7 Risks and Considerations for Healthcare HVAC Systems

The planning process for a healthcare construction project can be extensive. While healthcare workers and the public may be most interested in a facility’s design or function, it’s the behind-the-scenes activities that often require the most scrutiny.

Until recently, some may not have given healthcare HVAC systems a second thought, but these systems play a critical role in patient care, infection control, and employee satisfaction

Working with experienced and knowledgeable HVAC contractors can help you avoid making mistakes in the following areas.

1. HVAC Filtration for Infection Control

The top consideration when seeking to improve air quality and mitigate infection risks in healthcare facilities is filtration. With patients and visitors having numerous health conditions when entering a healthcare facility, air quality becomes a top concern. The introduction of dirt, dust, pollen, dander, and other particulates can negatively impact air quality as well, necessitating the need for proper air handling equipment filtration. 

Filter performance is rated based on the minimum efficiency reporting value (MERV). This rating determines how well a filter can capture particulates between 0.3 and 10.0 microns. Filter selection requires a clear understanding of a manufacturer’s recommended cubic feet per minute (CFM) air flow at a given static pressure. 

It might seem like a good idea to err on the side of filtering out the finest particles possible but doing so will also restrict the amount of air flow that can be pulled through the system. Before you know it, filters become plugged and the added strain on the motor results in a system failure or shortened lifespan. It’s a balancing act: filters need to be selected based on need and on a manufacturer’s recommendations.

Isolation rooms for patients with infectious illnesses must stay in a negative pressure state and air must be pulled into the room rather than escaping. These areas usually require high-efficiency particulate air (HEPA) filtration with bag systems. 

While not technically a filter, some HVAC units feature UV lights that help to kill pathogens inside the return air section of the air handling equipment. It’s one more line of defense against viruses, but comes at a cost. The construction manager will work with healthcare HVAC professionals and the manufacturer to help determine proper filtration and whether the MERV ratings need to be adjusted in certain areas. 

RELATED ARTICLE: Healthcare Building Design Considerations for Infection Control 

2. Cooling and Humidification

A top mistake when designing HVAC for healthcare is failing to provide enough cooling and dehumidification in surgery suites. Doctors and nurses wear full PPE under stressful situations and work under bright lighting, sometimes making it feel like a sauna. Not only do staff typically want the area to be cool and dry, but the presence of too much heat and humidity also increases risks of infection in patients. 

3. Air Changeover Rates

Not having proper air changeover rates is another risk. Facility planners need to consider HVAC standards for hospitals and CDC recommendations for the number of times the air changes per hour. Critical areas like operating, trauma, and delivery rooms should cycle through a minimum of 15 times per hour, whereas patient or examination rooms should change air at least six times. 

4. Placement of HVAC Units

The placement and location of HVAC units sometimes becomes a problem. Units need to be isolated away from areas where patient care might be impacted. You don’t want a massive air handling unit located directly above the floor where procedural rooms are and causing issues with vibration and noise during surgery. 

Serviceability also needs to be considered when designing and placing HVAC equipment, piping, and electrical systems. If someone needs to repair or replace a six-foot coil, the unit can’t be placed three feet from a wall. Be sure to look for potential service accessibility issues during the construction planning phase.

GET THE GUIDE: Healthcare Construction Planning Guide

5. Equipment Redundancy

Failing to plan for redundancy of some equipment is another common oversight. At first glance, it may seem that a recommended HVAC system is overrated for a facility, but a best practice is to take an N+1 approach — having the recommended number of pieces of equipment to serve an area plus one as a backup. If you have an air handling unit with a single fan that supplies air to a surgery suite and that fan malfunctions, air quality will suffer until it can be fixed. 

When designing or retrofitting an HVAC system for healthcare, consider putting in a system that consists of multiple fans arranged in a fan wall design. That way, it will cover adequate CFM even if one of the fans fails. Doing so allows technicians to replace or service a fan without losing serviceability to a space. 

6. Energy Consumption

Miscalculating energy usage is a common issue when selecting an HVAC system, and facility managers are sometimes surprised when a unit doesn’t deliver the energy savings purported by the manufacturer. It’s important to understand that the efficiency rating of an HVAC system is based on ideal conditions. If a facility is in a very hot and humid climate, or where winters are exceptionally harsh, the system will likely not reach the stated ratings. Just like a car might be rated at 35 mpg on the highway, it will only achieve that efficiency under ideal weather and road conditions while driving 55 mph.

Measures can be taken to maximize efficiency, such as proper placement of the units, routing of ductwork, placement of electric and gas meters, aggregating meters together to minimize peak demand, and staging when units turn on and off. Even so, real-world expectations of energy costs should be discussed with your construction manager.

7. Maintenance and Training

Underestimating maintenance and training rounds out the top oversights when investing in a new HVAC system. Today’s technology is vastly different than it was even 10 or 20 years ago. Modern HVAC systems have complex features which might require special training for maintenance staff. Just as vehicles now include a barrage of electronics and complex systems, modern HVAC systems rely heavily on technology. The old days of heading to the boiler room with a wrench and screwdriver are long gone.

In addition to potential training, the construction manager will work with facility managers to help develop a preventative maintenance program for checking filters, UV lights, economizers, and other components. Each zone in a building will likely require different maintenance schedules, and where a hospital is located can make a difference, too. Rural healthcare facilities may have more dust from area farms, whereas urban hospitals might deal with other forms of air pollution.

First Steps When Selecting Healthcare HVAC Systems

If you’re planning to construct or renovate a facility, consult with a construction management and engineering team that specializes in healthcare construction. Healthcare HVAC is a highly specialized industry, so working with knowledgeable professionals is critical

They can help you assess your current system’s condition and determine whether it’s best to invest in new technology, its expected ROI, and how it fits into a facility’s long-range plan. They will also help develop an implementation plan to ensure the least possible disruption on staff, patient care, and day-to-day operations. Working with the infectious control department and other facility staff during the planning phase will help to minimize disruption and provide the best outcome. 

Some full-service construction teams work with healthcare facility administrators to find alternate sources of funds or cost savings. Their engineering team can provide value engineering (VE) options to see whether anything can be cut or phased in over time. The construction manager might help explore local utility grants or rebates for replacing equipment or work with the equipment supplier to secure favorable financing and payment options.

Partnering with the right construction team can help ease the transition to a new HVAC system and determine the most economical and practical solutions. Healthcare HVAC systems are just one consideration when planning a facility renovation or construction project. Get more tips in our helpful Healthcare Construction Planning Guide below, and reach out to our team with additional questions.

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