Commissioning hospital electrical systems

Electrical systems in today’s hospitals should be commissioned as an integral part of every healthcare engineering project.

By Mark Gelfo, PE, LEED AP BD+C, O+M, CxA, TLC Engineering for Architecture November 22, 2011

Why should we commission healthcare electrical systems? Mission critical facilities, such as hospitals, have a higher need for electrical system commissioning than a commercial office building has. Electrical systems in today’s hospitals should always be commissioned as an integral part of every hospital project.

Commissioning is actually an old idea that comes from 1800s ship-building industry, where new ships would be commissioned before they were sent out to sea to make sure everything worked right. That same philosophy should be applied to all systems in our modern healthcare facilities, including the electrical and life safety systems. Today, commissioning of building systems is commonplace in the architecture, engineering, and construction industries, yet electrical system commissioning is one of the most neglected and overlooked areas of commissioning.

Testing of electrical systems to make sure they are operating the way they were intended is nothing new to many hospital designers and facility operators. They may have never called it commissioning, but that is essentially what they’re doing—or, more precisely, the functional testing phase of commissioning. Whether a new construction project or a renovation or expansion project (where new electrical system components are interconnected with existing equipment), proper electrical commissioning will confirm and document that these systems are functioning properly, the way they are intended to, ensuring the safety of patients and hospital staff.

Commissioning team

Commissioning is most effective and provides the biggest benefit to the hospital when a complete team is working together toward a common goal: a fully functional, efficient, reliable, safe healthcare facility. The effective commissioning team is much more than the lead commissioning agent (CxA, and his or her firm). The commissioning team should include hospital leadership (typically one or more members of the hospital’s C-suite: CEO, COO, CNO, CFO); the hospital’s facilities director and operations staff; the general contractor or construction manager; the electrical contractors, subcontractors, and the vendors representing each of the systems being commissioned (generator rep, fire alarm rep, nurse call rep, etc.); and the design team.

The CxA is the leader and facilitator of the commissioning team. He sets the expectations and goals for the various team members based upon their experience and roles in testing the electrical systems.

It is vitally important that the team have a commissioning kickoff meeting at the earliest opportunity. Ideally this would be in the design phase, but often this is not possible or practical until the construction phase, or even later with some of the subsystems vendors. The commissioning kickoff meeting (or series of kickoff meetings) is the opportunity for the CxA to set expectations, lay out the commissioning process, define each commissioning team member’s responsibilities, and establish the commissioning goals of the project. Having the hospital C-suite representative or facilities director present is helpful in relaying to the team the importance that the facility places on the commissioning process.

Table 1 shows a sample responsibility matrix for each of the commissioning team members. The chart is for commissioning of emergency power systems, but a similar chart can and should be completed for each of the electrical systems or subsystems being commissioned, and incorporated into the project specifications or the commissioning plan, or both.

The commissioning process

It is important to understand that commissioning is a process, not an event. Put simply, commissioning is making sure a building’s systems are operating the way they were intended. The CxA leads the commissioning team and is the owner’s advocate in communicating, verifying, and preserving the owner’s project requirements. It is a process where the building systems are reviewed, observed, inspected, tested, and documented.

Commissioning of the building’s energy-using systems is the most common, but the commissioning process can be applied to any building system or equipment—including emergency power systems, nurse call and code blue systems, fire alarm systems, or any of the dozens of electrical and low-voltage systems that protect patients, visitors, and staff in a healthcare facility.

The formal commissioning process starts in the design phase, with the review of the electrical construction documents—typically focusing on the electrical one-line or power riser diagrams, grounding schematics, nurse call systems, fire alarm risers, emergency power, and lighting control systems. The design phase review should focus on operation, reliability, and maintainability of the electrical systems. Short-circuit calculations and selective overcurrent device coordination should also be of particular focus, along with anything that has the potential to impact patient care or safety.

The design phase is also the time to start putting together the commissioning plan. The commissioning plan is the roadmap for the commissioning process and usually consists of:

  • Introduction and project overview
  • General building information
  • Commissioning team data
  • Roles and responsibilities of team members
  • Overview of the commissioning process
  • Schedule
  • Start-up checklists
  • Functional performance tests
  • Appendix with owner’s project requirement (OPR), basis of design (BOD), and commissioning specifications.

During the construction phase, the electrical commissioning team works with the design and construction teams to monitor the installation of the electrical systems and equipment. Particular emphasis should be placed on ensuring all required access and clearances are maintained. Regular commissioning meetings are held throughout the construction phase to review any installation concerns and to plan for the functional testing phase. The commissioning plan is revised and updated throughout the construction phase.

The acceptance phase (or functional testing phase) is where the rubber meets the road. This is where the CxA really tests all of the systems. In hospitals the main focus is typically on functional testing of the emergency power, fire alarm, and nurse call systems using real-world scenarios to make sure they are fully operational and functional.

Functional testing is easy enough to accomplish in a new hospital construction project that is yet to be occupied, but the vast majority of healthcare projects are renovations or additions to existing hospitals, where the electrical systems being tested serve areas that are occupied with patients and staff. This only amplifies the need for a formalized electrical commissioning process with an experienced commissioning team on-board from the earliest phases of the project to ensure that the testing is planned and executed is such a way as to minimize disruptions and ensure the safety of patients and staff.

The functional testing may continue into the occupancy phase, but hopefully everything is working properly and there is very little to do during this phase except monitor—and ensure that the hospital’s facility maintenance and operations staff is fully trained on the new systems and understands how the systems are intended to operate, why the settings are set the way they are, and what is required for ongoing maintenance and testing.

The post-occupancy phase consists of regular check-in with the hospital’s facility operations staff, typically a few months after opening and prior to the end of the one-year warranty, to see if there are any outstanding issues or concerns and to make sure that everything is still working properly.

Electrical systems in hospitals

So, which electrical systems should we commission in your hospital? Any system or subsystem can be commissioned, but the following is a summary of the most typical, and arguably most important, electrical systems to be commissioned.

Properly commissioned emergency power systems are efficient, reliable, and sustainable. When not properly commissioned or maintained, they often “run wild.” No electrical system is more important to patient safety than the emergency power system. Components of the emergency power system that must be commissioned include:

  • Engine-generator sets
  • Paralleling switchgear
  • Automatic and manual transfer switches
  • Fuel systems: storage tanks, day tanks, pumps, valves
  • Annunciation and alarms
  • Engine cooling systems
  • Control wiring and engine start wiring.

People are often surprised that extensive fuel system testing and generator alarm annunciation testing are part of the emergency power system commissioning. Not only is this testing required by NFPA 110, but it is also essential to ensuring proper system operation. If the fuel system is not functioning properly, the engine-generators are not going to run for very long. And if the alarm and annunciation systems are not properly wrung-out, it will be impossible for the operators and technicians to know what is going on if there is a problem.

A critical component of the electrical BOD is an emergency power systems sequence of operation. Commissioning processes need to promote incorporation of sequence of operations in electrical construction documents, especially for complex electrical systems and emergency power systems. This is absolutely essential for systems with multiple paralleled engine-generators and load shedding. Too often the generator’s load shed sequence either is nonexistent or is thrown together during the final days of construction, or is just left to factory defaults set up by the switchgear vendor.

After all of the individual components are tested, the only way to really test the emergency power systems is to simulate a normal power failure and verify that the design intent is followed in operation. Here is the process that was followed at the new 750,000-sq-ft Florida Hospital Memorial Medical Center (FHMMC) in Daytona Beach, Fla.

  • Throw the main normal power breaker(s) to simulate a utility outage.
  • Verify that the engine-generators start, parallel, and Priority 1 loads (life safety and critical branch) come online within 10 seconds. This also requires testing each transfer switch individually by turning off normal power to the transfer switch, to ensure that each transfer switch senses normal power loss and sends a start signal to the engine-generators.
  • Once all the emergency loads are online, walk through the building while on emergency power only. Are all of the equipment branch, critical branch, and life safety loads energized? Are the lights on? Are the air-handling units running? Do the elevators work? Are medical vacuum and air compressors working? Is kitchen equipment working?
  • De-energize the equipment branch loads, so that only the critical and life safety loads are energized. Are the red receptacles energized? Are the lights on? Are critical care areas up and running?
  • De-energize the critical branch loads so only the life-safety loads are energized. Are the egress lights and exit signs illuminated? Are medical gas alarm panels working? Is the fire alarm system up and running?

This takes some time and diligence to execute, but often this level of functional testing is the only way to ferret out and correct real potential emergency system problems.

The new central utility plant (CUP) serving the Mayo Clinic Campus in Jacksonville, Fla., also presented similar emergency power functional testing challenges. The CUP has multiple paralleled engine-generators, serving seven clinical and administration building on the campus, with a very complex load shed sequence. The commissioning plan required systematically testing and verifying that as each of the engine-generators was taken off-line, the appropriate loads were shed (load shedding in this case was accomplished through the transfer switches), as indicated on the load shed sequence diagram. This was verified not only at the automatic transfer switch (ATS) annunciator in the CUP, but also physically verified at each of the transfer switches throughout the campus. This required a huge team of people armed with walkie-talkies, and a very coordinated effort.

Normal power and grounding

For normal power systems commissioning, the focus is more in the construction phase than in the acceptance phase. During the construction phase, focus should be on installation of equipment to ensure proper clearances for maintainability, and to ensure that the correct breaker types are being provided (as shown in the coordination study) and with the proper ampere interrupting capacity (AIC) ratings (as shown in the short-circuit study). Once the service entrance, switchboards, and panels are energized, the commissioning focus shifts to breaker settings to ensure proper overcurrent protection and setting of ground fault protection devices. Infrared scans of panels and switchboards are also a good idea after building loads are operating. This allows the team to identify problems early, improve efficiency, eliminate potential hazards, and thus reduce future maintenance costs.

Grounding system commissioning can include visual inspection and impedance testing of the grounding electrodes and grounding electrode system. And of course a major focus of grounding in hospitals and healthcare facilities is the equipotential ground testing required by NFPA 99 in all patient care areas.

Fire alarm

Fire alarm systems may be the most important integrated system testing done in a healthcare facility. In addition to the testing the system’s alarms and annunciation stand-alone to ensure they are installed properly and function properly (as required by NFPA 72 and NFPA 101), the fire alarm system is integrated with many other systems. And it’s that integrated systems testing that is key in fire alarm system commissioning.

Fire alarm systems in hospitals are commonly integrated with HVAC equipment for shutdown and activation of smoke control systems, typically set up to shut down the smoke compartment in alarm and adjacent zones. In high-rise hospitals, the fire alarm system may also control, or at least be interfaced with, stair pressurization and smoke control systems. Plus the fire alarm system will be integrated with access control and infant abduction system to release upon fire alarm system activation.

Developing the functional testing procedures that capture all of these systems and scenarios with multiple smoke compartments and evacuation zones can get quite complex. Development of a fire-alarm shutdown matrix as part of the commissioning plan can be a very helpful tool to the CxA, the facility operations staff, and the fire marshal or other authority having jurisdiction (AHJ).

Nurse call

Commissioning of nurse call and code blue systems, while obviously specific to healthcare facilities, is not that different from fire alarm system commissioning, except with fewer systems integrated. The first major task is making sure the proper devices are installed in the proper locations—typically as required by “The Guidelines for Design and Construction of Healthcare Facilities,” Published by the Facility Guidelines Institute. The CxA should review this at both the design phase review and during construction phase observations.

The second major task is the functional testing during the acceptance phase. This sounds simple enough but can get complicated quickly as you verify the proper call prioritization—code blue, emergency, staff assist, toilet/shower call, normal call, and so on—and verify that all master stations, duty stations, dome lights, and zone lights receive the proper call, and give the proper distinctive audible and visual tones.

At the FHMMC, the functional testing of the nurse call and code blue systems was performed both prior to AHJ review and then with the AHJ. Teams of two or three people were used to initiate the various calls and observe the local visual and audible annunciation, plus one person manned the master station located at the nurse station to test voice communication and another was stationed at the central code blue annunciator at the 24-hour staffed location reporting via walkie-talkie that the proper calls were received. This process was repeated for each department and each patient floor throughout the 800,000-sq-ft facility, and issues were corrected throughout the process. Without this level of commissioning, the nursing staff and facilities operations staff would have been chasing down issues for months, or worse yet, not know if a call was initiated but not received.


Commissioning of lighting systems is pretty straightforward, even in most hospitals and healthcare facilities. Whether your hospital has simple manual switching/dimming, automatic daylight or occupancy switching/dimming, or a complex centralized lighting control system, you can boil down the functional testing procedure. Ask yourself: Do the lights come on when they are supposed to come on and turn off when they are supposed to turn off?

Because of the 24-hour operation of hospitals and most other healthcare facilities, most facilities are exempt from the ASHRAE 90.1 requirement to automatically shut off all lighting during nighttime hours. However, with ever-increasing focus on energy performance, more hospitals are considering turning off lights in unoccupied rooms, so occupancy sensors are becoming more commonplace in hospitals.

One of the keys to building systems commissioning, especially third-party independent commissioning, is that it brings all the players together, which is especially important in mission critical buildings such as healthcare facilities.

Preparing an RFQ for electrical commissioning

What should owners expect when they contract for commissioning? The best advice is to select a CxA with experience and knowledge of the commissioning process and the systems that are going to be commissioned. Specific experience working in healthcare facilities is absolutely essential.

If the hospital does not already have someone on staff or in mind who meets these requirements, then a request for qualifications (RFQ) is the best way to solicit commissioning services. One of the most difficult parts of the RFQ process is clearly defining the desired scope of work. Requests for proposals (RFP) that simply say “commission HVAC and controls systems” or “commission electrical systems” are common, but very inadequate and a disservice to the hospital. Unless the desired scope of commissioning services is clearly defined, the holes in the scope will be filled in with guesses and assumptions by the CxA, and that will make it impossible to get an apples-to-apples comparison of proposals. A much better course of action is for the hospital to issue an RFQ, listing the scope of services expected, preferred commissioning guidelines or standards (ACG Commissioning Guidelines, ASHE HFCx Guidelines, ASHRAE Guideline 0, for example), experience requirements, and commissioning certification such as the CxA credential from the AABC Commissioning Group (ACG).

Although there are currently many guidelines for commissioning of HVAC systems, the standards and scope of electrical commissioning needed vary between building size, type, and function. There is a huge need for a minimum standards guideline on electrical commissioning.

The American Society of Healthcare Engineers (ASHE) has developed Health Facility Commissioning Guidelines to meet its member’s needs because there was no other existing standard focused specifically on healthcare systems commissioning. The ASHE HFCx Guidelines promote that commissioning should be a part of every healthcare project. The ACG, like ASHE, also strongly promotes independent third-party commissioning with qualifications based selection.

The ASHE HFCx Guidelines include extensive document review at the schematic design, design development, and construction document phases, which is more of a peer review than any other typical Cx model guidelines and includes an extensive list of healthcare systems to be commissioned. These guidelines are a great place to start for any hospital considering commissioning.

“Don’t you have to be registered or certified to be a CxA?” The answers is, unfortunately, no. Anyone can call himself a CxA. However, there are a number of outstanding commissioning organizations—such as ACG, BCA (Building Commissioning Assn.), NEBB (National Environmental Balancing Bureau), AEE (Association of Energy Engineers), and University of Wisconsin-Madison—that offer commissioning certification programs for CxAs who want to distinguish themselves by demonstrating a base level of knowledge. But credentials are just a start. Just as in any other field, experience and past performance on similar projects is a much better indication of one’s qualifications to provide commissioning services than initials after your name.

Existing building commissioning

Retro-commissioning, or existing building commissioning is, simply put, commissioning of building systems that have not been previously commissioned. While the industry refers to this as retro-commissioning or RCx, the AABC Commissioning Group (ACG) prefers the term “existing building commissioning,” because RCx implies returning the systems to an earlier state of functionality. But what if the earlier state of functionality was awful? The focus should be on setting up the systems to a fully functional, reliable, maintainable state of condition that meets the hospital’s current needs.

Existing building commissioning and new building commissioning should be thought of as a risk management opportunity and tool. The process should ensure (at least theoretically) that the owner gets what it paid or asked for, and detect and correct any existing problems. Financial payback of existing building commissioning is easy to calculate and document for HVAC and lighting systems, in terms of expected energy savings. Unfortunately, financial payback of existing building commissioning of electrical systems is more difficult, if not impossible, to calculate because the benefits are measured in systems reliability and patient safety, which are harder to document in terms of dollars until it’s too late.

Commissioning electrical systems in an existing building presents a different set of challenges, given the 24-hour, critical nature of the systems that are going to be tested. Additionally, one of the main differences between new construction and existing building commissioning is that typically the design team, contractor, and subcontractor that originally designed and installed the systems are long gone and not available or willing to participate in the process. The CxA must work closely with the hospital staff, including facilities, maintenance, biomed, nursing, and administration—the people who know the systems and the people who protect the patients.

Gelfo is principal and division director at TLC Engineering for Architecture. He is chair of the U.S. Green Building Council North Florida Chapter and secretary/treasurer of the AABC Commissioning Group.