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Procedia Engineering 205 (2017) 41294134

10th
10th International
International Symposium
Symposium on
on Heating,
Heating, Ventilation
Ventilation and
and Air
Air Conditioning,
Conditioning, ISHVAC2017,
ISHVAC2017, 19-
19-
22 October 2017, Jinan, China
22 October 2017, Jinan, China

The Status of Research on Clean Air Conditioning System in

Hospital Operation Room
Zhiqiang
Zhiqiang Kang
Kang1,*,, Yubo
1,*
Yubo Zhang
Zhang1,, Jiannan
1
Jiannan Dong
1
Dong1 ,, Xiaocong
1
Xiaocong Cheng
Cheng1,, Guohui
1
Guohui Feng
Feng1
1
1 School
School of
of Municipal
Municipal and
and Environmental
Environmental Engineering,
Engineering, Shenyang
Shenyang Jianzhu
Jianzhu University,
University, Shenyang,
Shenyang, China
China 110168
110168

Abstract
Abstract

With
With the
the gradual
gradual improvement
improvement of of medical
medical level,
level, the
the influence
influence ofof the
the operating
operating room
room environment
environment on on surgical
surgical results
results is
is becoming
becoming
more
more and more obvious. This paper reviews the current situation and significance of clean air conditioning systems in
and more obvious. This paper reviews the current situation and significance of clean air conditioning systems in different
different
operating rooms
operating rooms of
of hospitals,
hospitals, and
and explores
explores the
the application
application ofof environmental
environmental control
control technology
technology in in the
the operating
operating room,
room, such
such as
as the
the
form
form ofof airflow
airflow in
in the
the operating
operating room,
room, the
the selection
selection ofof air-conditioning
air-conditioning system
system and
and equipment,
equipment, indoor
indoor heat
heat and
and humid
humid air
air
treatment
treatment process,
process, control
control of
of pollutant
pollutant concentration,
concentration, and
and soso on,
on, which
which reveals
reveals the
the important
important impact
impact of
of the
the operating
operating room
room
airflow environment
airflow environment onon surgery
surgery and
and forecasts
forecasts the
the application
application ofof clean
clean air-conditioning
air-conditioning system
system in
in the
the hospital
hospital operating
operating room.
room.
2017 The Authors. Published by Elsevier
2017 The Authors. Published by Elsevier Ltd. Ltd.
2017 The Authors.
Peer-review Published by
under responsibility
responsibility of Elsevier Ltd. committee of the 10th International Symposium on Heating, Ventilation and Air
the scientific
scientific
Peer-review under of the committee of the 10th International Symposium on Heating, Ventilation and Air
Peer-review
Conditioning. under responsibility of the scientific committee of the 10th International Symposium on Heating, Ventilation and
Conditioning.
Air Conditioning.
Keywords: Operating
Keywords: Operating room;
room; Clean
Clean air
air conditioning;
conditioning; Airflow
Airflow organization;
organization; Pollutant
Pollutant concentration
concentration

1.
1. Introduction
Introduction

With
With the
the rapid
rapid development
development of of China's
China's economy
economy in in recent
recent years,
years, people's
people's living
living standard
standard has has been
been greatly
greatly
enhanced,
enhanced, and higher demands for medical treatment have been pursued, which will further push forward
and higher demands for medical treatment have been pursued, which will further push forward thethe
improvement
improvement for for the
the construction
construction level
level of
of medical
medical facilities.
facilities. Therefore,
Therefore, clean
clean operation
operation room,
room, especially
especially senior
senior
clean
clean operation
operation room,
room, will
will give
give full
full play
play to
to aa more
more and
and more
more important
important role.
role. It
It is
is known
known to to us
us that
that the
the cleanness
cleanness ofof
an
an operation room is a key link in controlling infection, which will directly influence the infection rate after
operation room is a key link in controlling infection, which will directly influence the infection rate after the
the
operation.
operation. Therefore,
Therefore, the the requirement
requirement forfor clean
clean air
air conditioning
conditioning technology
technology isis gradually
gradually increasing[1].
increasing[1].
In GB50333-2002
In GB50333-2002 Specifications
Specifications for
for the
the Construction
Construction Technology
Technology of of Clean
Clean Hospital
Hospital Operation
Operation Rooms
Rooms published
published
and implemented
and implemented in in 2002[2],
2002[2], operation
operation rooms
rooms were
were divided
divided into
into four
four levels,
levels, including
including especially
especially clean
clean operation
operation
rooms,
rooms, standard
standard clean
clean operation
operation rooms,
rooms, generally
generally clean
clean operation
operation rooms,
rooms, andand to-be
to-be clean
clean operation
operation rooms.
rooms. Their
Their
leveling
leveling standards
standards and
and indicators
indicators are
are shown
shown inin Table
Table 1.
1.

*
* Corresponding
Corresponding author.
author. Tel.:
Tel.: +86-13840541633.
+86-13840541633.
E-mail address: kangzhiqiang101915@163.com
E-mail address: kangzhiqiang101915@163.com

1877-7058
1877-7058 2017
2017 The
The Authors.
Authors. Published
Published by
by Elsevier
Elsevier Ltd.
Ltd.
Peer-review
Peer-review under responsibility of the scientific committee
under responsibility of the scientific committee of
of the
the 10th
10th International
International Symposium
Symposium on
on Heating,
Heating, Ventilation
Ventilation and
and Air
Air Conditioning.
Conditioning.

1877-7058 2017 The Authors. Published by Elsevier Ltd.

Peer-review under responsibility of the scientific committee of the 10th International Symposium on Heating, Ventilation and
Air Conditioning.
10.1016/j.proeng.2017.10.152
4130 Zhiqiang Kang et al. / Procedia Engineering 205 (2017) 41294134
2 Zhiqiang Kang et al. / Procedia Engineering 00 (2017) 000000

Table1. Standard of clean operation room

The largest average

Air cleanliness level
concentration
Classification of the The maximum density of surface
Level
operating room forms pollution
Operating surrounding Operating surrounding
zone zone zone zone

special clean operating

0.2(5/m3 0.4(10/m3 5/m3 100 1000
room
standard clean operating
0.75(25/m3 1.5(50/m3 5/m3 1000 10000
room
general clean operating
2(75/m3 4(150/m3 5/m3 10000 100000
room
quasi clean operating room 5(175/m3 5/m3 300000

2. Clean operating room air-conditioning system features Air distribution mode

2.1. Air distribution mode

The airflow state in a clean operation room plays a vital role in controlling the pollutants in a clean room, which
can be divided into non-unidirectional airflow and unidirectional airflow in line with the level of the clean room, as
well as the requirements of the design. Unidirectional airflow gradually squeezes the dirty air and discharges it to
the return air outlet by means of piston displacement, to achieve certain dynamic balance, thus cleaning the air. On
the other hand, the principle of non-unidirectional airflow is to dilute the concentration of indoor pollutants by
mixing the clean airflow sent to the room and the indoor air.
Recently, foreign researchers have studied on the air distribution in clean operation rooms by making use of CFD
(Computational Fluid Dynamics) simulation technology, hoping to get more reasonable air distribution mode.
American scholar Farhad Memarzadeh[3,4] simulated the air distribution of different systematic modes by applying
CFD, and evaluated the distribution of all kinds of particles during the operation process through mathematical
models, to seek out the optimal systematic mode. Yan et al. [5] simulated the designed air quantity of operating
rooms by making use of CFD technology, verified the indoor cleanliness, and simulated personnels influence on the
cleanliness of operating rooms. As a result, they obtained the conclusion that with the air supply velocity of 0.48m/s,
it could meet the requirement of the velocity in cross section of operating rooms in the Standards, namely 0.25-
0.30m/s. Whats more, the dust concentration and bacterial colony number obtained from work can completely meet
the cleanliness requirement of 100-level clean operation room. Taking Level III operating rooms as the research
object, Deng [6] et al. studied the airflow mode in operating rooms by combining CFD value simulation, the result
of which shows that the vortex area of clean operation rooms may be increased with the decreasing size of air supply
outlet. Meanwhile, the blowing-in speed of air may be increased, but it is not favorable for the running of clean
operating rooms. Liang, et al. [7] from Nanjing Tech University have studied the effect of air curtain device on the
air distribution in operating room, and found that the air curtain not only has buffer function, but also has strong
resistance to external disturbance when it reaches to breaking wind speed, which can effectively protect the
operating area from being distracted by external environment.Wei, et al. [8] from Harbin Institute of Technology
have studied the characteristics of concentrated air supply and return air on both sides in unstable triangle eddy in
unidirectional-flow clean room. The results show that the height of the air outlet has a close relation to the width of
the triangle eddy. Upon the requirements, the width of the clean room shall be reduced as much as possible.

2.2. Air conditioning system and cold and heat sources

Design concept of an air conditioning system in the hospital clean operating room is different from the general
industrial clean room. Key parts shall be especially protected and bacteria control measures are required to ensure a
set of sterile protection system to ensure a smooth and effective operation. At present, clean air conditioning system
is divided into stand-alone system and multi-machine system. Stand-alone systems are served for one operating
room or 2 to 3 operating rooms [9]. Standards states that clean air conditioning system shall ensure the overall
 Zhiqiang Kang et al. / Procedia Engineering 205 (2017) 41294134 4131
Zhiqiang Kang et al. / Procedia Engineering 00 (2017) 000000 3

control of the clean operating room, and also keep the clean operating room to be in flexible use. Clean operating
room of level I and II shall use separated clean air conditioning system, and the air conditioning units shall be in
correspondence with the operating room. Joubret, et al. have optimized the ordinary unidirectional flow clean air
conditioning system. The present Joubret operating room air conditioning system has been formed after several
improvements. This system uses a three-stage fan to increase the indoor air circulation to increase the ventilation
coefficient and reduce the indoor bacteria concentration [10].Wu [11] has shown in the study of clean operation area
that 2-3 clean operating rooms of level I and II usually can share a clean air conditioning system, because different
operating rooms of different level have different heat and moisture load. The air supply parameters are also different.
So, operating rooms of different level shall have separated air conditioning units, and each operating room has
separate exhaust, as shown in Figure.1.

Fig.1 Multicomputer system

As the operating room is relatively independent in use, cold and heat sources of air conditioning in the operating
room shall not be shared with the hospital's cold and heat source. Since the clean operating room has good
leakprofness and heat insulation, and there are heating from indoor lighting, personnel and a variety of medical
equipment, cooling system is operated all year around. Thus, a variety of cold and heat source combinations have
been adapted to satisfy the different heating (cooling) demand under different climatic conditions in different
regions. At present, the commonly used cold and heat sources of air conditioning is the ordinary air source heat
pump unit and auxiliary electric heating systems, water chilling unit and boiler system [12]. The air cooled heat
pump unit can hardly supply heating and cooling at the same time, and the cooling dehumidification and reheating
system will cause cold and heat counteract and unreasonable energy use. Yan [13] has studied the cold and heat
source all-in-one machine technology applied in the clean operating room, and found that it can supply cold and heat
at the same time all year around. It is also adapted for different heating and cooling conditions, and has high
performance. The COP is up to 7.0 to 9.0, with significant energy-saving effects. Yang, et al. [14] have studied the
modular air-cooled heat pump unit applied in small and medium-sized clean operating room, and found that modular
air-cooled heat pump unit, compared with the traditional ones, is energy-saving, reliable and easy to operate when
the operating room is not fully used.
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2.3. Indoor air conditioning treatment process

There are a variety of air treatment solutions for operating room in summer, suitable for different regions and
conditions. In the early time, the model of fresh air conditioner in series connection with the operating room air
conditioner has been rapidly developed, while the practice has proved that the system has not only high construction
cost, but also high operating costs. Judging from most temperature and humidity requirements, the two air handling
system is not necessary to be in series [15].
According to the design and operating experience on the hospital operating room in recent years, the preferred
solution for the summer is that the fresh air takes full heat and humidity load. The air treatment solution of
secondary return air reheating and the primary and secondary air return is shown in Figure 2 and Figure 3. This
system is simple and has low energy consumption, and a number of operating rooms can share the same air
treatment unit, which can be widely used in many areas.

Fig.2 Primary return air system

The fresh air (W) is centrally processed to the middle value of dew point (L), and sent to the pressurized filter unit in operating room and mixed
with indoor air (N) to indoor air state point (O), and then sent to the room.

Fig.3 Secondary return air systems

Fresh air (W) is mixed with the return air (N1) to M, and centrally processed to the machine dew point (L) of each operating room, and sent to the
pressurized filter unit in operating room and secondary mixed with the rest indoor air (N2) to indoor air state point (O), and then sent to the room.
Zhao [16] has studied the hospital operation department in Beijing and found that primary return air reheating
system in will expend much more energy than the second return air and other solutions. The reason is that when
primary mixed air is treated to the dew point, the air supply temperature shall be raised to the air supply point in
order to maintain the indoor temperature and humidity. Secondary heating thus counteracts the heat loss.
In recent years, more and more scholars and engineering and technical personnel have begun to study the
temperature and humidity independent control air conditioning system. The principle of the air conditioning system
is that the fresh air undertakes full humidity load, so that the fan coils in the end can run under dry conditions, and
we can use high temperature cold water to control indoor temperature to achieve temperature and humidity
independent control [17]. Although the air conditioning system has the advantages of high air supply quality, high
dehumidification capacity adjustment range and precise control, there are many problems in practice. For example,
the initial investment is high; the payback period is long; and the system is complicated. Related problems will be
resolved in the follow up research.

2.4. Control of pollutants

Indoor pollutants mainly include the dust particles, microbes, bacteria and certain gases. For the clean operating
 Zhiqiang Kang et al. / Procedia Engineering 205 (2017) 41294134 4133
Zhiqiang Kang et al. / Procedia Engineering 00 (2017) 000000 5

room, the most important thing is to control the distribution and dissemination. The main sources of pollutants in the
operating room are that the air conditioning system is not completely purified; personnel bring in pollutants when
they come in and out of the operation room; and the door causes airflow when opened and closed. Purification issues
related to air conditioning system can be avoided by reasonable design and management mechanism of air
conditioning and purification system. Medical workers and necessary staff shall completely be purified before enter
the clean operating room. The medical workers and patients shall have separate routes to avoid cross-infection.
Chen [18] has studied the layout of operating room and found that the single channel system in operating room is
more in line with people's daily habits, but in this case the patients, medical workers, and supplies will enter in by
the same channel, which make it difficult to control cross-infection. Subject to the construction area restrictions, the
domestic hospital at present stage generally adopts the single channel mode. Under the permission of the
construction area, Sun [19] has pointed out that sterile supply gallery can separate sterile supplies. A ring gallery can
differentiate the clean area and accurate clean area to ensure that sterile supplies will not be cross-infected.

3. Results and discussion

Different levels of operation room use different forms of air flow in line with the "standard", reducing energy
consumption while ensuring indoor air quality. Class operating room air flow organization should use vertical
unidirectional flow, focusing on reducing the concentration of contaminants in the surgical area, to ensure the
operation smoothly. But for the large surgery hospital, staff and equipment will make great impact on vertical air
flow organization, so how to ensure that the air flow according to the ideal way need to be further studied.
The implementation of multi system complementary operation in line with the "standard", improve energy waste,
the difference of indoor air quality and positive pressure control instability due to the operating room partially
opened or stopped caused by a single system, ensure the air quality in the operating room with low energy
consumption. But multi system complementary operation in the process of running system and how to realize the
automatic control to restrict energy consumption at the lowest level are main problems of present research.
Clean operating room requires small temperature difference in air supply and large amount of fresh air. Using a
return air system resulting in severe heat and cold offset; the two air return system is difficult to meet the
requirements of a large number of fresh air, Fresh air to bear all wet load system can accurately control the
temperature and humidity of the air and the energy saving effect is obvious. In this paper, we analyze the common
heat and moisture treatment process in operation room, there is also need for a more in-depth study of the humidity
independent control system, which has its advantages in special circumstances.

4. Conclusions

Surgery is an indispensable part of the medical process, and the quality of the air in the operating room will affect
the results and quality of the operation. Therefore, ensuring the quality of air in the operating room is one of the
important conditions for the implementation of the operation. At present, China's hospital operating room is
gradually in line with the world, optimizing the quality of the air in the operating room and reducing the energy
consumption while meeting the operating room environmental standards will be an important research direction, and
also powerful guarantee for medical research.

Acknowledgements

This research was supported by National Nature Science Foundation of China No. 51401133, Science and
technology fund in Liaoning province No. 20141074, Scientific research projects in Liaoning province department
of education No. L2014230 and Shenyang Jianzhu University Postdoctoral Foundation No. SJZUBSH201620.

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