ASHRAE Research Project Report CO-RP3 Academic Research to Support Facility Guidelines Institute & ANSI/ASHRAE/ASHE Standard 170
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ASHRAE Research Project Report CO-RP3 Academic Research to Support Facility Guidelines Institute & ANSI/ASHRAE/ASHE Standard 170 Contractor: Facilities Guidelines Institute American Society for Healthcare Engineering (ASHE) Princial Investigator: Ehsan Mousavi Authors: Dr. Ehsan Mousavi, Roger Lautz, Fred Betz, Kevin Grosskopf Author Affiliations, Clemson University, University of Nebraska ‐ Lincoln, Affiliated Engineers, Inc. Sponsoring Committee: TC 9.6, Health Care Facilities Co-Sponsoring Committee: N/A Co-Sponsoring Organizations: ASHE and FGI Shaping Tomorrow’s Built Environment Today © Copyright ASHRAE & ASHE 2019 and FGI a nonexclusive right to publish, reproduce, duplicate and use such reports) providing that the ASHRAE/ASHE copyright notice is included on all copies of the reports) distributed by ASHRAE, ASHE and FGi. ASHRAE, ASHE and FGI may allow others to publish, reproduce, duplicate and use such reports) providing that the ASHRAE/ASHE copyright notice is included on ail such copies of the report(s). ASHRAE, ASHE, and FGI agree that when the reports) is (are) used by ASHRAE, ASHE and FGI, and reproduced for forwarding to others, that the reports shall be reproduced in full and will include all public notices, acknowledgments, and warnings. ASHRAE, ASHE and FGI warrant that they shall distribute the reports) to interested parties at a charge to recipients that does not exceed reasonable out-of-pocket costs for copying, handling, and postage. However, except as provided above, publication of these reports) in technical journals or other publications, whether in whole or in part, is not authorized without the expressed prior consent of You and the Organization. ThisfileislicensedtoStevenHammerling([email protected]).CopyrightASHRAE2020. Academic Research to Support Facility Guidelines Institute & ANSI/ASHRAE/ASHE Standard 170 ASHRAE CO‐RP‐03 Prepared By: Clemson University University of Nebraska ‐ Lincoln Affiliated Engineers, Inc. Prepared for: Facilities Guidelines Institute American Society for Healthcare Engineering ASHRAE Prepared on: February 28, 2019 Revised on: May 3, 2019 © Copyright ASHRAE & ASHE 2019 ThisfileislicensedtoStevenHammerling([email protected]).CopyrightASHRAE2020. Acknowledgements The research team: Dr. Ehsan Mousavi (Clemson University), Roger Lautz, PE (Affiliated Engineers, Inc.), Dr. Fred Betz (Affiliated Engineers, Inc.) and Dr. Kevin Grosskopf (University of Nebraska – Lincoln) would like to thank numerous people and organizations who contributed to the success of this research project. Firstly, and foremost, we would like to thank ASHRAE, FGI, and ASHE for funding this work that sets a foundation for what is known and unknown related to ASHRAE Standard 170, which is referenced in dozens of jurisdictions throughout the world. We would specifically like to acknowledge the Project Monitoring Subcommittee: Jonathan Flannery (ASHE), Kenneth Mead (CDC/NIOSH), Traci Hanegan (Coffman Engineers), Rick Hermans (AECOM), Steve Friedman (Memorial Sloan‐Kettering Cancer Center), and Ed Tinsley (Bernhard Energy) and thank them for their time and effort in providing thorough reviews and feedback to the research team. We further extend our appreciation to the staff at Greenville Health: Drs. William Kelly and Windsor Sherrill and Mrs. Connie Steed for hosting the research team for an afternoon of meetings and correspondence that supported the clinical scope of the research. Several researchers supported the work behind the scenes and we would particularly like to highlight the contributions of Dr. Negin Kananizadeh of Clemson University and Mr. Yiyuan Jia of Affiliated Engineers, Inc. Finally, we are grateful for the broader, interested engineering and scientific community members who contributed by identifying articles for review. This research project has been of keen interest to many parties and we hope that the broader healthcare community finds it valuable. ASHRAE CO‐RP‐03 © ASHRAE/ASHE Revision 1: May 3, 2019 page 1 ThisfileislicensedtoStevenHammerling([email protected]).CopyrightASHRAE2020. Executive Summary The purpose of this study was to conduct a review of ANSI/ASHE/ASHRAE Standard 170‐2013 – Ventilation of Healthcare Facilities to determine whether the 886 requirements defined in the Standard (Part 4 of the FGI Guidelines) are supported by engineering and (or) scientific evidence. This process began by assembling each of the requirements into a comprehensive spreadsheet (Appendix A). From this, the authors and the Project Monitoring Subcommittee (PMS) assigned these requirements into one of three (3) categories: Rational inclusion defines requirements that fall under practical engineering or life‐safety requirements; Clinical inclusion defines requirements that support clinical practices; Evidence‐based inclusion defines those remaining requirements that are supported by published scientific literature. Next, those categorized for evidence‐based inclusion were aligned with found citations that related to the requirement. Finally, the authors provided opinions on whether the evidence suggested the requirement was a basic necessity, an enhanced requirement, requires a change to the standard, is procedural, or requires further investigation. Approximately 162 (18%) of the Standard 170‐2013 requirements were categorized under the definition of rational inclusion. Another 5 requirements (<1%) were categorized under the definition of clinical inclusion. The remaining 719 requirements (81%) were further categorized into eight (8) topical subcategories and subjected to an extensive literature review to determine the strength of evidence supporting these standards. These topical subcategories included: 1. Ventilation rate 2. Supply and exhaust air distribution ASHRAE CO‐RP‐03 © ASHRAE/ASHE Revision 1: May 3, 2019 page 2 ThisfileislicensedtoStevenHammerling([email protected]).CopyrightASHRAE2020. 3. Pressure relationships 4. Anterooms 5. Temperature 6. Relative humidity 7. Recirculation 8. Filtration Keywords and medical subject headings (MeSH) related to these topical areas were systematically searched using available databases (e.g. PubMed, Science Direct, Scopus, etc.). A total of 2,542 publications were initially found. A cursory review of each publication reduced the number of relevant articles to 831 related to ventilation of healthcare facilities (Appendix B) of which 304 (cited by this document) provided original measurements through numerical, experimental, or hybrid methodologies. Next, the conclusiveness of findings (e.g. conclusive, partially conclusive, and non‐conclusive) for each publication was assessed relative to the quality of the study (e.g. good, average, and poor). Qualitative values were numerically weighted from 1 (e.g. randomized, clinical trial) to 6 (recommendations without supporting evidence) and tabulated. In addition, the type of study (e.g. experimental, numerical, case study, literature review, etc.) and study environment (hospital, lab‐scale, simulation, etc.) was recorded for each article. Overall, there are 209 requirements (23.6%) that were determined to be a Basic Necessity as supported by rational inclusion, clinical requirements or evidence and 6 requirements (0.7%) were considered to be Enhanced practices. Twelve requirements (1.4%) were determined to be procedural and not subject to evidence. Evidence was found to support a change to the standard for 8 requirements (0.9%). The remaining 651 requirements (73.5%) did not have evidence or conclusive evidence and are recommended for further study. ASHRAE CO‐RP‐03 © ASHRAE/ASHE Revision 1: May 3, 2019 page 3 ThisfileislicensedtoStevenHammerling([email protected]).CopyrightASHRAE2020. Contents Acknowledgements ....................................................................................................................................... 1 Executive Summary ....................................................................................................................................... 2 Introduction .................................................................................................................................................. 6 Rational Inclusion .......................................................................................................................................... 7 Clinical Inclusion ............................................................................................................................................ 8 Clinical Sources and Circular References .................................................................................................. 9 Clinical Conclusions ................................................................................................................................. 10 Literature Review ........................................................................................................................................ 10 Literature Search Method ........................................................................................................................... 13 Literature Review Results ........................................................................................................................... 16 1. Ventilation rate and boundary conditions ...................................................................................... 16 Introduction .......................................................................................................................................