CHAPTER 8

ROOM DESIGN
Many rooms in hospitals require special design considerations 8.1 INTRODUCTION TO
because of heightened infection concerns, high internal loads, special ROOM DESIGN
equipment, unique processes, and unique patients. Air change and
pressurization requirements for all such rooms are listed in Table 3-3;
these values reect ANSI/ASHRAE/ASHE Standard 170-2008
(ASHRAE 2008) with addenda through July 2012. This chapter
presents best practice suggestions along with details about how to
achieve these requirements..

Many spaces in hospitals require maintenance of a differential

pressure relative to adjacent spaces. For example, ORs, protective
isolation, and sterile supply require positive pressure, whereas airborne
infectious isolation, toilet, soiled, bronchoscopy, and decontamination
rooms require negative pressure.

Measuring a differential air pressure between a room and the 8.2 ROOM
corridor may provide evidence that all air movement is in one direction. PRESSURIZATION
There are a number of factors, however, that may well allow air to
escape from a room or air to enter a room in spite of a negative or
positive room-to-corridor pressure relationship. One such factor is
opening and closing of the room door.

The truly signicant factor in determining the amount of air migra-

tion from a room to a corridor is the airow volume differential (Hayden
et al. 1998). In all cases, some air volume migration occurs through an
open door when the air pressure difference is essentially zero.

An anteroom is recommended as a means of reducing airborne

contaminant concentration by containment and dilution of the migrating

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air and to protect the adjacent corridor from excess airow into or out
of the isolation room. In one study, for a range of room air exhaust
ows from 50 to 220 cfm [24 to 104 L/s], the migration between a
room and its anteroom was found to be 35 to 65 cfm [17 to 31 L/s]
(Hayden et al. 1998). For example, through dilution, a 500 ft3 [14 m3]
anteroom with a migration of 50 cfm [24 L/s] would (in an hour)
experience a 90% reduction in the transmission of contaminated air to
and from the patient room.

Provide a tight envelope to maintain desired pressurization. Walls

must extend from oor to structure and openings (such as electrical
and medical gas outlets) must be sealed. Maintain a specic differential
airow rate between supply and return/exhaust. Airow from one
space to another occurs through cracks or gaps in walls, ceilings,
oors, and around doors. The sum of the areas of all these pathways is
called the leakage area. The inltration or exltration ow from a
room is a function of the leakage area and the pressure differential
across all surfaces of the room. Isolation is maintained only when the
airow is unidirectional on each surface. Air pressure differential is a
measurable quantity and should be maintained at 0.01 in. of water
[2.5 Pa] relative to adjacent spaces.

As discussed in Chapter 6, differential measure may be achieved

by controlling supply and exhaust via a pressure monitor; or it can
be accomplished with a xed offset between supply and exhaust
airow. A minimum differential airow rate for a very tight room is
200 cfm [94 L/s]. The engineer must encourage the architect to seal
the room to allow a 0.01 in. of water [2.5 Pa] pressure difference with
a xed air volume difference. ASHRAE HandbookFundamentals
(ASHRAE 2009) provides a method to estimate the allowable leakage
area as follows:

AL = C5Qr (U'pr )1/2CD 'pr

AL =air leakage area, in.2 [cm2]

C5 =units conversion, 0.186 [10 000]
Qr =air leakage volume, cfm [m3/s]
U =air density, 0.0724 lbm/ft3 [1.158 kg/m3] at
normal room temperature
CD = discharge coefcient, often set to either 1.0 or 0.6
'pr = reference pressure difference, in. of water [Pa]

The coefcient CD depends upon the gaps through which the air
ows. An estimate of this parameter, 0.186, has been made and
empirically tested. The designer should estimate the leakage area AL
using the method from the ASHRAE HandbookFundamentals
chapter on inltration.

A rooms static-pressurization value is wholly dependent upon the

differential airow and the rooms leakage rate. Figure 8-1 shows, for
ROOM DESIGN 153

a room with 1.0 ft2 [0.09 m2] of leakage area, that a differential pressure
pr of just under 0.01 in. of water [2.5 Pa] occurs when the difference
between the rooms supply air and the total room exhaust is 250 cfm
[118 L/s]. This relationship exists regardless of the rooms ventilation
rate (air changes per hour). Therefore, to maintain a specic room
pressurization value, supply and exhaust airow must be controlled
and maintained at the appropriate value.

Most modest-sized patient rooms will have a total room leakage

area of at least 0.5 to 1.0 ft2 [0.05 to 0.09 m2], even with relatively tight
construction. To attain a tighter room, extensive sealing and meticulous
attention to wall, ceiling, and oor penetrations (where conduit, piping,
ductwork, and other items pass through) are required. Leaky rooms
require a larger airow offset, thereby wasting energy. An offset of 100
to 200 cfm [47 to 94 L/s] is desirable.

If the leakage area for a negative-air-pressure room cannot be 8.2.1 Negative Air Pressure
reduced to that needed for an airow differential of 100 cfm [47 L/s],
recalculate with the known air leakage area and solve for Qr . In most
cases, Qr will need to be larger; and can even equal the total cooling
supply air volume. To reduce the value of Qr , the ventilation designer
should inuence the envelope tightness as a means of decreasing the
leakage area. Per Figure 8-1, leakage areas of 60 in.2 [38,700 mm2]
require a Qr of 100 cfm [47 L/s] at 0.01 in. of water [2.5 Pa]. Maintaining

Figure 8-1 Room Differential Airow versus Differential Pressure for Various Room Leakage Areas
154 HVAC DESIGN MANUAL FOR HOSPITALS AND CLINICS

a negative air pressure difference between a room and the corridor

may not be enough to provide isolation. Because there are up to six
possible shared bounding surfaces for any room, and because there
may be adverse pressure relationships across any of these surfaces,
each surface must be considered. Pressures in adjoining rooms may
be lower than in the room under consideration and air may ow out.
To prevent such ows, the Qr may need to be increased beyond that
required to maintain appropriate ow to the corridor only. The value of
Qr must be set to ensure that the negative-air-pressure room will pull
air from all of the surrounding spaces.

8.2.2 Positive Air Pressure Maintaining positive air pressure, preferably with anterooms and
continuous alarms, requires continuous monitoring of pressurization. To
reduce airow to or from corridors, anterooms are highly recommended.

8.3 OPERATING ROOMS The purposes of the HVAC system in an operating room (OR) are
to minimize infection, maintain staff comfort, and maintain patient
comfort. As indicated in Table 8-1, the recommended air change per
hour (ACH) value has been 15 to 25 for 40 years. The current recom-
mendation in the FGI Guidelines (AGI 2010) and ANSI/ASHRAE/
ASHE Standard 170-2008 (per Table 3-3) is 20 ach supply air including
4 ach of outdoor air (20% outdoor air). Note that 100% outdoor air
systems have not been recommended since the early 1980s; although
until very recently the U.S. Veterans Administration has required 100%
outdoor air systems. Operating rooms must be designed for a positive
pressure differential of 0.01 in. of water [2.5 Pa]. As discussed above,
this will require a 200400 cfm [94189 L/s] offset. Although ANSI/
ASHRAE/ASHE Standard 170-2008 does not require continuous
monitoring, various authorities having jurisdiction (AHJs) frequently
request or require monitoring of temperature, relative humidity (RH),
and dew point in ORs.

The surgical suite contains operating rooms as well as substerile

rooms, clean supply, sterile corridor, preoperative preparation, and
postoperative recovery care (postanesthesia care unit [PACU]).
Common usage of the term OR is often intended to include both
the surgical room and these support areas. In some hospitals, other
spaces, such as locker rooms, doctors lounges, control desks,
anesthesia workrooms, and even surgical waiting areas, may be
included in the general term. The OR special environment, however,
embraces only the restricted area of the surgical suite. Surgeries may
be classied as shown in Table 8-2.

As indicated in Table 8-3, most standard operating rooms require

MERV 14 ltration. In the past, some standards recommended MERV
17 in orthopedic and organ transplant surgery operating rooms.
Although this is no longer the case in ANSI/ASHRAE/ASHE Standard
170-2008, many deem it good practice. Assuming that the nal lter
assembly is tight, only one nal lter is necessary. Placing two nal
lters in series, such as one in the AHU and one outside the OR, is