Facilities Manager Peer Exchange Meeting

March 15, 2013

Participating Hospitals

• Lurie Children's Memorial
• Mt. Sinai Hospital & Schwab Rehabilitation Institute
• Northwestern Memorial Hospital
• Norwegian American Hospital
• Presence Health
• Saint Bernard Hospital
• Shriners Hospital for Children - Chicago
• University of Chicago Medical Center

NOTE: If you would like to learn more about any of the following peer exchange discussion topics, please contact the CGHI team and we will connect you with the appropriate hospital(s).

Operating Room Airflow Setback During Unoccupied Hours

Click here for the presentation by Jean Gibbons and John Villani of Grumman/Butkus Associates.

Facility Energy Savings

• Saving a lot of energy is the sum of many small steps of which OR setback is one.
• Data on 10 hospitals in which retro-commissioning and other relatively low cost energy conservation measures have been implemented:
  • Annual energy costs reduced by $17,322 to $537,780
  • Annual energy costs reduced by $3.4% to 18.3%

Current Applicable Codes and Standards

• IDPH Part 205 for Ambulatory Surgical Treatment Centers: 
  • Procedure Room:  minimum 15 ach, positive
• IDPH Part 250 for Hospitals and Ambulatory Care Facilities
  • Surgical Suite – Operating Rooms:  minimum 15 ach, minimum 20% outside air, positive
• ASHRAE/ASHE Standard for Ventilation of Health Care Facilities:
  • Class B and C Operating Rooms:  minimum 20 ach, minimum 4 ach outside air, positive
  • Per Paragraph 7.1.1.c: “For spaces that required positive or negative pressure relationships, the number of air changers 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.”

Other considerations

• IDPH and ASHRAE specified ach are minimums, actual occupied ach can be higher if needed for cooling. Many rooms get up to 30 ach.
• IDPH has stated to G/BA that “it is acceptable to reduce OR air change rates lower than 15 ach when the rooms are unoccupied, provided that the positive pressurization is maintain, and the air changes per hour is 15 ach when the room is occupied again.”

Summary

• ORs are allowed to have an unoccupied mode PROVIDED they remain positively pressurized
• OR Room Pressure
  • Minimum +0.01” wg
  • Typically control to +0.02” or greater
• Air Changes per Hour
  • 15 per IDPH
  • 20 per ASHRAE
  • 30 typical at many facilities
  • 8 ACH in unoccupied mode (6 ACH Minimum) (verify this holds room positively pressurized)
• Design
  • Include supply and return terminal boxes or better yet air valves, not just dampers
  • Include occupancy sensors with multiple technology
  • Include door switches
  • Provide clear indication of room conditions and occupied/unoccupied mode status both inside and outside of OR
  • Provide remote monitoring and control from Nurse’s station
• Best Sequence
  • Uses a schedule PLUS occupancy sensors to initiate unoccupied mode
  • Uses manual intervention to re-occupy if an OR is needed during unoccupied time
• Temperature and Humidity
  • Allow “float” (deadband) in the OR temperature during unoccupied mode
  • Maintain OR humidity
• Testing and Trending!
  • Test/calibrate all BAS sensors and verify room pressure
  • Trend ORs, room pressure and mode

Discussion

• Need to check whether CMS is in favor of this approach
• We should approach IDPH and CMS as a group
• The Code does not address documentation, but you want it
• A reasonable trend is every 15 minutes
• 8 is a reasonable goal for air changes every hour and float temps between 60-72 degrees
• Must maintain humidity, according to Code
• Use fan VAVs for isolation rooms
• Turn off alarm in isolation rooms
• Have key switches for nurse at Northwestern, while Lurie uses a key pad
• Need to follow up with dprocedure template
• Remote monitors could increase quality assurance

Announcements

• Peoples Gas Double Rebates Information
• IFF - Energy loans at 3.5%, with project management at no additional cost. Click here for more information.
• Water bill exemption contact information (you will need your water account number and/or the amount of your last payment): Brian, Water Billing and Collections, 333 S. State Street, Ste. 330, Chicago, IL 60604, Hours: M-F 8:30am-4:30pm, Phone: 312.744.4420, Fax: 312.742.9153, Email: waterbill@cityofchicago.org
• Energy Efficiency and Clean Energy highlighted in Mayor Emanuel's Sustainable Chicago 2015 Action Agenda.
• Notes from the last CGHI Peer Exchange Meeting.
  
• The next CGHI Peer Exchange Meeting will be April 19th .