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As autumn approaches, healthcare facility managers and operators are preparing to transition from the cooling season to the heating season. The changeover can pose special challenges in the highly regulated healthcare environment. Building maintenance programs and construction and renovation projects fall under stringent standards, including those set by the Joint Commission on Accreditation of Healthcare Organizations (Joint Commission).

Taking the right preventive maintenance measures will ensure the facility continues to provide a healthy, high performing, energy efficient environment.

Temperature fluctuations, rainy weather, and repairs can make it difficult to uphold these standards and ensure comfortable and healthy Indoor Air Quality (IAQ), while maintaining energy efficiency. However, facility managers can take measures to make the seasonal transition go smoothly.

Fall Season Infection Control
Protecting patients against hospital acquired infections is a year- round challenge for healthcare administrators and facility managers.

The IAQ of a healthcare building is vital to ensuring positive hospital outcomes, including patient health and staff productivity. Up to 10% of patients contract a nosocomial infection in a healthcare setting, according to the Centers for Disease Control (CDC). Infection control experts estimate that it is possible to prevent a third of these infections, many of which are airborne.

IAQ is particularly important in critical hospital areas sensitive to infection control, such as intensive care units, surgical suites, protective environments and laboratories.

The Joint Commission requires hospitals to design, install, and maintain ventilation equipment for appropriate pressure relationships, air exchange rates and filtration efficiencies.

Healthcare Facility Maintenance Considerations
Rigorous Filter Maintenance-Check filters regularly for condition and pressure drop. During filter service, follow proper procedures and shut down fans to avoid allowing contaminated air to enter the ventilation systems. Make sure to avoid reverse of airflow direction between zones.

Where HEPA (High Efficiency Particulate Air) filters are applied, a rigorous maintenance program is critical. The filters need to be installed in equipment with filter racks, which tightly seal the filters in place to prevent bypassing of contaminated air. Monitor HEPA filters regularly to ensure they continue to operate to design performance and efficiency.

Calibrate Sensors-Check and calibrate critical temperature, pressure, humidity, and IAQ sensors for accuracy and adjust according to seasonal conditions. Critical sensors include zone pressure transducers, humidity sensors, airhandling unit temperatures, as well as supply and return water temperatures.

Maintain Moisture Control Systems-Moisture enters the building as liquid water or water vapor and can compromise infection control efforts.

Keep air handling systems clean, dry and performing properly to control building moisture and temperature conditions. Check filter condition, keep coil and drain pads clean and monitor control performance. Other humidity control measures are addressed later in this article.

Uphold Strict Pressure Control-Proper design and maintenance of HVAC systems ensure correct relative pressure relationships in specific hospital areas. Operating rooms and protective environment rooms are kept at positive pressure relative to other areas to diminish movement of infectious contaminants. Airborne infection isolation rooms are kept at negative pressure to limit movement of infectious agents from the patient to other areas of the building.

During maintenance, make sure that air filters, water strainers and flow control devices are clean and not causing improper pressure drops.

Log Temperature, Pressure and System Load Data-Monitor outside air temperature and time of day along with supply air temperatures, heating water temperatures, chilled water supply and return temperatures to confirm system performance and detect any operating degradation before it impacts patient outcome.

Maintain Energy Efficiency
According to the U. S. Department of Energy, hospital facilities spend $5.3 billion annually on energy and use more energy per square foot than any other commercial building type. A strategic operation and maintenance (O&M) program that specifically targets energy efficiency and performance in healthcare facilities can save from 5% to 20% on energy bills.

If the facility undergoes equipment upgrades, renovation, or construction this fall or winter season, consider installing energy- efficient systems, such as highly efficient lighting, variable-volume HVAC, dessicant dehumidification and the latest building controls.

Many healthcare facilities create organization-wide energy conservation programs to identify cost-effective measures to reduce energy consumption and make efficiency improvements. This could include measures ranging from negotiations with utility suppliers to shifting energy usage loads to offpeak hours and avoiding cooling or heating unoccupied areas of the facility.

Dessicant Systems for Humidity Control
Humidity control is a key aspect to infection control. To assure IAQ it is necessary to bring required quantities of outdoor air into the building through the ventilation system. Most of the moisture load in a healthcare building comes from this outdoor air. To minimize microbial growth and occupant discomfort, this moisture must be removed before the fresh air enters the building.

One way to enable tighter temperature control and lower humidity set points is dessicant dehumidification technology.

Dessicant dehumidification is a single unit solution for controlling humidity, temperature and ventilation. This helps to control infection and maintain the integrity of the building structure by reducing the potential for condensation on walls and ceilings.

Risk Assessments During Renovation
Autumn is the best time for facility managers to assess cooling system condition and performance as well as schedule any repairs, upgrades, or retrofits.

Proper isolation and IAQ control are required for healthcare renovation or maintenance work areas. During major construction the first step is to conduct an Infection Control Risk Assessment (ICRA) to maintain the integrity of the healing environment. ICRAs are required by the AIA’s “Guidelines for Design and Construction of Hospital and Health Care Facilities,” JCAHO’s “Environment of Care Standard 8.30,” and the CDC’s “Guidelines for Environmental Infection Control in Health-Care Facilities.”

ICRAs advise personnel involved in the construction process to consider precautions for infection control and risk management planning. They also identify infection control issues that may affect air quality during renovation or construction.

The following are critical ICRA steps:
• Identify high risk patient groups;
• Analyze and identify areas where airborne-infection control is necessary;
• Determine standards and parameters for the number of air changes per hour, filtration and pressurization;
• Maintain accurate, up-to-date records on maintenance response, quality management and risk management.

Best practices include dust and moisture control practices, pressurization strategies and constructing temporary barriers between construction areas and occupied space.

Standards Dictate Building Design and O&M Procedures
Healthcare facility managers undergo extensive training to ensure they uphold regulations and codes related to operating and maintaining healthcare building systems. This includes healthcare facility standards and accreditation set by American Institute of Architects (AIA), the Joint Commission, the Centers for Disease Control (CDC), and the American Society of Heating, Refrigeration and Air-Conditioning Engineers (ASHRAE), as well as hospital-specific regulations.

HVAC service providers also need training in healthcare system design, construction, maintenance and operation. Anyone working on healthcare building systems should have the proper training in healthcare accreditation standards. Discuss with the provider technician qualifications and experience working with healthcare facilities.

Stay Prepared Through Emergencies
Even with every preventive measure in place, there is always the possibility of a utility or HVAC system breakdown. Healthcare facilities require a contingency plan, including backup energy generation and solutions for quick installation of temporary heating and cooling equipment to ensure continuous operation.

The key components of a contingency plan are:
• Document the installed utility equipment, including critical HVAC system location, unit information, and component details;
• Identify potential sources of failure, the probability of failure and document the cooling required to maintain critical areas;
• Match specific equipment and all required connection components needed to support critical areas;
• Determine required response timeframe and budget;
• Determine the appropriate location for the temporary equipment and the logistics to set it in place, as well as electrical and water connection points;
• Assign roles and responsibilities for each entity involved in the plan and staff members;
• Plan how to adopt the existing system and controls to best prepare the facility for the use of a temporary solution;
• File, review, train and update the response plan and system specifics on a regular basis;
• Conduct periodic contingency drills.

Conclusion
The fall season is an excellent time for health care facility managers to step back and evaluate the condition and performance of building systems. It is also time to make the seasonal transition to winter operating conditions. Taking the right preventive maintenance measures will ensure the facility continues to provide a healthy, high performing, energy efficient environment.

Maureen Lally works for Trane, a leading HVAC systems, solutions and service provider. Trane has market leadership in high- erformance buildings and energy efficient building systems
for all types of facilities.

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