Ventilation of Health Care Facilities

Transcription

1 CMS Adoption of ANSI/ASHRAE/ASHE Standard Ventilation of Health Care Facilities Michael P. Sheerin, PE LEED AP Chief Executive Officer TLC Engineering for Architecture Vice Chair - ASHRAE 170 Committee October 17, 2016 AHCA Conference Presentation TLC Engineering for Architecture

2 History Roots in ASHRAE Standard 62 and the FGI Guidelines First SPC meeting: 2002 Standard issued in 2008 Mission Accomplished First ASHRAE Standard co-sponsored by ASHE Standard given Continuous Maintenance status Standard initially incorporated in 2010 Guidelines for Design and Construction of Health Care Facilities

3 ASHRAE Addendum Adoption Process Continuous Maintenance Addenda suggested by: SSPC committee members The public through the Change Proposal Process Public Review Publication

4 CMS Adoption Process

5 CMS Adoption it s complicated? Adopted 2012 NFPA 99 Health Care Facilities Code 5 July NFPA 99 References ASHRAE NFPA 99 approved by American National Standard August 31, 2011 ASHRAE 170 Under Continuous Maintenance

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7 CMS Adoption it s complicated? ASHRAE 170 Under Continuous Maintenance CMS Adoption of 99 5 July ASHRAE 170 Approved 31 August Addendum Adoption Date a 25 July 2009 b 16 Nov 2009 d 10 July 2010 e, f 3 Feb 2011 g 3 March 2011 h 27 July 2011 NFPA 99 Approved l, m 26 Jan 2012 r, s 29 June 2012 j, p, q, t 27 Oct 2012 k, n, v 30 Jan 2013 u, w 4 July 2013 x, z, ab 24 July 2013 ac 31 July 2013 y 5 Dec 2013 CMS Adoption of 99 5 July ASHRAE 170 Approved 5 Dec Addendum Adoption Date b 3 July 2014 ae 6 Oct 2014 a, e 1 Dec 2014 d 1 June 2015 g 1 Oct 2015 c, f, h 1 June 2016 NFPA 99 Adopted by CMS 5 July 2016

8 Addendum d Status Included in 2013 edition Topic Critical Area Humidity Requirements Reduces minimum relative space humidity from 30% RH to 20% RH in these short stay spaces: Class B and C Operating Rooms Operating/Surgical Cystoscopic Rooms Delivery Rooms Treatment Rooms Trauma Rooms Laser Eye Rooms Class A Operating/Procedure Rooms Gastrointestinal Endoscopy Procedure Rooms

9 Addendum v Status Included in 2013 edition Topic Relative Humidity in Recovery Spaces Reduces minimum relative humidity in Recovery spaces from 30% to 20%, to be commensurate with previous changes in Addendum d

10 Addendum g Status Included in 2013 edition Topic Displacement Ventilation Allows Group D diffusers for single bed patient rooms Includes minimum requirements for design of displacement ventilation systems

11 2011 American Society of Heating, Refrigerating and Air Conditioning Engineers, Inc. (www. ashrae.org) Reprinted by permission from 2011 ASHRAE Standard This material may not be copied or distributed in either paper or digital form without ASHRAE s permission.

12 Addendum h Status Included in 2013 edition Topic Recirculating Room HVAC Units All ventilation air must be filtered per Table 6-1 Rules for recirculating room HVAC units all outside air supplied to units must be filtered and conditioned may only serve a single space MERV-6 filter required if any surface designed to condense moisture Recirculated airflow counts towards Total Air Change Rates required by Table 7-1

13 Addendum j Status Included in 2013 edition Topic Nursing Facility Requirements Add definition of Nursing Facility: A facility that provides resident care, treatment and services areas, including skilled nursing, subacute care, and Alzheimer s and other dementia facilities. Restore requirement for higher level filtration in nursing facilities Require MERV 13 as Filter Bank Number 1, no requirement for Filter Bank Number 2

14 Addendum k Status Included in 2013 edition Topic Energy Recovery No more than 5% leakage potential Airborne Infectious Isolation (AII) Rooms only systems with zero potential for cross-contamination from exhaust (e.g. heat pipes, run around coils)

15 Addendum l Status Included in 2013 edition Topic Caesarean Delivery Rooms/New Spaces Operating/surgical cytoscopic rooms and caesarean delivery rooms have same air distribution requirements as Class B and C operating rooms Added additional new spaces to Table 7-1

16 2011 American Society of Heating, Refrigerating and Air Conditioning Engineers, Inc. (www. ashrae.org) Reprinted by permission from 2011 ASHRAE Standard This material may not be copied or distributed in either paper or digital form without ASHRAE s permission.

17 Addendum m Status Included in 2013 edition Topic Ducted Return Air Systems In addition to spaces listed in Table 7-1 that have differential pressure requirements, these spaces also must be served by ducted return air systems: Recovery Rooms Critical and Intensive Care Intermediate Care Burn Unit

18 Addendum ac Status Included in 2013 edition Topic Ducted Return Air

19 Addendum n Status Included in 2013 edition Topic Ventilation Air (Outside Air) Quantity Calculations The intent is to preclude AHJs from extrapolating the worst case room condition to the entire air handling zone Two Calculation Approaches Minimum ventilation rate sum of room totals based on Table 7-1 Multiple zone approach Ventilation Rate Procedure (multiple zone formula) in Standard 62.1

20 Addendum u Status Included in 2013 edition Topic ED and Radiology Waiting Room Exhaust Clarifies HEPA filtered air may be recirculated, in lieu of exhausted The Radiology Waiting Room requirement only applies to those spaces where patients with respiratory disease may be waiting Drops changes to footnote q after 1st public review

21 2011 American Society of Heating, Refrigerating and Air Conditioning Engineers, Inc. (www. ashrae.org) Reprinted by permission from 2011 ASHRAE Standard This material may not be copied or distributed in either paper or digital form without ASHRAE s permission.

22 Addendum w Status Included in 2013 edition Topic Gastrointestinal Endoscopy Procedure Room Reduces minimum Relative Humidity to 20% Requires space to be treated as Bronchoscopy if both procedures will be performed in the same space Changes differential pressure from Positive to No Requirement (N/R)

23 Addendum z Status Included in 2013 edition Topic ED Exam Room Requirements Pressure Relationship to Adjacent Areas (n) Table 7-1 Design Parameters Minimum Outdoor ach Minimum Total ach All Room Air Exhausted Directly to Outdoors (j) Air Recirculated by means of Room Units (a) Design Relative Humidity (k), (%) Design Temperature (l), ( F/ C) Function of Space SURGERY AND CRITICAL CARE Emergency Department exam/treatment room (p) N/R 2 6 N/R N/R max / American Society of Heating, Refrigerating and Air Conditioning Engineers, Inc. (www. ashrae.org) Reprinted by permission from 2011 ASHRAE Standard This material may not be copied or distributed in either paper or digital form without ASHRAE s permission.

24 Addendum ad Status Approved by ASHRAE BOD 7/29/2016 Topic Exam rooms Applies only to non-emergency department exam rooms. Identifies two types of exam rooms: General reduction in total air change rate to 4. Special maintains total air change rate of 6. Special exam rooms are intended for spaces that might encounter persons with undiagnosed gastrointestinal, respiratory, or skin symptoms.

25 Addendum ab Status Included in 2013 edition Topic Patient Room Air Changes Reduces Minimum Air Change Rate from 6 to 4, regardless of supplemental heating or cooling WHAT THE HECK? HOW? WHY? Re-examined the research, with careful consideration of balancing efficacy, patient comfort and energy consumption. Also assessed the impact of larger, single patient rooms on HVAC safety and energy.

26 Addendum c Status Approved Topic Laboratory work areas Terminology coordinated with FGI Laboratory Work Areas vs. Laboratories Reduction allowed via ANSI Z9.5 risk assessment or active sensing of contaminants or appropriate surrogates approach

27 Addendum f Status Approved Topic Operating Room Air Distribution Provides a specific definition of the primary supply diffuser array. Clarifies that no more than 30% of the Primary Supply Diffuser Array may be used for non-diffuser items. Additional diffusers may be located outside of the Primary Supply Diffuser Array if needed to achieve required environmental conditions or air change rates.

28 Addendum f- 2013

29 Addendum g Status Approved Topic Definitions of Operating and Procedure Rooms Continues re-definition of ORs and Procedure Rooms included in the 2014 FGI Guidelines. Deletes Class A, B, and C terminology and replaces with Operating Room, Procedure Room New definition of Operating Room is equivalent to Class B and C ORs previously. New definition of Procedure Room is equivalent to Class A ORs previously. Definition are included from 2014 FGI Guidelines for these spaces: Operating Room, Procedure Room, Invasive Procedure, Restricted Area

30 Addendum h Status Approved Topic Temperature in Sterile Processing Department (SPD) Disagreement between design (ASHRAE) and operational (AAMI) standards. Joint meeting with ASHRAE, AAMI, FGI, ASHE, AORN, and APIC April Agreed on temperature ranges for 3 spaces: Decontamination Room 60 F-73 F Clean Workroom 68 F-73 F Sterile Storage Max 75 F Reference to AAMI ST-79. Published joint interim guidelines.

31 Addendum i Status 1 st Public review complete Topic Unoccupied setback mode

32 Addendum i- 2013

33 Addendum k 2013 Status Approved Electro-Convulsive Therapy (ECT) Procedure Room Provide similar HVAC as a general exam room - 4 Total ACH / 2 OA

34 Addendum l Status Advisory public review concluded July 10, 2016 Topic Filtration revisions

35 Addendum m Status 1 st Public review concluded likely approval soon Topic Adiabatic humidifiers allowed Would no longer require Steam Type Humidifiers

36 Re-Publication January 2018 Incorporates all approved addenda And Then..Issued as Part of 2018 FGI Guidelines Like Death and Taxes, Unfinished (In Process) and New Addenda Will Continue After Re-Publication

37 New FGI Guidelines Approach FGI 2018 will be three books: Hospital Outpatient Residential 170 will be included in its entirety in each book. Work underway to identify and organize requirements for each occupancy. Outpatient Residential May re-format to 3 separate standards for 2022 addition.! (Similar to 90.1, 90.2, etc)

38 Addendum n 2013 out for public review now Creates Chapter 8 - Outpatient Spaces

39 Addendum n 2013 out for public review now Outpatient spaces Redundancy requirements for Inpatient only

40 Addendum n 2013 out for public review now

41 Addendum o 2013 coming very soon! Creates Chapter 9 - Residential Facilities Some Redundancy requirements may apply

42 WHAT IS THE BIG DEAL? How Minimum should a Minimum Standard be? How many Prescriptive Requirements should exist in the standard for the perceived safety of the all involved, included designers? 170 is under pressure to align or assign to ASHRAE 62 How can a Performance Approach be provided? How can a Performance Approach be reviewed by AHJs?

43 Current Activities Cooling Tower Placement Clarification Recent Legionella Incidences Alternate Compliance Method Risk Management Approach Natural Ventilation Separate Working Group Clean Linen OA Air Change Rate Outside Air Intake Separation from Exhaust Clarification of Recirculating Room HVAC Units Terminology and Space Name coordination with FGI updates

44 Future Areas of Focus Clarify ED terminology and space Patient Room Air Distribution OR Air Distribution Coordinate Central Sterile Ventilation requirements with AAMI Add new spaces for Table 7-1 Air Change Rate reductions Pharmacy requirements (USP 797 / 800) Anesthesia exhaust

45 WHERE ARE ALL THESE ADDENDA THINGS? Go to:

46 Questions? Answers? Comments? WHAT SHOULD WE CHANGE NEXT? Next meeting ASHRAE Winter Meeting/AHR Show in Las Vegas

47 Thank you for your attention!