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Integrated air tempering technologies work as a

system to reduce humidity, and microbiological


contaminants

Uses your HVAC system to reduce airborne spread


of disease and increase productivity

Factory-engineered, installed and controlled in


your building air-handling system

Trane CDQTM System


Take Control of The Critical
MicroClimate in your Healthcare Facilities

Its the air we breathe


Airborne nosocomial infections have proven to be
a persistent and sometimes tragic problem. If
transmission by direct contact predominates, as many
experts suggest, then surface disinfection
technologies should have a major impact in reducing
infection rates. But with more than a third of all
nosocomial infections possibly involving airborne
transmission at some point, the combination of
surface and air disinfection should produce optimum
results. 3
Various sources estimate that between 2 million and
4 million nosocomial infections occur annually,
resulting in 20,000 to 80,000 fatalities. The cost of
nosocomial infections in the United States is
estimated to be about $4 billion to $5 billion annually.

Theres no argument on how critical Indoor Air Quality (IAQ)


is in hospitals. In healthcare IAQ is more than just the
promotion of comfort. In reality proper IAQ is a factor in
patient recovery and in some instances, it is the major
treatment.
While temperature and humidity requirements are important
in hospitals, it is the issue of cross contamination and
bacterial concentration that assume critical importance in
HVAC design. The fundamental reason behind this is the
presence of airborne pathogens that can create havoc by
infecting healthy people, which complicates the recovery of
patients.

Airborne nosocomial infections are transmitted


directly or indirectly through air and may cause
respiratory (primarily pneumonia) and surgical-site
infections.1
The degree to which the transmission of nosocomial
infections is airborne is unknown. One source
estimates that 10% of nosocomial infections
are airborne, while another states that 16% of ICU
infections result from airborne-pathogen
transmission. 1 2

Typically, the strategies available for controlling the spread


and multiplication of airborne pathogens include
{ dilution through ventilation,
{ filtration,
{ ultraviolet germicidal irradiation (UVGI),
{ air purging and isolation through pressurization control.
{ stringent humidity and temperature control
Design of an Operating Theatre

According to the ASHRAE, from a functional standpoint, a


typical hospital basically comprises seven environmental
categories:
{ Surgery and critical care (operating theatre, delivery
room, etc.)
{ Nursing (patient rooms, intensive care unit, etc.)
{ Ancillary (radiology, laboratories, etc.)
{ Administration (offices)
{ Diagnostic and treatment (examination rooms, therapy
rooms, etc.)
{ Sterilization and supply (sterilizer room, equipment
storage, etc.)
{ Service (kitchen, laundry, etc.)

HVAC system design for an operating theatre starts with a


reminder of the following key objectives:
{ To control the concentration of harmful bacteria;
{ To prevent infiltration of less clean air into the operating
theatre;
{ To create an air flow pattern that carries contaminated
air away from the operating table;
{ To provide a comfortable environment for the patient
and operating team;
{
To ensure uninterrupted operations;
{ To save energy.
Which leaves us some questions:
Are hospitals making people sick? And if that is so, how
do we invest in better designs for better outcomes?
With the root causes lying within poor air quality and
ventilation, we are tasked with
{ Eradicating existing harmful microbiological
contaminants, and
{ Preventing its spread.

Functional requirements dictate HVAC requirements. The


HVAC view, however, boils down to seeing all spaces from
..At the source of the ventilation system, and within the
the point of view of:
microclimate environment of the operating theatre.
{ Temperature and humidity
{ Ventilation
{ Pressure relationship with surrounding spaces
{ Air cleanliness level
Temperature and humidity requirements in hospitals
{ Air distribution
{ Operating hours
Standards
General Pratice
{ System reliability
0
Room

1 Eickhoff, T.C. (1994). Airborne nosocomial infection: A


contemporary perspective..Infection Control and Epidemiology.,
15, 663-672.
2 Durmaz, G.,et al. (2005). The relationship between airborne
colonization and nosocomial infection in intensice care units.
Journal of Chemotherapy, 39, 465-471
3 Kowalski,W.J. (2006).

Temperature ( C)

Relative Humidity (%RH)

Operating Theatres

17 ~ 27

45 ~ 55

Intensive Care Unit

24 ~ 27

30 ~ 60

24

30 ~ 60

24 ~ 27

30 ~ 60

Wards (airconditioned)
Isolation Ward

THE CALL FOR EVIDENCE BASED MICROCLIMATE DESIGN


Evidence-Based Design is the process of basing decisions about the built
environment on credible research to achieve the best possible outcomes.
In todays competitive health care industry, evidence-based design is having more
and more of an impact ont the way health care facilities are designed.
Other design shortcomings like inadequate lighting can cause patient depression
and staff errors in medication. Poorly designed workspaces can contribute to staff
shortages and burnout, which could result in patient falls.
Smarter hospital architecture and design can pay for itself within a year by
improving service efficiency, patient safety and satisfaction, and market share.
-- Leonard Berry, Ph.D., of Texas A & M University

INVESTING IN BETTER DESIGN FOR BETTER OUTCOMES


Evidence-based designs are transforming the healthcare environment. As healthcare
facilities prepare to invest billions of dollars in renovations and updates, decision
makers are becoming more aware of the value of incorporating evidence-based
design elements into their plan. But how do healthcare facilities make the best use
of their limited resources to get the improved outcomes they want?
Several studies document the impact of design characteristics that can be used to
ensure that future healthcare facilities can promote healing in addition to providing
treatment.
Evidence-based design can improve healthcare environments in three key ways by:
Enhancing patient safety by reducing infection, risk, injuries from falls, and
medical errors.
Eliminating environmental stressors, such as noise, that negatively affect
outcomes and staff performance.
Reducing stress and promote healing by making healthcare facilities more
pleasant, comfortable, and supportive for patients and staff alike.

As Hospital Leaders continue to seek ways to improve quality and reduce errors, it is
critical that they look around their own physical environment with the goal of
ensuring the hospital contributes to, rather than impedes, the process of healing.
- Carolyn Clancy, M.D.US Director

General Industrial Design Parameters for Operating Theatres


Design parameters
1.
2.
3.
4.
5.
6.
7.
8.
9.

Temperature
Relative Humidity
Bacterial count
Supply air velocity at the operating table
Fresh air (recirculation is optional)
Total number of air changes
Pressurization
Filtration efficiency
Supply air discharge area

General
0

20 1 C
55 5%
<35 cfu/m3
0.38 m/s
20 air changes / hour
20 air changes / hour
+25 Pa
99.997% at terminal
2.4m x 1.8m

Ultra-clean
20 1 0C
55 5%
<10 cfu/m3
0.38 m/s
20 air changes / hour
20 air changes / hour
+25 Pa
99.997% at terminal
2.8m x 2.8m

Hospital Operating Rooms. The operating theatres are categorised as general and ultraclean, with Ultra-clean OTs, used for
specialized procedures, such as, organ transplant, orthopedic surgery, neurosurgery, etc., where bacterial contamination is
relatively much more critical. Operating rooms should be at a low relative humidity (35-55 % RH) and cool (600 - 680F) / (150 200C). This is an excellent application for CDQ. The improved latent capacity not only reduces the required cooling needed but the
supply-air dew points can eliminate the need for a secondary refrigeration coil or a heat-regenerated active desiccant system.
Because active desiccant systems provide hot air (which would then require a significant amount of post-cooling), using a CDQ
system can result in significant energy savings.

The OR Microclimate
Operating Rooms....the most critical enviroment that requires the highest level of humidity and temperature control, require:
Sterile and controlled enviroments
Adhere to codes/Standards
Reliable systems
By providing cooler, drier air, doctors complaints can be greatly reduced with improved space conditions. The need to provide a
colder surgery suite has become The expectation of doctors.
Cooler temperatures decrease bleeding and improve the patient outcomes.
Drier air delivered to the space results in drier ductwork on the outside and inside of the ductwork. Moisture inside the duct work
becomes a breeding ground for mold. Moisture on the outside of the ductwork drips on to ceilings and into the space.
By keeping moisture out of the space, breeding grounds for mold and nosocomial infections are reduced. They both need dirt and
moisture. Controlling to lower humidity levels reduces the presence of one of the main ingredients for mold growth.
If the dew point in the space is higher then the surface temperature of any of the equipment, condensate will form on those
surfaces.
The importance of temperature control in Operating Theatres
A hospitals physical environment is linked to the health of patients and caregivers, and it can have a direct impact on the
satisfaction of both. the modern surgical suite is prime example of how the environment directly affects both patient health and
caregiver satisfaction.
Many countries encounter high surgical site infection (SSI) rates in their hospitals. Besides economical effects, such
infections can have major impact on the health and recovery of the patient. The incidence of SSI depends on many variables,
including the type of surgery performed and the type of ventilation system. The air is one of the transfer routes for
microbiological contamination, therefore high performance requirements are set with respect to the ventilation system
applied. Besides, the ventilation system in an operating theatre affects, e.g., the thermal comfort of the personnel,
hypothermia of the patient, drying out of the wound, etc.

Comparatively, over time, the temperature in operating rooms has been driven to lower levels for a number of very practical
reasons:
Cooler temperatures slow down the metabolic rates of exposed organs and minimize bleeding during surgery.
Less blood loss and a slowed metabolism places less stress on the patient, which can improve patient health
outcomes. But again, operating room temperatures should not be allowed to go too low. Temperature sensors and
controls are crucials to maintaining the optimum temperature for patients and caregivers.
The increased desire by surgical teams to minimize exposure to airborne contaminants and the transfer of bodily
fluids has led to more complete gowning of the surgical team. This extra gowning traps more heat and results in the
need for lower temperatures in the surgery suite to minimize perspiration. Doctors and nurses do not
want to sweat during critical procedures.
In orthopedic procedures, which require the use of cements and glues to set joints, the drying rate of the adhesives
is crucial to improved patient outcomes. If the operating room temperature is too warm, the adhesives set too
quickly. Colder temperature allow adequate time for proper setting of the joints.

Surgery room conditions


temperature and humidity control requirements
Codes and Standards
dry
bulb
F / C
AIA (2001)
VA (2001)

68-73
(20-23)
62-80
(17-27)

relative
room
humidity
air
%
changes

Industrial Codes & Standards

outdoor
air
changes

%
outdoor
air

30-60

15

20

45-55

15

15

100

ASHRAE design
manual (2003)

68-75
(20-24)

30-60

25

20

ASHRAE Standard
170P (Sep 2006)

68-75
(20-24)

30-60

20

20

ASHRAE Handbook
(2007)

62-80
(17-27)
68-75
(20-24)
70-75
(21-24)

FGI
(2010)

Class B&C

Class A

Doctors require to set temperature upwards


gradually during operating procedures

25C

77oF(25oC) 50% RH
Unoccupied Mode 50% Airflow
+ve Pa

Warmest 77oF(25oC) 50%RH


22C

o
o
Warm 72 F(22 C)
50%RH

30-60

20

20

30-60

20

20

o
o
Cold 66 F(19 C)
50%RH

30-60

18

15

17C
o
o
Coldest 62 F(17 C)
50%RH

19C

but trend is for colder temperatures (65F, 62F (18C, 16C), or even colder)

The need to control the temperature and humidity of surgical suites is clear - patients and caregivers need a cool, dry surgical environment to support
them in the sometimes tension-fraught atmosphere of the operating room. In some even more challenging operations, whereby the surgical staffs might
want to rise the room temperature to a warmer conditions as they go through a series of various stages of operating procedures and yet, maintain the
relative humity within control. This poses a very challenging design to any airside equipment. Temperature and humidity ranges, and minimum
air-change rates are often prescribed by local codes or by industry-accepted guidelines.

HEALTHCARE

The CDQ desiccant wheel adsorbs water


vapor from the air downstream of the
cooling coil (CA) - indicated by the red line
from CA to SA. This lowers the humidity ratio
of the supply air (SA) from 51.6 gr/lb to 41.9
gr/lb (7.4g /kg to 5.9g/kg), but also raises the
dry-buld temperature slightly... from 520 F to
55.30 F (11.10C to 12.90 C). As the wheel
rotates it the adds (desorbs) water vapor
back into the air upstream of the coil (MA) indicated by the red line from MA to MA. This
raises the humidity ratio of the mixed air
(MA) from 53.2 gr/lb to 62.8 gr/lb (7.6g /kg to
9g/kg) , but also lowers the dry-buld
temperature slightly...from 69.60 F to 66.30F
(20.90C to 19.10 C). The primary benefit of
adding this special desiccant wheel is that it
increases the latent (dehumidification)
capacity of the cooling coil without increasing
its total cooling capacity (2.2 tons (7.7kw)).
Plus, it allows this system to achieve a lower
supply-air humidity ratio (41.9 gr/lb (5.9g/kg)
in this example) without requiring the use of a
lower leaving-coil temperature (CA is only 520
F (11.10C)).
Secondly, no reheat is required at full load.
The supply air (SA) leaves the process side
of the series desiccant wheel warm (53.30 F
(11.80C) dry bulb) and dry (41.9 gr/lb (5.9g/
kg) humidity ratio).
Like the dual-path approach, because reheat
energy is not being added to the airstream at
full load, the overall cooling capacity required
for this series desiccant system (2.2 tons
(7.7kw)) is lower than in either of the Cool
and Reheat systems (2.6 tons(9.1kw)).
(Note: Required cooling capacity is slightly
higher than in the dual-path system-2.2 tons
(7.7kw) compaared to 2.1 tons (7.4kw) because the resulting space is drier - 55%
RH compared to 60%. This is because the
series desiccant wheel comes in fixed
capacities.)
This specially-designed CDQ wheel uses a
type III desiccant chosen specifically for this
application. The ability of desiccant to adsorb
water vapor is very high when the relative
humidity of the air is high. Its ability to hold
water vapor greatly decreases as the
relative humidity of the air drops below 80%.

how it works

CDQ Desiccant Wheel


typical
leaving-coil
conditions
(CA)

high

typical
mixed-air
conditions
(MA)

ability to
hold water
vapor

low
0

20

40

60

80

relative humidity, %

100

Air leaving a cooling coil (CA on the previous slides) is generally at a very high relative
humidity (often greater than 90%). At this condition, the series desiccant wheel will
have a high affinity for water vapor and absorb it from the air that leaves the cooling
coil. When the wheel rotates into the mixed air stream (MA on the previous slides),
it will be exposed to air that is at a much lower relative humidity (typically 40% to
60%). At this lower relative humidity, the desiccant will have have a much lower
affinity for water vapor, and it will release water vapor into the air stream.Unlike
traditional desiccant dehumidification applications, the regeneration air stream does
not need to be hot in order to drive the process. It is driven by the characteristic of the
desiccant specifically chosen for this application, which allows the wheel to be
regenerted at low temperatures.

Trane CDQ Operation:


The CDQ system can be applied in
applications that require active humidity
control. CDQ system benefits over
cool-reheat units varies, but, in general,
you can expect:
Higher latent capacity per ton of total
capacity,
Lower achievable supply-air dew
point, and
Reduced reheat energy
Quieter operation
Very low controlled humidity
spaces. In the very low 35 to 45 percent
relative humidityapplications, the air handler
supply air dew point needs to be in the
25F to 40F (4C to 4.4C) dewpoint range
Enhanced CDQ units can achieve these l
evels without using complex and
expensive gas heat regenerated desiccant
wheels, glycol chillers or refrigeration
defrost DX systems.

Trane CDQTM (Series Desiccant System)- The Trane OT Microclimate


Solution
There are basically 3 broad systems in use today in humidity critical control
applications:
| Cool and reheat systems
| Split dehumidification unit
| Series desiccant system
The Trane CDQTM configuration uses a special desiccant dehumidification wheel
configured in series (wraparound) with a traditional cooling coil. This is a proprietary
(patented) system from Trane called Cool, Dry, Quiet (or CDQTM). The regeneration side of the CDQ wheel is located upstream of the coil and the process side of
the wheel is located downstrem of the coil. This specilally-designed desiccant wheel
primarily tranfers water vapor, with minimal sensible heat tranfer.
This system mixes outdoor air (OA) and recirculated return (RA), and then passes
the mixed air (MA) through the regeneration side of the desiccant wheel. The air
(MA) the passes through the cooling coil to be cooled and dehumidified (CA). Finally,
the air passes through the process side of the desiccant wheel (SA) before it is
delivered to the space.
The CDQ Operation:

Innovative CDQ

TM

dehumidification

Increased humidity ratio,

Normal humidity ratio,

Increased relative humidity

Normal relative humidity

Low controlled humidity spaces.


In the 55 to 60 percent relative humidity
spaces, the space dewpoint will be in the
400F - 570F(4.4C - 14C) dewpoint
range.
A CDQ unit, with its increased latent
capacity andlower SHR (Sensible Heat
Ratio), can match sensible and latent output
to the space at full and part load. The
result: Tighter humidity control with less
energy and noise.
For more information, go to
www.trane.com/cdq.

Very Low humidity ratio,

Low humidity ratio,

Lower relative humidity

Maximum relative humidity

Trane CDQ
wheel

Trane CDQ series desiccant system

peak DB
RA

62F(16.7oC) DB
55% RH

1900 CMH (1125 CFM) Supply Airflow


100%
O

MA

69.6F(21.1oC) DB
53.2 gr/lb(7.6g/kg)

MA'

66.3F(19oC) DB
62.8 gr/lb(9g/kg)

CA

52F(11.1oC) DB
51.6 gr/lb(7.4g/kg)

SA

55.3F (12.9oC)DB
41.9 gr/lb(6g/kg)
40(4.4)
30(-1)

C)

80%

F(
,
re
u
t
ra 70(21)
pe
m
te

SA

RA

180(25.7)
160(22.9)

colder

warmer

140(20)
drier

b
ul 60(15.6)
-b
t
e
w
MA'
50(10)

CA

60%

wetter

80(26.7)

40%

120(17.1)
100(14.3)

OA
20%

80(11.4)
60(8.6)

MA

coil loads:
2.2 tons(7.7Kw) (cooling)
0 MBh(Kw) (reheat)

40(5.7)
20(2.9)

30

40

50

60

70

80

90

100

110

(-1)

(4.4)

(10)

(15.6)

(21)

(26.7)

(32.2)

(37.8)

(43.3)

dry-bulb temperature, F (OC)

humidity ratio, grains/lb of dry air (g/kg)

OA

100F(38oC) DB
74F(23oC) WB

The Trane Intergrated System Control


Solution
Tracer ES accommodates the
needs of healthcare organizations that
operate multiple facilities. Tracer ES
software resides on a central server that
can be accessed from any secure Internet
connection.
Its open, non-proprietary
design enables integration
and communication with both
Trane and non-Trane systems.
Facility management staff can
use Tracer ES to remotely
monitor and control energy
management, lighting and
HVAC systems throughout
the organization to positively
impact operational efficiency,
patient and staff comfort, and
operating expenses.
To learn more about Tracer ES,
visit www.trane.com or
contact a Tracer ES Product
Specialist at 1-800-TRACER1.

Here is a diagram of this concept implemented in an indoor air handler. To save


footprint, one air stream can be situated above the other by using a stacked
air-handler arrangement. Supply fan, cooling coil, and outdoor-air intake locations all
impact the dehumidification performance of the CDQ system.
Finally, unlike a traditional parallel desiccant wheel, the series CDQ desiccant wheel
does not require a second airstream (typically either exhaust air or a second outdoor
airstearm) for regeneration of the wheel. This also eliminates any concern for
contamination due to cross-leakage through the wheel. All of the air passing through
the regeneration side of the wheel is mixed air that was about to enter the spaces
anyway.
Trane CDQ

Air Handler Configuration


OA

MA'

CA

MA

RA

SA

Control
Trane offers as standard, Trane propriety controls on all CDQ projects.
Trane provides a single source solution to the entire cooling and dehumification. The
AHU with the coil and CDQ wheel, the sensors and the controller. Single source
supply implies single source responsibility and accountability.
Economics
As an overall comparison:
y The basic constant-volume system is unable to meet both the temperature and
humidity requirements of the surgery room. This system requires the use of
reheat, even at full-load conditions.
y If the cooling equipment serving the surgery rooms are to be separate from the
existing chiller plant (i.e., standalone), then the split dehumidification unit or
CDQ system are typically preferred because they require no reheat at full load,
and therefore require less overall cooling capacity (about 20% less cooling
capacity in our example).
y In the CDQ system, the existing chiller plant might be able to provide all of
the cooling capacity because the temperature of the air leaving the cooling coil is
only 520 F (11.10C), which can likely be achieved with proper coil selection. This
system is able to achieve a lower supply-air humidity ratio (drier) without requiring
the use of a lower leaving-coil temperature.

CDQ-SLB001-EN July 05, 2010