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Hospital Accreditation

Tips for Maintaining Appropriate Pressure Relationships
Posted by
on 11/12/2019 10:00:00 AM
Picture this... a surveyor is tracing the surgical services department in your hospital. The surveyor asks for a box of tissue. Does the surveyor have a cold? Not at all. The surveyor places a piece of tissue under the door to an operating room. The tissue is sucked into the room, the surveyor declares that the room is under negative pressure, and your hospital just sustained a deficiency!
Why is this bad you may ask? Well, there are pressure relationship requirements for many areas of a hospital. Some areas - like operating rooms - are required to be under positive pressure (air blows out of a room into an adjacent area), while others - like a bronchoscopy room - must be under negative pressure (air blows into a room from an adjacent area). Appropriate air balance is a key step in assuring that clean areas (often where sterile procedures are performed) are not contaminated by "dirty" air.
Appropriate pressure relationships are defined by the ASHRAE. (American Society of Heating, Refrigeration and Air-Conditioning Engineers), ASHE (American Society of Healthcare Engineers of the American Hospital Association), and ANSI (American National Standards Institute). Some of the more common requirements are as follows:
AreaRequired Pressure
Operating Rooms Positive
Sterile Processing - Decontamination Negative
Sterile Processing - Clean Positive
Bronchoscopy Rooms Negative
Endoscopy Rooms Neutral (can be either positive or negative)
Soiled Utility Rooms Negative
CMS and most accrediting organizations require that appropriate air pressure be verified whenever a ventilation system is installed and after any repairs or modifications. In addition ANSI currently recommends that air balance testing occur at least every six months for operating rooms. Formal testing is usually performed by an outside vendor and can be quite costly.
Here are some tips that can help you be successful in maintaining appropriate air pressure relationships in your hospital.
  1. Check State Regulations
    While most States follow industry standards defined by ANSI et al, not all do. Always check your local building code and State regulations to identify possible conflict. If there is, then State regulation will govern your approach.
  2. Conduct Regular Field Tests
    The tissue test described above is called a "flutter test". It is inexpensive and easy to do. While far from scientific, it can tell you if there is a significant problem with the direction of airflow from one area to another. Smoke tube tests are another quick and easy way to determine airflow. Consider conducting field tests monthly. If a field test fails or is inconclusive, then formal testing would be indicated.
  3. Document Your Test Results
    Testing results should be documented, reviewed and evaluated. Surveyors will look to see that actions were taken to correct any issues, and a retesting of the area performed to assure that the appropriate pressure relationship was achieved.
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About the Author

Traci Curtis RCP, HACP

Traci Curtis is the Executive Director of Survey Operations for CIHQ. Traci has more than 15 years of experience in hospital survey preparation.
Traci's past positions include Chief Quality Officer for a multi-hospital community based health system where she was responsible for accreditation and regulatory compliance. Prior to joining CIHQ, Traci served as the Executive Director of Quality for a large regional medical center, providing executive management oversight in the areas of quality, risk, medical staff credentialing, and patient relations.
Traci received her degree in education from Pima in Tucson Arizona. She is nationally certified in healthcare accreditation, and serves on the Board of Examiners for the Healthcare Accreditation Certification Program.
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