Current hospital guidelines in Germany and in Switzerland · DIN 1946-4 Folie 3/ 73 Brunner HaustechnikBrunner Haustechnik AG, CHAG, CH--8304 Wallisellen8304 Wallisellen--ZZüürichrich

DIN 1946-4 Folie 2 / 73

Brunner HaustechnikBrunner HaustechnikBrunner Haustechnik AG, CHAG, CHAG, CH---8304 Wallisellen8304 Wallisellen8304 Wallisellen---ZZZüüürichrichrich

TESKON 2009 - TMMOB Makina Mühendisleri Odası Đzmir

Current hospital guidelines in Current hospital guidelines in Current hospital guidelines in Current hospital guidelines in

Germany and in Switzerland Germany and in Switzerland Germany and in Switzerland Germany and in Switzerland

DIN 1946-4: Ventilation and air conditioning;

Ventilation in hospitals

SWKI 99-3: Heating, ventilation and air-conditioning

in hospitals

DIN 1946-4 Folie 2 / 81 TESKON 2009 - TMMOB Makina Mühendisleri Odası Đzmir

DIN 1946-4 Folie 3 / 73



The new German

standard DIN 1946-4:

Ventilation in hospitals

Arnold Brunner, dipl. Ing. SIA


DIN 1946-4 Folie 4 / 73



DIN 1946DIN 1946DIN 1946DIN 1946----4: Ventilation in 4: Ventilation in 4: Ventilation in 4: Ventilation in hospitalshospitalshospitalshospitals

HistoryHistoryHistoryHistory and Basicsand Basicsand Basicsand Basics


DIN 1946-4 Folie 5 / 73



Juliusspital WJuliusspital WJuliusspital WJuliusspital Wüüüürzburg 1805rzburg 1805rzburg 1805rzburg 1805

Carl Caspar von Siebold (1769–1807)During Siebolds aegis occurred the reconfiguration of the Theatrumanatomicum (1788) and an extension of the capacity of the Juliusspital (1799) in which 1805 the first modern operating room of the world was setup.

DIN 1946-4 Folie 6 / 73



DIN 1946DIN 1946DIN 1946DIN 1946----4 Ventilation in 4 Ventilation in 4 Ventilation in 4 Ventilation in hospitalshospitalshospitalshospitals

DIN 1946-4 Folie 7 / 73



Inspiration Inspiration Inspiration Inspiration throughthroughthroughthrough Sir J. Sir J. Sir J. Sir J. CharnleyCharnleyCharnleyCharnley 1968196819681968

� Greenhouse ® room-in-room construction

� Anaesthesia separated

� Improved air filter

� Body exhaust system

� Self-instrumentation

DIN 1946-4 Folie 8 / 73



RealizationRealizationRealizationRealization bybybyby Weber/Meierhans 1970 Weber/Meierhans 1970 Weber/Meierhans 1970 Weber/Meierhans 1970

DIN 1946-4 Folie 9 / 73



Swiss Guideline for construction, operation and monitoring of ventilation systems in hospitals

� Swiss Guideline SKI Bulletin 4 published in 1975197519751975

� This guideline is based on the German standardDIN 1946, Part 4 (Ventilation in hospitals) 1963

� Three hygiene-room classes� Class I 10 CFU/m3

� Class II 200 CFU/m3

� Class III 500 CFU/m3

DIN 1946-4 Folie 10 / 73



RLTRLTRLTRLT----Richtlinie von 1975

DIN 1946-4 Folie 11 / 73



Swiss Ventilation Swiss Ventilation Swiss Ventilation Swiss Ventilation GuidelineGuidelineGuidelineGuideline 1975

DIN 1946-4 Folie 12 / 73



DIN 1946-4 Folie 13 / 73



LidwellLidwellLidwellLidwell----StudyStudyStudyStudy 1982 1982 1982 1982

DIN 1946-4 Folie 14 / 73



Swiss Guideline for the design, construction, Swiss Guideline for the design, construction, Swiss Guideline for the design, construction, Swiss Guideline for the design, construction, operation and monitoring of ventilation operation and monitoring of ventilation operation and monitoring of ventilation operation and monitoring of ventilation and and and and airconditioningairconditioningairconditioningairconditioning systems in hospitalssystems in hospitalssystems in hospitalssystems in hospitals

� Swiss-Guideline SKI-Band 35 (1987)(1987)(1987)(1987)

� Three hygiene room-classes

� Class I 10 CFU/m3

� Class II 200 CFU/m3 Class IIb 50 CFU/m3

� Class III 500 CFU/m3

DIN 1946-4 Folie 15 / 73



Swiss Swiss Swiss Swiss VentilationVentilationVentilationVentilation GGGGuideline 1987 uideline 1987 uideline 1987 uideline 1987 Low turbulence displacement air flow

Low turbulence displacement air flow with zonesegregation

Dilution air flow, no zone segregation

DIN 1946-4 Folie 16 / 73



Development of the standard OPDevelopment of the standard OPDevelopment of the standard OPDevelopment of the standard OP----Room: Room: Room: Room: "small" ULF with 2000 "small" ULF with 2000 "small" ULF with 2000 "small" ULF with 2000 ---- 3000 m3000 m3000 m3000 m3333/h /h /h /h

ULF: Unilateral flow (Laminar air flow)

DIN 1946-4 Folie 17 / 73



OP OP OP OP CCCCl.1: l.1: l.1: l.1: ULFULFULFULF withwithwithwith 8'000 8'000 8'000 8'000 ---- 10'000 m10'000 m10'000 m10'000 m3333/h/h/h/h

DIN 1946-4 Folie 18 / 73



1989: 1989: 1989: 1989: ÜÜÜÜberarbeitung der DIN 1946berarbeitung der DIN 1946berarbeitung der DIN 1946berarbeitung der DIN 1946----4444

Im Wesentlichen zwei Raumklassen (Luftreinheit):

� Raumklasse I (Operationsräume)Hohe bzw. besonders hohe Anforderungen an die Keimarmut

� Raumklasse II (übrige Räume im Krankenhaus)Übliche Anforderungen an die Keimarmut

DIN 1946-4 Folie 19 / 73



1989: Revision of DIN 19461989: Revision of DIN 19461989: Revision of DIN 19461989: Revision of DIN 1946----4444

Essentially two room classes (air cleanliness):

� Room class I (operating rooms)High and highest requirements with respect to low germ concentrations

� Room class II (remaining rooms in the hospital)General requirements with respect to low germconcentrations

DIN 1946-4 Folie 20 / 73



1990: 1990: 1990: 1990: DevelopmentDevelopmentDevelopmentDevelopment DIN 4799DIN 4799DIN 4799DIN 4799

DIN 1946-4 Folie 21 / 73



1990: 1990: 1990: 1990: DevelopmentDevelopmentDevelopmentDevelopment DIN 4799DIN 4799DIN 4799DIN 4799Supply air 1‘600 m3/h

DIN 1946-4 Folie 22 / 73



Revision of the Swiss Revision of the Swiss Revision of the Swiss Revision of the Swiss hospital hospital hospital hospital guideline guideline guideline guideline

� Start January 22nd, 1997� Target: End in 1998� essential Hospital-organisations participate

� Hospital hygiene� Technical and maintenance service� Building services engineering

� 1st draft with official consultation January 2001� final draft December 2002 (2nd official consultation)

DIN 1946-4 Folie 23 / 73



DIN 1946-4 Folie 24 / 73



InquiriesInquiriesInquiriesInquiries ((((publicationspublicationspublicationspublications, , , , companyscompanyscompanyscompanys))))

Bild Admeco

DIN 1946-4 Folie 25 / 73



Kostenvergleich: Ergebnisse (1) Kostenvergleich: Ergebnisse (1) Kostenvergleich: Ergebnisse (1) Kostenvergleich: Ergebnisse (1) EnergiebedarfsunterschiedeEnergiebedarfsunterschiedeEnergiebedarfsunterschiedeEnergiebedarfsunterschiede TFH Berlin

Merkmale CH 1 CH 2 DIN 1 DIN 2 DGKH 1 DGKH 2 DGKH-OPT EinheitVAU (OP + EIN/AUS) 800 1200 2800 1600 1000 1000 1000 m³/h

VZU (OP-LAF) 4000 4000 2400 2800 4000 8000 8000 m³/h

Überströmung mit mit ohne mit mit mit mit

Einfluß des Grundkonzeptes auf den Jahresenergiebedarf

108 %

88 %

122 %

198 %

78 %

100 %

0

5000

10000

15000

20000

25000

30000

CH 1 CH 2 DIN 1 DIN 2 DGKH 1 DGKH 2

Jah

rese

ner

gie

bed

arf

[kW

h/a

] Wärme

Strom

108 %

DGKH-OPT

DIN 1946-4 Folie 26 / 73



Kostenvergleich: Ergebnisse (2) Kostenvergleich: Ergebnisse (2) Kostenvergleich: Ergebnisse (2) Kostenvergleich: Ergebnisse (2) GesamtkostenunterschiedeGesamtkostenunterschiedeGesamtkostenunterschiedeGesamtkostenunterschiede

Einfluß des Grundkonzeptes auf die Jahreskosten

147 %

96 %97 %104 %100 %88 %

83%

0

5.000

10.000

15.000

20.000

25.000

30.000

35.000

40.000

45.000

50.000

CH 1 CH 2 DIN 1 DIN 2 DGKH 1 DGKH 2 DGKH-OPT

Jahr

esko

sten

[DM

/a] Energiekosten

BetriebskostenKapitalk. (20 a)

Strompreis: 0,20 DM/kWhWärmepreis: 0,08 DM /kWh

Merkmale CH 1 CH 2 DIN 1 DIN 2 DGKH 1 DGKH 2 DGKH-OPT EinheitVAU (OP + EIN/AUS) 800 1200 2800 1600 1000 1000 1000 m³/h

VZU (OP-LAF) 4000 4000 2400 2800 4000 8000 8000 m³/h

Überströmung mit mit ohne mit mit mit mit

TFH Berlin

DIN 1946-4 Folie 27 / 73



ComparisonComparisonComparisonComparison of of of of costscostscostscosts, , , , findingsfindingsfindingsfindings� By decreasing the outdoor air flow to 1000 m³/h and by

increasing the circulating air flow to 3.000 m³/h (OR-supplyair flow: 4000 m³/h) energy costs are virtually unaltered.

� Electricity costs are even lower at a circulating air flow of 7000 m³/h than in the case of DIN with an outdoor air flow of 2800 m³/h.

� Electricity costs only amount for approx. 5 – 8 % of the annualcosts for the air-conditioning of operating rooms.

� With optimisation of the ULF/circulating air concepts, annual costsmay even be further reduced compared to the DIN cases (seeDGKH-OPT-case).

DIN 1946-4 Folie 28 / 73



DIN 1946-4 Folie 29 / 73



Mai 2003

DIN 1946-4 Folie 30 / 73



The revision of the DIN 1946The revision of the DIN 1946The revision of the DIN 1946The revision of the DIN 1946----4 4 4 4

� Revision of the guidelineDIN 1946-4 "Ventilation and air conditioning. Part 4: Ventilation in hospitals" of 1999 was classified as unsatisfactory

� Alternatives are published

DIN 1946-4 Folie 31 / 73



DIN 1946-4 Folie 32 / 73



RKI requirements for surgeryRKI requirements for surgeryRKI requirements for surgeryRKI requirements for surgery

� Unidirectional airflow ventilation is essential for aseptic interventions with high risk of infection.

� The size of the ceiling panel has to conform to the type of surgical intervention. As a rule, the operating table and the instrument tables shall be protected.

� A room class I (DIN1946-4) shall be installed only in the operating room.

DIN 1946-4 Folie 33 / 73



Hygiene und Hygiene und Hygiene und Hygiene und MedizinMedizinMedizinMedizin 2002200220022002

DIN 1946-4 Folie 34 / 73



Conventions of theConventions of theConventions of theConventions of the German Society German Society German Society German Society forforforforHospital Hygiene (et all.) Hospital Hygiene (et all.) Hospital Hygiene (et all.) Hospital Hygiene (et all.)

� Protection range with a size of 2.8 x 2.8 m required (containing OP and instrument tables)

� unidirectional airflow� Total size: 3.2 x 3.2 m with aprons 5 - 50 cm� Filter class H 14� degree of primary turbulence < 5%� corridors for sterile goods supply shall be

operated with positive pressure at all times

DIN 1946-4 Folie 35 / 73



DIN 1946-4 Folie 36 / 73



DIN 1946-4 Folie 37 / 73



DIN 1946-4 Folie 38 / 73



Date of Date of Date of Date of publicationpublicationpublicationpublication: : : :

November 2008November 2008November 2008November 2008

TheTheTheThe newnewnewnew ventilationventilationventilationventilation standardstandardstandardstandardDIN 1946DIN 1946DIN 1946DIN 1946----4444

DIN 1946-4 Folie 39 / 73



PublicationPublicationPublicationPublication in November 2008in November 2008in November 2008in November 2008

DIN 1946-4 Folie 40 / 73



Table of contents Table of contents Table of contents Table of contents

Foreword

1 Scope

2 Normative references

3 Terms, definitions, and abbreviations

4 General requirements

5 Classification of rooms used for medical pur-poses (room classes) and ventilation concepts

DIN 1946-4 Folie 41 / 73




6 Requirements for ventilation and air-conditioning components

7 System qualification and Acceptance tests

8 Periodic tests

9 Requirements for the technical documentation

DIN 1946-4 Folie 42 / 73




Annex A Project phases and objectives

Annex B Flow visualisation for room class 1a

Annex C Acceptance test by determining theprotective effect for room class 1a

Annex D Acceptance test following the procedurefor measuring the turbulence intensity

Annex E System test / Pre-qualification (class 1a)

Annex F Microbiological tests

DIN 1946-4 Folie 43 / 73



Scope of Scope of Scope of Scope of DIN 1946DIN 1946DIN 1946DIN 1946----4444

- hospitals buildings- day hospitals- physician’s practices with intervention rooms- outpatient surgery centres / facilities / ambulatories- dialysis centres- facilities for internal and external (service) units for

the processing of medical devices / sterilization areas

DIN 1946-4 Folie 44 / 73



Guide Guide Guide Guide forforforfor planningplanningplanningplanning, , , , constructionconstructionconstructionconstruction and and and and operationoperationoperationoperation

Operation optimisation of existing operating systems6. Re-qualification

Personnel training, to supplement and complete thesystem documentation, maintenance management, disposal of consumables, short microbiological tests

5. Operation

To apply the performance specifications, systemqualification, documentation, to conclude theimplementation phase

4. Implementation

To implement the performance specifications in theplanning department, to conclude the planning phase

3. Planning

Performance specifications, to conclude the phase of establishing the objectives

2. Project aims

To determine the current situation, establish the basics, and declare the aims

1. Analysis

DIN 1946-4 Folie 45 / 73



Project Project Project Project performance performance performance performance specifications IIspecifications IIspecifications IIspecifications II

� Prepared by the orderer / customer in cooperation with experts

� The target definition phase will be concluded when the performance specification of the project is approved by all parties involved in target definition.

� This serves as a basis for planning.

DIN 1946-4 Folie 46 / 73



Project Project Project Project performance performance performance performance specificationsspecificationsspecificationsspecifications

� Project definition, Intended use description

� Project organisation and quality management (QM-Masterplan)

� Testing concept (system qualification)

� Energy control and measurement concept

� Fire protection concept (fire compartments, escape routes, smoke extraction, evacuation)

� Time schedule, cost estimate

DIN 1946-4 Folie 47 / 73



Project Project Project Project performance performance performance performance specificationsspecificationsspecificationsspecifications

� Room definitions (room data sheet) listing at least:� hygiene classification

� protective-overpressure concept

� electrical safety classification

� room-climate requirements (temperature, humidity, sound pressure level)

� materials to be used (walls, floor, ceilings, etc.)

� operational facilities, equipments (internal loads)

DIN 1946-4 Folie 48 / 73



parties involved in the project parties involved in the project parties involved in the project parties involved in the project

� Investor (authorities, hospital management, etc.)� Users (surgeons, anaesthetists, nursing service, etc.) � Hospital hygiene (hospital-hygiene experts, cleaning pers.)� Purchase departement (OP equipment, medium supply

system, IT equipment etc.)� Maintenance staff (technical service, external maintenance

service, energy suppliers, etc.)� Planner (architects, building services engineering, ...)� Consultant (organizational and financial consultants, ...)� Further parties involved in the project

DIN 1946-4 Folie 49 / 73



� Technical acceptance:

� Planner, manufacturer and supplier

� Hygienic acceptance:

� The measuring technician collect the readings

� the hospital-hygiene expert in charge makes the hygienic interpretation and determines the protective measures or use restrictions

Responsibilities Responsibilities Responsibilities Responsibilities

DIN 1946-4 Folie 50 / 73



Air Air Air Air hygienehygienehygienehygiene in oin oin oin operating roomsperating roomsperating roomsperating rooms

Operating rooms are distinguished into:

� Operating rooms with ventilation systems of unilateral flow (ULF) for attaining a protected areain which the operation takes place and where theinstruments tables are positioned (roomroomroomroom classclassclassclass 1A1A1A1A);

� Operating rooms with ventilation systems of mixedor turbulent displacement flow (roomroomroomroom classclassclassclass 1B1B1B1B).

DIN 1946-4 Folie 51 / 73



BBBBasic requirements on ventilation and airasic requirements on ventilation and airasic requirements on ventilation and airasic requirements on ventilation and air––––conditioning in operating rooms class conditioning in operating rooms class conditioning in operating rooms class conditioning in operating rooms class 1B1B1B1B

� Sound pressure level at a nominal air flow rate of max. 48 dB(A)

� Supply air temperature 19-26°C (adjustable)� Measurement of comfort (though not defined)� Testing of the recovery time (recovery test)

according to DIN EN ISO 14644-3� Reduction of the particle concentration

by 99 % within 25 minutes

DIN 1946-4 Folie 52 / 73



New New New New operatingoperatingoperatingoperating roomroomroomroom classclassclassclass 1A1A1A1A

� vertical displacement flow� minimum size of the ULF diffuser 9,0 m2

� terminal, manufacturer inspected, high efficiencyparticulate air (HEPA) filters H13

� surrounding airflow aprons down to the height of the doors (approx. 2,1 m above foor level)

� supply air volume flow > 8‘000 m3/h� outdoor air supply (800 –) 1200 m3/h

DIN 1946-4 Folie 53 / 73



BBBBasicasicasicasic requirements onrequirements onrequirements onrequirements on ULF air diffusersULF air diffusersULF air diffusersULF air diffusersin in in in operatingoperatingoperatingoperating roomsroomsroomsrooms classclassclassclass 1A1A1A1A

� supply air velocity = 0,23 to 0,25 m/s� minimum local supply air velocity = 0,15 m/s� sound pressure level at a nominal air flow rate

of max. 48 dB(A)� supply air temperature 19 - 26°C (adjustable)� local deviation from Tmean: 0,3 K� measurement of comfort (though not defined)

DIN 1946-4 Folie 54 / 73



Integral OP acceptance tests (qualification) Integral OP acceptance tests (qualification) Integral OP acceptance tests (qualification) Integral OP acceptance tests (qualification)

Two Two Two Two acceptance testsacceptance testsacceptance testsacceptance tests::::

Technical acceptance testTechnical acceptance testTechnical acceptance testTechnical acceptance testperformance parameter of the HVAC system

Hygienic acceptance testHygienic acceptance testHygienic acceptance testHygienic acceptance testsufficient protective effect against load entry from outside

sufficient protective effect against load entry from inside


Technical acceptance testTechnical acceptance testTechnical acceptance testTechnical acceptance testperformance parameter of the HVAC system


DIN 1946-4 Folie 55 / 73



OPOPOPOP----Room Room Room Room acceptance testacceptance testacceptance testacceptance test (outer load entry)(outer load entry)(outer load entry)(outer load entry)

M3

M1

OP-Tisch 200x60

OP-Lampe

OP-Tisch

M2

M11 M12 M13

M01 M02 M03

DIN 1946-4 Folie 56 / 73



OPOPOPOP----Room Room Room Room acceptance testacceptance testacceptance testacceptance test (inner load entry)(inner load entry)(inner load entry)(inner load entry)

M3

M1

OP-Tisch 200x60

OP-Lampe

OP-Tisch

M2

M11 M12 M13

M01 M02 M03

DIN 1946-4 Folie 57 / 73



Test structureTest structureTest structureTest structure IIII

DIN 1946-4 Folie 58 / 73



Test structure IITest structure IITest structure IITest structure II

DIN 1946-4 Folie 59 / 73



Reference load Reference load Reference load Reference load

� reference particle concentration CRef = 106 P/ft3

(room background, ULF field surroundings)

� Protection degree 10-5 is correctly traceablecx / cRef = 10 / 106 = 10-5

� aerosol flow is emitted at the specified locations, the emission having low momentum and being isothermal

DIN 1946-4 Folie 60 / 73



� measured values:measured values:measured values:measured values: particle concentration cx at a hygienically relevant measuring point X in the area to be protected

� definition

� example: cx = 950 P/ft³: SGX = 3,0

Local Local Local Local protection class protection class protection class protection class SGxSGxSGxSGx

−=

Ref

XX c

c logSG cRef : 106 P/ft³

DIN 1946-4 Folie 61 / 73



Result: Protection effect of the OPResult: Protection effect of the OPResult: Protection effect of the OPResult: Protection effect of the OP----Room Room Room Room

� The smallest numerical value of the local protection classes is used to characterise the actual protective effect of the operating room

� Usual range of values: SG = 1 ... 5

� The result integrates all influences of the clean air diffuser (ULF), medical devices and anaestheticequipment, i.e. heat-load, convection, turbulences,...

DIN 1946-4 Folie 62 / 73



Interpretation of the protection classes Interpretation of the protection classes Interpretation of the protection classes Interpretation of the protection classes

poor1’000’0000

insufficient100’0001

sufficient10’0002

Good1’0003

outstanding1004

excellent105

Classificationmean particle concen-tration at measuring point X [P/ft3]

Degree of protection SG

DIN 1946-4 Folie 63 / 73



hospitalhospitalhospitalhospital----hygiene hygiene hygiene hygiene conclusionconclusionconclusionconclusion

� StateStateStateState----ofofofof----thethethethe----art operating roomsart operating roomsart operating roomsart operating rooms

Minimum requirement:

For the entire protected area a protective effect> 4 (without operating lamps) or > 2 (with operating lamps)

respectively, shall be demonstrated.

DIN 1946-4 Folie 64 / 73



Acceptance test (turbulence intensity) Acceptance test (turbulence intensity) Acceptance test (turbulence intensity) Acceptance test (turbulence intensity)

Figure D.2: 17 test positions in the measuring grid

projected onto the floor below the ULF outlet

These examinations shall be carried out in the form of averaged double determinations above the test positions (n = 17 in accordance with Figure D.2 projected onto the floor below the LTF outlet ) marked by black, orange and white self-adhesive dots.

DIN 1946-4 Folie 65 / 73



MicrobiologicalMicrobiologicalMicrobiologicalMicrobiological teststeststeststests in in in in thethethethe operatingoperatingoperatingoperating roomroomroomroom

� The decision on the need for microbiological / hygienic checks during operation is made by the hospital-hygiene expert in charge.

� Requirements (Example sedimentation plates):room class Ia: mean value of the specific colony forming units: ≤ 1 CFU / (50 cm2 • 60 min);

� room class Ib: mean value of the specific colony forming units : ≤ 5 CFU / (50 cm2 • 60 min).

� Airborne-germ counts in the empty operating room are not required in any case.

DIN 1946-4 Folie 66 / 73



Hygiene requirements on HVACHygiene requirements on HVACHygiene requirements on HVACHygiene requirements on HVAC----Plants Plants Plants Plants

� In addition to hospital-specific requirements, the HVAC systems must also fulfil the “common” requirements.

� Furthermore, observe VDI 6022 „Hygienic standards for ventilation and air-conditioning systems – Offices and assembly rooms” and its requirements.

DIN 1946-4 Folie 67 / 73



nextnextnextnext generationgenerationgenerationgeneration guidelineguidelineguidelineguideline

DIN 1946-4 Folie 68 / 73



� The new hospital guidelines contains for the first time details on the technical and hygienic qualification of operating rooms

� The results of predefined test methods lead to clear quality characteristics which can be used to deduce specific design elements.

� Verifiability of each design element allows to achieve constant & reproducible quality levels

Summary and lookSummary and lookSummary and lookSummary and look----outoutoutout

DIN 1946-4 Folie 69 / 73



DIN 1946-4 Folie 70 / 73



� The target is a European guideline

� The first steps for the CEN guideline are made: RESOLUTION taken by CEN/TC 156 Ventilation for buildings, agrees to create the following Working Group:CEN/TC 156; WG 13 CEN/TC 156; WG 13 CEN/TC 156; WG 13 CEN/TC 156; WG 13 –––– Ventilation in HospitalsVentilation in HospitalsVentilation in HospitalsVentilation in Hospitals

� Research and development in the laboratory operating room at the HTA School of Engineering + Architecture in Lucerne

Summary and lookSummary and lookSummary and lookSummary and look----out IIout IIout IIout II

DIN 1946-4 Folie 71 / 73



Conclusion on hospital hygieneConclusion on hospital hygieneConclusion on hospital hygieneConclusion on hospital hygiene

� Applies to all operating theatres:Applies to all operating theatres:Applies to all operating theatres:Applies to all operating theatres:

Without a catalogue of flanking measures Without a catalogue of flanking measures Without a catalogue of flanking measures Without a catalogue of flanking measures and the application of due operational and the application of due operational and the application of due operational and the application of due operational discipline the best clean air technology discipline the best clean air technology discipline the best clean air technology discipline the best clean air technology can only be seen as an 'alibi exercise'. can only be seen as an 'alibi exercise'. can only be seen as an 'alibi exercise'. can only be seen as an 'alibi exercise'.

DIN 1946-4 Folie 72 / 73



Thank you for

your attention

Thank you for

your attention

Thank you for

your attention

Thank you for

your attention

Thank you for

your attention

Thank you for Thank you for Thank you for Thank you for

your attention your attention your attention your attention

DIN 1946-4 Folie 73 / 73



more information

www.bht.ch

DIN 1946-4 Folie 74 / 73



Swiss Swiss Swiss Swiss GuidelineGuidelineGuidelineGuideline SWKI 99SWKI 99SWKI 99SWKI 99----3333

� Some additional information

DIN 1946-4 Folie 75 / 73



Centralised sterilisationCentralised sterilisationCentralised sterilisationCentralised sterilisation

� Centralised sterilisation must be subdivided into: cleaning room, packing room and sterile goods storeroom

� Decontamination- and (additional) cleaning machines between cleaning area and packing area

� Pass-through autoclaves between packing area and sterile goods storeroom

� Outgassing is required for material sterilised by gas-eous media. These materials must be stored separately.

DIN 1946-4 Folie 76 / 73



HygieneHygieneHygieneHygiene ClassificationClassificationClassificationClassification of rooms of rooms of rooms of rooms based on the risk of infectionbased on the risk of infectionbased on the risk of infectionbased on the risk of infection

� General consideration

� Operating rooms and other rooms for surgical interventions

� Other rooms with increased hygienic-requirements

� Other hygienically relevant rooms

DIN 1946-4 Folie 77 / 73



Operating rooms and other rooms for Operating rooms and other rooms for Operating rooms and other rooms for Operating rooms and other rooms for surgical interventionssurgical interventionssurgical interventionssurgical interventions

� Outdoorair flow volume of 800 to 1000 m3/h

� for outdoorair three-stage filtering is required� work checked terminal H13-filters

� ULF supply-air diffuser (unilateral-flow diffuser )

� Minimum size for the ULF diffuser 9.0 m2

� surrounding apron down to the height of the doors (up to approx. 2,1m above floor level)

DIN 1946-4 Folie 78 / 73



Other hygienically relevant rooms Other hygienically relevant rooms Other hygienically relevant rooms Other hygienically relevant rooms

� Patient’s room

� Emergency ward

� Recovery, observation room

� Delivery, Labour room, Room for caesarean sections

� Waiting rooms

DIN 1946-4 Folie 79 / 73



Waiting rooms Waiting rooms Waiting rooms Waiting rooms

� The danger of transmitting unidentified pathogen makes it necessary to provide efficiently ventilated waiting rooms (exhaust-air rate in excess of 75 m3/(h·P).

� Separate waiting rooms must be available for patients undergoing immunological suppression

DIN 1946-4 Folie 80 / 73



Basic requirements for rooms with Basic requirements for rooms with Basic requirements for rooms with Basic requirements for rooms with increased hygienic demandsincreased hygienic demandsincreased hygienic demandsincreased hygienic demands

� Requires increased outdoor-air flow rate > 100 m3 / (h ·P)

� Terminal filter F9

� Non-unilateral flow may be accepted (turbulent ventilation)

DIN 1946-4 Folie 81 / 73



Rooms with increased Rooms with increased Rooms with increased Rooms with increased hyghyghyghyg....----requirementsrequirementsrequirementsrequirements

� Sterile-goods storage / sterile corridor

� Angiographie, heart catheter laboratory, surgical Angiographie where minor interventions serve to implant foreign material

� minor surgery, dermatology, wound care

� Rooms for transplant recipients after surgery

� Intensive care unit including neonatology

� Endoscopic diagnosis

DIN 1946-4 Folie 82 / 73



Isolating room Isolating room Isolating room Isolating room

� Closed space

� Supply-air rate per room of 500 m3/h or � Air-exchange rate of 12 vol/h

� Maintained at negative pressure

� Exhaust air shall be HEPA-filtered before entering the exhaust-air network (terminal high-efficiency particulate air filter, class H13)

DIN 1946-4 Folie 83 / 73



Isolating room Isolating room Isolating room Isolating room

gemeinsame Zuluft gemeinsame Abluft

LW = 12-fach

F9

ev. flexibel

Korridor (bei Normalzimmer) Patientenzimmer Dusche / WC / AusgussSchleuse (bei ordentlichem Isolierzimmer)

AC = 12/h

Joint supply air Joint exhaust

flexible ev.

Corridor (in case of normal room) Patient's room Shower / WC / SinkAirlock (in case of normal isolation room)

H13

50 m /h3

100 m /h3

150 m /h3

Documents

Current hospital guidelines in Germany and in Switzerland · DIN 1946-4 Folie 3/ 73 Brunner HaustechnikBrunner Haustechnik AG, CHAG, CH--8304 Wallisellen8304 Wallisellen--ZZüürichrich