Designing, retrofitting hospitals during COVID: Codes and standards

While COVID-19 has changed many aspects in a health care facility, some things remain identical; know the codes and standards

By Consulting-Specifying Engineer November 25, 2020


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?

Luis Alvarez Colon: NFPA 99: Health Care Facilities Code and NFPA 70: National Electrical Code Article 517 are the two most common standards for designing health care projects. Over the years, these standards have become more closely aligned so that they provide the same information for electrical engineers for the power distribution systems. NFPA 99 is a comprehensive guide for all the systems needed to design a health care facility, including plumbing, gas and vacuum systems, information technology, HVAC, electrical, etc. It also includes information on testing requirements that local departments of health will look for during inspections before facilities are approved to receive any patients. For example the receptacle testing in patient care areas, requires verification and confirmation of physical integrity of each receptacle and continuity of the grounding circuit in each electrical receptacle in addition to the verification and confirmation of the correct polarity of the hot and neutral connections as well and the verification and confirmation that the retention force of the grounding blade of each receptacle is no less than 115 grams (4 ounces).

Allison Graves: In our health care practice the most prominent codes and standards would of course be the NFPA life safety codes. From NFPA 70, NFPA 99 and NFPA 101: Life Safety Code, a majority of our base design is developed. Then, using Facility Guidelines Institute guidelines for health care design along with many of the ASHRAE standards, we are able to apply the flexibility of creative design to meet users’ needs. On top this is the local and state regulation which dictates exactly what will be accepted, permitted and licensed for health care use. California’s OSHPD would be a perfect example of overall state regulation of licensed facilities.

Keith D. Prata: Every professional should be well versed in the prevailing mechanical code, the National Electrical Code and prevailing EE code. However, the prevailing energy conservation code is the one code we find to be of greatest importance. The energy conservation code impacts the work of all engineering disciplines (mechanical, electrical, plumbing, fire protection) as well as the architectural work. An entire project can be disrupted by missing or mis-interpreting an aspect of the energy conservation code. It is critical for design teams to be very knowledgeable of the energy conservation code and raise any concerns or considerations during the early design phase of the project to avoid costly project redesigns or change orders.

How are codes, standards or guidelines for energy efficiency impacting the design of such projects?

Luis Alvarez Colon: Standards such as ASHRAE 90.1: Energy Standard for Buildings Except Low-Rise Residential Buildings have implemented mandatory energy efficient guidelines to ensure a minimum efficiency in the building. Some of the guidelines are the following: automatic controls for lighting for each space (Table 9.6.1 shows all the required controls to meet minimum mandatory controls as well as the power density allowed in such spaces). These standards push us to implement more automatic and smarter lighting controls. Power density is easily achievable now because of how far the LED lighting has come in terms of quality, cost and durability of hours of operation.

Allison Graves: In many ways, the codes for energy efficiency are only complementing the designs we currently have for health care facilities. As many of the systems within health care buildings are already complex, the tools necessary to implement energy efficiency measures already exist. Therefore, we are able to creatively implement control sequences and strategies that not only provide optimum patient comfort and safety but are also energy efficient. 

In what way do you believe codes and standards will change in the wake of COVID-19?

Allison Graves: In many ways I believe the codes will remain largely unchanged in the wake of COVID-19. However, I believe we will see many modifications to the standards moving forward. New and improved filtration standards will soon be out. Ways to passively and actively treat ventilation air, increase ventilation effectiveness, etc. will be developed by creative manufacturers of equipment. The standards will define how to better apply this new technology in the future.

Luis Alvarez Colon: I believe that there will be some updates in the codes, but they will most likely be focused on interiors and deal with the flow of the spaces and how people interact in the spaces. From an electrical perspective, I think the automatic controls for the different systems will be implemented more. This focus will reduce the need for people to touch public surfaces such as doors, lights, plumbing fixtures etc.

What are some best practices to ensure that such buildings meet and exceed codes and standards?

Allison Graves: Being familiar with the state and local codes and following the FGI guidelines would be some of the best practices to follow. Of course, being a part of any design team requires that the engineers bring enough experience to the table to ensure lessons learned from previous projects get applied to new projects.

What are some of the biggest challenges when considering code compliance and designing or working with existing buildings?

Luis Alvarez Colon: One of the biggest challenges of working with existing buildings is the infrastructure, especially the structure. Increased technology in hospitals requires a minimum floor-to-ceiling height that can be very difficult to achieve when the building was constructed 20 to 30 years ago. Installing state-of-the-art equipment and implementing code-driven requirements, such as how many times the air must change is hugely challenging. The ceiling space gets very tight when trying to accommodate the new systems. Another big challenge lack of up-to-date drawings of a space. If the latest drawing set is from the 1980s, field verification and surveys (3D scans have come a long way) are key to try to mitigate any surprises during construction and making sure the design intent will work.

Allison Graves: Some of the biggest challenges at the moment involve making the decision when close enough is good enough. In many cases, the existing systems in the older health care buildings were simply not designed for the challenges we are currently facing. Using current code and standard guidelines, the design engineer needs to make a professional decision on when the intent of these rules best and most closely meet the owner’s intended requirements.