Humidification In Health Care
by Brian Sikorski P. ENG., CEM
February 1, 2009
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1. Winter comfort zone for indoor air. |
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Maintaining
minimum requirements may involve more than you think. However, while
there are some areas — such as certain sensors — where you won’t
want to skimp, owners do have some flexibility in reaching acceptable
performance with lowest life-cycle cost.
Sometimes
a requirement for humidification in a building is poorly defined,
over-designed, and either over or underutilized. Humidity levels are
notoriously difficult to control and maintain in buildings of any
type. In particular, older buildings with leaky envelopes can lose so
much moisture so quickly that it is almost impossible to maintain
acceptable relative humidity levels. Fortunately, the human body has
a great tolerance for comfort, and we are used to dry skin and static
discharge in winter. So perhaps that is why building designers,
owners, and operators are happy to leave humidification to
specialized buildings like data centers, pharmacies, hospitals,
galleries, and museums — especially in the Northwest, where
extremely dry conditions only last a few days a year.
For
the purpose of our discussion, we will focus in humidification in
health care applications — hospitals, laboratories, clinics, and
extended care homes.
Comfort Guidelines
ASHRAE
recently published “Standard 170-2008 Ventilation of Health Care
Facilities,” which requires many areas within hospitals, like
operating rooms, to maintain humidity levels between 30% and 60% rh
at temperatures between 20°C and 24°C (70° to 75°F).
The
standard quite closely follows the winter thermal comfort guidelines
also developed by ASHRAE many years ago. The lower boundary of 30%
prevents discomfort from cold and dry conditions that exacerbate many
health conditions. The 60% rh upper boundary is meant to reduce the
opportunity for mold growth. Stagnant warm and humid air above this
control region is a breeding ground for mold growth and mildew, the
spores of which when airborne can cause respiratory problems. The
psychrometric chart in Figure 1 illustrates the accepted winter
comfort zone. The psychrometric analysis is used to calculate the
relative energy in moist air, among other valuable physical
properties, as we will see in the next example.
While
it is nice to have a broad guideline like this to allow some
flexibility for control of conditions, why would we ever want to
maintain temperature or humidity at the higher rh and temperature
states, and what would be the cost to do this? Well, the answer to
the first part of the question in winter — we don’t need to
unless we are getting too many comfort complaints or have special
medical conditions that require it. For energy cost considerations,
the acceptable low region should be the target at all times during
occupied periods.
Table 1 illustrates the
acceptable scenarios for a cold day for a 40,000 cfm system
humidifying outdoor air at realistic dry winter conditions. As can be
seen, the difference between the low end of 20°C and 30% rh and
24°C/60% rh is a substantial energy cost increase from $290 to $819
or $529/day. The latent energy requirement nearly triples between low
and high conditions.
Humidity Requirements
Unfortunately,
we can’t just keep the humidity and temperature in the optimum
energy state for various reasons — not the least being the
inability to measure and control accurately with standard HVAC-grade
sensors and controllers. So what is required to humidify a space like
an operating room or a delivery room?
Well,
there are several systems that can be used, but the simplest method
for general humidification — though perhaps not the purest method —
is the use of plant steam piped into a humidifier dispersion grid
located in the supply duct work of a major air-handling system. The
addition of low pressure (10 to 15 psi) steam from a humidification
coil enables water to be injected and evaporated into the airstream
within the minimum length of duct run. If the coil is large enough
and properly designed, and the air velocity is kept low enough (1,000
ft/min or less), then this method will evaporate steam in distance of
less than 6 ft (1.8 m). Good dispersion will avoid the saturation of
any duct insulation and filter media.
Steam Concerns
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1. Acceptable variation in rh and temperature vs. cost and energy for
a 40,000 cfm 100% outdoor air system. |
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Boiler
water chemical additives are often cited as a concern, but according
to ASHRAE, plant steam can be introduced into health care spaces —
as long as it meets the USDH FDA requirements of 173.310 in the Code
of Federal Regulations CFR21. This code, of course, cites numerous
possible chemical additives and their limitations in the steam,
especially if the steam comes in contact with milk or milk products
such as in food preparation areas. Fortunately,
these requirements are reasonably easy to meet, but a chemical
analysis of your plant steam is recommended. The requirements can be
found at
http://edocket.access.gpo.gov/cfr_2004/aprqtr/pdf/21cfr173.310.pdf.
Health Canada discusses safety “Guidelines for Incidental Additive
Submissions” under its Food and Nutrition division (see
http://www.hc-sc.gc.ca/fn-an/legislation/guide-ld/guide_incidental_addit_indirects-eng.php)
and mentions boiler water treatment compounds, but unlike the FDA
document, no direct reference to humidification is
made. ASHRAE Standard 170P restricts the use
of reservoir and pan-type humidifiers because these systems contain
standing water that is open to air and can induce mold and bacteria
growth. Other types of closed steam-injection type humidifiers are
acceptable. Steam-to-steam humidifiers that use a heat exchanger
supplied with plant steam or electric heating elements to boil steam
from a clean water source like a water purification system — can
also be used, but this can be very expensive. Use of domestic
(potable) water for this type of application can lead quickly to
maintenance problems if mineral levels in the water are too high and
cause buildup on control components like fill valves.
Streamlining
In
some cases, humidification may be required to be delivered at the
source, like the example given above with a large general supply fan,
or at the load like added to air supply at the branch that serves the
space — like an individual operating room. The problem with this
method is that the owner is required to maintain several small
humidification systems and service each one.
For
example, at Vancouver General Hospital in British Columbia, Canada,
there is an operating room (OR) suite of 20 ORs fed from four main
AHUs (serving the ORs and other less critical areas). The AHUs have
general humidity control, but in addition, each OR had its own direct
steam humidity control valve and dispersion grid. After a few years
of failed attempts to control the humidity in the spaces, all of the
humidifiers were abandoned after problems were discovered with poor
absorption of the moisture into the air that resulted in wet steam
condensing on duct surfaces and supply grills.
As
a consultant who looks at mainly retrofit projects in health care and
other commercial and institutional buildings, I have seen numerous
abandoned humidification systems that were either too difficult or
too costly to maintain and control.
At the very least
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2. Minimum elements for general humidification and control. |
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So
if you plan to maintain acceptable control of temperature and rh in a
critical space, at the same time controlling operating and
maintenance costs over the long term, then what do you need to do at
minimum? The minimum number of control
elements required are actually more than you may think or want. You
need a reliable source of steam, a good control valve that is sized
well to supply only the minimum requirement at the peak conditions,
and at least three and perhaps four rh sensors — a supply air
humidity duct sensor to ensure you don’t overspray the air, a
high-limit rh sensor mechanically interlocked to the control valve to
cut the humidity supply in case of a failure, a return or exhaust air
duct sensor, and possibly a space rh sensor to reset the supply rh.
Figure 2 illustrates the required elements. Of
course, the whole thing will be controlled from the building control
system, and appropriate failsafes and alarms need to be set up to
capture potential problems. And naturally, each control element will
have its own challenges during its lifetime (which needs to be as
long as possible). The supply air rh sensor needs to be reliable or
it will saturate one day when too much moisture hits it, and never
recover. The high-limit rh sensor should be a manually operated
device that only provides a relay dry-contact output to open the
control circuit. The return or exhaust air rh sensor is probably the
most critical since it is one used for rh the control in the end. Use
a high-quality sensor for this — even if it costs $1,000, it will
pay for itself easily in a large system. The
supply air rh sensor is often used to control the steam valve, but it
is ultimately reset by the return/exhaust air element. Unless the OR
has independent humidity control, the rh sensor in that space will
just be an indicator of conditions. Keep in mind that if the space is
cooler than average return air, the rh may be quite a lot higher,
which is yet another reason to keep rh levels at minimum acceptable
in the supply. The use of these systems is
obviously very seasonal, so it is a good idea to isolate the whole
system back at the source in early spring so that no heat is wasted.
Just letting the control program shut the valve on an outdoor
temperature limit is not enough. So in
conclusion, some humidity control in these critical environments is
important, but a lot of flexibility is allowed to help the building
owners and operators cope with issues like steam quality,
controllability, operating cost, and energy usage. Keep it to the
minimum, keep it as simple as possible, and use high-quality control
elements in order to enjoy an acceptable environment in your critical
spaces. ES
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