P

P
P
P
P
N
N
N
N
N
N
N

Operating/surgical cystoscopic rooms (e), (p), (q) (r)

Delivery room (p) (r)

Recovery room (p)

Critical and intensive care

Newborn intensive care

Treatment room (s)

Nursery suite

Trauma room (crisis or shock) (f) (s)

Trauma room (conventional ED or treatment) (f) (s)

Anesthesia gas storage

Endoscopy

Bronchoscopy (q)

ER waiting rooms

Triage

Radiology waiting rooms

Class A Operating (procedure) room (e) (r)

Pressure
Relationship to
Adjacent Areas (a)

Operating room (recirculating air system) (e) (r)

SURGERY AND CRITICAL CARE

Function Space

Minimum Air
Changes of
Outdoor Air
per Hour (b)

15

12

12

12

12

15

12

25

25

25

Minimum
Total Air
Changes per
Hour (c)

Table 4-1.

Yes (t) (u)

Yes

Yes

Yes

Yes

All Air
Exhausted
Directly to
Outdoors (m)

No

No

No

No

No

No

No

No

No

No

No

No

Air
Recirculated
Within Room
Units (d)

30-60

30-60

30-60

30-60

30-60

30-60

30-60

30-60

30-60

30-60

30-60

30-60

30-60

30-60

Relative
Humidity
(n)(%)

70-75 [21.1-23.9]

70-75 [21.1-23.9]

70-75 [21.1-23.9]

70-75 [21.1-23.9]

68-73 [20-22.8]

68-73 [20-22.8]

70-75 [21.1-23.9]

70-75 [21.1-23.9]

75-80 [23.9-26.7]

70-75 [21.1-23.9]

72-78 [22.2-25.6]

70-75 [21.1-23.9]

70-75 [21.1-23.9]

68-75 [20-23.9]

68-75 [20-23.9]

68-75 [20-23.9]

Design
Temperature (o)
F (C)

OVERVIEW OF HEALTH CARE HVAC

33

2
2
2
Optional
2

P
N
N
N

Laboratory, biochemistry (y)

Laboratory, cytology

Laboratory, glasswashing

Laboratory, histology

Darkroom

Laboratory, bacteriology

X-ray (surgery/critical care and

catheterization)

X-ray (diagnostic and treatment)

Laboratory, general (y)

RADIOLOGY (y)

ANCILLARY

Patient corridor

P/N

Isolation alcove or anteroom (w) (x)

Airborne infection isolation room (h),(q), (x)

Public Corridor

Protective environment room (i), (q), (w)

Newborn nursery suite

Labor/delivery/recovery/postpartum (LDRP)

Toilet room (g)

Optional

Minimum Air
Changes of
Outdoor Air
per Hour (b)

Patient room

NURSING

Function Space

Pressure
Relationship to
Adjacent Areas (a)

10

10

15

6(v)

10

12

12

10

6(v)

Minimum
Total Air
Changes per
Hour (c)

Table 4-1. (Continued)

Yes

Yes

Yes

Yes

Yes

Yes (j)

Yes

Yes (u)

Yes

All Air
Exhausted
Directly to
Outdoors (m)

No

No

No

No

No

No

No

No

No

No

No

No

Air
Recirculated
Within Room
Units (d)

30-60

30-60

30-60

30-60

30-60

30-60

30-60

30-60

30-60

30-60

Relative
Humidity
(n)(%)

70-75 [21.1-23.9]

70-75 [21.1-23.9]

70-75 [21.1-23.9]

70-75 [21.1-23.9]

70-75 [21.1-23.9]

70-75 [21.1-23.9]

72-78 [22.2-25.6]

70-75 [21.1-23.9]

70-75 [21.1-23.9]

70-75 [21.1-23.9]

72-78 [22.2-25.6]

70-75 [21.1-23.9]

Design
Temperature (o)
F (C)

34
HVAC DESIGN MANUAL FOR HOSPITALS AND CLINICS

Optional
2
2

N
P
N
N
P

Laboratory, sterilizing

Laboratory, media transfer

Autopsy room (q)

Nonrefrigerated body-holding room (k)

Pharmacy

2
2
2
2

P
N
N
P

Examination room

Medication room

Treatment room

Physical therapy and hydrotherapy

Soiled workroom or soiled holding

Clean workroom or clean holding

Optional

Bronchoscopy, sputum collection, and pentamidine

administration

DIAGNOSTIC AND TREATMENT

Admitting and waiting rooms

Laboratory, serology

ADMINISTRATION

Laboratory, pathology

Laboratory, nuclear medicine

Minimum Air
Changes of
Outdoor Air
per Hour (b)

Microbiology (y)

Function Space

Pressure
Relationship to
Adjacent Areas (a)

10

12

10

12

10

Minimum
Total Air
Changes per
Hour (c)

Table 4-1. (Continued)

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

All Air
Exhausted
Directly to
Outdoors (m)

No

No

No

No

No

No

No

No

No

Air
Recirculated
Within Room
Units (d)

30-60

30-60

30-60

30-60

30-60

30-60

30-60

30-60

30-60

30-60

30-60

30-60

30-60

30-60

Relative
Humidity
(n)(%)

72-78 [22.2-25.6]

72-80 [22.2-26.7]

70-75 [21.1-23.9]

70-75 [21.1-23.9]

70-75 [21.1-23.9]

70-75 [21.1-23.9]

70-75 [21.1-23.9]

70-75 [21.1-23.9]

70 [21.1]

70-75 [21.1-23.9]

70-75 [21.1-23.9]

70-75 [21.1-23.9]

70-75 [21.1-23.9]

70-75 [21.1-23.9]

70-75 [21.1-23.9]

Design
Temperature (o)
F (C)

OVERVIEW OF HEALTH CARE HVAC

35

Sterilizer equipment room

P
P

Clean workroom

Sterile storage

Optional
Optional
Optional

N
N
N
P
N
N
N
N

Warewashing

Dietary day storage

Laundry, general

Soiled linen sorting and storage

Clean linen storage

Linen and trash chute room

Bedpan room

Bathroom

Janitor's closet

Optional

2 (Optional)

Optional

Optional

Optional

Minimum Air
Changes of
Outdoor Air
per Hour (b)

Food preparation center (l)

SERVICE

Soiled or decontamination room

Central medical and surgical supply

ETO-sterilizer room

STERILIZING AND SUPPLY

Function Space

Pressure
Relationship to
Adjacent Areas (a)

10

10

10

10

10

10

10

10

10

10

Minimum
Total Air
Changes per
Hour (c)

Table 4-1. (Continued)

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

All Air
Exhausted
Directly to
Outdoors (m)

No

No

No

No

No

No

No

No

No

No

No

No

No

Air
Recirculated
Within Room
Units (d)

30-60

30-60

30-60

Relative
Humidity
(n)(%)

72-78 [22.2-25.6]

72-78 [22.2-25.6]

72-78 [22.2-25.6]

72-78 [22.2-25.6]

Design
Temperature (o)
F (C)

36
HVAC DESIGN MANUAL FOR HOSPITALS AND CLINICS

The ventilation rates in this table cover ventilation for comfort, as well as for asepsis and odor control in areas of acute care hospitals that directly affect patient care. Ventilation rates in accordance with
ASHRAE Standard 62, Ventilation for Acceptable Indoor Air Quality, should be used for areas for which specific ventilation rates are not given. Where a higher outdoor air requirement is called for in
Standard 62 than in Table 4-1, the higher value should be used.
Total air changes indicated should be either supplied or, where required, exhausted. Number of air changes can be reduced when the room is unoccupied if pressure relationship is maintained and the
number of air changes indicated is reestablished any time the space is being utilized. Air changes shown are minimum values. Higher values should be used when required to maintain room temperature
and humidity conditions based upon the cooling load of the space (lights, equipment, people, exterior walls and windows, etc.).

Recirculating HEPA filter units used for infection control (without heating or cooling coils) are acceptable. Gravity-type heating or cooling units such as radiators or convectors shall not be used in operating rooms and other special care areas.

For operating rooms, 100% outside air should be used only when codes require it and only if heat recovery devices are used.
The term trauma room as used herein is a first aid room and/or emergency room used for general initial treatment of accident victims. The operating room within the trauma center that is routinely used
for emergency surgery should be treated as an operating room.

See section on patient rooms in ASHRAE HandbookHVAC Applications for a discussion of design of central toilet exhaust systems.

The airborne infectious isolation rooms described in this table are those that might be used for infectious patients in the average community hospital. The rooms are negatively pressurized. Some isolation rooms may have a separate anteroom. Refer to the discussion in the chapter for more detailed information.

Protective environment rooms are those used for immunosuppressed patients. Such rooms are positively pressurized to protect the patient. Anterooms are generally required and should be negatively
pressurized with respect to the patient room.
All air need not be exhausted if darkroom equipment has scavenging exhaust duct attached and meets ventilation standards regarding NIOSH, OSHA, and local employee exposure limits.

A nonrefrigerated body-holding room is only applicable to facilities that do not perform autopsies on-site and use the space for short periods while waiting for the body to be transferred.

(b)

(d)

(e)
(f)

(g)

(h)

(i)

(k)

(p)

(o)

For indicated temperature ranges, the systems shall be capable of maintaining the rooms at any point within the range during normal operation. A single figure indicates a heating or cooling capacity to
at least meet the indicated temperature. This is usually applicable when patients may be undressed and require a warmer environment. Use of lower temperature is acceptable when patients' comfort and
medical conditions require those conditions.
National Institute for Occupational Safety and Health (NIOSH) Criteria Documents regarding Occupational Exposure to Waste Anesthetic Gases and Vapors and Control of Occupational Exposure
to Nitrous Oxide indicate a need for both local exhaust (scavenging) systems and general ventilation of the areas in which the respective gases are utilized.

Food preparation centers should have an excess of air supply for positive pressurization when hoods are not in operation. The number of air changes may be reduced or varied for odor control when the
space is not in use. Minimum total air changes per hour should be that required to provide proper makeup air to kitchen exhaust systems. See Chapter 30, Kitchen Ventilation, 1999 ASHRAE HandbookHVAC Applications. In addition care must be taken to ensure that exfiltration or infiltration to or from exit corridors does not compromise the exit corridor restrictions of NFPA 90A, the pressure
requirements of NFPA 96, or the maximum defined in the table. The number of air changes may be reduced or varied to any extent required for odor control when the space is not in use. See Section
7.31.D1.p. (2001 AIA Guidelines).
(m) Areas with contamination and/or odor problems shall be exhausted to the outside and not recirculated to other areas. Individual circumstances may require special consideration for air exhaust to the outside; intensive care units in which patients with pulmonary infection are treated and rooms for burn patients are examples. To satisfy exhaust needs, replacement air from the outside is necessary. Minimum outside air quantities should remain constant while the system is in operation.
(n) The relative humidity ranges listed are the minimum and maximum limits where control is specifically needed. These limits are not intended to be independent of a space temperature. For example, the
relative humidity is expected to be at the higher end of the range when the temperature is also at the higher end, and vice versa.

(l)

(j)

(c)

Where continuous directional control is not required, variations should be minimized, and in no case should a lack of directional control allow the spread of infection from one area to another. Boundaries between functional areas (wards or departments) should have directional control. Lewis (1988) describes methods for maintaining directional control by applying air-tracking controls. Design of the
ventilation system shall provide air movement, which is generally from clean to less clean areas. If any form of variable air volume or load shedding system is used for energy conservation, it must not
compromise the pressure balancing relationships or the minimum air changes required by the table. See note z for additional information.

(a)

Notes:
P = Positive N = Negative + = Continuous directional control not required

Table 4-1. (Continued)

OVERVIEW OF HEALTH CARE HVAC

37

Because some surgeons or surgical procedures may require room temperatures that are outside of the indicated range, operating room design conditions should be developed in consort with all users, surgeons, anesthesiologists, and nursing staff. The required total air change rates are also a function of space temperature setpoint, supply air temperature, sensible and latent load in the space. For recent
research refer to Appendix I.

The first aid room and/or emergency room used for initial treatment of accident victims can be ventilated as noted for the treatment room. Treatment rooms used for bronchoscopy shall be treated as
bronchoscopy rooms. Treatment rooms used for cryosurgery procedures with nitrous oxide shall contain provisions for exhausting waste gases.

In a recirculating ventilation system, HEPA filters can be used in lieu of exhausting the air from these spaces to the outside. In this application, the return air shall be passed through the HEPA filters
before it is introduced into any other spaces.

If exhausting the air from an airborne infection isolation room to the outside is not practical, the air may be returned through HEPA filters to an air-handling system exclusively serving the isolation
room.

(r)

(s)

(t)

(u)

A simple visual method such as smoke trail, ball-in-tube, or flutterstrip can be used for verification of airflow direction. These devices will require a minimum differential air pressure to indicate airflow
direction. In accordance with AIA 2001 Guidelines, recirculating devices with HEPA filters may have potential uses in existing facilities as interim, supplemental environmental controls to meet requirements for the control of airborne infectious agents. Limitations in design must be recognized. The design of either portable or fixed systems should prevent stagnation and short circuiting of airflow. The
supply and exhaust locations should direct clean air to areas where health care workers are likely to work, across the infectious source, and then to the exhaust, so that the health care worker is not positioned between the infectious source and the exhaust location. The design of such systems should also allow for easy access for scheduled preventative maintenance and cleaning.

As with the data presented in Table 4-1, these notes have been extracted from the ASHRAE HandbookHVAC Applications and the 2001 AIA Guidelines for Design and Construction of Health
Care Facilities. Material from the AIA 2001 Guidelines is used with permission.

When required, appropriate hoods and exhaust devices for the removal of noxious gases or chemical vapors shall be provided (see Section 7.31.D14 and 7.31.D15 2001 AIA Guidelines and NFPA 99).

(y)

(z)

(v)

Total air changes per room for patient rooms and labor/delivery/recovery/postpartum rooms may be reduced to 4 when supplemental heating and/or cooling systems (radiant heating and cooling, baseboard heating, etc.) are used.
(w) The protective environment airflow design specifications protect the patient from common environmental airborne infectious microbes (i.e., Aspergillus spores). These special ventilation areas shall be
designed to provide directed airflow from the cleanest patient area to less clean areas. These rooms shall be protected with HEPA filters at 99.97 percent efficiency for 0.3 micron-sized particles in the
supply airstream. These interrupting filters protect patient rooms from maintenance-derived release of environmental microbes from the ventilation system components. Recirculation HEPA filters can
be used to increase the equivalent room air exchanges. Constant volume airflow is required for consistent ventilation for the protected environment. If the design criteria indicate that airborne infection
isolation is necessary for protective environment patients, an anteroom should be provided. Rooms with reversible airflow provisions for the purpose of switching between protective environment and
airborne infection isolation functions are not acceptable (2001 AIA Guidelines).
(x) The infectious disease isolation room described in these guidelines is to be used for isolating the airborne spread of infectious diseases, such as measles, varicella, or tuberculosis. The design of airborne
infection isolation (AII) rooms should include the provision for normal patient care during periods not requiring isolation precautions. Supplemental recirculating devices may be used in the patient room
to increase the equivalent room air exchanges; however, such recirculating devices do not provide the outside air requirements. Air may be recirculated within individual isolation rooms if HEPA filters
are used. Rooms with reversible airflow provisions for the purpose of switching between protective environment and AII functions are not acceptable (2001 AIA Guidelines).

Differential pressure between space and corridors shall be a minimum of 0.01 inch water gauge (2.5 Pa). If monitoring device alarms are installed, allowances shall be made to prevent nuisance alarms.

(q)

Table 4-1. (Continued)

38
HVAC DESIGN MANUAL FOR HOSPITALS AND CLINICS