ANSI/ASHRAE/ASHE Standard 170-2008

ASH

WASHE STANDARD

Ventilation of

Health Care Facilities

Approved by the ASHRAE Standards Committee on June 21,2008; by the ASHRAE Board of Directors on
June 25,2008; by the American Society for Healthcare Engineering of the American Hospital Association on
July 18,2008; and by the American National Standards Institute on July 24, 2008.
This standard is under conlnuous maintenance by a Standing Standard Project Committee (SSPC) for which
the Standards Committee has established a documented program for regular publication of addenda or revisions, including procedures for timely, documented, consensus action on requests for change to any part of
the standard. The change submittal form, instructions, and deadlines may be obtained in electronic form from
the ASHRAE Web site, hHp:llwww.ashrae.org, or in paperform from the Manager of Standards. The latest edil o n of an ASHRAE Standard may be purchased from ASHRAE Customer Sewice, 1791 Tuiiie Circle, NE,
Atlanta, GA 30329-2305. E-mail: orders@ashrae.org. Fax: 404-321-5478. Telephone: 404-636-8400 (worldwide), or toil free. 1-800-527-4723 (for om'effi in US and Canada).

Q Copyright 2008 American Society of Healna, Refricleratina and Air-conditioning Engineers. Inc.

American Society olHeating. Rerrigeracing

and Air-conditioning Engineers. Inc.
179 1 Tullie Circle NE, Atlanta. GA 30329
www.ashrae.org

~ImeriennSodeiyrar Hdth-

Englnee

c~lll~i.dmuiiculiIurl~iWi,\rri~or~on

ASHRAE Standing Standard Project Committee 170

Cognizant TC: TC 9.6, Healthcare Facilities
SPLS Liaison: H. Michael Newman
Richard D. Hermans, Chair'
Paul T.Ninomura, Vice-Chair'

Peter Hogan Langowski'

Anand K. Seth'

Michael F. Mamayek, Secretary*

<-)

Rajendra N. Shah'
Dennis E. Shaughnessy
Michael Patrick Sheerin'

Theodore Cohen*
George A. Freeman
Gerald L. Hendrickson

Robert J. Weber
Michael E. Woolsey'

Michael R. Keen*
William M. Kingrey

Xudong Yang

Marvin L. Kloostra'

Michael Mayo

Frederick H. Kohioss
'Denotes members o f voting status when the document was approved forpublication
ASHRAE STANDARDS C O M M I T E E 2007-2008
Stephen D. Kennedy, Chair
Nadar R. Jayaraman
Byron W. Jones
Hugh F. Crowther, Vice-Chair
Robert G. Baker
Jay A. Kohler
James D. Lutz
Michael F. Beda
Donald L. Brandt
Carol E. Marriott
R. Michael Martin
Steven T. Bushby
Paul W. Cabot
Merie F. McBride
Kenneth W. Cooper
Frank Myers
H. Michael Newman
Samuel D. Cummings, Jr.
K. William Dean
Lawrence J. Schoen
Bodh R. Subherwal
Robert G. Doerr
Jerry W. White, Jr.
Roger L. Hedrick
Bjarne W. Olesen. BOD Ex0
Eli P. Howard, iii
Lynn G. Bellenger, CO
Frank E. Jakob
Claire B. Ramspeck. Assistant Director o f Technology for Standards and Special Projects
SPECIAL NOTE
This American National Standard (ANS) is a national voluntary consensus standard developed under the auspices of the American
Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE). Consensus is defined by the American National Standards
reached bv
Institute [ANSII.
, of which ASHRAE is a member and which has aooroved this standard as an ANS, as 'substantial aareement
directly and materially affected Interest categorlas.This signifies the concurrence of more than a simple majorily, but not necessarily unanimity.
Consensus requires that all views and objections be considered, and that an effort be made toward their resolution." Compliance with this
standard is voluntary until and unless e legal jurisdiction makes compliance mandatory through legislation.
ASHRAE obtains consensus throush oarticieatlon of ik national and international members, associated societies, and public review.
ASHRAE Slandards are preparedby'a ~roiectCornmtttee appolnled specifically for the purpose of wrlllng the Standard. The Pro,ect
Commlltee Chetr and Vice-Chair mLsl oe memban of ASnRAE: wh le otner commlnee members may or may no1 be ASHRAE members, all
must be technically qualified in the subject area of the Standard. Every effort is made to balance the concerned Interests on all Projecl
Committees.
The Assistant Director of Technology for Standards and Special Projects of ASHRAE should be contacted for:
a. interpretation of the contents of this Standard,
b. participation in lne next review of the Stanoard.
c. olierlng conslr-cl:ve crilicism tor improving the Standaro, or
d. permi&ion to reprint portions of the Standard.

..

DISCLAIMER
ASHRAE uses its best elforts to promulgate Standards and Guidelines for the benefit of the public in light of available Informationand
accepted lnd~strypmcl ces. However, ASHRAE does not gJaranlee. cenlhl. or assLre lhe salely or
of any prod.cts, components.
or svslems lened, nsta eo. or operated in accordance wtn ASHRAE'S Slanoards or Gu dellnes or lnat any lesls conducted Jnoer 11s
~taidardsor Guidelines will be nanhazardousor free from rislc
I

ASHRAE INDUSTRIAL ADVERTISING POLICY ON STANDARDS

ASHRAE Standards and Guidelines are established to assist Industry and the public by offering a uniform method of lestlng for rating
purposes, by suggeslingsafepracticesin designing andinstalling equipment, by providing properdefinitions ofthis equipment, andby providing
otherinformationthat may serve toguide theindustry. The creation of ASHRAE Standards and Guidelines is determined by the need forthem,
and conformance to them is completely voluntary.
in referring to this Standard orGuideline and in marking of equlpmentandin advertising, no claim shall be made, ellher stated or implied,
that the product has been approved by ASHRAE.

CONTENTS
ANSVASHRAUASHE Standard 170-2008
Ventilation of Health Care Facilities
PAGE

SECTION

Foreword...................................................................................................................................................................
. ~,

1 Purpose ....................................................................................................................................................

2 Scope ....................................................................................................................................................

3 Definitions................................................................................................................................................. 2

4 Compliance..................................................................................................................................................

5 Planning.................................................................................................................................................. 4
6 Systems and Equipment...............................................................................................................................

7 Space Ventilation ........................................................................................................................................

8 Planning, Construction, and System Start Up .........................................................................................

11

9 Normative References............................................................................................................................

12

lnformative Annex A ......................................................................................................................................

12

lnformative Annex B: Bibliography ...................................................................................................................

13

NOTE

When addenda, interpretations, or errata to this standard have been approved, they can be downloaded free of
charge from !he ASHRAE Web site at *wm.ashrae.org.

O Copyright 2008 American Society of Heating,

Refrigerating and Air-Conditioning Engineers, Inc.

1791 Tullie Circle NE

Atlanta. GA 30329
www.ashrae.org
All rights reserved.

lriglr risk irrr~~~trnocorr~pror~risPdpatients:

patients who have
the greatest risk of infection caused by airborne or waterborne
microorganisms. These patients include but are not limited to
allogeneic stem-cell transplant patients and intensive chemopatients.

)7

rrrfectron cortholrisk assessrrrent (ICRA): a determination of

the potential risk of transmission of various infectious agents
in the facility, a classification of those risks, and a list of
requiredpractices for mitigating those risks during conshuction or renovation.
ir~r~r~trr~aconrpranrised
patients: patients whose immune
mechanisms are deficient because of immunologic disorders
(e.g., human immunodeficiency virus [HIV] infection or
congenital immune deficiency syndrome), chronic diseases
(e.g., diabetes, cancer, emphysema, or cardiac failure), or
immunosuppressive therapy (e.g., radiation, cytotoxic chemotherapy, anti-rejection medication, or steroids) (see CDC
[2003] in Informative Annex B: Bibliography).

inpotierrt. apatient whose stay at the health care facility is anticipated to require twenty-four hours or more of patient care.
-

irrvasive if~ro~~rrgprocedrrre
room: a room in which radiographic imaging is used and in which instruments or devices
are insertedinto patients through the skin orbody o s c e under
sterile conditions for diagnosis andlor treatment.
non-aspirating difftrser: a diffuser that has unidirectional
downward airflow from the ceiling with minimum entrainment of room air. Classified as ASHRAE Group E, these
diffusers generally have very low overage veloci@. For the
purposes of this standard, the performance of these d i e r s is
to be measused in terms of average velocity.

protective environrne~rtroorrr: a patient room that is designed

according to this standard and intended to protect a high ~isli
in~mtrnocompmmisedpatientfrom human and environmental
airborne pathogens.
triage: the process of determining the severity of the illness of
or injury to patients so that those who have the most emergent
illnesses/iinjuries can be treated immediately and those less
severely injured can be treated later or in another area.
4.

'

COMPLIANCE

4.1 Compliance Requirements

4.1.1 New Buildings. New buildings shall comply with
the provisions of this standard.
4.1.2 Existing Buildings
4.1.2.1 Additions to Existing Buildings. Additions
shall comply with the provisions of this stmdard.
4.1.2.2 Alterations to Existing Buildings. Portions of
a heating, ventilating, and air-conditioning system and other
systems and equipment that are being altered shall comply
with the applicable requirements of this standard.
4.1.2.2.1 Head.g,Ven~ation,~ndiMonditioning
System Alterations. Alterations to mechanical systems sewing
the building heating, cooling, or ventilating needs shall comply

with the requirements of Section 6, "Systems and Equipmenk"

applicable to those specific poltions of the building and its systems that are being altered. Any new mechanical equipment
installed in conjunction with the alteration as a direct replacement of existing mechanical equipment shall comply with the
provisions of Sections 6.2,6.4,6.5, and 6.6.

4.1.2.2.2 Space Alterations. Alterations to spaces

listed in Table 6-1 (see page 5) shall comply with the requirements of Section 6.7 and Section 7, "Space Ventilation," applicable to those specific portions of the building and its systems
that are being altered Any alteration to existinghealth care space
in a building that will continue to treat patients during conshuction shall comply with Sections 8.1, 8.3, 8.4, and 8.5.
4.2 Administrative
Requirements.
Administrative
requirements relating to permit requirements, enforcement by
the authority having jurisdiction, interpretations, claims of
exemption, approved calculation methods, rights of approved
calculation methods, and rights of appeal are specified by the
authority having jurisdiction.
4.3 Compliance Documents
4.3.1 GeneraL Compliance documents are those plans,
specifications, engineering calculations, diagrams, reports,
and other data that are approved as part of the permit by the
authority having jurisdiction. The compliance documents
shall include all specific construction-relatedrequirements of
the owner's infection contra1risk assessment.
4.3.2 Construction Details. Compliance documents shall
contain all pertinent data and features of the building, equipment, andsystems in sufficient detail to allow a determination
of compliance by the authorityhaving jurisdiction and to indicate compliance with the requirements of this standard
4.3.3 Supplemental Information. Supplemental information necessary to veriFy compliance with this standar4
such as calculations, worksheets, compliance forms, vendor
literature, or other data, shall be made available when required
by the authority having jurisdiction.

4.4 Alternate Materials, Methods of Construction, or

Design. The provisions of this standard are not intended to
prevent the use of any material, method of construction,
design, or building system not specifically prescribed herein,
provided such construction, design, or building system has
been approved by the authority having jurisdiction as meeting
the intent of this standard
4.5 Informative Appendices. The informative appendices
to this standard andinformative notes located within this standard contain recommendations, explanations, and other nonmandatory information and are not part of this standard.
4.6 Criteria Ranges. This standard often specifies a range
of values that will comply with a speciiic requirement of the
standard Ifit ispermittedby the authority havingjurisdiction,
compliance with this requirementmay be achieved by the presentation of compliance documents that demonstrate a system's ability to perform within the specified range.

TABLE 6-1

Minimum Filter Efficiencies

Space Designation (According to Bunction)

Fiter Bank Number 1

Filter Bank Number 2

(MERV)"

WRv)'

Classes B and C surgery; inpatient and ambulatory diagnostic and therapeutic

radiolow; inpatient delivery and recovery spaces

14

Inpatient care, treatment, and diagnosis, and those spaces providing direct service or
clean supplies and clean processing (except as noted below);
An (rooms)

14

Protective environment rooms (PE)

17 (HEPA)'

Laboratories; Class A surgery and associated semi-reshicted spaces

1 3 ~

NIR*

Administrative; bulk storage; soiled holding spaces; food preparation spaces; and
laundries

NIR

All other outpatient spaces

NIR

Skilled nursine facilities

NIR

NR = not rquired
Notes The minimum cficiency reportingvnlue (MERV)ir basedon Ule meUlad oitening dsmibibcd in..tNSI/A5fRdE Sior~dotd52.11-2007, Metbod of Tertinp,Geneml l'enriiotion
Air-CleoningDwicerforRemo~01Ej7cIe8tq @P~?rticlcSize ( i e e I n f o d v c h e n 6 : Bihliapphy).
Note b: Additional picfillen m y be usedtoroducc mnintmancc for fillen with eficiends h i g h m h MERV 7.
Note c: Fiitcr B d c No. l may be n MERV 14 if n MERV 17 t d q terminn1 fiitrri3 provided for thee ipnces.

TABLE 6-2

Supply Air Outlets

Space Designation (According to Function)

All class A, B, and C surgeriesb
Protective environment (PE) rooms
Wound intensive care units (bum units)
Trauma rooms (crisis or shock)
A11 rooms
All other spaces

Supply Air Outlet ClassEcationn

Primary supply diffusers Group E, non-aspirating
additional supply difwesers, Group E
Group E, non-aspirating
Group E, non-aspirating
Group E, non-aspirating
Group A or Group E
Group A or Gmup E

Note c R e f a t o 2 M 5 ~ H o n d b o o k - F u n d ~ m e n 1 ~ 'Cbppta35,
,
for dehitiom reinred to auua clasiifimtion n n d p e r f o m c e (see Informotive Amen 8: Bibliopphy).
Note b: Swgeonr may require dtonnte air-dir&ibibudonsystem forromespeciakcd m g n i s . Suchrystcmr r b l i be consideredocccptnblc iffltey meet or a c e d the requircrnents
oilhi. s t m d d

6.5.2 Radiant Cooling Systems. If radiant coolmg panels

are utilized, the chilled-water temperature shall always
remain above the dew point temperature of the space.
6.5.3 Radiant Heating Systems. If radiant heating is provided for an A11room, aprotective environment room, a wound
intensive care unit @urn unit), or aroom for any class of surgery, either flat andsmooth radiant ceilingpanels with exposed
cleanable surfaces or radiant floor heating shall be used.
-

6.6 Humidifiers. When outdoor hum~dityand internal

moisture sources are not sufficient to meet the requirements
of Table 7.1, humidification shall be provided by means of
the health-care facility air-handling systems. Locate humidifiers within air-handling units or duchvork to avoid moisture accumulation in downstream components, including
filters and insulation. Chemical additives used for steam
humidifiers serving health care facilities shall comply with
FDA requirements.' Reservoir-type water humidifiers or
evaporative-pan-type humidifiers shall not he used in ductwork or air-handling units in health care facilities. A humidity sensor shall be provided, located at a suitable distance
downstream from the steam injection source. Controls shall
he provided to limlt duct humidity to a maximum value of

90% RH when the humidifier is operating. Humidifier steam

control valves shall be designed so that they remain om
whenever the air-handling unit is not in operation.

6.7 Air Distribution Systems

6.7.1 General. Maintain the pressure relationships
requiredinTable 7-1 in all modes ofHVAC system operation,
except as noted in the table. Spaces listed in Table 7-1 that
have required pressure relationships shall be served by fully
ducted returns. The air-distribution design shall maintain the
required space pressure relationships, taking into accountrecommeoded maximu& filter loading, heating-season lowered
aimow operation, and cooling-season higher airflow operation. Airstream surfaces of the air-distribution system downstream of Filter Bank No. 2, shall comply with Section 5.5 of
ANSVASHRAE Standard 62.1-2007. The air-distribution
system shall be provided with access doors, panels, or other
means to allow convenient access for inspection and cleaning.
(For further information, see ANSIIASHRAE Standard 62.1 .)
6.7.2 Air-Distribution Devices. All air-distribution
devices shall meet the following requirements:

a.

b.
c.
-

Surfaces of air-distribution devices shall be suitable for

cleaning. Supply air outlets in accordance with Table 6-2
shall be used
The supply difFusers in Classes B and C surgeries shall be
designed and installed to allow for internal cleaning.
Psychiatric, seclusion, and holding-patient rooms shall be
designed with security ditfusers, grilles, and<egisters.

7. SPACE VENTILATION
The ventilation requirements of this standard are minimums that provide control of environmental comfort, asepsis,
and odor in health care facilities. However, because they are
minimum requirements and because of the diversity of the
population and variations in susceptibility and sensitivity,
these requirements do not provide assured protection fiom
discomfort, airbome transmission of contagions, and odors.

2.
3.
4.

7.2 Additional Room Specific Requirements

7.2.1 Airborne Infection Isolation (AII) Rooms. Ventilation for A11 rooms sball meet the following requirements
whenever an infectious patient occupies the room:

7.1 General Requirements. The following general

requirements sball apply for space ventilation:

1. Spaces shall be ventilated according to Table 7-1

a. Design of the ventilation system shall provide air
movement that is genedly fiom clean to less
clean areas. If any form of variable-air-volume or
load-shedding system is used for energy conservation, it shall not compromise the pressure balancing relationships or the minimum air changes
required by the table. See Table 7-1 note (t) for
additional information.
b. The ventilation rates in this table are intended to
provide for comfort as well as for asepsis and
odor control in areas of a health care facility that
directly affect patient care. The air change rates
specified are for supply in positive pressure
rioms and for exhaust in negative pressure
rooms. Ventilation rates for many areas not specified here can be found in ANSIIASHRAE Standard 62.1 (see Informative Annex B:
Bibliography). Where areas with prescribed rates
in both Standard 62.1-2007 and Table 7-1 of this
standard exist, the higher of the two air change
rates shall be used
c. For design purposes, the minimum number of
total air changes indicated shall be either supplied for positive pressure rooms or exhausted
for negative pressure rooms. For spaces that
require a posilive or negative pressure relationship, the number of air changes can be reduced
when the space is unoccupied, provided that the
required pressure relationship to adjoining
spaces is maintained while the space is unoccupied and that the minimum number of air
changes indicated is reestablished anytime the
space becomes occupied. Air change rates in
excess of the minimum values are expected m
some cases in order to maintain room tempera-

ture and humidity conditions based upon the

space cooling or heating load.
Air filtration for spaces shall comply with Table 6-1.
Supply air outlets for spaces shall comply with Table 6-2.
In A11 rooms, protective environmentrooms,wound intensive -care units (bum units), and rooms for all classes of
surgery, heating with supply air or radiant panels that meet
the requirements of Section 6.5.3 sball be provided.

b.

c.

e.

f.

Each A11 room shall comply with requirements of Tables

6-1, 6-2, and 7-1. A11 rooms sball have a permanently
installed device and/or mechanism to constantly monitor
the differential air pressure between the room and adjacent spaces of the room when occupied by patients with
an airbome infectious disease. A local visual means sball
be provided to indicate whenever negative differential
pressure is not maintained.
AU air from the All room shall be exhausted.directly to
the outdoors.
Exception: A D rooms that are retrofitted from standard patient rooms from whicb it is impractical to
exhaust directly outdoors may be ventilated with recirculated air from the room's exhaust, provided that the air
f i s t passes through a HEPA (MERV 17) filter.
All exhaust nir from the AII rooms, associated anterooms,
&d associated toilet rooms shall be discharged directly to
the outdoors without &mg with exhaust air from any
other non-AII room or exhaust system.
Exhaust air grilles or registers in the patient room sbaU be
located directly above the patient bed on the ceiling o r o n
the wall near the head of the bed unless it can be demonstrated that such a location is not practical.
The room envelope shall be sealed to limit leakage air
flow at 0.01 in. wc (2.5 Pa) differential pressure across the
envelope.
i
Differential pressure between AII rooms and adjacent
spaces that have a different function sball be a minimum
of-0.01 in. wc (-2.5 Pa).

7.2.2 Protective Environment (PE) Rooms. Ventilation

for PE rooms sball meet the following requirements:

a The room envelope sball be sealed to l i t leakage air

b.

flow at 0.01 in. wc (2.5 Pa) differentialpressure across the

envelope.
Each PE room shall comply with the requirements of
Tables 6-1, 6-2, and 7-1. PE rooms shall have a permanently installed device and/or mechanism to constantly
monitor the differential air pressure between the room
and adjacent spaces of the room when occupied by
patients requiring &protectiveenvironment A local visual
means shall be provided to indicate whenever positive
differential pressure is not maintained.

2r

TABLE 7-1

Design Parameters

Pressure

LA (I[),

Dcsign Temperature (l),

n
-2

0,

Classes B and C operating rooms, (m), (n), (0)

Opemtinglsurgical cystoscopic rooms, (m),(n) (0)

Positive
Positive

4
4

20
20

NR
NR

No
No

30-60
30-60

68-75120-24
68-75120-24

Delivery room (Caesarean) (m), (n), (0)

Positive

20

NiR

No

30-60

68-75120-24

Substerile service area

NR

NR

No

NIR

NIR

Recovery room

NR

NiR

No

30-60

70-75/2 1-24

Critical and intensive care

Positive

NiR

No

30-60

70-7512 1-24

Wound intensive a r e (burn unit)

Positive

NR

No

40-60

70-75/21-24

Newbom intensive care

Positive

NIR

No

30-60

70-75/21-24

Treahnent room (p)

NR

NIR

NR

30-60

70-7512 1-24

30-60

70-7512 1-24

Trauma room (crisis or shock) (c)

Positive

N/R

No

Medicallanesthesia gas stomge (r)

Negative

Yes

NIR

NIR

NIR

Laser eye room

Positive

N/R

No

30-60

70-7512 1-24

ER waiting rooms (q)

Negative

Yes

NR

mnx 65

70-75/2 1-24

Triage

Negntive

Yes

NR

max 60

70-7512 1-24

ER decontamination
Rndiology waiting rooms (q)

Negative
Negative

12

Yes
Yes

No
NIR

NIR
maw 60

NIR
70-7512 1-24

Class A OperntingProcedure room (o), (d)

INPATIENT NURSING

Positive

15

NR

No

30-60

70-7512 1-24

Patient room (s)

NIR

NiR

NIR

max 60

70-75/2 1-24

Toilet room

Negative

NIR

10

Yes

No

NIR

NIR

Newbom nursery suite

Protective environment room (0,(n), (t)

NIR
Positive

2
2

6
I2

NIR
NIR

No
No

30-60
max 60

A11 room (e), (n), (u)

A11 isolntiol~anterooln (t) (u)

Negative
NR

2
NR

12
LO

Yes
Yes

No
No

mnx 60
NR

72-78/22-26
70-7512 1-21
70-797 1-24
NIR

Labor/deliveryIrecovery/poslpartum(LDRP) (s)

NR

NIR

NR

max 60

70-75/2 1-24

Laboddeliverylrecovery (LDR) (s)

NIR

NIR

NR

max 60

70-7512 1-24

Note: NiR= no requirement

?
5 i

TABLE 7-1

Deslgn Parameters

Pressure

RH (I[),
,"

O/"

F!
2

Design Temperature (I),

DAPP
-,

Exnmination room
Medication room

(n)
NR
Positive

2
2

6
4

t o Outdoors (j)

NR
NIR

NIR
NIR

max 60
mnx 60

70-75D 1-24
70-7512 1-24

Endoscopy

Positive

15

NIR

No

30-60

68-7300-23

Endoscope cleaning

Negative

I0

Yes

No

NIR

NIR

Treahnent room

NR

NIR

NR

max 60

70-7512 1-24

Hydrotherapy

Negative

NR

NR

NIR

72-80122-27

Pllysical tl~empy

Negative

NIR

NIR

Max 65

72-80122-27

Negative

NIR

10

Yes

No

NIR

NIR

Soiled or deconhmination room

Negative

Yes

No

NIR

72-78122-26

Clean worlcroom

Positive

NiR

No

lnax 60

72-78122-26

Sterile stornge

Positive

NR

NR

max 60

72-7802-26
72-78122-26

STERILIZING
Sterilizer equipment room
CENTRAL MEDICAL AND SURGICAL SUPPLY

SERVICE
Food preparntion center (i)

NR

10

NIR

No

NIR

Warewashing

Negative

NR

10

Yes

No

NIR

Dietnry storage

NR

NR

NR

No

NIR

72-78122-26

Laundry, general

Negative

10

Yes

No

NIR

NIR

Soiled linen sorting and storage

Negative

NR

10

Yes

No

NIR

NIR

Clenn linen storage

Positive

NR

NR

NIR

NIR

72-78122-26

NIR

Linen and trash chute room

Negative

NR

10

Yes

No

NIR

NIR

Bedpan room

Negative

NIR

10

Yes

No

NIR

NIR

Bathroom

Negative

NR

10

Yes

No

NIR

72-78122-26

Janitor's closet

Negative

NIR

10

Yes

No

NR

NIR

Soiled workroom or soiled l ~ o l d i g

Negative

10

Yes

No

NIR

Clean worlctoom or clean holding

Positive

NR

NR

NR

Havlrdous material storage

Negative

10

Yes

No

NIR

SUPPORT SPACE

Noto:
D

Nm = no requirement

NIR

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Air distribution patterns within the protective environment room shall conform to the following:
Supply air diffusers shall be above the patient be&
unless it can he demonstrated that such a location is
not practical. Diffuser design shall limit air velocity
at the patient bed to reduce patient discomfort. (See
ANSI/ASHR/IE Staildard 55-2004, Tlzerntal Einlirortntentol Coilditions for Htrnlail Ocnrpanqi in
Informative Annex B: Bibliography.)
Returdexhaust grilles or registers shall be located
near the patient room door.
Differential pressure between any dissimilar adjacent
d. spaces shall be a minimum of +0.01 in. wc (t2.5 Pa).
e. PE rooms retrofitted from standard patient rooms may be
ventilated with recirculated air, provided that air lint
passes through aHEPA filter and the room complies with
parts "a" through "d" of this section.

c.

Critical Care Units

7.3.1 Wound Intensive Care Units (Burn Units). Bum
unit patient rooms that require humidifiers to comply with
Table 7-1 shall be provided with individual humidity control.
7.3

Surgery Rooms
Class B and C Operating Rooms. Operatingrooms
shall be maintained at a positive pressure with respect to all
adjoining spaces at all times. A pressure differential shall be
maintained at a value of at least +0.01 in. wc (2.5 Pa). Operating rooms sball be provided with prirnnry supply diffusers
that are designed as follows:

accordance wtth the vent~lationrequirements for Class A surgexy. If anesthetic gases are administered, ventilation shall be
provided in accordance with the ventilation requirements for
Class B or C surgery.
7.5

Support Spaces

7.5.1 Morgue and Autopsy Rooms. Low sidewall

exhaust grilles shall be providedunless exhaust air is removed
through an autopsy table designed for this purpose. All exhaust
air from autopsy, nonrekigerated body-holding, and morgue
rooms shall he discharged directly to the outdoors without
mixing with air from any other room or exhaust system.

8. PLANNING, CONSTRUCTION, AND

SYSTEM STARTUP
8.1 Overview. For HVAC systems serving surgery and critical care spaces, compliance with this standard requires preparation of an acceptance testing plan.
8.2 Planning for the HVAC Services in a New Facility.
Design documents for new construction shall meet the following requirements:

7.4

7.4.1

The airflow shall be unidirectional, downwards, and the

merage velocity of the diffusers shall he 25 to 35 ciW@
(127 ~ l d m 'to 178 ~ s l m ' ) .The diffusers shall be concentrated to provide an airflow pattem over the patient and
surgical team. (see Memanadeh [2002] and Memarzadeh
[2004] in Informative AunexB: Bibliography.)
b. The area of the p h a r y supply diffuser array shall extend
a minimum of 12 in. (305 mm) beyond the footprint of
the surgical table on each side. No more than 30% of the
primary supply d i e r array area sball be used for nond i i s e r uses such as lights, gas columns, etc. Additional
supply d i e t s may be required to provide additional
ventilation to the operating room to achieve the environmental requirements of Table 7-1 relating to temperature,
humidity, etc.

The roomsball he providedwith at least two low sidewall

rehlrn or exhaust ,dies spaced at opposite corners or as far
apart as possible, with the bottom of these grilles installed
approximately 8 in. (203 mm) above the floor.
7.4.2 Sterilization Rooms. Steam that escapes from a
steam sterilizer shall be exhausted using an exhaust hood or
other suitable means. Ethylene oxide that escapes from a gas
sterilizer shall be exhausted using an exhaust hood or other
suitable means.
7.4.3 Imaging Procedure Rooms. If invasive procedures
occur in this type of room, ventilation shall be provided in
ANSUASHRAUASHE Standard 110-2008

General Mecl~anicalEquipment Rooms. The access to

mechanical rooms shall be planned to avoid the intrusion
of maintenance personnel into surgical and critical care
patient spaces.
b. Mechanical Room Layout. Mechanical room layout
shall include sufficient space for access to equipment for
operation, maintenance, and replacement. Floors in
mechanical rooms shall be sealed, including sealmg
around aU penetrations, when they are above surgical
suites and critical care.
c. MaintenancdRepair Personnel Access. Safe andpractical
means of accessing equipment shall be provided. Clearance is required at all senrice points to mechanical equipment to allow personnel access and working space. The
access to mechanical equipment sball he planned to make
it unnecessary for maintenance personnel to intrude into
surgical or critical care rooms.
d. Cooling Towers. Cooling towers shall be located so that
drift is directed away from air-handlmg unit intakes. They
sball meet the requirements of Section 6.3.2.

a.

83

Planning for tbeHVAC Services in an Existing Facility.

If any existing air-handling equipment is reused, the designer
shall evaluate the capacity of the equipment to determine
whetber it will meet the requirements of this standard for the
remodeled space.
8.4 Planning for Infection Control During Remodeling
of an Existing Facility. Prior to beginning modifications or
remodeling of HVAC systems in an existing facility, an owner
sball conduct an infection control risk assessment (ICRA).
The ICRA shall establish those procedures required to minimize the dismption of facility operation and the distribution
of dust, odors and particulates.

8.5 Documentation of New or Remodeled HVAC Systems. Owners shall retain an acceptance testingreportfor their
files. In addition, the design shall include requirements for
operations and maintenance staff training that is sufficient for
the staff to keep all HVAC equipment in a condition that will
maintain the original design intent for ventilation. Training of
operating staff shall include an explanation of the design
intent. The training materials shall include, at a m i n i m , the
following:

O&M procedures
Temperatuse and pressure control operation in all modes
Acceptable tolerances for system temperatures and
pressures
d Procedures for operations under emergency power or
other abnormal conditions that have been considered in
the facility design.

a.
b.
c.

8.6 Duct Cleanliness. The duct supply system shall meet

the following requirements for cleanliness:

a
-

h.
c.

The duct system shall be free of construction debris. New

supply duct system installations shall comply with level
WB:' the Intermediate Level of SMACNA Duct Cleanliness for New Construction ~uidelines?
The supply diffusers in the Class B & C operatin,0 rooms
shall he opened and cleaned before the space is used.
The permanent W A C systems shall not be operated
unless protection from contamination of the air distribution system is provided.

9. NORMATIVE REFERENCES

' Code of Federal Regulations: 21CFR 173.310 (April

1999), US Dept. of Health and Human Services, Food

and Drug Administration.
'DHHS (NIOSH) Publication No. 94-100 (NIOSH Alert)
Controlling Exposures to Nitrotis Oxide During An-thetic Administration, National Institute for Occupational Safety and Health (CDC), Atlanta, GA.
3
0 [1994].
~ Computerized
~
~ information system. Washington, DC: U.S. Department of Labor, Occupational
Safety and Health Administration.
4 ~ ~ ~ ~ ~Standard
~ H 154-2003
R A EVentilation for Contrnercial Cooking Operations, American Society of Heating, Retigerating and Air-Conditioning Engineers,
Atlanta, GA.
- 'NFPA 90A. National F i e Protection Association 1 Batterymarch Park, Quincy, MA 02169.
'NFPA 96. National Fire Protection Association 1 Batterymarch Park, Quincy, MA 02169.
'NIOSH Critical Documents. National Institute for Occupational Safety and Health, available at the Centers for
Disease Control and Prevention (CDC) web site: http://
www.cdc.gov/nioshlpubs/
criteria~date~desc~nopubnumhers,hhnl
'NFPA 99-2005: Standard for Healtl? Care Facilities.
National Fire Protection Association 1 Batterymarch
Park, Quincy, Massachusetts USA 02169
'SMACNA Duct Cleanliness for Nenl Consshiction GuideImes, (2000), Chantilly, VA 20151.

(This annex is not part of this standard. I t is merely

informative and does not contain requirements necessary
for conformance to the standard. It has not been
processed according to the ANSI requirements for a
standard and may contain material that has not been
subject to public review or a consensus process.
Unresolved objectors on informative material are not
offered the right to appeal at ASHRAI?. or ANSI.)
INFORMATIVE ANNEX A
A l . O&M IN HEALTH CARE FACILITIES
The following operations and maintenance procedures
are recommended for health care facilities.

A l . l Operating Rooms. Each operating room should be

tested for positive pressure semi-annually or on an effective
preventative maintenance schedule. When HEPA filters are
present with'm the diffuser of operating rooms, the filter
should he replaced based on pressure drop.
A1.2 Protective Environment (PE) Rooms. PE rooms
should remain under positive pressure with respect to all
adjoiningrooms whenever an imrnunocomp~omisedpatientis
present. PE rooms should be testedfor positive pressure daily
when an immunocompromised patient is present. When
HEPA filters are present within the diffuser of protective environment rooms, the filter should he replaced based on pressure drop.
A1.3 Airborne Infection Isolation (AII) Rooms. AU
rooms should remain under negative pressure relative to aU
adjoining rooms whenever an infectious patient is present
They should he testedfor negative pressure daily whenever an
infectious patient is present.
A1.4 Filters. Final filters and filter frames should be visually inspected for pressuredrop and for bypass monthly. Filters shouldhe replacedbasedonpressure drop with filters that
provide the efficiencies specified in Table 6-1.
A2. SPECIAL MAINTENANCE FOR HVAC UNITS
The following special maintenance procedures are
recommended for health care facilities.

A2.1 Pnn-Coil Unit and Heat Pumps. The fan-coil unit

and heat pump filters serving patient rooms should be
inspected monthly or on an effective preventative maintenance cycle forpressure drop andreplaced when that pressure
drop causes a reduction in air flow. Fan-coil unit and heat
pump drain pans under cooling coils should be cleaned
monthly, or on an effective preventative maintenance cycle.
A2.2 Pi-Tube Radiation Units, Induction Units a n d
Convection Units. Fm-tube radiation units, induction units
and convection units serving patient rooms should be cleaned
quarterly, or on an effective preventative maintenance cycle.
A2.3 Fan-Powered Terminal Units. Fan-powered teminal unit filters serving patient rooms should be inspected
monthly or on an effective preventative maintenance cycle for
pressure drop and replaced when the pressure drop causes a
reduction in air flow.

(This annex is not part of this standard. I t is merely

informative and does not contain requirements necessary
for conformance to the standard. I t has not been
processed according to the ANSI requirements for a
standard and may contain material that has not been
subject to public review or a consensus process.
Unresolved objectors on informative material are not
offered the right to appeal at ASHRAE or ANSI.)
INFORMATIVE ANNEX B
BIBLIOGRAPHY

ACS, 2000. Gu~deliiiesfor Optiiital Ainbtrlato~y Si~rgical

Care aird Oflce-based Sirrgeiy. 31d ed. American College of Surgeons, Chicago, IL 6061 1
AIA, 2006. The American Institute of Architects and The
Facilities Gu~delinesInstitute. G~rideliitesfor Design
and Conshrctioir of Hospital aiid Health Care Faci11ties. American Institute of Architects Press, Washiigton, DC 2006.
ASHRAE, 1999. hfethod of Testing General VentilationAirCleaning Devices for Removal Eficiency by Particle
Size. ANSUASHRAE Standard 522-1999.
ASHRAE, 2003. 2003 A S H M Handbaok-Applications,
Chapter 7, Health Care Facilities. American Society of
Heating, Rehgerating, and Air-Conditioning Engineers, Inc., Atlanta GA.
ASHRAE, 2003. W A C Desigrl 12faniinlfor Hospitals and
Health Care Facilities, American Society of Heating,
Refrigerating, and Air-Conditioning Engineers, Inc.,
Atlanta GA.
ASHRAE, 2004. 77teimal Enviroi~mental Cai~ditiomf i r
Hiiman Occiipai~cy,ANSUASHRAE Standard 55-2004.
ASHRAE, 2005. 2005 A S H M Handbook-Frmdomentals,
Chapter 35, Duct Desifg. American Society of Heating,
Refrigerating, and Air-Conditioning Engineers, Inc.,
Atlanta GA.
ASHRAE, 2007. Ventilation for Acceptable Indoor Air
Ouality, ANSUASHRAE Standard 62.1-2007. Ameri& Society of Heating, Refrigerating, and AirConditioning Engineers, Inc. Atlanta, GA.
CANICSA-2317.2-01 Special Requirements for Heating,
Ventilation, and Aii Conditioning Systems in Health
Care Facilities September 2001.

CDC, 2005. Gtiideliilesfor Preoeiitiiig the Transntissioil of

~fj~cabocteri~iiil
hiberculosis br Healtli-Care Facilities.
FederalRegistei; 2005. Centers for Disease Control and
Prevention, Atlanta, GA.
CDC, 2003. Guideliiresfor Ein~iroirii~ei~tal
ii$ectioit coiitrol
in health-care facilities. Morbidity and klortality
Weeldy Report (MMWR), June 6, 2003. Centers for
Disease Control and Prevention, Atlanta, GA.
Charles S. Hayden 11, O.E. Johnston, RT. Hughes, and P.A.
Jensen, 1998.Air Volimieiz.figrationf i r 1 1 Negative Pressure Isolatioir Raonls Dririiig Eiiby/Exit. Applied Occupational and Enviranmeotal Hygiene, 13(7): 518-527;
1998.
Coogan, JJ, 1996. Effects of Sui~olindiiigSpaces an Roonis
Presstriized by Differential Flow Control. ASHRAE
Transactions 1996, V 102, Pt 1.
Hermans, RD. 2000. Healtlz Care Facilify Design ManualRoom Design. ASHRAE Transactions Vol. 106, Pt. 2
Lewis, J.R, 1987. Operatiiig room air distributioil effectiveness. ASHRAE Transactions 93(2):1191-1198.
Memarzadeh F and Manning A, 2002. "Comparison of operating room ventilatioit ?stems in the protection of the
surgical site.", ASHRAE Transactions, V.108, Pt. 2,
2002.
Memarzadeh F and Jiang Z. 2004. "Effects of Operoting
Room Geomehy and Vei~tilationSystem Parameter Variations oil the Protectioii of the S~rrgicnlSite", LAQ 2004:
Critical Operations: Supporting the Healing Environment through IAQ Performance Standards.
Niiomura, P. and Judene Bartley, 2001. Nav Veiztilatioii
Guidelines for Healtlr-Care Facilities, ASHRAE Journal, June 2001, Atlanta, GA
NFPA, 2005. Standard for Health Care Facilities. NFPA-992005. National Fire Protection Association 1 Batterymarch Park, Quincy, Massachusetts USA 02169
SMACNA, Duct Cleaiilinessfor Nav Canstnrction Guidelines.
USP-797, Guidebook to Pharmaceutical CompoundingSterile Preparations, US Phamacopeial Convention.
29 CFRPart 1910.1047, Occupational Exposlue to Ethylene
Oxide.

NOTICE
INSTRUCTIONS FOR SUBMITTING A PROPOSED CHANGE TO
THIS STANDARD UNDER CONTINUOUS MAINTENANCE
This standard is maintained under continuous maintenance procedures by a Standing Standard Project Committee (SSPC) for
publication of addenda or revisions, includwhich the Standards Committee has established a documented progtam for regular
ing procedures for timely, documented, consensus action on requests for change to any part of the standard. SSPC consideration will be given to proposed changes within 13 months of receipt by the manager of standards (MOS).
Proposed changes must be submitted to the MOS in the latest published format available fiom the MOS. However, the MOS
may accept proposed changes in an earlier published format if the MOS concludes that the diEferences are immaterial to the
proposed change submittal. If the MOS concludes that a current form must he utilized, the proposer may he given up to
20 additional days to resubmit the proposed changes in the current format.

ELECTRONIC PREPARATIONISUBMISSION OF FORM

FOR PROPOSING CHANGES
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An electtonic version of each change, which must comply with the instructions in the Notice and the Form, is the prefened
form of submittal to ASHRAE Headquarters at the address shown below. The electronic format facilitates both paper-based
and computer-based processing. Submittal in paper form is acceptable. The following instructions apply to chnnge proposals
submitted in electronic form.
Use the appropriate file format for your word processor and save the file in either a recent version of Microsoft Word (preferred) or another commonly used word-processing program. Please save each change proposal file with a different name (for
example, "propOl.doc," "prop02.doc:' etc.). If supplemental background documents to support changes submitted are
included, it is preferred that they also be in electronic form as word-processed or scanned documents.
ASHRAE will accept the following as equivalent to the signature required on the change submittal form to convey nonexclusive copyright:
Files attached to an e-mail:

Eleclmnic signature on change submittal form

(as apicture; *.tif, or *.wpg).

Files on a CD:

Electronic signature on change submittal form

(as a pictute; *.tif, or *.wpg) or a letter with submitter's
signature accompanying the CD or sent by facsimile
(single letter may covet all of proponent's proposed cbanges).

Submit an e-mail or a CD containing the change proposal files to:

Manager of Standards
ASHRAE
1791 Tullie Circle, NE
Atlanta, GA 30329-2305
E-mail: change.proposal@ashrae.org
(Alternatively, mail paper versions to ASHRAE address or fax to 404-321-5478.)

The form and instructions for electronic submittal may be obtained from the Standards section of ASHRAE's Home Page,
www.ashrae.org, or by contacting a Standards Secretary, 1791 Tullie Circle, NE,Atlanta, GA 30329-2305.
Phone: 404-636-8400. Fax: 404-321-5478, E-mail: standards.section@ashrae.org.

POLICY STATEMENT DEFINING ASHRAE'S CONCERN

FOR THE ENVIRONMENTAL IMPACT OF ITS ACTIVITIES
ASHRAE is concerned with the impact of its members' activities on both the indoor and outdoor environment. ASHRAE's
members will strive to minimize any possible deleterious effect on the indoor and outdoor environment of the systems and
components in their responsibility while maximizing the beneficial effects these systems provide, consistent with accepted
standards and the practical state of the art.
ASHRAE's short-range goal is to ensure that the systems and components within its scope do not impact the indoor and
outdoor environment to a greater extent than specified by the standards and guidelines as established by itself and other
responsible bodies.
As an ongoing goal. ASHRAE will, through its Standards Committee and extensive technical committee structure,
continue to generate up-to-date standards and guidelines where appropriate and adopt, recommend, and promote those new
and revised standards developed by other responsible organizations.
Through its Handbook, appropriate chapters will contain up-to-date standards and design considerations as the material is
systematically revised.
ASHRAE will take the lead with respect to dissemination of environmental information of its prirnaty interest and will seek
out and disseminate information from other responsible organizations that is pertinent, as guides to updating standards and
guidelines.
The effects of the design and selection of equipment and systems will be considered within the scope of the system's
intended use and expected misuse. The disposal of hazardous materials, if any, will also be considered.
ASHRAE's primary concern for environmental impact will be at the site where equipment within ASHRAE's scope
operates. However, energy source selection and the possible environmental impact due to the energy source and energy
transportation will be considered where possible. Recommendations concerning energy source selection should be made by
its members.
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