This document discusses humidity control in healthcare facilities and its importance for patient health, electrostatic discharge prevention, and comfort. Maintaining proper humidity levels is challenging due to the introduction of dry outside air to meet ventilation requirements. Various international and national standards and regulations provide guidelines on humidity and air quality in different areas of healthcare facilities. The document presents humidity control solutions from Carel focused on humidification and dehumidification to maintain appropriate indoor humidity levels.

1. This document and all of its contents are property of Carel All unauthorised use, reproduction or distribution of this document or the information contained in it, by anyone other than Carel, is severely forbidden
Humidity control in healthcare facilities
A key driver for IAQ
Dubai - May, 3rd 2018

2. This document and all of its contents are property of Carel All unauthorised use, reproduction or distribution of this document or the information contained in it, by anyone other than Carel, is severely forbidden
We lead the evolution of control technology and
humidification for air conditioning and refrigeration.
Our products support customers
with the most efficient energy savings solutions.
Data-driven services through our IoT platform
grant personalised value.

3. This document and all of its contents are property of Carel All unauthorised use, reproduction or distribution of this document or the information contained in it, by anyone other than Carel, is severely forbidden
7
Production facilities
1350+
Employees
20
Subsidiaries
4,200+
Customers
6,200
Part numbers
7 Mln
Pcs per year
231 Mln€
Turnover
CAREL in snapshot

4. This document and all of its contents are property of Carel All unauthorised use, reproduction or distribution of this document or the information contained in it, by anyone other than Carel, is severely forbidden
Our key strategies
We offer integrated
solutions for
vertical applications
We innovate to
achieve higher
energy saving
We continuously
improve our
operating
performances and
ensure financial
solidity
We want to be
close to the
customers for a
better
understanding of
their needs
We operate
globally with the
same world-class
manufacturing
standards
We are specialists
in HVAC and
Refrigeration

5. This document and all of its contents are property of Carel All unauthorised use, reproduction or distribution of this document or the information contained in it, by anyone other than Carel, is severely forbidden
Agenda
Hospitals: why control humidity?
Patients health
ESD prevention
Comfort
What brings us out of range?
Standard & regulations
Carel’s solutions
Success stories
WHY
WHAT

6. This document and all of its contents are property of Carel All unauthorised use, reproduction or distribution of this document or the information contained in it, by anyone other than Carel, is severely forbidden
Agenda
Hospitals: why control humidity?
Patients health
ESD prevention
Comfort
What brings us out of range?
Standard & regulations
Carel’s solutions
Success stories
WHY
WHAT

7. This document and all of its contents are property of Carel All unauthorised use, reproduction or distribution of this document or the information contained in it, by anyone other than Carel, is severely forbidden
Patients health
Legionella
focus
Pathogens growth
Aerial Transmission
Airways infection1
2
3
4
Hospitals: why control humidity?

8. This document and all of its contents are property of Carel All unauthorised use, reproduction or distribution of this document or the information contained in it, by anyone other than Carel, is severely forbidden
• Condensate = Water + nutrients: perfect habitat for
pathogens growth
• Spores detach from mould
Patients health: Pathogens growth
Avoid condensate formation in duct and room
RH < 80%
Drop separator
Pathogens intake
from patients and
visitors / personnel?
Stainless steel
No stagnation

9. This document and all of its contents are property of Carel All unauthorised use, reproduction or distribution of this document or the information contained in it, by anyone other than Carel, is severely forbidden
BIG decrease in transmission
rate AND infectivity
Increased suspension time
and lenght travelled
Taylor S. (2016),
“Breathe Easy”
Patients health: Aerial transmission
Low RH
40% < RH < 60%
Noti J.D et al. (2013), “High humidity
leads to loss of infectious influenza
virus from simulated coughs”.

10. This document and all of its contents are property of Carel All unauthorised use, reproduction or distribution of this document or the information contained in it, by anyone other than Carel, is severely forbidden
Last defence:
mucociliary clearance
Mucous dries out at
low RH values, ciliar
movement stops
Patients health: Airways infectivity
RH > 40 %

11. This document and all of its contents are property of Carel All unauthorised use, reproduction or distribution of this document or the information contained in it, by anyone other than Carel, is severely forbidden
Patients health: Sterling chart

12. This document and all of its contents are property of Carel All unauthorised use, reproduction or distribution of this document or the information contained in it, by anyone other than Carel, is severely forbidden
Legionellosis
Patients health: Legionella
Legionella
Legionnaires’ disease
Pontiac Fever
.........
.........
Average fatality rate for Legionnaires’ disease = 10 %
If healthcare associated = 25 % !

13. This document and all of its contents are property of Carel All unauthorised use, reproduction or distribution of this document or the information contained in it, by anyone other than Carel, is severely forbidden
Growth of bacteria depends on:
• temperature
• presence of nutrients
Legionella bacterium lives at temperatures
between 25 and 42°C (77 and 108°F),
commonly found in plumbing and air-
conditioning systems.
Patients health: Legionella
Stagnant water and dirt accumulation
provides optimal environment

14. This document and all of its contents are property of Carel All unauthorised use, reproduction or distribution of this document or the information contained in it, by anyone other than Carel, is severely forbidden
0°C
10°C
20°C
30°C
40°C
50°C
60°C
70°C
80°C
90°C
100°C
32°F
50°F
68°F
86°F
104°F
122°F
140°F
158°F
176°F
194°F
212°F
LEGIONELLA IS DORMANT
LEGIONELLA ACTIVATES
IDEAL GROWTH RANGE
LEGIONELLA DEACTIVATES INSTANTLY
Mains water
Cooling and dehumidifying coils
Spray humidification
Pools and hot tubs
Cooling towers
Showers
Heating systems (radiators)
Steam humidification
Patients health: Legionella

15. This document and all of its contents are property of Carel All unauthorised use, reproduction or distribution of this document or the information contained in it, by anyone other than Carel, is severely forbidden
Legionella begins to be destroyed at
temperatures above 70°C (158°F), steam
is aseptic and doesn’t carry bacterias:
isothermal humidifiers are intrinsecally
safe.
Patients health: Legionella
Steam humidifiers
Some countermeasures need to be taken...
Adiabatic humidifiers

16. This document and all of its contents are property of Carel All unauthorised use, reproduction or distribution of this document or the information contained in it, by anyone other than Carel, is severely forbidden
• drinkable water, bacteriologically pure (WTS).
Adiabatic humidifiers
Patients health: Legionella
• Stainless steel AISI 304, prevent accumulation of dirt and
release of fibres
• UV lights treatment
• using droplet separators
• draining the water at the end of each
evaporation cycle
• periodically washing internal parts with once-
through water
• NO use of recirculated water

17. This document and all of its contents are property of Carel All unauthorised use, reproduction or distribution of this document or the information contained in it, by anyone other than Carel, is severely forbidden
Agenda
Hospitals: why control humidity?
Patients health
ESD prevention
Comfort
What brings us out of range?
Standard & regulations
Carel’s solutions
Success stories
WHY
WHAT

18. This document and all of its contents are property of Carel All unauthorised use, reproduction or distribution of this document or the information contained in it, by anyone other than Carel, is severely forbidden
Electrostatic discharges are accumulated due to
friction between materials.
The probability of this
phenomenon depends on:
• type of materials
• possible constructive solution
(grounding connection, ... )
• relative humidity in the
environment
ESD Electrostatic discharges:
Hospitals: why control humidity?
If the electric field potential generated by charge
accumulation exceeds the dielectric strenght of
the medium that separates them (e.g. air),
electrostatic discharges will occur.
what?

19. This document and all of its contents are property of Carel All unauthorised use, reproduction or distribution of this document or the information contained in it, by anyone other than Carel, is severely forbidden
YES!
EDS can cause to (medical) equipment:
• damage or destruction of components
• shutdown
• incorrect readings
• deletion of memory
• accumulation of static electricity on X-ray
films
At RH < 20% ESD may reach levels in
the tens of kilovolts ...
... but few thousand volts may be
enough to cause irreversible
damages! Unnoticed by operators!
Electrostatic discharges: a big risk?
RH > 35 %

20. This document and all of its contents are property of Carel All unauthorised use, reproduction or distribution of this document or the information contained in it, by anyone other than Carel, is severely forbidden
Agenda
Hospitals: why control humidity?
Patients health
ESD prevention
Comfort
What brings us out of range?
Standard & regulations
Carel’s solutions
Success stories
WHY
WHAT

21. This document and all of its contents are property of Carel All unauthorised use, reproduction or distribution of this document or the information contained in it, by anyone other than Carel, is severely forbidden
Thermal comfort
• Temperature
• Relative humidity
• Air velocity
Noise level
Occupants comfort is not
hospital primary aim ...
Hospitals: why control humidity?
Comfort: what does it depend on?
... but some environments are «lower risk»
(halls, visitors rooms, ...)
Indoor air quality
• Air changes (volumes/hour, l/s
per person)
• CO2, VOC (Volatile Organic
Compound) concentration
• Microorganisms

22. This document and all of its contents are property of Carel All unauthorised use, reproduction or distribution of this document or the information contained in it, by anyone other than Carel, is severely forbidden
Correct relative humidity:
 affects perspiration and internal energy
balance
 avoid dryness sensation of respiratory
tracts, skin, eyes
 reduces the amount of airborne dust
Continuous exposure to non-healthy
environments can cause a real
pathology:
Comfort: wellbeing
Sick Building Syndrome
40% < RH < 60%

23. This document and all of its contents are property of Carel All unauthorised use, reproduction or distribution of this document or the information contained in it, by anyone other than Carel, is severely forbidden
Wyon P. et al. (2005), “Experimental
determination of the limiting criteria for
human exposure to low winter humidity
indoors”.
• Up to + 7% performance in office tasks!
Comfort: performance
40% < RH < 60%
• Lower absenteeism due to sickness!

24. This document and all of its contents are property of Carel All unauthorised use, reproduction or distribution of this document or the information contained in it, by anyone other than Carel, is severely forbidden
Agenda
Hospitals: why control humidity?
Patients health
ESD prevention
Comfort
What brings us out of range?
Standard & regulations
Carel’s solutions
Success stories
WHY
WHAT

25. This document and all of its contents are property of Carel All unauthorised use, reproduction or distribution of this document or the information contained in it, by anyone other than Carel, is severely forbidden
In healthcare facilities, minimum
ventilation rate is the strategy to
keep right IAQ.
In hot and dry climate, introduction
of fresh air causes a loss of humidity
XE = 4,5 g/kg
What brings us out of range?
XSP = 9,8 g/kg
RIYADH (KSA)
Set Point 22°C @ 55%rH, Xsp =9,8 g/kg
Ext. Air 35°C @ 12 %rH, Xe=4,5 g/kg
dX= - 5,3 g/kg
W =
Ge x (Xe − Xsp)
1000
W = humidity request [kg/h]
Ge = Fresh air mass[kg/h]

26. This document and all of its contents are property of Carel All unauthorised use, reproduction or distribution of this document or the information contained in it, by anyone other than Carel, is severely forbidden
Agenda
Hospitals: why control humidity?
Patients health
ESD prevention
Comfort
What brings us out of range?
Standard & regulations
Carel’s solutions
Success stories
WHY
WHAT

27. This document and all of its contents are property of Carel All unauthorised use, reproduction or distribution of this document or the information contained in it, by anyone other than Carel, is severely forbidden
Standard & regulation
Regulations vary, according to:
• Environment (surgery room, general care, halls,
warehouses, foyers, ... )
• Country
• Type of regulation (international, national, regional, hospital
specific)
• Stringency (statutory law, good practice and guidelines)
Legionella
Air conditions:
Temperature
Relative humidity
Number of air changes
Separate regulation:Hum system:
Hum type
Equipment technical
requirements

28. This document and all of its contents are property of Carel All unauthorised use, reproduction or distribution of this document or the information contained in it, by anyone other than Carel, is severely forbidden
Standard Description Type Country
ASHRAE Standard 170-2013 -- Ventilation of Health Care Facilities Law US / International
ASHRAE HVAC Manual for design Hospital and Clinics Guideline International
ASHRAE Advanced Energy Design Guide for Large Hospitals (Achieving 50%
Energy Savings Toward a Net Zero Energy Building)
Guideline International
ASHRAE Advanced Energy Design Guide for Small Hospitals and Healthcare
Facilities (Achieving 30% Energy Savings Toward a Net Zero Energy
Building)
Guideline International
DPR 14/01/1997 Coordinamento alle regioni e alle province autonome di
Trento e di Bolzano, in materia di requisiti strutturali, tecnologici ed
organizzativi minimi per
l’esercizio delle attività sanitarie.
Law Italy
UNI 11425 Impianto di ventilazione e condizionamento a contaminazione
controllata (VCCC) per il blocco operatorio. Progettazione,
installazione, messa in marcia, qualifica, gestione e manutenzione
Guideline, referred
to in law
Italy
ISPESL 2009 Linee guida sugli standard di sicurezza e di igiene
Del lavoro nel reparto operatorio.
Guideline Italy
Standard & regulation

29. This document and all of its contents are property of Carel All unauthorised use, reproduction or distribution of this document or the information contained in it, by anyone other than Carel, is severely forbidden
Standard Description Country
DIN 1946-4 Ventilation and air conditioning – part 4: Hospital ventilation Germany
NFS 90351 Salles propres et environments maîtrisés apparéntes – Exigences relatives pour la
maîtrise de la contamination aéroportée
France
SWKI 99-3 Installation de chauffage, ventilation et climatisation des hôpitaux. Switzerland
ÖNORM H 6020-1 Ventilation and air conditioning plants in hospital. Design, construction and
inspectioning.
Austria
GOST R 52539 Air cleanliness in hospitals. General requirements Russia
VDI 6022 Ventilation and indoor-air quality - Hygiene requirements for ventilation and air-
conditioning systems and units (VDI Ventilation Code of Practice)
Germany
EN 13779 Ventilation for non–residential buildings – Performance requirements for ventilation
and room conditioning systems
EU
HTM 03-01 Heating and ventilation of health sector buildings UK
GB50333-2013 Architectural technical code for hospital clean operating department China
Standard & regulation

30. This document and all of its contents are property of Carel All unauthorised use, reproduction or distribution of this document or the information contained in it, by anyone other than Carel, is severely forbidden
Agenda
Hospitals: why control humidity?
Patients health
ESD prevention
Comfort
What brings us out of range?
Standard & regulations
Carel’s solutions
Success stories
WHY
WHAT

31. This document and all of its contents are property of Carel All unauthorised use, reproduction or distribution of this document or the information contained in it, by anyone other than Carel, is severely forbidden
Carel solutions

32. This document and all of its contents are property of Carel All unauthorised use, reproduction or distribution of this document or the information contained in it, by anyone other than Carel, is severely forbidden
humiFog multizone
High pressure water atomizer
Working principle
Water is pressurized by an inverter pump (70 bar)
and atomized into minuscule droplets (10-20µ)
 Low energy consumption (<4 W/kg)
 High precision (±2% RH)
 With demineralized water maintenance is
minimized
 One unit can be used for DEC + IEC
 High absorption ratio (up to 95%)
 No recirculating water: certified hygiene
Carel solutions : adiabatic technologies

33. This document and all of its contents are property of Carel All unauthorised use, reproduction or distribution of this document or the information contained in it, by anyone other than Carel, is severely forbidden
humidity control as a chance for energy saving :
evaporative cooling effect
 Supply air is humidified and cooled
down at the same time
 Ideal in hot and dry climates, where the
needs for humidification and cooling coexist

34. This document and all of its contents are property of Carel All unauthorised use, reproduction or distribution of this document or the information contained in it, by anyone other than Carel, is severely forbidden
humidity control as a chance for energy saving :
evaporative cooling effect
 Return air is humidified and cooled down before
entering the heat recovery system
 Supply air is not humidified, but only sensibly cooled
 Investement optimimization

35. This document and all of its contents are property of Carel All unauthorised use, reproduction or distribution of this document or the information contained in it, by anyone other than Carel, is severely forbidden
RELIABILITY
• Seismic certification
• Backup & rotation function
HYGIENE
VDI 6022 compliant, as certified by the IHL of Berlin.
No need for biocides. Washing cycles and no recirculating water.
How humiFog meets hospital requirements:
ENERGY SAVING
Only 4W/l. Evaporative cooling effect can be exploited.
EASE OF INSTALLATION & MAINTENANCE
Tailor made distribution systems. No ordinary maintenance inside the
AHU is required when used with demineralized water.
Carel solutions

36. This document and all of its contents are property of Carel All unauthorised use, reproduction or distribution of this document or the information contained in it, by anyone other than Carel, is severely forbidden
heaterSteam
Resistive steam humidifier
Working principle
Water is heated up to the boiling point by
immersed heating elements.
 Steam hygienic safety
 Two versions: process & titanium
 High precision (±1% RH)
 With demineralized water maintenance is
virtually zero
 Backup & rotation function
 Embedded PTC against overheating
 Supervision from browser (web server)
Carel solutions : steam technologies

37. This document and all of its contents are property of Carel All unauthorised use, reproduction or distribution of this document or the information contained in it, by anyone other than Carel, is severely forbidden
RELIABILITY
• Anti-corrosion elements
• Backup & rotation function
HYGIENE
Intrinsic safety: steam is completely aseptic.
Automatic inactivity drain.
How heaterSteam meets hospital requirements:
ENERGY SAVING
50 evaporation cycles (normally 40) between dilution drains.
EASE OF INSTALLATION & MAINTENANCE
Installation wizard. Working with demi water, need for maintenance is
minimized also thanks to the thermal shock.
Carel solutions
• Anti-Foaming System
• Embedded PTC

38. This document and all of its contents are property of Carel All unauthorised use, reproduction or distribution of this document or the information contained in it, by anyone other than Carel, is severely forbidden
Agenda
Hospitals: why control humidity?
Patients health
ESD prevention
Comfort
What brings us out of range?
Standard & regulations
Carel’s solutions
Success stories
WHY
WHAT

39. This document and all of its contents are property of Carel All unauthorised use, reproduction or distribution of this document or the information contained in it, by anyone other than Carel, is severely forbidden
HÔPITAL NECKER – ENFANTS MALADES
Location: Paris, France
Type of activity: hospital
Established in 1802 and recently renewed, it was the world’s first hospital for children.
Success stories

40. This document and all of its contents are property of Carel All unauthorised use, reproduction or distribution of this document or the information contained in it, by anyone other than Carel, is severely forbidden
SYSTEM CHARACTERISTICS
Success stories
• Pressurized steam (0.5 bar) from the hospital’s existing supply network
• 25 ducts, differing in size
• Different set points: delivery flow is adapted to the specific needs using a
modulating valve
• Short absorption distance required
• Multi-pipe distributors to ensure more uniform steam delivery

41. This document and all of its contents are property of Carel All unauthorised use, reproduction or distribution of this document or the information contained in it, by anyone other than Carel, is severely forbidden
Success stories
other references in Middle East

42. This document and all of its contents are property of Carel All unauthorised use, reproduction or distribution of this document or the information contained in it, by anyone other than Carel, is severely forbidden
Success stories
White paper available
@ carel.com
Who chose us?

43. This document and all of its contents are property of Carel All unauthorised use, reproduction or distribution of this document or the information contained in it, by anyone other than Carel, is severely forbidden