How are hospitals being designed to meet codes and standards?

Hospitals and health care facility codes and standards are changing and their engineered systems must transform with them

By Consulting-Specifying Engineer December 7, 2021
Courtesy: Moses Engineering


  • Mark Chrisman, PE, PhD, Healthcare Practice Director, Principal, Henderson Engineers, Lenexa, Kansas 
  • Mike Fialkowski, PE, RCDD, LEED AP, Technology Services Market Leader, Affiliated Engineers Inc, Madison, Wisconsin 
  • Zach Frasier, PE, Mechanical Engineer, Moses Engineering, Gainesville, Florida 
  • Steve Lutz, PE, LEED AP, Associate Director, Harris, St. Paul, Minnesota 

Mark Chrisman, PE, PhD, Healthcare Practice Director, Principal, Henderson Engineers, Lenexa, Kansas
Mike Fialkowski, PE, RCDD, LEED AP, Technology Services Market Leader, Affiliated Engineers Inc, Madison, Wisconsin
Zach Frasier, PE, Mechanical Engineer, Moses Engineering, Gainesville, Florida
Steve Lutz, PE, LEED AP, Associate Director, Harris, St. Paul, Minnesota

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?  

Mark Chrisman: Beyond standard building codes that apply to most facilities, we use The FGI Guidelines for Design and Construction, which are consensus-based guidelines for health care in accordance with research and best practices. Furthermore, we typically use NFPA 101: Life Safety Code (as adopted by Centers for Medicare & Medicaid Services for health care facilities interested in Medicaid/Medicare reimbursement), which also includes many reference codes and standards that address various code requirements for building systems and fire and life safety.  

Given the sheer quantity of applicable codes and standards, it is important to review all relevant requirements to make sure a design meets the most stringent standards. As part of Henderson’s training and mentorship program, we have created templates that assist emerging health care designers/engineers with these challenges. 

Mike Fialkowski: We continue to see the need to educate project teams on the code required minimum size of IT/technology equipment rooms. The combination of FGI and NFPA 99: Health Care Facilities Code need to be acknowledged in space programming to ensure these spaces meet enforceable minimum size requirements (12 feet width by 14 to 16 feet depth), working clearance requirements (3 feet from both sides rack mounted equipment), maximum serving area requirements (20,000 square feet) and clearances from electrical noise (12 feet). Addressing project specific codes is absolutely necessary to get these spaces placed and sized early so they are not retrofitted with major impacts to patient care spaces. 

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

Mark Chrisman: Expanding our expertise on applicable codes and standards for health care design is key. As part of Henderson’s training and mentorship program, we have created templates that assist emerging health care designers/engineers with this challenge. Our technical leadership team researches all applicable requirements and blends them with best practices and knowledge from our project experience to create baseline standards within our templates. Additionally, we maintain independent standards for health systems that have their own requirements/standards and processes. This, along with continual updates and involvement in the code and regulatory process, ensures we are designing according to all applicable requirements and exceeding standards whenever desired by owners. 

COVID-19 TAII isolation wing installed during the 2020 lockdown. Moses Engineering reconfigured 48 beds across two floors to serve as TAII spaces with staff facilities separated using pressurized ante chambers. TAII reconfiguration was designed using the existing facility HVAC system and available commercial off the shelf materials that could be locally sourced by the contractor. The project design, approval and construction were completed within two weeks. Courtesy: Moses Engineering

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

Zach Frasier: The energy efficiency standards, such as ASHRAE 90.1 and 62.1 contradict the patient safety orientation of ASHRAE 170 and are implemented where applicable. 

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

Mark Chrisman: Flexibility was needed in health care facilities even before COVID-19. This has historically not been addressed well in codes and standards. As a result of the pandemic, many code development committees are beginning to address this need for flexibility as we move forward. At the American Society for Healthcare Engineering’s Planning, Design & Construction conference (PDC Summit) earlier this year, Henderson presented some concepts and systems that should be considered in the future. Most of them include greater technology use (telehealth, apps for scheduling appointments and assisting with wayfinding within facilities, etc.) and flexibility (e.g., emergency department or intensive care unit rooms that double for other uses when not needed as additional negative rooms). 

Zach Frasier: The code is written to mitigate bacterial infection and contamination. The code was never intended to prevent viral transmission. Effective viral hardening methods (i.e., high-intensity ultraviolet lights, air ionization or high purity air filtration) will necessarily create a sterile environment, which will eliminate the building air biome that is healthy for human occupancy. This will be an emerging field of study once it is recognized that this is an issue. 

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

Mark Chrisman: Existing health care facilities present a variety of code or regulatory challenges. If these are not found during a life safety or statement of conditions survey, they often arise during a renovation, addition or infrastructure project. As building systems engineers, we initially make sure we understand the full extent of the issue in the field. We then do a deep dive into all applicable codes and present some options to the owner along with the rest of the design and construction team. Once we have an agreed upon approach, we have a discussion with the Authority Having Jurisdiction(s) and work through any concerns or questions from their end. We are often able to find an acceptable solution using the existing provisions of NFPA 101 (required by CMS for health care facilities), the International Existing Building Code or the International Fire Code, all of which contain requirements for existing buildings. 

Zach Frasier: Existing code violations and inconsistent application of design standards introduced by previous projects at the facility.