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
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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…..
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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
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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…”
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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
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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
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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
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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
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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…..
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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.
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What Changed?
Operating Room: invasive procedures, physiological monitoring, active
life support, aseptic, environmental controls, restricted access
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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
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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
(out)10 (downdraft type) No
68°F–73°F
(20°C–23°C)20%–60%
Clean/sterile storagePositive
(out)4 (downdraft type) No
75°F
( 24°C) 70%
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SPD Criteria - AORN/AAMI Guide - Gone
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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
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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
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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
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Surgery Ventilation
70%
• Laminar non-aspirating diffusers required:
•PE rooms
•Wound ICU (burn units)
•Trauma rooms
•Procedure rooms
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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
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Airborne Infectious Rooms
• Surgery & AII spaces musts:
• Redundant heat sources
• Pressurization maintained at all times
• Redundant cooling sources
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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!
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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
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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
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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!
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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
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Healthcare Engineers’ Action Items
Dan Koenigshofer, PE, HFDPDewberry Engineers Inc.
919.425.7616
Alex Harwell, EIDewberry Engineers Inc.
919.425.3769
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Thank You !!