Smoke Management in Operating Room Renovations Sandy Bonderman PE, LEED AP Sean Riley PE, LEED AP Brian Robinett PE, LEED AP Notkin Mechanical Engineers
Overview Smoke Management in OR Renovations Why it s Important How it s Different Requirements Applicable Codes Prescriptive vs. Non-Prescriptive Compliance OR Suite Pressurization Controls Challenges Case Studies
Why it s Important
How It s Different Office/Residential Turn off select mechanical system(s) Evacuate Alert Fire Dept.
How It s Different Hospital Can t evacuate many patients Must be able to move patients to other areas on the floor (at least one smoke barrier per floor) Alert Fire Dept. Alert Staff Defend in Place
How It s Different Operating Room Must Continue Surgery Can t Affect Other ORs Doesn t Trigger Fire Alarm Alert Operating Staff, Facilities, Security OR Switches from Positive to Negative Pressure Defend in Place OR Exhausts Smoke Switch Back to Positive Pressure ASAP
Requirements No Current Code Requires Smoke Control in Operating Rooms. So Why Do It? CMS If you want to bill for Medicare & Medicaid services you must meet NFPA 99 1999 Edition standards.
Requirements NFPA 99 1999 Edition 5-4.1.2 Supply and exhaust systems for windowless anesthetizing locations shall be arranged to automatically vent smoke and products of combustion. 5-4.1.3 Ventilating systems for anesthetizing locations shall be provided that automatically (a) prevent recirculation of smoke originating within the surgical suite and (b) prevent the circulation of smoke entering the system intake, in either case interfering with the exhaust function of the system.
Requirements
Requirements When is Smoke Management Required? New Construction of ORs Renovations to HVAC Systems in an OR Non-HVAC Renovations to OR (may or may not trigger the requirements, check with DOH early) Other Anesthetizing Locations
Requirements How Smoke Events Happen Equipment Fire are Rare, Usually Controlled by Cutting Power to the Device Oxygen Rich Environment Human Error Electro-Surgical (ESU) Pencils Electro-Cauterization
Requirements Typical OR Smoke Event Response Control Fire Stop flow of breathing gases Put out fire, remove burning materials from patient Care for Patient Resume patient ventilation Control bleeding Evacuate the patient as needed Isolate Room to Contain Fire/Smoke
Applicable Codes International Building Code Smoke dampers required at smoke barriers. Fire smoke dampers required at horizontal partitions and shaft penetrations. Dampers close upon detection of smoke. International Mechanical Code Smoke detectors in return air system over 2,000 cfm. If smoke is detected system shuts down. NFPA 101 Smoke detectors must activate fire alarm, unless used to operate dampers or shutdown mechanical equipment.
Prescriptive Compliance Mechanical Room & OR in same Smoke Zone Roof Mounted Equipment on the Roof of the OR Floor AHU Serves 100% Outside Air HVAC System is Dedicated to a Single OR
Non-Prescriptive Compliance
Positive Pressure Normal Operations
Negative Pressure Smoke Mode
Pressure Relationships
Controls & Devices AHU Operation
Normal Operation Positive Pressure 1,000 CFM Supply -700 CFM Exhaust/Return +300 CFM Pressure
Smoke Mode Increase Exhaust/Return Air 1,000 CFM Supply -1300 CFM Exhaust/Return -300 CFM Pressure
Normal Mode Increase Exhaust/Return Air
Smoke Mode Increase Exhaust/Return Air
Normal Operation Positive Pressure 1,000 CFM Supply -700 CFM Exhaust/Return +300 CFM Pressure
Smoke Mode Decrease Supply Air 400 CFM Supply -700 CFM Exhaust/Return -300 CFM Pressure
Normal Mode Decrease Supply Air
Smoke Mode Decrease Supply Air
Normal Operation Positive Pressure 1,000 CFM Supply -700 CFM Exhaust/Return +300 CFM Pressure
Smoke Mode Pressure Independent Supply Boxes 400 CFM Supply -700 CFM Exhaust/Return -300 CFM Pressure
Normal Mode Pressure Independent Supply Boxes
Smoke Mode Pressure Independent Supply Boxes
Controls & Devices Smoke Detector Indoor Air Quality Sensor
Controls & Devices Manual Smoke Mode Activation
Controls & Devices OR Control Panels
Controls & Devices Nurses Station Control Panel
Challenges Proper Team Involvement Jurisdictional Authorities Fire Department Building Inspector Department of Health Contractors Mechanical DDC Fire Alarm Electrical General OR Smoke Management Design Team Mechanical Engineer Electrical Engineer Architect DDC Engineer FA Engineer Commissioning Commissioning Agent Testing & Balancing Contractor Owner Owner s Rep Facilities Security Nurses & Doctors Housekeeping
Challenges Commissioning Is each area pressurized correctly during normal operating mode and in smoke mode? Are the alarms triggering correctly during a smoke event and reading out to the right control panel locations? Are all control panels in easy to see and reach locations with appropriate signage? Are all alarms silenced manually (and not able to be silenced locally)? Are the IAQs attenuated to the right smoke level?
Challenges Training & Signage Visible Control Panels (in OR and at Nurses Station) Visible Signage with Instructions Regarding OR Pressurization, Smoke Management, & Controls Tell the Story
Case Study 1 Operating Room Conversion Existing, One Room Remodel Upgraded to State-of-the-Art OR One-off Smoke Management/Display System Extended Project Duration
Case Study 2 Mechanical System & Controls Upgrade
Case Study 2 Mechanical System & Controls Upgrade
Case Study 3 OR Electrical & Med-gas Upgrade Added Smoke Management at Minimal Cost & No Added Time Smoke Detector Wired to DDC System OR Electrical & Med-gas Upgrade Existing AHU Supplying 100% Outside Air Dedicated Supply Terminal Units for Each OR Older Installation: Fire Dampers at Shaft Penetrations DDC/BMS Controls are not Necessary
Final Thoughts OR Smoke Management mitigates the impact of an OR fire on adjacent spaces (by containing smoke, maintaining pressurization of adjacent spaces, and handling the event without triggering the fire alarm.) Tell the Story (educate providers, housekeeping, facilities, security, consultants, contractors, designers, inspectors, fire department, department of health )
Questions?
Thank You! Contact Us: (206) 448-1911 2301 Fifth Avenue, Suite 401 Seattle, WA 98121 Sandy Bonderman PE, LEED AP sandyb@notkin.com Sean Riley PE, LEED AP seanr@notkin.com Brian Robinett PE, LEED AP brianr@notkin.com You can download the deck at www.notkin.com/orsmokemanagement