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Ventilation, Temps and Humidity Requirements
PO Box 3187
Charleston, WV 25332
www.mckennaconsulting.com
304-988-1047
Inquisit
February 6, 2014
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Ventilation, Temps and Humidity Requirements
Relevance Without high quality ventilation
Healthcare workers, patient visitors can become infected
Poorly ventilated – pathogen particles very high
Higher concentrations, higher efforts
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Ventilation, Temps and Humidity Requirements
Relevance CMS – draft worksheets under
Infection Control TJC – Focus on temperature, humidity,
and pressure gradients State Surveyors – Focus on
temperature, humidity and pressure gradients (sometimes have higher requirements)
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Ventilation, Temps and Humidity Requirements
Findings for TJC EC.02.05.01 46% EC.02.06.01 36% IC.02.02.01 47%
Healthcare organizations fail
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Ventilation, Temps and Humidity Requirements
Findings for CMS Section 1.A.5 Infection control/prevention
program and resources at least 6 (existing facility) or 12 (new
construction/renovation) air changes per hour or per state licensure rules) and;
direct exhaust of air to outside, if not possible air returned to air handling system or adjacent spaces if directed through HEPA filters and;
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Ventilation, Temps and Humidity Requirements
Findings for CMS
Section 1.A.5 Infection control/prevention program and resources when AIIR is in use for a patient on
Airborne Precautions, documentation that monitoring of air pressure is done daily with visual indicators (smoke tubes, flutter strips), regardless of differential pressure sensing devices (i.e. manometers)
AIIR door kept closed when not required for entry and exit
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Ventilation, Temps and Humidity Requirements
Findings for CMS
Section 1.D.7 Personnel Education System / Infection Control TrainingThe hospital infection control system
ensures that respiratory fit testing is provided at least annually to appropriate healthcare personnel
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Ventilation, Temps and Humidity Requirements
Findings for CMS
Section 4.H Isolation: Airborne Precautions 4. H.1 NIOSH-approved particulate respirators
(N-95 or higher) are available and located near point of use
4. H.2 Signs indicating patient is on Airborne Precautions are clear and visible
4. H.3 Patients on Airborne Precautions are housed in airborne infection isolation rooms (AIIR)
4. H.4 Hand hygiene is performed before entering patient care environment
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Ventilation, Temps and Humidity Requirements
Findings for CMS
Section 4.H Isolation: Airborne Precautions 4. H.5 HCP wear a NIOSH-approved particulate
respirator (N95 or higher) upon entry into the AIIR for patients with confirmed or suspected TB. Facility policies are followed for other pathogens requiring AIIR
4. H.6 Facility limits movement of patients on Airborne Precautions outside of their room to medically-necessary purposes (note policy should address that patient wear surgical mask)
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Ventilation, Temps and Humidity Requirements
Findings for CMS
Section 4.H Isolation: Airborne Precautions 4. H.7 If a patient on Airborne Precautions
must leave their room for medically necessary purposes, there are methods followed to communicate that patient’s status and to prevent transmission of infectious disease (note policy should address that patient wear surgical mask when transported)
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Ventilation, Temps and Humidity RequirementsFindings for CMS
Section 5.A Protective Environment (e.g. Bone Marrow patients) 5. A.1 Positive pressure [air flows out to the
corridor]. 5. A.2 Twelve (12) air changes per hour 5. A.3 Supply air is HEPA filtered 5. A.4 Well sealed rooms so that there are no
penetration spaces in walls, ceilings, or windows 5. A.5 Self closing door that fully closes on all
room exits
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Ventilation, Temps and Humidity Requirements
Findings for CMS
Section 5.A Protective Environment (e.g. Bone Marrow patients) 5. A.6 Documents and demonstrates that
failures are addressed 5. A.7 For patients requiring a Protective
Environment, the hospital ensures that ventilation specifications are monitored using visual methods (e.g. flutter strips, smoke tubes) and observations documented daily
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Ventilation, Temps and Humidity Requirements
Space Ventilation
Air movement Generally from clean to less clean Variable air volume or load shedding for
energy conservation cannot compromise the minimum air exchanges
Ventilation rates provide comfort as well asepsis/odor control
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Ventilation, Temps and Humidity Requirements
Space Ventilation
Air ExchangesSupply in positive pressureExhaust in negative pressure
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Ventilation, Temps and Humidity Requirements
Space Ventilation
Air Filtration Well defined for specific areas Filter banks
Efficiency ratingsHEPAs – some areas including Protective
Environment Must have access to clean and to inspection Pressure measuring devices
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Ventilation, Temps and Humidity Requirements
Space Ventilation
HumidifierOutside humidity and internal moisture
insufficientProvided by healthcare facility air
handling systems – many specs
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Ventilation, Temps and Humidity Requirements
Isolation Rooms
Negative Pressure Airborne Infecting Isolation (AII)
Transmitted by airborne routesBacteria / virus suspend in air – carried
long distances • TB• Varicella (chickenpox)• Zoster (shingles)• Measles
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Ventilation, Temps and Humidity Requirements
Room Pressure Monitor
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Ventilation, Temps and Humidity Requirements
Negative Pressure - . 01 NStaff should know what pressure
should beAlarms should not be bypassed when
an airborne isolation room is in use
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Ventilation, Temps and Humidity Requirements
CMSMeasure at least daily – not just gaugeTools
Pressure Monitor/Smoke or flutterTissue (problems)Documentation should be clear
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Ventilation, Temps and Humidity Requirements
Pressure Gradients Negative Pressure Model
Patient Room
Lower pressure
Higher pressure (air into room)
Exhaust (directly outside)
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Ventilation, Temps and Humidity Requirements
TestSmoke Test
Smoke goes into the room – it is negative
FlutterFlutters when it is exposed to
the airflowNegative-outside room doesn’t
flutter inside-does flutter
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Ventilation, Temps and Humidity Requirements
Problem AreasAirborne Isolation RoomsProtective isolation RoomsSurgical AreasDecontamination Areas
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Ventilation, Temps and Humidity Requirements
See Findings - Word doc
See Ventilation Requirements Chart – PDF
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References Draft Worksheets:
http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-13-03.pdf
AIA ACADEMY OF ARCHITECTURE FOR HEALTH, UNITED STATES. DEPT OF HEALTH AND HUMAN SERVICES. Guidelines for design and construction of hospital and health care facilities. American Institute of Architects Press, 2010
Joint Commission (2014). Comprehensive Accreditation Manual, Department of Publications and Education Joint Commission Resources, Oakbrook Terrace, Illinois, 2014
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Thank you
McKenna Consulting
Post Office Box 3187
Charleston, WV 25332
304-988-1047
www.mckennaconsulting.com