Pedoman Teknis HVAC Rumah Sakit Oleh Ir. John Budi H Listijono, M.Eng.Sc, Fellow ASHRAE PT Metropolitan Bayutama dan PT Metropolitan Bayu Industri Presentasi untuk Semiloka, Jakarta, 20 Mar 2014

Rumah Sakit - Pusat dari orang sakit. - Sumber dari Berbagai penyakit. - Sumber dari Berbagai zat/gas yang berbahaya. -Pusat dari pertemuan para medis/dokter/pengunjung/keluarga (orang sehat) dan orang sakit. -Pusat dari perawatan/pemeliharaan orang sakit.

HVAC Rumah Sakit Diperlukan perhatian khusus dan ketat agar penyebaran penyakit dari satu orang ke lainnya dibuat seminimum mungkin. Diperlukan design khusus agar ruangan2 yang ditempati tidak menjadi sumber penyakit baik untuk penghuni(orang sakit) maupun para medis/dokter, pengunjung dan sekitarnya. Penyebaran penyakit banyak melalui Udara.

Parameter HVAC yang harus di perhatikan untuk rumah sakit. 1. Temperature bola kering. 2. Kelembaban relative ruangan. 3. Kebersihan. 4. Ventilasi udara. 5. Tekanan ruangan untuk ruangan khusus. 6. Distribusi udara. 7. Noise/kebisingan. 8. Vibrasi/getaran.

Temperature, Kelembaban dan Cirkulasi udara di rumah sakit berdasarkan ASHRAE Standar 170-2011

Indoor Air Quality Masalah Indoor Air Quality di rumah sakit merupakan masalah utama, karena banyak penularan penyakit dari satu orang ke orang lainnya melalui udara.

Indoor Air Quality Indoor Air Quality (IAQ): The composition and characteristics of the air in an enclosed space that affect the occupants of that space. The indoor air quality of a space refers to the relative quality of air in a building with respect to contaminants and hazards and is determined by the level of indoor air pollution and other characteristics of the air, including those that impact thermal comfort such as air temperature, relative humidity and air speed.

What influence IAQ IAQ can be affected by microbial contaminants (mold, bacteria), gases (including carbon monoxide, radon, volatile organic compounds), particulates, or any mass or energy stressor that can induce adverse health conditions. Indoor air is becoming an increasingly more concerning health hazard than outdoor air. Using ventilation to dilute contaminants, filtration, and source control are the primary methods for improving indoor air quality in most buildings

Contoh umum VOCs pada Bangunan Bahan Cat, Pembersih lantai, Bahan pengawet bangunan, kayu, bahan pembuat plastik, bahan antiseptic dll. Formalin, bensin, speritus, detergent, vinil. Gas yang dikeluarkan oleh jamur, bakteri dll.

Cara paling umum untuk mengurangi konsentrasi VOCs Menambah jumlah udara Ventilasi di dalam ruangan agar kadar VOCs di larutkan.

Legionella

Tempat Terjadi nya Legionella Cooling Tower Evaporative Condenser

Lanjutan Legionella Direct Evaporative Cooler Air Washer

Indirect Evaporator Cooler ShowerHeads

Produce Misting System Cooling Mister

Hot Tubs

Mold (Jamur)

Jamur yang tumbuh di Diffuser

Jamur yang tumbuh di sistem ducting

Jamur yang tumbuh di belakang Wall Paper

Tumbuh nya Jamur di pengaruhi 1. Air (Kelembaban/RH, RH > 60%). 2. Adanya Bahan makanan Jamur  Cellulose, Kayu, Bahan mineral, Bahan organik dll. 3. Waktu  lebih dari 24 jam.

The Effect of Relative Humidity to the Growth rate

Thermal Comfort ASHRAE Standard 55-2004

Thermal Comfort ASHRAE Standard 55-2010

Kenyamatan Thermal Untuk Kondisi di Indonesia (Panas dan Lembab) Temperature : 23 C – 27C ( 25 C +/- 1 C) Kelembaban : 65% - 55% ( 55% +/- 5%) Kadar Uap air : < 12 gram /kg udara Kecepatan Udara: < 0.15 m/s Pakaian yang di pakai CLO = 0.5 – 0.6 Aktifitas orang di dalam = 1.0 – 1.2 MET

How to reduce the indoor Particles/ contaminants 1. To use Filtration. 2. To increase the ventilation rate.

Filtration 1. Prefilter  MERV (Minimum Efficiency Reporting Value) 7 or G4 (Eff = 25%-35%). 2. Medium Filter  MERV 13 or F8/F9 (Eff = 85% -95%). 3. HEPA Filter  MERV 17 or H13 (Eff = 99.97%).

Kebutuhan udara Ventilasi

Ventilation air for Breathing zone ASHRAE Standard 62.1-2007

Contoh 1 untuk office Kebutuhan Ventilation Air for Breathing Zone Sebuah Office 10m x 10m =100 m2 dengan Jumlah orang: Biasanya udara supply berkisar antara 1200 CFM. Rumus udara Ventilasi for Breathing (the breathing zone outdoor airflow (Vbz) = Rp Pz + Ra Az 1. Jumlah 5 orang  Jumlah OA (Vbz) = 5 x 5CFM + 100m2 x10.8 x 0.06CFM/ft2 = 89.8 CFM ~ 90CFM jadi, 90CFM/5 orang = 18 CFM/orang. Udara Ventilasi >=7.5% udara supply. 2. Jumlah 10 orang  Jumlah OA (Vbz) = 10 x5CFM +100m2 x10.8x0.06CFM/ft2 = 114.8 CFM = 11.5 CFM/orang. Udara Ventilasi >= 9.5% udara supply. 3. Jumlah 20 orang  Jumlah OA (Vbz)= 20 x 5CFM + 100m2 x 10.8 x 0.06 CFM/ft2 = 164.8 CFM = 8.24 CFM/orang. Udara Ventilasi >=13.8% udara supply.

Kebutuhan udara Ventilasi for Breathing - Untuk Office : 10 -15% dari udara Supply. (0.8~1 ACH) - Untuk Mall : 15 – 20% dari udara Supply.(1-1.5 ACH) - Untuk Ball Room: 20 – 25% dari udara Supply.(1.5-2ACH) - Untuk Rumah Tinggal: 7.5 – 10% dari udara Supply.(0.7~1 ACH) - Untuk Rumah Sakit : 15 – 20% dari udara Supply. (>2ACH) - Untuk Ruang Operasi: 20 – 25% dari udara Supply.(min 4ACH).

Tujuan dari Udara Ventilasi - Melarutkan/membersihkan kandungan zat/gas/particel dari udara didalam ruangan. - Menghilangkan bau-2 an yang ada didalam ruangan. - Mensupply oxygen untuk penghuni didalam ruangan.

Outdoor Air Temperature and Moisture contains

Infiltration/Ventilation air load Comperation Sub Tropical Climate Tropical Climate Outdoor Temperature 34 oC DB/ 28 oCWB  25 oC/55%RH  20,804 W/1000 CFM (194%) = 70,941 BTU/H.1000CFM ( 5,231W  sensible Heat; 15,573 W  Latent Heat) Sensible Heat Ratio = 0.251  Sensible Heat 25.1% Outdoor Tempterature 35 oC DB/24 oCWB  25oC/55%RH  10,722 W/1000CFM = 36,562 BTU/H.1000CFM ( 5,812 W  Sensible Heat; 4,920 W Latent Heat) Sensible Heat Ratio= 0.542  sensible Heat 54.2%

Udara Ventilation for AC

Pengaruh Udara Ventilasi terhadap AC

Air Conditioning Unit Sub Tropical Climate Tropical Climate 1. DX unit  1hp (9000 BTUH)  250 CFM. 2. AHU unit  1 TR (12000 BTUH)  300-350 CFM/TR. 3. Ventilation air  1 CFM= 90.2 BTUH (143 %). 4. DX unit  Number of Rows= 3-4 Rows. 5. AHU unit  Number of rows = 4-6 Rows used 5/8” tube. 6. Sensible Heat Ratio = 0.6-0.65. 1. DX unit  1 hp (9000 BTUH)  275-300CFM. 2. AHU unit  1 TR (12000 BTUH)  375-400CFM/TR. 3. Ventilation air  1 CFM = 63 BTUH. 4. DX unit  Number of rows = 2-3 rows. 5. AHU unit  Number of rows 4 rows and used ½” tube. 6. Sensible Heat Ratio = 0.7-0.8

HVAC untuk Ruang Operasi HVAC di ruang operasi untuk sebuah rumah sakit sangat penting sekali untuk mencegah terjadinya penyebaran penyakit, dan menghindarin terjadinya komplikasi pada saat operasi dan pasca operasi. AC biasa tidak bisa digunakan didalam system AC ruang operasi karena harus tidak di rancang untuk ruang operasi.

Ruang Operasi  Clean Room 1. Temperature ruangan : 200 C – 240 C 2. Kelembaban Ruangan: < 60%. 3. Kebersihan diatas meja operasi : Class 10000 4. Kebersihan di dalam ruangan : Class 100000 5. Tekanan Ruangan terhadap sekitarnya: +1  (10-12 Pa) 6. Diatas meja operasi  laminar Flow.

What should be controlled in a Clean room Airborne particles. To dilute and remove the particles and Bacteria dispersed from personal and machinery within the room. Temperature. Humidity. ( Very Serius for Tropical Climate) Pressure. Air Distribution. Sound. Lighting. Vibration

Conventional AC can not be used in Cleanroom application: Conventional AC is designed to control only Temperature of the room. Not to control Humidity. Not to control pressure. Not to control cleanness.

Operating Theater Requirement

Operating Theater applied in Australia

System Filtration -Minimum harus terdiri dari 3 filters: 1. Pre Filter  G4 (25-35%) atau MERV 7. 2. Medium Filter  F8/F9 (85-95%) atau MERV 13/14. 3. HEPA Filter di atas ruang operasi  H13/H14 ( 99.97% - 99.997%) atau MERV 17/18.

System Filtration Air Velocity from the outlet of HEPA filter = 0.45 m/s +/- 0.1 m/s. 24” x 24” (600mm x 600mm) HEPA Filter = 350CFM +/- 20% = (280 CFM ~ 420 CFM) 24” x 48” (600 mm x 1200 mm) HEPA Filter = 700 CFM +/- 20% = 560 CFM ~ 840 CFM Pre-Filter = MERV 7 or G4. Medium Filter = MERV 13/14 or F8/9. HEPA Filter = MERV 17 or H13 Fan Static Pressure >= 4” H2o or 1000 Pa.

System Air Lock

Unit AC untuk ruang operasi Unit AC harus mampu mengatur: 1. Temperature Ruangan secara konstan 220C +/- 2C. 2. Kelembaban Ruangan : 55% +/- 5%. 3. Melawan gesekan ducting dan Filter  tekanan static Fan > 1000 Pa. (4” water gauge). 4. Mampu menurunkan kelembatan udara luar yang lembab. Baik pada beban penuh maupun beban partial. 5. Mampu menjaga positive pressure di dalam ruang operasi meskipun filter2 nya kotor. 6. Mampu terus menjaga tertukaran udara yang telah ditetapkan. (ACH = konstan).

illustrasi System AC pada Operating Room (Class 100.000) AC Conventional dengan ELECTRIC HEATRER

Conventional Air Con with BY PASS

Conventional Air Con with Conventional Coil System

AC Conventional for Operating Theater with Dehumidifier

Modern AC for Operating Room (Class 100.000) with AC HEAT PIPE (TANPA Dehumidifier or Electric Heater)

Plug Fan system

AC HEAT PIPE (Big Capacity) Dimension unit Indoor AC HEAT PIPE (Big Capacity)

PLUG FAN COMPARITION CONVENTIONAL FAN Vs High Efficiency > 70% Low Power Consumption No Fan Belt Low Maintenance Efficiency < 60% High Power Consumption With Fan Belt High Maintenance

Comparison between conventional HVAC (using electric Heater) with HVAC using active heat pipe Operation cost 100% Unit capacity is bigger Use electricity  21.2% CC Using Active Heat pipe Operation cost = 45.1% (saving more that 54%) Unit capacity is smaller (less 11.3%) No need electricity.

Psychometric Chart of a Reheat system (electric heater)

Psychometric Chart of a Active heatpipe system

Modern Typical AC untuk Ruang Operasi Saving up to 50% Operation Cost

Hal-hal yang perlu di perhatikan didalam ruang operasi 1. Kebersihan ruangan operasi.  mengurangi timbulnya partikel/kotoran. 2. Pemasangan HEPA filter dan distribusi udaranya yang benar serta pengecekannya. 3. Mengurangi sumber kelembaban ruangan. 4. Mempertahankan positive pressure ruangan. 5. Rutin penggantian filter2 AC unit dan HEPA filter. 6. Rutin melakukan maintemance dan pengecekan unit AC.

HEPA Filter

Arah Aliran udara

Particle Counter

Perhitungan kolonial Microbial

Centrifugal sampling

Relationship Between IAQ and Health

Oxygen Deficiency Hazards (ODH) The Occupational Safety and Health Administration (OSHA) Respiratory Protection Standard (29CFR1910.134) defines an oxygen-deficient atmosphere as an atmosphere with an oxygen content below 19.5% by volume. Normal oxygen content in atmosphere is 20.8%. a reduction of as little as 1.3% may result in adverse health consequences, including loss of consciousness and death.

Oxygen and Health "Cancer has only one prime cause. It is the replacement of normal oxygen respiration of the body's cells by an anaerobic (i.e.. oxygen-deficient) cell respiration.“ -Dr. Otto Warburg. Two-time Nobel Laureate Winner of the Nobel Prize For Cancer Research "Lack of oxygen clearly plays a major role in causing cells to become cancerous.“ -Dr. Harry Goldblatt. Journal of Experimental Medicine "The true cause of allergy is lowered oxidation process within the body, causing the affected individual to be abnormally sensitive to foreign substances entering the body. Only when the oxidation mechanism is restored to its original highest state of efficiency can the sensitivity be eliminated.“ -Dr. Wendell Hendricks. Hendricks Research Foundation "Starved of oxygen the body will become ill, and if this persists it will die, I doubt if there is an argument about that.“ -Dr. John Muntz. Nutritional Scientist

Continued... "In all serious disease states we find a concomitant low oxygen state... Low oxygen in the body tissues is a sure indicator for disease... Hypoxia, or lack of oxygen in the tissues, is the fundamental cause for all degenerative disease.“ -Dr. Stephen Levine. Renowned Molecular Biologist. Author, "Oxygen Deficiency: A Concomitant to All Degenerative Illness" "Simply put, disease is due to a deficiency in the oxidation process of the body leading to an accumulation of toxins. These toxins would ordinarily be burned in normal metabolic functioning.“ -Dr. Albert Wahl "Insufficient oxygen means insufficient biological energy that can result in anything from mild fatigue to life threatening disease. The link between insufficient oxygen and disease has now been firmly established." -Dr. W. Spencer Way, in the Journal of the America Association of Physicians

Degenerative Illness Diabitise Millitus. Stroke. Disfunction Erection. High Blood Pressure. Heart Diesese. Etc.

Terima kasih atas perhatiannya. Mari berdiskusi