achieving compliance with ashrae 170nchea.memberlodge.com/resources/documents/2018/spring...

NCHEA Spring Seminar - March 15, 2018Dan Koenigshofer, PE, ASHRAE S-170 Committee

Alex Harwell, former DHSR Inspector & Plan Reviewer

Achieving Compliance with ASHRAE 170

1996-2017

DHSR Hospital Licensure Rules

10A NCAC 13B .6225

Ventilation Requirements Table 1

• What changed from licensure to FGI 2018/ASHRAE 170-2017

• What this means for Hospital Engineers, Vendors, & Designers

• What to look out for under the new regulations

2 | Achieving Compliance with ASHRAE 170 | March 15, 2018

Objectives

1950s-1996NC DFS Standards based on ASHRAE / AIA / DHEW Guides

1996-2017NC DFS / DHSR NCAC Rules based on 1992 ASHRAE Guides

January 1, 201813B.6225 is gone, replaced by 13B.6105 adopting…..


The old DHSR Hospital Licensure Rules

History of the North Carolina Hospital Ventilation Standards

1996

2018

FuturePast

• Automatically adopts newest version of FGI, current is 2018

• By reference includes the ASHRAE Std. 170-2017 HVAC requirements

• Includes new architectural requirements in addition to HVAC

• Mid-cycle addenda adoption path is circuitous, but there


New DHSR Rules

10A NCAC 13B .6105 2018 ed. 2.1-8.2 2017 ed.

• 2010 FGI adopted ASHRAE Std. 170 (S-170) for HVAC Requirements

• New 2018 DHSR adoption includes addenda:

10A NCAC 13B .6105 “The Guidelines for the Design & Construction of

Hospitals & Outpatient Facilities are incorporated herein by reference,

including all subsequent amendments & editions”

• Both are written as Design Standards, not as Operational Standards;

“Systems shall be capable of…”


A Little About The New . . .

Vs.

• 3 Volumes: Hospitals, Outpatient, Residential

• Space program vs. functional program

• Acoustic requirements

• Sustainable design

• Emergency preparedness & management

• Patients “of size”

• Sexual assault exam room

• Geriatric treatment in ED

Taken directly from introduction to FGI 2018


FGI 2018 – What’s New?

• Telemed spaces

• Mobile medical units

• Pre-post procedure area layout

• 2 rooms required for sterile processing except countertop units

• Single patient rooms in ICU’s except NICU

• Clarify procedure vs. operating room

• Clarify imaging services: procedure vs. OR


FGI 2018 – What’s New?

On projects involving installation of new or modification to existing

physical environment elements critical to patient care & safety or facility

energy use, at minimum the following systems shall be

commissioned:

• 1.2-8.1.1 HVAC

• 1.2-8.1.2 Automatic temperature control

• 1.2-8.1.3 Domestic hot water

• 1.2-8.1.4 Fire alarm & fire protection systems (integration with other systems)

• 1.2-8.1.5 Essential electrical power systems

• 1.2-8.1.6 Security systems


1.2-8.1 Commissioning Requirements

• Designers & Operators of hospital HVAC

systems

Hospital engineering design firms

Hospital Facilities Engineers

Hospital HVAC system vendors

Regulators & inspectors

• Who still doesn’t technically care (but could):

Outpatient Facilities

Ambulatory Surgical Centers


Who Cares?

• New Hospitals

S-170 applies to all hospital patient care & support

areas within a hospital for design & construction after

January 1, 2018

• Existing Hospitals

Designs logged in by DHSR prior to 2018 may remain

compliant to old standards

Renovations after 1/1/18 must be brought to new code

• Worth Noting

The Outpatient chapters of FGI were NOT adopted by

the new rule change, interesting note…..


Who Cares?

• NC rules will automatically update without legislative action

• Public participation in rulemaking at

https://www.ashrae.org/technical-resources/standards-and-

guidelines/public-review-drafts

• Modernized & expanded space categories. Now 89, before 53. See

S-170 Table 7.1 (handout)

• Each space has supply air changes, min OA, pressure, temperature &

humidity bands, exhaust, & recirculation based on current “scientific”

opinions.


What Changed?

https://protect-us.mimecast.com/s/3wQ8CDk0o6toMnpmClEiNR?domain=ashrae.org

Operating Room: invasive procedures, physiological monitoring, active

life support, aseptic, environmental controls, restricted access


What Kind Of Room Is It?

• Invasive: penetrates skin, aseptic space, entry

to “sterile” body cavity, insertion of object.

• Procedure: All that isn’t INVASIVE

May be performed outside surgical suite

May use sterile instruments

Local anesthesia is OK, if no WAGD

More sub-categories in FGI Table 2.2-1

Pharmacies: S-170 or USP?

• Pharmacy requirements currently in S-170,

but reference to USP. Soon to remove from

S-170….we’ll have to live with USP-797 & 800


Pharmacy & SPD

Sterile Processing: AORN/AAMI or S-170?

• AAMI/AORN to cease publication of HVAC requirements

• S-170 greatly eased: Max 60% RH (no min), acceptable

temp range 60-73F, 4-6 ACH

Functional Area Airflow

Minimum #

of Air Exchanges

per Hour

All Air Exhausted

Directly to

the Outdoors

TemperatureRelative

Humidity

Soiled/ decontaminated Negative (in)10

*(6) FGIYes

60°F–65°F

(16°C–18°C)20%–60%

Sterilizer equipment access Negative (in) 10 Yes75°F–85°F

(24°C–29°C)20%–60%

Sterilizer loading/ unloadingPositive

(out)10 Yes

68°F–73°F

(20°C–23°C)20%–60%

Restrooms/ housekeeping Negative (in) 10 Yes68°F–73°F

(20°C–23°C)20%–60%

Preparation & packagingPositive

(out)10 (downdraft type) No

68°F–73°F

(20°C–23°C)20%–60%

Textile packaging roomPositive


68°F–73°F

(20°C–23°C)20%–60%

Clean/sterile storagePositive


75°F

( 24°C) 70%


SPD Criteria - AORN/AAMI Guide - Gone


Filtration Standards

Filtration standards DHSR to S-170• More categories

• Switch from DOP to MERV filter rating scale

• Allowance for single bed filters with lower ratings for lab work spaces, procedure

rooms, & other semi-restricted spaces; smaller units for dedicated

outpatient/minor secondary care.

1996 DHSR Licensure


Filtration ASHRAE 170-2017

Space Designation (According to Function)(Pre) Filter Bank #1

(MERV)a

(Final) Filter Bank #2

(MERV)a

Operating rooms; inpatient & ambulatory diagnostic & therapeutic radiology; inpatient delivery & recovery spaces 7 14

Inpatient care, treatment, & diagnosis, & those spaces providing direct service or clean supplies & clean

processing (except as noted below); All (rooms)7 14

Protective Environment (PE) rooms 7 HEPAc,d

Laboratory work areas; Procedure rooms, & associated semirestricted spaces 13b NR

Administrative; bulk storage, soiled holding spaces; food preparation spaces; & laundries 7 NR

All other outpatient spaces 7 NR

Nursing facilities 13 NR

Psychiatric hospitals 7 NR

Resident care, treatment, & support areas in inpatient hospice facilities 13 NR

Resident care, treatment, & support areas in assisted living facilities 7 NR

• High pressure, adiabatic atomizing is allowed,

new for S-170-2017

• Requires RO water, UV sterilization, & filtration

• Applications where steam is not available

• 20% min RH in “short stay areas” – OR,

procedure

• Burn unit to have individual humidifier


Humidification

• Imaging rooms using anesthetic

gases shall meet ACH of OR

• Supply air must be concentrated

over table +12” on all sides.

• Array above table must be at least

70% diffusers

• Smoke evacuation not required


Surgery Ventilation

70%

• Laminar non-aspirating diffusers required:

•PE rooms

•Wound ICU (burn units)

•Trauma rooms

•Procedure rooms


Supply Air Outlet Arrangements

• Anteroom not required

• Local monitor room to corridor

• Pressure monitor of anteroom not

required

• Retrofit isolation rooms may use

portable HEPA

• Tightly sealed to achieve 0.01”

• PE room returns next to door


Airborne Infectious Rooms

• Surgery & AII spaces musts:

• Redundant heat sources

• Pressurization maintained at all times

• Redundant cooling sources


New Redundancy & Power Requirements

*

• Reduction in outdoor air intake separation from 30’ to 25’

• In-line exhaust fans provided welded duct is utilized

• Specific prohibition of lined duct in ALL areas after final

filters

• No more operable window requirement!


What Else Changed?

Now 5’ Less!

• Surgery returns 8” AFF, rather than 3” (you should do this!)

• Specific planning requirements for infection control, phasing, &

turnover

• Owner training requirements for design projects

• Unoccupied setback is allowed, but must maintain pressure

relationships


Anything Else?

8” AFF vs. 3”

• Recirculation is allowed in patient rooms

• Single patient rooms may use 6 ACH w/ volume based on 6’ AFF

• Condensing recirc unit? Then MERV 6 required before cooling coil

• IMC & L&D allow only 4 ACH with supplemental heating/cooling


Even More Interesting Changes

• Be sure your designers are designing to S-170-2017

• Any self-performed equipment replacements of boxes, AHU, chillers,

etc., must meet S-170 requirements

• Check section 10.5 of S-170, you are owed more & better training &

documentation at turnover!


Healthcare Engineers’ Action Items

• Look out for the expanded list of pressure control requirements &

minimum .01” dp values in Table 7.1

• Start planning for redundancy for your cooling systems

• Start planning for emergency power to maintain full range

temperature control and pressurization


Healthcare Engineers’ Action Items

Dan Koenigshofer, PE, HFDPDewberry Engineers Inc.

[email protected]

919.425.7616

Alex Harwell, EIDewberry Engineers Inc.

[email protected]

919.425.3769


Thank You !!

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