Survey Report Final

NIST GCR 05-883
Strategies to Reduce the Spread of Airborne Infections in Hospitals

Survey of Design Practice
Martha J. Hewett Richard D. Hermans, P.E.
NIST GCR 05-883
Strategies to Reduce the Spread of Airborne Infections in Hospitals

Survey of Design Practice
Prepared for National Institute of Standards and Technology Gaithersburg, MD 20899-2100
By Martha J. Hewett Richard. D. Hermans, P.E. Center for Energy and Environment
with the assistance of Anderson, Niebuhr & Associates
June 2006
U.S. Department of Commerce Carlos M. Gutierrez, Secretary Technology Administration Robert Cresanti, Undersecretary of Commerce for Technology National Institute of Standards and Technology William A. Jeffrey, Director
TABLE OF CONTENTS
DISCALIMERS EXECUTIVE SUMMARY..............................................................................................E-1 OBJECTIVE .................................................................................................................... 1 BACKGROUND .............................................................................................................. 1 METHODOLOGY ............................................................................................................ 3 RESULTS........................................................................................................................ 4 Characteristics of the Original Sample Groups .......................................................... 4 Characteristics of the Redefined Sample Groups ...................................................... 6 Design of Operating Rooms..................................................................................... 10 Design of Airborne Infection Isolation Rooms .......................................................... 20 AII Rooms without Anterooms ............................................................................ 21 AII Rooms with Anterooms ................................................................................. 22 AII Rooms Generally .......................................................................................... 26 Familiarity with Various Sources of Hospital Design Guidance................................ 36 Quality Control and Design Standards..................................................................... 37 Challenges in Maintaining Proper Space Pressure Relationships ........................... 40 DISCUSSION................................................................................................................ 41 ACKNOWLEDGEMENTS ............................................................................................. 45 REFERENCES.............................................................................................................. 45 APPENDIX A. APPENDIX B. Survey Instrument Tabulations
LIST OF TABLES
Table 1. Table 2. Table 3. Sample disposition.................................................................................................... 4 Case summaries of design pressure relationships for projects having AII rooms with anterooms. ........................................................................................... 25 Responses to an open-ended question asking about the most significant challenge in designing and building ORs, PE rooms and AII rooms to maintain proper space pressure relationships for control of airborne infections. .................. 41
LIST OF FIGURES
Figure 1. Number of new hospitals, hospital additions, and hospital remodels for which respondent is the Engineer of Record that are located in the U.S. and that started schematic design after January 1, 2001 and are currently at any stage from 50 % construction documents to completed and occupied (qualifying projects), by original sample group (n = 10, 10). ..................................................... 5 Total number of new hospitals, hospital additions, and hospital remodels designed at respondents location, whether by respondent or another engineer of record, that are located in the U.S. and that started schematic design after January 1, 2001 and are currently at any stage from 50 % construction documents to completed and occupied, by original sample group (n = 10, 10)........ 5 Number of qualifying projects by redefined sample groups (n = 10, 10) .................. 7 Number of qualifying projects that include rooms of different types, by redefined sample group. Scale is the same for all room types (n = 10, 10 for each plot). ................................................................................................................. 7 Total number of new hospitals, hospital additions, and hospital remodels designed at respondents location, whether by the respondent or by another engineer of record, that are located in the U.S. and that started schematic design after January 1, 2001 and are currently at any stage from 50 % construction documents to completed and occupied, by redefined sample group (n = 10, 10). .................................................................................................... 8 Hospital work as a percent of mechanical design work at respondents location over the past five years, by redefined sample group. ............................................... 8 Breakdown of qualifying hospital projects by type of hospital and by type of owner, for the redefined sample groups (n=10, 10 for both graphs)......................... 9 Type of firm for which respondents work, by redefined sample groups (n = 10, 10)............................................................................................................................. 9 Firm locations (n = 10, 10). ..................................................................................... 10 Design pressure differences for ORs in most recent qualifying project with ORs, by redefined sample groups. ......................................................................... 11 Difference between OR design supply airflow and design return/exhaust flow for most recent qualifying project with ORs, by redefined sample groups. ............. 11
Figure 2.
Figure 3. Figure 4.
Figure 5.
Figure 6. Figure 7. Figure 8. Figure 9. Figure 10. Figure 11.
Figure 12. Figure 13.
Design excess of supply air over return/exhaust air (cfm) vs. design pressure difference (in. wg) for ORs...................................................................................... 12 Range of effective leakage areas (in2) implicit in design excess supply flow and design pressure difference for ORs, by redefined sample groups (n = 7, 7)............................................................................................................................. 13 Design pressure difference (in. wg), design excess of supply over exhaust flow (cfm), and implicit ELA (in2) for ORs in most recent project, vs. number of qualifying projects with ORs. .................................................................................. 14 Area that is the point of reference for the operating room pressure. ...................... 15 Use of terminal boxes or airflow control valves for ORs on this project.................. 15 Percent of respondents including a monitoring device for the OR pressure difference in the specifications for their most recent project with an OR. ............... 16 Engineers control over airtightness of the OR envelope, expected tightness of the OR envelope, and relation of implicit ELA to these responses for most recent qualifying project with ORs. ......................................................................... 17 Percent of specifications including a performance requirement for the airtightness of the OR envelope, percent of those that do have a performance requirement that include an actual test to measure airtightness, and relation of implicit ELA to these responses.............................................................................. 18
Figure 14.
Figure 15. Figure 16. Figure 17. Figure 18.
Figure 19.
Figure 20a. Code, standard or guideline the engineer was required to use to establish the design OR pressure difference for this project. ...................................................... 19 Figure 20b. Design OR pressure difference (in. wg) as a function of whether AIA guidelines were required. ...................................................................................... 20 Figure 21. Figure 22. Figure 23. Figure 24. Percent of projects having AII rooms without anterooms and with anterooms, for respondents most recent project with AII rooms............................................... 21 Percent of AII rooms without anterooms that are positive or negative relative to the adjacent area, and design pressure difference............................................. 22 Percent of AII rooms with anterooms that are positive or negative relative to the adjacent area, and design pressure difference................................................. 23 Percent of projects designed to maintain a pressure difference between the anteroom and an adjacent area other than the AII room itself, sign of pressure difference, and magnitude of pressure difference. ................................................. 24 Absolute value of difference between AII room exhaust airflow and sum of relevant supply airflows for most recent qualifying project with AII rooms, by redefined sample groups. ....................................................................................... 26 Absolute value of design exhaust minus supply flow vs. absolute value of design pressure difference for AII rooms................................................................ 27 Range of effective leakage areas implicit in design excess exhaust flow and design pressure difference for AII rooms without and with anterooms (n = 10, 10)........................................................................................................................... 27 Design pressure difference, design excess of exhaust over supply and implicit ELA for AII rooms in most recent project, vs. number of qualifying projects with AII rooms. ............................................................................................................... 28
Figure 25.
Figure 26. Figure 27.
Figure 28.
Figure 29. Figure 30. Figure 31.
Location of terminal boxes or airflow control valves for AII rooms in this project (n = 10, 10). ............................................................................................................ 29 Methods of controlling space temperature and space pressure for AII rooms with terminal boxes or airflow control valves. ......................................................... 29 Engineers control over the airtightness of the AII room envelope, expected tightness of the AII room envelope, and relation of implicit ELA to these responses for most recent qualifying project with AII rooms................................... 31 Percent of specifications including a performance requirement for the airtightness of the AII room envelope, percent of those that do have a performance requirement that include an actual test to measure airtightness, and relation of implicit ELA (in2) to these responses. ............................................. 33 Monitoring provided for AII rooms........................................................................... 34 Code, standard or guideline to engineer was required to use to establish the design AII room pressure difference for this project. .............................................. 34 Design pressure difference compared with version of the AIA guidelines the designer was required to use, if any. ...................................................................... 35 Familiarity with various sources of design guidance (n=10, 10 for each graph). .... 37 Quality control processes for qualifying projects. ................................................... 38 Percent of respondents whose companies have mandatory organizational design standards at respondents location, and percent of these that are also required at other company locations....................................................................... 38 Likelihood that other engineers of record at respondents location follow the same design criteria and practices as those reported by respondent in the survey. .................................................................................................................... 39 Percent of projects that included an Infection Control Risk Assessment, among respondents who could provide this information......................................... 40
Figure 32.
Figure 33. Figure 34. Figure 35. Figure 36. Figure 37. Figure 38.
Figure 39.
Figure 40.
DISCLAIMERS
Use of Non-SI Units in a NIST Publication The policy of the National Institute of Standards and Technology is to use the International System of Units (SI units) in all its publications. However, in the North American construction and heating, ventilating and air-conditioning (HVAC) industries, certain non-SI units are so widely used instead of SI units that it is more practical and less confusing to include values in the customary IP units in this report. Software Certain software is identified in this paper in order to specify the procedure adequately. Such identification is not intended to imply recommendation or endorsement by the National Institute of Standards and Technology, nor is it intended to imply that the software identified is necessarily the best available for the purpose.
EXECUTIVE SUMMARY
A key factor in the control of airborne infections in hospitals is the establishment of proper pressure relationships between certain critical areas of the building and their surroundings. Operating rooms (ORs) must be kept at positive pressure relative to surrounding areas to limit movement of infectious agents into the ORs where they may be deposited in surgical wounds. Protective environment (PE) rooms must be kept at positive pressure to protect immunocompromised patients such as bone marrow transplant recipients from infectious agents elsewhere in the building. Airborne infection isolation (AII) rooms must be kept at negative pressure to limit movement of infectious agents such as tuberculosis from the patient in the AII room to other areas of the building. The U.S. guidance on differential pressures for infection control has changed significantly in recent years. The 1997 edition of the American Institute of Architects Guidelines for Design and Construction of Hospital and Health Care Facilities required only that the direction of airflow be outward for ORs and PE rooms and inward for AII rooms. The guidelines did suggest that reference be made to certain publications by the Centers for Disease Control (CDC). One of these recommended a pressure of -0.001 in. wg (-0.25 Pa) for AII rooms and the other recommended a 10 % to 20 % excess of supply air over exhaust air in new specialized care units for high risk patients (PE rooms). The AIAs 2001 edition of the guidelines, however, required a differential pressure of +0.01 in. wg (2.5 Pa) for operating rooms and PE rooms and -0.01 in. wg (-2.5 Pa) for AII rooms. The 2003 CDC guidelines likewise recommended that a 0.01 in. wg (2.5 Pa) pressure differential be maintained. They further indicated that an ideal pressure differential would be 0.032 in. wg (8 Pa) or more for PE rooms and -0.01 in wg (-2.5 Pa) or less for AII rooms. No systematic information has been available regarding designers awareness of the new guidance or the means by which it is being addressed in practice through design, construction, commissioning and operation. This project surveyed hospital design engineers to assess the current state of the art in design of critical space pressurization for infection control. Twenty engineers were interviewed in mid2004 to determine what design parameters, features and strategies are currently being used to maintain the necessary pressure relationships. Both the heating, ventilating and air conditioning (HVAC) design and the efforts to minimize the leakiness of the room boundaries were examined. Qualifying projects included only those for which the respondent personally was the Engineer of Record and which were at any stage from 50 % construction documents through completed and occupied at the time of the interviews. For the respondents as a whole, this included 425 projects. Because of constraints on the survey length, the detailed questions addressed only operating rooms and AII rooms, omitting PE rooms. The designers practices were compared with the requirements and recommendations of the AIA and CDC guidelines. Two distinct sample groups were defined, with ten interviews completed for each. The first group was intended to represent firms that do a large volume of hospital design, and was selected from the 2003 Engineering News Records list of the top 25 firms in health care (by 2002 design revenue), and specifically from the subset of 13 that provide engineering services. The second sample group was intended to represent firms that do occasional health care design. These firms were selected from those designing hospital projects placed on the McGraw Hill Dodge
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Construction Reports on-line Plans Service in summer 2004, excluding firms on the ENR 2003 list of the top 25 firms in health care and those in the American Society of Hospital Engineers 2001 directory of design professionals. The original sample design did not prove to be effective in separating frequent hospital designers from occasional hospital designers, so the respondents were assigned post hoc to redefined sample groups. Since January 1, 2001, the new many projects group have served as engineers of record for 19 to 80 qualifying hospital projects each, with a mean of 36.3 projects and a median of 22.0. The new few projects group have served as engineers of record for 2 to 10 qualifying hospital projects each since January 1, 2001, with a mean of 6.2 projects and a median of 5.5. There was no significant difference between the redefined sample groups in the types of hospitals designed, although there were significant differences in the type of clients served, with the few projects group having done a significantly larger percentage of projects for local and state government owners than the many projects group. The 19 respondents who had a recent U. S. project that included one or more ORs had all designed the ORs to be positively pressurized relative to the adjacent area. Sixteen of the nineteen had designed for a specific pressure difference, which ranged over a factor of 100 from +0.001 in. wg (0.25 Pa) to +0.10 in. wg (25 Pa). Almost three-quarters of respondents used one of three pressure differences: +0.01 in. wg (2.5 Pa) (26.3 %), +0.05 in. wg (12.5 Pa) (31.6 %) and +0.10 in. wg (25 Pa) (15.8 %). Only two (10.5 %) had used a design pressure difference less than the +0.01 in. wg (2.5 Pa) recommended by the current AIA guidelines. Another three designers did not design for a specific pressure difference, so the compliance of their designs with the AIA guidelines is indeterminate. One of these had designed for a specific percentage difference (15 %) between supply and return/exhaust flow, and two had designed for a difference between supply and return/exhaust airflows, one 100 cfm (47 L/s) per doorway and one nonspecific. There was no significant difference between the many projects and few projects groups in the design pressure differences used. Sixteen of the 19 designers provided a response in cubic feet per minute (L/s) regarding the difference between the design supply airflow to each OR and the design return/exhaust airflow. The differences ranged from 100 cfm to 500 cfm (47 L/s to 236 L/s) with a mean of 272 cfm (128 L/s) and a median of 225 cfm (106 L/s), and were very similar for the many projects and few projects groups.1 The other three respondents provided information on the difference between supply and return/exhaust flow on a percentage basis only, with two giving 10 % and one giving 15 %. There was a significant correlation between the pressure difference the designer was seeking to maintain and the volume of excess supply air provided, but it was the opposite of that which would be expected physically: the higher the pressure difference the designer was seeking to maintain, the less excess supply air was provided. An effective leakage area (ELA) of the OR envelope is implicit in the assumption that a given pressure difference can be maintained with a given airflow difference. The implicit ELA calculated from the design OR pressure difference and the design excess supply airflow, where both were provided, ranged by a factor of more than 30 from 17 in2 to 523 in2 (111 cm2 to 3375 cm2), with a mean of 117 in2 (754 cm2) and a median
1
All SI values were computed from the unrounded IP values in Appendix B and then rounded.
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of 63 in2 (407 cm2). There was no significant difference in the ELAs implicit in the designs of the many projects and few projects groups. The amount of control the design engineers said they had over the airtightness of the OR envelope varied, but there was no relationship between the amount of control they had and the ELAs implicit in their designs. About one-third of each sample group said that the specifications included a performance requirement for airtightness of the OR envelope. Where such a requirement was included, all of the many projects group but only one out of three in the few projects group included a test to measure the airtightness. There was no significant difference in implicit ELAs between the projects that did and did not have performance requirements for airtightness. Half of the many projects group and almost 90 % of the few projects group said that the specifications included a fixed mechanical or electronic device to allow the medical staff to monitor the OR pressure difference. The AIA guidelines do not require such a device for ORs. Over two thirds of the designers had been required to use the AIA guidelines to establish the design OR pressure difference for their most recent project, either alone or in combination with other documents, and all but one of these had been required to use the 2001 edition. All of the respondents had designed at least one qualifying project with airborne infection isolation rooms during the period of interest. Sixty percent said that their most recent project with AII rooms had included one or more AII rooms without anterooms, and 75 % said it had included one or more AII rooms with anterooms. All of the respondents whose most recent qualifying project with AII rooms included any AII rooms without anterooms had designed these rooms to maintain a pressure differential with respect to adjacent areas. Eleven of the twelve (91.7 %) had designed the AII rooms to be negative relative to the adjacent area, while one had designed them to be positive. Eleven of the twelve (91.7 %) had designed for a specific pressure difference, which ranged from -0.10 in. wg (-25 Pa) to +0.05 in. wg (12.5 Pa). Three of these projects, the one with positive pressure and two with negative pressures of -0.005 in. wg (-1.25 Pa), appear not to meet the AIA 2001 guidelines. A twelfth project was not designed for a specific pressure difference but for the supply flow to be 15 % less than the return/exhaust airflow. Among the 15 respondents whose most recent qualifying project with AII rooms included any AII rooms with anterooms, 14 (93.3 %) said that the mechanical systems were designed to maintain a pressure difference between the AII room itself and adjacent areas. Of these, eleven (78.6 %) said that the AII room was negative relative to the adjacent area and three (21.4 %) said it was positive. Of the latter three, two appeared to be designed to allow airflow from the AII room to general areas of the building, since the AII room was positive to the anteroom and the anteroom was positive to the corridor or nursing station. The third was designed with the AII room positive to the corridor but the anteroom negative to the corridor. Twelve of the fourteen (85.7 %) had designed for a specific pressure differential, which ranged from -0.10 in. wg (-25 Pa) to +0.10 in. wg (25 Pa); only one of the design differentials had an absolute value less than 0.01 in. wg (2.5 Pa). Of the two engineers who did not design for a specific pressure difference, one had designed for supply airflow 15 % less than the return/exhaust flow and one
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had designed for 100 cfm (47 L/s) per doorway. Of the 14 who said that the HVAC system was designed to maintain a pressure difference between the AII room itself and the adjacent area, 57.1 % said that the anteroom was the point of reference for the AII room pressure, 35.7 % said the corridor was the point of reference, and 7.1 % said that both the anteroom and the corridor were the point of reference. Of the 15 designers whose projects included AII rooms with anterooms, eight (53.3 %) said that the mechanical systems were designed to maintain a pressure difference between the anteroom and an adjacent area other than the AII room itself. Five (62.5 %) said the anteroom was negative relative to this other area and three (37.5 %) said it was positive. Six of the eight (75 %) had designed for a specific pressure difference, which ranged from -0.01 in. wg (-2.5 Pa) to +0.005 in. wg (1.25 Pa). One had designed for 100 cfm (47 L/s) per doorway, and one for a nonspecific pressure differential. Sixteen of the twenty designers provided a response in cubic feet per minute (L/s) regarding the difference between the design exhaust airflow from each AII room, including toilet exhaust, and the sum of all relevant supply flows. The differences varied by a factor of 30, from 10 cfm to 300 cfm (5 L/s to 142 L/s), with a mean of 139 cfm (65 L/s) and a median of 150 cfm (71 L/s), and were very similar for the many projects and few projects groups. The other four respondents provided differences on a percentage basis only, with three of these giving 10 % and one giving 15 %. There was no relationship between the absolute value of the pressure difference the designer was seeking to maintain and the volume of excess exhaust or supply provided. Implicit effective leakage areas could be calculated for ten respondents who had designed AII rooms without anterooms and ten who had designed AII rooms with anterooms. For the AII rooms without anterooms, implicit effective leakage areas ranged from 1 in2 to 117 in2 (9 cm2 to 756 cm2), with a mean of 47 in2 (305 cm2), and a median of 40 in2 (255 cm2). For the AII rooms with anterooms it ranged from 13 in2 to 117 in2 (85 cm2 to 755 cm2), with a mean of 51 in2 (331 cm2) and a median of 47 in2 (301 cm2). As with the ORs, there was little difference in the implicit ELAs assumed by the many projects and few projects groups. As with the ORs, the amount of control the engineers had over the airtightness of the AII room envelope varied, but there was no relationship between the amount of control they had and the ELAs implicit in their designs. Only 20 % said that the specifications for the project included a performance requirement for airtightness of the AII room envelope, but three quarters of these said the specifications also included a test to measure the airtightness. The projects with performance requirements did not have lower implicit ELAs than those without. The AIA 2001 guidelines state that AII rooms shall have a permanently installed visual mechanism to constantly monitor the pressure status of the room when occupied by patients with an airborne infectious disease. Ninety percent of the designers said their specifications included an alarm. Just over 60 % of those provided a means for it to be switched off or muted when no patient with an airborne infection was present.
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Just under two thirds of the designers had been required to use the AIA guidelines to establish the design AII room pressure difference for their most recent qualifying project, either alone or in combination with other documents, and 85 % of these had been required to use the 2001 edition. Forty percent of the respondents had designed at least one project with rooms designed to switch back and forth between AII functions and PE functions in the period of interest, although the 2001 AIA guidelines (Table 7.2 notes 17 and 18) stated that Rooms with reversible airflow provisions for the purpose of switching between protective environment and AII functions are not acceptable. Some owners may require such rooms despite the AIA guidance. Respondents were asked about their familiarity with various documents that provide guidance on hospital design. They were most familiar with the American Institute of Architects 2001 edition of the Guidelines for Design and Construction of Hospital and Health Care Facilities, with 80 % very familiar with it and 15 % somewhat familiar with it. Only 45 % of respondents were very familiar with the chapter on Health Care Design in the American Society of Heating, Refrigerating and Air Conditioning Engineers 2003 ASHRAE Handbook: Heating, Ventilating and Air Conditioning Applications or with ASHRAEs 2003 HVAC Design Manual for Hospitals and Clinics, and only 35 % were very familiar with the Centers for Disease Controls 2003 edition of the Guidelines for Environmental Infection Control in Health Care Facilities. Two thirds of the designers had been required to use the AIA guidelines, alone or with other documents, to establish the design room pressure differences for their most recent project, far more than any other code or standard. Respondents were asked how many of their qualifying projects had included a formal commissioning process for the mechanical systems, and how many had included formal verification of the airflow balancing. For the group as a whole, 100 of the 425 hospital projects designed (24 %) included commissioning, and 190 of 425 (45 %) included formal TAB verification. After the specific questions, we asked the respondents what, in their experience, is the single most significant challenge in designing and building ORs, PE rooms and AII rooms to maintain proper space pressure relationships for control of airborne infections. This question was openended. Although respondents were asked to identify the single most significant challenge, some identified more than one. The most commonly identified challenges pertained to construction or coordination: getting quality workmanship or contractors, getting work done according to specifications and details, getting the balancing or automatic temperature control (ATC) done properly, coordination between the balancer and ATC contractor, and coordination between staff and the construction team. Room tightness, raised by two respondents, may have been an issue of construction quality or of architectural design. Another commonly mentioned group of issues related to budgets, to the architectural/budgetary issues of space allocation and floor to floor height, and to the managerial/budgetary issue of getting the owner or his representatives to understand what the engineer is trying to do.
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Other challenges identified appeared to relate to operating issues or possibly to HVAC design issues, including operating the facility per se, maintaining control of the airflows or pressures, and finding a quality, accurate pressure monitor. For the most part the differences in design practices between the two groups were not large. The variability in design practices within groups, however, was quite substantial. This survey is exploratory rather than representative in that it interviewed only 20 engineers. However, these respondents had been engineers of record for 425 projects since January 1, 2001. The findings allow tentative conclusions and recommendations to be formulated for further examination: 1. Of the various documents that provide guidance on hospital design and construction, the AIA guidelines appear to offer the most important point of leverage to influence these practices, since the majority of designers interviewed were required to follow them and designers were more familiar with them than any other guidance document. 2. A significant minority of designers are not following the current AIA guidelines with regard to pressure differentials between critical spaces and other areas, suggesting a need to further increase awareness of the latest guidance. For ORs, two of 20 respondents designed for differential pressures closer to neutral than the -0.01 in. wg (-2.5 Pa) called for by AIA, and three designed for percentage or absolute flow differences rather than pressure differences per se. For AII rooms without anterooms, four of 12 projects appeared not to follow the current AIA guidelines, with one designed for a positive room pressure, two designed for a negative pressure smaller than -0.01 in. wg (-2.5 Pa), and one designing for a percent difference in flow. For AII rooms with anterooms, five of 14 projects appeared not to follow the guidelines, with two designed for positive AII room pressure relative to the anteroom and positive anteroom pressure relative to the corridor or nurses station, one designed for a negative pressure smaller than -0.01 in. wg (-2.5 Pa), and two designed for percentage or absolute flow differences rather than pressure differences per se. 3. A number of factors suggest that there may be a need for engineers to gain a greater understanding of and give more explicit consideration to the effective leakage area (ELA) of room boundaries when establishing design pressure and flow differentials. Physically, there is a positive relationship between the desired differential pressure and flow differential required to achieve it, but this was not reflected in the survey responses for either ORs or AII rooms. The ELA implicit in the designs varied by one to two orders of magnitude. Moreover, implicit ELAs were not correlated with the amount of control the engineer had over the design, whether s/he expected the room to be tighter or looser than in previous projects, or whether there were performance requirements for airtightness. 4. There may be a need to provide greater guidance on room airtightness. About half of the respondents said they had little or no control over the airtightness of ORs or AII rooms, and only a minority of the project specifications included a performance requirement for airtightness. 5. Respondents identified problems with construction and coordination between trades as the most significant challenge in achieving proper space pressure relationships. This suggests the need to enhance quality control through increased use of airtightness testing (used in a
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small minority of the respondents most recent projects), TAB verification (used in about 45 % of the respondents qualifying projects), and commissioning (used in about 24 %). 6. Forty percent of the respondents had designed at least one project with rooms designed to switch back and forth between AII functions and PE functions in the period of interest, in spite of the fact that the 2001 AIA guidelines state that this is unacceptable. This suggests a need to increase awareness of AIA guidance on this issue among designers and owners.
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OBJECTIVE
A key factor in the control of airborne infections in hospitals is the establishment of proper pressure relationships between certain critical areas of the building and their surroundings. Operating rooms (ORs) must be kept at positive pressure relative to surrounding areas to limit movement of infectious agents into the ORs where they may be deposited in surgical wounds. Protective environment (PE) rooms likewise must be kept at positive pressure to protect immuno-compromised patients such as bone marrow transplant recipients from infectious agents elsewhere in the building. Airborne infection isolation (AII) rooms must be kept at negative pressure to limit movement of infectious agents such as tuberculosis from the patient in the AII room to other areas of the building. Twenty mechanical engineers who design hospitals were interviewed in mid-2004 to determine what design parameters, features and strategies are currently being used to maintain the necessary pressure relationships for infection control. Both the HVAC design and efforts to minimize the effective leakage area of the room boundaries were examined. The designers practices were compared with relevant guidelines, such as those issued by the American Institute of Architects (AIA) and the United States Centers for Disease Control and Prevention (CDC). This survey was the first step of a larger NIST project that will examine airflow and pressure relationships associated with critical spaces in healthcare facilities and how engineering principles related to airtightness and multizone airflow analysis methods can be used to understand these relationships and improve design and operation. In addition to the survey, the first phase of the project also includes a review of plans and specifications from projects by the survey respondents, airflow and airtightness measurements in one healthcare facility, and airflow modeling in a generic healthcare facility.
BACKGROUND
Control of airborne infections in hospitals is critical both to effective health care and to the control of direct and indirect health care costs. In 1992, the U.S. Centers for Disease Control estimated that two million patients per year contract infections in hospitals, causing $4.5 billion in excess health care costs (CDC 1992). The CDC still uses these estimates of the impact of health-care associated infections in hospitals, also estimating that they cause 90,000 deaths per year (CDC 2006). The indirect costs of hospital construction, operation and maintenance for infection control are also significant: per unit area; hospitals are among the most expensive buildings to build and are among the highest energy users. A number of design features and strategies are used to control the spread of airborne infections in hospitals. These include primarily: providing high total air change rates and outdoor air change rates, providing adequate separation between outdoor air intakes and exhaust outlets, providing very high efficiency filters that serve to either trap or destroy microbes,
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maintaining proper space pressure relationships to control the direction of movement of infectious agents, providing anterooms to reduce air exchange due to door openings, locating air outlets and inlets to minimize the flow of contaminated air over uninfected persons, maintaining space relative humidity within an optimal range, avoiding internally lined ductwork, using antimicrobial coatings on ductwork, and using ultra-violet light in ducts to kill microbes.
This survey is part of a larger project to review current design practice relative to all of these features and strategies, but it places particular emphasis on directional pressure differences for several reasons: 1. The impact of space pressure control on the spread of airborne infections has been researched less than most of the other design issues that affect airborne infection control. 2. The U. S. guidance on differential pressures for infection control has changed significantly in recent years. In 1997, Streifel began recommending a design pressure differential of about 0.01 in. wg (2.5 Pa) (Streifel and Marshall 1997, Streifel 1999, Streifel 2000). (This range was reported by Streifel to have been drawn from work on migration of environmental tobacco smoke across space boundaries with various pressure differences, rather than on studies of airborne infectious agents per se). The American Institute of Architects 2001 edition of the Guidelines for Design and Construction of Hospital and Health Care Facilities incorporated this recommendation, requiring a differential pressure of +0.01 in. wg (2.5 Pa) for operating rooms and protective environment rooms and -0.01 in. wg (-2.5 Pa) for airborne infection isolation rooms, whereas the 1997 edition had required only airflow out for ORs and PE rooms and airflow in for AII rooms. The 1997 guidelines did suggest that reference be made to certain publications by the Centers for Disease Control (CDC). Of these, one (CDC 1994a) recommended a negative pressure of 0.001 in. wg (0.25 Pa) for AII rooms and the other (CDC 1994b) recommended a 10 % to 20 % excess of supply air over exhaust air in new specialized care units for high risk patients (PE rooms), specifically in the context of interruption of transmission of aspergillus spores. The 2003 CDC guidelines, which compiled and updated CDC guidance from a number of previous CDC publications, followed the 2001 AIA guidelines in recommending that a 0.01 in. wg (2.5 Pa) pressure differential be maintained. They further indicated that an ideal pressure differential would be more than +0.032 in. wg (8 Pa) for PE rooms and less than -0.01 in. wg (-2.5 Pa) for AII rooms. The 1999 ASHRAE Handbook: Heating, Ventilating and Air-Conditioning Applications required only directional airflow, but the 2003 edition called for a -0.01 in wg (-2.5 Pa) pressure differential for AII rooms and a +0.01 in. wg (2.5 Pa) pressure differential for PE rooms and some types of ORs. 3. The pressure difference required has a potentially significant impact on first costs due to equipment sizing and on operating costs due to the energy impact.
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No systematic information is currently available regarding designers awareness of the new guidance or the means by which it is being addressed in practice through design, construction, commissioning and operation. Therefore this project is being carried out to better understand current practice and to investigate opportunities to improve design and operation for airborne infectious disease control.
METHODOLOGY
The population of interest for the survey consists of hospital design engineers who started schematic design of one or more projects after the 2001 AIA guidelines, calling for space pressure differences of 0.01 in. wg (2.5 Pa), went into effect. Two distinct sample groups were defined, with a goal of ten interviews for each. The first group was intended to represent firms that do a large volume of hospital design, and was selected from the 2003 Engineering News Records list of the top 25 firms in health care (by 2002 design revenue). Of these 25, only the 13 firms that were listed on the ENRs web site as providing engineering services were included in the population of interest. The ten designers actually interviewed from this sample group work for firms whose combined health care design revenues in 2002 totaled $281 Million. The interviews with this group were intended to allow us to characterize the approaches used by experienced health care designers whom we expected to have the financial interest and resources to keep up with the state-of-the-art and the experience to produce effective designs to achieve their performance objectives. The second sample group was intended to represent firms that do occasional health care design. These firms were selected from those designing hospital projects placed on the McGraw Hill Dodge Construction Reports on-line Plans Service in summer 2004. Only those firms whose posted projects included one of the three space types of interest (ORs, AII rooms and PE rooms) were considered for selection. In addition, firms that were on the ENR 2003 list of the top 25 firms in health care or who were in the American Society of Hospital Engineers (ASHE) 2001 directory of design professionals for health facilities were omitted. The interviews with the second group were intended to allow us to characterize the approaches used by those who might be less able to keep up with the state-of-the-art and more likely to rely on general engineering expertise to achieve their performance objectives. The survey instrument was developed by the Center for Energy and Environment and the survey research firm conducting the interviews, Anderson, Niebuhr and Associates (ANA). To keep the interview length within 30 minutes, the questions were limited primarily to the design parameters, features and strategies used to maintain proper pressure relationships between spaces, with a few general questions about recent projects and characteristics of the design firm. Because of constraints on the survey length, the detailed questions addressed only operating rooms and AII rooms and omitted PE rooms. Pretest interviews were conducted with two design engineers. Although the survey instrument was shortened considerably after the first of these interviews, few of the questions that remained were changed, and the changes in wording were slight. Accordingly, the pretest interviews were
Page 3
retained and included in the final sample. Follow-up calls were made to clarify responses from these two interviews where necessary for consistency with the other interviews. The pretests and interviews were conducted by ANA between July 20 and September 2, 2004. Respondents were offered a $100 honorarium to encourage participation, a standard practice in interviews with professionals. An overall response rate of 69 % was achieved, including 91 % of the frequent hospital designers sample group and 56 % of the occasional hospital designers sample group. The sample disposition is shown in Table 1. Responses were cleaned, coded and entered into an SPSS database by ANA. Analysis was completed by CEE using SPSS for Windows 13.0.
Table 1. Sample disposition.
Total sample touched (gross sample) Out of sample* Adjusted sample Total completes Non-respondents** Response rate (completes/adjusted sample)
Overall 32 3 29 20 9 69 %
Frequent hospital designers 13 2 11 10 1 91 %
Occasional hospital designers 19 1 18 10 8 56 %
*Out of sample: company does not work on hospitals (1); company does not provide mechanical engineering design (1); duplicate of company already on list (1). **Non-respondents: not reached after five attempts (5); unresolved at end of study (4).
RESULTS Characteristics of the Original Sample Groups

The original sample design was not effective in separating frequent hospital designers from occasional hospital designers. Respondents were asked, Considering only projects for which you personally are the Engineer of Record, how many new hospitals, hospital additions, and hospital remodels located in the U. S. have you started schematic design for since January 1, 2001 that are currently at any stage from 50 % construction documents to completed and occupied? These projects are referred to in this report as the respondents qualifying projects. In total, the respondents in the frequent hospital design group had served as engineers of record for 165 projects since January 1, 2001, while the occasional hospital design group had served as engineers of record for 260 projects. The respondents in the frequent hospital design group were the engineers of record for 2 to 50 relevant projects, with a mean of 16.5 projects and a median of 14.5 projects (Figure 1). The respondents in the occasional hospital design group were the engineers of record for 3 to 80 relevant projects, with a mean of 26.0 and a median of 14.5 projects. These differences are not statistically significant. Nor did the sample groups differ significantly in the number of projects they had designed with the various room types of interest (see Appendix B).
Page 4
The respondents were also asked the number of hospital projects designed at their location in the same time period for which others were the engineer of record. When these other projects were added to the respondents projects, there was still no significant or even suggestive difference between the frequent and occasional hospital design sample groups. The frequent groups firms had designed an average of 36.6 projects at their location with a median of 24.5, and the occasional group had designed an average of 32.3 projects with a median of 14.5 (Figure 2).
Q1. Number of hospital projects since Jan 1 2001 for which respondent is the Engineer of Record
80
extreme outlier > 3.0 IQR above 3rd Q (or below 1st Q)
60
mild outlier >1.5 but 3.0 IQR above 3rd Q (or below 1st Q)
40
highest value not more than 1.5 IQR above 3rd Q third quartile (3rd Q) median
interquartile range (IQR)
20
first quartile (1stQ) lowest value not less than 1.5 IQR below 1st Q
0 Frequent Hospital Design Occasional Hospital Design
Boxplot key
Sample Group
Figure 1.
Number of new hospitals, hospital additions, and hospital remodels for which respondent is the Engineer of Record that are located in the U.S. and that started schematic design after January 1, 2001 and are currently at any stage from 50 % construction documents to completed and occupied (qualifying projects), by original sample group (n = 10, 10).
(Created - sum Q1 and Q43) Total projects designed at location
120
100
80
60
40
20
0 Frequent Hospital Design Occasional Hospital Design
Sample Group
Figure 2.
Total number of new hospitals, hospital additions, and hospital remodels designed at respondents location, whether by respondent or another engineer of record, that are located in the U.S. and that started schematic design after January 1, 2001 and are currently at any stage from 50 % construction documents to completed and occupied, by original sample group (n = 10, 10). Page 5
Hospitals do appear to account for a marginally higher percentage of the design work done by the firms in the frequent hospital design group. Sixty percent of respondents in this group said that hospitals had accounted for 50 % or more of the mechanical design work at that location in the past five years, while only 20 % of those in the occasional hospital design group said hospitals had been more than 50 % of their mechanical work (p = 0.068m).2 There is no significant difference between the two sample groups in the types of hospitals designed. For both groups of respondents, two-thirds to three-quarters of the hospital projects designed since the start of 2001 have been primary care or community hospitals, with the rest divided about equally between secondary, tertiary and quaternary care or teaching hospitals. Nor are there significant differences in the types of clients (for profit, non-profit, local, state and federal government) for which the two groups have done design work since the start of 2001. The sample groups did differ in the types of firms represented. Eighty percent of the frequent hospital design group work for combined architecture and engineering firms, while only 30 % of the occasional hospital design group do (p = 0.025*).
Characteristics of the Redefined Sample Groups

Given the poor correlation between the original sample groups and the actual number of hospital projects designed by the respondents, the sample groups were redefined for analysis. The new many projects group, which includes 10 respondents, have served as engineers of record for 19 to 80 projects since January 1, 2001, with a mean of 36.3 projects and a median of 22.0 projects. The new few projects group, which also includes 10 respondents, have served as engineers of record for 2 to 10 hospital projects since January 1, 2001, with a mean of 6.2 projects and a median of 5.5 projects (Figure 3). The difference between these two groups is highly significant (p = 0.002*3). The few projects group has designed a total of 62 hospital projects in the period of interest, while the many projects group has designed 363 projects, almost six times as many. In the period of interest, the many projects group has also designed significantly more projects with operating rooms (an average of 11.2 vs. 2.5, p = 0.005*) and AII rooms (18.4 vs. 4.2, p = 0.028*) and marginally more projects with PE rooms (6.0 vs. 2.6, p = 0.094m) than the few projects group (Figure 4). The two groups also differ significantly (p = 0.001*) in the total number of hospital projects designed at their location (the sum of those for which the respondent and other engineers were the engineers of record) (Figure 5). The many projects groups firms have designed 19 to 120 relevant projects at that location, with a mean of 59.3 and a median of 60.0, and the few projects group have designed 3 to 30 relevant projects with a mean of 9.6 and a median of 6.5.
In this report, a 95 % confidence that the probability of the observed response occurring by chance is 5 % is treated as significant (*), while a 95 % confidence that the probability of the observed response occurring by chance is >5 % but 10 % is treated as marginally significant (m), and a probability of the observed response occurring by chance that is > 10 % is treated as not significant (ns). 3 Probabilities for independent samples t-tests of means do not assume equal variances.
Page 6 Strategies to Reduce the Spread of Airborne Infections in Hospitals: Survey of Design Practice
2
80
60
40
20
0 few projects many projects
Redefined Sample Groups
Figure 3.
Number of qualifying projects by redefined sample groups (n = 10, 10)
60
60
60
50
50
50
Number of projects
40
40
40
30
30
30
20
20
20
10
10
10
a. Operating Rooms
b. Airborne Infection Isolation Rooms
c. Protective Environment Rooms
Figure 4.
Number of qualifying projects that include rooms of different types, by redefined sample group. Scale is the same for all room types (n = 10, 10 for each plot).
Based on the foregoing comparisons, it appears that the redefined sample groups are effective in separating those with more extensive recent experience in hospital design from those with less extensive experience. The two groups differ in other ways as well. Hospitals account for a marginally higher percentage of the design work done by the many projects group (p(linearby-linear association4) = 0.025*) (Figure 6).
Linear-by-linear association is a test for categorical data in which the categories are at least ordinal. It tests whether there is a linear relationship between the variables. Given the small sample sizes in this survey, exact rather than asymptotic significances are used.
Page 7
120
100
80
60
40
20
Figure 5.
Total number of new hospitals, hospital additions, and hospital remodels designed at respondents location, whether by the respondent or by another engineer of record, that are located in the U.S. and that started schematic design after January 1, 2001 and are currently at any stage from 50 % construction documents to completed and occupied, by redefined sample group (n = 10, 10).
60.0% 50.0% 40.0%

few projects (n=10) many projects (n=10)
Percent
30.0% 20.0% 10.0% 0.0% Less than 25% 25%, but < 50% 50%, but < 75% 75% or more
Q47. Percent of building mechanical design work at this location over the past five years that has been for hospitals
Figure 6.
Hospital work as a percent of mechanical design work at respondents location over the past five years, by redefined sample group.
There is no significant difference between the redefined sample groups in the types of hospitals designed (Figure 7a). For both groups of respondents, the bulk of relevant projects have been primary care or community hospitals (72.3 % for the many projects group vs. 68.8 % for the few projects group). For the many projects group, the remainder of projects are slanted somewhat more heavily toward quaternary care or teaching hospitals (17.8 %, vs. 6.0 % for the few projects group), while for the few projects group, the remainder of projects are slanted somewhat more heavily toward secondary and tertiary care hospitals (25.2 % combined, vs. 10.0 % for the many projects group), but these differences are not statistically significant.
Page 8
Mean Percent of Projects of Each Hospital Type
80.0
Mean percent of projects by type of owner
100.0
60.0
Primary care or community hospitals Secondary care hospitals Tertiary care hospitals Quaternary care or teaching hospitals
100.0
80.0
For-profit Non-profit Local government State government Federal government
60.0
40.0
40.0
20.0
20.0
0.0 few projects many projects
a. Percent of projects by type of hospital

Figure 7.
b. Percent of projects by type of owner.
Breakdown of qualifying hospital projects by type of hospital and by type of owner, for the redefined sample groups (n=10, 10 for both graphs).
The many projects group has done a significantly smaller percentage of projects for local government owners (8.1 % vs. 27.9 %, p = 0.017*) and state government owners (0 % vs. 13.5 %, p = 0.047*) than has the few projects group (Figure 7b).
10
Q46. Type of company

Engineering only Architecture /Engineering
Count
Figure 8.
Type of firm for which respondents work, by redefined sample groups (n = 10, 10).
Seventy percent of the many projects group work for combined architecture and engineering firms, while only 40 % of the few projects group do, but this difference is not significant (p(Fishers exact test) = 0.37ns5) (Figure 8). The greatest number of respondents are from the South, followed by the Midwest, West and Northeast (Figure 9).
Fishers exact test is a test of association between categorical variables that is used in place of the chi square test when any of the expected cell counts are small (<5).
Page 9
50.0%

few projects many projects
40.0%
Percent
30.0%
20.0%
10.0%
0.0% West Midwest Northeast South
Census Region
a. Location of firm by Census Region

Figure 9. Firm locations (n = 10, 10).
b. Census Regions
Design of Operating Rooms

Respondents were asked a series of questions about ORs in which they were instructed
please consider only your most recent U.S. project that includes ORs and is at least at the 50 % construction documents stage. Please do not include ORs intended for surgery on highly infectious patients.
All but one of the respondents had designed one or more qualifying projects with ORs. All of the respondents had designed their most recent relevant project with the ORs positively pressurized relative to the adjacent area. Sixteen of the nineteen had designed for a specific pressure difference, which ranged over a factor of 100 from +0.001 in. wg (0.25 Pa) to +0.10 in. wg (25 Pa). Of the other three, all of which were in the many projects group, one said that he had designed for a specific percentage difference (15 %) between supply and return/exhaust flow, and two said they had designed for a difference between supply and return/exhaust airflows (one non-specific and one 100 cfm (47 L/s) per doorway). The most common design pressure differences were +0.05 in. wg (12.5 Pa) (31.6 % of those with ORs in their most recent projects), +0.01 in. wg (2.5 Pa) (26.3 %) and +0.10 in. wg (25 Pa) (15.8 %), with each other response given by only one designer (5.3 %). There was no significant difference between the many projects and few projects groups in the design pressure differences used. The many projects group gave pressures ranging from +0.005 in. wg (1.25 Pa) to +0.10 in. wg (25 Pa) with a mean of +0.041 in. wg (10 Pa) and a median of +0.01 in. wg (2.5 Pa); the few projects group gave pressures ranging from +0.001 in. wg (0.25 Pa) to +0.10 in. wg (25 Pa) with a mean of +0.041 in. wg (10 Pa) and a median of +0.05 in. wg (12.5 Pa) (Figure 10).
Page 10
60.0% 50.0% 40.0% few projects (n=9) many projects (n=10)
Q4 (Recode3) OR/ What is the design pressure difference? (numeric)
0.100
0.080
Percent
30.0% 20.0% 10.0% 0.0% 0.001 inch 0.005 inch 0.01 inch 0.05 inch 0.10 inch 15% cfm diff 100 rather cfm per than doorDP way
0.060
0.040
0.020
Q4 (Recode2) OR/ What is the design pressure difference?
a. All responses (n = 9, 10)

Figure 10.
b. Responses in in. wg (n = 9, 7)
Design pressure differences for ORs in most recent qualifying project with ORs, by redefined sample groups.
few projects (n=9) many projects (n=10) 25.0%
Q7. OR/What is the difference, in cubic feet per minute, between the design supply air flow and the design return/exhaust flow?
30.0%
500
400
20.0%
Percent
15.0%
300
10.0%
200
5.0%
0.0% 100 125 150 200 250 300 325 350 450 500 10% 15% cfm cfm cfm cfm cfm cfm cfm cfm cfm cfm
Q7 OR Design difference in air flow all responses

Figure 11.
b. Responses in cfm (n = 7, 9)
Difference between OR design supply airflow and design return/exhaust flow for most recent qualifying project with ORs, by redefined sample groups.
Sixteen of the nineteen designers provided a response in cubic feet per minute regarding the difference between the design supply airflow to each OR and the design return/exhaust airflow for their most recent project with an OR. The differences ranged from 100 cfm to 500 cfm (47 L/s to 236 L/s) with a mean of 272 cfm (128 L/s), a median of 225 cfm (106 L/s) and a mode of 200 cfm (94 L/s). The range and distribution of responses for the many projects and few projects groups were very similar (Figure 11). The other three respondents who had designed ORs in the period of interest provided information on the difference between supply and return/exhaust flow on a percentage basis only, with two (both in the few projects group) giving 10 % and one (in the many projects group) giving 15 %.
Strategies to Reduce the Spread of Airborne Infections in Hospitals: Survey of Design Practice Page 11
There was a significant correlation between the pressure difference the designer was seeking to maintain and the volume of excess supply air provided (R2 = 0.282, p = 0.05*), but it was the opposite of that which would be expected physically: the higher the pressure difference the designer was seeking to maintain, the less excess supply air was provided (Figure 12).
500

400
300
200
100 0.000 0.020 0.040 0.060 0.080 0.100
Figure 12.
Design excess of supply air over return/exhaust air (cfm) vs. design pressure difference (in. wg) for ORs.
An effective leakage area is implicit in the assumption that a given pressure difference can be maintained with a given airflow difference. The relationship is given by (ASHRAE Fundamentals 2005, p 26.33):
AL = C 5 Qr
/2
CD
1 p r
(1)
where: AL = effective leakage area, in2 (cm2) C5 = unit conversion factor = 0.186 (10 000) Qr = predicted (reference) airflow rate at reference pressure difference pr, cfm (m3/s) = air density, assumed here to be 0.0765 lbm/ft3 (1.2 kg/m3) CD = discharge coefficient, assumed to be 1.0 for effective leakage area as commonly calculated in the U.S. pr = reference pressure difference, inches of water, assumed here to be 0.016 in. wg, (4 Pa) as commonly used in the U.S. Since: Q = Cp n
Page 12
(2)
and n is typically assumed to be 0.65 for building leaks, Qr in the above equation can be replaced by:
Qr = Qd p r0.65 0.65 p d
(3)
where: Qd = design excess supply airflow reported by respondent, cfm (m3/s) pd = design room pressurization reported by respondent, in. wg (Pa) With this substitution, the effective leakage area reduces to:
AL = C 5
Qd 0 p d .65
/2
CD
p r0.650.5 = 0.019564
Qd 0 p d .65
(4)
600.00
500.00
400.00
OR_ELA
300.00
200.00
100.00
Figure 13.
Range of effective leakage areas (in2) implicit in design excess supply flow and design pressure difference for ORs, by redefined sample groups (n = 7, 7).
The implicit effective leakage area calculated from the design OR pressure difference and the design excess supply airflow, where both were provided, ranged by a factor of more than 30 from 17 in2 to 523 in2 (111 cm2 to 3375 cm2), with a mean of 117 in2 (754 cm2) and a median of 63 in2 (407 cm2). There was very little difference in the implicit ELAs assumed by the many projects and few projects groups (Figure 13). Looking in more detail at the design pressure differences, airflow differentials and implicit effective leakage areas as a function of number of qualifying projects with ORs (Figure 14), we found no significant correlation between the design parameters and this proxy for experience.
0.080
0 5 10 15 20 25
0.100
500
400
0.060
300
0.040
200
0.020
100
0.000
0 0 5 10 15 20 25
Q2a. Number of projects with operating rooms

600.00
500.00
400.00
OR_ELA
300.00
200.00
100.00
0.00 0 5 10 15 20 25
Figure 14.
Design pressure difference (in. wg), design excess of supply over exhaust flow (cfm), and implicit ELA (in2) for ORs in most recent project, vs. number of qualifying projects with ORs.
The designers identified a range of areas as the point of reference for the OR pressure, with a sterile corridor the most often identified (47.4 %) (Figure 15). There was no statistically significant difference between the many projects and few projects groups on this variable (p(FET) = 0.37ns).
Page 14
60.0% 50.0% 40.0%

Percent
30.0% 20.0% 10.0% 0.0%

sterile surroundg ante-room surroundg substerile circ some corridor area in area in sterile rm corridor/ corridor/ other area genl genl/ subsub("clean ante-room sterile rm sterile rm core")
Q3a. OR/What adjacent area is the point of reference for the OR pressure?
Figure 15.
Area that is the point of reference for the operating room pressure.
The majority of designers in both groups had used terminal boxes or airflow control valves on both the supply and the return/exhaust OR flows for their most recent project (60.0 % of the many projects group and 77.8 % of the few projects group), with the rest of the respondents using terminal boxes or airflow control valves on the supply only (Figure 16).
80.0%

60.0%
Percent
40.0%
20.0%
0.0% Both supply/return Supply only
Q6. OR/Do the ORs have terminal boxes or airflow control valves...
Figure 16.
Use of terminal boxes or airflow control valves for ORs on this project.
Only 50.0 % of the many projects group said that the specifications for their most recent project with an OR included a fixed mechanical or electronic device to allow the medical staff to monitor the OR pressure difference, whereas 88.9 % of the few projects groups specifications included such a device (Figure 17). This difference was not significant (p(FET) = 0.141ns).
Page 15
100.0%

80.0%
Percent
60.0%
40.0%
20.0%
0.0% Yes No
Q11. OR/Do the specs include a mechanical or electronic device to allow the medical staff to monitor the OR pressure difference?
Figure 17.
Percent of respondents including a monitoring device for the OR pressure difference in the specifications for their most recent project with an OR.
The 2001 AIA guidelines do not contain any requirements for airtightness of OR boundaries (although the public review draft for the 2006 version does state, in section 7.9.B6, that Operating room perimeter walls, ceiling, and floors, including penetrations, shall be sealed.). Of the 19 designers with a project including an OR, 26.3 % said they had a lot of control over the airtightness of the OR envelope in their most recent project, 26.3 % said they had some control, 31.6 % a little control, and 15.8 % no control. The differences between the many projects and few projects groups were not significant (p(FET) = 0.545ns) (Figure 18a). The many projects group was more likely to say that they expected the OR envelope on this project to be tighter than other ORs for which they had designed the HVAC (90 % vs. 33.3 %), and less likely to say the OR envelope would be about the same as others for which they had designed the HVAC (10 % vs. 55.6 %) (p(FET) = 0.025*) (Figure 18b). The data do not show any tendency for the engineers who had little or no control over the airtightness of the OR envelope to design for higher effective leakage areas (Figure 18c). Nor do they show any tendency for engineers who expect the OR envelope to be tighter than others for which theyve designed the HVAC to design for lower ELAs (Figure 18d).
Page 16
50.0%

100.0%

40.0%
80.0%
Percent
30.0%
Percent
None A little Some A lot
60.0%
20.0%
40.0%
10.0%
20.0%
0.0%
0.0% Tighter
Q8. OR/How much control did you as the engineer have over the airtightness of the OR envelope?
About same as others
Don't know
Q9. OR/Do you expect the OR envelope to be...
a. Control over airtightness of OR by redefined sample group (n = 9, 10)

Q8. OR/How much control did you as the engineer have over the air-tightness of the OR envelope?
None A little Some A lot
b. Expected airtightness of OR by redefined sample group (n = 9, 10)

Tighter About same as others Don't know
100
200
300
400
500
600
100
200
300
400
500
600
OR_ELA
OR_ELA
c. Implicit OR effective leakage area (in2) vs. amount of control respondent had over airtightness.
Figure 18.
d. Implicit OR effective leakage area (in2) vs. expected airtightness of OR relative to other projects
Engineers control over airtightness of the OR envelope, expected tightness of the OR envelope, and relation of implicit ELA to these responses for most recent qualifying project with ORs.
About one-third of each group said that the specifications for this project included a performance requirement for airtightness of the OR envelope (Figure 19a). Where there was a performance requirement, all of the many projects group but only one out of three in the few projects group included a test to measure the airtightness (Figure 19b). There was no significant difference in implicit ELAs between the projects that did and did not have performance requirements for airtightness (Figure 19c). The number of projects with performance requirements is sufficiently small that the effect on implicit ELAs of requiring a test of air leakage cannot be tested.
Page 17
70.0% 60.0% 50.0%

100.0%

80.0%
Percent
Percent
Yes No
40.0% 30.0% 20.0% 10.0% 0.0%
60.0%
40.0%
20.0%
0.0% Yes No
Q10. OR/Do the specs include a performance requirement for the airtightness of the OR envelope?
Q10a. OR/Do the specs include a test to measure the air-tightness?
a. Performance requirement for airtightness of OR envelope by redefined sample group (n = 9, 10)
b. Test to measure airtightness, for those with a performance requirement, by redefined sample group.(n = 3,3)
Q10a. OR/Do the specs include a test to measure the airtightness?
Q10. OR/Do the specs include a performance requirement for the airtightness of the OR envelope?
Yes No
Yes No
100
200
300
400
500
600
50
100
150
OR_ELA
OR_ELA
c. Implicit OR effective leakage area (in2) vs. performance requirement for airtightness of envelope.
Figure 19.
d. Implicit OR effective leakage area (in2) vs. test to measure airtightness
Percent of specifications including a performance requirement for the airtightness of the OR envelope, percent of those that do have a performance requirement that include an actual test to measure airtightness, and relation of implicit ELA to these responses.
The great majority of both groups said that the specifications for their most recent project with an OR provide a means to reduce total airflow to the ORs when they are not in use (90.0 % of the many projects group and 77.8 % of the few projects group. Among the 19 designers with a project including an OR, 52.6 % said that they had been required to use the AIA guidelines to establish the design OR pressure difference for this project, 21.1 % said they had been required to use a state code, and 10.5 % said they had been required to use
both the AIA guidelines and a state code. The others (each 5.3 %) had been required to use both the AIA guidelines and the ASHRAE handbook, the ASHRAE handbook alone, and both federal requirements and the ASHRAE handbook (The interviewers asked the respondents to select one code, standard or guideline, but some respondents were unwilling to select just one) (Figure 20a). All but one of the engineers who had been required to use the AIA guidelines, either alone or with something else, had been required to use the 2001 version. Being required to use the AIA guidelines, either alone or with another code, standard or guideline, was not correlated with the design pressure difference used (Figure 20b). Familiarity with the AIA 2001 guidelines, CDC 2003 guidelines, the ASHRAE 2003 HVAC handbook chapter on health care design, and the ASHRAE 2003 HVAC Design Manual for Hospitals and Clinics were not correlated with the design pressure difference used. Each of these calls for a minimum differential pressure of 0.01 in. wg (2.5 Pa) for operating rooms.
70.0% 60.0% 50.0%

Percent
40.0% 30.0% 20.0% 10.0% 0.0%

AIA Guidelines... state code state code/AIA Guidelines... AIA Guidelines... /ASHRAE Handbook ASHRAE Handbook federal requirements/ ASHRAE Handbook
Q13. OR/What code/standard/guideline were you required to use to establish the design OR pressure difference?
Figure 20a.
Code, standard or guideline the engineer was required to use to establish the design OR pressure difference for this project.
Page 19
Use AIA alone or with another code/std/guideline
yes
no
0.00
0.02
0.04
0.06
0.08
0.10
Figure 20b.
Design OR pressure difference (in. wg) as a function of whether AIA guidelines were required. Case required to use 1997 version marked with *. The rest were required to use the 2001 version, or in one case both the 1997 and 2001 versions. Both of the designers who used pressure differences of 0.001 in. wg (0.25 Pa) said they were required to use the 2001 version. One of the designers who used a cfm difference rather than a design pressure difference was also required to use the 2001 AIA guidelines.
Design of Airborne Infection Isolation Rooms

Respondents were asked a series of questions about AII rooms in which they were instructed
please consider only your most recent U.S. project that includes AII rooms and is at least at the 50 % construction documents stage. Please include AII rooms in emergency or intensive care areas. Do not include rooms that are designed to switch back and forth between protective environment functions and airborne infection isolation functions.
All of the respondents had designed at least one project with airborne infection isolation rooms during the period of interest. Sixty percent said that their most recent project with AII rooms had included one or more AII rooms without anterooms, and 75 % said their most recent project with AII rooms had included one or more AII rooms with anterooms (Figure 21).
Page 20
80.0%

80.0%

60.0%
60.0%
Percent
40.0%
Percent
Yes No
40.0%
20.0%
20.0%
0.0%
0.0% Yes No
Q14. AII/Are there any AII rooms that do not have anterooms separating them from the corridor?
Q18. AII/Are there any AII rooms that do have anterooms separating them from the corridor?
Figure 21.
Percent of projects having AII rooms without anterooms and with anterooms, for respondents most recent project with AII rooms.
AII Rooms without Anterooms

In all cases, the mechanical systems for the AII rooms without anterooms had been designed to maintain a pressure difference between the AII room and adjacent areas. Eleven of the twelve designers (91.7 %) whose projects included AII rooms without anterooms said the AII rooms were negative relative to the adjacent area, while one (8.3 %) said they were positive (Figure 22a). Eleven of the twelve had designed for a specific pressure difference, which ranged from -0.10 in. wg (-25 Pa) to +0.05 in. wg (12.5 Pa). The twelfth had designed for the supply flow to be 15 % less than the return/exhaust airflow (Figure 22b). For the AII rooms without anterooms, 91.7 % of designers said that the point of reference for the AII room pressure is the corridor, while 8.3 % said it is the nurses station. There were no statistically significant differences between the many projects and few projects groups on any of these design features or parameters.
Page 21
100.0%

50.0%

80.0%
40.0%
Percent
60.0%
Percent
Positive Negative
30.0%
40.0%
20.0%
20.0%
10.0%
0.0%
Q17. AII (w/o anteroom)/Are the AII rooms positive or negative relative to the adjacent area?
0.0% -15% -0.10 inch -0.05 inch -0.01 inch
Q16. (Recode2)AII (w/o anteroom)/What is the design pressure difference?
-0.005 inch
+0.05 inch
a. Sign of pressure difference

Figure 22.
b. Design pressure difference
Percent of AII rooms without anterooms that are positive or negative relative to the adjacent area, and design pressure difference.
AII Rooms with Anterooms

For the AII rooms with anterooms, 14 of the 15 designers (93.3 %) said that the mechanical systems were designed to maintain a pressure difference between the AII room itself and adjacent areas. Of these 14, 78.6 % said that the AII room was negative relative to the adjacent area and 21.4 % said it was positive (Figure 23a). Of the latter three, two appeared to be designed to allow airflow from the AII room to general areas of the building, since the AII room was positive to the anteroom and the anteroom was positive to the corridor or nursing station (Table 2). The third was designed with the AII room positive to the corridor but the anteroom negative to the corridor. Twelve of the fourteen (85.7 %) had designed for a specific pressure difference, which ranged from -0.10 in. wg (-25 Pa) to +0.10 in. wg (25 Pa) (Figure 23b). One (7.1 %) said he had designed for supply airflow 15 % less than the return/exhaust flow and one (7.1 %) said he had designed for 100 cfm (47 L/s) per doorway. Of the 14 who said that the HVAC system was designed to maintain a pressure difference between the AII room itself and the adjacent area, 57.1 % said that the anteroom was the point of reference for the AII room pressure, 35.7 % said the corridor was the point of reference, and 7.1 % said that both the anteroom and the corridor were the point of reference.
Page 22
100.0%

80.0% few projects (n=7) many projects (n=7)
50.0%

40.0%
Percent
60.0%
Percent
Positive Negative
30.0%
40.0%
20.0%
20.0%
10.0%
0.0%
0.0%
Q21. AII (w/anteroom)/Are the AII rooms positive or negative to the adjacent area?
-100 cfm per doorway
-15%
-0.10 inch
-0.05 inch
-0.01 inch
-0.008 inch
+0.05 inch
+0.10 inch
Q20 (Recode2). AII (w/anteroom)/What is the design pressure difference?
a. Sign of pressure difference

Figure 23.
b. Design pressure difference
Percent of AII rooms with anterooms that are positive or negative relative to the adjacent area, and design pressure difference.
Of the 15 designers whose projects included AII rooms with anterooms, 53.3 % said that the mechanical systems were designed to maintain a pressure difference between the anteroom and an adjacent area other than the AII room itself, 33.3 % said they were not, and 13.3 % said they did not know (Figure 24a). Of the 8 designers who said the systems were designed to maintain a pressure difference, 62.5 % said the anteroom was negative relative to the adjacent area and 37.5 % said it was positive (Figure 23b). Six of the eight (75 %) had designed for a specific pressure difference, which ranged from -0.01 in. wg (-2.5 Pa) to +0.005 wg (1.25 Pa). One designer (12.5 %) had designed for 100 cfm (47 L/s) (negative) per doorway, and the final designer said that the anteroom pressure per se would not be monitored but that the AII room is monitored (Figure 24c). Seven of the eight (87.5 %) said the corridor was the point of reference for the anteroom pressure, while the eighth (12.5 %) said the nurses station was the point of reference. Of the eight who designed the mechanical systems to maintain a pressure difference between the anterooms and adjacent areas other than the AII rooms, five (62.5 %) provided the anterooms with both supply and exhaust flow, two (25 %) with exhaust flow only, and one (12.5 %) with supply flow only.
Page 23
70.0% 60.0% 50.0%

70.0% 60.0% 50.0%

Percent
Percent
Yes No Don't know
40.0% 30.0% 20.0% 10.0% 0.0%
40.0% 30.0% 20.0% 10.0% 0.0% Positive Negative
Q22. AII (w/anteroom)/Were the mechanical systems designed to maintain a pressure difference between the anteroom and an adjacent area other than the AII room itself?
Q23. AII/Are the anterooms positive or negative relative to this adjacent area?
a. Design for pressure difference between anteroom and other area.

40.0%
few projects (n=5)
b. Sign of pressure difference between anteroom and other area.

many projects (n=3)
30.0%
Percent
20.0%
10.0%
0.0%
-It wouldn't -0.01 inch -0.005 inch -0.003 inch be monitored; AII room is monitored +0.005 inch +100 cfm per doorway
Q24 (Recode2) AII/What is the design pressure difference?
c. Design pressure difference between anteroom and other area.

Figure 24. Percent of projects designed to maintain a pressure difference between the anteroom and an adjacent area other than the AII room itself, sign of pressure difference, and magnitude of pressure difference.
Page 24
Table 2.
Table 2.
Case summaries of design pressure relationships for projects having AII rooms with anterooms.
Q18. AII/Are there any AII rooms that do have anterooms separating them from the corridor? Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes the anteroom -0.01 inch the corridor -0.01 inch the corridor -100 cfm per doorway Negative Negative Negative . . . the anteroom -0.05 inch Negative No No Yes No No the corridor . . the anteroom 0.10 inch Positive Yes the anteroom -0.01 inch Negative Yes the anteroom -0.008 inch Negative Yes the anteroom 0.05 inch Positive Yes the corridor -0.01 inch Negative Don't know the nurse's station the corridor the corridor the corridor . . Positive . Positive Negative Negative Positive
Q19. AII (w/ anteroom)/Were the mechanical systems designed to maintain a pressure difference between the AII room itself and adjacent areas? Yes Q19a. AII (w/ anteroom)/ What adjacent area is point of reference for the AII room pressure? the corridor Q20 (Recode2). AII (w/anteroo m)/What is the design pressure difference? 0.05 inch Q21. AII (w/anteroo m)/Are the AII rooms positive or negative to the adjacent area? Positive . Q22a. AII/What adjacent area is point of reference for the anteroom pressure? the corridor Q23. AII/Are the anterooms positive or negative relative to this adjacent area? Negative
Q22. AII (w/anteroom)/ Were the mechanical systems designed to maintain a pressure difference between the anteroom and an adjacent area other than the AII room itself? Yes
Q24 (Recode2) AII/What is the design pressure difference? -0.005 inch . 0.005 inch -0.003 inch -0.01 inch 0.005 inch . . 100 cfm per doorway . . . . . .
1 2 3
Yes
Yes
Yes
Yes the corridor -0.01 inch Negative Yes the corridor Negative -It wouldn't be monitored; AII room is monitored -0.10 inch -15% -0.05 inch 14 14 Negative Negative Negative 14 No Don't know Yes 15 the corridor 8 . . Negative 8 . . -0.005 inch 8 . . Yes Yes Yes 15 15 the anteroom the anteroom the anteroom/the corridor
Yes
Yes
Yes
4 5 6 7 8 9
Yes
Yes
Yes
10 11 12
Yes
Yes
Yes
Case summaries of design pressure relationships for projects having AII rooms with anterooms.
13 14 15
Yes
Yes
Page 25
Total
AII Rooms Generally

Sixteen of the twenty designers provided a response in cubic feet per minute (Liters per second) regarding the difference between the design exhaust airflow from each AII room, including toilet exhaust, and the sum of all relevant supply flows. The differences ranged from 10 cfm to 300 cfm (5 L/s to 142 L/s), with a mean of 139 cfm (65 L/s) and a median of 150 cfm (71 L/s). The range and distribution of responses for the many projects and few projects groups were similar (Figure 25). The other four respondents provided a difference on a percentages basis only, with three of these giving 10 % and one giving 15 %.

25.0%
Q30. AII/What is the difference, in cubic feet per minute, between the design exhaust air flow from each AII room and all relevant supply flows?
30.0%
300
250
20.0%
Percent
200
15.0%
150
10.0%
100
5.0%
50
0.0%
10 30 50 100 120 150 160 175 200 275 300 10% 15% cfm cfm cfm cfm cfm cfm cfm cfm cfm cfm cfm
Q30 AII Room design difference in air flow all responses

Figure 25.
b. Responses in cfm (n = 8, 8)
Absolute value of difference between AII room exhaust airflow and sum of relevant supply airflows for most recent qualifying project with AII rooms, by redefined sample groups.
There was no relationship between the absolute value of the pressure difference the designer was seeking to maintain and the volume of excess exhaust or supply provided (Figure 26).
Page 26
Design air flow difference (cfm) as a function of design pressure difference ("wg) for AII rooms (both as absolute values)
300
AII Rooms with Anterooms AII Rooms without Anterooms
250
200
150
100
50
0.000
0.020
0.040
0.060
0.080
0.100
Figure 26.
Absolute value of design exhaust minus supply flow vs. absolute value of design pressure difference for AII rooms.
Implicit effective leakage areas, sq.in.

120
100
80
60
40
20
0 AIIELAwo AIIELAw
Figure 27.
Range of effective leakage areas implicit in design excess exhaust flow and design pressure difference for AII rooms without and with anterooms (n = 10, 10).
Implicit effective leakage areas could be calculated for ten respondents who had designed AII rooms without anterooms and ten who had designed AII rooms with anterooms.6 For the AII
The same value of exhaust minus supply flows was used to calculate ELA for both the AII rooms without anterooms and the AII rooms with anterooms. The question was intended to refer to both types of AII rooms but its
6
rooms without anterooms, implicit effective leakage areas ranged from 1 in2 to 117 in2 (9 cm2 to 756 cm2) with a mean of 47 in2 (305 cm2) and a median of 40 in2 (255 cm2) (Figure 27). For the AII rooms with anterooms it ranged from 13 in2 to 117 in2 (85 cm2 to 755 cm2) with a mean of 51 in2 (331 cm2) and a median of 47 in2 (301 cm2). As with the ORs, there was little difference in the implicit ELAs assumed by the many projects and few projects groups.
without anteroom with anteroom
0.10
300
250
0.05
200
150
0.00
100
-0.05
50
0 0 10 20 30 40 50
-0.10 0 10 20 30 40 50
Q2c. Number of projects with airborne infection isolation rooms
a. Design pressure difference, in. wg (signed) vs. number of projects with AII rooms
120
b. Abs value of exhaust minus supply, cfm vs. number of projects with AII rooms
100
80 without anterooms with anterooms
60
40
20
0 0 10 20 30 40 50
c. Implicit effective leakage area (in2) vs. number of projects with AII rooms
Figure 28. Design pressure difference, design excess of exhaust over supply and implicit ELA for AII rooms in most recent project, vs. number of qualifying projects with AII rooms.
placement in the questionnaire (see Appendix A) could have made this ambiguous to the respondents. In each case, the design pressure relevant to the particular type of AII room was used. In four cases, a respondent gave a design pressure in inches of water gauge for both the AII rooms without anterooms and the AII rooms with anterooms. For three of the four, the design value was the same, while for the fourth the design pressure difference for the AII room without an anteroom was -0.005 in. wg (-1.25 Pa) and for the AII room with anteroom was -0.008 in. wg (-2.0 Pa).
Looking in more detail at how these various design parameters relate to the number of projects with AII rooms designed since January 1, 2001, we found no significant relationship between the design pressure difference and the number of qualifying projects with AII rooms, or between the pooled ELAs and the number of projects with AII rooms, although there was a significant relationship between the absolute value of the airflow difference and the number of qualifying projects with AII rooms. (Figure 28).
50.0%

40.0%
Percent
30.0%
20.0%
10.0%
0.0%
Both supply/return Supply only Neither Varies supply/return between both & supply only
Q26. AII/Do the AII rooms have terminal boxes or airflow control valves...
Figure 29.
Location of terminal boxes or airflow control valves for AII rooms in this project (n = 10, 10).
100.0%

50.0%

80.0%
40.0%
Percent
Percent
30.0%
60.0%
20.0%
40.0% 10.0% 20.0% 0.0% 0.0% varying flow & temp varying flow only varying supply temp only
static balancing constant space press constant constant cfm differential/ differential constant space pressure Some other means
Q27. AII/Is the space temperature in the AII rooms controlled...
Q28. AII/Is the space pressure in the AII rooms controlled...
a. Space temperature control

Figure 30.
b. Pressure control
Methods of controlling space temperature and space pressure for AII rooms with terminal boxes or airflow control valves.
Page 29
Half of the 20 designers said that the AII rooms in their most recent projects had terminal boxes or airflow control valves on both the supply and the return/exhaust (Figure 29). Forty percent said they AII rooms had terminal boxes on the supply only, 5 % said some AII rooms had terminal boxes or airflow control valves on both and others on the supply only, and 5 % said they had terminal boxes on neither the supply nor the return/exhaust. There was no difference between the many projects and few projects groups on this design feature (p(FET) = 0.650ns). Of the 19 designers who had used terminal boxes or airflow control valves for the AII rooms, 78.9 % said that the space temperature in the AII rooms is controlled by varying the supply air temperature only, 15.8 % said it is controlled by varying both supply airflow and temperature, and 5.3 % said it is controlled by varying supply airflow only (Figure 30a). These 19 designers had employed a variety of approaches to control space pressure in the AII rooms: 36.8 % said it was controlled by static balancing, 31.6 % by measuring space pressure continuously and adjusting one or both flows to maintain it, 21.1 % by measuring supply and return/exhaust airflows continuously, and maintaining a constant differential between flows, 5.3 % by measuring both space pressure and supply and return/exhaust flows, and 5.3 % by constant airflow differentials with automatic adjustments (Figure 30b). There was no difference between the many projects and few projects groups on these design strategies. The eight designers who said that space pressure was controlled by static balancing, and the designer who had not used terminal boxes or airflow control valves at all, were asked how the specification called for the supply and exhaust to be balanced. Seven designers (87.5 %) said that the specification called for the balancer to balance both the supply and return/exhaust flow to the specified cfm (L/s), and one said it called for the balancer to balance one flow but not the other. None of the designers said that the specification called for the balancer to balance one flow to the specified cfm (L/s) and the other to achieve the specified space pressure difference, or that the specific procedure to use was left to the balancer. The 2001 AIA guidelines, Section 7.2.C3, state that, Airborne infection isolation room perimeter walls, ceiling, and floors, including penetrations, shall be sealed tightly so that air does not infiltrate the environment from the outside or from other spaces. The glossary defines a Sealed (tight) room as A room that meets specific ventilation requirements and must have a minimum air leakage to achieve a particular designed air quality, airflow direction, and pressure differential. As with the ORs, the engineers level of control over the airtightness of the AII room envelope in their most recent project with AII rooms varied: 15 % said they had a lot of control, 30 % some control, 25 % a little control, and 30 % no control (p(linear-by-linear) = 0.305ns). The majority of the designers (55 %) expected the envelope of the AII rooms on this project to be about the same as other AII rooms for which they had designed the HVAC, 35 % expected it to be tighter, and 10 % said they didnt know how it would compare. Differences between the two subgroups were not significant. As with the ORs, the data for AII rooms do not show any tendency for the engineers who had little or no control over the airtightness of the OR envelope to design for higher effective leakage areas (Figure 31c, e). Nor do they show any tendency for engineers who expect the OR envelope to be tighter than others for which theyve designed the HVAC to design for lower ELAs (Figure 31d, f).
Page 30
40.0%

70.0% 60.0% 50.0%

30.0%
Percent
Percent
none A little Some A lot
40.0% 30.0% 20.0% 10.0%
20.0%
10.0%
0.0%
0.0% Tighter
Q31. AII/How much control did you as the engineer have over the airtightness of the AII room envelope?
Don't know
Q32. AII/Do you expect the AII room envelope to be...
a. Control over airtightness of AII rooms by redefined sample group (n = 10, 10)
Q31. AII/How much control did you as the engineer have over the air-tightness of the AII room envelope?
b. Expected airtightness of OR by redefined sample group (n = 10, 10)
Tighter About same as others
20
40
60
80
100
120
20
40
60
80
100
120
AIIELAwo
AIIELAwo
c. Implicit effective leakage area (in2) for AII rooms without anterooms vs. amount of control respondent had over airtightness.
Figure 31.
d. Implicit effective leakage area (in2) for AII rooms without anterooms vs. expected airtightness of AII rms relative to other projects
Engineers control over the airtightness of the AII room envelope, expected tightness of the AII room envelope, and relation of implicit ELA to these responses for most recent qualifying project with AII rooms.
Page 31
Tighter About same as others Don't know
20
40
60
80
100
120
20
40
60
80
100
120
AIIELAw
AIIELAw
e. Implicit effective leakage area (in2) for AII rooms with anterooms vs. amount of control respondent had over airtightness.
Figure 31. cont.
f. Implicit effective leakage area (in2) for AII rooms with anterooms vs. expected airtightness of AII rms relative to other projects
Only 20 % said that the specifications for the project included a performance requirement for airtightness of the AII room envelope, while 75 % said that they did not and 5 % said they didnt know (Figure 32a). Three of the four respondents who said there was a performance requirement also said the specifications included a test to measure the airtightness of the AII room envelope (Figure 32b). The AIA 2001 guidelines state that for AII rooms, Rooms shall have a permanently installed visual mechanism to constantly monitor the pressure status of the room when occupied by patients with an airborne infectious disease. The mechanism shall continuously monitor the direction of the airflow (Section 7.2.C7). Ninety percent of the designers said their specifications included a visible or audible alarm to notify the medical staff if the AII room pressure difference is not at the required level; this included all of the many projects group and 80 % of the few projects group (p(FET) = 0.474ns) (Figure 33a). Overall, 61.1 % of those who provided such an alarm provided a means for it to be switched off or muted when no patient with an airborne infection was present, 33.3 % did not and 5.6 % did not know whether the specifications included this or not. Eighty percent of the many projects group and 37.5 % of the few projects group provided a means to mute or switch off the alarm (p(FET) = 0.145ns). Overall, 85 % of the designers said the specifications provided a fixed mechanical or electronic device to allow the medical staff to read the AII room pressure difference, which included 100 % of the many projects group and 70 % of the few projects group (p(FET) = 0.211ns) (Figure 33c).
Page 32
80.0%

100.0%

80.0%
60.0%
Percent
Percent
Yes No Don't know
60.0%
40.0%
40.0% 20.0% 20.0%
0.0%
0.0% Yes No
Q33. AII/Do the specs include a performance requirement for airtightness of the AII room envelope?
Q33. AII/Do the specs include a performance requirement for air-tightness of the AII room envelope?
Q33a. AII/Do the specs include a test to measure the air-tightness of the AII room envelope?
Yes No
Yes No
20
40
60
80
100
120
20
40
60
80
100
120
AIIELAwo
AIIELAwo
Yes No Don't know
Yes
20
40
60
80
100
120
20
40
60
80
100
120
AIIELAw
AIIELAw
Figure 32.
Percent of specifications including a performance requirement for the airtightness of the AII room envelope, percent of those that do have a performance requirement that include an actual test to measure airtightness, and relation of implicit ELA (in2) to these responses.
Page 33
100.0%

80.0%

100.0%

80.0%
80.0%
60.0%
Percent
Percent
60.0%
Percent
Yes No Don't know
60.0%
40.0%
40.0% 20.0% 20.0%
40.0%
20.0%
0.0% Yes No
0.0%
0.0% Yes No
Q34. AII/Do the specs include a visible or audible alarm to notify the medical staff if the AII room pressure difference is not at the required level?
Q34a. AII/Do the specs include a means for the alarm to be switched off or muted when no patient w/ an airborrne infection is present?
Q35. AII/Do the specs include a fixed mechanical or electronic device to allow the medical staff to read the AII room pressure difference?
a. Visible or audible alarm

Figure 33.
b. Means to switch off or mute alarm c. Means to read AII room pressure difference
Monitoring provided for AII rooms.
Only 15 % of the designers provided a control sequence in the specifications to reduce total airflow to the AII rooms when no patient with an airborne infection is present, and this included roughly equal proportions of both subgroups.
60.0% 50.0% 40.0%

Percent
30.0% 20.0% 10.0% 0.0%

AIA state code state code AIA federal reqs ASHRAE Guidelines.. /AIA Guidelines.. /ASHRAE Handbook . Guidelines.. ./CDC Handbook . guidelines
Q37. AII/What code/standard/guideline were you required to use to establish the design AII room pressure difference?
Figure 34.
Code, standard or guideline to engineer was required to use to establish the design AII room pressure difference for this project.
Fifty-five percent of the designers said they had been required to use the AIA guidelines to establish the AII room pressure difference for this project, 25 % had been required to use a state code, 5 % both the AIA guidelines and a state code, 5 % both the AIA guidelines and the CDC guidelines, 5 % the ASHRAE handbook, and 5 % both federal requirements and the ASHRAE handbook. Of the 13 designers who said they had been required to use the AIA guidelines, either
alone or with something else, eleven (84.6 %) said that the 2001 guidelines were required and two (15.4 %) said that the 1997 guidelines were required. There were no differences on these points by group. Since the 1997 AIA guidelines required a pressure difference of -0.001 in. wg (-0.25 Pa) for AII rooms and the 2001 AIA guidelines required -0.01 in. wg (-2.5 Pa), the relationship between the version of the AIA guidelines the designer was required to use, if any, and the design pressure difference was examined. For the AII rooms without anterooms, five of seven users of the 2001 AIA guideline had used design pressure differences of -0.01 in. wg (-2.5 Pa) or more, but two had used -0.005 in. wg (-1.25 Pa). One of the two users of the 1997 guidelines had used -0.10 in. wg (-25 Pa) but one had used +0.05 in. wg (12.5 Pa). For the AII rooms with anterooms, seven of the nine users of the 2001 AIA guidelines had used a negative design pressure difference of 0.01 in. wg (-2.5 Pa) or greater; while one had used -0.008 in. wg (-2.0 Pa) and one had used +0.05 in. wg (12.5 Pa). There were no users of the 1997 guidelines among those whose project had included AII rooms with anterooms (Figure 35).
70.0% 60.0% 50.0%
60.0%
Q37 AII: Use AIA 2001, AIA1997 or Other?

AIA2001 (n=7) AIA1997 (n=2) Other (n=3)
Q37 AII: Use AIA 2001, AIA1997 or Other?

AIA2001 (n=9) Other (n=5)
50.0%
40.0%
Percent
40.0% 30.0%
Percent
30.0%
20.0%
20.0%
10.0%
10.0%
0.0%
0.0%
-15% -0.10 inch -0.05 inch -0.01 inch -0.005 inch 0.05 inch
-100 cfm -15% per doorway
-0.10 inch
-0.05 inch
-0.01 inch
-0.008 inch
0.05 inch
0.10 inch
Q16. (Recode2)AII (w/o anteroom)/What is the design pressure difference?
Q20 (Recode2). AII (w/anteroom)/What is the design pressure difference?
Figure 35.
Design pressure difference compared with version of the AIA guidelines the designer was required to use, if any.
Forty percent of the respondents had designed at least one project with rooms designed to switch back and forth between AII functions and PE functions in the period of interest. The 2001 AIA guidelines state that Rooms with reversible airflow provisions for the purpose of switching between protective environment and AII functions are not acceptable. However, some authorities having jurisdiction, such as the Veterans Administration, may require switchable rooms.
Page 35
Familiarity with Various Sources of Hospital Design Guidance

Respondents were asked about their degree of familiarity with several key hospital design guidelines and reference documents. Respondents were most familiar with the American Institute of Architects 2001 edition of the Guidelines for Design and Construction of Hospital and Health Care Facilities, with 80 % very familiar with it and 15 % somewhat familiar. The many projects group was marginally more familiar with the AIA document, with 100 % saying they were very familiar with it, vs. 60 % of the few projects group (p(FET) = 0.087m) (Figure 36). Thirty-five percent of respondents said they were very familiar with the Centers for Disease Control and Preventions 2003 edition of the Guidelines for Environmental Infection Control in Health Care Facilities, and 30 % were somewhat familiar with it, but 30 % were not at all familiar with it. Differences between groups were not significant. Forty-five percent of respondents were very familiar with the chapter on Health Care Design in the 2003 ASHRAE Handbook: Heating, Ventilating and Air Conditioning Applications, and 40 % were somewhat familiar with it. The percentages were virtually identical for ASHRAEs 2003 HVAC Design Manual for Hospitals and Clinics. There were no significant differences between the many projects and few projects groups in their familiarity with the ASHRAE references.
100.0%

100.0%

80.0%
80.0%
Percent
Percent
60.0%
60.0%
40.0%
40.0%
20.0%
20.0%
0.0% Very familiar Somewhat familiar Not at all familiar
0.0% Very familiar Somewhat familiar Slightly familiar Not at all familiar
Q42c. Familiarity with AIA 2001 edition of Guidelines for Design and Construction of Hospital and Health Care Facilities
Q42d. Familiarity with CDC 2003 edition of Guidelines for Environmental Infection Control in HC Facilities
Page 36
100.0%

100.0%

80.0%
80.0%
Percent
60.0%
Percent
Very familiar Somewhat familiar Slightly familiar Not at all familiar
60.0%
40.0%
40.0%
20.0%
20.0%
0.0%
0.0% Very familiar Somewhat familiar Slightly familiar Not at all familiar
Q42a. Familiarity with ASHRAE 2003 HVAC Applications Handbook chapter on Health Care Design
Q42b. Familiarity with ASHRAE 2003 HVAC Design Manual for Hospitals and Clinics
Figure 36.
Familiarity with various sources of design guidance (n=10, 10 for each graph).
Quality Control and Design Standards

Respondents were asked several questions that relate to quality control or to design standards. They were asked how many of their qualifying projects had a formal commissioning process for the mechanical systems. Forty percent said that none of their projects had included a formal commissioning process, 30 % said that between 1 % and 25 % had, and 30 % said that more than 25 % had. There was no significant difference between the two groups in the use of commissioning (p(FET) = 0.541ns)(Figure 37a). For the respondents as a whole, 100 of the 425 hospital projects designed (24 %) included a formal commissioning process. Respondents were also asked how many of their qualifying projects included formal verification of the airflow balancing, consisting of measurements repeated by the balancer under observation by another party. Twenty percent said that none of their projects had included this TAB verification, 30 % said that between 1 % and 25 % of their projects had, 5 % said that 26 % to 50 % had, and 45 % said that 76 % to 100 % had. There was no difference between the subgroups in the prevalence of TAB verification (p(FET) = 0.836ns)(Figure 37b). For the entire group, a total of 190 of the 425 hospital projects (45 %) had included formal TAB verification.
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50.0%

50.0%

40.0%
40.0%
Percent
Percent
0 1 to 25% 26 to 50% 51 to 75% 76 to 100%
30.0%
30.0%
20.0%
20.0%
10.0% 10.0%
0.0% 0.0% 0 1 to 25% 26 to 50% 76 to 100%
Q38a. Pct of projects with formal commissioning process, categorical
Q38b Pct of projects with formal TAB verification, categorical
Figure 37.
Quality control processes for qualifying projects.
Sixty-five percent of respondents said that their company has organizational design standards for hospitals that they and all other engineers of record at their location are required to follow. The ratio was essentially the same for the few projects and many projects groups (p(FET) = 1.0ns) (Figure 38a). Most of the respondents whose firms had organizational design standards also had multiple locations, and in 61.5 % of cases the engineers at other company locations were required to follow these design standards as well (Figure 38b).
100.0%

100.0%

80.0%
80.0%
Percent
60.0%
Percent
Yes No
60.0%
40.0%
40.0%
20.0%
20.0%
0.0%
0.0% Yes No
Q44. Does your company have organizational design standards that you and all other engineers of record at this location are required to follow?
No other locations
Q44a. Are engineers of record at other company locations also required to follow these design standards?
Figure 38.
Percent of respondents whose companies have mandatory organizational design standards at respondents location, and percent of these that are also required at other company locations.
Respondents were asked whether the recent projects designed by other engineers of record at their location would have followed the same design criteria and practices for the specific design issues the survey had covered. Of the fifteen designers who worked at locations where there were other engineers of record doing hospital design, eight (53 %) said projects by other
engineers definitely followed the same design criteria and practices, six (40 %) said they probably did, and one (7 %) said they definitely did not. There was no significant correlation between these responses and whether the company had organizational design standards for hospitals that all engineers of record were required to follow (Figure 39).
60.0%

few projects (n=10 many projects (n=10)
50.0%
40.0%
Percent
30.0%
20.0%
10.0%
0.0% Definitely the same Probably Defi not the None at this the same same location
Q45. Would you say that the recent projects designed by other engineers of record at your location...
Figure 39.
Likelihood that other engineers of record at respondents location follow the same design criteria and practices as those reported by respondent in the survey.
Infection Control Risk Assessments (ICRAs) have been required since 2001 by the AIA guidelines (Sec. 5.1) for renovations, remodels and additions, and to a limited extent (e.g., determining the number of AII rooms required) for new construction. They are the responsibility of the hospital, so the engineer might not be aware whether one was done, although a good ICRA would likely result in the addition of requirements to the specifications. Respondents were asked how many of their projects had included an ICRA. Twenty percent of respondents did not know. Of the 16 respondents who were able to provide information on this, 18.8 % said that none of their projects had had an ICRA, 12.5 % said that 1 % to 25 % had had one, 43.8 % said that 26 % to 50 % had had one, and 12.5 % each said that 51% to 75 % or 76 % to 100 % had had one.
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50.0%

40.0%
Percent
30.0%
20.0%
10.0%
0.0% none 1 to 25% 26 to 50% 51 to 75% 76 to 100%
Q38c Pct of projects with ICRA, categorical
Figure 40.
Percent of projects that included an Infection Control Risk Assessment, among respondents who could provide this information (note 20 % of each group said they did not know).
Challenges in Maintaining Proper Space Pressure Relationships

After the specific questions, we asked the respondents what, in their experience, is the single most significant challenge in designing and building ORs, PE rooms and AII rooms to maintain proper space pressure relationships for control of airborne infections. This question was openended. Although respondents were asked to identify the single most significant challenge, some identified more than one. The most commonly identified challenges pertained to construction or coordination: getting quality workmanship or contractors, getting work done according to specifications and details, getting the balancing or automatic temperature control (ATC) done properly, coordination between the balancer and ATC contractor or coordination between staff and the construction team (see Table 3). The challenge of room tightness raised by two respondents may have been an issue of architectural design or of construction quality. Another commonly mentioned group of issues related to budgets, to the architectural/budgetary issues of space allocation and floor-to-floor height, and to the managerial/budgetary issue of getting the owner or his representatives to understand what the engineer is trying to do. Other challenges identified appeared to relate to operating issues or possibly to HVAC design issues, including operating the facility per se, maintaining control of the airflows or pressures, and finding a quality, accurate pressure monitor.
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Table 3.
Responses to an open-ended question asking about the most significant challenge in designing and building ORs, PE rooms and AII rooms to maintain proper space pressure relationships for control of airborne infections.
Code
Challenge Identified APPARENT CONSTRUCTION OR COORDINATION ISSUES Getting quality workmanship/building the room following all specifications and details/construction Getting quality contractors Air balance/getting the balance done Getting automatic temperature control system to function properly/coordination of the temperature Coordination between the air balancer and the ATC contractor Trying to get the information to them soon enough/communication between staff and construction team APPARENT BUDGET OR ARCHITECTURAL DESIGN ISSUES Room tightness Budget issues Floor to floor height/ceiling constraints Space allocation Getting the owners or owners representatives to gain an understanding of what youre trying to do APPARENT OPERATING OR MECHANICAL DESIGN ISSUES To maintain control of the supply and return or exhaust Maintaining the proper pressure relationship Operating the facility after its built Accuracy of a good quality monitor
Number of respondents identifying issue as 1st 2nd 3rd most significant challenge 4 2 2 1 2 1 1 2 1 1 1 1 1 1 1 1 1
3 2 9 4 5 7 10 13 8 14 6 1 15 12 11
2 1
DISCUSSION
This survey is exploratory rather than representative in that it interviewed only 20 engineers. However, these respondents had been engineers of record for 425 projects since January 1, 2001 so they represent a substantial number of projects. The sample was divided for analysis into those who had done many projects (19 or more) and those who had done few projects (10 or less), but for the most part the differences in design practices between these groups were not large. The variability in design practices within groups, however, was substantial. For operating rooms, the design pressure differences used on respondents most recent project varied by a factor of 100 from +0.001 in. wg (0.25 Pa) to +0.10 in. wg (25 Pa), with 16 % of respondents not designing to a specific pressure difference at all. The excess of supply airflow over return/exhaust airflow varied by a factor of 5 from 100 cfm to 500 cfm (47 L/s to 236 L/s). The correlation between the design pressure difference and the design volume of excess supply air was the opposite of that which would be physically expected: the higher the pressure difference the designer was seeking to maintain, the less excess supply air was provided.
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To maintain a given pressure difference across room boundaries, a design team can either increase the difference between supply and return/exhaust flow or decrease the effective leakage area of the boundaries. The mechanical system designers generally have only the airflow rates under their direct control: 47 % of those interviewed said they had had little or no control over the airtightness of the OR boundaries on their most recent project. Only about a third of projects have a performance requirement for airtightness of the OR boundaries. Under these circumstances, the designer must assume a leakage area, either explicitly or implicitly. The effective leakage area (ELA) of the OR boundaries implicit in the design pressure differences and excess supply airflows used by the respondents varied by a factor of 30, from 17 in2 to 523 in2 (111 cm2 to 3375 cm2). The 17 in2 (111 cm2) at the low end is roughly equivalent to a (1.3 cm) gap under a standard width door and implies that the remainder of the room boundaries are totally airtight, while the 523 in2 (3375 cm2) figure is equivalent to over 3.6 ft2 (0.33 m2) of openings or one square opening about 23 in (58 cm) on each side. There is little evidence that this range of implicit ELAs reflects knowledge by the designers of widely differing envelope leakages: the engineers who had little or no control over airtightness of the OR envelope did not design for higher ELAs than those who had some or a lot of control over it. Nor did the designers who were expecting the OR envelope to be tighter than in past projects design for lower ELAs than those who did not. The projects that included performance requirements for airtightness of the OR envelope were not designed for lower ELAs than those that did not include performance requirements. There is no correlation between the implicit ELA and the number of projects with ORs the designer has done since January 2001, a possible proxy for overall experience. The wide range of implicit ELAs may indicate that some designers have not thought through the relationship between pressure difference, airflow and ELA. There are variations among designers as well in the area used as the point of reference for the OR pressure, the use of terminal boxes on the supplies and returns or supplies only, and the provision of devices to allow medical staff to monitor the OR pressure. Substantial variations were also found in the design of AII rooms. For AII rooms without anterooms, four of 12 projects were apparently out of compliance with the AIA 2001 guidelines: one was reportedly designed for positive AII room pressures, one was reportedly designed for a percent difference in flow rather than a specific pressure difference, and two were designed for a negative pressure smaller than -0.01 in. wg (-2.5 Pa). For the AII rooms with anterooms, five of 14 projects were apparently out of compliance: two were reportedly designed for positive AII room pressures relative to the anteroom and positive anteroom pressures relative to the corridor, two were reportedly designed for a percent or cfm (L/s) difference in flow rather than a specific pressure difference, and one was designed for a negative pressure smaller than -0.01 in. wg (2.5 Pa). For those in compliance, design pressure differences varied by a factor of ten from 0.01 in. wg (-2.5 Pa) to -0.10 in. wg (-25 Pa). The difference between AII room supply and return/exhaust flow (absolute value) varied by a factor of 30 from 10 cfm to 300 cfm (5 L/s to 142 L/s). There was no correlation between the design pressure difference (absolute value) and the design difference in airflows.
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Much as with ORs, 55 % of the respondents said they had little or no control over the airtightness of the AII room boundaries on their most recent project with AII rooms, and only 20 % of the projects included a performance requirement for airtightness of these boundaries. The effective leakage areas implicit in the design pressure differences and airflow differences ranged from 1 in2 to 117 in2 (9 cm2 to 756 cm2). As with the ORs, this wide range was not obviously related to knowledge by the designers of widely differing envelope leakages. The engineers who had little or no control over the airtightness of the AII room envelope did not design for higher ELAs than those who had some or a lot of control over it. Nor did the designers who were expecting the AII room envelope to be tighter than in past projects design for lower ELAs than those who did not. The projects that included performance requirements for airtightness of the AII room envelope were not designed for lower ELAs than those that did not include performance requirements. Designers who do more projects design for larger differences between AII room supply and return/exhaust airflows, but they do not design for significantly different pressure differences or implicit ELAs. There are variations among designers as to whether the mechanical systems for AII rooms with anterooms are designed to maintain a pressure difference between the anteroom and an adjacent area other than the AII room itself, whether this pressure difference is positive or negative, and its magnitude. For AII rooms generally, there are variations in such design features and strategies as whether there are terminal boxes on both the supply and return, the supply only, or neither, whether the space pressure is controlled by static balancing, direct pressure control, cfm (L/s) differentials or both, and whether a means is provided to switch off the AII room pressure alarm. The AIA guidelines were the document the majority of the designers had been required to follow in establishing OR and AII room pressure differences for their most recent qualifying projects with those space types. State codes, many of which are based on the AIA guidelines, were the second most commonly required. In addition, more respondents were very familiar with the AIA guidelines (80 %) than with the CDC guidelines, ASHRAEs applications handbook or ASHRAEs new Design Manual for Hospitals and Clinics. Thus the AIA guidelines are clearly the most important point of leverage to influence hospital design practices. In spite of the requirement to use the AIA guidelines and the reportedly high familiarity with them, there are still those in our sample who do not follow the differential pressure requirement of at least 0.01 in. wg (2.5 Pa), either using a lower number or using a differential air volume design alone. It is possible that those designers local authority allows a different standard, with which they are complying. The results of the questions regarding familiarity with the various design guidelines do show that designers who work in this market are trying to keep up with the state of the art in health care ventilation design. The findings allow tentative conclusions and recommendations to be formulated for further examination: 1. Of the various documents that provide guidance on hospital design and construction, the AIA guidelines appear to offer the most important point of leverage to influence these practices,
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2.
3.
4.
5.
6.
since the majority of designers interviewed were required to follow them and designers were more familiar with them than any other guidance document. A significant minority of designers are not following the current AIA guidelines with regard to pressure differentials between critical spaces and other areas, suggesting a need to further increase awareness of the latest guidance. For ORs, two of 20 respondents designed for differential pressures smaller than the -0.01 in. wg (-2.5 Pa) called for by AIA, and three designed for percentage or absolute flow differences rather than pressure differences per se. For AII rooms without anterooms, four of 12 projects were apparently out of compliance, with one designed for a positive room pressure, two designed for a negative pressure smaller than -0.01 in. wg (-2.5 Pa), and one designing for a percent difference in flow. For AII rooms with anterooms, five of 14 projects appeared to be out of compliance, with two designed for positive AII room pressure relative to the anteroom and positive anteroom pressure relative to the corridor or nurses station, one designed for a negative pressure smaller than -0.01 in. wg (-2.5 Pa), and two designed for percentage or absolute flow differences rather than pressure differences per se. A number of factors suggest that there may be a need for engineers to gain a greater understanding of and give more explicit consideration to the effective leakage area (ELA) of room boundaries when establishing design pressure and flow differentials. Physically, there is a positive relationship between differential pressure and differential flow, but this was not reflected in the survey responses for either ORs or AII rooms. As a result, the ELA implicit in the designs varied by one to two orders of magnitude. Moreover, implicit ELAs were not correlated with the amount of control the engineer had over the design, whether s/he expected the room to be tighter or looser than in previous projects, or whether there were performance requirements for airtightness. There may be a need to provide greater guidance on room airtightness. About half of the respondents said they had little or no control over the airtightness of ORs or AII rooms, and only a minority of the project specifications included a performance requirement for airtightness. Respondents identified problems with construction and coordination between trades as the most significant challenge in achieving proper space pressure relationships. This suggests the need to enhance quality control through increased use of airtightness testing (used in a small minority of the respondents most recent projects), TAB verification (used in about 45 % of the respondents qualifying projects), and commissioning (used in about 24 %). Forty percent of the respondents had designed at least one project with rooms designed to switch back and forth between AII functions and PE functions in the period of interest, in spite of the fact that the 2001 AIA guidelines state that this is unacceptable. This suggests a need to increase awareness of AIA guidance on this issue.
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ACKNOWLEDGEMENTS
This work was funded by the National Institute of Standards and Technology as part of a larger project under Order Number SB1341-04-W-0751. Anderson, Niebuhr and Associates reviewed the questionnaire design, conducted the interviews and cleaned and coded the data. Twenty mechanical engineers took time from their busy schedules to provide information that they understood could help to advance the state of the art in hospital infection control; we greatly appreciate their input, without which this project would not have been possible.
REFERENCES
AIA 2001. Guidelines for Design and Construction of Hospital and Health Care Facilities: 2001 Edition. New York: American Institute of Architects/Facility Guidelines Institute. ASHE 2001. Directory of Planning and Design Professionals for Health Facilities. Chicago: American Society for Healthcare Engineering of the American Hospital Association. ASHRAE 2005. 2005 ASHRAE Handbook: Fundamentals. Atlanta: American Society of Heating, Refrigerating and Air-Conditioning Engineers, Inc. ASHRAE 2003. 2003 ASHRAE Handbook: Heating, Ventilating and Air-Conditioning Applications. Atlanta: American Society of Heating, Refrigerating and Air-Conditioning Engineers, Inc. ASHRAE 2003. HVAC Design Manual for Hospitals and Clinics. Atlanta: American Society of Heating, Refrigerating and Air-Conditioning Engineers, Inc. CDC 2006. Healthcare-Associated Infections (HAIs). Retrieved February 3, 2006 from http://www.cdc.gov/ncidod/dhqp/healthDis.html. CDC 2003. Guidelines for Environmental Infection Control in Health-Care Facilities: Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC). CDC 1994a. Guidelines for preventing the transmission of mycobacterium tuberculosis in health care facilities. Morbidity and Mortality Weekly Report. October 28, 1994, Vol. 43 (No. RR-13). CDC 1994b. Guidelines for prevention of nosocomial pneumonia, 1994. Am J Infect Control (22:247-292). CDC 1992. Public health focus: surveillance, prevention, and control of nosocomial infections. Morbidity and Mortality Weekly Report. October 23, 1992, Vol. 41(42);783-787. ENR, 2003. The Top 500 Design Firms Sourcebook 2003. Engineering News-Record. McGraw Hill Construction. June 2003.
Streifel, A.J., 2000. Health-care IAQ: guidance for infection control. HPAC Heating/Piping/Air Conditioning Engineering V. 72, No. 10. October 2000. p. 28-30, 33, 34, 36. Streifel, A.J. 1999. Design and maintenance of hospital ventilation systems and the prevention of airborne nosocomial infections [Chapter 80]. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. 2nd ed. Philadelphia, PA: Lippincott Williams and Wilkins, 1999. Streifel, A.J., and J.W. Marshall. 1997. Parameters for ventilation controlled environments in hospitals. Proceedings of Healthy Buildings/IAQ'97, Atlanta, GA: American Society of Heating, Refrigerating and Air Conditioning Engineers, Vol. 1. September 27-October 2,1997, p. 433437. Also published in Moschandreas DJ, editor. Design, Construction and Operation of Healthy Buildings. Solutions to Global and Regional Concerns. Atlanta: ASHRAE Press; 1998. p. 305-9.
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APPENDIX A. Survey Instrument
Version 11 MECHANICAL ENGINEER SURVEY HOSPITAL DESIGN INTRODUCTION FOR RECEPTIONIST: Hello, my name is ________ and Im calling from Anderson, Niebuhr & Associates, a national research firm. Could I speak with one of your mechanical engineers who is the Engineer of Record for a significant portion of your hospital projects since January 2001, and who is familiar with your companys design practices? IF PERSON IS NOT IN, PLEASE RECORD NAME AND PHONE NUMBER. IF RECEPTIONIST OFFERS MORE THAN ONE NAME, RECORD ALL NAME PHONE
INTRODUCTION FOR MECHANICAL ENGINEER: Hello, my name is ________ and Im calling from Anderson, Niebuhr & Associates, a national research firm. S1. Your receptionist said that you are the Engineer of Record for a significant portion of the hospital projects designed by your firm at this location since January 2001, and that you are familiar with your companys design practices. Is that correct? a. _____ Yes b. _____ No
IF RESPONDENT ANSWERED NO TO S1, PLEASE ASK FOR THE NAME AND PHONE NUMBER OF A PERSON WHO IS THE MECHANICAL ENGINEER OF RECORD FOR A SIGNIFICANT PORTION OF THE HOSPITAL PROJECTS DESIGNED BY THIS FIRM AT THIS LOCATION SINCE JANUARY 2001. IF THE RESPONDENT OFFERS MORE THAN ONE NAME, RECORD ALL. NAME PHONE
TELL RESPONDENT WE WILL CONTACT THIS PERSON (OR ONE OF THESE PEOPLE) TO COMPLETE THE INTERVIEW. THANK THEM AND TERMINATE. ONCE YOU REACH THE CORRECT PERSON: As part of a project sponsored by the National Institute of Standards and Technology, or NIST, a building research laboratory, we are asking mechanical engineers like you questions about hospital design practices. The goal of this research is to better understand current practices and to develop new approaches that are easier to implement. We are offering all those who meet the criteria for our study a check for $100. Your responses will be kept strictly confidential and will never be identified with you, your firm or your projects unless you specifically authorize us to do so. Responses will be aggregated to prepare a summary report for NIST and others, and you will receive a copy of this report if you wish. The interview will take about 20 minutes. Is this a good time to ask you some questions about your recent hospital projects? (IF NOT, PLEASE SCHEDULE AN APPOINTMENT) APPOINTMENT DATE ____________ TIME ___________
Page A-1
1)
Considering only projects for which you personally are the Engineer of Record, how many new hospitals, hospital additions, and hospital remodels located in the U.S. have you started schematic design for since January 1, 2001 that are currently at any stage from 50 % construction documents to completed and occupied? [PROBE FOR SPECIFIC NUMBER] _____ (IF NONE or DONT KNOW, PLEASE TELL THE RESPONDENT THAT THEY DO NOT MEET THE CRITERIA OF OUR STUDY, THANK THEM, AND TERMINATE) How many of these projects have included each of the following types of spaces (READ a. d., RECORD NUMBER OF PROJECTS WITH EACH TYPE OF SPACE PROBE FOR SPECIFIC NUMBER) a) operating rooms ... _____ b) protective environment rooms, designed to protect immuno-compromised patients from infectious diseases . _____ c) airborne infection isolation rooms, designed to protect the rest of the hospital from patients infectious diseases .. _____ d) rooms designed to switch back and forth between airborne infection isolation functions and protective environment functions?.............................. _____ (IF NONE OF THE PROJECTS INCLUDES OPERATING ROOMS (a) OR AII ROOMS (c), OR IF THEY DONT KNOW, PLEASE TELL THE RESPONDENT THAT THEY DO NOT MEET THE CRITERIA OF OUR STUDY, THANK THEM, AND TERMINATE)
2)
OPERATING ROOMS
IF THE ANSWER TO Q2a IS ZERO, SKIP TO INTRODUCTION TO SECTION ON AIRBORNE INFECTION ISOLATION ROOMS (BEFORE Q14) The next group of questions pertains to operating rooms, or ORs. In answering these questions, please consider only your most recent U.S. project that includes ORs and is at least at the 50 % construction documents stage. Please do not include ORs intended for surgery on highly infectious patients. 3) For this project, were the mechanical systems designed to maintain a pressure difference between the ORs and adjacent areas? a) _____ Yes What adjacent area is the point of reference for the OR pressure? Is it: (READ LIST; CHECK ONE) i) _____ the surrounding area in general, ii) _____ a sterile corridor, iii) _____ a circulating corridor, iv) _____ a substerile room, v) _____ a pump room, vi) _____ an anteroom, or vii) _____ some other area? What area? _____________________________ viii) _____ (DO NOT READ) dont know b) _____ No (SKIP TO SECTION ON PROTECTIVE ENVIRONMENT ROOMS) c) _____ Dont know (SKIP TO Q6) What is the design pressure difference? (DO NOT READ LIST; CHECK ONE REPEAT THEIR NUMBER AFTER THEY ANSWER TO VERIFY] a) _____ No specific value, just slight pressure difference b) _____ 0.01 inch water gauge (one one-hundredth of an inch) c) _____ 0.001 inch water gauge (one one-thousandth of an inch) d) _____ 2.5 Pascals e) _____ 0.25 Pascals f) _____ Other ______________________________________ g) _____ Dont know
4)
Page A-2
5)
Are the ORs positive or negative relative to the adjacent area? a) _____ Positive b) _____ Negative c) _____ Dont know Do the ORs on this project have terminal boxes or airflow control valves: (READ LIST; CHECK ONE) a) _____ on both the supply and the return/exhaust b) _____ on the supply but not on the return/exhaust c) _____ on the return/exhaust but not on the supply, or d) _____ on neither the supply nor the return/exhaust? e) _____ (DO NOT READ) Dont know Approximately what is the difference, in cubic feet per minute, between the design supply airflow to each OR and the design return/exhaust airflow from the OR? __________ cfm (cubic feet per minute) (IF RESPONDENT OFFERS A PERCENTAGE, RECORD PERCENTAGE AND PROBE FOR AND RECORD ESTIMATE OF CFM) _______ percent _____ Dont know How much control did you as the engineer have over the airtightness of the OR envelope, including the ceiling, floor, walls, doors and all other room boundaries? Would you say: (READ LIST, CHECK ONE): a) _____ none b) _____ a little c) _____ some d) _____ a lot, or e) _____ complete control? Do you expect the OR envelope to be:(READ LIST; CHECK ONE) a) _____ tighter b) _____ looser, or c) _____ about the same as other ORs for which youve designed the HVAC? d) _____ (DO NOT READ) Dont know
6)
7)
8)
9)
10) Do the specifications include a performance requirement for airtightness of the OR envelope? a) _____ Yes Do they include a test to measure the airtightness? i) _____ Yes ii) _____ No iii) _____ Dont know b) _____ No c) _____ Dont know 11) Do the specifications include a fixed mechanical or electronic device to allow the medical staff to monitor the OR pressure difference? a) _____ Yes b) _____ No c) _____ Dont know 12) Does the control sequence in the specifications provide a means to reduce total airflow to the ORs when they are not in use? a) _____ Yes b) _____ No c) _____ Dont know
Strategies to Reduce the Spread of Airborne Infections in Hospitals: Survey of Design Practice Page A-3
13) What code, standard or guideline were you required to use to establish the design OR pressure difference on this project? Was it: (READ LIST; CHECK ONE. FOR THE RESPONSE GIVEN, ASK THE FOLLOW-UP QUESTION) a) _____ a state mechanical code What state? ____________________________________ b) _____ a local mechanical code What locality? _________________________________ c) _____ federal requirements What federal agency? _____________________________ d) _____ the AIA Guidelines for Design and Construction of Hospital and Health Care Facilities Which edition? i) _____ 2001 ii) _____ 1997 iii) _____ Dont know e) _____ the ASHRAE handbook, or f) _____ something else What? __________________________________________________ g) _____ (DO NOT READ) Dont know.
AIRBORNE INFECTION ISOLATION ROOMS

IF THE ANSWER TO Q2c IS ZERO, SKIP TO INTRODUCTION TO SECTION ON GENERAL QUESTIONS ABOUT RECENT PROJECTS (BEFORE Q38) The next group of questions pertains to Airborne Infection Isolation Rooms or AII rooms, designed to protect the rest of the hospital from the room occupants airborne infectious diseases. In answering these questions, please consider only your most recent U.S. project that includes AII rooms and is at least at the 50 % construction documents stage. Please include AII rooms in emergency or intensive care areas. Do not include rooms that are designed to switch back and forth between protective environment functions and airborne infection isolation functions. 14) Are there any AII rooms in this project that do not have anterooms separating them from the corridor? a) _____ Yes b) _____ No (SKIP TO Q18) c) _____ Dont know (SKIP TO Q18) 15) For the AII rooms without anterooms, were the mechanical systems designed to maintain a pressure difference between the AII room and adjacent areas? a) _____ Yes What adjacent area is the point of reference for the AII room pressure? Is it (READ LIST; CHECK ONE) i) _____ the corridor, ii) _____ the nurses station, or iii) _____ some other area? What area? ___________________________ iv) _____ (DO NOT READ) Dont know b) _____ No (SKIP TO Q18) c) _____ Dont know (SKIP TO Q18) 16) What is the design pressure difference? (DO NOT READ LIST; CHECK ONE REPEAT THEIR NUMBER AFTER THEY ANSWER TO VERIFY) a) _____ No specific value, just slight pressure difference b) _____ 0.01 inch water gauge (one one-hundredth of an inch) c) _____ 0.001 inch water gauge (one one-thousandth of an inch) d) _____ 2.5 Pascals e) _____ 0.25 Pascals f) _____ Other ______________________________________ g) _____ Dont know
Page A-4 Strategies to Reduce the Spread of Airborne Infections in Hospitals: Survey of Design Practice
17) Are the AII rooms positive or negative relative to the adjacent area? a) _____ Positive b) _____ Negative c) _____ Dont know 18) Are there any AII rooms in this project that do have anterooms separating them from the corridor? a) _____ Yes b) _____ No (SKIP to Q26) c) _____ Dont know (SKIP TO Q26) 19) For the AII rooms with anterooms, were the mechanical systems designed to maintain a pressure difference between the AII room itself and adjacent areas? a) _____ Yes What adjacent area is the point of reference for the AII room pressure? Is it: (READ LIST; CHECK ONE) i) _____ the anteroom, ii) _____ the corridor, iii) _____ the nurses station, or iv) _____ some other area? What area? __________________________ v) _____ (DO NOT READ) Dont know. b) _____ No (SKIP TO Q22) c) _____ Dont know (SKIP TO Q22) 20) What is the design pressure difference? (DO NOT READ LIST; CHECK ONE REPEAT THEIR NUMBER AFTER THEY ANSWER TO VERIFY) a) _____ No specific value, just slight pressure difference b) _____ 0.01 inch water gauge (one one-hundredth of an inch) c) _____ 0.001 inch water gauge (one one-thousandth of an inch) d) _____ 2.5 Pascals e) _____ 0.25 Pascals f) _____ Other ______________________________________ g) _____ (DO NOT READ) Dont know 21) Are the AII rooms positive or negative relative to the adjacent area? a) _____ Positive b) _____ Negative c) _____ Dont know 22) Were the mechanical systems designed to maintain a pressure difference between the anteroom and an adjacent area other than the AII room itself? a) _____ Yes What adjacent area is the point of reference for the anteroom pressure? Is it: (READ LIST; CHECK ONE) i) _____ the corridor, ii) _____ the nurses station, or iii) _____ some other area? What area? ___________________________ iv) _____ (DO NOT READ) dont know b) _____ No (SKIP TO Q26) c) _____ Dont know (SKIP TO Q26) 23) Are the anterooms positive or negative relative to this adjacent area? a) _____ Positive b) _____ Negative c) _____ Dont know
Strategies to Reduce the Spread of Airborne Infections in Hospitals: Survey of Design Practice Page A-5
24) What is the design pressure difference? (DO NOT READ LIST; CHECK ONE REPEAT THEIR NUMBER AFTER THEY ANSWER TO VERIFY) a) _____ No specific value, just slight pressure difference b) _____ 0.01 inch water gauge (one one-hundredth of an inch) c) _____ 0.001 inch water gauge (one one-thousandth of an inch) d) _____ 2.5 Pascals e) _____ 0.25 Pascals f) _____ Other ______________________________________ g) _____ Dont know 25) Do the anterooms for the AII rooms have supply flow only, exhaust flow only, or both supply and exhaust flow? a) _____ Supply flow only b) _____ Exhaust flow only c) _____ Both supply and exhaust flow d) _____ Dont know 26) Do the AII rooms on this project have terminal boxes or airflow control valves: (READ LIST; CHECK ONE) a) _____ on both the supply and the return/exhaust b) _____ on the supply but not on the return/exhaust c) _____ on the return/exhaust but not on the supply, or d) _____ on neither the supply nor the return/exhaust? (SKIP TO Q29) e) _____ (DO NOT READ) dont know 27) Is the space temperature in the AII rooms controlled (READ LIST; CHECK ONE) a) _____ by varying both airflow and supply air temperature, b) _____ by varying airflow only, or c) _____ by varying supply air temperature only? d) _____ (DO NOT READ) dont know 28) Is the space pressure in the AII rooms controlled (READ LIST; CHECK ONE) a) _____ by static balancing b) _____ by measuring supply and return/exhaust airflows continuously, and maintaining a constant differential between flows (SKIP TO Q30) c) _____ by measuring the space pressure itself continuously, and adjusting one or both of the flows to maintain it (SKIP TO Q30) d) _____ or by some other means What means? ____________________________________ ________________________________________________________ (SKIP TO Q30) e) _____ (DO NOT READ) dont know 29) Does the specification for the AII rooms call for the balancer to (READ LIST; CHECK ONE) a) _____ balance both supply and return/exhaust flow to the specified cfm b) _____ balance one flow to the specified cfm and the other to achieve the specified space pressure difference c) _____ balance one flow but not the other, or d) _____ does it leave the specific balancing procedure to the balancer? e) _____ (DO NOT READ) dont know
Page A-6
30) Approximately what is the difference, in cubic feet per minute, between the design exhaust airflow from each AII room, including toilet exhaust, and the sum of all relevant supply flows? __________ cfm (cubic feet per minute) (IF RESPONDENT OFFERS A PERCENTAGE, RECORD PERCENTAGE AND PROBE FOR AND RECORD ESTIMATE OF CFM) _______ percent _____ dont know 31) How much control did you as the engineer have over the airtightness of the AII room envelope, including the ceiling, floor, walls, doors and all other boundaries? Would you say: (READ LIST, CHECK ONE): a) _____ none b) _____ a little c) _____ some d) _____ a lot, or e) _____ complete control? 32) Do you expect the AII room envelope to be (READ LIST; CHECK ONE) a) _____ tighter, b) _____ looser, or c) _____ about the same as other AII rooms for which youve designed the HVAC? d) _____ (DO NOT READ) Dont know 33) Do the specifications include a performance requirement for airtightness of the AII room envelope? a) _____ Yes Do they include a test to measure the airtightness of the AII room envelope? i) _____ Yes ii) _____ No iii) _____ Dont know b) _____ No c) _____ Dont know 34) Do the specifications include a visible or audible alarm to notify the medical staff if the AII room pressure difference is not at the required level? a) _____ Yes Do they include a means for the alarm to be switched off or muted when no patient with an airborne infection is present? i) _____ Yes ii) _____ No iii) _____ Dont know b) _____ No c) _____ Dont know 35) Do the specifications include a fixed mechanical or electronic device to allow the medical staff to read the AII room pressure difference? a) _____ Yes b) _____ No c) _____ Dont know 36) Does the control sequence in the specifications provide a means to reduce total airflow to the AII rooms at times when no patient with an airborne infection is present? a) _____ Yes b) _____ No c) _____ Dont know
Page A-7
37) What code, standard or guideline were you required to use to establish the design AII room pressure difference on this project? (READ LIST; CHECK ONE. FOR THE RESPONSE GIVEN, ASK THE FOLLOW-UP QUESTION) a) _____ a state mechanical code What state? ____________________________________ b) _____ a local mechanical code What locality? _________________________________ c) _____ federal requirements What federal agency? _____________________________ d) _____ the AIA Guidelines for Design and Construction of Hospital and Health Care Facilities Which edition? i) _____ 2001 ii) _____ 1997 iii) _____ (DO NOT READ) Dont know e) _____ the ASHRAE handbook, or f) _____ something else What? _________________________________________________ g) _____ (DO NOT READ) dont know
GENERAL QUESTIONS ABOUT RECENT PROJECTS

The next few questions pertain to all of your [READ NUMBER FROM Q1] hospital projects that started schematic design after January 1, 2001 and are currently at least at the 50 % construction documents stage. 38) How many of these projects, if any, include each of the following: (READ LIST, RECORD NUMBER OF PROJECTS FOR EACH) a) a formal commissioning process for the mechanical systems?.................. _____ __ DK b) formal verification of the airflow balancing, consisting of measurements repeated by the balancer under observation by another party? .. _____ __ DK c) an Infection Control Risk Assessment?...................................................... _____ __ DK 39) How many fall into each of the following categories in terms of the level of health care provided? (READ LIST; RECORD NUMBER OF PROJECTS IN EACH CATEGORY) a) Primary care or community hospital _____ b) Secondary care hospital _____ c) Tertiary care hospital _____ d) Quarternary care or teaching hospital _____ (TOTAL SHOULD EQUAL NUMBER OF PROJECTS IN Q1) e) _____ (DO NOT READ) dont know 40) How many fall into each of the following ownership categories? (READ LIST; RECORD NUMBER OF PROJECTS IN EACH CATEGORY) a) For-profit owner _____ b) Non-profit owner _____ c) County, city, or other local government owner _____ d) State government owner _____ e) Federal government owner _____ (TOTAL SHOULD EQUAL NUMBER OF PROJECTS IN Q1) f) _____ (DO NOT READ) dont know
Page A-8
GENERAL QUESTIONS
41) In your experience, what is the single most significant challenge in designing and building ORs, PE rooms and AII rooms to maintain proper space pressure relationships for control of airborne infections?
42) Would you say you are very familiar, somewhat familiar, slightly familiar or not at all familiar with each of the following: (READ a. c. CIRCLE ONE RESPONSE FOR EACH) Somewhat familiar Not at all familiar N N N N
Page A-9
a) ASHRAEs 2003 HVAC Applications Handbook chapter on Health Care Design b) ASHRAEs 2003 HVAC Design Manual for Hospitals and Clinics c) the American Institute of Architects 2001 edition of the Guidelines for Design and Construction of Hospital and Health Care Facilities d) the Centers for Disease Control and Preventions 2003 edition of the Guidelines for Environmental Infection Control in Health-Care Facilities
VF VF VF VF
SWF SWF SWF SWF
43) Approximately how many new hospitals, hospital additions, or hospital remodels for which you personally are not the engineer of record started schematic design at your location after January 1, 2001 and are currently at least at the 50 % construction documents stage? _____ _____ Dont know 44) Does your company have organizational design standards for hospitals that you and all other engineers of record at this location are required to follow? a) _____ Yes Are engineers of record at other company locations also required to follow these design standards? i) _____ Yes ii) _____ No iii) _____ There are no other locations iv) _____ Dont know b) _____ No c) _____ Dont know
Slightly familiar SLF SLF SLF SLF
Very familiar
45) Considering the specific design issues we have discussed for your recent projects, would you say that the recent projects designed by other engineers of record at your location: (READ LIST, CHECK ONE) a) _____ definitely followed the same design criteria and practices, b) _____ probably followed the same criteria and practices, c) _____ probably did not follow the same criteria and practices, or d) _____ definitely did not follow the same criteria and practices. e) _____ (DO NOT READ) no recent projects by other engineers at this location f) _____ (DO NOT READ) dont know 46) Is your company an engineering firm only, an architecture and engineering firm, or a contracting firm offering design services? a) _____ Engineering only b) _____ Architecture and engineering c) _____ Contracting firm offering design services 47) Over the past five years, approximately what percentage of the building mechanical design work done by your company at this location has been for hospitals? Is it: a) _____ Less than 25 % b) _____ At least 25 % but less than 50 % c) _____ At least 50 % but less than 75 %, or d) _____ 75 % or more? e) _____ (DO NOT READ) dont know f) _____ (DO NOT READ) refused 48) In a later phase of this project, the Center for Energy and Environment or CEE, a contractor to NIST, will be reviewing plans and specifications for hospitals to characterize current HVAC design practices. The information gathered from this review will be presented in the form of statistical summaries, and will not be identified by designer, design firm, hospital owner or location. Participants will receive a copy of the research results if they wish. Would you be willing to share plans and specifications for one of your projects with CEE for this purpose, assuming that CEE would pay any costs of reproduction? a) _____ Yes May we give your name to CEE so they can contact you? __Yes __ No b) _____ Maybe May we give your name to CEE so they can contact you? __Yes __ No c) _____ No 49) Also in a later phase of this project, CEE will conduct on-site measurements of airflows, pressure relationships and boundary leakages in a sample of hospitals. Again, the information gathered will not be identified by designer, design firm, hospital owner or location. Do you have a project for which construction was completed after December 2000 that you would be willing to have CEE consider for inclusion in this sample? a) _____ Yes May we give your name to CEE so they can contact you? __Yes __ No b) _____ Maybe May we give your name to CEE so they can contact you? __Yes __ No c) _____ No 50) May we share your individual responses to this survey with CEE so that they can contact you with more technical follow-up questions? a) _____ Yes b) _____ No 51) Would you like a copy of the report on the survey results, when it is completed? a) _____ Yes b) _____ No
Page A-10 Strategies to Reduce the Spread of Airborne Infections in Hospitals: Survey of Design Practice
Thats it! Thank you very much for your time. Now, may I verify your name and address so we can be certain you receive your $100 check? You should receive it by mail within 10 to 14 days.
Name________________________________________ Company_____________________________________ Street________________________________________ City/State/Zip code__________________________________________

____________________________________________________________________________________________________________________________________________________________
Interviewer ID: __ __ __ __ Time: ______:______

Sample group: _____ frequent hospital design _____ infrequent hospital design
Page A-11
APPENDIX B: Tabulations
Version 11 MECHANICAL ENGINEER SURVEY HOSPITAL DESIGN INTRODUCTION FOR RECEPTIONIST: Hello, my name is ________ and Im calling from Anderson, Niebuhr & Associates, a national research firm. Could I speak with one of your mechanical engineers who is the Engineer of Record for a significant portion of your hospital projects since January 2001, and who is familiar with your companys design practices? IF PERSON IS NOT IN, PLEASE RECORD NAME AND PHONE NUMBER. IF RECEPTIONIST OFFERS MORE THAN ONE NAME, RECORD ALL NAME PHONE
INTRODUCTION FOR MECHANICAL ENGINEER: Hello, my name is ________ and Im calling from Anderson, Niebuhr & Associates, a national research firm. S1. Your receptionist said that you are the Engineer of Record for a significant portion of the hospital projects designed by your firm at this location since January 2001, and that you are familiar with your companys design practices. Is that correct? a. _____ Yes c. _____ No
IF RESPONDENT ANSWERED NO TO S1, PLEASE ASK FOR THE NAME AND PHONE NUMBER OF A PERSON WHO IS THE MECHANICAL ENGINEER OF RECORD FOR A SIGNIFICANT PORTION OF THE HOSPITAL PROJECTS DESIGNED BY THIS FIRM AT THIS LOCATION SINCE JANUARY 2001. IF THE RESPONDENT OFFERS MORE THAN ONE NAME, RECORD ALL. NAME PHONE
TELL RESPONDENT WE WILL CONTACT THIS PERSON (OR ONE OF THESE PEOPLE) TO COMPLETE THE INTERVIEW. THANK THEM AND TERMINATE. ONCE YOU REACH THE CORRECT PERSON: As part of a project sponsored by the National Institute of Standards and Technology, or NIST, a building research laboratory, we are asking mechanical engineers like you questions about hospital design practices. The goal of this research is to better understand current practices and to develop new approaches that are easier to implement. We are offering all those who meet the criteria for our study a check for $100. Your responses will be kept strictly confidential and will never be identified with you, your firm or your projects unless you specifically authorize us to do so. Responses will be aggregated to prepare a summary report for NIST and others, and you will receive a copy of this report if you wish. The interview will take about 20 minutes. Is this a good time to ask you some questions about your recent hospital projects? (IF NOT, PLEASE SCHEDULE AN APPOINTMENT) APPOINTMENT DATE ____________ TIME ___________
Page B-1
1)
Considering only projects for which you personally are the Engineer of Record, how many new hospitals, hospital additions, and hospital remodels located in the U.S. have you started schematic design for since January 1, 2001 that are currently at any stage from 50 % construction documents to completed and occupied? [PROBE FOR SPECIFIC NUMBER] _____ (IF NONE or DONT KNOW, PLEASE TELL THE RESPONDENT THAT THEY DO NOT MEET THE CRITERIA OF OUR STUDY, THANK THEM, AND TERMINATE)
Statistics
Q1. Number of hospital projects since Jan 1 2001 for which respondent is the Engineer of Record few projects N Valid 10 Missing 0 Mean 6.20 Minimum 2 Maximum 10 Sum 62 Percentiles 25 3.00 50 5.50 75 10.00 many projects N Valid 10 Missing 0 Mean 36.30 Minimum 19 Maximum 80 Sum 363 Percentiles 25 20.00 50 22.00 75 52.50
Q1. Number of hospital projects since Jan 1 2001 for which respondent is the Engineer of Record Redefined Sample Groups few projects Frequency 1 2 1 1 1 1 3 10 1 4 1 2 1 1 10
Group Statistics Redefined Sample Groups few projects many projects N 10 10 Mean 6.20 36.30 Std. Deviation 3.259 22.010 Std. Error Mean 1.031 6.960
Valid
many projects
Valid
2 3 4 5 6 9 10 Total 19 20 24 50 60 80 Total
Percent 10.0 20.0 10.0 10.0 10.0 10.0 30.0 100.0 10.0 40.0 10.0 20.0 10.0 10.0 100.0
Valid Percent 10.0 20.0 10.0 10.0 10.0 10.0 30.0 100.0 10.0 40.0 10.0 20.0 10.0 10.0 100.0
Cumulative Percent 10.0 30.0 40.0 50.0 60.0 70.0 100.0 10.0 50.0 60.0 80.0 90.0 100.0
Page B-2
Independent Samples Test Levene's Test for Equality of Variances t-test for Equality of Means 95% Confidence Interval of the Difference Lower Upper -44.882 -45.916 -15.318 -14.284
F Q1. Number of hospital projects since Jan 1 2001 for which respondent is the Engineer of Record Equal variances assumed Equal variances not assumed 29.974
Sig. .000
t -4.278 -4.278
df 18 9.394
Sig. (2-tailed) .000 .002
Mean Difference -30.100 -30.100
Std. Error Difference 7.036 7.036
Page B-3
2)
How many of these projects have included each of the following types of spaces (READ a. d., RECORD NUMBER OF PROJECTS WITH EACH TYPE OF SPACE PROBE FOR SPECIFIC NUMBER) a) operating rooms ... _____ b) protective environment rooms, designed to protect immunocompromised patients from infectious diseases . _____ c) airborne infection isolation rooms, designed to protect the rest of the hospital from patients infectious diseases .. _____ d) rooms designed to switch back and forth between airborne infection isolation functions and protective environment functions?.............................. _____ (IF NONE OF THE PROJECTS INCLUDES OPERATING ROOMS (a) OR AII ROOMS (c), OR IF THEY DONT KNOW, PLEASE TELL THE RESPONDENT THAT THEY DO NOT MEET THE CRITERIA OF OUR STUDY, THANK THEM, AND TERMINATE)
Statistics Q2c. Number of projects with airborne infection isolation rooms 10 0 4.20 2 9 42 2.75 3.00 6.50 10 0 18.40 2 50 184 9.00 13.00 23.75 Q2d. Number of projects with rooms that switch between AII and PE functions 10 0 .90 0 3 9 .00 1.00 1.25 10 0 .60 0 5 6 .00 .00 .25
Redefined Sample Groups few projects
N Mean Minimum Maximum Sum Percentiles
Valid Missing
many projects
25 50 75 Valid Missing
25 50 75
Q2a. Number of projects with operating rooms 10 0 2.50 0 8 25 1.00 2.00 3.25 10 0 11.20 1 25 112 5.50 10.00 16.25
Q2b. Number of projects with protective environment rooms 10 0 2.60 0 8 26 .00 2.00 4.50 10 0 6.00 0 15 60 2.00 3.50 12.00
Q2a. Number of projects with operating rooms Redefined Sample Groups few projects Frequency 1 2 4 1 1 1 10 1 1 2 2 2 1 1 10 Percent 10.0 20.0 40.0 10.0 10.0 10.0 100.0 10.0 10.0 20.0 20.0 20.0 10.0 10.0 100.0 Valid Percent 10.0 20.0 40.0 10.0 10.0 10.0 100.0 10.0 10.0 20.0 20.0 20.0 10.0 10.0 100.0 Cumulative Percent 10.0 30.0 70.0 80.0 90.0 100.0 10.0 20.0 40.0 60.0 80.0 90.0 100.0
Valid
many projects
Valid
0 1 2 3 4 8 Total 1 4 6 10 15 20 25 Total
Page B-4
Q2b. Number of projects with protective environment rooms Redefined Sample Groups few projects Frequency 3 1 2 1 1 1 1 10 1 3 1 1 1 2 1 10 Percent 30.0 10.0 20.0 10.0 10.0 10.0 10.0 100.0 10.0 30.0 10.0 10.0 10.0 20.0 10.0 100.0 Valid Percent 30.0 10.0 20.0 10.0 10.0 10.0 10.0 100.0 10.0 30.0 10.0 10.0 10.0 20.0 10.0 100.0 Cumulative Percent 30.0 40.0 60.0 70.0 80.0 90.0 100.0 10.0 40.0 50.0 60.0 70.0 90.0 100.0
Valid
many projects
Valid
0 1 2 3 4 6 8 Total 0 2 3 4 8 12 15 Total
Q2c. Number of projects with airborne infection isolation rooms Redefined Sample Groups few projects Frequency 2 5 1 1 1 10 1 1 2 1 1 2 2 10 Percent 20.0 50.0 10.0 10.0 10.0 100.0 10.0 10.0 20.0 10.0 10.0 20.0 20.0 100.0 Valid Percent 20.0 50.0 10.0 10.0 10.0 100.0 10.0 10.0 20.0 10.0 10.0 20.0 20.0 100.0 Cumulative Percent 20.0 70.0 80.0 90.0 100.0 10.0 20.0 40.0 50.0 60.0 80.0 100.0
Valid
many projects
Valid
2 3 6 8 9 Total 2 6 10 12 14 15 50 Total
Q2d. Number of projects with rooms that switch between AII and PE functions Redefined Sample Groups few projects Frequency 4 4 1 1 10 8 1 1 10 Percent 40.0 40.0 10.0 10.0 100.0 80.0 10.0 10.0 100.0 Valid Percent 40.0 40.0 10.0 10.0 100.0 80.0 10.0 10.0 100.0 Cumulative Percent 40.0 80.0 90.0 100.0 80.0 90.0 100.0
Valid
many projects
Valid
0 1 2 3 Total 0 1 5 Total
Group Statistics Redefined Sample Groups few projects many projects few projects many projects N 10 10 10 10 few projects many projects few projects many projects 10 10 10 10 Mean 2.50 11.20 2.60 6.00 4.20 18.40 .90 .60 Std. Deviation 2.224 7.525 2.716 5.312 2.530 17.141 .994 1.578 Std. Error Mean .703 2.380 .859 1.680 .800 5.421 .314 .499
Q2a. Number of projects with operating rooms Q2b. Number of projects with protective environment rooms Q2c. Number of projects with airborne infection isolation rooms projects Q2d. Number of with rooms that switch between AII and PE
Page B-5
Independent Samples Test Levene's Test for Equality of Variances t-test for Equality of Means 95% Confidence Interval of the Difference Lower Upper -13.913 -14.189 -7.364 -7.464 -25.711 -26.517 -.939 -.956 -3.487 -3.211 .564 .664 -2.689 -1.883 1.539 1.556
F Q2a. Number of projects with operating rooms Equal variances assumed Equal variances not assumed Equal variances assumed Equal variances not assumed Equal variances assumed Equal variances not assumed Equal variances assumed Equal variances not assumed 11.122
Sig. .004
t -3.506 -3.506
df 18 10.560 18 13.405 18 9.392 18 15.177
Sig. (2-tailed) .003 .005 .088 .094 .018 .028 .617 .618
Mean Difference -8.700 -8.700 -3.400 -3.400 -14.200 -14.200 .300 .300
Std. Error Difference 2.481 2.481 1.887 1.887 5.479 5.479 .590 .590
Q2b. Number of projects with protective environment rooms
8.669
.009
-1.802 -1.802
Q2c. Number of projects with airborne infection isolation rooms Q2d. Number of projects with rooms that switch between AII and PE functions
9.459
.007
-2.592 -2.592
.307
.586
.509 .509
Page B-6
OPERATING ROOMS
IF THE ANSWER TO Q2a IS ZERO, SKIP TO INTRODUCTION TO SECTION ON AIRBORNE INFECTION ISOLATION ROOMS (BEFORE Q14) The next group of questions pertains to operating rooms, or ORs. In answering these questions, please consider only your most recent U.S. project that includes ORs and is at least at the 50 % construction documents stage. Please do not include ORs intended for surgery on highly infectious patients. 3) For this project, were the mechanical systems designed to maintain a pressure difference between the ORs and adjacent areas? a) _____ Yes What adjacent area is the point of reference for the OR pressure? Is it: (READ LIST; CHECK ONE) i) _____ the surrounding area in general, ii) _____ a sterile corridor, iii) _____ a circulating corridor, iv) _____ a substerile room, v) _____ a pump room, vi) _____ an anteroom, or vii) _____ some other area? What area? _____________________________ viii) _____ (DO NOT READ) dont know b) _____ No (SKIP TO SECTION ON PROTECTIVE ENVIRONMENT ROOMS) c) _____ Dont know (SKIP TO Q6)
Q3. OR/Were the mechanical systems designed to maintain a pressure difference between the ORs and adjacent areas? Redefined Sample Groups few projects Frequency 9 1 10 10 Percent 90.0 10.0 100.0 100.0 Valid Percent 100.0 Cumulative Percent 100.0
many projects
Valid Missing Total Valid
Yes System Yes
100.0
100.0
Page B-7
Q3a. OR/What adjacent area is the point of reference for the OR pressure? * Redefined Sample Groups Crosstabulation Redefined Sample Groups few projects many projects 1 2 11.1% 3 33.3% 1 11.1% 2 22.2% 0 .0% 1 11.1% 1 11.1% 0 .0% 9 100.0% 20.0% 6 60.0% 0 .0% 0 .0% 1 10.0% 0 .0% 0 .0% 1 10.0% 10 100.0%
Total 3 15.8% 9 47.4% 1 5.3% 2 10.5% 1 5.3% 1 5.3% 1 5.3% 1 5.3% 19 100.0%
Q3a. OR/What adjacent area is the point of reference for the OR pressure?
the surrounding area in general a sterile corridor
a substerile room
an anteroom
some other area
the surrounding area in general/an anteroom a circulating corridor/a substerile room a sterile corridor/a substerile room Total
Count % within Redefined Sample Groups Count % within Redefined Sample Groups Count % within Redefined Sample Groups Count % within Redefined Sample Groups Count % within Redefined Sample Groups Count % within Redefined Sample Groups Count % within Redefined Sample Groups Count % within Redefined Sample Groups Count % within Redefined Sample Groups
Chi-Square Tests Value 8.304a 11.011 7.622 .966 19

b
df 7 7
Pearson Chi-Square Likelihood Ratio Fisher's Exact Test Linear-by-Linear Association N of Valid Cases
Asymp. Sig. (2-sided) .307 .138
Exact Sig. (2-sided) .296 .353 .370 .371
Exact Sig. (1-sided)
Point Probability
.326
.187
.035
a. 16 cells (100.0%) have expected count less than 5. The minimum expected count is .47. b. The standardized statistic is -.983.
Page B-8
4)
What is the design pressure difference? (DO NOT READ LIST; CHECK ONE REPEAT THEIR NUMBER AFTER THEY ANSWER TO VERIFY] a) _____ No specific value, just slight pressure difference b) _____ 0.01 inch water gauge (one one-hundredth of an inch) c) _____ 0.001 inch water gauge (one one-thousandth of an inch) d) _____ 2.5 Pascals e) _____ 0.25 Pascals f) _____ Other ______________________________________ g) _____ Dont know
Q4 (Recode2) OR/ What is the design pressure difference? Frequency 3 6 5 1 1 1 1 1 19 1 20 Percent 15.0 30.0 25.0 5.0 5.0 5.0 5.0 5.0 95.0 5.0 100.0 Valid Percent 15.8 31.6 26.3 5.3 5.3 5.3 5.3 5.3 100.0 Cumulative Percent 15.8 47.4 73.7 78.9 84.2 89.5 94.7 100.0
Valid
Missing Total
0.10 inch 0.05 inch 0.01 inch 0.005 inch 0.001 inch 15% do it with a cfm difference rather than a pressure differenc 100 cfm per doorway Total System
Q4 (Recode2) OR/ What is the design pressure difference? Redefined Sample Groups few projects Frequency 1 5 2 1 9 1 10 2 1 3 1 1 1 1 10 Percent 10.0 50.0 20.0 10.0 90.0 10.0 100.0 20.0 10.0 30.0 10.0 10.0 10.0 10.0 100.0 Valid Percent 11.1 55.6 22.2 11.1 100.0 Cumulative Percent 11.1 66.7 88.9 100.0
Valid
many projects
Missing Total Valid
0.10 inch 0.05 inch 0.01 inch 0.001 inch Total System 0.10 inch 0.05 inch 0.01 inch 0.005 inch 15% do it with a cfm difference rather than a pressure differenc 100 cfm per doorway Total
20.0 10.0 30.0 10.0 10.0 10.0 10.0 100.0
20.0 30.0 60.0 70.0 80.0 90.0 100.0
Page B-9
Statistics Q4 (Recode3) OR/ What is the design pressure difference? (numeric) few projects N Valid Missing Mean Minimum Maximum Sum Percentiles 25 50 75 many projects N Valid Missing Mean Minimum Maximum Sum Percentiles 25 50 75
9 1 .04122 .001 .100 .371 .01000 .05000 .05000 7 3 .04071 .005 .100 .285 .01000 .01000 .10000
Q4 (Recode3) OR/ What is the design pressure difference? (numeric) Redefined Sample Groups few projects Frequency 1 2 5 1 9 1 10 1 3 1 2 7 3 10 Percent 10.0 20.0 50.0 10.0 90.0 10.0 100.0 10.0 30.0 10.0 20.0 70.0 30.0 100.0 Valid Percent 11.1 22.2 55.6 11.1 100.0 Cumulative Percent 11.1 33.3 88.9 100.0
Valid
many projects
Missing Total Valid
.001 .010 .050 .100 Total System .005 .010 .050 .100 Total System
14.3 42.9 14.3 28.6 100.0
14.3 57.1 71.4 100.0
Missing Total
Group Statistics Redefined Sample Groups few projects many projects N 9 7 Mean .04122 .04071 Std. Deviation .030429 .043246 Std. Error Mean .010143 .016346
Independent Samples Test Levene's Test for Equality of Variances t-test for Equality of Means 95% Confidence Interval of the Difference Lower Upper -.038920 -.042154 .039936 .043170
F Q4 (Recode3) OR/ What is the design pressure difference? (numeric) Equal variances assumed Equal variances not assumed 2.253
Sig. .156
t .028 .026
df 14 10.359
Sig. (2-tailed) .978 .979
Mean Difference .000508 .000508
Std. Error Difference .018383 .019237
Page B-10
5)
Are the ORs positive or negative relative to the adjacent area? a) _____ Positive b) _____ Negative c) _____ Dont know
Q5. OR/Are the ORs positive or negative relative to the adjacent area? Redefined Sample Groups few projects Frequency 9 1 10 10 Percent 90.0 10.0 100.0 100.0 Valid Percent 100.0 Cumulative Percent 100.0
many projects
Positive System Positive
100.0
100.0
Page B-11
6)
Do the ORs on this project have terminal boxes or airflow control valves: (READ LIST; CHECK ONE) a) _____ on both the supply and the return/exhaust b) _____ on the supply but not on the return/exhaust c) _____ on the return/exhaust but not on the supply, or d) _____ on neither the supply nor the return/exhaust? e) _____ (DO NOT READ) Dont know
Q6. OR/Do the ORs have terminal boxes or airflow control valves... Redefined Sample Groups few projects Frequency 7 2 9 1 10 6 4 10 Percent 70.0 20.0 90.0 10.0 100.0 60.0 40.0 100.0 Valid Percent 77.8 22.2 100.0 Cumulative Percent 77.8 100.0
Valid
many projects
Missing Total Valid
Both supply/return Supply only Total System Both supply/return Supply only Total
60.0 40.0 100.0
60.0 100.0
Case Processing Summary Cases Missing N Percent
Valid N Q6. OR/Do the ORs have terminal boxes or airflow control valves... * Redefined Sample Groups Percent
Total Percent
19
95.0%
5.0%
20
100.0%
Chi-Square Tests Value .693b .114 .704

c
df 1 1 1
Pearson Chi-Square Continuity Correctiona Likelihood Ratio Fisher's Exact Test Linear-by-Linear Association N of Valid Cases
Asymp. Sig. (2-sided) .405 .735 .401
Exact Sig. (2-sided) .628 .628 .628 .628
Exact Sig. (1-sided) .370 .370 .370 .370
Point Probability
.656 19
.418
.279
a. Computed only for a 2x2 table b. 2 cells (50.0%) have expected count less than 5. The minimum expected count is 2.84. c. The standardized statistic is .810.
Page B-12
7)
Approximately what is the difference, in cubic feet per minute, between the design supply airflow to each OR and the design return/exhaust airflow from the OR? __________ cfm (cubic feet per minute) (IF RESPONDENT OFFERS A PERCENTAGE, RECORD PERCENTAGE AND PROBE FOR AND RECORD ESTIMATE OF CFM) _______ percent _____ Dont know
Statistics
Q7. OR/What is the difference, in cubic feet per minute, between the design supply air flow and the design return/exhaust flow? N Valid 16 Missing 4 Mean 271.88 Percentiles 25 200.00 50 225.00 75 343.75
Q7. OR/What is the difference, in cubic feet per minute, between the design supply air flow and the design return/exhaust flow? Frequency 1 1 1 5 1 2 1 1 1 2 16 4 20 Percent 5.0 5.0 5.0 25.0 5.0 10.0 5.0 5.0 5.0 10.0 80.0 20.0 100.0 Valid Percent 6.3 6.3 6.3 31.3 6.3 12.5 6.3 6.3 6.3 12.5 100.0 Cumulative Percent 6.3 12.5 18.8 50.0 56.3 68.8 75.0 81.3 87.5 100.0
Valid
Missing Total
100 125 150 200 250 300 325 350 450 500 Total System
Statistics Q7. OR/What is the difference, in cubic feet per minute, between the design supply air flow and the design return/exhaust flow? few projects N Valid 7 Missing 3 Mean 260.71 Minimum 125 Maximum 500 Sum 1825 Percentiles 25 150.00 50 200.00 75 350.00 many projects N Valid 9 Missing 1 Mean 280.56 Minimum 100 Maximum 500 Sum 2525 Percentiles 25 200.00 50 250.00 75 387.50
Page B-13
Q7. OR/What is the difference, in cubic feet per minute, between the design supply air flow and the design return/exhaust flow? Redefined Sample Groups few projects Frequency 1 1 2 1 1 1 7 3 10 1 3 1 1 1 1 1 9 1 10 Percent 10.0 10.0 20.0 10.0 10.0 10.0 70.0 30.0 100.0 10.0 30.0 10.0 10.0 10.0 10.0 10.0 90.0 10.0 100.0 Valid Percent 14.3 14.3 28.6 14.3 14.3 14.3 100.0 Cumulative Percent 14.3 28.6 57.1 71.4 85.7 100.0
Valid
many projects
Missing Total Valid
125 150 200 300 350 500 Total System 100 200 250 300 325 450 500 Total System
11.1 33.3 11.1 11.1 11.1 11.1 11.1 100.0
11.1 44.4 55.6 66.7 77.8 88.9 100.0
Missing Total
Statistics Q7pct. OR/Difference in percentage form few projects N Valid Missing Mean Minimum Maximum Sum Percentiles 25 50 75 many projects N Valid Missing Mean Minimum Maximum Sum Percentiles 25 50 75
2 8 10.00 10 10 20 10.00 10.00 10.00 1 9 15.00 15 15 15 15.00 15.00 15.00
Q7pct. OR/Difference in percentage form Redefined Sample Groups few projects Frequency 2 8 10 1 9 10 Percent 20.0 80.0 100.0 10.0 90.0 100.0 Valid Percent 100.0 Cumulative Percent 100.0
many projects
Valid Missing Total Valid Missing Total
10 System 15 System
100.0
100.0
Page B-14
Statistics OR_ELA N Mean Minimum Maximum Percentiles Valid Missing
25 50 75
14 6 116.8826 17.14 523.08 19.7959 63.0312 180.5337
OR_ELA Frequency 1 2 1 1 1 1 1 1 1 1 2 1 14 6 20 Percent 5.0 10.0 5.0 5.0 5.0 5.0 5.0 5.0 5.0 5.0 10.0 5.0 70.0 30.0 100.0 Valid Percent 7.1 14.3 7.1 7.1 7.1 7.1 7.1 7.1 7.1 7.1 14.3 7.1 100.0 Cumulative Percent 7.1 21.4 28.6 35.7 42.9 50.0 57.1 64.3 71.4 78.6 92.9 100.0
Valid
Missing Total
17.14 17.48 20.57 27.42 41.14 47.99 78.07 126.86 153.13 175.65 195.17 523.08 Total System
Statistics OR_ELA few projects N Mean Minimum Maximum Percentiles Valid Missing
many projects
N Mean Minimum Maximum Percentiles
25 50 75
7 3 129.9211 17.14 523.08 20.5687 47.9937 195.1716 7 3 103.8440 17.48 195.17 17.4774 126.8615 175.6544
Page B-15
OR_ELA Redefined Sample Groups few projects Frequency 1 1 1 1 1 1 1 7 3 10 2 1 1 1 1 1 7 3 10 Percent 10.0 10.0 10.0 10.0 10.0 10.0 10.0 70.0 30.0 100.0 20.0 10.0 10.0 10.0 10.0 10.0 70.0 30.0 100.0 Valid Percent 14.3 14.3 14.3 14.3 14.3 14.3 14.3 100.0 Cumulative Percent 14.3 28.6 42.9 57.1 71.4 85.7 100.0
Valid
many projects
Missing Total Valid
17.14 20.57 27.42 47.99 78.07 195.17 523.08 Total System 17.48 41.14 126.86 153.13 175.65 195.17 Total System
28.6 14.3 14.3 14.3 14.3 14.3 100.0
28.6 42.9 57.1 71.4 85.7 100.0
Missing Total
OR_ELA
Independent Samples Test Levene's Test for Equality of Variances t-test for Equality of Means 95% Confidence Interval of the Difference Lower Upper -138.186 -147.693 190.34060 199.84703
F OR_ELA Equal variances assumed Equal variances not assumed 1.960
Sig. .187
t .346 .346
df 12 8.022
Sig. (2-tailed) .735 .738
Mean Difference 26.07708 26.07708
Page B-16
8)
How much control did you as the engineer have over the airtightness of the OR envelope, including the ceiling, floor, walls, doors and all other room boundaries? Would you say: (READ LIST, CHECK ONE): a) _____ none b) _____ a little c) _____ some d) _____ a lot, or e) _____ complete control?
Q8. OR/How much control did you as the engineer have over the air-tightness of the OR envelope? * Redefined Sample Groups Crosstabulation Redefined Sample Groups few projects many projects 1 2 11.1% 4 44.4% 3 33.3% 1 11.1% 9 100.0% 20.0% 2 20.0% 2 20.0% 4 40.0% 10 100.0%
Total 3 15.8% 6 31.6% 5 26.3% 5 26.3% 19 100.0%
Q8. OR/How much control did you as the engineer have over the air-tightness of the OR envelope?
None
A little
Some
A lot
Total
Count % within Redefined Sample Groups Count % within Redefined Sample Groups Count % within Redefined Sample Groups Count % within Redefined Sample Groups Count % within Redefined Sample Groups

b
df 3 3
Exact Sig. (2-sided) .545 .545 .545 .527
Point Probability
.468
.308
.132
a. 8 cells (100.0%) have expected count less than 5. The minimum expected count is 1.42. b. The standardized statistic is .727.
Page B-17
9)
Do you expect the OR envelope to be:(READ LIST; CHECK ONE) a) _____ tighter b) _____ looser, or c) _____ about the same as other ORs for which youve designed the HVAC? d) _____ (DO NOT READ) Dont know
Q9. OR/Do you expect the OR envelope to be... * Redefined Sample Groups Crosstabulation Redefined Sample Groups few projects many projects 3 9 33.3% 5 55.6% 1 11.1% 9 100.0% 90.0% 1 10.0% 0 .0% 10 100.0%
Tighter
Don't know
Total
Count % within Redefined Sample Groups Count % within Redefined Sample Groups Count % within Redefined Sample Groups Count % within Redefined Sample Groups
Total 12 63.2% 6 31.6% 1 5.3% 19 100.0%
Chi-Square Tests Value 6.632a 7.384 6.267 4.504 19

b
df 2 2
Exact Sig. (2-sided) .025 .025 .025 .017
Point Probability
.034
.015
.014
a. 4 cells (66.7%) have expected count less than 5. The minimum expected count is .47. b. The standardized statistic is -2.122.
Page B-18
10) Do the specifications include a performance requirement for airtightness of the OR envelope? a) _____ Yes Do they include a test to measure the airtightness? i) _____ Yes ii) _____ No iii) _____ Dont know b) _____ No c) _____ Dont know
Q10. OR/Do the specs include a performance requirement for the air-tightness of the OR envelope? * Redefined Sample Groups Crosstabulation Redefined Sample Groups few projects many projects 3 3 33.3% 6 66.7% 9 100.0% 30.0% 7 70.0% 10 100.0%
Total 6 31.6% 13 68.4% 19 100.0%
Q10. OR/Do the specs include a performance requirement for the air-tightness of the OR envelope? Total
Yes
No
Count % within Redefined Sample Groups Count % within Redefined Sample Groups Count % within Redefined Sample Groups

c
df 1 1 1
Asymp. Sig. (2-sided) .876 1.000 .876
Exact Sig. (2-sided) 1.000 1.000 1.000 1.000
Exact Sig. (1-sided) .630 .630 .630 .630
Point Probability
.023 19
.879
.372
Q10a. OR/Do the specs include a test to measure the air-tightness? * Redefined Sample Groups Crosstabulation Redefined Sample Groups few projects many projects 1 3 33.3% 2 66.7% 3 100.0% 100.0% 0 .0% 3 100.0%
Total 4 66.7% 2 33.3% 6 100.0%
Q10a. OR/Do the specs include a test to measure the air-tightness?
Yes
No
Total
Chi-Square Tests Value 3.000b .750 3.819

c
df 1 1 1
Asymp. Sig. (2-sided) .083 .386 .051
Exact Sig. (2-sided) .400 .400 .400 .400
Exact Sig. (1-sided) .200 .200 .200 .200
Point Probability
2.500 6
.114
.200
a. Computed only for a 2x2 table b. 4 cells (100.0%) have expected count less than 5. The minimum expected count is 1.00. c. The standardized statistic is -1.581.
Page B-19
11) Do the specifications include a fixed mechanical or electronic device to allow the medical staff to monitor the OR pressure difference? a) _____ Yes b) _____ No c) _____ Dont know
Q11. OR/Do the specs include a mechanical or electronic device to allow the medical staff to monitor the OR pressure difference? * Redefined Sample Groups Crosstabulation Redefined Sample Groups few projects many projects 8 5 88.9% 1 11.1% 9 100.0% 50.0% 5 50.0% 10 100.0%
Total 13 68.4% 6 31.6% 19 100.0%
Q11. OR/Do the specs include a mechanical or electronic device to allow the medical staff to monitor the OR pressure difference? Total
Yes
No
Chi-Square Tests Value 3.316b 1.760 3.557

c
df 1 1 1
Asymp. Sig. (2-sided) .069 .185 .059
Exact Sig. (2-sided) .141 .141 .141 .141
Exact Sig. (1-sided) .091 .091 .091 .091
Point Probability
3.141 19
.076
.084
a. Computed only for a 2x2 table b. 2 cells (50.0%) have expected count less than 5. The minimum expected count is 2.84. c. The standardized statistic is 1.772.
Page B-20
12) Does the control sequence in the specifications provide a means to reduce total airflow to the ORs when they are not in use? a) _____ Yes b) _____ No c) _____ Dont know
Q12. OR/Does the control sequence in the spec provide a means to reduce total air flow to the ORs when they are not in use? * Redefined Sample Groups Crosstabulation Redefined Sample Groups few projects many projects 7 9 77.8% 2 22.2% 9 100.0% 90.0% 1 10.0% 10 100.0%
Q12. OR/Does the control sequence in the spec provide a means to reduce total air flow to the ORs when they are not in use? Total
Yes
No
Total 16 84.2% 3 15.8% 19 100.0%

c
df 1 1 1
Asymp. Sig. (2-sided) .466 .921 .463
Exact Sig. (2-sided) .582 .582 .582 .582
Exact Sig. (1-sided) .458 .458 .458 .458
Point Probability
.504 19
.478
.372
a. Computed only for a 2x2 table b. 2 cells (50.0%) have expected count less than 5. The minimum expected count is 1.42. c. The standardized statistic is -.710.
Page B-21
13) What code, standard or guideline were you required to use to establish the design OR pressure difference on this project? Was it: (READ LIST; CHECK ONE. FOR THE RESPONSE GIVEN, ASK THE FOLLOW-UP QUESTION) a) _____ a state mechanical code What state? ____________________________________ b) _____ a local mechanical code What locality? _________________________________ c) _____ federal requirements What federal agency? _____________________________ d) _____ the AIA Guidelines for Design and Construction of Hospital and Health Care Facilities Which edition? i) _____ 2001 ii) _____ 1997 iii) _____ Dont know e) _____ the ASHRAE handbook, or f) _____ something else What? __________________________________________________ g) _____ (DO NOT READ) Dont know.
Q13. OR/What code/standard/guideline were you required to use to establish the design OR pressure difference? * Redefined Sample Groups Crosstabulation Redefined Sample Groups few projects many projects 3 1 33.3% 3 33.3% 1 11.1% 1 11.1% 1 11.1% 0 .0% 9 100.0% 10.0% 7 70.0% 0 .0% 1 10.0% 0 .0% 1 10.0% 10 100.0%
Total 4 21.1% 10 52.6% 1 5.3% 2 10.5% 1 5.3% 1 5.3% 19 100.0%
Q13. OR/What code/standard/guideline were you required to use to establish the design OR pressure difference?
state code
AIA Guidelines...
ASHRAE Handbook
state code/AIA Guidelines... AIA Guidelines... /ASHRAE Handbook federal requirements/ASHRAE Handbook Total
Count % within Redefined Sample Groups Count % within Redefined Sample Groups Count % within Redefined Sample Groups Count % within Redefined Sample Groups Count % within Redefined Sample Groups Count % within Redefined Sample Groups Count % within Redefined Sample Groups

b
df 5 5
Exact Sig. (2-sided) .402 .562 .325 .712
Point Probability
.683
.374
.052
a. 11 cells (91.7%) have expected count less than 5. The minimum expected count is .47. b. The standardized statistic is .408.
Page B-22
Q13d. OR/Which edition of the AIA Guidelines... was used? * Redefined Sample Groups Crosstabulation Redefined Sample Groups few projects many projects 5 6 100.0% 0 .0% 0 .0% 5 100.0% 75.0% 1 12.5% 1 12.5% 8 100.0%
Q13d. OR/Which edition of the AIA Guidelines... was used?
2001
1997
Both 2001 & 1997
Total
Total 11 84.6% 1 7.7% 1 7.7% 13 100.0%

b
df 2 2
Exact Sig. (2-sided) 1.000 1.000 1.000 .744
Point Probability
.373
.359
.359
Page B-23
AIRBORNE INFECTION ISOLATION ROOMS

IF THE ANSWER TO Q2c IS ZERO, SKIP TO INTRODUCTION TO SECTION ON GENERAL QUESTIONS ABOUT RECENT PROJECTS (BEFORE Q38) The next group of questions pertains to Airborne Infection Isolation Rooms or AII rooms, designed to protect the rest of the hospital from the room occupants airborne infectious diseases. In answering these questions, please consider only your most recent U.S. project that includes AII rooms and is at least at the 50 % construction documents stage. Please include AII rooms in emergency or intensive care areas. Do not include rooms that are designed to switch back and forth between protective environment functions and airborne infection isolation functions. 14) Are there any AII rooms in this project that do not have anterooms separating them from the corridor? a) _____ Yes b) _____ No (SKIP TO Q18) c) _____ Dont know (SKIP TO Q18)
Q14. AII/Are there any AII rooms that do not have anterooms separating them from the corridor? * Redefined Sample Groups Crosstabulation Redefined Sample Groups few projects many projects 5 7 50.0% 5 50.0% 10 100.0% 70.0% 3 30.0% 10 100.0%
Total 12 60.0% 8 40.0% 20 100.0%
Q14. AII/Are there any AII rooms that do not have anterooms separating them from the corridor?
Yes
No
Total
Count % within Redefined Sample Groups Count % within Redefined Sample Groups Count % within Redefined Sample Groups Chi-Square Tests
Value .833b .208 .840

c
df 1 1 1
Asymp. Sig. (2-sided) .361 .648 .359
Exact Sig. (2-sided) .650 .650 .650 .650
Exact Sig. (1-sided) .325 .325 .325 .325
Point Probability
.792 20
.374
.240
Page B-24
15) For the AII rooms without anterooms, were the mechanical systems designed to maintain a pressure difference between the AII room and adjacent areas? a) _____ Yes What adjacent area is the point of reference for the AII room pressure? Is it (READ LIST; CHECK ONE) i) _____ the corridor, ii) _____ the nurses station, or iii) _____ some other area? What area? ___________________________ iv) _____ (DO NOT READ) Dont know b) _____ No (SKIP TO Q18) c) _____ Dont know (SKIP TO Q18)
Q15. AII(w/o anteroom)/ Were the mechanical systems designed to maintain a pressure difference between the AII room and adjacent areas? * Redefined Sample Groups Crosstabulation Redefined Sample Groups few projects many projects Q15. AII(w/o anteroom)/ Were the mechanical systems designed to maintain a pressure difference between the AII room and adjacent areas? Total Yes Count 5 % within Redefined Sample Groups 7 12
Total
100.0% 5 100.0%
100.0% 7 100.0%
100.0% 12 100.0%
Count % within Redefined Sample Groups
Q15a. AII (w/o anteroom)/What adjacent area is the point of reference for the AII room pressure? * Redefined Sample Groups Crosstabulation Redefined Sample Groups few projects many projects 5 6 100.0% 0 .0% 5 100.0% 85.7% 1 14.3% 7 100.0%
Total 11 91.7% 1 8.3% 12 100.0%
Q15a. AII (w/o anteroom)/What adjacent area is the point of reference for the AII room pressure? Total
the corridor
the nurse's station
Chi-Square Tests Value .779b .000 1.142

c
df 1 1 1
Asymp. Sig. (2-sided) .377 1.000 .285
Exact Sig. (2-sided) 1.000 1.000 1.000 1.000
Exact Sig. (1-sided) .583 .583 .583 .583
Point Probability
.714 12
.398
.583
a. Computed only for a 2x2 table b. 3 cells (75.0%) have expected count less than 5. The minimum expected count is .42. c. The standardized statistic is .845.
Page B-25
16) What is the design pressure difference? (DO NOT READ LIST; CHECK ONE REPEAT THEIR NUMBER AFTER THEY ANSWER TO VERIFY) a) _____ No specific value, just slight pressure difference b) _____ 0.01 inch water gauge (one one-hundredth of an inch) c) _____ 0.001 inch water gauge (one one-thousandth of an inch) d) _____ 2.5 Pascals e) _____ 0.25 Pascals f) _____ Other ______________________________________ g) _____ Dont know (Recoded to combine sign from Q17 with magnitude from Q16)
Q16. (Recode2)AII (w/o anteroom)/What is the design pressure difference? Frequency 1 2 5 1 2 1 12 8 20 Percent 5.0 10.0 25.0 5.0 10.0 5.0 60.0 40.0 100.0 Valid Percent 8.3 16.7 41.7 8.3 16.7 8.3 100.0 Cumulative Percent 8.3 25.0 66.7 75.0 91.7 100.0
Valid
Missing Total
-15% -0.005 inch -0.01 inch -0.05 inch -0.10 inch 0.05 inch Total System
Q16. (Recode2)AII (w/o anteroom)/What is the design pressure difference? Redefined Sample Groups few projects Frequency 1 2 1 1 5 5 10 1 1 3 2 7 3 10 Percent 10.0 20.0 10.0 10.0 50.0 50.0 100.0 10.0 10.0 30.0 20.0 70.0 30.0 100.0 Valid Percent 20.0 40.0 20.0 20.0 100.0 Cumulative Percent 20.0 60.0 80.0 100.0
Valid
many projects
Missing Total Valid
-0.005 inch -0.01 inch -0.05 inch 0.05 inch Total System -15% -0.005 inch -0.01 inch -0.10 inch Total System
14.3 14.3 42.9 28.6 100.0
14.3 28.6 71.4 100.0
Missing Total
Page B-26
17) Are the AII rooms positive or negative relative to the adjacent area? a) _____ Positive b) _____ Negative c) _____ Dont know
Q17. AII (w/o anteroom)/Are the AII rooms positive or negative relative to the adjacent area? * Redefined Sample Groups Crosstabulation Redefined Sample Groups few projects many projects 1 0 20.0% 4 80.0% 5 100.0% .0% 7 100.0% 7 100.0%
Total 1 8.3% 11 91.7% 12 100.0%
Q17. AII (w/o anteroom)/Are the AII rooms positive or negative relative to the adjacent area? Total
Positive
Negative

c
df 1 1 1
Asymp. Sig. (2-sided) .217 .860 .170
Exact Sig. (2-sided) .417 .417 .417 .417
Exact Sig. (1-sided) .417 .417 .417 .417
Point Probability
1.400 12
.237
.417
a. Computed only for a 2x2 table b. 3 cells (75.0%) have expected count less than 5. The minimum expected count is .42. c. The standardized statistic is 1.183.
Page B-27
18) Are there any AII rooms in this project that do have anterooms separating them from the corridor? a) _____ Yes b) _____ No (SKIP to Q26) c) _____ Dont know (SKIP TO Q26)
Q18. AII/Are there any AII rooms that do have anterooms separating them from the corridor? * Redefined Sample Groups Crosstabulation Redefined Sample Groups few projects many projects 8 7 80.0% 2 20.0% 10 100.0% 70.0% 3 30.0% 10 100.0%
Q18. AII/Are there any AII Yes rooms that do have anterooms separating them from the corridor? No
Total
Total 15 75.0% 5 25.0% 20 100.0%

c
df 1 1 1
Asymp. Sig. (2-sided) .606 1.000 .605
Exact Sig. (2-sided) 1.000 1.000 1.000 1.000
Exact Sig. (1-sided) .500 .500 .500 .500
Point Probability
.253 20
.615
.348
Page B-28
19) For the AII rooms with anterooms, were the mechanical systems designed to maintain a pressure difference between the AII room itself and adjacent areas? a) _____ Yes What adjacent area is the point of reference for the AII room pressure? Is it: (READ LIST; CHECK ONE) i) _____ the anteroom, ii) _____ the corridor, iii) _____ the nurses station, or iv) _____ some other area? What area? __________________________ v) _____ (DO NOT READ) Dont know. b) _____ No (SKIP TO Q22) c) _____ Dont know (SKIP TO Q22)
Q19. AII (w/ anteroom)/Were the mechanical systems designed to maintain a pressure difference between the AII room itself and adjacent areas? * Redefined Sample Groups Crosstabulation Redefined Sample Groups few projects many projects 7 7 87.5% 1 12.5% 8 100.0% 100.0% 0 .0% 7 100.0%
Total 14 93.3% 1 6.7% 15 100.0%
Q19. AII (w/ anteroom)/Were the mechanical systems designed to maintain a pressure difference between the AII room itself and adjacent areas? Total
Yes
No
Count % within Redefined Sample Groups Count % within Redefined Sample Groups Chi-Square Tests
Value .938b .000 1.320

c
df 1 1 1
Asymp. Sig. (2-sided) .333 1.000 .251
Exact Sig. (2-sided) 1.000 1.000 1.000 1.000
Exact Sig. (1-sided) .533 .533 .533 .533
Point Probability
.875 15
.350
.533
a. Computed only for a 2x2 table b. 2 cells (50.0%) have expected count less than 5. The minimum expected count is .47. c. The standardized statistic is -.935.
Q19a. AII (w/ anteroom)/What adjacent area is point of reference for the AII room pressure? * Redefined Sample Groups Crosstabulation Redefined Sample Groups few projects many projects 5 3 71.4% 2 28.6% 0 .0% 7 100.0% 42.9% 3 42.9% 1 14.3% 7 100.0%
Total 8 57.1% 5 35.7% 1 7.1% 14 100.0%
Q19a. AII (w/ anteroom)/What adjacent area is point of reference for the AII room pressure?
the anteroom
the corridor
the anteroom/the corridor
Total
Page B-29

b
df 2 2
Exact Sig. (2-sided) .592 .592 .592 .413
Point Probability
.250
.206
.163
a. 6 cells (100.0%) have expected count less than 5. The minimum expected count is .50. b. The standardized statistic is 1.149.
Page B-30
20) What is the design pressure difference? (DO NOT READ LIST; CHECK ONE REPEAT THEIR NUMBER AFTER THEY ANSWER TO VERIFY) a) _____ No specific value, just slight pressure difference b) _____ 0.01 inch water gauge (one one-hundredth of an inch) c) _____ 0.001 inch water gauge (one one-thousandth of an inch) d) _____ 2.5 Pascals e) _____ 0.25 Pascals f) _____ Other ______________________________________ g) _____ (DO NOT READ) Dont know (Recoded to combine sign from Q17 with magnitude from Q16)
Q20 (Recode2). AII (w/anteroom)/What is the design pressure difference? Frequency 1 1 1 5 2 1 1 2 14 6 20 Percent 5.0 5.0 5.0 25.0 10.0 5.0 5.0 10.0 70.0 30.0 100.0 Valid Percent 7.1 7.1 7.1 35.7 14.3 7.1 7.1 14.3 100.0 Cumulative Percent 7.1 14.3 21.4 57.1 71.4 78.6 85.7 100.0
Valid
Missing Total
-100 cfm per doorway -15% -0.008 inch -0.01 inch -0.05 inch -0.10 inch 0.10 inch 0.05 inch Total System
Q20 (Recode2). AII (w/anteroom)/What is the design pressure difference? Redefined Sample Groups few projects Frequency 1 2 1 1 2 7 3 10 1 1 3 1 1 7 3 10 Percent 10.0 20.0 10.0 10.0 20.0 70.0 30.0 100.0 10.0 10.0 30.0 10.0 10.0 70.0 30.0 100.0 Valid Percent 14.3 28.6 14.3 14.3 28.6 100.0 Cumulative Percent 14.3 42.9 57.1 71.4 100.0
Valid
many projects
Missing Total Valid
-0.008 inch -0.01 inch -0.05 inch 0.10 inch 0.05 inch Total System -100 cfm per doorway -15% -0.01 inch -0.05 inch -0.10 inch Total System
14.3 14.3 42.9 14.3 14.3 100.0
14.3 28.6 71.4 85.7 100.0
Missing Total
Page B-31
21) Are the AII rooms positive or negative relative to the adjacent area? a) _____ Positive b) _____ Negative c) _____ Dont know
Q21. AII (w/anteroom)/Are the AII rooms positive or negative to the adjacent area? * Redefined Sample Groups Crosstabulation Redefined Sample Groups few projects many projects 3 0 42.9% 4 57.1% 7 100.0% .0% 7 100.0% 7 100.0%
Total 3 21.4% 11 78.6% 14 100.0%
Q21. AII (w/anteroom)/Are the AII rooms positive or negative to the adjacent area?
Positive
Negative
Total
Value 3.818b 1.697 4.988

c
df 1 1 1
Asymp. Sig. (2-sided) .051 .193 .026
Exact Sig. (2-sided) .192 .192 .192 .192
Exact Sig. (1-sided) .096 .096 .096 .096
Point Probability
3.545 14
.060
.096
Page B-32
22) Were the mechanical systems designed to maintain a pressure difference between the anteroom and an adjacent area other than the AII room itself? a) _____ Yes What adjacent area is the point of reference for the anteroom pressure? Is it: (READ LIST; CHECK ONE) i) _____ the corridor, ii) _____ the nurses station, or iii) _____ some other area? What area? ___________________________ iv) _____ (DO NOT READ) dont know b) _____ No (SKIP TO Q26) c) _____ Dont know (SKIP TO Q26)
Q22. AII (w/anteroom)/Were the mechanical systems designed to maintain a pressure difference between the anteroom and an adjacent area other than the AII room itself? * Redefined Sample Groups Crosstabulation Redefined Sample Groups few projects many projects 5 3 62.5% 2 25.0% 1 12.5% 8 100.0% 42.9% 3 42.9% 1 14.3% 7 100.0%
Total 8 53.3% 5 33.3% 2 13.3% 15 100.0%
Q22. AII (w/anteroom)/Were the mechanical systems designed to maintain a pressure difference between the anteroom and an adjacent area other than the AII room itself? Total
Yes
No
Don't know
Count % within Redefined Sample Groups Count % within Redefined Sample Groups Count % within Redefined Sample Groups Count % within Redefined Sample Groups Chi-Square Tests
Value .636a .640 .929 .061 15

b
df 2 2
Exact Sig. (2-sided) .782 .782 .782 .695
Point Probability
.805
.420
.174
a. 6 cells (100.0%) have expected count less than 5. The minimum expected count is .93. b. The standardized statistic is .247. Q22a. AII/What adjacent area is point of reference for the anteroom pressure? * Redefined Sample Groups Crosstabulation Redefined Sample Groups few projects many projects 4 3 80.0% 1 20.0% 5 100.0% 100.0% 0 .0% 3 100.0%
Total 7 87.5% 1 12.5% 8 100.0%
Q22a. AII/What adjacent area is point of reference for the anteroom pressure?
the corridor
the nurse's station
Total
Page B-33
Chi-Square Tests Value .686b .000 1.024

c
df 1 1 1
Asymp. Sig. (2-sided) .408 1.000 .312
Exact Sig. (2-sided) 1.000 1.000 1.000 1.000
Exact Sig. (1-sided) .625 .625 .625 .625
Point Probability
.600 8
.439
.625
Page B-34
23) Are the anterooms positive or negative relative to this adjacent area? a) _____ Positive b) _____ Negative c) _____ Dont know
Q23. AII/Are the anterooms positive or negative relative to this adjacent area? * Redefined Sample Groups Crosstabulation Redefined Sample Groups few projects many projects 2 1 40.0% 3 60.0% 5 100.0% 33.3% 2 66.7% 3 100.0%
Total 3 37.5% 5 62.5% 8 100.0%
Q23. AII/Are the anterooms positive or negative relative to this adjacent area?
Positive
Negative
Total

c
df 1 1 1
Asymp. Sig. (2-sided) .850 1.000 .850
Exact Sig. (2-sided) 1.000 1.000 1.000 1.000
Exact Sig. (1-sided) .714 .714 .714 .714
Point Probability
.031 8
.860
.536
Page B-35
24) What is the design pressure difference? (DO NOT READ LIST; CHECK ONE REPEAT THEIR NUMBER AFTER THEY ANSWER TO VERIFY) a) _____ No specific value, just slight pressure difference b) _____ 0.01 inch water gauge (one one-hundredth of an inch) c) _____ 0.001 inch water gauge (one one-thousandth of an inch) d) _____ 2.5 Pascals e) _____ 0.25 Pascals f) _____ Other ______________________________________ g) _____ Dont know
Q24 (Recode2) AII/What is the design pressure difference? Frequency Valid -It wouldn't be monitored; AII room is monitored -0.003 inch -0.005 inch -0.01 inch 0.005 inch 100 cfm per doorway Total System 1 1 2 1 2 1 8 12 20 Percent 5.0 5.0 10.0 5.0 10.0 5.0 40.0 60.0 100.0 Valid Percent 12.5 12.5 25.0 12.5 25.0 12.5 100.0 Cumulative Percent 12.5 25.0 50.0 62.5 87.5 100.0
Missing Total
Q24 (Recode2) AII/What is the design pressure difference? Redefined Sample Groups few projects Frequency 1 1 1 2 5 5 10 1 1 1 3 7 10 Percent 10.0 10.0 10.0 20.0 50.0 50.0 100.0 10.0 10.0 10.0 30.0 70.0 100.0 Valid Percent 20.0 20.0 20.0 40.0 100.0 Cumulative Percent 20.0 40.0 60.0 100.0
Valid
many projects
Missing Total Valid
-0.003 inch -0.005 inch -0.01 inch 0.005 inch Total System -It wouldn't be monitored; AII room is monitored -0.005 inch 100 cfm per doorway Total System
33.3 33.3 33.3 100.0
33.3 66.7 100.0
Missing Total
Page B-36
25) Do the anterooms for the AII rooms have supply flow only, exhaust flow only, or both supply and exhaust flow? a) _____ Supply flow only b) _____ Exhaust flow only c) _____ Both supply and exhaust flow d) _____ Dont know
Q25. AII/Do the anterooms for the AII rooms have... * Redefined Sample Groups Crosstabulation Redefined Sample Groups few projects many projects 0 1 .0% 2 40.0% 3 60.0% 5 100.0% 33.3% 0 .0% 2 66.7% 3 100.0%
Total 1 12.5% 2 25.0% 5 62.5% 8 100.0%
Q25. AII/Do the anterooms for the AII rooms have...
supply flow only
exhaust flow only
both supply/exhaust
Total
Chi-Square Tests
Value 2.880a 3.855 2.448 .233 8

b
df 2 2
Exact Sig. (2-sided) .464 .464 .643 1.000
Point Probability
.629
.464
.268
Page B-37
26) Do the AII rooms on this project have terminal boxes or airflow control valves: (READ LIST; CHECK ONE) a) _____ on both the supply and the return/exhaust b) _____ on the supply but not on the return/exhaust c) _____ on the return/exhaust but not on the supply, or d) _____ on neither the supply nor the return/exhaust? (SKIP TO Q29) e) _____ (DO NOT READ) dont know
Q26. AII/Do the AII rooms have terminal boxes or airflow control valves... * Redefined Sample Groups Crosstabulation Redefined Sample Groups few projects many projects 5 5 50.0% 5 50.0% 0 .0% 0 .0% 10 100.0% 50.0% 3 30.0% 1 10.0% 1 10.0% 10 100.0%
Total 10 50.0% 8 40.0% 1 5.0% 1 5.0% 20 100.0%
Q26. AII/Do the AII rooms have terminal boxes or airflow control valves...
Both supply/return
Supply only
Neither supply/return
Varies between both & supply only Total

b
df 3 3
Exact Sig. (2-sided) .650 .650 .650 .440
Point Probability
.269
.220
.095
Page B-38
27) Is the space temperature in the AII rooms controlled (READ LIST; CHECK ONE) a) _____ by varying both airflow and supply air temperature, b) _____ by varying airflow only, or c) _____ by varying supply air temperature only? d) _____ (DO NOT READ) dont know
Q27. AII/Is the space temperature in the AII rooms controlled... * Redefined Sample Groups Crosstabulation Redefined Sample Groups few projects many projects 2 1 20.0% 1 10.0% 7 70.0% 10 100.0% 11.1% 0 .0% 8 88.9% 9 100.0%
Total 3 15.8% 1 5.3% 15 78.9% 19 100.0%
Q27. AII/Is the space temperature in the AII rooms controlled...
varying flow & temp
varying flow only
varying supply temp only
Total

b
df 2 2
Exact Sig. (2-sided) 1.000 1.000 1.000 .582
Point Probability
.427
.333
.209
Page B-39
28) Is the space pressure in the AII rooms controlled (READ LIST; CHECK ONE) a) _____ by static balancing b) _____ by measuring supply and return/exhaust airflows continuously, and maintaining a constant differential between flows (SKIP TO Q30) c) _____ by measuring the space pressure itself continuously, and adjusting one or both of the flows to maintain it (SKIP TO Q30) d) _____ or by some other means What means? ____________________________________ ________________________________________________________ (SKIP TO Q30) e) _____ (DO NOT READ) dont know
Q28. AII/Is the space pressure in the AII rooms controlled... * Redefined Sample Groups Crosstabulation Redefined Sample Groups few projects many projects 5 2 50.0% 2 20.0% 2 20.0% 1 10.0% 0 .0% 10 100.0% 22.2% 2 22.2% 4 44.4% 0 .0% 1 11.1% 9 100.0%
Total 7 36.8% 4 21.1% 6 31.6% 1 5.3% 1 5.3% 19 100.0%
Q28. AII/Is the space pressure in the AII rooms controlled...
static balancing
constant differential
constant space press
Some other means
constant differential/constant space pressure Total
Count % within Redefined Sample Groups Count % within Redefined Sample Groups Count % within Redefined Sample Groups Count % within Redefined Sample Groups Count % within Redefined Sample Groups Count % within Redefined Sample Groups

b
df 4 4
Exact Sig. (2-sided) .420 .420 .420 .239
Point Probability
.199
.147
.068
Q28d What other means * Redefined Sample Groups Crosstabulation Redefined Sample Groups few projects 1 100.0% 1 100.0%
Total 1 100.0% 1 100.0%
Q28d What other means Total
constant air flow differentials w/automatic adjustments
Count % within Redefined Sample Groups Count % within Redefined Sample Groups
Page B-40
29) Does the specification for the AII rooms call for the balancer to (READ LIST; CHECK ONE) a) _____ balance both supply and return/exhaust flow to the specified cfm b) _____ balance one flow to the specified cfm and the other to achieve the specified space pressure difference c) _____ balance one flow but not the other, or d) _____ does it leave the specific balancing procedure to the balancer? e) _____ (DO NOT READ) dont know
Q29. AII/Does the spec for the AII rooms call for the balancer to... * Redefined Sample Groups Crosstabulation Redefined Sample Groups few projects many projects 5 2 100.0% 0 .0% 5 100.0% 66.7% 1 33.3% 3 100.0%
Total 7 87.5% 1 12.5% 8 100.0%
Q29. AII/Does the spec for the AII rooms call for the balancer to...
balance both
balance only one but not other Total

c
df 1 1 1
Asymp. Sig. (2-sided) .168 .783 .137
Exact Sig. (2-sided) .375 .375 .375 .375
Exact Sig. (1-sided) .375 .375 .375 .375
Point Probability
1.667 8
.197
.375
Page B-41
30) Approximately what is the difference, in cubic feet per minute, between the design exhaust airflow from each AII room, including toilet exhaust, and the sum of all relevant supply flows? __________ cfm (cubic feet per minute) (IF RESPONDENT OFFERS A PERCENTAGE, RECORD PERCENTAGE AND PROBE FOR AND RECORD ESTIMATE OF CFM) _______ percent _____ dont know
Statistics Q30. AII/What is the difference, in cubic feet per minute, between the design exhaust air flow from each AII room and all relevant supply flows? N Valid 16 Missing 4 Mean 138.75 Minimum 10 Maximum 300 Percentiles 25 100.00 50 150.00 75 171.25
Q30. AII/What is the difference, in cubic feet per minute, between the design exhaust air flow from each AII room and all relevant supply flows? Frequency 1 1 1 3 1 4 1 1 1 1 1 16 4 20 Statistics Q30. AII/What is the difference, in cubic feet per minute, between the design exhaust air flow from each AII room and all relevant supply flows? few projects N Valid 8 Missing 2 Mean 113.13 Minimum 10 Maximum 275 Percentiles 25 62.50 50 100.00 75 142.50 many projects N Valid 8 Missing 2 Mean 164.38 Minimum 30 Maximum 300 Percentiles 25 150.00 50 155.00 75 193.75 Percent 5.0 5.0 5.0 15.0 5.0 20.0 5.0 5.0 5.0 5.0 5.0 80.0 20.0 100.0 Valid Percent 6.3 6.3 6.3 18.8 6.3 25.0 6.3 6.3 6.3 6.3 6.3 100.0 Cumulative Percent 6.3 12.5 18.8 37.5 43.8 68.8 75.0 81.3 87.5 93.8 100.0
Valid
Missing Total
10 30 50 100 120 150 160 175 200 275 300 Total System
Page B-42
Q30. AII/What is the difference, in cubic feet per minute, between the design exhaust air flow from each AII room and all relevant supply flows? Redefined Sample Groups few projects Frequency 1 1 3 1 1 1 8 2 10 1 3 1 1 1 1 8 2 10 Percent 10.0 10.0 30.0 10.0 10.0 10.0 80.0 20.0 100.0 10.0 30.0 10.0 10.0 10.0 10.0 80.0 20.0 100.0 Valid Percent 12.5 12.5 37.5 12.5 12.5 12.5 100.0 Cumulative Percent 12.5 25.0 62.5 75.0 87.5 100.0
Valid
many projects
Missing Total Valid
10 50 100 120 150 275 Total System 30 150 160 175 200 300 Total System
12.5 37.5 12.5 12.5 12.5 12.5 100.0
12.5 50.0 62.5 75.0 87.5 100.0
Missing Total
Group Statistics Redefined Sample Groups few projects N 8 many projects 8 164.38 74.135 26.211 Mean 113.13 Std. Deviation 78.145 Std. Error Mean 27.629
Independent Samples Test Levene's Test for Equality of Variances t-test for Equality of Means 95% Confidence Interval of the Difference Lower Upper -132.930 30.430
F Q30. AII/What is the difference, in cubic feet per minute, between the design exhaust air flow from each AII room and all relevant supply flows? Equal variances assumed Equal variances not assumed .045
Sig. .834
t -1.346
df 14
Sig. (2-tailed) .200
Mean Difference -51.250
Std. Error Difference 38.083
-1.346
13.961
.200
-51.250
38.083
-132.952
30.452
Statistics Q30pct. AII/Difference in percentage form few projects N Valid Missing Mean Minimum Maximum Percentiles 25 50 75 many projects N Valid Missing Mean Minimum Maximum Percentiles 25 50 75
2 8 10.00 10 10 10.00 10.00 10.00 2 8 12.50 10 15 10.00 12.50 15.00
Page B-43
Q30pct. AII/Difference in percentage form Redefined Sample Groups few projects Frequency 2 8 10 1 1 2 8 10 Percent 20.0 80.0 100.0 10.0 10.0 20.0 80.0 100.0 Valid Percent 100.0 Cumulative Percent 100.0
many projects
10 System 10 15 Total System
50.0 50.0 100.0
50.0 100.0
Missing Total
Statistics N Mean Minimum Maximum Percentiles Valid Missing AIIELAwo 10 10 47.2667 1.37 117.11 10.4867 39.5611 79.6289 AIIELAw 10 10 51.2454 13.11 117.10 13.7125 46.5935 78.0686
25 50 75
AIIELAwo Frequency 1 1 1 1 1 1 1 1 1 1 10 10 20 Percent 5.0 5.0 5.0 5.0 5.0 5.0 5.0 5.0 5.0 5.0 50.0 50.0 100.0 Valid Percent 10.0 10.0 10.0 10.0 10.0 10.0 10.0 10.0 10.0 10.0 100.0 Cumulative Percent 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.0
Valid
Missing Total
1.37 2.62 13.11 19.52 20.57 58.55 68.31 73.50 98.00 117.11 Total System
AIIELAw Frequency 1 2 1 1 1 1 1 1 1 10 10 20 Percent 5.0 10.0 5.0 5.0 5.0 5.0 5.0 5.0 5.0 50.0 50.0 100.0 Valid Percent 10.0 20.0 10.0 10.0 10.0 10.0 10.0 10.0 10.0 100.0 Cumulative Percent 10.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.0
Valid
Missing Total
13.11 13.71 27.42 39.03 54.15 58.55 68.31 107.34 117.10 Total System
Page B-44
Statistics Redefined few projects N Mean Minimum Maximum Percentiles Valid Missing AIIELAwo 4 6 28.7404 1.37 73.50 5.9079 20.0435 60.2700 6 4 59.6176 2.62 117.11 10.4867 63.4324 102.7800 AIIELAw 5 5 45.5912 13.71 107.34 13.7125 39.0343 80.7485 5 5 56.8995 13.11 117.10 20.2665 58.5515 92.7065
many projects
25 50 75
Page B-45
31) How much control did you as the engineer have over the airtightness of the AII room envelope, including the ceiling, floor, walls, doors and all other boundaries? Would you say: (READ LIST, CHECK ONE): a) _____ none b) _____ a little c) _____ some d) _____ a lot, or e) _____ complete control?
Q31. AII/How much control did you as the engineer have over the air-tightness of the AII room envelope? * Redefined Sample Groups Crosstabulation Redefined Sample Groups few projects many projects 3 3 30.0% 4 40.0% 3 30.0% 0 .0% 10 100.0% 30.0% 1 10.0% 3 30.0% 3 30.0% 10 100.0%
Total 6 30.0% 5 25.0% 6 30.0% 3 15.0% 20 100.0%
none
A little
Some
A lot
Total

b
df 3 3
Exact Sig. (2-sided) .247 .179 .247 .305
Point Probability
.215
.153
.079
a. 8 cells (100.0%) have expected count less than 5. The minimum expected count is 1.50. b. The standardized statistic is 1.241.
Page B-46
32) Do you expect the AII room envelope to be (READ LIST; CHECK ONE) a) _____ tighter, b) _____ looser, or c) _____ about the same as other AII rooms for which youve designed the HVAC? d) _____ (DO NOT READ) Dont know
Q32. AII/Do you expect the AII room envelope to be... * Redefined Sample Groups Crosstabulation Redefined Sample Groups few projects many projects 5 2 50.0% 4 40.0% 1 10.0% 10 100.0% 20.0% 7 70.0% 1 10.0% 10 100.0%
Total 7 35.0% 11 55.0% 2 10.0% 20 100.0%
Tighter
Don't know
Total

b
df 2 2
Exact Sig. (2-sided) .650 .650 .475 .608
Point Probability
.506
.304
.075
Page B-47
33) Do the specifications include a performance requirement for airtightness of the AII room envelope? a) _____ Yes Do they include a test to measure the airtightness of the AII room envelope? i) _____ Yes ii) _____ No iii) _____ Dont know b) _____ No c) _____ Dont know
Q33. AII/Do the specs include a performance requirement for air-tightness of the AII room envelope? * Redefined Sample Groups Crosstabulation Redefined Sample Groups few projects many projects 2 2 20.0% 7 70.0% 1 10.0% 10 100.0% 20.0% 8 80.0% 0 .0% 10 100.0%
Total 4 20.0% 15 75.0% 1 5.0% 20 100.0%
Yes
No
Don't know
Total
Value 1.067a 1.453 1.129 .859 20

b
df 2 2
Exact Sig. (2-sided) 1.000 1.000 1.000 .751
Point Probability
.354
.375
.209
a. 4 cells (66.7%) have expected count less than 5. The minimum expected count is .50. b. The standardized statistic is -.927. Q33a. AII/Do the specs include a test to measure the air-tightness of the AII room envelope? * Redefined Sample Groups Crosstabulation Redefined Sample Groups few projects many projects 1 2 50.0% 1 50.0% 2 100.0% 100.0% 0 .0% 2 100.0%
Total 3 75.0% 1 25.0% 4 100.0%
Yes
No
Total
Value 1.333b .000 1.726

c
df 1 1 1
Asymp. Sig. (2-sided) .248 1.000 .189
Exact Sig. (2-sided) 1.000 1.000 1.000 1.000
Exact Sig. (1-sided) .500 .500 .500 .500
Point Probability
1.000 4
.317
.500
a. Computed only for a 2x2 table b. 4 cells (100.0%) have expected count less than 5. The minimum expected count is .50. c. The standardized statistic is -1.000.
Page B-48
34) Do the specifications include a visible or audible alarm to notify the medical staff if the AII room pressure difference is not at the required level? a) _____ Yes Do they include a means for the alarm to be switched off or muted when no patient with an airborne infection is present? i) _____ Yes ii) _____ No iii) _____ Dont know b) _____ No c) _____ Dont know
Q34. AII/Do the specs include a visible or audible alarm to notify the medical staff if the AII room pressure difference is not at the required level? * Redefined Sample Groups Crosstabulation Redefined Sample Groups few projects many projects 8 10 80.0% 2 20.0% 10 100.0% 100.0% 0 .0% 10 100.0%
Total 18 90.0% 2 10.0% 20 100.0%
Q34. AII/Do the specs include a visible or audible alarm to notify the medical staff if the AII room pressure difference is not at the required level? Total
Yes
No
Value 2.222b .556 2.995

c
df 1 1 1
Asymp. Sig. (2-sided) .136 .456 .084
Exact Sig. (2-sided) .474 .474 .474 .474
Exact Sig. (1-sided) .237 .237 .237 .237
Point Probability
2.111 20
.146
.237
Q34a. AII/Do the specs include a means for the alarm to be switched off or muted when no patient w/ an airborrne infection is present? * Redefined Sample Groups Crosstabulation Redefined Sample Groups few projects many projects 3 8 37.5% 4 50.0% 1 12.5% 8 100.0% 80.0% 2 20.0% 0 .0% 10 100.0%
Total 11 61.1% 6 33.3% 1 5.6% 18 100.0%
Q34a. AII/Do the specs include a means for the alarm to be switched off or muted when no patient w/ an airborrne infection is present?
Yes
No
Don't know
Total
Page B-49

b
df 2 2
Exact Sig. (2-sided) .145 .145 .145 .068
Point Probability
.130
.064
.057
Page B-50
35) Do the specifications include a fixed mechanical or electronic device to allow the medical staff to read the AII room pressure difference? a) _____ Yes b) _____ No c) _____ Dont know
Q35. AII/Do the specs include a fixed mechanical or electronic device to allow the medical staff to read the AII room pressure difference? * Redefined Sample Groups Crosstabulation Redefined Sample Groups few projects many projects 7 10 70.0% 3 30.0% 10 100.0% 100.0% 0 .0% 10 100.0%
Total 17 85.0% 3 15.0% 20 100.0%
Q35. AII/Do the specs include a fixed mechanical or electronic device to allow the medical staff to read the AII room pressure difference? Total
Yes
No
Value 3.529b 1.569 4.691

c
df 1 1 1
Asymp. Sig. (2-sided) .060 .210 .030
Exact Sig. (2-sided) .211 .211 .211 .211
Exact Sig. (1-sided) .105 .105 .105 .105
Point Probability
3.353 20
.067
.105
Page B-51
36) Does the control sequence in the specifications provide a means to reduce total airflow to the AII rooms at times when no patient with an airborne infection is present? a) _____ Yes b) _____ No c) _____ Dont know
Q36. AII/Does the control sequence in the specs provide a means to reduce total air flow to the AII rooms when no patient w/an airborne infection is present? * Redefined Sample Groups Crosstabulation Redefined Sample Groups few projects many projects 2 1 20.0% 8 80.0% 10 100.0% 10.0% 9 90.0% 10 100.0%
Total 3 15.0% 17 85.0% 20 100.0%
Q36. AII/Does the control sequence in the specs provide a means to reduce total air flow to the AII rooms when no patient w/an airborne infection is present? Total
Yes
No
Value .392b .000 .399

c
df 1 1 1
Asymp. Sig. (2-sided) .531 1.000 .528
Exact Sig. (2-sided) 1.000 1.000 1.000 1.000
Exact Sig. (1-sided) .500 .500 .500 .500
Point Probability
.373 20
.542
.395
Page B-52
37) What code, standard or guideline were you required to use to establish the design AII room pressure difference on this project? (READ LIST; CHECK ONE. FOR THE RESPONSE GIVEN, ASK THE FOLLOW-UP QUESTION) a) _____ a state mechanical code What state? ____________________________________ b) _____ a local mechanical code What locality? _________________________________ c) _____ federal requirements What federal agency? _____________________________ d) _____ the AIA Guidelines for Design and Construction of Hospital and Health Care Facilities Which edition? i) _____ 2001 ii) _____ 1997 iii) _____ (DO NOT READ) Dont know e) _____ the ASHRAE handbook, or f) _____ something else What? _________________________________________________ g) _____ (DO NOT READ) dont know
Q37. AII/What code/standard/guideline were you required to use to establish the design AII room pressure difference? * Redefined Sample Groups Crosstabulation Redefined Sample Groups few projects many projects 3 2 30.0% 5 50.0% 1 10.0% 1 10.0% 0 .0% 0 .0% 10 100.0% 20.0% 6 60.0% 0 .0% 0 .0% 1 10.0% 1 10.0% 10 100.0%
Total 5 25.0% 11 55.0% 1 5.0% 1 5.0% 1 5.0% 1 5.0% 20 100.0%
Q37. AII/What code/standard/guideline were you required to use to establish the design AII room pressure difference?
state code
AIA Guidelines...
ASHRAE Handbook
AIA Guidelines.../CDC guidelines state code/AIA Guidelines... federal requirements/ASHRAE Handbook Total
Count % within Redefined Sample Groups Count % within Redefined Sample Groups Count % within Redefined Sample Groups Count % within Redefined Sample Groups Count % within Redefined Sample Groups Count % within Redefined Sample Groups Count % within Redefined Sample Groups

b
df 5 5
Exact Sig. (2-sided) 1.000 1.000 1.000 .500
Point Probability
.434
.250
.053
Page B-53
Q37d. AII/Which edition of AIA Guidelines... was used? * Redefined Sample Groups Crosstabulation Redefined Sample Groups few projects many projects 5 6 83.3% 1 16.7% 6 100.0% 85.7% 1 14.3% 7 100.0%
Total 11 84.6% 2 15.4% 13 100.0%
Q37d. AII/Which edition of AIA Guidelines... was used?
2001
1997
Total
Value .014b .000 .014

c
df 1 1 1
Asymp. Sig. (2-sided) .906 1.000 .906
Exact Sig. (2-sided) 1.000 1.000 1.000 1.000
Exact Sig. (1-sided) .731 .731 .731 .731
Point Probability
.013 13
.909
.538
Page B-54
GENERAL QUESTIONS ABOUT RECENT PROJECTS

The next few questions pertain to all of your [READ NUMBER FROM Q1] hospital projects that started schematic design after January 1, 2001 and are currently at least at the 50 % construction documents stage. 38) How many of these projects, if any, include each of the following: (READ LIST, RECORD NUMBER OF PROJECTS FOR EACH) a) a formal commissioning process for the mechanical _____ __ DK systems?.................. b) formal verification of the airflow balancing, consisting of measurements repeated by the balancer under observation by another _____ __ DK party? .. c) an Infection Control Risk _____ __ DK Assessment?......................................................
Statistics (Created) Percent of hospital projects with formal commissio ning process for mechanical systems since Jan 1 2001 (Q38a/Q1) 20 0 21.7095 .00 100.00 .0000 7.0833 32.8947
Valid Missing
25 50 75
(Created) Percent of hospital projects with formal verification of the air flow balancing since Jan 1 2001 (Q38b/Q1) 20 0 52.0472 .00 100.00 5.5000 37.5000 100.0000 Crosstab
(Created) Percent of hospital projects with Infection Control Risk Assessment since Jan 1 2001 (Q38c/Q1) 16 4 43.1031 .00 100.00 21.2500 45.0000 65.0000
Q38a. Pct of projects with formal commissioning process, categorical
1 to 25%
26 to 50%
51 to 75%
76 to 100%
Total
Redefined Sample Groups few projects many projects 4 4 40.0% 2 20.0% 2 20.0% 0 .0% 2 20.0% 10 100.0% 40.0% 4 40.0% 1 10.0% 1 10.0% 0 .0% 10 100.0%
Total 8 40.0% 6 30.0% 3 15.0% 1 5.0% 2 10.0% 20 100.0%
Page B-55
Chi-Square Tests Value 4.000a 5.178 3.670 20 df 4 4 Asymp. Sig. (2-sided) .406 .269 Exact Sig. (2-sided) .541 .492 .541
Pearson Chi-Square Likelihood Ratio Fisher's Exact Test N of Valid Cases
a. 10 cells (100.0%) have expected count less than 5. The minimum expected count is .50.
Crosstab Redefined Sample Groups few projects many projects 2 2 20.0% 2 20.0% 1 10.0% 5 50.0% 10 100.0% 20.0% 4 40.0% 0 .0% 4 40.0% 10 100.0%
Total 4 20.0% 6 30.0% 1 5.0% 9 45.0% 20 100.0%
Q38b Pct of projects with formal TAB verification, categorical
1 to 25%
26 to 50%
76 to 100%
Total
Chi-Square Tests Value 1.778a 2.177 1.847 20 df 3 3 Asymp. Sig. (2-sided) .620 .536 Exact Sig. (2-sided) .836 .836 .836
Pearson Chi-Square Likelihood Ratio Fisher's Exact Test N of Valid Cases
a. 8 cells (100.0%) have expected count less than 5. The minimum expected count is .50.
Crosstab Redefined Sample Groups few projects many projects 2 1 25.0% 1 12.5% 3 37.5% 1 12.5% 1 12.5% 8 100.0% 12.5% 1 12.5% 4 50.0% 1 12.5% 1 12.5% 8 100.0%
Total 3 18.8% 2 12.5% 7 43.8% 2 12.5% 2 12.5% 16 100.0%
Q38c Pct of projects with ICRA, categorical
none
1 to 25%
26 to 50%
51 to 75%
76 to 100%
Total
Page B-56
Chi-Square Tests Value .476a .483 1.301 .158 16

b
df 4 4
Exact Sig. (2-sided) 1.000 1.000 1.000 .850
Point Probability
.691
.425
.144
Page B-57
39) How many fall into each of the following categories in terms of the level of health care provided? (READ LIST; RECORD NUMBER OF PROJECTS IN EACH CATEGORY) g) Primary care or community hospital _____ h) Secondary care hospital _____ i) Tertiary care hospital _____ j) Quarternary care or teaching hospital _____ (TOTAL SHOULD EQUAL NUMBER OF PROJECTS IN Q1) k) _____ (DO NOT READ) dont know
Statistics (Created) Percent of hospital projects since Jan 1 2001 that are primary care or community hospitals (Q39a/Q1) 10 0 68.8333 20.00 100.00 688.33 31.2500 80.0000 100.0000 10 0 72.2500 .00 100.00 722.50 46.8750 80.0000 100.0000 (Created) Percent of hospital projects since Jan 1 2001 that are secondary care hospitals (Q39b/Q1) 10 0 15.0000 .00 80.00 150.00 .0000 .0000 27.5000 10 0 5.0833 .00 20.83 50.83 .0000 .0000 12.5000 (Created) Percent of projects since Jan 1 2001 that are quaternary care or teaching hospitals (Q39d/Q1) 10 0 6.0000 .00 50.00 60.00 .0000 .0000 2.5000 10 0 17.7500 .00 100.00 177.50 .0000 .0000 24.3750
Valid Missing
many projects
25 50 75
(Created) Percent of projects since Jan 1 2001 that are tertiary care hospitals (Q39c/Q1) 10 0 10.1667 .00 66.67 101.67 .0000 .0000 13.7500 10 0 4.9167 .00 25.00 49.17 .0000 .0000 10.0000
Group Statistics
Redefined Sample Groups few projects many projects few projects many projects few projects many projects few projects many projects N 10 10 10 10 10 10 10 10 Mean 68.8333 72.2500 15.0000 5.0833 10.1667 4.9167 6.0000 17.7500 Std. Deviation 34.73044 33.55034 27.98809 8.66426 21.43681 8.16922 15.77621 31.72035 Std. Error Mean 10.98273 10.60955 8.85061 2.73988 6.77892 2.58333 4.98888 10.03086
(Created) Percent of hospital projects since Jan 1 2001 that are primary care or community hospitals (Q39a/Q1) (Created) Percent of hospital projects since Jan 1 2001 that are secondary care hospitals (Q39b/Q1) (Created) Percent of projects since Jan 1 2001 that are tertiary care hospitals (Q39c/Q1) (Created) Percent of projects since Jan 1 2001 that are quaternary care or teaching hospitals (Q39d/Q1)
Page B-58
Independent Samples Test Levene's Test for Equality of Variances t-test for Equality of Means 95% Confidence Interval of the Difference Lower Upper -35.49843 28.66510
F (Created) Percent of hospital projects since Jan 1 2001 that are primary care or community hospitals (Q39a/Q1) (Created) Percent of hospital projects since Jan 1 2001 that are secondary care hospitals (Q39b/Q1) Equal variances assumed Equal variances not assumed Equal variances assumed Equal variances not assumed 6.175 .554
Sig. .466
t -.224
df 18
Sig. (2-tailed) .825
Mean Difference -3.41667
Std. Error Difference 15.27033
-.224 .023 1.070
17.979 18
.825 .299
-3.41667 9.91667
15.27033 9.26500
-35.50118 -9.54838
28.66784 29.38172
1.070
10.709
.308
9.91667
9.26500
-10.54321
30.37654
(Created) Percent of projects since Jan 1 2001 that are tertiary care hospitals (Q39c/Q1) (Created) Percent of projects since Jan 1 2001 that are quaternary care or teaching hospitals (Q39d/Q1)
Equal variances assumed Equal variances not assumed Equal variances assumed Equal variances not assumed
2.602
.124
.724 .724
18 11.560 18 13.196
.479 .484 .308 .313
5.25000 5.25000 -11.75000 -11.75000
7.25447 7.25447 11.20299 11.20299
-9.99107 -10.62310 -35.28660 -35.91614
20.49107 21.12310 11.78660 12.41614
2.111
.163
-1.049 -1.049
Page B-59
40) How many fall into each of the following ownership categories? (READ LIST; RECORD NUMBER OF PROJECTS IN EACH CATEGORY) f) For-profit owner _____ g) Non-profit owner _____ h) County, city, or other local government owner _____ i) State government owner _____ j) Federal government owner _____ (TOTAL SHOULD EQUAL NUMBER OF PROJECTS IN Q1) l) _____ (DO NOT READ) dont know
Statistics (Created) Percent of projects since Jan 1 2001 that have county, city or other local government owners (Q40c/Q1) 10 0 27.9444 .00 60.00 279.44 8.3333 30.0000 42.5000 10 0 8.1053 .00 35.00 81.05 .0000 .0000 16.5132 (Created) Percent of projects since Jan 1 2001 that have state government owners (Q40d/Q1) 10 0 13.5000 .00 50.00 135.00 .0000 5.0000 28.7500 10 0 .0000 .00 .00 .00 .0000 .0000 .0000 (Created) Percent of projects since Jan 1 2001 that have federal government owners (Q40e/Q1) 10 0 7.8333 .00 33.33 78.33 .0000 .0000 21.2500 10 0 11.0000 .00 100.00 110.00 .0000 .0000 2.5000
Valid Missing
many projects
25 50 75
(Created) Percent of projects since Jan 1 2001 that have for-profit owners (Q40a/Q1) 10 0 25.6111 .00 66.67 256.11 8.3333 22.5000 37.5000 10 0 45.6491 .00 100.00 456.49 .0000 44.1667 100.0000
(Created) Percent of projects since Jan 1 2001 that have non-profit owners (Q40b/Q1) 10 0 25.1111 .00 77.78 251.11 .0000 16.6667 50.0000 10 0 35.2456 .00 100.00 352.46 .0000 22.8947 72.5000
Group Statistics Redefined Sample Groups few projects many projects few projects many projects few projects many projects few projects many projects few projects many projects N 10 10 10 10 10 10 10 10 10 10 Mean 25.6111 45.6491 25.1111 35.2456 27.9444 8.1053 13.5000 .0000 7.8333 11.0000 Std. Deviation 20.93567 43.85786 28.78042 39.11695 19.86244 12.18497 18.56670 .00000 13.00641 31.42893 Std. Error Mean 6.62044 13.86907 9.10117 12.36986 6.28105 3.85322 5.87130 .00000 4.11299 9.93870
(Created) Percent of projects since Jan 1 2001 that have for-profit owners (Q40a/Q1) (Created) Percent of projects since Jan 1 2001 that have non-profit owners (Q40b/Q1) (Created) Percent of projects since Jan 1 2001 that have county, city or other local government owners (Q40c/Q1) (Created) Percent of projects since Jan 1 2001 that have state government owners (Q40d/Q1) (Created) Percent of projects since Jan 1 2001 that have federal government owners (Q40e/Q1)
Page B-60
Independent Samples Test Levene's Test for Equality of Variances t-test for Equality of Means 95% Confidence Interval of the Difference Lower Upper -52.32539 -53.26539 -42.39887 -42.60489 4.35794 4.12692 1.16485 .21819 -25.76447 -26.60339 12.24937 13.18937 22.12986 22.33588 35.32042 35.55144 25.83515 26.78181 19.43113 20.27006
F (Created) Percent of projects since Jan 1 2001 that have for-profit owners (Q40a/Q1) (Created) Percent of projects since Jan 1 2001 that have non-profit owners (Q40b/Q1) Equal variances assumed Equal variances not assumed Equal variances assumed Equal variances not assumed Equal variances assumed Equal variances not assumed Equal variances assumed Equal variances not assumed Equal variances assumed Equal variances not assumed 10.273
Sig. .005
t -1.304 -1.304
df 18 12.899 18 16.536 18 14.934 18 9.000 18 11.995
Sig. (2-tailed) .209 .215 .518 .518 .015 .017 .034 .047 .772 .773
Mean Difference -20.03801 -20.03801 -10.13450 -10.13450 19.83918 19.83918 13.50000 13.50000 -3.16667 -3.16667
Std. Error Difference 15.36820 15.36820 15.35724 15.35724 7.36878 7.36878 5.87130 5.87130 10.75614 10.75614
1.471
.241
-.660 -.660
(Created) Percent of projects since Jan 1 2001 that have county, city or other local government owners (Q40c/Q1) (Created) Percent of projects since Jan 1 2001 that have state government owners (Q40d/Q1) (Created) Percent of projects since Jan 1 2001 that have federal government owners (Q40e/Q1)
1.594
.223
2.692 2.692
22.644
.000
2.299 2.299
.696
.415
-.294 -.294
Page B-61
GENERAL QUESTIONS
41) In your experience, what is the single most significant challenge in designing and building ORs, PE rooms and AII rooms to maintain proper space pressure relationships for control of airborne infections? See report Table 3.
Page B-62
42) Would you say you are very familiar, somewhat familiar, slightly familiar or not at all familiar with each of the following: (READ a. c. CIRCLE ONE RESPONSE FOR EACH) Somewhat familiar Not at all familiar N N N N
Page B-63
ASHRAEs 2003 HVAC Applications Handbook chapter on Health Care Design b) ASHRAEs 2003 HVAC Design Manual for Hospitals and Clinics c) the American Institute of Architects 2001 edition of the Guidelines for Design and Construction of Hospital and Health Care Facilities d) the Centers for Disease Control and Preventions 2003 edition of the Guidelines for Environmental Infection Control in Health-Care Facilities
Crosstab Redefined Sample Groups few projects many projects 4 5 40.0% 4 40.0% 2 20.0% 0 .0% 10 100.0% 50.0% 4 40.0% 0 .0% 1 10.0% 10 100.0%
a)
VF VF VF VF
SWF SWF SWF SWF
Total 9 45.0% 8 40.0% 2 10.0% 1 5.0% 20 100.0%
Q42a. Familiarity with ASHRAE 2003 HVAC Applications Handbook chapter on Health Care Design
Very familiar
Somewhat familiar
Slightly familiar
Not at all familiar
Total

b
df 3 3
Exact Sig. (2-sided) .554 .554 .554 1.000
Point Probability
.793
.500
.192
Slightly familiar SLF SLF SLF SLF
Very familiar
Crosstab Redefined Sample Groups few projects many projects 4 5 40.0% 4 40.0% 1 10.0% 1 10.0% 10 100.0% 50.0% 4 40.0% 1 10.0% 0 .0% 10 100.0%
Total 9 45.0% 8 40.0% 2 10.0% 1 5.0% 20 100.0%
Q42b. Familiarity with ASHRAE 2003 HVAC Design Manual for Hospitals and Clinics
Very familiar
Somewhat familiar
Slightly familiar
Not at all familiar
Total

b
df 3 3
Exact Sig. (2-sided) 1.000 1.000 1.000 .617
Point Probability
.430
.308
.156
Crosstab Redefined Sample Groups few projects many projects 6 10 60.0% 3 30.0% 1 10.0% 10 100.0% 100.0% 0 .0% 0 .0% 10 100.0%
Q42c. Familiarity with AIA 2001 edition of Guidelines for Design and Construction of Hospital and Health Care Facilities
Very familiar
Somewhat familiar
Not at all familiar
Total
Total 16 80.0% 3 15.0% 1 5.0% 20 100.0%

b
df 2 2
Exact Sig. (2-sided) .087 .087 .087 .087
Point Probability
.067
.043
.043
Page B-64
Crosstab Redefined Sample Groups few projects many projects 4 3 40.0% 1 10.0% 1 10.0% 4 40.0% 10 100.0% 30.0% 5 50.0% 0 .0% 2 20.0% 10 100.0%
Total 7 35.0% 6 30.0% 1 5.0% 6 30.0% 20 100.0%
Q42d. Familiarity with CDC 2003 edition of Guidelines for Environmental Infection Control in HC Facilities
Very familiar
Somewhat familiar
Slightly familiar
Not at all familiar
Total

b
df 3 3
Exact Sig. (2-sided) .263 .263 .263 .597
Point Probability
.478
.299
.109
Page B-65
43) Approximately how many new hospitals, hospital additions, or hospital remodels for which you personally are not the engineer of record started schematic design at your location after January 1, 2001 and are currently at least at the 50 % construction documents stage? _____ _____ Dont know
Statistics Q43. Number of hospital projects designed by other Engineers of Record since Jan 1 2001 at your location few projects N Valid 10 Missing 0 Mean 3.40 Minimum 0 Maximum 20 Sum 34 Percentiles 25 .00 50 2.00 75 3.50 many projects N Valid 10 Missing 0 Mean 1022.80 Minimum 0 Maximum 9998 Sum 10228 Percentiles 25 .00 50 15.00 75 70.00
Q43. Number of hospital projects designed by other Engineers of Record since Jan 1 2001 at your location Redefined Sample Groups few projects Frequency 4 3 1 1 1 10 4 1 1 1 1 1 1 10 Percent 40.0 30.0 10.0 10.0 10.0 100.0 40.0 10.0 10.0 10.0 10.0 10.0 10.0 100.0 Valid Percent 40.0 30.0 10.0 10.0 10.0 100.0 40.0 10.0 10.0 10.0 10.0 10.0 10.0 100.0 Cumulative Percent 40.0 70.0 80.0 90.0 100.0 40.0 50.0 60.0 70.0 80.0 90.0 100.0
Valid
many projects
Valid
0 2 3 5 20 Total 0 10 20 40 60 100 Don't know Total
Statistics (Created - sum Q1 and Q43) Total projects designed at location few projects N Valid 10 Missing 0 Mean 9.60 Minimum 3 Maximum 30 Sum 96 Percentiles 25 5.75 50 6.50 75 12.00 many projects N Valid 10 Missing 0 Mean 59.30 Minimum 19 Maximum 120 Sum 593 Percentiles 25 35.00 50 60.00 75 81.00
Page B-66
(Created - sum Q1 and Q43) Total projects designed at location Redefined Sample Groups few projects Frequency 1 1 3 1 1 2 1 10 1 1 1 1 3 1 1 1 10 Percent 10.0 10.0 30.0 10.0 10.0 20.0 10.0 100.0 10.0 10.0 10.0 10.0 30.0 10.0 10.0 10.0 100.0 Valid Percent 10.0 10.0 30.0 10.0 10.0 20.0 10.0 100.0 10.0 10.0 10.0 10.0 30.0 10.0 10.0 10.0 100.0 Cumulative Percent 10.0 20.0 50.0 60.0 70.0 90.0 100.0 10.0 20.0 30.0 40.0 70.0 80.0 90.0 100.0
Valid
many projects
Valid
3 5 6 7 9 12 30 Total 19 20 40 50 60 80 84 120 Total
Independent Samples Test Levene's Test for Equality of Variances t-test for Equality of Means 95% Confidence Interval of the Difference Lower Upper -70.581 -71.800 -28.819 -27.600
F (Created - sum Q1 and Q43) Total projects designed at location Equal variances assumed Equal variances not assumed 6.273
Sig. .022
t -5.001 -5.001
df 18 10.156
Sig. (2-tailed) .000 .001
Mean Difference -49.700 -49.700
Page B-67
44) Does your company have organizational design standards for hospitals that you and all other engineers of record at this location are required to follow? d) _____ Yes Are engineers of record at other company locations also required to follow these design standards? i) _____ Yes ii) _____ No iii) _____ There are no other locations iv) _____ Dont know e) _____ No f) _____ Dont know
Q44. Does your company have organizational design standards that you and all other engineers of record at this location are required to follow? * Redefined Sample Groups Crosstabulation Redefined Sample Groups few projects many projects 6 7 60.0% 4 40.0% 10 100.0% 70.0% 3 30.0% 10 100.0%
Total 13 65.0% 7 35.0% 20 100.0%
Q44. Does your company have organizational design standards that you and all other engineers of record at this location are required to follow? Total
Yes
No
Value .220b .000 .220

c
df 1 1 1
Asymp. Sig. (2-sided) .639 1.000 .639
Exact Sig. (2-sided) 1.000 1.000 1.000 1.000
Exact Sig. (1-sided) .500 .500 .500 .500
Point Probability
.209 20
.648
.325
Q44a. Are engineers of record at other company locations also required to follow these design standards? * Redefined Sample Groups Crosstabulation Redefined Sample Groups few projects many projects 3 5 50.0% 3 50.0% 0 .0% 6 100.0% 71.4% 1 14.3% 1 14.3% 7 100.0%
Total 8 61.5% 4 30.8% 1 7.7% 13 100.0%
Q44a. Are engineers of record at other company locations also required to follow these design standards?
Yes
No
No other locations
Total
Page B-68

b
df 2 2
Exact Sig. (2-sided) .396 .396 .396 1.000
Point Probability
.846
.576
.294
Page B-69
45) Considering the specific design issues we have discussed for your recent projects, would you say that the recent projects designed by other engineers of record at your location: (READ LIST, CHECK ONE) g) _____ definitely followed the same design criteria and practices, h) _____ probably followed the same criteria and practices, i) _____ probably did not follow the same criteria and practices, or j) _____ definitely did not follow the same criteria and practices. k) _____ (DO NOT READ) no recent projects by other engineers at this location l) _____ (DO NOT READ) dont know
Q45. Would you say that the recent projects designed by other engineers of record at your location... * Redefined Sample Groups Crosstabulation Redefined Sample Groups few projects many projects 6 2 60.0% 2 20.0% 0 .0% 2 20.0% 10 100.0% 20.0% 4 40.0% 1 10.0% 3 30.0% 10 100.0%
Total 8 40.0% 6 30.0% 1 5.0% 5 25.0% 20 100.0%
Definitely the same
Probably the same
Defi not the same
None at this location
Total

b
df 3 3
Exact Sig. (2-sided) .314 .314 .314 .278
Point Probability
.228
.139
.055
Page B-70
Q45. Would you say that the recent projects designed by other engineers of record at your location... * Q44. Does your company have organizational design standards that you and all other engineers of record at this location are required to follow? Crosstabulation Q44. Does your company have organizational design standards that you and all other engineers of record at this location are required to follow? Yes No 5 3
Total 8
Definitely the same
Probably the same
Defi not the same
None at this location
Total
Count % within Q44. Does your company have organizational design standards that you and all other engineers of record at this location are required to follow? Count % within Q44. Does your company have organizational design standards that you and all other engineers of record at this location are required to follow? Count % within Q44. Does your company have organizational design standards that you and all other engineers of record at this location are required to follow? Count % within Q44. Does your company have organizational design standards that you and all other engineers of record at this location are required to follow? Count % within Q44. Does your company have organizational design standards that you and all other engineers of record at this location are required to follow?
38.5%
42.9%
40.0%
30.8%
28.6%
30.0%
7.7%
.0%
5.0%
23.1%
28.6%
25.0%
13
20
100.0%
100.0%
100.0%
Chi-Square Tests Value .623a .945 .888 .002 20

b
df 3 3
Exact Sig. (2-sided) 1.000 1.000 1.000 1.000
Point Probability
.966
.567
.145
Page B-71
46) Is your company an engineering firm only, an architecture and engineering firm, or a contracting firm offering design services? d) _____ Engineering only e) _____ Architecture and engineering f) _____ Contracting firm offering design services
Q46. Type of company * Redefined Sample Groups Crosstabulation Redefined Sample Groups few projects many projects 6 3 60.0% 4 40.0% 10 100.0% 30.0% 7 70.0% 10 100.0%
Total 9 45.0% 11 55.0% 20 100.0%
Q46. Type of company
Engineering only
Architecture/Engineering
Total

c
df 1 1 1
Asymp. Sig. (2-sided) .178 .369 .174
Exact Sig. (2-sided) .370 .370 .370 .370
Exact Sig. (1-sided) .185 .185 .185 .185
Point Probability
1.727 20
.189
.150
Page B-72
47) Over the past five years, approximately what percentage of the building mechanical design work done by your company at this location has been for hospitals? Is it: a) _____ Less than 25 % b) _____ At least 25 % but less than 50 % c) _____ At least 50 % but less than 75 %, or d) _____ 75 % or more? e) _____ (DO NOT READ) dont know f) _____ (DO NOT READ) refused
Q47. Percent of building mechanical design work at this location over the past five years that has been for hospitals * Redefined Sample Groups Crosstabulation Redefined Sample Groups few projects many projects 6 0 60.0% 2 20.0% 1 10.0% 1 10.0% 10 100.0% .0% 4 40.0% 1 10.0% 5 50.0% 10 100.0%
Total 6 30.0% 6 30.0% 2 10.0% 6 30.0% 20 100.0%
Q47. Percent of building mechanical design work at this location over the past five years that has been for hospitals
Less than 25%
25%, but < 50%
50%, but < 75%
75% or more
Total

b
df 3 3
Exact Sig. (2-sided) .030 .030 .023 .016
Point Probability
.011
.008
.006
a. 8 cells (100.0%) have expected count less than 5. The minimum expected count is 1.00. b. The standardized statistic is 2.543.
Page B-73
48) In a later phase of this project, the Center for Energy and Environment or CEE, a contractor to NIST, will be reviewing plans and specifications for hospitals to characterize current HVAC design practices. The information gathered from this review will be presented in the form of statistical summaries, and will not be identified by designer, design firm, hospital owner or location. Participants will receive a copy of the research results if they wish. Would you be willing to share plans and specifications for one of your projects with CEE for this purpose, assuming that CEE would pay any costs of reproduction? d) _____ Yes May we give your name to CEE so they can contact you? __Yes __ No e) _____ Maybe May we give your name to CEE so they can contact you? __Yes __ No f) _____ No
Q48. Willing to share plans/specifications for one project with CEE (at CEE's cost) * Redefined Sample Groups Crosstabulation Redefined Sample Groups few projects many projects 1 5 10.0% 5 50.0% 4 40.0% 10 100.0% 50.0% 2 20.0% 3 30.0% 10 100.0%
Total 6 30.0% 7 35.0% 7 35.0% 20 100.0%
Q48. Willing to share plans/specifications for one project with CEE (at CEE's cost)
Yes
Maybe
No
Total
Value 4.095a 4.383 3.879 1.834 20

b
df 2 2
Exact Sig. (2-sided) .202 .202 .202 .279
Point Probability
.176
.139
.089
a. 6 cells (100.0%) have expected count less than 5. The minimum expected count is 3.00. b. The standardized statistic is -1.354.
Page B-74
49) Also in a later phase of this project, CEE will conduct on-site measurements of airflows, pressure relationships and boundary leakages in a sample of hospitals. Again, the information gathered will not be identified by designer, design firm, hospital owner or location. Do you have a project for which construction was completed after December 2000 that you would be willing to have CEE consider for inclusion in this sample? d) _____ Yes May we give your name to CEE so they can contact you? __Yes __ No e) _____ Maybe May we give your name to CEE so they can contact you? __Yes __ No f) _____ No
Q49. Willing to participate in on-site study of air flows/pressure relationships/boundary leakages * Redefined Sample Groups Crosstabulation Redefined Sample Groups few projects many projects 0 2 .0% 4 40.0% 6 60.0% 10 100.0% 20.0% 3 30.0% 5 50.0% 10 100.0%
Total 2 10.0% 7 35.0% 11 55.0% 20 100.0%
Q49. Willing to participate in on-site study of air flows/pressure relationships/boundary leakages
Yes
Maybe
No
Total
Value 2.234a 3.007 1.927 .955 20

b
df 2 2
Exact Sig. (2-sided) .500 .500 .650 .520
Point Probability
.328
.260
.163
a. 4 cells (66.7%) have expected count less than 5. The minimum expected count is 1.00. b. The standardized statistic is -.977.
Page B-75
50) May we share your individual responses to this survey with CEE so that they can contact you with more technical follow-up questions? c) _____ Yes d) _____ No
Q50. Willing to share survey responses with CEE so they can contact you with more technical questions * Redefined Sample Groups Crosstabulation Redefined Sample Groups few projects many projects 7 9 70.0% 3 30.0% 10 100.0% 90.0% 1 10.0% 10 100.0%
Total 16 80.0% 4 20.0% 20 100.0%
Q50. Willing to share survey responses with CEE so they can contact you with more technical questions Total
Yes
No

c
df 1 1 1
Asymp. Sig. (2-sided) .264 .576 .255
Exact Sig. (2-sided) .582 .582 .582 .582
Exact Sig. (1-sided) .291 .291 .291 .291
Point Probability
1.188 20
.276
.248
Page B-76
51) Would you like a copy of the report on the survey results, when it is completed? a) _____ Yes b) _____ No
Q51. Want of copy of results * Redefined Sample Groups Crosstabulation Redefined Sample Groups few projects many projects 10 9 100.0% 0 .0% 10 100.0% 90.0% 1 10.0% 10 100.0%
Q51. Want of copy of results
Yes
No
Total
Total 19 95.0% 1 5.0% 20 100.0%

c
df 1 1 1
Asymp. Sig. (2-sided) .305 1.000 .230
Exact Sig. (2-sided) 1.000 1.000 1.000 1.000
Exact Sig. (1-sided) .500 .500 .500 .500
Point Probability
1.000 20
.317
.500
Page B-77
Thats it! Thank you very much for your time. Now, may I verify your name and address so we can be certain you receive your $100 check? You should receive it by mail within 10 to 14 days.
Name________________________________________ Company_____________________________________ Street________________________________________ City/State/Zip code__________________________________________

____________________________________________________________________________________________________________________________________________________________
Interviewer ID: __ __ __ __ Time: ______:______

Sample group: _____ frequent hospital design _____ infrequent hospital design
Page B-78

Survey Report Final

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NIST GCR 05-883

Strategies to Reduce the Spread of Airborne Infections in Hospitals

Martha J. Hewett Richard D. Hermans, P.E.

NIST GCR 05-883

Strategies to Reduce the Spread of Airborne Infections in Hospitals

with the assistance of Anderson, Niebuhr & Associates

Figure 6. Figure 7. Figure 8. Figure 9. Figure 10. Figure 11.

Figure 12. Figure 13.

Figure 15. Figure 16. Figure 17. Figure 18.

Figure 26. Figure 27.

Figure 29. Figure 30. Figure 31.

Frequent hospital designers 13 2 11 10 1 91 %

Occasional hospital designers 19 1 18 10 8 56 %

RESULTS Characteristics of the Original Sample Groups

interquartile range (IQR)

0 Frequent Hospital Design Occasional Hospital Design

(Created - sum Q1 and Q43) Total projects designed at location

0 Frequent Hospital Design Occasional Hospital Design

Characteristics of the Redefined Sample Groups

0 few projects many projects

Redefined Sample Groups

Number of qualifying projects by redefined sample groups (n = 10, 10)

0 few projects many projects

0 few projects many projects

0 few projects many projects

Redefined Sample Groups

Redefined Sample Groups

Redefined Sample Groups

b. Airborne Infection Isolation Rooms

c. Protective Environment Rooms

(Created - sum Q1 and Q43) Total projects designed at location

0 few projects many projects

Redefined Sample Groups

60.0% 50.0% 40.0%

Redefined Sample Groups

Mean Percent of Projects of Each Hospital Type

Mean percent of projects by type of owner

For-profit Non-profit Local government State government Federal government

0.0 few projects many projects

0.0 few projects many projects

Redefined Sample Groups

Redefined Sample Groups

a. Percent of projects by type of hospital

b. Percent of projects by type of owner.

Q46. Type of company

0 few projects many projects

Redefined Sample Groups

Redefined Sample Groups

0.0% West Midwest Northeast South

a. Location of firm by Census Region

Design of Operating Rooms

60.0% 50.0% 40.0% few projects (n=9) many projects (n=10)

Q4 (Recode3) OR/ What is the design pressure difference? (numeric)

Redefined Sample Groups

0.000 few projects many projects

Q4 (Recode2) OR/ What is the design pressure difference?

Redefined Sample Groups

a. All responses (n = 9, 10)

few projects (n=9) many projects (n=10) 25.0%

Redefined Sample Groups

100 few projects many projects

Q7 OR Design difference in air flow all responses

Redefined Sample Groups