Specialised medical refrigeration – reliability is key

By Ilana Koegelenberg

From the laboratory to the clinic, the pharmacy and even on the road — what is the importance of
refrigeration in maintaining the medical cold chain?

Vaccines can become ineffective if stored at the wrong temperature for prolonged periods.
Image credit: getdoc.co

Refrigeration plays a major role in the medical field (I‘m resisting the urge to call it ‗a matter of life
and death‘, even though it is). It is vital, particularly when it comes to storing vaccines, blood or
organs — and even in the mortuary. Temperature-sensitive items rely on refrigeration that is reliable,
consistent, and durable. What types of refrigeration are used in the medical field and what are the
challenges we face in South Africa, in particular with regard to maintaining the medical cold chain?

Disclaimer: As usual, this seemed like a pretty straightforward topic when I pinned it to my features
list. However, when I started looking into it, I realised just how wide this topic actually stretched.
Each sector could literally be its own feature. I‘ve collected bits and pieces of information on the
topic, but please note, once again, this is by no means a comprehensive guideline.

Patient, product, operator

When it comes to all things pharmaceutical, my first call is always to Basil Mugwagwa, maintenance
manager at Pharmacare Limited (trading as Aspen Pharmacare) and ad hoc RACA Journal contributor.

―The topic is quite wide as the medical side of refrigeration can be looked at from either the angle of
patient safety (theatres, patient comfort, and so forth) or from medicinal product safety (looking at
storage conditions, such as temperature and humidity control of medicines),‖ Mugwagwa explained.

―What you need to remember in the medical field is the golden rule of patient, product, and operator
in all you do,‖ he said.

Patient: the medication must reach the patient in a safe manner and in the right state/form and
dosage (temperature / humidity control is vital here).
 “Vaccines are very temperature sensitive and must be stored within specifications.”

Product: must always be in its intended purest form (efficacy and purity) without any cross-
contamination. (Think of the role of temperature and humidity when certain medicines change state,
say from ointment to liquid.)

Operator: be it the nurse, doctor, pharmacist or any other medical personnel in the value chain, they
should be protected from unintended intake of medication. (It‘s all about the right temperature and
humidity — think of liquids that can turn to vapour and inhaled unintentionally due to high
temperature.)

At the centre of it all is the ventilation, air movement, and containment in the medical field. It‘s not
just about refrigeration, but HVAC as well. But for this particular feature, we‘ll focus more on the
refrigeration side of things, looking at how to keep product at its desired temperature.

So where does one start?

Why keep it cold?

Step one – why is refrigeration important when it comes to vaccines in particular? Not too long ago,
there was an interesting article on health24.com about exactly this — and particular to South Africa.
It highlighted that domestic fridges were often used in doctors‘ rooms, which may not store
temperature-sensitive vaccines properly, leaving them ineffective.

If vaccines are not kept strictly at the right temperature they will not work. There is growing concern
internationally and in South Africa that many health care providers are unaware they are
administering vaccines rendered useless through inadequate refrigeration in domestic or ‗bar‘ fridges.

The problem can be addressed, however, through regular ‗temperature mapping‘ of fridges, which is
now a requirement of the Pharmacy Act.
Refrigeration is vital in mortuaries to keep bodies from decomposing too fast.
Image credit: rd.com

Vaccines are highly effective — if stored correctly. ―Vaccines are very temperature sensitive and must
be stored within specifications,‖ confirms Dr Melinda Suchard, head of the Centre for Vaccines and
Immunology at the National Institute for Communicable Diseases.

Certain vaccines are particularly fragile. Live vaccines (such as for measles) may lose potency if
stored at too high temperatures. Diluent (liquid mixed with some vaccines) may also be a problem if
it is stored too cold and accidentally freezes. Vaccines for tetanus, human papilloma virus,
pneumococcal disease, and rotavirus, for example, are destroyed by accidental freezing.

Health professionals may not realise they are administering an ineffective vaccine. The handling
toolkit for the Centres for Disease Control and Prevention (CDC)‘s vaccine storage states that when
some vaccines accidentally freeze, there is no visual evidence this has occurred.

A recent review of research on temperature variations during refrigeration by the United States‘
National Institute of Standards and Technology showed that 13.5% of vaccines get accidentally
frozen. In South Africa, this number is probably even higher.

The CDC warns against using domestic or bar fridges to store vaccines, and recommends continuous
temperature monitoring to avoid vaccine damage.

Dr James Southern, advisor to the Medicines Control Council (MCC), states that vaccines should be
stored between 2°C and 8°C. ―Many routine domestic refrigerators run at above this, some even at
+15°C in hot weather. This shortens a vaccine‘s overall shelf-life. Some vaccines are reasonably
stable up to 25°C, but only for short excursions, up to an hour perhaps. Live vaccines are less stable,
but they are freeze-dried for extra protection,‖ he says.

One dangerous practice is reconstituting freeze-dried vaccines, then returning them to the fridge, or
leaving the vial on the bench for a while. They‘ll usually be stable for a couple of hours, but then
rapidly lose potency. Bright light can also damage their potency. Vaccines come with vial monitors
that show if the cold chain has been broken and the product is no longer effective.

―Replacing multi-dose vials in the fridge after removing a few doses is also risky. Theoretically, they
should be fine for a week or more, but any contamination or exposure to warmer temperatures can
damage them,‖ says Dr Southern.

Douglas Siepman, CEO of 5nines, which conducts temperature compliance monitoring, reckons that
around 90% of the domestic refrigerators they have analysed failed to meet vaccine storage
standards.

Damaged vaccines are also a financial burden. For example, if a specific flu vaccine for infants costs
about R500 a shot, a public health care facility can, at any given time, have half a million to a million
rands worth of stock in a single fridge. If that refrigerator goes out of range (correct temperature) the
vaccines would have to be discarded because they would have lost their efficacy.

Rules and regulations

Mugwagwa sent me a whole series of emails on standards and regulations that relate to the medical
field which really is strictly regulated and precise (although, as usual, we struggle with non-
compliance). There simply isn‘t space (or time) to go into all of these in detail so here‘s the ‗executive
summary‘.
You need very specific fridges when it comes to maintaining the medical cold chain — not just
beverage coolers.

In February 2015, the Pharmacy Act was amended to require that anyone storing, distributing or
administering vaccines must use appropriate storage areas and temperature-monitoring instruments,
along with conducting regular checks including annual temperature mapping. However, compliance to
these regulations is poor, particularly in the private sector including retailers.

The standards are all World Health Organisation (WHO) related as detailed in the main documents.
These are grouped under four sections, namely:
Oral Solid Dosage (OSD) — which are the normal tablets and powders.
Sterile — these include injections, drips, and ointments and are taken directly into the blood stream;
hence, very critical in nature.
Liquids — liquids that are taken by way of mouth (oral), as well as for wounds — external application.
Biological — human tissue, as well as dangerous live organisms.
Good baseline guidelines are the WHO TRS 961 and 957 which lead to the other guidelines for sterile
and so forth.

Then there are documents like ISO 14644 part 1 to part 4, which regulate the facility design and the
requirements for this.

Look out for storage guidelines too; these normally come as supplementary guidelines.

ASHRAE has also published numerous standards, including a guideline specifically for HVAC&R in the
medical field. This can be downloaded from their website upon registration.

All about temperature control

The manufacturing of medical refrigeration must include effective and sturdy insulation. If there is a
power cut and the refrigeration systems are left with no electricity source, the unit is expected to be
able to hold its temperature for approximately one day — provided that the door remains sealed for
the duration until power is restored.

Minus 40 has been manufacturing medical refrigeration and equipment for almost three decades at its
modern plant situated next to Cape Town International Airport. From vaccine fridges and breast milk
bank refrigerators to solar refrigeration and even mortuary equipment, they do it all, covering the
entire spectrum from birth to death (for both humans and animals).

I chatted to Minus 40 managing director, Michael Werner, about the state of the local medical
refrigeration industry and the challenges it faces.

Refrigeration is perceived as being a simple technology, and clients have their perception shaped by
their contact with domestic appliances, explains Werner. ―However, there is significant complexity
with temperature control, inclusive of accommodating defrost cycles and temperature variability that
occurs in daily operations when fridges are in use.‖

There is a huge challenge to educate clients on how to specify their products correctly to the
tolerances that their products require across the cold chain. This is solved by either receiving
internationally set standards from customers, usually defined by manufacturers of medicines /
vaccines or NGO organisations such as the WHO, or by interacting directly with the customers to help
them define optimum operating specifications.

You need very specific fridges when it comes to maintaining the medical cold chain. For example,
breast milk has to be kept at <-20°C for five continuous days to kill CMV viruses. Laboratories also
have very specific requirements in terms of temperature and humidity control. The requirements have
been set, but they are simply not always adhered to.

There actually is better compliance in the government sector than in the private sector, according to
Werner. Various national companies are storing their products in domestic and commercial beverage
fridges and not complying with regulations.

In 2013, the Gates Foundation did an assessment at the point of inoculation of vaccines in Africa and
found the vaccine efficacy failure at a staggering 55% at the point of inoculation in rural areas. South
Africa did not score much better either — but this study was not detailed enough. The bottom line is,
we have a problem – a big one.

Transport
It‘s not just about keeping product at the right temperature in the clinics and pharmacies. The correct
transport of the sensitive product is also vital to maintain a proper cold chain. Otherwise, the product
could be damaged or spoiled even before it reaches its destination.

The correct transport of the sensitive product is vital to maintain a proper cold chain.
Image credit: Twister

―The thermal stability of several pharmaceuticals places special demands on the refrigeration
logistics,‖ explains Kenan Gröss, managing director at Twister Trans. Numerous statutory
specifications and industry standards govern temperature-controlled transport operations and
represent a great challenge for shipping and forwarding agents. ―The effectiveness of medication and
vaccines may become reduced considerably by unavoidable temperature fluctuations during
transport,‖ explains Gröss.

To protect the patients dependent on the medication, the South African government has implemented
the Good Distribution Practice (GDP) Directive.

In the morgue
When a body is preserved through refrigeration, it is kept at a temperature below 4.5°C, which
sufficiently delays decomposition.

Refrigeration is often employed when there will be no viewing, wake, or visitation, or if the casket will
remain closed during the service (as many funeral homes require that the body be embalmed if it is
to be on display). Refrigeration is also used if the body will be cremated, as some authorities require
that a body be refrigerated for a given amount of time prior to cremation.

If the body will be buried in a ‗green‘ cemetery or natural burial ground, the body must be
refrigerated as those locations generally do not allow for the burial of embalmed bodies.

Maintenance
It‘s not just about installing the right equipment, but also looking after it properly. This is where
regular maintenance comes in.

The level of maintenance required for medical refrigeration is quite strict. Regular checks must be
made and logged to ensure that all equipment is safe, working at full capacity, and kept in
accordance to relevant standards and guidelines.
The question is, is this being done?

Not doing maintenance doesn‘t just put the product at risk but can also be costly in terms of having
to replace faulty equipment later on. Medical budgets mean that savings must be made wherever
possible, so efficient and reliable equipment is essential.

―Customers need to learn that modern refrigeration technology is reliable and durable, but not
maintenance free,‖ explains Werner. ―In medical environments such as in hospitals, we assume that
the environment is ‗clean‘, but the impact of lint, for example, in hospitals results in condensers being
blocked, impeding cooling airflow, and ultimately results in fridge failures due to overheating.‖

Having disciplined and regular cleaning of the refrigeration system will ensure reliable temperature
control within set parameters as well as extending the life of the equipment to decades.

Measurement matters – BMS

Medicines and vaccines often contain active ingredients that are sensitive to light, heat, humidity, and
other pollutants. If the environments in which they are manufactured, stored, and distributed are not
controlled carefully, their efficacy may be impacted. That control is so important that it has been
legislated in South Africa. Building management systems (BMS) and access control solutions are
playing an increasingly important role in ensuring that legislation is met.

Proven and approved validation systems help pharmaceutical manufacturing and distribution
organisations monitor and report on key processes employed in the manufacture of medicines, the
environment in which they are stored, and the conditions under which they are handled and
transported. ―Validation is important for the management of dangerous pathogens — it‘s important to
control and be able to validate the laboratory conditions in which they are kept and handled, from
origination to disposal,‖ explains Neil Cameron, Johnson Controls area general manager: building
efficiency – Africa.

Intelligent BMSs with their capability to measure, monitor and control environments based on
preconfigured requirements are important tools to help meet and enforce validation requirements. In
South Africa, legislation requires that on receipt of goods the recording devices (temperature data
loggers, refrigeration tags, freezer tags, log tags or cold chain monitoring cards) be checked and
documented. Elsewhere in the world, more rigorous requirements are in place that require the use of
validated technologies.
Vaccines come with vial monitors that show if the medicine has been out of the temperature range
and is no longer effective.

In the US, for example, the Food and Drug Administration (FDA) sets out validation requirements for
BMS. Today, pharmaceutical companies cannot export goods to the US that do not comply with FDA
validation requirements. To achieve this validation, organisations must make use of processes and
systems that measure, capture, and manage critical information related to the life cycle of the
product (manufacture, distribution, and so on) in a secure way.

A BMS for validated environments will, for example, provide scalable configurations, system security,
secure data management and reporting, electronic records and signatures, pre-selected and free-
form annotations, time-stamped audit trails, extensive integration capabilities at all system levels,
Web-based reporting (mean kinetic temperature, trend analysis and alarm analysis), and remote
alarming (email, text messaging, and the like).

“Customers need to learn that modern refrigeration technology is reliable and durable
but not maintenance free.”

In particular, technologies used for validation need to meet the FDA‘s Electronic Records and
Signature requirements. To comply, the computer systems used to collect and analyse data must be
validated to meet the FDA requirements for electronic records and signatures — that is, these
electronic signatures (authorisation) must be legally binding and the electronic records must be
protected from point of creation to receipt, meaning any tampering with information must be
detectable, explains Cameron.

Using an FDA certified BMS for validated environments the validation process can be integrated or
configured within the organisation‘s building automation system. Validation can be further
implemented within access control systems — an important consideration in the control of disease
and handling of dangerous pathogens.

FDA-certified BMSs for validated environments differ from standard BMS. Where a standard BMS will
measure the temperature in an environment, a BMS for validated environments will measure and
guarantee that temperature — it certifies that the temperature sensor is providing a true value, that
the controller to which the sensor information is sent is responding as it should, that the information
subsequently stored in the database is secure and cannot be tampered with, and that the output
report containing the FDA-required information is protected.

―While implementation of validation systems require effort, once in place, they provide the assurance
that validation processes are being followed and that the products the organisation is taking into the
market are safe and effective and of the required quality,‖ says Cameron.

―It‘s critical that South Africa begin to make use of the technologies now becoming available to
manage, monitor, and validate processes related to manufacturing, storing, and distributing
medicines in the country. It will protect us from human error and lower risks, but also help improve
processes and raise standards in the industry,‖ Cameron explains.

Education is key
Werner says he sees a trend towards better education in the medical field. ―People are aware that
they need to do better; medical practitioners are getting a better understanding. But the finance
people governing them do not necessarily understand — that‘s the problem. They just want the
cheapest model. This is more of a problem in the private sector, as government is more professional
in its procurement practices.‖

It all comes down to an education process. ―Education and legislation go hand in hand. We‘re getting
there but it‘s a slow process,‖ says Werner. Companies like Netcare for instance have started a drive
to dispose of domestic fridges and are now procuring the correct medical fridges.

Government tenders are also becoming much better at specifying what they need.

We still have a long way to go.

Exciting future
So where are we going? ―The medical industry is becoming more demanding in terms of specific
specifications, including higher attention to quality and service standards due to poor experience from
suppliers,‖ explains Werner. Also, the private sector is asking for increasingly eco-friendly products
both in terms of energy efficiency and in materials (specifically refrigerant gases). The government
sector is increasingly motivated to buy local to reduce import dependency.

Several exciting things are happening in the medical refrigeration field. For example, Minus 40 has
engaged with clients and suppliers to innovate products on an ongoing basis. Recent work with a
major South African health care company has resulted in a totally South African developed and
manufactured Breast Milk Bank solution, inclusive of milk pasteuriser, fridge, and freezers specific to
the milk bank duties, as well as a tracking and product control system to comply with proposed South
African regulations coming into effect this year. The solution is a completely integrated Breast Milk
Bank system, which is unique and costs less than half of the fragmented elements that were
previously imported, with associated support back-up challenges that were prevalent with earlier
practices.

Current projects include a unique South African designed and manufactured vaccine refrigeration
solution that will comply with WHO PQS certification.

Watch this space. The medical refrigeration market may not be a huge one, but it is a critical one.

Source: www.health24.com
ECM Motors For Large Central AHU Designs

Historically used in smaller-load residential settings, electronically commutated mo-tor

(ECM) technology is making the leap thanks to recent improvements and in-creased
awareness among engineers. Start with the basics, proceed to advantages and caveats,
and consider the ways ECM designs can streamline the economics of air movement.

FIGURE 1. Commercial building energy distribution.

FIGURE 2.
Popular AHU configuration.

September 1, 2016

Gary Hamilton P.E.

According to the United States Department of Energy, motors in homes and commercial buildings
consume more than one-third of all the electricity used in these buildings. Sixty-five percent of
electrical energy used in commercial and industrial systems goes to support electrical motors
powering centrifugal pumps and fans.

This makes the motor one of the most important components of HVAC systems. The efficiency and
reliability of the HVAC system is dependent on the performance of the motor, which is the primary
building block for all pumps and fans.

What are electric Motors?

Electric motors use the principles of electromagnetics to produce the torque used to rotate an axle.
When current passes through a coil of wire, a magnetic field is induced perpendicular to the plane of
the coil. A magnetic field produced by an electric current is called an electromagnet. This magnetic
effect due to the current loop is amplified when the wire is coiled around a ferrous metal. Magnetic
north poles attract magnetic south poles and repel magnetic north poles. These attractive and
repulsive forces are manipulated in an electric motor to produce torque, or rotational force, on the
axle.

The two most common motors in HVAC system are induction motors and synchronous motors.
Induction motors are so called because voltage is induced in the rotor (thus no need for brushes), but
for this to happen, the rotor must rotate at a lower speed than the magnetic field to allow for the
existence of an induced voltage. This difference between the motor and the magnetic field is known
as the ―slip.‖ The most common of this type of motor is the squirrel cage motors. Primary induction
motors are the most common in HVAC systems because of the low initial cost and high reliability.

Synchronous motors are so called because the rotor tries to line up with the rotating magnetic field in
the stator. It has the stator of an induction motor but the rotor of a dc motor. The difference between
the two motors is that the synchronous motor rotates in exact synchronism with the line frequency.
This motor does not rely on the current induction to produce the rotor‘s magnetic field. These types
of motors are used in equipment and appliances where high-precision constant speed is required.

ECM Motors

Recent development and improvement in motor technologies have introduced the HVAC industry to a
motor that is more efficient than primary induction motors, even when combined with VFDs. These
motors are known as electronically commutated motors (ECM). ECM motors were formally called
integrated control motors (ICM), which are electronically controlled by microprocessors.

The control module is the brains of the ECM motor. The control device converts AC power to DC
power to operate the internal electronics of the motor, thus allowing the motor to act like a DC
motor. The microprocessor in the control module is programmed to convert DC power to a 3-phase
signal to drive the motor, which makes it a 3-phase motor. It also has the added ability to control the
frequency (which controls the speed in revolutions per minute) and the amount of torque
(current/power) it delivers to the motor.

Advantages of ECM Motors

ECM motors have a number of advantages when compared to induction motors. The most notable is
the more efficient operation; it is approximately 50% more efficient than a comparable induction
motor. Since the motor operation is controlled by microprocessor, it offers significant advantages with
its operational range and accuracy. Because of this, an ECM motor is able to measure and regulate its
speed and power output without the use of external sensors or controllers. The microprocessor
precisely controls the magnetic field in the ECM motor, and therefore it is always synchronous, as
opposed to the asynchronous induction motors. Unlike the heat loss that induction motors experience
because of that lag, ECM operates at almost zero heat loss.

What about Variable Frequency Drives on an induction motor?

There exists the argument that an induction motor in a traditional fan array with a VFD is the most
energy-efficient arrangement for an AHU design. This fan/VFD arrangement is viewed as the best
means of ensuring that the fan is performing in the most energy-efficient manner during operation.
However, it is important to note that induction motors are designed to deliver maximum efficiency at
a single voltage, load, and speed, typically at their rated load and speed. Moving the motor operation
off this point will reduce the motor efficiency, typically from 55-65% and possibly as low as 12-18%.
It is common for an induction motor operating at its low speed to consume as much power as its
rated operational point and thus offset the energy reduction intended with an attached VFD.

Where ECM motors are Commonly Used in the HVAC Industry?

ECM motors are predominantly used in the residential HVAC industry. ECMs are used in the motors
for modulating furnaces, modulating boilers, condensing units, heat pumps, cooling towers,
geothermal heat pumps, fancoil units, and fan powered VAV boxes. They are used in many HVAC
systems with small horsepower ratings.

ECM Motors in Air handling Units

AHUs are the most common air distribution system for the HVAC industry. Figure 1 shows that cooling
and ventilation accounts for 35% of the energy use in commercial buildings. For this reason, the
industry should be focused on reducing this 35% by using technologies that will reduce the energy
used by air distribution system. A typical AHU in the commercial industry consists of the following
components: pre-filter and final filter, humidifier, heating coil, cooling coil, supply and return fans.
The fans are the workhorse for the AHUs and are singularly responsible for the air delivery to every
air distribution terminal in a building. The more efficient the fans are, the more energy efficient the
AHU (and by extension the overall HVAC system in the building) will be.

There are several types of fans utilized in AHUs, the most common are airfoil, plug, plenum, and
centrifugal. Although the efficiency of fans has been dramatically improved over the past ten years,
there is still room for improvement for fan technology when it comes to efficiency.

Over the past five years, improvements in ECM technology have increased the use of ECM motors for
the fans in AHUs. In the past, they were mostly used for small AHUs below 2,000 cfm. However, we
are now seeing the use of ECM motors in large custom AHUs, even moreso due to the use of fan
arrays in these settings.

Fan arrays are the most widely used technology in today‘s AHU applications because of the better
efficiencies when compared to larger centrifugal fans. Because they involve smaller cfm, the multiple-
fan scenario naturally lends itself to the use of ECM motors. The use of ECM fans is on the rise
because they provide much better efficiency than the most premium efficiency fan motor. There are
several advantages that ECM has when compared to traditional fan array configuration, including the
following.

 Unlike a typical ―fan wall or fan matrix,‖ fans do not need to shut off individually.
 In the event that one fan/motor assembly should fail, the other fans in the array can simply
increase output to compensate until the matter can be resolved.
 Since the motor and drive are built into every fan, no lengthy line runs are required and thus
the harmonics are greatly reduced.
 The superior construction involving airfoil or backward-inclined fan blades with a directly
coupled motor reduces turbulence and the potential for vibration, eliminates stratification,
and eliminates conventional noises caused by belt and sheaves assemblies.

ECM fans also provide several other key benefits that are important for certain industries. They are
compact, occupy smaller footprints, have longer operating life, have very high cfm range, and there is
no VFD required for the units.

One of the most important routine maintenance responsibilities regarding AHUs involves filter
replacement. The lack of proper filter maintenance is a large contributor to increased energy use in
commercial buildings. One of the huge benefits of using ECM fans is that the airflow will not vary with
filter loading, and therefore poor filter maintenance will not lead to additional energy use.

ECM fans are not suited for all applications. In addition to horsepower considerations, there are some
limitations to the technology due to the maximum pressure drop that can be handled by ECM motors.
Most ECM fans are limited to a maximum of 5 inch w.c. of external static pressure. Therefore, ECM is
not suited for large applications that require high external static pressures.

Mechanical engineers should start investigating innovative ways of specifying ECM motors for large
AHUs even in an application where there is high static pressure. I have implemented this strategy
when designing large custom AHUs for high static pressure applications. The supply static pressure
for the supply side was too high to use ECM fans, but the return fans‘ pressures were low enough for
its use. The ECM fan array was specified for a return section of unit, while the higher static pressure
supply side was specified with normal fan array arrangement with VFD.

Conclusion

Reducing the energy consumption for commercial buildings should be the focus of the HVAC industry.
Business as usual will not solve the dire situation with climate change. HVAC engineers should
continue to utilize new technologies that have the potential to reduce the energy footprints of
buildings. The use of ECM fans is becoming commonplace in the HVAC industry. This is encouraging
because it will contribute to reducing the 35% of energy use for the ventilation and air conditioning in
buildings.

The continued research into the technology will contribute to its wider application. The ECM is more
expensive than the normal fan array technology, but the applications have a better lifecycle cost than
the traditional fan array configuration. ECM fans are the future of fan array technology for both small-
and large-scale AHU applications.

Garold ―Gary‖ Hamilton is a Senior Vice President and Healthcare Practice Lead at WSP, one of the
nation‘s largest engineering and infrastructure firms. He is a licensed professional engineer in the
U.S.A. as well as in the Europe. He has over 21 years of experience in the design and analysis of
HVAC systems for a variety of market sectors, but with special focus on health care facilities. He is a
LEED AP and has designed over 22 projects that achieved LEED certified status. He is also a certified
commissioning Authority with the AAB Commissioning Group (ACG). He is an active member of
American Society of Healthcare Engineers (ASHE) and is a Senior of ASHE (SAHSE). He is also a
member of the International Code Council Ad Hoc Committee on Healthcare (AHC). Email him at
gary.hamilton@wsp.com or visit www.wsp.com for more details of his projects.
Terms Of Service: Motor Fundamentals

In the first of a pair of articles on motor fundamentals for HVACR, the author gets into
everything from industry standards and service conditions to changing speeds,
enclosures, and the often misunderstood service factor. You‟ll want to save this one for
your team‟s reference library.

FIGURE 1.

FIGURE 2.
FIGURE 3. Name plate design letters and their corresponding characteristics.

TABLE 1. Motor enclosure types.

TABLE 2.
Motor insulation classes.

March 8, 2017

Timothy J. Coyle, P.E.

Our objective in specifying motors for HVACR equipment is to start and run the driven equipment
under all operating conditions reliably and with reasonable life expectancy. The manufacturer of the
equipment and motor supplier have primary responsibility for this, but we should understand motor
ratings, design features, and application conditions well enough to identify project-specific conditions
that affect motor selection and include them in the equipment schedule or motor specification. This
article is the first of two on the subject that aim to take you beyond the basics of voltage, speed, and
horsepower and help you address other important considerations in your specification.

The „Workhorse of Industry‟

Our initial discussion is limited to the AC induction motor — the simple and durable electric motor that
drives the majority of fans, pumps, and compressors in HVACR applications. An induction motor
consists of coils of wire wound in a steel core around the periphery of the enclosure, referred to as
the stator, and a rotor consisting of a ―squirrel cage‖ of conductive bars in a steel core. Voltage
applied to the stator windings produces a rotating magnetic field and induces current to flow in the
rotor, producing a magnetic field there. Interaction between the stator and rotor fields develops
torque, causing the rotor to turn in the same direction as the stator field.

The nominal speed of a motor in RPM is the ―synchronous speed‖ of the rotating field determined by
the number of magnetic poles designed into the stator; for a 60 Hz motor, possible synchronous
speeds are 7,200/N, where N is the number of poles and must be an even number. Relative rotation
between the stator field and rotor is required to induce rotor current and produce torque, so speed
under load is always slightly lower than synchronous speed, such as 3,560 RPM or 1,780 RPM. As
nominal speed is reduced, the size and cost of the motor increases. The most economical speeds for
most applications are 3,600 or 1,800 RPM with 1,800 RPM preferred for bearing life.

Industry Standards

The primary American standard for motors is the National Electric Manufacturer‘s Association (NEMA)
MG1 – Motors and Generators. It covers motors from fractional to 50,000 hp and is divided into
requirements for small and medium machines, which apply up to 500 hp in 1,800 RPM and 3,600
RPM motors, and requirements for large machines over 500 hp in those same RPM ratings. MG1
includes standard frame sizes and dimensions for small and medium machines. For standard
applications, small and medium motors of the same frame, hp, speed, and voltage are typically
physically interchangeable. It does not establish frame sizes or dimensions for large motors. For this
reason, large machines are often referred to as ―above NEMA,‖ which can be misleading as they
should still comply with MG1 performance requirements.

Other standards include American Petroleum Institute (API) Standard 541 and Institute of Electrical
and Electronics Engineers (IEEE) Standards 841 and C50.41. These apply to severe environments and
demanding applications such as petrochemical and central station power plants. They represent
overkill for most commercial HVACR applications, but are a good resource when designing industrial
or utility projects.

Service Conditions

NEMA defines usual service conditions for AC motors as the following:<.p>

  Voltage plus or minus 10% of rated and balanced within 1% at rated frequency

 Frequency plus or minus 5% of rated at rated voltage

 Ambient temperature of 40ºC

 Maximum altitude of 3,300 ft AMSL

Permissible starting frequency, load inertia, and over-speed capability vary with the hp and speed of
the motor.

Unusual service conditions which require special design or selection of the motor include:

 Abnormal voltage or frequency including reduced voltage starting or operation from a VFD

 Frequent starting and/or frequent reversing (plugging)

 Corrosive, hazardous (explosion-proof), or high ambient temperature environments

 Loads with high inertia or high starting torque requirements

 Operation from an ungrounded electrical system

Some of these are addressed by the equipment manufacturer without designer involvement, but site-
or application-specific conditions should be included in your specification.

Voltage is the Key to Torque

Producing torque to start, accelerate, and run the load requires adequate voltage at the motor.
Torque is proportional to the square of voltage, so a small change in voltage can have a significant
impact on the developed torque. Motor voltage ratings differ from electrical system voltages by
approximately 5% to allow for voltage drop in the circuit conductors (the electrical equivalent of
friction loss in piping) without reducing motor voltage below the rated value. A motor for use on a
480V system will have a nameplate rating of 460V, for a 240V system a nameplate rating of 230V,
and so on.

A motor may have a dual rating for use with more than one system voltage. 230/460V three-phase
motors have two sets of windings for each phase with separate leads brought out to the terminal box.
The individual sets of phase windings are connected in parallel for a 240V system and in series for a
480V system. A similar configuration is available in single-phase motors rated 115/230V.

Can a 230V motor be safely run on a 208V system? 208V is 9.5% below the 230V rating, so even if
you maintain nominal system voltage all the way to the motor, you are at the bottom of the range for
producing rated torque. If the motor is lightly loaded, you may get lucky but should specify a 200V
motor for this application.

Getting Up to Speed

Figure 1 shows a typical motor speed-torque characteristic superimposed on the speed-torque

characteristic of a centrifugal load for which torque varies with speed squared. When the motor is
started, margin between the motor torque and load torque accelerates their combined inertia until
the point where the motor and load characteristics cross, defining the steady state operating speed
and torque of the combination.

Current at 0 RPM is referred to as ―locked rotor current‖ and has implications for both the motor and
the electrical system. Locked rotor current heats the motor at a higher rate than running current and
produces magnetic forces on the windings. This is the reason that standards and manufacturers limit
starting frequency and require a minimum time between successive hot starts.

Figure 2 shows motor current versus speed. A typical motor draws six to seven times rated current
from rest until it reaches 85% to 90% of rated speed, where the current drops off steeply to a steady
state value corresponding to the steady state speed. Current at 0 RPM is referred to as ―locked rotor
current‖ and has implications for both the motor and the electrical system. Locked rotor current heats
the motor at a higher rate than running current and produces magnetic forces on the windings. This
is the reason that standards and manufacturers limit starting frequency and require a minimum time
between successive hot starts.

Starting large motors may cause unacceptable voltage dip on the electrical system. If voltage
supplied to other loads drops below rated it can adversely affect their operation. Voltage dip at the
starting motor reduces starting torque, extends acceleration time and heating, and may lead to
insulation deterioration and shortened life. To mitigate this, large motors may be started with
methods that reduce locked rotor current, such as ―soft starters.‖ However, most methods reduce
current by reducing voltage applied to the motor, and the resulting loss of starting torque must be
considered. We‘ll discuss different methods of starting large motors in August, but for now know that
if you intend to utilize a reduced-voltage starting method, you need to communicate that to the
manufacturer.

Design Letter

MG1 defines the key points on the speed-torque characteristic by a Design Letter which appears on
the nameplate (Figure 3). As you can see, the typical curve discussed earlier is Design B. Design C
has a similar characteristic to Design B but provides higher torque during acceleration that makes it
suited for equipment such as conveyors that start under load. Design D has very high starting and
breakdown torque suitable for driving loads that experience momentary extreme overloads without
stalling out. This comes with some trade-offs: poorer speed regulation under load due to the
shallower slope of the curve at high speed, and lower efficiency.

If an application requires a characteristic other than Design B, it should be determined by the

equipment manufacturer, but it is common to specify that motors be Design B unless otherwise
required to allow replacement with a readily available motor in the future.

Off and Running

Figure 1 also explains what happens as load on a running motor changes. Under light load, such as a
centrifugal pump started against a closed discharge valve or an empty conveyor, speed is close to
synchronous speed and current is low. As the valve opens or material is placed on the conveyor, load
torque increases and the motor ―backs up‖ the speed-torque curve and slows down. At the same
time, lower speed causes current to increase toward rated. If load torque exceeds the rating of the
motor, current increases above rated, causing excess heating and shortening the life of the winding
insulation. An increase in load torque above the motor breakdown torque results in stalling the motor,
current increasing to the locked rotor level, and a certain trip.

Environment and Enclosure

Motor enclosure specification should be based on the operating environment. Table 1 lists common
low-voltage motor enclosure types and acronyms used to specify them. For most indoor applications
an ODP enclosure, which protects against accidental contact and dripping liquids, is adequate. In
outdoor locations and wet or dirty indoor locations, a totally-enclosed motor is usually specified. Since
no enclosure can seal perfectly, temperature changes result in introduction of ambient air into the
enclosure over time. Totally enclosed motors in outdoor or unheated indoor locations that do not run
continuously should be provided with a drain/breather and a winding heater to prevent internal
condensation.

ODP motors are cooled by an internal shaft-mounted fan, drawing air through one end of the
enclosure, passing it over the windings and rotor, and discharging at the other end. The most
common totally-enclosed construction, TEFC, has an external shaft-mounted fan under a protective
cowling that blows air across the enclosure, which usually has raised surfaces to improve heat
transfer. TEAO motors are intended to be mounted in the airstream of a fan driven by the motor and
therefore do not have a fan. TENV motors also have no fan and are limited to small sizes in which the
motor can be adequately cooled by convection alone.

Service Factor

The service factor (SF) is one of the least understood ratings of an AC motor, with many thinking it is
a multiplier of the hp rating at which the motor can be operated continuously with no loss of
performance or life expectancy, i.e. that a service factor of 1.15 makes a 10 hp motor effectively an
11.5 hp motor. However, MG1 states that when the voltage and frequency are maintained at the
nameplate value, a motor may be loaded up to the hp obtained by multiplying the rated hp by the
service factor, but it may have efficiency, power factor, and speed different from that at rated load
and will have reduced life expectancy.

If voltage drops below rated when operating within the service factor, current may increase, leading
to excess heating and/or tripping on overload. A design should not count on use of service factor to
meet the normal hp requirement of the load. Specifying SF higher than 1.0 should be considered a
means of providing margin for temporary overloads or temporary under-voltage conditions when
operating within rated hp.

Insulation Class

The primary factor in life expectancy of electrical insulation is temperature. Table 2 lists available
temperature ratings of motor insulation, defined by a Class Letter which is unrelated to the Design
Letter of the speed-torque characteristic discussed earlier. Classes B and F are most common with
Class H and N generally reserved for demanding applications such as very high ambient temperature
or long acceleration times. It is common in industrial and utility applications to specify that a motor
be provided with Class F insulation, but be designed for Class B temperature rise under load. This
provides margin for high ambient temperatures or short-term overloads and extended life at normal
ambient temperature and load.

Note that this temperature margin applies only to the winding insulation. If extended or frequent
operation at higher than standard temperatures is anticipated, the ability of the bearings and their
lubrication system to operate satisfactorily must also be addressed.

More to Come

I hope this has provided some useful insight into motor operation and ratings. In the August issue,
we will continue the discussion with starting methods, efficiency, European standards, and variable
speed operation.
 Table 1. Motor enclosure types.

Table 2. Motor insulation classes.

Timothy Coyle, an electrical engineer with 35 years of experience, specializes in planning, analysis,
and design of critical power systems in institutional and utility facilities. He is a senior electrical
engineer with Karges-Faulconbridge, Inc. Email him at tjcoyle@kfi-eng.com.

ECM Motors

Jeff Miller, September 20, 2016

With 30 years‘ experience in large HVAC motor control (3-phase), I have seen new advancements in
motor and VFD technologies, but never an advancement that Mr. Hamilton describes: - 50% more
efficient than an induction motor and VFD (please take one ECM out of a fan array out and replace
with premium efficient induction motor and VFD and test. We can go to Vegas and bet) - An induction
motor on the same load as the ECM, running at low speed, drawing the same current as at the design
speed (again, Vegas) - ECM having a longer life (I would love to see this data!) - ECM fans and
loaded filters not drawing more power (physics) - ECM doesn't require a VFD (because it is built into
the motor!) - ECM generates less harmonics (again physics, place a meter and they have 2-3 x more
harmonics reflected into the AC line) I challenge Mr. Hamilton to replace one ECM with a premium
efficient induction motor and VFD in a fan array (must have same fan and operating conditions) and
let the facts come out. ECM systems have their place, but they are not the magical creature described
in this article. They certainly would not be on a critical system that had my name on the drawings.

Fan motor selection is driven by the fan system connected

John Reints, November 4, 2016

ECM motors are the obvious choice. Your article should become the basis of good industry design
standards moving forward. There is a lot of energy savings to be gained in optimizing the fan load,
the supply ductwork delivery system. Ductwork design is the "last energy frontier" to be optimized for
energy savings.

FAN AFFINITY LAWS & PEAK EFFICIENCY

Matthew Severson, September 16, 2016

"One of the huge benefits of using ECM fans is that the airflow will not vary with filter loading, and
therefore poor filter maintenance will not lead to additional energy use." - Please share the fan curves
that led you to this conclusion. How does filter loading (i.e. increasing pressure drop) result in no
additional energy use?
Motors: Terms Of Service, Part 2

Round out this discussion of motor fundamentals for HVACR with a closer look at
starting, standards, and more.

Figure1.

TABLE 1.
Effect on starting current and torque of common motor starting methods.

August 7, 2017

Timothy J. Coyle, P.E.

This is the second half of a two-part article discussing principles and application of the AC induction
motors that provide motive power for most of the equipment HVACR engineers specify. In March, we
covered basic principles, application conditions, motor ratings, and nameplate data. This month, we
dig a bit deeper into starting methods, VFD application, efficiency, and international standards.

Starting Methods

The simplest way to start a motor is to connect it directly to the voltage source. EEs call this a full-
voltage start; it is also referred to as ―across the line‖ starting. A full-voltage start provides the
highest starting torque and shortest acceleration time of the motor and load but has consequences
that may sometimes be undesirable.

If the motor is large relative to the capacity of the electrical system, the high starting current may
cause the voltage to dip during the acceleration period, adversely affecting other loads. Full starting
torque applied instantaneously may over-stress the driven equipment, belts, or coupling. Either or
both starting current and transient torque can be reduced through one of the commonly used
methods listed in Table 1, which compares their relative effects on starting current and torque to a
full voltage start.
Percent of Full Voltage Value
Starting Method
Line Current Torque
Solid State Reduced Voltage 0-50 0-25
Primary Resistor or Reactor with 50%/65%/80% Tap
50/65/80 25/42/64
Connections
Autotransformer with 50%/65%/80% Tap Connections 25/42/64 25/42/64
Wye-Delta 33 33
Table 1. Effect on starting current and torque of common motor starting methods.

The need to reduce starting current is more common than the need to reduce transient torque and
the first three methods use techniques that reduce current by reducing the voltage applied to the
motor during starting. As explained in the previous article, motor torque varies with the square of
voltage, and the effect of this on the load must be considered. Figure 1 presents the same motor and
load speed-torque characteristics we considered in Part 1, but it shows the variation of motor torque
with starting voltage. Clearly, a reduced voltage start decreases the margin of torque that is available
for acceleration, and if it causes the motor torque curve to cross the load torque curve, acceleration
will stop at that RPM and the motor will run below rated speed until the starting current causes an
overload trip.

Reduction of starting torque with voltage does not present a problem for most centrifugal fan and
pump loads that start in an unloaded condition. For these loads, the solid state reduced voltage
starter, also referred to as a ―soft‖ starter, is the most popular option because of its ability to ramp
the voltage up gradually and eliminate transient torque during starting. These starters use power
electronics to control the voltage during starting and close a bypass contactor when the motor
reaches full speed to eliminate the losses and associated heating in the power electronic components
while running. They have the advantage of being able to re-engage the power electronics for a ―soft‖
stop as well, which can reduce check valve wear and water hammer in piping systems. Both the solid
state and resistor or reactor type starters reduce the starting current proportionally to the reduction
in motor voltage.

Equipment like positive displacement pumps or conveyors that start under load, and centrifuges or
large diameter fans that have high inertia, may not tolerate the exponential reduction in starting
torque with voltage of a standard reduced voltage starter. The autotransformer starter reduces the
starting current drawn from the electrical system by the square of the voltage applied to the motor,
which allows it to maintain a higher starting torque for the same degree of current reduction than the
solid state and reactor type starters. The Wye-Delta starter provides an equivalent ratio of maintained
starting torque to starting current reduction by changing the way the three-phase motor windings are
connected between starting and running. This starting method is popular for factory-wired starters for
equipment such as hydraulic elevators and chillers, but it is not commonly used when the starter is
located in an MCC because it requires six conductors to the motor instead of the usual three.

As discussed in Part 1, standard service conditions for motors include full-voltage starting. If the size
of the motor or other considerations dictate an alternate starting method, the manufacturer must be
informed of that in your specification, even if the starter is furnished separately from the equipment.

Variable Speed Operation

Varying the frequency of the applied voltage, which changes the speed of the rotating magnetic field,
is the most common method of AC motor speed control. VFDs use power electronics to convert 60 Hz
AC voltage into DC voltage and then convert the DC back into an AC voltage of the desired frequency.
Characteristics of the output voltage of VFDs and operation below rated speed can have adverse
impacts on the motor that must be considered. Most designers are familiar with the term ―inverter
duty‖ as indicating that a motor design has taken these factors into account and can be safely applied
with a VFD.

Requirements for inverter duty motors are defined in MG1 Part 31. This requires additional insulation
to protect against voltage spikes and neutral shift, as well as defining temperature rise and speed-
torque characteristics under VFD operation. The standard condition is assumed to be load torque
varying with the square of speed. Since current decreases with decreasing torque, less heat is
produced in the motor at lower speeds, which is important since the shaft-mounted fan provides less
cooling. Turn-down capability for a motor with a variable torque load on a VFD may be as high as 10-
to-1. If load torque does not drop off as quickly with speed, available turn-down is lower and
operation at the bottom end of the speed range may require an external blower to provide cooling air
independent of rotor speed.

A motor on a VFD will run hotter than the same motor on sine wave power under the same load and
ambient conditions, due to additional heat produced by harmonic components of the VFD output
voltage. A motor with a 1.15 SF on standard sine wave voltage thus has a 1.00 SF on a VFD, and it is
common to specify thermal margin in the insulation system (typically Class F insulation with Class B
design temperature rise) for VFD applications.

Load speed-torque characteristic also affects specification of the VFD itself. As with the motor, the
base condition is a centrifugal load, for which a Normal Duty VFD is appropriate. A non-centrifugal
torque characteristic may require specifying a Heavy Duty VFD capable of providing more current at
low frequencies. Normal Duty and Heavy Duty have supplanted the previously-used terms Variable
Torque and Constant Torque, but the principle remains the same.
A final consideration for specifying motors for VFDs is protection against bearing currents. High-
frequency switching used to create the motor voltage can impose a high-frequency voltage to ground
on the motor shaft. If this voltage is high enough, it will break down the normally-insulating layer of
lubricating oil between the balls or rollers and the bearing race. When breakdown occurs, a small
spark of current passes through the oil and erodes material from the ball and the race.

A continuous series of such breakdowns has the same effect as electrical discharge machining,
eventually damaging the bearing surface enough to lead to premature failure. While this effect has
been well documented and proven in situations where damage has been observed, there is no good
way to predict in advance whether it will occur for any particular motor-VFD application.
Recommended protection for large or critical motors consists of an insulated or ceramic bearing on
one end of the shaft and a brush assembly to continuously ground the other end of the shaft. For
small and non-critical motors, it is common not to provide protective measures unless a problem
develops.

Incidentally, although not discussed in the section on starting methods, the VFD makes an excellent
reduced voltage starter. By maintaining a constant ratio of voltage to frequency as the motor
accelerates, it allows the motor to produce rated torque while drawing only rated current. The cost
and efficiency penalty does not justify its use in a constant-speed application where a standard
reduced voltage starter will perform satisfactorily, but it is a good solution if a significant reduction in
starting current is required and high starting torque must be maintained.

Efficiency

A 2011 International Energy Agency report estimated that electric motors account for between 43%
and 46% of global electricity consumption, making efficiency an important parameter for facility
owners concerned about the cost and environmental impact of their operations. In the U.S., national
standards for motor efficiency have existed since the enactment of the Environmental Policy Act
(EPACT) in 1992. The current requirements, effective on June 1, 2016, state that most electric motors
must comply with minimum efficiency levels that NEMA has identified as Premium Efficient in MG1
Table 12-12.

EPACT-mandated efficiencies are defined by a Nominal Efficiency value on the motor nameplate that
represents the average efficiency of a group of motors of the same HP rating, RPM, and type. Some
motors will have higher efficiencies and some lower, but any motor must operate at not less than the
Minimum Efficiency associated with its Nominal Efficiency value. In general, the required efficiency
increases with size and for any particular horsepower rating is highest for 4-pole (1,800 RPM)
construction.

Motor efficiency is tested at full load under standard conditions including horizontal operation at 25ºC
ambient and standard deep groove ball bearings. If the actual operating conditions are different, the
motor efficiency may be different. The manufacturer‘s motor datasheet will specify efficiencies at 25,
50, 75, and 100% load, which are more accurate for predicting actual power consumption. These
datasheets also illustrate that efficiency varies with load and peak efficiency typically occurs in the
neighborhood of 75% load. This is a good thing since the limited number of standard HP ratings and
the improbability of a pump or fan‘s BHP requirement landing neatly on a standard HP rating means
that most motors operate at less than their full-load rating.

International Motors
While motors manufactured in the U.S. are governed by the NEMA Standard MG1 described in Part 1,
motors manufactured in Europe and most of the rest of the world are governed by standards of the
International Electrotechnical Commission, or IEC. We will not discuss these standards in detail, but
try to provide a comparison of IEC and NEMA terminology that will help you navigate the nameplate
of a motor sourced from outside the U.S.

IEC motors are rated in kW rather than HP and the conversion is based on the standard 0.746 kW per
HP. Use of a rating that we associate with electrical and not mechanical loads carries a caution; this is
still output shaft power and cannot be used to calculate the motor input current without taking into
consideration efficiency and power factor.

NEMA combines the integrity of the enclosure with the cooling method as in Open Drip Proof (ODP),
but IEC provides separate designations. The enclosure integrity is defined by an IP code (IP stands
for Ingress Protection) similar to those used for other electrical equipment in which the first digit
defines the degree of protection against solids and the second against liquids. IP22 for example
would closely correspond to a NEMA drip-proof guarded enclosure and IP54 to a totally enclosed
motor. Cooling is defined by a separate IC code, such as IC00 for an open machine and IC411 for a
fan-cooled machine. Thus an IEC equivalent of a TEFC motor would be IP54/IC411.

IEC motors also use design letters to define their torque characteristics. An IEC Design N torque
characteristic is similar to a standard NEMA design B characteristic, and an IEC Design H
characteristic is similar to a NEMA high-torque Design C characteristic. IEC motors use the same
insulation classes as NEMA motors and, although the permitted design temperature rise for each class
varies slightly, a motor with Class F insulation and Class B rise should provide similar insulation life
expectancy in either NEMA or IEC construction.

The ratings of an IEC motor for use in the U.S. should match one of the standard NEMA voltages and
be at 60 Hz. Many motor nameplates list multiple voltage ratings, so don‘t be alarmed if you see both
380V at 50 Hz and 460V at 60 Hz; as long as the winding connections for the appropriate system
voltage are used, the motor will perform satisfactorily. However, a motor rated only for 50 Hz
operation should not be used on a 60 Hz system unless the manufacturer has determined that the
motor can safely operate at the 20% higher speed and the driven equipment load at that speed is
within the motor‘s torque capability.

Timothy Coyle, an electrical engineer with 35 years of experience, specializes in planning, analysis,
and design of critical power systems in institutional and utility facilities. He is a senior electrical
engineer with Karges-Faulconbridge, Inc. Email him at tjcoyle@kfi-eng.com.
Dehumidification For Health Care

Operating rooms are home to some of the widest swings in required room conditions.
Review three dehumidification options on the way to tailoring the right design for your
next projects.

FIGURE 1. AHU system configuration.

FIGURE 2. Upper limit system supply air temperature analysis.

FIGURE 3. Lower limit system supply air temperature analysis.

FIGURE 4. DX and glycol dehumidification.

FIGURE 5. Desiccant dehumidification.

TABLE 1. Energy consumption of each system.

TABLE 2.

Energy cost of each system.

October 10, 2017

Ionel Petrus P.E., Rosemary Hwang, and Trey Eaton

Atypical approach when designing HVAC systems for operating rooms (ORs) is to go to ASHRAE
Standard 1701 and identify what types of ORs are being designed (e.g., Class B, Class C). One would
then determine the appropriate temperature and relative humidity design setpoints for all ORs in the
suite. The next step would be to calculate the OR sensible and latent loads, followed by the selection
and sizing of the related HVAC system. Since the OR HVAC system has been designed and sized per
the requirements of ASHRAE 1701, one would expect that such system will meet all user expectations
and operate as intended. Unfortunately, this ―one size fits all‖ approach does not give the users the
flexibility to perform complex procedures while having a reliable and energy efficient mode of
operation.

With a continuous pressure to decrease turnover time while also providing the medical staff with
utmost flexibility, the design of the HVAC systems for today‘s operating rooms requires not just
special attention but also complex analyses. As such, it is crucial for the OR HVAC systems to support
a wide range of temperature and associated relative humidity setpoints. For instance, an orthopedic
surgery room could require a design OR setpoint of 63°F and 40% rh; such procedure might then be
followed by a long and demanding pediatric surgery that requires higher temperature and relative
humidity setpoint (75°F and 50% rh).

It is important to note that Note O on Table 7-1 of ASHRAE Standard 1701 states that ―Surgeons or
surgical procedures may require room temperatures, ventilation rates, humidity ranges, and/or air
distribution methods that exceed the minimum indicated ranges.‖ Due to various factors that affect
the design, different HVAC system configurations must be analyzed in order to meet the ever
increasing and ever more complex expectations from the OR HVAC systems.
This article focuses on three types of dehumidification methods that can be used to cater to the
various OR design needs: 1) Low temperature DX dehumidification, 2) Low temperature glycol
dehumidification, and 3) Desiccant dehumidification. This article compares the benefits and limitations
of the three different dehumidification methods, and analyzes the energy impact and related cost for
each. In order to simplify the energy analysis and to mitigate the risk of having system specific
parameters (i.e., external fan static pressure) that could skew the results, the fan energy and related
fan heat gain have been removed from the analysis for all three systems.

Design Conditions (shown in Figure 1)

The minimum OR temperature setpoint is 65°F and relative humidity setpoint is 40%, while the
maximum are 75°F and 50% rh, respectively.

 The ORs are teaching type with high latent load; SHR line is 0.8.

 Supply air temperature setpoint is 55°F.

 VAV terminal devices with reheat coils are serving each OR.

 The AHU total supply airflow is 13,000 cfm.

 Each OR is designed to operate between the minimum and maximum temperature and
relative humidity setpoints.

 The design mixed air temperature (i.e., between return air and outside air) is 79.9°F
DB/68.4°F WB.

Dehumidification cannot be discussed without using the ―infamous‖ Psychrometric chart, and the
three dehumidification methods are illustrated in such charts throughout this article. The two typical
design conditions that will be considered are: 1) At 75°F and 50% rh with a humidity ratio W RA of
64.9 gr/lb and 2) at 65°F and 40% rh with the humidity ratio WRA of 36.7 gr/lb.

The upper limit of 75°F and 50% rh ( WSA =~56.8 gr/lb, DPSA=~51.5°F shown in Figure 2) can be
addressed using a standard approach, as this relatively ―warm‖ dew point (DP) temperature can
easily be achieved with a standard chilled water coil design. Unlike the upper limit conditions,
however, lower limit conditions require a more complex approach.

With the intent of having the system supply air temperature (SAT) located somewhere on the sensible
heat ratio (SHR) line and as confirmed by the latent heat gain equation, in order to maintain the
lower temperature and relative humidity OR setpoints, the corresponding required supply air humidity
ratio WSA is approximately 32.4 gr/lb and the required dew point temperature DP SA is approximately
37°F (Figure 3). In order to meet this relatively cold temperature requirement of 37°F dew point
temperature and dry bulb temperature of 37.1°F, a more complex HVAC system must be considered.
The remainder of this article analyzes three systems to meet these design conditions and the system
energy consumption. With the intent of comparing ―apples to apples,‖ it is assumed that all cooling is
done at the AHU.

Low-temperature DX dehumidification. With a DX system, assume that two DX cooling coils,

arranged in series, are required in order to cool the air down to a 37°F DP temperature (this may
vary depending on the DX system and/or manufacturer). The maximum refrigerant saturated suction
temperature should be around 35ºF to meet this condition. Depending on the coil type lower
refrigerant temperatures might be required. However, in order to achieve a design supply air dry bulb
temperature of 55ºF, a reheat coil is required to heat the air from 37°F DB back up to 55ºF before it
leaves the AHU. Figure 4 shows this system in a psychrometric chart.

Low-temperature glycol dehumidification. From a psychrometric perspective, the second

system is similar to the first system, but this one uses two glycol cooling coils that are installed in
series to cool the air down to 37ºF DP temperature. The low-temperature glycol water, which has a
concentration of 35% propylene glycol, is delivered by two low-temperature air cooled chillers. The
design cooling coil glycol entering temperature is 20ºF DB, and the design cooling coil glycol leaving
temperature is 29ºF DB.

Desiccant dehumidification. Unlike the two previous systems, desiccant dehumidification utilizes a
series desiccant wheel to drive the air well below a 37ºF DP temperature, as shown in Figure 5. The
cooling coil leaving air temperature is 48.5ºF DB. A separate preheat coil is used to regenerate the
desiccant wheel making the preheat coil leaving air temperature to be 113.8ºF DB. A secondary
cooling coil is required to cool the air that leaves the desiccant wheel down to 55ºF DP.

Although all three systems have the capability to meet the design conditions, the energy consumption
and related energy cost of each system is significantly different. The following energy and energy
cost analyses are completed based on the design condition. This article is not intended to determine
which of the three systems is most suited for designing ORs. Project specific variables such as
weather, first costs, operational costs, building type (i.e hospital, ambulatory surgery center) could tilt
the balance in favor of each of the three systems.

TABLE 1. Energy consumption of each system.

The estimated energy and energy source consumption at design conditions associated with each
system is presented in Table 1.

For estimating the electricity consumption for each system, the following assumptions were made:

 The desiccant system uses chilled water from a chilled water plant with an energy efficiency
of 0.85 kW/ton.

 The low-temperature glycol air cooled chillers have an energy efficiency of 6.4 EER, including
pump energy.

 The low-temperature air cooled condensing units have an energy efficiency of 8 EER.

For estimating the source energy consumption, the following assumptions were made:

 Electricity, 32% efficiency (5% extraction and processing losses, 57% generation losses, 6%
distribution losses).

 Natural gas, 92% efficiency (7% extraction and processing losses, 1% distribution losses).
TABLE 2. Energy cost of each system.

The estimated energy cost, at design conditions, associated with each system is presented in Table
2.

The following assumptions were made in order to conduct a cost and energy analysis:

 Cost of electricity $0.10/ kWh

 Cost of natural gas $10/1,000 CFH

 Heating is done via hot water coils

 Hot water boilers with 85% efficiency

Conclusion

When designing HVAC systems for operating rooms, it is extremely important to engage the medical
staff early in the design process. As stated in the ASHE/AORN Guidance 2, ―[the] Design requirements
are NOT the same as clinical practice recommendations. Each has a distinct purpose and intent. The
ASHRAE/ASHE standards and FGI guidelines are intended to establish the minimum design
requirements and criteria that must be met to construct an HVAC system that will support clinical
functions during the life of a building. The AAMI and AORN guidelines are intended to guide the daily
operation of the HVAC system and clinical practice once the health care facility is occupied.‖

In other words, there are no single temperature and relative humidity setpoints that satisfy all ORs
within a suite. Instead, the HVAC system should be designed to accommodate a wide variety of OR
temperatures. Without this much needed flexibility, there is a risk for the OR HVAC system to
negatively impact infection control, OR turnover time, and patient recovery time. The intent of this
article is not to claim that the presented three systems are the only ones that can meet the
temperature and relative humidity demands of today‘s ORs. Each of the three systems, or any other
similar system combinations for that matter, has its pros and cons. Different systems should be
utilized based on project specific requirements and needs.

References

1. ANSI/ASHRAE/ASHE Standard 170 – 2013, Ventilation of Healthcare facilities

2. ASHE/AORN Joint Interim Guidance, September 21, 2015.

3. Ionel Petrus is a licensed professional engineer and has over six years of mechanical design
experience. In addition to being a LEED AP, he is also a Certified Energy Manager. His
experience includes designing HVAC systems for commercial buildings, research laboratories,
healthcare facilities, and museums. He performs energy calculations, ROI analyses, as well as
life-cycle cost analyses. He can be contacted at ionel.petrus@smithgroupjjr.com.
4. Rosemary Hwang is a mechanical engineer with SmithGroupJJR in Washington, DC. She
attended Penn State University where she graduated with an integrated M.A.E/B.A.E of
 Architectural Engineering degree in 2016. She is working towards gaining valuable HVAC
design experience and is expected to take her Professional Engineering Exam in 2019. She
can be contacted at rosemary.hwang@smithgroupjjr.com.
5. Trey Eaton is a Trane HVAC systems account manager and has over three years of
experience. He is a certified Six-Sigma Greenbelt and his experience includes assisting design
engineers with commercial buildings, research laboratories, high-rise multifamily, data
centers, and health care facilities. In addition, he is also capable of performing ROI analysis
and life-cycle cost calculations. Reach him at Trey.Eaton@Trane.com.
Renovating Operating Rooms To Meet Modern Medical Advancements

While the latest surgical technologies lead the push for more OR suite square footage,
they also contribute to ever-tighter ceiling space. Add updated requirements for IAQ and
electricity, and any renovation team needs to sharpen its strategy in advance of this
delicate operation.

FIGURE 1. Carilion operating room renovation project with complete AHU replacement.

FIGURE 2. Highland Community Hospital OR renovation project in unfinished condition.

FIGURE 3. Carilion Clinic OR renovation project with completed OR space.

October 9, 2017

Gary Hamilton P.E.

Today‘s operating rooms are inefficient and overcrowded, and the turnover between cases is often
lengthy and variable. New technologies and devices are often introduced haphazardly into an already
technologically complex environment. This often leads to an HVAC system that is not equipped to
handle these technological advancements. Adding these technologies over time will tremendously
reduce the effectiveness of the HVAC system and its ability to meet the load and infection control
requirements. This, in turn, potentially affects patient safety and hospital operating costs.

Surgeons are demanding very sophisticated operating rooms, larger ones, and more stringent
temperature and humidity requirements. Existing operating rooms, because of age and changes in
codes, will struggle to meet the demand of these surgical teams. Existing hospitals operating rooms
are often in need of a major overhaul to meet these stringent requirements, and the luxury of new
construction is rarely on the cards. So upgrading these operating rooms usually means very complex
renovation projects in one of the most important spaces in the hospital. What can a hospital facility
team do to make renovation and expansion of the operating suite efficient and cost effective? This
article will address some of the key items that need to be addressed to ensure a successful operating
room renovation project.

As project teams dissect and reassemble the most revered real estate in any hospital, utilizing
technological advancement, portable technology, and the inclusion of hybrid operating rooms can all
work to a facility‘s advantage. Hospital facilities teams should be prepared for multiple project phases
and disruption to their hospital operation. These intricate renovation projects can last anywhere from
six months to five years, depending on finances and the level of renovation required.
Technological Advancements driving today‟s Operating Rooms

Operating room technologies have change a lot over the years, mostly due to the advent of less
invasive surgical procedures. Computer-assisted technology and highly specialized tools and
instruments are used to assist the surgeons with visualization and control. The popularity of image-
guided procedures have introduced the health care industry to hybrid operating rooms and tele-
surgeries.

Procedures such as tubular ablation for cancer treatment and single-incision laparoscopy surgery are
all conducted using image-guided three-dimensional videos images. Operating rooms are now being
designed to accommodate machine intelligence and robotics. This process and innovation continues
to enhance the human/machine interaction. The use of da Vinci and TransEnterix surgical robots are
becoming commonplace for use in soft tissue surgeries. This is very beneficial to patient care and
safety because they provide a number of benefits when compared to traditional surgical procedures;
some of these benefits are smaller surgical incisions, reduced blood loss, lesser post-operative pain,
faster recovery time, less scarring, and improved function.

MEP and Structural Drivers

Operating room renovation projects often starts with the poor state of the existing space. However,
there are a number of other factors that have to be considered before starting the design process.
Usually some of these factors are not as visible as the surgeons need for space and better
environmental condition. The most important of these considerations are the MEP and structural
requirements of the new space. The facilities team is encouraged to conduct a full evaluation of the
existing MEP and structural systems. The condition and capacity of these systems will play a
significant role in the feasibility and phasing plan as well as the construction budget. MEP systems
that are more than 20 years old are unlikely to meet the current code requirements.

The 2014 Guidelines for Design and Construction of Hospital and Outpatient Facilities now refer to
operating rooms as a ―wet room.‖ This means that isolation panels are required to be installed before
any renovation of the existing OR spaces, which in turn increases the electrical requirements. This
means that two isolation power panels will be required: one for normal and one for critical power.
This could be two critical power panels with each panel coming from a separate automatic transfer
switch (ATS). Electrical systems that are in excess of 15 years old are unlikely to meet these new
guidelines.

This also means that the wall housing the isolator power panels will need to be a minimum of 12 in
deep depending on the manufacturer of the panels. A possible solution to this wall depth requirement
is to place the isolation panels in the corner wall of the duct chase. Sometimes the renovation
involves the addition of a hybrid OR with fixed imaging and interventional equipment in the room —
such as catheter lab equipment, these hybrid rooms usually require additional cables, power,
integration, and HVAC.

Additional structural support will be needed for lights, booms, and monitors, and therefore the room
will have to be expanded to accommodate this equipment. Operating rooms have become
increasingly larger because of the equipment and code requirements. Older operating rooms are
usually 350 to 400 sq ft, while new general ORs are between 500 and 600 sq ft. Neurosurgical and
orthopedic operating rooms are between 600 and 800 sq feet, whereas a hybrid OR might be
anywhere from 800 to 1,200 sq ft. Those upgrades to the MEP infrastructure systems, which are the
first step in the renovation process, could be up to 50% of the construction cost.
The available ceiling height also affects the mechanical systems layout in operating rooms. Floor-to-
floor ceiling heights of 15 ft are more are a dream for engineers renovating a surgery suite. If you
have 15 ft or more from floor to floor, the mechanical ducts and terminal units or air valves are not
limited in where they can be placed in the room. Floor-to-floor ceiling heights of less than 12 ft are a
huge challenge for engineers because the mechanical ducts will not fit in the center of the rooms,
making low soffits around the perimeter of the operating rooms necessary. Lack of ceiling space can
also affect ceiling-mounted booms that support medical gases, lights, power, data, monitors, and
shelves for equipment. Locating the mechanical ducts and structural support for equipment booms
can also be very challenging in low floor-to-floor heights.

Solutions for handling low ceilings heights

Renovating an operating room is often associated with complicated ceiling coordination. The
structural supports for the booms can be located on the sides of the air distribution ductwork. For
example, the engineering team was working on a project where there was a low structural beam in
the ceiling which only allowed hybrid operating room equipment to pass but not the ductwork. The
solution was to separate the terminal units and lights to operate on each side of the structural beam.

In another project, the ductwork could not be relocated so a ceiling-mounted monitor was located at
the end of the operating room table with an extension arm. The only space available was for an
anesthesia boom, so hose reels were used for electrical and medical gases, which required less space.
Lights with extended arms can also be used to reach the surgical table and small monitors can be
located on the same arm. When dealing with low ceiling heights, communication between the facility
engineers, mechanical and structural engineers, and the architect is crucial as each situation will likely
require a unique solution.

Streamlining the design and construction process

Operating room renovation projects often require multiple phases during the construction to keep the
surgery suite in operation. These phasing plans will have to be documented in the architectural and
engineering plans to ensure that the process of execution is well thought-out and communicated to
the design and construction team. Phasing of the project should start with the design team; the
mechanical engineer is usually a very important part of the process because phasing is usually based
on the AHU zoning.

The construction team should then revisit the phasing plans and update it based on the surveyed
existing condition. Phasing of the project should also be reviewed with the surgery staff, facility
manager, and by the project team to ensure all parties understand what moves and the disruptions
that will take place, the duration, and when they‘ll occur. It is better to implement the pull planning
technique for the scheduling of the tasks during these types of projects. Breaking down each phase
and documenting it for the renovation phasing will setup the team for a successful project
implementation.

The control of dust and debris in operational operating rooms can be challenging during construction,
and IAQ needs to be managed closely to ensure that it doesn‘t become an issue for the surgery staff.
The most import aspect of the renovation process is to ensure the sterility of the surgical suite at all
times. Therefore, all work in the surgery suites should be constructed in compliance with local
infection control risk assessment standards and the 2014 Guidelines for Design and Construction of
Hospital and Outpatient Facilities. These standards are for the building and site areas that will be
affected by construction and should include the determination of specific hazards and protection for
each construction area.

Construction crews need to be flexible in their work hours because construction noise can be a
dealbreaker for surgical procedures. If the noise cannot be contained, the construction team should
conduct any noise related activities during evenings and on weekends. The noise related activities
should be fully coordinated with the facility staff and the surgical team. The best scenario would be to
block off an area of the surgical suite and create a separate construction entrance and egress for
materials and debris. If this is not possible, the construction crew will need to be gowned with feet
covered, and all material going in or out of the operating room must be covered.

During the construction duration, a TAB engineer independent of the construction team or hospital
engineer should monitor airflow regularly to ensure negative pressure in the construction zone and to
prevent contamination. One helpful approach is to find an adjoining soft space, such as an office or
storage room, to explore an expansion.

For example, for the Carilion Clinic operating room expansion and renovation project, a storage and
sub sterile space adjacent to an existing special procedure room was used to create a new minor
procedure room and to avoid the shortage of space during renovation.

Keys to success

In the end, renovation and upgrading of the surgical suite can best be accomplished by using an
integrated team and a collaborative process. This process requires successful communication between
the surgical staff, the facility team, the commissioning agent, the contractor, and the
architecture/engineering team. This communication should occur throughout the renovation process
and into the initial operational phase. The more information the staff has, the fewer surprises there
will be for the project team. It is also important during the initial operational phase to create a
feedback loop so that issues can be resolved by the construction team during project close out.

When surgery suite rooms are upgraded to meet the new space requirements, MEP and structural
requirements, this usually results in a surgery environment that consist of advanced technology
integration. This will allow surgeons to be able to perform day-to-day operations for complicated
procedures in the safest environment for patients and staff.

Garold ―Gary‖ Hamilton is a Senior Vice President and Healthcare Practice Lead at WSP, one of the
nation‘s largest engineering and infrastructure firms. He is a licensed professional engineer in the
U.S.A. as well as in the Europe. He has over 21 years of experience in the design and analysis of
HVAC systems for a variety of market sectors, but with special focus on health care facilities. He is a
LEED AP and has designed over 22 projects that achieved LEED certified status. He is also a certified
commissioning Authority with the AAB Commissioning Group (ACG). He is an active member of
American Society of Healthcare Engineers (ASHE) and is a Senior of ASHE (SAHSE). He is also a
member of the International Code Council Ad Hoc Committee on Healthcare (AHC). Email him at
gary.hamilton@wsp.com or visit www.wsp.com for more details of his projects.
Reliable V-Belt Drive Operation

Facility engineers who must maintain or oversee installation of V-belts throughout an

HVAC system: take these dozen tips for proper tensioning, followed by more on how to
identify and troubleshoot the consequences of improper tension.

FIGURE 1. Belt and sheave gauges.

FIGURE 2. Dished out pattern of a worn sheave groove.

FIGURE 3. Alignment of sheaves.

FIGURE 4. Belt span and deflection.

FIGURE 5. Belt tension testers are available from belt and sheave manufacturers and suppliers.
FIGURE 6. Types of shaft and sheave misalignment.

FIGURE 7. Belt tension versus expected belt life.

TABLE 1. Example belt deflection force for A and B cross sections.

June 2, 2017

Thomas Bishop, P.E.

Over-tensioning shortens not only the life of V-belts but also that of the sheaves, electric motor, and
driven equipment bearings. In extreme cases, it can even bend or break a motor shaft. Unfortunately,
premature failures due to the excessive radial load of over-tensioned belts often prompt users to
replace drive end ball bearings with roller bearings, rather than to set the belt tension to the correct
value. To assure long, reliable operation of all drive system components, follow these procedures
when installing, tensioning, and troubleshooting V-belts.

Installing and tensioning V-belt drives

Worried that V-belts may slip and squeal, installers often over-tension them — by a lot. By doing so,
they know the belts won‘t squeal and they‘ll avoid a return trip (and thus, the process of shutting
down the drive, removing the covers, loosening motor feet, retensioning the belts, and putting
everything back together). This approach can have costly downsides, however, including reduced life
of drive components (including catastrophic failures in some cases), unscheduled downtime, and lost
production.

In general, the proper way to tension belts for V-belt drives is to set them to an initial over-tension
and then readjust the tension after a short operating period. The following 12-step method details the
procedures.

Steps for proper installation of V-belts

1. Make certain the motor is turned off and strictly adhere to lockout-tagout (LOTO) and other
safety procedures. That includes making sure the belt drive cannot rotate (e.g., such as when
an airflow back-draft drives a fan in reverse rotation).

2. After removing the sheave guard, back off the belt tension adjustment, loosen the motor
feet, and remove the belt. (Caution: Do not pry the belt off; this could damage the sheave.)
Inspect the guard for wear or damage and for evidence of belt contact on the inside. Clean
and repair the guard, if necessary, in preparation for reinstallation.
3. Inspect the sheaves and belts for contamination, wear, and damage (e.g., abrasive wear,
cracks or fractures in the sheave, and cuts in the belts). If necessary, clean oil, grease, rust,
or other contamination from sheave grooves. Measure sheave and belt wear using sheave
and belt gauges available from belt and sheave manufacturers or suppliers (Figure 1). Always
replace worn belts as a set. Replace sheaves that are worn more than 1/16 in (1.5mm) along
one side of the groove. Sheave grooves that are worn to a dished out shape (Figure 2) lose
gripping power, causing belts to slip and squeal.

4. Make certain the belts are a matched set from the same manufacturer, and that they were
stored in a clean, cool (less than 86ºF /30ºC), and somewhat dry (less than 70% rh) location.
Check that both motor (driver) and driven sheaves are rated for the belt cross-section (e.g.,
B, C, 5V, 8V). Compare belt cross-section profiles with a belt gauge to confirm sizes,
particularly 5L and B sections, which have the same height and width.

5. Loosen the motor feet, back off the belt tension adjustment (if not done in Step 2 ), and slip
the new belts over the sheaves, inserting them into the grooves without using force. Using
pry-bar like devices to insert belts can damage the sheaves as well as the belts.

6. Adjust the motor sheave tension by shifting the motor on its base until the belts are snug.

7. Check the alignment of the motor and driven sheaves with a straightedge, string, or laser
alignment device. If using a straightedge or string, make sure they are in contact with the
outside faces of both sheaves without a gap between the straightedge or string and the
sheave face (Figure 3). Misalignment in excess of 1/10 in per foot (0.5º) angularity can
reduce V-belt life.

Caution: Make certain that the sheave rims are equal in thickness. That is, measure the
distance from the top (outside diameter) of the sheave groove to the outside of each sheave.
If the distances are not equal, repeat the check on the opposite (inboard) side of the sheave.
Align using the side that has equal rims of equal thickness.

A laser aligner can also be used to accurately correct sheave misalignment. The laser base
unit (transmitter) projects a laser-thin beam of light onto a reflector on the opposite pulley,
indicating offset and vertical-angle misalignment. The beam is then reflected back to the base
unit, indicating horizontal-angle misalignment. Some aligners use multiple reflectors,
providing a precise indication (overlapping return beams coalesce into a single point of light
on the transmitter side) when alignment is achieved.

―Infrared thermography can also be helpful in adjusting belt tension. Since belts get hotter if
they are slipping or too tight, this technology can be used to ―tune‖ the belts to the lowest
temperature for the optimum belt tension.‖

8. Set the belt tension. The correct tension is the lowest tension that keeps a V-belt from
slipping under the highest load condition. Too much tension shortens belt, sheave, and
bearing life and may even bend or break the shaft. Follow these steps to achieve the proper
V-belt tension:
 a. Measure the length of the span (LS) between the centerlines of the motor and driven
shafts (i.e., the center of the sheaves) and divide by 64 to get the required deflection amount
(DA) as shown in Figure 4.

b. Determine the belt deflection force from the applicable table in the manufacturer‘s catalog.
These tables list minimum, new belt, and retension values for various belt cross-sections (see
Table 1 as an example).

c. Place a belt tension tester (Figure 5) on top of the belt at the middle of the span and press
down to obtain the required DA. Compare the measured deflection force with the appropriate
value (―minimum,‖ ―new belt,‖ or ―retension‖) in the belt manufacturer‘s table. Adjust and
retest belt tension as needed to obtain the correct deflection force.

Example: Determine the setting for a new A section belt that will be used with a small sheave
diameter of 4.6 in and has a measured length of span (LS) of 24 in (61 mm).

• Belt deflection amount (DA) = LS/64 or 24/64 = 0.375 in (9.5 mm).

• Table 1 recommended deflection force for the new belt is 5.2 lbs (2.4 kg).

• The tension tester should indicate about 5.2 lbs (2.4 kg) when the top of each belt is
depressed 0.375 in (9.5 mm).

Note: The formula for determining belt deflection is ―dimensionless,‖ so the amount of belt
deflection when using metric units remains DA = LS/64.

Newer technologies for setting belt tension include sonic tension meters and infrared
thermography. Sonic tension meters work on the principle that the correct tension will cause
the belt to vibrate and emit a sound at a specific frequency. When the belt is tapped
manually, the meter detects the vibration frequency and displays the force associated with
that frequency. The tension is then adjusted to achieve the correct force value.

Infrared thermography can also be helpful in adjusting belt tension. Since belts get hotter if
they are slipping or too tight, this technology can be used to ―tune‖ the belts to the lowest
temperature for the optimum belt tension.

9. Fully tighten the motor base bolts and then recheck the tension; it may change as the bolts
are tightened.

10. Replace the belt guard(s) and make certain the motor is secure on its base.

11. Start the motor, observe the drive operation, and listen for unusual noise; if possible, check
motor and driven equipment vibration and bearing temperatures.

12. New belts stretch, so belt tension will decrease after the initial seating process. Therefore,
readjust the tension after about 24 hours of operation, using the retension deflection force
from the belt manufacturer‘s tables. Periodically (at least every six to 12 months) check the
deflection force and adjust the belt tension if it is less than the minimum or greater than the
retension value.

For the A section belt in the example, if the deflection force measures less than the minimum
of 3.5 lbs (1.6 kg) with the tension tester after 24 hours of operation, the tension should be
 reset to the retension value of 4.6 lbs (2.1 kg) per Table 1. Note that this is less than the new
belt tension value of 5.2 lbs (2.4 kg).

V-belt drive problems and solutions

Although premature failure of motor drive end ball bearings and breakage of shafts at the drive end
bearing shoulder are commonly associated with over-tensioned drive belts, many other faults or
undesirable practices can produce similar outcomes. The focus here, however, is limited to V-belt
drive problems and solutions associated with over-tensioned belts.

Worn or damaged sheaves. These conditions can lead to belt slippage, rapid belt wear, and
possibly vibration. Badly worn sheaves often result in over-tensioning to prevent belt slippage, which
in turn can overheat and overload motor and driven equipment bearings. When some sheave grooves
are worn more than others, the belts may appear to be mismatched. This may also cause ―differential
driving,‖ where not all of the belts carry the same load (stress). To evaluate sheave wear, follow the
guidance in Step 3.

―Do not use ―belt dressing‖ to reduce or eliminate belt squeal. Such compounds treat the symptom
not the cause and are usually made from petroleum derivatives that can deteriorate belt materials.‖

Misaligned sheaves. This problem can cause vibration, rapid and uneven wear of V-belt sidewalls,
and uneven wear on sheave groove walls, considerably shortening the service life of both belts and
sheaves. Misalignment can also lead to separation of the tie-band on banded belts, or apparent
mismatching of individual belts in multiple belt drives. V-belt sheave alignment should be within 1/16
in per 12 in (~ 5 mm per m) of drive center distance in any or all horizontal angular, vertical angular,
or parallel types of shaft and sheave orientation (Figure 6).

Insufficient belt tension. Other than worn sheave grooves, this is the leading cause of V-belt
slippage. Figure 7 illustrates the effects of insufficient tension and over-tension on belt life.

Belt squeal with load often indicates insufficient tension, but belt squeal or ―chirping‖ at startup may
be normal. In either case, the best practice is to check belt tension as explained in Step 8.

V-belts don‘t always squeal when they are slipping, so the problem sometimes goes undetected.
Besides squealing belts, another indication of belt slippage is an accumulation of belt ―dust‖ in the
bottom of the belt guard. Belt slippage can also be confirmed by scanning the grooves in the sheave
with an infrared thermal imager. (This can be done while the machine is operating if the grooves are
visible within the belt guard.) If slippage is occurring, the groove temperature will be at least 40ºF
(~20ºC) above ambient.

Regarding belt temperature, there are two factors to consider. The first is that tests have found that
V-belt service life is cut in half for every 18°F (10°C) increase in belt temperature. The second factor
is that V-belt life decreases more rapidly once the temperature exceeds 140°F (60°C) or 185°F (85°C)
for synchronous belts. Belts that run hot will harden and develop cracks from the bottom of the belt
upwards.

Note: Do not use ―belt dressing‖ to reduce or eliminate belt squeal. Such compounds treat the
symptom not the cause and are usually made from petroleum derivatives that can deteriorate belt
materials.
Excessive belt tension. This can be even more detrimental than insufficient tension, affecting not
only V-belts but also bearings and shafts (see Figure 7). The best practice is to set belt tension to the
deflection force prescribed by the belt manufacturer. Common indicators of excessive belt tension
include:

 Repeated belt breakage

 Overheated motor and driven equipment bearings

 Excessive vibration

 Shaft whip, bent or broken shaft

Mixed brands or mismatched belts. Belts from different manufacturers cannot be matched, and
mixed brands will not deliver the service life they should. The same applies to mismatched belts,
which are inherently different. Although all belt manufacturers use similar numbering systems,
different brands with the same number will have slightly different dimensions and thus should not be
mixed in a set. Due to construction differences, they also stretch and ride in sheave grooves
differently.

Note: Belt manufacturers say most complaints involving belt matching actually stem from other
causes, such as misalignment and worn sheaves. Be sure to consider these factors if mismatched
belts are suspected.

Noisy belt drive. When a belt drive is excessively noisy, the belts are often suspected as the cause.
To determine if the belts are the source of the noise, spray them with soapy water while the drive is
operating. If the noise goes away or decreases, the belts are at least part of the problem. If the same
noise remains unchanged after spraying, the problem is probably associated with other drive
components.

Conclusion

Although some installers may resist following the above tensioning and troubleshooting procedures
for V-belt drives, the payoff for doing so is well worth the effort — longer, more reliable operation of
belts and connected equipment, including motors. And that adds up to fewer failures and less
unscheduled downtime and lost production.

Thomas Bishop, P.E., is a senior technical support specialist at the Electrical Apparatus Service
Association (EASA) in St. Louis.EASA is an international trade association of about 1,870 firms in
nearly 70 countries that sell and service electromechanical apparatus.
Optimizing Hospital Chiller Plants

You can create a tailored algorithm or you can use Hartman Loop technology. You can
implement better temperature controls for the chilled water supply or the condenser
water. Keep your eye on the long term and pick your weapon.

FIGURE 1. Chilled water pumps in Kaiser Glenlake chiller plant.

FIGURE 2. Kaiser Permanente penthouse enclosing their chiller plant.

FIGURE 3. Chiller in Kaiser Glenlake chiller plant.

July 11, 2017

Gary Hamilton P.E.

Hospitals consume approximately 5% of the total energy use in the United States. That equates to
458 trillion Btus (Commercial Building Energy Consumption Survey [CBECS]). Hospitals spends
approximately $5 billion on energy per year, or 1-3% of its operating budget (Department of Energy).
Reducing the operational cost of most health care systems is very important to meet the C-Suite
Triple Aim and now the new ―Quadruple Aim.‖

Most of the energy consumed by health care systems arise from the heating and air conditioning
systems. Chiller plants are the single largest consumer of energy in most health care facilities. This
energy use can be exacerbated if the system is not design to operate at its maximum efficiency. Many
health care facilities are 24-hour operations, and therefore chiller plants operate every day all year
round. Therefore, making the chiller plant more efficient is one of the greatest means of reduction of
energy use for large health care systems.

Chillers generally achieve maximum efficiency when they operate between 65% and 85% of its full
load capacity. Chillers operating below 50% of their rated load are usually associated with very large
energy consumption and poor energy performance. Therefore, the chiller operational efficiency under
variable load is the key to energy saving for a chilled water plant. Chillers should be designed to
operate between 60% and 80% of their rated capacity range in order to maximize the energy savings
for a chiller plant. On that premise, this article will discuss how a health care facility can maximize its
chiller system performance and enhance operational cost.

Chiller Optimization

By reviewing the normal operating loads and parameters, health care facilities can create an
economic dispatch algorithm that can optimize the starting and stopping of chiller plant equipment.
The goal of creating the algorithm is to consistently run each machine within its ideal performance
range, thus optimizing the overall system efficiency for a given chiller system demand. This is
undoubtedly a very complicated process, and it may not appeal to facilities managers who wish to
keep things as simple as possible, but the trade-off for complexity is a significant opportunity for
savings. This can be done by writing an optimization sequence of control that can be implemented by
a control contractor and controls manufacturers. This type of control mechanism requires a significant
amount of programing and modification to an existing plant and can be very expensive and complex
to implement.

An alternative and more effective way of achieving chiller plant optimization is the application of the
Hartman Loop technology that is available from multiple control manufacturers. The Hartman Loop
technology is not new to the industry and has been patented since 2001. This technology will not
allow the various components (chiller, tower, and chilled water distribution pump) to act as
independent components, but it enables the total system to operate together as a single system.

Chilled water and condenser water temperatures are not controlled directly in this high-performance
operating concept. Instead, each component is operated such that its performance is optimized with
respect to all other components and the requirements of the current load conditions of the system.
The main motivation behind the technology is maximizing the value of the variable speed
technologies that are now a part of all chiller systems. The result is annual energy consumption that
can be below 40% to 50% percent of a traditionally designed high-efficiency chiller plant in hospitals.

As a designer, I have designed and specified the optimization package for many chiller plants, but
less than half have been installed due to the high first cost of implementation. This is not entirely
surprising given the tough financial climate that health care systems are experiencing. These budget
constraints force projects to focus on first cost and not the low longer-term operational cost. Health
care project managers should pay more attention to the lifecycle cost of the optimization packages.
The calculated payback is often less than five years. Where sufficient expertise is not available, in-
house the facility managers should consider working with reliable controls partners and mechanical
control engineers to assist them in the implementation of a chiller optimization package.

Chilled Water Plant Equipment

There are many factors to consider besides the chiller itself when trying to optimize the chilled water
plant. Auxiliary equipment, such as cooling towers and pumps, has a huge impact on the efficiency of
the chiller operation. When looking at chiller plant optimization, you have to examine the individual
components and how their interaction will affect the entire system. In addition to combined
equipment capacity, several other factors will influence the system‘s ability to meet the building
cooling load. Some of the factors are the type of refrigerants, operating hours, weather conditions,
electricity rates, and building use. These factors should all be examined in detail when trying to
optimize the chiller system performance.

Chiller Technologies

Chiller technologies have improved tremendously over the past 20 years, resulting in newer chillers
operating at higher efficiency than older model chillers. For example, chillers from the leading chiller
manufacturers like Daikin, Trane, Carrier, and Johnsons Control have full load efficiencies of between
0.45 kW per ton and 0.5 kW per ton at AHRI conditions. These chillers also have integrated part load
values (IPLVs) of between 0.29 kW per ton and 0.305 kW per ton. Newer magnetic bearing chillers
such as Daikin Magnitude, Johnson Controls YMC2, and Multistack‘s MagLev have integrated part load
values as low as 0.29 kW per ton, which can be very attractive for new chiller plants.
―Each component‘s performance is optimized with respect to all other components and the
requirements of the current load conditions. The main motivation behind the technology is
maximizing the value of the variable speed technologies that are now a part of all chiller systems. The
result is annual energy consumption that can be 40% to 50% percent less than a traditional hospital
chiller plant.‖

Ten years ago, centrifugal and screw chillers had full-load efficiency ratings of 0.75 to 0.85 kW per
ton. Ten years prior, the full-load efficiencies were in the range of 0.85 to 1.00 kW per ton. Based on
these numbers, this means that newer chillers are operating at as much as 60% better than chillers
that were manufactured and installed 20 years ago. This does not take into consideration reduced
efficiencies that are associated with poor maintenance and normal wear and tear of existing chiller
machines. New chillers should be selected not only on first cost but on lifecycle cost and overall
equipment efficiencies.

Selecting a very efficient full-load chiller will not guarantee efficient chiller performance. Most chillers
are operated at full load less than 5% of their total run time. The other 95% of the time, the chillers
are operating at part-load efficiencies. Understanding the load profile of the new or existing system
will help the designer to select the most efficient chiller for a chilled water plant. Chiller water plant
optimization for most new systems starts with the right selection of the new equipment. Although it
may cost more to purchase a chiller with better part-load efficiency, these incremental costs usually
have a short payback period due to energy savings. Facility managers should work in tandem with
their mechanical engineers to ensure that the right chillers are selected for their hospitals.

Chilled Water Supply Temperature Control

For years, chillers were controlled to supply constant temperature water to the hospitals regardless of
cooling load. However, modern chillers can vary the chilled water supply temperature as the cooling
load decreases. By allowing the water temperature to float up during low-cooling load periods,
savings of about 1% per degree temperature rise are typical. Therefore, raising chilled water supply
temperature by an average of 5ºF will save about 5% in chiller energy.

To do this, the chiller must somehow sense when there is reduced load. Sometimes, chilled water
return temperature is used as an indicator (higher return temperatures indicate fewer cooling loads
are being taken out of the loop, i.e. reduced load). More sophisticated systems will monitor the worst-
case zone — the one with the most open cooling water valve. When the temperature of that zone
starts to rise, chilled water temperature is lowered. Chilled water supply temperature control is an
important subset of chiller plant optimization. However, this can be done as a standalone optimization
or can be implemented as part of the chiller optimization package.

Condenser Water Temperature Setpoint Control

A condenser water reset approach can be applied to chiller plants with cooling towers where the
condenser water temperature can be varied. Most cooling tower control sequences maintain a
constant condenser water temperature (usually at 85ºF) by varying the flow rate of air. As the
outdoor wetbulb temperature decreases, the condenser water temperature can be decreased. The
result is less work for the compressors and a savings of about 0.5% for each 1ºF decrease in
condenser water temperature.
―Ten years ago, centrifugal and screw chillers had full-load efficiency ratings of 0.75 to 0.85 kW per
ton. Ten years prior, the full-load efficiencies were in the range of 0.85 to 1.00 kW per ton. This
means that newer chillers are operating at as much as 60% better than chillers made 20 years ago. ‖

Therefore, lowering condenser water temperature by an average of 5ºF will save about 2.5% in
chiller energy. There are limits to how low you can go — check with your chiller manufacturer. Most
chillers can handle temperatures of 70ºF or below. Again, this can be done as a standalone
optimization or can be implemented as part of the chiller optimization package.

Dynamic Chiller Optimization

SmithGroupJJR has partnered with many health care systems to execute the dynamic chiller
optimization (DCO) process. This process involves the gathering of real-time data from existing
operational chiller water systems. Information on all the key conditions that affect comfort, energy,
and intended performance is collected. This collected data is then used to create actionable measures
which will help to optimize the operation of the chilled water plant. The application of DCO will allow
many health care owners to save energy while helping maintain peak performance for the chiller
plants.

The first step in implementing DCO for a chilled water plant is to record pre-baseline measurements
to track existing chiller water system performance. Metering data will have to be collected. This is
done by adding transducers to the cooling towers, all pumps, as well as trending for chiller energy
use (kWh) to track system performance. The collected metering data will provide an accurate
baseline to compare future performances.

One key benefit of using DCO is that it often helps to increase chilled water plant capacity and
manage system problems. Implementing DCO can also address cooling tower capacity issues and
over-pumping by implementing control sequences that can effectively and efficiently control the
cooling towers. This can improve the cooling tower capacity by optimizing the chiller performance
while reducing tower fan energy.

Conclusion

Chiller plant optimization is a major undertaking for the facility department because of its impact on
the plant operation and the high first cost to the facility department. However, the economic impact
of implementing such a system far outweighs the first cost and will help the hospital system to reduce
its operating cost. The bottom line is that a chiller water plant optimization makes sense because it is
contributes to the ―triple/quadruple aim‖ of the health care system.

Recent improvement in chiller technology and efficiencies makes the decision easier for new chilled
water plants, especially at a time when energy costs are ratcheting upward every day. For existing
chiller plants, DCO should be implemented in order to reap the full benefits of the chilled water plant
optimization.

Garold ―Gary‖ Hamilton is a Senior Vice President and Healthcare Practice Lead at WSP, one of the
nation‘s largest engineering and infrastructure firms. He is a licensed professional engineer in the
U.S.A. as well as in the Europe. He has over 21 years of experience in the design and analysis of
HVAC systems for a variety of market sectors, but with special focus on health care facilities. He is a
LEED AP and has designed over 22 projects that achieved LEED certified status. He is also a certified
commissioning Authority with the AAB Commissioning Group (ACG). He is an active member of
American Society of Healthcare Engineers (ASHE) and is a Senior of ASHE (SAHSE). He is also a
member of the International Code Council Ad Hoc Committee on Healthcare (AHC). Email him at
gary.hamilton@wsp.com or visit www.wsp.com for more details of his projects.

HVAC Systems In Hospitals

Start with the basic mission, then move on to HAIs, air changes, and other challenges in
this singularly demanding environment.

FIGURE 1. Standard 170 room requirements.

FIGURE 2. Infection equation.

FIGURE 3. Effect of air changes on particle count.

FIGURE 4. Moving air via pressure differentials.

FIGURE 5. Filtration standard.

FIGURE 6. OR design.
FIGURE 7. OR temperature, humidity, and dewpoint.

FIGURE 8.

HVAC system design implications.

October 11, 2017

Dan Koenigshofer, P.E., MSPH, HFDP and Pavel Likhonin, P.E., CEM

HVAC systems provide comfort and quality air for patients, staff, and visitors in hospitals. Comfort is
generally determined by temperature, humidity, and air speed. Air quality is generally defined by
particle count — both organic and inorganic. Current design codes and standards specify precise
levels of filtration, air change rates, and outside air for dilution, and vary for each space in a hospital.
These are the minimum standards used by engineers to design hospitals. Of course, over time the
performance of the HVAC is determined primarily by the operation and maintenance of the systems
and the activities of the occupants.

Hospital Engineering Industry

ASHRAE is recognized as the world leader in establishing standards and training for the design of
HVAC systems. The standards most frequently used in healthcare engineering are:

 ASHRAE 170 — Ventilation of Health Care Facilities (building code in approximately 40 states)

 ASHRAE 55 — Thermal Environmental Conditions for Human Occupancy

 ASHRAE 52.2 — Method of Testing General Ventilation Air-Cleaning Devices for Removal
Efficiency by Particle Size

 ASHRAE book: HVAC Design Manual for Hospitals and Clinics

The American Society of Hospital Engineers (ASHE) is part of the American Hospital Association. ASHE
publishes guidelines for the operation and maintenance of health care facilities. Various clinical
associations also publish guidelines that occasionally affect hospital HVAC design. ASHRAE is working
to coordinate and incorporate the HVAC portions of these guidelines into Standard 170. These
associations include:

 Association of Operating Room Nurses (AORN)

 American Association of Medical Instrumentation (AAMI)

 US Pharmacopeia (USP)
FIGURE 1. Standard 170 room requirements.

ASHRAE 170 is on continuous maintenance and addenda are issued several times a year. Figure 1 is
an excerpt from Standard 170. As shown, it calls out the pressurization, rate of dilution with outside
air, supply air rate, whether or not the air may be recirculated, humidity range, and temperature
range.

Comfort

Comfort is different for each person and highly dependent on clothing, age, health, activity,
temperature, humidity, and airflow rate. Standard 55 bases comfort on surveys of occupants in a
variety of conditions and defines ―comfortable‖ as when 80% of the occupants are satisfied.

Standard 170 is a minimum design guide with the intention of designing systems that will ―provide
environmental control for comfort, asepsis, and odor in health care facilities.‖ Surgeons often request
temperatures below Standard 170 (68ºF). This can create problems when the HVAC system is
designed to the minimum. Prudent design with chilled water will allow temperatures as low as 63ºF in
operating rooms.
The demand for low temperature is particularly common in orthopedic and cardiac operating rooms
where lengthy surgeries often take place. The gowns, caps, gloves, masks, etc. can overheat the
surgical team. Unfortunately, the OR support staff can often become uncomfortably cold when the
temperature is lowered.

These conflicting desires often cause difficulties for the design engineer and the operations personnel.
It is the job of the designer to provide a system that can meet virtually all of the disparate
temperature and humidity requests. The hospital engineer is usually the one caught in the middle of
competing requirements.

Another side effect of the surgeons demanding low temperatures is the impact on the patient. Most
clinicians and anesthesiologists feel that lower temperatures have an adverse impact on patients. To
mitigate these adverse effects, surgeons will often ask that the HVAC system be able to quickly raise
the room temperature as soon as the surgery is complete. This need for a speedy temperature
recovery also affects the HVAC design.

Infection Control

Even more important than comfort in a hospital is air quality. Hospital-associated infections (HAI)
result in many lives lost and cost the U.S. billions each year. While the estimates vary, most experts
agree that airborne sources of infection are responsible for 5 to 15% of HAIs. These are estimated to
cost approximately $500 million per year. It is the task of hospital HVAC engineers to mitigate the
incidence of airborne HAI.

An article entitled ―Multistate Point-Prevalence Survey of Health Care — Associated Infections‖ by

Shelley S. Magill, M.D., Ph.D., et al, which appeared in The New England Journal of Medicine in March
2014, provided the following information on hospital-associated infections:

 HAIs result in the deaths of approximately 75,000 people per year in the U.S. (averaging 200
per day).

 Hospitals average 15 HAI deaths per year.

 There are approximately 722,000 non-lethal infections per year, averaging 150 per year at
each hospital.

 In 2011, one of every 25 patients admitted to a hospital contracted HAI.

 Approximately 35,000 incidents, or at least 5%, each year are airborne-related infections.

 A surgical site infection occurs in approximately one in 50 surgeries.

FIGURE 2. Infection equation.

A simple, conceptual equation for the probability of infection in in Figure 2.

Many factors affecting infections are unrelated to HVAC, such as handwashing, visitors, staff,
surfaces, cleaning, and the level of defense of the patient. Many engineers are not aware that their
designs can and will impact all of the variables in Figure 2.
Dose

Generally, bacteria and viruses ride on larger particles and aerosols. These might be skin particles,
dust, sneeze/cough aerosols, spores, and even insects (mites). The HVAC system can reduce the
density of particles in the room by introducing clean air. As shown in Figure 3, the rate of air
changes of clean air is directly related to the residence time of the particles (the ―fly‖) in the room. In
general, the greater the air change per hour (ACH), the fewer infections.

The HVAC system is also used to move dirty air out of the hospital in a logical path, as shown in
Figure 4. The idea is to design the system so that the cleanest air is introduced to the operating
rooms and other sensitive areas, then moved via pressure difference to less clean areas and
eventually out of the hospital.

FIGURE 5. Filtration standard.

Another way to reduce dosage is by recirculating air through good filters. In many environments,
filtered air is cleaner than outside air. Figure 5 shows the required minimum filter efficiencies for
different parts of health care facilities. MERV is a measure of filter efficiency with a scale of 5-17. High
Efficiency Particle Arrestance (HEPA) filters provide the best filtration and may be as efficient as
99.9995% at the most penetrating particles. As shown, MERV 14 is the minimum for the final filter
serving operating rooms.

Site

The likelihood of infection is also affected by the site impinged by the particles. Particles landing on
the skin are much less likely to cause infection than ones deposited in open wounds. The means of
delivering clean, filtered air may affect infections. As shown in Figure 6, clean air is directed into the
room through laminar diffusers. These are large metal arrays perforated with small holes. The intent
is to deliver a gentle ―waterfall‖ of clean air over the table. The area directly below this diffuser is
referred to as the ―sterile field.‖

Air is blown from the diffuser at a low rate to reduce turbulence. Anything that disrupts this stream of
sterile air reduces its effectiveness. Disruptions are caused by the surgeons and staff, objects (light
booms, tables), thermal plumes (markedly hot or cold air), and air currents caused by devices,
personnel, and doors.

Ideally, air is supplied at the ceiling and removed near the floor, in an effort to wash the patient and
staff with clean air and remove ―dirty‖ air in one linear flow path.

FIGURE 6. OR design.

Virulence

Although limited, the HVAC system has some effect on the virulence of microorganisms. Inside the
AHU, UV lights will kill bacteria and algae growing on the wet surfaces. There have been some efforts
to install UV lights in ductwork, but the high speed of the air makes this ineffective. Some hospitals
are now experimenting with portable UV lights which they bring into unoccupied operating rooms to
bathe the room in UV and kill microorganisms. Others have experimented with ozone.

There is much debate about the role of humidity in infections. It is generally accepted that the
maximum long-term room humidity should be less than 60% in order to minimize the growth of mold
and other organisms. The minimum humidity is controversial. For decades, it was accepted that in
operating rooms the minimum should be 30 to 35%. In the past few years, however, ASHE has
recommended the minimum be lowered to 20% for short-stay areas (such as operating rooms).
There is good evidence that low humidity has adverse effects on humans over the long term.
Unfortunately, there is no agreement on the exact length of time. Some point out that flu season
coincides with low winter humidity, but it is unclear if low humidity over hours or even days is
harmful. The psychrometric chart in Figure 7 shows that a constant supply of air at 48ºF with 48ºF
dewpoint (saturated) will meet all normally recommended ranges of humidity in operating rooms.
Note that some doctors will require lower operating room temperatures than recommended by
ASHRAE, in which case a lower dewpoint temperature is required.

FIGURE 7. OR temperature, humidity, and dewpoint.

Time

The time that microorganisms spend in an operating room is directly related to the airflow rate. The
air changes per hour (ACH) for operating rooms is a minimum of 20 changes per hour. In most
operating rooms, this is a flow rate of 2,000 – 3,000 cfm. In simplistic terms, 20 ACH will result in
99% flushing in 14 minutes. Some hospitals require more ACH; while some hospitals are arguing for
fewer ACH.

The early U.S. Department of Health and Human Services and U.S. Department of Health and Human
Services publications required 100% OA. For the most part this requirement fell to political pressure
after the oil embargo in the late 1970s. Energy can be saved by reducing OA. The hospitals within the
U.S. Department of Veterans Affairs system retained the 100% OA requirement until the early 2000s.
The current Standard 170 requirement is four ACH of outside air in operating rooms. Some hospitals
and scientists are arguing to reduce this, seeking to reduce energy use.

Implications for HVAC Design

The HVAC system in a hospital is composed of numerous devices that must act in unison to deliver
the desired results. The system generally consists of chillers and boilers, air handlers, ductwork,
terminal boxes, and thermostats. All of it is controlled by a BAS. The implications of infection
mitigation affect the engineering design of humidification, outside air rate, chilled and hot water
temperature, airflow rate, filtration, air distribution, and pressurization.

The greatest concerns are in summer, especially in non-arid locales, including much of the country
east of Colorado. If the dewpoint of supply air exceeds 48ºF, it will be impossible to provide the low
temperatures demanded by orthopedic surgeons while maintaining the relative humidity below 60%.
The practical impact of that is that hospital chilled water (CHW) systems must provide water at a
temperature lower than 41ºF. This low temperature CHW will allow the air handlers to remove the
moisture from the air via condensation, allowing the supply air (SA) dewpoint to reach 48ºF. When
SA is higher than 48ºF, and the operating room temperature is set below 64ºF, the relative humidity
will exceed 60%. Misguided attempts to save energy by raising CHW temperature often result in
excessive relative humidity.

Conversely, in winter the air must be humidified to maintain higher than 20 to 30% rh. This is
commonly accomplished by blowing steam into the supply air. Of course, this must be controlled
carefully to avoid condensation in the ductwork. Poor control and/or the installation of humidifiers can
often result in condensation or an ―It‘s ‗raining‘ in my OR‖ situation.

Operating room air handlers have two filters: pre- and final. It is paramount that the final filter
assembly be installed properly to prevent air bypassing the filters. This requires rigid steel supports
and tight fitting gaskets. The filters must be changed as needed and kept dry.

Directions in Hospital HVAC Design

Saving energy has monetary, environmental, and moral appeal. The test of a high-performing
hospital HVAC system can be measured by the following criteria:

 Performance, including infection control, comfort, patient outcome

 Safety, including fire prevention and control and minimizing falls and injuries for employees,
visitors, and patients

 Reliability and minimizing lost revenue

 Minimizing maintenance costs

 Minimizing energy costs

 Adaptability

Motivated primarily by energy savings, some in the industry advocate eliminating the prescriptive ACH
rates in favor of controlling the ventilation rate by real-time particle counts. This may be reasonable if
accurate, reliable, and affordable particle counters and control systems are available.

Many of these HVAC requirements are controversial and provide fodder for many academic
discussions at national meetings. Much research is needed. Some of the controversial requirements
include:

 ACH rate

 ACH filtered? Or recirculate without filtration?

 Diffuser velocity in the operating room

 HEPA v. MERV 14
 OA rate (S-62 v. 170)

 Temperature

 Humidity (recent studies indicate more than 40%)

 Scientific evidence is needed, especially dose/response

 Monitoring ―requirements‖

 Dan Koenigshofer was raised in Los Angeles, where as a child, he suffered from asthma,
allergies, and loss of outdoor play time exacerbated by smog. He received a bachelor‘s
degree in physics with a minor in meteorology from the University of California at Davis and a
master‘s degree in public health, air and industrial hygiene, from the University of North
Carolina at Chapel Hill. His first job was at an air pollution testing and engineering firm. In
1990, he began specializing in hospital engineering and has written numerous articles and a
book on hospital HVAC design. He serves on the ASHRAE Standard 170 committee and is a
senior member of the ASHE.
 Pavel Likhonin is a project manager and senior mechanical engineer in the Raleigh, NC, office
of Dewberry. He is active in ASHRAE and a member of the national ASHRAE Technical
Committee 9.6 Health Care HVAC and the S-170 Committee on Ventilation in Health Care. He
is currently leading the effort to rewrite a chapter on Health Care HVAC for the ASHRAE
Handbook — Applications as a TC9.6 Handbook Subcommittee vice chair. He holds a
bachelor‘s degree and a master‘s degree in architectural engineering from Penn State
University.
The Case For Humidity Control In Hospital Procedure Rooms

December 1, 2015

Charbel Farah, P.E.

The case for humidification and dehumidification in hospital procedure rooms — particularly operating
rooms — is a neverending debate of have‘s and have-not‘s. Many acute care facilities see it as cost-
prohibitive to install a complete humidification system in certain climates only to use it for one short
week a year. And yet a hospital‘s most critical areas, including operating and isolation rooms, require
precise humidity control year round regardless of outside temperature and humidity conditions.

Per NFPA 99, the National Healthcare Facilities Code, humidity shall be maintained between 30% and
60%. This range is the topic of debate — ASHRAE, ASHE, and other health care governing agencies
say a lower rh of 20% can still meet the needs of most of today‘s procedure rooms. Additionally,
because global weather patterns are evolving to include more droughts, extreme colds, and storms,
specifying engineers are finding they can rely less and less on historical weather data to determine
the need for humidification in acute facility design. Together, these issues have led to the inclusion of
humidification systems in most hospitals as a best practice.

Humidification Considerations in Today‟s Health care Facilities

When determining what role humidification should play in an acute care facility design, you have a
number of important considerations, including: understanding applicable codes and standards,
implementation strategies for both humidification and dehumidification, and the impact of
humidification on hospital certification. These considerations will dictate what type of humidity control
strategy is needed and will help establish system design and operational parameters.

Consideration #1: Governing Codes, Standards, and Best Practices

The humidification debate is overshadowed by national, state, and local edicts. Depending on the
facility function, a variety of codes, standards, and other guidelines exist.
On a national level, the following codes and standards require compliance.

 NFPA 99: Health Care Facilities Code requires rh to be between 30% and 60%.
 ASHRAE Standard 170 used to be the same as NFPA 99, but recent recommendations are
changing this standard to widen the allowed humidification to 20% to 60% rh.
 Similarly, ASHE/ASHRAE/FGI Standard 170.1d also expanded their standard to a rh of 20% to
60%.
 Facility Guidelines Institute for Design and Construction of Healthcare Facilities also holds to
the NFPA 99 standard, but it recently changed recommendations to 20% to 60% rh.
 AIA guidelines for health care construction recommend that designers follow NFPA 99 and
ASHRAE Standards.
 U.S. Veterans Affairs (VA) hospitals have specific humidification requirements of 30% to 60%
rh.

Expert interviews from professionals in infection prevention and control, health care epidemiology,
perioperative care, and mechanical/health care engineering, coupled with studies like one by the
National Institutes of Health (NIH) examining the impact on surgical outcomes of lowering rh to 20%,
have all been the impetus for many of the above organizations to accept a broader range of rh.

Local state codes will often have their own specific compliance requirements as well. For example,
California‘s Office of Statewide Health Planning and Development (OSHPD) requires hospitals to
employ humidification systems or possibly risk the loss of their operating licenses. California
Mechanical Code is consistent with NFPA 99 and requires 30% to 60% rh.

It‘s interesting to note that codes on the national or state level never actually require a health care
facility to install the necessary equipment to meet their requirements, nor do they require monitoring.
Instead, the code leaves method and monitoring up to the user for flexibility. Some code changes
may be needed to recognize differences among facilities, including type and delivery of care or local
and regional geography.

The jury is still out on code changes, although as another recent study by the NIH showed no clinical
benefits to maintaining a 35% minimum rh in OR‘s, it did show some comfort benefits to maintaining
a 30% minimum rh in longer-term stay areas such as patient rooms.

In an effort to evaluate the need for humidification, the following should be considered.

1. When using geographic weather data, run a model to predict and show how often the minimum rh
is not met. This could vary from as little as a few hours per year to months on end, depending on
facility location and local climate. In addition to modeling and evaluation, it is important to perform a
risk assessment and to understand the patient and surgical staff needs and procedures for operating
rooms.

2. Based on how often the minimum humidity is not maintained, and understanding the deviation
(e.g. 10% or 20%, etc.), a decision can be made on how to address humidification. Of course, if the
deviation is within 10%, this means that the lowest humidity is at or around 20% to 30%. Here, a
case can potentially be made that humidification may not be required given the new
recommendations of ASHE/ASHRAE/FGI 170.1 that suggest 20% rh is acceptable as a lower limit on
rh. Otherwise, in general for ORs, rh shouldn‘t fall below 30% on a consistent basis.

3. Having all the analyses complete, another critical component is securing approval from the
authority having jurisdictions (AHJ). Be prepared for deviations to hold up the approval process. That
being said, most AHJs allow an alternate compliance method, and in some cases, deviations that
meet code intent are granted through collaboration and a well thought-out process. Cost can play a
role in deviations, and some AHJs may take this into consideration if hardship can be proven;
however, in most cases, it is unlikely to be the only determining factor, as a hospital shall be built and
must function as intended.

Consideration #2: Humidification Requirements and Implementation Strategies

There are a variety of humidification systems on the market today. Once the specifying engineer is
knowledgeable about the applicable codes and standards and thoroughly understands the hospital‘s
design parameters based on local climate and operational requisites, it‘s time to choose the
humidification system that‘s right for implementation. Here‘s a sampling of the most common
humidification systems.

1. Direct steam injection

2. Evaporative pan

3. Water spray

4. Other types including portable or fixed room-type humidifiers

Although the direct steam injection using clean steam is by far the most common humidification
system type in hospitals, other types should be considered depending on the application and
suitability. In addition, water quality plays a significant role when it comes to humidification. In most
applications, reverse osmosis (RO) water is a requirement in order to achieve lean and breathable
steam quality.

Consideration #3: Dehumidification and implementation strategies

Generally, thermal comfort is maximized when rh is kept below 60% (temperature, air velocity, and
other comfort parameters are constant). In addition, lower humidity results in less risk of
condensation and reduces fogging on items such as magnifying lenses and polished metal. In health
care procedure and OR rooms, each surgical team is wearing multiple layers of clothing, face masks,
hair covers, and gloves that trap body heat and result in sweating and added perspiration. Sweating
is counterproductive to the surgical work at hand. Therefore, colder, dryer air achieved through
dehumidification is a must in procedure and/or OR rooms. For example, some ORs do require 60˚ to
64˚F and 40% to 50% rh. As a frame of reference, other health care areas require 72˚ to 75˚F and
50% rh.

The need for colder and dryer air requires positive dehumidification during which the supply air dew
point is depressed and controlled below space dew point at all times, regardless of the space
temperature needs. In hot and humid weather, a lack of proper dehumidification can pose and will
pose significant space humidity control challenges, resulting not only in thermal discomfort but also
potential IAQ concerns as well. Similar challenges can be encountered in cool and humid/wet areas
where positive dehumidification is a must. Just like humidification, dehumidification has its own
strategies and implementation techniques.

Common types of dehumidification for procedure rooms include the following.

 Low temperature chiller

  Subcool and reheat supply air

 Desiccant

 Split dehumidification units — these typically have a dedicated outside air coil (DOAC) or a
dedicated conventional HVAC with dehumidifying coils. This may be sufficient for non-critical
or procedure areas of the healthcare facility.

Consideration #4: Humidification Impact on Hospitals and their Certification

Health care is rapidly changing and requiring more precise environmental conditions and controls
(temperature and humidity), and these environmental requirements are beginning to have an impact
on a hospital‘s bottom line in terms of efficiency and type of operations that can be performed and
ultimately produce profit. Providing proper and well considered humidification and dehumidification
systems is the best approach to meeting evolving health care requirements. Designing a sustainable,
flexible, and adaptable mechanical system is not only a best practice, it also ensures that code
requirements are met and possibly exceeded, and therefore all certifications and functional
requirements are met.

The trickle down

In order to meet everchanging patient needs and the newest regulations, codes, and standards in
today‘s acute care facilities, humidification systems must be provided. Today‘s surgeons and health
care providers are expecting (and sometimes demanding) precise temperature and humidity controls
for a more comfortable work environment with better patient outcomes. ES

Charbel Farah, P.E. is a Senior Principal at Syska Hennessy Group‘s Los Angeles office, specializing in
build environment /HVAC systems.

Travis English, December 14, 2015

Thanks for the well-written article on health care humidification. I was vexed that it dealt only with
fulfilling codes and standards. Standards are great to reference, but the reasons behind the
requirements are important, too. I felt your ―case for humidity control‖ was missing ―Consideration 0:
How humidity affects health care outcomes‖. Engineers should know the risks involved in low
humidity health-care spaces. There are, traditionally, three, to know: • Fire - In the past, anesthetic
gasses were flammable. There was a bona-fide fire risk due to those gases. That risk has been
eliminated with modern anesthesia. • Dry Static - Varies by space type, equipment type, vendor, and
climate. (It may also be mitigated within the equipment, rather than by a humidifier.) • Infection -
The effect of low humidity on infections was deeply downplayed in the research by ASHE and the
NIH, as you mentioned. There remains discussions about diseases like influenza and RSV, which
propagate in low-humidity. But, those diseases propagate more in schools, office buildings, and public
spaces than, say, operating rooms. You and I both come from the southwest, which has a unique
problem - alluded to in your piece. In most of the US, humidifiers are used about 30% of the year.
But, in the southwest, we only need humidifiers 2%-5% of the year. It is not just a cost issue; it‘s
also operational. A facility engineer can ignore their humidifiers 95% of the year with no problem.
That makes it hard to expect them to work flawlessly in the 5% of hours when you need them. To
me, it is worth noting both the UK and German national standards do not require humidifiers. The UK
standard recommends omitting them, since the humidifiers themselves pose infection and facility
risks. Travis English travis.r.english@kp.org