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Controlling Operating Room Temperature & Humidity

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Controlling Operating Room Temperature & Humidity WISCONSIN HEALTHCARE ENGINEERING ASSOCIATION (WHEA) Operating Room Temperature and Humidity Control © Tom Rossiter Photography Webinar: July 12, 2018 AFFILIATED ENGINEERS, INC. July 12, 2018 | Slide 1 Presenter Introduction KEVIN OTTE, PE ABHISHEK AJANSONDKAR Mechanical Engineer Mechanical Engineer 608-236-1218 608-236-1236 [email protected] [email protected] AFFILIATED ENGINEERS, INC. July 12, 2018 | Slide 2 Agenda Why do we care about OR temperature and humidity control? How do we meet OR temperature and humidity requirements? How do we control OR temperature and humidity? How can we save energy and operational costs while maintaining OR temperature and humidity? AFFILIATED ENGINEERS, INC. July 12, 2018 | Slide 3 Why do we care about OR temperature and humidity control? AFFILIATED ENGINEERS, INC. July 12, 2018 | Slide 4 Why do we care about OR temperature and humidity control? • Code Requirements • Surgical Procedure Requirements • Equipment Requirements • Infection Control • Surgeon Comfort AFFILIATED ENGINEERS, INC. July 12, 2018 | Slide 5 Why do we care about OR temperature and humidity control? • Code Requirements • Surgical Procedure Requirements • Equipment Requirements • Infection Control • Surgeon Comfort AFFILIATED ENGINEERS, INC. July 12, 2018 | Slide 6 Why do we care about OR temperature and humidity control? • Code Requirements • Surgical Procedure Requirements • Equipment Requirements • Infection Control • Surgeon Comfort Image Source: Facilities Guidelines Institute (FGI) AFFILIATED ENGINEERS, INC. July 12, 2018 | Slide 7 Why do we care about OR temperature and humidity control? • Code Requirements • Surgical Procedure Requirements • Equipment Requirements • Infection Control • Surgeon Comfort Image Source: ASHRAE AFFILIATED ENGINEERS, INC. July 12, 2018 | Slide 8 Why do we care about OR temperature and humidity control? • Code ASHRAE 170-2013 Space Design Parameters Table 7.1: Requirements • Surgical Procedure Requirements • Equipment Requirements • Infection Control • Surgeon Comfort Image Source: ASHRAE 170-2013 AFFILIATED ENGINEERS, INC. July 12, 2018 | Slide 9 Why do we care about OR temperature and humidity control? • Code ASHRAE 170-2013 Design Parameters for OR’s: Requirements • Surgical Procedure Requirements 68°F - 75°F • Equipment Requirements • Infection 20% - 60% RH Control • Surgeon Comfort AFFILIATED ENGINEERS, INC. July 12, 2018 | Slide 10 Why do we care about OR temperature and humidity control? ASHRAE 170-2013 Space Design Parameters Table 7.1: • Code Requirements • Surgical Procedure Requirements Table 7.1, Note l: Systems shall be capable of maintaining the rooms • Equipment Requirements within the range during normal operation. Lower or • Infection higher temperature shall be permitted when patient Control comfort and/or medical conditions require those • Surgeon conditions Comfort AFFILIATED ENGINEERS, INC. July 12, 2018 | Slide 11 Why do we care about OR temperature and humidity control? • Code Requirements • Surgical Procedure Requirements • Equipment Requirements • Infection Control • Surgeon Comfort Image Source: Artic Sun Temperature Management System Image Source: IOB Medical AFFILIATED ENGINEERS, INC. July 12, 2018 | Slide 12 Why do we care about OR temperature and humidity control? • Code Requirements • Surgical Procedure Requirements • Equipment Requirements • Infection Control • Surgeon Comfort Image Source: Affiliated Engineers, Inc. AFFILIATED ENGINEERS, INC. July 12, 2018 | Slide 13 Why do we care about OR temperature and humidity control? • Code Requirements Equipment Requirements: • Surgical 65°F - 71°F Procedure Requirements 40% - 60% RH • Equipment Requirements • Infection Control ASHRAE 170 Requirements: • Surgeon Comfort 68°F - 75°F 20% - 60% RH Image Source: Siemens Healthcare AFFILIATED ENGINEERS, INC. July 12, 2018 | Slide 14 Why do we care about OR temperature and humidity control? • Most common type of HAI: Pneumonia and • Code surgical site infection (SSI) Requirements • Surgical Procedure Requirements • Equipment Requirements • Infection Control • • Surgeon Direct costs associated with HAI: $28.4-$45 Billion Comfort (Scott, CDC Paper, 2012) AFFILIATED ENGINEERS, INC. July 12, 2018 | Slide 15 Why do we care about OR temperature and humidity control? • Code 100 Influenza: Total Aerosol Fractions Requirements 80 • Surgical Procedure 60 Requirements 40 • Equipment Requirements 20 % Infectivity • Infection 0 Control 0 10 20 30 40 50 60 70 80 • Surgeon % Relative Humidity Comfort SOURCE: NOTI J, ET AL. HIGH HUMIDITY LEADS TO LOSS OF INFECTIOUS INFLUENZA VIRUS FROM SIMULATED COUGHS AFFILIATED ENGINEERS, INC. July 12, 2018 | Slide 16 Why do we care about OR temperature and humidity control? • Surgeon discomfort is an infection risk • Code Requirements • Sweating • Surgical • Exasperation Procedure • Concentration Requirements • Equipment Requirements • Infection Control • Surgeon Comfort Illustration © Affiliated Engineers, Inc. AFFILIATED ENGINEERS, INC. July 12, 2018 | Slide 17 Why do we care about OR temperature and humidity control? Per ASHRAE 170, Table 7.1, • Code note (o): Requirements • Surgical Surgeons or surgical Procedure procedures may require room Requirements temperatures, ventilation • Equipment Requirements rates, humidity ranges, and/or • Infection air distribution methods that Control exceed the minimum • Surgeon indicated ranges. Comfort Illustration © Affiliated Engineers, Inc. AFFILIATED ENGINEERS, INC. July 12, 2018 | Slide 18 How do we meet OR temperature and humidity requirements? AFFILIATED ENGINEERS, INC. July 12, 2018 | Slide 19 How do we meet OR temperature and humidity requirements? Sources of Heat • Occupants • Lights • Equipment Sources of Humidity • Occupants © Tom Rossiter Photography AFFILIATED ENGINEERS, INC. July 12, 2018 | Slide 20 Example Hospital 10’-0” Ceilings 10 People 2 W/SF Lighting 12 W/SF Equipment 42°F Chilled Water 10 psi Low Pressure Steam 160°F Heating Hot Water Image Source: Affiliated Engineers, Inc. AFFILIATED ENGINEERS, INC. July 12, 2018 | Slide 21 Standard Operating Room 68°F and 30% to 60%RH AFFILIATED ENGINEERS, INC. July 12, 2018 | Slide 22 Standard OR University of Colorado Health, Longs Peak Hospital Image Source: Affiliated Engineers, Inc. AFFILIATED ENGINEERS, INC. July 12, 2018 | Slide 23 What is your primary means of maintaining temperature in an operating room? AFFILIATED ENGINEERS, INC. July 12, 2018 | Slide 24 Typical OR Ceiling AFFILIATED ENGINEERS, INC. July 12, 2018 | Slide 25 Standard Operating Room 68°F, 30%-60% RH • Cooling Airflow Required: • Sources of Heat o Sensible load: 31,500 BTU/H and Humidity o Load=1.085xCFMx(68°F– 55°F) [50°F Leaving the Cooling Coil + Fan Heat] o Room Airflow=2,200 CFM → Does not meet FGI requirements! • Standard OR • Hybrid Imaging OR • Cardiovascular OR • C-Section OR • Code Required Airflow: o 700x10x20/60 = 2,400 CFM AFFILIATED ENGINEERS, INC. July 12, 2018 | Slide 26 Standard Operating Room - Psychrometrics • Cooling coil leaving air dewpoint must be less than 51°F AFFILIATED ENGINEERS, INC. July 12, 2018 | Slide 27 Hybrid (Imaging) Operating Room 65°F and 30% to 60%RH AFFILIATED ENGINEERS, INC. July 12, 2018 | Slide 28 Hybrid OR Houston Methodist Hospital, Walter Tower Image Source: Affiliated Engineers, Inc. AFFILIATED ENGINEERS, INC. July 12, 2018 | Slide 29 Hybrid Imaging OR 65°F, 30%-60% RH • Sources of Heat and Humidity • Standard OR • Hybrid Imaging OR Standard OR • Cardiovascular OR • C-Section OR Image Source: Siemens Hybrid OR AFFILIATED ENGINEERS, INC. July 12, 2018 | Slide 30 • Sources of Heat and Humidity • Standard OR • Hybrid Imaging OR • Cardiovascular OR • C-Section OR AFFILIATED ENGINEERS, INC. July 12, 2018 | Slide 31 Image Source: Siemens Hybrid OR Hybrid Imaging OR 65°F, 30%-60% RH • Cooling Airflow Required: • Sources of Heat o Sensible load: 50,000 BTU/H and Humidity o Load=1.085xCFMx(65°F– 52°F) [47°F Leaving the Cooling Coil + Fan Heat] o Room Airflow=3,600 CFM → 25 ACH → More than FGI • Standard OR requirements! • Hybrid Imaging OR • Cardiovascular OR • C-Section OR • Code Required Airflow: o 700x10x20/60 = 2,400 CFM AFFILIATED ENGINEERS, INC. July 12, 2018 | Slide 32 Hybrid Imaging OR • Cooling coil leaving air dewpoint must be less than 48°F AFFILIATED ENGINEERS, INC. July 12, 2018 | Slide 33 Cardiovascular (Low Temperature) Operating Room 60°F and 30% to 60%RH AFFILIATED ENGINEERS, INC. July 12, 2018 | Slide 34 Cardio OR Houston Methodist Hospital, Walter Tower Image Source: Affiliated Engineers, Inc. AFFILIATED ENGINEERS, INC. July 12, 2018 | Slide 35 Cardiovascular OR 60°F, 30%-60% RH • Cooling Airflow Required: • Sources of Heat o Sensible load: 45,000 BTU/H and Humidity o Load=1.085xCFMx(60°F– 48°F)[37°F Leaving Cooling Coil +Reheat+ Fan Heat] o Room Airflow=3,400 CFM → 25 ACH → More than FGI • Standard OR requirements! • Hybrid Imaging • Requires low temperature chilled water to hit space dew point OR condition • Cardiovascular OR • C-Section OR • Code Required Airflow: o 700x10x20/60 = 2,400 CFM AFFILIATED ENGINEERS, INC. July 12, 2018 | Slide 36 Cardiovascular OR • Cooling coil leaving air dewpoint must be less than 38°F AFFILIATED ENGINEERS, INC. July 12, 2018 | Slide 37 Cardiovascular OR 60°F, 30%-60% RH • Sources of Heat and Humidity • Standard OR • Hybrid Imaging OR Methods to address the strict dehumidification requirement • Cardiovascular will be addressed in the next section of the presentation OR • C-Section OR AFFILIATED ENGINEERS, INC. July 12, 2018 | Slide 38 C-Section Operating Room 80°F and 30% to 60%RH
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