Cleanroom Diffusers

For General Procedure Hospital Operating Rooms

APPLICATION NOTES

DESIGN CRITERIA
In an operating room, primary importance is placed on providing a ventilation system capable of
minimizing the number of particles impacting the patient incision site. The system then must also
provide breathing air and comfort for the surgical team, and it must be arranged in the ceiling in such a
manner that ceiling mounted operating room (OR) equipment and other ceiling penetrations are
accommodated without themselves creating a pathway for particles and microorganisms to enter the
OR. The system must work to isolate the patient from as many airborne particles as possible, by
employing suppression, dilution and filtration methods.

Research through the last two decades has increasingly

shown that a properly designed and installed laminar (or
unidirectional) ventilation system in an OR can substantially
reduce the number of airborne particles impacting a surgical
site in an OR1, and that a correlation exists between the
number of airborne particles and the rate of surgical site
infections. United States National Institutes of Health (NIH)
research has identified design criteria which, when employed
in the design of OR ventilation systems, can control and
minimize the number of particles at the incision site. These
parameters include air change rate, diffuser selection, filtration diffuser application, and return/exhaust
location and.

The American Institute of Architects2 (AIA) and the American Society of Heating, Refrigerating and Air-
conditioning Engineers (ASHRAE) provide guidelines and standards for designing OR ventilation
systems.

AIR CHANGE RATE

By providing a minimum air change rate, not only are contaminants in the OR air diluted, but the
surgical team is provided with air for breathing and to minimize the accumulation of odors. The number
of air changes varies, as governed by the local authority having jurisdiction (AHJ). The NIH research
has most recently shown that for a general purpose OR, 20 air changes per hour (ACH) are optimal.
Higher air change rates are sometimes indicated for ORs where higher-risk procedures take place.
These ultraclean ORs include orthopedic, bone marrow and large organ transplant rooms and some
cardio rooms.

1
Memarzadeh F and Jiang Z. Effects of Operating Room Geometry and Ventilation System Parameter Variations
on the Protection of the Surgical Site, IAQ 2004: Critical Operations: Supporting the Healing Environment
through IAQ Performance Standards. 2004
2
The American Institute of Architects and The Facilities Guidelines Institute. Guidelines for design and
construction of hospital and health care facilities. 2001 Washington, DC. American Institute of Architects Press,
2001.
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DIFFUSER SELECTION
Air enters ORs through diffusers. The choice of diffuser impacts the ability of the ventilation system to
keep the particles at a minimum. Uni-directional non-aspirating diffusers sometimes also called
laminar flow diffusers or laminar flow modules - are recommended by ASHRAE as a result of NIH and
other research. A quantity of diffusers must be selected so that the resulting average velocity is in the
range of 25 35 cubic feet per minute for every square foot of diffuser face (25 35 CFM/ft2.) Within
this operating range, unidirectional diffusers minimize the number of airborne particles drifting upward
from the patient and the surgical team, while also minimizing the number of existing airborne particles
blown downward into the patients incision.

FILTRATION
OR ventilation systems commonly provide HEPA filtered air to the OR. ASHRAE recommends two
banks of filters in the OR ventilation system, a MERV 8 pre-filter and a MERV 14 final filter in general
operating rooms. In those ORs where higher-risk-of-infection procedures are carried out, ASHRAE
recommends MERV 17 (HEPA) filters. An economic analysis should be conducted to evaluate the
benefits of installing nominally more costly MERV 17 HEPA filters in all OR ventilation systems.

The cleanest possible system results from a terminal HEPA filter mounted inside the unidirectional flow
diffuser. This arrangement prevents any unseen ductwork contamination from entering the room.
Mounting the second bank of filtration in line, upstream of the diffuser, has also been shown to be
effective, and can add the convenience of filter change out over a corridor or in a room outside the OR.
Likewise, filters may be remotely located in the air handling unit, which reduces the number of filters,
but may require the simultaneous shutdown of several ORs served by the air handler, in order to
service that single filter.

Each bank of final filters should be provided with a visual indicator of the filter loading, to aid the
maintenance staff in determining the need to replace dirty filters.
DIFFUSER APPLICATION
OR ceilings have historically been crowded with lights, booms and various other penetrations for
sprinklers, speakers, etc. Increasingly, ceilings are used to suspend items traditionally reserved to
rolling carts: anesthesia machines, instrument trays, etc. This practice is resulting in less ceiling area
for the placement of diffusers. The NIH research has shown that in order to minimize particle counts at
the incision site, diffusers must be concentrated over the patient. No less than 70% of the area in the
ceiling area above the patient should be active unidirectional flow. To maximize the concentration,
diffusers should be placed as closely together as possible.
Although individual diffusers may be surface-mounted to a hard
OR ceiling, ceiling framing systems should be considered as a
convenient method of not only organizing the OR ceiling, but
also of allowing for the closest possible side-by-side diffuser
placement. State-of-the-art framing systems also incorporate fill-
in panels for those modules within the ceiling that contain
penetrating booms, light pedestals, med-gas columns, etc.
These fill-in panels are aesthetically designed to match the finish
and appearance of the unidirectional flow diffuser, and may also
serve as future access to the space above the ceiling. Please
refer to Precision Air Products Lami-Air System literature for
more information about framing systems.

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RETURN/EXHAUST APPLICATION
The location of return/exhaust grilles influences the overall effectiveness of the ventilation system.
Ideally, four of these grilles are placed in the room, one in each corner. Two grilles have also been
shown to be an effective contributor to low particle counts in the OR. Precision Air Products
recommends that any grilles be arranged symmetrically on opposing sides of the OR, to prevent
induction of particles past the patient.

SELECTION GUIDELINES
1. Determine the required air change rate (ACH) for the operating room. If local code does not dictate an air change rate, we
recommend 20 ACH, unless more is required for cooling.
2. Determine the total airflow rate (CFM) for the operating room by dividing the OR volume by the air change rate.
2
3. Determine the required total nominal diffuser face area (ft ) range by dividing the airflow rate by the NIH prescribed face
velocity range of 25 35 CFM/ft2.
4. Determine the filtration configuration. Select either upstream or terminal filtration placement.
5. Select a diffuser model to provide unidirectional flow, with no aspiration at the face. Diffuser should be cataloged with a
stated tolerance in the tested face velocity. We recommend LAMI-Vent model PAT-A diffusers for upstream final filtration,
or HEPA-Vent model HEP-A diffusers for terminal filtration applications, with a tested face velocity tolerance of +/- 10%.
6. Select diffuser quantity, flow range and sizes that satisfy the total nominal diffuser face area.
7. Arrange the diffusers to comply with industry standards and guidelines. Concentrate the diffusers over the patient so that
the primary diffuser array provides at least 70% active unidirectional diffuser face area.
8. Analyze diffuser performance. Determine volume and pressure drop of each diffuser. Determine sound level (NC).
9. Select a diffuser mounting method. An integrated ceiling system such as Precision Air Products Lami-Air System
organizes the diffusers in the ceiling while providing a positive seal against the space above the ceiling. This system may
also be used to suspend fluorescent lights, aesthetically treat modules with ceiling penetrations, and provide access to the
space above the ceiling.
10. Select desired product options from appropriate Ordering Codes.

TUTORIAL
Design Goal
An operating is to be built to the dimensions of 24 w x 28 l x 10 h, and the local AHJ requires a minimum of 20 ACH.
Operating table dimensions to be 78.5" L X 21.75" W. Specify the diffusers.
Solution
1. ACH = 20 air changes/hour (ACH)
2. Total airflow rate = [room volume (ft3)] x [ACH] / [60 minutes/hour].
= [24 x 28 x 10] x [20 ACH] / [60 minutes/hour]
= 2800 cfm
3. Nominal diffuser face area range = 2800 cfm/ 25 to 35 cfm/ft2
= 80 to112 ft2
4. Filtration configuration = no AHJ preference. Inline (upstream) filters selected.
5. Diffuser selection = Unidirectional flow diffuser (+/- 10% ), to operate in the 25 to 35 CFM/ft2
average velocity range. Specified as Precision Air Products Lami-Vent series,
model PAT-A
6. Diffuser quantity assume 24x48 std. modules
= [80 to112 ft2] / 8 ft2
= 10 to 14 diffusers (combinations of different module sizes may also be
used, provided the total diffuser face area falls within the range
calculated in 3. above.
7. Arrange the diffusers
a. Define the primary diffuser array = [table length + 36] x [table width + 36]
= 115 L x 58 W
= 46 ft2, centered above operating table.
b. Design minimum 70% active diffuser area
= 46 ft2 x 0.7
= 32 ft2, which equates to (4) 24 x 48 diffusers within the primary diffuser
array.

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VERIFICATION OF DESIGN
Designers often ask the question: How do I know that the catalog data adequately represents the
performance achieved in the as-built OR? Many differences exist between the state-of-the-art test
chambers used to develop and test todays diffusers, and the end-user facilities they serve. Industry
guidelines provide a reasonable method of selecting diffusers, without extensive mock-ups. For
more critical applications, however, CFD (Computational Fluid Dynamics) modeling is a useful tool.
With CFD, one may compute airflow, temperature gradients, particle tracking, etc. Precision Air
Products can assist you in such modeling projects contact a Precision Air Products Application
Engineer for details.

RECOMMENDED SOLUTIONS
Precision Air Products
manufacturers a wide range of
solutions for Pharmaceutical
laboratory ventilation, including
Lami-Vent laminar flow / uni-
directional flow diffusers, HEPA-
Vent terminal HEPA filter laminar
flow diffusers and Lami-Air
integrated ceiling systems.

In addition to providing
manufactured solutions, Precision
Air Products provides application
assistance, to help you achieve the
desired outcome on your ventilation
project.

SIMILAR HEALTHCARE FACILITY APPLICATIONS

Protective Environment (PE), Wound Intensive Care (Burn Unit), and Trauma, invasive Procedure
(Cath, Angio, Endo, EP) rooms also benefit from laminar flow, as they are all applications where the
patient undergoes an invasive procedure and is thus at risk of infection.

RELATED LITERATURE
For laminar flow diffusers without terminal HEPA filtration, refer to Lami-Vent literature.
For laminar flow diffusers with terminal HEPA filtration, refer to HEPA-Vent literature.
For Orthopedic Ultraclean Operating Rooms, refer to Ortho-Island documentation.
For Cardio Ultraclean Operating Rooms, refer to Cardio-Island documentation.
For Catheterization and other invasive procedure rooms, see Lami-Air EQ documentation.

2005, Precision Air Products Co. Subject to change without notice.

1-800-404-0931
www.precisionairproducts.com

Form 04-011, effective 3/2006

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