1. Laboratories and Hospitals Which Way is the Air Blowing? Presented by: Douglas Wrenn – CCM, QCxP, CXCP, LEED ap

2. RCEP Standards MBP has met the standards and requirements of the Registered Continuing Education Providers Program (RCEPP). Credit earned on completion of this program will be reported to RCEPP. A certificate of completion will be issued to each participant. As such, it does not include content that may be deemed or construed to be an approval or endorsement by NCEES or RCEPP. 2

3. Goal and Objectives 3 The purpose of this presentation is to provide you with a general understanding of the importance of air flow in Laboratories and Hospitals; and your role in air flow control during construction At the end of this presentation you will be able to: 1.Identify different types of biological laboratories 2.Identify how air flow patterns work in laboratories 3.Understand air flow requirements in hospitals 4.Understand your role in air flow control during construction and commissioning of these facilities This 50 minute presentation will provide you with one CE credit.

4. Basic Information for Laboratories and Hospitals What is air? Google images: www.flemmingbojensen.com

5. Basic Information for Laboratories and Hospitals Air = The invisible gaseous substance surrounding the earth. It is comprised mostly of nitrogen and oxygen Life cannot exist without it Air is a fluid in a gaseous state Air moves based on changes in pressure – Air Always Moves from High Pressure to Low Pressure

6. Basic Information for Laboratories and Hospitals Definitions: – Air Change Rate: In most construction air delivery is measured in cubic feet per minute (CFM) which is a volumetric flow rate In Laboratory and Healthcare work volumetric flow rate is calculated in air change rates, or how many times an hour is the air in a room completely changed. This is usually expressed as ACH This is a function of both the supply and exhaust in a room or space.

7. Basic Information for Laboratories and Hospitals Definition – Air Washing

8. Laboratories Two Basic Categories – Research - Bio-Safety Protecting the outside world from the what is inside – Production – Pharmacology, Microchips Protecting what is inside from the world outside It is critical that you understand which category applies to your project, because it impacts the construction process from design through commissioning

9. Laboratories Codes and Design Criteria – For Bio-Safety Projects: BMBL – Biosafety in Microbiological and Biomedical Laboratories – For Any Projects with a Vivarium (Animal Holding) ILAR - Institute for Laboratory Animal Research AAALAC – The Association for Assessment and Accreditation of Laboratory Animal Care International

10. Laboratories Definitions – Containment barrier: The three dimensional enclosure that keeps unwanted pathogens or contaminants either in or out of the research area depending on the type of laboratory Filters are an important part of the containment barrier

11. Laboratories Definitions Continued – Failure Scenarios What is the worst thing that can happen? – Prevention - How do you prevent these things from happening? – Protocol - What do you do when this happens? These need to be identified at the start of the project for the design, the construction and through commissioning. They must be monitored throughout the project. – Think Risk Management Plan 11

12. Types of Laboratories Bio-Safety Laboratories (BSL) – BSL-2 Generally non-lethal non-airborne pathogens with standard protocols for treatment Lyme Disease, Influenza, Mumps, Measles – BSL-3 Generally lethal airborne pathogens with standard protocols for treatment Encephalitis, Tuberculosis, Yellow Fever, SARS – BSL-4 Generally lethal airborne pathogens without standard protocols for treatment Hemorrhagic Fever, Ebola Virus, Marburg Virus, Smallpox

13. Types of Laboratories BSL-2

14. Types of Laboratories BSL-3 Google images: ki.se (left), en.wikipedia.org (right)

15. Types of Laboratories BSL-4 Google images: www.armedforces-int.com (left), www.wolfhazmat.de (right)

16. Laboratories – Control and Cx of Air Flow Air Flow Patterns in Laboratories www.niaid.nih.gov Google images: www.niaid.nih.gov

17. Laboratories – Control and Cx of Air Flow Prep Room Work Area Supply Filter Exhaust Filters Normal Operation Access Area

18. Laboratory Flow – Suites Add Air to Space BSL-4 – Exhaust from each suite adds 30 to 70 CFM Google images: www.armedforces-int.com (left), www.wolfhazmat.de (right)

19. Laboratories – Control and Cx of Air Flow Prep Room Work Area Supply Filter Exhaust Filters Commissioning Failure Scenario Reverse Flow Access Area

20. Laboratories – Control and Cx of Air Flow Prep Room Work Area Supply Filter Exhaust Filters Commissioning Failure Scenario Hyper-Negative Access Area

21. Laboratories - Control of Air Flow between spaces Air Pressure Doors and Chemical Showers – For construction and commissioning it is important to observe integration between BMS and Security

22. Laboratories – It’s all about Filtration HEPA Filters – High Efficiency Particulate Absorption

23. Laboratories – It’s all about Filtration Filters for other air sources HHHEPA Filter

24. Laboratories – It’s all about Filtration What do you mean toilets breathe?

25. Laboratories – It’s all about Filtration Cartridge Filters Used for System Air: – Plumbing Vents – Compressed Air – Vacuum Air

26. Laboratories – Bio-Safety Cabinets Bio-Safety Cabinets (BSC) BSC-2 – Exhausted – Recirculating Google images: ki.se (left), en.wikipedia.org (right)

27. Laboratories – Bio-Safety Cabinets Bio-Safety Cabinets (BSC) BSC-3 – Exhaust Only - Also known as aerobiology Rooms

28. Laboratories – Construction Work in a Lab Failure Scenario Control Plan (Risk Management Plan) – Worst Case Scenarios Identified at the Start of the Project Prevention and Protocols Quality Control Plan – Must address prevention of Worst Case Scenarios Commissioning Plan – Failure Scenario Testing Confirmation of Air flow patterns Confirmation of what happens in failure scenarios 28

29. Laboratories – Things to Remember What are you Protecting from What? Bio-Safety Lab Categories – BSL-2 – BSL-3 – BLS-4 Filtration, Filtration, Filtration Use Failure Scenarios to manage the project! – Prevention and Protocol 29

30. Hospitals Codes and Design Guidelines – ASHRAE Standard 170-2013 – ASHE – American Society of Healthcare Engineers – Department of Health: Guidelines in the Planning and Design of a Hospital and Other Health Facilities – JCAHO: The Joint Commission on Accreditation of Healthcare Organization Now known as “The Commission”

31. Hospitals Important to Always Remember: – Who are you protecting from whom? – More people died from hospital acquired infections than died in car accidents in 2011 – Non-Invasive vs. Invasive Non-invasive: Does not break the skin Minimally Invasive: Anything other than Open Surgery Invasive: Open surgery – PATIENT COMFORT

32. Hospitals – Air Washing Relationship of Patient to Caregiver Infectious Patient Immune-suppressed Patient SupplyExhaust Supply

33. Hospitals – Patient Washing Surgical Suite Google images: allbiorecovery.com (left)

34. Hospitals – Air Flow Patterns Isolation Rooms Contagious Patient Air Flow Design and Commissioning Ante Room Patient Room Corridor

35. Hospitals – Air Flow Patterns Isolation Room Immune Suppressed Patients Design and Commissioning Ante Room Patient Room Corridor Typical for Surgical Suites or Invasive Procedure Rooms

36. Hospital – Construction Isolation Plan SMACNA Guideline for Indoor Air Quality Practices for Buildings Under Construction – Intended to be an authoritative source for providing project management guidance in maintaining indoor air quality undergoing renovation or construction. Center for Disease Control – Guidelines for Hospital Construction – Available online

37. Hospital – Construction Isolation Plan Properly installed and maintained isolation barriers are a critical part of the Isolation Plan

38. Hospital - Construction Isolation Plan Construction Air Management is a major part of the Construction Isolation Plan

39. Hospital - Construction Isolation Plan Proper Exhaust Fans and Filtration are important parts of the Isolation Plan Google images: tzjiayi.en.alibaba.com (left), www.globalindustrial.com (right)

40. Hospital – Construction Isolation Plan Moisture control is critical in hospitals for the prevention of infections. Standing water cannot be allowed on a hospital construction site.

41. Hospital - Construction Isolation Plan Differential pressure monitoring and record keeping are important to documenting the plan implementation

42. Important Points to Remember Who is being protected from Whom SMACNA Guideline for Indoor Air Quality Construction Isolation Plan – Maintaining Air Flow Protocols to prevent cross contamination – Proper Isolation Materials and Equipment – Testing and documenting continued air flow isolation throughout construction PATIENT COMFORT! 42

43. One Last Thought 43

44. Thank you for your time! This concludes the educational content of this presentation 44 Questions? www.mbpce.comwww.mbpce.com 800-898-9088