Design in renovation to Design in renovation to optimize Ventilation optimize Ventilation

Case Study Case Study

Dr R ChandarshekharDr R ChandarshekharSenior Architect DteGHSSenior Architect DteGHS

ZONING / LOCATIONZONING / LOCATIONSeparation of Curative & Preventive AreaAppropriate traffic flow (e.g., no “dirty”movement through “clean” areas)Location of sinks and dispensers for hand washingConvenient location of soiled utility areas Isolation rooms with anterooms as appropriateLocation of adequate storage and supply areasProperly engineered areas for linen services and solid waste managementAir-handling systems engineered for optimal performance, easy maintenance, and repair

CASE STUDY

ART (Anti Retroviral Therapy) Centre

Dr RML Hospital New Delhi INDIA

CHALLENGESCHALLENGES

•• SITE LOCATIONSITE LOCATION•• HEIGHT OF BLDGHEIGHT OF BLDG•• TIME LINETIME LINE

A R T CENTRE At Dr R M L HOSPITAL DELHI

600x300(1200)

600x300150x300 (500)

450x300275x300 (500)

275x300175x300 (500)

OUT DOOR 3.0TR

AC MCB BOXFOR 1.5 TR

AC MCB BOXFOR 3.0 TR

AC MCB BOXFOR 3.0 TR

EXHAUST FAN(02SETS) SUPPLY FAN

(01 SET)

SUPPLY FAN (01 SET)

EXHAUST FAN(02 SETS)

1.5 TR1.5 TR1.5 TR1.5 TR

1.5 TR

850 CMH

850 CMH

850 CMH

2000 CMH 2000 CMH 2000 CMH 2000 CMH

LOCAL CONTROL PANEL

6000 CMH

1000 CMH

6500 CMH1500 CMH

1500 CMH 1500 CMH

AIR WASHER UNIT 7500 CMH(EACH) 2NOS

OUT DOOR 3.0 TR

OUT DOOR 1.5 TR

SUPPLY FAN (01 SET)

SUPPLY FAN (01 SET)

A R T CENTRE AT Dr R M L HOSPITAL DELHI

WAITING AREA

CONSULTANT ROOM

CUT OUT IN DOOR FOR AIR OUTLET

WAITING AREA

WAITING AREA ( EXHAUST AIR )

DIVIDER BETWEEN WAITING AREAS

TYPICAL DESIGN OF WARD BASED ON

EVIDENCE BASE DESIGN

TYPICAL  WARD  LAYOUT

TOILET(M)

TOILET(F)

BALCONY

D.U.

C.U.

STORE

ISOLATIONROOM

TOILET

ISOLATION

TREATMENTROOM

TOILET

NURSERESTRM.

DAY ROOM

NURSES' STN.

NURSES' STN.LIGHTSHAFT

LIGHTSHAFT

LIGHTSHAFT

G.T

L.T

TOILET(M)

TOILET(F)VISITORWAITING

TEACHING

DOC.DUTY

DOC.TOILET

PANTRY

TOI.

TYPICAL WARD LAYOUT

D.U.

C.U.

STORE

ISOLATION

TREATMENTROOM

TOILET

NURSERESTRM.

NURSES' STN.

NURSES' STN.LIGHTSHAFT

LIGHTSHAFT

TOILET(M)

TOILET(F)

TEACHING

DOC.DUTY

DOC.TOILET

PANTRY

TOI.

TYPICAL  WARD  LAYOUT

TOILET(M)

TOILET(F)

BALCONYISOLATIONROOM

TOILET

NURSERESTRM.

DAY ROOM

NURSES' STN.

NURSES' STN.LIGHTSHAFT

LIGHTSHAFT

G.T

L.T

VISITORWAITING

TOI.

TYPICAL DETAIL OF ONE CUBICLE IN WARD

DETAIL AT "A"

SCALE-1:100

WARD DESIGN WITH EVIDENCE BASED

I A Q Indoor Air Quality

IAQ IAQ

Particulates

Microbial

Gases

ParticulatesParticulates

Dust, dander, pollen, organic clumpsDust, dander, pollen, organic clumpsUsually handled by air filtration.Usually handled by air filtration.Filters must be maintained to be affective.Filters must be maintained to be affective.

MicrobialMicrobial••Single Cell OrganismSingle Cell Organism••Self contained and can reproduce without a hostSelf contained and can reproduce without a host••E.g., MRSA, E.g., MRSA, E. Coli, Staph, Strep…..

Bacteria

Viruses

Mold Spores

••Minimal structure of genetic material and proteinMinimal structure of genetic material and protein••Can only be seen with an electron microscopeCan only be seen with an electron microscope••E.g., Norwalk, SARS, Avian FluE.g., Norwalk, SARS, Avian Flu……..

••Airborne Single Cell OrganismAirborne Single Cell Organism••Grows into mold as soon as conditions permitGrows into mold as soon as conditions permit••Causes allergic reactions, asthma episodes, Causes allergic reactions, asthma episodes, irritations, infections, sinus congestion irritations, infections, sinus congestion problemsproblems……..

GasesGases••VOCVOC’’s (Volatile Organic Compound)s (Volatile Organic Compound) are found are found in smoke, adhesives, carpets, cleaning agents, in smoke, adhesives, carpets, cleaning agents, nail polish, paint, new construction, pressed nail polish, paint, new construction, pressed wood productswood products……••Can cause eye, nose, and throat irritation, Can cause eye, nose, and throat irritation, headaches, loss of coordination, nauseaheadaches, loss of coordination, nausea……

VOC’s

Odors••Caused by odorant molecules dissolved in the Caused by odorant molecules dissolved in the air.air.••E.g., pet odors, perfumes, food odorsE.g., pet odors, perfumes, food odors……

Current IAQ TechnologiesCurrent IAQ Technologies

ULTRA VIOLET LIGHT For Microbial

Inverse Square LawUV

100% POWER25% POWER

6.25% POWER

1.56% POWER

1”

2”

4”

8”

UV Treated Heat Exchanger

On Surface

Inside Heat Exchanger

PHOTO HYDRO IONIZATION (PHI )PHOTO HYDRO IONIZATION (PHI )

Hydrogen based oxidizers are created by Hydrogen based oxidizers are created by exposing activated oxygen molecules to a exposing activated oxygen molecules to a hydrated catalyst containing four unique metals hydrated catalyst containing four unique metals and 300 nm UV lightand 300 nm UV light (Photon Energy). (Photon Energy). These Friendly Oxidizers areThese Friendly Oxidizers are……..

–– HydroHydro--peroxidesperoxides–– HydroxidesHydroxides–– Super Oxide IonsSuper Oxide Ions–– Ozonide IonsOzonide Ions

HVAC PHI

HVAC PHI

The System is designed to provide enough The System is designed to provide enough UVC exposure (dose) to destroy UVC exposure (dose) to destroy aspergillus. UV technology disinfects aspergillus. UV technology disinfects HVAC surfaces and then keeps those HVAC surfaces and then keeps those areas clean by continuously radiating the areas clean by continuously radiating the reservoirs where microorganisms can reservoirs where microorganisms can thrive.thrive.This Systems combine This Systems combine filtrationfiltration and the and the germicidal effect of germicidal effect of UVCUVC. Rather than just . Rather than just trapping aspergillus spores trapping aspergillus spores

What is PHI CellWhat is PHI Cell

•Friendly Oxidizers are blown into the conditioned space

•Microbes and gases are destroyed on contact.

•Oxidizers break down into oxygen and water vapor

Kills airborne and surface pollutants

This is an integrated system of This is an integrated system of components engineered for components engineered for Indoor Air Indoor Air Quality (IAQ),Quality (IAQ), air purification, energy air purification, energy savings and biosavings and bio--defense. The major defense. The major components of this System are components of this System are ultra violet ultra violet germicidal irradiationgermicidal irradiation, , filtrationfiltration, reflective , reflective materials and monitoring hardware.materials and monitoring hardware.This is This is flexibleflexible and can be installed in and can be installed in any new or existing HVAC system.any new or existing HVAC system.

–– Creating comfort conditions in Creating comfort conditions in ““General AreasGeneral Areas”” in place of in place of normal airnormal air--conditioning by lowconditioning by low--energy techniquesenergy techniques

–– Earth Tunnel cooling systems Earth Tunnel cooling systems for non airfor non air--conditioned spacesconditioned spaces

–– Use of flashUse of flash--misting and other misting and other evaporative techniques evaporative techniques including indirect systemsincluding indirect systems

HVAC and Climate Control

Improve Indoor air quality with well designed ventilation system and air filters to prevent nosocomial infection.

–– VAV (Variable Air Volume) VAV (Variable Air Volume) systems for efficiency in systems for efficiency in unbalanced occupancy unbalanced occupancy conditions coupled with VFDs in conditions coupled with VFDs in Air Handling UnitsAir Handling Units

–– Enthalpy ( Total Heat) Control in Enthalpy ( Total Heat) Control in nonnon--medical areasmedical areas

HVAC and Climate Control (Contd.)

VAV System

Enthalpy controlEnthalpy control is a control which checks to see if is a control which checks to see if both the temperature (sensible heat) and the humidity both the temperature (sensible heat) and the humidity (latent heat) are low enough to be used for cooling. (latent heat) are low enough to be used for cooling. This combination provides for the greatest comfort at This combination provides for the greatest comfort at the least cost.the least cost.

If the indoor thermostat calls for cooling and the If the indoor thermostat calls for cooling and the outside air outside air enthalpy (total heat)enthalpy (total heat) is low enough then the is low enough then the economizer brings in this cooler and less humid air economizer brings in this cooler and less humid air and uses it for cooling instead of operating the and uses it for cooling instead of operating the compressor. Using the outside air for cooling is less compressor. Using the outside air for cooling is less expensive than operating the compressor to provide expensive than operating the compressor to provide cooling.cooling.

Enthalpy control is located in the outdoor air airEnthalpy control is located in the outdoor air air--stream and is a relatively sensitive control, it is not stream and is a relatively sensitive control, it is not uncommon to have to replace it every few years uncommon to have to replace it every few years depending upon the location of the equipment and the depending upon the location of the equipment and the weather extremes in the area.weather extremes in the area.

STUDIES & FINDINGSSTUDIES & FINDINGSFor the effectiveness of UVGI, the best ventilation rates For the effectiveness of UVGI, the best ventilation rates seem to fall in the range of seem to fall in the range of 1010--12 ACH for winter12 ACH for winter (no (no baseboard heating) and at baseboard heating) and at 6ACH for summer6ACH for summer with the with the UVGI locationUVGI locationUVGI does result in the killing of a significant percentage UVGI does result in the killing of a significant percentage of the viable particles in the room.of the viable particles in the room.Changing the location of the UV lamp and increasing its Changing the location of the UV lamp and increasing its intensity result in a higher percentage of particles being intensity result in a higher percentage of particles being killed. However, further increases in UV intensity show killed. However, further increases in UV intensity show diminishing returns. diminishing returns. The addition of baseboard heating results in better kill The addition of baseboard heating results in better kill UVGI rates irrespective of ACH.UVGI rates irrespective of ACH.Baseboard heating should therefore be used in winter Baseboard heating should therefore be used in winter cases, especially at low ACH.cases, especially at low ACH.

Assessing the Efficacy of Ultraviolet Germicidal IrradiationAssessing the Efficacy of Ultraviolet Germicidal Irradiationand Ventilation in Removing Mycobacterium Tuberculosisand Ventilation in Removing Mycobacterium Tuberculosis

High level exhausts are generally better High level exhausts are generally better than low level exhausts in terms of vented than low level exhausts in terms of vented percentage for the particle release points percentage for the particle release points considered in the study, particularly at low considered in the study, particularly at low to medium ACH. This trend is not present to medium ACH. This trend is not present at the higher values of ACH. However, at the higher values of ACH. However, note that patient rooms display better air note that patient rooms display better air conditions for low exhausts at low to conditions for low exhausts at low to medium ACH, medium ACH,

Antibiotics are not the cure for superbugs, cleanliness is - and the hospitals simply aren't clean enough in India .

Accountability is needed, not money,

Run a hospital like a fast food joint. "Clean as you go" and it is all staff's responsibility to clean up, not delegated to the lowest bidder

FOR ANY QUERY

E - Mail

cdb@nb.nic.in

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The All India Institute of Medical Sciences, New Delhi in The All India Institute of Medical Sciences, New Delhi in collaboration with WHO, Academy of Hospital collaboration with WHO, Academy of Hospital

Administration, The Indian Institute of Architects (NC) & Administration, The Indian Institute of Architects (NC) & School of Planning and Architecture announces School of Planning and Architecture announces ““THE THE

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