Codes, standards cause health care building design model to shift
As hospitals and health care codes and standards evolve, the designs and technologies must change.
Hospital, health care insights
- Engineers who design systems with hospitals, health care facilities and related medical buildings have a host of codes and standards to follow, such as NFPA 99, ASHRAE 170, NFPA 110 and many others.
- COVID-19 is bringing stricter HVAC and air ventilation codes and standards to the forefront.
- Tanner Burke, PE, Senior Fire Protection Engineer, ACS Group, Austin, Texas
- Derek Cornell, Senior Associate, Certus Consulting Engineers, Dallas, Texas
- Beth Gorney, PE, Assistant Project Manager, Dewberry, Raleigh, North Carolina
- Sierra Spitulski, PE, LEED AP BD+C, Associate Principal/Studio Leader/Mechanical Engineer/Project Manager, P2S Inc., Long Beach, California
- Kristie Tiller, PE, LEED AP, Associate, Team Leader, Lockwood Andrews & Newnam Inc. (LAN), Dallas, Texas.
Please explain some of the codes, standards and guidelines you commonly use during the project’s design process. Which codes/standards should engineers be most aware of?
Derek Cornell: All disciplines (mechanical, electrical, plumbing and fire/life safety) must be intricately familiar with NFPA 99: Health Care Facilities Code and Facility Guidelines Institute as well as any specific state health care codes. These codes are very prescriptive in their requirements and a detailed understating of them is a must for the design engineer. For the electrical engineer, there is also NFPA 70: National Electrical Code Article 517, which largely follows NFPA 99, and NFPA 110: Standard for Emergency and Standby Power Systems. In addition, ASHRAE Standard 170: Ventilation of Health Care Facilities is crucial for mechanical engineering designs.
Tanner Burke: On hospital projects, the project team needs to be cognizant of whether the facility receives Centers for Medicare & Medicaid Services funding, in which NFPA 101: Life Safety Code and NFPA 99 will be applicable. This will be in addition to state health board regulations and local jurisdiction codes, which typically adopt International Code Council codes, such as the International Building Code and International Fire Code. Because there can be subtle differences in each of these codes, it is imperative that the design team recognizes conflicts and uses the most restrictive provisions. Engineers should also be aware of the difference between the application of NFPA 101 requirements for new and existing hospitals.
Kristie Tiller: In addition to standard local and regional building codes, most health care institutions also have their own technical design guidelines to maintain consistency across their campuses.
What are some best practices to ensure that such buildings meet and exceed codes and standards?
Tanner Burke: For complex buildings such as hospitals, a code compliance approach report should be developed early in the design process and updated as design and construction progresses. These reports should clearly outline the applicable codes and standards, key provisions the building is subject to and the means and methods used to meet the codes. Because NFPA 99 is a risk-based code that applies various requirements for electrical, gas/vacuum, fire protection and HVAC systems based on the prescribed risk category, it should be completed before or concurrently with the code compliance approach report. Where unique conditions that fall outside the framework of the codes exist or alternative methods not addressed by the codes are proposed, these reports should summarize the alternative approach and include reference to such documentation detailing the proposed alternative that provides an equivalent level of safety to the applicable codes.
Derek Cornell: The relevant codes and standards are updated on a three-year cycle, so staying abreast of not only the new technologies, but also every changing code and standard is essential. Attending webinars, reading articles and even hosting vendor lunch and learns help with this, to a degree.
However, at Certus, some of the most successful ways we’ve found to ensure that designs are meeting all of the applicable requirements is dedicated internal training and a rigid QA/QC program. We realize as engineers, we should never stop learning and by providing an avenue to not only teach, but to learn from each other and share experiences ultimately leads to better design.
How are codes, standards or guidelines for energy efficiency impacting the design of such projects?
Kristie Tiller: Energy efficiency standards are increasing every year, which is encouraging manufacturers to make more energy-efficient equipment and engineers to design more energy-efficient spaces. Meeting elevated standards, while providing long-term energy management and savings solutions, are upwardly impacting construction costs. These increased costs are sometimes offset by government incentive programs offering rebates for high-performance buildings. This is leading to the installation of more monitoring and controls in building automation systems and verifying effectiveness of the energy-efficient design during commissioning.
In what way do you believe codes and standards will change in the wake of COVID-19?
Derek Cornell: Both supply air filtration and air change rate requirements are already strict in health care facilities. Perhaps more requirements for these in nonclinical areas are on the horizon. However, I would foresee more mandated quantity of airborne infection isolation rooms throughout the clinical areas. We can also expect to see more touchless technologies being implemented and nonshared touch points such as drinking cooler locations being eliminated. We may even start to see mandates for redundancies built in to the HVAC systems such as redundant isolation exhaust.
Sierra Spitulski: We are constantly updating our knowledge on issues involving indoor air quality and infection and disease control and we are continuously learning so that we can provide the most effective solutions for your health care facilities. As a result of the COVID-19 pandemic, flexibility and disaster resiliency is now at the forefront of facility owner’s minds and we have to look at communities as a whole picture. Maybe one hospital is a regional burn center and another is best suited for infection control.
Regardless of specialization and the needs associated with each, these emergency response centers will need to be fitted to survive natural disasters, long periods disconnected from the grid and sudden significant spikes in patient occupancy to support the needs of the communities they serve. Is there infrastructure in place for that? We all need to be looking at things like tanker truck hookups for water or waste, on-site storage tanks for a minimum of 72 hours of maintained operations at reduced capacity and 96 hours of emergency generator fuel oil reserves, to ensure hospitals and communities have the support they need to be resilient.
What are some of the biggest challenges when considering code compliance and designing or working with existing buildings?
Derek Cornell: One of the biggest challenges when designing electrical systems for health care is meeting the requirement for selective coordination when working in existing health care facilities and more specifically within smaller health care facilities that were built before the selective coordination requirement in health care facilities was introduced in the 2005 edition of NFPA 70. Before 2005, electrical distribution systems were designed without much regard for selective coordination or at least not mandated. However, now that it is a requirement, any renovation project that affects the distribution system must comply and this requires changing existing components, sometimes in obsolete gear, to meet the requirements.
Tanner Burke: The biggest challenge associated with doing work in existing hospitals is identifying as-built conditions and determining the proper codes of record for each renovation project that has occurred over the building’s lifetime. This can be accomplished by reviewing as-built documentation and performing on-site existing condition assessments to ensure that there are no existing gaps in code compliance that will have an impact on the proposed project. Once this is determined, it is equally challenging to determine the applicability of the various codes which may have conflicting provisions such as the IBC, International Existing Building Code and NFPA 101.