HEALTHCARE VENTILATION
Opportunities for Change
NCHEA District III Winter Meeting
January 12, 2017
Wayne R. Thomann, Dr.P.H.
Director, Occupational and Environmental Safety
Duke University/Medical Center
VENTILATION OF HEALTH CARE FACILITIES
ANSI/ASHE/ASHRAE Standard 170-2013
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Currently Under Continuous Maintenance
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Change requests (addenda) can be submitted at any
time and by anyone
>9 addenda have been published since 2013
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They are officially a part of the Standard when published
You should download these from ASHRAE as a reference
SSPC 170 Oversees the Development/Revisions
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Integrated into TC 9.6 – Healthcare
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Members may initiate addenda
VENTILATION OF HEALTH CARE FACILITIES
Standard 170-2013 – Key Addenda
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Addendum c – June 2016
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Changed from “laboratories” to “Laboratory work
areas”
Includes provisions to reduce total ACH
Addendum d – June 2015
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Clarifies requirements for certain exhaust
discharge, like ED, Hot Labs, pentamidine
administration, etc.
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Added new separation distance requirements
VENTILATION OF HEALTH CARE FACILITIES
Standard 170-2013 – Key Addenda
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Addendum g – October 2015
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Addendum f – June 2016
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Coordinated operating room and procedure room
terminology with 2014 FGI Guidelines
No change to technical requirements of 170
Clarifies requirements for the primary
supply diffuser array for the OR
Addendum k – August 2016
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Clarifies requirements for ElectroConvulsive Therapy (ECT) Rooms
VENTILATION OF HEALTH CARE FACILITIES
Standard 170-2013 – Key Addenda
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Addendum b – July 2014
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Addendum ae – October 2014
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Updated reference requirements of the Standard
Includes changes resulting from
coordination with the 2010 Guidelines for
Design and Construction of Health Care
Facilities (FGI Guidelines)
Addendum e – December 2014
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Expanded prohibition of positive/negative
switching of rooms from AII to all areas.
VENTILATION OF HEALTH CARE FACILITIES
Standard 170-2013 – Key Addenda
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Addendum h – May 2016
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Addresses differences between ASHRAE and AAMI
requirements for environmental conditions in
Sterile Processing
“ASHRAE standards guide the design of these
areas, While AAMI standards guide their
operations”.
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“Note: See AAMI Standard ST79-2013 for additional
information for these spaces”.
VENTILATION OF HEALTH CARE FACILITIES
Standard 170-2013 – Key Addenda
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Addendum h – May 2016 (continued)
 Changed “Central Medical and Surgical
Supply” to “Sterile Processing Department”
in Table 7.1
 Changed temperature range for
“Decontamination Room” to 60-73 0F
 Changed temperature range for “Clean
workroom” to 68-73 0F
 Changed temperature range for “Sterile
storage room” to maximum of 75 0F
 Did not change RH requirements
RATIONALE FOR TEMPERATURE
CHANGE IN DECON AREA
Rationale: Processing areas should be
comfortable for personnel. Comfort is a
particular consideration in the
decontamination area, where PPE is worn for
long periods of time and where temperatures
suitable for other areas might be
uncomfortably hot. Controlling the
temperature in sterilization equipment access
rooms may promote higher efficiency of the
equipment contained within the enclosures.
COMMENTS ON AAMI STANDARDS
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They Call Them “Guides”
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A standard or recommended practice is
limited, however, in the sense that it
responds generally to perceived risks and
conditions that may not always be relevant
to specific situations. A standard or
recommended practice is an important
reference in responsible decision-making,
but it should never replace responsible
decision-making.
COMMENTS ON AAMI STANDARDS
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They Call Them “Guides”
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“The application of a standard or
recommended practice is solely within the
discretion and professional judgement of
the user of the document.”
PROPOSED ADDENDUM o TO
170-2013
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Alternative Path for Ventilation Rates in
Table 7.1
Posted as an “Advisory Public Review Draft”
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https://osr.ashrae.org/sitepages/showdoc2.asp
x/ListName/Public%20Review%20Draft%20Sta
ndards/ItemID/1589/IsAttachment/N/170o(201
3)_1stAPRDraftFINAL.pdf
Comment Period from December 16, 2016January 30, 2017
PROPOSED ADDENDUM o TO
170-2013
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Seeking Comments on the Basic Soundness
of the Concept
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The purpose of an APR is to seek suggestions
for new, unusual, or potentially controversial
elements of the proposed standard that the
project committee believes would benefit from
increased public scrutiny prior to finalizing the
draft for its first formal public review.
https://www.ashrae.org/standards-research-technology/public-review-drafts
PROPOSED ADDENDUM o TO
170-2013
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Proposes a New Normative Appendix D:
Risk-Based Means of Compliance
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For those health care providers that have
the expertise to analyze, implement, and
document their specific ventilation
requirements, this proposed addendum
provides a risk-based approach to establish
alternate ventilation rates for spaces
required in this Standard.
PROPOSED ADDENDUM o TO
170-2013
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It is a “Voluntary” Alternative Path to
Compliance with 170
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It is based on the Healthcare approach/option in
Standard 188
Requires an Airborne Hazard Risk
Management Plan (AHRMP)
Permitted for Entire Facility or any Portion(s)
of the Facility
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Prescriptive requirements of 170 in other areas
PROPOSED ADDENDUM o TO
170-2013
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May Design to Prescriptive Requirements of
170 but Operate at AHRMP Level
Can Use the AHRMP in/for Areas/Operations
not Covered in 170
Requires Approval by the AHJ
Must Implement CDC’s 2005 TB Guidelines
and their 2007 Isolation Precautions
Guidelines
PROPOSED ADDENDUM o TO
170-2013
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Designated Team
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Senior Leadership Appoints the Leader
from EOC Team
Risk Management (CPHRM)
Senior person for ventilation decisions
Environmentalist or IP (CIC)
Experienced Engineering Healthcare Design
Professional
PROPOSED ADDENDUM o TO
170-2013
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Designated Team
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Develop, Implement, and Document all
Aspects of the AHRMP
PROPOSED ADDENDUM o TO
170-2013
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Prescriptive Requirements
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Higher risk areas in Standard 170
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ORs, ICUs, PE rooms, Sterile Storage, etc.
Airborne Hazard areas
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Medical/anesthesia gas storage, AII rooms and
anterooms, ED waiting, Labs, etc.
PROPOSED ADDENDUM o TO
170-2013
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Develop a Graphical Air System Space Plan
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Space name
Intended presence of immuno-suppressed
patients
Estimated likelihood of airborne contaminants
Estimated likelihood of odiferous contaminants
Identify spaces with more than a single patient
Spaced with chemical contaminants of concern
PROPOSED ADDENDUM o TO
170-2013
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New Construction, Renovation, and
Change of Use
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Designated Team shall review the Scope of
Work and determine the risk
Builder must:
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Work cooperatively with the Team, basically a
CRA/ICRA process
Provide timely reports of compliance
Provide a commissioning plan
PROPOSED ADDENDUM o TO
170-2013
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Existing Buildings
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Provide annual evaluation and re-assessment
of the likelihood of airborne hazard impact
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Revise the evaluation and AHRMP when:
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Ventilation systems are changed
Major maintenance to the ventilation system
Changes to intended presence of immunocompromised patients
Modify the AHRMP as appropriate
PROPOSED ADDENDUM o TO
170-2013
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Airborne Hazard Risk Management Plan
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Air system space plan
Identify spaces excluded from the plan
Identify areas with higher probability of
infection
Design requirements for the prevention and
control of airborne infection, comfort, and odor
control
Building monitoring procedures
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Determination of corrective actions
PROPOSED ADDENDUM o TO
170-2013
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Airborne Hazard Risk Management Plan
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Assignment of all actions related to the AHRMP
Documentation of the AHRMP
Disease prevention response to elevated risk
Actions if an airborne infection is identified
Procedures to monitor the implementation and
effectiveness of the AHRMP
PROPOSED ADDENDUM o TO
170-2013
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Building Ventilation System Procedures
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The airborne hazard management plan
shall include procedures for the building
ventilation operation and maintenance at a
minimum as described in Informative
Appendix A of ASHRAE/ASHE Standard
170.
INTERPRETATION DOCUMENTS
FOR 170-2013
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Both Formal and Informal
Interpretations are Provided by SSPC
170
Another Good Source of Information
available on the ASHRAE Website
Anyone can Request and Interpretation
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Seek clarification for tough decisions
ANSI/ASHRAE STANDARD 188-2015
Legionellosis: Risk Management for Building
Water Systems
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Normative Annex A – Health Care Facilities
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Under Continuous Maintenance
Alternative compliance path for health care
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Designated Team
Water System Flow Diagram
Risk Management Plan
Existing Buildings, New Construction, and Renovation
Building Water System Procedures
ANSI/ASHRAE STANDARD 188-2015
Legionellosis: Risk Management for Building
Water Systems
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Normative Annex A – Health Care Facilities
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Building Water System Procedures
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Potable water systems
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Systems start-up and shutdown
System maintenance
Water treatment
ANSI/ASHRAE STANDARD 188-2015
Legionellosis: Risk Management for Building
Water Systems
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Normative Annex A – Health Care Facilities
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Building Water System Procedures
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Cooling towers and evaporative condensers
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System Maintenance
Water Treatment
Shutdown and start-up
Disinfection of cooling towers and evaporative condensers
Location of cooling tower makeup valve
ANSI/ASHRAE STANDARD 188-2015
Legionellosis: Risk Management for Building
Water Systems
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Normative Annex A – Health Care Facilities
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Building Water System Procedures
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Pools and spas
Ornamental fountains and open water features
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Operation
Maintenance
Water treatment
ADDITIONAL EFFORTS
Clarifying Relationship Between 62.1 and 170
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On-going Discussions
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Achieve more consistent terminology
Define which Standard applies where
Add Construction and O&M to 170 and
adjust 62.1 to be consistent with that
ADDITIONAL EFFORTS
Filtration
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A new Work Group is Looking at
Filtration and Air Cleaning in Healthcare
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How can we show trade-offs between
traditional filters and other air treatment
types?
No addendum/addenda proposals yet
NEXT STEPS
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Submit a Comment on Addendum o
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Supporting comments are appreciated
Recruit your colleagues/peers
Get Involved
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Join a Committee
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Monitor actions and changes
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Contribute to the discussion and decisions
Be a good student
Review your current systems
ASHRAE HEALTHCARE
RESOURCES
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https://www.ashrae.org/resources-publications/bookstore/health-carefacilities-resources
QUESTIONS and DISCUSSION