Building safe, effective health care facilities: Codes and standards

It’s hard to think of an engineering project with higher standards than a hospital or health care facility—successfully designed and installed systems can literally be a matter of life and death. Codes, standards, and regulations govern how these buildings must be designed.

By Consulting-Specifying Engineer November 17, 2014


  • J. Patrick Banse, PE, LEED AP, Senior Mechanical Engineer, Smith Seckman Reid, Houston
  • Daniel L. Doyle, PE, LEED AP O+M, Chairman, Grumman/Butkus Associates, Evanston, Ill.
  • Robert Jones Jr., PE, LEED AP, Associate Director of Electrical, JBA Consulting Engineers, Las Vegas
  • Craig Kos, PE, LEED AP, Vice President, ESD Inc., Chicago
  • Essi Najafi, Senior Vice President/Principal, Global Engineering Solutions, Rockville, Md.
  • Paul J. Orzewicz, PE, Mechanical Engineer, Project Manager, RMF Engineering Inc., Baltimore
  • David A. Smith, PE, EDAC, Principal, National Director of Health Care, KJWW Engineering Consultants, Madison, Wis. 

CSE: What codes, standards, or guidelines do you use as a guide as you work on these facilities?

Jones: NFPA 99, NFPA 70: National Electrical Code (NEC) Article 517, and NFPA 101 are the specific codes applicable to these types of facilities. However, the NEC is applicable for all standard building requirements and only superseded by specialty items included in Article 517. In other words, the building is designed per the NEC with specific requirements coming from Article 517. The International Energy Conservation Code (IECC), when adopted by the governing jurisdiction, has specific requirements for lighting energy allowances and controls. Hospital accreditation agencies, such as the The Joint Commission, require compliance with the Facility Guidelines Institute (FGI) Guidelines for Design and Construction of Health Care Facilities (previously published by AIA).
Banse: Health care facilities have codes and standards to follow in addition to the usual building, mechanical, plumbing, and fire codes of the International Code Council (ICC). NFPA 99: Healthcare Facilities Code, the FGI 2010 and 2014 Guidelines for Design and Construction of Hospitals and Outpatient Facilities, and many standards incorporated by reference such as ASHRAE 170-2013, 62.1-2010, and 90.1-2013, and NFPA 72.
Najafi: There are many codes, standards and guidelines that we use, some required based on location and others based on client. The following are those we most commonly use.
  • ASHRAE 90.1
  • FGI Guidelines for Design and Construction of Hospitals and Outpatient Facilities
  • IMC
  • ASHRAE 62.1
  • ASHRAE HVAC Design Manual for Hospitals and Clinics
  • Facility Guidelines Institute (FGI)
  • International Code Council (ICC) – International Building Code
  • NEC, Article 517
  • NFPA 72 
  • NFPA 99
  • NFPA 101 
  • NFPA 110 
  • Army & Navy Hospital Guidelines
  • National Safety Code (for medium-voltage systems, when owned by the client and not by the utility company).
Different agencies may have specific design guidelines:
  • VA: Design Guides PG-18-12 – Clinical series as applicable to each type of project; Electrical Design Manual for different VA building types
  • NAVFAC and Army: Unified Facilities Criteria (UFC) (especially used)
  • UFC 3-501-01 Electrical Engineering
  • UFC 3-520-01 Interior Electrical Systems
  • UFC 3-530-01 Design: Interior and Exterior Lighting and Controls
  • UFC 3-540-01 Engine-Driven Generator Systems for Backup Power Applications
  • UFC 3-550-01 Exterior Electrical Power Distribution
  • UFC 4-510-01 – Design of Military Medical Facilities
CSE: Have Energy Star, ASHRAE, U.S. Green Building Council, etc., affected your work on health care building projects? What are some positive/negative aspects of these guides?
Smith: Most of our health care clients are mainly interested in the Energy Star program because it is about energy, which saves the hospital real dollars off its bottom line. The Energy Star program allows facilities to compare how they stack up against peer facilities. Most states now have adopted the FGI guidelines in whole or at least in part. FGI now references ASHRAE for energy guidelines, so there are no discrepancies between the two.
Jones: The specific impact we have seen is the application of recent IECC legislation and U.S. Green Building Council LEED involvement. While the intent of the application of energy reduction is generally an excellent practice, it sometimes can be difficult to implement in a complicated facility such as a hospital. Increased controls requirements in the IECC can be confusing to designers, contractors, and users. Manufacturers have developed excellent systems that comply with IECC requirements, but are sometimes difficult to document on drawings using our traditional methods. Implementation of the design for these controls with the coordination of equipment suppliers often results in less confusion or guessing when constructed. Since this industry is always evolving, consider the ever-increasing application of LEDs; it is becoming easier to implement aggressively lower power densities. Care must be given to the power factors and harmonics being produced by the LED drivers and the impact to the electrical distribution systems.
Banse: Newly updated and recently adopted ASHRAE Standard 90.1-2013 includes lowered water chiller efficiencies that will be effective Jan. 1, 2015. New and replacement equipment must meet these requirements. ASHRAE Standard 170-2013 has also been updated to meet current design trends and procedures for proper directional airflows, temperatures, and air change rates. Many owners want to have LEED Certified buildings. Facility managers are concerned with energy use and want efficient equipment and the means to operate their systems efficiently. The end results are usually all positive, but higher construction first costs generally are viewed as a negative influence. That is where a proper lifecycle cost analysis (LCCA) can help incorporate design features that aid a building operation in the long term.
Najafi: The implementation of these guidelines as well as requirements for LEED accredited buildings have focused the engineering community toward environmentally friendly designs, energy-efficient considerations, and a coherent approach of the overall building envelope and systems serving the building. Such design approaches result in lower utility bills and an extended building life. For this to be achieved, however, it usually requires a higher initial investment (especially as you target the higher certification levels).
CSE: Which code/standard proves to be most challenging in hospitals and health care facilities?
Orzewicz: The most challenging code/standard in a hospital and health care facility is the implementation of the ventilation code. Most health care facilities consist of not only patient care areas, but also administrative spaces. This combination of space types means that both ASHRAE 170 and ASHRAE 62.1 ventilation standards may apply to an HVAC system. It is often difficult or impractical to serve the administrative areas from separate HVAC systems than the health care areas. When both standards apply to a system, the larger ventilation quantity must be used, which can sometimes lead to wasted energy due to an increased ventilation load.
Smith: The biggest challenge is that sometimes codes conflict. This is especially true when states have not adopted current codes or only partially adopt codes and add their own amendments.
Banse: Now it seems that NFPA 99-2012 is one of the most challenging due to its recent revision to a risk-based document from an occupancy-based document and the inclusion of new chapters. The anticipated adoption of this code by the Centers for Medicare and Medicaid Services (CMS) and the adoption by hospital accreditation organizations have pushed the design of systems in this direction. Of course, some states still use the 2002 or 2005 editions of NFPA 99, which can also complicate the process.
Jones: Because of the ever-changing ASHRAE/IECC/LEED requirements, I believe it would be these basic codes/standards that are always the most difficult to stay on top of. In the case of governmental type facilities, especially federal, the design is produced in compliance with the codes and standards in effect when the building is designed. However, due to funding difficulties and/or budget constraints, the project construction is not started for several years, and by that time the specified lighting equipment and controls have changed and evolved considerably for the better, but are difficult to implement into the facility because of limitations and flexibility of governmental standards and the impacts to the design documents.