MsaUhno Min utes. Concurrent Meeting with the Healthcare Guidelines Revision Committee (HGRC) St. Louis, MO 4/20/09

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1 0 E p MsaUhno Min utes Concurrent Meeting with the Healthcare Guidelines Revision Committee (HGRC) St. Louis, MO 4/20/09 1. Meeting opened. The meeting was chaired by Vice-Chair Sheerin. See attached sign-in sheet. 2. Voting members present: Sheerin, Rousseau, Bartley, Erickson, Gregory (part time), Hermans (part time), Keen, Kloostra, Langowski, Mamayek, Memarzadeh, Seth, Streifel, Woolsey. 3. Voting members absent : inomura, Cohen. 4. Chicago meeting minutes. Acceptance moved by Keen, seconded by Kloostra. Motion passed Discussion of low humidity issues. Streifel - research has been done, regional guidance is required. Erickson - no clinical advantage to humidity >20% has been shown. Bartley - local humidification at the patient is better than whole room humidification. Discussion of potential research done by IH. Memarzadeh expressed interest. Erickson, Memarzadeh, Hermans to discuss fiirther. ash asked if humidity was being treated independently of temperature. Erickson indicated, yes, for now. Mamayek indicated Standard 62 has no lower limit on relative humidity. Standard 55 needs to be checked. Agreed the research needs to be focused on the low end limit. 6. Integration of 170 into the Guid elines. Erickson indicated FGI and ASI3REIE have agreed to incorporate 170 in total within the Guidelines book, as a new Part. othing will be removed from the Guidelines that is not addressed in 170. Discussion about how to include 170 addenda in the Guidelines. 7. Addendum b. Langowski presented a proposed addendum (see attached). Striefel - HEPA filters for PE rooms at the air handling unit is a problem due to potential contamination of ductwork. Seth- in addition to wind-driven rain penetration at outside air intakes, we need to think about snow and sand. Streifel - rigid filter blank-offs should be water-resistant and non-flammable. Motion to accept proposed Addendum b by Rousseau, Gregory second. Motion passed Isolation room design. Memarzadeh reported that IH has done some significant research into this topic. Production, transmission, and insulation have

2 been addressed, in addition to coughing and walking. Hopefiilly, by June, this information will be available for public distribution. 9. Displacement ventilation (DV). Memarzadeh reported that the Kaiser Permanente group studying this topic had made great progress. Based on what he has seen of their research, he feels there is promise, but additional work is required. Specifically, in the dynamic state - effect of personnel movement and solar gain through windows. Rousseau advised that the HGRC has two current proposals regarding DV - one is an appendix note that mentions DV as a possible system type, the other is text material that allows a reduction in the space volume for air change rate calculations when DV is used. Both of these will be voted on later this week. Rousseau also mentioned that there is nothing currently in the Guidelines that precludes DV, but that 170 does preclude DV due to the allowable diffuser types. Hermans indicated this was intentional, and that all the allowable diffusers were based on a mixing approach to air distribution. Farhad pointed out that Ventilation Effectiveness does not apply to DV systems. 10. Laboratory ventilation. Discussed AEI's letter to Memarzadeh regarding clinical lab ventilation. Erickson moved, and Bartley seconded, a motion to change the "o" in the Air Recirculated by Means of Room Units column for the 12 laboratory types in Table 7-l, to "/R" and add this item to Addendum b. Motion passed A task group consisting of Hermans, Seth, Woolsey, and Streifel was appointed to research history and past problems with these types of systems and report back prior to the June meeting in Louisville. 11. Standard 62. Hermans reported that SSPC 62 voted in Chicago to remove the remaining healthcare occupancies from their ventilation table and defer to OR temperature control. Rousseau moved, and Gregory seconded, that the following sentence be appended to the end of Section 7.4: "Each operating room shall have individual temperature control", and included in Addendum b. Motion passed This is currently a requirement in the Guidelines. 13. Unitary filters. Rousseau moved, and Hei7nans seconded, that an exception be added to the end of Section 6.4, as follows: "Exception: Where recirculating room units are allowed by Table 7-1 they shall be equipped with minimum MERV 7 filters located upstream of the recirculating room unit's heating and/or cooling coils.", and included in Addendum b. Motion passed Morgue and Autopsy. Hermans moved, and Rousseau seconded, that the differential pressure previously approved (see Item 7 above) for these spaces only be required when a body was present. Speaking against the motion, Memarzadeh advised that even though a body had been removed, the aerosols produced would still be present. It was also pointed out that there was not a big energy cost savings here. The motion was defeated Critical and wound intensive care. Bartley moved, and Langowski seconded, to change the pressure relationship for these two spaces from positive to no requirement (/R) and include this in Addendum b. Motion passed SP 91. Hen-nans reported that the HVAC Design Manual for Hospitals and Clinics would be updated. SP 91 is being re-formed.

3 17. Endoscopy air change rates. Discussed the required 15 total air changes vs. 6. Hermans pointed out that the 15 air changes was based on a recommendation from Dr. Milton Goldman, a urologist. Sheerin moved (for Lautz), and Mamayek seconded, that the total air changes be changed from 15 to 6, that the name of the space be changed to Gastrointestinal Endoscopy Procedure Room, and that this change be included in Addendum b. Motion passed Voting details. See attached for specific vote counts on each item. 19. Meeting adjouned. 20. ext meeting. June 21, 2009, ASHRAE Annual Meeting, Louisville, K. CPR 5/12/09 3

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6 BSR/ASHRAE /ASHE Add e ndum b to ASI IASHRAE /ASH E Stand ard P u blic Review Draft ASHRAE ^"' S tandard Proposed Addendum b to Standard , Ventilation of Health Care Facilities First Public Review (Month 2009) (Draft Shows Proposed Changes to Current Standard) This draft has been recommended for public review by the responsible project committee. To submit a comment on this proposed addendum, go to the ASHRAE website at and access the online comment database. The draft is subject to modification until it is approved for publication by the Board of Directors and ASI. Until this time, the current edition of the standard (as modified by any published addenda on the ASHRAE web site) remains in effect. The current edition of any standard may be purchased from the ASHRAE or by calling or (for orders in the U.S. or Canada). This Standard is under continuous maintenance. To propose a change to the current standard, use the change submittal fo: m available on the ASHRAE web The appearance of any technical data or editorial material in this public review document does not constitute endorsement, warranty, or guaranty by ASHRAE of any product, service, process, procedure, or design, and ASHRAE expressly disclaims such. O Month date, This draft is covered under ASHRAE copyright. Permission to reproduce or redistribute all or any part-of this document must be obtained from the ASHRAE Manager of Standards, 1791 Tullie Circle, E, Atlanta, GA Phone: , Ext Fax: standards.section@ashrae.org. AMERICA SOCIET OF HEATIG, REFRIGERATIG AD AIR-CODITIOIG EGIEERS, IC Tuliie Circle, E Atlanta GA

7 BSR/ASHRAE/ASHE Addendum b to ASI/ASHRAE/ASHE Standard , Ventilation ofhealth Care Facilities Standing Standard Project Committee Review Draft 21Apri12009 (This foreword is not part of this standard. It is merely informative and does not contain requirements necessary for conformance to the standard. It has not been processed according to the ASI requirements for a standard and may contain material that has not been subject to public review or a consensus process. Unresolved objectors on informative material are not offered the right to appeal at ASHRAE or ASI. ) FOREWORD The proposed addendum adds additional Standard requirements and clarifies previous Standard requirements. Coordinat ion with both ASHRAE Standard ar^ d the Guidelines for Design and Construction ofhospital and Health Care Fac ilities are reflected with in th is proposed addendum. The following discusses the specific changes proposed. 1. Modifications to Table 6-1 andfootnotes c and d. This proposed change more accurately defines the HEPA filter utilized by the Table. The MERV 17 equivalent rating ofashrae 52.2 previously referenced is removed. 2. Modifications to Outdoor Air Intakes. This proposed change recognizes that reliefair discharges need to be addressed by the Standard. 3. Modifications ztioas to 6.4 Filtration. This proposed change recognizes that air bypassing the filter media greatly decreases the performance ofthe Filter Bank and needs to be addressed by the Standard. 4. Modifications to 7. S.1 Morgace and Autopsy Rooms. This proposed change adds requirements for a minimum differential pressure from these spaces that may contain potentially infectious remains. 5. Modification s to Table 7-1. This proposed change creates a new entry for Intermediate Care and revises entries for Triage and Radiology Waiting Rooms. Additionally this proposed change emphasizes the intent that the Standard defines design requirements as noted in it's Purpose by revising the RH column header for all entries within the entire Table. 2

8 BSR/ASI-II2AE/ASHE Addendum b to ASI/ASHRAE/ASHE Standard , Ventilation ofhealth Care Facilities Standing Standard Project Committee Review Draft 21Apri12009 [ote to Reviewers: This addendum makes proposed changes to the current standard. These changes are indicated in the text by underlining (for additions) and strffmthro l^ (for deletions) except where the reviewer instructions specifically describe some other means ofshowing the changes. Only these changes to the current standard are open for review and comment at this time. Additional material is providedfor context only and is not openfor comment except as it relates to the proposed changes.] Addendum b to Revise the Standard as follows (I-P and SI units) Reviewer ote: In Table 6.1, revise one entry and notes "c"and "d" as shown below. Table 6.1 Minimum Filter Efficiencies Sp a c e D es igna t ion (Acco rdin g to Functi on) F ilt e r B ank F ilter B ank no. 1 no. 2 (MERV)" (MERV) a Protective environment rooms (PE); HEPA)" ote c: Filter Bank o. 2 may be a MERV 14 if a T`^nERA'n tertiary terminal HEPA filter is provided for these spaces. ote d: High Efficiency Particulate Air (HEPA) filters are those filters which remove at least 99.97% of 0.3 micron sized particles at the rated flow p er IEST RP-CC Reviewer ote: In paragraph 6.3.1, add two new sentences as shown below Outdoor Air Intakes. Outdoor air intakes for air-handling units shall be located a minimum of 25 feet (8 m) from cooling towers and all exhaust and vent discharges. Relief air is exempt from trle 25 foot separation requirement. Relief air is defined as the Class 1 air (for further information see ASHRAE ) that could be returned to the air-handling unit from the occupied spaces but is being discharged to the outdoors to maintain building pressurization (such as during air-side economizer operation). Outdoor air intakes shall be located such that the bottom of the air intake is at least six feet (2 m) above grade.

9 BSR/ASHRAE/ASHE Addendum b to ASUASH]2AE/ASHE Standard , Ventilation ofhealth Care Facilities Standing Standard Project Committee Review Draft 21Apri12009 Intakes on top of buildings shall be located a minimum of three feet (1 m) above roof level. ew facilities with moderate-to-high risk of natural or man-made extraordinary incidents shall locate air intakes away from public access. All intakes shall be designed to prevent the entrainment of winddriven rain, shall contain features for draining away precipitation, and shall be equipped with a birdscreen of mesh no smaller than 0.5 inch (13 mm). Reviewer ote: In paragraph 6.4, add new subparagraph as shown below Filter Bank Slanlc-Off Panels. Filter Bank blank off panels shall be permanently attached to the filter bank frame, constructed of rigid materials, and have sealing surfaces equal to or greater than the filter media installed within the filter bank aame. Reviewer ote: Paragraph is reformatted similar to other subparagraphs and new minimum requirements for differential pressure are proposed in 7.5.I.c Morgue and Autopsy Rooms. Low sidewall e)diaust grilles shall be provided upaess exhaust air is removed duough an autopsy table designed for this purpose. All e^^aust air from autopsy, non Fefriger-ated body holding and morgue roems shallbe disehar-ged dir-eetly to the outdoors without mixing with air- ft-om any other room orexhaust system Morgue and Autopsy Rooms. Ventilation for Morgue and Autopsy Rooms shall meet the followin g requirements: a. Low sidewall exhaust grilles shall be provided unless exhaust air is removed through an autopsy table designed for this purpose. 4

10 BSR/ASHRAE/ASHE Addendum b to ASI/ASHRAE/ASHE Standard , Ventilation ofhealth Care Facilities Standing Standard Project Committee Review Draft 21Apri12009 b. All exhaust air from autopsy, non-refrigerated body-holding and morgue rooms shall be discharged directly to the outdoors without mixing with air from any other room or exhaust system. c. Differential pressure between morgue and autopsy rooms and any dissimilar adjacent spaces shall be a minimum of in. we (-2.5 Pa). Reviewer ote: Table 7-1 entries andfootnotes are revised as noted. The new "Intermediate Care" entry is inserted between current the "Critical and intensive care" and "Wound intensive care (burn unit) " entries. Footnote (s) is expanded to include the new "Intermediate Care " entry. The RH column header is revisedfor every entry within the entire table (including all those entries not listed in this czddendzt»z). Part of the footnote (q) text is broken out into a new footnote (w) as this sentence was not applicable to the ER waiting rooms entry which also utilizes footnote (q).

11 BSR/ASHRAE/ASHE Addendum b to ASUASHRAE/ASHE Standard , Ventilation ofhealtlz Care Facilities Standing Standard Project Committee Review Draft 21Apri12009 Table 7-1 Design Parameters Function of Space Pressure All Room Air R# Desig n Des ign Relationship to Exhausted Air Recirculated Re lative Temp e rature Adjacent Areas Minimum Min imum Total Directly to by means of Humidi ty (k), (n) Outdoor ach ach Outdoors (j) Room Un its (a ) (% ) ( F( C) SURGER AD CRITICAL CARE Intermediate Care (s) /R 2 6 /R /R max /21-24 Triage (q) egative 2 12 es IR max /21-24 Radiology waiting rooms (q), (w) egative 2 12 es /R max /21-24 (q) (s) (w) In a recirculating ventilation system, HEPA filters shall be permitted instead of exhausting the air from these spaces to the outdoors provided the return air passes through the HEPA filters before it is introduced into any other spaces. This r-equirement applies anly to waiting reems b awaiting diagnosis For patient rooms, intermediate cue laborldelivery/recovery rooms and labor/delivery/recovery/postpartum rooms may four total air changes per hour shall be permitted when supplemental heating and/or cooling systems (radiant heating and cooling, baseboard heating, etc.) are used. This requirement applies only to waiting rooms proerammed to hold patients awaiting chest x-rays for diagnosis of respiratory disease. 6

12 Voting Record St. Louis Meeting 4/20/2009 Voting Initial Laboratory Members Addendum b, Ventilation, M inutes Item 7 Minutes Item 10 inomura Sheerin Rousseau Bartley Cohen Erickson Gregory Hermans Keen Kloostra Langowski Mamayek Memarzadeh Seth Streifel Woolsey OR Temperature Control, Minutes Item 12 Unitary Filters, Minutes Item 13 Morgue & Autopsy, Mintues Item 14 A A A Intensive Care, Endoscopy, Minutes Item 15 Minutes Item 17 A Key: A ea ay Abstain ot Present 5/12/2009