Ventilation of Health Care Facilities

Ventilation of Health Care Facilities /1ig/1 risk immu11ocompromised patiems: patients who havc the greatest risk ofinfection caused Ьу airЬome or waterboriie 111..icroorganisшs. These patie11ts i11clude but are 110t liшited 10 allogeneic stem-cell transplant patients and intensive chemo­ thcrapy paticnts. infectio11 co11trol risk assessme11t (/CRA): а detcпnin.ation of the potential risk oftransmission ofvarious infectious agents in the facility, а classification of those risks, and а list of required practices for mitigating those risks during construc­ tion or renovation. imm1mocompromised patients: paticnts whose immunc mechanisms are deficic11t becausc of immunologic disordcrs (e.g., human immunodeficiency virus [IПV) infection or congenJtal immunc dcficiency syndrome), chron.ic diseases (e.g., diaЬetes, canccr, emphyseшa, or canliac failure), or immunosuppressivc thcrнpy (e.g., radiation, cytotoжic cliemo­ thcrapy, anti-rcjection medication, or stcroids) (scc CDC [2003] in Infonпative Anncx В: BiЬ!iogrophy). inpatient: а pahent whose stnyatthe health carefacility is antic­ ipated to require twenty-four hours or more of patient care. in)•asive imaging proced11re room: а room in wlrich radio­ graphic imaging is used and in which instrun1ents or devices are inserted into patients through tl1e skin or Ьodyoritice under i;terile conditions for diagoosis and/or treaimen1. 11011-aspirating dijfu.�er: а diffuser that has unidirectional downward airflow from thc ceiling with minimum cntrain­ mcnt of room air. Classified as ASHRAE Group Е, 1hese diffusers geпerally have very low overage ve/ocity. For the purposes ofthis stш1dard, the pcrfonnance ofthese diffuscrs is to Ьс mcasurcd in tenns of avcrage vclocity. protective envirotiment room: а pnticnt room that is designcd nccording to this standard and intended to protect а high risk immunocompromiscdpaticnt fron1 human and environmentзl airЬome pathogens. triage: the process of dctennining the severity ofthe illness of or injury to patients so that those who have the most emcrgent illnesses/injuries can Ьс treated immediately and those less severely injurcd can Ьс treated later or in ano1hcr area. 4. COMPLIANCE 4.J Coшpliance Rcquircшcnts 4.1.1 Ne,v Buildings. New buildings shall comply ,vith the provisions ofthis standard. 4.1.2 Existing Buildlngs 4.1.2.J Additions to Existing Buildings. Additions shall сошрlу with the provisions of tbis standard. 4.1.Z.2 Alteratlons to Exlsting Buildlngs. Portions of а hcating, vcntilating, and air-conditio11ing system and 01l1cr systcms and equipшent that are Ьcing altered shall comply with the арр\iсаЫе requireшents ofthis standard. 4.J.2.2.1 Heating, Ventiladon,andAJr-Condidonlng System Alteratlons. Alterations to mcchanical systems serving the building heatinц, cooling, or vcntilatiпg nct-ds shall comply with the requirements of Scc1ion 6, "Systems and Equipmcnt,'' applicaЫe: to tlюse spccific portions of tЬе Ьuildiпg ni1d its sys­ teшs that are Ьеiпg altcrcd. Any new mechanical equipшent installcd in conjunction with the altcration as а direct rq>lace­ mcnt of cxisting mechanical cquipmcnt shall comply wi1h thc provisions ofScctions 6.2, 6.4, 6.5, nnd 6.6. 4.1.2.2.2 Space Alterations. Alterations to spaces listed in ТаЫе 6-J (sce page S) shall comply with the require­ ments of Section 6.7 and Sect.ion 7, "Space Ventilation," appli­ caЫe ю those spccific portions of the building and its systems that are Ьeing altcrcd. Any alteration toexisting heэlthcare space in а building that wШ continue 10 treat patients during coпstruc­ tioo shall complywith Sections 8.1, 83, 8.4, and 8.5. 4.2 Admlnistrative Rcquircments. Admin.istrative requirements rclating to pennit requiremcnts, enforcemen1 Ьу the authority having jurisdiction, intcrprctations, clairns of cжcшption, :ipproved calculation metbods, rights of approved calculation methods, and rights of appeal are spccified Ьу thc authority havingjurisdichon. 4.3 Compliance Docu1:11ents 4.3.1 Gencra\. Compljance docuntents are those plans, specificutions, cngineering calculations, diagrams, rcpons, :ind other data that nre npproved as part of the permit Ьу the authority having jurisdiction. Thc compliance documents shall include all spccific construction-relatcd requiremcnts of the owner's infcction control risk asscssmcnt. 4.3.2 Constructlon Dctalls. Compliance documents shall contain all pertinent data and features ofthe building, equip­ шcnt, and systems iп sufficient detail to allow а detcnnination ofcompliance Ьу the authority havingjurisdiction and to indi­ cate compliance with the requiremcnts of this staлdard. 4.3.3 Supplcmental Jnformation. Sнpplemental infor• m3tion necessary to verify compliance with this standard, such as calculations, worksheets, compliance fonns, vendor literature, or othcr data, shall Ье made availaЫe when required Ьу the authority having jurisdiction. 4.4 Altemate Mяtcrials, М.ethods of Construction, or Oeslgn. The provisions of this standard are not in1ended to prevcnt the use of any material, mcthod of constntction, design, or bui1ding system not specifically prescriЬed hcrein, provided such construction, design, or Ьuilding systcm has Ьсе11 approved Ьу thc aulhority haviнgjurisdiction as шeeting tl1e inten1oftbls sta11dard. 4.5 lnformative Appcndices. The infonnative appendices to this standard and infonnative notcs located within this stan­ dard contain recomшendations, explanations, and other non­ mandatory infoпnation and are not part ofthis standanl. 4.6 Crileria Rangcs. This standard often specifies а range ofvalues 1hat wi11 comply with а specific requirement ofthe standard. lfit is pemliued Ьу the autlюrity havingjurisdictioл, compliance with tЬis requirement may Ье achicved Ьу the prc­ sentation of compliancc documents that demonstrate а sys­ tem's ability to perform within 1l1e specified raпge. 5. PLANNING Owners/managers oГhea1th care fucilities shall prepare а detailed program that sha11 include the c1inical serviccexpec1ed in each space, the specific equipmcnt expecied to Ье used in each space, and any special clinical necds for temperatiщ:, humidity, and pressшe control. This program shall Ье prepared in the planning phase of design. 6. SYSTEMS AND EQUIPMENT Air-handling and distribution systems arc required to provide health earc faciJities not оо\у with а co1nfortaЫe envi­ ronment buta1so with ventilation to dilute and removc contam­ inants, to provide conditioned air, and to assi�t in controlling thc transmission of airЬome infcction. ln order to meet these requirements, air-handling and distriЬution systcrns shall Ье designed according to the requiremcnts ofthis sandard. 6.1 Utilit.ies 6.1.1 Ventilation Upon L,oss or Electrical Power. The space vcntilation and pressure re1ationship requiremcnts of ТаЫе 7-1 (see page 7) shall Ье maintained for the following spaces, even in the even1 ofloss ofnonnal clcc1rical power: а. Allrooms Ь. PErooms с. Class В & С Operating Rooms, including Delivcry Rooms (Caesarean) For further infomшtion, see NFPA 99 (2005), in lnformative Anncx В: BiЬ!iography. 6.1.2 Reserve Heatlng and Couling Sources 6.1.2.1 Provide heal 0011rces and essential accessories in numЬer and arrangement sufficient to accommodate the facШty needs, even when any one of the heat sources is not operating due to а breakdown or routine maintenance. The capacity ofthe remaining source(s) shall Ье sufficient to pro­ vidc for sterilization and dietary purposes and toprovide heat­ ing for operating, delivery, Ьirthing, laЬor, recovery, emergency, intensive саге, nursery, алd inpnticnt rooms. (For further information, see AIA (2001) in Infomшtive Annex В: BiЫiography. Exception; Rescrve capacity is not required iftheASHRAE 99% heating dry Ьulb temperaturc for thc facility is greater than or cqual to 25°F. 6.1.2.2 For central cooling systems greater than 400 tor1s резk cooling load, the numbcr and aпaлgement of cool­ ing sources and essential accessorics shall Ье sufficient to sup­ port tlie owner's facility operatioв plan upon а breakdown or routine maintcnance ofany onc ofthe cooling sources. Exception: Reservc capacity is not required if the ASHRAE 1 % cooling dry bu\b temperature is lcss tlian or equal to 85°F. 0.2 Air-Ha11tШ11g U11il De�lg11 6.2.l Alr-Handling Unil Casing. The casing of the air­ handling unit shall Ье designed to prevent \vater intrusion, resist corrosion, and permit access for inspection and шainte- nancc. AII air:streamsurfacesofair-handling units-e.g., inte­ rior surfaces and components-shall comply with Section 5.5 of ANSIIASJIRAE Srandard 62.1-2007, Venrilarion for АссерtаЫе Jndoor Air Q11ality. (For more infonnation, scc ANSI/ASHRAE Sttшdard 62.1-2007 and ASHRAE positioп documcnt Minimi2ing lndoor Mold Proh/ems 1!1гоиgh Мш1• ogement ofMoi.st11re in Building Systems.) 6.3 Outduor Air Tntakes and Exhaust Dlscharges 0.З.1 Outdoor Air lntakes. Outdoor air intakes for air­ handling units shaJI Ье located а minimum of25 ft (8 m) ftom cooling towers and all exhaust and vent discharges. Outdoor air int.akes shall Ье locatcd such that the Ьonom of the air intake is at lcast six ft (2 m) above grnde. Intakes on top of Ьuildings sball Ье located а minimumofthree ft (1 m) аЬоvе rooflevel. New facilitics with 1oodera1c-to-high risk ofnatuml or mnn-шade extraordinary incidents shall locate air i111akes away ftom puЫic access. AII intakes shall Ье designed to pre­ vent thc cntrainn1ent ofwind-drivcn min, shall contain featurcs for draining away prccipitation, and shall Ьс equipped with а blrdscrten ofmcsh по smaller thnn 0.5 in. (13 mm). 6.З.2 Exhaust Discharges. Exhaust discharge outlcts that discharge air from АП rooms, bronchoscopy rooms, cmergeпcy department waiting rooшs, nuclear шedicine Jab­ orutories, radiology waiting, and laboratory chcшical fume hoodsshall а. Ь. с. Ьс desigлed so that all ductwork in occupied spaccs is under negative pressure; discharge in а vertical direction at lcnst 10 ft (3 m) аЬоvе roof level andshall Ье located not less than 10 ft horizon­ tally frorn air intakes, ореnаЫе windows/door:s, or areas that are nonnally accessiЫe to the puЬlic or maintenance per:sonnel and that are higher in elcvation than the exhaust discharge; and Ье locuted such that they minimize the recirculation of exhausted air back into the building. 6.4 l<'iltratlon. 1-ilterbanks sha11 Ье provided in accordiшcc with ТаЫе 6-1. Each fi1ter bank with an efficiency of gтcater than MERV 12 shall Ье provided with an ins1alled manometer or diffcrential pressure measuring device that is readily acces­ siЫe апd provides а reading of differential staLic pressure across thc filter to indicate when the fi1tcr needs 10 Ье changcd. (For furthcr information, scc AlA [2006] and CDC [2003] in Infonnativc Annex В: BiЫiogтaphy.) 6.4.1 First li'illration Bank. Filter Bank No. 1 shall Ье placed upstrtam of the heating and cooling coils such that all mix.ed air is filtcred. 6.4.2 Sccond Filtration Bank. Filter B ank No. 2 shall Ье insta11ed downstrcam of all wet air cooling coils and thc supply fun. All second filttt Ьank.s shall have sealing interface surfuccs. 6.5 Hcating and Cooliлg Systcшs 6.5.1 Cooling Coils and Drain Pans. Cooling coils and drain pans shall comply with the requirements of ANSI/ ASHRAE Standard 62.1-2007. TABLE 6-1 Mlnlmum Fllter Efflclencles Fllter Bank Number 1 SpaeeDesi1:natlon(AccordingtoFunctlon) (MERV)' Filter Bank NurnЬcr 1 Classcs В and С surgery; inpaticnt and amЬulatory diagnostic and thcrapeutic radio[ogy;inpaticntdclivcryandrecovcryspaccs lnpaLicnt carc, trc:itment, rшddia gnosis, nnd those spnc« providing direct service or c1cansupp1iesandclcanprocessing(exceptasnotcdЬclow); AJI(rooms) Protcctivc cnviroament rooms (Pll) (MERVf 14 14 17(НЕРА)с NIR' LaЬoratorics; Qass А surgcry and associatcd scmi-restricted spaccs Administrnti\'C; b\1lk !il:oragc; soiled holding spaces; foodpreparation spaces; and laundries Л\lothcrou1patien1spaces Skillcdnursingfacilities N/R N/R N/R •:NR•...,.requl,U Nolo 1, Tho minim1m cffioicr>c:y rcp«tir,a valuc (MГ:RV) i1 � on 1Ьо mahod o!tulint delcliЬod in ANSIIASIIRAF.Su,nd�nl 51.2-200?, Mcdtodi,/T•ting (kмп,/ v..,rl/a№n Atr-Ckanfng I>,м,:cfor Rcmmюl lffjcimcyby ltmklcSiu (sec lnf,,,...a!М: Anna В: Bib�og,&phy). Note Ь: Addioon&l pц,6J1enm11yЬe uш1 !О rroute u.iлlenaroce for ftltcn with efl\cieneia lligller than MERV 7 Notcc:Fi!!erDankNo. 2 тауЬе1 MERV 14 ifaMГ,RV 17ccniarylonninalfi1tcrilpl0Yidtd forlhelcsp.ol!I. TABLE 6-2 Supply Air Outlets Spaee Dcslgnation (Accordini;: to Functlon) All с[ам А, В, and С surgcricsb Protcctivc cnvironmeлt (РЕ) rooms Woundintcnsivecareunits(Ьumunits) Trauma rooms (crisis or shock) Allrooms Allothcrspaces Supply Air Outlct Classiflcatlon• Primary supply diffusers Group Е, non-aspirating additional supply diffuscrs, Group Е GroupE,non-aspirating GroupE,non-aspirating Group Е, non-aspiratirщ Group А or Group Е Group А or Group Е Note.: R�ferW ]()0$,ISJ/RAE Halllilюtм-1-·.мamu,u,/r, Chap!er 35,fur defini(ions rcla!edto0<1tlot cluoiбcation мd pcrfom,a,кc (see lnfonщt1i.., Лиnех В: BiЬliography). No\e'b: Sшgc,on11may ,equщ, tltctU.tc air....iistr!Ьulloa 1ysccn11 for 11.>mc 11pe,:ltlw:d a,rger\Ci. S11eh 1Y5tc11111h8!I Ьс coas!daed acceptaЬle lrlhcy mccto,u�ced 1hc rcquirc1nent1 oftbls1tandanl. 6.5.2 Radiant CoolingSystems. lfradiant coolingpanels are utilized, the chilled-water tempcrature shall always remain above the dew point temperarurc ofthe space. 6.5.3 Radiant Heatiлg Systems. lfradiant heating is pro­ vided foran АЛ room, а protecti,-e environment room, а wound intensive care unit (Ьum unit), or а room for any class ofsur­ gery, eilher flat andsmooth radiant ceiling panels withexposed с\еаnаЬ!е surГaces or radiant floor heating shall Ье used. 6.6 HumldШers. When outdoor humidity and internal шoisture sources are not sufficient to шееt the requireшents оfТаЫе 7-1, lшmidification shall Ьс providcd Ьу means of the hcalth-care facility air-handling systems. Locate humid­ ificn within air-handling units or ductwork to avoid mois• ture accumulation in downstream components, including filteN; and insulation. Chemicзl additives used for steam humidifien serving healtb care facilitics shall comply with FDA requirements.1 Reservoir-type water humidifiers or evaporative-pan-type humidifiers shall nol Ье used in duct­ work: or air-handling units in health care facШties. А humid­ ity sensor shall Ье provided, located at а suitaЬ!e distance downstream from thc steam injection source. Controls shall Ье provided 10 limit duct humidity to а maximum va1ue of 90% RН when the humidifier is operating. Humidifier stcam control valvcs shall Ье designed so that they remain оя: whenevcr the air-handling unit is not in operation. 6.7 Alr Dlstribution Systems 6.7.J Gencral. Мaintain the pressure relationships required in ТаЫе 7-1 in а11 modes ofHVAC system operation, except as noted in the tаЫс. Spaces listed in ТаЫе 7-1 that have required pressure relationships shall Ье served Ьу fully ductcd retums. The air-distribution design shall maintain the required space pressure relationships, tak:ing into accounr rec­ ommended maximum filter Joading, heating-season lowered airflow operation, and cooling-season lt.igher airflow opera­ tion. Airstream surfaces oГthe air-distribution system down­ stream ofFilter BankNo. 2, shall comply with Section 5.5 of ANSUASHRAE Standard 62.1-2007. The air-distribution system shall Ье provided with access doors, panels, or other шeans to a!low convenient access for inspcction and cleaning. (For further inГormation, see ANSVASHRAE Standard 62.1.) 6.7.2 Alr-Dlstributlon Devices. AII air-distribution deviccs shall meet the Гollowing requirements: а. Ь. с. SLtrfaces of air-distr:ibt1tion deviccs shall Ье s11itзЫe for cleaning. Supply air outlcts in accordancc with ТаЫе 6-2 shal! Ье uscd. Тhе supply diffusers in Classes В and С surgeries shall Ье designed and instзlled to alJow for intcrn.a! cleaning. Psychiatric, seclusion, and holding-patient rooms shall Ье designed with security diffusers, grilles, and registers. 7. $РАСЕ VENТILATION Tl1e ventiJation requiremcnts of this staшlard are inini­ mums that provide control of e11viro1Ш1e11tal comfort, asepsis, and odor in hcalth c.ire facilities. Howcver, bccause thcy nrc minimum rcquircmcnts and bccnuse of thc diversity of thc population and variations in susceptibi[ity and sensitivity, these rcquirements do not provide assured protection from discomfo11, airbome transmission of contagions, and odors. turc and humidity conditions based upon lhe space cooling or heating load. 2. Air filtration for spaces shall comply with ТаЫе 6-1. 3. Supply air outlets for spaces shnll comply with Table 6--2. 4; ln Лl1 roonщ protective environment rooms, wound intensive care units (Ьum units), and rooms for all classes of surgery, heating with supply air or radiant panels that meet the requirements ofSection 6.5.3 shall Ье provided. 7.2 Additional Room Specific RequJгcmcnts 7.2.1 Airborne Infection lsolation (АП) Rooms. Venti­ lation for All rooms shall meet the following requirements whenevcr an iлfecl.ious patient occupies the room: а. 7.1 Gcncral Requircmcnts. The following general rcquiremcnts sha11 apply for space ventilation: 1. Spaces sha\l Ьс ventilated according 10 ТаЬ!е 7-1. а. Design ofthe ventilarion system shall provide air movement that is generally from c1ean to less clean areas. Jfany fonn ofvariable-air-volume or Joad-sl1cdding system is used for encrgy co11ser­ vation, it shall not con1promist: the pressure bal­ ancing relationships or thc minimum air changes rcquircd Ьу the 1аЬ1е. Sce ТаЫе 7-1 note (t) for additiona1 infonnation. Ь. The vcntilntioo mtes in this tnЫe arc intended to providc for eomfon as wcll as for asepsis and odor control in nreas of а hcalth eare faeility that dircctly affect pnticnt care. Thc nir chn.nge rntcs specified arc for supply in positive pressure rooms and for exhaust in negative prcssure rooms. Venlllation rates for many areas not spcci­ fied here can Ье found in ANSI/ASHRAE Stan­ dard 62.1 (see Informative Annex В: BiЫiography). Whcre areas with prescriЬed rates in both Standard 62.1-2007 and ТаЫе 7-1 ofthis standard exist, the higher of the two air change rntes shall Ье used. с. For design purposes, the minimum numЬer of total air changes indicated shall Ье either sup­ plied for posiLive pressure rooms or exhausted for пegativc pressure rooms. For spaces that rcquire а positive or negativc pressure relation­ ship, the numbcr of air changcs can Ьс reduced when the space is unoccupied, providcd that the required pressure relationship to adjoining spaces is maintained while the space is unoccu­ pied and that the minimum numЬer of air changes indicated is rccstaЫishcd anytime the space bccomes occupied. Air change mtes in cxccss of the minimum values are expected in some cases in order to maintain room tcmpera- Ь. с. d. е. f. Each All room sha1t comply with requircments ofTaЫes 6-1, 6-2, and 7-1. АП rooms shall havc а peпnanently installed device and/or meclumism to coпstantly monitor the differcntial air prcssure Ьetween the room and adja­ cent spaces of the rootn when occupied Ьу pa1ients with an airЬomc infectious discase. А local visual means shall Ье provided to indicate whenevcr negative differcntial pressure is not maintained. All air from the All room shall Ье cxhausted directly to the outdoors. Exception: AII rooms that arc retrofitted from stan­ dard patient rooms from which it is impractical 10 exhaust directly outdoors may Ье ventilated with rccir­ culated air from the room's exhaust, provided that the air first passes through а НЕРА (МERV 17) filter. А!] exhaust air f.rom tl1c All rooms, associated antcrooffi8, and associatcd toilct rooms shall Ье dischargcd dircctly to the outdoors without mix.ing with cxhaust air from any other non-AII room or cxhaшt systcm. Exhausl air grillcs or registers in the patient room shall Ье \ocated directly аЬоvс the patient bed on the ceiling or оп the wall ncar the head of the Ьеd unless it сап Ье demon­ strated that such а 1ocation is not practical. The room enve1opc sha11 Ье sealed to limit leakage air Поw at 0.01 in. wc (2.5 Ра) differential pressureacross the envelopc. Differential pressure Ьetween АП rooms and adjacent spaces that have а dilferent fш1ction shall Ье а minimwn of-О.О I in. wc (-2.5 Ра). 7.2.2 Protective Environment (РЕ) H.ooms. Ventilation for РЕ rooms shall meet the following reqt1ircments: а. Ь. The room c:nvelope slшll Ье sealed to limit leakagc air flow at 0.01 in. wc (2.5 Ра) differential pressure across thc envelopc. Each РЕ room sho.11 comply with the requirements of ТаЫеs 6-1, 6-2, and 7-1. РЕ rooms shall have а perma­ nently instзlled device and/or mechanism to constantly monitor the differential air pressure Ьetwecn the room and adjacent spaces of the room when occupied Ьу patients requiring а protectivc environmcnt. А local visual mcans shall Ье providcd to indicate whenevcr positive differential pressure is not maintзined. FunetionofSpace Pressure Relatlonshipto AdjacentAreas TABLE7-1 Design Parameters MinUUum Outdoorach Mlnimum Tot1lach AII RoomAir Exhausted Direetly toOutdoors (п) AirRecireul1ted byMeansof RuomUnits(a) RН(k1 Design Temperatщ °F!"C 68-75/20-24 % SURGERY AND CRlTICAL CARE Cla.sses В and Coperating rooms, (m), (п), (о) Positive 20 NIR No Opcratinglsurgical cystoscopic rooms, (m), (n) (о) Positive 20 NIR No Delivery room (Caesarcan) (m), (n), (о) Positive 20 NIR No 30--<0 30--<0 30--<0 SuЬsterilesetvicearea N/R NIR No NIR N/R Recoveryroom NIR NIR No 70---75/21-24 70---75/21-24 68-75/20-24 68-75/20-24 Criticalandintensivecare Positi\•e NIR No 30--<0 30--<0 ,vound inlellSive care(Ьum unit) P ositi\·e NIR No 40--<0 70-75/21-24 NewЬom intcnsive ст Positi\·e NIR No 70-7S/21-24 Trcatmentrooш(p) N/R N/R Trauma room(crisisorshock) {с) P ositi\•e NIR No Medieal/anesthcsiagasstoгage(r) Negativc " NIR 30--<0 30--<0 30--<0 Уо, N/R NIR 70-7S/21-24 70---75/21-24 NIR NIR LaserC)·eroom Positi,'C IS NIR No 3....,, 70-7S/21-24 ER w!Uting rooms (q) Negativc 12 Yos NIR maii:6S 70-75/21-24 70-75!11-24 Triage Negative 12 Yos NIR =•60 ER dec ontamination Negative 12 Yos No NIR N/R Radio1ogy waiting rooms (q) Ncgative 12 Ycs NIR Positi,'C IS NIR No =60 30--<0 70---75/21-24 Class А Operatini/Procedure ro om (о), (d) NIR 70-75121-24 INPAT!ENТ NURSrNG Paticntroom(s) NIR N/R =60 Toiletroom Negative 10 Yos NIR N/R 6 No NewЬom nurscry suite NIR № Protectivc cnvirorunent room (f), (n), (t) PositГ,c 12 NIR No АП room (с), (n), (u) Negativ� All isolation anteroom (t) (u) NIR Lahor/delivcry/reco,,cry/postpartum (LDRP) (s) NIR Lahor/delivery/recovcry (LDR) (s) NIR ll'ot�:NIR-noraiuilcme:it NIR 12 NIR Yes No ,....,, =60 =•60 70--7S/21-24 NIR 72-78fn.-26 70---75/21-24 70-75/21-24 10 Yos No NIR NIR 6 NIR N/R NIR NIR =60 =60 70---75/21-24 70-75/21-24 FunctionofSpace Pлsiure Relationsbiplo AdjacentAreas TABLE7-1 Design Parameters Minim11m Outdooracb !Шnimum Totalacb (n) Coпidor N/R NIR All RoomAir Exhausted Diret:tly toOuldoon(j) AirRccirtula1cd byMeansor Room Unl1s (а) RН(k), N/R NIR NIR ¾ DesignTemperatur °F?C NIR SКILLEDNURSING FACILГГY NIR NIR 70-75/2)-24 NIR NIR Rcsidentgathering/activity/dining NIR NIR NIR NIR 70-75/21-24 Physicaltherapy Ncgati\'e NIR NIR N/R 70-75/21-24 Occupatioiшl therapy NIR NIR NIR NIR 70-75/21-24 Bathing r oom Negзtive 70-75/21-24 Resid<:ntroom NIR Ус, NIR NIR NIR NIR m,x60 72-78/22-26 15 NIR No m,x60 70-75/21-24 Yos No N/R NIR 68-73/20-23 10 RADJOLOGY (v) X-ray (diagnostic nnd trcatmcnt) NIR X-rny(surgery/critical care and catbet.eriиtion) Positivc Darkroom(g ) Ncgative 10 Bronchoscopy, sputum collcction, and e p ntamidineadministr.:1.tio n(n) Negзti\'C 12 Yos No NIR LaЬomtory, general (v) Negati\'e N/R No N/R LaЬorat ory, bacteriology (v) Ncgati\'C у" No NIR 7fr-75/21-24 LaЬoratory. Ьiochemistry(v) LaЬomtory, cyto\og y (v) Negativc Yos No N/R 70-75/21-24 7fr-75/21-24 DL\GNOSTIC AND ТRЕАТМЕNТ 7fr.75/21-24 Yos No NIR Lahoratory,glas:swashing Ncgati\'C 10 Y,s No NIR NIR LaЬoratory, histology (v) Negati\'C 6 Yos No N/R 70-75/21-24 LaЬoratory, microЬioJogy (v) Nc gative 6 Уо, No NIR 70-75/21-24 - 7Cr-7512l-24 Negali'\-e LaЬoratory, nuclear mtdic ine (v) Negativc у" No N/R LaЬoratory, pathology (v) Negati.,·e Уе, No N/R LaЬoratoiy, serol ogy (v) Negati\'C у" No NIR 70-75/21-24 LaЬomtory, steriliznig Ntgati\'C 10 Уе, No NIR 70-75/21-24 4 N/R No NIR 70-75/21-24 LaЬorntory, me diatransfer (v) Positivc Autopsyroom(n) Negativc Nonrefrigerated Ьody-bolding ro om (Ь) Negati\'e NIR PO$itivc 2 Pharmac:y(Ь) N�1�:Nlk•aor.,quin:met1t 70-75/21-24 12 у" No NIR 68-75/20-24 10 Уе, No N/R 70-75/21-24 NIR NIR NIR N/R TABLE7-1 FunctionofSpace Pnssure Relationsblp to Minimum AdjacentAreas Outdoorach Design Parameters J\tinimum Totalach All Room Air Exbausted Directiy toOu1doors(j) AirReci�ulated b}'Meansof Room Units (а) RН(k), % (n) DesignTtmpE'П1.tu1 °FrC Exanrinationroom N/R NIR N/R -60 70-75/21-24 Medkat:ionroom Positive 4 N/R N/R =60 70---75/21-24 Endoscopy Positive 15 N/R No 30-60 68-73/20-23 Endoscopecleaning Negative 1О Уе, No N/R NIR Treatmentroom N/R N/R N/R =60 70-75/21-24 Hydrotherapy Ncgative N/R N/R N/R 72-80/22-27 PhysicaJ lherapy Ncgative N/R N/R Мах65 72-80/21-27 SТERIUZING S1eri!izerequipmentroom Negative N/R 10 Yos No N/R N/R Soiled or da;ontшnination room N egativc Уе, No N/R 72-78/2.2-26 CJean v,orkroom Positive N/R No max60 72-78/22-26 Sterilesto.-age Positive N/R N/R =60 72-78122-26 NIR 72-78/22-26 CENТRAL MEDICAL AND SURGJCAL SUPPLY SERVICE Food preparationcenter (i) N/R 2 10 Warewashing Negative N/R 10 Diel3rysюmgc N/R N/R La.undry, general Negath•e Soiled linen sorting and storage Negative N/R Ocanlinenstoragc Positive N/R Linen a11d trash chute room N/R No у" Yos No No No No N/R N/R N/R 10 10 Yes N/R N/R N/R 72-78/22-26 NIR N/R N/R N/R N/R 72-78121-26 Negative NIR 10 у" No N/R Btdpanroom Ncgative N/R 10 Ves No N/R NIR в,ttmюm Negative NIR 10 Yos No NIR 72-78/22-26 Janitor'scloset Negative NIR 10 Yos No NIR NIR N/R SUPPORT SPACE Soiled workroom or soilcd holding Negative Clean 111orkroom or clean holding Positivc Hazardousmaterialstoragc Ncgativc м,1�,N/R•norequiremen1 1О 10 Yos No N/R N/R N/R N/R N/R NIR V,s No N/R NIR Тr,Ь!е 7-1 Noles: Recircu1aring room НУАС units (with hcating orcooling ooils) areacceptaЬle to acble..-e the requiredairchange rat.es. llecause ofthe c1eaning difficulty and the poteotial forЬuildup ofoonll tion, recirculatin g room units shall not Ьс uscd in arcas maiked "No." Lsol.ation and intcnsive care unit rooms тау Ье vcn1ilated Ьу rehcat iлduction units in which only thc primary air supp!ied eentral system passes through the rehea1 unit. Gravity•type hearing oreool.шg Wlits, 11uch a.s r:idiзtors or convectors, shall 001 Ьс used in operating rooms and other speciAI care аrеаэ. Ь. Pharmacy compounding areas may have addi tional air change 11nd filteПng requirement.� Ьeyond the minimum of1his tаЫе depending on the type of pharmacy, thercgulatory requirements ( nu.y include adoption ofUSP 797), the associatcd level ofrisk ofthe wodc (see USP 797), апd the r:quipment щilized in the spaccs. с. Тhс tcrm trauma room as used herein is а first aid room and/or emergency room used for general initial treatment of accideпt victims. Тhе opemtiпg room wi1hin the 1rauma centcr that i tinely used for emergcncy surgery is considered to Ье an operating mom Ьу this Standard. d. Prn.sun: relationships need not Ьt: maintained wben tl1e room is unoccupied. е. Some iso\ation rooms тау Ье provided with а scpaгa.te anteroom, but an antc rocm is not rcquired Ьу this standard. [ Protcctivc eпvironment rooms are lhosc used for high-risk imnшnocomprom.iscd patienlS. Such rooms are positivcly pressurized relative to all adjoining spaces to pr otcct the paticnt. g. Exceplion: А11 airneed not Ье exhaus1ed if darkroom cquipment has а scavcoging exhaust duct attaeЬed and meets ventilarion standards rcgarding NlOSH, ОSНА, and local cmployec cxposurc liл h. А nonrcfrigerntcd Ьody-holding room is applicahle only to facilities lhat do 001 pclform aut ops ics on-site aod usc the space for short pcriods 1,1•hi\e waiting for thc: Ьоdу to Ье transra-red. i. Minimum t otэl air cbanges pcrhour (асЬ) shaП Ье that required 10 provide proper makeup air to kitchcn exhaust systemsas specificd in ANSIIASНRAE Standard 154.4 In some cases, exces1 trution or infillnltion to or ftom �it oorridors compromises the exit oorridor restrictions ofNFPA 90А,5 the pressure requircments ofNl'PA 96,6 or thc maximwn defincd in the tаЫе. DW"Щi ation , а reduction 10 the nшnЬer ofair changes 10 апу extent required for odorcontrol shall Ье pcrmitto:d when tЬс space is not in use. (See А1А (2006} in Infoпnativc: � В: BiЫiogmphy. j. ln somc areas with potential contamination aшi/orodorproЬlems, exhaust airshall Ье discharged directly to the outdoors and oot recin:ulated to otlюr areas. lndividual circшnstances may requU cial oonsideration for airexЬausted to the outdoors, for example, intensive care units in which patients with pulmonary infection are treatcd and rooms for Ьum patients. То satisfy exhaust need' stant rqil.acement air from the outdoors is nc:cessary when thc systcm is in opcratioo. k. Thc RН ranges listed 11re the minimurn алd maximurn limits where control is spe(:ifieally needed. L Systems shall Ье еараЫе ofmaintaining tЬе rooms within the range dшing normal operэ.tion. Lower or higher tempernrure shall Ье pennitted whcn patients' comfon andlor medical cond.itions r thoscconditions. m. National lnstitu1e for Occupational Safety мd Health (NIOSH) criteria docшnents regarding occupational exposure to wastc anesthcric gases wtd VIJPOr s, and control of occupa1ional схро.! nitrous oxide 7 indieate а need for Ьoth loc:al exhaust (sca,·mgiпg) sys1ems and genernl vcntilation ofthc areas in which the respective gases are utilized. Refer to NFPA 99 for 01her requircmetJ Ifmonitoring de\'ice alanns arc installcd, alJowances shall Ье made 10 prevent nuisance alarms. Short 1crm excursions from requircd pressure relation.ships shall Ье allowed while doors aR то, temporarily opcn. Simple visual mcthods such as smoke tmil , ЬalJ.in-tuЬe, or Лutterstrip shall Ьe permitted for verificotion of airflow dircction. Recirculating deviccs with ПЕРА filtcrs shall ( m.itted in r.xisting facilities as intcrim, supplemental environmental controls to meel requirements for the eontrol of airЬome infectioos agents. Тhе design of cither portaЫe or fixcd syslems : prevent stagnat i on and shon circuiting ofairflow. The design ofsuch systcms shall also allow foreasy acccss for schedu1cd pm-entative maintenanc e and clcaning. о. Surgeons or surgical proccdures may requirt: room temperatum, \'Ctllilation rates, humidity rangcs, and/or airdistnЪution mcthods t:hat excccd tЬе minimurn indicated ranges. р. Treatment room� usc:d for bronchoscopy shall Ье treated as broocltoscopy rooms. Treatment rooms used forprocedures with nitrous oxide shal1 contain pravisions for exhausting anesthctic waste q. Jn а recirculating ventilation system, НЕРА fillers sh.all Ье peпnined instead of ahausting thc air fr om these spaces to the outdoors providcd the retum air passes through the НЕРА filters Ьеfс introduced iпto апу other spaccs. This rcquiremcnt applics only to waiting rooms prograrnrned to hold pat.ients awaiting chest x-rays for diagnosis of �piratory disease. r. Sce NFPA 99 for further requirements.8 s. For patient rooms. laЬor/delivery/rccovery moms, and laЬor/delivery/recoverylposфartum rooms, fourto!al. ach shall Ье perm.i11ed wЬen supplemeotal heating and/or eooling systems {radiant h and coo1ing, ЬaseЬoard heatiпg, etc.) ш used. t. The prote<:ti,-e environmc:nt airfl.ow design spccifieations protect the patient from eommon errviroпmental airЬome infectious microЬes (i.e., Aspergillus spores). Re,cin:ulatioo НЕРА бlters s1 pe1П1itted to increasc the r:quival�t room air exchanges; however. the outdoor air chШliCS are stilJ required. Constant volume ainlow is required for consistent vcnti1arion for theprotected с� ment. Uthe design criteria indicate that А11 is nc:cessary for protectivc eпviromnent patients, an anteroom should Ье providcd. Rooшs with reversi.Ыe airtlow provisions forthe pwpose of swi betwceл protccti,·e environment and AII functions shall no1 Ье pennit1cd. u. 1Ъс AJI roorn descriЬed in this standard shall Ье used for isolatiлg: the airЬome spread ofinfectious diseases, such as meas�s. varicella, ortuЬerculosis. The design Qf AII roomssha11 inc1ude tJ: vision fornormal pat.icotcarc during periods not requiring iso1ation precautions. Supplcmental recirculatin g devkx:s using НЕРА fillers shall Ье peпnittcd in tЬс patien1 room to increase 1he equi room airexcЬanges; ho..,,'cver, the outdoor air chaлges are still required. All rooms t hat arc retrofitted from standard palient rooms from which i1 is impracUea.l. ю exhaust directly outside may Ьс culated with air fi-om the АП room, provided that lhe air fust: pмses through а НЕРА filter. НЕРА Бltered exhaust air from А11 rooms may mix with exhaust air that sen'l.'S non-AП spaces р Ьeing discharged directly outdoors. Rooms with rcversiЫe airflow provisions forthe pwpose ofswitching Ьc:tween pro1cctive environment and AII functions shall not he pemi.ittcd Sec thc gui< in Infoпnativc Anncx 8; BiЫ i ography for more infoпnation. v. When required, appropriate hoods aod exhaust devices forthe removэl ofnox.ious gases ог chcmical ,,apors shall Ье providc d in accordanee with NFPA 99.8 а. с. d с. Air distribution partems witl1in the protective environment room shall conform to the followi11g: Supply air diffusers sha11 Ье аЬоvе the patient bed, unless it can Ье demonstrated that such а locatioo is not practical. Diffuser design sl1all liшit air velocity at the patient Ьеd to reduce patient discoшfurt. (See ANSIIASHRAE Standard 55-2004, Тhermal Envi­ ronmental Conditions for /Juman Осс11рапсу, in Infonnative Annex В: BiЫiogrnphy.) Retumlexh:шst grilles or registers shall Ьс located near the patient room door. Differential pressure between any dissimilar adjacent spaces shall Ье а minimum of+o.01 in. wc (+2.5 Ра). РЕ rooms retrofitted from standard patient rooms may Ье ventilated with recirculated air, provided that air first ршеs through а НЕРА filter and the room complics with pans "а" through "d" ofthis section. 7.3 Critical Care Units 7.З.1 \Vound Jntensive Care Units (Вurn Unils). Bum unit patient roo1ns that require humidifiers to comply with ТаЫе 7-1 shall Ье provided with individual humidity co11u-ol. 7.4 Surgery Rooms 7.4.1 Class В яnd С Opcrяting Rooms. Opcrating rooms shal\ Ье maintained at а positive pressure with respect to all adjoining spaces at all times. А pressure differential shall Ье maintained at а value ofat leas1 +О.О! in. wc (2.5 Ра). Oper­ ating roorns shall Ьс provided witl1 pri111ary supply diffusers that are designed as follows: а. Ь. Тhе airflow shall Ье unidirection.al, downwards, arкl the average ve/ocity ofthe diffusers shall Ье 25 to 35 cfin/ft2 (127 Us/m2 to 178 Us/m2). Thediffuserssha11 beconcen­ trated to provide an airЛow pattem over the patient and surgical team. (see Memarzadeh [2002] and Memarzadeh (2004] in Infonnative Annex В: BiЬ!iography.) Тhе area ofthe primary supply diffuser nrтay shall extend а minimum of 12 in. (305 mm) Ьeyond the footprint of the surgical tаЫе on each side. No пюrе than 30% of the primary supply diffuser array area shall Ье used for non• diffuser uses such as lights, gas columns, etc. Additiona1 supply diffusers mo.y Ье required to provide o.dditional ventilation to the opemting room to achicvc thc environ• mental requirements оfТаЫе 7-1 relating to tcmperature, humidity,ctc. Тhе room shall Ье providcd with at least two low sidewall retum or exhaust grilles spaced at opposite comcrs or as far ара11 as possiЫe, witl1 the Ьонош of these grilles installed approximately 8 in. (203 mm) аЬоvс thc floor. 7.4.2 Stcrili:t.ation Rooms. Steam that escapes from а steam sterilizer shall Ье exhaus1ed using an cxhaust hood or otltcr suitaЬ\c mea11s. Etl1yleш: oxide that escapes from а gas stcrilizcr shall Ьс cxltausted using an exhaust hood or other suitaЫe mcans. 7.4.3 lmaglng Procedure Rooms. Ifinvasive procedures occur in this type of room, vcntilation sha\l Ье provided in accordance wi1h the ventilation requirements for CJass А sur­ gery. lf anes1l1etic guses arc adminis1cred, ventilation shall Ье provided i11 accorda11ce wilh tl1c vc11tilatio11 requireшents for Class В or С surgery. 7.5 Support Spaces 7.S.J Morguc aod Autopsy Roon1s. Low sidcwall cx.haust griJles shall Ье providcd unlcss cxhaus1 air is rcmovcd through rш autopsy 111Ыcdcsigncd for this purpose. Лll ex.haust air fтom autopsy, nonrefrigerated Ьody-holding, and morgue rooms shall Ье discharged directly to the outdoors without mixing with air front any other room or exhaust system. 8. PLANNING, CONSTRUCTION, AND SYSTEM STARТIJP 8.1 Ovcrview. For HVAC s�tems scrvi11g surgery a11d crit­ ical care spaces, compliance with this standnrd requires prcp­ aration of an acccptnnce testing plnn. 8.2 Plannlng for t.he НVАС Servlces ln а New Facility, Design docшnents for new ccnstruction shall mcct thc follow­ ing requirements: а. General Mechanical Equipment Rooms. The access to mcchanical rooms shall Ье planned to avoid thc intrusion of main1enance personnel into surgical and critica1 care paticnt spaces. Ь. Mer.:hunica/ Rоот Ulyout. Mechanical room 1ayout shall include sufficient space for access to equipment for operation, maintcnance, and replacement. Floors in mechnnical rooms shnll Ье sealed, including se.:i1ing around all penetrations, when they are above surgicnl suites andcritica1 care. с. Maintenance/Repair Persom1e/ Access. Safe апd practical means of accessing equipment shall Ье providcd. Clear­ ancc is required at all scrvice points 10 mechnnical equip• ment to allow pcrsonnel access and working spacc. The acccss to mechзnical equipment shaU Ье plaiшed to шаkе it urmecessary for main1cnnnce personnel to intrude into sшgical or critical саге rooms. d. Cooling Towers. Cooling towcrs shall Ье locnted so that drift is directed nv;•ay ftom air-handling unit intakes. They shall meet the requirentcnts ofSection 6.3.2. 8.3 Planning Jor the НVЛС Scrvices in вn Existing Facility. lf any exis1ing air-handling equipment is rcused, the designer shal1 evalua1e the capacity of thc eqпipment to deteпninc whether it wi1! meet the requirements of this standard for the rcmodeled space. 8.4 Planning for lnfcction Control During Remodcling of an Existlng FacJlily. Prior to beginning modifications or remode!ingofHVAC systcms in an exis1i11g facility, an owner shall conduct an infection control risk assessment (JCRA). Тhс TCRA shall estaЫish those procedures rcquired to mini­ ntizc the disruption offacility operation and the distriЬution of dust, odors and paniculates. К.5 Documentation of New or Remodeled HVAC Sys. tems. Owncrs shall rctain an acceptance testi.ng rcport for their filcs. In addition, thc design shalt includc requircmcnts for opcr.itions al\d inainrcnance stafftraining that is sufficicnt for l.l1t: staff 10 keep .tll НVЛС equip1ne11t i11 а co11ditio11 tlшt will maintaiп the original dcsign intent for vc11tila1ion. Tmit1iog of opcrating staff sha11 includc an explanation of the dcsign intcnt. Thc training nшtcrials shall includc, 111 а minimum, the fo!lowing: а. О&М proccdures Ь. Tcmperaturc and prcssure control opcration in all modcs с. ЛсссрtаЫс tolcraпces for systcm tcniperaturcs and prcssures d Proccdures for opcrations under emcrgcлcy power or othcr aЬnoпnnl conditionз thnt have bccn considcrcd in thefucilitydesign. 8.6 Duct Cleanliness. The duct suppty systcm shall mcet the following requircmcnts for cleanlincss: а. Ь. с. Тhс duct systcm shall Ье Пее of construction deЬris. Ncw supply duct systcm insta\lations shall comply with lcvcl "В," the lnteпnediate Level of SМACNA Duct CleanJi. ness for New Constrnctio11 Guidelines.9 The!.'Upply diffusers in the Class В & С opcrating rooms shall Ье opcncd and cleancd bcfore the space i.s uscd. The pemianc11t HVAC systcms shall 1101 Ье opcmtcd unless protection from contamination of thc air distriЬu­ tion systeш is pruvidcd. 9. NORMATIVE REFERENCES 1 Code of Federal Rcgulations: 21CFR 173.310 (Лpril 1999), US Dcpt. of Hca1th and Ht1man Services, Food a11d Drug Administrntion. 2DННS (NIOSH) PuЬlication No. 94·100 (NIOSH Лlcrt) Co,itra/ling Exposures to Nitroщ Oxide During A,ies­ thetic Administrafion, National lnstitute for Occupa­ tio11al Safety and Hca1th (СОС), Atlanta, GA. 3 оsнл [1994]. Computcrized information system. Wash• ington, DC: U.S. Dcpartment of Labor, Occupational Safcty and Hcal1h Лdministrotio11. 4ANSUЛSНRAE Standard 154•2003 Ventilation for Com­ mercial Cooking Operations, American Socicty of Heat• ing, Refrigerating and Air•Conditioning Engineers, ЛtJanta,GA. SNFPA 90Л. Nз.tionз.l Firc Protcction Лssociation I Bз.ttcry• march Park, Quincy, МА 02169. 6NFPA 96. №tional Fire !Jrotcction Association 1 Battery­ march Park, Quincy, МЛ 02169. 7NIOSH Critical Docuшcnts. National Institutc for Occupa• tional Safcty a11d Hc11lth, avnilnЫe at tho Ccnters for Diseasc Contтol and Prcvcntion (СОС) wcb sitc: http:// www.cdc.gov/niosh/p11bs/ critcria_date_descJ1opubnumbers.html 8NFPA 99·2005: S/andard for Health Саге Facilities. National Firc Protcction Association I Btittcrymarch Park, Quincy, Massachusetts USA 02169 9SMЛCNA Duct Cleanline.r.Y for New Construction Guide• lines, (2000), Chantilly, VA 20151. (This 11111еж ts not part of this standard. Н ls mercly lnformative and does not contnln rcquircments nccessar)' for conformance to the standard. lt has not been proccssed according to the ANSI rcqui�ments for 11 standard and may contain material that has not been subjcct to puЫic review or а consensus process. Unresolved objectors оп informative malerlal art not orfercd tbe rlght to арреа\ at ASHRAE or ANSI.) INFORMATIVE ANNEX А А1. О&М IN HEALTH CARE FACШTIES Thc following opcrations and maintcnaлce procedures arc recommcndcd for health caro facilities. Al.l Operating Rooms. Each opcrating room should Ьс tcstcd for positivc prcssure scmi-annually ог on an cffcctive preventativc maintenancc schcdule. Whcn НЕРЛ filtcrs arc present within the diffuscr of operating rooшs, lhc filtcr should Ье replaccd based 011 prcssure drop. А1.2 Protcctive Envlronme11t (РЕ) Rooms. РЕ rooms should remain under positive pressure with rospcct to а11 adjoining rooms whenever an immunocompromised paticnt is prcscnt. РЕ rooms should Ье tcstcd for JIOSitive pressure daily wl1en an i mmuпocompromised patit:nt is proscnt. \Vl1cn НЕРЛ filters arc present within thc diffuser ofprotcctivc cnvi­ ron.mcnt rooms, the filter should Ье replaced base,I оп prcs• suredrop. А1.3 Alrborш: lnfectlon lsolation (All) Rooms. AII rooms should rcmain under ncgativc prcssure relativc to all adjoining rooms whcncvcr an infcctious patient is present. Thcyshould Ьс tcstcd for negativc prcssure daily whcncvcr an i11fectious patient is present. At.4 Filters. Final filters and filter frmnes should Ье visu• ally inspcctcd for pressure drop and for bypass monthly. Fil­ tcrs should Ье replaccd based on prcssure drop with filters that providc thc cfficiencics spccified in ТаЫс 6-1. А2. SPECIAL MAINTENANCE FOR HVAC UNITS Thc fo1Jowi11g special maintcnance proccdurcs arc rccommendcd fo, health curc focilities. А2.1 Fan..Coil Unit and Heat Pumps. The fan-coil unit and hcal pump filters serving patient rooms should Ье inspectcd montlily or оп 'an effcctivc prcventative шainte· nancc cycle for prcssurc drop and rcplaced whcn thntpressurc drop causes а rcduction in air flow. Fan-coil W1it an d heat pump drain pans undcr cooliлg coils sbould Ье cleaned monthly, or on an cffectivc prcvcntutive mainteщшcc cyclc. А2.2 Fin•Тube Radiation Units, lnduction Units and Conveetlon Units. Fi11•tube radiation u11its, induction units and convectio11 units serving patient rooms should Ьс clcancd quarterly, or 011 an cffectivc prcvcntative maintcnancc cyclc. А2.З Fa11-Powered Terшiпal Units. Fan•powt:rcd tcrmi• nal unit filtcrs scrving patic11t rooms should Ье inspcctcd monthly or on an effective preventative maintcnancc cycle for pressurc drop and replaccd when the prcssurc drop causcs а reducrion in air flow. (Тhls anncx is not part of this standard. lt is rncrcly Inforrnatlve and docs not coпtain rcqulrements ncccssary for oonformance to the standard. It has not Ьесn prnccssed accпrding to the ANSI req11ircments for а standard and may contatn material l.hat has not Ьееn subject to puЬlic review or а conscnsus process. UnresolYed objectors on informative material are not offercd the right to appeal at ASHRAE ог ANSI.) INFORMATIVE ANNEX В BIBLIOGRAPHY ACS, 2000. Guidelines for Optima/ АтЬи/аtо,у Surgical Саге and Office-based Sr1rgery. 3rd ed. American Col­ lcge of Surgcons, Chicago, IL 60611 AIA, 2006. The Amcrican Institute of Architects and The Facilitics Guidelines Institutc. Guidelines for Design and Constructio,1 о/ Ho.}pital and Нea/th Саге Facili­ ties. American lnstitutc of Лrchitccts Press, Washing­ ton, DC2006. ASНRAE, 1999. Method o/Testing General Ventilation Air­ Cleaning Devices for Remoi'йl Efficiency Ьу Particle Size. ANSI/ASHRAE Standard 52.2-1999. ASHRAE, 2003. 2003 ASHRAE HandЬook-Applications, Chaptcr 7, Health Carc Facilitics. Aшcrica.11 Society of Heating, Rcfrigcrating, and Лir-Conditioning Engi­ neers, lnc., Atlanta GЛ. ASНRAE, 2003. HVAC Design Man11al for llospitals and /Jealth Care Facilities, American Socicty of Hcating, Rcfrigcrating, and Air-Conditioning Enginccrs, Inc., Лtlanta GЛ. ASHRAE, 2004. Thermal Environmental Conditions for lfuman Оссирапсу, ANSI/ASHRAE Standard 55-2004. ЛSНRЛЕ, 2005. 2005 A.SHRAE f/andfюok-Fundamcntafs, Chapter 35, Duct Design. American Society ofHeating, Rcfrigcrnting, and Air-Conditioning Engineers, Inc., ЛtlantaGA. ASHRAE, 2007. Ventilation for АссерtаЫе lndoor Air Qua/ity, ANSI/ЛSНRЛE Standard 62.1-2007. Amcri­ can Socicty of Hcating, Rcfrigerating, and Air­ Conditioning Engineers; Jnc. Atlanta, GA. CAN/CSA-Z317.2-01 Spccia1 Rcquircments for Hcating, Ventilation, and Лir Conditioning Systems in Hcalth Care Facilitics ScptcmЬcr 2001. CDC, 2005. Guidelines for Prevenring tl1e Transmission о/ MycoЬacterium шЬercufosls in Heцfth-Care 1-Ucilille.J. Federa/ Register, 2005. Cc11ters for Discasc Co11trol and Prcvcntion, Лtlanta, ОЛ. CDC, 2003. Guidellnes for Environmental infectlon сопtю/ in heaft/1-care facilities. MurЬidity a11d Mortality Wcckly Report (ММWR), Junc 6, 2003. Ccntcrs for Disease Control and Prevcntion, Лtlnnta, GA. Cbarlcs S. Hayden 11, О.Е. Jobnston, RТ. Hughes, and Р.А. Jcnscn, 1998. Air Volume Migration /гот Negative Prгs­ sure Jso/ation Rooms During Entry/Exit. Applicd Occu­ pational and Environmental Hygicne, 13(7): 518-527; 1998. Coogan, JJ, 1996. Effects ofS11rrounding Spaces оп Rooms Pressurizcd Ьу Dijfcrentiol Plow Control. ASHRAE Trnnsactions 1996, V 102, Pt 1. Hcrmans, RD. 2000. f/ealth Care Pacility Design Manual­ Room Design. ЛSНRЛЕ Transactions Vo\. 106, Pt. 2 Lewis, J.R, 1987. Opcroting room airdistribution effective­ ness. ЛSНRЛЕ Transactions 93(2):1191-1198. Memarzadeh F and Manning Л, 2002. "Comparison о/ oper­ ating room ventilalion systemJ in the protection о/ the surgical sile.", ASНRAE Tran:;:actions, V.108, Pt. 2, 2002. Mcmarzadch F and Jiang Z. 2004. "Effects о/ Operating Room Geomelry and Venti/otion System Parameter Vuri­ otions 011 the Protection ofthe Surgical Site", IЛQ 2004: Criticnl Opcrntions: Supporting the Hcaling Environ­ ment through IЛQ Pcrfoлnance Standards. Ninomura, Р. and Judc11c BanJey, 2001. New Venti/ution Guide/ines for Healt/1-Care Fucilities, ЛSHRAE Jour­ nal, Junc 2001, Лtlnnta, GA NFPA, 2005. Sta11durdfor Heu/th Cure Facilitie�-. NFPA-992005. №tionnl Firc Protection Лssociation I Dattcry­ march Park, Quincy, Mn.чsnchusctts USЛ 02169 SМACNA, Duct Cleanline.}'S for New Com1truction Guide­ /ines. USP-797, GuidcЬook to Pharmaceutical Compounding­ Stcrilc Prcparations, US Plшnпacopcial Convention. 29 CFR Pat11910.1047, Occupational Exposurc to Ethylene Oxide.