process Cooling
314
Electrical Design
• Typically a single 100-200 amp, 3-phase, 480-volt power
to a disconnect provided by contractor
• Downstream usually by manufacturer’s installer
• Engineer to verify coordination
• Voltage required
• Power quality
• EPS
• Isolated power?
• Who does detailed raceway layout?
315
Electrical Load – Cath Lab #1 (Heart Center)
ASHRAE #1343-RP (Koenigshofer & Guevara June 2009)
316
Electrical Load – 40-Slice
317
Electrical Load – MRI Room #2 (MRI Sonata)

318
Electrical Load – Linear Accelerator
319
Emergency Power
• Verify owner’s desires; if objective is to maintain equipment
charge, for example MRI, then power equipment only. If full
normal operation, then cooling lighting, controls and
equipment on EPS
• If EPS, then normal is required also (2 sources)
• UPS duration
320
Construction and Commissioning
• Shop drawings
• Smoke purge test
• Fire alarm interface test
• Medical gas certification
• HVAC test in all modes, test & balance
• FM 200 exhaust
• Electrical tests: equipotential (mV & ohms), grounding,
isolated power
• Certificate of occupancy
• O&M manual, training
321
Summary
• Hire an engineer/architect
• Verify existing conditions
• Obtain manufacturer’s final drawings
• Understand user’s need
• Installation responsibilities
• Budget, ownership
• Electrical requirements
• Understand modality
• Know CODES!!!
• Three zones for good temp & humidity control
• Test all systems; all scenarios
322
Part 2-3:
Isolation and Patient Room Design
Standard Details for Patient Rooms
• Neutral pressurization
• 70°- 75°F, 30% - 60%
• MERV 14 Filtration
• May have solar / envelope load that dictates higher ACH
• Recirculation system allowed – not recommended
324
Schematic Patient Room
325
ICU Department
• Intensive Care Unit (ICU) or Critical Care Unit (CCU)
• Often designated by the service it supports:
 SICU = surgery ICU
 CVICU = cardio-vascular ICU
 PICU = pediatric ICU
 Wound ICU = burn unit – requires humidity control
 NICU = neonatal ICU – low air velocity and noise!
326
ICU Rooms
• Positive pressurization
• 70°- 75°F, 30% - 60% RH
• MERV 14 (90%) Filtration
• Some AHJs require 12 ACH
• Some AHJs require low returns
327
Labor – Delivery
• Special lighting may congest ceiling
• Provide adequate cooling for high
activity and occupancy load
Nursery/ NICU
• Separate thermostatic zones
for staff and patient areas
• Avoid creating air drafts
328
Hospital Areas Affected By Aii (1)
• General / Public – Undiagnosed
 ED waiting room
 Triage
 Registration
 Radiology sub-waiting
• That’s why AIA/ASHRAE Guides

call for full exhaust in those
areas… to protect hospital staff.
329
Hospital Areas Affected By Aii (2)
• Monitored / Suspected / Diagnosed
 Designated patient isolation rooms in ED, ICU and
medical – surgical areas
 Bronchoscopy – treat like AII/Procedure Room
 Inhalation therapy / sputum induction
 PACU isolation room as designated
330
Infectious Isolation
• Negative pressurization
• TB and other infectious disease-carrying patients
• Anteroom – maybe
• 12 ACH (min. – 15 better), negative room
• 70°- 75°F / 30% - 60% RH
• 100% exhaust on emergency power
• Continuous pressure monitoring required including
logging information
• Oversize low wall grille to avoid noise
331
Infectious Isolation Schematic
332
333
Protective Environment (PE) Room –
Rationale for Isolation
• Protection for immuno-suppressed or immuno-compromised
patients
• Examples: post-transplant patients, AIDS, bone marrow
recipients, cancer treatment, burn treatment
• How is this accomplished:
 HEPA filtered air
 Clean-to-less clean airflow pattern within room
 Positively pressurized space (w/ tightly sealed
construction)
334
Protective Isolation
• Immuno-compromised patients
• HIV
• Organ or bone marrow transplants
• Other highly susceptible patients
• 12 ACH 68°- 75°F / 30% - 60% RH, positive room
• Continuous pressure monitoring required including
logging information
• Tight construction
• MERV 17
335
Protective Isolation Schematic
336
Start-Up and Ongoing Operation of
Specialty Rooms
• Testing & balancing – really
• Start-up
• Training
• Monitoring
• Periodic testing
• O&M manual
• Real as-builts
337
Part 2-4:
Special Use Space Design
Emergency Department
• Urgent care / Fast track / Acute care
 Pathways from walk-in or ambulatory entrance
• Waiting room/Registration – 100% exhaust, 12 ACH, filter RA?
• Triage
• Trauma / Resuscitation / Heart / Stroke

 Operating room-like space
• Exam rooms
• Procedure rooms / Radiology
• Nurse Station / Team area
• Emergency exhaust
• Decontamination area
339
Emergency Department
• Seclusion / Holding / Psychiatric
 Generally a secured space
• Airborne Infectious Isolation (AII) Room
• Negative pressure
• Located near heliport (air intake)
• Located near ambulance entrance (air intake)
340
Pharmacy
• Automated systems
• Refrigerators
• Walls/buffer area
• “Pharmacy in a box”
• Hoods, workbenches (“Primary Engineering
Control”)
• USP 797- 2008 cleanroom (ISO 7, 30 ACH)
depending on drug hazard classification
• Chemo hood (ISO 5)
• See http://usp.org
341
Pharmacy
• Confirm hood exhaust requirements – chemo hood
exhausted, others typically recirculating HEPA type
• USP 797- ISO Class 7 (Class 10,000) in Med Prep and Ante-
room, meaning HEPA air at high ACH (approx 30 ACH)
• Use of barrier isolator (glovebox) should negate
requirement of clean room requirement
• Lots of equipment and fridges =
high cooling load
• Do not do night setback
342
Pharmacy
343
Sterile Processing Department
• Central Sterile Supply (CSS)
• Processing instruments from surgery and procedures
• Flow of materials from dirty to clean
• Wash / Soiled / Workroom = dirty, wet work area
• Clean / Processing = sterilized, final assembly area
• Clean Supply = storage area for later use, low humidity
344
• High heat, humidity; discharge from
sterilizers, washers
• Source capture – exhaust at equipment
• Airflow from space to equipment exhausts
• High heat from equipment jacket losses;
steam piping in sterilizer equipment room
345
SPD Criteria – AORN/AAMI Guide for SPD
Minimum # All Air
of Air Exhausted Relative
Functional Area Airflow Temperature
Exchanges Directly to Humidity
per Hour the Outdoors
10 60°F to 65°F
Soiled / decontaminated Negative (in) Yes 20% to 60%
*(6) FGI (16°C to 18°C)
Sterilizer equipment 75°F to 85°F
Negative (in) 10 Yes 20% to 60%
access (24°C to 29°C)
Sterilizer loading / 68°F to 73°F
Positive (out) 10 Yes 20% to 60%
unloading (20°C to 23°C)
Restrooms / 68°F to 73°F
Negative (in) 10 Yes 20% to 60%
housekeeping (20°C to 23°C)
Preparation and 10 (downdraft 68°F to 73°F
Positive (out) No 20% to 60%
packaging type) (20°C to 23°C)
10 (downdraft 68°F to 73°F
Textile packaging room Positive (out) No 20% to 60%
type) (20°C to 23°C)
4 (downdraft 75°F
Clean / sterile storage Positive (out) No  70%
type) ( 24°C)
346
347
POST-ANESTHESIA
CARE UNIT (PACU)
348
Typical Prep / PACU
349
OR Sub-Sterile
350
Requirements for Procedure Rooms
• 15 ACH SA
• 3 ACH OA
• Positive pressure
• High supplies
• Low returns on opposite sides of the room
• Reg is 68º - 75º dB, 30% - 60% RH
• Most doctors want 62º - 70º dB, 30% - 60% RH
• About same as OR
• MERV 14
351
Bronchoscopy Room
Room
Pressure
Monitor
352
Endoscopy
• Similar to OR
• NR
• Often used for
bronchoscopy
353
Scope Clean / Supply
354
AUTOPSY / MORGUE 355
Morgue Refrigerators
356
Autopsy
• 12 ACH, 2 OA, negative
• Dedicated 100% exhaust on EPS, no dampers
• Label duct and fan on roof
• Optional filter on exhaust
• Table exhaust downflow
• Hard ceiling with exam lights
• Local pressure monitor – ball-in-tube
• Where are refrig condensers?
357
Part 2-5:
Commissioning and
Retro-Commissioning of
Healthcare HVAC Systems
What is the Commissioning Process?
A quality-based process
developed from industry best
practice to ensure an owner receives
at the END OF A PROJECT
what they stated they wanted in the
BEGINNING OF THE PROJECT
359
Goals of the Commissioning Process
• Document Owner’s Project Requirements (OPR)
• Keep project team focused on Owner’s goals
• Prevent or eliminate problems early and
inexpensively
• Lower overall costs for the Owner
• Increase profits for project team by decreasing
costs/overhead
360
Hospital HVAC Systems Must:
• Provide required air changes, temperature setpoints
humidity setpoints, pressure differentials, and OA %.
• Be effective in Emergency and Life Safety operation.
• Have reliable and redundant systems operate as designed.
• Be easily maintained.
• Be energy efficient.
Well-designed and commissioned systems can accomplish
all of the above SIMULTANEOUSLY!!
361
The Commissioning Process Step-By-Step
362
Potential Savings vs. Project Schedule
Potential Cost to Fix

Savings
Concept Design Construction O&M
Project Timeline
363
OPR / BOD Requirements for Healthcare
• Emergency preparedness requirements
• Smoke control strategies
• Pressurization control strategies
 Operating rooms
 Isolation rooms
 Other directional control spaces
• Smoke and fire ratings
• Life Safety plan
364
OPR / BOD Requirements for Healthcare
• Redundancy/reliability considerations
• Requirements – CHW, HW/Steam, DHW, DCW, SS, Med Gas
• Future expansion capabilities/desires
• Energy efficiency/LEED
• Infection control considerations
• Temperature/humidity requirements for various spaces
• UPS requirements
• Emergency power requirements
• Operational /occupancy requirements
• If renovation, ICRA and re-used equipment
365
Verification During Construction
Assure systems are accessible, maintainable and labeled
• Terminal unit controls and valves
• Building automation devices
• Fire/smoke damper access, size and location
• Electrical junction boxes
• Boiler/chiller plant gauges and valves
• Humidifiers
• Filters
• Air flow stations
• Infection control measures
366
Functional Performance Testing
• Verifies that systems operate and meet the performance
requirements in the Project Intent
• Test procedures developed and directed by the
Commissioning Authority and completed by the contractors
• Final document provides assurance of completion to both
owner and contractors
367
Functional Testing for Healthcare Facilities
• ALL areas requiring pressurization control
• All emergency power system components
• All OR, pharmacy, isolation room exhaust and supply air
flows and controls
• Witness test 10% - 15% of testing and balancing values
• All special sequences of operation for energy efficiency
• All special smoke control sequences
• All special sequences for emergency preparedness
368
Functional Testing
• Includes all smoke and fire dampers
• Includes all smoke control sequences/interfaces with
fire alarm system
• Includes all unique energy conservation sequences:
 Heat wheels
 Heat recovery loops
 Occupied / unoccupied programming
 Return air tracking / VAV setpoints
369
Functional Testing
• Includes complete check of sequences and operation for:
 Operating rooms
 Isolation rooms
 Pharmacy and Laboratory
 Other pressure-controlled areas
370
Training
• Assure operations and maintenance staff receives
detailed training on all systems and components
• Assure maintenance staff receives detailed basis of
design training from the design professionals
• Good manuals
• Good record drawings
371
Retro-Commissioning & System Tune-Ups
Save Energy, Reduce Pollution and Improve Performance
372
BAS Tune-Ups
• Tune-ups cost a little but save a lot
• Reduce maintenance
• Pay now or pay later
373
Small Changes Have
Big Effect on Performance
• 1o F ∆ in CHW temp = 7% – 10% ∆ cooling
• 2o F ∆ supply air dewpoint = 6% ∆ RH at 72°
• 5o F ∆ in supply air setpoint = 25% ∆ cooling
374
Energy-Saving Priorities
• Lighting is ~15% of total; install more efficient fixtures
Save 15% x 15% = 2%
• Plug loads including Imaging Equipment ~15%; change habits
Save 10% x 15% = 1.5%
• DHW & Misc ~5%; change habits reduce short-circuiting
Save 10% x 5% = 0.5%
• HVAC ~65%; control tune-up
Save 25% x 65% = 15%
375
BAS Tune-Up Components
• Verify correct location of sensors
• Calibrate sensors
• Verify correct operation of all devices
• Optimize sequences – performance, energy
• Optimize feedback loops
• Establish trends and track
• Correct graphics
• Dashboard
376
Typical RxC SOW
• Direct / verify TAB
• Verify / calibrate sensors
• Verify graphics
• Energy Conservation Measure (ECM) recommendations
• Facility Improvement Measure (FIM) recommendations
• Emergency operation test and tune sequences
377
Systems to Concentrate On
• Air handling systems
• Chilled water systems
• Steam and hot water systems
• Terminal boxes and thermostats
• Isolation room systems
378
Typical Controls Maintenance Agreement
• Training: #hr/yr
• Fixed hours/month for fixed cost: ($)/month
• Keep the software updated
• Sometimes sensor calibration
• Reduced hourly rate
• Generally need guidance on assignments
379
Controls Maintenance Contracts
Usually don’t include:
• Visual verification of operation
• Update of graphics
• Energy metrics, ECMs
• Engineering system analyses
• Testing and tuning of control sequences
• Dashboard
• Device replacement
380
Return Air System With Economizer
Open On
20.7%
4280
CFM 100% 35% 78.7oF 13130 CFM
Normal
On 100%
On
Open 20.7% Open
45.5oF
31848
10600 CFM 71% CFM
38.6oF
37% .12 .19 NORMAL

1.5in wc
38.8% Open
100%
On 0%
71%
What is Wrong Here?

381
Air Flows Don’t Add Up
Open On
20.7%
4280
100% 35% 78.7oF 13130 CFM
CFM
Normal
On
100%
Open 20.7% On Open
38.8% 45.5oF
31848
10600 CFM 59.9oF Normal 55.2oF
38.6oF 71% CFM
37% .12 .19

NORMAL
On 1.5in wc
38.8% Open
100%
On 0%
71% 0.0 in wc
13,130 - 4,280 + 10,600 ≠ 31,948

Maybe OA flow sensor is wrong. What is OAT? 382
Temps & Valve Positions Don’t Make Sense
On
20.7%
4280
100% 35% 78.7oF 13130 CFM
CFM
Normal
100%
Open 20.7% On Open
38.8% 45.5oF
10600 CFM 31848
59.9oF 55.2oF 71% CFM
38.6oF
37% .19
NORMAL
On 1.5in wc
38.8% Open
100%
On 0%
71% 0.0 in wc
MAT 59.9°F,CHWV 100%,SAT 55.2°F? Is SAT 38.6°F?

383
Chilled Water System
54.3oF
59.1%
644 Tons
38.0oFc
87.8oF
37.9oF
11.1 PSI
0.0%
On
45.3oF 62%
682 Tons 2166.0 GPM
45.0oF
0%
45.2oF
46.0oF
0.0 PSI
Off
78.7oF
77.8oF 51.4 0.0 GPM
1000 GPM
0 Tons
38.0oF
38.0oF
384
Chiller Data Panel Analysis
-2.5
38.0oF 38.0oF
38.0oF 0.5
45.5oF 87.3oF
87.5oF 3.6
81.1oF -2.2
115.5.0oF
621.8oF
3200 GPM
4260 GPM
385
CHW System Issues
• Low ∆T 8°F, 3-way valves?
• Bypass open – short circuit
• Is ∆P loop optimized? Excess flow?
• ∆P sensor(s) locations correct?
• Actual OAT ~35°F, so WB reading is wrong @ 40°F
• Per graphic, is this chiller 1&2 or 7&8?
• Evap flow too high @ 2.5 gpm/ton x 700 ton ~1750 gpm,
chiller panel says 3200 gpm, graphic shows ~2100 gpm
• Cond flow too high @ 3 gpm/ton x 700 ton ~ 2100 gpm,
control panel 4260 gpm, not shown on graphic
386
Condenser Water System
86.3oF
0%
100%
79.2oF
0%
0%
46.0oF
%
80oF
82oF
70oF
387
Condenser Water System Issues
• CT fan speed?
• No CW gpm on graphic
• No OAT reading
• OA WB incorrect, convert to dewpoint
• Need time/date
• Reclaim water flow 2,600,000 gpm?
• CWR and CWS too high given low OAT
• Save energy with lower CW temp
388
Control Strategies
• SA reset
• CHWS temp reset
• Unoccupied air flow reduction
• VAV
• HHW reset
• Minimize steam pressure
• Remember: Most areas of hospital are unaffected
by OA conditions
389
VAV Box
390
Typical VAV Box Sequence
• Set at 70° / 200 cfm / RHC at 0% / 55° SAT
• 68° / 100 cfm
• 66° / open reheat valve. Modulate to maintain 68°-70°
• 72° / 300 cfm / RHC at 0%
• Be careful in areas with ΔP requirements
391
Supply Air Temp Reset
20%
65°/47°F DP
RHC 50%
100%
80% CFM 100%
47°/46°F DP
0%
90°/64°F DP
65°/47°F DP
52% RH
20% of SA 70°/50°F DP
Match SA dewpoint to room temp/%RH.

Hit the “sweet spot” for each space.
392
OR AHU – Raise SAT to 52°F
20%
65°/52°F DP
RHC 44%
80%
80% CFM 100%
49°/47°F DP
0%
90°/64°F DP
65°/52°F DP
63% RH
20% of SA
70°/54°F DP
Summer Operation – Increasing supply temperature

decreases cooling and heating energy, but increases humidity
in operating room. Beware of high RH at low OR temps.
393
Steam / HW Losses
Excessive pressure can increase losses by 10%.
Losses inside hospital become cooling loads.
STEAM PRESSURE TEMPERATURE
60 PSI 307°F
70 PSI 316°F
80 PSI 324°F
90 PSI 331°F
100 PSI 338°F
Heating Hot Water 180°F
Higher Pressure = Higher Temperature = Higher Heat Losses
394
Electricity Speedometer
• Electricity = 12,500,000 kWh/yr

• 12.5 M kWh/365 day/yr = 34,250 kWh/day
• Ballpark of daily consumption: 10,000 –
100,000 kWh/day. Alarm if out of limits.
395
Demand Speedometer
• Annual peak = 4000 kW

• August daily range 1000 - 4000 kW
• Alarm if exceed limits
396
Energy Speedometer
• 250 kBtu/ft2/yr
• 28.5 Btu/h (could do per day)
• Gas: 100,000 Btu/ft3
• Electricity: 3413 Btu/kWh
397
Cost Speedometer
• $4,000,000/yr
• $457/hr
• Alarm if exceed limits
398
Awareness Campaign
• Metering and dashboards
• Energy Use “speedometer” on employee screen saver
• EPA Energy Star, advertise goal
• Requires $200M services rendered (at 2% margin) to pay
$4M energy bill
• Purchasing decisions; for example, water-cooled energy
imaging equipment
• Design guidelines to stress cost-effective energy efficiency
• Regular controls tune-ups
399
Summary: How To Tune-Up?
• Double-check readings
• Change setpoints and observe actual changes vs. expected
• Install metering
• Simple readouts, trends, alarms, dashboards
• Apply common sense
• Prius effect: just knowing your instantaneous “mileage” results
in improvement
400
Questions & Answers
THANK YOU!
ASHRAE Professional Certification
• Because you’re interested in healthcare HVAC design, you
may also be interested in the Healthcare Facility Design
Professional certification program.
• Do you want to stand out from the crowd? Become ASHRAE
certified.
• Assure employers and clients that you have mastered the body
of knowledge that subject matter experts have identified as
reflecting best practices.
• An ASHRAE Certification also serves as a springboard for
continued professional development. Visit this webpage
http://www.ashrae.org/HFDP to complete your application.
ASHRAE Career Enhancement
Curriculum Program
Expand your knowledge of IAQ and Energy Savings Practices
through a select series of ASHRAE Learning Institute courses
• Receive up-to-date instruction on new technology from

industry experts
• Gain valuable HVAC knowledge
• Accelerate your career growth
• Receive a certificate for successful completion of the
course series
Visit www.ashrae.org/careerpath to learn more.

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Practice Design & Applications

*AHA Benchmarking 2.0 Report

Dose x Site x Virulence x Time

N = Nose U = Pharynx-Bronchi M = Bronchioles

Protective Environment (PE) rooms 7 HEPAc,d

8 30-35% Over 3 micron Pre-filters Pleated

* None of these filters control organic gases

Operating room (Class B and C)

Recovery room NR 2 6 NR No 20-60 70-75/21-24

Critical and intensive care NR 2 6 NR No 30-60 70-75/21-24

Intermediate care (s) NR 2 6 NR NR max 60 70-75/21-24

Wound intensive care (burn unit) NR 2 6 NR No 40-60 70-75/21-24

Newborn intensive care Positive 2 6 NR No 30-60 70-75/21-24

Treatment room (p) NR 2 6 NR NR 20-60 70-75/21-24

Excerpt: ASHRAE Standard 170-2013

Buoyancy driven, natural convection from the patient

Memarzadeh & Jiang

• Not practical in ductwork

CHW TEMP • AIR DISTRIBUTION PATTERNS/LOCATION

Variables Determined by Use of Space

Double Wall W/ Foam

Easy access to BOTH sides Multiple Fans

• If exterior, aluminum or stainless steel housing

Twice as Much Water

MORNING: 65°F AFTERNOON: 80°F

• Overnight temperature usually will not drop below dewpoint

Fills a swimming pool in 5 days!

3. Biological Events (Epidemics)

Stage 2 – Fire occurs in a smoke compartment; the nursing

• Relocate patients horizontally and provide a safe holding area on

“Early involvement in the conceptual phase helps

Patient Risk Group TYPE A TYPE B TYPE C TYPE D

12576 $388,363 335368 $46,952 1145 11432 $147,981

3-50 Ton Modules and Accessories Cost $ 446,670 - 3 Year Payback

• Storage should be at 60°C (140°F) or greater, or separate

37.9oF 2029.9 GPM

Misc. Steam &

Fans Steam for Heating

Steam for Domestic

These items account for approximately

Staff & Patient Lights & Equipment * Minimum OA Reheat

* Breaks on your own

(1) 100% OA System

Staff & Patient Lights & Equipment * Minimum OA Reheat

Reheat Anywhere on This Line 251

AIR RATE = ACH x Room Volume

= 20 x 4000 ft3 = 20 x 108 000 L

We recommend at least 190 L/s (400 cfm)

Example: 22.2ºC (72ºF) return, 4.4ºC (40ºF)

• Calibrate sensors, especially humidity

AVOID TERMINAL HUMIDIFIERS WHERE POSSIBLE

Return Air on Opposite Sides 267

CONGESTED CEILING 269

MEDICAL GAS ON BOOM

ASHRAE #1343-RP (Koenigshofer & Guevara June 2009)

ASHRAE #1343-RP (Koenigshofer & Guevara June 2009)

ASHRAE #1343-RP (Koenigshofer & Guevara June 2009)

ASHRAE #1343-RP (Koenigshofer & Guevara June 2009)

• That’s why AIA/ASHRAE Guides

• Trauma / Resuscitation / Heart / Stroke

• Located near ambulance entrance (air intake)

Potential Cost to Fix