Author: Kirsten Nielsen

Rita Patel joined HH Angus in 2010.

What is your favorite thing about working at HH Angus?

For me, it is the people and the interaction, and the general atmosphere in the office. It’s almost familial – everyone gets along, everyone is open, super nice and very helpful. You can walk into any VP’s office, or the President’s office, talk to them about anything, whether work-related or not. And the fact that, at least for me in my role, it is not a desk job – I get to go to site.

How do you contribute to design and construction of the built environment?

I do everything from initial concept design to detailed design, to seeing the project through construction and handover to the owner. So, all of it!

Why did you become an engineer?

I was applying to university and selecting courses, thinking the whole time that I wanted to go into some sort of bio-med or airline pilot program. But, the courses were all business courses and geographical courses – there was no math involved – and I began thinking, “I’m not going like any of this”. So, when we started picking the courses I liked, I was advised that I should be an engineer, because the courses I selected were all math related, with definitive answers and some challenges. That’s how I ended up in engineering.  So, a pilot was not what I wanted as a career after all!  I ended up doing that on the side instead.

My two mentors have taught me a lot; for example, how to behave in a meeting and how to interact with clients. They’ve always kept me involved and have helped me build client relationships.

What projects that you are most proud of?

I mainly engineer hospital renovations, and I am proud of most of those projects because they are so challenging to deliver within the space. In healthcare facilities, you can’t just go in and disrupt everyone.  The fact that we are able to do renovations in functioning operating rooms or operating theatres is great! I recall one OR project where we had to replace all the medical gases in eighteen suites over two weeks, and it went really well. I was quite nervous about that project, because it was an OR suite, so it would be very critical if anything went wrong. But, it turned out great and went exactly as planned.

You worked elsewhere before HH Angus - was that also in consulting?

No, it was in aerospace, where I was doing a lot of computational aerodynamics. I realized I wasn’t satisfied sitting at a computer doing essentially the same thing over and over. My sister was familiar with HH Angus and put me in touch with managers here, and that’s how I started working here.

So the big sell was that you wouldn’t be sitting at a desk?

Yes! Just the fact that I get to go to Sunnybrook Hospital, which is only 5 km away, made it exciting – I get to see construction, I get to see things actually getting built, which I didn’t get to do before.

Describe a typical day.

They’re never the same. Sometimes I come into the office, sometimes I go straight to a site. For me, that’s the great part – you never know what is going to happen from week to week, or even day to day. It is not a monotonous job where you just come in and do the same thing again and again.

What’s a special moment you’ve enjoyed recently?

Being promoted to Manager, Construction Services is a good one. I’m now working in both healthcare and construction. The great thing about construction is that I was already working closely with the inspectors, so it wasn’t much of a change for me. I already understood what they do, and being able to help them even more now is a good thing.

How have senior managers helped guide you?

My two mentors have taught me a lot; for example, how to behave in a meeting and how to interact with clients. They’ve always kept me involved and have helped me build client relationships. Now, they trust me with their clients. Technically, my mechanical mentor has provided the best guidance I could ever ask for. He just knows how to get things built, and he can solve any problem I have ever faced.

What advice would you give to somebody applying to work at HH Angus?

Don’t be afraid to ask for help, because you don’t know what you don’t know. I see younger staff, especially new grads, being hesitant to ask questions because they think they should know the answer already. But there are literally no dumb questions, and no one will judge you for asking.

What is it about design that drives you?

It’s fun! Let’s say you are renovating a space - how do we get air supply to this space? We have to figure out how we are going to do that. It’s a challenge, especially in existing facilities. And then you get to roll it out and see that it works! I like going through the entire process because you know that you did the whole thing, from start to finish. Also, because I work in the healthcare sector, it is nice knowing that you are helping people.

Don’t be afraid to ask for help. My other favourite line is – you don’t know what you don’t know. I see younger staff being afraid to ask questions because they think they should already know the answer. But, literally, there are no dumb questions, and no one will judge you for asking.

What trends are you excited about?

I am a member of the CSA HVAC Committee. We are constantly developing new clauses or new standards to help improve the quality of HVAC in healthcare facilities. Being part of this committee is really exciting. Also implementing those new standards; for example, providing extra air filtration for patients with immune system challenges - if you have low immunity, you need greater filtration of the air being pumped into the room. Also, implementing technology that helps reduce airborne infections. Hospitals risk many healthcare-associated infections, and we want to do all we can to minimize those risks, so we specify equipment such as copper toilet seats or UV lighting. Copper kills bacteria, so if you have a copper-infused toilet seat, airborne infectious matter in the vicinity will not survive.

What would people be surprised to know about you?

I flew small planes for two or three years. It was fun, but probably gets more fun when you get to bigger planes.

What skills or traits help you most in progressing through your career?

People tell me that I am pretty efficient, and self-sufficient. If you give me something to do, I will find a way to get it done. And, most of the time, 99.9% of my work will be done on time and of good quality.

If you could change one thing how hospitals are constructed, what would it be?

I would tell hospitals to stop putting patients in buildings that are over 40 years old, where there are no HVAC systems. Regarding new builds, the biggest challenge we have is space – said every engineer ever! All the space tends to be taken up for clinical use, and mechanical/electrical infrastructure is often an afterthought. We are always struggling with service distribution. So, I would ensure there was adequate space allowed for these essential building services.

Creating intelligent, responsive and flexible spaces allows building owners to improve occupant comfort, productivity, health & wellness and security, while also increasing the value of the asset. By leveraging data from connected building automation systems, IoT devices and other applications, we can design ‘smart spaces’ that optimize the built environment – from workplaces to hospitals and more.


Benefits of smart spaces

  • Optimize work flows and processes
  • Realize operational and energy efficiency
  • Improve tenant/occupant experience
  • Increase the value of your property assets

Unlike new construction, where it is easier to design and implement smart building technologies,we wanted to better understand the process and pain points around retrofitting an existing structure into a smart space. HH Angus has launched a Smart Spaces pilot project to explore smart building technologies within our own office environment, with the goal of supporting our clients’ interest in similar initiatives.

The Smart Spaces pilot will evaluate technologies that can benefit our clients in a real-world setting. We are installing sensors in selected conference rooms and volunteered workstations that will anonymously monitor occupancy and environmental conditions, such as temperature and humidity. We’re excited to be collaborating with Argentum Electronics, a Toronto-based start-up that is providing the sensors (Spacr.ai Smart Building IoT Platform).

We are also developing a Smart Spaces dashboard and companion mobile app that will aggregate and display data from the sensors and building systems to provide actionable insights, such as adjusting environmental conditions in the space, improve the meeting room booking process, increasing efficiency of lighting systems, and more.

What’s next? The sensors installation has begun, and when these have all been deployed in our office, we will be sharing our progress - including challenges and successes - throughout the process, so stay tuned for updates!  

Jessica joined HH Angus in 2017 and is a Senior Engineering Designer in our Technology Division.

What is your favourite thing about working at HH Angus?

By far, it’s the sense of camaraderie and community - not only with my immediate colleagues, but between junior staff and management. Everybody genuinely cares about everybody else’s well-being, everyone is very open. It is always a positive working environment.  

What drew you to consulting engineering and to HH Angus coming out of school?

The summer before I graduated, I worked for ACML (Angus Consulting Management Limited) at the TD Centre in downtown Toronto. Many of my colleagues there told me I had done a great job and recommended that I apply to HH Angus next year. It helped get my foot into the door but also opened my eyes to consulting engineering. Seeing HH Angus in action at the TD Centre site attracted me to the company specifically, but also to consulting, because I had a clearer idea about what it is. 

How do you personally contribute to design and construction here at the company?

I am doing a lot of construction administration (CA) work for the Health Division during the (COVID-19) pandemic, which has been a rewarding way to give back to the company and my community. I also do CA on my own projects because I appreciate construction and find it interesting to see a project through from a design on paper to a completed installation in front of me.

What is Contract Administration?

The majority of it is attending site meetings and walking through the site. We take the drawings that HH Angus issues and, essentially, review and verify the contractor’s progress, and help when the contractor has questions or challenges along the way. We handle the RFIs (Requests for Information), shop drawings, examine change notices, review costs and make recommendations to the owner…just generally being a steward between the owner and the constructor.

I really like the company culture and how open people are. As someone who learns best verbally, I often walk over to someone’s desk and ask
a question.

How has working at HH Angus helped you grow your career?

This being my first job, I warrant an incredible amount of technical advice from my mentor as well as my manager. As you get onto different projects, you are exposed to different things. I always have an abundance of questions, so the answers add to my technical knowledge. I’ve worked on diverse projects and have had really good exposure to the construction industry and how it works from a trades perspective rather than from an engineering perspective. I feel that I have a better sense of what it actually takes to get that thing built that I am designing.  

Why did you decide to become an engineer?

I always liked science and math, but I disliked biology, so that took me out of the path of health sciences. In my Grade 12 Physics class, a former student made a Women in Engineering presentation – I was at an all-girls school. I remember thinking, ‘this is so interesting’ – I loved the idea of females in engineering and that push forward for woman getting into STEM and the varied career opportunities you can have with those skills. I remember thinking, “Oh, engineering… I could do that. I would be good at that! Let’s focus my energy there now”.

What HH Angus projects are you proud to have worked on?

I’m proud of the laboratory jobs that I have worked on, mostly because I have firsthand experience performing research during my undergrad at Queen’s University. Through that experience, I recognize how important a functional lab is to quality of research, and then how important research is for the greater good of society. I’m always proud that we can build the lab that meets a professor’s standards.  I’ve never had a happier client than a professor who gets to go in and start getting their hands dirty in their new lab.

Bright and Ultra Modern High Tech Laboratory Full of Advanced Technological Wonders, Computers, Analyzing Machines, Test Tubes and Beakers.

Which lab projects have you worked on?

I’ve worked on a small cleanroom at the University of Toronto. And I am doing CA for a virology lab at Sunnybrook that is going to be testing Coronavirus samples so, very relevant. The state-of-the-art lab was already in development, but when the hospital saw that Coronavirus was on the rise, they designated it as a testing facility. It was all hands on deck to get the project out the door and up and running; it was unusual to see everybody from the construction team completely come together. And when the owner says something “needs to be done yesterday”, the construction team responds - no questions asked - because everybody knows how important this is.

Describe a typical day.

There really is no typical day! 50% of the week, I’m on site. When I am in the office, it’s answering emails, doing design-related work, etc. Often, I find a big chunk of my day goes towards coordination between the disciplines. I usually work on projects where we’re the Prime Consultant, so I make sure that the sub-consultants have all the information they need. I also look at their drawings and our drawings and make sure that when the package leaves the door the client receives a unified design.

Is what you are doing now at HH Angus what you expected to be doing when you graduated?

When I graduated, I thought, ‘I am a mechanical engineer, I’ll be working on mechanical things’. I didn’t realize that I’d also be working with architects to learn what an effective building envelope is, structural engineers to learn about load carrying, and even acoustic engineers. Not to mention that I work closely with our in-house electrical engineering group. I find that, because I am working with so many different disciplines, I have learned quite a bit about each segment of the industry such that I can hold a conversation with each party and understand their scope. That was a big surprise. 

What are some of the things that you like about HH Angus apart from the work itself?

I really like the company culture and how open people are. As someone who learns best verbally, I often walk over to someone’s desk and ask a question. I find that my colleagues will always take the time to sit down with me and go into an in-depth analysis so that I understand. I love that I’m comfortable doing that, which I think is unique and probably one of the things that is of the most of value. Everyone knows that the company has to put its best foot forward and one of the ways we do that is by senior team members helping junior ones.  

What is your proudest moment here?

I have two answers. One is fun: I’m super-proud that I won the HH Angus Limerick Contest this year! I’ve been trying to win for years. I’ve submitted an entry every year and I’ve always run them by my colleagues for a laugh. As nerdy as it is (and the limericks are always nerdy), I think they’re great! But this year I won and I was very proud.

My serious answer is that I am most proud that I can gain people’s respect at a meeting, despite being both young and female. I’m often the only woman in the room. When I first started, I found that the older contractors with a lot of experience would ask me a question and if I couldn’t immediately answer, I didn’t gain their respect. This would quickly become evident when they would later go over my head to someone more senior. So, I’m proud that in the meetings now I have people’s respect from the start, they come to me immediately and trust my judgment.

How did you get to that point?

It happened when I was able to demonstrate in-depth technical knowledge about my drawings. I find that when I’m meeting a contractor for the first time, they will always fire questions at me and if I can answer each one and they’re satisfied, I gain their respect for the duration of the project. So, it’s having complete knowledge of the drawings and being able to communicate that effectively. With clients, I’m good at taking something that is highly technical and explaining it in a way that people without technical training can understand. That was learned on the job… although it is a trait I also developed through tutoring in high school and university. 

Can you recall a time when a senior staff member helped you, maybe early in your career?

I have a vivid memory of being in a client meeting with my manager when he unknowingly taught me something important just by example. We knew going in that it was going to be a difficult meeting and there was some tension on both sides. My manager led the meeting and every time it started to get out of hand, he immediately deflated the situation and you could feel the tension de-escalate. I remember thinking, ‘wow, look at how he handled a difficult client so well’. Now, when I am in a meeting on my own and find myself in a similar situation, I think, ‘okay, well what would he do?’ and it helps my judgment.

Jessica, first from left with her colleagues

Jessica, at left with colleagues

When you’re with friends who are not in the industry, what’s the first thing you tell them about HH Angus?

That we have a lot of fun! For example, I started a staff softball team with my colleagues. Or I tell them about our annual Golf Day - I’m horrible at golf, but it is always a memorable day. The office has a relaxed environment and the entire staff gets along well. I think that is largely because the company genuinely cares about their employees and work/life balance.

What inspires you?

I’m inspired by seeing other females thrive in engineering. One of our young female managers in my division really inspires me, and I am happy to see a decreasing gender gap in the industry. I have been helping my mother, who is an elementary school teacher, expose her female students to things like building robots and coding. I guess, it’s just bringing more women into this field.

What are some of the trends and tech that excite you?

I love the 3D scanner and the fact that you can put goggles on and walk around a site virtually. And I love the developing field of being able to take a 3D scan and, by clicking a button, have it to go into AutoCAD or Revit. We are not quite there yet, but the technology is going that way and that’s really exciting for our industry.

Do you have any secret talents?

I love to bake bread! And being at home during the pandemic, I am experimenting with sourdough starter and making sourdough bread. I think I have made 12 loaves so far!

September 26, 2017. Photo by Brett Gundlock

Akira Jones joined HH Angus in 2012.

What do you like most about working at HH Angus?

It’s the people, which I say to anyone who works elsewhere! This company has done a great job of bringing on people who are friendly and open, and this supports a very social environment. I’m happy to come to work every day, and I genuinely like the people I work with. When people ask me in social situations about my work, I always say, “It’s a great place to work!” And then my wife jumps in with, “oh, he loves his job so much!” I spend more time here then I do anywhere else, so it is really important to me that it’s a good place to work, it’s comfortable, management is great, it is open door everywhere – it’s the best!

How do you contribute to the design and construction of the built environment?

I joined HH Angus as a Revit specialist on the massive CHUM hospital project in Montreal (Centre hospitalier de l’Université de Montréal), where I supported our team by troubleshooting issues and managing the Revit and BIM aspects of the project. Then I transitioned into project engineering, because that’s my background, and I did project engineering on CHUM and a variety of other projects, including BMO Field, which was a very enjoyable project. Then, I began doing purely BIM work and now serve as the BIM manager. My team supports all HH Angus projects on the BIM-related aspects of our projects – hardware, software, troubleshooting, process, providing interface with other consultants regarding BIM issues, etc.

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Centre hospitalier de l'Université de Montréal

BMO Field

How has HH Angus helped you grow in your career?

The company has always provided me with a lot of latitude to try new things and explore new technology. They provide all the support and training I need to do that. Being able to try new ideas allows staff to own their own growth, with the support of formal training and mentorship. I’ve had great mentorship from senior managers here, who provided so much insight and support early in my career to help me continue to progress.  When you’re starting out, getting that kind of knowledge transfer from somebody who has a lot more experience, and who is willing to take the time to pass it on and guide you through your career, that makes a big impact on all of us here.

Why did you want to become an engineer?   

As a kid, I really liked building stuff. I loved Lego and toys like that. My family also has a history of DIY renovations around the house, so I was always learning how to do things. Also, I was good at math and science and I assumed engineering would be the best option. How I got into consulting? I think it was pure luck; it could have been anything. But, I am very happy where I ended up, because now I get to do work that I am passionate about.

The company has always provided me with a lot of latitude to try new things and explore new technology. They provide all the support and training I need to do that.

What have been some significant projects for you?

CHUM, obviously – it’s probably the biggest project that I’ll ever work on! It had so many different moving parts, so many great teams. I gained so much experience – technical, project management, project administration, and so on. I came onto the project as a Revit expert and came out of it knowing even more, which is great. We had the opportunity to try many different approaches, software-wise and technology-wise, on CHUM and we were able to push the boundaries of BIM, which I thought was great.

Another significant project was BMO Field – it was a great project with an amazing team. It was a special because BMO Field is a landmark in Toronto, and we were able to contribute to making it a world-class soccer facility for professionals. That was pretty cool – a great learning experience.

Describe a typical day for you.

Much of my role is keeping my team moving, helping them with issues they need answers to. It doesn’t mean that I always know the answer, but I sometimes will offer a suggestion and say ‘try this and see if it works out’. I connect with clients; I have active projects, so I deal with issues on those projects; I work a lot on the technical and knowledge management aspects of our projects. A lot of my work is answering questions, solving challenges, and helping people to do the work they are trying to deliver – that’s a big part of being a manager.

What are some of the things you like about HH Angus, outside the technical work?

I love the social events - the Stampede Breakfast, Golf Day, the Christmas Luncheon. I love that we have a formal dinner dance for the entire staff every couple of years to celebrate our long-time employees. It really shows what is great about this company - you can see when we are all together in a social setting that everybody is smiling, everybody is having a good time, everybody is happy. That says a lot.

What are some accomplishments you’re proud of?

There are a couple of things, actually.  One is the Matterport scanner – I introduced it to the company and now it’s constantly in use. The employees enjoy it, the clients enjoy the benefits – that’s a great tool.

Another proud moment was finishing BMO Field. It was an extremely fast-paced, two-phase project that had to be delivered in time for the start of the soccer season. There was a very aggressive schedule. Everybody involved really had to step up. So, when both phases were completed, it was a very proud moment for me on behalf of HH Angus because, as a team, we came together and made that work.

How do you explain your job to someone outside the engineering industry?

I think most engineers experience this: somebody spots the engineer’s ring and says, “oh, you’re an engineer, so you must know how to do this or that.” Most people have only a vague idea about what engineers do and don’t really appreciate that we specialize across such a wide variety of engineering fields. So when I tell people what I do, I say that I use technology to facilitate the engineering work that we do, and keep it very simple so people’s eyes don’t glaze over. Because it’s somewhat complicated when you get into BIM and database-driven design, Revit models and databases and 3D visualization

Akira with his team

Akira with his team

What are trends in engineering that excite you?

Engineering is changing. There are so many different aspects to data and Big Data, and you can already see the impact of analytics. Large construction companies are using analytics to increase their abilities, and to manage and gain information about the project; for example, safety information or construction scheduling.

We are also able to make better decisions based on the information we have. It is not only to being able to automate some of the work that we do, but also to use technology; for example, generative design.  It is not necessarily that we do the work faster, but we can do exponentially more tasks faster. A computer can generate a thousand good options on how a building could be oriented, versus engineers using our judgment and experience and saying, “well, based on my years of experience - this is the best”. Now, the computer will give you a thousand options that are better than you could ballpark.

The ability to make really good decisions about creating efficient designs is important, because a big part of what we should be thinking about is sustainability. We have a huge part to play in creating buildings that approach Net Zero, and technology can help us make better decisions sooner, so we can create those designs. I think that’s interesting. We hear a lot about AI machines, etc.  I think that’s coming, but it may be a bit further away for consulting engineers specifically; but, we certainly can automate the work that is repetitive and labour intensive.

Is artificial intelligence going to affect the human element of our industry?

It will. Every time there is a paradigm shift in how we work, people fear that - “what are the people who do this work going to do?” But, the reality is that new technology makes the pie bigger and provides opportunities for new types of work that employ more people. This means that there will be more work that is fruitful and less work that is repetitive and unstimulating. There are so many examples: people thought ATMs were going to end tellers’ jobs. However, ATMs allowed banks to open more branches, serve more customers, and actually employ more tellers. That’s a great example of how this works. So we are going to see shifts like that.    

What skills or traits have helped you advance in your career?

Persistence! Never give up, that’s the thing - you have to keep going. Never lose the will to learn something new. We are living in a time of change – you have to be able to change how you do things at any age, you have to be able to learn something new every day and never lose the urge to try something different. Also, be kind to the people around you – HH Angus is a great example of that. This place always keeps itself moving, but it is also important to take time to help somebody, because you never know when you are going to need help. 

What would people be surprised to know about you?

I really like cooking! Maybe people will be surprised to know that.  And I really like taking back-country canoe trips. That’s something my wife and I have done a lot in the past and one of our favorite things to do. I also like to play Frisbee.

In the context of the current COVID-19 pandemic, healthcare facilities are looking more closely at options for safe  and fast conversions/retrofits of hospital infrastructure to increase their numbers of patient beds that can serve as airborne infection isolation rooms, as well as ensuring the safety of their operating rooms for performing surgical procedures on confirmed or suspected COVID-19 patients. Recently, HH Angus’ Nick Stark, Vice President, and Jessica Fullerton, Construction Lead – Infection Prevention and Control at The Ottawa Hospital, presented a webinar organized by the Canadian Healthcare Engineering Society, in which they discussed some of the critical design aspects of isolation rooms in healthcare facilities. Nick is Chair of CSA Z317.2, Special requirements for HVAC systems in healthcare facilities. Jessica is Chair of CSA Z317.13, Infection control during construction, renovation or maintenance of health care facilities.

With recent serious outbreaks such as SARS, MERS and now COVID-19, the design of healthcare facilities should take into consideration how these buildings can better address infectious disease control during pandemic crisis situations such as we are currently experiencing. Isolation rooms are one tool that hospitals can utilize as part of their overall approach to safely dealing with certain types of infectious diseases.

Key takeaways from the webinar and our firm’s experience with building systems serving infectious disease control procedures include:

Isolation Room Types

Isolation rooms are grouped under ‘Special Precautions Rooms’. They are sometimes confused with other types of isolation, such as segregation or seclusion rooms; for the purposes of this communication, the term refers to rooms that provide airborne isolation vs contact precautions.

The three main types of isolation room are:

  1. Airborne Isolation Room (AIR) or Airborne Infection Isolation Room (AIIR) — designed, constructed, and ventilated to limit the spread of airborne micro-organisms from an infected occupant to the surrounding areas of the healthcare facility. AIRs are designed to maintain negative pressurization relative to adjacent areas. The AIR room category also includes exam/treatment rooms, which require anterooms. ERs require an internal washroom, and these are recommended for Ambulatory Care areas.

     

  2. Protective Environment Room (PER) — designed, constructed, and ventilated to limit introduction of airborne micro-organisms from the surrounding areas to an immuno-compromised or immuno-suppressed occupant. PERs are designed to maintain positive pressurization relative to adjacent areas.

     

  3. Combination Airborne Isolation and Protective Environment Room (AIR/PER) — designed to protect immunocompromised patients who are also infectious.

Operating Rooms for Infectious Patients

These should be treated like a combination airborne isolation room/protective environment room (AIR/PER), and include operating rooms (OR) for infectious patients, along with the OR anteroom that serves as an airlock for stretchers.

The OR anteroom would be negatively pressurized relative to the both OR and corridor.

The OR air handling unit (AHU) requires 100% outdoor air.  Method of Procedure issues must also be addressed; for example, the movement of sterile supplies, identifying a site for intubation, and transportation of the patient to avoid cross contamination. 

Air Handling Unit (AHU)

Isolation Room Design Criteria

Key room design factors include high level air separation (7.5 Pa of negative or positive pressure, 12 air changes per hour and directional airflow, with non-aspirating diffusers and low-level exhaust near the head of the patient bed.) Also required: a higher level of airtightness to maintain pressure, and consideration of pressure testing during construction to verify effectiveness.

An important tip: during construction, ensure contractors clearly understand what the room will be used for, why sealing is so critical, and why it is vital that there be no leakage.

Regarding ‘grandfathering’ of existing rooms - these require a risk assessment to identify any deficiencies that must be addressed in order to meet the revised standard. Some common leakage sources include lighting fixtures, conduits, sliding doors and uneven floors.

Redundancy

Isolation rooms are designated as a Type 1 space under CSA HVAC standards, requiring uninterrupted operation for airflow, pressurization, temperature, exhaust systems for AIRs, and supply systems for PERs. AHUs require redundancy with parallel, interconnected systems with automated controls and emergency power.

Filtration

AIR supply air requires two-stage filtration. PER and combination AIR/PER supply air requires three-stage filtration, with HEPA filters downstream of MERV 8 and MERV 14 filtration. HEPA filters can be AHU mounted, duct mounted or terminal. All require accessible means of testing.  On the exhaust side, AIR and AIR/PER exhaust air is treated as contaminated exhaust, and must comply with CSA Z317.2 requirements.  Additionally, recent design improvements for contaminated exhaust include bag-in/bag-out HEPA filters on the exhaust system, in order to reduce the potential for outdoor wind, building wake zones and surrounding buildings to disperse contaminated air.

Anterooms

Anterooms are now required for all AIRs, per Z8000-18, to offer additional controls against unwanted air movement, and for the donning and removal of PPE, among other considerations. Air flow should be negative relative to the corridor and positive relative to the isolation room. Also required – dedicated exhaust from both patient room and anteroom, with the adjacent washroom connected to the dedicated exhaust.

Studies provide strong evidence supporting the use of anterooms, due to the re-emergence of infectious diseases, such as tuberculosis. The CSA has completed a research study of pressure differentials, which interested readers may benefit from consulting: “Pressure Differential in Health Care Facility Airborne Isolation Rooms”. The study, a comprehensive examination of available literature, is helping to inform CSA standards, as well as zoning for pandemic requirements. For example, one finding is that anterooms provide significantly improved containment of particles at pressure differentials above 2.5 Pa, especially during healthcare provider movement through doors. Other systems proven effective in augmenting traditional cleaning are ultraviolet germicidal irradiation systems (UVGI).

Pandemic Planning and Catastrophic Event Management

Designing for planning and management of pandemic and catastrophic events requires consideration of zoning, and how healthcare facilities can isolate entire areas of a healthcare facility. As well, the facility will need the ability to switch between 100% outdoor air to 100% recirculated air, depending on where contaminants originate.  Negative pressure ‘pods’ for ERs and ICUs are also a design consideration, providing the ability to lock down larger areas of a hospital. 

Outbreak Control Zone

These zones have already been in place in British Columbia for the past 12 years, primarily in inpatient areas and ICUs. To create an isolation pod, a typical 16-bed unit is identified and planned as an outbreak control zone. It is designed as a standard patient care unit, but one that can be self-contained. Within the walls of the unit, allowances have been made for clean and soiled holding areas in order to reduce traffic in and out of the control zone. In addition, the area design should provide for a relatively simple procedure to convert it to negative pressure. Also required are defined space for an anteroom that meets the standards for whole unit isolation with all air being exhausted, as well as pressure monitoring and alarms. In addition, controls must be programmed into the Building Management System at the required isolation unit settings, in order to provide single command implementation. These systems are then commissioned, balanced and demonstrated to the facility as part of the verification process.

Operations and Maintenance

CSA Z8001 Commissioning and CSA Z8002 Operation and Maintenance (O&M) standards both offer useful information for O&M processes. Some design considerations to facilitate O&M are: including accommodations for testing and precautions for those who will need to provide O&M for isolation rooms; accessible locations for safely changing bag-in/bag-out HEPA filters; servicing for ductwork inspection and cleaning (annually for CSA and semi-annually for MOL). 

Of special note:  isolation rooms tend to lose pressure over time. For HVAC performance, this stems from degradation of doors and frames, wall openings for maintenance work that were subsequently not properly sealed, damage to walls, and poor sealing of services penetrating walls above ceilings.

Reactivation, Conversion and Retrofits

During the current COVID-19 pandemic, hospitals are seeking to better protect healthcare workers from getting sick, as well as looking at options for safe and fast reactivation of medical and surgical beds to respond to increased demand, including conversions/retrofits of hospital infrastructure to enable this reactivation.

Other options for some healthcare facilities may involve identifying beds/units that were initially designed to serve as AIRs, but were since repurposed. These would require detailed inspection and testing, along with any attendant servicing to ensure the rooms/units meet all relevant codes and standards for patient and staff safety.  

In identifying potential conversion space, hospitals should look for an existing patient area where access to the area can be controlled to minimize interaction between COVID-19 patients and healthcare staff/other patients. The space should also have the ability to be converted to outside air/exhaust that can enable a slightly negative pressure condition relative to the adjacent space which helps in controlling the spread of infectious germs from patients throughout the area. Alternatively, consider modifying an existing private room(s) with individual ductless units which do not circulate through ductwork into a central HVAC system.

For any AIR, the key is to control airflow to manage all contaminants, whether gases or droplets. The air handling strategy utilized (mixed ventilation, displacement ventilation or other) will depend on the size of the room, layout and other factors.

Because speed of construction and becoming operational is critical, effective collaboration and trust between hospital administrators, engineers, designers and contractors is essential. The entire team has to get these rooms designed, approved, built and operating quickly.  

Guidance Documents

Canadian Standards Authority guidance documents dealing with standards for isolation rooms include:
CSA Z8000 Canadian health care facilities | latest issue 2018

CSA Z317.2 Special requirements for HVAC systems in health care facilities

CSA Z317.1 Plumbing

CSA Z317.13 Infection Control

CSA Z317.12 Cleaning and Disinfection – coming soon

Cancer Care Ontario Position Statement – Hospital isolation practices for hematopoietic stem cell transplantation

CSA Study Executive Summary:
Pressure Differential in Health Care Facility Airborne Isolation Rooms
Advisory Panel members include HH Angus’ Nick Stark and Rita Patel

If you would like to discuss any aspect of the design of your facility’s isolation rooms or plans, please contact:

Nick Stark portrait

Nick Stark, P.Eng., CED, LEED® AP, ICD.D
Principal | VP Knowledge Management
nick.stark@hhangus.com

Kim Spencer

Kim Spencer, P.Eng., LEED AP
Principal | Division Director, Health
kim.spencer@hhangus.com