NABH REQUIREMENTS AIR CONDITIONING OF OPERATING

THEATRES

ASSUMPTIONS

Size of the OT is 20 feet x 20 feet x 10 feet.

Occupancy level is 5 to 8 persons.

Equipment heat load of maximum 7 kw.

Ambient temperature, humidity and other conditions to be considered

while designing the system.

SUPER SPECIALITY OTs

Minimum of 30 air changes per hour.

Fresh air change should be minimum of 5 out of 30. In other words,

fresh air should be a minimum of approximately 17%.

If the hospital management prefers to use 100% fresh air system, then
appropriate energy saving devices should be installed.

Air velocity should be 90 to 120 fpm at the grille level.

Mentions about unidirectional air flow from the supply air grille
downward towards the operating table.

OT positive pressure should be a minimum of 15 Pascals (1.5 mm WC)

with respect to all adjoining linked areas.

Terminal HEPA filters are to be installed at the outlet of air in the OT.

The minimum size of the supply air terminal in the OT should be 8 feet
x 6 feet covering the entire surgical team and the operating table.

Supply air quantity must comply with both the face velocity at the
supply grille and the minimum air change rate required.

Air quality at grille level must satisfy ISO Class 5 as per ISO 14644-1 or
Class 100 as per FED.STD.209E in AT REST condition.

Return air grille level must be at 6 inches from the floor level.

Temperature requirement is 21 + / - 3

C.

Humidity requirement is 40 to 60 % RH, although 55% RH is the ideal

figure.

Facility for monitoring and displaying the temperature and % RH should

be made available inside the OT.

AHU should contain washable 10 and 5 micron filters with SS 304 or

aluminium casing only. Hepa filters should not be fixed in the AHU and
should only be installed in the supply terminal at the OT.

GENERAL OT

Minimum of 25 air changes per hour.

Fresh air change should be minimum of 4 out of 25. In other words,

fresh air should be a minimum of 16%.

There is no specific mention about the air velocity range that is to be

maintained at the grille level.

However the face velocity at supply grille should be in accordance to

the air quantity required to achieve the necessary minimum air
changes per hour supplied over the grille dimensions stipulated.

OT positive pressure should be a minimum of 15 Pascals (1.5 mm WC)

with respect to all adjoining linked areas.

Terminal HEPA filters are NOT required to be installed at the outlet of

air in the OT. They must be installed inside the AHU.

The minimum size of the supply air terminal in the OT should be 6 feet
x 4 feet covering the entire surgical team and the operating table.

Return air grille level must be at 6 inches from the floor level.

Air quality at grille level must satisfy ISO Class 6 as per ISO 14644-1 or
Class 1000 as per FED.STD.209E in AT REST condition.

Temperature requirement is 21 + / - 3

Humidity requirement is 40 to 60 % RH, although 55% RH is the ideal

figure.

C.

Facility for monitoring and displaying the temperature and % RH should

be made available inside the OT.

AHU should contain washable 10 and 5 micron filters with SS 304 or

aluminium casing only. Hepa filters should be installed in the AHU.

Facility should be made available in the AHU for accessing the exit side
of the AHU by way of an entry door for performing the Filter integrity
test on the HEPA filter.

GENERAL GUIDELINES

The AHU of each OT should be dedicated and should not be linked to

other areas.

The AHU needs to be run round the clock during non functional hours
of the operation theatre also.

The AHU blower may be at a lower speed and without temperature

control. VFDs may be used for this purpose.

Window ACs and spilt ACs should not be used in any type of operation
theatre.

TESTING

Temperature and Humidity

Airborne particle concentration

Air velocity at the Supply air terminal

Air change rate

Pressure differential with respect to adjoining areas

Filter integrity test (Leak testing) for the HEPA filters

All the above tests are detailed in ISO 14644- Part 1 and 3

AIR CHANGES PER HOUR

ACPH = (Air flow rate into the room X 60) / (Room Volume)
Air flow rate in cfm and room volume in cft.
For easy understanding if there is a room of size 20 x 20 x 10 feet, the
ACPH will be 30 if the air flow into the room is 2000 cfm.

SOME FINER POINTS

HEPA filters should be installed absolutely leak free otherwise the

facility will fail during the Filter integrity test.

When the HEPA filter is terminally installed as in Super specialty OTs,

the ducting system gets pressurized. So installation of ducts also needs
to be leak free.

Extreme care needs to be taken while handling and installing HEPA

filters as they are very fragile. If any visible damage is seen in the
filters, the same needs to be replaced immediately.

SOME FINER POINTS Contd.

HEPA filters have high pressure drops and hence consume more
energy. Hence opt for HEPA filters with higher media area and lower
pressure drop.

The HEPA filter mounting arrangement also needs to be completely

leak free. Enough care needs to be taken to see that there is no leak
between the filter mounting frame members and between the
mounting frame and the side wall of the AHU or the supply plenum.

CLASS

ISO 14644-1 FED STD 209

ISO 14644D / E CLASS 100 1 CLASS 6
CLASS 5
(Particles
(Particles
per Cu M)
(Particles
per C Ft)
per Cu M)

FED STD 209 D /

E CLASS 1000
(Particles per
C Ft)

0.3 MICRON

10200

300

102000

Not specified

0.5 MICRON

3520

100

35200

1000

5 MICRON

29

Not specified

293