Table Of ContentHVAC DESIGN MANUAL
FOR
HOSPITALSA ND CLINICS
This publication was prepored under ASHRAE Special Project SP-g1 in cooperation with the
cognizant ASHRAE group, TC 9.8, Large Building Air-Conditioning Applications.
LIST OF CONTRIBUTORS
Final Voting Committee Members
Robert Cox, P.E. Farhad Memarzadeh,P h.D.,P .E.
Farnsworth Group National Instituteso f Health
Paul J. DuPont, P.E.
FrankA. Millso C.Eng.
DuPont Engineering
EnvironmentalD esign ConsultantsL td., U.K.
DouglasE rickson
American Societyfor Health Care Engineering Vince Mortimer
Kimball Ferguson, P.E. NIOSH
Duke University Health Syslem Paul T. Ninomura, P.E.
Milton Goldman, M.D., P.E.
Indian Health Service
Mann Mechanical Co.
Mary Jane Phillips
Jeffrey Hardin, P.E.
U.S.A rmy Corps of Engineers U.S.N avy Bureau
Richard I). Hermans, P.E. of Medicine and Surgery( Ret.)
Centerfor Energy and Environment Anand K. Seth, P.E.
Carl N. Lawson
PartnersH ealthCareS ystemI,n c.
Duke UniversityM edical Center
John Lewis, P.E. Andrew Streifel
P2S Engineers,I nc. Universityo f Minnesota
Other Major Contributors and Reviewers
*Original members who are no longer active
**Active Corresponding Members
(Only major reviewers and contributors are listed. The committee is very thankful to
numerous individuals who freely gave their time to review several parts of this manual.)
Joseph Bonanno, Senior Engineer (Multiple Chapters) Mark Lentz, P.E.*
Richard D. Kimball CompanyI,n c. Lentz Engineering& Associates
Cris Copley, P.E. (Chapter 12) Olga Leon, P.E.** (All Chapters)
BR+A PartnersH ealthCareS ystemI,n c.
Jason l)'Antona, P.E. (Appendix G) C. Glen Mayhall, M.D. (Chapter2 )
PartnersH ealthCareS ystemI,n c. University of TexasM edical Branch
Richard DiRinzio (Appendix H) Howard J. Mckew, P.8., CPE (Multiple Chapters)
EngineeredS olutions Richard D. Kimball Company,I nc.
Alexandra Dragan, Ph.D.,P .E.* Andrew Nolfo, P.E.** (Multiple Chapters)
Departmento f Public Work
NEBB
Kenneth E. Gill, P.E.*
Andrew Persily, Ph.D. (Chapter2 )
Aguirre Corp.
William Goode, P.E. (All Chapters) National Institute of Standardsa nd Technologt
W.J.G oodeC orp. Chris RousseauP, .E.*
Ray Grill, P.E. (Chapter l l) Ne',,vcomb& Boyd
RJA Group Anesha Morton Rumble
Darold Hanson* (Chapterl 0) Formerly with NIOSH; Currently with
Formerly with Honqtwell, now retired MCAQ (MecklenburgC ountyA ir Quality)
George Hardisty, P.E. (Appendix G) Teerachai Srisirikul (Appendix H)
BR+A PartnersH ealthCareS ystemI,n c.
Joe Howard*
Esmail Torkashvan, P.E.** (Multiple Chapters)
Formerly with BJC Health Systems
NIH, NCRR
Leon Kloostra (Chapter 10)
Marjorie Underwood (Chapter2 )
Titus Corp.
Mt. Diablo Medical Center,C oncord,C alif.
Paul Konz, P.E. (Appendix G)
TRO James E. Woods, Ph.D., P.E. (Chapter2 )
Mitsu Koshima, Senior Engineer (Multiple Chapters) Building Dianostic ResearchI nstitute
Richard D. Kimball Company,I nc. Mark Yankich, P.E. (Chapter9 )
John Kramer, P.E. (Chapter 10) Rogers,L ovelock,a nd Fritz
Staff Engineer Duke Medical Center
Walter Grondzik, Technical Editor (All Chapters)
Florida A&M University
H\AC DESIGN MANUAL
FOR
HOSPITALS AND CLINICS
ISBN l-931862-26-5
O2003 American Society of Heating, Refrigerating
and Air-Conditioning Engineers, Inc.
l79l Tullie Circle, N.E.
Atlanta, GA30329
www.ashrae.org
All rights reserved.
Printed in the United Stateso f America
Cover design by Tracy Becker.
ASHRAE has compiled this publication with care, but ASHRAE has not investigated, and ASHRAE expressly disclaims
any duty to investigate, any product, service, process, procedure, design, or the like that may be described herein. The
appearanceo f any technical data or editorial material in this publication does not constitute endorsement, warranty, or
guaranty by ASHRAE of any product, service, process, procedure, design, or the like. ASHRAE does not warrant that the
information in the publication is free of errors, and ASHRAE does not necessarily agree with any statemento r opinion in
this publication. The entire risk of the use of any information in this publication is assumedb y the user.
No part of this book may be reproduced without permission in writing from ASHRAE, except by a reviewer who may
quote brief passageso r reproduce illustrations in a review with appropriate credit; nor may any part of this book be repro-
duced, stored in a retrieval system, or transmitted in any way or by any means-electronic, photocopying, recordirrg, o,
other-without permission in writing from ASHRAE.
ASHRAE STaTT
SpncnI- PuBLrcATroNS PuerrsHrNcS nnvrcns
Mildred Geshwiler Barry Kurian
Editor Manager
Erin S. Howard Jayne Jackson
Assistant Editor Production Assistant
Christina Helms
Assistant Editor
PuerrsHER
Michshell Phillips
Secretary W. Stephen Comstock
DEDICATION
This design manual is dedicated to our friend and colleague, John Lewis. While the manual was being prepared,
John suffered a stroke. During the final months of its preparation, we missed his keen engineering insight, insistence
on technical accuracy,a nd clear and understandablew riting. Above all, we missed his humor and friendly presencea t
our meetings. We look forward to his continuing contribution to health care engineering and HVAC design. The
ASHRAE SP 91 Committee is grateful for extraordinary effort by John Lewis in creating this document.
CONTENTS
FOREWORD.
CHAPTERI -INTRODUCTION . .1
1.1 Preface .1
1.2 Purpose .2
1.3 IntendedA udience .2
1.4 Overview .2
CHAPTER 2-TERMINOLOGY. . . .
2.1 Introduction
2.2 Terms....
CHAPTER3 -FACILITY DESCRIPTIONS . . . . . . . 1 5
3.1 Introduction-HealthCareFacilities . . . . . . . 1 5
3.2 PatienCt areU nits. . . . . . . . . . . 1 6
3.3 Diagnostica ndT reatmenCt enters . . . . . . . 1 7
3.4 SurgeryS uites . . .. . . . 2 1
3.5 AdministrativeAreas . . . . . . . 2 1
3.6 SupportS ervices . . . . . . . 2 3
CHAPTER 4-OVERVIEW OF HEALTH CARE HVAC . . . . ....... 27
4.1 Introduction . . . ..27
4.2 Infection and Safety Hazards ...28
4.3 Infection Control. ...29
4.4 Criteria ...31
4.5 Energy Efficiency and Operating Cost ...32
4.6 Equipment Sizing for Heating and Cooling Loads. . . ...32
4.7 Ventilation and OutsideA ir Quality. . . ...40
4.8 EnvironmentalC ontrol. . ...41
"System
4.9 HVAC Hygiene" ...42
4.10 Flexibility for Future Changes ...43
4.11 IntegratedD esign ...43
CHAPTER s-HVAC SYSTEMS . ...47
5.1 Introduction.... ...47
5.2 HVAC System.s . ...47
5.3 All-Air Systems. ...48
vii
HVAC DESIGN MANUAL FOR HOSPITALSA ND CLINICS
vlll
5.4 Air andW aterS ystems .53
5.5 All-WaterS ystems .54
5.6 Unitary Refrigerant-BaseSdy stemsfo r Air Conditioning.. . . . . . . 5 5
CHAPTER6 -DESIGN CONSIDERATIONSF OR EXISTING FACILITIES 57
6.1, GeneraCl onsiderationfso r ExistingF acilities ,57
.58
6.2 Infection Control During Construction
CHAPTER 7-COOLING PLANTS .61
.61
7.1 Introduction . .
.61
7.2 Design Considerations.
.66
7.4 ChilledW aterD istributionS ystems .67
7.5 Chiller PlantC ontrolsa ndI nstrumentation .69
7.6 Start-Upa ndC ommissioningA ctivities .70
.70
7.7 Cooling Plants for Clinics . . .
CHAPTER8 -SPACE AND PROCESSH EATING SYSTEMS. . . 7t
.. 71
8.2 IleatingP lantConsiderations. . .71
8.3 Featureso f Heating EquiPment 74
8.4 Terminal Heating Equipment . . . . . . 7 6
. . . . . . 7 6
8.5 Piping Systems
. . . . . . 7 8
8.6 Domestic Water Systems
.79
.87
.87
9.2 ConcepDt esign
9.3 BasicA ir-HandlingU nit DesignC onsiderations. .87
9.4 Air-HandlingS ystemA lternatives.. .
9.5 Ductwork ..96
9.6 TerminalU nits . .98
9.1 RoomA ir Distribution.. ..99
101
9.8 AcousticalConsiderations
9.9 General Considerationsf or Handling SaturatedA ir . .._103
. . .103
9.10 DesiccantS ystems
9.11 PackageUdn its ...104
CHAPTER1 O -CONTROLS AND INSTRUMENTATION 105
10.1 Introduction. . .....105
10.2 Characteristicsa nd Attributes of Control Methods .....105
10.3 Pressurization,O utside Air Ventilation, and Outside Air Economizer Controls .....106
10.4 Isolation Rooms and Similar Rooms with RDP Criteria .....109
110
10.5 Operating Room Controls
10.6 LaboratoryC ontrols 111
10.7 GeneraCl ontrolS equenceUss edi n Hospitalsa ndC linics . 111
10.8 Control" Safeties" ....t12
10.9 DX SystemC ontrols. . . . . . . 1 1 3
CHAPTERl l-SMOKE CONTROLA ND LIFE SAFETY.. . 1r5
115
lt7
CONTENTS ix
11.3 PassiveS mokeC ontrol. .120
ll.4 Active Smoke Control .r20
I 1.5 Stairwell Pressurization. . . . . . .122
11.6 Elevators .123
II.7 Controls and Sequencing .123
11.8 Energy Managementa nd SmokeC ontrol . . .124
11.9 Testinga nd Commissioning.. .124
11.10H ealtha nd Life Safety .125
I 1.1I Atrium Smoke Control .126
ll.l2 EngineeredF ire SafetyD esign. .127
11.13C limatic Effectso n Buildins Svstems ...t27
CHAPTER l2-ROOM DESIGN . ...r29
l2.l GeneralI nformation. . . . ...129
12.2 Role of Ventilation in Infection Control and Comfort. . . ...129
12.3 Health Care Room Design Criteria ...133
CHAPTER I3-CLINICS AND OTHER HEALTH CARE FACILITIES . . t43
13.1 OccupancyC lassifications r43
145
..147
l4.l Introduction . . .,r47
14.2 Maintenance. . . ..147
14.3 Modern Maintenance Tools ..t49
14.4 Operation ..153
14.5 Complyingw ith Joint CommissionR equirements ...153
14.6 Construction.. ...155
14.7 SpeciaMl aintenanceC onsiderationfso r HVAC Systems/Equipment ...160
14.8 BuildingC ommissioning ...160
14.9 Capital lnvestment Planning . ...160
CHAPTER Is-COMMISSIONING. . . ...161
15.1 Introduction. . ...161
15.2 CommissioningAuthority . . . ...161
15.3 The CommissionineP rocess. ...162
15.4 Documentation ...165
15.5 ConstructionP rocessa nd CommissioningI nterface . . ...167
15.6 Retro-Commissioning ...168
15.7 Costs,O ffsets,a nd Benefits . . . ...170
15.8 Summary ...172
CHAPTER 16 -ENERGY EFFICIENT DESIGN AND
CONSERVATION OF ENERGY RESOURCES. 173
16.1 Introduction . . t73
r73
16.3 Energy Usagei n Health Care Facilities . t74
16.4 Design of Energy Efficient HVAC Systems. 181
16.5 Air-to-Air Heat RecoveryS trategies t87
16.6 Design of Energy Efficient Chilled Water and CondenserW ater Systems . . 189
L6.7 Energy Conservation Design of Central Heating Systems. t92
16.8 Design of Energy Efficient Building Envelopes 195
FIVAC DESIGN MANUAL FOR HOSPITALSA ND CLINICS
.195
16.10 Commissioning/Recommissioning. .195
16.11 Financing an Energy Efficiency Program . 195
APPENDIX A-MANAGING CONSTRUCTION AND RENOVATION
TO REDUCE RISK IN HEALTH CARE FACILITIES. . . ...197
A.1 Introduction. . ...197
. r97
A.2 RiskA ssessment.
. 198
A.3 Planning
A.4 Environmental Assessment ....198
....r99
A.5 VentilationControl
....r99
,4'.6 Projectlmplementation
....200
A.7 Communication
.. . .201
A.8 Commissioning
... ,201
A.9 Legal Issues
APPENDIXB -DISASTER MANAGEMENT .203
8.1 Introduction. . ....203
8.2 Terrorism ....203
8.3 DisasteCr lassification. . ....204
. .. .206
B.4 SpaceD efinitions. . . .
8.5 Required Services in Emergency and Disaster 207
8.6 Summary
APPENDIXC -LOAD CALCULATIONS AND EQUIPMENTH EAT GAINS
.2r3
C.l Introduction . .
.2r3
C.2 Outdoor and Indoor Design Conditions. . .
.2t3
C.3 Design Loads
C.4 Diversity Factors and Scheduleo f Operations .214
.....215
.....215
. . . ..21s
APPENDIXD -INFECTION CONTROLI SSUES . .217
..217
D.l Introduction . .
D.2 Context for Infection Control. . . . . . .2t7
D.3 Nonsocomial Infection Costsa nd Morbidity. . . .2t7
D.4 Isolation . . ...218
D.5 Anterooms.. . ...218
D.6 Infection
Airborne Respiratory Diseases and Mechanical Systems
for Control of Microbes, W.J. Kowalski and William Bahnfleth
APPENDIX E-LIFE.CYCLE COST ANALYSIS . . .
E.1 Life-Cycle Cost Analysis . .. ..231
APPENDIX F-VENTILATION STANDARDSA ND CURRENTT RENDS.. . . .....233
F.1 Introduction . .
F.2 Ventilation Codes and Standards.
F.3 Ventilation Background and Details. . . . .
F.4 Air Diffirsion Criteria. . . .
F.5 New Trend in Ventilation System Design .244
F.6 Conclusions . . .246
