HVAC IN HOSPITALS (OT)

SUBMITTED BY – ANMOL BHATIA, 3A

INTRODUCTION
The primary task of the ventilation system in an operating room is to -

Acceptable Indoor To Remove Odour & Reduce the Risk of

Climate Released Anaesthetic Infection in the
For Patients gases Operating Area

The greatest amount of Bacteria found in Operating rooms comes from the Surgical team and is the result of
their activity during Surgery.

THEREFORE,
✓ Heating, Ventilating and Air-Conditioning (HVAC) installations in hospital ORs play a determinant role on the
indoor environmental quality (IEQ).
✓ The priority is to control the indoor air quality (i.e. protects from airborne hazards or chemical agents like
anaesthetic gases ) and maintain indoor comfort conditions (i.e. temperature, humidity, ventilation and airflow).
✓ The air in an OR must be aseptic, at a reasonably constant temperature and humidity and have low velocity in
order to avoid drafts and swirls that promote the recirculation of microbes.
✓ The total heat production caused by the staff, operation room lighting and equipment may be about 2 KW or
1750 kcal per hour.
✓ That’s why we need good HVAC setup in OT rooms to tackle the heat and providing comfortable environment.
✓ The HVAC system comprises of the following components –
1. Compressor 2. Condenser 3. Evaporator 4. Pumps & Cooling Towers 5. AHU 6. Air Distribution systems
SPACE LAYOUT
✓ Usually the No. of OT’s are 2.5% of the Total beds in that Hospital.
✓ The sizes of OT varies from 25 m2 to 75 m2 depending upon the use of medical equipments.

TYPICAL SPACE LAYOUT OF OT FACILITIES

AIR CONDITIONING IN OT
✓ For fulfilling the air conditioning requirements for Operation Theatre the following guidelines have been finalized.
✓ For this purpose OT’s have been divided into 2 groups-
o Super specialty OT: Super specialty OT means operation theatres for Neurosciences, Orthopaedics (Joint
Replacement), Cardiothoracic and Transplant Surgery (Renal, Liver etc).
o General OT: This includes operation theatres for Ophthalmology, District hospital OTs, FRU OT and all other
basic surgical disciplines.
✓ The following basic assumptions have been kept in view:
o Occupancy: Standard occupancy of 5-8 persons at
any given point of time inside the OT is considered.
o Equipment Load: Standard equipment load of 5-7
kW considered per OT
o Ambient temperature & humidity at each location
to be considered while designing the system.

REQUIREMENTS -:
1. Air Changes Per Hour:
✓ Minimum total air changes should be 25 based on
international guidelines although the same will vary
with biological load and the location.
✓ The fresh air component of the air change is required
to be minimum 4 air changes (i.e. 16%) out of total
minimum 25 air changes. 20 for general OT .
✓ If HCO chooses to have 100% fresh air system than
appropriate energy saving devices like heat recovery
wheel, run around pipes etc should be installed.
-In this equation:
Q is the volume flow rate of air being calculated, and ACH is the
number of air changes per hour .
✓ For a average room size of 50 m2 / 5400 cubic
ft., the volume flow rate of air will be-
FACT -
o Just one air-change with fresh air can remove 63% of
suspended particles from the room air.
Q = (25) X (5400) = 2250 cu. Ft / min. o If a ventilation system can perform 10 air changes per hour
60 (ACH), it takes 14 minutes to remove 90% of airborne
contaminants in a room and 28 minutes to remove 99%.
2. Air Velocity:
✓ The vertical down flow of air coming out of the
diffusers should be able to carry bacteria carrying
particle load away from the operating table.
✓ The airflow needs to be unidirectional and downwards
on the OT table.
✓ The air velocity recommended as per the international
and national guidelines is 90120 FPM at the Grille/
Diffuser level.

FEW GOOD AND BAD VENTILATION EXAMPLES INSIDE OT

3. Positive Pressure:
✓ There is a requirement to maintain
positive pressure differential
between OT and adjoining areas to
prevent outside air entry into OT.
✓ The minimum positive pressure
recommended is 15 Pascal (0.05
inches of water) as per ISO 14644
Clean Room Standard.
4. Air handling in the OT including air Quality:
✓ Air is supplied through Terminal HEPA filters in the ceiling.
✓ The minimum size of the filtration area should be 8’ x 6’ to cover the entire OT table and surgical team.
✓ The minimum supply air volume to the OT (in CFM) should be compliant with the desired minimum air change.
✓ Air quality at the supply i.e. at grille level should be Class 100/ ISO Class 5 (at rest condition).
Note: Class 100 means a cubic foot of air should not have more than 100 particles measuring more than 0.5 microns
or larger.

Typical AHU used in OT’s

5. Air Filtration:
✓ The AHU must be an air purification unit and air filtration unit.
✓ There must be two sets of washable flange type pre filters of capacity 10 microns and 5 microns with aluminium/
SS 304 frame within the AHU.
✓ The necessary service panels to be provided for servicing the filters, motors & blowers.
✓ HEPA filters of efficiency 99.97% down to 0.3 microns or higher efficiency are to be provided in the OT and not in
the AHU.
6. Temp & RH for Super-specialty OT:
✓ It should be maintained 21 C +/- 3 C (except for Ortho for Joints replacement as 18 C +0 & -2 C) with corresponding
relative humidity between 40% to 60% though the ideal RH is considered to be 55%.
✓ Appropriate devices to monitor and display these conditions inside the OT may be installed.
 DESIGN CONSIDERATIONS FOR PLANNING NEW OPERATION THEATRES.
✓ The AHU of each OT should be dedicated one and should not be linked to air conditioning of any other area for all
OT constructed.
✓ During the non functional hours AHU blower will be operational round the clock (may be without temperature
control).
o Variable frequency devices (VFD) may be used to conserve energy.
✓ Window & split A/c should not be used in any type of OT because they are pure re circulating units and have
convenient pockets for microbial growth which cannot be sealed.
✓ The flooring, walls and ceiling should be non porous, smooth, seamless without corners (coving) and should be
easily cleanable repeatedly.
o The material should be chosen accordingly. Hermetic sealing of the doors is recommended.
✓ Validation of system to be done as per ISO 14664 standards and should include:
o Temperature and Humidity check
o Air particulate count
o Air Change Rate Calculation
o Air velocity at outlet of terminal filtration unit /filters
o Pressure Differential levels of the OT w.r.t ambient / adjoining areas
o Validation of HEPA Filters by appropriate tests like DOP etc; repeat after 6month in case HEPA found healthy.
MAINTENANCE OF THE SYSTEM:
✓ It is recommended that periodic preventive maintenance be carried out in terms of cleaning of pre filters at the
interval of 15 days.
✓ Preventive maintenance of all the parts is carried out as per manufacturer recommendations.
NOTE :
❑ Each AHU should serve one or two surgical suites and some secondary use spaces.
❑ The installations must also have the proper number of backup AHUs.
❑ A 24-hour use of the AHU throughout the year is necessary in order to ensure proper indoor conditions.
❑ To cut down on operating costs, implement an energy conservation strategy (i.e. energy recovery) and control
the operation of the system during the off-service periods of the OR at 30% of full load conditions.
 PROBLEM
Indoor air temperature high in
summer and low in winter
Low air exchange rates
AHU does not operate at night.
Indoor conditions can not be
controlled by surgical team
Missing HVAC installation in
secondary use OR spaces
Indoor air circulation problems
Ductwork in poor condition
High noise inside the surgical
suite
CAUSE ACTION
Fouling of cooling heating coils, Check coils, Check controls ,
malfunction of controls, undersized resize AHU
AHU.
Blocked diffusers, fan size, high pressure Check diffusers, fan ,check
drop, AHU not in operation filters). AHU must always be in
operation.
AHU is turned of for cutting down Operate AHU at 30% full load
operation cost conditions, use energy recovery
systems
Missing controls ,not easily accessible, Check installation, replace
not properly functioning controls and sensors and install new controls
improper installation.
Bad design because of financial Install new equipment, do not
limitations expand existing one unless the
system is properly resized.
Not properly sized or located supply and Check diffusers, remove
exhaust outlets, blocked. obstacles, adjust blades, clean.
Adjust fan.
Poor maintenance, cleaning. Difficult to Secure easy access, organize
access and implement a regular
cleaning schedule.
Mechanical system malfunction, high air Check installation, use sound
speed, vibrations transferred through attenuator. Relocate general
the ductwork. use, noisy, auxiliary spaces
 Different
perforated plate
arrangement for
air supply

Representative control systems

 BIBLIOGRAPHY

✓ http://arogyakeralam.gov.in/docs/quality
/NABH_Air_Conditioning_OT_07022014.
pdf
✓ https://www.slideshare.net/heenakousar
102/air-condition-requirement-in-
hospitals
✓ HVAC design for healthcare facilities
www.CEDengineering.com
✓ Environmental Control Including
Ventilation In Hospitals (Vipin Kaushal,
P.S. Saini, A.K. Gupta).
✓ Research Paper :
Master Planning of HVAC Installations in
Hospital Operating Rooms.
✓ Google Images .