CMS Adoption of ANSI/ASHRAE/ASHE Standard 170-2008

Ventilation of Health Care

Facilities
Michael P. Sheerin, PE LEED AP
Chief Executive Officer
TLC Engineering for Architecture
Vice Chair - ASHRAE 170 Committee

October 17, 2016 AHCA Conference Presentation

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 History

Roots in ASHRAE Standard 62 and the FGI Guidelines

First SPC meeting: 2002
Standard issued in 2008 Mission Accomplished
First ASHRAE Standard co-sponsored by ASHE
Standard given Continuous Maintenance status
Standard initially incorporated in 2010 Guidelines for
Design and Construction of Health Care Facilities
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 ASHRAE Addendum Adoption Process

Continuous Maintenance
Addenda suggested by:
SSPC committee members
The public through the Change Proposal Process
Public Review
Publication
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 CMS Adoption Process

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 CMS Adoption its complicated?
Adopted 2012 NFPA 99 Health Care Facilities Code 5 July 2016

2012 NFPA 99 References

ASHRAE 170

2012 NFPA 99
approved by
American National Standard
August 31, 2011

ASHRAE 170 Under Continuous Maintenance

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Copyright 2016 ASHRAE
 CMS Adoption its complicated?
ASHRAE 170 Under Continuous Maintenance

CMS Adoption of 99 5 July 2016 CMS Adoption of 99 5 July 2016

2008 ASHRAE 170 Approved 31 August 2011 2013 ASHRAE 170 Approved 5 Dec 2013
2008 170 Addendum Adoption Date 2013 170 Addendum Adoption Date
a 25 July 2009 b 3 July 2014
b 16 Nov 2009 ae 6 Oct 2014
d 10 July 2010 a, e 1 Dec 2014
e, f 3 Feb 2011 d 1 June 2015
g 3 March 2011 g 1 Oct 2015
h 27 July 2011 c, f, h 1 June 2016
NFPA 99 Approved NFPA 99 Adopted by CMS 5 July 2016
l, m 26 Jan 2012
r, s 29 June 2012
j, p, q, t 27 Oct 2012
k, n, v 30 Jan 2013
u, w 4 July 2013
x, z, ab 24 July 2013
ac 31 July 2013
y 5 Dec 2013

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 Addendum d- 2008

Status Included in 2013 edition

Topic Critical Area Humidity Requirements
Reduces minimum relative space humidity from 30% RH to 20% RH in these short stay
spaces:
Class B and C Operating Rooms
Operating/Surgical Cystoscopic Rooms
Delivery Rooms
Treatment Rooms
Trauma Rooms
Laser Eye Rooms
Class A Operating/Procedure Rooms
Gastrointestinal Endoscopy Procedure Rooms
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 Addendum v- 2008

Status Included in 2013 edition

Topic Relative Humidity in Recovery Spaces
Reduces minimum relative humidity in Recovery spaces from 30% to
20%, to be commensurate with previous changes in Addendum d

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 Addendum g- 2008

Status Included in 2013 edition

Topic Displacement Ventilation
Allows Group D diffusers for single bed patient rooms
Includes minimum requirements for design of displacement ventilation systems

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 2011 American Society of Heating, Refrigerating and Air Conditioning Engineers, Inc. (www. ashrae.org) Reprinted by permission from 2011 ASHRAE Standard 70-2008. This
material may not be copied or distributed in either paper or digital form without ASHRAEs permission.

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 Addendum h- 2008

Status Included in 2013 edition

Topic Recirculating Room HVAC Units
All ventilation air must be filtered per Table 6-1
Rules for recirculating room HVAC units
all outside air supplied to units must be filtered and
conditioned
may only serve a single space
MERV-6 filter required if any surface designed to
condense moisture
Recirculated airflow counts towards Total Air
Change Rates required by Table 7-1
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 Addendum j- 2008

Status Included in 2013 edition

Topic Nursing Facility Requirements
Add definition of Nursing Facility:
A facility that provides resident care, treatment and services areas, including
skilled nursing, subacute care, and Alzheimers and other dementia facilities.
Restore requirement for higher level filtration in nursing facilities
Require MERV 13 as Filter Bank Number 1, no requirement for Filter Bank
Number 2

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 Addendum k- 2008

Status Included in 2013 edition

Topic Energy Recovery
No more than 5% leakage potential
Airborne Infectious Isolation (AII) Rooms only systems
with zero potential for cross-contamination from exhaust
(e.g. heat pipes, run around coils)

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 Addendum l- 2008

Status Included in 2013 edition

Topic Caesarean Delivery Rooms/New Spaces
Operating/surgical cytoscopic rooms and caesarean delivery rooms have
same air distribution requirements as Class B and C operating rooms
Added additional new spaces to Table 7-1

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 2011 American Society of Heating, Refrigerating and Air Conditioning Engineers, Inc. (www. ashrae.org) Reprinted by permission from 2011 ASHRAE Standard 70-2008. This
material may not be copied or distributed in either paper or digital form without ASHRAEs permission.

Copyright 2016 ASHRAE

 Addendum m- 2008

Status Included in 2013 edition

Topic Ducted Return Air Systems
In addition to spaces listed in Table 7-1
that have differential pressure
requirements, these spaces also must
be served by ducted return air
systems:
Recovery Rooms
Critical and Intensive Care
Intermediate Care
Burn Unit
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 Addendum ac- 2008

Status Included in 2013 edition

Topic Ducted Return Air

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 Addendum n- 2008

Status Included in 2013 edition

Topic Ventilation Air (Outside Air) Quantity Calculations
The intent is to preclude AHJs from extrapolating the worst
case room condition to the entire air handling zone
Two Calculation Approaches
Minimum ventilation rate sum of room totals based on Table
7-1
Multiple zone approach Ventilation Rate Procedure (multiple
zone formula) in Standard 62.1

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 Addendum u- 2008

Status Included in 2013 edition

Topic ED and Radiology Waiting Room Exhaust
Clarifies HEPA filtered air may be recirculated, in lieu of exhausted
The Radiology Waiting Room requirement only applies to those
spaces where patients with respiratory disease may be waiting
Drops changes to footnote q after 1st public review

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Copyright 2016 ASHRAE

 2011 American Society of Heating, Refrigerating and Air Conditioning Engineers, Inc. (www. ashrae.org) Reprinted by permission from 2011 ASHRAE Standard 70-2008. This
material may not be copied or distributed in either paper or digital form without ASHRAEs permission.

Copyright 2016 ASHRAE

 Addendum w- 2008

Status Included in 2013 edition

Topic Gastrointestinal Endoscopy
Procedure Room
Reduces minimum Relative Humidity to
20%
Requires space to be treated as
Bronchoscopy if both procedures will be
performed in the same space
Changes differential pressure from Positive
to No Requirement (N/R)

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 Addendum z- 2008

Status Included in 2013 edition

Topic ED Exam Room Requirements

Table 7-1 Design Parameters

Design
Pressure All Room Air Air Relative Design
Relationship to Exhausted Recirculated Humidity Temperature
Adjacent Areas Minimum Minimum Total Directly to by means of (k), (l),
Function of Space (n) Outdoor ach ach Outdoors (j) Room Units (a) (%) (F/C)
SURGERY AND CRITICAL CARE
Emergency Department
exam/treatment room (p) N/R 2 6 N/R N/R max 60 70-75/21-24

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2011 American Society of Heating, Refrigerating and Air Conditioning Engineers, Inc. (www. ashrae.org) Reprinted by permission from 2011 ASHRAE Standard 70-2008. This
material may not be copied or distributed in either paper or digital form without ASHRAEs permission.

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 Addendum ad- 2013

Status Approved by ASHRAE BOD

7/29/2016
Topic Exam rooms
Applies only to non-emergency department
exam rooms.
Identifies two types of exam rooms:
General reduction in total air change rate to 4.
Special maintains total air change rate of 6.
Special exam rooms are intended for spaces
that might encounter persons with
undiagnosed gastrointestinal, respiratory, or
skin symptoms.
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 Addendum ab- 2008

Status Included in 2013 edition

Topic Patient Room Air Changes
Reduces Minimum Air Change Rate from 6 to
4, regardless of supplemental heating or
cooling
WHAT THE HECK? HOW? WHY?
Re-examined the research, with careful
consideration of balancing efficacy, patient
comfort and energy consumption. Also
assessed the impact of larger, single patient
rooms on HVAC safety and energy.
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 Addendum c- 2013

Status Approved
Topic Laboratory work areas
Terminology coordinated with FGI
Laboratory Work Areas vs. Laboratories
Reduction allowed via ANSI Z9.5 risk
assessment or active sensing of
contaminants or appropriate surrogates
approach

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 Addendum f- 2013

Status Approved
Topic Operating Room Air Distribution
Provides a specific definition of the primary
supply diffuser array.
Clarifies that no more than 30% of the
Primary Supply Diffuser Array may be used
for non-diffuser items.
Additional diffusers may be located outside of
the Primary Supply Diffuser Array if needed to
achieve required environmental conditions or
air change rates.
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 Addendum f- 2013

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 Addendum g- 2013

Status Approved
Topic Definitions of Operating and
Procedure Rooms
Continues re-definition of ORs and Procedure
Rooms included in the 2014 FGI Guidelines.
Deletes Class A, B, and C terminology and
replaces with
Operating Room, Procedure Room
New definition of Operating Room is
equivalent to Class B and C ORs previously.
New definition of Procedure Room is
equivalent to Class A ORs previously.
Definition are included from 2014 FGI Courtesy:

Guidelines for these spaces:

Operating Room, Procedure Room,
Invasive Procedure, Restricted Area

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 Addendum h- 2013

Status Approved
Topic Temperature in Sterile Processing
Department (SPD)
Disagreement between design (ASHRAE)
and operational (AAMI) standards.
Joint meeting with ASHRAE, AAMI, FGI,
ASHE, AORN, and APIC April 2015.
Agreed on temperature ranges for 3 spaces:
Decontamination Room 60F-73F
Clean Workroom 68F-73F
Sterile Storage Max 75F
Reference to AAMI ST-79.
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Published joint interim guidelines.

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 Addendum i- 2013

Status 1st Public review complete

Topic Unoccupied setback mode

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 Addendum i- 2013

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 Addendum k 2013

Status Approved
Electro-Convulsive Therapy (ECT) Procedure Room
Provide similar HVAC as a general exam room - 4 Total ACH / 2 OA

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 Addendum l- 2013

Status Advisory public review concluded July 10, 2016

Topic Filtration revisions

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 Addendum m- 2013

Status 1st Public review concluded likely approval soon

Topic Adiabatic humidifiers allowed
Would no longer require Steam Type Humidifiers

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 Re-Publication

January 2018 Incorporates all approved addenda

And Then..Issued as Part of 2018 FGI Guidelines

Like Death and Taxes, Unfinished (In Process) and

New Addenda Will Continue After Re-Publication

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 New FGI Guidelines Approach

FGI 2018 will be three books:

Hospital
Outpatient
Residential
170 will be included in its entirety in each
book.
Work underway to identify and organize
requirements for each occupancy.
Outpatient
Residential
May re-format to 3 separate standards for
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2022 addition. ! (Similar to 90.1, 90.2, etc)

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 Addendum n 2013 out for public review now

Creates Chapter 8 - Outpatient Spaces

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 Addendum n 2013 out for public review now

Outpatient spaces

Redundancy requirements for Inpatient only

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 Addendum n 2013 out for public review now

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 Addendum o 2013 coming very soon !

Creates Chapter 9 - Residential Facilities

Some Redundancy requirements may apply Courtesy:

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 WHAT IS THE BIG DEAL?

How Minimum should a Minimum Standard be ?

How many Prescriptive Requirements should exist in the
standard for the perceived safety of the all involved, included
designers ?
170 is under pressure to align or assign to ASHRAE 62
How can a Performance Approach be provided ?
How can a Performance Approach be reviewed by AHJs?

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 Current Activities

Cooling Tower Placement Clarification Recent Legionella Incidences

Alternate Compliance Method Risk Management Approach
Natural Ventilation Separate Working Group
Clean Linen OA Air Change Rate
Outside Air Intake Separation from Exhaust
Clarification of Recirculating Room HVAC Units
Terminology and Space Name coordination with FGI updates

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 Future Areas of Focus

Clarify ED terminology and space

Patient Room Air Distribution
OR Air Distribution
Coordinate Central Sterile Ventilation requirements with AAMI
Add new spaces for Table 7-1
Air Change Rate reductions
Pharmacy requirements (USP 797 / 800)
Anesthesia exhaust

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 WHERE ARE ALL THESE ADDENDA THINGS ?

Go to: https://www.ashrae.org/standards-research--technology/standards-addenda

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 Questions ? Answers ? Comments ? WHAT SHOULD WE CHANGE NEXT ?

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Next meeting ASHRAE Winter Meeting/AHR Show in Las Vegas

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 Thank you for your attention!

Copyright 2016 ASHRAE