Documente Academic
Documente Profesional
Documente Cultură
The Facility
Guidelines Institute
The American
Institute of Architects
Academy of Architecture
for Health
AIA
for Design and Construction
of Health Care Facilities
2006
The Facility
Guidelines Institute
The American
Institute of Architects
Academy of Architecture
for Health
A IA
This publication supersedes the Guidelines for Design and Construction
of Hospital and Health Care Facilities, 2001 edition.
ISBN: 1-57165-013-X
members dedicate this Guidelines edition to Chairman Emeritus J. Armand Burgun, FAIA, FACHA,
in grateful acknowledgment of his 50 years of extraordinary leadership, dedication, and vision in the
Preface
The 2006 edition is the latest in the 59-year history At the conclusion of the revision cycle that resulted
of this Guidelines document to aid in the design and in the 1983–84 edition, DHHS asked the American
construction of health care facilities. Institute of Architects Committee on Architecture for
Health (AIA/CAH) to form an advisory group to work
The original General Standards appeared in the Federal with, and be funded by, the Public Health Service for
Register on February 14, 1947, as part of the imple- the next revision. When the revisions to the document
menting regulations for the Hill-Burton program. The were complete, the federal government declined to
standards were revised from time to time as needed. publish it. The AIA/CAH asked several nonprofit
In 1974 the document was retitled Minimum Require- agencies and professional associations to publish and
ments of Construction and Equipment for Hospital and distribute the Guidelines. An agreement was finally
Medical Facilities to emphasize that the requirements reached with the American Institute of Architects
were generally minimum, rather than ideal standards. (AIA) to publish the 1987 edition. At this point, revi-
The 1974 edition was the first to request public input sion of the Guidelines would have ceased, or even its
and comment. Requirements relating to the prepara- existence, if three people had not taken it upon them-
tion of plans, specifications, and estimates or to site selves to approach the Public Health Service and the
survey and soil investigation, which had been a part Health Care Financing Administration and request a
of all previous editions, were removed. These require- federal grant to fund a revision cycle. These same three
ments were published in a document entitled Technical people, working with AIA/CAH, put together the first
Manual on Facility Design and Construction published Steering Committee, which in turn set up the first
by the Department of Health, Education, and Welfare’s Health Guidelines Revision Committee (HGRC) not
(DHEW) Office of Facilities Engineering. under the aegis of the federal government.
In 1984 the Department of Health and Human Services The members of this multidisciplinary group came
(DHHS) removed from regulation the requirements from the federal and state governments and the pri-
relating to minimum standards of construction, vate sector and offered expertise in design, operation,
renovation, and equipment of hospitals and medical and construction of health care facilities. The 1992–93
facilities, as cited in the Minimum Requirements, edition of the Guidelines was published and distrib-
DHEW Publication No. (HRA) 81-14500. Since the uted by the AIA. The Steering Committee from the
federal grant and loan programs had expired, there 1992–93 cycle requested and received federal funding
was no need for the federal government to retain the from DHHS for another cycle. Substantial funding was
guidelines in regulation format. To reflect its nonregu- also provided by the American Hospital Association
latory status, the title was changed to Guidelines for and the AIA/CAH. The consensus process was
Construction and Equipment of Hospital and Medical enhanced and the input base broadened by asking the
Facilities. However, the document was, and still is, used public to propose changes to the Guidelines and then
by many state authorities having jurisdiction for licen- to comment on the proposed changes. Approximately
sure or registration. Further, the Guidelines are used 2,000 proposals and comments were received and
by DHHS staff to assess Department of Housing and processed. Three HGRC meetings—one on the East
Urban Development applications for hospital mortgage Coast, one on the West Coast, and one in the middle
insurance and for Indian Health Service construction of the country—were held to discuss the merits of all
projects. Therefore, regulatory language has been proposals and comments. More than 65 experts
retained. The 1983–84 edition of the Guidelines was attended these sessions and reached a consensus on
the last one revised and published by the federal gov- the content of the 1996–97 edition of the Guidelines.
ernment; at the same time, DHHS published and A letter ballot was sent to all eligible members of the
distributed an addendum to the Guidelines entitled HGRC and the document was approved by a unani-
Energy Considerations for Hospital Construction and mous vote. To better reflect its content, the title of the
Equipment. document was changed to Guidelines for Design and
Construction of Hospital and Health Care Facilities.
It was during this revision cycle that the AIA FGI monitors requests for interpretations from the pub-
Committee on Architecture for Health became the lic. Goals are to make sure that requests are answered
AIA Academy of Architecture for Health (AIA/AAH). in a timely manner, interpretations are rendered by
the individuals best equipped to reflect the intent of
In an effort to create a more formal procedure and the committee when the document was written, and
process and to keep the document current, the Facility interpretations are made available to the public.
Guidelines Institute (FGI) was founded as an inde-
pendent, not-for-profit 501(c)(3) corporation in 1998. The 2001 edition of the Guidelines resulted from the
The main objectives of FGI are (1) to see that the first revision cycle to be completed under the aegis
Guidelines are reviewed and revised on a regular cycle and direction of FGI. It received major funding from
with a consensus process carried out by a multidisci- DHHS/Health Care Financing Administration and
plinary group of experts from the federal, state, and the AIA/AAH. The American Society for Healthcare
private sectors, (2) to stimulate research in support of Engineering (ASHE), the National Institutes of Health
evidence-based guidelines, and (3) to reinvest all of (NIH), and the AIA provided staff and technical
the net revenue derived from FGI’s share of the sale support. The HGRC met in Washington, D.C., and
of Guidelines documents in research and development reviewed the 1996–97 edition of the Guidelines line
for improved future editions of the Guidelines. FGI, by line to ascertain issues that needed to be addressed,
in its role as a promulgator of health care facility including infection control, safety, and environment of
guidelines and standards, contracts with the American care. The membership for this revision cycle included
Institute of Architects for support of the consensus an increased number of state authorities having juris-
revision process and publication of the document. diction (AHJs), consistent with the increasing number
of states utilizing all or portions of the Guidelines as
FGI is primarily interested in consensus methodology state regulation by adoption. The work of the HGRC
and in overseeing the Guidelines revision process. was greatly enhanced by the attendance and participa-
Specifically, FGI wants to make sure the Health tion of these AHJs.
Guidelines Revision Committee
At the beginning of the 2001 revision cycle, an
● is properly funded, announcement requesting proposals for change to the
document was made in health care industry publica-
● has a balance of stakeholder representation from tions. The HGRC received and gave serious considera-
individuals with expertise or jurisdiction, tion to 539 proposals to modify the document. After
the HGRC meeting in Irvine, California, a document
● uses the consensus process, containing proposed changes was made available for
public comment. The HGRC received and gave careful
● requests public input in the form of proposals for consideration to 1,030 comments on the proposed
change and comments on proposed changes, changes. For the first time, the Internet was used
extensively to distribute the draft of the document
● reviews and revises the Guidelines on a timely basis and to receive proposals and comments.
to maintain a balance between minimum standards
and the state of the art in health care design and The 2001 Guidelines were the result of many hours
construction, and spent at three meetings, each attended by 82 to 86
members of the 97-member HGRC. Committee
● operates under a formal set of bylaws governing its members spent countless hours in subcommittee and
purpose, scope, membership, and goals that includes focused task groups reviewing the proposals for
standing rules governing voting procedures, recog- change and comments on them. Text for the 2001
nized duties and responsibilities for committee edition of the Guidelines formally adopted at the final
members, and established rules regarding appoint- HGRC meeting in Denver was sent to the HGRC
ments, terms, and officers. members for letter ballot. The result of the ballot
process was an overwhelming endorsement of the
xvi 2006 Guidelines for Design and Construction of Health Care Facilities
P R E FA C E
document. The adopted Guidelines were approved by When possible, the Guidelines standards are perform-
FGI and turned over to the AIA for publication and ance oriented for desired results. Prescriptive measure-
distribution. A major change in format was adopted ments, when given, have been carefully considered
for this edition, placing appendix material at the foot relative to generally recognized standards. For exam-
of the relevant pages in the main text. A glossary of ple, experience has shown that it would be extremely
terms and a form to request an interpretation were difficult to design a patient bedroom smaller than the
added to the book. size suggested and still have space for the normally
expected functions and procedures.
The 2006 edition of the Guidelines also received
major funding from DHHS/Centers for Medicaid and Authorities adopting the Guidelines should encourage
Medicare Services, ASHE, and NIH, and the AIA again design innovation and grant exceptions where the
provided staff and technical support. This edition was intent of the standard is met. These standards assume
also the result of many hours of formal and informal that appropriate architectural and engineering practice
meetings on the part of more than 107 HGRC mem- and compliance with applicable codes will be observed
bers. There were never fewer than 85 members present as part of normal professional service.
at the three “all-hands” meetings in Washington, D.C.;
Austin, Texas; and Irvine, California; and 67 individu- The Guidelines change to keep pace with evolving
als faithfully attended every session. Committee mem- health care needs and in response to requests for up-
bers spent untold hours at “all-hands” meetings and to-date guidance from health care providers, designers,
subcommittee and focused task group meetings, as and regulators. It is recognized that many health care
well as time outside the meetings, writing proposals services may be provided in facilities not subject to
and reviewing proposed changes and comments. They licensure or regulation, and it is intended that these
reviewed 797 proposals for change and 1,156 comments Guidelines be suitable for use by all health care
on proposed changes. The HGRC reached a consensus providers. It is further intended that when used as
at its final meeting and unanimously endorsed the regulation, some latitude be granted in complying
revised guidelines to be sent out for letter ballot. The with these Guidelines so long as the health and safety
result of the letter ballot was unanimous approval of of the occupants of the facility are not compromised.
the 2006 document. The HGRC also elected a new
Steering Committee for the 2010 revision cycle. In some facilities, areas, or sections, it may be desirable
to exceed the Guidelines standards for optimum func-
The 2006 HGRC took on the challenge of two goals tion. For example, door widths for inpatient hospital
stated in the preface of the 2001 edition: to prepare rooms are noted as 3 feet 8 inches (1.11 meters),
more committee-generated changes to reflect the col- which satisfies applicable codes, to permit the passage
lective knowledge and experience of the members and of patient beds. However, widths of 3 feet 10 inches
to improve the format, readability, and indexing or (1.22 meters) may be desirable to reduce damage to
searchability of the document to make it a more useful doors and frames when beds and large equipment
and user-friendly tool. The HGRC developed a num- are frequently moved. The decision to exceed the stan-
ber of work groups and added time to the revision dards should be included in the functional program of
cycle to draft proposals for new language. The com- the health care facility.
mittee also approved a complete reorganization to
make the Guidelines more accessible to users. This The Guidelines and the methodology for revising
time-intensive effort has resulted in a book presented them have been, and still are, evolving. When first
in four parts: one with information applicable to all published, the document comprised a set of regula-
health care facility types, one on hospitals, one on tions developed by a single department of the federal
ambulatory care facilities, and one for other health government as a condition for receiving a federal hos-
care facilities. (Details about the reorganization appear pital construction grant under the Hill-Burton Act.
in the Major Additions and Revisions section that Even in those early days, the document was highly
follows this preface.) respected and influential throughout the world. From
the time it was first issued and enforced, U.S. hospitals
2006 Guidelines for Design and Construction of Health Care Facilities xvii
P R E FA C E
have become the ideal and the goal to be achieved by ● Encourage and sponsor research projects to support
those building hospitals in all nations. the evidence-based decision-making process.
Gradually, state hospital authorities and other federal ● Allow more time to study and evaluate proposals for
agencies were added to the HGRC, then private, changes and to comment on recommended changes.
nongovernmental health care professional societies,
practitioners, and designers. Educational programs ● Improve the committee’s ability to communicate
and seminars were introduced in the 1980s to inform and receive information electronically, making
the public about the subjects addressed in the full use of the Internet and other formats and
Guidelines and the reasons for inclusion of certain programs as they become available. This would
requirements. Very slowly, public input was requested include requests for interpretation, tentative interim
by the committee in the form of comment on proposed amendments, etc.
changes. This has now exploded into the current ava-
lanche of proposals and comments. In each succeeding ● Work constantly to improve the process and the
cycle, the committee has been enlarged to increase the content of the Guidelines to keep it a dynamic
base of expertise and to allow more public representa- document that truly reflects the state of the art.
tion. Further, the consensus procedure was adopted
for all decision-making. ● Continue to have the courage and wisdom to adopt
requirements that are forward looking and address
As the process became more complex, as the committee the needs of the future, looking backward only to
grew larger, as more and more public proactive and discover what not to do.
reactive input was requested and received, as the
practice of health care delivery and the buildings that ● Continue to strive for a document that is credible,
house them began to change at an ever faster rate, a reasonable, and knowledge-based and that will
more formal and expeditious process became manda- maintain the tradition of the American hospital as
tory. Adding to the complexity of the process is the the role model for the rest of the world.
expansion in the scope of the document from covering
only acute care general hospitals to including nursing This publication supersedes the Guidelines for Design
homes, rehabilitation facilities, ambulatory care facilities, and Construction of Hospital and Health Care Facilities,
psychiatric hospitals, mobile health care units, hospice 2001 edition.
care, assisted living, and so on.
Inquiries or questions about interpretations of the
It is the desire of the Health Guidelines Revision Com- Guidelines may be addressed to:
mittee to continue working with the American Institute The Facility Guidelines Institute
of Architects and the Facility Guidelines Institute to 1919 McKinney Avenue
make certain the Guidelines and the revision process Dallas, TX 75201
continue. The HGRC does, however, wish to maintain its www.fgi-guidelines.org
independence as an objective, multidisciplinary com-
mittee, operating without pressure from any organiza- Questions about the Guidelines revision process may
tion and arriving at conclusions candidly, fairly, and be addressed to:
knowledgeably through an open consensus process. The American Institute of Architects
Knowledge Resources Department
It is also the desire of the HGRC to see that the 1735 New York Avenue, N.W.
process continues to improve with each passing cycle. Washington, DC 20006
Some goals for the future follow: 202-626-7367 or 800-242-3837
healthcareguidelines@aia.org
● Seek more public input from a wider base, not only
from professionals but from patients and other To order copies of the Guidelines, call 202-626-7541
consumers. or 1-800-AIA-3837 (menu option 4) or send an e-mail
to bookstore@aia.org.
xviii 2006 Guidelines for Design and Construction of Health Care Facilities
MAJOR ADDITIONS AND REVISIONS
2006 Guidelines for Design and Construction of Health Care Facilities xix
MAJOR ADDITIONS AND REVISIONS
The Environment of Care chapter (formerly Chapter Perhaps the most widely anticipated change in the
2, now Chapter 1.2) has been significantly expanded. text in the General Hospitals chapter (now Chapter
The goal of the chapter is to identify the overall com- 2.1) is the change in room capacity in medical/surgical
ponents and specific elements that directly affect the (including postpartum) units. The 2006 edition
experience of participants in the health care delivery specifies that the single-bed room is the minimum
system. The functional program, as the key document standard in new construction. Approval of a two-bed
used to identify a provider’s goals and objectives arrangement is still permitted if a facility’s functional
for the environment of care and to describe specific program demonstrates it is necessary. In addition,
strategies for achieving them during design and con- when an organization undertakes a major renovation,
struction, receives expanded coverage in this chapter. the patient room bed compliment is permitted to
remain the same.
The contents of former Chapters 5 and 6 have been
consolidated into the new Chapter 1.5, which covers The text of the General Hospitals chapter includes the
planning, design, construction, and postconstruction following completely new and significantly revised
considerations. Language relating to the infection con- material:
trol risk assessment (ICRA) has been reworked and
expanded, and a revised section on infection control ● New section on intermediate care units
risk mitigation recommendations has been included.
Information about the design process, finishes and ● Bed clearances in critical care units and neonatal
surfaces, construction phasing, critical ventilation intensive care units (NICUs)
requirements during construction, commissioning,
and record drawings and manuals have been intro- ● Bedside documentation areas in critical care units
duced and combined to address the entire planning,
design, and construction (PDC) process. ● Expanded lighting requirements for NICUs
Chapter 1.6 is a new chapter intended to capture ● Revised text for in-hospital psychiatric nursing units
requirements that are common to all or nearly all
health care facility types. Chapters on individual facility ● New section on in-hospital skilled nursing units
types will refer back to this chapter and identify any
instances in which the common requirements do not ● Appendix language on surge capacity in emergency
apply to a particular facility type. Other chapters con- departments
tain references to material in Chapter 1.6 that applies
to them. This approach makes it easier to update tech- ● Revised language on decontamination areas in
nical information, which can be changed in only one emergency departments
location rather than in multiple chapters. This chapter
will receive significant attention during the 2010 revi- ● New section on observation units in emergency
sion cycle, and the Steering Committee expects the departments
public and the HGRC members to make substantial
proposals to expand its content. ● New section on freestanding emergency facilities
● New language on waste management and processing tings has increased. Minimum standards are set for
this classification, recognizing that the patients served
● New language specifying the use of ducted systems are ambulatory but that they often need a similar envi-
for all return ventilation in patient care areas ronment of care to ensure positive outcomes.
● New language on ventilation for airborne infection Minimum dimensions have been defined for clean and
isolation rooms (AIIRs) and protective environment sterile supply rooms, operating rooms, post-anesthesia
rooms care areas, and storage rooms.
● New description of electronic surveillance systems Other new chapters added in this part of the book
cover these facility types:
Part 3: Ambulatory Care Facilities
Chapter 9 of the 2001 edition, Outpatient Facilities, ● Gastrointestinal endoscopy facilities
has been divided into 11 chapters for the 2006 edition.
Chapter 3.1 offers guidelines for outpatient facilities ● Renal dialysis centers
in general, with some notations about facility types to
which parts of the chapter do not apply. The sections ● Psychiatric outpatient centers
on specific facility types that previously appeared in
Chapter 9 have all been made into individual chapters. Part 4: Other Health Care Facilities
In addition, the former Chapter 12, Mobile, Trans- Part 4 includes chapters on nursing facilities, hospice
portable, and Relocatable Units, is located in Part 3. facilities, assisted living facilities, and adult day health
care facilities.
Significant content changes to chapters in this part
of the book are mentioned here. First, the section on Chapter 4.1 (formerly Chapter 8), Nursing Facilities,
“Freestanding Emergency Service” has been moved to was not extensively revised, but some significant
the General Hospitals chapter, and a new classification, changes were made:
“Freestanding Urgent Care Facilities,” appears in Part
3. This arrangement reserves the term “emergency ● Clarification of maximum room occupancy in
department” for use in the chapter covering hospitals renovation projects as two (unless the room already
and makes the requirements for the two types of accommodates up to four residents)
emergency departments similar. Urgent care facilities
are distinguished as those facilities providing basic ● A new requirement that rooms for ventilator-
care for non-emergency conditions on a less-than-24- dependent residents provide for the administration
hour-per-day schedule. of oxygen and suction
The second major content change is in the chapter ● Use of noncentral air-handling systems (e.g., through-
containing guidelines for outpatient surgical facilities. the-wall fan coil units) for recirculation only
This chapter has been greatly expanded and improved
to create guidelines that require outpatient surgery ● Provision of a central ventilation system capable of
facilities to provide the same environmental design providing the minimum outdoor air requirements
functions, controls, and finish materials as those found for each individual space in all new facilities
in the surgery departments of inpatient facilities.
These changes will help mandate a similar standard of ● New minimum requirements for ambient and task
care for all perioperative patients, no matter where a lighting levels consistent with standards developed
procedure is performed. for senior living by the Illuminating Engineering
Society of North America
A new chapter has been created for office surgical
facilities. As more and more procedures are performed Requirements for the remaining facility types in Part 4
on an outpatient basis, concern about unregulated set- were nonexistent in previous editions, with chapter
2006 Guidelines for Design and Construction of Health Care Facilities xxi
MAJOR ADDITIONS AND REVISIONS
xxii 2006 Guidelines for Design and Construction of Health Care Facilities
MAJOR ADDITIONS AND REVISIONS
In addition, during the public review and comment ● Stimulation of early action, research, development,
period for the first draft the 2006 edition, a number and dissemination of information for consideration
of new proposals were received on subjects of critical and discussion
interest to many health facility providers, designers,
and regulators that could not be processed so late in ● Provision of admittedly preliminary drafts on
the revision cycle. Subjects of immediate concern that subjects about which very little else may then be
were introduced too late to develop draft consensus available
recommendations for public review and comment
included these: ● Receipt of feedback that can better inform the
Guidelines to be developed and published for
● Bariatric design jurisdictional adoption and use in 2010
● Design for safe use of patient lifts and transport To prepare for the issuance of such research mono-
devices graphs and white papers, and to give purchasers of
Guidelines 2006 a place to access them when they are
● Acoustics and speech privacy published, FGI has developed a Guidelines Web site.
It is the authors’ and publisher’s mutual intent to offer
● Inpatient and outpatient oncology facilities such papers free of charge to all users of Guidelines
2006 by making them available for download from
● Interventional radiology the FGI and AIA Web sites, as well as the Web sites
of other interested organizations, with a feedback
Recognizing that both the public and the HGRC need mechanism to be developed and advertised when
a minimum of four years to use, digest, critique, and the papers become available.
develop true consensus recommendations for modifi-
cations to each new edition of the Guidelines, and that
the industry probably cannot afford to wait another
four years to receive useful guidance on some of these
emergent issues, FGI has organized task groups that
are working on the development of draft white papers
or monographs on several of them. The results of these
efforts will be reviewed at the first full meeting of the
HGRC for the 2010 revision cycle. After due considera-
tion and modification at that meeting, FGI plans to
issue draft documents for public consideration about
as many of these subjects as possible.
2006 Guidelines for Design and Construction of Health Care Facilities xxiii
ACKNOWLEDGMENTS
Acknowledgments
The revision cycle that resulted in the 2006 edition of After the HGRC completed the work of updating the
the Guidelines for Design and Construction of Health content of the Guidelines, a massive effort was under-
Care Facilities embodied much work on the part of taken to reorganize and renumber the document.
many dedicated individuals committed to providing Martin Cohen was retained to provide his expertise
up-to-date information on health care facility design and work with AIA editor Pamela James Blumgart
and construction. The Facility Guidelines Institute to think through the purpose of the reorganization,
(FGI) and the American Institute of Architects (AIA) arrive at a new structure for the document, and ulti-
extend sincere thanks to all those who worked to mately reorganize and review the entire text to imple-
produce this document. ment and refine the new structural concept. Together,
they carefully reworked the final draft manuscript to
FGI and the AIA express sincere gratitude to all those incorporate many of the recommendations presented
who took the time to submit proposals for change and in the Clemson University research study on how to
comments on those proposals for consideration by improve the document, without changing the intent
the Health Guidelines Revision Committee (HGRC). of the draft as approved by the HGRC. Their work was
Many thanks are due the members of the HGRC, a aided by a continuous virtual dialogue with Steering
multidisciplinary group of individuals dedicated to Committee and other HGRC members, who reviewed
improving the environment in which health care is particular sections and chapters via e-mail.
delivered. The committee members—architects, engi-
neers, doctors, nurses, and health facility managers Of those HGRC members who reviewed the reorgani-
and consultants from the private sector, state authori- zation while it was in process, a particular debt is owed
ties having jurisdiction, and representatives of federal to Douglas Erickson, who reviewed the manuscript
agencies—worked for many hours discussing, writing, for all of Parts 1, 2, and 3. The following individuals
and voting on proposals to change the 2001 edition of reviewed portions of the document according to their
the Guidelines to better reflect the practice of health expertise: Kurt Rockstroh, Judene Bartley, Albert S.
care in the 21st century. Buck, Jon Cechvala, Ramona Conner, Roger Gehrke,
Thomas Jung, William Lindeman, Robert Loranger,
Appreciation is also extended to the organizations that Margaret Montgomery, Chris Rousseau, Wade Rudolph,
supported the travel and work of the HGRC members. Arthur St. André, Alberto Salvatore, Judy Smith,
Listed are the members of the HGRC who attended at David Uhaze, and Enrique Unanue. Lee Mickle of
least two meetings during the revision cycle and thus EEI Communications, Inc., prepared the final draft
were eligible to vote on the final document. Some par- manuscript that resulted from the meetings of the
ticipants were physically able to attend only one meeting, full HGRC, constructed the relocation matrix, and
but their speakerphone input at other sessions and reviewed the new numbering system, especially
contributions between meetings greatly benefited the correcting the cross-references. Great thanks are
document. In particular, Lorraine G. Hiatt, Ph.D., of extended to all!
Innovage Consultants, and Ellie Ward, RN, of Dare
Home Health & Hospice, deserve recognition for their At each of the three meetings of the full HGRC, local
assistance on rewrites of the adult day health care and architecture firms kindly sent individuals supplied
hospice facility chapters, respectively. In addition, rep- with computers and projectors to help record the
resentatives of the following organizations gathered decisions that resulted from committee members’ dis-
with HGRC members and spent many hours deter- cussions in subcommittees. The following individuals
mining the best way to address assisted living facilities (followed by the firms that sent them) were much
in this document: the American Association of Homes appreciated participants in the 2006 revision cycle:
and Services for the Aging, AARP, the Assisted Living In Washington, D.C.—Kathy Dixon, AIA (McKissack
Federation of America, the Alzheimer’s Association, & McKissack); Jennifer Jackson, AIA (SmithGroup);
the National Center for Assisted Living (of the Alison Parks, Assoc. AIA (SmithGroup); and Michael
American Health Care Association), and the AIA Smyser, AIA, ACHA (HDR). In Austin, Texas: Richard
Design for Aging Knowledge Community.
xxiv 2006 Guidelines for Design and Construction of Health Care Facilities
ACKNOWLEDGMENTS
Burnight, AIA, ACHA (O’Connell Robertson & Executive Committee Revision Committee
Associates); Sean H. Carlson, AIA (Graeber, Simmons Chairman Paul Evans Acre, PE
Joseph G. Sprague, FAIA, Arkansas Department of Health &
& Cowan); Alan D. Felder, AIA (Felder Group FACHA, FHFI Human Services
Architects); and William P. Peeples, AIA (Bower HKS Architects, Inc.
Downing Partnership). In Irvine, California: Edward Maria Allo, MD, FACS
Vice Chairman Santa Clara Valley Medical Center
G. Avila, AIA (HMC); Bruce MacPherson, AIA, LEED
Douglas S. Erickson, FASHE American College of Surgeons
AP (Puchlik Design Associates); Caroline Sheridan, American Society for Healthcare
LEED AP (Taylor); and Russell Triplett, AIA Engineering (of the American Donald C. Axon, FAIA, FACHA
Hospital Association) DCA/FAIA, Inc.
(Perkins + Will).
International Congress of Building
Vice Chairman Officials
Special thanks are also extended to the Centers for Martin H. Cohen, FAIA, FACHA
Medicare and Medicaid Services of the U.S. Depart- Design for Aging and Health Care Donald E. Baptiste
Architecture Consultant Sturdy Memorial Hospital, Inc.
ment of Health and Human Services for funding of
the revision cycle and to the American Society for Chairman Emeritus Michael Bayley, RA
Healthcare Engineering, the National Institutes of J. Armand Burgun, FAIA, FACHA Texas Department of State Health
Services
Health, and the American Institute of Architects,
Steering Committee
which provided staffing and other support throughout Judene Bartley, MS, MPH, CIC Chad E. Beebe, AIA
the revision cycle and the reorganization effort. Epidemiology Consulting Washington State Department
Services, Inc. of Health
Joseph G. Sprague, FAIA, FACHA, FHFI Alfred S. Buck, MD, FACS Chris Bettlach
Chairman Martin, Blanck & Associates, Inc. Sisters of Mercy Health System–
Health Guidelines Revision Committee Joint Commission on St. Louis
Accreditation of Healthcare
Organizations Elizabeth A. Bolyard, RN, MPH
Centers for Disease Control &
Roger W. Gehrke Prevention
Idaho Department of Health
& Welfare William J. Bonn III, AIA
Utah Department of Health
Thomas M. Jung, RA
New York State Department of John A. Braeckel, MS
Health Indiana State Department
of Health
Robert A. Loranger, PE, CHFM
New England Medical Center Roger V. Brown, PE
United Health Services Hospitals
James Merrill, PE
Centers for Medicare & Medicaid Christopher M. Burney, MS, CPE
Services Hartford Hospital
2006 Guidelines for Design and Construction of Health Care Facilities xxv
ACKNOWLEDGMENTS
Michael D. Coppedge, AIA, ACHA Robert G. Larsen, FAIA Richard K. Nolen, AIA Tom A. Thliveris, AIA
Weller Architects Larsen Shein Ginsberg Snyder HCR ManorCare, Inc. Arizona Department of Health
Architects American Health Care Association Services
Kenneth N. Dickerman, AIA,
ACHA, FHFI John Larson, AIA Pamela Ward O’Malley, RA Dan R. Thompson, MD, MA
Leo A Daly Company Larson & Associates, Inc. The Children’s Hospital of Albany Medical College
Philadelphia
John M. Dombrowski, PE Rod Laucomer, RA George R. Tingwald, MD, AIA,
H. F. Lenz Company Nebraska Health & Human Robin Orr, MPH ACHA
Services System The Robin Orr Group Skidmore, Owings & Merrill
Brian Madden Dubey, AIA, CSI
Maryland Department of Health Rebecca J. Lewis, AIA, CID, ACHA Eric T. Overton David B. Uhaze, RA
& Mental Hygiene DSGW Architects Sparling New Jersey Department of
Community Affairs
Jennifer M. Dunaway William E. Lindeman, AIA Peter P. Petresky
Nevada Health Division WEL Designs PLC Pennsylvania Department of Enrique J. Unanue, AIA, ACHA
Accreditation Association for Health Illinois Department of Public
Glenn S. A. Gall, AIA Ambulatory Health Care Health
California Office of Statewide Michael P. Pietrzak, MD, FACEP
Health Planning James T. Lussier KMS/Project ER One Marjorie Underwood, RN, BSN,
& Development St. Charles Medical CIC
Center/Cascade Health Services Donald Pyskacek, AIA Three Rivers Community Hospital
David L. Ginsberg, FAIA Universal Health Services, Inc. Association for Professionals in
Larsen Shein Ginsberg Snyder, Linda Lybert Infection Control & Epidemiology
Architects DuPont Christopher P. Rousseau, PE
Newcomb & Boyd Christopher Upton, AIA, FAAMA,
Warren N. Goodwin, FAIA Stephan G. Lynn, MD, FACEP CSI
St. Luke’s Roosevelt Hospital Wade Rudolph, CBET Kirksey
Thomas C. Gormley Center North Central Health Care
HCA American College of Emergency Wisconsin Healthcare Engineering Walter Vernon, PE
Physicians Association Mazzetti & Associates
James R. (Skip) Gregory, RA
Florida Agency for Health Care Rita Rael Meek, RA Alberto Salvatore, AIA Marjorie E. Vincent, RN, MBA,
Administration New Mexico Department Salvatore Associates CNOR, CASC
of Health Woodrum/ASD
Robin Guenther, FAIA James D. Scott, PE
Guenther 5 Architects Farhad Memarzadeh, PhD, PE Michigan Department of Ronald J. Vitori, MD
National Institutes of Health Community Health Axis Construction Corporation
Jeffery M. Hardin, PE
U.S. Army Corps of Engineers James F. Miller Jr., RA William B. Selan, AIA Robert D. White, MD
Arkansas Children’s Hospital RBSD Architects Memorial Hospital
Maurene Harvey, RN Consensus Committee to Establish
Consultants in Critical Care, Inc. Richard D. Moeller, PE, SASHE Lloyd H. Siegel, FAIA Recommended Standards for
CDi Engineers U.S. Department of Veterans NICU Design
Daniel L. Hightower, AIA Affairs
BBH Design Margaret Montgomery, RN, MSN Dale Woodin, CHFM, SASHE
(U.S. Public Health Service, ret.) American College of Emergency David M. Sine, CSP, ARM American Society for Healthcare
Physicians National Association of Psychiatric Engineering (of the American
Andrea V. Hyde, ASID Health Systems Hospital Association)
Hyde Inc. Interior Design R. Gregg Moon, AIA, ACHA
M. D. Anderson Cancer Center Judith Smith, MHA M. Judy Zumbo, RN, BSN, JD
Gerald R. Inglett, RA Smith Hager Bajo, Inc. Delaware Office of Health Facilities
Indian Health Service, DHHS Hugh O. Nash Jr., PE, FIEEE Licensing & Certification
Nash Lipsey Burch Joseph J. Strauss, AIA, ACHA
Thomas W. Jaeger, PE Mitretek Systems
Jaeger & Associates, LLC Gaius G. Nelson, AIA
American Health Care Association Nelson-Tremain Partnership– Andrew J. Streifel
Architecture & Design for Aging University of Minnesota
Paul A. Jensen, PhD, PE, CIH Society for the Advancement of Department of Environmental
Centers for Disease Control & Gerontological Environments Health & Safety
Prevention
Paul T. Ninomura, PE Dana E. Swenson, PE
John P. Kouletsis, AIA Indian Health Service, DHHS UMass Memorial Health Care
Kaiser Permanente System
xxvi 2006 Guidelines for Design and Construction of Health Care Facilities
General
1
1.1.2 This document covers health care facilities com- (1) Any deletions, additions, and changes desired by
mon to communities in the United States. the adopting authority should be noted separately
in the adopting instrument.
1.1.3 Facilities with unique services will require special
consideration. However, sections herein may be appli- (2) In order to assist FGI in following the uses
cable for parts of any facility and may be used where made of this document, adopting authorities
appropriate. are requested to notify FGI when they adopt
these Guidelines or use them in any other
1.2 About This Document regulatory fashion.
These Guidelines for Design and Construction of
Health Care Facilities (Guidelines) are developed 1.2.2 Disclaimers
through a consensus process similar to one approved 1.2.2.1 While FGI administers the process and establish-
by the American National Standards Institute. This es rules to promote fairness in the development of con-
process brings together the members of the Health sensus, it does not independently test, evaluate, or verify
Guidelines Revision Committee (HGRC) of the the accuracy of any information or the soundness of
Facility Guidelines Institute Inc. (FGI). The HGRC is any judgments or advice contained in these Guidelines.
a balanced group of volunteers representing varied
viewpoints and interests in health care facility plan- 1.2.2.2 FGI endeavors to develop performance-oriented
ning, design, and construction. It considers proposals minimum requirements as suggested standards for
for change received from the public; achieves consen- American health care facility design, without prescribing
sus on health care facility planning, design, and con- design solutions. FGI disclaims liability for any per-
struction issues; and develops proposed revisions to sonal injury or property or other damages of any
the previous edition of these Guidelines. The pro- nature whatsoever, whether special, indirect, conse-
posed revisions are then published for public com- quential, or compensatory, directly or indirectly result-
ment and revised by the HGRC, as needed, in ing from the publication, use of, or reliance on this
response to those comments. The product of this document. FGI also makes no guaranty or warranty as
revision process is then compiled and published as to the accuracy or completeness of any information
a new edition of the Guidelines by the American published herein.
Institute of Architects (AIA).
1.2.2.3 In issuing and making this document available,
1.2.1 Uses of This Document FGI and the AIA are not undertaking to render pro-
These Guidelines are made available for a wide variety fessional or other services for or on behalf of any per-
of public and private uses. These include reference in son or entity. Nor are FGI and the AIA undertaking to
laws, codes, rules, and regulations, as well as use in perform any duty owed by any person or entity to
private self-regulation and standardization of space someone else.
and equipment requirements and the promotion of
safe practices and methods in planning, design, and 1.2.2.4 Anyone using this document should rely on his
construction for various types of health care facilities. or her own independent judgment or, as appropriate,
seek the advice of a competent professional in deter- 1.3.1.2 Appendix. An appendix is associated with each
mining the exercise of reasonable care in any given chapter in the main body of the text.
circumstance.
(1) An asterisk (*) preceding a paragraph number
1.2.2.5 Neither FGI nor the AIA has any power, nor do indicates that explanatory or educational material
they undertake, to police or enforce compliance with can be found in an appendix item located at the
the contents of this document. Nor do FGI or the AIA bottom of the page.
list, certify, test, or inspect designs or construction for
compliance with this document. (2) Appendix items are identified by the letter “A”
preceding the paragraph number in the main text
1.2.2.6 Any certification or other statement of compli- to which they relate.
ance with the requirements of this document shall not
be attributable to FGI or the AIA and is solely the 1.3.1.3 Front and back matter
responsibility of the certifier or maker of the statement.
(1) Informative introductory sections, including a
1.2.3 Copyright preface, a summary of major additions and revi-
The content of this document, in both book and sions to the previous edition, acknowledgments,
CD form, is copyrighted by the Facility Guidelines and the table of contents precede the main body
Institute, Inc. (FGI), and its compilation is copyrighted of the document.
by the American Institute of Architects (AIA). By mak-
ing this document available for use and adoption by (2) A glossary of terms and a detailed index follow the
public authorities and private users, FGI and the AIA main body of the text, together with forms for use
do not waive any rights in copyright to this document. in submitting requests for formal interpretations
and proposals to change these Guidelines. For
1.3 How to Use These Guidelines Guidelines 2006, a “where to find it” matrix of relo-
cated information has been added to help readers
1.3.1 Basic Organization familiar with previous editions of these Guidelines
1.3.1.1 Main body. The main body of this document find information that has been moved to a different
comprises four parts: location in the reorganized document.
(1) Part 1 contains chapters that address considera- 1.3.2 Minimum Standards for New Facilities
tions applicable to all health care facilities, except Each chapter in this document contains information
as noted or modified in specific facility-type intended as minimum standards for designing and
chapters in the remaining parts. constructing new health care facility projects.
(2) Part 2 addresses inpatient care, with chapters 1.3.2.1 Standards set forth in these Guidelines shall be
devoted to general hospitals, small primary care considered as minimum.
hospitals, rehabilitation facilities, and psychiatric
hospitals. 1.3.2.2 Insofar as practical, these standards relate to
desired performance or results or both.
(3) Part 3 addresses ambulatory care, including chap-
ters devoted to same day outpatient facilities and 1.3.3 Code Language
adult day care facilities. For brevity and convenience, these standards are pre-
sented in “code language.” Use of words such as shall
(4) Part 4 addresses other health care venues, includ- indicates mandatory language only where the text is
ing long-term, residential, and other care settings. applied by an adopting authority having jurisdiction
Chapters are devoted to nursing facilities; hospice (AHJ). However, when adopted by an AHJ, design and
care; assisted living; and mobile, transportable, construction shall conform to the requirements of
and relocatable units. these Guidelines.
compliance would not substantially improve safety but 3.5.2 Conversion to other appropriate use or replace-
would create an unreasonable hardship. ment should be considered when cost prohibits com-
pliance with acceptable standards.
3.1.1.2 These standards should not be construed as pro-
hibiting a single phase of improvement. (For example, 3.6 Undiminished Safety
a facility may plan to replace a flammable ceiling with Renovations, including new additions, shall not
noncombustible material but lack funds to do other diminish the safety level that existed prior to the start
corrective work.) However, they are not intended as of the work; however, safety in excess of that required
encouragement to ignore deficiencies when resources for new facilities is not required.
are available to correct life-threatening problems. (See
Section 1.1-7.3.) 3.7 Long-Range Improvement
Reduction Program (NEHRP) provisions developed shall be given to roofing, entryways, glazing, and flash-
by the Building Seismic Safety Council (BSSC) for the ing design to minimize uplift, impact damage, and
Federal Emergency Management Agency (FEMA). other damage that could seriously impair functioning
Facilities shall be designed to meet the requirements of the building.
of ASCE/SEI 7-05 or the building codes specified in
Section 1.1-7.5.1, provided their requirements are 5.3.4.4 If ballast is used it shall be designed so as not
substantially equivalent to ASCE/SEI 7. to become a projectile.
5.3.1.2. Other seismic standards. The following seismic 5.4 Flood Protection
standards are essentially equivalent to the ASCE/SEI 7 Flood Protection, Executive Order No. 11988, was
provisions: issued to minimize financial loss from flood damage
to facilities constructed with federal assistance. In
(1) NEHRP Recommended Provisions for Seismic accordance with that order:
Regulations for New Buildings
5.4.1 Possible flood effects shall be considered when
(2) International Building Code selecting and developing the site.
5.3.1.3. Executive Order 12699, dated January 5, 1990, 5.4.2 Insofar as possible, new facilities shall not be
specified the use of the maps in the most recent edi- located on designated floodplains.
tion of ANSI A58 for seismic safety of federal and fed-
erally assisted or regulated new building construction. 5.4.3 Where locating a facility on a floodplain is
unavoidable, consult the Corps of Engineers regional
5.3.2 Design for Continued Operation office for the latest applicable regulations pertaining
For those facilities that must remain operational in the to flood insurance and protection measures that may
aftermath of a disaster, special design is required to be required.
protect systems and essential building services such as
power, water, medical gas systems, and, in certain areas, 5.5 Emergency Supply Storage
air conditioning. In addition, special consideration must
be given to the likelihood of temporary loss of externally 5.5.1 Required Supplies
supplied power, gas, water, and communications Should normal operations be disrupted, the facility
shall provide adequate storage capacity for, or a
5.3.3 Seismic Construction Inspection functional program contingency plan to obtain, the
The owner shall provide special inspection during following supplies:
construction of seismic systems described in Section
11A.1.3 and testing described in Section 11A.2 of 5.5.1.1 Food
ASCE/SEI 7-05.
5.5.1.2 Sterile supplies
5.3.4 Roof Considerations
5.3.4.1 Roof coverings and mechanical equipment 5.5.1.3 Pharmacy supplies
shall be securely fastened or ballasted to the support-
ing roof construction and shall provide weather pro- 5.5.1.4 Linen
tection for the building at the roof.
5.5.1.5 Water for sanitation
5.3.4.2 Roof covering shall be applied on clean and dry
decks in accordance with the manufacturer’s instruc- 5.5.2 Storage Capacity
tions, these Guidelines, and related references. Such storage capacity or plans shall be sufficient for at
least four continuous days of operation.
5.3.4.3 In addition to the wind force design and con-
struction requirements specified, particular attention
6 National Standards for the Protection reference; but other codes and/or standards may be includ-
of Certain Health Information ed as part of these Guidelines (see Section 1.1-7.5.1).
6.1.2 HIPAA does not preempt or override laws that 7.3 Equivalency
grant individuals even greater privacy protection.
Additionally, covered entities are free to retain or 7.3.1 Performance Standards
adopt more protective policies or practices. Insofar as practical, the minimum standards in these
Guidelines have been established to obtain a desired
6.1.3 HIPAA provides for civil and even criminal performance result.
penalties for violations.
7.3.2 Prescriptive Standards
6.1.4 Ultimately, designers and owners must assume Prescriptive limitations (such as exact minimum dimen-
responsibility in developing policies and procedures sions or quantities), when given, describe a condition
for verification of all applicable requirements that that is commonly recognized as a practical standard for
appropriately limit access to personal health informa- normal operation. For example, reference to a room or
tion without sacrificing the quality of health care. area by the patient, equipment, or staff activity that
identifies its use avoids the need for complex descrip-
tions of procedures for appropriate functional planning.
7 Codes and Standards
7.3.3 Technical Standards
7.1 Safe Environment 7.3.3.1 NFPA document 101A is a technical standard
Every health care facility shall provide and maintain a for evaluating equivalency to certain requirements of
safe environment for patients, personnel, and the public. NFPA 101, the Life Safety Code.
7.2 Code Compliance 7.3.3.2 The Fire Safety Evaluation System (FSES) has
In the absence of state or local requirements, the proj- become widely recognized as a method for establish-
ect shall comply with approved nationally recognized ing a safety level equivalent to that of the Life Safety
building codes except as modified in the latest edition Code. It may be useful for evaluating existing facilities
of NFPA 101 and/or herein. that will be affected by renovation. For purposes of
these Guidelines, the FSES is not intended to be used
7.2.1 References made in these Guidelines to appropri- for new construction.
ate model codes and standards do not, generally,
duplicate wording of the referenced codes. 7.3.4 Equivalency
While these Guidelines are adopted as a regulatory stan-
7.2.2 National Fire Protection Association (NFPA) dard by many jurisdictions, it is the intent of the docu-
standards, especially NFPA 101, are the basic codes of ment to permit and promote equivalency concepts.
7.3.4.1 When contemplating equivalency allowances, normally be acceptable where requirements for func-
the authority having jurisdiction may use a variety of tion and safety are not reduced; however, editions of
expert sources to make equivalency findings and may different dates may have portions renumbered or reti-
document the reasons for approval or denial of equiv- tled. Care must be taken to ensure that appropriate
alency to the requester. sections are used.
7.3.4.2 Alternate methods, procedures, design criteria, Access Board (an independent federal agency)
and functional variations from these Guidelines, (http://www.access-board.gov/ufas/ufas-html/ufas.htm).
because of extraordinary circumstances, new pro- Uniform Federal Accessibility Standard (UFAS).
grams, or unusual conditions, may be approved by
the authority having jurisdiction when the facility American Conference of Governmental Industrial
can effectively demonstrate that the intent of the Hygienists (www.acgih.org).
Guidelines is met and that the variation does not Industrial Ventilation: A Manual of Recommended
reduce the safety or operational effectiveness of the Practice, 25th ed.
facility below that required by the exact language of
the Guidelines. American Society of Civil Engineers
(http://www.pubs.asce.org).
7.3.4.3 In all cases where specific limits are described, ASCE/SEI 7-05 Minimum Design Loads for
equivalent solutions will be acceptable if the authority Buildings and Other Structures.
having jurisdiction approves them as meeting the
intent of these standards. American Society of Heating, Refrigerating and
Air-Conditioning Engineers (ASHRAE)
7.3.4.4 Nothing in this document shall be construed as (http://www.ashrae.org).
restricting innovations that provide an equivalent level ASHRAE Handbook of Fundamentals.
of performance with these standards in a manner 2003 ASHRAE Handbook–HVAC Applications.
other than that which is prescribed by this document, Humidity Control Design Guide for Commercial
provided that no other safety element or system is and Institutional Buildings.
compromised in order to establish equivalency. Standard 52.1-1992, Gravimetric and Dust-Spot
Procedures for Testing Air-Cleaning Devices
7.4 English/Metric Measurements Used in General Ventilation for Removing
7.4.1 Where measurements are a part of this docu- Particulate Matter.
ment, English units are given as the basic standards, Standard 52.2, Method of Testing General
with equivalent metric units in parentheses. Ventilation Air-Cleaning Devices for Removal
Efficiency by Particle Size.
7.4.2 Either method shall be consistently used through- Standard 55-2004, Thermal Environmental
out a given design. Conditions for Human Occupancy.
Standard 62-1999, Ventilation for Acceptable
7.5 Referenced Codes and Standards Indoor Air Quality.
Codes and standards that have been referenced in Standard 90.1, Energy Standard for Buildings
whole or in part in the various sections of this docu- Except Low-Rise Residential Buildings.
ment are listed in Section 1.1-7.5.1. Names and Standard 154-2003, Ventilation for Commerical
addresses of the originators are included in Section Cooking Operations.
1.1-7.5.2 for information.
American Society of Mechanical Engineers (ASME)
7.5.1 Publication References (http://www.asme.org/cns/departments/Safety/Public/
Users of these Guidelines are encouraged to use these A17/ or www.ansi.org).
publications for further information as may be neces- ANSI/ASME A17.1, Safety Code for Elevators and
sary to achieve the final product. The issues available Escalators, 2000.
at the time of publication are cited. Later issues will
ANSI/ASME A17.3, Safety Code for Existing Publication #E-10, Maintenance of Medical Gas and
Elevators and Escalators, 2002. Vacuum Systems in Health-Care Facilities, 2001.
American Society for Testing and Materials (ASTM) Defense Standardization Program, U.S. Department of
(www.astm.org) Defense (http://www.dsp.dla.mil).
C1071-05, Standard Specification for Fibrous Glass MIL STD 282, Filter Units, Protective Clothing,
Duct Lining Insulation (Thermal and Sound Gas-Mask Components and Related Products:
Absorbing Material), 2005 Performance-Test Methods.
(http://assist.daps.dla.mil —Click “Quick
American Water Works Association (AWWA) Search” and enter “MIL-STD-282” as the
(www.awwa.org). document ID.)
Recommended Practice for Backflow Prevention
and Cross-connection Control, 2004. Food and Drug Administration (http://www.fda.gov).
FDA Food Code, 2001.
Americans with Disabilities Act. U.S. Department of (http://www.cfsan.fda.gov/~dms/fc05-
Justice ADA Information Line, 1-800-514-0301 or toc.html).
1-800-514-0383 (TDD). (http://www.usdoj.gov/
disabilities.htm). Hydronics Institute Division of the Gas Appliance
Manufacturers Association (http://www.gamanet.org/).
Association for the Advancement of Medical I-B-R Boiler Ratings Procedural Guide, 2002.
Instrumentation (www.aami.org). I-B-R Testing and Rating Standards for Baseboard
ANSI/CDV-1 RD62, 2001, Water Treatment Radiation, 1990.
Equipment for Hemodialysis Applications. I-B-R and Rating Standards for Finned Tube
(Commercial) Radiation, 1990.
Building Seismic Safety Council (National Institute of
Building Sciences) (http://www.bssconline.org). Illuminating Engineering Society of North America
NEHRP (National Earthquake Hazards Reduction (IESNA) (http://www.iesna.org).
Program) Recommended Provisions for Seismic ANSI/IESNA RP-28-01, Lighting and the Visual
Regulations for New Buildings, 2000 ed. Environment for Senior Living.
ANSI/IESNA Publication RP-29-06, Lighting for
Centers for Disease Control and Prevention (CDC) Hospitals and Health Care Facilities.
(www.cdc.gov).
“Guidelines for Preventing the Transmission of Industrial Safety Equipment Association (ISEA)
Mycobacterium tuberculosis in Health-Care (www.ansi.org).
Settings, 2005.” Morbidity and Mortality ANSI-Z-358.1-2004, American National Standard
Weekly Report (MMWR) 2005:54 (No. RR-17). for Emergency Eyewash and Shower
(http://www.cdc.gov/mmwr/PDF/rr/rr5417.pdf) Equipment.
“Guidelines for Preventing Health Care-
Associated Pneumonia, 2003.” Morbidity and National Association of Psychiatric Health Systems
Mortality Weekly Report (MMWR) 53 (RR03); (www.NAPHS.org).
1-36. (http://www.cdc.gov/ncidod/dhqp/ “Guidelines for the Built Environment of Behavioral
gl_hcpneumonia.html) Health Facilities” (http://www.naphs.org/
Teleconference/safetystandards.html)
College of American Pathologists. 1-800-323-4040
(www.cap.org). National Council on Radiation Protection and Measure-
Medical Laboratory Planning and Design, 1985. ments (NCRP). (http://www.ncrp.com/ncrprpts.html)
Report #102, Medical X-Ray, Electron Beam and
Compressed Gas Association (CGA). Gamma-Ray Protection for Energies Up to 50
(http://www.cganet.com/Pubs/CGA_Publications). MeV (Equipment Design, Performance and
Use), 1989.
Report # 144, Radiation Protection Design for Occupational Safety and Health Administration, U.S.
Particle Accelerator Facilities, 2003. Department of Labor (www.osha.org).
Report # 147, Structural Shielding Design for Code of Federal Regulations (CFR) Title 29—
Medical Use of X Ray Imaging Facilities, 2004. OSHA Regulations. Part 1910 (29 CFR
1910), Occupational Safety and Health
National Fire Protection Association Standards.
(http://www.nfpa.org/categoryList.asp). (http://www.osha.gov/pls/oshaweb/
NFPA 13, Installation of Sprinkler Systems, 2002. owastand.display_standard_group?p_toc_
NFPA 20, Standard for the Installation of Stationary level=1&p_part_number=1910)
Fire Pumps for Fire Protection, 2003.
NFPA 70, National Electrical Code, 2005. Plumbing-Heating-Cooling Contractors—National
NFPA 72, National Fire Alarm Code, 2002 Association (PHCC—National Association)
NFPA 80, Standard for Fire Doors, Fire Windows, (http://www.phccweb.org/).
1999. National Standard Plumbing Code, 2000.
NFPA 82, Standard on Incinerators and Waste and
Linen Handling Systems and Equipment, 2004. 7.5.2 Resources for Codes and Standards
NFPA 90A, Standard for the Installation of Air Providers of some of the codes and standards used in this
Conditioning and Ventilating Systems, 2002. publication are listed here. Unless otherwise noted in
NFPA 90B, Standard for the Installation of War Air Section 1.1-7.5.1, federal publications may be obtained
Heating and Air-Conditioning Systems, 20002. from the Government Printing Office in Washington, D.C.
NFPA 96, Standard for Ventilation Control and
Fire Protection of Commercial Cooking Air Conditioning and Refrigeration Institute
Operations, 2004. 4100 North Fairfax Drive, Suite 200
NFPA 99, Standard for Health Care Facilities, 2005. Arlington, VA 22203
NFPA 101, Life Safety Code, 2003. Tel. 703-524-8800
NFPA 110, Standard for Emergency and Standby Web: http://www.ari.org
Power Systems, 2005.
NFPA 253, Standard Method of Test for Critical Architectural and Transportation Barriers
Radiant Flux of Floor Covering Systems Using Compliance Board
a Radiant Heat Energy Source, 2000. Office of Technical and Information Services
NFPA 255, Standard Method of Test of Surface Burn- 1331 F St., N.W., Suite 1000
ing Characteristics of Building Materials, 2000. Washington, DC 20004-1111
NFPA 258, Standard Research Test Method of Tel. 202-272-5434, 1-800-872-2253
Determining Smoke Generation of Solid Web: http://www.access-board.gov
Materials, 2001.
NFPA 418, Standard for Heliports, 2001. Americans with Disabilities Act
NFPA 701, Standard Methods of Fire Tests for U.S. Department of Justice
Flame Propagation of Textiles and Films, 2004. 950 Pennsylvania Ave., N.W.
NFPA 801, Standard for Fire Protection for Facilities Washington, DC 20530-0001
Handling Radioactive Materials, 2003. Tel. 202-514-2000
Web: http://www.usdoj.gov/crt/ada/adahom1.htm
Nuclear Regulatory Commission (NRC)
(http://www.nrc.gov/reading-rm/doc-collections/cfr/). American National Standards Institute (ANSI)
Code of Federal Regulations (CFR) Title 10— 1819 L Street, N.W., Sixth floor
Energy, Chapter 1—Nuclear Regulatory Washington, DC 20036
Commission Part 20 (10 CFR 20), Standards Tel. 202-293-8020
for Protection Against Radiation. Web: http://www.ansi.org
Part 35 (10 CFR 35), Medical Use of Byproduct
Material.
Plumbing-Heating-Cooling Contractors—
National Association
180 South Washington Street, P.O. Box 6808
Falls Church, VA 22040
Tel. 1-800-533-7694
Web: http://www.phccweb.org
Underwriters Laboratories, Inc.
333 Pfingsten Road
Northbrook, IL 60062-2096
Tel. 847-854-3577
Web: http://www.ul.com
(2) The functional program shall support the delivery operational efficiencies and the satisfaction of patients
of care model to allow the design of the physical or residents, families, and staff.
environment to respond appropriately.
2.1.2.5 Physical environment. The physical environ-
2.1.2.2 Facility and service users (people). The physical ment shall be designed to support the intended deliv-
environment shall support the facility and service ery of care model and address the key elements listed
users in their effort to administer the delivery of care below:
model.
*(1) Light and views. Use and availability of natural
*2.1.2.3 Systems design. The physical environment shall light, illumination, and views shall be considered
support organizational, technological, and building sys- in the design of the physical environment.
tems designed for the intended delivery of care model.
*(2) Clarity of access (wayfinding). Clarity of access
*2.1.2.4 Layout/operational planning. The layout and shall be addressed in the overall planning of the
design of the physical environment shall enhance facility, individual departments, and clinical areas.
APPENDIX
A2.1.2.3 Systems design restorative gardens for patients and/or caregivers as a component
Physical relationships between services or new aggregations of of the functional program, as appropriate.
services should be clearly defined and supported. Clustering of
e. Artificial lighting strategies. The Illuminating Engineering Society
related services affects the criteria for design of the physical
of North America (IESNA) has developed two publications that
environment.
apply to health care facilities; both are American National
Information technology, medical technology, and/or staff utiliza- Standards Institute (ANSI) standards. ANSI/IESNA RP-29,
tion and cross training are issues that should be addressed. Lighting for Hospitals and Health Care Facilities addresses lighting
for the general population and special lighting for medical proce-
A2.1.2.4 Layout/operational planning
dures. ANSI/IESNA RP-28, Lighting and the Visual Environment for
Criteria for evaluation of the layouts should be consistent with the
Senior Living addresses the special lighting needs of older adults.
delivery of care model to allow each optional layout and opera-
tional plan to be reviewed appropriately. f. Lamp selection should address color rendering properties.
A2.1.2.5 (1) Light and views A2.1.2.5 (2) Clarity of access (wayfinding)
Natural light, views of nature, and access to the outdoors should a. Entry points to the medical facility should be clearly defined
be considered in the design of the physical environment wherever from all major exterior circulation modes (roadways, bus stops,
possible. vehicular parking).
a. Siting and organization of the building should respond to and b. Clearly visible and understandable signage and visual land-
prioritize unique natural views and other natural site features. marks for orientation should be provided.
b. Access to natural light should be achieved without going into c. Boundaries between public and private areas should be well
private spaces (i.e., staff should not have to enter a patient/ marked, and clearly distinguished.
resident room to have access to natural light). Examples include
d. A system of interior “landmarks” should be developed to aid
windows at the ends of corridors, skylights into deep areas of the
occupants in cognitive understanding of destinations. These may
building in highly trafficked areas, transoms, and door sidelights.
include water features, major art, distinctive color, or decorative
c. In residential health care occupancies, dining areas, lounges, treatments at major decision points in the building. These features
and activity areas should be designed to include natural light. should attempt to involve tactile, auditory and language cues, as
well as visual recognition.
d. Hospitals and long-term care facilities should provide a garden
or other controlled exterior space that is accessible to building e. Signage systems should be flexible, expandable, adaptable,
occupants. Consider specifically designed therapeutic and and easy to maintain.
*(3) Control of environment. Patient/resident/staff addressed in the overall planning of the facility
ability to control their environment shall be consistent with the functional program.
addressed in the overall planning of the facility
consistent with the functional program. *(6) Finishes. The effect of materials, colors, textures,
and patterns on patients or residents, staff, and
*(4) Privacy and confidentiality. The level of patient visitors shall be considered in the overall planning
or resident privacy and confidentiality shall be and design of the facility. Maintenance and per-
addressed in the overall planning of the facility formance shall be considered when selecting these
consistent with the functional program. items.
*(5) Safety and security. The safety and security of *(7) Cultural responsiveness. The culture of patients
patients or residents, staff, and visitors shall be or residents, staff, and visitors shall be considered
in the overall planning of the facility.
APPENDIX
A2.1.2.5 (3) Control of environment control and secure all access points in the event of an emer-
a. Every effort should be made to allow individual control over as gency. Factors such as adequate exterior lighting in parking lots
many elements of the environment as possible and reasonable, and entry points to the facility and appropriate reception/securi-
including but not limited to temperature, lighting, sound, and privacy. ty services are essential to ensuring a safe environment.
b. Lighting in patient and staff areas should allow for individual b. Since the strict control of access to a medical facility is neither
control and provide variety in lighting types and levels. possible nor appropriate, safety within the facility should also be
addressed through the design of circulation paths and functional
c. Building design should address individual control over the ther-
relationships. Provisions for securing the personal belongings of
mal environment through carefully considered zoning of mechani-
staff, visitors, and patients or residents should be addressed.
cal systems.
c. The physical environment should be designed to support the
d. Noise has been proven to be a negative environmental stressor
overall safety and security policies and protocols of the institution.
for patients, families, and staff. Noise should be minimized by the
Safety and security monitoring, when provided, should respect
design of the physical environment and the selection of opera-
patient privacy and dignity.
tional systems and equipment.
A2.1.2.5 (6) Finishes
A2.1.2.5 (4) Privacy and confidentiality
a. In any design project, the selection of a color palette should
a. Public circulation and staff/patient circulation should be sepa-
be based upon many factors, including the building population,
rated wherever possible.
anticipated behavior in the space, time of encounter, and level of
b. Waiting areas for patients on stretchers or in gowns should be stress. The color palette selected should be suitable and appropri-
located in a private zone within the plan, out of view of the public ate for the specific environment, taking into account the specific
circulation system. activities conducted in that environment.
c. Private alcoves or rooms should be provided for all communica- b. Finishes and color palettes should respond to the geographic
tion concerning personal information relative to patient illness, location of the health care facility, taking into account climate and
care plans, and insurance and financial matters. light, regional responses to color, and the cultural characteristics
of the community served.
d. In facilities with multi-bed rooms, family consultation rooms,
grieving rooms, and/or private alcoves in addition to family A2.1.2.5 (7) Cultural responsiveness
lounges should be provided to permit patients and families to Organizational culture is defined by the history of the organization,
communicate privately. leadership philosophy, management style, and caregivers’ dispositions.
A2.1.2.5 (5) Safety and security Regional culture is defined by the physical location and demo-
a. Attention should be given to balancing readily accessible and graphics (including age, nationality, religion, and economics) of
visible external access points to the facility with the ability to the communities served.
*(8) Water features. Where provided, open water fea- (2) Describe the types and projected numbers of
tures shall be equipped to safely manage water procedures for treatment areas.
quality to protect occupants from infectious or
irritating aerosols. 2.1.3.2 Equipment requirements
*2.1.2.6 Design process and implementation. Groups (1) Describe building service equipment.
(stakeholders) affected by and integral to the design
shall be included in the planning and implementation (2) Describe fixed and movable equipment.
process.
2.1.3.3 Circulation patterns
2.1.3 Functional Requirements
The facility shall incorporate the following informa- (1) Describe the circulation patterns for staff, patients
tion into the functional program commensurate with or residents, and the public.
the scope and purpose of the project.
(2) Describe the circulation patterns for equipment
2.1.3.1 The size and function of each space and any and clean and soiled materials.
other design feature
(3) Where circulation patterns are a function of
(1) Include the projected occupant load, numbers asepsis control requirements, note these features.
and types of staff, patients, residents, visitors,
and vendors. 2.1.3.4 Consideration of potential future expansion
that may be needed to accommodate increased
demand
APPENDIX
2.2 Nomenclature
A2.1.2.5 (8) Water features 2.2.1 Use the same names for spaces and departments
Fountains and other open decorative water features may represent as used in these Guidelines. If acronyms are used, they
a reservoir for opportunistic human pathogens; thus, they are not shall be clearly defined.
recommended for installation within any enclosed spaces in
health care environments. 2.2.2 The names and spaces indicated in the functional
program shall be consistent with the submitted floor
a. If a water feature is provided, the design should limit human
plans.
contact with the water and/or allow for the application of water
disinfection systems. Materials used to fabricate the water feature
2.3 Use
should be resistant to chemical corrosion. Water features should
2.3.1 Following approval, the functional program shall
be designed and constructed to minimize water droplet produc-
be made available for use in the development of project
tion. Exhaust ventilation should be provided directly above the
design and construction documents.
water feature.
b. If aquariums are used, they should be enclosed to prevent 2.3.2 The facility shall retain the approved functional
patient or visitor contact with the water. Aquariums are not subject program with other design data to facilitate future
to exhaust ventilation recommendations. alterations, additions, and program changes.
*3.1.1 Site Selection and Development 3.1.3.2 Design for water conservation shall not
Design to minimize negative environmental impacts adversely affect patient health, safety, or infection
associated with buildings and related site development. control.
APPENDIX
APPENDIX
2 Location
3 Facility Site Design
2.1 Access
The site of any health care facility shall be convenient 3.1 Roads
both to the community and to service vehicles, includ- Paved roads shall be provided within the property for
ing fire protection apparatus, etc. access to all entrances and to loading and unloading
docks (for delivery trucks).
*2.2 Availability of Transportation
A transportation plan shall be established. 3.2 Pedestrian Walkways
Paved walkways shall be provided for pedestrian traffic.
2.3 Security
Health facilities shall have security measures for patients, 3.3 Parking
families, personnel, and the public consistent with the Parking shall be made available for patients, families,
conditions and risks inherent in the location of the facility. personnel, and the public, as described in the individ-
ual sections for specific facility types. Signage shall be
2.4 Availability of Utilities provided to direct people unfamiliar with the facility
Facilities shall be located to provide reliable utilities to appropriate parking areas.
(water, gas, sewer, electricity).
*3.4 Emergency Access
APPENDIX 3.4.1 Hospitals with an organized emergency service
shall have the emergency access well marked to facilitate
A2.2 Availability of Transportation entry from the public roads or streets serving the site.
Facilities should be located so they are convenient to public trans-
portation where available, unless acceptable alternate methods 3.4.2 Access to emergency services shall be located to
of transportation to public facilities and services are provided. The incur minimal damage from floods and other natural
transportation plan should support alternatives to fossil-fueled disasters.
single-occupancy vehicles, including preferred van/carpool park-
ing, bike parking and changing facilities, alternative vehicle fueling
stations, and nearby transit access. *4 Environmental Pollution Control
A3.4 Other vehicular or pedestrian traffic shall not conflict with
4.1 Environmental Pollution
access to the emergency station.
The design, construction, renovation, expansion,
A4 Release of Toxic Substances from Equipment equipment, and operation of health care facilities
Equipment should minimize the release of chlorofluorocarbons are all subject to provisions of several federal envi-
(CFCs) and any potentially toxic substances that may be used in their ronmental pollution control laws and associated
place. For example, the design of air conditioning systems should agency regulations. Moreover, many states have
specify CFC alternatives and recovery systems as may be practicable. enacted substantially equivalent or more stringent
4.1.1.4 Clean Air Act (CAA) (1) The Protocol shall describe the scope and proce-
dures to be used to conduct the assessment(s).
4.1.1.5 Safe Drinking Water Act (SDWA)
(2) The EIS and/or HRA shall be prepared in accor-
4.1.1.6 Occupational Safety and Health Act (OSHA) dance with a final Protocol approved by the
appropriate agency or agencies. Approval is most
4.1.2 State and Local Regulations likely to be obtained in a timely manner and
Consult the appropriate U.S. Department of Health with minimum revisions if standard methods
and Human Services (DHHS) and U.S. Environmental are initially proposed for use in the EIS and/or
Protection Agency (EPA) regional offices and any HRA. Standard methods suitable for specific
other federal, state, or local authorities having juris- assessment tasks are set forth in particular EPA
diction for the latest applicable state and local regula- documents.
tions pertaining to environmental pollution that may
affect the design, construction, or operation of the *4.2 Mercury Elimination
facility, including the management of industrial
chemicals, pharmaceuticals, radionuclides, and wastes 4.2.1 Applicability
thereof, as well as trash, noise, and traffic (including 4.2.1.1 New construction. In new construction, health
air traffic). care facilities shall not use mercury-containing equip-
ment, including thermostats, switching devices, and
other building system sources.
APPENDIX
4.2.1.2 Renovation. For renovation, health care
A4.2 Mercury Elimination facilities shall develop a plan to phase out mercury-
Health care facilities should collect and properly store, recycle, or containing sources and upgrade current mercury-
dispose of mercury encountered during construction or demolition containing lamps to low or no mercury lamp
(such as mercury accumulated in P-traps, air-handling units, technology.
sumps, etc.).
3 Equipment Requirements
2.2.1 Design shall be prepared by the ICRA panel and shall address,
Building design features, including the following, shall but not be limited to, the following:
be addressed when developing the ICRA:
2.3.1.1 Patient placement and relocation
2.2.1.1 Number, location, and type of airborne infec-
tion isolation and protective environment rooms 2.3.1.2 Standards for barriers and other protective
measures required to protect adjacent areas and
2.2.1.2 Location(s) of special ventilation and filtra- susceptible patients from airborne contaminants
tion such as emergency department waiting and
intake areas 2.3.1.3 Temporary provisions or phasing for construc-
tion or modification of heating, ventilating, air condi-
2.2.1.3 Air-handling and ventilation needs in surgical tioning, and water supply systems
services, airborne infection isolation and protective
environment rooms, laboratories, local exhaust sys- 2.3.1.4 Protection from demolition
tems for hazardous agents, and other special areas
2.3.1.5 Measures to be taken to train hospital staff,
2.2.1.4 Water systems to limit Legionella sp. and water- visitors, and construction personnel
borne opportunistic pathogens
2.3.2 Project Requirements
*2.2.1.5 Finishes and surfaces The owner shall ensure that construction-related
infection control risk mitigation recommendations,
2.2.2 Construction as well as ICRA-generated design recommendations,
When developing the ICRA, building and site areas are incorporated into the project requirements.
anticipated to be affected by construction shall be
addressed, including consideration of the following:
APPENDIX
2.2.2.1 The impact of disrupting essential services to
patients and employees A2.2.1.5 Finishes and surfaces
Preferred surface characteristics (of the ideal product) include
2.2.2.2 Determination of the specific hazards and the following:
protection levels for each
a. Ease of maintenance/repair and cleanable
b. Does not support microbial growth
2.2.2.3 Location of patients by susceptibility to infec-
c. Nonporous—smooth
tion and definition of risks to each
d. Sound absorption/acoustics, where applicable
e. Inflammable—Class I fire rating or better
2.2.2.4 Impact of potential outages or emergencies and
f. Durable
protection of patients during planned or unplanned
g. Sustainable
outages, movement of debris, traffic flow, cleanup, and
h. Low VOC (no off-gassing)
testing and certification
i. Low smoke toxicity
j. Initial and life-cycle cost-effectiveness
2.2.2.5 Assessment of external as well as internal
k. Slip resistance—appropriate coefficient of friction
construction activities
l. Ease of installation, demolition, and replacement
m. Non-problematic substrate and/or assemblies
2.2.2.6 Location of known hazards
n. Seamless
o. Resilient, impact resistant
2.3 Infection Control Risk Mitigation
p. Control of reflectivity/glare
q. Options for color, pattern, and texture
2.3.1 ICRMR Preparation
r. Non-toxic/non-allergenic
The infection control risk mitigation recommendations
3.1 Phasing
Projects involving renovation of existing buildings *4 Commissioning
shall include phasing to minimize disruption of
existing patient services. This phasing is essential Commissioning is a quality process used to achieve,
to ensure a safe environment in patient care areas. validate, and document that facilities and component
infrastructure systems are planned, constructed,
3.1.1 Phasing Provisions installed, tested, and are capable of being operated
Phasing provisions shall include assurance for clean and maintained in conformity with the design intent
to dirty airflow, emergency procedures, criteria for or performance expectations.
interruption of protection, construction of roof
surfaces, written notification of interruptions, and 4.1 Mechanical Systems
communication authority. Acceptance criteria for mechanical systems shall be
specified.
3.1.2 Noise and Vibration
Phasing plans shall include considerations of noise and 4.1.1 Crucial ventilation specifications for air bal-
vibration control that result from construction activities. ance and filtration shall be verified before owner
acceptance.
APPENDIX
4.1.2 Areas requiring special ventilation (such as
A3.2 Ventilation of the Construction Zone surgical services, protective environments, airborne
a. Airflow into the construction zone from occupied spaces should infection isolation rooms, laboratories, and local
be maintained by means of a dedicated ventilation/exhaust system exhaust systems for hazardous agents) shall be
for the construction area. recognized as requiring mechanical systems that
ensure infection control. Ventilation deficiencies
b. Locations of exhaust discharge relative to existing fresh air
shall not be accepted.
intakes and filters, as well as the disconnection and sealing of
existing air ducts, should be reviewed as required by the ICRA.
4.1.3 Acceptance criteria for local exhaust systems
c. If the existing building system or a portion thereof is used dealing with hazardous agents shall be specified and
to achieve this requirement, the system should be thoroughly verified.
cleaned prior to occupancy of the construction area.
APPENDIX
b. Commissioning should be performed by an entity that is inde- d. Systems and components to be included in TBC. Key systems
pendent from the installing contractor. and components that need to be tested and validated, at a mini-
mum, during the TBC process include the design and operations
c. Total building commissioning. Historically, the term “commis-
of the HVAC, plumbing, electrical, emergency power, fire protec-
sioning” has referred to the process by which the heating, venti-
tion/suppression, telecommunications, nurse call, intrusion
lation, and air conditioning (HVAC) system of a building was
and other alarm devices, and medical gas systems, as well as
tested and balanced according to established standards prior
specialty equipment.
to acceptance by the building owner. The HVAC commissioning
did not include other building components that did not directly Air balancing, pressure relationships, and exhaust criteria for
affect the performance of the HVAC systems. Today, the definition mechanical systems should be clearly described and tested to
of commissioning is being expanded to total building commis- create an environment of care that provides for infection control.
sioning (TBC). The fundamental objective of TBC is to create a
Areas requiring emergency power should be specified and tested.
process whereby the owner will be assured that all building and
system components, not just the HVAC system, will function Special plumbing systems should be certified to support the
according to design intent, specifications, equipment manufac- chemicals scheduled for use in them.
turers’ data sheets, and operational criteria. Because all building
e. Areas to be included in commissioning. While all areas of the
systems are integrated and validated, the owner can expect
health care facility are included in the commissioning process,
benefits to include improved occupant comfort, energy savings,
the following areas are of particular concern: critical and intensive
environmental conditions, system and equipment function,
care areas; surgical services; isolation rooms, including those
building operation and maintenance, and building occupants’
used for airborne infection/pathogens; pharmacies, and other
productivity.
areas potentially containing hazardous substances.
The TBC process should include a feedback mechanism that
f. A reference source for an existing HVAC commissioning process
can be incorporated into the owner’s postoccupancy evaluation
is ASHRAE Guideline 1, The HVAC Commissioning Process.
process to enhance future facility designs.
*(1) Capacity. The water-heating system shall have (2) An air gap shall be provided where condensate
sufficient supply capacity at the temperatures drains empty into building drains.
and amounts indicated in the applicable table.
Storage of water at higher temperatures shall (3) Heater elements shall be provided for condensate
be permitted. lines in freezers or other areas where freezing may
be a problem.
(2) Hot water distribution systems serving patient/
resident care areas shall be under constant 2.1.3 Plumbing Fixtures
recirculation to provide continuous hot water The following standards shall apply to plumbing
fixtures:
APPENDIX
A2.1.2.1 (1) Water temperature is measured at the point of use or increasing the hot water supply temperature to 140°F (60°C) is
inlet to the equipment. typically considered the easiest option, the risk of scalding, espe-
cially to youth and the elderly, is significant. Additional consider-
A2.1.2.1 (4) There are several ways to treat domestic water sys-
ation should be given to domestic water used in bone marrow
tems to kill Legionella and opportunistic waterborne pathogens.
transplant units. See CDC and ASHRAE Guideline 12, “Minimizing
Complete removal of these organisms is not feasible, but methods
the Risk of Legionellosis Associated with Building Water Systems,”
to reduce the amount include hyperchlorination (free chlorine,
for additional information. Another reference on this topic is
chlorine dioxide, monochloramine), elevated hot water tempera-
“Legionella Control in Health Care Facilities,” available from the
ture, ozone injection, silver/copper ions, and ultraviolet light.
American Society of Plumbing Engineers.
Each of these options has advantages and disadvantages. While
(1) Materials. The material used for plumbing fix- (1) If duct lining is used, it shall be coated and sealed
tures shall be nonabsorptive and acid-resistant. and shall meet ASTM C1071.
(2) Clearances. Water spouts used in lavatories and (2) These linings (including coatings, adhesives, and
sinks shall have clearances adequate to avoid con- exterior surface insulation on pipes and ducts in
taminating utensils and the contents of carafes, etc. spaces used as air supply plenums) shall have a
flame-spread rating of 25 or less and a smoke-
2.1.3.2 Hand-washing stations. General hand-washing developed rating of 50 or less, as determined by
stations used by medical and nursing staff, patients, an independent testing laboratory in accordance
and food handlers shall be trimmed with valves that with NFPA 255.
can be operated without hands. Single-lever or wrist
blade devices shall be permitted. Blade handles used (3) Duct linings exposed to air movement shall
for this purpose shall not exceed 4-1/2 inches (11.43 not be used in ducts serving operating rooms,
centimeters) in length. delivery rooms, LDR rooms, nurseries, protective
environment rooms, and critical care units. This
2.1.3.3 Showers and tubs. Showers and tubs shall have requirement shall not apply to mixing boxes and
nonslip walking surfaces. sound attenuators that have special coverings
over such lining.
2.1.3.4 Ice machines. Copper tubing shall be provided
for supply connections to ice machines. (4) Duct lining shall not be installed within 15 feet
(4.57 meters) downstream of humidifiers.
2.2 Heating, Ventilating, and Air-Conditioning
(HVAC) Systems (5) Renovation. If existing lined ductwork is
reworked in a renovation project, the liner seams
2.2.1 Thermal Insulation and Acoustical Provisions and punctures shall be resealed.
2.2.1.1 General. Insulation shall be provided within the
building to conserve energy, protect personnel, prevent 2.2.2 HVAC Air Distribution
vapor condensation, and reduce noise. 2.2.2.1 HVAC ductwork
(1) General
(1) Vapor barrier. Insulation on cold surfaces shall
include an exterior vapor barrier. (Material that (a) Air-handling duct systems shall be designed
will not absorb or transmit moisture will not with accessibility for duct cleaning and shall
require a separate vapor barrier.) meet the requirements of NFPA 90A.
(2) Flame-spread rating. Insulation, including (b) When smoke partitions are required, heating,
finishes and adhesives on the exterior surfaces ventilating, and air conditioning zones shall
of ducts, piping, and equipment, shall have a be coordinated with compartmentation
flame-spread rating of 25 or less and a smoke- insofar as practical to minimize the need
developed rating of 50 or less as determined by to penetrate fire and smoke partitions.
an independent testing laboratory in accordance
with NFPA 255. *(2) Duct humidifiers
(3) Renovation. Existing accessible insulation within (a) If duct humidifiers are located upstream of
areas of facilities to be modernized shall be the final filters, they shall be at least 15 feet
inspected, repaired, and/or replaced, as appropriate. (4.57 meters) upstream of the final filters.
(b) Ductwork with duct-mounted humidifiers (e) Dampers shall be activated in accordance with
shall have a means of water removal. NFPA 90A. Installation of switching systems
for restarting fans shall be permitted for fire
(c) An adjustable high-limit humidistat shall department use in venting smoke after a fire
be located downstream of the humidifier to has been controlled. Provisions to avoid possi-
reduce the potential for condensation inside ble damage to the system due to closed
the duct. dampers shall be permitted.
(d) Humidifiers shall be connected to airflow (4) Construction requirements. Ducts that penetrate
proving switches that prevent humidification construction intended to protect against x-ray,
unless the required volume of airflow is pres- magnetic, RFI, or other radiation shall not impair
ent or high-limit humidistats are provided. the effectiveness of the protection.
(e) All duct takeoffs shall be sufficiently down- 2.2.3 Steam and Hot Water Systems
stream of the humidifier to ensure complete 2.2.3.1 Boilers
moisture absorption.
(1) Capacity. Boilers shall have the capacity, based
(f) Steam humidifiers shall be used. Reservoir- upon the net ratings published by the Hydronics
type water spray or evaporative pan humidi- Institute or another acceptable national standard,
fiers shall not be used. to supply the normal heating, hot water, and
steam requirements of all systems and equip-
(3) Fire and smoke dampers ment. Their number and arrangement shall
accommodate facility needs despite the break-
(a) Fire and smoke dampers shall be construct- down or routine maintenance of any one boiler.
ed, located, and installed in accordance with The capacity of the remaining boiler(s) (reserve
the requirements of NFPA 101, 90A, and the capacity) shall be sufficient to provide hot water
specific damper’s listing requirements. service for clinical, dietary, and patient or resi-
dent use; steam for sterilization and dietary pur-
(b) Fans, dampers, and detectors shall be inter- poses; and space heating for operating, delivery
connected so that damper activation will not and birthing, labor, recovery, nurseries, and
damage ducts. intensive care.
(c) Maintenance access shall be provided at all (2) Space heating requirements. Reserve capacity for
dampers. facility space heating is not required in geographic
areas where a design dry-bulb temperature of
(d) All damper locations shall be shown on 25o F (-4o C) or more represents not less than
design drawings. 99 percent of the total hours in any one heating
month as noted in the ASHRAE Handbook—
APPENDIX Fundamentals, under the “Table for Climatic
Conditions for the United States.”
A2.2.2.1 (2) One way to achieve basic humidification may be
by a steam-jacketed manifold-type humidifier with a condensate 2.2.3.2 Boiler accessories. These, including feed
separator that delivers high-quality steam. Additional booster pumps, heat-circulating pumps, condensate return
humidification (if required) should be provided by steam-jacketed pumps, fuel oil pumps, and waste heat boilers, shall be
humidifiers for each individually controlled area. Steam to be connected and installed to provide both normal and
used for humidification may be generated in a separate steam standby service.
generator. The steam generator feedwater may be supplied either
from soft or reverse osmosis water. Provisions should be made
for periodic cleaning.
2.3.1 Lighting
*2.3.1.1 General
APPENDIX
A2.3.1.1 Light intensity for staff and patient needs should gener-
ally comply with health care guidelines set forth in the IES publi-
cations referenced in Section 1.6-2.3.1.1. Consideration should
be given to controlling intensity and/or wavelength to prevent
harm to the patient's eyes (i.e., retina damage to premature
infants and cataracts due to ultraviolet light).
1 General Considerations for service delivery vehicles and vehicles utilized for
emergency patients.
1.1 Applicability
The general hospital shall meet all the standards 2 Common Elements
described herein. Deviations shall be described and
justified in the functional program for specific 2.1 General
approval by authorities having jurisdiction. The spaces included in this section are common to
most hospital facilities and shall be required for a
1.2 Functional Program specific hospital unit or location when specified in
For each project, there shall be a functional program the Guidelines text for that unit or location.
for the facility in accordance with Section 1.2-2.
2.2 Patient Rooms or Care Areas
1.2.1 Size and Layout
Department size and clear floor areas shall depend on 2.2.1 Toilet Rooms
program requirements and organization of services Each patient shall have access to a toilet room without
within the hospital. Combination or sharing of some having to enter a general corridor area.
functions shall be permitted provided the layout does
not compromise safety standards and medical and 2.2.1.1 One toilet room shall serve no more than two
nursing practices. patient rooms and no more than four beds.
*1.2.2 Swing Beds 2.2.1.2 The toilet room shall contain a water closet and
When the concept of swing beds is part of the func- a hand-washing station.
tional program, care shall be taken to include require-
ments for all intended categories. 2.2.1.3 Toilet room doors shall swing outward or be
double acting. Where local requirements permit, use
1.3 Site of folding doors shall be permitted, provided adequate
provisions are made for acoustical and visual privacy.
*1.3.1 Parking
1.3.1.1 Each new facility, major addition, or major 2.2.2 Patient Storage Locations
change in function shall have parking space to satisfy Each patient shall have within his or her room a sepa-
the needs of patients, personnel, and the public. rate wardrobe, locker, or closet suitable for hanging
full-length garments and for storing personal effects.
1.3.1.2 A formal parking study is desirable. In the
absence of such a study, provide one space for each APPENDIX
bed plus one space for each employee normally pres-
ent on any single weekday shift. This ratio may be A1.2.2 Swing Beds
reduced in an area convenient to public transportation Facility design for swing beds often requires additional corridor
or public parking facilities, or where carpool or other doors and provisions for switching nurse call operations from one
arrangements to reduce traffic have been developed. nurse station to another depending on use.
A1.3.1 Parking
1.3.1.3 Additional parking may be required to accom-
A formal parking/traffic study should be conducted to ensure that
modate outpatient and other services.
adequate parking and traffic flow is provided to accommodate
inpatients, outpatients, staff, and visitors.
1.3.1.4 Separate and additional space shall be provided
2.3 Support Areas for Patient Care 2.3.4.2 Self-contained medicine dispensing unit
2.3.1 Administrative Center or Nurse Station (1) Location of a self-contained medicine dispensing
2.3.1.1 This area shall have space for counters and unit shall be permitted at the nurse station, in the
storage and shall have convenient access to hand- clean workroom, or in an alcove, provided the
washing stations. unit has adequate security for controlled drugs
and adequate lighting to easily identify drugs.
2.3.1.2 This area may be combined with or include
centers for reception and communication. (2) Convenient access to hand-washing stations shall
be provided. (Standard cup-sinks provided in
2.3.2 Documentation Area many self-contained units are not adequate for
Charting facilities shall have linear surface space ade- hand-washing.)
quate to ensure that staff and physicians can chart and
have simultaneous access to information and commu- 2.3.5 Nourishment Area
nication systems. 2.3.5.1 A nourishment area shall have a sink, work
counter, refrigerator, storage cabinets, and equipment
2.3.3 Multipurpose Room for hot and cold nourishment between scheduled
Multipurpose rooms are provided for staff, patients, meals. This area shall include space for trays and
and patients’ families for patient conferences, reports, dishes used for nonscheduled meal service.
education, training sessions, and consultation.
2.3.5.2 Provisions and space shall be included for sepa-
2.3.3.1 These rooms shall be accessible to each nursing rate temporary storage of unused and soiled dietary
unit. trays not picked up at mealtime.
2.3.3.2 These rooms may be on other floors if conven- 2.3.5.3 Hand-washing stations shall be in or immedi-
ient for regular use. ately accessible from the nourishment area.
2.3.3.3 One such room shall be permitted to serve 2.3.6 Ice Machine
several nursing units and/or departments. 2.3.6.1 Ice-making equipment may be in the clean
workroom/holding room or at the nourishment station.
2.3.4 Medication Station
Medication shall be distributed from a medicine 2.3.6.2 Ice intended for human consumption shall be
preparation room or unit, from a self-contained medi- from self-dispensing ice makers.
cine dispensing unit, or by another approved system.
2.3.7 Clean Workroom or Clean Supply Room
2.3.4.1 Medicine preparation room Such rooms shall be separate from and have no direct
(1) This room shall be under visual control of the connection with soiled workrooms or soiled holding
nursing staff. rooms.
(2) This room shall contain a work counter, a hand- 2.3.7.1 Clean workroom. If the room is used for
washing station, a lockable refrigerator, and preparing patient care items, it shall contain a work
locked storage for controlled drugs. counter, a hand-washing station, and storage facilities
for clean and sterile supplies.
(3) When a medicine preparation room is to be used
to store one or more self-contained medicine- 2.3.7.2 Clean supply room. If the room is used only for
dispensing units, the room shall be designed with storage and holding as part of a system for distribution
adequate space to prepare medicines with the self- of clean and sterile materials, omission of the work
contained medicine-dispensing unit(s) present. counter and hand-washing station shall be permitted.
2.3.8 Soiled Workroom or Soiled Holding Room direct control of the nursing staff, such as a cardiopul-
Such rooms shall be separate from and have no direct monary resuscitation (CPR) cart. This space shall be
connection with clean workrooms or clean supply located in an area appropriate to the functional pro-
rooms. gram but out of normal traffic.
2.3.8.1 Soiled workrooms. These shall contain the 2.3.10 Housekeeping Room
following: 2.3.10.1 Housekeeping rooms shall be directly accessi-
ble from the unit or floor they serve and may serve
(1) A clinical sink (or equivalent flushing-rim fixture) more than one nursing unit on a floor.
and a hand-washing station. Both fixtures shall
have a hot and cold mixing faucet. 2.3.10.2 In nursing locations, at least one housekeep-
ing room per floor shall contain a service sink or floor
(2) A work counter and space for separate covered receptor and provisions for storage of supplies and
containers for soiled linen and a variety of waste housekeeping equipment.
types.
2.4 Support Areas for Staff
2.3.8.2 Soiled holding rooms. Omission of the clinical
sink and work counter shall be permitted in rooms 2.4.1 Staff Lounge Facilities
used only for temporary holding of soiled material. If Lounge facilities shall be sized per the functional
the flushing-rim clinical sink is not provided, facilities program but shall not be less than 100 square feet
for cleaning bedpans shall be provided elsewhere. (9.29 square meters).
3.1.1 Typical Patient Rooms square meters) of clear floor area in single-bed
Each patient room shall meet the following standards: rooms, exclusive of toilet rooms, closets, lockers,
wardrobes, alcoves, or vestibules.
3.1.1.1 Capacity
(2) Dimensions and clearances. The dimensions and
(1) In new construction, the maximum number of arrangement of rooms shall be such that there is a
beds per room shall be one unless the functional minimum of 3 feet (91.44 centimeters) between the
program demonstrates the necessity of a two-bed sides and foot of the bed and any wall or any other
arrangement. Approval of a two-bed arrangement fixed obstruction. In multiple-bed rooms, a clear-
shall be obtained from the licensing authority. ance of 4 feet (1.22 meters) shall be available at the
foot of each bed to permit the passage of equip-
(2) Where renovation work is undertaken and the ment and beds. (See “bed size” in the glossary.)
present capacity is more than one patient, maxi-
mum room capacity shall be no more than the (3) Renovation. Where renovation work is undertak-
present capacity, with a maximum of four en, every effort shall be made to meet the above
patients. minimum standards. If it is not possible to meet
the above minimum standards, the authorities
3.1.1.2 Space requirements. Minor encroachments, having jurisdiction shall be permitted to grant
including columns and hand-washing stations, that approval to deviate from this requirement. In
do not interfere with functions may be ignored when such cases, patient rooms shall have no less than
determining space requirements for patient rooms. 80 square feet (7.43 square meters) of clear floor
area per bed in multiple-bed areas and 100 square
*(1) Area. In new construction, patient rooms shall be feet (9.29 square meters) of clear floor area in sin-
constructed to meet the needs of the functional gle-bed rooms exclusive of the spaces previously
program and have a minimum of 100 square feet noted in this section.
(9.29 square meters) of clear floor area per bed in
multiple-bed rooms and 120 square feet (11.15 *3.1.1.3 Windows. Each patient room shall have a win-
dow in accordance with Section 2.1-8.2.2.5.
APPENDIX
3.1.1.4 Patient privacy. In multiple-bed rooms, visual
A3.1.1.2 (1) In new construction, single patient rooms should privacy from casual observation by other patients and
be at least 12 feet (3.66 meters) wide by 13 feet (3.96 meters) visitors shall be provided for each patient. The design
deep (or approximately 160 square feet, or 14.86 square meters) for privacy shall not restrict patient access to the
exclusive of toilet rooms, closets, lockers, wardrobes, alcoves, or entrance, hand-washing station, or toilet.
vestibules. These spaces should accommodate comfortable furni-
ture for family members (one or two) without blocking access of *3.1.1.5 Hand-washing stations. These shall be provided
staff members to patients. Efforts should be made to provide to serve each patient room.
the patient with some control of the room environment.
(1) A hand-washing station shall be located in the
A3.1.1.3 Windows are important for the psychological well-being
toilet room.
of many patients, as well as for meeting fire safety code require-
ments. They are also essential for continued use of the area in
(2) A hand-washing station shall be provided in
the event of mechanical ventilation system failure.
the patient room in addition to that in the toilet
A3.1.1.5 Where renovation work is undertaken, every effort room. This shall be located outside the patient’s
should be made to meet this standard. Where space does not cubicle curtain and convenient to staff entering
permit the installation of an additional hand-washing station in and leaving the room.
the patient room, or where it is technically infeasible, the authority
having jurisdiction may grant approval of alternative forms of hand (3) A hand sanitation station in patient rooms utiliz-
cleansing. ing waterless cleaners may be used in renovation
of existing facilities where existing conditions 3.1.5 Support Areas for Medical/Surgical Nursing Units
prohibit an additional hand-washing station. *3.1.5.1 Administrative center(s) or nurse station(s).
This area shall be provided in accordance with Section
3.1.1.6 Toilet rooms. Toilet rooms shall be provided in 2.1-2.3.1.
accordance with Section 2.1-2.2.1.
3.1.5.2 Documentation area. This area shall be provided
3.1.1.7 Patient storage locations. Patient storage shall on the unit in accordance with Section 2.1-2.3.2.
be provided in accordance with Section 2.1-2.2.2.
3.1.5.3 Nurse or supervisor office
*3.1.2 Patient/Family-Centered Care Rooms
*3.1.5.4 Multipurpose room(s). Room(s) shall be
3.1.3 Examination/Treatment Room(s) provided for patient conferences, reports, education,
Omission of such rooms shall be permitted if all patient training sessions, and consultation in accordance with
rooms in the nursing unit are single-bed rooms. Section 2.1-2.3.3.
(2) If it is convenient to each, one hand-washing 3.1.5.12 Equipment and supply storage
station shall be permitted to serve several areas.
(1) Clean linen storage. Each nursing unit shall con-
3.1.5.6 Medication station. Provision shall be made for tain a designated area for clean linen storage in
distribution of medications in accordance with accordance with Section 2.1-2.3.9.1.
Section 2.1-2.3.4.
(2) Equipment storage room or alcove. Appropriate
3.1.5.7 Nourishment area. This area shall be provided room(s) or alcove(s) shall be provided in accor-
in accordance with Section 2.1-2.3.5. dance with Section 2.1-2.3.9.2.
3.1.5.8 Ice machine. Each nursing unit shall have (3) Storage space for stretchers and wheelchairs. Space shall
equipment to provide ice for treatments and nourish- be provided in accordance with Section 2.1-2.3.9.3.
ment. Ice-making equipment shall be provided in
accordance with Section 2.1-2.3.6. (4) Emergency equipment storage. Storage shall be
provided for emergency equipment in accordance
3.1.5.9 Patient bathing facilities with Section 2.1-2.3.9.4.
A3.1.5.13 A storage or bin space should be included for recyclable (3) This lounge shall provide comfortable seating.
materials: white paper, mixed paper, cans, bottles, and cardboard.
(4) This lounge shall be designed to minimize the that purpose. This process ensures a more accurate
impact of noise and activity on patient rooms and determination of environmentally safe and appropri-
staff functions. ate room types and spatial needs. Special ventilation
requirements are found in Table 2.1-2.
3.1.7.2 Toilet room(s). A toilet room(s) with hand-
washing station shall be located convenient to multi- 3.2.2.2 Location. Airborne infection isolation rooms
purpose room(s). may be located within individual nursing units and
used for normal acute care when not required for
(1) Patient use. If the functional program calls for the patients with airborne infectious diseases, or they
toilet rooms(s) to be for patient use, it shall be may be grouped as a separate isolation unit.
designed/equipped for patient use.
3.2.2.3 Capacity. Each room shall contain only one bed.
(2) Public use. If called out in the functional pro-
gram, the toilet room(s) serving the multipurpose 3.2.2.4 Facility requirements. Each airborne infection
rooms(s) may also be designated for public use. isolation room shall comply with the acute care
patient room section (Section 2.1–3.1.1) of this
3.2 Special Patient Care Areas document as well as the following requirements:
3.2.1 Applicability (1) Each room shall have an area for hand-washing,
As designated by the functional program, both air- gowning, and storage of clean and soiled materi-
borne infection isolation and protective environment als located directly outside or immediately inside
rooms may be required. Many facilities care for the entry door to the room.
patients with an extreme susceptibility to infection
(e.g., immunosuppressed patients with prolonged (2) Construction requirements
granulocytopenia, most notably bone marrow recipi-
ents, or solid-organ transplant recipients and patients (a) Airborne infection isolation room perimeter
with hematological malignancies who are receiving walls, ceiling, and floors, including penetra-
chemotherapy and are severely granulocytopenic). tions, shall be sealed tightly so that air does
These rooms are not intended for use with patients not infiltrate the environment from the out-
diagnosed with HIV infection or AIDS, unless they side or from other spaces. (See Glossary.)
are also severely granulocytopenic. Generally, protec-
tive environments are not needed in community (b) Airborne infection isolation room(s) shall have
hospitals, unless these facilities take care of these self-closing devices on all room exit doors.
types of patients.
(3) Separate toilet, bathtub (or shower), and hand-
*3.2.2 Airborne Infection Isolation Room(s) washing stations shall be provided for each air-
The airborne infection isolation room requirements borne infection isolation room.
contained in these Guidelines for particular areas
throughout a facility should be predicated on an infec- *(4) Rooms shall have a permanently installed visual
tion control risk assessment (ICRA) and based on the mechanism to constantly monitor the pressure
needs of specific community and patient populations
served by an individual health care provider APPENDIX
(see Glossary and Section 1.5–2.3).
A3.2.2 For additional information, refer to the Centers for Disease
3.2.2.1 Number. At least one airborne infection Control and Prevention (CDC) “Guidelines for Preventing the
isolation room shall be provided in the hospital. The Transmission of Mycobacterium tuberculosis in Health Care
number of airborne infection isolation rooms for indi- Facilities” as they appear in the Federal Register dated October
vidual patient units shall be increased based upon an 28, 1994, and to the CDC “Guidelines for Environmental Infection
ICRA or by a multidisciplinary group designated for Control in Health-Care Facilities,” December 2003.
status of the room when occupied by patients 3.2.3.4 Capacity. Protective environment rooms shall
with an airborne infectious disease. The mecha- contain only one bed.
nism shall continuously monitor the direction of
the airflow. 3.2.3.5 Facility requirements. Protective environment
rooms shall comply with Section 2.1-3.2.2. Special
*3.2.3 Protective Environment Room(s) ventilation requirements are found in Table 2.1-2.
The differentiating factor between protective
environment rooms and other patient rooms is (1) Each protective environment room shall have an
the requirement for positive air pressure relative area for hand-washing, gowning, and storage of
to adjoining spaces, with all supply air passing clean and soiled materials located directly outside
through high-efficiency particulate air (HEPA) filters or immediately inside the entry door to the room.
with 99.97 percent efficiency for particles > 0.3 µm
in diameter. (2) Patient bathing and toilet facilities. Separate toilet,
bathtub (or shower), and hand-washing stations
3.2.3.1 Applicability. When determined by an ICRA, shall be directly accessible from each protective
special design considerations and ventilation to ensure environment room.
the protection of patients who are highly susceptible
to infection shall be required. (3) Monitoring equipment. Rooms shall have a per-
manently installed visual mechanism to constantly
3.2.3.2 Functional program. The appropriate clinical monitor the pressure status of the room when
staff shall be consulted regarding room type, and spatial occupied by patients requiring a protective envi-
needs to meet facility infection control requirements ronment. The mechanism shall continuously
shall be incorporated into the functional program. monitor the direction of the airflow.
3.2.3.3 Number and location. The appropriate num- (4) Construction requirements
bers and location of protective environment rooms
shall be as required by the ICRA. (a) Protective environment room perimeter walls,
ceiling, and floors, including penetrations,
APPENDIX
A3.2.2.4 (4) In general, reliance on a substantial pressure differ- A3.2.3 Immunosuppressed host airborne infection isolation
ential (> 0.01"wg/12.5Pa) will maintain the appropriate direc- (protective environment/airborne infection isolation)
tional airflow with or without an anteroom. The anteroom concept
a. Having a protective environment is not a minimum require-
should remain an option (i.e., not required).
ment. Facilities with protective environment rooms should
a. Anterooms, in general, should be designed to meet local fire include at least one immunosuppressed host airborne infection
safety code as well as to prevent air from the patient room from isolation room.
escaping to the corridor or other common areas.
b. An anteroom is required for the special case in which an
b. In addition to the concept of containment of airborne microor- immunosuppressed patient requires airborne infection isolation.
ganisms, anterooms may appropiately be used for storage of See Section 2.1-3.2.1 for more information.
personal protective equipment (PPE) (e.g., respirators, gowns,
c. There is no prescribed method for anteroom ventilation—the
gloves), clean equipment, and hand hygiene.
room can be ventilated with either of the following airflow patterns:
c. In ganged anterooms (two patient rooms with a common ante- (1) airflows from the anteroom, to the patient room and the corri-
room), it may be difficult to maintain directional airflow and pres- dor, or (2) airflows from the patient room and the corridor, into the
sure differential intended to avoid contamination from one room anteroom. The advantage of pattern (1) is the provision for a clean
to the other through the anteroom. The design, installation, and anteroom in which health care workers need not mask before
monitoring of ventilation systems in such configurations is of entering the anteroom.
utmost importance.
shall be sealed tightly so that air does not 3.2.4 Seclusion Room(s)
infiltrate the environment from the outside 3.2.4.1 Applicability. If indicated by the functional
or from other spaces. program, the hospital shall provide one or more sin-
gle-bed rooms for patients needing close supervision
(b) Protective environment room(s) shall have for medical and/or psychiatric care.
self-closing devices on all room exit doors.
3.2.4.2 Location. These rooms may be part of the
(5) Renovation. See references to protective environ- psychiatric unit described in Section 2.1-3.8.
ment rooms during renovation and construction
in Section 1.5–2.2. 3.2.4.3 Facility requirements. If the single-bed
room(s) is part of the acute care nursing unit, the
*3.2.3.6 Bone marrow transplant units. Rooms in allo- provisions of Section 2.1-3.8.2 shall apply, with the
geneic bone marrow transplant units shall be designed following exceptions:
to meet specific patient needs.
(1) Each room shall be for single occupancy.
APPENDIX
A3.2.3.6 Bone marrow transplant facilities e. Patients should be housed in single-bed rooms with full-height
General space and staffing requirements are critical for bone mar- partitions, sealed airtight to the structure to prevent cross-infections.
row transplant facilities. Patients in these units may be acutely
f. All surfaces, floors, walls, ceilings, doors, windows, and curtains
aware of the surrounding environment, which is their life support
in the patient room should be scrubbable.
system during the many weeks they are confined in an immuno-
suppressed condition. Means of controlling unnecessary noise are g. Windows should be provided so that each patient may be cog-
important. At times, each patient may require individual privacy, nizant of the outdoor environment. Windowsill height should not
although each is required to be under close staff supervision. exceed 3 feet (0.91 meter) above the floor and should be above
grade. All windows in the unit should be fixed sash and sealed to
a. Location. Bone marrow transplant rooms should be located
eliminate infiltration.
to have access within the hospital to out-of-unit diagnostic and
treatment equipment, particularly radiation therapy equipment. h. Viewing panels should be provided in doors or walls for nursing
staff observation. Flame-retardant curtains or other means should
b. All bone marrow transplant-designated beds should be in
be provided to cover windows and viewing panels when a patient
exceptionally clean environments, which should consist of protec-
requires visual privacy. Glazing should be safety glass, wire glass, or
tive environment rooms equipped with HEPA filtration, preferably
tempered clear plastic to reduce hazards from accidental breakage.
located close to each other.
i. Nurse and emergency call systems. Each patient room should
c. A countertop with scrub sink and space for high-level disinfec-
be provided with a nurse call system accessible at the bed, sitting
tion procedures should be available outside the entrance to each
area, and patient toilet room. An emergency call system should
patient room when located within the nursing unit or at each
also be provided at each patient bed and toilet room to summon
entrance to a dedicated bone marrow transplant room. A hand-
additional personnel from on-call rooms, consultation rooms, and
washing station should be accessible near the entrance to each
staff lounges.
patient room within a dedicated bone marrow transplant unit.
j. Facilities for administration of suction, compressed air, and oxy-
d. Toilet and bathing facilities. Each bone marrow transplant
gen should be provided at the bed.
patient room should have a private toilet room, which contains
a water closet and a bathing facility, for the exclusive use of the k. Staff and visitor support areas. Each geographically distinct unit
patient. The patient should be able to enter the room directly should provide appropriate space to support nurses’ administrative
without leaving the patient room or passing through the vestibule. activities, report/conference room activities, doctors’ consultation,
The patient should also have a lavatory for the patient’s exclusive drug preparation and distribution, emergency equipment storage,
use, located in the patient room or the private toilet room. and closed accessible waiting for family members.
(2) Each room shall be located to permit staff beds shall be permitted to constitute a separate unit or
observation of the entrance, preferably adjacent to be a designated part of another unit.
the nurse station.
3.3.1.4 Nurse management space. There shall be a sep-
(3) Each room shall be designed to minimize the arate physical area devoted to nursing management for
potential for escape, concealment, injury, or suicide. the care of the intermediate patient.
(4) If vision panels are used for observation of patients, 3.3.2 Patient Rooms
the arrangement shall ensure patient privacy and pre- The following shall apply to all intermediate care units
vent casual observation by visitors and other patients. unless otherwise noted.
3.3.1.2 Applicability. These standards shall apply to (2) Clearances. In new construction, the dimensions and
adult beds designated to provide intermediate care, arrangement of rooms shall be such that there is a
but not pediatric or neonatal intermediate care. minimum clearance of 4 feet (1.22 meters) between
the sides of the beds and other beds, walls, or fixed
3.3.1.3 Location. In hospitals that provide intermediate obstructions. A minimum clearance of 4 feet (1.22
care, beds shall be designated for this purpose. These meters) shall be available at the foot of each bed to
permit the passage of equipment and beds.
APPENDIX
(3) Renovation. Where renovation work is undertaken,
A3.2.5 Protected Units every effort shall be made to meet these standards.
The purpose of this section is to lend guidance in the design of If it is not possible to meet these minimum stan-
units that by their very nature require a protected environment for dards, the authorities having jurisdiction may
the treatment and care of their patients. The following units fall grant approval to deviate from this requirement.
within this intended guidance, although this list is not inclusive: In such cases, patient rooms shall have no less
transplant units, burn units, nurseries, units for immunosuppressed than 100 square feet (9.29 square meters) of clear
populations, and neonatal intensive care units. Portions of emer- floor area per bed in multiple-bed rooms and 120
gency departments where the initial triage occurs may be incorpo- square feet (11.15 square meters) of clear floor
rated as part of the triage service while an assessment of potential area in single-bed rooms.
infection and contamination is made prior to processing the sus-
pected patient. Consideration for appropriate pressurization and 3.3.2.3 Windows. Each patient room shall have a
air exchange rates to control contamination should be addressed. window in accordance with Section 2.1-8.2.2.5.
3.3.2.4 Patient privacy. In multiple-bed rooms, visual with the requirements of Section 2.1-3.2.2. Special
privacy shall be provided for each patient. The design ventilation requirements are found in Table 2.1-2.
for privacy shall not restrict patient access to the room
entrance, lavatory, toilet, or room windows. 3.3.4 Support Areas—General
3.3.4.1 Provision for the support areas listed below
3.3.2.5 Nurse call systems. Nurse call systems for two- shall be in or readily available to each intermediate
way voice communication shall be provided in accor- care unit.
dance with Section 2.1-10.3.8. The call system for the
unit shall include provisions for an emergency code 3.3.4.2 The size and location of each staff support area
resuscitation alarm to summon assistance from out- shall depend upon the numbers and types of beds
side the intermediate care unit. served.
3.3.2.6 Hand-washing stations. These shall be provided 3.3.4.3 Identifiable spaces are required for each of the
to serve each patient room. indicated functions. Where the words “room” or
“office” are used, a separate, enclosed space for the one
(1) In new construction and renovation, a hand- named function is intended; otherwise, the described
washing station shall be provided in the patient area may be a specific space in another room or com-
room in addition to that in the toilet room. mon area.
(2) The hand-washing station in the patient room 3.3.4.4 Services shared with adjacent units shall be
shall be located outside the patient’s cubicle permitted.
curtain so it is convenient to staff entering and
leaving the room. 3.3.5 Support Areas for Intermediate Care Units
3.3.5.1 Administrative center or nurse station
3.3.2.7 Toilet rooms. Toilet rooms shall be provided in
accordance with Section 2.1-2.2.1. (1) An administrative center or nurse station shall be
provided in accordance with Section 2.1-2.3.1.
3.3.2.8 Bathing facilities. Patients shall have access to
bathing facilities within their rooms or in a central (2) There shall be direct or remote visual observation
bathing facility. between the administrative center or nurse station,
staffed charting stations, and all patient beds in
(1) Each shower or bathtub in a central bathing facility the unit.
shall be in an individual room or enclosure that
provides privacy for bathing, drying, and dressing. 3.3.5.2 Documentation area. This area shall be
provided within the patient unit in accordance with
(2) A water closet and lavatory in a separate enclosure Section 2.1-2.3.2.
shall be directly accessible to each central bathing
facility. 3.3.5.3 Medication station. Provision shall be made for
24-hour distribution of medications in accordance
3.3.2.9 Patient storage. Storage locations for patient with Section 2.1-2.3.4.
use shall be provided in accordance with Section
2.1-2.2.2. 3.3.5.4 Hand-washing stations
3.3.3 Airborne Infection Isolation Room (1) In nursing locations, hand-washing stations shall
Access to at least one airborne infection isolation be conveniently accessible to the nurse station,
room shall be provided unless provided elsewhere in medication station, and nourishment area.
the facility. The number of airborne infection isolation
rooms shall be determined on the basis of an infection (2) If it is convenient to each, one hand-washing
control risk assessment (ICRA). Each room shall comply station shall be permitted to serve several areas.
3.3.5.5 Nourishment area. There shall be a nourish- 3.3.6.2 Staff toilet room(s). These shall be provided in
ment area with a work counter, a hand-washing station, accordance with Section 2.1-2.4.2.
a refrigerator, storage cabinets, and equipment for
preparing and serving hot and cold nourishments 3.3.6.3 Staff storage facilities. Storage facilities for per-
between scheduled meals. sonal use of the staff shall be provided in accordance
with Section 2.1-2.4.3.
3.3.5.6 Ice machine. A self-dispensing ice machine
shall be provided to supply ice for treatments and 3.4 Critical Care Units
nourishment.
3.4.1 General Considerations
3.3.5.7 Clean workroom or clean supply room. This 3.4.1.1 Applicability
room shall be provided in accordance with Section
2.1-2.3.7. (1) The following standards are intended for typical
critical care services. Design of critical care units
3.3.5.8 Soiled workroom or soiled holding room. This shall comply with these standards and shall be
room shall be provided in accordance with Section appropriate to the needs of the functional program.
2.1-2.3.8.
(2) Where specialized services are required, additions
3.3.5.9 Equipment and supply storage and/or modifications shall be made as necessary
for efficient, safe, and effective patient care.
(1) Equipment storage room. An equipment storage
room shall be provided for storage of equipment 3.4.1.2 Environment of care. Critical care units require
necessary for patient care. special space and equipment considerations for safe
and effective patient care, staff functions, and family
(a) This room shall be permitted to serve more participation. Families and visitors to critical care
than one unit. units often wait for long periods, including overnight,
under highly stressful situations. They tend to congre-
(b) Each unit shall provide sufficient storage gate at unit entries to be readily accessible to staff
area(s) located on the patient floor to keep interaction. Clinical personnel perform in continously
its required corridor width free of all equip- stressful circumstances over long hours. Often they
ment and supplies, but not less than 20 cannot leave the critical care unit, necessitating space
square feet (1.86 square meters) per patient and services to accommodate their personal and staff
bed shall be provided. group needs in close proximity to the unit. Design
shall address such issues as privacy, atmosphere, and
(2) Emergency equipment storage. This shall be aesthetics for all involved in the care and comfort of
provided in accordance with Section 2.1-2.3.9.4. patients in critical care units.
3.3.5.10 Housekeeping room. This room shall be 3.4.1.3 Functional program. Not every hospital will pro-
provided in accordance with Section 2.1-2.3.10. vide all types of critical care. Some hospitals may have a
small combined unit; others may have separate, sophis-
3.3.6 Support Areas for Staff ticated units for highly specialized treatments. Critical
3.3.6.1 Staff lounge facilities. Staff lounge facilities care units shall comply in size, number, and type with
shall be provided in accordance with Section 2.1-2.4.1. these standards and with the functional program.
(1) The location of these facilities shall be convenient 3.4.1.4 Unit location. The following shall apply to all
to the intermediate care unit. types of critical care units unless otherwise noted.
(2) These facilities may be shared with other nursing (1) The location shall offer convenient access from
unit(s). the emergency, respiratory therapy, laboratory,
radiology, surgery, and other essential departments (a) Separate rooms or cubicles for single patient
and services as defined by the functional program. use shall be no less than 150 square feet
(13.94 square meters).
(2) The unit shall be located so that medical emer-
gency resuscitation teams can respond promptly (b) Multiple-bed space shall contain at least 150
to emergency calls with minimum travel time. square feet (13.94 square meters) of clear
floor area per bed, exclusive of the spaces
(3) Space arrangement shall include provisions for noted for new construction in Section 2.1-
access to emergency equipment from other 3.4.2.1 (1)(a).
departments.
(3) Windows. Each patient bed shall have visual
(4) The location shall be arranged to eliminate the access, other than skylights, to the outside envi-
need for through traffic. ronment, with not less than one outside window
in each patient bed area, in accordance with
*3.4.1.5 Elevator considerations. In new construction, Section 2.1-8.2.2.5.
where elevator transport is required to move critically
ill patients, the size of the cab, door width, and mecha- (4) Privacy
nisms and controls shall meet the specialized needs.
(a) When private rooms or cubicles are provided,
*3.4.2 Critical Care Units (General) view panels to the corridor shall be required
The following shall apply to all types of critical care with a means to ensure visual privacy.
units unless otherwise noted.
(b) Each patient bed area shall have space at each
*3.4.2.1 Patient care areas bedside for visitors and shall have provisions
for visual privacy from casual observation by
(1) Space requirements for new construction other patients and visitors.
(a) Area. Each patient space (whether separate *(5) Nurse call system
rooms, cubicles, or multiple-bed space) shall have
a minimum of 200 square feet (18.58 square
meters) of clear floor area with a minimum
headwall width of 13 feet (3.96 meters) per bed, APPENDIX
exclusive of anterooms, vestibules, toilet rooms,
closets, lockers, wardrobes, and/or alcoves. A3.4.1.5 Transportation of patients to and from the critical care
unit should ideally be separated from public corridors and visitor
(b) Clearances. Bed clearances for all adult and waiting areas.
pediatric units shall be a minimum of 5 feet
A3.4.2 Provision should be made for rapid and easily accessible
(1.52 meters) at the foot of the bed to the
information exchange and communication within the unit and the
wall, 5 feet (1.52 meters) on the transfer side,
hospital.
4 feet (1.22 meters) on the non-transfer side,
and 8 feet (2.44 meters) between beds. A3.4.2.1 In critical care units, the size of the patient care space
should be determined by the intended functional use. The
(2) Space requirements for renovation. In renovation patient space in critical care units, especially those caring for
of existing critical care units, every effort shall be surgical patients following major trauma or cardiovascular, trans-
made to meet the above minimum standards. If plant, or orthopedic procedures and those caring for medical
it is not possible to meet the above area standards, patients simultaneously requiring ventilation, dialysis, and/or
authorities having jurisdiction may grant approval treatment with other large equipment (e.g., intra-aortic balloon
to deviate from this requirement. In such cases, pump) may be overwhelmed if designed to the absolute mini-
the following standards shall be met: mum clear floor area.
(a) Nurse call systems for two-way voice com- (iii) Where sliding doors are used for access
munication shall be provided in accordance to cubicles within a suite, a 3-foot-wide
with Section 2.1-10.3.8. (91.44 centimeters) swinging door shall be
permitted for personnel communication.
(b) The communication system for the unit shall
include provisions for an emergency code (b) Windows in renovation projects
resuscitation alarm to summon assistance
from outside the critical care unit. (i) Clerestory windows with windowsills
above the heights of adjacent ceilings may
(6) Hand-washing stations be used, provided they afford patients a
view of the outside and are equipped with
(a) Hand-washing stations shall be convenient to appropriate forms of glare and sun control.
nurse stations and patient bed areas.
(ii) Distance from the patient bed to the
(b) There shall be at least one hand-washing outside window shall not exceed 50 feet
station for every three beds in open plan (15.24 meters).
areas and one in each patient room.
(iii) Where partitioned cubicles are used,
(c) The hand-washing station shall be located patients’ view to outside windows shall
near the entrance to the patient cubicle or be through no more than two separate
room, sized to minimize splashing water clear vision panels.
onto the floor, and equipped with hands-free
operable controls. (8) Design criteria for mechanical, electrical, and
plumbing systems. The electrical, medical gas,
(d) Where towel dispensers are provided, they heating, ventilation, and communication services
shall operate so that dispensing requires only shall support the needs of the patients and critical
the towel to be touched. care team members under normal and emergency
situations.
(7) Construction requirements
3.4.2.2 Airborne infection isolation room
(a) Doors
(1) At least one airborne infection isolation room shall
(i) Where only one door is provided to a be provided, unless provided in another critical
bed space, it shall be at least 4 feet (1.22 care unit. The number of airborne infection isola-
meters) wide and arranged to minimize tion rooms shall be determined based on an ICRA.
interference with movement of beds and
large equipment. (2) Each room shall comply with the requirements
of Section 2.1-3.2.2; however, the requirement
(ii) Sliding doors shall not have floor for the bathtub (or shower) may be eliminated.
tracks and shall have hardware or a Compact, modular toilet/sink combination units
breakaway feature that minimizes may replace the requirement for a “toilet room.”
jamming possibilities.
(3) Special ventilation requirements are found in
APPENDIX Table 2.1-2.
A3.4.2.1 (5). A staff emergency assistance system should be pro- 3.4.2.3 Diagnostic, treatment, and service areas
vided on the most accessible side of the bed. The system should
annunciate at the nurse station with backup from another staffed (1) Special procedures room. This shall be provided
area from which assistance can be summoned. if required by the functional program. It may be
located outside the critical care unit if conveniently shall be provided in accordance with Section
accessible. 2.1-2.3.1.
(2) The following shall be available. Provision of (b) Visual observation. There shall be direct or
these services from the central departments or remote visual observation between the
from satellite facilities shall be permitted as administrative center, nurse station, or
required by the functional program. staffed charting stations and all patient beds
in the critical care unit.
(a) Imaging facilities
*(2) Documentation and information review spaces.
(b) Respiratory therapy services Space shall be provided within the unit to accom-
modate the recording of patient information.
(c) Laboratory services
*(a) The documentation space shall be located
(d) Pharmacy services within or adjacent to the patient bed space.
It shall include countertop that will provide
3.4.2.4 Support areas for critical care units. The fol- for a large flow sheet typical of critical care
lowing shall be provided for all types of critical care units and a computer monitor and keyboard.
units unless otherwise noted. There shall be one documentation space with
seating for each patient bed.
*(1) Administrative center or nurse station
*(b) There shall be a specifically designated area
(a) An administrative center or nurse station within the unit for information review located
to facilitate concentration.
APPENDIX
A3.4.2.4 (1). Patients should be visually observed at all times. staff (both medical and nursing) that could be present at any one
This can be achieved in a variety of ways. time and translate that to adequate charting surfaces.
a. If a central station is chosen, it should be located to allow b. The secretarial area should be accessible to all. However, the
for complete visual control of all patient beds in the critical care charting areas may be somewhat isolated to facilitate concentration.
unit. It should be designed to maximize efficiency in traffic pat-
c. Storage for chart forms and supplies should be readily accessible.
terns. Patients should be oriented so that they can see the nurse
but cannot see the other patients. There should be an ability to d. Space for computer terminals and printer and conduit for com-
communicate with the clerical staff without having to enter the puter hookup should be provided when automated information
central station. systems are in use or planned for the future.
b. If a central station is not chosen, the unit should be designed to e. Patient records should be readily accessible to clerical, nursing,
provide visual contact between patient beds so that there can be and physician staff.
constant visual contact between the nurse and patient.
A3.4.2.4 (2)(a). Documentation space. The countertop area
A3.4.2.4 (2). The requirements for documenting patient infor- should be a minimum of 8 square feet (0.74 square meters). If a
mation by providers have become substantial and continue to documentation space is to serve two patient beds, it should be a
grow. A growing number of providers and others review patient minimum of 10 square feet (0.93 square meter).
records in critical care units. Confidentiality of patient informa-
A3.4.2.4 (2)(b). Information review space. There should be a
tion is important. Computers are increasingly used to meet these
minimum of 8 square feet (0.74 square meters) of countertop
expectations.
and seating to accommodate two people for every five patient
a. Separate areas need to be designed for the unit secretary and beds it serves.
staff charting. Planning should consider the potential volume of
*(3) Office space. Adequate office space for critical care and at the nurse station. Monitors shall be located
medical and nursing management/administrative to permit easy viewing and access but shall not
personnel shall be available immediately adjacent interfere with access to the patient.
to the critical care unit. The offices shall be linked
with the unit by telephone or an intercommuni- (7) X-ray viewing facility. The unit shall have an x-ray
cations system. viewing facility, which may be shared by more
than one critical care unit provided direct access
(4) Multipurpose room(s). Multipurpose room(s) is available from each.
shall be provided for staff, patients, and patients’
families for patient conferences, reports, educa- (8) Nourishment area. This area shall be provided in
tion, training sessions, and consultation. These accordance with Section 2.1-2.3.5. It shall be imme-
rooms shall be accessible to each nursing unit. diately available within each critical care suite. More
than one critical care unit shall be permitted to share
*(5) Medication station. Provision shall be made for this area provided direct access is available from each.
24-hour distribution of medications in accor-
dance with Section 2.1-2.3.4. (9) Ice machine. This equipment shall be provided in
accordance with Section 2.1-2.3.6.
*(6) Patient monitoring equipment. Each unit shall
contain equipment for continuous monitoring, (10) Clean workroom or clean supply room.
with visual displays for each patient at the bedside
(a) This room shall be provided in accordance
APPENDIX with Section 2.1-2.3.7.
A3.4.2.4 (3). The offices should be large enough to permit (b) This room shall be immediately available in
consulting with members of the critical care team and visitors. each critical care suite. More than one critical
care unit shall be permitted to share a clean
A3.4.2.4 (5). To minimize distraction of those preparing medica-
workroom or clean supply room provided
tions, the area should be enclosed. A glass wall or walls may be
direct access is available from each.
advisable to permit observation of patients and unit activities. A
self-contained medicine-dispensing unit may be located at the
(11) Soiled workroom or soiled holding room.
nurse station, in the clean workroom, in an alcove, or in another
area directly under visual control of nursing or pharmacy staff.
(a) This room shall be provided in accordance
A3.4.2.4 (6). The unit should provide the ability to continuously with Section 2.1-2.3.8.
monitor the physiological parameters appropriate for the types of
patients the unit is expected to care for. (b) It shall be immediately available in each criti-
cal care suite, but more than one critical care
A3.4.2.4 (12)(b). Equipment storage room or alcove
unit shall be permitted to share the room
a. The location of the equipment storage room or alcove should provided direct access is available from each.
not interfere with the flow of traffic.
(12) Equipment and supply storage
b. Work areas and storage of critical care supplies should be read-
ily accessible to nursing and physician staff.
(a) Clean linen storage. This shall be provided in
c. Shelving, file cabinets, and drawers should be accessible to all accordance with Section 2.1-2.3.9.1. This area
requiring use. shall be immediately available within each
critical care suite. More than one critical care
d. Electrical outlets should be provided in sufficient numbers to
unit shall be permitted to share the room
permit recharging stored battery-operated equipment.
provided direct access is available from each.
e. Alcoves should be provided for the storage and rapid retrieval of
crash carts and portable monitor/defibrillator units. *(b) Equipment storage room or alcove
(i) Appropriate room(s) or alcove(s) shall (d) Adequate furnishings, equipment, and space
be provided in accordance with Section for comfortable seating and the preparation
2.1-2.3.9.2. and consumption of snacks and beverages
shall be provided unless provisions have been
(ii) Each critical care unit shall have suffi- made elsewhere.
cient storage area(s) located on the
patient floor to keep the required corri- (e) One lounge shall be permitted to serve adja-
dor width free of all equipment and sup- cent critical care areas.
plies. No less than 20 square feet (1.86
square meters) per patient bed shall be (2) Staff storage facilities. Facilities for personal use of
provided for equipment storage. staff shall be provided in accordance with Section
2.1-2.4.3.
(c) Wheelchair and stretcher storage. Space to
store stretchers and wheelchairs shall be pro- (3) Staff accommodations. Sleeping and personal care
vided in accordance with Section 2.1-2.3.9.3. accommodations shall be provided for staff on
24-hour, on-call work schedules.
(d) Emergency equipment storage. Space shall
be provided in accordance with Section
2.1-2.3.9.4. 3.4.2.6 Support areas for visitors
The following shall be provided and may be located
(13) Housekeeping room. A housekeeping room shall outside the unit if conveniently accessible.
be provided within or immediately adjacent to the
critical care unit. (1) Visitor waiting room
(a) This room shall not be shared with other (a) This room shall be designed to accommodate
nursing units or departments. the long stays and stressful conditions com-
mon to such spaces, including provisions for
(b) It shall contain a service sink or floor receptor privacy, means to facilitate communications,
and provisions for storage of supplies and and access to toilets.
housekeeping equipment.
(b) The locations and size shall be appropriate
3.4.2.5 Support areas for staff. The following shall for the number of patients and units served,
be provided for all types of critical care units unless with a seating capacity of not less than one
otherwise noted. family member per patient bed.
(1) Staff lounge(s) and toilet(s). The following may be 3.4.3 Coronary Care Unit
located outside the unit if conveniently accessible. Coronary patients have special needs. They are often
fully aware of their surroundings but still need imme-
(a) These shall be located so that staff may diate and critical emergency care. In addition to the
be recalled quickly to the patient area in standards in Section 2.1-3.4.2, the following standards
emergencies. apply to the coronary critical care unit:
(b) The lounge shall have telephone or intercom 3.4.3.1 Each coronary patient shall have a separate
and emergency code alarm connections to room for acoustical and visual privacy.
the critical care unit it serves.
3.4.3.2 Each coronary patient shall have access to a toi-
(c) If not provided elsewhere, provision for let in the room. Portable commodes shall be permitted
the storage of coats, etc., shall be made in in lieu of individual toilets, but provisions must be
this area. made for their storage, servicing, and odor control.
3.4.4 Combined Medical/Surgical Critical Care and (a) Space at each bedside for families and visitors
Coronary Care in addition to the space provided for staff. The
If medical/surgical and coronary critical care services space provided for parental accommodations
are combined in one critical care unit, at least 50 per- as defined by the functional program shall
cent of the beds shall be located in private rooms or not limit or encroach upon the minimum
cubicles. clearance requirements for staff and medical
equipment around the patient’s bed station.
3.4.5 Pediatric Critical Care
Critically ill pediatric patients have unique physical *(b) Sleeping space for parents who may be
and psychological needs. required to spend long hours with the
patient. If the sleeping area is separate from
3.4.5.1 General the patient area, it shall be in communication
with the critical care unit.
(1) Applicability. The standards previously set forth
for a general critical care unit (Section 2.1-3.4.2) (2) Consultation/demonstration room within, or
shall apply to a pediatric critical care unit. convenient to, the pediatric critical care unit for
private discussions
(2) Functional program. If a facility has a specific
pediatric critical care unit, the functional pro- (3) Storage facilities
gram shall include consideration for staffing, iso-
lation, transportation, life support, and *(a) Provisions for formula storage
environmental systems.
(b) Separate storage cabinets or closets for toys
3.4.5.2 Patient care areas. A pediatric critical care unit and games
shall provide the following:
*(c) Equipment storage space. Space for equip-
(1) Space requirements ment storage shall be provided in accordance
with Section 2.1-2.3.9.2.
A3.4.5.2 (1)(b) Parent sleeping accommodations should be 3.4.6 Newborn Intensive Care Units
provided at the patient’s bedside. The following standards apply to the newborn inten-
sive care unit (NICU):
A3.4.5.2 (3)(a) Formula storage may be outside the unit but
should be available for use at all times. The functional program
3.4.6.1 Patient care areas
should determine the location and size of formula storage.
A3.4.5.2 (3)(c) Space allowances for pediatric beds and cribs (1) Safety and security
are greater than those for adult beds because of the variation in
bed/crib sizes and the potential for change. The functional pro- *(a) All entries to the NICU shall be controlled.
gram may determine that general storage be provided in the pedi- The family entrance and reception area shall
atric critical care unit above the minimum required under Section be clearly identified. The reception area shall
2.1-3.4.2.4 (12)(b). permit visual observation and contact with
all traffic entering the unit.
A3.4.5.3 The number and location of examination/treatment
rooms should be based on the functional program.
(b) The NICU shall be designed as part of an
A3.4.6.1 (1)(a) There should be efficient access to the unit from overall safety program to protect the physical
the labor and delivery area and emergency department or other security of infants, parents, and staff and to
referral entry points. minimize the risk of infant abduction.
(b) There shall be an aisle adjacent to each (i) Infant bed areas and the spaces opening
infant care space with a minimum width of onto them shall be designed to produce
4 feet (1.22 meters) in multiple-bed rooms. minimal background noise and to con-
When single-patient rooms or fixed cubicle tain and absorb much of the transient
partitions are utilized in the design, there noise that arises within the NICU.
shall be an adjacent aisle of not less than 8
feet (2.44 meters) in clear and unobstructed (ii) The combination of continuous back-
width to permit the passage of equipment ground sound and transient sound in
and personnel. any patient care area shall not exceed an
hourly Leq of 50 dB and an hourly L10
(c) In multiple-bed rooms, there shall be a mini- of 55 dB, both A-weighted slow response.
mum of 8 feet (2.44 meters) between infant The Lmax (transient sounds) shall not
care beds. exceed 70 dB, A-weighted slow response.
(3) Viewing windows. When viewing windows are (b) Doors. At least one door to each patient
provided, provision shall be made to control room in the unit must be large enough in
casual viewing of infants. both width and height to accommodate
portable x-ray and ultrasound equipment.
(4) Privacy. Each patient care space shall be designed
to allow privacy for the infant and family. (c) Ceilings
(5) Control station. A central area shall serve as a (i) Ceilings shall be easily cleanable and
control station. nonfriable.
(a) This area shall have space for counters and (ii) Ceilings shall have a noise reduction
storage. coefficient (NRC) of at least 0.90.
(b) This area shall have convenient access to (iii) Ceiling construction shall limit passage
hand-washing stations. of particles from above the ceiling plane
into the clinical environment.
(c) It shall be permitted to be combined with or
to include centers for reception and commu- (8) Lighting
nication and patient monitoring.
(a) Provisions shall be made for indirect lighting
(6) Hand-washing stations and high-intensity lighting in the NICU.
(a) In a multiple-bed room, every bed position (b) Controls shall be provided to enable lighting
shall be within 20 feet (6.10 meters) of a to be adjusted over individual patient care
hands-free hand-washing station. Where an spaces.
individual room concept is used, a hands-
free hand-washing station shall be provided (c) Darkening sufficient for transillumination
within each infant care room. shall be available when necessary.
(d) No direct ambient lighting shall be permitted 3.4.6.3 Diagnostic, treatment, and service areas. Support
in the infant care space, and any direct ambient space shall be accessible for respiratory therapy, blood
lighting used outside the infant care area shall gas lab, developmental therapy, social work, laboratory,
be located or framed to avoid a direct line of pharmacy, radiology, and other ancillary services when
sight from any infant to the fixture. This does these activities are routinely performed on the unit.
not exclude the use of direct procedure lighting.
3.4.6.4 Support areas for newborn intensive care units
(e) Lighting fixtures shall be easy to clean.
(1) Documentation area. Charting facilities shall have
(f) At least one source of daylight shall be visible adequate linear surface space to ensure that staff
from newborn care areas. and physicians may chart and have simultaneous
access to information and communication systems.
(i) External windows in infant care rooms
shall be glazed with insulating glass to (2) Nurse/supervisor office or station. This shall be
minimize heat gain or loss. provided in accordance with Section 2.1-3.4.2.4 (3).
(ii) External windows in infant care rooms (3) Multipurpose room(s) for staff, patients, and
shall be situated at least 2 feet (60.96 patients’ families for patient conferences, reports,
centimeters) away from any part of a education, training sessions, and consultation.
baby’s bed to minimize radiant heat loss
from the baby. (a) These rooms must be accessible to each
nursing unit. They may be on other floors if
(iii) All external windows shall be equipped convenient for regular use.
with easily cleaned shading devices that
are neutral color or opaque to minimize (b) One such room may serve several nursing
color distortion from transmitted light. units and/or departments.
3.4.6.2 Airborne infection isolation room. An airborne (4) Medication station. A medication station shall be
infection isolation room shall be required in at least provided in accordance with Section 2.1-2.3.4.
one level of nursery care.
(5) Lactation support space. Space shall be provided
(1) The room shall be enclosed and separated from the for lactation support and consultation in or
nursery unit with provisions for observation of the immediately adjacent to the NICU. Provision shall
infant from adjacent nurseries or control area(s). be made, either within the room or conveniently
located nearby, for hand-washing station, counter,
(2) All airborne infection isolation rooms shall com- refrigeration and freezing, storage for pump and
ply with the requirements of Section 2.1-3.2.2, attachments, and educational materials.
except the requirements for separate toilet, bath-
tub, or shower. *(6) Clean workroom or clean supply room. This
room shall be provided in accordance with
APPENDIX Section 2.1-3.4.2.4 (10).
A3.4.6.4 (6) Whenever possible, supplies should flow through *(7) Soiled workroom or soiled holding room. This
special supply entrances from external corridors so that penetration room shall be provided in accordance with
of the semi-sterile zone by non-nursery personnel is unnecessary. Section 2.1-3.4.2.4 (11).
(9) Housekeeping room. A housekeeping room shall 3.6.1.1 Location. All nurseries other than pediatric
be provided for the unit. nurseries shall be convenient to the postpartum
nursing unit and obstetrical facilities.
(a) This room shall be directly accessible from
the unit and dedicated for the exclusive use 3.6.1.2 Layout
of the NICU.
(1) The nurseries shall be located and arranged to
(b) This room shall contain a service sink or preclude the need for unrelated pedestrian traffic.
floor receptor and provisions for storage of
supplies and housekeeping equipment. (2) No nursery shall open directly onto another
nursery.
3.4.6.5 Support areas for staff
3.6.2 Patient Care Areas (General)
(1) Staff lounge, storage facilities, and toilet. A The following standards shall apply to nurseries:
lounge, locker room, and staff toilet shall be pro-
vided within or adjacent to the unit for staff use. 3.6.2.1 Space requirements. Enough space shall be
provided for parents to stay 24 hours.
(2) Staff accommodations. Physician sleeping facilities
with access to a toilet and shower. If not contained 3.6.2.2 Viewing windows. Glazed observation win-
within the unit itself, the area shall have a telephone dows to permit the viewing of infants from public
or intercom connection to the patient care area. areas, workrooms, and adjacent nurseries shall be
provided.
3.4.6.6 Support areas for patients and visitors
3.6.2.3 Hand-washing station(s). At least one lavatory,
(1) Visitor waiting room. See Section 2.1-3.4.2.6. equipped with a hands-free hand-washing facility, shall
be provided for each eight or fewer infant stations.
(2) Parent/infant room(s). A room(s) shall be provided
within the NICU that allow(s) parents and infants 3.6.2.4 Storage for infant supplies. Convenient, accessible
extended private time together. storage for linens and infant supplies shall be provided
at each nursery room.
(a) The room(s) shall have direct, private access
to sink and toilet facilities, communication 3.6.3 Airborne Infection Isolation Room
linkage with the NICU staff, electrical and An airborne infection isolation room shall be provided
medical gas outlets as specified for other in or near at least one level of nursery care.
NICU beds, sleeping facilities for at least one
parent, and sufficient space for the infant’s 3.6.3.1 The room shall be enclosed and separated from
bed and equipment. the nursery unit with provisions for observation of the
infant from adjacent nurseries or control area(s).
(b) The room(s) may be used for other purposes
when they are not required for family use. 3.6.3.2 All airborne infection isolation rooms shall
comply with the requirements of Section 2.1-3.2.2,
3.5 Postpartum Units except for separate toilet, bathtub, or shower.
See Section 2.1-4.2.
3.6.4 Neonate Examination and Treatment Areas
3.6 Nurseries Such areas, when required by the functional program,
shall contain a work counter, storage facilities, and a
3.6.1 General hands-free hand-washing station.
Infants shall be housed in nurseries that comply with
the standards in this section.
3.6.5 Support Areas for Nurseries (1) Provision shall be made, either within the room
The following standards shall apply to nurseries: or conveniently located nearby, for hand-washing
station, counter, refrigeration and freezing, stor-
3.6.5.1 Documentation area. Charting facilities shall age for pump and attachments, and educational
have linear surface space to ensure that staff and materials.
physicians may chart and have simultaneous access
to information and communication systems. (2) If conveniently located, this ancillary area shall be
permitted to be shared for other purposes.
*3.6.5.2 Workroom(s). Each nursery room shall be
served by a connecting workroom. 3.6.5.4 Neonate formula facilities
(1) The workroom shall contain scrubbing and (1) Location. Where infant formula is prepared on-
gowning facilities at the entrance for staff and site, direct access from the formula preparation
housekeeping personnel, work counter, refrigera- room to any nursery room is prohibited. The
tor, storage for supplies, and a hands-free hand- room may be located near the nursery or at other
washing station. appropriate locations in the hospital.
(2) One workroom may serve more than one nursery (2) The formula preparation room shall include the
room provided that required services are conven- following:
ient to each.
(a) Cleanup area for washing and sterilizing sup-
(3) The workroom serving the full-term and continu- plies. This area shall include a hand-washing
ing care nurseries may be omitted if equivalent station, facilities for bottle washing, a work
work and storage areas and facilities, including counter, and sterilization equipment.
those for scrubbing and gowning, are provided
within that nursery. Space required for work areas (b) Separate room for preparing infant formula.
located within the nursery is in addition to the This room shall contain warming facilities,
area required for infant care. refrigerator, work counter, formula sterilizer,
storage facilities, and a hand-washing station.
(4) Provision shall be made for storage of emergency
cart(s) and equipment out of traffic. (c) Refrigerated storage and warming facilities
for infant formula accessible for use by nurs-
(5) Provision shall be made for the sanitary storage ery personnel at all times.
and disposal of soiled waste.
(3) If a commercial infant formula is used, the sepa-
(6) Visual control shall be provided via borrowed rate cleanup and preparation rooms may be omit-
lights and/or view panels between the staff work ted. The storage and handling may be done in
area and each nursery. the nursery workroom or in another appropriate
room that is conveniently accessible at all hours.
3.6.5.3 Lactation support room. A consultation/ The preparation area shall have a work counter,
demonstration/breastfeeding or pump room shall be a hand-washing station, and storage facilities.
provided convenient to the nursery.
3.6.5.5 Soiled workroom or soiled holding room shall
APPENDIX be provided in accordance with Section 2.1-2.3.8.
A3.6.5.2 When the functional program includes a mother-baby 3.6.5.6 Housekeeping room
couplet approach to nursing care, the workroom functions
described above may be incorporated into the nurse station (1) A housekeeping/environmental services room
that serves the postpartum patient rooms. shall be provided for the exclusive use of the
3.6.7.2 The continuing care bassinets are permitted to A3.7.1.3 Family support spaces, including family sleep rooms,
be within the hospital’s NICU in a defined location for pantry, toilets, showers, washers and dryers, and access to
these infants. computers, phones, and copy machines, should be provided.
3.7.1.4 Window. Each patient room shall have a parent/family comfort, consultation, and teaching.
window in accordance with Section 2.1-8.2.2.5.
(3) Insulation, isolation, and structural provisions
3.7.2 Airborne Infection Isolation Room(s) shall minimize the transmission of impact noise
3.7.2.1 At least one such room shall be provided in through the floor, walls, or ceiling of the multi-
each pediatric unit. The total number of infection purpose room(s).
isolation rooms shall be determined by an ICRA.
3.7.4.2 Formula facilities. Space for preparation and stor-
3.7.2.2 Airborne infection isolation room(s) shall age of infant formula shall be provided within the unit or
comply with the requirements of Section 2.1-3.2.2. other convenient location. Provisions shall be made for
continuation of special formula that may have been pre-
3.7.3 Examination/Treatment Rooms scribed for the infant prior to admission or readmission.
An examination/treatment room shall be provided for
pediatric and adolescent patients. A separate area for 3.7.4.3 Clean and soiled workrooms. Separate clean
infant examination and treatment shall be permitted and soiled workrooms or holding rooms shall be pro-
within the pediatric nursery workroom. vided as described in Sections 2.1-2.3.7 and 2.1-2.3.8.
3.7.4 Support Areas for Pediatric/Adolescent Units (3) Provisions shall also be made for storage of equipment
The staff support areas in the pediatric and adolescent and supplies (including cots or recliners, extra linen,
nursing units shall conform to Sections 2.1-3.1.4 through etc.) for parents who stay with the patient overnight.
2.1-3.1.6 and shall also meet the following standards:
3.7.5 Support Areas for Patients
3.7.4.1 Multipurpose or individual room(s) 3.7.5.1 Patient toilet room(s). Toilet room(s) with
hand-washing station(s) in each room, in addition to
(1) These shall be provided within or adjacent to those serving bed areas, shall be convenient to multi-
areas serving pediatric and adolescent patrons for purpose room(s) and to each central bathing facility.
dining, education, and developmentally appropri-
ate play and recreation, with access and equip- 3.8 Psychiatric Nursing Unit
ment for patients with physical restrictions.
3.8.1 General
(2) If the functional program requires, an individual 3.8.1.1 Psychiatric care in a medical unit. See Section
room shall be provided to allow for confidential 2.1-3.2.4 for psychiatric care in a medical unit.
*3.8.1.4 Security. Security appropriate for the planned skilled nursing units found in Chapter 4.1 of these
treatment programs shall be provided. Guidelines. These extended stay unit beds are licensed
hospital beds for patients requiring skilled nursing care
3.8.1.5 Shared facilities. In no case shall adult and as part of their recovery process. Many of these facilities
pediatric clients be mixed. This does not exclude shar- are intended for elderly patients undergoing various
ing of nursing stations or support areas, as long as the levels of rehabilitation and recuperating stroke victims
separation and safety of the units can be maintained. or brain trauma victims requiring rehabilitation.
3.8.3 Seclusion Treatment Rooms (1) The location of the unit shall provide convenient
See Section 2.3-2.2.1. access to the Physical and Rehabilitation Medicine
departments.
3.8.4 Support Areas for Staff and Visitors
See Section 2.3-2.6. (2) Wherever possible, the unit shall be located to
provide access to outdoor spaces that can be
3.9 In-Hospital Skilled Nursing Units utilized for therapeutic purposes.
Many facilities have incorporated extended stay units
for the medical/surgical department; these are often 3.9.1.2 Layout. The unit shall be located to exclude
referred to as in-hospital skilled nursing units or facili- unrelated traffic going through the unit to access other
ties. These units should not be confused with long-term areas of the hospital.
APPENDIX
A3.8.1.4 A safe environment is critical; however, no environment a. The patient room size should meet the requirements in
can be entirely safe and free of risk. The majority of persons who Section 2.1-3.1.1.2.
attempt suicide suffer from a treatable mental disorder or a sub-
b. Adequate storage should meet the requirements in
stance abuse disorder or both. Patients of inpatient psychiatric
Section 2.1-2.2.2.
treatment facilities are considered at high risk for suicide; the envi-
ronment should avoid physical hazards while maintaining a thera- c. A desk or writing surface for patient use may be provided in
peutic environment. The built environment, no matter how well each room, but this is not required.
designed and constructed, cannot be relied upon as an absolute
d. A quiet room is not required on units of 12 beds or fewer unless
preventive measure. Staff awareness of their environment, latent
required by the functional program.
risks of that environment, and the behavior risks and needs of
the patients served in the environment are absolute necessities. e. The functional needs of the program should determine the need
Different organizations and different patient populations will for a nurse call system. If a nurse call system is provided, it should
require greater or lesser tolerance for risk. meet the requirements of Section 2.1-10.3.8. However, provisions
should be made for easy removal or covering of the call system.
a. Consideration should be given to visual control (including elec-
tronic surveillance) on nursing units of corridors, dining areas, and f. Visual privacy in multi-bed rooms (e.g., cubicle curtains) is not
social areas such as dayrooms and activity areas. Hidden alcoves required.
or blind corners or areas should be avoided.
g. The functional needs of the program will determine the need
b. The openness of the nurse station will be determined by the for medical gas and/or vacuum systems. If a medical gas/
planned treatment program. Consideration should be given to vacuum system is provided, it should meet the requirements of
patient privacy and also to staff safety. Sections 2.1-10.1.4.1 and 2.1-10.1.2.1 (2). However, provisions
should be made for easy removal and/or covering of the medical
A3.8.2 Patient Rooms. The guidelines noted in Sections 2.3-1
gas/vacuum system.
through 2.3-2.3.3 and Section 2.3-2.6 should apply, with the
following exceptions:
3.9.3 Treatment Areas (a) In new construction, the total area set aside
3.9.3.1 Physical rehabilitation room. When required by for dining, patient lounges, and recreation
the functional program, a physical rehabilitation room shall be at least 25 square feet (2.32 square
shall be provided for the use of the skilled nursing meters) per bed with a minimum total area
unit if the unit is not located conveniently to the facili- of at least 225 square feet (20.90 square
ty’s physical and rehabilitation therapy departments. meters). At least 20 square feet (1.86 square
The room size and the equipment provided shall be meters) per bed shall be available for dining.
adequate to provide the therapeutic milieu required Additional space may be required for outpa-
by the facility’s functional program. tient day care programs.
3.9.4 Support Areas for In-Hospital (b) For renovations, at least 14 square feet (1.30
Skilled Nursing Units square meters) per bed shall be available for
In addition to the support areas required under dining. Additional space may be required for
Sections 2.1-3.1.4 through 2.1-3.1.6, the following outpatient day care programs.
rooms and support elements shall be provided:
3.9.5.2 Private space. When required by the function-
3.9.4.1 Storage for wheelchairs and walking aids. al program, the unit shall contain private space for
Additional storage spaces to accommodate the the use of individual patients, family, and caregivers
increase in wheelchair and walking aids used by this to discuss the specific patient’s needs or private
patient population shall be included in the design of family matters.
the unit, with an additional square footage of 7 square
feet (0.65 square meters) per bed. (1) This space shall have a minimum clear area of 250
square feet (23.23 square meters).
3.9.5 Support Areas for Patients
3.9.5.1 Dining and recreation spaces (2) This space is permitted to be considered part of
the square footage per bed outlined in Section
(1) Factors for determining space requirements. The 2.1-3.9.5.2.
space needed for dining and recreation shall be
determined by considering the following: 3.9.5.3 Patient grooming room. When required by the
functional program, a room for patient grooming shall
(a) The needs of patients who use adaptive be provided.
equipment and mobility aids and receive
assistance from support and service staff (1) The minimum area shall not be part of the aggre-
gate area under Section 2.1-3.9.5.2 and shall be as
(b) The extent to which support programs shall determined by the functional program.
be centralized or decentralized
(2) This room shall provide spaces for hair-washing
(c) The number of patients to be seated for din- station(s), hair clipping and hair styling, and
ing at one time, as required by the functional other grooming needs.
program
(3) A hand-washing station, mirror, work counter(s),
(2) Space requirements. Nothing in these Guidelines storage shelving, and sitting area(s) for patients
is intended to restrict a facility from providing shall be provided as part of the room.
(3) Rail ends shall be returned to the wall or floor. 4.2.2 Airborne Infection Isolation Room(s)
An airborne infection isolation room is not required
for the obstetrical unit. Provisions for the care of the
4 Obstetrical Facilities perinatal patient with an airborne infection shall be
determined by an ICRA.
*4.1 General
4.2.3 Examination/Treatment Room and/or
4.1.1 Location and Layout Multipurpose Diagnostic Testing Room
The obstetrical unit shall be located and designed to pro- 4.2.3.1 Space requirements. This room shall have a min-
hibit nonrelated traffic through the unit. When delivery imum clear floor area of 120 square feet (11.15 square
and operating rooms are in the same suite, access and meters). When used as a multi-patient diagnostic test-
service arrangements shall be such that neither staff nor ing room, a minimum clear floor area of 80 square feet
patients need to travel through one area to reach the other. (7.43 square meters) per patient shall be provided.
APPENDIX
A4.1 Obstetrical program models vary widely in their delivery The birthing woman moves only as a postpartum patient to
methodologies. The models are essentially of three types. The follow- her bedroom or to a cesarean section delivery room (surgical
ing narrative describes the organizational framework of each model. operative room) if delivery complications occur.
a. Traditional Model After the mother and baby are recovered in the LDR, they are
transferred to a mother-baby care unit for postpartum stay.
Under the traditional model, labor, delivery, recovery, and postpar-
tum occur in separate areas. The birthing woman is treated as the c. Labor-Delivery-Recovery-Postpartum Model
moving part. She is moved through these functional areas
Single-room maternity care in labor-delivery-recovery-postpartum
depending on the status of the birth process.
rooms (LDRPs) adds a "P" to the LDR model. Room design and
The functional areas are separate rooms consisting of the labor capability to handle most emergencies remain the same as the
room, delivery room, recovery room, postpartum bedroom, and LDRs. However, the LDRP model eliminates a move to postpartum
infant nurseries (levels determined by acuity). after delivery. LDRP uses one private room for labor, delivery,
recovery, and postpartum stay.
b. Labor-Delivery-Recovery Model
Equipment is moved into the room as needed, rather than moving
All labor-delivery-recovery rooms (LDRs) are designed to accom-
the patient to the equipped room. Certain deliveries are handled
modate the birthing process from labor through delivery and
in a cesarean section delivery room (surgical operative room)
recovery of mother and baby. They are equipped to handle most
should delivery complications occur.
complications, with the exception of cesarean sections.
4.2.3.2 Toilet room. An adjoining toilet room shall be 4.2.4.9 Equipment and supply storage
provided for patient use.
(1) Clean linen storage. This shall be provided in
4.2.4 Support Areas for the Postpartum Unit accordance with Section 2.1-2.3.9.1.
The following support areas shall be provided for this unit.
(2) Equipment storage room. Each unit shall provide
4.2.4.1 A nurse station sufficient storage area(s) on the patient floor to
keep its required corridor width free of equip-
4.2.4.2 Documentation area ment and supplies.
4.2.4.3 A nurse office (a) This storage area shall be not less than
10 square feet (0.93 square meter) per post-
4.2.4.4 Consultation/conference room(s) partum room and 20 square feet (1.86 square
meters) per each labor-delivery-recovery
4.2.4.5 Medication station. Provision shall be made for (LDR) or LDRP room.
storage and distribution of drugs and routine medica-
tions. This may be done from a medicine preparation (b) This storage area shall be in addition to any
room or unit, from a self-contained medicine-dispens- storage in patient rooms.
ing unit, or by another system.
(3) Storage space for stretchers and wheelchairs.
(1) Medicine preparation room or unit Storage space shall be provided in accordance
with Section 2.1-2.3.9.3.
(a) If used, a medicine preparation room or unit
shall be under visual control of nursing staff. (4) Emergency equipment storage. Storage shall be
close to the nurse station.
(b) This room or unit shall contain a work
counter, sink, refrigerator, and double-locked 4.2.4.10 Housekeeping room. A housekeeping room
storage for controlled substances. shall be provided for the exclusive use of the obstetri-
cal suite in accordance with Section 2.1-2.3.10.
(c) Convenient access to hand-washing stations
shall be provided. (Standard cup-sinks pro- 4.2.5 Support Areas for Staff
vided in many self-contained units are not The following support areas shall be provided for this unit.
adequate for hand-washing.)
4.2.5.1 Staff lounge
4.2.4.6 Nourishment area. A nourishment station shall
be provided in accordance with Section 2.1-2.3.5. 4.2.5.2 Staff storage facilities. Lockable closets or cabi-
nets for personal articles of staff shall be provided.
4.2.4.7 Clean workroom or clean supply room. A clean
workroom or clean supply room shall be provided in 4.2.5.3 Staff toilet room
accordance with Section 2.1-2.3.7. A clean workroom
is required if clean materials are assembled within the 4.2.6 Support Areas for Patients and Visitors
obstetrical suite prior to use. The following support areas shall be provided for this unit.
4.2.4.8 Soiled workroom or soiled holding room. A 4.2.6.1 Patient lounge. The patient lounge may be
soiled workroom or soiled holding room shall be pro- omitted if all rooms are single-bed rooms.
vided for the exclusive use of the obstetrical suite in
accordance with Section 2.1-2.3.8. 4.2.6.2 Patient bathing facilities
patient rooms, there shall be at least one shower may be separate from the labor room if under staff
and/or bathtub for each six beds or fraction control) for use of patients in labor shall be provided.
thereof.
4.3.2 Delivery Room(s)
(2) A toilet and hand-washing station shall be provided 4.3.2.1 Space requirements. These shall have a mini-
within or directly accessible to each bathing facility. mum clear area of 300 square feet (27.87 square
meters) exclusive of fixed cabinets and built-in shelves.
4.3 Cesarean/Delivery Suite
4.3.2.2 Emergency communication system. An emer-
4.3.1 Labor Rooms gency communication system shall be connected with
4.3.1.1 General the obstetrical suite control station.
(1) Number. In facilities that have only one cesarean/ 4.3.3 Cesarean/Delivery Room(s)
delivery room, two labor rooms shall be provided. 4.3.3.1 Number. There shall be a minimum of one
such room in every obstetrical unit.
(2) Access. Labor rooms shall have controlled access
with doors that are arranged for observation from 4.3.3.2 Space requirements. These shall have a mini-
a nursing station. mum clear floor area of 360 square feet (33.45 square
meters) with a minimum dimension of 16 feet (4.88
4.3.1.2 Capacity. Where LDRs or LDRPs are not pro- meters) exclusive of built-in shelves or cabinets.
vided, a minimum of two labor beds shall be provided
for each cesarean/delivery room. 4.3.4 Infant Resuscitation Space
4.3.4.1 Location. Infant resuscitation shall be provided
4.3.1.3 Space requirements within cesarean/delivery room(s) and delivery rooms
or in a separate but immediately accessible room.
(1) Each room shall be designed for either one or two
beds, with a minimum clear area of 120 square 4.3.4.2 Space requirements
feet (11.15 square meters) per bed.
(1) Space in delivery rooms. A minimum clear floor
(2) In renovation projects, labor room(s) (LDR or area of 40 square feet (3.72 square meters) shall
LDRP rooms may be substituted) shall have a be provided for the infant resuscitation space in
minimum clear area of 100 square feet (9.29 addition to the required area of each delivery or
square meters) per bed. cesarean/delivery room.
4.3.1.4 Windows. Windows in labor rooms, if provid- (2) Space in a separate room. Infant resuscitation
ed, shall be located, draped, or otherwise arranged to space provided in a separate but immediately
preserve patient privacy from casual observation from accessible room shall have a minimum clear floor
outside the labor room. area of 150 square feet (13.94 square meters).
4.3.1.5 Hand-washing station. Each labor room shall 4.3.4.3 Electrical outlets. Six single or three duplex
contain a hand-washing station. electrical outlets shall be provided for the infant in
addition to the facilities required for the mother.
4.3.1.6 Toilet room
4.3.5 Recovery Room(s)
(1) Each labor room shall have access to a toilet room. LDR or LDRP rooms, when located within or adjacent
to the cesarean/delivery suite, may be substituted.
(2) One toilet room may serve two labor rooms.
4.3.5.1 Capacity. Recovery rooms shall contain at least
4.3.1.7 Bathing facilities. At least one shower (which two beds.
4.3.5.2 Support areas for recovery rooms 4.3.6.3 Areas permitted to be shared. The following
support areas shall be permitted to be shared with
(1) Nurse station and documentation area. Recovery the surgical facilities in accordance with the functional
room shall have a nurse station with charting facil- program. Where shared, areas shall be arranged to
ities located to permit visual control of all beds. avoid direct traffic between the delivery and operating
rooms.
(2) Hand-washing station. Each room shall include a
hand-washing station. (1) A supervisor’s office or station
(3) Medication dispensing facilities. Each room shall (2) Medication station. A drug distribution station
include facilities for dispensing medicine. with hand-washing stations and provisions for
controlled storage, preparation, and distribution
(4) Clinical sink. A clinical sink with bedpan flushing of medication shall be provided. A self-contained
device shall be available. medication dispensing unit in accordance with
Section 2.1-2.3.4 may be utilized instead.
(5) Equipment and supply storage. Storage for sup-
plies and equipment shall be available. (3) Scrub facilities for cesarean/delivery rooms
4.3.5.3 Support areas for families (a) Two scrub positions shall be provided adja-
cent to the entrance to each cesarean/delivery
(1) When required by the functional program, there room.
shall be enough space for baby and crib and a chair
for the support person. There shall be the ability to (b) Scrub facilities shall be arranged to minimize
maintain visual privacy for the new family. any splatter on nearby personnel or supply
carts.
4.3.6 Support Areas for the Cesarean/Delivery Suite
4.3.6.1 General. Individual rooms shall be provided as (c) In new construction, view windows shall be
indicated in the following standards; otherwise, provided at scrub stations to permit the
alcoves or other open spaces that do not interfere with observation of room interiors.
traffic may be used.
(4) Anesthesia workroom. An anesthesia workroom
4.3.6.2 Areas solely for the cesarean/delivery suite. The for cleaning, testing, and storing anesthesia equip-
following support areas shall be provided: ment shall be provided. It shall contain a work
counter, sink, and provisions for separation of
(1) A control/nurse station. This shall be located to clean and soiled items.
restrict unauthorized traffic into the suite.
*(5) Sterilization facilities. Sterilization facilities with
(2) Soiled workroom or soiled holding room. This high-speed sterilizers shall be located convenient
room shall be provided in accordance with to all cesarean/delivery rooms. Sterilization facili-
Section 2.1-2.3.8. ties shall be separate from the delivery area and
adjacent to clean assembly.
(3) Fluid waste disposal
(6) Clean workroom or clean supply room
(b) Clean supply room. Provision of a clean supply 4.3.7.3 Support person change areas. Change areas,
room shall be permitted when the functional designed as described above, shall be provided for
program defines a system for the storage and male and female support persons.
distribution of clean and sterile supplies. See
(7)(a) just below for sterile storage. 4.3.7.4 Staff accommodations. An on-call room(s)
shall be provided for physician and/or staff. It may
(7) Equipment and supply storage. Storage room(s) be located elsewhere in the facility.
shall be provided for equipment and supplies
used in the obstetrical suite. These shall include 4.3.8 Support Areas for Visitors
the following: The following support areas shall be permitted to be
shared with the surgical facilities in accordance with
(a) A clean sterile storage area readily available the functional program.
to the delivery room. The size shall be based
on level of usage, functions provided, and 4.3.8.1 Waiting room. A waiting room, with toilets,
supplies from the hospital central distribu- telephones, and provisions for drinking water shall be
tion area. conveniently located. The toilet room shall contain
hand-washing stations.
(b) Medical gas storage facilities. See Section
2.1-5.3.5.14 (3). 4.4 LDR and LDRP Rooms
When required by the functional program, delivery
(c) An area for storing stretchers out of the path procedures in accordance with birthing concepts may
of normal traffic be performed in the LDR or LDRP rooms.
mother’s area shall be provided for infant stabi- 4.4.7 Medical Gas Outlets
lization and resuscitation. 4.4.7.1 See Table 2.1-5 for medical gas outlet
requirements.
4.4.3.2 Renovation. When renovation work is under-
taken, every effort shall be made to meet the above 4.4.7.2 These outlets shall be located in the room so
minimum standards. If it is not possible to meet the they are accessible to the mother’s delivery area and
above square-foot standards, existing LDR or LDRP infant resuscitation area.
rooms shall be permitted to have a minimum clear
area of 200 square feet (18.58 square meters). 4.4.8 Finishes
Finishes shall be selected to facilitate cleaning and to
4.4.4 Patient Privacy resist strong detergents.
Windows or doors within a normal sightline that
would permit observation into the room shall be 4.4.9 Lighting
arranged or draped as necessary for patient privacy. Portable examination lights shall be permitted, but
must be immediately accessible.
4.4.5 Hand-Washing Stations
Each room shall be equipped with hand-washing sta-
tions. (Hand-washing stations with hands-free opera- 5 Diagnostic and Treatment Locations
tion are acceptable for scrubbing.)
*5.1 Emergency Service
4.4.6 Patient Bathroom
Each LDR or LDRP room shall have direct access to a 5.1.1 General
private toilet with shower or tub. *5.1.1.1 Definition
Levels of emergency care range from initial emergency
management to definitive emergency care.
APPENDIX
A5.1 Surge Capacity proper performance of the means to accomplish the intended
In preparation for the emergence of highly infectious patients, hos- goals. DHHS, the Office of Emergency Preparedness, will have
pitals should have the capacity to handle a surge of up to ten or a more up-to-date information.
fourfold increase above the current emergency department capac-
A5.1.1.1 Classification of emergency departments/
ity for such patients.
services/trauma centers
a. This preparation should include the provision of adjacent space Basic aspects of previous Level I-IV emergency department/
for triage and management of infectious patients. services classifications are still recognizable in current criteria
statements but have evolved substantially to address changes in
b. Utility upgrades for these areas (oxygen, water, electrical)
practice, needs, and technologies. The following publications are
should be considered.
especially useful references for understanding and listing current
c. The area should provide for depressurization to help control refined and expanded requirements:
aerosolized infectious particles with 100 percent exhaust capabili-
American College of Surgeons. "Trauma Center Descriptions and
ty. If 100 percent exhaust cannot be achieved, appropriate proven
Their Roles in a Trauma System," chapter 2 in Resources for
technology should be utilized to reduce airborne particles by > 95
Optimal Care of the Injured Patient (ACS, 1999). This reference
percent. If patient care areas are to be utilized in the hospital to
provides detailed descriptions of Level I–Level IV trauma centers.
house these patients, the route to the patient care unit should
(www.facs.org)
minimize the potential for cross-contamination. Existing smoke
control areas could be utilized to meet the ventilation requirements. Riggs, Leonard M., Jr., ed. Emergency Department Design (American
Air-handling systems should be designed to provide required pres- College of Emergency Physicians, 1993). The author discusses plan-
sure differentials. Written protocols must be developed to ensure ning for various levels of treatment acuity. (www.acep.org)
(1) Initial emergency management is care provided require minimal care but also for persons with
to stabilize a victim’s condition and to minimize severe illness and injuries who must receive
potential for further injury during transport to an immediate emergency care and assistance prior
appropriate service. Patients may be brought to to transport to other facilities.
the “nearest hospital,” which may or may not have
all required services for definitive emergency (2) Provisions for initial emergency management
management. In those cases, it is important that shall include the following:
the hospital be able to assess and stabilize emer-
gent illnesses and injuries and arrange for appro- 5.1.2.2 Entrance. A well-marked, illuminated, and cov-
priate transfer. ered entrance shall be provided at grade level. The emer-
gency vehicle entry cover shall provide shelter for both
(2) Emergency care may range from the suturing of the patient and the emergency medical crew during
lacerations to full-scale emergency medical proce- transfer from an emergency vehicle into the building.
dures. Facilities that include personnel and equip-
ment for definitive emergency care provide for 5.1.2.3 Reception, triage, and control station. This shall
24-hour service and complete emergency care be located to permit staff observation and control of
leading to discharge to the patient’s home or access to treatment area, pedestrian and ambulance
direct admission to the appropriate hospital. entrances, and public waiting area.
5.1.1.2 Applicability. The extent and type of emergency 5.1.2.4 Communication system. Communication
service to be provided depends on community needs hookups to the Poison Control Center and regional
and the availability of other services in the area. emergency medical service (EMS) system.
for protective environment rooms as described in (1) This shall provide direct access from public roads
Section 2.1-3.2.3 shall be determined by an ICRA. for ambulance and vehicle traffic.
5.1.2.7 Equipment and supply storage. Storage for gen- (2) Entrance and driveway shall be clearly marked.
eral medical/surgical emergency supplies, medications,
and equipment such as ventilator, defibrillator, splints, (3) If a raised platform is used for ambulance dis-
etc. This shall be located out of traffic and under staff charge, a ramp shall be provided for pedestrian
control. and wheelchair access.
5.1.2.8 Waiting room. Provisions for reception, con- *5.1.3.4 Reception, triage, and control station
trol, and public waiting. These shall include a public
toilet with hand-washing station(s) and a telephone. (1) Reception, triage, and control station shall be
located to permit staff observation and control of
5.1.2.9 Patient toilet. A patient toilet room with hand- access to treatment area, pedestrian and ambu-
washing station(s). This shall be convenient to the lance entrances, and public waiting area. (See
treatment room(s). Table 2.1-5.)
*5.1.3 Definitive Emergency Care (2) The triage area requires special consideration. As
5.1.3.1 General. Where 24-hour emergency service is the point of entry and assessment for patients with
to be provided, the type, size, and number of the serv- undiagnosed and untreated airborne infections,
ices shall be as defined in the functional program. As a the triage area shall be designed and ventilated to
minimum, the following shall be provided: reduce exposure of staff, patients, and families to
airborne infectious diseases. (See Table 2.1-2.)
5.1.3.2 Emergency access. Paved emergency access to
permit discharge of patients from automobiles and 5.1.3.5 Communications center. The communications
ambulances and temporary parking convenient to the center shall be convenient to the nursing station and
entrance shall be provided. have radio, telephone, and intercommunication sys-
tems. (See Section 2.1-8.1.3.)
5.1.3.3 Entrance. A well-marked, illuminated, and cov-
ered entrance shall be provided at grade level. 5.1.3.6 Public waiting area
APPENDIX
A5.1.3 Fast-Track Area access at all times. In the event of a disaster, terrorist event, or
A separate fast-track area when annual emergency department infectious disease outbreak, the emergency service must remain
visits exceed 20,000–30,000 visits should be considered. This under the control of the hospital and limit contamination to
area should include space for registration, discharge, triage, and ensure its continued availability as a resource.
waiting, as well as a physician/nurse work station. Storage areas
a. Efforts will be made to separate patients waiting for triage in a
for supplies and medication should be included. A separate treatment/
secure area with appropriate ventilation that is clearly visible from
procedure room of 120 square feet (11.15 square meters) of clear
the triage station. This area will be separate from the post-triage
floor space should be provided. Examination/treatment areas
waiting area to limit the spread of contamination and/or contagion.
should be 100 square feet (9.29 square meters) of clear floor
space, with hand-washing stations, vacuum, oxygen, and air out- b. Although the triage station must have unobstructed visibility of
lets, and examination lights. At least one treatment/examination the waiting area to permit observation of patients waiting for treat-
room should be designated for pelvic examinations. ment, a reception and control or security function must be provid-
ed to monitor the main entrance to the department and all public
A5.1.3.4 The design of the emergency department is critical, par-
areas. Public access points to the treatment area shall be minimal
ticularly at the main public access point, to ensure that emergency
in number, and under direct observation by the reception and con-
medical staff and hospital security personnel maintain control of
trol or security function.
(1) This shall have toilet facilities, drinking fountains, (e) For oxygen and vacuum, see Table 2.1-5.
and telephones.
(f) Treatment/examination rooms used for pelvic
(2) If so determined by the hospital ICRA, the emer- exams shall allow for the foot of the examina-
gency department waiting area shall require special tion table to face away from the door.
measures to reduce the risk of airborne infection
transmission. These measures may include *(2) Trauma/cardiac rooms for emergency procedures,
enhanced general ventilation and air disinfection including emergency surgery
similar to inpatient requirements for airborne
infection isolation rooms. See the CDC “Guidelines (a) Space requirements
for Preventing the Transmission of Mycobacterium
tuberculosis in Health Care Facilities.” (i) Each room shall have at least 250 square feet
(23.23 square meters) of clear floor space.
5.1.3.7 Diagnostic, treatment, and service areas
(ii) Additional space with cubicle curtains for
(1) Examination and treatment room(s) privacy may be provided to accommo-
date more than one patient at a time in
(a) Space requirements. Each examination room the trauma room.
shall have a minimum clear floor area of 120
square feet (11.15 square meters), exclusive (b) Facility requirements. The room shall con-
of fixed casework. tain cabinets and emergency supply shelves,
x-ray film illuminators, examination lights,
(b) Facility requirements. Each examination and counter space for writing.
room shall contain work counter(s); cabi-
nets; hand-washing stations; supply storage (c) Patient monitoring. Provisions shall be made
facilities; examination lights; a desk, counter, for monitoring the patients.
or shelf space for writing; and a vision panel
adjacent to and/or in the door. (d) Supply storage. Storage shall be provided for
immediate access to attire used for universal
(c) Renovation. Where renovation work is precautions.
undertaken, every effort shall be made to
meet these minimum standards. In such (e) Door width. Doorways leading from the
cases, each room shall have a minimum clear ambulance entrance to the cardiac trauma
area of 100 square feet (9.29 square meters), room shall be a minimum of 5 feet (1.52
exclusive of fixed or wall-mounted cabinets meters) wide to simultaneously accommo-
and built-in shelves. date stretchers, equipment, and personnel.
be no less than a clear area of 240 square feet (3) Provisions for orthopedic and cast work. These
(22.30 square meters), and doorways leading may be in separate room(s) or in the trauma room.
from the ambulance entrance to the room may
be 4 feet (1.22 meters) wide. (a) Space requirements. The clear floor space for
this area shall be dependent on the functional
APPENDIX
A5.1.3.7 (4) When advanced imaging technologies such as CT are the ambulance entrance, but no less than 30 feet (9.14 meters)
available, the emergency department should have convenient access. distant; lighted and protected from the environment in the same
way as the ambulance entrance; a yellow painted boundary line 3
A5.1.3.7 (5) Decontamination area on the exterior perimeter
feet (0.91 meter) from each side of the door and extending 6 feet
a. Ideally 150 feet (45.72 meters) from the ambulance entrance (if
(1.83 meters) from the hospital wall; the word “DECON” painted
required by the constraints of the structures involved, this may be
within these boundaries.
no less than 30 feet (9.14 meters) from the ambulance entrance).
b. Internal entrance to a corridor within the emergency area.
b. At a location where no windows or doors abut the defined area
or where all doors are securable from the outside and all windows c. It shall have spatial requirements and the medical support servic-
are capable of being shuttered. es of a standard emergency area airborne infection isolation room,
with air externally exhausted separate from the hospital system. It
c. Boundaries shall be defined on the paved ground surface with a
shall contain a work counter, hand-washing station with hands-free
yellow paint line and the word “DECON” painted within these
controls, an area for personnel gowning, and a storage area for
boundaries.
supplies, as well as equipment for the decontamination process.
d. At least two shower heads, temperature-controlled and separat-
d. Ceiling, wall, and floor finishes shall be smooth, nonporous,
ed by at least 6 feet (1.83 meters); a separate spigot for attach-
scrubbable, nonadsorptive, nonperforated, capable of withstand-
ment of a hose.
ing cleaning with and exposure to harsh chemicals, nonslip, and
e. Semipermanent or portable/collapsible structures (curtains, without crevices or seams. Floors shall be self-coving to a height
tents, etc.) that will provide shelter from the environment, privacy, of 6 inches (15.24 centimeters). The surface of the floor shall be
and some containment of the contaminant/infectious agent. self-finished and require no protective coating for maintenance.
f. Secured access to the hospital telephone system and a duplex e. Two hospital telephones; two duplex electrical outlets, secured
electrical outlet for each two shower heads and no closer than 4 appropriately for a wet environment.
feet (1.22 meters) to any shower.
f. At least two hand-held shower heads, temperature-controlled; cur-
g. Exterior lighting to maximize visibility; appropriate for wet/ tains or other devices to allow patient privacy, to the extent possible.
shower facilities.
g. Appropriately heated and air-cooled for a room with an external
h. Negative airflow and ventilation system on the hospital perime- door and very high relative humidity.
ter wall but drawing air within the confines of the decontamination
h. Water drainage must be contained and disposed of safely to
structure; exhausted directly to the outdoors, no less than 50 feet
ensure that it does not enter the hospital or community drainage
(15.24 meters) away from the decontamination site with no recir-
systems. There should be a “saddle” at the floor of the door buck
culation of air. This system shall be defunctionalized when the
to prevent efflux.
decontamination structure is not in use.
i. A certified physicist or other qualified expert representing the
i. Water runoff shall be contained and disposed of safely to ensure
owner or the state agency shall specify the type, location, and
that it does not enter community drainage systems. This shall be
amount of radiation protection to be installed in accordance with
accomplished either by graded floor structures leading to a drain
final approved department layout and the functional program.
with a collection system separate from that of the hospital or by
These specifications shall be incorporated into the plans.
the use of plastic pools or specialized decontamination stretchers.
j. The decontamination area may function as an isolation room or
Decontamination room within the facility
a patient hygiene room under routine departmental function.
a. Separate, independent, secured external entrance adjacent to
program and the procedures and equipment controls and dedicated holding tank with
accommodated here. floor drain.
(b) Plaster trap. If a sink is used for the disposal of (ii) Portable or hard-piped oxygen shall be
plaster of paris, a plaster trap shall be provided. provided. Portable suction shall also be
available.
(c) Equipment and supply storage. They shall
include storage for splints and other ortho- (d) Construction requirements. The room shall
pedic supplies, traction hooks, x-ray film have all smooth, nonporous, scrubbable,
illuminators, and examination lights. nonadsorptive, nonperforated surfaces.
Fixtures shall be acid resistant. The floor
*(4) Diagnostic service areas. Convenient access to radi- of the decontamination room shall be self-
ology and laboratory services shall be provided. coving to a height of 6 inches (15.24
centimeters).
*(5) Decontamination area
(e) This section does not preclude decontamina-
(a) Location. In new construction, a decontami- tion capability at other locations or entrances
nation room shall be provided with an out- immediately adjacent to the emergency
side entry door as far as practical from the department.
closest other entrance. The internal door
of this room shall open into a corridor of *(6) Pediatric care
the emergency department, swing into the
room, and be lockable against ingress from 5.1.3.8 Special patient care areas
the corridor.
(1) Airborne infection isolation room. At least one
(b) Space requirements. The room shall provide airborne infection isolation room shall be provid-
a minimum of 80 square feet (7.43 square ed as described in Table 2.1-2 and Sections 2.1-
meters) clear floor area. 3.2.2.2, 3.2.2.4 (2)(a) and (b), and 3.2.2.4 (4). The
need for additional airborne infection isolation
(c) Facility requirements rooms or for protective environment rooms as
described in Section 2.1-3.2.3 shall be determined
(i) The room shall be equipped with two by an ICRA.
hand-held shower heads with temperature
APPENDIX
A5.1.3.7 (6) Pediatric treatment rooms. Provisions for the treat- clear floor space. Each of these rooms should have hand-washing
ment of pediatric cases in dedicated pediatric room(s) within the stations; vacuum, oxygen, and air outlets; examination lights; and
unit should be provided. The quantity of dedicated rooms should wall/column-mounted ophthalmoscopes/otoscopes.
depend on the census of the particular institution.
Where possible, rooms should be sized larger than 120 square
a. This area should include space for registration, discharge, triage, feet (11.15 square meters) of clear area (exclusive of casework) to
waiting, and a playroom. Pediatric designated rooms should be accommodate the additional equipment and escorts that accom-
adjacent to a family waiting area and toilet. An area for the nurse pany pediatric cases.
station and physician station, storage for supplies and medication,
c. Particular attention should be paid to the soundproofing of
and one to two isolation rooms should also be included.
these treatment rooms.
b. Each examination/treatment room should have 100 square feet
d. At least one room for pelvic examinations should be included.
(9.29 square meters) of clear floor space, with a separate proce-
dure/trauma room of 120 square feet (11.15 square meters) of e. X-ray illuminators should be available.
(c) Toilet room. One toilet room shall be provid- (d) Patient room doors shall swing out and shall
ed for each eight treatment cubicles or major have hardware on the exterior side only.
fraction thereof. Doors shall have an electric strike that is tied
into the fire alarm.
(d) Shower room. One shower room shall be pro-
vided for each sixteen treatment cubicles or 5.1.3.9 Support areas for definitive emergency man-
major fraction thereof; the shower room and toi- agement facilities
let room may be combined into the same room.
(1) Administrative center or nurse station for staff
(e) Nourishment area. A nourishment station work and charting.
that may be shared shall be provided. It shall
include a sink, work counter, refrigerator, (a) These areas shall have space for counters,
storage cabinets, and equipment for hot and cabinets, and medication storage, and shall
cold nourishment between scheduled meals. have convenient access to hand-washing
stations.
(3) Secure holding room. When required by the func-
tional program, there shall be a secure holding (b) They are permitted to be combined with or
APPENDIX
A5.1.3.8 (2) Observation/holding units for patients requiring A5.1.3.9 (2) A security station and/or system should be located
observation up to 23 hours or admission to an inpatient unit to maximize visibility of the treatment areas, waiting areas, and
should be located separately but near the main emergency key entrance sites.
department. The size will depend upon the function (observation
a. The system should include visual monitoring devices installed
and/or holding), patient acuity mix, and projected utilization.
both internally in the emergency department as well as externally
a. As defined by the functional plan, this area should consist of a at entrance sites and parking lots.
centralized nurse station; 100 square feet (9.29 square meters) of
b. Special requirements for a security station should include
clear floor space for each cubicle, with vacuum, oxygen, and air
accommodation for hospital security staff, local police officers,
outlets, monitoring space, and nurse call buttons.
and monitoring equipment.
b. A patient bathroom should be provided.
c. Design consideration should include installation of silent
c. Storage space for medical and dietary supplies should be alarms, panic buttons, and intercom systems, and physical barri-
included. ers such as doors to patient entry areas.
d. X-ray illuminators should be available. d. The security monitoring system should be included on the hos-
pital’s emergency power backup system.
include centers for reception and communi- (9) Housekeeping room. A housekeeping room shall
cation or poison control. be directly accessible from the unit and shall con-
tain a service sink or floor receptor and provisions
(c) Nursing stations decentralized near clusters for storage of supplies and housekeeping equip-
of treatment rooms are permitted. ment.
(d) Where feasible, visual observation of all traf- 5.1.3.10 Support areas for staff
fic into the unit and of all patients shall be
provided from the nursing station. (1) Staff lounge. Convenient and private access to
staff toilets, lounge, and lockers shall be provided.
*(2) Security station. Where dictated by local needs, a
security system shall be located near the emer- (2) Staff storage facilities. Securable closets or cabinet
gency entrances and triage/reception area. compartments shall be provided for the personal
effects of emergency service personnel in accor-
(3) Poison control center and EMS communications dance with Section 2.1-2.4.3.
center. If provided, they shall be permitted to be
part of the staff work and charting area. *5.1.3.11 Support areas for patients
(4) Scrub stations. Scrub stations located in or adjacent and *(1) Bereavement room
convenient to each trauma and/or orthopedic room.
(2) Patient toilet room. A minimum of one patient
(5) Provisions for disposal of solid and liquid waste. toilet room per eight treatment rooms or fraction
This may be a clinical sink with bedpan flushing thereof shall be provided, with hand-washing sta-
device within the soiled workroom. tion(s) in each toilet room.
(6) Clean workroom or clean supply room. A clean 5.2 Freestanding Emergency Service
workroom or clean supply room shall be provided
in accordance with Section 2.1-2.3.7. If the area 5.2.1 Definition
serves children, additional storage shall be provid- Freestanding emergency service shall mean an extension
ed to accommodate supplies and equipment in of an existing hospital emergency department that is
the range of sizes required for pediatrics. physically separate from the main hospital emergency
department and that is intended to provide compre-
*(7) Soiled workroom or soiled holding room. A soiled hensive emergency service. A service that does not
workroom or soiled holding room shall be pro- provide 24-hour-a-day, seven-day-a-week operation
vided in accordance with Section 2.1-2.3.8 for the
exclusive use of the emergency service. APPENDIX
(8) Equipment and supply storage A5.1.3.9 (7) Disposal space for regulated medical waste
(e.g., gauzes/linens soaked with body fluids) should be separate
(a) Wheelchair and stretcher storage. Storage from routine disposal space.
for wheelchairs and stretchers for arriving
A5.1.3.11 Other space considerations. Provision of a patient
patients shall be located out of traffic with
hygiene room with shower and toilet facilities should be considered.
convenient access from emergency entrances.
A5.1.3.11 (1) At least one bereavement room should be provided.
(b) Emergency equipment storage. Sufficient space This room should be accessible from both the emergency treat-
shall be provided for emergency equipment ment corridor and the emergency waiting area. This room should
(e.g., a CPR cart, pumps, ventilators, patient be comfortable enough to provide respite to the bereaved family
monitoring equipment, and portable x-ray and should be equipped with a sound transmission coefficient
unit) in accordance with Section 2.1-2.3.9.4. equivalent to 65 for the walls and 45 for the floors and ceiling.
5.2.2.3 Definitive emergency care. See Section 2.1-5.1.3. (2) Provision for serving patient and staff meals shall
be provided. A kitchen or a satellite serving facili-
5.2.2.4 Support areas. See Sections 2.1-5.1.3.9 through ty shall be permitted.
2.1-5.1.3.11.
(3) Support services and functions shall include
APPENDIX housekeeping, laundry, general stores, mainte-
nance and plant operations, and security.
A5.3 Surgery
a. The size and location of the surgical procedure rooms shall be *5.3 Surgery
determined by the level of care to be provided. The levels of care
as defined by the American College of Surgeons are as follows: 5.3.1 Surgical Suites
Note: Additions to, and adaptations of, the following
Class A: Provides for minor surgical procedures performed under
elements shall be made for the special procedure oper-
topical, local, or regional anesthesia without pre-operative seda-
ating rooms found in larger facilities.
tion. Excluded are intravenous, spinal, and epidural routes; these
methods are appropriate for Class B and Class C facilities.
5.3.1.1 Size. The number of operating rooms and
Class B: Provides for minor or major surgical procedures per- recovery beds and the sizes of the support areas shall
formed in conjunction with oral, parenteral, or intravenous seda- be based on the expected surgical workload.
tion or under analgesic or dissociative drugs.
5.3.1.2 Layout
Class C: Provides for major surgical procedures that require general
or regional block anesthesia and support of vital bodily functions.
(1) The surgical suite shall be located and arranged to
b. When invasive procedures are performed on patients known prevent nonrelated traffic through the suite.
or suspected to have pulmonary tuberculosis, these procedures
should not be performed in the operating suite. They should be (2) The clinical practice setting shall be designed to
performed in a room meeting airborne infection isolation room facilitate movement of patients and personnel
ventilation requirements or in a space using local exhaust ventila- into, through, and out of defined areas within the
tion. If the procedure must be performed in the operating suite, surgical suite. Signs shall clearly indicate the sur-
see the “CDC Guidelines for Preventing the Transmission of gical attire required.
Mycobacterium Tuberculosis in Health Care Facilities.”
(3) An operating room suite design with a sterile core sterile supplies or scrubbed persons may
shall provide for no cross-traffic of staff and sup- be located.
plies from the soiled/decontaminated areas to the
sterile/clean areas. The use of facilities outside the 5.3.1.3 Provision of outpatient surgery. In the func-
operating room for soiled/decontaminated pro- tional program, the size, location, and configuration
cessing and clean assembly and sterile processing of the surgical suite and support areas shall reflect the
shall be designed to move the flow of goods and projected volume of outpatients. This may be achieved
personnel from dirty to clean/sterile without by designing either an outpatient surgery facility or a
compromising universal precautions or aseptic combined inpatient/outpatient surgical suite.
techniques in both departments.
(1) Hospital surgical suite. Where outpatient surgery
(4) The surgical suite shall be divided into three des- is provided in the surgical suite of the hospital
ignated areas—unrestricted, semirestricted, and facility, it shall comply with the requirements for
restricted—defined by the physical activities per- outpatient surgery in Chapter 3.7, Outpatient
formed in each area. Surgical Facility.
(a) Unrestricted area (2) Separate hospital unit or outpatient surgical facil-
ity. Where outpatient surgery and post-anesthetic
(i) The unrestricted area includes a central care is provided in a separate unit of the hospital
control point established to monitor the facility or in a separate outpatient surgical facility,
entrance of patients, personnel, and it shall comply with the requirements for outpa-
materials. tient surgery in Chapter 3.7.
(ii) Street clothes are permitted in this area 5.3.2 Operating and Procedure Rooms
and traffic is not limited. 5.3.2.1 General operating room(s)
(i) The semirestricted area includes the (a) Space requirements. Each room shall have
peripheral support areas of the surgical a minimum clear area of 400 square feet
suite. It has storage areas for clean and (37.16 square meters) exclusive of fixed or
sterile supplies, work areas for storage wall-mounted cabinets and built-in shelves,
and processing of instruments, and cor- with a minimum of 20 feet (6.10 meters)
ridors leading to the restricted areas of clear dimension between fixed cabinets and
the surgical suite. built-in shelves.
(ii) Traffic in this area is limited to author- (b) Communication system. Each room shall
ized personnel and patients. Personnel have a system for emergency communication
are required to wear surgical attire and with the surgical suite control station.
cover all head and facial hair.
(c) X-ray viewers. X-ray film viewers for han-
(c) Restricted area dling at least four films simultaneously or
digital image viewers shall be provided.
(i) The restricted area includes operating
and procedure rooms, the clean core, and (d) Construction requirements. Operating
scrub sink areas. room perimeter walls, ceiling, and floors,
including penetrations, shall be sealed.
(ii) Surgical attire and hair coverings are (See Glossary.)
required. Masks are required where open
*(2) Renovation. Where renovation work is undertak- provided in the cardiovascular, orthopedic,
en, every effort shall be made to meet the above neurosurgical, pump, and storage rooms.
minimum standards. If it is not possible to meet
the above square-footage standards, each room (5) Renovation. Where renovation work is undertak-
shall have a minimum clear area of 360 square en, every effort shall be made to meet the above
feet (33.45 square meters), exclusive of fixed or minimum standards. If it is not possible to meet
wall-mounted cabinets and built-in shelves, with the above square-footage standards, the following
a minimum of 18 feet (5.49 meters) clear dimen- standards shall be met:
sion between fixed cabinets and built-in shelves.
(a) Orthopedic surgical rooms shall have a mini-
5.3.2.2 Room(s) for cardiovascular, orthopedic, neuro- mum clear area of 360 square feet (33.45
logical, and other special procedures that require addi- square meters), with a minimum dimension
tional personnel and/or large equipment of 18 feet (5.49 meters).
(1) Space requirements. When included, these (b) Rooms for cardiovascular, neurological, and
room(s) shall have, in addition to the above other special procedures shall have a mini-
requirements for general operating rooms, a min- mum clear area of 400 square feet (37.16
imum clear area of 600 square feet (55.74 square square meters).
meters), with a minimum of 20 feet (6.10 meters)
clear dimension exclusive of fixed or wall-mounted 5.3.2.3 Additional requirements for orthopedic surgery
cabinets and built-in shelves.
(1) Equipment storage. Where included, this room
(2) Pump room. Where open-heart surgery is per- shall, in addition to the above requirements, have
formed, an additional room in the restricted area enclosed storage space for splints and traction
of the surgical suite, preferably adjoining this equipment. Storage may be outside the operating
operating room, shall be designated as a pump room but must be conveniently located.
room where extra corporeal pump(s), supplies,
and accessories are stored and serviced. (2) Plaster trap. If a sink is used for the disposal of
plaster of paris, a plaster trap shall be provided.
(3) Equipment storage rooms. Where complex ortho-
pedic and neurosurgical surgery is performed, 5.3.2.4 Room(s) for surgical cystoscopic and other
additional rooms shall be in the restricted area of endourologic procedures
the surgical suite, preferably adjoining the special-
ty operating rooms, which shall be designated as (1) Space requirements
equipment storage rooms for the large equipment
used to support these procedures. (a) This room shall have a minimum clear area
of 350 square feet (32.52 square meters)
(4) Plumbing and electrical connections. Appropriate exclusive of fixed or wall-mounted cabinets
plumbing and electrical connections shall be and built-in shelves, with a minimum of 15
feet (4.57 meters) clear dimension between
APPENDIX fixed cabinets and built-in shelves.
A5.3.2.1 (2) The functional program may require additional clear (b) In renovation projects, rooms for surgical cys-
space, plumbing, and mechanical facilities to accommodate toscopy shall be permitted to have a minimum
special functions in one or more of these rooms. When existing clear area of 250 square feet (23.23 square
functioning operating rooms are modified, and it is impractical meters).
to increase the square footage because of walls or structural
members, the operating room may continue in use when (2) X-ray viewer. X-ray viewing capability to accommodate
requested by the hospital. at least four films simultaneously shall be provided.
5.3.2.5 Endoscopy suite. See Chapter 3.9, (3) Patient privacy. Provisions for patient privacy
Gastrointestinal Endoscopy Facilities. such as cubicle curtains shall be made.
5.3.3 Pre- and Postoperative Holding Areas (4) Facility requirements. Each PACU shall contain a
5.3.3.1 Preoperative patient holding area(s). In facili- medication station; hand-washing stations; nurse
ties with two or more operating rooms, areas shall be station with charting facilities; clinical sink; provi-
provided to accommodate stretcher patients as well as sions for bedpan cleaning; and storage space for
sitting space for ambulatory patients. stretchers, supplies, and equipment.
(1) Location. These areas shall be under the direct (a) Hand-washing station(s). At least one hand-
visual control of the nursing staff and may be part washing station with hands-free or wrist
of the recovery suite to achieve maximum flexibil- blade-operable controls shall be available for
ity in managing surgical caseloads. every four beds, uniformly distributed to
provide equal access from each bed.
(2) Space requirements. Each stretcher station shall
be a minimum of 80 square feet (7.43 square (b) Staff toilet. A staff toilet shall be located
meters) exclusive of general circulation space within the working area to maintain staff
through the ward and shall have a minimum availability to patients.
clearance of 4 feet (1.22 meters) on the sides of
the stretchers and the foot of the stretchers. (5) Provisions shall be made for the isolation of
infectious patients.
(3) Patient privacy. Provisions such as cubicle curtains
shall be made for patient privacy. (6) An airborne infection isolation room (AIIR) is
not required in a PACU. Provisions for the recov-
(4) Provisions shall be made for the isolation of ery of a potentially infectious patient with an air-
infectious patients. borne infection shall be determined by an ICRA.
(5) An airborne infection isolation room is not 5.3.3.3 Phase II recovery. Where outpatient surgeries are
required in a preoperative holding area. Provisions to be part of the surgical suite, and where outpatients
for the recovery of a potentially infectious patient receive Class B or Class C sedation, a separate Phase II
with an airborne infection shall be determined by or step-down recovery room shall be provided.
an ICRA.
(1) Layout. In new construction, at least one door
*5.3.3.2 Post-anesthetic care units (PACUs) shall access the PACU without crossing unrestrict-
ed corridors of the hospital.
(1) Space requirements. The design shall provide a
minimum of 80 square feet (7.43 square meters) (2) Space requirements
for each patient bed, exclusive of general circu-
lation space within the PACU, with a space for (a) The design shall provide a minimum of 50
additional equipment described in the function- square feet (4.65 square meters) for each
al program and for clearance of at least 5 feet patient in a lounge chair, with space for addi-
(1.52 meters) between patient beds and 4 feet tional equipment described in the functional
(1.22 meters) between patient bedsides and
adjacent walls. APPENDIX
(2) Layout. In new construction, at least one door to A5.3.3.2 Separate and additional recovery space may be necessary
the recovery room shall provide access directly to accommodate patients. If children receive care, recovery space
from the surgical suite without crossing public should be provided for pediatric patients and the layout of the
hospital corridors. surgical suite should facilitate the presence of parents in the PACU.
program and for clearance of 4 feet (1.22 5.3.4 Diagnostic and Treatment Locations
meters) on the sides of the lounge chairs and 5.3.4.1 Examination provisions. Provisions shall be
the foot of the lounge chairs. made for patient examination, interviews, preparation,
testing, and obtaining vital signs of patients for outpa-
(b) A minimum clear floor area of 100 square tient surgery.
feet (9.29 square meters) shall be provided in
single-bed rooms. 5.3.4.2 Area for preparation and examination of frozen
sections. This area may be part of the general labora-
(3) Patient privacy. Provisions for patient privacy tory if immediate results are obtainable without
such as cubicle curtains shall be made. unnecessary delay in the completion of surgery.
(4) Facility requirements. The room shall contain 5.3.5 Support Areas for the Surgical Suite
hand-washing stations, a nurse station with chart- Support areas, except for the enclosed soiled workroom
ing facilities, clinical sink, provision for bedpan mentioned in Section 2.1-5.3.5.10 and the housekeeping
cleaning, and storage space for supplies and room in Section 2.1-5.3.5.14, may be shared with the
equipment. obstetrical facilities in accordance with the functional
program. Support areas, where shared with delivery
(a) Hand-washing stations rooms, shall be designed to avoid the passing of
patients or staff between the operating room and the
(i) A hand-washing station shall be provided delivery room areas. The following shall be provided:
in each room.
5.3.5.1 A control station. This shall be located to per-
(ii) At least one hand-washing station with mit visual observation of all traffic into the suite.
hands-free operable controls shall be
provided for every four lounge chairs, 5.3.5.2 A supervisor office or station. The number of
uniformly distributed to provide equal offices, stations, and teaching areas in the surgical suite
access from each lounge chair. shall depend upon the functional program.
(5) Provisions shall be made for the isolation of (2) Scrub facilities shall be arranged to minimize
infectious patients. incidental splatter on nearby personnel, medical
equipment, or supply carts.
(6) An airborne infection isolation room is not
required in a Phase II recovery area. Provisions (3) In new construction, view windows at scrub sta-
for the recovery of a potentially infectious patient tions permitting observation of room interiors
with an airborne infection shall be determined by shall be provided.
an ICRA.
(4) The scrub sinks shall be recessed into an alcove
out of the main traffic areas. The alcove shall be
located off the semirestricted or restricted areas of (a) It shall contain a work counter, a hand-washing
the surgical suite. station, storage facilities for clean supplies, and
a space to package reusable items.
5.3.5.5 Medication station. Provision shall be made for
storage and distribution of drugs and routine medica- (b) The storage for sterile supplies must be sepa-
tions in accordance with Section 2.1-2.3.4. rated from this space.
5.3.5.6 Ice machine. An ice machine shall be provided (3) Clean supply room. If the room is used only for
in accordance with Section 2.1-2.3.6. storage and holding as part of a system for distribu-
tion of clean and sterile supply materials, the work
5.3.5.7 Patient holding area. In facilities with two or counter and hand-washing station may be omitted.
more operating rooms, an area shall be provided to
accommodate stretcher patients waiting for surgery. 5.3.5.10 Soiled workroom or holding room. Soiled and
This holding area shall be under the visual control of clean workrooms or holding rooms shall be separated.
the nursing staff.
(1) An enclosed soiled workroom (or soiled holding
5.3.5.8 A substerile service areas(s). This area acts as a room that is part of a system for the collection
service area between two or more operating or proce- and disposal of soiled material) shall be provided
dure rooms. Other facilities for processing and steriliz- for the exclusive use of the surgical suite.
ing reusable instruments, etc., are typically located in
another hospital department, such as central services. (2) The room shall be located in the restricted area.
(1) It shall be equipped with a flash sterilizer, warm- (3) The soiled workroom shall contain a flushing-rim
ing cabinet, sterile supply storage area, and hand- clinical sink or equivalent flushing-rim fixture, a
washing station with hands-free controls. hand-washing station, a work counter, and space
for waste receptacles and soiled linen receptacles.
(2) A sterilizing facility(ies) with high-speed steriliz- Rooms used only for temporary holding of soiled
er(s) or other sterilizing equipment for immediate material may omit the flushing-rim clinical sink
or emergency use shall be grouped to service sev- and work counters. However, if the flushing-rim
eral operating rooms for convenient, efficient use. clinical sink is omitted, other provisions for dis-
posal of liquid waste shall be provided.
(3) A work space and hand-washing station shall be
provided if required by the functional program. (4) The room shall not have direct connection with
operating rooms or other sterile activity rooms.
5.3.5.9 Clean workroom or clean supply room. Soiled
and clean workrooms or holding rooms shall be sepa- 5.3.5.11 Anesthesia workroom. An anesthesia work-
rated. The clean workroom or supply room shall not room for cleaning, testing, and storing anesthesia
be used for food preparation. equipment.
(1) Storage space for sterile and clean supplies shall (1) This room shall contain work counter(s) and
be sized to meet the functional program. The sink(s) and racks for cylinders.
space shall be moisture and temperature con-
trolled and free from cross-traffic. (2) Provisions shall be made for separate storage of
clean and soiled items.
(2) Clean workroom. A clean workroom shall be pro-
vided when clean materials are assembled within (3) In new construction, depending on the functional
the surgical suite prior to use or following the and space programs, the anesthesia workroom
decontamination cycle. shall provide space for anesthesia case carts and
other anesthesia equipment.
5.3.5.12 Storage for blood, organs, and pathological provisions for storage of supplies and housekeeping
specimens equipment.
(1) Provisions for refrigerated blood bank storage 5.3.6 Support Areas for Staff
that meets the standards of the American Blood 5.3.6.1 Staff lounge and toilet facilities
Banking Association shall be provided.
(1) Separate or combined lounges shall be provided
(2) Storage for harvested organs. Where applicable, for male and female staff.
refrigeration facilities for harvested organs shall
be provided. (2) Lounge(s) shall be designed to minimize the need
to leave the suite and to provide convenient access
5.3.5.13 Storage for pathological specimens. Provisions to the recovery room.
for storage of pathological specimens prior to transfer
to pathology section shall be provided. 5.3.6.2 Staff clothing change areas. Appropriate areas
shall be provided for male and female personnel
5.3.5.14 Equipment and supply storage (orderlies, technicians, nurses, and doctors) working
within the surgical suite.
*(1) Storage room(s) shall be provided for equipment
and supplies used in the surgical suite. Each surgical (1) The areas shall contain lockers, showers, toilets,
suite shall provide sufficient storage area to keep its hand-washing stations, and space for donning
required corridor width free of equipment and sup- surgical attire.
plies, but not less than 150 square feet (13.94 square
meters) or 50 square feet (4.65 square meters) per (2) These areas shall be arranged to encourage a
operating room, whichever is greater. one-way traffic pattern so that personnel entering
from outside the surgical suite can change and
(2) Storage areas shall be provided for portable x-ray move directly into the surgical suite.
equipment, stretchers, fracture tables, warming
devices, auxiliary lamps, etc. These areas shall be 5.3.7 Support Areas for Patients
out of corridors and traffic. 5.3.7.1 Patient clothing change areas. If the functional
program defines outpatient surgery as part of the sur-
(3) Medical gas storage. Main storage of medical gical suite, a separate area shall be provided where
gases may be outside or inside the facility in outpatients and same-day admission patients may
accordance with NFPA 99. Provision shall be change from street clothing into hospital gowns and
made for additional separate storage of reserve be prepared for surgery.
gas cylinders necessary to complete at least one
day’s procedures. (1) It shall include a waiting room, locker(s), toilet(s),
and clothing change or gowning area.
5.3.5.15 Housekeeping facilities. Housekeeping facilities
shall be provided for the exclusive use of the surgical (2) Where private holding room(s) or cubicle(s) are
suite. They shall be directly accessible from the suite provided, a separate change area is not required.
and shall contain a service sink or floor receptor and
5.4 Interventional Imaging Facilities
APPENDIX
5.4.1 Cardiac Catheterization Lab (Cardiology)
5.3.5.14 (1) Equipment storage room(s) for equipment and 5.4.1.1 Location. The cardiac catheterization lab is
supplies used in the surgical suite should be strategically located normally a separate suite, but location in the imaging
and sized for convenient access and utilization. In larger surgical suite shall be permitted provided the appropriate
suites, storage spaces should be located for ready access to sterile environment is provided. See Section 2.1-5.5.7.
specialty rooms.
5.4.1.2 Space requirements (6) Clean workroom or clean supply room. A clean
workroom or clean supply room shall be provided
(1) Procedure rooms in accordance with Section 2.1-2.3.7.
(a) The number of procedure rooms shall be (7) Soiled workroom or soiled holding room. A soiled
based on expected utilization. workroom shall be provided in accordance with
Section 2.1-2.3.8.
(b) The procedure room shall be a minimum
of 400 square feet (37.16 square meters) (8) Film file room. Film file room shall be available
exclusive of fixed cabinets and shelves. for use by the cardiac catheterization suite.
(2) Prep, holding, and recovery rooms. The size of the (9) Housekeeping closet. A housekeeping closet shall
prep, holding, and recovery areas shall be based be provided in accordance with Section 2.1-2.3.10.
on expected utilization.
5.4.1.5 Support areas for staff
5.4.1.3 Electrophysiology labs. If electrophysiology labs
are also provided in accordance with the approved func- (1) Staff clothing change area(s). Staff change area(s)
tional program, these labs may be located within and shall be provided and arranged to ensure a traffic
integral to the catheterization suite or located in a sepa- pattern so that personnel can enter from outside
rate functional area proximate to the cardiac care unit. the suite, change their clothing, and move directly
into the cardiac catheterization suite.
5.4.1.4 Support areas for the cardiac catheterization lab
5.5 Imaging Suite
(1) Scrub facilities. Scrub facilities with hands-free
operable controls shall be provided adjacent to 5.5.1 General
the entrance of procedure rooms, and shall be *5.5.1.1 Functional program. Equipment and space
arranged to minimize incidental splatter on near- shall be as necessary to accommodate the functional
by personnel, medical equipment, or supplies. program. The imaging department provides diagnostic
procedures. An imaging department commonly includes
(2) Patient prep, holding, and recovery area or room. fluoroscopy, radiography, mammography, tomography,
A patient preparation, holding, and recovery computerized tomography scanning, ultrasound, mag-
area or room shall be provided and arranged to netic resonance, angiography, and similar techniques.
provide visual observation before and after the
procedure. *5.5.1.2 Layout. Beds and stretchers shall have ready
access to and from other departments of the institution. (2) Provision shall be made within the facility for
extended post-procedure observation of outpatients.
5.5.1.3 Radiation protection. Most imaging requires
radiation protection. A certified physicist or other 5.5.2.2 Control room. A control room shall be provid-
qualified expert representing the owner or appropriate ed as necessary to accommodate the functional pro-
state agency shall specify the type, location, and gram. A view window shall be provided to permit full
amount of radiation protection to be installed in view of the patient.
accordance with the final approved department layout
and equipment selections. *5.5.2.3 Viewing area. A viewing area shall be provided.
(1) Where protected alcoves with view windows are 5.5.2.4 Scrub facilities. A scrub sink located outside the
required, a minimum of 1 foot 6 inches (45.72 staff entry to the procedure room shall be provided for
centimeters) shall be provided between the view use by staff.
window and the outside partition edge.
5.5.2.5 Equipment storage. Storage for portable equip-
(2) Radiation protection requirements shall be incor- ment and catheters shall be provided.
porated into the specifications and the building
plans. *5.5.2.6 Patient holding area. A patient holding area
shall be provided.
5.5.1.4 Construction requirements
5.5.3 Computerized Tomography (CT) Scanning
(1) Floor. Floor shall be adequate to meet load 5.5.3.1 Space requirements. CT scan rooms shall be as
requirements. required to accommodate the equipment.
(2) Ceiling. A lay-in type ceiling shall be permitted to 5.5.3.2 Control room. A control room shall be provid-
be considered for ease of installation, service, and ed that is designed to accommodate the computer and
remodeling. other controls for the equipment.
*(1) Space requirements. Space shall be provided as (2) The angle between the control and equipment
necessary to accommodate the functional program. centroid shall permit the control operator to see
the patient’s head.
APPENDIX
(3) The control room shall be located to allow con-
A5.5.2.1 (1) The procedure room should be a minimum of 400 venient film processing.
square feet (37.16 square meters).
5.5.3.4 Patient toilet. A patient toilet shall be provided.
A5.5.2.3 Viewing areas should be a minimum of 10 feet (3.05
It shall be convenient to the procedure room and, if
meters) in length.
directly accessible to the scan room, arranged so a
A5.5.2.6 A patient holding area should be provided to accommo- patient can leave the toilet without having to reenter
date two stretchers with additional spaces for additional proce- the scan room.
dure rooms.
5.5.4 Diagnostic X-Ray
A5.5.4.1 Radiography rooms should be a minimum of 180 square
*5.5.4.1 Space requirements. Radiography rooms shall
feet (16.72 square meters). (Dedicated chest X-ray may be smaller.)
be of a size to accommodate the functional program.
A5.5.4.2 Tomography and radiography/fluoroscopy (R&F) rooms
should be a minimum of 250 square feet (23.23 square meters). *5.5.4.2 Tomography, radiography/fluoroscopy rooms
(1) Separate toilets with hand-washing stations shall *5.5.5.6 Darkroom. A darkroom shall be provided.
be provided with direct access from each fluoro-
scopic room so that a patient can leave the toilet *5.5.5.7 Cryogen storage. Cryogen storage shall be
without having to reenter the fluoroscopic room. provided.
(2) Rooms used only occasionally for fluoroscopic 5.5.5.8 Equipment installation requirements
procedures shall be permitted to use nearby
patient toilets if they are located for immediate *(1) Power conditioning shall be provided.
access.
*(2) Magnetic shielding shall be provided.
*5.5.4.3 Mammography rooms
(3) For super-conducting MRI, cryogen venting and
5.5.4.4 Shielded control alcoves emergency exhaust must be provided in accor-
dance with the original equipment manufacturer’s
(1) Each x-ray room shall include a shielded control specifications.
alcove. This area shall be provided with a view
window designed to provide full view of the 5.5.6 Ultrasound
examination table and the patient at all times, 5.5.6.1 Space requirements. Space shall be provided as
including full view of the patient when the table necessary to accommodate the functional program.
is in the tilt position or the chest x-ray is in use.
5.5.6.2 Patient toilet. A patient toilet, accessible from
(2) For mammography machines with built-in shield- the procedure room, shall be provided.
ing for the operator, the alcove shall be permitted
to be omitted when approved by the certified APPENDIX
physicist or state radiation protection agency.
A5.5.4.3 Mammography rooms should be a minimum of 100
5.5.5 Magnetic Resonance Imaging (MRI) square feet (9.29 square meters).
5.5.5.1 Space requirements
A5.5.5.3 Control rooms should be a minimum of 100 square feet
(9.29 square meters), but may be larger depending on the vendor
(1) Space shall be provided as necessary to accommo-
and magnet size.
date the functional program.
A5.5.5.4 When patient holding areas are provided, they should be
(2) The MRI room shall be permitted to range from located near the MRI unit and should be large enough to accom-
325 square feet (30.19 square meters) to 620 modate stretcher(s).
square feet (57.60 square meters), depending
A5.5.5.5 A computer room may range from 150 square feet
on the vendor and magnet strength.
(13.94 square meters) to 380 square feet (35.30 square meters)
depending on the vendor and magnet strength. Self-contained air
5.5.5.2 Layout. When spectroscopy is provided, caution
conditioning supplement is normally required.
shall be exercised in locating it in relation to the mag-
netic fringe fields. A5.5.5.6 A darkroom may be required for loading cassettes and
shall be located near the control room. This darkroom shall be
*5.5.5.3 Control room. A control room shall be outside the 10-gauss field.
provided with full view of the MRI.
A5.5.5.7 Cryogen storage may be required in areas where service
to replenish supplies is not readily available. When provided,
*5.5.5.4 Patient holding area. A patient holding area
space should be a minimum of 50 square feet (4.65 square
shall be provided.
meters) to accommodate two large dewars of cryogen.
*5.5.5.5 Computer room. A computer room shall be A5.5.5.8 (1) Power conditioning and voltage regulation equip-
provided. ment as well as direct current (DC) may be required.
5.5.7 Cardiac Catheterization Lab (Cardiology) 5.5.8.5 Patient holding area. A convenient holding area
The cardiac catheterization lab is normally a separate under staff control shall be provided to accommodate
suite (see Section 2.1-5.4.1) but location within the inpatients on stretchers or beds.
imaging suite shall be permitted provided the appropri-
ate sterile environment is provided. Combination with 5.5.8.6 Clerical offices/spaces. Office space shall be
angiography shall be permitted in low usage situations. provided as necessary for the functional program.
5.5.8 Support Areas for the Imaging Suite 5.5.8.7 Film processing room
The following spaces are common to the imaging
department and are minimum requirements unless (1) If film systems are used, a darkroom shall be pro-
stated otherwise: vided for processing film unless the processing
equipment normally used does not require a
5.5.8.1 Control desk and reception area darkroom for loading and transfer. When daylight
processing is used, the darkroom shall be permit-
5.5.8.2 Offices for radiologist(s) and assistant(s). ted to be minimal for emergency and special uses.
Offices shall include provisions for viewing, individual
consultation, and charting of film. (2) Film processing shall be located convenient to the
procedure rooms and to the quality control area.
5.5.8.3 Hand-washing stations
5.5.8.8 Quality control area. An area or room shall
(1) Hand-washing stations shall be provided within be provided near the processor for viewing film
each procedure room unless the room is used only immediately after it is processed. All view boxes shall
for routine screening such as chest x-rays where be illuminated to provide light of the same color value
the patient is not physically handled by the staff. and intensity for appropriate comparison of several
adjacent films.
(2) Hand-washing stations shall be provided con-
venient to the MRI room, but need not be with- 5.5.8.9 Contrast media preparation
in the room.
(1) If contrast media are used, this area shall include
5.5.8.4 Consultation area. An appropriate area for a sink, counter, and storage to allow for mixing of
individual consultation with referring clinicians shall contrast media.
be provided.
(2) One preparation room, if conveniently located,
APPENDIX shall be permitted to serve any number of rooms.
A5.5.5.8 (2) Magnetic shielding may be required to restrict the (3) Where pre-prepared media are used, this area
magnetic field plot. Radio frequency shielding may be required to shall be permitted to be omitted, but storage shall
attenuate stray radio frequencies. The area around, above and below be provided for the media.
the MRI suite shall be reviewed and evaluated for the following:
5.5.8.10 Cleanup facilities. Provisions for cleanup shall
• Possible occupancy by person(s) who could have pacemakers
be located within the suite for convenient access and use.
or other metal implants.
• Equipment that can be disrupted by a magnetic field. Examples (1) The facilities shall include service sink or floor
include but are not limited to personal computers, monitors, CT receptacle as well as storage space for equipment
scanners, and nuclear cameras. and supplies.
After reviewing and evaluating the surrounding space, appropriate
(2) If automatic film processors are used, a receptacle
magnetic shielding should be provided based upon the type of
of adequate size with hot and cold water for
MRI scanner to be installed.
cleaning the processor racks shall be provided.
5.5.8.11 Clean storage. Provision shall be made for the 5.5.10.1 Patient waiting area
storage of clean supplies and linens. If conveniently
located, storage shall be permitted to be shared with (1) The area shall be out of traffic, under staff con-
another department. trol, and shall have seating capacity in accordance
with the functional program.
5.5.8.12 Soiled holding. Provision shall be made for
soiled holding. Separate provisions for contaminated (2) If the suite is routinely used for outpatients and
handling and holding shall be made. Hand-washing inpatients at the same time, separate waiting areas
stations shall be provided. shall be provided with screening for visual privacy
between them.
5.5.8.13 Film storage
(3) If so determined by an ICRA, the diagnostic
(1) Film storage (active). A room with cabinet or imaging waiting area shall require special meas-
shelves for filing patient film for immediate ures to reduce the risk of airborne infection trans-
retrieval shall be provided. mission. These measures shall include enhanced
general ventilation and air disinfection techniques
(2) Film storage (inactive). A room or area for inactive similar to inpatient requirements for airborne
film storage shall be provided. It shall be permitted infection isolation rooms (see Table 2.1-2).
to be outside the imaging suite, but must be under See the “CDC Guidelines for Preventing the
imaging’s administrative control and properly Transmission of Mycobacterium Tuberculosis
secured to protect films against loss or damage. in Health Care Facilities.”
(3) Storage for unexposed film. If film systems are 5.5.10.2 Patient toilet rooms. Toilet rooms with
used, storage facilities for unexposed film shall hand-washing stations convenient to the waiting
include protection of film against exposure or rooms and equipped with an emergency call system
damage and shall not be warmer than the air of shall be provided.
adjacent occupied spaces.
5.5.10.3 Patient dressing rooms. Dressing rooms shall
5.5.8.14 Medication storage. Provision shall be made be provided convenient to the waiting areas and x-ray
for locked storage of medications and drugs. rooms. Each room shall include a seat or bench, mir-
ror, and provisions for hanging patients’ clothing and
5.5.9 Support Areas for Staff securing valuables.
The following spaces are common to the imaging
department and are minimum requirements unless 5.6 Nuclear Medicine
stated otherwise:
5.6.1 General
5.5.9.1 Staff lounge. Staff lounge with lockers shall be *5.6.1.1 Space requirements. Space shall be provided as
permitted to be outside the suite but shall be conven- necessary to accommodate the functional program.
ient for staff use. Where the functional program calls for it, nuclear
medicine procedure room(s) shall accommodate the
5.5.9.2 Staff toilets. Toilets shall be permitted to be equipment specified in the functional program, a
outside the suite but shall be convenient for staff use. stretcher, exercise equipment (treadmill and/or bicycle),
In suites of three or more procedure rooms, toilets and staff work space.
internal to the suite shall be provided.
APPENDIX
5.5.10 Support Areas for Patients
The following spaces are common to the imaging A5.6.1.1 Nuclear medicine may include positron emission
department and are minimum requirements unless tomography, which is not common to most facilities. It requires
stated otherwise: specialized planning for equipment.
APPENDIX
A5.6.3 Positron Emission Tomography (PET) Facilities b. Gas storage area. A gas storage area large enough to accom-
Space requirements modate bottles of gas should be provided. Each gas will be piped
a. Space should be provided as necessary to accommodate the individually and may go to the cyclotron or to the lab.
functional program. PET scanning is generally used in experimen-
Construction requirements
tal settings and requires space for a scanner and for a cyclotron.
Radiation protection. Significant radiation protection may be
b. Scanner room. The scanner room should be a minimum of 300 required, since the cyclotron may generate high radiation.
square feet (27.87 square meters).
Ventilation requirements
c. Cyclotron room. Where a cyclotron room is required, it should a. Ventilation adequate for the occupancy is required. Compressed
be a minimum of 225 square feet (20.90 square meters) with a air may be required to pressurize a water circulation system.
16-square-foot (1.47 square meters) space safe for storage of
b. Special ventilation systems together with monitors, sensors,
parts that may need to cool down for a year or more.
and alarm systems may be required to vent gases and chemicals.
Laboratory facilities
c. The heating, ventilating, and air conditioning system will require
a. Both a hot (radioactive) lab and a cold (nonradioactive) lab
particular attention; highest pressures should be in coldest (radia-
may be required, each a minimum of 250 square feet (23.23
tion) areas and exhaust should be in hottest (radiation) areas.
square meters).
Redundancy may be important.
b. A blood lab of a minimum of 80 square feet (7.43 square
Plumbing requirements
meters) should be provided.
The cyclotron is water cooled with de-ionized water. A heat
Facility requirements exchanger and connection to a compressor or connection to
a. Patient holding area. A patient holding area to accommodate chilled water may be required. A redundant plumbing system con-
two stretchers should be provided. nected to a holding tank may be required to prevent accidental
leakage of contaminated water into the regular plumbing system.
(3) Hoods for pharmaceutical preparation shall meet (a) Medical staff offices. Offices for physicians
applicable standards. and assistants shall be provided and
equipped for individual consultation, view-
*5.6.3 Positron Emission Tomography (PET) ing, and charting of film.
5.6.4 Nuclear Medicine Area (b) Other staff offices. Clerical offices and spaces
The nuclear medicine area, when operated separately shall be provided as necessary for the pro-
from the imaging department, shall include the gram to function.
following:
*(4) Darkroom. If film processing is used, an on-site
5.6.4.1 Space requirements. Space shall be adequate to darkroom shall be provided for film processing.
permit entry of stretchers and beds and able to accom-
modate imaging equipment, electronic consoles, and if (5) Computer room. When the functional program
present, computer terminals. requires a centralized computer area, it shall be a
separate room with access terminals available
5.6.4.2 A control desk and reception area within the imaging rooms.
5.6.4.3 Hand-washing stations. These shall be provided (6) A soiled workroom or holding room
within each procedure room.
(a) Soiled workroom. It shall contain a hand-
*5.6.4.4 Dose administration area. A dose administra- washing station and a clinical sink (or equiv-
tion area as specified by the functional program shall alent flushing-rim fixtures).
be provided, located near the preparation area. Since
as much as several hours may elapse for a dose to take (b) Soiled holding room. If the room is used for
effect, the area shall provide for visual privacy from temporary holding of soiled materials, omis-
other areas. sion of the clinical sink shall be permitted.
5.6.4.5 Support areas for the nuclear medicine area (7) Equipment and supply storage
(1) Consultation area. A consultation area with view (a) Film storage. Inactive film storage under
boxes illuminated to provide light of the same departmental administrative control and
color value and intensity for appropriate com- properly secured to protect film against
parison of several adjacent films shall be provid- loss or damage shall be provided and can
ed. Space shall be provided for computer access be off site.
and display terminals if such are included in the
program. (b) Clean linen storage. A storage area for clean
linen with a hand-washing station.
(2) Patient holding area
(8) Housekeeping rooms. Provisions for cleanup shall nuclear medicine patients shall be provided
be located within the suite for convenient access convenient to waiting and procedure rooms.
and use. Cleanup facilities shall include service
sink or floor receptacle as well as storage space 5.6.5 Radiotherapy Suite
for housekeeping equipment and supplies. *5.6.5.1 Space requirements
5.6.4.6 Support areas for staff (1) Rooms and spaces shall be provided as necessary
to accommodate the functional program.
(1) Staff toilet(s). These shall be provided convenient
to the nuclear medicine laboratory. *(2) Simulator, accelerator, and cobalt rooms shall be
sized to accommodate the equipment and patient
5.6.4.7 Support areas for patients access on a stretcher, medical staff access to the
equipment and patient, and service access.
(1) Patient waiting areas. Waiting areas shall be pro-
vided out of traffic, under staff control, and 5.6.5.2 Radiation protection requirements. Cobalt, lin-
with seating capacity in accordance with the ear accelerators, and simulation rooms require radia-
functional program. If the department is rou- tion protection.
tinely used for outpatients and inpatients at the
same time, separate waiting areas shall be pro- (1) Layouts shall be designed to prevent the escape of
vided with screening or visual privacy between radioactive particles.
the waiting areas.
(2) Openings into the room, including doors, duct-
(2) Patient dressing rooms work, vents, and electrical raceways and conduits,
shall be baffled to prevent direct exposure to
(a) These shall be convenient to the waiting area other areas of the facility.
and procedure rooms.
(3) A certified physicist representing the owner or
(b) Each dressing room shall include a seat or appropriate state agency shall specify the type,
bench, a mirror, and provisions for hanging location, and amount of protection to be installed
patients’ clothing and securing valuables. in accordance with final approved department
layout and equipment selection. The architect
(3) Patient toilet rooms. Toilet rooms reserved for shall incorporate these specifications into the hos-
pital building plans.
APPENDIX
5.6.5.3 Construction requirements
A5.6.5.1 Equipment manufacturers’ recommendations should be
sought and followed, since space requirements may vary from one (1) Flooring shall be adequate to meet load require-
machine to another and one manufacturer to another. ments for equipment, patients, and personnel.
a. The radiotherapy suite may contain electron beam therapy or
(2) Provision for wiring raceways, ducts, or conduit
radiation therapy or both.
shall be made in floors and ceilings.
b. Although not recommended, a simulation room may be omitted
in small linear accelerator facilities where other positioning geom- (3) Ceiling-mounted equipment shall have properly
etry is provided. designed rigid support structures located above
the finished ceiling.
A5.6.5.1 (2) Minimum size should be 260 square feet (24.15
square meters) for the simulator room; 680 square feet (63.17
5.6.5.4 Support areas for the radiotherapy suite. The
square meters), including the maze, for accelerator rooms; and
following areas shall be provided. Sharing of these areas
450 square feet (41.81 square meters) for cobalt rooms.
between the radiotherapy suite and other areas shall be 5.6.5.5 Optional support areas for the radiotherapy
permitted if required by the functional program: suite. The following areas may be required by the
functional program:
(1) Exam rooms for each treatment room. These shall
be as specified by the functional program. (1) Offices
(a) Each exam room shall be a minimum of 100 (a) Oncologist’s office (may be combined with
square feet (9.29 square meters). consultation room)
(b) Each exam room shall be equipped with a (b) Physicist’s office (may be combined with
hand-washing station. treatment planning)
(2) A stretcher hold area (2) Treatment planning and record room
(a) This shall be located adjacent to the treat- (3) Consultation room
ment rooms, screened for privacy, and com-
bined with a seating area for outpatients. (4) Quality control area. This shall have view boxes
illuminated to provide light of consistent color
(b) The size of the area will be dependent on the value and intensity.
program for outpatients and inpatients.
(5) Computer control area. This is normally located
(3) Patient gowning area just outside the entry to the treatment room(s).
(a) Safe storage for valuables and clothing shall (6) Dosimetry equipment area
be provided.
(7) Hypothermia room (may be combined with an
(b) At least one space should be large enough for exam room)
staff-assisted dressing.
(8) Workstation/nutrition station
(4) Business office and/or reception/control area
5.6.5.6 Additional support areas for linear accelerator
(5) Darkroom. This shall be convenient to the treat-
ment room(s) and the quality control area. (1) Mold room with exhaust hood and hand-washing
station
(a) Where daylight processing is used, the dark-
room may be minimal for emergency use. (2) Block room with storage. The block room may be
combined with the mold room.
(b) If automatic film processors are used, a recep-
tacle of adequate size with hot and cold water 5.6.5.7 Additional support areas for cobalt room
for cleaning the processor racks shall be
provided either in the darkroom or nearby. (1) Hot lab
5.7.1.2 Where two or more rehabilitation services are 5.7.3.1 Work areas and counters. These shall be suit-
included, facilities and equipment may be shared as able for wheelchair access.
appropriate.
*5.7.3.2 Teaching area. An area for teaching daily living
5.7.2 Physical Therapy activities shall be provided. It shall contain an area for
If physical therapy is part of the service, at least the a bed, kitchen counter with appliances and sink, a
following shall be provided: bathroom, and a table and chair.
5.7.2.1 Individual treatment area(s) with privacy screens 5.7.3.3 Hand-washing stations
or curtains. Each such space shall have not less than 70
square feet (6.51 square meters) of clear floor area. 5.7.3.4 Equipment and supply storage
5.7.2.4 Hand-washing stations 5.7.4.2 Space for evaluation and fitting. This shall have
provision for privacy.
(1) Hand-washing stations for staff shall be located
either within or at each treatment space. 5.7.4.3 Space for equipment, supplies, and storage
(2) Each treatment room shall have at least one hand- 5.7.5 Speech and Hearing Services
washing station. If speech and hearing services are offered, at least the
following shall be provided:
5.7.2.5 Support areas for physical therapy
5.7.5.1 Space for evaluation and treatment
(1) Soiled material storage. Separate storage for soiled
linen, towels, and supplies shall be provided. 5.7.5.2 Space for equipment and storage
(2) Equipment and supply storage 5.7.6 Support Areas for the Rehabilitation
Therapy Department
(a) Clean linen and towel storage Each rehabilitation therapy department shall include
the following, which may be shared or provided as
(b) Storage for equipment and supplies separate units for each service:
5.7.2.6 Support areas for patients. If required by the 5.7.6.1 Reception and control station(s). This shall
functional program, patient dressing areas, showers, permit visual control of waiting and activities areas
and lockers shall be provided. They shall be accessible and may be combined with office and clerical space.
and usable by the disabled.
5.7.6.2 Office and clerical space. Provision shall be
APPENDIX made for filing and retrieval of patient records.
A5.7.3.2 The facilities should be similar to a residential environment. 5.7.6.3 Multipurpose room. Access to a demonstration/
conference room shall be provided.
5.7.6.4 Wheelchair and stretcher storage. Space(s) shall enclosures that have discharge HEPA filters and
be provided for storing wheelchairs and stretchers out exhaust directly to the outside).
of traffic while patients are using the services. These
spaces may be separate from the service area but must 5.8.1.2 If a ventilated booth is used, the air exchange
be conveniently located. rate within the booth shall be at least 12 air changes
per hour, with a minimum exhaust flow rate of 50 cfm
5.7.6.5 Housekeeping room. A conveniently accessible and differential pressure of 0.0l" w.c. (2.5 Pa).
housekeeping room and service sink for housekeeping
use shall be provided. 5.8.1.3 These procedures may also be performed in a
room that meets the ventilation requirements for air-
5.7.7 Support Areas for Staff borne infection control. See Table 2.1-2 for airborne
Each rehabilitation therapy department shall include infection isolation room ventilation requirements.
the following, which may be shared or provided as
separate units for each service: 5.8.2 Outpatient Testing and Demonstration
If respiratory services such as testing and demonstra-
5.7.7.1 Convenient access to toilets tion for outpatients are part of the program, addition-
al facilities and equipment shall be provided as
5.7.7.2 Locking closets or cabinets shall be provided necessary for the appropriate function of the service,
within the vicinity of each work area for securing staff including but not limited to the following:
personal effects.
5.8.2.1 A reception and control station
5.7.8 Support Areas for Patients
Each rehabilitation therapy department shall include 5.8.2.2 Room(s) for patient education and demonstration
the following, which may be shared or provided as
separate units for each service: 5.8.2.3 Patient waiting area with provision for wheelchairs
5.7.8.1 Patient waiting area(s). These shall be located 5.8.2.4 Patient toilets and hand-washing stations
out of traffic with provision for wheelchairs.
5.8.3 Space and Utilities for Cleaning and
5.7.8.2 Patient toilets with hand-washing stations Disinfecting Equipment
accessible to wheelchair patients. 5.8.3.1 The space for receiving and cleaning soiled
materials shall be physically separated from the space
5.8 Respiratory Therapy Service for storage of clean equipment and supplies.
The type and extent of respiratory therapy service in
different institutions vary greatly. In some, therapy is 5.8.3.2 Appropriate local exhaust ventilation shall be
delivered in large sophisticated units, centralized in a provided if glutaraldehyde or other noxious disinfec-
specific area; in others, basic services are provided only tants are used in the cleaning process.
at patients’ bedsides. If respiratory service is provided,
the following elements shall be provided as a minimum, 5.8.4 Storage for Equipment and Supplies
in addition to those elements stipulated in Sections
2.1-5.7.6.1 and 5.7.6.2 and 2.1-5.7.7.1 and 5.7.7.2: 5.9 Renal Dialysis Unit (Acute and Chronic)
5.9.1.2 Location (1) If a stat laboratory for blood and urinalysis is pro-
vided, the stat laboratory shall contain a hand-
(1) The location shall offer convenient access for out- washing station, work counters, storage spaces, an
patients. Accessibility to the unit from parking and undercounter refrigerator for specimens, and a
public transportation shall be a consideration. cup sink.
(2) Inpatient services are permitted in critical care (2) An area for the phlebotomists’ use shall be pro-
units and designated areas in the hospital with vided adjacent to the laboratory.
appropriate utilities.
(3) A pass-through for specimens shall be provided
5.9.2 Treatment Area between the patient toilet room and the laboratory.
5.9.2.1 Layout. The treatment area shall be permitted
to be an open area and shall be separate from adminis- 5.9.2.8 Private treatment area. If home training is pro-
trative and waiting areas. vided in the unit, a private treatment area shall be
provided.
5.9.2.2 Space requirements
(1) A private treatment area of at least 120 square feet
(1) Area. Individual patient treatment areas shall (11.15 square meters) shall be provided for
contain at least 80 square feet (7.43 square patients who are being trained to use dialysis
meters), exclusive of general circulation space equipment at home.
within the ward.
(2) This room shall contain a counter, hand-washing
(2) Clearance. There shall be at least a 4-foot (1.22 stations, and a separate drain for fluid disposal.
meters) space between beds and/or lounge chairs.
5.9.2.9 Airborne infection isolation room(s). The num-
5.9.2.3 Privacy. The open unit shall be designed to ber of and need for required airborne infection isola-
provide privacy for each patient. tion rooms shall be determined by an ICRA. When
required, the airborne infection isolation room(s) shall
5.9.2.4 Nurse station(s). These shall be located within comply with the requirements of Section 2.1-3.2.2.
the dialysis treatment area and designed to provide
visual observation of all patient stations. 5.9.3 Examination Room
An examination room with hand-washing stations and
5.9.2.5 Hand-washing stations writing surface shall be provided with at least 100
square feet (9.29 square meters).
(1) Hand-washing stations shall be convenient to the
nurse station and patient treatment areas. 5.9.4 Support Areas for the Renal Dialysis Unit
5.9.4.1 Administrative space. Office and clinical work-
(2) There shall be at least one hand-washing station space shall be available for administrative services.
serving no more than four stations.
5.9.4.2 Medication dispensing station. If required by
(3) The hand-washing stations shall be uniformly dis- the functional program, there shall be a medication
tributed to provide equal access from each patient dispensing station for the dialysis center.
station.
(1) A work counter and hand-washing stations shall
5.9.2.6 Patient toilet. A patient toilet with hand-wash- be included in this area.
ing stations shall be provided.
(2) Provisions shall be made for the controlled stor-
5.9.2.7 Stat laboratory age, preparation, distribution, and refrigeration of
medications.
5.9.4.3 Nourishment station. If a nourishment station bution of clean and sterile materials, the work
for the dialysis service is provided, it shall contain a counter and hand-washing station may be omitted.
hand-washing station, a work counter, a refrigerator,
storage cabinets, a water-dispensing unit separate from 5.9.4.9 Soiled workroom. A soiled workroom shall
the hand-washing station, and equipment for serving be provided and contain a flushing-rim sink, hand-
nourishments as required. The nourishment station washing station, work counter, storage cabinets, waste
shall be located away from the treatment area to pre- receptacles, and a soiled linen receptacle.
vent the risk of cross-contamination.
5.9.4.10 Equipment and supply storage
5.9.4.4 Dialyzer reprocessing room. If dialyzers are
reused, a reprocessing room sized to perform the func- (1) Clean linen storage. A clean linen storage area
tions required shall be provided. shall be provided. It may be within the clean
workroom, a separate closet, or an approved dis-
(1) This room shall include a one-way flow of materi- tribution system. If a closed cart system is used,
als from soiled to clean. storage may be in an alcove. It must be out of the
path of normal traffic and under staff control.
(2) This room shall include provisions for refrigera-
tion for temporary storage of dialyzers, deconta- (2) Supply areas/carts. Supply areas or supply carts
mination/cleaning areas, sinks, processors, shall be provided.
computer processors and label printers, a packag-
ing area, and dialyzer storage cabinets. (3) Stretcher/wheelchair storage. If stretchers are pro-
vided, storage space shall be available for wheel-
5.9.4.5 Mixing room and delivery system. Each facility chairs and stretchers, out of direct line of traffic.
using a central batch delivery system shall provide, either
on the premises or through written arrangements, indi- 5.9.4.11 Environmental services closet. An environ-
vidual delivery systems for the treatment of any patient mental services closet shall be provided adjacent to
requiring special dialysis solutions. The mixing room and for the exclusive use of the unit.
shall include a sink, storage space, and holding tanks.
(1) The closet shall contain a floor receptor or service
5.9.4.6 Water treatment equipment room. The water treat- sink and storage space for housekeeping supplies
ment equipment shall be located in an enclosed room. and equipment.
5.9.4.7 Equipment repair room. If required by the func- (2) Water supply and drain connection for testing
tional program, an equipment repair and breakdown machines shall be provided.
room shall be equipped with a hand-washing station,
deep service sink, work counter, and storage cabinet. 5.9.5 Support Areas for Staff
Appropriate staff clothing change areas and lounge shall
5.9.4.8 Clean workroom or supply room. A clean be available for male and female personnel. The areas shall
workroom shall be provided. Soiled and clean work- contain lockers, shower, toilet, and hand-washing stations.
rooms or holding rooms shall be separated and have
no direct connection. 5.9.6 Support Areas for Patients
5.9.6.1 Patient support provisions. A waiting room,
(1) Clean workroom. If the room is used for prepar- toilet room with hand-washing stations, source of
ing patient care items, it shall contain a work drinking water, public telephone, and seating accom-
counter, a hand-washing station, and storage modations for waiting periods shall be available or
facilities for clean and sterile supplies. accessible to the dialysis unit.
(2) Clean supply room. If the room is used only for 5.9.6.2 Patient storage. Storage for patients’ belongings
storage and holding as part of a system for distri- shall be provided.
APPENDIX
A5.9.8.1 All installed reverse osmosis water and dialysis solution Space requirements
piping should be accessible. The space required to house Class A chambers and supporting
equipment should be defined by NFPA 99, Chapter 20 and the
A5.9.8.2 Due to the nature of the dialyzing process and the
equipment manufacturer, but in any case should not be less than
nature of the patient’s illness, the temperature should be main-
the following:
tained at 72°to 78°F (22°to 26°C) with a relative humidity level
of 30 to 60 percent. a. Minimum clearances around a (Class A) hyperbaric chamber
should be as follows:
A5.10 Hyperbaric Suite
Applicability b. Chamber entry should be designed for gurney/stretcher access:
These guidelines should apply to hyperbaric facilities designated 10 feet (3.04 meters).
for clinical hyperbaric oxygen therapy, including hospital-affiliated
c. Entries designed for wheeled gurneys should be provided with
and freestanding facilities.
access ramps that are flush with the chamber entry doorway.
General Facility Requirements
d. Chambers that utilize fixed internal stretcher frames and trans-
Hyperbaric chambers should be constructed in conformance with
fer gurneys should be designed to allow immediate removal of the
applicable construction codes (ASME PVHO-1, Safety Standard for
patient upon chamber depressurization.
Pressure Vessels for Human Occupancy) and carry a “U” stamp.
e. Chamber man lock entries or compartments utilizing circular
The facility should be constructed to comply with applicable local,
entry hatchways: 4 feet (1.21 meters).
state, and national construction codes governing the type of occu-
pancy (health care, commercial, other) housing the hyperbaric f. The chamber should have a minimum of 4 feet (1.21 meters) of
chamber(s). clearance all the way around the chamber, except as specified
with regard to entry areas.
When a hyperbaric suite/clinic is provided, it should meet the
requirements of Chapter 20, NFPA 99, and Chapter 12, NFPA 101. g. If the chamber control console is immediately adjacent to the
chamber, a minimum passageway of 4 feet (1.21 meters) should
Multiplace (NFPA Class “A” Chamber) Facilities
be provided between the control console and any obstruction.
Emergency exit requirements
a. The facility housing a Class A chamber should be designed to Monoplace (Class B) Facilities
allow rapid or emergency removal of patients and staff. Emergency exit requirements
a. In the case of multiple Class B chambers installed in a single
b. In the case of multiple Class A chambers installed in a single
setting, the rapid or emergency removal of a patient from one
setting or a Class A chamber that contains multiple compart-
chamber should not restrict in any way the rapid and simultane-
ments, the rapid or emergency removal of a patient or personnel
ous removal of patients from all other chambers.
from one chamber/compartment should not restrict in any way
the rapid and simultaneous removal of patients or personnel from b. A minimum of two exits should be provided for the chamber room
all other chambers or compartments. unless a single exit opens directly to a primary evacuation hallway.
c. A minimum of two exits should be provided for the chamber room c. Exit doorways should have a minimum opening of 46 inches.
unless a single exit opens directly to a primary evacuation hallway. (1.16 meters)
APPENDIX
The space housing Class B chambers should conform to NFPA 99, d. Consultation/treatment rooms. Appropriate room for individual con-
Chapter 20 requirements. sultation and treatment with referring clinicians should be provided.
Minimum clearances between individual (Class B) hyperbaric e. Patient record storage area. An area should be provided that is
chambers should be as follows: out of traffic flow and under staff control. This can be in the clini-
cal area or located at the reception/control desk.
a. Chamber and side wall, 18 inches (45.72 centimeters).
Exception: If any chamber controls, ventilation valves, or other f. Hand-washing stations. A lavatory equipped for hand-washing
operator-adjustable devices are located on or under the chamber with hands-free operable controls should be located in the room
adjacent to the side wall, minimum clearance should be 36 inches where the hyperbaric chambers are located.
(91.44 centimeters).
g. Compressor room. This area should be large enough to house
b. Between control side of two chambers, 48 inches (1.21 meters). the chamber compressors, accumulator tanks, fire suppression
system and their ability to meet the requirements of NFPA 99,
c. Between back side of two chambers, 24 inches (60.96 centimeters)
Chapter 20. The reserve breathing gases could also be housed
d. A minimum passage of 14 inches (35.56 centimeters) should here if it is in close proximity to the chamber room.
be provided at the foot end of each chamber. An oxygen shut-off
h. Soiled holding area. A soiled holding room should be provided
valve should be provided for each chamber and should be unob-
with waste receptacles and soiled linen receptacles.
structed by the chamber and located as to be immediately acces-
sible to the chamber operator. i. Equipment and supply storage
e. A minimum space of 102 inches (2.59 meters) should be avail- Clean supply and linen storage. A clean storage space should be
able at the head end of the chamber to allow for the safe insertion provided for clean supplies and linens. Hand-washing fixtures should
and removal of the patient from the chamber. be provided with hands-free operable controls. When a separate
storage room is provided, it may be shared with another department.
f. Any electrical service outlets located within 10 feet of the Class
B chamber entrance should be sited no less than 3 feet (0.91 Gas cylinder room. This room should be large enough to accommo-
meter) above floor level. date the storage of enough (H) cylinders and manifolds for the reserve
breathing gases required for chamber operations. The minimum room
Support Areas
size should be able to house eight (H) cylinders and two gas mani-
The following support areas should be provided for the hyperbaric
folds, consisting of at least two (H) cylinders on each manifold.
facility. If the hyperbaric facility is included as an integral portion
of another service such as a wound care department, support j. Housekeeping room. The housekeeping room should contain a
areas may be shared: floor receptor or service sink and storage space for housekeeping
supplies and equipment, and should be located nearby.
Support areas for the hyperbaric suite
a. Reception/control desk Support areas for staff
Toilets with hand-washing fixtures with hands-free operable controls
b. Patient waiting area. The waiting area should be large enough to
may be outside the suite but should be convenient for staff use.
accommodate the clinical program and chamber mix if also used
as a holding area. The area should be out of traffic, under staff Support areas for patients
control, and should have seating capacity in accordance with the a. Patient dressing rooms. Dressing rooms for outpatients should
functional program. When the hyperbaric suite is routinely used for be provided and should include a seat or bench, mirror, and provi-
outpatients and inpatients at the same time, separate waiting sions for hanging patients’ clothing and for securing valuables. At
areas should be provided with screening for visual privacy between least one dressing room should be provided to accommodate
the waiting areas. Patient waiting areas may be omitted for two or wheelchair patients.
fewer Class B hyperbaric chamber units.
b. Patient toilet rooms. Toilet rooms should be provided with
c. Holding area. The area should be out of traffic flow from the hand-washing fixtures with hands-free operable controls with
chamber and should not obstruct access to the exits. A holding direct access from the hyperbaric suite.
5.11 Laboratory Suite (2) Work areas shall include sinks with water and
access to vacuum, gases, and air, and electrical
5.11.1 General services as needed.
5.11.1.1 Type. Laboratory facilities shall be provided
for the performance of tests in hematology, clinical 5.11.2.2 Hand-washing stations. These shall be located
chemistry, urinalysis, microbiology, anatomic pathology, within 25 feet (7.62 meters) of each workstation and
cytology, and blood banking to meet the workload within each room with a workstation.
described in the functional program.
5.11.2.3 Design considerations
5.11.1.2 Location. Certain procedures may be per-
formed on-site or provided through a contractual (1) Chemical safety provisions. These shall include
arrangement with a laboratory service acceptable to emergency shower, eye-flushing devices, and
the authority having local jurisdiction. appropriate storage for flammable liquids, etc.
(1) Provisions shall be made for the following proce- (2) Terminal sterilization provisions. Facilities and
dures to be performed on-site: blood counts, uri- equipment shall be provided for terminal sterili-
nalysis, blood glucose, electrolytes, blood urea and zation of contaminated specimens before trans-
nitrogen (BUN), coagulation, transfusions (type port (autoclave or electric oven). (Terminal
and cross-match capability), and stat gram stains. sterilization is not required for specimens that are
incinerated on-site.)
(2) Provisions shall be included for specimen collec-
tion and processing. (3) Radioactive material-handling provisions. If
radioactive materials are employed, facilities for
5.11.1.3 Equipment requirements. The functional pro- long-term storage and disposal of these materials
gram shall describe the type and location of all special shall be provided. No special provisions shall nor-
equipment that is to be wired, plumbed, or plugged in, mally be required for body waste products from
and the utilities required to operate each. most patients receiving low-level isotope diagnos-
tic material. Requirements of authorities having
Note: Refer to NFPA code requirements applicable to jurisdiction shall be verified.
hospital laboratories, including standards clarifying that
hospital units do not necessarily have the same fire safe- 5.11.2.4 Support areas for the laboratory suite
ty requirements as commercial chemical laboratories.
(1) Administrative areas. These shall include offices as
5.11.2 Facility Requirements well as space for clerical work, filing, and record
The following physical facilities shall be provided maintenance.
within the hospital:
(2) Refrigerated blood storage facilities. A refrigerator
5.11.2.1 Work areas to store blood for transfusions shall be equipped
with temperature-monitoring and alarm signals.
(1) Laboratory work counter(s) with space for micro-
scopes, appropriate chemical analyzer(s), incuba- *(3) Storage facilities for reagents, standards, supplies,
tor(s), centrifuge(s), biosafety hoods, etc. shall be and stained specimen microscope slides, etc.
provided. These shall include refrigeration. Such facilities
shall conform to applicable NFPA standards.
APPENDIX
(4) A specimen collection facility. This facility may be
A5.11.2.4 (3). For example, separate facilities should be provided located outside the laboratory suite.
for such incompatible materials as acids and bases, and vented
storage should be provided for volatile solvents.
(a) The blood collection area shall have a work 6 Service Areas
counter, space for patient seating, and hand-
washing stations. 6.1 Pharmacy
(b) The urine and feces collection facility shall 6.1.1 General
be equipped with a water closet and hand- 6.1.1.1 Functional program. The size and type of serv-
washing station. ices to be provided in the pharmacy will depend upon
the type of drug distribution system used, number of
5.11.2.5 Support areas for staff. Lounge, locker, and patients to be served, and extent of shared or purchased
toilet facilities shall be conveniently located for male services. These factors shall be described in the func-
and female laboratory staff. Location of these areas tional program.
outside the laboratory area and sharing of these areas
with other departments shall be permitted. 6.1.1.2 Location. The pharmacy room or suite shall be
located for convenient access, staff control, and security.
5.12 Morgue
6.1.1.3 Facility requirements
5.12.1 Location
These facilities shall be accessible through an exterior (1) Facilities and equipment shall be as necessary to
entrance and shall be located to avoid the need for accommodate the functional program. (Satellite
transporting bodies through public areas. facilities, if provided, shall include those items
required by the program.)
*5.12.2 Autopsy Facilities
If autopsies are performed in the hospital, the follow- (2) As a minimum, the following elements shall be
ing elements shall be provided: provided:
5.12.2.1 Refrigerated facilities for body holding. Body- 6.1.2 Dispensing Facilities
holding refrigerators shall be equipped with tempera- 6.1.2.1 A room or area for receiving, breakout, and
ture-monitoring and alarm signals. inventory control of materials used in the pharmacy
5.12.2.2 An autopsy room. This shall contain the 6.1.2.2 Work counters and space for automated and
following: manual dispensing activities
(1) A work counter with a hand-washing station *6.1.2.3 An extemporaneous compounding area. This
shall include a sink and sufficient counter space for
(2) A storage space for supplies, equipment, and drug preparation.
specimens
6.1.2.4 An area for reviewing and recording
(3) An autopsy table
6.1.2.5 An area for temporary storage, exchange, and
(4) A deep sink for washing specimens restocking of carts
6.1.2.6 Security provisions for drugs and personnel in 6.1.5.4 Provisions for patient counseling and instruc-
the dispensing counter area, if one is provided tion. A room separate from the pharmacy shall be per-
mitted to meet this requirement.
6.1.3 Manufacturing Facilities
6.1.3.1 A bulk compounding area 6.1.5.5 A room for education and training. A multi-
purpose room shared with other departments shall be
6.1.3.2 Provisions for packaging and labeling permitted to serve this purpose.
6.1.5.2 Pharmacological information. Poison control, 6.1.6.2 Staff storage. Convenient access to locker shall
reaction data, and drug information centers be provided.
6.1.5.3 Office. A separate room or area shall be provid- 6.2 Dietary Facilities
ed for office functions. This room shall include space
to accommodate a desk, filing capabilities, communi- 6.2.1 General
cation equipment, and reference materials. *6.2.1.1 Applicability. Food service facilities shall pro-
vide food service for staff, visitors, inpatients, and out-
APPENDIX patients in accordance with the functional program.
A6.2.1.1 Consideration may also be required for meals to VIP 6.2.1.2 Location. Patient food preparation areas shall
suites and for cafeterias for staff, ambulatory patients, and visi- be located adjacent to delivery, interior transportation,
tors, as well as providing for nourishments and snacks between and storage facilities.
scheduled meal service.
100 2006 Guidelines for Design and Construction of Health Care Facilities
2 . 1 G E N E R A L H O S P I TA L S
6.2.1.3 Standards. Food service facilities and equip- (2) The cart traffic shall be designed to eliminate any
ment shall conform to these standards and to the stan- danger of cross-circulation between outgoing
dards of the National Sanitation Foundation and other food carts and incoming, soiled carts, and the
applicable codes. cleaning and sanitizing process. Cart circulation
shall not be through food processing areas.
6.2.1.4 Construction requirements. Finishes in the
dietary facility shall be selected to ensure cleanability 6.2.2.6 Dining area. Dining space(s) shall be provided
and the maintenance of sanitary conditions. for ambulatory patients, staff, and visitors. These
spaces shall be separate from the food preparation and
6.2.2 Functional Elements distribution areas.
If on-site conventional food service preparation is
used, the following shall be provided, in size and num- 6.2.2.7 Area for receiving, scraping, and sorting soiled
ber appropriate for the functional program: tableware. This shall be adjacent to ware-washing and
separate from food preparation areas.
6.2.2.1 Receiving/control stations. An area for receiv-
ing and control of incoming dietary supplies shall be 6.2.2.8 Ware-washing facilities
provided.
(1) These shall be designed to prevent contamination of
(1) This area shall be separated from the general clean wares with soiled wares through cross-traffic.
receiving area
(2) The clean wares shall be transferred for storage or
(2) It shall contain a control station and a breakout use in the dining area without having to pass
area for loading, uncrating, and weighing supplies. through food preparation areas.
(1) Work spaces shall be provided for food prepara- (2) Supplemental heat for hot water to clean pots and
tion, cooking, and baking. These areas shall be as pans shall be by booster heater, steam jet, or other
close as possible to the user (i.e., tray assembly appropriate means.
and dining).
(3) Mobile carts or other provisions shall be made for
(2) Additional spaces shall be provided for thawing drying and storing pots and pans.
and portioning.
6.2.2.10 Facilities for commissary or contract services
6.2.2.4 Assembly and distribution. A patient tray from other areas
assembly area shall be close to the food preparation
and distribution areas. (1) Provision shall be made to protect food delivered
to ensure freshness, retain hot and cold, and avoid
6.2.2.5 Food service carts contamination. If delivery is from outside sources,
protection against weather shall be provided.
(1) A cart distribution system shall be provided, with
spaces for storage, loading, distribution, receiving, (2) Provision shall be made for thorough cleaning
and sanitizing of the food service carts. and sanitizing of equipment to avoid mixing
soiled and clean equipment.
2006 Guidelines for Design and Construction of Health Care Facilities 101
2 . 1 G E N E R A L H O S P I TA L S
6.2.2.11 Vending services. If vending devices are used (a) These may be lockable from outside but
for unscheduled meals, a separate room shall be pro- must have release mechanism for exit from
vided that can be accessed without having to enter the inside at all times.
main dining area.
(b) Interior shall be lighted.
(1) The vending room shall contain coin-operated
machines, bill changers, a hand-washing station, (c) All shelving shall be corrosion resistant, easily
and a sitting area. cleaned, and constructed and anchored to
support a loading of at least 100 pounds per
(2) Facilities for servicing and sanitizing the machines linear foot.
shall be provided as part of the facility’s food
service program. (6) Cooking equipment. All cooking equipment shall
be equipped with automatic shutoff devices to
6.2.3 Support Areas for Dietary Facilities prevent excessive heat buildup.
6.2.3.1 Office spaces. Offices for the use of the food
service manager shall be provided. In smaller facilities, (7) Ice-making equipment
this space may be located in an area that is part of the
food preparation area. (a) This equipment shall be convenient for serv-
ice and easily cleaned.
6.2.3.2 Equipment
(b) It shall be provided for both drinks and food
(1) Mechanical devices shall be heavy-duty, suitable products (self-dispensing equipment) and for
for use intended, and easily cleaned. general use (storage-bin type equipment).
(2) Where equipment is movable, heavy-duty locking (8) Construction requirements. Under-counter con-
casters shall be provided. If equipment is to have duits, piping, and drains shall be arranged to not
fixed utility connections, the equipment shall not interfere with cleaning of the equipment or of the
be equipped with casters. floor below.
(3) Walk-in coolers, refrigerators, and freezers shall 6.2.3.3 Equipment and supply storage
be insulated at floor as well as at walls and top.
(1) General. Storage spaces shall be convenient to the
(4) Coolers, refrigerators, and freezers shall be thermo- receiving area and accessible without traveling
statically controlled to maintain desired tempera- through the food preparation area.
ture settings in increments of 2 degrees or less.
(2) Food storage
(a) Coolers and refrigerators shall be capable of
maintaining a temperature down to freezing. (a) Storage spaces for bulk, refrigerated, and
frozen foods shall be provided. Provision
(b) Freezers shall be capable of maintaining a shall be made for storage of a minimum of
temperature of 20 degrees below 0° F. four days’ supplies.
(c) Interior temperatures shall be indicated digi- (b) Food storage components shall be grouped
tally so as to be visible from the exterior. for convenient access to the receiving and
Controls shall include audible and visible food preparation areas.
high and low temperature alarm.Time of
alarm shall be automatically recorded. (c) All food shall be stored clear of the floor.
Lowest shelf shall be not less than 12 inches
(5) Walk-in units (30.48 centimeters) above the floor or shall
102 2006 Guidelines for Design and Construction of Health Care Facilities
2 . 1 G E N E R A L H O S P I TA L S
be closed in and sealed tight for ease of minators shall deliver into clean processing
cleaning. area/workrooms.
(3) Additional storage rooms. These shall be provided *6.3.1.2 Clean assembly/workroom. This workroom
as necessary for the storage of cooking wares, shall contain hand-washing stations, work space, and
extra trays, flatware, plastic and paper products, equipment for terminal sterilizing of medical and
and portable equipment. surgical equipment and supplies.
(4) Cleaning supplies storage. A separate storage 6.3.2 Equipment and Supply Storage Areas
room shall be provided for the storage of nonfood 6.3.2.1 Clean/sterile medical/surgical supplies
items such as cleaning supplies that might con-
taminate edibles. (1) A room for breakdown shall be provided for
manufacturers’ clean/sterile supplies. The clean
6.2.3.4 Housekeeping rooms processing area shall not be in this area but in an
adjacent space.
(1) These shall be provided for the exclusive use of
the dietary department and shall contain a floor (2) Storage for packs, etc., shall include provisions for
sink and space for mops, pails, and supplies. ventilation, humidity, and temperature control.
(2) Where hot water or steam is used for general 6.3.2.2 Storage room for patient care and distribution
cleaning, additional space within the room shall carts. This area shall be adjacent and easily available to
be provided for the storage of hoses and nozzles. clean and sterile storage and close to the main distri-
bution point to keep traffic to a minimum and ease
6.2.4 Support Areas for Staff work flow.
6.2.4.1 Toilets, lockers, and lounges. Toilets, lockers
and lounge facilities shall be convenient to the dietary 6.3.3 Support Areas for Staff
department. These facilities shall be permitted to 6.3.3.1 Administrative/changing room. If required by
be shared with adjacent services provided they are the functional program, this room shall be separate
adequately sized. from all other areas and provide for staff to change
from street clothes into work attire.
6.3 Central Services
The following shall be provided: 6.3.3.2 Staff accommodations. Lockers, hand-washing
2006 Guidelines for Design and Construction of Health Care Facilities 103
2 . 1 G E N E R A L H O S P I TA L S
station, and showers shall be made available within the 6.4.3 Additional Areas for Outside Laundry Services
immediate vicinity of the department. If linen is processed outside the building, provisions
shall also be made for:
6.4 Linen Services
6.4.3.1 Service entrance. A service entrance, protected
6.4.1 General from inclement weather, shall be provided for loading
Each facility shall have provisions for storing and and unloading of linen.
processing of clean and soiled linen for appropriate
patient care. Processing may be done within the facility, 6.4.3.2 Control station. A control station shall be pro-
in a separate building on- or off-site, or in a commer- vided for pickup and receiving.
cial or shared laundry.
6.4.4 On-Site Laundry Facility
6.4.2 Internal Linen Processing If linen is processed in a laundry facility that is part of
Facilities and equipment shall be as required for cost- the project (within or as a separate building), the follow-
effective operation as described in the functional pro- ing shall be provided in addition to the requirements for
gram. At a minimum, the following elements shall be internal processing facilities in Section 2.1-6.4.2.
provided:
6.4.4.1 Layout. Equipment shall be arranged to permit
6.4.2.1 Soiled linen holding room. A separate room an orderly work flow and minimize cross-traffic that
shall be provided for receiving and holding soiled might mix clean and soiled operations.
linen until ready for pickup or processing.
6.4.4.2 Control and distribution room. A receiving,
6.4.2.2 Clean linen storage. A central clean linen holding, and sorting room shall be provided for con-
storage and issuing room(s) shall be provided in trol and distribution of soiled linen. Discharge from
addition to the linen storage required at individual soiled linen chutes shall be received in a separate room
patient units. adjacent to it.
6.4.2.3 Cart storage area(s). These shall be provided *6.4.4.3 Laundry processing room. This shall have
for separate parking of clean- and soiled-linen carts commercial or industrial-type equipment that can
out of traffic. process at least a seven-day supply within the regular
scheduled work week.
6.4.2.4 A clean linen inspection and mending room or
area. If not provided elsewhere, a clean linen inspec- 6.4.4.4 Hand-washing stations. Employee hand-wash-
tion, delinting, folding, assembly, and packaging area ing stations shall be provided in each room where
shall be provided as part of the linen services. clean or soiled linen is processed and handled.
(1) Mending shall be provided for in the linen services 6.4.4.5 Storage for laundry supplies
department.
6.4.4.6 Staff support locations. Conveniently accessible
(2) A space for tables, shelving, and storage shall be staff lockers, showers, and lounge shall be provided.
provided.
6.4.5 Linen Chutes
6.4.2.5 Hand-washing stations. These shall be provided If provided, these shall meet or exceed the following
in each area where unbagged, soiled linen is handled. standards:
A6.4.4.3 This may require a capacity for processing a seven-day (1) Service openings to chutes shall comply with
supply in a 40-hour week. NFPA 101.
104 2006 Guidelines for Design and Construction of Health Care Facilities
2 . 1 G E N E R A L H O S P I TA L S
(2) Chutes shall meet the provisions described in transport containers for supplies moving
NFPA 82. from central warehouses to individual receiv-
ing sites.
(3) Chute discharge into collection rooms shall com-
ply with NFPA 101. 6.5.2 General Stores
In addition to supply facilities in individual depart-
6.4.5.2 Dimensions. The minimum cross-sectional ments, a central storage area shall be provided.
dimension of gravity chutes shall be 2 feet (60.96
centimeters). 6.5.2.1 General
General stores may be located in a separate building
6.5 Materials Management on site with provisions for protection against inclement
weather during transfer of supplies. The following
6.5.1 Receiving shall be provided:
The following shall be provided:
6.5.2.2 General storage room(s)
6.5.1.1 Off-street unloading facilities
(1) Location. Location of storage in separate, concen-
6.5.1.2 Receiving area trated areas within the institution or in one or
Adequate receiving areas shall be provided to accom- more individual buildings on site shall be permitted.
modate delivery trucks and other vehicles. Off-site location for a portion of this storage shall
be permitted.
*(1) Location
(2) Space requirements. General storage room(s) with
(a) Dock areas shall be segregaged from other a total area of not less than 20 square feet (1.86
occupied building areas and located so that square meters) per inpatient bed shall be provided.
noise and odors from operation will not
adversely affect building occupants. 6.5.2.3 Additional storage areas for outpatient facilities
(b) The receiving area shall be convenient to (1) Location. Location of additional storage areas in
service elevators and other internal corridor combination with and in addition to the general
systems. stores, or in a central area within the outpatient
department, shall be permitted. Off-site location
(c) Receiving areas shall be segregated from for a portion of this storage shall also be permitted.
waste staging and other outgoing materials-
handling functions. (2) Space requirements. Additional storage areas
for outpatient facilities shall be provided in an
(2) Space requirements amount not less than 5 percent of the total area
of those facilities.
(a) Adequate space shall be provided to enable
breakdown, sorting, and staging of incoming 6.5.3 Waste Management
materials and supplies. *6.5.3.1 Collection and storage. Waste collection and
storage locations shall be determined by the facility as
(b) Balers and other devices shall be located to a component of the functional program.
capture packaging for recycling or return to
manufacturer or deliverer. APPENDIX
(c) In facilities with centralized warehousing, A6.5.1.2 (1) The receiving area should be located to promote the
adequate space shall be provided at receiving safe, secure, and efficient movement of arriving materials without
points to permit the staging of reusable compromising patient areas.
2006 Guidelines for Design and Construction of Health Care Facilities 105
2 . 1 G E N E R A L H O S P I TA L S
(a) If provided, regulated medical waste or infec- 6.6.1 Facilities for Cleaning and Sanitizing Carts
tious waste storage spaces shall have a floor Facilities shall be provided to clean and sanitize carts
APPENDIX
A6.5.3.1 Collection and storage. The underlying framework of be given to sorting and staging areas. The following elements are
waste management comprises waste minimization and segrega- examples that may be considered:
tion. Facilities should seek both to minimize all components of
a. Building should include adequate space to accommodate
each waste stream and to separate different components of the
bins/carts for appropriate waste segregation such as recyclables,
total waste stream. At a minimum, the functional program should
infectious waste, sharps, etc. Corridors and materials handling
include consideration of regular trash, medical/infectious waste,
systems should be designed to achieve an efficient movement
hazardous waste, and low-level radioactive waste.
of waste from points of generation to storage or treatment while
The program should address the development of effective collec- minimizing the risk to personnel.
tion, transport, pest control, and storage systems; waste manage-
b. Dedicated storage and flow space and cleaning/sanitation
ment and contingency planning; protection of the health and
facilities should facilitate reuse of items such as medical products,
safety of workers; and proper siting of all on-site waste treatment
food service items, and the like to eliminate disposables
technologies.
and reduce waste.
Optimizing waste management has programmatic and space
c. Space should be included for autoclaves, shredders, and other
impacts throughout the facility at points where waste is generated,
technologies for processing medical waste prior to removals to
collected, and staged for disposal. For facilities or municipalities
landfill. Secure storage should be provided for staging fluorescent
with recycling programs in place, particular consideration should
lamps for recycling.
106 2006 Guidelines for Design and Construction of Health Care Facilities
2 . 1 G E N E R A L H O S P I TA L S
serving the central service department, dietary facilities, 6.7.2.8 Site lighting, post indicator valves, and other
and linen services. These facilities shall be permitted to equipment normally installed on the exterior of the
be centralized or departmentalized. building
6.7.2 Equipment Locations (2) Storage for solvents and flammable liquids shall
Room(s) or separate building(s) shall be provided for comply with applicable NFPA codes.
boilers, mechanical, and electrical equipment, except:
6.7.6.2 Outdoor equipment storage. Yard equipment
6.7.2.1 Rooftop air conditioning and ventilation and supply storage areas shall be provided. These shall
equipment installed in weatherproof housings be located so that equipment may be moved directly
to the exterior without interference with other work.
6.7.2.2 Standby generators where the engine and
appropriate accessories (i.e., batteries) are properly
heated and enclosed in a weatherproof housing 7 Administrative and Public Areas
6.7.2.3 Cooling towers and heat rejection equipment 7.1 Public Areas
The following shall be provided:
6.7.2.4 Electrical transformers and switchgear where
required to serve the facility and where installed in a 7.1.1 Entrance
weatherproof housing This shall be at grade level, sheltered from inclement
weather, and accessible to the disabled.
6.7.2.5 Medical gas parks and equipment
7.1.2 Lobby
6.7.2.6 Air-cooled chillers where installed in a weather- This shall include:
proof housing
7.1.2.1 A counter or desk for reception and information
6.7.2.7 Trash compactors and incinerators
2006 Guidelines for Design and Construction of Health Care Facilities 107
2 . 1 G E N E R A L H O S P I TA L S
7.1.2.2 Public waiting area(s) sions for the use of visual aids. Several services shall be
permitted to share one multipurpose room.
7.1.2.3 Public toilet facilities
7.2.5 Medical Records
7.1.2.4 Public telephones Rooms, areas, or offices for the following personnel
and/or functions shall be provided:
7.1.2.5 Provisions for drinking water
7.2.5.1 Medical records administrator/technician
7.1.3 Public Waiting Areas
All public waiting areas serving more than 15 people 7.2.5.2 Review and dictation
shall include toilet room(s) equipped with hand-wash-
ing stations. These toilet rooms shall be located near the 7.2.5.3 Sorting, recording, or microfilming records
waiting areas and may serve more than one such area.
7.2.5.4 Record storage
7.2 Administrative and Related Support Areas
The following shall be provided: 7.2.6 Equipment and Supply Storage
Storage shall be provided for office equipment and
7.2.1 Admissions Area supplies.
If required by the functional program for initial
admission of inpatients, the area shall include: 7.2.7 Support Areas for Employees and Volunteers
Lockers, lounges, toilets, etc. shall be provided for employ-
7.2.1.1 A separate waiting area for patients and accom- ees and volunteers. These shall be in addition to, and sepa-
panying persons rate from, those required for medical staff and the public.
108 2006 Guidelines for Design and Construction of Health Care Facilities
2 . 1 G E N E R A L H O S P I TA L S
contained herein, and the requirements of authorities gency-radio communication system shall be provided
having jurisdiction. If there are no applicable local in each facility.
codes, the International Building Code or NFPA 5000
shall be used (see Section 1.1-7). (1) This system shall operate independently of the
building’s service and emergency power systems
8.1.2.2 Fire prevention/protection measures. during emergencies.
Compartmentation, exits, fire alarms, automatic
extinguishing systems, and other fire prevention and (2) The system shall have frequency capabilities to
fire protection measures, including those within communicate with state emergency communica-
existing facilities, shall comply with NFPA 101, with tion networks.
the following stipulation. The Fire-Safety Evaluation
System (FSES) is permitted, subject to AHJ approval, (3) Additional communication capabilities are
in new construction and renovation. (The FSES is required of facilities containing a formal commu-
intended as an evaluation tool for fire safety only.) nity emergency-trauma service or other specialty
See Section 1.1-7 for exceptions. services (such as regional pediatric critical care
units) that utilize staffed patient transport units.
Note: For most projects it is essential that third-party
reimbursement requirements also be followed. Verify 8.2 General Standards for Details and Finishes
where these may be in excess of standards in these
Guidelines. 8.2.1 General
8.2.1.1 New construction. Details and finishes in new
8.1.2.3 Interior finishes. Interior finishing materials construction projects, including additions and alter-
shall comply with the flame-spread limitations and the ations, shall comply with the following standards (see
smoke-production limitations indicated in NFPA 101. Section 1.1-3 concerning existing facilities where total
This requirement does not apply to minor quantities compliance is structurally impractical).
of wood or other trim (see NFPA 101) or to wall cov-
ering less than 4 mil thick applied over a noncom- *8.2.1.2 Renovation. If approved by the authorities
bustible base. having jurisdiction, retained portions of existing facili-
ties that are not required to be totally modernized due
8.1.2.4 Insulation materials. Building insulation mate- to financial or other hardships shall be permitted, as a
rials, unless sealed on all sides and edges with non- minimum, to comply with applicable requirements of
combustible material, shall have a flame-spread rating the Existing Health Care Occupancies Section of
of 25 or less and a smoke-developed rating of 150 or NFPA 101.
less when tested in accordance with NFPA 255.
8.2.2 Details
8.1.3 Provisions for Disasters 8.2.2.1 Corridor width
See also Section 1.1-5.
(1) In outpatient suites and in areas not commonly
8.1.3.1 General used for patient bed or stretcher transportation,
reduction of corridor width to 5 feet (1.52
(1) Unless specifically approved, hospitals shall not be meters) shall be permitted.
built in areas subject to damage or inaccessibility
due to natural floods. (2) Location of items such as drinking fountains, tele-
phone booths, vending machines, and portable
(2) Where facilities may be subject to wind or water
hazards, provision shall be made to ensure con- APPENDIX
tinuous operation.
A8.2.1.2 A plan of correction for these portions of existing facili-
8.1.3.2 Emergency communication system. An emer- ties should be developed and implemented.
2006 Guidelines for Design and Construction of Health Care Facilities 109
2 . 1 G E N E R A L H O S P I TA L S
equipment shall not restrict corridor traffic or reduce (b) Manual or automatic sliding doors may be
the corridor width below the minimum standard. exempt from this standard where fire and
other emergency exiting requirements are
8.2.2.2 Ceiling height. The minimum ceiling height not compromised and where cleanliness of
shall be 7 feet 10 inches (2.39 meters), with the follow- surfaces can be maintained.
ing exceptions:
(2) Door size
(1) Corridors, storage rooms, toilet rooms, etc. Ceilings
in these spaces shall be not less than 7 feet 8 inches (a) General. Where used in these Guidelines,
(2.34 meters) in height. Ceiling heights in small, door width and height shall be the nominal
normally unoccupied spaces may be reduced. dimension of the door leaf, ignoring projec-
tions of frame and stops. Note: Although
(2) Rooms with ceiling-mounted equipment/light these standards are intended to accommo-
fixtures. Ceilings in radiographic, operating, and date access by patients and patient equip-
delivery rooms, and other rooms containing ceil- ment, size of office furniture, etc., shall also
ing-mounted equipment or ceiling-mounted sur- be considered.
gical light fixtures, shall be of sufficient height to
accommodate the equipment or fixtures and their (b) Inpatient bedrooms
normal movement.
(i) New construction. The minimum door
(3) Seclusion treatment rooms. These rooms shall have size for inpatient bedrooms in new work
a minimum ceiling height of 9 feet (2.74 meters). shall be 3 feet 8 inches (1.12 meters) wide
and 7 feet (2.13 meters) high to provide
(4) Boiler rooms. Boiler rooms shall have ceiling clearance for movement of beds and
clearances not less than 2 feet 6 inches (76.20 other equipment.
centimeters) above the main boiler header and
connecting piping. (ii) Renovation. Existing doors of not less
than 2 feet 10 inches (86.36 centimeters)
(5) Clearances wide may be considered for acceptance
where function is not adversely affected
(a) Suspended tracks, rails, and pipes located in and replacement is impractical.
the traffic path for patients in beds and/or on
stretchers, including those in inpatient service (c) Rooms for stretchers/wheelchairs. Doors to
areas, shall be not less than 7 feet (2.13 meters) other rooms used for stretchers (including
above the floor. Clearances in other areas hospital wheeled-bed stretchers) and/or
may be 6 feet 8 inches (2.03 meters). wheelchairs shall have a minimum width of
2 feet 10 inches (86.36 centimeters).
(b) Where existing structures make the above
ceiling clearance impractical, clearances shall (3) Door swing. Doors, except those to spaces such
be as required to avoid injury to individuals as small closets not subject to occupancy, shall
up to 6 feet 4 inches (1.93 meters) tall. |not swing into corridors in a manner that might
obstruct traffic flow or reduce the required corri-
8.2.2.3 Doors dor width. (Large walk-in-type closets are consid-
ered inhabitable spaces.)
(1) Door type
(4) Door hardware
(a) All doors between corridors, rooms, or
spaces subject to occupancy, except elevator (a) Patient bathing/toilet facilities
doors, shall be of the swing type.
110 2006 Guidelines for Design and Construction of Health Care Facilities
2 . 1 G E N E R A L H O S P I TA L S
(i) Rooms that contain bathtubs, sitz baths, (1) Safety glass; wired glass; or plastic, break-resistant
showers, and/or water closets for inpa- material that creates no dangerous cutting edges
tient use shall be equipped with doors when broken shall be used in the following:
and hardware permitting emergency
access from the outside. (a) Glass doors, lights, sidelights, borrowed
lights, and windows located within 12 inches
(ii) When such rooms have only one open- (30.48 centimeters) of a door jamb (with a
ing or are small, the doors shall open bottom-frame height of less than 5 feet or
outward or in a manner that will avoid 1.52 meters above the finished floor)
pressing a patient who may have col-
lapsed within the room. (b) Wall openings in active areas such as recre-
ation and exercise rooms, unless otherwise
(iii) Similar considerations may be desirable required for fire safety
for certain outpatient services.
(2) Safety glass–tempered or plastic glazing materials
(b) Patient toilet rooms in psychiatric units. If shall be used for the following:
required by the functional program, design
of door hardware on patient toilet rooms in (a) Shower doors and bath enclosures
psychiatric nursing units shall be permitted
to allow staff to control access. (b) Interior windows and doors, including those
in pediatric and psychiatric unit corridors
8.2.2.4 Thresholds and expansion joints
(3) Flame-spread ratings. Plastic and similar materials
(1) Thresholds and expansion joint covers shall be used for glazing shall comply with the flame-
flush with the floor surface to facilitate the use of spread ratings of NFPA 101.
wheelchairs and carts.
(4) Renovation. In renovation projects, only glazing
(2) Expansion and seismic joints shall be constructed within 1 foot 6 inches (45.72 centimeters) of the
to restrict the passage of smoke. floor must be changed to safety glass, wire glass,
or plastic, break-resistant material.
8.2.2.5 Windows
8.2.2.8 Hand-washing stations
(1) Operable windows. Operable windows are not
required in patient rooms. If operable windows (1) Fittings. Location and arrangement of fittings for
are provided in patient rooms or suites, operation hand-washing stations shall permit their proper
of such windows shall be restricted to inhibit pos- use and operation. Particular care shall be given to
sible escape or suicide. the clearances required for blade-type operating
handles.
8.2.2.6 Insect screens. Windows and outer doors that
frequently may be left open shall be equipped with (2) Mirrors. Mirrors shall not be installed at hand-
insect screens. washing stations in food preparation areas, nurs-
eries, clean and sterile supply areas, scrub sinks,
8.2.2.7 Glazing materials or other areas where asepsis control would be
lessened by hair combing.
Note: Provisions of this section concern safety from
hazards of breakage. NFPA 101 contains additional (3) Provisions for hand drying
requirements for glazing in exit corridors, etc., espe-
cially in buildings without sprinkler systems. (a) Provisions for hand drying shall be included at
all hand-washing stations except scrub sinks.
2006 Guidelines for Design and Construction of Health Care Facilities 111
2 . 1 G E N E R A L H O S P I TA L S
(b) These provisions shall be paper or cloth units of occupied areas from exceeding a temperature of
enclosed to protect against dust or soil and to 10oF (6oC) above ambient room temperature.
ensure single-unit dispensing. Hot air dryers
shall be permitted provided that installation 8.2.3 Finishes
precludes possible contamination by recircu- 8.2.3.1 Noncombustible or flame-retardant materials
lation of air.
(1) Cubicle curtains and draperies shall be noncom-
(4) Anchoring. Lavatories and hand-washing stations bustible or flame-retardant and shall pass both
shall be securely anchored to withstand an the large- and small-scale tests of NFPA 701 when
applied vertical load of not less than 250 pounds applicable.
(113.4 kilograms) on the fixture front.
(2) Materials and certain plastics known to produce
8.2.2.9 Grab bars. Grab bars shall be provided in all noxious gases when burned shall not be used for
patient toilets, showers, bathtubs, and sitz baths at a mattresses, upholstery, and other items insofar as
wall clearance of 1-1/2 inches (3.81 centimeters). Bars, practical.
including those that are part of such fixtures as soap
dishes, shall be sufficiently anchored to sustain a con- 8.2.3.2 Floors
centrated load of 250 pounds (113.40 kilograms).
(1) Floor materials shall be easily cleanable and
8.2.2.10 Radiation protection appropriately wear-resistant for the location.
(1) Radiation protection requirements for x-ray and (a) Floors in areas used for food preparation or
gamma ray installations shall conform with food assembly shall be water-resistant.
NCRP Report Nos. 33 and 49 and all applicable
local requirements. Testing is to be coordinated (b) Floor surfaces, including tile joints, shall be
with local authorities to prevent duplication of resistant to food acids.
test observations or construction inspections.
(c) In all areas subject to frequent wet-cleaning
(2) Provision shall be made for testing completed methods, floor materials shall not be physically
installations before use. All defects shall be cor- affected by germicidal cleaning solutions.
rected before approval.
(2) Floors subject to traffic while wet (such as shower
8.2.2.11 Noise control and bath areas, kitchens, and similar work areas)
shall have a nonslip surface.
(1) Recreation rooms, exercise rooms, equipment
rooms, and similar spaces where impact noises (3) In new construction or major renovation work,
may be generated shall not be located directly the floors and wall bases of all operating rooms
over patient bed areas or delivery and operating and any delivery rooms used for cesarean sections
suites, unless special provisions are made to mini- shall be monolithic and joint free.
mize such noise.
(4) The floors and wall bases of kitchens, soiled
(2) The noise reduction criteria shown in Table 2.1-1 workrooms, and other areas subject to frequent
shall apply to partitions, floors, and ceiling con- wet cleaning shall also be homogenous, but may
struction in patient areas. have tightly sealed joints.
8.2.2.12 Temperature control. Rooms containing heat- (5) Floors in areas and rooms in which flammable
producing equipment, such as boiler or heater rooms anesthetic agents are stored or administered shall
or laundries, shall be insulated and ventilated to pre- comply with NFPA 99.
vent the floor surface above and/or the adjacent walls
112 2006 Guidelines for Design and Construction of Health Care Facilities
2 . 1 G E N E R A L H O S P I TA L S
(2) In dietary areas and in other areas where dust fall- 9.1.1 Testing
out may present a problem, suspended ceilings 9.1.1.1 Prior to acceptance of the facility, all special
shall be provided. systems shall be tested and operated to demonstrate
to the owner or his designated representative that
(3) Semirestricted areas the installation and performance of these systems
conform to design intent.
(a) Ceiling finishes in semirestricted areas such
as airborne infection isolation rooms, protec- 9.1.1.2 Test results shall be documented for
tive environment rooms, clean corridors, maintenance files.
central sterile supply spaces, specialized radi-
ographic rooms, and minor surgical proce- 9.1.2 Documentation
dure rooms shall be smooth, scrubbable, 9.1.2.1 Upon completion of the special systems equip-
nonabsorptive, nonperforated, capable of ment installation contract, the owner shall be furnished
withstanding cleaning with chemicals, and with a complete set of manufacturers’ operating, main-
without crevices that can harbor mold and tenance, and preventive maintenance instructions, a
bacterial growth. parts lists, and complete procurement information
including equipment numbers and descriptions.
(b) If lay-in ceiling is provided, it shall be gasketed
or clipped down to prevent the passage of 9.1.2.2 Operating staff persons shall also be provided
particles from the cavity above the ceiling with written instructions for proper operation of sys-
plane into the semirestricted environment. tems and equipment. Required information shall
Perforated, tegular, serrated cut, or highly include all safety or code ratings as needed.
textured tiles are not acceptable.
2006 Guidelines for Design and Construction of Health Care Facilities 113
2 . 1 G E N E R A L H O S P I TA L S
9.1.3 Insulation of the hospital plan and the expected vertical trans-
Insulation shall be provided surrounding special sys- portation requirements.
tem equipment to conserve energy, protect personnel,
and reduce noise. 9.2.3 Dimensions and Clearances
9.2.3.1 Hospital-type elevator cars shall have inside
9.2 Elevators dimensions that accommodate a patient bed with
attendants. Cars shall be at least 5 feet 8 inches
9.2.1 General (1.73 meters) wide by 9 feet (2.74 meters) deep.
All hospitals having patient facilities (such as bed-
rooms, dining rooms, or recreation areas) or critical *9.2.3.2 Car doors shall have a clear opening of
services (such as operating, delivery, diagnostic, not less than 4 feet (1.22 meters) wide and 7 feet
or therapeutic areas) located on other than the (2.13 meters) high.
grade-level entrance floor shall have electric or
hydraulic elevators. 9.2.3.3 In renovations, an increase in the size of exist-
ing elevators shall not be required if the elevators can
9.2.2 Number accommodate patient beds used in the facility.
In the absence of an engineered traffic study, the fol-
lowing guidelines for number of elevators shall apply: 9.2.3.4 Additional elevators installed for visitors and
material handling shall be permitted to be smaller
9.2.2.1 At least two hospital-type elevators shall be than noted above, within restrictions set by standards
installed where 1 to 59 patient beds are located on any for disabled access.
floor other than the main entrance floor.
9.2.4 Leveling Device
9.2.2.2 At least two hospital-type elevators shall be Elevators shall be equipped with a two-way automatic
installed where 60 to 200 patient beds are located on level-maintaining device with an accuracy of ± 1/4
floors other than the main entrance floor, or where inch (± 6.35 millimeters).
the major inpatient services are located on a floor
other than those containing patient beds. (Reduction 9.2.5 Elevator Controls
in elevator service shall be permitted for those floors 9.2.5.1 Each elevator, except those for material han-
providing only partial inpatient services.) dling, shall be equipped with an independent keyed
switch for staff use for bypassing all landing button
9.2.2.3 At least three hospital-type elevators shall be calls and responding to car button calls only.
installed where 201 to 350 patient beds are located on
floors other than the main entrance floor, or where the *9.2.5.2 Elevator call buttons and controls shall not be
major inpatient services are located on a floor other activated by heat or smoke. Light beams, if used for
than those containing patient beds. (Reduction in ele- operating door reopening devices without touch, shall
vator service shall be permitted for those floors pro- be used in combination with door-edge safety devices
viding only partial inpatient services.) and shall be interconnected with a system of smoke
detectors.
9.2.2.4 For hospitals with more than 350 beds, the
number of elevators shall be determined from a study 9.2.6 Installation and Testing
9.2.6.1 Standards. Installation and testing of elevators
APPENDIX shall comply with ANSI/ASME A17.1 for new con-
struction and ANSI/ASME A17.3 for existing facilities.
A9.2.3.2 Elevator car doors should have a clear opening of not (See ASCE/SEI 7 for seismic design and control sys-
less than 4.5 feet (1.37 meters). tems requirements for elevators.)
A9.2.5.2 This is so the light control feature will be overridden or
9.2.6.2 Documentation. Field inspections and tests
disengaged should it encounter smoke at any landing.
shall be made and the owner shall be furnished with
114 2006 Guidelines for Design and Construction of Health Care Facilities
2 . 1 G E N E R A L H O S P I TA L S
written certification stating that the installation meets 25 feet (7.62 meters) from inlets to HVAC systems.
the requirements set forth in this section as well as all If the technology involves heat dissipation, suffi-
applicable safety regulations and codes. cient cooling and ventilation shall be provided.
(c) Odor, noise, and the visual impact of medical b. When incinerators are used, consideration should be given to
waste operations on patients, visitors, public the recovery of waste heat from on-site incinerators used to dis-
access, and security shall be considered. pose of large amounts of waste materials. Incinerators should be
designed in a manner fully consistent with protection of public and
(2) Space requirements. These shall be determined by environmental health, both on-site and off-site, and in compliance
the equipment requirements, including associated with federal, state, and local statutes and regulations. Toward this
area for opening waste entry doors, access to con- end, permit applications for incinerators and modifications thereof
trol panels, space for hydraulic lifts, conveyors, should be supported by Environmental Assessments and/or
and operational clearances. Mobile or portable Environmental Impact Statements (EISs) and/or Health Risk
units, trailer-mounted units, underground instal- Assessments (HRAs) as may be required by regulatory agencies.
lations, or all-weather enclosed shelters at an Except as noted below, such assessments should utilize standard
outdoor site may also be used, subject to local U.S. EPA methods, specifically those set forth in U.S. EPA guide-
regulatory approvals. lines, and should be fully consistent with U.S. EPA guidelines for
health risk assessment. Under some circumstances, however, reg-
(3) Ventilation. Exhaust vents, if any, from the treat- ulatory agencies having jurisdiction over a particular project may
ment technology shall be located a minimum of require use of alternative methods.
2006 Guidelines for Design and Construction of Health Care Facilities 115
2 . 1 G E N E R A L H O S P I TA L S
(2) All valves shall be tagged, and a valve schedule Practice for Backflow Prevention and Cross-
shall be provided to the facility owner for perma- Connection Control.
nent record and reference.
(b) Vacuum breakers or backflow prevention
(3) No plumbing piping shall be exposed overhead or devices shall be installed on hose bibs and
on walls where possible accumulation of dust or supply nozzles used for connection of hoses
soil may create a cleaning problem or where leaks or tubing in laboratories, housekeeping
would create a potential for food contamination. sinks, bedpan-flushing attachments, autopsy
tables, etc.
10.1.2.2 Hemodialysis/hemoperfusion piping
(4) Bedpan-flushing devices. Bedpan-flushing devices
(1) In new construction and renovation in any hospi- (may be cold water) shall be provided in each
tal where hemodialysis or hemoperfusion is rou- inpatient toilet room; however, installation is
tinely performed, a separate water supply and a optional in psychiatric and alcohol-abuse units
drainage facility that does not interfere with where patients are ambulatory.
hand-washing shall be provided.
(5) Potable water storage. Potable water storage ves-
(2) When the functional program includes hemodial- sels (hot and cold) not intended for constant use
ysis, continuously circulated filtered cold water shall not be installed.
shall be provided. Piping shall be in accordance
with AAMI RD6.2. (6) Emergency eyewash and showers shall comply
with ANSI Z358.1.
10.1.2.3 Potable water supply systems
10.1.2.4 Hot water systems. See Section 1.6-2.1.2.1.
(1) Capacity. Systems shall be designed to supply
water at sufficient pressure to operate all fixtures 10.1.2.5 Drainage systems
and equipment during maximum demand.
Supply capacity for hot- and cold-water piping (1) Piping
shall be determined on the basis of fixture units,
using recognized engineering standards. When the (a) Drain lines from sinks used for acid waste
ratio of plumbing fixtures to occupants is propor- disposal shall be made of acid-resistant
tionally more than required by the building occu- material.
pancy and is in excess of 1,000 plumbing fixture
units, a diversity factor shall be permitted. (b) Drain lines serving some types of automatic
blood-cell counters shall be of carefully
(2) Valves. Each water service main, branch main, selected material that will eliminate potential
riser, and branch to a group of fixtures shall have for undesirable chemical reactions (and/or
valves. explosions) between sodium azide wastes
and copper, lead, brass, solder, etc.
(a) Stop valves shall be provided for each fixture.
(c) Insofar as possible, drainage piping shall not
(b) Appropriate panels for access shall be provided be installed within the ceiling or exposed in
at all valves where required. operating and delivery rooms, nurseries, food
preparation centers, food-serving facilities,
(3) Backflow prevention food storage areas, central services, electronic
data processing areas, electric closets, and
(a) Systems shall be protected against cross-con- other sensitive areas. Where exposed over-
nection in accordance with American Water head drain piping in these areas is unavoid-
Works Association (AWWA) Recommended able, special provisions shall be made to
116 2006 Guidelines for Design and Construction of Health Care Facilities
2 . 1 G E N E R A L H O S P I TA L S
protect the space below from leakage, (6) Plaster traps. Where plaster traps are used, provisions
condensation, or dust particles. shall be made for appropriate access and cleaning.
(a) Floor drains shall not be installed in operat- 10.1.3 Plumbing Fixtures
ing and delivery rooms. In addition to the requirements of Section 1.6-2.1.3,
the following standards shall apply to plumbing fix-
*(b) If a floor drain is installed in cystoscopy, it tures in a general hospital:
shall contain a nonsplash, horizontal-flow
flushing bowl beneath the drain plate. 10.1.3.1 Clinical sinks
(c) Dietary area floor drains and/or floor sinks (1) Clinical sinks shall be trimmed with valves that
can be operated without hands. Single-lever or
(i) Type. These shall be of a type that can be wrist blade devices shall be permitted. Handles
easily cleaned by removing the cover. on clinical sinks shall be at least 6 inches (15.24
Removable stainless steel mesh shall be centimeters) long.
provided in addition to grilled drain cov-
ers to prevent entry of large particles of (2) Clinical sinks shall have an integral trap wherein
waste that might cause stoppages. the upper portion of the water trap provides a
visible seal.
(ii) Location. Floor drains or floor sinks shall
be provided at all “wet” equipment (as ice 10.1.3.2 Scrub sinks. Freestanding scrub sinks and
machines) and as required for wet cleaning lavatories used for scrubbing in procedure rooms shall
of floors. Location of floor drains and floor be trimmed with foot, knee, or ultrasonic controls;
sinks shall be coordinated to avoid condi- single-lever wrist blades are not permitted.
tions where locations of equipment make
removal of covers for cleaning difficult. 10.1.4 Medical Gas and Vacuum Systems
10.1.4.1 Medical gas systems. The installation, testing,
(3) Autopsy table drain systems. Drain systems for and certification of nonflammable medical gas and air
autopsy tables shall be designed to positively systems shall comply with the requirements of NFPA
avoid splatter or overflow onto floors or back 99. (See Table 2.1-5 for rooms requiring station outlets.)
siphonage and for easy cleaning and trap flushing.
APPENDIX
(4) Sewers. Building sewers shall discharge into com-
munity sewerage. Where such a system is not A10.1.2.5 (2)(b) Floor drains in cystoscopy operating rooms have
available, the facility shall treat its sewage in been shown to disseminate a heavily contaminated spray during
accordance with local and state regulations. flushing. Unless flushed regularly with large amounts of fluid, the
trap tends to dry out and permit passage of gases, vapors, odors,
(5) Kitchen grease traps insects, and vermin directly into the operating room.
For new construction, if the users insist on a floor drain, the drain
(a) Grease traps shall be of capacity required.
plate should be located away from the operative site, and should
be over a frequently flushed nonsplash, horizontal-flow type of
(b) Grease traps shall be located and arranged to
bowl, preferably with a closed system of drainage. Alternative
permit easy access without the need to enter
methods include (a) an aspirator/trap installed in a wall connect-
food preparation or storage areas.
ed to the collecting trough of the operating table by a closed,
disposable tube system, or (b) a closed system using portable
(c) Grease traps shall be accessible from outside the
collecting vessels. (See NFPA 99.)
building without need to interrupt any services.
2006 Guidelines for Design and Construction of Health Care Facilities 117
2 . 1 G E N E R A L H O S P I TA L S
118 2006 Guidelines for Design and Construction of Health Care Facilities
2 . 1 G E N E R A L H O S P I TA L S
purposes, such as fan-coil units, heat pump controlled to ensure movement of air from “clean”
units, etc.). These units may be used as recir- to “less clean” areas, especially in critical areas.
culating units only. All outdoor air require-
ments shall be met by a separate central (5) Although natural ventilation for nonsensitive
air-handling system with proper filtration, areas and patient rooms (via operable windows)
as noted in Table 2.1-3. shall be permitted, mechanical ventilation shall be
considered for all rooms and areas in the facility.
(3) Vibration isolators. Mechanical equipment, duct-
work, and piping shall be mounted on vibration 10.2.1.3 Testing and documentation
isolators as required to prevent unacceptable
structure-borne vibration. (1) Upon completion of the equipment installation
contract, the owner shall be furnished with a
(4) System valves. Supply and return mains and risers complete set of manufacturers’ operating, main-
for cooling, heating, and steam systems shall be tenance, and preventive maintenance instruc-
equipped with valves to isolate the various sec- tions, parts lists, and complete procurement
tions of each system. Each piece of equipment information, including equipment numbers and
shall have valves at the supply and return ends. descriptions. Required information shall include
energy ratings as needed for future conservation
(5) Renovation. If system modifications affect greater calculations.
than 10 percent of the system capacity, designers
shall utilize pre-renovation water/air flow rate (2) Operating staff persons shall also be provided
measurements to verify that sufficient capacity is with written instructions for proper operation of
available and that renovations have not adversely systems and equipment.
affected flow rates in non-renovated areas.
10.2.2 Requirements for Specific Locations
*10.2.1.2 Ventilation and space conditioning require- 10.2.2.1 Airborne infection isolation rooms. The infec-
ments. All rooms and areas used for patient care shall tious disease isolation room is used for isolating the
have provisions for ventilation. airborne spread of infectious diseases, such as measles,
varicella, or tuberculosis.
(1) Ventilation rates. The ventilation systems shall be
designed and balanced, as a minimum, according (1) The design of airborne infection isolation rooms
to the requirements shown in Table 2.1-2 and the (AIIRs) shall be permitted to include provisions
applicable notes. The ventilation rates shown in for normal patient care during periods not
Table 2.1-2 do not preclude the use of higher, requiring isolation precautions.
more appropriate rates.
(2) Use of supplemental recirculating devices shall be
(2) Air change rates. Air supply and exhaust in rooms permitted in the patient room to increase the
for which no minimum total air change rate is equivalent room air exchanges; however, such
noted may vary down to zero in response to room recirculating devices do not provide outside air
load. For rooms listed in Table 2.1-2, where VAV
systems are used, minimum total air change shall APPENDIX
be within limits noted.
A10.2.1.2 Owing to potential operational problems for the ultravi-
(3) Temperature and humidity. Space temperature olet germicidal irradiation (UVGI) lamps, and the fact that the
and relative humidity shall be as indicated in effectiveness of UVGI is dependent on the airflow pattern in the
Table 2.1-2. room, use of UVGI may be considered as a supplement to the ven-
tilation system design, rather than the main control mechanism.
(4) Air movement direction. To maintain asepsis con- The ACH of the room should therefore be set as if no UVGI system
trol, airflow supply and exhaust shall generally be is installed.
2006 Guidelines for Design and Construction of Health Care Facilities 119
2 . 1 G E N E R A L H O S P I TA L S
requirements. Recirculation of air within individ- (4) If the facility determines that airborne infection
ual isolation rooms shall be permitted if HEPA isolation is necessary for protective environment
filters are used. patients, an anteroom shall be provided.
(3) Rooms with reversible airflow provisions for the (5) Rooms with reversible airflow provisions for the
purpose of switching between protective environ- purpose of switching between protective environ-
ment and AII functions are not acceptable. ment and airborne infection isolation functions
are not acceptable.
10.2.2.2 Protective environment rooms. The protective
environment (PE) room is used to protect the patient 10.2.2.3 Psychiatric patient areas. Special consideration
from common environmental airborne infectious shall be given to the type of heating and cooling units,
microbes (i.e., Aspergillus spores). ventilation outlets, and appurtenances installed in
patient-occupied areas of psychiatric units. The fol-
(1) These special ventilation areas shall be designed lowing shall apply:
to provide directed airflow from the cleanest
patient care area to less clean areas. (1) All air grilles and diffusers shall be of a type that
prohibits the insertion of foreign objects. All
(2) These rooms shall be protected with HEPA filters exposed fasteners shall be tamper-resistant.
at 99.97 percent efficiency for a 0.3 µm sized par-
ticle in the supply airstream. These interrupting (2) All convector or HVAC enclosures exposed in the
filters protect patient rooms from maintenance- room shall be constructed with rounded corners
derived release of environmental microbes from and shall have enclosures fastened with tamper-
the ventilation system components. Recirculation resistant screws.
HEPA filters can be used to increase the equiva-
lent room air exchanges. (3) HVAC equipment shall be of a type that mini-
mizes the need for maintenance within the room.
(3) Constant volume airflow is required for consistent
ventilation for the protected environment.
APPENDIX
A10.2.2.4 (3)(a) Operating and delivery room ventilation should be set appropriately such that it covers at least the area
footprint of the table plus a reasonable margin around it. In the
a. The operating and delivery room ventilation systems should
cited study, this margin is 21 inches (53.34 centimeters) on the
operate at all times to maintain the air movement relationship to
short side and 12 inches (25.40 centimeters) on the long side.
adjacent areas. The cleanliness of the spaces is compromised
when the ventilation system is shut down. For example, airflow Note: The above conclusions were derived from studies conducted
from a less clean space such as the corridor can occur, and by the National Institutes of Health: Farhad Memarzadeh and
standing water can accumulate in the ventilation system Andrew P. Manning, “Comparison of Operating Room Ventilation
(near humidifiers or cooling coils). Systems in the Protection of the Surgical Site” (ASHRAE
Transactions 2002, Vol. 108, pt. 2) and Farhad Memarzadeh
b. The recommended air change rate in an operating room is 20
and Zheng Jiang, “Effect of Operation Room Geometry and
to 25 air changes per hour (ACH) for ceiling heights between 9
Ventilation System Parameter Variations on the Protection of
feet (2.74 meters) and 12 feet (3.66 meters).
the Surgical Site” (IAQ 2004).
c. The system should provide a single directional flow regime, with
e. If additional diffusers are required, they may be located outside
both high and low exhaust locations.
this central diffuser array. Up to 30 percent of the central diffuser
d. A face velocity of around 25 to 35 fpm (0.13 to 0.18 m/s) is array may be allocated to non-diffuser items (medical gas
sufficient from the non-aspirating diffuser array provided the array columns, lights, etc.).
size itself is set correctly. The non-aspirating diffuser array size
120 2006 Guidelines for Design and Construction of Health Care Facilities
2 . 1 G E N E R A L H O S P I TA L S
10.2.2.4 Operating and delivery rooms 10.2.2.6 Anesthesia storage rooms. The ventilation sys-
tem for anesthesia storage rooms shall conform to the
(1) Air supply requirements of NFPA 99, including the gravity
option. Mechanically operated air systems are optional
(a) In new construction and major renovation in these rooms.
work, air supply for operating and delivery
rooms shall be from non-aspirating ceiling 10.2.2.7 ETO sterilizer space. The ventilation system for
diffusers with a face velocity in the range of the space that houses ethylene oxide (ETO) sterilizers
25 to 35 fpm (0.13 to 0.18 m/s), located at shall be designed as follows:
the ceiling above the center of the work area.
Return air shall be near the floor level, at a (1) A dedicated (not connected to a return air or
minimum. Return air shall be permitted high other exhaust system) exhaust system shall be
on the walls, in addition to the low returns. provided. Refer to 29 CFR Part 1910.1047.
(b) Each operating and delivery room shall have (2) All source areas shall be exhausted, including the
at least two return-air inlets located as far sterilizer equipment room, service/aeration areas,
from each other as practical. and the space above the sterilizer door, as well as
the aerator.
(c) Turbulence and other factors of air move-
ment shall be considered to minimize the fall (a) If the ETO cylinders are not located in a
of particulates onto sterile surfaces. well-ventilated, unoccupied equipment
space, an exhaust hood shall be provided
(2) Temperature. Temperature shall be individually over the cylinders.
controlled for each operating and delivery room.
(b) The relief valve shall be terminated in a well-
(3) Ventilation rates ventilated, unoccupied equipment space or
outside the building.
*(a) Operating and delivery room ventilation sys-
tems shall operate at all times, except during (c) If the floor drain to which the sterilizer(s)
maintenance and conditions requiring shut- discharges is not located in a well-ventilated,
down by the building’s fire alarm system. unoccupied equipment space, an exhaust
drain cap shall be provided (coordinate with
(b) During unoccupied hours, operating and local codes).
delivery room air change rates may be
reduced, provided the positive room pressure (3) General airflow shall be away from the sterilizer
is maintained as required in Table 2.1-2. operator(s).
(4) Standards for special procedures. Where extraor- (4) A dedicated exhaust duct system for ETO shall be
dinary procedures, such as organ transplants, provided. The exhaust outlet to the outside shall
justify special designs, installation shall properly be at least 25 feet (7.62 meters) away from any air
meet performance needs as determined by appli- intake.
cable standards. These special designs should be
reviewed on a case-by-case basis. (5) An audible and visual alarm shall activate in the
sterilizer work area, and in a 24-hour staffed loca-
10.2.2.5 Cough-inducing procedure rooms. Rooms used tion, upon loss of airflow in the exhaust system.
for sputum induction, aerosolized pentamadine treat-
ments, or other cough-inducing procedures shall meet the
requirements of Table 2.1-2 for airborne infection isola-
tion rooms. If booths are used, refer to Section 2.1-5.8.1.
2006 Guidelines for Design and Construction of Health Care Facilities 121
2 . 1 G E N E R A L H O S P I TA L S
10.2.2.9 Fuel-fired equipment rooms. Rooms with (a) Each space routinely used for administering
fuel-fired equipment shall be provided with sufficient inhalation anesthesia and inhalation analgesia
outdoor air to maintain equipment combustion rates shall be served by a scavenging system to
and to limit workstation temperatures. vent waste gases.
10.2.3 Thermal Insulation and Acoustical Provisions (b) When anesthesia scavenging systems are
See Section 1.6-2.2.1. required, air supply shall be at or near the
ceiling. Return or exhaust air inlets shall be
10.2.4 HVAC Air Distribution near the floor level.
10.2.4.1 Return air systems. For patient care areas,
return air shall be via ducted systems. (c) If a vacuum system is used, the gas-collecting
system shall be arranged so it does not dis-
10.2.4.2 HVAC ductwork. See Section 1.6-2.2.2.1. turb patients’ respiratory systems.
122 2006 Guidelines for Design and Construction of Health Care Facilities
2 . 1 G E N E R A L H O S P I TA L S
10.2.4.4 Air outlets and inlets exhaust hoods and safety cabinets (when in
use), supplementary makeup air (filtered and
*(1) Fresh air intakes preheated) shall be provided around these
units to maintain the required airflow direc-
(a) Fresh air intakes shall be located at least 25 tion and exhaust velocity. Use of makeup air
feet (7.62 meters) from exhaust outlets of ven- will avoid dependence upon infiltration from
tilating systems, combustion vents (including outdoor and/or from contaminated areas.
those serving rooftop air handling equip-
ment), medical-surgical vacuum systems, (c) Makeup systems for hoods shall be arranged
plumbing vents, or areas that may collect to minimize “short circuiting” of air and to
vehicular exhaust or other noxious fumes. avoid reduction in air velocity at the point of
(Prevailing winds and/or proximity to other contaminant capture.
structures may require greater clearances.)
(2) Laboratory fume hoods. Laboratory fume hoods
(b) Plumbing vents that terminate at a level shall meet the following standards:
above the top of the air intake may be located
as close as 10 feet (3.05 meters). (a) General standards
(c) The bottom of outdoor air intakes serving (i) An average face velocity of at least 75
central systems shall be as high as practical, feet per minute (0.38 meters per second)
but at least 6 feet (1.83 meters) above ground
level, or, if installed above the roof, 3 feet (ii) Connection to an exhaust system to the
(91.44 centimeters) above roof level. outside that is separate from the building
exhaust system
(2) Relief air. Relief air is exempt from the 25-foot
(7.62-meter) separation requirement. Relief air is (iii) Location of an exhaust fan at the dis-
defined as air that otherwise could be returned charge end of the system
(recirculated) to an air handling unit from the
occupied space, but is being discharged to the (iv) Inclusion of an exhaust duct system of
outdoors to maintain building pressure, such as noncombustible corrosion-resistant
during outside air economizer operation. material as needed to meet the planned
usage of the hood
(3) Gravity exhaust. Where conditions permit, gravity
exhaust shall be permitted for nonpatient areas (b) Special standards for use with strong oxidants
such as boiler rooms, central storage, etc.
(i) Fume hoods and their associated equip-
(4) Construction requirements. The bottoms of air dis- ment in the air stream intended for use
tribution devices (supply/return/exhaust) shall be at with perchloric acid and other strong
least 3 inches (7.62 centimeters) above the floor. oxidants shall be constructed of stainless
steel or other material consistent with
10.2.4.5 Ventilation hoods special exposures.
2006 Guidelines for Design and Construction of Health Care Facilities 123
2 . 1 G E N E R A L H O S P I TA L S
(iv) When perchloric acid or other strong (2) Noncentral air-handling systems shall be
oxidants are only transferred from one equipped with permanent (cleanable) or replace-
container to another, standard laboratory able filters with a minimum efficiency of MERV 3
fume hoods and the associated equip- (68 percent weight arrestance).
ment may be used in lieu of stainless
steel construction. (3) Filter efficiencies, tested in accordance with
ASHRAE 52.1, shall be average.
(c) Special standards for use with infectious or
radioactive materials. In new construction 10.2.5.2 Filter bed location. Where two filter beds are
and major renovation work, each hood used required, filter bed no. 1 shall be located upstream of
to process infectious or radioactive materials the air conditioning equipment and filter bed no. 2
shall meet the following requirements: shall be downstream of any fan or blowers.
(i) Each hood shall have a minimum face 10.2.5.3 Filter frames. Filter frames shall be durable
velocity of 90 to 110 feet per minute and proportioned to provide an airtight fit with the
(0.45 to 0.56 meters per second) with enclosing ductwork. All joints between filter segments
suitable pressure-independent air-mod- and enclosing ductwork shall have gaskets or seals to
ulating devices and alarms to alert staff provide a positive seal against air leakage.
of fan shutdown or loss of airflow.
10.2.5.4 Filter housing blank-off panels. Filter housing
(ii) Each shall also have filters with a 99.97 blank-off panels shall be permanently attached to the
percent efficiency (based on the DOP frame, constructed of rigid materials, and have sealing
test method) in the exhaust stream and surfaces equal to or greater than the filter media
be designed and equipped to permit the installed in the filter frame.
safe removal, disposal, and replacement
of contaminated filters. Filters shall be as 10.2.5.5 Filter manometers. A manometer shall be
close to the hood as practical to mini- installed across each filter bed having a required effi-
mize duct contamination. ciency of 75 percent or more, including hoods requir-
ing HEPA filters. Provisions shall be made to allow
(iii) Fume hoods intended for use with access to the manometer for field testing.
radioactive isotopes shall be constructed
of stainless steel or other material suit- 10.2.6 Steam and Hot Water Systems
able for the particular exposure and shall See Section 1.6-2.2.3.
comply with NFPA 801, Facilities for
Handling Radioactive Materials. Note: 10.3 Electrical Systems
Radioactive isotopes used for injections,
etc., without probability of airborne par- 10.3.1 General
ticulates or gases may be processed in a 10.3.1.1 Applicable standards
124 2006 Guidelines for Design and Construction of Health Care Facilities
2 . 1 G E N E R A L H O S P I TA L S
(1) All electrical material and equipment, including (2) Overload protective devices. These shall operate
conductors, controls, and signaling devices, shall properly in ambient room temperatures.
be installed in compliance with applicable sec-
tions of NFPA 70 and NFPA 99. 10.3.3.2 Panelboards
(2) All electrical material and equipment shall be listed (1) Panelboards serving critical branch, equipment
as complying with available standards of listing system, or normal system loads shall be located
agencies or other similar established standards on the same floor as the loads to be served.
where such standards are required.
(2) Location of panelboards serving life safety branch
(3) Field labeling of equipment and materials shall be loads on the floor above or the floor below the
permitted only when provided by a nationally rec- loads to be served shall be permitted.
ognized testing laboratory that has been certified by
the Occupational Safety and Health Administration (3) New panelboards shall not be located in public
(OSHA) for that referenced standard. access corridors.
10.3.1.2 Testing and documentation. The electrical 10.3.3.3 Ground-fault circuit interrupters
installations, including alarm, nurse call, and commu-
nication systems, shall be tested to demonstrate that (1) Ground-fault circuit interrupters (GFCIs) shall
equipment installation and operation is appropriate comply with NFPA 70.
and functional. A written record of performance tests
on special electrical systems and equipment shall show (2) When ground-fault circuit interrupters are used
compliance with applicable codes and standards. in critical areas, provisions shall be made to
ensure that other essential equipment is not
10.3.2 Electrical Requirements for Specific affected by activation of one interrupter.
Hospital Locations
10.3.2.1 Inhalation anesthetizing locations. At inhala- 10.3.4 Power Generating and Storing Equipment
tion anesthetizing locations, all electrical equipment 10.3.4.1 Emergency electrical service
and devices, receptacles, and wiring shall comply with
applicable sections of NFPA 99 and NFPA 70. (1) Emergency power shall be provided for in accor-
dance with NFPA 99, NFPA 101, and NFPA 110.
10.3.3 Electrical Distribution and Transmission
10.3.3.1 Switchboards (2) Where stored fuel is required, storage capacity shall
permit continuous operation for at least 4 hours.
(1) Location
10.3.5 Lighting
(a) Main switchboards shall be located in an 10.3.5.1 General. See Section 1.6-2.3.1.1.
area separate from plumbing and mechanical
equipment and shall be accessible to author- 10.3.5.2 Lighting for specific locations in the hospital
ized persons only.
(1) Patient rooms. Patient rooms shall have general
(b) Switchboards shall be convenient for use, lighting and night lighting.
readily accessible for maintenance, and away
from traffic lanes. (a) A reading light shall be provided for each
patient.
(c) Switchboards shall be located in a dry, venti-
lated space free of corrosive or explosive (i) Reading light controls shall be accessible
fumes, gases, or any flammable material. to the patient(s) without the patient hav-
ing to get out of bed.
2006 Guidelines for Design and Construction of Health Care Facilities 125
2 . 1 G E N E R A L H O S P I TA L S
(ii) Incandescent and halogen light sources (1) Fixed and mobile x-ray equipment installations
that produce heat shall be avoided to shall conform to articles 517 and 660 of NFPA 70.
prevent burns to the patient and/or bed
linen. (2) The x-ray film illuminator unit or units for dis-
playing at least two films simultaneously shall be
(iii) Unless specifically designed to protect installed in each operating room, specified emer-
the space below, the light source shall be gency treatment rooms, and x-ray viewing room
covered by a diffuser or lens. of the radiology department. All illuminator units
within one space or room shall have lighting of
(iv) Flexible light arms, if used, shall be uniform intensity and color value.
mechanically controlled to prevent the
lamp from contacting the bed linen. *10.3.6.2 Special electrical equipment. Special equip-
ment is identified in the sections on critical care units,
(b) At least one night light fixture in each patient newborn nurseries, pediatric and adolescent unit, psy-
room shall be controlled at the room entrance. chiatric nursing unit, obstetrical suite, surgical suites,
emergency service, imaging suite, nuclear medicine,
(c) Lighting for coronary and intensive care bed laboratory suite, rehabilitation therapy department,
areas shall permit staff observation of the renal dialysis unit, respiratory therapy service, morgue,
patient while minimizing glare. pharmacy, dietary facilities, administrative and public
areas, medical records, central services, general stores,
(2) Nursing unit corridors. Corridors in nursing units and linen services. These sections shall be consulted to
shall have general illumination with provisions ensure compatibility between programmatically
for reducing light levels at night. defined equipment needs and appropriate power and
other electrical connection needs.
(3) Exam/treatment/trauma rooms. A portable or
fixed examination light shall be provided for *10.3.6.3 Hand-washing stations and scrub sinks. If
examination, treatment, and trauma rooms. operation of a scrub sink or a hand-washing station in
critical care areas, emergency departments, labor and
(4) Operating and delivery rooms. Operating and delivery, and surgical suites is dependent on the build-
delivery rooms shall have general lighting in addi- ing electrical service, it shall be connected to the
tion to special lighting units provided at surgical essential electrical system.
and obstetrical tables. General lighting and special
lighting shall be on separate circuits. 10.3.7 Receptacles
10.3.7.1 Receptacles in corridors
10.3.5.3 Emergency lighting. See Section 1.6-2.3.1.2.
(1) Duplex-grounded receptacles for general use shall
10.3.5.4 Exit signs. See Section 1.6-2.3.1.3. be installed approximately 50 feet (15.24 meters)
apart in all corridors and within 25 feet (7.62
10.3.6 Equipment meters) of corridor ends.
10.3.6.1 X-ray equipment
(2) Receptacles in pediatric and psychiatric unit
APPENDIX corridors shall be of the tamper-resistant type.
A10.3.6.2 Special attention should be paid to safety hazards (3) Special receptacles marked for x-ray use shall
associated with equipment cabling. Every attempt should be be installed in corridors of patient areas so that
made to minimize these hazards, where practical. mobile equipment may be used anywhere within
a patient room using a cord length of 50 feet
A10.3.6.3 Refer to NFPA 99 for a description of the essential
(15.24 meters) or less. If the same mobile x-ray
electrical system.
unit is used in operating rooms and in nursing
126 2006 Guidelines for Design and Construction of Health Care Facilities
2 . 1 G E N E R A L H O S P I TA L S
areas, receptacles for x-ray use shall permit the connected to emergency system power and be so
use of one plug in all locations. Where capacitive labeled.
discharge or battery-powered x-ray units are used,
special x-ray receptacles are not required. (8) Each general care examination and treatment
table and each work table shall have access to two
10.3.7.2 Receptacles in patient care areas duplex receptacles.
(1) Patient rooms. Each patient room shall have (9) Operating and delivery rooms
duplex-grounded receptacles.
(a) Each operating and delivery room shall have
(a) There shall be one at each side of the head at least six receptacles convenient to the head
of each bed; one for television, if used; one of the procedure table.
on every other wall; and one for each
motorized bed. (b) Each operating room shall have at least 16
simplex or eight duplex receptacles. Where
(b) Receptacles may be omitted from exterior mobile x-ray, laser, or other equipment requir-
walls where construction or room configura- ing special electrical configurations is used,
tion makes installation impractical. additional receptacles distinctively marked for
x-ray or laser use shall be provided.
(2) Intermediate care rooms. These shall have at least
four duplex outlets per bed. The outlets shall be (10) Renal dialysis units
arranged to provide two duplex outlets on each
side of the head of the bed. (a) For renal dialysis units, two duplex recepta-
cles shall be on each side of a patient bed or
(3) Critical care areas. As defined by NFPA 99 and lounge chair.
NFPA 70, including pediatric and newborn inten-
sive care units, critical care areas shall have at least (b) One duplex receptacle on each side of the
seven duplex outlets at the head of each bed, crib, bed shall be connected to emergency power.
or bassinet. Approximately 50 percent of critical
care outlets shall be connected to emergency sys- 10.3.7.3 Emergency system receptacles. Electrical receptacle
tem power and be so labeled. cover plates or electrical receptacles supplied from the
emergency systems shall be distinctively colored or marked
(4) Nurseries. Nurseries shall have at least two for identification. If color is used for identification purposes,
duplex-grounded receptacles for each bassinet. the same color shall be used throughout the facility.
(5) LDRP rooms. LDRP rooms shall have receptacles as 10.3.8 Call Systems
required for patient rooms (Section 2.1-10.3.7.2 (1)); in 10.3.8.1 General. Alternate technologies shall be per-
addition, the bassinet shall have receptacles as required mitted for emergency or nurse call systems. If radio
for nursery bassinets (Section 2.1-10.3.7.2 (4)). frequency systems are utilized, consideration shall be
given to electromagnetic compatibility between inter-
(6) Trauma and resuscitation rooms. These shall have nal and external sources.
eight duplex outlets located convenient to the
head of each bed. 10.3.8.2 Patient room call station. In patient areas,
each patient room shall be served by at least one call-
(7) Emergency department. Examination and treat- ing station for two-way voice communication.
ment rooms in the emergency department shall
have a minimum of six duplex outlets located (1) Each bed shall be provided with a call device. Two
convenient to the head of each bed. Approximately call devices serving adjacent beds may be served
50 percent of emergency care outlets shall be by one calling station.
2006 Guidelines for Design and Construction of Health Care Facilities 127
2 . 1 G E N E R A L H O S P I TA L S
(2) Signal location (c) Imaging suite. Patient toilet rooms within the
imaging suite shall be equipped with a nurse
(a) Calls shall activate a visible signal in the cor- emergency call.
ridor at the patient’s door, in the clean work-
room, in the soiled workroom, in medication, (d) Renal dialysis units. Toilet rooms in renal
charting, clean linen storage, nourishment, dialysis units shall be served by an emergency
equipment storage, and examination/treat- call. The call shall activate a signal at the
ment room(s) and at the nursing station of nurses’ station.
the nursing unit.
10.3.8.4 Limited call system. In areas such as critical
(b) In multi-corridor nursing units, additional care, recovery, pre-op, and emergency, where patients
visible signals shall be installed at corridor are under constant visual surveillance, the nurse call
intersections. may be limited to the following:
(c) In rooms containing two or more calling sta- (1) A bedside button or station that activates a signal
tions, indicating lights shall be provided at readily seen at the control station to summon
each station. additional assistance (see Section 2.1-10.3.8.5)
(3) Nurse call systems at each calling station shall be (2) An emergency code resuscitation alarm to summon
equipped with an indicating light that remains medical assistance from the code team
lighted as long as the voice circuit is operating.
10.3.8.5 Staff emergency assistance system
10.3.8.3 Emergency call system
(1) Location of call system. An emergency assistance
(1) The emergency call shall be designed so that a sig- system for staff to summon additional assistance
nal activated at a patient’s call station will initiate shall be provided in each operating, delivery,
a visible and audible signal that can be turned off recovery, emergency examination, treatment, and
only at the patient call station and that is distinct intermediate care area, and in critical care units,
from the regular nurse call signal. nurseries, special procedure rooms, cardiac
catheterization rooms, stress-test areas, triage,
(2) The emergency call shall activate an annunciator outpatient surgery, admission and discharge areas,
panel at the nurse station, a visible signal in the and areas for psychiatric patients, including seclu-
corridor at the patient’s door, and at other areas sion and security rooms, anterooms and toilet
defined by the functional program. rooms serving them, communal toilet and bathing
facility rooms, and dining, activity, therapy, exam,
(3) Specific locations in the hospital and treatment rooms.
(a) Patient toilet and bathing facilities. A nurse (2) Location of annunciator. This system shall
emergency call system shall be provided at annunciate visibly and audibly in the clean work-
each inpatient toilet, bath, sitz bath, and room, in the soiled workroom, in medication,
shower room. A nurse emergency call shall charting, clean linen storage, nourishment, equip-
be accessible to a collapsed patient lying on ment storage, and examination/treatment
the floor. Inclusion of a pull cord will satisfy room(s) if provided, and at the nursing station of
this standard. the nursing unit, with backup to another staffed
area from which assistance can be summoned.
(b) Outpatient and treatment areas. Provisions
for emergency calls shall be provided in out- 10.3.8.6 Emergency resuscitation alarm. In critical care
patient and treatment areas where patients units, recovery, and pre-op, the call system shall include
may be subject to incapacitation. provisions for an emergency code resuscitation alarm
to summon assistance from outside the unit.
128 2006 Guidelines for Design and Construction of Health Care Facilities
2 . 1 G E N E R A L H O S P I TA L S
2006 Guidelines for Design and Construction of Health Care Facilities 129
2 . 1 G E N E R A L H O S P I TA L S
Table 2.1-2
Ventilation Requirements for Areas Affecting Patient Care in Hospitals and Outpatient Facilities1
NURSING UNITS
Patient room — 2 610 — — — 70-75 (21–24)
Toilet room In — 10 Yes — — —
Newborn nursery suite — 2 6 — No 30-60 72-78 (22-26)
Protective environment room11 Out 2 12 — No — 75 (24)
Airborne infection isolation room11 In 2 12 Yes12 No — 75 (24)
Isolation alcove or anteroom In/Out — 10 Yes No — —
Patient corridor — — 2 — — — —
OBSTETRICAL FACILITIES
Delivery room13 Out 3 15 — No 30-60 68-73 (20–23)
Labor/delivery/recovery — 2 610 — — — 70-75 (21–24)
Labor/delivery/recovery/postpartum — 2 610 — — — 70-75 (21–24)
SUPPORT AREAS
Medication room Out — 4 — — — —
Clean workroom or clean holding Out — 4 — — — —
Soiled workroom or soiled holding In — 10 Yes No — —
130 2006 Guidelines for Design and Construction of Health Care Facilities
2 . 1 G E N E R A L H O S P I TA L S
SERVICE AREAS
Pharmacy Out — 4 — — — —
Food preparation center — — 10 — No — —
Warewashing In — 10 Yes No — —
Dietary day storage In — 2 — — — —
Laundry, general — — 10 Yes — — —
Soiled linen (sorting and storage) In — 10 Yes No — —
Clean linen storage Out — 2 — — — —
Soiled linen and trash chute room In — 10 Yes No — —
Bedpan room In — 10 Yes — — —
Bathroom In — 10 — — — 75 (24)
Housekeeping room In — 10 Yes No — —
1
The ventilation rates in this table cover ventilation for comfort, as well as for exhaust, shall be as required by good engineering practice. Minimum outside
asepsis and odor control in areas of acute care hospitals that directly affect air quantities shall remain constant while the system is in operation. In vari-
patient care and are determined based on healthcare facilities being predomi- able volume systems, the minimum outside air setting on the air-handling unit
nantly “No Smoking” facilities. Where smoking may be allowed, ventilation shall be calculated using the ASHRAE 62 method.
rates will need adjustment. Areas where specific ventilation rates are not given 4
Number of air changes may be reduced when the room is unoccupied if provi-
in the table shall be ventilated in accordance with ASHRAE Standard 62, sions are made to ensure that the number of air changes indicated is reestab-
Ventilation for Acceptable Indoor Air Quality, and ASHRAE Handbook—HVAC lished any time the space is being utilized. Adjustments shall include
Applications. Specialized patient care areas, including organ transplant units, provisions so that the direction of air movement shall remain the same when
burn units, specialty procedure rooms, etc., shall have additional ventilation the number of air changes is reduced. Areas not indicated as having continu-
provisions for air quality control as may be appropriate. OSHA standards ous directional control may have ventilation systems shut down when space is
and/or NIOSH criteria require special ventilation requirements for employee unoccupied and ventilation is not otherwise needed, if the maximum infiltra-
health and safety within health care facilities. tion or exfiltration permitted in Note 2 is not exceeded and if adjacent pressure
2
Design of the ventilation system shall provide air movement which is generally balancing relationships are not compromised. Air quantity calculations must
from clean to less clean areas. If any form of variable air volume or load shed- account for filter loading such that the indicated air change rates are provided
ding system is used for energy conservation, it must not compromise the corri- up until the time of filter change-out. The minimum total air change require-
dor-to-room pressure balancing relationships or the minimum air changes ments for Table 2.1-2 shall be based on the supply air quantity in positive
required by the table. pressure rooms, and the exhaust air quantity in negative pressure rooms.
5
3
To satisfy exhaust needs, replacement air from the outside is necessary. Table Air change requirements indicated are minimum values. Higher values should
2.1-2 does not attempt to describe specific amounts of outside air to be sup- be used when required to maintain indicated room conditions (temperature
plied to individual spaces except for certain areas such as those listed. and humidity), based on the cooling load of the space (lights, equipment,
Distribution of the outside air, added to the system to balance required people, exterior walls and windows, etc.).
2006 Guidelines for Design and Construction of Health Care Facilities 131
2 . 1 G E N E R A L H O S P I TA L S
6
Air from areas with contamination and/or odor problems shall be exhausted to exhaust (scavenging) systems and general ventilation of the areas in which
the outside and not recirculated to other areas. Note that individual circum- the respective gases are utilized.
stances may require special consideration for air exhaust to the outside, e.g., 14
Some surgeons may require room temperatures that are outside of the indi-
in intensive care units in which patients with pulmonary infection are treated, cated range. All operating room design conditions shall be developed in con-
and rooms for burn patients. sultation with surgeons, anesthesiologists, and nursing staff.
*7
Recirculating room HVAC units refers to those local units that are used prima- 15
The term trauma room as used here is the operating room space in the emer-
rily for heating and cooling of air, and not disinfection of air. Because of clean- gency department or other trauma reception area that is used for emergency
ing difficulty and potential for buildup of contamination, recirculating room surgery. The first aid room and/or “emergency room” used for initial treatment
units shall not be used in areas marked “No.” However, for airborne infection of accident victims may be ventilated as noted for the “treatment room.”
control, air may be recirculated within individual isolation rooms if HEPA filters Treatment rooms used for bronchoscopy shall be treated as bronchoscopy
are used. Isolation and intensive care unit rooms may be ventilated by reheat rooms. Treatment rooms used for cryosurgery procedures with nitrous oxide
induction units in which only the primary air supplied from a central system shall contain provisions for exhausting waste gases.
passes through the reheat unit. Gravity-type heating or cooling units such as
16
radiators or convectors shall not be used in operating rooms and other spe- In a ventilation system that recirculates air, HEPA filters can be used in lieu of
cial care areas. See footnote A7 (at the bottom of the page) for a description exhausting the air from these spaces to the outside. In this application, the
of recirculation units to be used in isolation rooms. return air shall be passed through the HEPA filters before it is introduced into
8
any other spaces.
The ranges listed are the minimum and maximum limits where control is
17
specifically needed. The maximum and minimum limits are not intended to be The endoscopic instrument processing room is a room adjacent to the gas-
independent of a space’s associated temperature. The humidity is expected to trointestinal endoscopy room that is used for cleaning endoscopic equipment
be at the higher end of the range when the temperature is also at the higher and instruments.
end, and vice versa. See Figure 2.1-1 for a graphic representation of the indi- 18
When required, appropriate hoods and exhaust devices for the removal of
cated changes on a psychrometric chart. Shaded area is acceptable range. noxious gases or chemical vapors shall be provided (see Section 2.1-
9
Where temperature ranges are indicated, the systems shall be capable of main- 10.2.4.5. (2) and NFPA 99).
taining the rooms at any point within the range during normal operation. A single 19
The air movement relationships for laboratories apply between laboratory and
figure indicates a heating or cooling capacity of at least the indicated tempera- adjacent non-laboratory spaces. Reference DHHS publication “Biosafety in
ture. This is usually applicable when patients may be undressed and require a Microbiological and Biomedical Laboratories” (CDC and NIH) on the CDC Web site.
warmer environment. Nothing in these guidelines shall be construed as preclud-
ing the use of temperatures lower than those noted when the
patients’ comfort and medical conditions make lower tempera-
tures desirable. Unoccupied areas such as storage rooms shall
have temperatures appropriate for the function intended.
10
Total air changes per room for patient rooms, intermediate care,
labor/delivery/recovery rooms, and labor/delivery/recovery/
postpartum rooms may be reduced to 4 when supplemental
heating and/or cooling systems (radiant heating and cooling,
baseboard heating, etc.) are used.
*11
Differential pressure shall be a minimum of 0.01” water
gauge (2.5 Pa). If alarms are installed, allowances shall be
made to prevent nuisance alarms of monitoring devices.
12
If it is not practical to exhaust the air from the airborne infection
isolation room to the outside, the air may be returned through
HEPA filters to the air-handling system exclusively serving the
isolation room.
13
National Institute for Occupational Safety and Health (NIOSH)
Criteria Documents regarding Occupational Exposure to Waste
Anesthetic Gases and Vapors, and Control of Occupational
Exposure to Nitrous Oxide indicate a need for both local
APPENDIX
A7
Recirculating devices with HEPA filters may have potential uses in exist- the exhaust, so that the health care worker is not in position between
ing facilities as interim, supplemental environmental controls to meet the infectious source and the exhaust location. The design of such sys-
requirements for the control of airborne infectious agents. Limitations in tems should also allow for easy access for scheduled preventative main-
design must be recognized. The design of either portable or fixed sys- tenance and cleaning.
tems should prevent stagnation and short circuiting of airflow. The sup-
A11
ply and exhaust locations should direct clean air to areas where health The verification of airflow direction can include a simple visual method
care workers are likely to work, across the infectious source, and then to such as smoke trail, ball-in-tube, or flutterstrip. These devices will
require a minimum differential air pressure to indicate airflow direction.
132 2006 Guidelines for Design and Construction of Health Care Facilities
2 . 1 G E N E R A L H O S P I TA L S
2006 Guidelines for Design and Construction of Health Care Facilities 133
2 . 1 G E N E R A L H O S P I TA L S
Table 2.1-5
Station Outlets for Oxygen, Vacuum (Suction), and Medical Air Systems in Hospitals1
134 2006 Guidelines for Design and Construction of Health Care Facilities
2.2 Small Inpatient Primary Care Hospitals
Appendix material, which appears in shaded boxes at the bottom of the page, is advisory only.
2006 Guidelines for Design and Construction of Health Care Facilities 135
2 . 2 S M A L L I N PAT I E N T P R I M A R Y C A R E H O S P I TA L S
spaces to satisfy the needs of the patient population, 2.2 Typical Patient Rooms
personnel, and public.
2.2.1 Capacity
1.3.2.2 In the absence of a formal parking study, provide 2.2.1.1 New construction. In new construction, the
one space for each bed plus one space for each employ- maximum number of beds per room shall be one
ee normally present on any single weekday shift. unless the functional program demonstrates the
necessity of a two-bed arrangement. Approval of a
1.3.2.3 Additional parking may be required to accom- two-bed arrangement shall be obtained from the
modate other services. licensing authority.
1.3.2.4 Separate and additional space shall be provided 2.2.1.2 Renovation. Where renovation work is under-
for service delivery vehicles, vehicles utilized for emer- taken and the present capacity is more than one
gency services, and mobile transportable units. patient, maximum room capacity shall be no more
than the present capacity, with a maximum of four
patients.
2 Nursing Unit
2.2.2 Space Requirements
2.1 General Minor encroachments, including columns and hand-
washing stations, that do not interfere with functions
2.1.1 Size may be ignored when determining space requirements
2.1.1.1 A single nursing unit shall be provided for the for patient rooms.
small inpatient primary care facility. The number of
patient rooms contained in the unit shall be as deter- *2.2.2.1 Area. In new construction, patient rooms shall
mined by the functional program but shall not exceed be constructed to meet the needs of the functional
25 beds per unit. program and have a minimum of 100 square feet (9.29
square meters) of clear floor area per bed in multiple-
2.1.1.2 An additional unit may be incorporated into bed rooms and 120 square feet (11.15 square meters) of
the design of the facility based on a demographic clear floor area in single-bed rooms, exclusive of toilet
analysis and the facility’s demonstrated ability to pro- rooms, closets, lockers, wardrobes, alcoves, or vestibules.
vide adequate support services for the additional beds.
2.2.2.2 Dimensions and clearances. The dimensions
2.1.2 Multiple Modalities and arrangement of rooms shall be such that there is a
The unit shall be designed to accommodate multiple minimum of 3 feet (91.44 centimeters) between the
patient modalities, with adequate support areas to accom- sides and foot of the bed and any wall or any other
plish the modalities referenced in the functional program. fixed obstruction. In multiple-bed rooms, a clearance
of 4 feet (1.22 meters) shall be available at the foot of
2.1.3 Facility Requirements each bed to permit the passage of equipment and beds.
Each nursing unit shall include the following:
2.2.2.3 Renovation. Where renovation work is under-
APPENDIX taken, every effort shall be made to meet the above
minimum standards. If it is not possible to meet the
A2.2.2.1 In new construction, single-patient rooms should be at above minimum standards, the authorities having
least 12 feet (3.65 meters) wide by 13 feet (3.96 meters) deep jurisdiction may grant approval to deviate from this
(approximately 160 square feet or 14.86 square meters) exclusive requirement. In such cases, patient rooms shall have
of toilet rooms, closets, lockers, wardrobes, alcoves, or vestibules. no less than 80 square feet (7.43 square meters) of
These spaces should accommodate comfortable furniture for one clear floor area per bed in multiple-bed areas and 100
or two family members without blocking staff member access to square feet (9.29 square meters) of clear floor area in
patients. Efforts should be made to provide the patient with some single-bed rooms, exclusive of the spaces previously
control of the room environment. noted in this section.
136 2006 Guidelines for Design and Construction of Health Care Facilities
2 . 2 S M A L L I N PAT I E N T P R I M A R Y C A R E H O S P I TA L S
2.2.8.2 Adequate spaces for sitting, lounging, and visit- 2.3.5.2 If LDR/LDRP functions are programmed for a
ing shall be provided to meet the needs outlined in the small inpatient primary care center, a storage area with
functional program. a minimum of 100 square feet (9.29 square meters)
per LDR bed shall be provided for the storage of case
2.3 Special Patient Care Areas carts, delivery equipment, and bassinets.
2.3.3 Seclusion Room 2.4.3 Identifiable spaces are required for each of the
If the functional program requires a seclusion room, it shall indicated functions.
meet the criteria established in Section 2.3-2.2.1.
2006 Guidelines for Design and Construction of Health Care Facilities 137
2 . 2 S M A L L I N PAT I E N T P R I M A R Y C A R E H O S P I TA L S
2.5 Support Areas for Nursing Unit(s) (3) When a medicine preparation room is to be used
to store one or more self-contained medicine-
2.5.1 Administrative Center or Nurse Station dispensing units, the room shall be designed with
2.5.1.1 Location. This area shall be located to control adequate space to prepare medicines with the self-
access to the nursing unit and serve as a security contained medicine-dispensing unit(s) present.
checkpoint for visitors and vendors entering the
nursing unit. It shall have direct visual access to the 2.5.5.2 Self-contained medicine dispensing unit
entrance to the unit.
(1) Location of a self-contained medicine dispensing
2.5.1.2 Facility requirements unit shall be permitted at the nurse station, in the
clean workroom, or in an alcove, provided the
(1) This area shall have space for counters and storage. unit has adequate security for controlled drugs
and adequate lighting to easily identify drugs.
(2) This area shall have convenient access to hand-
washing facilities. (2) Convenient access to hand-washing stations shall
be provided. (Standard cup sinks provided in
(2) This area may be combined with or include cen- many self-contained units are not adequate for
ters for reception and communication. hand-washing.)
138 2006 Guidelines for Design and Construction of Health Care Facilities
2 . 2 S M A L L I N PAT I E N T P R I M A R Y C A R E H O S P I TA L S
2.5.8.1 Clean workroom. If the room is used for program. Each unit shall provide sufficient storage
preparing patient care items, it shall contain a work areas located on the patient floor to keep its required
counter, a hand-washing station, and storage facilities corridor width free of all equipment and supplies, but
for clean and sterile supplies. not less than 10 square feet (0.93 square meters) per
patient bed shall be provided.
2.5.8.2 Clean supply room. If the room is used only for
storage and holding as part of a system for distribution 2.5.10.3 Emergency equipment storage. Space shall
of clean and sterile materials, omission of the work be provided for emergency equipment that is under
counter and hand-washing station shall be permitted. direct control of the nursing staff, such as a cardiopul-
monary resuscitation (CPR) cart. This space shall be
2.5.9 Soiled Workroom or Soiled Holding Room located in an area appropriate to the functional pro-
Such rooms shall be separate from and have no gram, but out of normal traffic.
direct connection with clean workrooms or clean
supply rooms. 2.5.11 Housekeeping Room
A housekeeping room shall be provided for each
2.5.9.1 Soiled workroom. These shall contain the nursing unit.
following:
2.5.11.1 The room shall contain a service sink or floor
(1) A clinical sink (or equivalent flushing-rim fixture) receptor.
and a hand-washing station. Both fixtures shall
have a hot and cold mixing faucet. 2.5.11.2 Provisions for storage of supplies and house-
keeping equipment shall be made within the room.
(2) A work counter and space for separate covered con-
tainers for soiled linen and a variety of waste types. 2.6 Support Areas for Staff
2.5.9.2 Soiled holding room. Omission of the clinical 2.6.1 Staff Lounge
sink and work counter shall be permitted in rooms 2.6.1.1 Size. Facilities provided for staff shall be pro-
used only for temporary holding of soiled material. If grammatically sized but not less than 100 square feet
the flushing-rim clinical sink is not provided, facilities (9.29 square meters) in area.
for cleaning bedpans shall be provided in the patient
toilet rooms. 2.6.1.2 Location. These facilities shall be located as
close as possible to the centralized nurse station or, if
2.5.10 Equipment and Supply Storage the nurse station is decentralized, in close proximity to
2.5.10.1 Clean linen storage. Each nursing unit shall the work core of the nursing unit.
contain a designated area for clean linen storage.
2.6.2 Staff Toilet Rooms
(1) Location of this area within the clean workroom, Toilet rooms for the exclusive use of staff shall be con-
a separate closet or alcove, or an approved distri- veniently located in the unit.
bution system shall be permitted.
2.6.3 Staff Storage Locations
(2) If a closed cart system is used, storage in an alcove Securable lockers, closets, and cabinet compartments
shall be permitted. This cart storage shall be out for the personal articles of staff shall be located in or
of the path of normal traffic, under staff control, near the nurse station and staff lounge.
and protected from contamination.
2.7 Support Areas for Patients
2.5.10.2 Equipment storage room or alcove. A room
or alcove shall be provided in each nursing unit 2.7.1 Patient Toilet Rooms
appropriate for the storage of equipment necessary In addition to those serving bed areas, patient toilet
for patient care and as required by the functional rooms shall be conveniently located to multipurpose
2006 Guidelines for Design and Construction of Health Care Facilities 139
2 . 2 S M A L L I N PAT I E N T P R I M A R Y C A R E H O S P I TA L S
rooms. Patient toilet rooms located within the multi- 3.1.3.2 Hand-washing station. A hand-washing station
purpose rooms may also be designated for public use. shall be provided.
3.1.3 Treatment Rooms 3.1.5.2 Medication station. This may be part of the
3.1.3.1 Space requirements. Rooms for minor surgical work station.
and cast procedures shall have a minimum floor area
of 120 square feet (11.15 square meters) excluding (1) This shall include a work counter, hand-washing
vestibule, toilet, and closets. The minimum room station, lockable refrigerator, and locked storage
dimension shall be 10 feet (3.05 meters) clear. for controlled drugs. (Standard cup sinks in
140 2006 Guidelines for Design and Construction of Health Care Facilities
2 . 2 S M A L L I N PAT I E N T P R I M A R Y C A R E H O S P I TA L S
many self-contained units are not adequate for 3.2 Emergency Facilities
hand-washing.) Emergency facilities for the small inpatient primary
care center shall meet the criteria established for
(2) If a self-contained medicine dispensing unit is Section 2.1-5.2, Freestanding Emergency Service.
provided, it may be located at the work station, in
the clean workroom, or in an alcove, provided the 3.3 Surgical Facilities
unit has adequate security for controlled drugs Surgical procedures that occur in these facilities shall
and adequate lighting to easily identify drugs. be limited to types that can be performed and sup-
ported in an ambulatory surgical setting.
3.1.5.3 Sterilizing facilities. A system for sterilizing
equipment and supplies shall be provided. Sterilizing 3.3.1 Surgical facilities for the small inpatient primary
procedures may be done on or off site as long as the care center shall meet the criteria established for
off-site location is monitored by the facility regularly Sections 2, 3, 5, and 6 of Chapter 3.7, Outpatient
and meets the facility’s infection control criteria for Surgical Facilities.
sterilizing locations and transportation and handling
methods for sterilized supplies. Disposable supplies 3.3.2 Such facilities shall meet all criteria established
may be used to satisfy the facility’s needs. under Chapter 18 of NFPA 101, Life Safety Code.
3.1.5.4 Clean storage. A separate room or closet for 3.4 Imaging Facilities
storing clean and sterile supplies shall be provided. Facilities for basic diagnostic procedures shall be
This storage shall be in addition to that provided by provided, including the following:
cabinets and shelves.
*3.4.1 Radiography Rooms
3.1.5.5 Soiled workroom or soiled holding room. Such Radiography rooms shall be of a size to accommodate
rooms shall be separate from and have no direct con- the functional program.
nection with clean workrooms or clean supply rooms.
3.4.2 Support Areas for Imaging Facilities
(1) Soiled workrooms. These shall contain the following: 3.4.2.1 Viewing and administrative areas shall be
provided.
(a) A clinical sink (or equivalent flushing-rim
fixture) and a hand-washing station. Both 3.4.2.2 Film processing facilities shall be provided. (If
fixtures shall have a hot and cold mixing part of a picture archiving and communication system
faucet. (PACS), film processing may be retained for emergency
use and film development for special cases.)
(b) A work counter and space for separate cov-
ered containers for soiled linen and a variety 3.4.2.3 Storage facilities shall be provided for film and
of waste types equipment.
(2) Soiled holding rooms. Omission of the clinical 3.4.3 Support Areas for Staff and Patients
sink and work counter shall be permitted in 3.4.3.1 Toilet rooms with hand-washing stations acces-
rooms used only for temporary holding of soiled sible to dressing rooms, work stations, and fluoroscopy
material. If the flushing-rim clinical sink is not rooms shall be provided.
provided, facilities for cleaning bedpans shall be
provided elsewhere.
APPENDIX
3.1.5.6 Wheelchair storage. Wheelchair storage spaces
shall be out of the line of traffic. A3.4.1 Radiography rooms should be a minimum of 180 square
feet (7.43 square meters). (Dedicated chest X-ray rooms may be
smaller.)
2006 Guidelines for Design and Construction of Health Care Facilities 141
2 . 2 S M A L L I N PAT I E N T P R I M A R Y C A R E H O S P I TA L S
142 2006 Guidelines for Design and Construction of Health Care Facilities
2 . 2 S M A L L I N PAT I E N T P R I M A R Y C A R E H O S P I TA L S
(2) One or more ports shall be provided for use 4.3 Engineering Services and Maintenance
by the facility and the tertiary care center, as The following shall be provided:
required by the functional program and identi-
fied community needs. 4.3.1 Equipment Rooms
Equipment rooms for boilers, mechanical equipment,
3.6.6.2 Connection to special life safety needs. The and electrical equipment shall have a minimum clear-
mobile transportable unit shall be integrated with all ance around the equipment of 2 feet 6 inches (76.20
of the facility’s life safety systems, including connec- centimeters) for ease of maintenance.
tion to the facility’s fire alarm, sprinkler, security, and
exiting systems. 4.3.2 Storage Rooms
Storage rooms shall be provided for supplies and
3.7 Additional Diagnostic and Treatment Facilities equipment.
Additional diagnostic and treatment facilities for the
small inpatient primary care center shall meet the
criteria established in the following sections of these 5 Administrative and Public Areas
Guidelines:
Section 3.1-7.2.3.1, Cough-Inducing and Aerosol- 5.1 Public Areas
Generating Procedures These shall be conveniently accessible to persons with
Section 3.1-6, Special Systems disabilities and include the following:
Section 3.1-7, Building Systems
Chapter 3.4, Freestanding Outpatient Diagnostic 5.1.1 Entrance
and Treatment Facilities The entrance to the small inpatient primary care
Chapter 3.9, Gastrointestinal Endoscopy Facilities center shall be located at grade level and be able to
accommodate wheelchairs.
If mobile units are used to provide these services,
refer to Chapter 3.12, Mobile, Transportable, and 5.1.2 Reception
Relocatable Units. A reception and information counter or desk shall be
located to control the entrance to the facility and to
monitor visitors and arriving patients.
4 Service Areas
5.1.3 Public Waiting Spaces
4.1 Materials Management
5.1.4 Public Toilets
4.1.1 Waste Management
4.1.1.1 Collection and storage. Space and facilities shall 5.1.5 Public Telephones
be provided for the sanitary storage of waste.
5.1.6 Provisions for Drinking Water
4.1.1.2 Refuse chutes. If trash chutes are used, they
shall comply with NFPA 82. 5.1.7 Enclosed Vending Area
Note: See Section 2.2-7.1 for text on waste processing. 5.1.8 Wheelchair Storage Areas
These shall be provided out of the path of traffic.
4.2 Environmental Services
5.2 Administrative Areas
4.2.1 Housekeeping Rooms
At a minimum, one housekeeping room per support 5.2.1 Interview Spaces
unit or suite shall be provided. These rooms shall con- Spaces shall be provided for private interviews related
tain a sink and storage spaces for clean supplies and to social services, credit, patient intake, and so on. These
cleaning equipment. spaces shall be designed for confidentiality and privacy.
2006 Guidelines for Design and Construction of Health Care Facilities 143
2 . 2 S M A L L I N PAT I E N T P R I M A R Y C A R E H O S P I TA L S
5.2.2.2 General clerical spaces or rooms for typing, Note: For waste collection and storage and refuse
photocopying, filing, and other clerical work shall be chute requirements, see Section 2.2-6.1.1.
provided. These shall be separated from the public
areas for confidentiality.
8 Building Systems
5.2.3 Multipurpose Rooms
Multipurpose rooms equipped for visual aids shall be 8.1 Plumbing
provided for conferences, training, meetings, health edu-
cation programs, and community outreach activities. 8.1.1 Hemodialysis and Hemoperfusion Piping
8.1.1.1 In facilities where hemodialysis and hemoperfusion
5.2.4 Equipment and Supply Storage are routinely performed, there shall be separate water
Facilities shall be provided for storage of general sup- supply and drainage facilities that do not interfere with
plies and equipment needed for continuing operation. required staff, visitors, and patient hand-washing functions.
5.2.5 Employee Storage Locations 8.1.1.2 If perfusion or dialysis occurs at the patient
Storage spaces with locking drawers or cabinets shall bedside, a separate outlet for de-ionized water and
be provided for the personal effects of the staff. Such drainage of effluent shall be provided at the patient
storage shall be near individual work stations and bedside. It shall be located to prevent contact with elec-
under staff control. trical outlets and equipment and from potential water
droplet contamination of the patient, staff, and visitors.
7.1 General
Section 2.1-9 and related schedules shall apply to this
chapter.
144 2006 Guidelines for Design and Construction of Health Care Facilities
2.3 Psychiatric Hospitals
Appendix material, which appears in shaded boxes at the bottom of the page, is advisory only.
2006 Guidelines for Design and Construction of Health Care Facilities 145
2.3 PSYCHIATRIC HOSPITALS
2 Nursing Locations (2) One toilet room shall serve no more than four
beds and no more than two patient rooms.
2.1 General Psychiatric Nursing Unit
Each nursing unit shall include the following (see (3) The toilet room shall contain a water closet and a
Sections 1.1-1.3.5 and 1.1-3 for exceptions to standards hand-washing station.
where existing conditions make absolute compliance
impractical). (4) The door to the toilet room shall swing outward
or be double-acting.
2.1.1 Typical Psychiatric Patient Rooms
Each patient room shall meet the following standards: 2.1.1.6 Patient storage locations
2.1.1.1 Capacity. Maximum room capacity shall be two (1) Each patient shall have within his or her room a
patients. separate wardrobe, locker, or closet suitable for
hanging full-length garments and for storing
2.1.1.2 Space requirements. Minor encroachments, personal effects.
including columns and hand-washing stations, that
do not interfere with functions may be ignored when (2) Adequate storage shall be available for a daily
determining space requirements for patient rooms. change of clothes for seven days.
(1) Patient room areas, exclusive of toilet rooms, clos- 2.1.2 Security Rooms
ets, lockers, wardrobes, alcoves, or vestibules, shall Security rooms may be included if required by the
be at least 100 square feet (9.29 square meters) for functional program.
single-bed rooms and 80 square feet (7.43 square
meters) per bed for multiple-bed rooms. 2.1.2.1 Security rooms shall be single-bed rooms
designed to minimize potential for escape, hiding,
(2) The areas noted herein are intended as minimums injury to self or others, or suicide. Access to toilets,
and do not prohibit use of larger rooms where showers, and wardrobes shall be restricted.
required by the functional program.
2.1.2.2 Security rooms may be centralized on one unit
2.1.1.3 Windows. Each patient room shall have a win- or decentralized among units.
dow in accordance with Section 2.1-8.2.2.5.
*2.1.3 Outdoor Areas
2.1.1.4 Desk. There shall be a desk or writing surface
in each room for patient use. 2.2 Special Patient Care Areas
A2.1.3 Outdoor areas are not required; however, if patient care (2) There shall be at least one seclusion room for
programs require them to be provided, they should be arranged to each 24 beds or fraction thereof on each psychi-
prevent confused residents from wandering outside of designated atric unit.
resident areas.
146 2006 Guidelines for Design and Construction of Health Care Facilities
2.3 PSYCHIATRIC HOSPITALS
(3) If a facility has more than one psychiatric nursing (a) The entrance door to the seclusion room
unit, the number of seclusion rooms shall be a shall swing out.
function of the total number of psychiatric beds
in the facility. (b) Doors shall be 3 feet 8 inches (1.12 meters)
wide and shall permit staff observation of the
2.2.1.2 Location patient through a vision panel, while also
maintaining provisions for patient privacy.
(1) The room(s) shall be located for direct nursing
staff supervision. (4) Minimum ceiling height shall be 9 feet (2.74 meters).
(2) Seclusion rooms may be grouped together. (5) Electrical switches and receptacles are prohibited
within the seclusion room.
2.2.1.3 Space requirements
2.2.2 Airborne Infection Isolation Room(s)
(1) Seclusion treatment rooms shall have an area of 2.2.2.1 Number. The need for and number of required
at least 60 square feet (5.57 square meters) with a airborne infection isolation rooms in the psychiatric
minimum wall length of 7 feet (2.13 meters) and hospital shall be determined by an ICRA.
a maximum wall length of 11 feet (3.35 meters).
2.2.2.2 Where required, the airborne infection isola-
(2) Where restraint beds are required by the func- tion room(s) shall comply with the general require-
tional program, 80 square feet (7.43 square ments of Section 2.1-3.2.2.
meters) shall be required.
2.3 Child Psychiatric Unit
2.2.1.4 Layout. Seclusion treatment rooms shall be Child psychiatric unit patient areas shall be separate
accessed by an anteroom or vestibule that also pro- and distinct from any adult psychiatric unit patient
vides access to a toilet room. The doors to the ante- areas. The standards of Sections 2.3-2.1, 2.3-2.2.1 and
room and the toilet room shall be a minimum of 2.2.2, and 2.3-2.6 shall be applied to child units with
3 feet 8 inches (1.12 meters) wide. the following exceptions:
2.2.1.5 Details and finishes. Seclusion treatment rooms 2.3.1 Patient Rooms
shall be constructed to prevent patient hiding, escape, 2.3.1.1 Capacity. Maximum room capacity shall be
injury, or suicide. four children.
(1) Fire rating of materials 2.3.1.2 Space requirements. Patient room areas
(with beds or cribs) shall be at least 100 square feet
(a) Where the interior of the seclusion treatment (9.29 square meters) for single-bed rooms; 80 square
room is padded with combustible materials, feet (7.43 square meters) per bed and 60 square feet
these materials shall be of a type acceptable (5.57 square meters) per crib in multiple-bed rooms.
to the local authority having jurisdiction.
2.3.1.3 Storage. Storage space shall be provided for
(b) The room area, including floor, walls, ceilings, toys, equipment, extra cribs and beds, and cots or
and all openings, shall be protected with not recliners for parents who may stay overnight.
less than one-hour-rated construction.
2.3.2 Activity Areas
(2) Seclusion treatment rooms shall not contain 2.3.2.1 Space requirements
outside corners or edges.
(1) The combined area for social activities shall be
(3) Doors 35 square feet (3.25 square meters) per patient.
2006 Guidelines for Design and Construction of Health Care Facilities 147
2.3 PSYCHIATRIC HOSPITALS
(2) The total area for social activities and dining feet (2.79 square meters) per patient.
space shall be a minimum of 50 square feet
(4.65 square meters) per patient. 2.4.2.2 Bathing facilities. Patients shall have access to at
least one bathtub in each nursing unit.
(3) If a separate dining space is provided, it shall be a
minimum of 15 square feet (1.39 square meters) 2.4.2.3 Wheelchair storage. Storage space for wheel-
per patient. chairs shall be provided in the nursing unit.
(2) Provisions shall be made for easy removal of or 2.6.1.2 Each support area may be arranged and located
for covering call button outlets. to serve more than one nursing unit; however, unless
otherwise noted, at least one such support area shall
(3) Call cords or strings in excess of 6 inches (15.24 be provided on each nursing floor.
centimeters) shall not be permitted.
2.6.2 Where the words room or office are used, a
2.4.2 Support Areas for Geriatric, Alzheimer’s, and separate, enclosed space for the one named function
Other Dementia Units is intended; otherwise, the described area may be a
2.4.2.1 Social spaces. The standards of Section specific space in another room or common area.
2.3-2.9.1 shall apply for social spaces, except that the
combined area for social activities shall be 30 square 2.7 Support Areas for Psychiatric Nursing Units
A2.3.3 Outdoor areas should be protected to allow children to 2.7.2 Documentation Area
have easy access to secure outdoor areas for play and therapy in A separate charting area with provisions for acoustical
facilities where length of stay is two weeks or greater. and patient file privacy shall be provided.
148 2006 Guidelines for Design and Construction of Health Care Facilities
2.3 PSYCHIATRIC HOSPITALS
2.7.4.1 Visitor room. A visitor room for patients to 2.7.7.1 A nourishment station
meet with friends or family with a minimum floor
space of 100 square feet (9.29 square meters). 2.7.7.2 A kitchenette designed for patient use with staff
control of heating and cooking devices
2.7.4.2 Quiet room. A quiet room shall be provided for
a patient who needs to be alone for a short period of 2.7.7.3 A kitchen service within the unit that includes
time but does not require a seclusion room. a hand-washing station, storage space, refrigerator, and
facilities for meal preparation
(1) A minimum of 80 square feet (7.43 square
meters) shall be provided. 2.7.8 Ice Machine
See Section 2.1-2.3.6.
(2) The visitor room may serve this purpose.
2.7.9 Clean Workroom or Clean Supply Room
2.7.4.3 Consultation room(s) See Section 2.1-2.3.7.
(3) The visitor room may serve as a consultation room. 2.7.11.2 Wheelchair storage space. Storage space for
wheelchairs may be outside the psychiatric unit, pro-
2.7.4.4 Conference room. A conference and treatment vided that provisions are made for convenient access
planning room shall be provided for use by the psychi- as needed for disabled patients.
atric unit. This room may be combined with the
charting room. 2.7.11.3 Emergency equipment storage. Space shall
be provided for emergency equipment that is under
2.7.4.5 Space for group therapy. This may be com- direct control of the nursing staff, such as a CPR cart.
bined with the quiet space noted in Section 2.3-2.9.1
when the unit accommodates not more than 12 (1) This space shall be in close proximity to a nurse
patients and when at least 225 square feet (20.90 station.
square meters) of enclosed private space is available
for group therapy activities. (2) The space may serve more than one unit.
2006 Guidelines for Design and Construction of Health Care Facilities 149
2.3 PSYCHIATRIC HOSPITALS
2.9.1.3 Dining facilities may be located off the nursing 3.4 Rehabilitation Therapy Department
unit in a central area.
3.4.1 General
2.9.2 Patient Bathing Facilities Rehabilitation therapy in a psychiatric hospital is
2.9.2.1 A bathtub or shower shall be provided for each primarily for the diagnosis and treatment of mental
six beds not otherwise served by bathing facilities functions but may also seek to address physical func-
within the patient rooms. tions in varying degrees. It may contain one or several
categories of services.
2.9.2.2 Bathing facilities shall be designed and located
for patient convenience and privacy. 3.4.1.1 If a formal rehabilitative therapy service is
included in a project, the facilities and equipment shall
150 2006 Guidelines for Design and Construction of Health Care Facilities
2.3 PSYCHIATRIC HOSPITALS
3.4.2.2 Exercise area and facilities 3.4.3.4 Equipment and supply storage
3.4.2.3 Provision for additional therapies. If required by (1) Storage shall be provided for supplies and
the functional program, provisions for thermotherapy, equipment.
diathermy, ultrasonics, and hydrotherapy shall be made.
(2) Secured storage shall be provided for potentially
3.4.2.4 Hand-washing stations harmful supplies and equipment.
(1) Hand-washing stations for staff shall be available 3.4.3.5 Electrical switching. Remote electrical switching
either within or at each treatment space. shall be provided for potentially harmful equipment.
(2) One hand-washing station may serve several 3.4.4 Vocational Therapy
treatment stations. Vocational therapy assists patients in the development
and maintenance of productive work and interaction
3.4.2.5 Support areas for physical therapy skills through the use of work tasks. These activities
may occur in an industrial therapy workshop in
(1) Soiled material storage. Separate storage for soiled another department or outdoors. If vocational therapy
linen, towels, and supplies shall be provided.
APPENDIX
(2) Equipment and supply storage
A3.4.3.2 (1) Exposure to some art materials, such as solvents
(a) Clean linen and towel storage and ceramic glazes, is associated with adverse health effects. Such
risks should be controlled by adopting methods recommended in
(b) Storage for equipment and supplies appropriate instructional manuals.
2006 Guidelines for Design and Construction of Health Care Facilities 151
2.3 PSYCHIATRIC HOSPITALS
(2) Secured storage for potentially harmful supplies 3.4.7 Support Areas for Rehabilitative Therapy
and equipment shall be provided. Departments
Each rehabilitative therapy department shall include
3.4.4.4 Electrical switching. Remote electrical switching the following, which may be shared or provided as
shall be provided for potentially harmful equipment. separate units for each service.
152 2006 Guidelines for Design and Construction of Health Care Facilities
2.3 PSYCHIATRIC HOSPITALS
housekeeping room and service sink for housekeeping 4.1.1.2 Facility requirements. It shall include provisions
use shall be provided. for procurement, storage, distribution, and recording
of drugs and other pharmacy products.
3.4.8 Support Areas for Staff
3.4.8.1 Convenient access to toilets and lockers shall be 4.1.2 Satellite Facilities
provided. Satellite facilities, if provided, shall include those items
required by the functional program.
3.4.8.2 A secured area or cabinet shall be provided
within the vicinity of each work area for securing staff 4.2 Dietary Facilities
personal effects. See Section 2.1-6.2.
2006 Guidelines for Design and Construction of Health Care Facilities 153
2.3 PSYCHIATRIC HOSPITALS
5 Administrative and Public Areas (c) Ideally, the door closer (if required) should be
within view of a nurse or staff workstation.
See Section 2.1-7.
(4) Door hinges
5.1 Medical Records
See Section 2.1-7.2.5. (a) Door hinges shall be designed to minimize
points for hanging (i.e., cut hinge type).
5.2 Employee Facilities
See Section 2.1-7.2.7. (b) Door hinges used shall be consistent with the
level of care for the patient.
6 Construction Standards (5) Door lever handles. These shall point downward
when in the latched position.
6.1 Design and Construction, Including Fire-
Resistant Standards (6) Fasteners. All hardware shall have tamper-resistant
See Section 2.1-8.1. fasteners.
6.2 General Standards for Details and Finishes *6.2.2.2 Windows. All glazing (both interior and
exterior), borrow lights, and glass mirrors shall be
6.2.1 General fabricated with laminated safety glass or protected
Details and finishes shall comply with Section 2.1-8.2 by polycarbonate, laminate, or safety screens.
except as shown in this section. Special design consid-
eration shall be given to injury and suicide prevention 6.2.2.3 Furniture
as discussed here:
(1) Clothing rods or hooks, if present, shall be
6.2.2 Details designed to minimize the opportunity for residents
6.2.2.1 Doors to cause injury.
(1) Door width. The minimum door width for (2) Furniture shall be constructed to withstand physical
patient use access in new work shall be at least abuse.
3 feet (91.44 centimeters).
(3) Drawer pulls shall be of the recessed type to
(2) Door swings. Door swings for private patient eliminate the possibility of use as a tie-off point.
bathrooms or shower areas shall swing out to
allow for staff emergency access. 6.2.2.4 Bathroom hardware and accessories. Special
design considerations for injury and suicide preven-
(3) Door closers tion shall be given to shower, bath, toilet, and sink
hardware and accessories, including grab bars and
(a) Door closers are to be avoided unless toilet paper holders.
required.
(1) Grab bars
(b) Door closer devices, if required on the
patient room door, shall be mounted on (a) ADA- or ANSI-compliant grab bars are
the public side of the door rather than the required in 10 percent of the private/semi-
private patient side of the door. private patient toilet rooms. The remaining
rooms are not required to have grab bars.
APPENDIX
(b) Grab bars in patient toilet rooms for fully
A6.2.2.2 The use of drapery is discouraged. ambulatory patients shall be removable.
154 2006 Guidelines for Design and Construction of Health Care Facilities
2.3 PSYCHIATRIC HOSPITALS
(c) Where grab bars are provided, the space (2) In private patient bathrooms, air distribution
between the bar and the wall shall be filled to devices, lighting fixtures, sprinkler heads, and other
prevent a cord being tied around it for hanging. appurtenances shall be of the tamper-resistant type.
(c) Lever handles 7.1.1.2 Test results shall be documented for mainte-
nance files.
6.2.3 Finishes
6.2.3.1 Ceilings 7.1.2 Documentation
7.1.2.1 Upon completion of the special systems equip-
(1) In private patient bathrooms, the ceiling shall be ment installation contract, the owner shall be furnished
of the tamper-resistive type or of sufficient height with a complete set of manufacturers' operating, main-
to prevent patient access. Ceiling systems of a tenance, and preventive maintenance instructions, parts
non-secured (non-clipped down) lay-in ceiling lists, and complete procurement information including
tile design are not permitted. equipment numbers and descriptions.
(2) In patient bedrooms where acoustical ceilings are 7.1.2.2 Operating staff persons shall also be provided
permitted by the functional program, the ceiling with written instructions for proper operation of
shall be secured or of sufficient height to prevent systems and equipment. Required information shall
patient access. include all safety or code ratings as needed.
2006 Guidelines for Design and Construction of Health Care Facilities 155
2.3 PSYCHIATRIC HOSPITALS
7.2.3 Elevator Controls chapters in the International Plumbing Code that area
7.2.3.1 Each elevator, except those for material han- applicable for this occupancy.
dling, shall be equipped with an independent keyed
switch for staff use for bypassing all landing button 8.1.2 Plumbing and Other Piping Systems
calls and responding to car button calls only. 8.1.2.1 General piping and valves. See Section 2.1-10.1.2.1.
*7.2.3.2 Elevator call buttons shall be key controlled if 8.1.2.2 Potable water supply systems. See Section
required by the functional program, and controls shall 2.1-10.1.2.3.
not be activated by heat or smoke. Light beams, if used
for operating door reopening devices without touch, shall 8.1.2.3 Hot water systems. See Section 1.6-2.1.2.1.
be used in combination with door-edge safety devices and
shall be interconnected with a system of smoke detectors. 8.1.2.4 Drainage systems. See Section 2.1-10.1.2.5.
7.2.4 Installation and Testing 8.1.2.5 Condensate drains. See Section 1.6-2.1.2.2.
7.2.4.1 Standards. Installation and testing of elevators
shall comply with ANSI/ASME A17.1 for new con- 8.1.2.6 Plumbing in food preparation and storage
struction and ANSI/ASME A17.3 for existing facilities. areas. See Section 2.1-10.1.2.5.
(See ASCE 7-93 for seismic design and control systems
requirements for elevators.) 8.1.3 Plumbing Fixtures
8.1.3.1 See Sections 1.6-2.1.3 and 2.1-10.1.3.
7.2.4.2 Documentation. Field inspections and tests
shall be made and the owner shall be furnished with 8.1.3.2 Special design considerations for injury and
written certification stating that the installation meets suicide prevention shall be given to shower, bath,
the requirements set forth in this section as well as all toilet, and sink plumbing fixtures. Shower heads shall
applicable safety regulations and codes. be of flush-mounted design to minimize hanging
appendages.
7.3 Waste Processing
See Section 2.1-9.3. (See Section 2.1-6.5.3 for text on 8.1.4 Medical Gas and Vacuum Systems
waste management.) 8.1.4.1 Installation, testing, and certification of non-
flammable medical gas and air systems. See Section
2.1-10.1.4.1.
8 Building Systems
8.1.4.2 Clinical vacuum systems. See Section 2.1-10.1.4.2.
8.1 Plumbing
8.2 Heating, Ventilating, and Air-Conditioning
8.1.1 General (HVAC) Systems
Unless otherwise specified herein, all plumbing systems
shall be designed and installed in accordance with the 8.2.1 General
8.2.1.1 Mechanical system design
APPENDIX
*(1) Efficiency. The mechanical system shall be
A7.2.3.2 This is so the light control feature will be overridden or designed for overall efficiency and appropriate
disengaged should it encounter smoke at any landing. life-cycle cost. Details for cost-effective implemen-
tation of design features are interrelated and too
A8.2.1.1 (1) Remodeling and work in existing facilities may pres-
numerous (as well as too basic) to list individually.
ent special problems. As practicality and funding permit, existing
insulation, weather stripping, etc., should be brought up to stan-
(a) Recognized engineering procedures shall be
dard for maximum economy and efficiency. Consideration should
followed for the most economical and effec-
be given to additional work that may be needed to achieve this.
tive results.
156 2006 Guidelines for Design and Construction of Health Care Facilities
2.3 PSYCHIATRIC HOSPITALS
(b) In no case shall patient care or safety be isolators as required to prevent unacceptable
sacrificed for conservation. structure-borne vibration.
(c) Insofar as practical, the facility shall include (4) System valves. Supply and return mains and risers
provisions for recovery of waste cooling and for cooling, heating, and steam systems shall be
heating energy (ventilation, exhaust, water equipped with valves to isolate the various sec-
and steam discharge, cooling towers, incin- tions of each system. Each piece of equipment
erators, etc.). shall have valves at the supply and return ends.
*(d) Use of recognized energy-saving mecha- (5) Renovation. If system modifications affect greater
nisms such as variable-air-volume (VAV) than 10 percent of the system capacity, designers
systems, load shedding, programmed shall utilize pre-renovation water/air flow rate
controls for unoccupied periods (nights measurements in the affected zones to verify that
and weekends, etc.), and natural ventilation sufficient capacity is available and that renova-
shall be considered, site and climatic tions have not adversely affected flow rates in
conditions permitting. non-renovated areas.
(e) Facility design considerations shall include 8.2.1.2 Ventilation and space conditioning require-
site, building mass, orientation, configura- ments. All rooms and areas used for patient care shall
tion, fenestration, and other features relative have provisions for ventilation.
to passive and active energy systems.
(1) Ventilation rates. The ventilation systems shall be
(2) Air-handling systems designed and balanced, as a minimum, according
to the requirements shown in Table 2.1-2 and its
(a) These shall be designed with an economizer applicable notes. The ventilation rates shown in
cycle where appropriate to use outside air. Table 2.1-2 do not preclude the use of higher,
(Use of mechanically circulated outside air more appropriate rates.
does not reduce need for filtration.)
(2) Air change rates. Air supply and exhaust in rooms
(b) VAV systems. The energy-saving potential for which no minimum total air change rate is
of variable air volume systems is recognized, noted may vary down to zero in response to room
and these standards are intended to maxi- load. For rooms listed in Table 2.1-2 , where VAV
mize appropriate use of such systems. Any systems are used, minimum total air change shall
system used for occupied areas shall include be within limits noted.
provisions to avoid air stagnation in interior
spaces where thermostat demands are met (3) Temperature and humidity levels. Space tempera-
by temperatures of surrounding areas. ture and relative humidity shall be as indicated in
Table 2.1-2 .
(c) Noncentral air-handling systems (i.e., indi-
vidual room units that are used for heating 8.2.1.3 Documentation
and cooling purposes, such as fan-coil units,
heat pump units, etc.). These units may be (1) Upon completion of the equipment installation con-
used as recirculating units only. All outdoor tract, the owner shall be furnished with a complete
requirements shall be met by a separate
central air-handling system with the proper APPENDIX
filtration, as noted in Table 2.1-3.
A8.2.1.1 (1)(d) Systems with excessive installation and/or main-
(3) Vibration isolators. Mechanical equipment, duct- tenance costs that negate long-range energy savings should be
work, and piping shall be mounted on vibration avoided.
2006 Guidelines for Design and Construction of Health Care Facilities 157
2.3 PSYCHIATRIC HOSPITALS
set of manufacturers’ operating, maintenance, and with grease filters, fire-extinguishing systems, and
preventive maintenance instructions, parts lists, heat-actuated fan controls.
and complete procurement information, including
equipment numbers and descriptions. Required (3) Cleanout openings shall be provided every 20 feet
information shall include energy ratings as needed (6.10 meters) and at changes in direction in the
for future conservation calculations. horizontal exhaust duct systems serving these
hoods. Horizontal runs of ducts serving range
(2) Operating staff persons shall also be provided hoods shall be kept to a minimum.
with written instructions for proper operation
of systems and equipment. 8.2.2.4 Fuel-fired equipment rooms. Rooms with fuel-
fired equipment shall be provided with sufficient out-
8.2.2 Requirements for Specific Locations door air to maintain equipment combustion rates and
8.2.2.1 Patient-occupied areas. Special consideration to limit workstation temperatures.
shall be given to the type of heating and cooling units,
ventilation outlets, and appurtenances installed in 8.2.3 Thermal Insulation and Acoustical Provisions
patient-occupied areas of the psychiatric hospital. See Section 1.6-2.2.1.
The following shall apply:
8.2.4 HVAC Air Distribution
(1) All air grilles and diffusers shall be of a type that 8.2.4.1 Return air systems. For patient care areas,
prohibits the insertion of foreign objects. All return air shall be via ducted systems.
exposed fasteners shall be tamper-resistant.
8.2.4.2 HVAC ductwork
(2) All convector or HVAC enclosures exposed in the
room shall be constructed with rounded corners (1) General
and shall have enclosures fastened with tamper-
resistant screws. (a) Air-handling duct systems shall be designed
with accessibility for duct cleaning and shall
(3) HVAC equipment shall be of a type that mini- meet the requirements of NFPA 90A.
mizes the need for maintenance within the room.
(b) When smoke partitions are required, heating,
8.2.2.2 Cough-inducing procedure rooms. Rooms used ventilation, and air conditioning zones shall
for sputum induction, aerosolized pentamidine treat- be coordinated with compartmentation inso-
ments, and other cough-inducing procedures shall meet far as practical to minimize need to penetrate
the requirements of Table 2.1-2 for airborne infection iso- fire and smoke partitions.
lation rooms. If booths are used, refer to Section 2.1-5.8.1.
*(2) Duct humidifiers
8.2.2.3 Food preparation centers
(a) If duct humidifiers are located upstream of
(1) Exhaust hoods handling grease-laden vapors in food the final filters, they shall be at least 15 feet
preparation centers shall comply with NFPA 96. (4.57 meters) upstream of the final filters.
(2) All hoods over cooking ranges shall be equipped (b) Ductwork with duct-mounted humidifiers
shall have a means of water removal.
APPENDIX
(c) An adjustable high-limit humidistat shall be
A8.2.4.2 (2) See Industrial Ventilation: A Manual of located downstream of the humidifier to
Recommended Practice, published by the American Conference reduce the potential for condensation inside
of Governmental Industrial Hygienists (www.acgih.org), for addi- the duct.
tional information.
158 2006 Guidelines for Design and Construction of Health Care Facilities
2.3 PSYCHIATRIC HOSPITALS
(d) All duct takeoffs shall be sufficiently down- (3) Fans serving exhaust systems shall be located at
stream of the humidifier to ensure complete the discharge end and shall be readily serviceable.
moisture absorption. Steam humidifiers shall
be used. 8.2.4.4 Air outlets and inlets
(4) Construction requirements. Ducts that penetrate (3) Exhaust outlets from areas that may be contami-
construction intended for x-ray or other ray pro- nated shall be above roof level, arranged to mini-
tection shall not impair the effectiveness of the mize recirculation of exhaust air into the building,
protection. and directed away from personnel service areas.
8.2.4.3 Exhaust systems (4) Gravity exhaust. Where conditions permit, gravity
exhaust shall be permitted for nonpatient areas
(1) To enhance the efficiency of recovery devices such as boiler rooms, central storage, etc.
required for energy conservation, combined
exhaust systems shall be permitted. 8.2.5 HVAC Filters
8.2.5.1 Filter efficiencies
(2) Local exhaust systems shall be used wherever possi-
ble in place of dilution ventilation to reduce expo- (1) All central ventilation or air conditioning systems
sure to hazardous gases, vapors, fumes, or mists. shall be equipped with filters with efficiencies equal
to, or greater than, those specified in Table 2.1-3.
2006 Guidelines for Design and Construction of Health Care Facilities 159
2.3 PSYCHIATRIC HOSPITALS
(2) Noncentral air-handling systems shall be gency signed system, and communication systems,
equipped with permanent (cleanable) or replace- shall be tested to demonstrate that equipment installa-
able filters with a minimum efficiency of MERV 3 tion and operation is appropriate and functional. A
(68 percent weight arrestance). written record of performance tests on special electri-
cal systems and equipment shall show compliance
(3) Filter efficiencies, tested in accordance with with applicable codes and standards.
ASHRAE 52.1, shall be average.
8.3.2 Electrical Distribution and Transmission
8.2.5.2 Filter frames. Filter frames shall be durable 8.3.2.1 Switchboards
and proportioned to provide an airtight fit with the
enclosing ductwork. All joints between filter segments (1) Location
and enclosing ductwork shall have gaskets or seals to
provide a positive seal against air leakage. (a) Main switchboards shall be located in an
area separate from plumbing and mechanical
8.2.5.3 Filter housing blank-off panels. Filter housing equipment and shall be accessible to author-
blank-off panels shall be permanently attached to the ized persons only.
frame, constructed of rigid materials, and have sealing
surfaces equal to or greater than the filter media (b) Switchboards shall be convenient for use,
installed in the filter frame. readily accessible for maintenance, and away
from traffic lanes.
8.2.5.4 Filter manometers. A manometer shall be
installed across each filter bed having a required effi- (c) Switchboards shall be located in dry, ventilat-
ciency of 75 percent or more. Provisions shall be made ed spaces free of corrosive or explosive
to allow access for field testing. fumes, gases, or any flammable material.
8.2.6 Steam and Hot Water Systems (2) Overload protective devices. These shall operate
Boilers shall have the capacity, based upon the net rat- properly in ambient room temperatures.
ings published by the Hydronics Institute or another
acceptable national standard, to supply the normal 8.3.2.2 Panelboards
heating, hot water, and steam requirements of all
systems and equipment. (1) Panelboards serving normal lighting and appli-
ance circuits shall be located on the same floor as
8.3 Electrical Systems the circuits they serve.
(2) All electrical material and equipment shall be list- 8.3.2.3 Ground-fault circuit interrupters
ed as complying with available standards of listing
agencies or other similar established standards (1) Ground-fault circuit interrupters (GFCIs) shall
where such standards are required. comply with NFPA 70.
8.3.1.2 Testing and documentation. The electrical (2) When ground-fault circuit interrupters are used in
installations, including alarm, nurse call, staff emer- critical areas, provisions shall be made to ensure
160 2006 Guidelines for Design and Construction of Health Care Facilities
2.3 PSYCHIATRIC HOSPITALS
that other essential equipment is not affected by fixture in each patient room shall be controlled at
activation of one interrupter. the room entrance.
8.3.3 Power-Generating and -Storing Equipment (2) Nursing unit corridors. Corridors in nursing units
8.3.3.1 Emergency Electrical Service shall have general illumination with provisions
for reducing light levels at night.
(1) As a minimum, psychiatric hospitals or sections
thereof shall have emergency electrical systems as (3) Exterior lighting. Approaches to buildings and park-
required in NFPA 99, NFPA 101, and NFPA 110. ing lots and all occupied spaces shall have lighting
fixtures that can be illuminated as necessary.
(2) Where the psychiatric facility is a distinct part of
an acute care hospital, it may use the emergency 8.3.5 Electrical Equipment
generator system for required emergency lighting 8.3.5.1 General electrical equipment. Special design
and power if such sharing does not reduce hospi- considerations for injury and suicide prevention shall
tal services. Life support systems and their respec- be given to the electrical equipment in the psychiatric
tive areas shall be subject to applicable standards hospital, including light fixtures, electrical outlets,
of Section 2.1-10.3. electrical appliances, nurse call systems and staff
emergency assistance systems.
(3) An emergency electrical source shall provide
lighting and/or power during an interruption of 8.3.5.2 Special electrical equipment. Special equipment
the normal electrical supply. is identified in the sections on nursing units, support
areas, rehabilitation therapy, laboratory, pharmacy,
8.3.4 Lighting and imaging, if applicable. These sections shall be con-
8.3.4.1 General sulted to ensure compatibility between programmati-
cally defined equipment needs and appropriate power
(1) Lighting shall be engineered to the specific and other electrical connection needs.
application.
8.3.6 Receptacles (Convenience Outlets)
(2) Recommended lighting levels for health care facil- 8.3.6.1 Receptacles in corridors
ities developed by the Illuminating Engineering
Society of North America (IES) shall be consid- (1) Duplex-grounded receptacles for general use shall
ered. Refer to the IES publication RP-29, Lighting be installed approximately 50 feet (15.24 meters)
for Hospitals and Health Care Facilities. apart in all corridors and within 25 feet (7.62
meters) of corridor ends.
(3) Consideration shall be given to the special needs
of the elderly. Excessive contrast in lighting levels (2) These outlets shall be tamper-resistant or equipped
that makes effective sight adaptation difficult with ground-fault circuit interrupters (GFCIs).
shall be minimized. Refer to IES publication
RP-28, Lighting and the Visual Environment for 8.3.6.2 Receptacles in patient rooms. Each patient
Senior Living. room shall have duplex-grounded receptacles.
8.3.4.2 Light fixtures. Light fixtures shall be secured or (1) Electrical receptacles in patient rooms shall be
of sufficient height to prevent patient access. tamper-resistant or equipped with ground-fault
circuit interrupters (GFCIs).
8.3.4.3 Lighting for specific locations in the psychiatric
hospital (2) There shall be one at each side of the head of each
bed and one on every other wall.
(1) Patient rooms. Patient rooms shall have general
lighting and night lighting. At least one nightlight (3) Receptacles may be omitted from exterior walls
2006 Guidelines for Design and Construction of Health Care Facilities 161
2.3 PSYCHIATRIC HOSPITALS
where construction or room configuration makes patient’s calling station will initiate a visible and
installation impractical. audible signal distinct from the regular nurse call
system.
8.3.6.3. Emergency system receptacles. Electrical recep-
tacle cover plates or electrical receptacles supplied (2) The signal shall activate an annunciator panel at
from the emergency system shall be distinctively col- the nurse station or other appropriate location, a
ored or marked for identification. If color is used for distinct visible signal in the corridor at the door to
identification purposes, the same color shall be used the room from which the signal was initiated, and
throughout the facility. at other areas defined by the functional program.
(2) All hardware shall have tamper-resistant fasteners. 8.5.1 Electronic Surveillance Systems
8.5.1.1 Electronic surveillance systems are not required
(3) Signal location in psychiatric nursing units, but if provided for the
safety of the residents, any devices in resident areas
(a) Calls shall activate a visible signal in the cor- shall be mounted in a tamper-resistant enclosure that
ridor at the patient’s door and at an annunci- is unobtrusive.
ator panel at the nurse station or other
appropriate location. 8.5.1.2 Electronic surveillance system monitoring
devices shall be located so they are not readily observ-
(b) In multi-corridor nursing units, additional able by the general public or other patients.
visible signals shall be installed at corridor
intersections. 8.5.1.3 If installed, electronic surveillance systems
shall be supplied with power from the emergency
8.3.7.3 Emergency call system electrical system in the event of a disruption of nor-
mal electrical power.
(1) If provided, the staff emergency call shall be
designed so that a signal activated by staff at a 8.5.2 Fire Detection and Suppression System
8.5.2.1 Fire alarm and detection systems shall be pro-
APPENDIX vided in compliance with NFPA 101 and NFPA 72.
A8.3.7.1 If radio frequency systems are used, consideration 8.5.2.2 Fire extinguisher cabinets and fire alarm pull
should be given to electromagnetic compatibility between internal stations shall be located in staff areas or otherwise
and external sources. secured in patient-accessible locations.
162 2006 Guidelines for Design and Construction of Health Care Facilities
2.4 Rehabilitation Facilities
Appendix material, which appears in shaded boxes at the bottom of the page, is advisory only.
In general, rehabilitation facilities will have larger 2.1.1.5 Hand-washing station (s). Hand-washing sta-
space requirements than general hospitals, have longer tions shall be provided in each patient room.
lengths of stay, and have environments that are less
institutional and more residential. 2.1.1.6 Toilet room
2.1 Nursing Unit (2) One toilet room shall serve no more than four
Where inpatients are a part of the facility, each nursing beds and no more than two patient rooms.
unit shall provide the following:
(3) The toilet room shall contain a water closet and
2.1.1 Patient Rooms a hand-washing station. Omission of the hand-
Each patient room shall meet the following standards: washing station shall be permitted where the
toilet room serves single-bed and two-bed rooms
2.1.1.1 Capacity if each such patient room contains a hand-washing
station.
(1) Maximum room occupancy shall be four patients.
(4) Each toilet room shall be of sufficient size to
(2) Larger units shall be permitted if justified by the ensure that wheelchair users will have access.
functional program.
2.1.1.7 Patient storage locations
(3) At least two single-bed rooms with private toilet
rooms shall be provided for each nursing unit. (1) Each patient shall have a wardrobe, closet, or
locker with minimum clear dimensions of 1 foot
2.1.1.2 Space requirements 10 inches (55.88 centimeters) by 1 foot 8 inches
(50.80 centimeters).
(1) Area. Minimum room areas exclusive of toilet
rooms, closets, lockers, wardrobes, alcoves, or (2) An adjustable clothes rod and adjustable shelf
vestibules shall be 140 square feet (13.01 square shall be provided.
meters) in single-bed rooms and 125 square feet
(11.61 square meters) per bed in multiple-bed 2.1.1.8 Nurse call system. A nurse call system shall be
rooms. provided.
2006 Guidelines for Design and Construction of Health Care Facilities 163
2 . 4 R E H A B I L I TAT I O N FA C I L I T I E S
2.1.2 Examination/Treatment Room 2.1.3.3 Charting facilities for nurses and doctors
2.1.2.1 General
2.1.3.4 Nurse office
(1) Omission of this room shall be permitted if all
patient rooms are single-bed rooms. 2.1.3.5 Hand-washing stations
(2) The examination room in the evaluation unit (1) Hand-washing stations shall be located near the
shall be permitted to serve this purpose if it is nurse station and the drug distribution station.
conveniently located.
(2) One hand-washing station shall be permitted to
2.1.2.2 Space requirements serve both areas.
(1) This room shall have a minimum floor area of 2.1.3.6 Medication station. Provisions shall be made
120 square feet (11.15 square meters), excluding for convenient and prompt 24-hour distribution of
space for vestibules, toilet, closets, and work medicine to patients. Distribution may be from a
counters (whether fixed or movable). medicine preparation room, self-contained medicine
dispensing unit, or by another approved system.
(2) The minimum room dimension shall be 10 feet
(3.05 meters). (1) A medicine preparation room
2.1.2.3 Facility requirements. The room shall contain a (a) If used, this room shall be under the visual
work counter; hand-washing station; storage facilities; control of the nursing staff.
and a desk, counter, or shelf space for writing.
(b) If used, this room shall contain a work
2.1.3 Support Areas for the Nursing Unit counter, refrigerator, and locked storage for
2.1.3.1 General biologicals and drugs.
(b) Although identifiable spaces are required for 2.1.3.7 Nourishment area. The nourishment station shall
each indicated function, consideration shall be accessible to patients and shall contain the following:
be given to alternative designs that accom-
modate some functions without designating (1) Equipment for serving nourishment between
specific areas or rooms. scheduled meals
164 2006 Guidelines for Design and Construction of Health Care Facilities
2 . 4 R E H A B I L I TAT I O N FA C I L I T I E S
2.1.3.10 Soiled workroom or soiled holding room otherwise served by bathing facilities within
patient rooms.
2.1.3.11 Equipment and supply storage
(2) Each tub or shower shall be in an individual room
(1) Clean linen storage or privacy enclosure that provides space for the
private use of bathing fixtures, for drying and
(a) A separate closet or an area within the clean dressing, and for a wheelchair and an assistant.
workroom shall be provided for this purpose.
(3) Showers in central bathing facilities shall be at
(b) If a closed-cart system is used, storage in an least 4 feet (1.22 meters) square, curb-free, and
alcove shall be permitted. designed for use by a wheelchair patients.
(2) Equipment storage room. A storage room shall 2.2 Special Patient Care Areas
be provided for equipment such as IV stands,
inhalators, air mattresses, and walkers. 2.2.1 Airborne Infection Isolation Rooms
2.2.1.1 Number. The need for and number of required
(3) Storage space for stretchers and wheelchairs. airborne infection isolation rooms in the rehabilita-
Parking for stretchers and wheelchairs shall be tion facility shall be determined by an infection con-
located out of the path of normal traffic. trol risk assessment.
(4) Storage for administrative supplies 2.2.1.2 Location. They may be located within individual
nursing units and used for normal acute care when
2.1.4 Support Areas for Staff not required for isolation cases, or they may be
2.1.4.1 Lounge and toilet room(s) grouped as a separate isolation unit.
2.1.4.2 Staff storage facilities. Individual closets or 2.2.1.3 Facility requirements. Where required, the air-
compartments for safekeeping of the personal effects borne infection isolation room(s) shall comply with
of nursing personnel shall be located convenient to the the general requirements of Section 2.1-3.2.2.
duty station or in a central location.
(2) Doors to toilet rooms shall have a minimum 3.1.1 Space Requirements
width of 2 feet 10 inches (86.36 centimeters) to 3.1.1.1 Inpatient spaces. A total of 55 square feet (5.11
admit a wheelchair. The doors shall permit access square meters) per bed shall be provided.
from the outside in case of an emergency.
3.1.1.2 Outpatient services. If dining is part of the
(3) A hand-washing station shall be provided for each day care program, a total of 55 square feet (5.11 square
water closet in each multi-fixture toilet room. meters) per person shall be provided. If dining is not
part of the program, at least 35 square feet (3.25 square
2.1.5.2 Patient bathing facilities meters) per person shall be provided for recreation
and day spaces.
(1) Bathtubs or showers shall be provided at a ratio
of one bathing facility for each eight beds not
2006 Guidelines for Design and Construction of Health Care Facilities 165
2 . 4 R E H A B I L I TAT I O N FA C I L I T I E S
166 2006 Guidelines for Design and Construction of Health Care Facilities
2 . 4 R E H A B I L I TAT I O N FA C I L I T I E S
(2) The elements listed in this section (2.4-4.3.1) 4.3.1.6 Support areas for patients. Patients’ dressing
shall be provided. Shared use of the facilities in areas, showers, lockers, and toilet rooms shall be
Sections 2.4-4.3.1.5 and 4.3.1.6 by occupational provided as required by the functional program.
therapy patients and staff shall be permitted if the
functional program reflects this sharing concept. 4.3.2 Occupational Therapy Unit
4.3.2.1 General
4.3.1.2 Treatment area(s)
(1) The size of the unit shall depend upon the
(1) Privacy. For thermotherapy, diathermy, ultrason- requirements of the functional program.
ics, hydrotherapy, etc., cubicle curtains shall be
provided around each individual treatment area. (2) The elements listed in this section (2.4-4.3.2) shall
be provided. (Facilities in Sections 2.4-4.3.2.3 and
(2) Hand-washing station(s) shall also be provided. 4.3.2.4 may be planned and arranged for shared
One hand-washing station may serve more than use by physical therapy patients and staff if the
one cubicle. functional program reflects this sharing concept.)
(3) Facilities for collection of wet and soiled linen 4.3.2.2 Activity areas
and other material shall be provided.
4.3.2.3 Support areas for the occupational therapy unit
(4) As a minimum, one individual treatment area
shall be enclosed within walls and have a door for (1) Waiting space
access—minimum size 80 square feet (7.43 square
meters). Curtained treatment areas shall have a min- (2) Office space
imum size of 70 square feet (6.51 square meters).
(3) Equipment and supply storage
4.3.1.3 Exercise area. Space requirements shall be
designed to permit access to all equipment and be 4.3.2.4 Support areas for patients
sized to accommodate equipment for physical therapy. Patients’ dressing areas, showers, lockers, and toilet
rooms shall be provided as required by the functional
4.3.1.4 Therapeutic pool. A therapeutic pool shall be program.
provided if required by the functional program. The
size of the pool shall depend upon the requirements of 4.3.3 Prosthetics and Orthotics Unit
the functional program. 4.3.3.1 General
4.3.1.5 Support areas for the physical therapy unit (1) The size of the unit shall depend upon the
requirements of the functional program.
(1) Waiting space
(2) The following elements shall be provided:
(2) Office space
4.3.3.2 Work space for technician(s)
(3) Equipment and supply storage
4.3.3.3 Space for evaluation and fitting. This shall
(a) Storage for clean linen, supplies, and equip- include provision for privacy.
ment shall be provided.
4.3.3.4 Support areas for the prosthetics and orthotics
(b) Wheelchair and stretcher storage shall be unit. Space for equipment, supplies, and storage shall
provided. be provided.
2006 Guidelines for Design and Construction of Health Care Facilities 167
2 . 4 R E H A B I L I TAT I O N FA C I L I T I E S
4.3.4 Speech and Hearing Unit arrangement with a nearby hospital or laboratory
4.3.4.1 General service for hematology, clinical chemistry, urinalysis,
cytology, pathology, and bacteriology.
(1) The size of the unit shall depend upon the
requirements of the functional program. (2) Size. The size of the unit shall depend upon the
requirements of the functional program.
(2) The unit shall include the following:
4.3.7.2 Minimum services
4.3.4.2 Space for evaluation and treatment If laboratory facilities are provided through contract,
the following minimum laboratory services shall be
4.3.4.3 Support areas for the speech and hearing unit provided in the rehabilitation facility:
(1) Office(s) for therapists (1) Laboratory work counter(s). These shall have a
sink and gas and electric service.
(2) Equipment and supply storage
(2) Hand-washing stations
4.3.5 Dental Unit
4.3.5.1 Operatory. This shall contain a hand-washing (3) Specimen collection facilities
station.
(a) Urine collection rooms shall be equipped
4.3.5.2 Laboratory and film processing facilities with a water closet and hand-washing station.
4.3.6 Imaging Suite (b) Blood collection facilities shall have space for
4.3.6.1 Size. The size of the unit shall depend upon the a chair and work counter.
requirements of the functional program. The sizes of
the various areas shall depend on the requirements of (4) Storage cabinet(s) or closet(s)
the service to be provided.
4.3.8 Home Health Service
4.3.6.2 Facility requirements. This unit shall contain
imaging room(s) as required by the functional pro-
gram. (See Section 2.1-5.5 for special requirements.) 5 Service Areas
Areas for the following services, if required, shall be
provided as outlined in Section 2.1-5.5.5. The following service areas, if required by the func-
tional program, shall be provided as outlined.
(1) Electromyography
5.1 Pharmacy Unit
(2) CAT scan
5.1.1 General
(3) MRI The size and type of services to be provided in the
pharmacy will depend on the drug distribution system
(4) Nuclear medicine chosen and whether the facility proposes to provide,
purchase, or share pharmacy services.
(5) Radiography
5.1.2 Facility Requirements
4.3.7 Laboratory Facilities If a pharmacy is required by the functional program,
4.3.7.1 General provisions shall be made for the following functional
areas:
(1) Location. Facilities shall be provided within the
rehabilitation department or through contract 5.1.2.1 A compounding area
168 2006 Guidelines for Design and Construction of Health Care Facilities
2 . 4 R E H A B I L I TAT I O N FA C I L I T I E S
5.1.2.3 A quality control area (1) This shall be located in a room or alcove separate
from the food preparation and serving area.
5.1.2.4 A dispensing area. This shall have a hand-
washing station. (2) Commercial dish-washing equipment shall be
provided.
5.1.2.5 A drug information area
(3) A hand-washing station shall be conveniently available.
5.1.2.6 Order review area. An editing or order review
area shall be provided. (4) Space shall also be provided for receiving, scraping,
sorting, and stacking soiled tableware and for
5.1.2.7 Support areas for the pharmacy transferring clean tableware to the using areas.
5.2.2 Facility Requirements 5.2.3.2 Equipment storage. Storage areas shall be pro-
The following facilities shall be provided as required to vided for cans, carts, and mobile tray conveyors.
implement the food service selected:
5.2.3.3 Housekeeping room
5.2.2.1 Control station. A control station for receiving
food supplies shall be provided. (1) This shall be located within the dietary department.
5.2.2.2 Hand-washing station(s). Hand-washing station(s) (2) This shall contain a floor receptor or service sink
shall be located in the food preparation area. and storage space for housekeeping equipment
and supplies.
5.2.2.3 Food preparation facilities
5.2.3.4 Waste storage facilities. These shall be located
(1) Conventional food preparation systems require in a separate room easily accessible to the outside for
space and equipment for preparing, cooking, and direct waste pickup or disposal.
baking.
5.2.4 Support Areas for Staff
(2) Convenience food service systems such as frozen 5.2.4.1 Separate dining space for staff
prepared meals, bulk packaged entrees, individu-
ally packaged portions, and contractual commis- APPENDIX
sary services require space and equipment for
thawing, portioning, cooking, and/or baking. A5.2.1 Services may consist of an on-site conventional food
preparation system, a convenience food service system, or an
5.2.2.4 Patient meal service facilities. Facilities shall be appropriate combination thereof. On-site facilities should be
provided for tray assembly and distribution. provided for emergency food preparation and refrigeration.
2006 Guidelines for Design and Construction of Health Care Facilities 169
2 . 4 R E H A B I L I TAT I O N FA C I L I T I E S
5.2.4.2 Toilets. Toilets shall be provided for dietary staff. 5.4.1.5 Supply storage. Storage shall be provided for
Hand-washing stations shall be immediately available. laundry supplies.
5.3 Sterilizing Facilities 5.4.1.6 Housekeeping room. This shall contain a floor
Where required by the functional program, a system receptor or service sink and shall provide storage space
for sterilizing equipment and supplies shall be provided. for housekeeping equipment and supplies.
Its size shall depend upon the requirements of the
functional program. 5.4.2 Off-Site Processing
If linen is processed off the rehabilitation facility site,
5.4 Linen Services the following shall be provided:
APPENDIX
A5.5.1 The underlying framework of waste management compris- should be given to sorting and staging areas. The following
es waste minimization and segregation. Facilities should seek both elements are examples that may be considered:
to minimize all components of each waste stream and to separate
a. Building should include adequate space to accommodate
different components of the total waste stream. At a minimum, the
bins/carts for appropriate waste segregation such as recyclables,
functional program should include consideration of regular trash,
infectious waste, sharps, etc. Corridors and materials handling
medical/infectious waste, hazardous waste, and low-level
systems should be designed to achieve an efficient movement
radioactive waste.
of waste from points of generation to storage or treatment while
The program should address the development of effective collection, minimizing the risk to personnel.
transport, pest control, and storage systems; waste management
b. Dedicated storage and flow space and cleaning/sanitation facili-
and contingency planning; protecting the health and safety of work-
ties should facilitate reuse of items such as medical products, food
ers; and proper siting of all on-site waste treatment technologies.
service items, and the like to eliminate disposables and reduce waste.
Optimizing waste management has programmatic and space
c. Space should be included for autoclaves, shredders, and other
impacts throughout the facility, at points where waste is generat-
technologies for processing medical waste prior to removals to
ed, collected, and staged for disposal. For facilities or municipali-
landfill. Secure storage should be provided for staging fluorescent
ties with recycling programs in place, particular consideration
lamps for recycling.
170 2006 Guidelines for Design and Construction of Health Care Facilities
2 . 4 R E H A B I L I TAT I O N FA C I L I T I E S
(c) Red bag waste shall be staged in enclosed and 6 Administrative and Public Areas
secured areas. Biohazardous and environmen-
tally hazardous materials, including mercury, 6.1 Public Areas
nuclear reagent waste, and other regulated
waste types, shall be segregated and secured. 6.1.1 Entrance
A grade-level entrance, sheltered from the weather and
(2) Space requirements. The functional program shall able to accommodate wheelchairs, shall be provided.
outline the space requirements, including central-
ized waste collection and storage spaces. Size of 6.1.2 Lobby
spaces shall be determined based upon volume of The lobby shall include the following:
projected waste and length of anticipated storage.
6.1.2.1 A reception and information counter or desk
5.5.1.2 Regulated waste storage spaces
6.1.2.2 Waiting space(s)
(1) If provided, regulated medical waste or infectious
waste storage spaces shall have a floor drain, 6.1.2.3 Public toilet facilities
cleanable floor and wall surfaces, lighting, and
exhaust ventilation, and should be safe from 6.1.2.4 Public telephone(s)
weather, animals and unauthorized entry.
6.1.2.5 Provision for drinking water
(2) Refrigeration requirements for such storage facili-
ties shall comply with state and/or local regulations. 6.1.2.6 Wheelchair storage space(s)
5.5.1.3 Refuse chutes. The design and construction of 6.1.2.7 Convenience store. An expanded gift shop with
trash chutes shall comply with NFPA 82. toiletries and other items available to patients during
extended stays shall be provided according to the
5.6 Environmental Services requirements of the functional program.
2006 Guidelines for Design and Construction of Health Care Facilities 171
2 . 4 R E H A B I L I TAT I O N FA C I L I T I E S
6.2.4 Patient Storage Locations 7.1.1.2 Interior finishes. Interior finish materials for
Rehab patients’ length of stay is longer than that inpatient facilities shall comply with the flame-spread
of typical acute care patients. Space for storage of limitations and the smoke-production limitations in
patients’ personal effects shall meet the needs of the NFPA 101.
functional program.
7.1.1.3 Insulation materials. Building insulation mate-
6.2.5 General Storage rials, unless sealed on all sides and edges, shall have a
Separate space shall be provided for office supplies, flame-spread rating of 25 or less and a smoke-devel-
sterile supplies, pharmaceutical supplies, splints and oped rating of 150 or less when tested in accordance
other orthopedic supplies, and housekeeping supplies with NFPA 255.
and equipment.
7.1.2 Provisions for Disasters
6.2.6 Employee Facilities For design and construction standards relating to hur-
In addition to the employee facilities such as locker ricanes, tornadoes, and floods, see Section 2.1-8.1.3.
rooms, lounges, toilets, or showers called for in certain
departments, a sufficient number of such facilities to 7.2 General Standards for Details and Finishes
accommodate the needs of all personnel and volun-
teers shall be provided. 7.2.1 General
Patients in a rehabilitation facility will be disabled to
differing degrees. Therefore, high standards of safety
7 Construction Standards for the occupants shall be provided to minimize
accidents. All details and finishes for renovation
7.1 Design and Construction, including Fire- projects as well as for new construction shall comply
Resistant Standards with the following requirements insofar as they affect
patient services:
7.1.1 Construction Requirements
7.1.1.1 General. Except as noted below, construction 7.2.2 Details
of freestanding outpatient rehabilitation facilities shall 7.2.2.1 Corridor width. Items such as provisions for
comply with the applicable requirements of NFPA drinking water, telephone booths, vending machines,
101, and the standards contained herein, and the and portable equipment shall not restrict corridor
requirements of authorities of having jurisdiction. traffic or reduce the corridor width below the required
Rehabilitation facilities that accommodate inpatients minimum.
shall comply with the construction requirements for
general hospitals in Section 2.1-8.1. 7.2.2.2 Ceiling height. The minimum ceiling height
shall be 7 feet 10 inches (2.39 meters), with the follow-
7.1.1.2 Fire prevention/protection measures ing exceptions:
(1) Compartmentation, exits, automatic extinguishing (1) Corridors, storage rooms, and toilet rooms.
systems, and other details relating to fire preven- Ceilings in corridors, storage rooms, toilet rooms,
tion and fire protection in inpatient rehabilitation and other minor rooms shall be not less than 7
facilities shall comply with requirements listed in feet 8 inches (2.34 meters).
NFPA 101.
(2) Rooms with ceiling-mounted equipment/light fix-
(2) In freestanding outpatient rehabilitation facilities, tures. Ceilings of radiographic and other rooms
details relating to exits and fire safety shall comply containing ceiling-mounted equipment, including
with the appropriate occupancy chapter of NFPA those with ceiling-mounted surgical light fixtures,
101 and the requirements outlined herein. shall have sufficient height to accommodate the
equipment and/or fixtures.
172 2006 Guidelines for Design and Construction of Health Care Facilities
2 . 4 R E H A B I L I TAT I O N FA C I L I T I E S
(3) Boiler rooms. Boiler rooms shall have a ceiling (i) Rooms that contain bathtubs, sitz baths,
clearance not less than 2 feet 6 inches (76.20 showers, and water closets subject to
centimeters) above the main boiler header and patient use shall be equipped with doors
connecting piping. and hardware that will permit access
from the outside in an emergency.
(4) Clearances. Suspended tracks, rails, and pipes located
in the path of normal traffic shall be not less than 6 (ii) When such rooms have only one opening
feet 8 inches (2.03 meters) above the floor. or are small, the doors shall open out-
ward or be otherwise designed to open
7.2.2.3 Doors without pressing against a patient who
may have collapsed within the room.
(1) Door type
7.2.2.4 Thresholds and expansion joint covers. These
(a) Doors between corridors and rooms or those shall be flush with the floor surface to facilitate use of
leading into spaces subject to occupancy, wheelchairs and carts in new facilities.
except elevator doors, shall be swing-type.
7.2.2.5 Windows
(b) Openings to showers, baths, patient toilets,
and other small, wet-type areas not subject to (1) Operable windows are not required in patient
fire hazard are exempt from this requirement. rooms.
(3) Door swing. Doors, except those to spaces such as (2) Safety glass or plastic glazing material shall be
small closets not subject to occupancy, shall not used for shower doors and bath enclosures.
swing into corridors in a manner that obstructs
traffic flow or reduces the required corridor width. 7.2.2.8 Hand-washing stations. Location and arrange-
ment of hand-washing stations shall permit proper
(4) Door hardware use and operation and meet the following:
(a) Patient bathing/toilet facilities (1) Particular care shall be given to clearance required
for blade-type operating handles.
2006 Guidelines for Design and Construction of Health Care Facilities 173
2 . 4 R E H A B I L I TAT I O N FA C I L I T I E S
(2) Lavatories intended for use by disabled patients 7.2.2.11 Radiation protection
shall be installed in accordance with Section 1.1-4,
Design Standards for the Disabled. (1) Radiation protection requirements of x-ray and
gamma ray installations shall conform to state
(3) Mirrors. Mirrors shall be arranged for convenient and local laws.
use by wheelchair patients as well as by patients in
a standing position. (2) Provisions shall be made for testing the complet-
ed installation before use. All defects shall be
(4) Provisions for hand drying shall be included at all corrected before acceptance.
hand-washing stations.
7.2.2.12 Noise control
(5) Lavatories and hand-washing stations shall be
securely anchored to withstand an applied vertical (1) Recreation rooms, exercise rooms, and similar
load of not less than 250 pounds (113.40 kilograms) spaces where impact noises may be generated
on the front of the fixture. shall not be located directly over patient bed areas
unless special provisions are made to minimize
7.2.2.9 Grab bars such noise.
(1) Grab bars shall be provided in all patient toilets, (2) Noise reduction criteria shown in Table 2.1-1
bathtubs, showers, and sitz baths with a wall shall apply to partition, floor, and ceiling con-
clearance of 1-1/2 inches (3.81 centimeters) clear- struction in patient areas.
ance to walls.
7.2.2.13 Temperature control. Rooms containing heat-
(3) Grab bars shall be sufficiently anchored to sus- producing equipment (such as boiler or heater rooms
tain a concentrated load of 250 pounds (113.40 and laundries) shall be insulated and ventilated to pre-
kilograms). vent any floor surface above from exceeding a temper-
ature 10oF (6oC) above the ambient room temperature.
(4) Ends of grab bars shall be constructed to prevent
snagging the clothes of patients. 7.2.3 Finishes
7.2.3.1 Noncombustible or flame-retardant materials.
(5) Special consideration shall be given to shower Cubicle curtains and draperies shall be noncom-
curtain rods that may be momentarily used for bustible or rendered flame retardant and shall pass
support. Recessed soap dishes shall be provided both the large- and small-scale tests in NFPA 701.
in showers and bathrooms.
7.2.3.2 Floors
7.2.2.10 Handrails
(1) Floor materials shall be readily cleanable and
(1) Handrails shall be provided on both sides of appropriately wear-resistant for the location.
corridors used by patients.
(a) In all areas frequently subject to wet cleaning
(2) A clear distance of 1-1/2 inches (3.81 centimeters) methods, floor materials shall not be physically
shall be provided between the handrail and the affected by germicidal and cleaning solutions.
wall, and the top of the rail shall be about 2 feet 8
inches (81.28 centimeters) above the floor, except (b) Wall bases in kitchens, soiled workrooms,
for special care areas such as those serving children. and other areas that are frequently subject
to wet cleaning methods shall be monolithic
(3) Ends of handrails shall be constructed to prevent and coved with the floor, tightly sealed within
snagging the clothes of patients. the wall, and constructed without voids that
can harbor insects.
174 2006 Guidelines for Design and Construction of Health Care Facilities
2 . 4 R E H A B I L I TAT I O N FA C I L I T I E S
(2) Floor surfaces in patient areas shall be smooth minimize entry of pests. Joints of structural elements
and without irregular surfaces to prevent tripping shall be similarly sealed.
by patients using orthotic devices.
(3) Floors subject to traffic while wet, such as shower 8 Special Systems
and bath areas, kitchens, and similar work areas,
shall have a nonslip surface. 8.1 General
(2) Dietary and food preparation areas. Finish, trim, 8.1.2.2 Operating staff persons shall also be provided
and wall construction in these areas shall be free with instructions for proper operation of systems and
from spaces that can harbor pests. equipment. Required information shall include all
safety or code ratings as needed.
7.2.3.4 Ceilings
8.1.3 Insulation
(1) Ceilings throughout shall be readily cleanable. Insulation shall be provided surrounding special sys-
tem equipment to conserve energy, protect personnel,
(2) All overhead piping and ductwork in the dietary and reduce noise.
and food preparation area shall be concealed
behind a finished ceiling. 8.2 Elevators
2006 Guidelines for Design and Construction of Health Care Facilities 175
2 . 4 R E H A B I L I TAT I O N FA C I L I T I E S
8.2.3.2 Car doors shall have a clear opening of not *8.3.1.1 Incineration. On-site hospital incinerators
less than 4 feet (1.22 meters) wide and 7 feet (2.13 shall comply with federal, state, and local regulatory
meters) high. and environmental requirements. The design and con-
struction of incinerators shall comply with NFPA 82.
8.2.3.3 In renovations, existing elevators that can
accommodate patient beds used in the facility will not 8.3.1.2 Other technologies. Types of non-incineration
be required to be increased in size. waste treatment technology(ies) shall be determined
by the facility in conjunction with environmental, eco-
*8.2.4 Elevator Controls nomic, and regulatory considerations. The functional
Elevator call buttons and controls shall not be activat- program shall describe waste treatment technology
ed by heat or smoke. Light beams, if used for operat- components.
ing door reopening devices without touch, shall be
used in combination with door-edge safety devices (1) Location
and shall be interconnected with a system of smoke
detectors. (a) Safe transfer routes, distances from waste
sources, temporary storage requirements, and
8.2.5 Installation and Testing space requirements for treatment equipment
8.2.5.1 Standards. Installation and testing of elevators shall be considered in determining the loca-
shall comply with ANSI/ASME A17.1 for new con- tion for a non-incineration technology.
struction and ANSI/ASME A17.3 for existing facilities.
(See ASCE 7 for seismic design and control systems (b) The location of the technology shall not
requirements for elevators.) cause traffic problems as waste is brought in
and out.
8.2.5.2 Testing. Field inspections and tests shall be
made and the owner shall be furnished with written (c) Odor, noise, and the visual impact of medical
certification stating that the installation meets the waste operations on patients, visitors, public
requirements set forth in this section as well as all access and security shall be considered.
applicable safety regulations and codes.
APPENDIX
A8.2.4 This is so the light control feature will be overridden or federal, state, and local statutes and regulations. Toward this end,
disengaged should it encounter smoke at any landing. permit applications for incinerators and modifications thereof
should be supported by Environmental Assessments and/or
A8.3.1.1 The EPA has identified medical waste incineration as a
Environmental Impact Statements (EISs) and/or Health Risk
significant contributor to air pollution worldwide. Health care facili-
Assessments (HRAs) as may be required by regulatory agencies.
ties should seek to minimize incineration of medical waste, consis-
Except as noted below, such assessments should utilize standard
tent with local and state regulations and public health goals.
U.S. EPA methods, specifically those set forth in U.S. EPA guide-
When incinerators are used, consideration should be given to the lines, and should be fully consistent with U.S. EPA guidelines for
recovery of waste heat from on-site incinerators used to dispose of health risk assessment. Under some circumstances, however,
large amounts of waste materials. Incinerators should be designed regulatory agencies having jurisdiction over a particular project
in a manner fully consistent with protection of public and environ- may require use of alternative methods.
mental health, both on-site and off-site, and in compliance with
176 2006 Guidelines for Design and Construction of Health Care Facilities
2 . 4 R E H A B I L I TAT I O N FA C I L I T I E S
(2) Space requirements. Space needed for such tech- 9.1.2.3 Potable water supply systems. The following
nologies shall be determined by the equipment standards shall apply to potable water supply systems:
requirements, including associated area for open-
ing waste entry doors, access to control panels, (1) Capacity. Systems shall be designed to supply
space for hydraulic lifts, conveyors, and opera- water at sufficient pressure to operate all fixtures
tional clearances. Mobile or portable units, trailer- and equipment during maximum demand.
mounted units, underground installations, or Supply capacity for hot- and cold-water piping
all-weather enclosed shelters at an outdoor site shall be determined on the basis of fixture units,
may also be used, subject to local regulatory using recognized engineering standards. When the
approvals. ratio of plumbing fixtures to occupants is propor-
tionally more than required by the building occu-
(3) Ventilation. Exhaust vents, if any, from the treat- pancy and is in excess of 1,000 plumbing fixture
ment technology shall be located a minimum of units, a diversity factor is permitted.
25 feet (7.62 meters) from inlets to HVAC systems.
If the technology involves heat dissipation, suffi- (2) Valves. Each water service main, branch main,
cient cooling and ventilation shall be provided. riser, and branch to a group of fixtures shall have
valves.
9 Building Systems (a) Stop valves shall be provided for each fixture.
(3) No plumbing lines shall be exposed overhead or (4) Bedpan-flushing devices. Bedpan-flushing devices
on walls where possible accumulation of dust or (may be cold water) shall be provided in each
soil may create a cleaning problem or where leaks inpatient toilet room.
would create a potential for food contamination.
(5) Potable water storage. Potable water storage ves-
9.1.2.2 Hemodialysis/hemoperfusion piping. Where sels (hot and cold) not intended for constant use
the functional program includes hemodialysis, contin- shall not be installed.
uously circulated filtered cold water shall be provided.
Piping shall be in accordance with ANSI/AAMI RD62, 9.1.2.4 Hot water systems. See Section 1.6-2.1.2.1.
Water Treatment Equipment for Hemodialysis
Applications. 9.1.2.5 Drainage systems. The following standards
shall apply to drainage systems:
2006 Guidelines for Design and Construction of Health Care Facilities 177
2 . 4 R E H A B I L I TAT I O N FA C I L I T I E S
(1) Piping (3) Autopsy table drain systems. Drain systems for
autopsy tables shall be designed to positively
(a) Drain lines from sinks used for acid waste dis- avoid splatter or overflow onto floors or back
posal shall be made of acid-resistant material. siphonage and for easy cleaning and trap flushing.
(b) Drain lines serving some types of automatic (4) Sewers. Building sewers shall discharge into com-
blood-cell counters shall be of carefully munity sewerage. Where such a system is not
selected material that will eliminate potential available, the facility shall treat its sewage in
for undesirable chemical reactions (and/or accordance with local and state regulations.
explosions) between sodium azide wastes and
copper, lead, brass, solder, etc. (5) Grease traps. Kitchen grease traps shall be located
and arranged to permit easy access without the
(c) Insofar as possible, drainage piping shall not need to enter food preparation or storage areas.
be installed within the ceiling or exposed in Grease traps shall be of capacity required and
operating rooms, food preparation centers, shall be accessible from outside the building
food serving facilities, food storage areas, without need to interrupt any services.
central services, electronic data processing
areas, electric closets, and other sensitive (6) Plaster traps. Where plaster traps are used, provi-
areas. Where exposed overhead drain piping sions shall be made for appropriate access and
in these areas is unavoidable, special provi- cleaning.
sions shall be made to protect the space
below from leakage, condensation, or dust 9.1.2.6 Condensate drains. See Section 1.6-2.1.2.2.
particles.
9.1.3 Plumbing Fixtures
(2) Floor drains In addition to the requirements of Section 1.6-2.1.3,
the following standards shall apply to plumbing fix-
(a) Floor drains shall not be installed in operat- tures in a rehabilitation hospital:
ing rooms.
9.1.3.1 Clinical sinks
(b) If a floor drain is installed in cystoscopy, it
shall contain a nonsplash, horizontal-flow (1) Handles on clinical sinks shall be at least 6 inches
flushing bowl beneath the drain plate. (15.24 centimeters) long.
(c) Dietary area floor drains and/or floor sinks (2) Clinical sinks shall have an integral trap wherein
the upper portion of the water trap provides a
(i) Type. These shall be of a type that can visible seal.
be easily cleaned by removing the cover.
Removable stainless steel mesh shall be 9.1.3.2 Scrub sinks. Freestanding scrub sinks and
provided in addition to grilled drain cov- hand-washing stations used for scrubbing in proce-
ers to prevent entry of large particles of dure rooms shall be trimmed with foot, knee, or
waste that might cause stoppages. |ultrasonic controls; single lever wrist blades are not
permitted.
(ii) Location. Floor drains or floor sinks shall
be provided at all “wet” equipment (as ice 9.1.4 Medical Gas and Vacuum Systems
machines) and as required for wet cleaning 9.1.4.1 Medical gas and air systems. The installation,
of floors. Location of floor drains and floor testing, and certification of nonflammable medical gas
sinks shall be coordinated to avoid condi- and air systems shall comply with the requirements of
tions where locations of equipment make NFPA 99. (See Table 2.1-5 for rooms requiring station
removal of covers for cleaning difficult. outlets.)
178 2006 Guidelines for Design and Construction of Health Care Facilities
2 . 4 R E H A B I L I TAT I O N FA C I L I T I E S
9.1.4.2 Clinical vacuum systems. Clinical vacuum sys- (2) Air-handling systems
tem installations shall be in accordance with NFPA 99.
(See Table 2.1-5 for rooms requiring station outlets.) *(a) These shall be designed with an economizer
cycle where appropriate to use outside air.
9.2 Heating, Ventilating, and Air-Conditioning (Use of mechanically circulated outside air
(HVAC) Systems does not reduce need for filtration.)
(d) Insofar as practical, the facility shall include (4) System valves. Supply and return mains and risers
provisions for recovery of waste cooling for cooling, heating, and steam systems shall be
and heating energy (ventilation, exhaust, equipped with valves to isolate the various sec-
water and steam discharge, cooling towers, tions of each system. Each piece of equipment
incinerators, etc.). shall have valves at the supply and return ends.
*(e) Use of recognized energy-saving mecha- (5) Renovation. If system modifications affect greater
nisms such as variable air volume (VAV) than 10 percent of the system capacity, designers
systems, load shedding, programmed
controls for unoccupied periods (nights APPENDIX
and weekends, etc.), and use of natural
ventilation shall be considered, site and A9.2.1.1 (1)(e) Systems with excessive installation and/or
climatic conditions permitting maintenance costs that negate long-range energy savings should
be avoided.
(f) Facility design considerations. These shall
A9.2.1.1 (2)(a) It may be practical in many areas to reduce or
include site, building mass, orientation, con-
shut down mechanical ventilation under appropriate climatic and
figuration, fenestration, and other features
patient care conditions and to use open windows for ventilation.
relative to passive and active energy systems
2006 Guidelines for Design and Construction of Health Care Facilities 179
2 . 4 R E H A B I L I TAT I O N FA C I L I T I E S
shall utilize pre-renovation water/air flow rate (2) Operating staff persons shall also be provided
measurements to verify that sufficient capacity is with written instructions for proper operation of
available and that renovations have not adversely systems and equipment.
affected flow rates in non-renovated areas.
9.2.2 Requirements for Specific Locations
9.2.1.2 Ventilation and space conditioning require- 9.2.2.1 Cough-inducing procedure rooms. Rooms used
ments. All rooms and areas in the facility used for for sputum induction, aerosolized pentamidine treat-
patient care shall have provisions for ventilation. ments, or other cough-inducing procedures shall meet
the requirements of Table 2.1-2 for airborne infection
(1) Ventilation rates. The ventilation systems shall be isolation rooms. If booths are used, refer to Section
designed and balanced, as a minimum, according 2.1-5.8.1.
to the requirements shown in Table 2.1-2 and the
applicable notes. The ventilation rates shown in 9.2.2.2 ETO sterilizer space. The ventilation system for
Table 2.1-2 do not preclude the use of higher, the space that houses ethylene oxide (ETO) sterilizers
more appropriate rates. shall be designed as follows:
(2) Air change rates. Air supply and exhaust in rooms (1) A dedicated exhaust system (one not connected to
for which no minimum total air change rate is a return air or other exhaust system) shall be pro-
noted may vary down to zero in response to room vided. Refer to 29 CFR Part 1910.1047.
load. For rooms listed in Table 2.1-2, where VAV
systems are used, minimum total air change shall (2) All source areas shall be exhausted, including the
be within limits noted. sterilizer equipment room, service/aeration areas,
over the sterilizer door, and the aerator.
(3) Temperature and humidity levels. Space tempera-
ture and relative humidity shall be as indicated in (a) If the ETO cylinders are not located in a well-
Table 2.1-2. ventilated, unoccupied equipment space, an
exhaust hood shall be provided over the
(4) Air movement direction. To maintain asepsis cylinders.
control, airflow supply and exhaust shall generally
be controlled to ensure movement of air from (b) The relief valve shall be terminated in a well-
“clean” to “less clean” areas, especially in critical ventilated, unoccupied equipment space, or
areas. outside the building.
(5) Although natural ventilation for nonsensitive (c) If the floor drain which the sterilizer(s) dis-
areas and patient rooms (via operable windows) charges to is not located in a well-ventilated,
shall be permitted, mechanical ventilation shall be unoccupied equipment space, an exhaust
considered for all rooms and areas in the facility. drain cap shall be provided (coordinate with
local codes).
9.2.1.3 Testing and documentation
(3) General airflow shall be away from the sterilizer
(1) Upon completion of the equipment installation operator(s).
contract, the owner shall be furnished with a
complete set of manufacturers’ operating, main- (4) A dedicated exhaust duct system for ETO shall be
tenance, and preventive maintenance instruc- provided. The exhaust outlet to the outside shall
tions, parts lists, and complete procurement be at least 25 feet (7.62 meters) away from any air
information, including equipment numbers and intake.
descriptions. Required information shall include
energy ratings as needed for future conservation (5) An audible and visual alarm shall activate in
calculations. the sterilizer work area, and in a 24-hour staffed
180 2006 Guidelines for Design and Construction of Health Care Facilities
2 . 4 R E H A B I L I TAT I O N FA C I L I T I E S
location, upon loss of airflow in the exhaust system. 9.2.4.4 Air outlets and inlets
(1) Exhaust hoods handling grease-laden vapors in food (a) Fresh air intakes shall be located at least
preparation centers shall comply with NFPA 96. 25 feet (7.62 meters) from exhaust outlets
of ventilating systems, combustion vents
(2) All hoods over cooking ranges shall be equipped (including those serving rooftop air han-
with grease filters, fire-extinguishing systems, and dling equipment), medical-surgical vacuum
heat-actuated fan controls. systems, plumbing vents, or areas that may
collect vehicular exhaust or other noxious
(3) Cleanout openings shall be provided every 20 feet fumes. (Prevailing winds and/or proximity
(6.10 meters) and at changes in direction in the to other structures may require greater
horizontal exhaust duct systems serving these clearances.)
hoods. Horizontal runs of ducts serving range
hoods shall be kept to a minimum. (b) Plumbing vents that terminate at a level
above the top of the air intake may be located
9.2.2.4 Fuel-fired equipment rooms. Rooms with fuel- as close as 10 feet (3.05 meters).
fired equipment shall be provided with sufficient out-
door air to maintain equipment combustion rates and (c) The bottom of outdoor air intakes serving
to limit work station temperatures. central systems shall be as high as practical,
but at least 6 feet (1.83 meters) above ground
9.2.3 Thermal Insulation and Acoustical Provisions level, or, if installed above the roof, 3 feet
See Section 1.6-2.2.1. (91.44 centimeters) above roof level.
9.2.4 HVAC Air Distribution (2) Relief air. Relief air is exempt from the 25-foot
(7.62-meter) separation requirement. Relief air is
9.2.4.1 Return air systems. For patient care areas, all defined as air that otherwise could be returned
return ventilation shall be via ducted systems. (recirculated) to an air handling unit from the
occupied space, but is being discharged to the
9.2.4.2 HVAC ductwork. See Section 1.6-2.2.2.1. outdoors to maintain building pressure, such
as during outside air economizer operation.
9.2.4.3 Exhaust systems
(3) Gravity exhaust. Where conditions permit, gravity
(1) General exhaust shall be permitted for nonpatient areas
such as boiler rooms, central storage, etc.
(a) To enhance the efficiency of recovery devices
required for energy conservation, combined 9.2.4.5 Ventilation hoods
exhaust systems shall be permitted.
(1) Exhaust hoods and safety cabinets
(b) Local exhaust systems shall be used whenever
possible in place of dilution ventilation to (a) Hoods and safety cabinets may be used for
reduce exposure to hazardous gases, vapors, normal exhaust of a space providing mini-
fumes, or mists. mum air change rates are maintained.
(c) Fans serving exhaust systems shall be located (b) If air change standards in Table 2.1-2 do not
at the discharge end and shall be readily provide sufficient air for proper operation of
serviceable. exhaust hoods and safety cabinets (when in
use), makeup air (filtered and preheated)
2006 Guidelines for Design and Construction of Health Care Facilities 181
2 . 4 R E H A B I L I TAT I O N FA C I L I T I E S
shall be provided around these units to tration by water. Lubricants and seals
maintain the required airflow direction and shall not contain organic materials.
exhaust velocity. Use of makeup air will
avoid dependence upon infiltration from (iv) When perchloric acid or other strong
outdoors and/or from contaminated areas. oxidants are only transferred from one
container to another, standard laborato-
(c) Makeup systems for hoods shall be arranged ry fume hoods and the associated equip-
to minimize “short circuiting” of air and to ment may be used in lieu of stainless
avoid reduction in air velocity at the point of steel construction.
contaminant capture.
(c) Special standards for use with infectious or
(2) Laboratory fume hoods. Laboratory fume hoods radioactive materials. In new construction
shall meet the following general standards: and major renovation work, each hood used
to process infectious or radioactive materials
(a) General standards shall meet the following requirements:
(i) An average face velocity of at least 75 (i) A minimum face velocity of 90 to 110 feet
feet per minute (0.38 meters per second) per minute (0.45 to 0.56 meter per sec-
ond) with suitable pressure-independent
(ii) Connection to an exhaust system to the air modulating devices and alarms to alert
outside that is separate from the building staff of fan shutdown or loss of airflow.
exhaust system
(ii) Filters with a 99.97 percent efficiency
(iii) Location of an exhaust fan at the dis- (based on the DOP test method) in the
charge end of the system exhaust stream, and shall be designed
and equipped to permit the safe
(iv) Inclusion of an exhaust duct system of removal, disposal, and replacement of
noncombustible corrosion-resistant contaminated filters. Filters shall be as
material as needed to meet the planned close to the hood as practical to mini-
usage of the hood mize duct contamination.
(b) Special standards for use with strong oxidants (iii) For fume hoods intended for use with
radioactive isotopes, construction of stain-
(i) Fume hoods and their associated equip- less steel or other material suitable for the
ment in the air stream intended for use particular exposure. These hoods shall
with perchloric acid and other strong comply with NFPA 801, Facilities for
oxidants shall be constructed of stainless Handling Radioactive Materials. Note:
steel or other material consistent with Radioactive isotopes used for injections,
special exposures. etc., without probability of airborne partic-
ulates or gases may be processed in a clean-
(ii) These hoods and equipment shall be workbench-type hood where acceptable to
provided with a water wash and drain the Nuclear Regulatory Commission.
system to permit periodic flushing of
duct and hood. 9.2.5 HVAC Filters
9.2.5.1 Filter efficiencies
(iii) Electrical equipment intended for
installation within such ducts shall be (1) All central ventilation or air conditioning systems
designed and constructed to resist pene- shall be equipped with filters with efficiencies equal
to, or greater than, those specified in Table 2.1-3.
182 2006 Guidelines for Design and Construction of Health Care Facilities
2 . 4 R E H A B I L I TAT I O N FA C I L I T I E S
(2) Noncentral air-handling systems shall be areas where a design dry-bulb temperature of
equipped with permanent (cleanable) or replace- 25oF (-4oC) or more represents not less than 99
able filters with a minimum efficiency of MERV 3 percent of the total hours in any one heating
(68 percent weight arrestance). month as noted in the ASHRAE Handbook—
Fundamentals under the “Table for Climatic
(3) Filter efficiencies, tested in accordance with Conditions for the United States.”
ASHRAE 52.1, shall be average.
9.2.6.2 Boiler accessories. These, including feed
9.2.5.2 Filter bed location. Where two filter beds are pumps, heat-circulating pumps, condensate return
required, filter bed no. 1 shall be located upstream of pumps, fuel oil pumps, and waste heat boilers, shall be
the air conditioning equipment and filter bed no. 2 connected and installed to provide both normal and
shall be downstream of any fan or blowers. standby service.
9.2.5.3 Filter frames. Filter frames shall be durable and 9.3 Electrical Systems
proportioned to provide an airtight fit with the
enclosing ductwork. All joints between filter segments 9.3.1 General
and enclosing ductwork shall have gaskets or seals to 9.3.1.1 Applicable standards
provide a positive seal against air leakage.
(1) All electrical material and equipment, including
9.2.5.4 Filter housing blank-off panels. Filter housing conductors, controls, and signaling devices, shall
blank-off panels shall be permanently attached to the be installed in compliance with applicable sec-
frame, constructed of rigid materials, and have sealing tions of NFPA 70 and NFPA 99.
surfaces equal to or greater than the filter media
installed in the filter frame. (2) All electrical material and equipment shall be listed
as complying with available standards of listing
9.2.5.5 Filter manometers. A manometer shall be installed agencies or other similar established standards
across each filter bed having a required efficiency of 75 where such standards are required.
percent or more, including hoods requiring HEPA filters.
Provisions shall be made to allow access for field testing. 9.3.1.2 Testing and documentation. The electrical
installations, including alarm, nurse call, and commu-
9.2.6 Steam and Hot Water Systems nication systems, shall be tested to demonstrate that
9.2.6.1 Boilers equipment installation and operation is appropriate
and functional. A written record of performance tests
(1) Capacity. Boilers shall have the capacity, based on special electrical systems and equipment shall show
upon the net ratings published by the Hydronics compliance with applicable codes and standards.
Institute or another acceptable national standard,
to supply the normal heating, hot water, and 9.3.2 Electrical Distribution and Transmission
steam requirements of all systems and equipment. 9.3.2.1 Switchboards
Their number and arrangement shall accommo-
date facility needs despite the breakdown or rou- (1) Location
tine maintenance of any one boiler. The capacity
of the remaining boiler(s) (reserve capacity) shall (a) Main switchboards shall be located in an
be sufficient to provide hot water service for clini- area separate from plumbing and mechanical
cal, dietary, and patient use; steam for sterilization equipment and shall be accessible to author-
and dietary purposes; and space heating for oper- ized persons only.
ating, recovery, and general patient rooms.
(b) Switchboards shall be convenient for use,
(2) Space heating requirements. Reserve capacity for readily accessible for maintenance, away from
facility space heating is not required in geographic traffic lanes
2006 Guidelines for Design and Construction of Health Care Facilities 183
2 . 4 R E H A B I L I TAT I O N FA C I L I T I E S
(c) Switchboards shall be located in dry, venti- (3) An emergency electrical source shall provide
lated spaces free of corrosive or explosive lighting and/or power during an interruption of
fumes, gases, or any flammable material. the normal electric supply.
(1) Ground-fault circuit interrupters (GFCIs) shall (c) Unless specifically designed to protect the
comply with NFPA 70. space below, the light source shall be covered
by a diffuser or lens.
(2) Where GFCIs are used in critical areas, provisions
shall be made to ensure that other essential equip- (2) Nursing unit corridors. Nursing unit corridors
ment is not affected by activation of one interrupter. shall have general illumination with provisions
for reducing light levels at night.
9.3.3 Power Generating and Storing Equipment
9.3.3.1 Emergency electrical service 9.3.5 Receptacles
9.3.5.1 Corridors. Duplex-grounded receptacles for
(1) As a minimum, nursing units or sections thereof general use shall be installed approximately 50 feet
shall have emergency electrical systems as (15.24 meters) apart in all corridors and within 25
required in NFPA 99, NFPA 101, and NFPA 110. feet (7.62 meters) of corridor ends.
(2) Where the nursing unit is a distinct part of an 9.3.5.2 Patient room. Each patient room shall have
acute-care hospital, it may use the emergency duplex-grounded receptacles.
generator system for required emergency light-
ing and power, if such sharing does not reduce (1) There shall be one at each side of the head of each
hospital services. bed and one on every other wall.
(a) Such a shared system shall be designed with (2) Receptacles may be omitted from exterior walls
the capacity to meet the needs of both the where construction or room configuration makes
hospital and the rehabilitation facilities. installation impractical.
(b) Life support systems and their respective 9.3.5.3 Emergency system receptacles. Electrical recep-
areas shall be subject to applicable standards tacle cover plates or electrical receptacles supplied
of Section 2.1-10. from the emergency system shall be distinctively
184 2006 Guidelines for Design and Construction of Health Care Facilities
2 . 4 R E H A B I L I TAT I O N FA C I L I T I E S
colored or marked for identification. If color is used (2) The signal shall activate an annunciator panel at the
for identification purposes, the same color shall be nurse station or other appropriate location, a visible
used throughout the facility. signal in the corridor at the patient’s door, and at
other areas defined by the functional program.
9.3.6 Equipment
9.3.6.1 Data processing and/or automated laboratory (3) A nurse emergency call shall be provided at each
or diagnostic equipment, if provided, may require inpatient toilet, bath, sitz bath, and shower room.
safeguards from power line disturbances. This emergency call shall be accessible to a col-
lapsed patient lying on the floor. Inclusion of a
9.3.6.2 X-ray equipment. Fixed and mobile x-ray pull cord will satisfy this standard.
equipment installations shall conform to articles 517
and 660 of NFPA 70. 9.4 Telecommunications and Information Systems
9.3.6.3 Special electrical equipment. Special equipment 9.4.1 Locations for terminating telecommunications
is identified in the sections in this chapter on nursing and information system devices shall be provided.
units, support areas, physical therapy, occupational
therapy, and imaging, if applicable. These sections shall 9.4.2 An area shall be provided for central equipment
be consulted to ensure compatibility between program- locations. Special air conditioning and voltage regula-
matically defined equipment needs and appropriate tion shall be provided when recommended by the
power and other electrical connection needs. manufacturer.
2006 Guidelines for Design and Construction of Health Care Facilities 185
3
Ambulatory Care Facilities
3.1 Outpatient Facilities
Appendix material, which appears in shaded boxes at the bottom of the page, is advisory only.
1.2 Outpatient Facility Classification A1.1.2 The applicability of Sections 3.1-6 (Special Systems) and
3.1-7 (Building Systems) generally are specified in these sections
1.2.1 The outpatient facilities described in this part of and/or in the text of the individual facility type chapters.
2006 Guidelines for Design and Construction of Health Care Facilities 189
3 . 1 O U T PAT I E N T FA C I L I T I E S
1.6.1 Where the outpatient occupancy is part of *2.1.1 General Purpose Examination Room(s)
another facility, separation and access shall be main- 2.1.1.1 Space requirements
tained as described in NFPA 101. (1) Area. Rooms for medical, obstetrical, and similar
examinations, if provided, shall have a minimum
1.6.2 Building entrances used to reach the outpatient floor area of 80 net square feet (7.43 square
services shall be at grade level, clearly marked, and locat- meters) excluding vestibules, toilets, closets, and
ed so patients need not go through other activity areas. fixed casework.
(Lobbies of multi-occupancy buildings may be shared.)
(2) Clearances. Room arrangement shall permit a
1.6.3 Design shall preclude unrelated traffic within the unit. minimum clearance of 2 feet 8 inches (81.28
centimeters) at each side and at the foot of the
1.7 Site examination table.
Clinical and support areas shall be provided to sup- 2.1.2.2 Hand-washing station. A hand-washing station
port the functional program. The following spaces are shall be provided.
common to most outpatient facilities:
2.1.2.3 Documentation space. A counter or shelf space
APPENDIX for writing shall be provided.
A1.7.1 Community outpatient units should ideally be conveniently *2.1.3 Treatment Room(s)
accessible to patients via available public transportation. 2.1.3.1 Space requirements
190 2006 Guidelines for Design and Construction of Health Care Facilities
3 . 1 O U T PAT I E N T FA C I L I T I E S
closets, and fixed casework. The minimum room 2.1.7.2 Drug distribution station. This may be a part
dimension shall be 10 feet (3.05 meters). of the nurses station and shall include a work counter,
sink, refrigerator, and locked storage for biologicals
(2) Clearance. Room arrangement shall permit a and drugs.
minimum clearance of 3 feet (91.44 centimeters)
at each side and at the foot of the bed. 2.1.7.3 Sterilizing facilities. A system for sterilizing
equipment and supplies shall be provided. Sterilizing
2.1.3.2 Hand-washing station. A hand-washing station procedures may be done on- or off-site, or disposables
shall be provided. may be used to satisfy functional needs.
2.1.3.3 Documentation space. A counter or shelf for 2.1.7.4 Clean storage. A separate room or closet for
writing shall be provided. storing clean and sterile supplies shall be provided.
This storage shall be in addition to that of cabinets
2.1.4 Observation Room(s) and shelves.
*2.1.4.1 Location. The room shall be convenient to a
nurse or control station. 2.1.7.5 Soiled holding. Provisions shall be made for
separate collection, storage, and disposal of soiled
2.1.4.2 Space requirements. If provided, observation materials.
rooms for the isolation of suspect or disturbed
patients shall have a minimum floor area of 80 square 2.1.7.6 Wheelchair storage space. Such storage shall be
feet (7.43 square meters). This square footage shall out of the direct line of traffic.
exclude vestibule, toilet, closets, and fixed casework.
2.1.8 Support Areas for Patients
2.1.5 Airborne Infection Isolation Rooms 2.1.8.1 Toilet(s) for patient use. These shall be provided
2.1.5.1 Applicability. In facilities with a functional pro- separate from public use toilet(s) and located to permit
gram that includes treatment of patients with known access from patient care areas without passing through
infectious disease, the need for and number of such publicly accessible areas.
rooms shall be determined by an infection control risk
assessment (ICRA). *2.2 Imaging Facilities
Basic diagnostic procedures (these may be part of the out-
2.1.5.2 Standards. Where airborne infection isolation patient service, off-site, shared, by contract, or by referral)
room(s) are required, they shall comply with the gen- shall be provided and shall include the following:
eral requirements of Section 2.1-3.2.2, except that a
shower or tub shall not be required. APPENDIX
2.1.6 Protective Environment Rooms A2.1.4.1 This is to permit close observation of patients. An
2.1.6.1 Applicability. The need for and number of examination room may be modified to accommodate this function.
required protective environment rooms shall be A toilet room with lavatory should be immediately accessible.
determined by an infection control risk assessment.
A2.2 Imaging Facilities
a. Access. Stretchers should have ready access to and from other
2.1.6.2 Standards. When required, the protective
areas of the facility. The emergency, surgery, cystoscopy, and
environment room(s) shall comply with the general
outpatient clinics should be accessible to the imaging suite.
requirements of Section 2.1-3.2.3, except that a toilet,
bathtub, or shower shall not be required. b. Layout. Particular attention should be paid to the management
of outpatients for preparation, holding, and observation.
2.1.7 Support Areas for Examination and Treatment Rooms
c. Location. Imaging should be located with consideration of
2.1.7.1 Nurse station(s). A work counter, communica-
ceiling height requirements, proximity to electrical services, and
tion system, space for supplies, and provisions for
future expansion considerations.
charting shall be provided.
2006 Guidelines for Design and Construction of Health Care Facilities 191
3 . 1 O U T PAT I E N T FA C I L I T I E S
2.2.1 Access (2) Blood collection facilities shall have seating space,
a work counter, and hand-washing station.
2.2.2 Radiographic Room(s)
See Section 2.1-5.5 for special requirements.
3 Service Areas
2.2.3 Support Areas for Imaging Facilities
2.2.3.1 Viewing and administrative areas(s) 3.1 Environmental Services
2.2.3.2 Film and media processing facilities. These 3.1.1 Housekeeping Room(s)
shall be provided as indicated in the functional pro- 3.1.1.1 Number. At least one housekeeping room per
gram and as technology requires. floor shall be provided.
2.2.3.3 Storage facilities for exposed film. These shall 3.1.1.2 Facility requirements. Each housekeeping room
be provided as indicated in the functional program shall contain a service sink and storage for housekeep-
and as technology requires. ing supplies and equipment.
2.2.4 Support Areas for Patients 3.2 Engineering Services and Maintenance
2.2.4.1 Dressing rooms or booths. These shall be The following shall be provided (sharing of these with
provided as required by the functional program, with other services shall be permitted provided capacity is
convenient toilet access. appropriate for overall use):
2.2.4.2 Toilet rooms. Toilet rooms with hand-washing 3.2.1 Equipment Rooms
stations shall be accessible to procedure room(s) Equipment room(s) for boilers, mechanical equip-
if procedures provided may result in the need for ment, and electrical equipment shall be provided.
immediate access to patient toilet facilities.
3.2.2 Equipment and Supply Storage
2.3 Laboratory Storage room(s) for supplies and equipment shall be
Facilities shall be provided within the outpatient provided.
department, or through an effective contract arrange-
ment with a nearby hospital or laboratory service, for 3.3 Materials Management
hematology, clinical chemistry, urinalysis, cytology,
pathology, and bacteriology. If these services are pro- 3.3.1 Waste Management
vided on contract, the following laboratory facilities For information on treatment or disposal of waste, see
shall also be provided in (or be immediately accessible Section 3.1-6.3.
to) the outpatient facility:
3.3.1.1 Collection and storage
2.3.1 Laboratory Work Counter(s)
These shall have sink, vacuum, gas, and electric services. (1) Space and facilities shall be provided for the
sanitary storage of waste in accordance with the
2.3.2 Hand-washing Station(s) functional program.
Hand-washing stations or counter sink(s) equipped
for hand washing shall be provided. (2) These facilities shall use techniques acceptable
to the appropriate health and environmental
2.3.3 Support Areas for the Laboratory authorities.
2.3.3.1 Storage cabinet(s) or closet(s)
3.3.1.2 Trash chutes. The design and construction of
2.3.3.2 Specimen collection facilities trash chutes shall comply with NFPA 82.
192 2006 Guidelines for Design and Construction of Health Care Facilities
3 . 1 O U T PAT I E N T FA C I L I T I E S
4.1.5 Public Telephones 5.1.1.2 Outpatient facilities that are an integral part of
Conveniently accessible public telephone(s) shall be a hospital or that share common areas and functions
provided. with a hospital shall comply with the construction
standards for general hospitals. See applicable sections
4.1.6 Provisions for Drinking Water of Chapter 2.1.
Conveniently accessible provisions for drinking water
shall be provided. 5.1.2 Provision for Disasters
5.1.2.1 Earthquakes. Seismic force resistance of new
4.1.7 Wheelchair Storage construction for outpatient facilities shall comply with
Conveniently accessible wheelchair storage shall be Section 1.1-5 and shall be given an importance factor
provided. of one. Where the outpatient facility is part of an
existing building, that facility shall comply with appli-
*4.2 Administrative Areas cable local codes.
4.2.1 Interview Space(s) 5.1.2.2 Other natural disasters. Special design provi-
Space(s) shall be provided for private interviews relat- sions shall be made for buildings in regions that have
ed to social service, credit, etc. sustained loss of life or damage to buildings from hur-
ricanes, tornadoes, floods, or other natural disasters.
4.2.2 General or Individual Office(s)
Space providing adequate work area for business
transactions, records storage, and administrative and APPENDIX
professional staffs shall be provided.
A4.1.3 Consideration should be given to special needs of specific
4.2.3 Medical Records patient groups in a shared/general waiting area, such as separa-
Provisions shall be made for securing medical records. tion of adolescent and geriatric patients.
2006 Guidelines for Design and Construction of Health Care Facilities 193
3 . 1 O U T PAT I E N T FA C I L I T I E S
5.2 General Standards for Details and Finishes comply with NFPA 101 and the standards out-
lined herein.
5.2.1 Details
Details shall comply with the following standards: 5.2.1.4 Door width
5.2.1.1 Corridor width (1) The minimum nominal door width for patient
use shall be 3 feet (0.91 meter).
(1) Minimum public corridor width shall be 5 feet
(1.52 meters). Staff-only corridors shall be per- (2) If the outpatient facility serves hospital inpatients,
mitted to be 3 feet 8 inches (1.12 meters) wide. the minimum nominal width of doors to rooms
used by hospital inpatients transported in beds
(2) Items such as provisions for drinking water, tele- shall be 3 feet 8 inches (1.12 meters).
phone booths, vending machines, etc., shall not
restrict corridor traffic or reduce the corridor 5.2.1.5 Glazing materials
width below the required minimum.
(1) Doors, sidelights, borrowed lights, and windows
(3) Out-of-traffic storage space for portable equip- glazed to within 18 inches (45.72 centimeters)
ment shall be provided. of the floor shall be constructed of safety glass,
wired glass, or plastic glazing material that resists
5.2.1.2 Ceiling height. The minimum ceiling height breakage and creates no dangerous cutting edges
shall be 7 feet 10 inches (2.39 meters), with the follow- when broken.
ing exceptions:
(2) Similar materials shall be used in wall openings of
(1) Corridors, storage rooms, toilet rooms, etc. playrooms and exercise rooms unless otherwise
Ceiling height in corridors, storage rooms, toilet required for fire safety.
rooms, and other minor rooms shall not be less
than 7 feet 8 inches (2.34 meters). (3) Glazing materials used for shower doors and bath
enclosures shall be safety glass or plastic.
(2) Rooms with ceiling-mounted equipment/light fix-
tures. Radiographic and other rooms containing 5.2.1.6 Hand-washing stations
ceiling-mounted equipment shall have ceilings of
sufficient height to accommodate the equipment (1) Hand-washing stations shall be located and
and/or fixtures. arranged to permit proper use and operation.
(3) Boiler rooms. Boiler rooms shall have ceiling (2) Particular care shall be taken to provide the
clearances not less than 2 feet 6 inches (76.20 required clearance for operation of blade-type
centimeters) above the main boiler header and handles.
connecting piping.
(3) Provisions for hand drying shall be included at all
(4) Clearances. Tracks, rails, and pipes suspended hand-washing stations except scrub sinks.
along the path of normal traffic shall be not less
than 6 feet 8 inches (2.03 meters) above the floor. 5.2.1.7 Thresholds and joints. Threshold and expan-
sion joint covers shall be flush with the floor surface to
5.2.1.3 Exits facilitate use of wheelchairs and carts.
(1) Each building shall have at least two exits that are 5.2.1.8 Radiation protection. Radiation protection for
remote from each other. x-ray and gamma ray installations shall comply with
Section 2.1-5.5.
(2) Other details relating to exits and fire safety shall
194 2006 Guidelines for Design and Construction of Health Care Facilities
3 . 1 O U T PAT I E N T FA C I L I T I E S
(2) The flame-spread and smoke-developed ratings of 6.1.2.2 Test results. Test results shall be documented
finishes shall comply with Section 2.1-8.1. Where for maintenance files.
possible, the use of materials known to produce
large amounts of noxious gases shall be avoided. 6.1.3 Documentation
6.1.3.1 Upon completion of the special systems equip-
5.2.2.2 Floors ment installation contract, the owner shall be furnished
with a complete set of manufacturers’ operating, main-
(1) Floor materials shall be readily cleanable and tenance, and preventive maintenance instructions, a
appropriately wear-resistant. parts lists, and complete procurement information,
including equipment numbers and descriptions.
(2) In all areas subject to wet cleaning, floor materials
shall not be physically affected by liquid germicid- 6.1.3.2 Operating staff persons shall also be provided
al and cleaning solutions. with instructions for proper operation of systems and
equipment. Required information shall include all
(3) Floors subject to traffic while wet, including safety or code ratings as needed.
showers and bath areas, shall have a nonslip
surface. 6.1.4 Insulation
Insulation shall be provided surrounding special sys-
(4) Wall bases in areas frequently subject to wet tem equipment to conserve energy, protect personnel,
cleaning shall be monolithic and coved with the and reduce noise.
floor, tightly sealed to the wall, and constructed
without voids. 6.2 Elevators
5.2.2.4 Penetrations. Floor and wall areas penetrated 6.2.2 Leveling Device
by pipes, ducts, and conduits shall be tightly sealed to Elevators shall be equipped with a two-way automatic
minimize entry of rodents and insects. Joints of struc- level-maintaining device with an accuracy of ±1/2
tural elements shall be similarly sealed. inch (±12.7 millimeters).
2006 Guidelines for Design and Construction of Health Care Facilities 195
3 . 1 O U T PAT I E N T FA C I L I T I E S
6.2.3.2 Elevator controls, alarm buttons, and tele- 6.3.2.2 Space requirements
phones shall be accessible to wheelchair occupants and
usable by the blind. (1) Incinerators with capacities of 50 pounds per
hour or more shall be in a separate room or out-
6.2.4 Installation and Testing doors; those with lesser capacities shall be permit-
6.2.4.1 Standards. Installation and testing of elevators ted to be in a separate area within the facility
shall comply with ANSI/ASME A17.1 for new con- boiler room.
struction and ANSI/ASME A17.3 for existing facilities.
(See ASCE/SEI 7 for seismic design and control system (2) Rooms and areas containing incinerators shall
requirements for elevators.) have adequate space and facilities for charging
and cleaning incinerators, as well as necessary
6.2.4.2 Documentation. Field inspections and tests clearances for work and maintenance.
shall be made and the owner shall be furnished with
written certification stating that the installation meets (3) Provisions shall be made for operation, temporary
the requirements set forth in this section as well as all storage, and disposal of materials so that odors
applicable safety regulations and codes. and fumes do not drift back into occupied areas.
196 2006 Guidelines for Design and Construction of Health Care Facilities
3 . 1 O U T PAT I E N T FA C I L I T I E S
*6.3.2.5 Environmental/health risk assessments performed, a separate water supply and drainage
facility that does not interfere with hand-washing
6.3.3 Nuclear Waste Disposal shall be provided.
See Code of Federal Regulations, title X, parts 20 and
35, concerning the handling and disposal of nuclear 7.1.2.3 Potable water supply systems. The following
materials in health care facilities. standards shall apply to potable water supply systems:
2006 Guidelines for Design and Construction of Health Care Facilities 197
3 . 1 O U T PAT I E N T FA C I L I T I E S
(b) Vacuum breakers or backflow prevention Where exposed overhead drain piping in these
devices shall be installed on hose bibs and areas is unavoidable, special provisions shall be
supply nozzles used for connection of hoses or made to protect the space below from leakage,
tubing in laboratories, housekeeping sinks, etc. condensation, or dust particles.
(4) Potable water storage vessels (hot and cold) not (2) Floor drains
intended for constant use shall not be installed.
(a) Floor drains shall not be installed in operat-
(5) Emergency eyewash and showers shall comply ing and delivery rooms.
with ANSI Z358.1.
*(b) If a floor drain is installed in cystoscopy, it
7.1.2.4 Hot water systems. See Section 1.6-2.2.1. shall contain a nonsplash, horizontal-flow
flushing bowl beneath the drain plate.
7.1.2.5 Drainage systems. The following standards shall
apply to drainage systems: (c) Dietary area floor drains and/or floor sinks
A7.1.2.5 (2)(b) Floor drains in cystoscopy operating rooms have (4) Kitchen grease traps
been shown to disseminate a heavily contaminated spray during
flushing. Unless flushed regularly with large amounts of fluid, the trap (a) Grease traps shall be of capacity required.
tends to dry out and permit passage of gases, vapors, odors, insects,
and vermin directly into the operating room. For new construction, (b) These shall be located and arranged to permit
if the users insist on a floor drain, the drain plate should be located easy access without the need to enter food
away from the operative site and should be over a frequently flushed preparation or storage areas.
nonsplash, horizontal-flow type of bowl, preferably with a closed sys-
tem of drainage. Alternative methods include (1) an aspirator/trap (c) These shall be accessible from outside the
installed in a wall connected to the collecting trough of the operating building without need to interrupt any
table by a closed, disposable tube system or (2) a closed system services.
using portable collecting vessels. (See NFPA 99.)
198 2006 Guidelines for Design and Construction of Health Care Facilities
3 . 1 O U T PAT I E N T FA C I L I T I E S
(5) Plaster traps. Where plaster traps are used, provi- (1) Efficiency. The mechanical system shall be
sions shall be made for appropriate access and designed for overall efficiency and life-cycle cost-
cleaning. ing. Details for cost-effective implementation of
design features are interrelated and too numerous
7.1.2.6 Condensate drains. See Section 1.6-2.1.2.2. (as well as too basic) to list individually.
(1) Handles on clinical sinks shall be at least 6 inches (b) Different geographic areas may have climatic
(15.24 centimeters) long. and use conditions that favor one system over
another in terms of overall cost and efficiency.
(2) Clinical sinks shall have an integral trap wherein
the upper portion of the water trap provides a (c) In no case shall patient care or safety be
visible seal. sacrificed for conservation.
7.1.3.2 Scrub sinks. Freestanding scrub sinks and lava- (d) Facility design features such as site, building
tories used for scrubbing in procedure rooms shall mass, orientation, configuration, fenestration,
be trimmed with foot, knee, or ultrasonic controls; and other features relative to passive and
single-lever wrist blades shall not be permitted. active energy systems shall be considered.
7.1.4 Medical Gas and Vacuum Systems (e) Use of recognized energy-saving mechanisms
7.1.4.1 Medical gas systems. If piped medical gas is such as variable-air-volume (VAV) systems,
used, the installation, testing, and certification of non- load shedding, programmed controls for unoc-
flammable medical gas and air systems shall comply cupied periods (nights and weekends, etc.),
with the requirements of NFPA 99. Station outlets and use of natural ventilation shall be consid-
shall be provided consistent with need established ered, site and climatic conditions permitting.
by the functional program. (See also Table 3.1-2.)
APPENDIX
7.1.4.2 Vacuum systems. Central vacuum systems. Where
the functional program requires, central clinical vacuum A7.2.2.1 Mechanical system design
system installations shall be in accordance with NFPA 99. a. Remodeling and work in existing facilities may present special
problems. As practicality and funding permit, existing insulation,
7.2 Heating, Ventilating, and Air-Conditioning (HVAC) weather stripping, etc., should be brought up to standard for
Systems maximum economy and efficiency. Consideration should be
given to additional work that may be needed to achieve this.
7.2.1 Applicability
b. Insofar as practical, the facility should include provisions for
These requirements do not apply to small primary
recovery of waste cooling and heating energy (ventilation, exhaust,
(neighborhood) outpatient facilities or outpatient
water and steam discharge, cooling towers, incinerators, etc.).
facilities that do not perform invasive applications or
procedures. See Section 3.3-6.2 for requirements for c. Systems with excessive installation and/or maintenance costs
small primary (neighborhood) outpatient facilities. that negate long-range savings should be avoided.
2006 Guidelines for Design and Construction of Health Care Facilities 199
3 . 1 O U T PAT I E N T FA C I L I T I E S
(2) Air-handling systems (2) Air change rates. Air supply and exhaust in rooms
for which no minimum total air change rate is
*(a) Air-handling systems shall be designed with noted may vary down to zero in response to room
an economizer cycle where appropriate to use load. For rooms listed in Table 2.1-2 , where VAV
outside air. systems are used, minimum total air change shall
be within limits noted.
(b) VAV systems. The energy-saving potential of VAV
systems is recognized, and the standards herein (3) Temperature and humidity. Space temperature and
are intended to maximize appropriate use of relative humidity shall be as indicated in Table 2.1-2 .
such systems. Any system used for occupied areas
shall include provisions to avoid air stagnation (4) Air movement direction. To maintain asepsis con-
in interior spaces where thermostat demands trol, airflow supply and exhaust shall be con-
are met by temperatures of surrounding areas. trolled to ensure general movement of air from
“clean” to “less clean” areas, especially in critical
(c) Non-central air-handling systems (i.e., individual areas. The ventilation systems shall be designed
room units used for heating and cooling purpos- and balanced according to the requirements in
es, such as fan-coil units, heat pump units, etc.) Table 2.1-2 and in the applicable notes.
shall meet the following requirements: These
units may be used as recirculating units only. All (5) Natural ventilation. Although natural window
outdoor air requirements shall be met by a sepa- ventilation for nonsensitive and patient areas
rate central air handling system with the proper shall be permitted, mechanical ventilation shall
filtration, as noted in Table 3.1-1. be provided for all rooms and areas in the facility.
(3) Vibration isolators. Mechanical equipment, duct- (6) Renovation. For renovation projects, prior to the
work, and piping shall be mounted on vibration start of construction and preferably during design,
isolators as required to prevent unacceptable airflow and static pressure measurements shall be
structure-borne vibration. taken at the connection points of new ductwork to
existing systems. This information shall be used by
(4) System valves. Supply and return mains and risers the designer to determine if existing systems have
for cooling, heating, and steam systems shall be sufficient capacity for intended new purposes, and
equipped with valves to isolate the various sec- so any required modifications to the existing sys-
tions of each system. Each piece of equipment tem can be included in the design documentation.
shall have valves at the supply and return ends.
7.2.2.3 Testing and documentation
7.2.2.2 Ventilation and space conditioning require-
ments. All rooms and areas used for patient care shall (1) Upon completion of the equipment installation
have provisions for ventilation. contract, the owner shall be furnished with a com-
plete set of manufacturers’ operating, maintenance,
(1) Ventilation rates. The ventilation rates shown in and preventive maintenance instructions, parts
Table 2.1-2 shall be used only as minimum stan- lists, and complete procurement information,
dards; they do not preclude the use of higher, including equipment numbers and descriptions.
more appropriate rates. Required information shall include energy ratings
as needed for future conservation calculations.
200 2006 Guidelines for Design and Construction of Health Care Facilities
3 . 1 O U T PAT I E N T FA C I L I T I E S
7.2.3 Ventilation Requirements for Specific Locations (b) During unoccupied hours, operating room
*7.2.3.1 Operating rooms air change rates may be reduced, provided
that the positive room pressure is maintained
(1) Air supply as required in Table 2.1-2.
(a) In new construction and major renovation 7.2.3.2 Cough-inducing procedure rooms. Rooms
work, air supply for operating rooms shall used for sputum induction, aerosolized pentamidine
be from non-aspirating ceiling diffusers with treatments, or other cough-inducing procedures shall
a face velocity in the range of 25 to 35 fpm meet the requirements of Table 2.1-2 for airborne
(0.13 to 0.18 m/s), located at the ceiling infection isolation rooms. If booths are used, refer
above the center of the work area. Return air to Section 2.1-5.8.1.
shall be near the floor level, at a minimum.
Return air shall be permitted high on the 7.2.3.3 Anesthesia storage rooms. The ventilation
walls, in addition to the low returns. system for anesthesia storage rooms shall conform to
the requirements of NFPA 99, including the gravity
(b) Each operating and delivery room shall have option. Mechanically operated air systems are
at least two return-air inlets located as far optional in this room.
from each other as practical.
7.2.3.4 ETO sterilizer space. The ventilation system for
(c) Turbulence and other factors of air move- the space that houses ethylene oxide (ETO) sterilizers
ment shall be considered to minimize the fall shall be designed as follows:
of particulates onto sterile surfaces.
(1) A dedicated (not connected to a return air or
(2) Temperature. Temperature shall be individually other exhaust system) exhaust system shall be
controlled for each operating room. provided. Refer to 29 CFR Part 1910.1047.
(3) Ventilation rates (2) All source areas shall be exhausted, including the
sterilizer equipment room, service/aeration areas,
(a) Operating room ventilation systems shall and the space above the sterilizer door, as well as
operate at all times, except during mainte- the aerator.
nance and conditions requiring shutdown by
the building’s fire alarm system.
APPENDIX
A7.2.3.1 Ventilation for operating rooms is set correctly. The non-aspirating diffuser array size should be set so
a. The operating and delivery room ventilation systems should oper- that it covers at least the area footprint of the table plus a reasonable
ate at all times to maintain the air movement relationship to adjacent margin around it. In the cited study, this margin is 21 inches (0.53
areas. The cleanliness of the spaces is compromised when the venti- meter) on the short side and 12 inches (0.3 meter) on the long side.
lation system is shut down. For example, airflow from a less clean If additional diffusers are required, they may be located outside this
space such as the corridor can occur, and standing water can accu- central diffuser array. Up to 30% of the central diffuser array may be
mulate in the ventilation system (near humidifiers or cooling coils). allocated to non-diffuser items (medical gas columns, lights, etc.).
b. The recommended air change rate in an operating room is 20 to 25 The recommended ventilation rates in the previous paragraph were
air changes per hour (ACH) for ceiling heights between 9 feet (2.74 derived from studies conducted by the National Institutes of Health
meters) and 12 feet (3.66 meters). The system should provide a sin- titled “Comparison of Operating Room Ventilation Systems in the
gle directional flow regime, with both high and low exhaust locations. Protection of the Surgical Site” (Memarzadeh 2002) and “Effect
A face velocity of around 25 to 35 fpm (0.13 to 0.18 m/s) is sufficient of Operation Room Geometry and Ventilation System Parameter
from the non-aspirating diffuser array provided that the array size itself Variations on the Protection of the Surgical Site” (Memarzadeh 2004).
2006 Guidelines for Design and Construction of Health Care Facilities 201
3 . 1 O U T PAT I E N T FA C I L I T I E S
(a) If the ETO cylinders are not located in a 7.2.3.6 Fuel-fired equipment rooms. Rooms with fuel-
well-ventilated, unoccupied equipment fired equipment shall be provided with sufficient out-
space, an exhaust hood shall be provided door air to maintain equipment combustion rates and
over the cylinders. to limit workstation temperatures.
(b) The relief valve shall be terminated in a well- 7.2.4 Thermal Insulation and Acoustical Provisions
ventilated, unoccupied equipment space or See Section 1.6-2.2.1.
outside the building.
7.2.5 HVAC Air Distribution
(c) If the floor drain to which the sterilizer(s) 7.2.5.1 Return air systems. All return air ventilation
discharges is not located in a well-ventilated, systems in patient care areas of outpatient surgery
unoccupied equipment space, an exhaust facilities shall be ducted.
drain cap shall be provided (coordinate with
local codes). 7.2.5.2 HVAC ductwork. See Section 1.6-2.2.2.1.
(3) General airflow shall be away from the sterilizer 7.2.5.3 Exhaust systems
operator(s).
(1) General
(4) A dedicated exhaust duct system for ETO shall
be provided. The exhaust outlet to the outside (a) To enhance the efficiency of recovery devices,
shall be at least 25 feet (7.62 meters) away from required for energy conservation, combined
any air intake. exhaust systems shall be permitted.
(5) An audible and visual alarm shall activate in the (b) Local exhaust systems shall be used whenever
sterilizer work area, and in a 24-hour staffed loca- possible in place of dilution ventilation to
tion, upon loss of airflow in the exhaust system. reduce exposure to hazardous gases, vapors,
fumes, or mists.
7.2.3.5 Food preparation centers. Exhaust hoods han-
dling grease-laden vapors in food preparation centers (c) Fans serving exhaust systems shall be located
shall meet the following requirements: at the discharge end and shall be readily
serviceable.
(1) Hoods shall comply with NFPA 96.
(d) Airborne infection isolation rooms shall not
(2) All hoods over cooking ranges shall be equipped be served by exhaust systems incorporating a
with grease filters, fire extinguishing systems, and heat wheel.
heat-actuated fan controls.
*(2) Anesthesia scavenging system. Each space routinely
(3) Cleanout openings shall be provided every 20 feet used for administering inhalation anesthesia and
(6.10 meters) and at changes in direction in the inhalation analgesia shall be served by a scaveng-
horizontal exhaust duct systems serving these ing system to vent waste gases.
hoods. Each horizontal duct run shall have at least
one cleanout opening. Horizontal runs of ducts (a) If a vacuum system is used, the gas-collecting
serving range hoods shall be kept to a minimum. system shall be arranged so that it does not
disturb patients’ respiratory systems.
APPENDIX
(b) Gases from the scavenging system shall be
A7.2.5.3 (2) See Industrial Ventilation: A Manual of Recommended exhausted directly to the outside. The anes-
Practice, published by the American Conference of Governmental thesia evacuation system may be combined
Industrial Hygienists (www.acgih.org), for additional information. with the room exhaust system, provided that
202 2006 Guidelines for Design and Construction of Health Care Facilities
3 . 1 O U T PAT I E N T FA C I L I T I E S
the part used for anesthesia gas scavenging (3) Gravity exhaust. Where conditions permit, gravity
exhausts directly to the outside and is not exhaust may be used for nonpatient areas such as
part of the recirculation system. boiler rooms, central storage, etc.
(c) Where anesthesia scavenging systems are (4) Construction requirements. The bottom of air dis-
required, air supply shall be at or near the tribution devices (supply/return/exhaust) shall be
ceiling. Return or exhaust air inlets shall be at least 3 inches (7.62 centimeters) above the floor.
near the floor level.
7.2.5.5 Ventilation hoods
(d) Scavenging systems are not required for areas
where gases are used only occasionally, such (1) Exhaust hoods and safety cabinets
as the emergency department, offices for
routine dental work, etc. (a) Hoods and safety cabinets are permitted to be
used for normal exhaust of a space provided
7.2.5.4 Air outlets and inlets minimum air change rates are maintained.
(1) Fresh air intakes (b) If air change standards in Table 2.1-2 do not pro-
vide sufficient air for proper operation of exhaust
(a) Fresh air intakes shall be located at least 25 hoods and safety cabinets (when in use), makeup
feet (7.62 meters) from exhaust outlets of air (filtered and preheated) shall be provided
ventilating systems, combustion equipment around these units to maintain the required air-
stacks, medical-surgical vacuum systems, flow direction and exhaust velocity. Use of make-
plumbing vents, or areas that may collect up air will avoid dependence upon infiltration
vehicular exhaust or other noxious fumes. from outdoor and/or from contaminated areas.
(Prevailing winds and/or proximity to other
structures may require greater clearances.) (c) Makeup systems for hoods shall be arranged
to minimize “short circuiting” of air and to
(b) The requirement for a 25-foot (7.62-meter) avoid reduction in air velocity at the point of
separation also pertains to the distance contaminant capture.
between the intake and the exhaust and/or
gas vent off packaged rooftop units. (2) Laboratory fume hoods. Laboratory fume hoods
shall meet the following general standards:
(c) Plumbing and vacuum vents that terminate
at a level above the top of the air intake may (a) General standards
be located as close as 10 feet (3.05 meters).
(i) Average face velocity of 75 feet per
(d) The bottom of outdoor air intakes serving minute (0.45 to 0.56 meters per second).
central systems shall be as high as practical,
but at least 6 feet (1.83 meters) above ground (ii) Connection to an exhaust system to the
level or, if installed above the roof, 3 feet outside that is separate from the building
(0.91 meter) above roof level. exhaust system
(2) Exhaust outlets. Exhaust outlets from areas that (iii) Location of an exhaust fan at the dis-
may be contaminated shall be above roof level, charge end of the system
arranged to minimize recirculation of exhaust air
into the building and directed away from personnel (iv) Inclusion of an exhaust duct system
service areas. of noncombustible corrosion-resistant
material as needed to meet the planned
usage of the hood.
2006 Guidelines for Design and Construction of Health Care Facilities 203
3 . 1 O U T PAT I E N T FA C I L I T I E S
(b) Special standards for use with strong oxidants (iii) Fume hoods intended for use with
radioactive isotopes shall be constructed
(i) Fume hoods, and their associated equip- of stainless steel or other material suitable
ment in the air stream intended for use for the particular exposure and shall com-
with perchloric acid and other strong ply with NFPA 801, Facilities for Handling
oxidants, shall be constructed of stain- Radioactive Materials. Note: Radioactive
less steel or other material consistent isotopes used for injections, etc., without
with special exposures. probability of airborne particulates or
gases may be processed in a clean-work-
(ii) These hoods and equipment shall be bench-type hood where acceptable to the
provided with a water wash and drain Nuclear Regulatory Commission.
system to permit periodic flushing of
duct and hood. 7.2.6 HVAC Filters
7.2.6.1 Filter efficiencies
(iii) Electrical equipment intended for
installation within such ducts shall be (1) All central ventilation or air conditioning systems
designed and constructed to resist pene- shall be equipped with filters with efficiencies equal
tration by water. Lubricants and seals to, or greater than, those specified in Table 3.1-1.
shall not contain organic materials.
(2) Non-central air handling systems shall be
(iv) When perchloric acid or other strong equipped with permanent (cleanable) or replace-
oxidants are only transferred from one able filters with a minimum efficiency of MERV 3
container to another, standard laborato- (68 percent weight arrestance).
ry fume hoods and the associated equip-
ment may be used in lieu of stainless (3) Filter efficiencies, tested in accordance with
steel construction. ASHRAE 52.1, shall be average.
(c) Special standards for use with infectious or 7.2.6.2 Filter bed location. Where two filter beds are
radioactive materials. In new construction required, filter bed no. 1 shall be located upstream of
and major renovation work, each hood used the air conditioning equipment and filter bed no. 2
to process infectious or radioactive materials shall be downstream of any fan or blowers.
shall meet the following requirements:
7.2.6.3 Filter frames. Filter frames shall be durable
(i) Each hood shall have a minimum face and proportioned to provide an airtight fit with the
velocity of 90 to 110 feet per minute enclosing ductwork. All joints between filter segments
(0.45 to 0.56 meters per second) with and enclosing ductwork shall have gaskets or seals to
suitable pressure-independent air-mod- provide a positive seal against air leakage.
ulating devices and alarms to alert staff
of fan shutdown or loss of airflow. 7.2.6.4 Filter manometers. A manometer shall be
installed across each filter bed having a required
(ii) Each hood shall have filters with a 99.97 efficiency of 75 percent or more, including hoods
percent efficiency (based on the DOP requiring HEPA filters. Provisions shall be made to
test method) in the exhaust stream, and allow access for field testing.
be designed and equipped to permit the
safe removal, disposal, and replacement 7.2.7 Steam and Hot Water Systems
of contaminated filters. Filters shall be as See Section 1.6-2.2.3.
close to the hood as practical to mini-
mize duct contamination.
204 2006 Guidelines for Design and Construction of Health Care Facilities
3 . 1 O U T PAT I E N T FA C I L I T I E S
(2) All electrical material and equipment shall be list- (3) Panelboards serving life safety emergency circuits
ed as complying with available standards of listing may also serve floors above and/or below.
agencies or other similar established standards
where such standards are required. 7.3.2.3 Ground-fault circuit interrupters
7.3.1.2 Testing and documentation. Electrical installa- 7.3.3 Power Generating and Storing Equipment
tions, including alarm and communication systems, 7.3.3.1 Emergency electrical service. Emergency light-
shall be tested to demonstrate that equipment installa- ing and power shall be provided for in accordance
tion and operation is appropriate and functional. A with NFPA 99, NFPA 101, and NFPA 110.
written record of performance tests on special electri-
cal systems and equipment shall show compliance 7.3.4 Lighting
with applicable codes and standards. 7.3.4.1 General. See Section 1.6-2.3.1.1.
7.3.1.3 Power disturbance safeguards. Data processing 7.3.4.2 Lighting for specific locations in the outpatient
and/or automated laboratory or diagnostic equipment, facility
if provided, may require safeguards from power line
disturbances. (1) Exam/treatment/trauma rooms. A portable or
fixed examination light shall be provided for
7.3.2 Electrical Distribution and Transmission examination, treatment, and trauma rooms.
7.3.2.1 Switchboards
(2) Operating and delivery rooms. Operating and
(1) Location delivery rooms shall have general lighting in addi-
tion to special lighting units provided at surgical
(a) Main switchboards shall be located in an and obstetrical tables. General lighting and special
area separate from plumbing and mechanical lighting shall be on separate circuits.
equipment and shall be accessible to author-
ized persons only. 7.3.4.3 Emergency lighting. See Section 1.6-2.3.1.2.
(b) Switchboards shall be convenient for use and 7.3.5 Receptacles (Convenience Outlets)
readily accessible for maintenance but away 7.3.5.1 Duplex grounded-type receptacles (conven-
from traffic lanes. ience outlets) shall be installed in all areas in sufficient
quantities for tasks to be performed as needed.
(c) Switchboards shall be located in dry, ventilated
spaces free of corrosive or explosive fumes or 7.3.5.2 Each examination and worktable shall have
gases or any flammable material. access to a minimum of two duplex receptacles.
2006 Guidelines for Design and Construction of Health Care Facilities 205
3 . 1 O U T PAT I E N T FA C I L I T I E S
7.3.6 Equipment
7.3.6.1 X-ray equipment. Fixed and mobile x-ray
equipment installations shall conform to articles 517
and 660 of NFPA 70.
206 2006 Guidelines for Design and Construction of Health Care Facilities
3 . 1 O U T PAT I E N T FA C I L I T I E S
Table 3.1-1
Filter Efficiencies for Central Ventilation and Air Conditioning Systems in Outpatient Facilities
Laboratories 1 13 (80%) —
These requirements do not apply to small primary (neighborhood) outpatient facilities or outpatient facilities that do not perform invasive applications or procedures.
1
Notes
1. Additional roughing or prefilters should be considered to reduce maintenance required for main filters.
2. MERV = minimum efficiency reporting value. MERVs are based on ASHRAE 52.2.
3. The filtration efficiency ratings are based on average dust spot efficiency per ASHRAE 52.1.
Table 3.1-2
Station Outlets for Oxygen, Vacuum, and Medical Air in Outpatient Facilities
2006 Guidelines for Design and Construction of Health Care Facilities 207
3.2 Primary Care Outpatient Centers
Appendix material, which appears in shaded boxes at the bottom of the page, is advisory only.
3.1.2 Reception
APPENDIX 3.1.2.1 Reception/information counter. A reception
and information counter or desk shall be located to
A2.1 Examination rooms and services as described in Section 3.1- provide visual control of the entrance to the outpa-
2.1 may be provided. In addition, offices and/or practitioner tient unit and shall be immediately apparent from
consultation rooms may be combined with examination rooms. that entrance.
208 2006 Guidelines for Design and Construction of Health Care Facilities
3 . 2 P R I M A R Y C A R E O U T PAT I E N T C E N T E R S
3.1.2.2 Control counter. A control counter shall be pro- 3.2.5 Supply Storage
vided with access to patient files and records for sched- Office supply storage (closets or cabinets) shall be
uling of services. This shall be permitted to be part of provided within or convenient to administrative areas.
the reception, information, and waiting room control.
3.2.6 Support Areas for Staff
3.1.3 Waiting Area A staff toilet and lounge in addition to and separate
3.1.3.1 The waiting area for patients and escorts shall from public and patient facilities.
be under staff control.
3.1.3.2 The seating area shall contain not fewer than two 4 Building Systems
spaces for each examination and/or treatment room.
4.1 Plumbing
3.1.3.3 Where the outpatient unit has a formal pedi- All standards set forth in Section 3.1-7.1 of the
atrics service, a separate, controlled area for pediatric Outpatient Facilities shall be met.
patients shall be provided.
4.2 Heating, Ventilating, and Air-Conditioning
3.1.3.4 Wheelchairs shall be accommodated within the Systems
waiting area. All standards set forth in Section 3.1-7.2 of the
Outpatient Facilities chapter shall be met.
3.1.4 Provisions for Drinking Water
Drinking water shall be available for waiting patients.
In shared facilities, provisions for drinking water may
be outside the outpatient area if convenient for use.
3.2.1 Office(s)
3.2.1.1 Office(s), separate and enclosed, with provisions
for privacy shall be provided.
2006 Guidelines for Design and Construction of Health Care Facilities 209
3.3 Small Primary (Neighborhood) Outpatient Facilities
210 2006 Guidelines for Design and Construction of Health Care Facilities
3 . 3 S M A L L P R I M A R Y ( N E I G H B O R H O O D ) O U T PAT I E N T FA C I L I T I E S
(2) Biological and drug storage. Locked storage for 3.2.1 Office
biologicals and drugs shall be provided. An office area for business transactions, records, and
other administrative functions, separate from public
2.2 Diagnostic Facilities and patient areas, shall be provided.
2.2.1.2 Standards. When these services are provided 3.2.3 Staff Storage
within the facility, spaces to accommodate them shall Locked storage (cabinets or secure drawers) convenient
meet the standards of Section 3.1-2. to workstations shall be provided for staff valuables.
2.2.2 Laboratory
Laboratory services and/or facilities shall meet the 4 Construction Standards
following standards:
Every building and every portion thereof shall be
2.2.2.1 Specimen collection. Urine collection rooms designed and constructed to sustain all dead and live
shall be equipped with a water closet and hand-washing loads in accordance with accepted engineering prac-
station. Use of the toilet room provided within the tices and standards. If existing buildings are converted
examination and treatment room for specimen collec- for use, consideration shall be given to the structural
tion shall be permitted. requirements for concentrated floor loadings, including
x-ray equipment, storage files, and similar heavy
2.2.2.2 Blood collection. Blood collection facilities equipment that may be added.
shall have space for a chair and work counter.
3.1 Public Areas 5.1.1 Systems shall comply with applicable codes, be
Public areas shall include the following: free of leaks, and be designed to supply water at suffi-
cient pressure to operate all fixtures and equipment
3.1.1 Reception during maximum demand.
A reception and information center or desk shall be
provided. 5.1.2 Backflow preventers (vacuum breakers) shall be
installed on all water supply outlets to which hoses or
3.1.2 Waiting Area tubing can be attached.
This space shall include provisions for wheelchairs.
5.1.3 Water temperature at lavatories shall not exceed
3.2 Administrative Areas 110oF (43oC).
2006 Guidelines for Design and Construction of Health Care Facilities 211
3 . 3 S M A L L P R I M A R Y ( N E I G H B O R H O O D ) O U T PAT I E N T FA C I L I T I E S
5.3.1 Testing
Prior to completion and acceptance of the facility,
all electrical systems shall be tested and operated
to demonstrate that installation and performance
conform to applicable codes and functional needs.
5.3.2 Lighting
5.3.2.1 Lighting shall be provided in all facility spaces
occupied by people, machinery, and/or equipment,
and in outside entryways.
5.3.3 Receptacles
Sufficient duplex grounded-type receptacles shall be
available for necessary task performance. Each exami-
nation and work table area shall be served by at least
one duplex receptacle.
212 2006 Guidelines for Design and Construction of Health Care Facilities
3.4 Freestanding Outpatient Diagnostic and Treatment Facilities
Appendix material, which appears in shaded boxes at the bottom of the page, is advisory only.
1 Applicability
1.2 Standards
The general standards for outpatient facilities set
forth in Sections 1 through 5 of Chapter 3.1 (General
Considerations, Diagnostic and Treatment Locations,
Service Areas, Administrative and Public Areas, and
Construction Standards) shall be met for the free-
standing outpatient diagnostic and treatment facility,
with two modifications:
APPENDIX
2006 Guidelines for Design and Construction of Health Care Facilities 213
3.5 Freestanding Urgent Care Facilities
1.2.2.3 Street, public, and shared lot spaces, if included (1) Where a procedure room is set up for multi-
as part of this standard, shall be exclusively for the use patient use, each patient area shall have a mini-
of the urgent care facility. mum clear area of 250 net square feet (23.23
square meters) excluding vestibule, toilet, closet,
1.2.2.4 All required parking spaces shall be convenient and fixed casework.
to the urgent care entrance.
(2) Room arrangement shall permit a minimum
clearance of 3 feet 6 inches (1.07 meters) at each
2 Diagnostic and Treatment Locations side, head, and foot of the bed.
2.1 Examination and Treatment Rooms 2.1.2.3 Scrub stations. Hands-free scrub stations shall
In addition to the requirements of Section 3.1-2.1, the be located at each procedure room.
following shall be provided:
214 2006 Guidelines for Design and Construction of Health Care Facilities
3 . 5 F R E E S TA N D I N G U R G E N T C A R E FA C I L I T I E S
2006 Guidelines for Design and Construction of Health Care Facilities 215
3 . 5 F R E E S TA N D I N G U R G E N T C A R E FA C I L I T I E S
Administrative and public areas shall conform to the (1) Urgent care waiting area
standards in Section 3.1-4, with the following additions.
(a) This shall include provisions for wheelchairs.
3.1 Public Areas
(b) This shall be separate from the area provided
3.1.1 Entrances for scheduled outpatient service.
3.1.1.1 Entrances shall be well marked, illuminated,
and covered to permit protected transfer of patients (2) Diagnostic imaging waiting area. If the urgent care
from ambulance and/or automobile. facility ICRA determines that the diagnostic imag-
ing waiting area requires special consideration to
3.1.1.2 The urgent care entrance shall have vision reduce the risk of airborne infection transmission,
panels to minimize conflict between incoming and public waiting areas shall be designed, ventilated,
outgoing traffic and to allow for observation of the and maintained with available technologies such
unloading area from the control station. as enhanced general ventilation and air disinfec-
tion techniques similar to inpatient requirements
3.1.1.3 Accessibility for airborne infection isolation rooms. See the
CDC “Guidelines for Preventing the Transmission
(1) Convenient access to wheelchairs and stretchers of Mycobacterium tuberculosis in Health Care
shall be provided at the urgent care entrance. Settings” (full reference at 1.1-7.5.1).
3.1.2 Lobby and Waiting Areas 3.1.3.1 Facilities for conducting interviews on means
These shall satisfy the following requirements: of reimbursement, social services, and personal data
shall include provisions for acoustical privacy.
3.1.2.1 Reception
Reception and information functions may be com- 3.1.3.2 These facilities shall be permitted to be separate
bined or separate. These areas shall meet the following from the reception area but must be convenient to the
requirements: urgent care service waiting area.
(1) These areas shall provide direct visual control of 3.2 Administrative Areas
the urgent care entrance and access to the treat-
ment area and the lobby. Urgent care entrance 3.2.1 Offices
control functions shall include observation of For standards concerning general and individual
arriving vehicles. offices, see Section 3.1-4.2.2.
(2) Control stations normally include a triage func- 3.2.2 Multipurpose Rooms
tion and shall be in direct communication with Multipurpose room(s) shall be provided for staff con-
medical staff. ferences. This room may also serve for consultation.
216 2006 Guidelines for Design and Construction of Health Care Facilities
3 . 5 F R E E S TA N D I N G U R G E N T C A R E FA C I L I T I E S
4 Construction Standards
5 Building Systems
5.1 Plumbing
See Section 3.1-7.1 for applicable plumbing standards.
2006 Guidelines for Design and Construction of Health Care Facilities 217
3.6 Freestanding Birthing Centers
The freestanding birthing center is “any health facility, 2.1.3 Space Requirements
place, or institution that is not a hospital and where Birthing rooms shall be adequate in size to accommo-
births are planned to occur away from the mother’s date one patient, her family, and attending staff.
usual place of residence” (American Public Health
Association, 1982). 2.1.3.1 Area and dimensions
218 2006 Guidelines for Design and Construction of Health Care Facilities
3 . 6 F R E E S TA N D I N G B I R T H I N G C E N T E R S
2.2.4.2 Emergency equipment. An area for maternal 4.1.1.2 Childproof electrical outlets. These shall be used
and newborn emergency equipment and supplies in public areas of the freestanding birthing center.
(carts or trays) shall be designated out of the direct
line of traffic and conveniently accessible to the 4.1.2 Entrance
birthing rooms. 4.1.2.1 The entrance to the birthing center shall be at
ground level, well marked and illuminated.
2.3 Support Areas for Staff
A secure storage space for personal effects, toilet, 4.1.2.2 Provisions shall be made for emergency vehicle
shower, change, and lounge area sufficient to accom- access.
modate staff needs shall be provided.
4.1.3 Reception
2.4 Support Areas for Patients A reception area with facility to accommodate outdoor
Toilet, hand-washing station, and bath/shower facili- wear shall be provided.
ties with appropriately placed grab bars shall be adja-
cent to each birthing room. Bath/shower facilities shall 4.1.4 Family Room
not be shared by more than two birthing rooms. A family room with a designated play area for children
shall be provided.
2006 Guidelines for Design and Construction of Health Care Facilities 219
3 . 6 F R E E S TA N D I N G B I R T H I N G C E N T E R S
4.1.7 Telephone
Convenient access to telephone service shall be provided.
4.2.1 Records
Space for performing administrative functions, chart-
ing, and secure record storage shall be provided.
220 2006 Guidelines for Design and Construction of Health Care Facilities
3.7 Outpatient Surgical Facilities
Appendix material, which appears in shaded boxes at the bottom of the page, is advisory only.
2006 Guidelines for Design and Construction of Health Care Facilities 221
3 . 7 O U T PAT I E N T S U R G I C A L FA C I L I T I E S
APPENDIX
A1.5.2 Outpatient Surgical Facility Layout A2.3.1 American College of Surgeons Surgical Facility
a. The unrestricted area includes a central control point estab- Classes
lished to monitor the entrance of patients, personnel, and materi- a. Class A–Provides for minor surgical procedures performed
als into the restricted areas. Street clothes are permitted in this under topical and local infiltration blocks with or without oral
area, and traffic is not limited. or intramuscular preoperative sedation. Excluded are spinal,
epidural axillary, stellate ganglion blocks, regional blocks (such
b. The semi-restricted area includes the peripheral support areas
as interscalene), supraclavicular, infraclavicular, and intravenous
of the surgical suite and has storage areas for clean and sterile
regional anesthesia. These methods are appropriate for Class B
supplies, work areas for storage and processing of instruments,
and C facilities.
and corridors leading to the restricted areas of the surgical suite.
Traffic in this area is limited to authorized personnel and patients. b. Class B–Provides for minor or major surgical procedures
Personnel are required to wear surgical attire and cover all head performed in conjunction with oral, parenteral, or intravenous
and facial hair. sedation or under analgesic or dissociative drugs.
c. The restricted area includes operating and procedure rooms, c. Class C–Provides for major surgical procedures that require
the clean core, and scrub sink areas. Surgical attire and hair general or regional block anesthesia and support of vital bodily
coverings are required. Masks are required where open sterile functions.
supplies or scrubbed persons may be located.
Note: Those facilities meeting the guidelines for Class B proce-
A2 Provisions should be made to separate pediatric from adult dures automatically qualify for Class A procedures, and those
patients. Separate areas should include pre- and postoperative facilities meeting the guidelines for Class C automatically qualify
care areas and should allow for parental presence. for Classes A and B.
222 2006 Guidelines for Design and Construction of Health Care Facilities
3 . 7 O U T PAT I E N T S U R G I C A L FA C I L I T I E S
feet (45.72 square meters) with a minimum clear 2.3.2 Emergency Communication System
dimension of 12 feet (3.65 meters). This square All operating rooms shall be equipped with an emer-
footage and minimum dimensions shall exclude gency communication system connected with the
vestibule and fixed casework. control station.
(2) Clearances. There shall be a minimum clear dis- *2.3.3 Image Viewer
tance of 3 feet 6 inches (1.07 meters) at each side, There shall be at least one medical image viewer in
the head, and the foot of the operating table. each room.
(3) Location. These minor surgical procedure rooms 2.3.4 Mechanical System and Medical Gas
may be located within the restricted corridors of Requirements
the surgical suite or in an unrestricted corridor See Tables 2.1-2 and 3.1-2 for mechanical system and
adjacent to the surgical suite. medical gas requirements.
(3) Location. These major surgical procedure rooms A2.3.3 For surgeries dependent upon medical imaging, such as
shall be located within the restricted corridors of many orthopedic procedures, medical image viewers should be
the surgical suite. provided in each operating room.
2006 Guidelines for Design and Construction of Health Care Facilities 223
3 . 7 O U T PAT I E N T S U R G I C A L FA C I L I T I E S
*(1) Number. A minimum of one recovery station per (2) In Phase II or stepdown units, a nurse utility/
operating room shall be provided. control station with visualization of patients is
not required.
(2) Area and clearances. Each post-anesthetic care
unit (PACU) shall provide a minimum clear floor 2.4.2.2 Space requirements. The design shall provide
area of 80 square feet (7.43 square meters) for a minimum of 50 square feet (4.65 square meters) for
each patient station with a space for additional each patient in a lounge chair with space for addition-
equipment described in the functional program al equipment described in the functional program and
and for clearance of at least 5 feet (1.52 meters) for clearance of 4 feet (1.22 meters) between the sides
between patient stretchers and 4 feet (1.22 of the lounge chairs and the foot of the lounge chairs.
meters) between patient stretchers and adjacent
walls (at the stretcher’s sides and foot). 2.4.2.3 Patient privacy. Provisions for patient privacy
such as cubicle curtains shall be made.
(3) Patient privacy. Provisions for patient privacy
such as cubicle curtains shall be made. 2.4.2.4 Facility requirements. The step-down room
shall contain hand-washing station(s), storage space
(4) Hand-washing stations. Hand-washing stations for supplies and equipment, clinical work space, space
with hands-free or wrist blade-operable controls for family members, and nourishment facilities.
shall be available, with at least one station for
every four stretchers or portion thereof, and uni- 2.4.2.5 Patient toilet room. A patient toilet room shall
formly distributed to provide equal access from be provided in the Phase II recovery area for the exclu-
each patient position. sive use of patients. In facilities with two or fewer
operating rooms and an outpatient surgery change
2.4.1.3 Support areas for post-anesthesia recovery rooms area adjacent to the recovery area, the toilet required
by Section 3.7-2.6.11 shall be permitted to meet this
(1) Facility requirements. The recovery areas shall requirement.
include provisions for staff hand-washing station,
medication preparation and dispensing, supply 2.5 Support Areas for Surgical Service Areas
storage, soiled linen and waste holding, and chart- The following shall be provided in surgical service
ing and dictation. areas:
(2) Equipment storage. The recovery areas shall 2.5.1 Control Station
include dedicated space as needed to keep equip- A control station shall be located to permit visual sur-
ment (warming cabinet, ice machine, crash cart, veillance of all traffic entering the restricted corridor
etc.) out of required circulation clearances. (access to operating rooms and other ancillary
clean/sterile areas).
2.4.2 Phase II Recovery
2.4.2.1 General 2.5.2 Scrub Facilities
(1) A Phase II or stepdown recovery room shall be (1) Station(s) shall be provided near the entrance to
provided. each operating room and may service two operat-
ing rooms if needed.
APPENDIX
(2) Scrub facilities shall be arranged to minimize
2.4.1.2 (1) In the absence of a functional program, recovery posi- splatter on nearby personnel or supply carts.
tions should be considered at a ratio of one per Class A operating
room, two per Class B operating room, and three per Class C oper- 2.5.3 Drug Distribution Station
ating room. Up to half the total recovery positions may be provided A drug distribution station shall be provided.
in the Phase II recovery area.
224 2006 Guidelines for Design and Construction of Health Care Facilities
3 . 7 O U T PAT I E N T S U R G I C A L FA C I L I T I E S
(1) Provisions shall be made for storage and prepara- 2.5.7.2 Medical gas storage. Provisions shall be made
tion of medications administered to patients. for the medical gas(es) used in the facility. Adequate
space for supply and storage, including space for
(2) A refrigerator for pharmaceuticals and double- reserve cylinders, shall be provided.
locked storage for controlled substances shall be
provided. 2.5.7.3 General equipment and supply storage.
Equipment storage room(s) shall be provided for
(3) Convenient access to hand-washing stations shall equipment and supplies used in the surgical suite.
be provided.
(1) Area. The combined area of equipment and supply
2.5.4 Soiled Workroom storage room(s) shall have a minimum floor area
A soiled workroom shall be provided. This may be the of 50 square feet (15.24 square meters) for each
same workroom described in Section 3.7-3.1.2.1. operating room(s) up to two and an additional 25
square feet (7.62 square meters) per additional
(1) The soiled workroom shall contain a clinical sink operating room.
or equivalent flushing-type fixture, a work counter,
a hand-washing station, and waste receptacle(s). (2) Location. Equipment storage room(s) shall be
located within the semi-restricted area.
(2) The soiled workroom shall be located within the
semi-restricted area. 2.5.7.4 A stretcher storage area. A stretcher storage
area shall be convenient for use and out of the direct
2.5.5 Sterilizing Facilities line of traffic.
Space shall be provided for a high-speed sterilizer or
other sterilizing equipment for immediate or emer- 2.5.7.5 Wheelchair storage. Space shall be provided for
gency use, as called for in the functional program. temporary storage of wheelchairs.
(1) This space shall be located in the restricted area. 2.5.7.6 Emergency equipment/supply storage.
Provisions shall be made for convenient access to and
(2) The space shall include a separate area for clean- use of emergency resuscitation equipment and sup-
ing and decontamination of instruments prior to plies (crash cart(s) and/or anesthesia carts) at both
sterilization. the surgical and recovery areas.
2006 Guidelines for Design and Construction of Health Care Facilities 225
3 . 7 O U T PAT I E N T S U R G I C A L FA C I L I T I E S
(1) The area(s) shall contain lockers, toilet(s), hand- 3.1.1.2 Provisions shall be made for sanitizing clean
washing station(s), and space for donning scrub and soiled carts and/or vehicles consistent with the
attire. needs of the particular transportation system.
2.7 Support Areas for Patients (1) The soiled workroom shall be located in the semi-
restricted area.
2.7.1 Outpatient Surgery Change Area(s)
A separate area shall be provided for outpatients to (2) The soiled workroom shall contain a flushing-rim
change from street clothing into hospital gowns and to clinical sink or equivalent flushing-rim fixture, a
prepare for surgery. hand-washing station, a work counter, and space
for waste receptacles and soiled linen receptacles.
2.7.1.1 This area shall include lockers, toilet(s), cloth- Rooms used only for temporary holding of soiled
ing change or gowning area(s), and space for adminis- material may omit the flushing-rim clinical sink
tering medications. and work counters. However, if the flushing-rim
clinical sink is omitted, other provisions for
2.7.1.2 Provisions shall be made for securing patients’ disposal of liquid waste shall be provided.
personal effects.
(3) The room shall not have direct connection with oper-
ating rooms. Soiled and clean workrooms or holding
3 Service Areas rooms shall be separated. A self closing door or pass-
through opening for decontaminated instruments is
3.1 Sterilizing Facilities permitted between soiled and clean workrooms.
A system for sterilizing equipment and supplies shall
be provided. *3.1.2.2 Clean assembly/workroom. This room shall
contain sterilization equipment.
3.1.1 General
3.1.1.1 When sterilization is provided off site, a room (1) This room shall contain a hand-washing station,
for the adequate handling (receiving and distribution) workspace, and equipment for terminal sterilizing
and on-site storage of sterile supplies shall be provided of medical and surgical equipment and supplies.
that conforms to Section 3.7-3.1.2.3.
(2) Clean and soiled work areas shall be physically
APPENDIX separated.
A3.1.2.2 This room is exclusively for the inspection, assembly, (3) Access to this room shall be restricted.
and packaging of medical/surgical supplies and equipment for
sterilization. The area should contain worktables or counters and (4) The clean assembly room shall have adequate
storage facilities for backup supplies and instrumentation. An space for the designated number of work areas as
area for a drying cabinet or equipment may be required. The area defined in the functional program, as well as
should be spacious enough to hold sterilizer carts, if used, for space for storage of clean supplies, sterilizer car-
loading or prepared supplies for sterilization. riages (if used), and instrumentation.
226 2006 Guidelines for Design and Construction of Health Care Facilities
3 . 7 O U T PAT I E N T S U R G I C A L FA C I L I T I E S
3.1.2.3 Storage for clean/sterile supplies 4.2.6 Support Areas for Staff
Special storage, including locking drawers and/or cabi-
(1) Storage for packs, etc., shall include provisions for nets, for the personal effects of administrative staff.
ventilation, humidity, and temperature control.
(2) The clean and sterile supply room shall have a 5 Construction Standards
minimum floor area of 100 square feet (30.48
square meters) or 50 square feet (15.24 square 5.1 Design and Construction, including Fire-Resistant
meters) per operating room, whichever is greater. Standards
4.1 Public Areas 5.1.2 Separation for hazardous areas and smoke sepa-
ration shall conform to NFPA 101.
*4.1.1 Entrance
A covered entrance shall be provided for pickup of 5.1.3 Flammable anesthetics shall not be used in out-
patients after surgery. patient surgical facilities.
4.2 Administrative Areas 5.2 General Standards for Details and Finishes
In addition to the standards in Section 3.1-5.2, the
4.2.1 Interview Space guidelines in this section shall be met.
Interview space(s) for private interviews relating to
admission shall be provided. This may be the same 5.2.1 Details
room required under Section 3.7-4.2.4. Details shall conform to the following guidelines:
2006 Guidelines for Design and Construction of Health Care Facilities 227
3 . 7 O U T PAT I E N T S U R G I C A L FA C I L I T I E S
5.2.1.2 Exits. The outpatient surgical facility shall have (c) Perforated, tegular, serrated, or highly tex-
not fewer than two exits to the exterior. Exits shall tured tiles shall not be used.
conform to NFPA 101.
(2) Restricted areas. Ceilings in restricted areas such
5.2.1.3 Door width as operating rooms shall be monolithic, scrub-
bable, and capable of withstanding chemicals.
(1) Doors serving occupiable spaces shall have a mini- Cracks or perforations in these ceilings are not
mum nominal width of 3 feet (91.44 centimeters). allowed.
(2) Doors requiring gurney/stretcher access shall have (3) Mechanical and electrical rooms. Suspended ceilings
a nominal width of 3 feet 8 inches (1.12 meters). may be omitted in mechanical and electrical rooms/
spaces unless required for fire safety purposes.
5.2.1.4 Toilet rooms. Toilet rooms for patient use in sur-
gery and recovery areas shall comply with the following: 5.2.2.3 Floors. Floor finishes shall be appropriate for the
areas in which they are located and shall be as follows:
(1) These toilet rooms shall be equipped with doors
and hardware that permit access from the outside (1) Floor finishes shall be cleanable.
in emergencies.
(2) Floor finishes in areas such as clean corridors,
(2) When such rooms have only one opening or are central sterile supply spaces, specialized radi-
small, the doors shall open outward or be other- ographic rooms, and Class A operating rooms
wise designed to open without pressing against a shall be washable, smooth, and able to withstand
patient who may have collapsed within the room. chemical cleaning.
5.2.2.2 Ceilings. Ceiling finishes shall be appropriate (4) All floor surfaces in clinical areas shall be con-
for the areas in which they are located and shall be as structed of materials that allow the easy move-
follows: ment of all required wheeled equipment.
(1) Semi-restricted areas 5.2.2.4 Walls. Wall finishes shall be appropriate for the
areas in which they are located and shall be as follows:
(a) Ceiling finishes in semi-restricted areas such
as clean corridors, central sterile supply (1) Wall finishes shall be cleanable.
spaces, specialized radiographic rooms, and
Class A operating rooms shall be smooth, (2) Wall finishes in areas such as clean corridors, cen-
scrubbable, nonabsorptive, nonperforated, tral sterile supply spaces, specialized radiographic
capable of withstanding cleaning with chemi- rooms, and minor surgical procedure rooms shall
cals, and without crevices that can harbor be washable, smooth, and able to withstand
mold and bacteria growth. chemical cleaning.
(b) If a lay-in ceiling is used, it shall be gasketed (3) Wall finishes in areas such as operating rooms,
or clipped down to prevent the passage of delivery rooms, and trauma rooms shall be scrub-
particles from the cavity above the ceiling bable, able to withstand chemical cleaning, and
plane into the semi-restricted environment. monolithic. See also Section 3.8-4.1.2.2.
228 2006 Guidelines for Design and Construction of Health Care Facilities
3 . 7 O U T PAT I E N T S U R G I C A L FA C I L I T I E S
6 Building Systems
6.1 Plumbing
See Section 3.1-7.1.
6.2.1 General
Heating, ventilating, and air-conditioning (HVAC)
systems shall be as described for similar areas in
Section 3.1-7.2 and Table 2.1-2, with the following
exceptions:
6.2.2 Filters
See Table 3.1-1 for filter efficiency standards.
2006 Guidelines for Design and Construction of Health Care Facilities 229
3.8 Office Surgical Facilities
An office surgical facility is an outpatient facility that 2.3 Support Areas for Operating Rooms
has within it physician office(s) and space(s) for the The following shall be immediately accessible to the
performance of invasive procedures. operating room(s):
230 2006 Guidelines for Design and Construction of Health Care Facilities
3 . 8 O F F I C E S U R G I C A L FA C I L I T I E S
2.4 Support Areas for Staff (4) The clean assembly room shall have adequate
A staff clothing change area shall be provided. space for the designated number of work areas as
defined in the functional program.
3.1 Sterilizing Facilities (1) Storage for packs, etc., shall include provisions for
A system for sterilizing equipment and supplies shall ventilation, humidity, and temperature control.
be provided.
(2) A system for sterilizing equipment and supplies
3.1.1 General shall be provided. When sterilization is provided
3.1.1.1 When sterilization is provided off site, adequate off site, adequate handling and on-site storage of
handling (receiving and distribution) and on-site stor- sterile supplies shall be provided.
age of sterile supplies must be accommodated and shall
meet the minimum requirements for on-site facilities. (3) Provision shall be made for cleaning and sanitizing
of carts and vehicles used for transporting supplies.
3.1.1.2 Provisions shall be made for the cleaning and
sanitizing of clean and soiled carts and vehicles trans- 3.1.2.4 Soiled holding area
porting supplies.
(1) Space shall be provided for handling and storage
3.1.2 On-Site Facilities of soiled materials and equipment separate from
If on-site processing facilities are provided, they shall areas designated for storage of clean and sterile
include the following: materials and equipment.
(3) Clean and soiled work areas shall be physically (1) The minimum nominal door width for patient
separated. use shall be 3 feet (0.91 meter) except that doors
2006 Guidelines for Design and Construction of Health Care Facilities 231
3 . 8 O F F I C E S U R G I C A L FA C I L I T I E S
(2) Toilet room doors for patient use shall open out-
ward or be equipped with hardware that permits
access from the outside in emergencies.
4.1.2 Finishes
4.1.2.1 Ceilings
232 2006 Guidelines for Design and Construction of Health Care Facilities
3.9 Gastrointestinal Endoscopy Facilities
Appendix material, which appears in shaded boxes at the bottom of the page, is advisory only.
1.5 Facility Layout and Circulation A1.3 Visual and acoustical privacy should be provided by design
and include the registration, preparation, examination, treatment,
and recovery areas.
2006 Guidelines for Design and Construction of Health Care Facilities 233
3 . 9 G A S T R O I N T E S T I N A L E N D O S C O P Y FA C I L I T I E S
2.3 Procedure Suite (2) The following shall be provided in this area:
(2) Clearances. Room arrangement shall permit a min- 2.3.3 Support Areas for the Procedure Suite
imum clearance of 3 feet, 6 inches (1.07 meters) at 2.3.3.1 Nurse station. Nurse control and charting area
each side, head, and foot of the stretcher/table. that provides view of patient positions shall be provided.
2.3.1.2 Privacy. Procedure rooms shall be designed for 2.3.3.2 Medication station. Provisions shall be made
visual and acoustical privacy for the patient. for storage and preparation of medications adminis-
tered to patients.
2.3.1.3 Medical gases. Station outlets for oxygen and
vacuum (suction) shall be available in the procedure (1) A refrigerator for pharmaceuticals and double-
room. See Table 3.1-2. locked storage for controlled substances shall be
provided.
2.3.1.4 Hand-washing station. A separate dedicated
hand-washing station with hands-free controls shall be (2) Convenient access to hand-washing stations shall
available in the suite. be provided.
2.3.1.5 Patient toilet room. Direct access may be 2.3.3.3 Toilet facilities. These shall be permitted to be
provided to a patient toilet room. (See also Section accessible from patient holding or directly from proce-
3.9-2.3.3.3.) dure room(s) or both.
2.3.1.6 Communication system. A system for emer- 2.3.3.4 Clean utility space. A clean utility room or area
gency communication shall be provided. shall be provided.
2.3.1.7 Floors. Floor covering in the procedure suite 2.3.3.5 Equipment storage. The following shall be
shall be monolithic and joint free. provided:
2.3.2 Patient Holding/Prep/Recovery Area (1) Stretcher storage area(s). Such areas shall be con-
2.3.2.1 General venient for use and out of the direct line of traffic.
(1) This area shall meet the size requirements of a (2) Wheelchair storage. Space for temporary storage
stepdown recovery area, Section 3.7-2.4.2.1. of wheelchairs shall be provided.
234 2006 Guidelines for Design and Construction of Health Care Facilities
3 . 9 G A S T R O I N T E S T I N A L E N D O S C O P Y FA C I L I T I E S
2.4.1.3 Lockers and space for changing clothes 3.2.1 Processing Rooms
Dedicated processing room(s) for cleaning and decon-
2.4.1.4 Staff shower. At least one shower shall be con- taminating instruments shall be provided.
veniently accessible to the procedure suite and patient
holding/prep/recovery areas. 3.2.1.1 Number. Processing room(s) shall be permitted
to serve multiple procedure rooms.
2.4.2 Lounge and Toilet Facilities
These shall be provided in facilities having three or 3.2.1.2 Size. The size of the processing room(s) shall
more procedure rooms. be dictated by the amount of equipment to be
processed.
2.5 Support Areas for Patients
3.2.1.3 Layout. The cleaning area shall allow for flow
2.5.1 Patient Change Areas of instruments from the contaminated area to the
A separate area shall be provided for patients to clean assembly area and then to storage. A physical
change from street clothing into hospital gowns and to barrier shall be provided to prevent droplet contami-
prepare for procedures. nation on the clean side. Clean equipment rooms,
including storage, should protect the clean equipment
2.5.1.1 This area shall include lockers, toilet(s), cloth- from contamination.
ing change or gowning area(s), and space for adminis-
tering medications. 3.2.2 Decontamination Area
The decontamination area shall be equipped with the
2.5.1.2 Provisions shall be made for securing patients’ following:
personal effects.
*3.2.2.1 Utility sink(s). Sink(s) shall be provided as
appropriate to the method of decontamination used.
3 Service Areas
3.2.2.2 Hand-washing station. One freestanding hand-
3.1 Clean Storage and Soiled Holding Areas washing station shall be provided.
3.1.1.2 Such areas shall be separated from unrelated A3.2.2.1 This may require soaking sink(s), rinse sink(s),
activities and controlled to prohibit public contact. automated cleaning device(s), or a combination.
2006 Guidelines for Design and Construction of Health Care Facilities 235
3 . 9 G A S T R O I N T E S T I N A L E N D O S C O P Y FA C I L I T I E S
3.4 Fluid Waste Disposal Facilities 4.2.2.1 Provisions for confidentiality of records shall
Fluid waste disposal facilities shall be provided. be made.
236 2006 Guidelines for Design and Construction of Health Care Facilities
3 . 9 G A S T R O I N T E S T I N A L E N D O S C O P Y FA C I L I T I E S
5 Construction Standards (b) When such rooms have only one opening or
are small, the doors shall open outward or be
5.1 Design and Construction, including otherwise designed to open without pressing
Fire-Resistant Standards against a patient who may have collapsed
within the room.
5.1.1 The separate endoscopy facility or section shall
comply with the “New Ambulatory Health Care 5.2.2 Finishes
Occupancies” section of NFPA 101 and requirements 5.2.2.1 Floors. Floor finishes shall be appropriate for the
described herein. areas in which they are located and shall be as follows:
5.1.2 Flammable anesthetics shall not be used in out- (1) Floor finishes shall be cleanable.
patient endoscopy facilities.
(2) Floor finishes in areas such as clean corridors and
5.2 General Standards for Details and Finishes patient care areas shall be washable, smooth, and
All details and finishes shall meet the standards in capable of withstanding chemical cleaning.
Section 3.1-5.2 except as modified below.
(3) Floor finishes in areas such as procedure rooms
5.2.1 Details and the decontamination room shall be scrub-
5.2.1.1 Corridor width bable, capable of withstanding chemical cleaning,
and monolithic with an integral base.
(1) Minimum public corridor width shall be 5 feet
(1.52 meters), except that corridors where 5.2.2.2 Walls. Wall finishes shall be appropriate for the
patients are transported on stretchers or beds areas in which they are located and shall be as follows:
shall be 8 feet (2.44 meters) wide.
(1) Wall finishes shall be cleanable.
(2) Passages and corridors used exclusively for staff
access may be 3 feet 8 inches (1.12 meters) in (2) Wall finishes in areas such as clean corridors, cen-
clear width. tral sterile supply spaces, specialized radiographic
rooms, and endoscopic procedure rooms shall be
5.2.1.2 Doors washable, smooth, and capable of withstanding
chemical cleaning.
(1) Door width
(3) Wall finishes in areas such as procedure rooms
(a) Doors serving occupiable spaces shall have a shall be scrubbable, capable of withstanding
minimum nominal width of 3 feet (91.44 chemical cleaning, and monolithic.
centimeters).
5.2.2.3 Ceilings. Ceiling finishes shall be appropriate
(b) Doors requiring gurney/stretcher access shall for the areas in which they are located and shall be as
have a nominal width of 3 feet 8 inches (1.12 follows:
meters).
(1) Ceiling finishes in general areas are optional and
(2) Toilet room doors may be omitted in mechanical and electrical
rooms/spaces unless required for fire-resistive
(a) Toilet rooms in procedure and recovery areas purposes.
for patient use shall be equipped with doors
and hardware that permit access from the (2) Ceiling finishes in procedure rooms, the deconta-
outside in emergencies. mination room, and other semirestricted areas
shall be capable of withstanding cleaning with
chemicals and without crevices that can harbor
2006 Guidelines for Design and Construction of Health Care Facilities 237
3 . 9 G A S T R O I N T E S T I N A L E N D O S C O P Y FA C I L I T I E S
6 Building Systems
6.1 Plumbing
See Section 3.1-7.1.
238 2006 Guidelines for Design and Construction of Health Care Facilities
3.10 Renal Dialysis (Acute and Chronic) Centers
Appendix material, which appears in shaded boxes at the bottom of the page, is advisory only.
2.1 Examination Room 2.3.1.2 Where required, the airborne infection isola-
An examination room with hand-washing stations and tion room(s) shall comply with the requirements of
writing surface shall be provided with at least 100 square Section 2.1-3.2.2.
feet (9.29 square meters).
2.3.2 Bloodborne Infection Isolation Room(s)
2.2 Treatment Area(s) Facilities that dialyze patients with known bloodborne
pathogens shall have at least one separate room to use
2.2.1 Layout for those patients.
2.2.1.1 The treatment area shall be permitted to be an
open area and shall be separate from administrative 2.3.3 Home Training Room
and waiting areas. If home training is provided at the center, the follow-
ing requirements shall be met:
2.2.1.2 The open treatment area shall be designed to
provide privacy for each patient. 2.3.3.1 A private treatment area of at least 120 square
feet (11.15 square meters) shall be provided for patients
2.2.2 Space Requirements who are being trained to use dialysis equipment at
2.2.2.1 Individual patient treatment areas shall contain home.
at least 80 square feet (7.44 square meters).
2.3.3.2 This room shall contain counter, hand-washing
stations, and a separate drain for fluid disposal.
2006 Guidelines for Design and Construction of Health Care Facilities 239
3 . 1 0 R E N A L D I A LY S I S ( A C U T E A N D C H R O N I C ) C E N T E R S
2.4 Support Areas for the Renal Dialysis 2.6 Support Areas for Patients
Treatment Center
2.6.1 Patient Toilet
2.4.1 Medication Station A patient toilet with hand-washing station shall be
If required by the functional program, there shall be a provided. It shall be equipped with an emergency
medication dispensing station for the dialysis center. call station.
2.4.1.1 A work counter and hand-washing stations 2.6.2 Patient Storage Space
shall be included in this area. Storage for patients’ belongings shall be provided.
240 2006 Guidelines for Design and Construction of Health Care Facilities
3 . 1 0 R E N A L D I A LY S I S ( A C U T E A N D C H R O N I C ) C E N T E R S
5 Building Systems
5.1 Plumbing
*5.1.1 Piping
All dialysis system piping shall be readily accessible
for inspection and maintenance. Design consideration
shall be given to the disposal of liquid waste from the
dialyzing process to prevent odor and backflow.
APPENDIX
2006 Guidelines for Design and Construction of Health Care Facilities 241
3.11 Psychiatric Outpatient Centers
Appendix material, which appears in shaded boxes at the bottom of the page, is advisory only.
1.3 Site 2.4.3.1 One room may be primarily for staff use but
also available for public access as needed.
1.3.1 Parking
Parking spaces for patients and family shall be provided 2.4.3.2 If the program so indicates, these functions
to meet the functional program. may take place in group room(s).
242 2006 Guidelines for Design and Construction of Health Care Facilities
3 . 1 1 P S Y C H I AT R I C O U T PAT I E N T C E N T E R S
2.5 Support Areas for Staff 3.1.4.2 The seating shall contain no fewer than two
spaces for each consultation room and no fewer than
2.5.1 Staff Toilet and Lounge 1.5 spaces for the combined projected capacity at one
2.5.1.1 Staff toilet and lounge shall be provided in addi- time of the group rooms.
tion to and separate from public and patient facilities.
3.1.4.3 Where the psychiatric outpatient unit has a
*2.5.1.2 Centralized staff facilities are not required in formal pediatrics service, a separate, controlled area
small centers.. for pediatric patients shall be provided.
2006 Guidelines for Design and Construction of Health Care Facilities 243
3 . 1 1 P S Y C H I AT R I C O U T PAT I E N T C E N T E R S
4 Construction Standards
4.2 Security
4.3 Details
244 2006 Guidelines for Design and Construction of Health Care Facilities
3.12 Mobile, Transportable, and Relocatable Units
Appendix material, which appears in shaded boxes at the bottom of the page, is advisory only.
1.1.1.1 Mobile unit. A mobile unit is any pre-manufac- 1.1.3 Maximum Size
tured structure, trailer, or self-propelled unit equipped These facilities shall be defined as space and equipment
with a chassis on wheels and intended to provide shared for services provided by four or fewer workers at any
medical services to the community on a temporary one time.
basis.
1.2 Site
(1) These units are typically no larger than 8 feet wide
by 48 feet long (2.44 meters by 14.63 meters). 1.2.1 Location
1.2.1.1 Access for the unit to arrive shall be taken into
(2) Some units are equipped with expanding walls. consideration for site planning. Turning radius of the
vehicles, slopes of the approach (6 percent maximum),
(3) Typically these units are designed to be moved on and existing conditions shall be addressed.
a daily basis.
1.2.1.2 Consideration shall be given to location of the
1.1.1.2 Transportable unit. A transportable unit is any unit so that diesel exhaust of the tractor and/or unit
pre-manufactured structure or trailer equipped with generator is kept away from the fresh air intake of the
a chassis on wheels that is intended to provide shared facility.
medical services to the community on an extended
temporary basis. 1.2.2 Facility Access
Each site shall provide access to the unit for wheelchair/
(1) The units are typically no larger than 12 feet wide stretcher patients.
by 60 feet long (3.66 meters by 18.29 meters).
1.2.3 Environmental Standards
(2) The units are designed to be moved periodically, All mobile, transportable, and relocatable units shall
depending on need. be sited in full compliance with such federal, state, and
2006 Guidelines for Design and Construction of Health Care Facilities 245
3 . 1 2 M O B I L E , T R A N S P O R TA B L E , A N D R E L O C ATA B L E U N I T S
local environmental laws and regulations as may 2 Diagnostic and Treatment Locations
apply; for example, those listed in Section 1.3-4.
2.1 Mobile Units
*1.2.4 Utility Requirements
1.2.4.1 Sites shall be provided with properly sized 2.1.1 Hand-Washing Stations
power, including emergency power, water, waste, tele- 2.1.1.1 Noninvasive procedure locations. Mobile units
phone, and fire alarm connections, as required by local where noninvasive procedures are performed shall be
and state building codes. provided with hand-washing stations unless each site
can provide hand-washing stations within 25 feet
1.2.4.2 Adequate protection shall be provided for utili- (7.47 meters) of the unit.
ty hook-ups, cables, and wires by concealing them in
conduits, burying them underground, or installing 2.1.1.2 Invasive procedure locations. When invasive
them overhead. procedures are performed in a mobile unit, all units
shall be provided with hand-washing stations.
1.2.5 Foundation
*1.2.5.1 Sites shall have level concrete pads or piers 2.2 Transportable Units
and be designed for the structural loads of the facility. Transportable units shall be provided with hand-
Construction of pads shall meet local, state, and seis- washing stations.
mic codes.
2.3 Relocatable Units
1.2.5.2 Each facility shall provide a means of prevent-
ing unit movement, either by blocking the wheels or 2.3.1 Seismic and Structural Requirements
by providing pad anchors. 2.3.1.1 Seismic force resistance for relocatable units
shall comply with Section 1.1-5 and shall be given an
1.2.6 Parking and Drop-off Zones importance factor of one when applied to the seismic
Sites shall provide hazard-free drop-off zones and design formulas.
adequate parking for patients. (See also 3.12-3.1.1.)
2.3.1.2 These units shall meet the structural require-
1.2.7 MRI Unit Site Considerations ments of local and state building codes.
1.2.7.1 Gauss fields of various strengths generated by
magnetic resonance imaging (MRI) units shall be consid- 2.3.2 Hand-Washing Stations
ered; both for the environmental effects on (interference Relocatable units shall be provided with hand-washing
with) the integrity of the scan, and for the potentially stations.
adverse effects of the field on adjacent electrical and/or
magnetic devices and materials. Radio frequency inter- 2.4 Support Areas for Mobile, Transportable, and
ference shall be considered when planning a site. Relocatable Facilities
1.2.7.2 Sites utilizing MRI systems shall consider provid- 2.4.1 Cryogenic Equipment and Supply Storage
ing adequate access for cryogen-servicing of the magnet. Storage for dewars, which are of substantial weight
Cryogen dewars are of substantial weight and size. and size, shall be included in space planning.
APPENDIX
3 Administrative and Public Areas
A1.2.4 It is recommended that each site requiring water and
waste services to the unit provide a means of freeze protection 3.1 Public Areas
in geographic areas where freezing temperatures occur.
*3.1.1 Entrance
A1.2.5.1 Concrete-filled steel pipe bollards are recommended for
Patient protection from the elements during transport
protection of the facility and the unit.
to and from the mobile unit shall be provided.
246 2006 Guidelines for Design and Construction of Health Care Facilities
3 . 1 2 M O B I L E , T R A N S P O R TA B L E , A N D R E L O C ATA B L E U N I T S
3.1.1.1 Use of means other than covered walkways shall 4.2.1.2 Stairs
be permitted to protect patients from the elements.
(1) Stairs for mobile and transportable units shall be
3.1.1.2 Snow shall be kept clear of pathways to and in accordance with Table 3.12-1.
from the mobile unit. Effective means of abating ice
shall be used when conditions exist. (2) There shall be no variation exceeding 3/16 inch
(4.76 millimeters) in depth of adjacent treads or
3.1.2 Public Waiting Area in the height of adjacent risers, and the tolerance
The facility shall provide waiting space for patient between the largest and smallest tread shall not
privacy as close to the unit docking area as possible. exceed 3/8 inch (9.52 millimeters) in any flight.
4.1.1 Applicable Codes (3) Stairs and landings for relocatable units shall
Existing facilities shall comply with applicable require- comply with NFPA 101.
ments of the Existing Business Occupancies chapter of
NFPA 101, Life Safety Code. Where patients incapable (4) Handrails shall be provided on at least one side.
of self-preservation are receiving inhalation anesthesia,
the Existing Ambulatory Health Care Occupancies (5) Handrails shall be installed and constructed in
chapter of NFPA 101 shall apply. accordance with NFPA 101, with the following
exception: Provided the distance from grade
4.1.2 Radiation Protection to unit floor height is not greater than 4 feet 5
Radiation protection for x-ray and gamma ray instal- inches (1.35 meters), one intermediate handrail
lations shall be in accordance with NCRP reports with a clear distance between rails of 19 inches
49 and 91 in addition to all applicable local and state (48.26 centimeters) maximum shall be permitted.
requirements. (This exception is not applicable to existing units
having a floor height of 5 feet 3 inches, or 1.60
4.2 General Standards for Details and Finishes meters, maximum.)
for Unit Construction
Requirements below apply to all units unless otherwise 4.2.2 Finishes
noted: 4.2.2.1 Interior finish materials
(2) Units shall be permitted a single means of egress A3.1.1 It is recommended that each site provide a covered
as permitted by NFPA 101. walkway or enclosure to ensure patient safety from the outside
elements. Protecting the patient from dust and wind also needs
(3) All glazing in doors shall be safety or wire glass. to be considered.
2006 Guidelines for Design and Construction of Health Care Facilities 247
3 . 1 2 M O B I L E , T R A N S P O R TA B L E , A N D R E L O C ATA B L E U N I T S
(2) Textile materials having a napped, tufted, looped, 5.1.2 Medical Gas and Vaccuum Systems
woven, nonwoven, or similar surface shall be Medical gases and suction systems, if installed, shall be
permitted on walls and ceilings provided such in accordance with NFPA 99.
materials have a class A rating and rooms or areas
are protected by automatic extinguishment or 5.2 Heating, Ventilating, and Air-Conditioning
sprinkler system. Systems
248 2006 Guidelines for Design and Construction of Health Care Facilities
3 . 1 2 M O B I L E , T R A N S P O R TA B L E , A N D R E L O C ATA B L E U N I T S
equipment and shall be accessible to author- shall be provided for examination, treatment, and
ized persons only. trauma rooms.
(b) Switchboards shall be convenient for use and 5.3.5 Receptacles (Convenience Outlets)
readily accessible for maintenance but away 5.3.5.1 Duplex grounded-type receptacles (conven-
from traffic lanes. ience outlets) shall be installed in all areas in sufficient
quantities for tasks to be performed as needed.
(c) Switchboards shall be located in dry, ventilated
spaces free of corrosive or explosive fumes, 5.3.5.2 Each examination and work table shall have
gases, or any flammable material. access to a minimum of two duplex receptacles.
2006 Guidelines for Design and Construction of Health Care Facilities 249
3 . 1 2 M O B I L E , T R A N S P O R TA B L E , A N D R E L O C ATA B L E U N I T S
Table 3.12-1
Stair Requirements for Mobile and Transportable Units
250 2006 Guidelines for Design and Construction of Health Care Facilities
4
Other Health Care Facilities
4.1 Nursing Facilities
Appendix material, which appears in shaded boxes at the bottom of the page, is advisory only.
2006 Guidelines for Design and Construction of Health Care Facilities 253
4 . 1 N U R S I N G FA C I L I T I E S
of this section. However, when a project calls for shar- and communications as provided in the functional
ing or purchasing services, appropriate modifications program for the facility.
or deletions in space and parking requirements shall
be permitted. 2.1 General
254 2006 Guidelines for Design and Construction of Health Care Facilities
4 . 1 N U R S I N G FA C I L I T I E S
(2) Room size and configuration shall permit resi- 2.2.2.2 Clearances
dent(s) options for bed location(s) and make pro-
vision for visual privacy. (1) In multiple-bed rooms, clearance shall allow for
the movement of beds and equipment without
disturbing residents.
APPENDIX
A2.1.3 Clusters and Staffing Considerations –Clusters provide a method of distributing nursing staff through a
a. Clustering refers to several concepts wherein the design of building, nearer to bedrooms at night, so they can be responsive to
traditional nursing home floor plans (straight halls, double- or single- vocal calls for assistance and toileting. (Central placement of staff
loaded corridors) is reorganized to provide benefits to both residents requires greater skill in using traditional call systems than many
and to the effectiveness with which people care for them. Clustering is residents possess.)
done to achieve better image, faster service, shorter walking/wheeling
–Cluster units of a given size may “stack” or be placed over each other,
distances, and more subtle handling of linen. It can also afford more
but might have different staffing for varying care levels.
localized social areas and optional decentralized staff work areas.
–If digital call systems are used (such as those allowing repro-
b. A functioning cluster as described here is more than an architectural
gramming of what room reports to which zone or nursing assis-
form where rooms are grouped around social areas without reference to
tant’s work area), then one unit might easily be changed over
caregiving. In a functioning cluster, the following will be accomplished:
time, such as when client needs justify higher ratios of nursing
–Utility placement is better distributed for morning care: Clean and assistants to older people. For example, a 48-bed unit might start
soiled linen rooms are located closer to the resident rooms, minimizing at 1:8 staffing but also respond to 1:6 staffing needs. In some
staff steps and maximizing the appearance of corridors (carts are not units, staffing might also be slightly uneven, such as where 60-
scattered through halls). bed units are comprised of clusters of 1:7 and 1:8 during days.
–Unit scale and appearance reinforces smaller groups of rooms d. Architectural form and clustering: Clusters involve architectural
seen as being grouped or related: Clusters should offer identifiable form and may have an impact on overall building shape.
social groups for both staff and older people, thereby reducing
–The longer length of stay of nursing home residents compared with
the sense of largeness often associated with centralized facilities.
hospital clients is one factor that makes clustering rooms in more resi-
–Geographically effective staffing: The staffing pattern and design dential groups particularly appropriate. However, the visual advantages
reinforce each other so that nursing assistants can offer primary of units without long corridors has also attracted hospital planners.
nursing care and relate to a given set of rooms. Their room assign- In both facility types, architectural clustering may help both staff and
ments are grouped together and generally do not require unequal residents socially identify a space or sub-unit within a larger unit.
travel distances to basic utilities. Staff “buddying” is possible.
–Though architectural clustering may involve grouping rooms, this
Buddying involves sharing responsibilities such as lifting a non-
should not result in windowless social areas, or the incorporation of
weight-bearing person or covering for someone while the buddy
all social options in a windowless social area directly outside of the
provides off-unit transport or is on a break.
bedroom doorways.
–Staffing that works as well at night as during the day: An effec-
A2.2.1 Changes to the maximum number of residents per room may
tive cluster design incorporates multiple staffing ratios. A unit
be made upon a determination by the authority having jurisdiction
might have 42 beds, but with clustering, could staff effectively in
that such an alternate room configuration provides a preferable
various ratios of licensed nurses to nurses assistants: 1:7 days
environment for residents with unusual care requirements. Single
(six clusters); 1:14 or 1:21 nights (three or two neighborhoods).
resident rooms with an individual toilet room are encouraged. In
c. Clustering can also have some other benefits: two-bed rooms, consideration should be given to creating room
configurations that maximize individual resident privacy, access
–Cluster design can provide more efficient “gross/net area” when
to windows, room controls, and equivalent space.
a variety of single and/or double rooms are “nested.”
A2.2.2 For purposes of planning minimum clearances around
–Cluster design can be useful when a project is to have a high
beds, unless specified otherwise by the functional program, the
proportion of private occupancy rooms, because it reduces
rectangular dimensions of the bed are width: 3 feet 4 inches
distances to staff work areas or nursing stations.
(1.01 meters) and length: 8 feet (2.44 meters).
2006 Guidelines for Design and Construction of Health Care Facilities 255
4 . 1 N U R S I N G FA C I L I T I E S
(2) Clear access to one side of the bed shall be 2.2.5 Resident Privacy
provided along 75 percent of its length. Visual privacy shall be provided for each resident in
multiple-bed rooms. Design for privacy shall not restrict
(3) Mechanical and fixed equipment shall not resident access to the toilet, room entrance, window, or
obstruct access to any required element. other shared common areas in the resident room.
(4) These guidelines shall allow arrangement of fur- 2.2.6 Hand-Washing Station
niture that may reduce these access provisions, A hand-washing station shall be provided in each resi-
without impairing access provisions for other dent room. Omission of this station shall be permitted
occupants. in a single-bed or two-bed room when a hand-washing
station is located in an adjoining toilet room that serves
2.2.3 Layout that room only.
Beds shall be no more than two deep from windows in
new construction and three deep from windows in 2.2.7 Toilet Room
renovated construction. Each resident shall have access to a toilet room with-
out the need to enter the corridor area.
2.2.4 Window(s)
Each room shall have a window that meets the 2.2.7.1 One toilet room shall serve no more than two
requirements of Section 4.1-8.2.2.4. residents in new construction and no more than four
beds or two resident rooms in renovation projects.
Alternative grab bar configurations should address the following 2.2.8 Resident Storage Locations
scenarios: Each resident shall be provided a separate wardrobe,
locker, or closet.
a. When a resident is capable of independent transfer facilitated
by the grab bar and side-wall location required by accessibility
2.2.8.1 This storage shall have minimum clear dimen-
standards, a removable/temporary wall structure and grab bar
sions of 1 foot 10 inch (55.88 centimeters) depth by
can be installed alongside the toilet.
1 foot 8 inch (50.80 centimeters) width.
b. When a resident requires partial assistance in transfer, fold-
down grab bars on one or both sides of the toilet would facilitate 2.2.8.2 A clothes rod and shelf shall be provided at
such transfers. heights accessible to the resident. Accommodations shall
256 2006 Guidelines for Design and Construction of Health Care Facilities
4 . 1 N U R S I N G FA C I L I T I E S
be made for storage of full-length garments. The shelf 2.4.2 Medication Station
may be omitted if the unit provides at least two drawers. Provision shall be made for 24-hour distribution of
medications. A medicine preparation room, a self-
*2.2.9 Medical Gases contained medicine-dispensing unit, or other system
Resident rooms designated for ventilator dependency shall be used for this purpose.
shall have provisions for the administration of oxygen
and suction. 2.4.2.1 Medicine preparation room
2.3 Support Areas—General (1) The medicine preparation room, if used, shall be
visually controlled from the staff work area.
2.3.1 Size and Features
The size and features of each staff support area shall (2) It shall contain a work counter, sink, refrigerator,
depend upon the number and types of residents served. and locked storage for controlled drugs.
2.3.2 Space Requirements (3) It shall have a minimum area of 50 square feet
Identifiable spaces are required for each indicated (4.65 square meters).
function, but consideration shall be given to multiple-
use design solutions that provide equivalent, though 2.4.2.2 Self-contained medicine dispensing unit
unspecified, areas. Except where the word room or
office is used, support functions may be accommodated (1) Location of a self-contained medicine-dispensing
in a multipurpose area. unit, if used, shall be permitted at the staff work
area, in the clean workroom, in an alcove, or in
2.3.3 Location other space convenient for staff control.
Staff support areas may be arranged and located to
serve more than one resident unit, but at least one
such support area shall be located on each resident APPENDIX
floor unless noted otherwise. The following staff
support areas shall be located in or readily accessible A2.2.9 When a dedicated unit is provided for ventilator-dependent
to each resident unit. residents, piped oxygen and vacuum should be provided. Refer
to NFPA 99 for emergency power requirements and medical gas
2.4 Support Areas for Resident Units installation information.
*2.4.1.2 Decentralized staffing. Where caregiving is A2.4.1.2 Depending upon the type of service and care plan to be
decentralized, supervisory work areas need not accom- provided, direct care staff work areas need not be encumbered
modate charting activities nor have direct visualization with all of the provisions for a supervisory administrative staff work
of resident rooms. Rather, such functions shall be area. In some decentralized arrangements, caregiving functions
accomplished at decentralized direct care staff work may be accommodated at a piece of residential furniture (such as
areas, which shall provide for charting or transmitting a table or a desk) or at a work counter recessed into an alcove off
charted data and any storage or administrative activi- a corridor or activity space, with or without computer and commu-
ties required by the functional program. nications equipment, storage facilities, etc.
2006 Guidelines for Design and Construction of Health Care Facilities 257
4 . 1 N U R S I N G FA C I L I T I E S
(2) Convenient access to hand-washing stations shall 2.4.6 Equipment and Supply Storage
be provided. (Standard cup-sinks provided in 2.4.6.1 Clean linen storage. A separate closet or desig-
many self-contained units are not adequate for nated area shall be provided. If a closed-cart system is
hand-washing.) used, storage may be in an alcove where staff control
can be exercised.
2.4.3 Nourishment Area
2.4.3.1 The nourishment area shall contain a work 2.4.6.2 Supply storage. Storage space(s) for supplies
counter, refrigerator, storage cabinets, and a sink for and recreation shall be provided near their points of
serving nourishment between meals. use, as required by the functional program.
2.4.3.2 The nourishment station shall include space for 2.4.6.3 Wheelchair and other equipment storage. Space
trays and dishes used for nonscheduled meal service for wheelchairs and other equipment shall be provided
and may also be used as a pantry for food service away from normal traffic.
adjacent to a resident’s dining room or area.
2.5 Support Areas for Staff
2.4.3.3 Ice machine. Ice for residents’ consumption
shall be provided by ice-maker units. Where accessible 2.5.1 Staff Lounge Area(s)
to residents and the public, ice-maker units shall be These areas may be shared by more than one resident
self-dispensing. Ice makers shall be located, designed, unit or service.
and installed to minimize noise (and may serve more
than one nourishment station). 2.5.2 Staff Storage
Lockable closets, drawers, or compartments shall be
2.4.3.4 Hand-washing stations. Hand-washing stations provided for safekeeping of staff personal effects such
shall be in or immediately accessible from the nour- as handbags.
ishment station.
2.5.3 Toilet Room(s)
2.4.4 Clean Workroom or Clean Supply Room These shall contain water closets with hand-washing
2.4.4.1 Clean workroom. If the room is used for stations for staff and may be unisex.
preparing resident care items, it shall contain a work
counter, a hand-washing station, and storage facilities 2.6 Support Areas for Residents
for clean and sterile supplies.
*2.6.1 Resident Bathing Facilities
2.4.4.2 Clean supply room. If the room is used only 2.6.1.1 A minimum of one bathtub or shower shall be
for storage and holding as part of a system for distri- provided for every 20 residents (or major fraction thereof)
bution of clean and sterile materials, the work counter not otherwise served by bathing facilities in resident rooms.
and hand-washing station may be omitted.
2.6.1.2 Residents shall have access to at least one
2.4.5 Soiled Utility or Soiled Holding Room(s) bathing unit (room) per floor or unit, sized to permit
It shall contain a clinical sink or equivalent flushing- assisted bathing in a tub or shower.
rim fixture with a rinsing hose or a bedpan sanitizer,
hand-washing station, soiled linen receptacles, and (1) The bathtub in this room shall be accessible to
waste receptacles in number and type as required by residents in wheelchairs.
the functional program.
(2) The shower shall accommodate a shower gurney
with fittings for a resident in a recumbent position.
APPENDIX
2.6.1.3 Other showers or tubs shall be in an individual
A2.6.1 Consideration should be given to privacy when locating room(s) or enclosure(s) with space for private use of
entrances to bathing rooms. the bathing fixture and, for drying and dressing, and
258 2006 Guidelines for Design and Construction of Health Care Facilities
4 . 1 N U R S I N G FA C I L I T I E S
3.2.2 Windows
3 Special Care Facilities Operable windows shall be permitted and shall comply
with Section 4.1-8.2.2.4.
*3.1 Subacute Care Facilities
*3.2.3 Outdoor Spaces
3.2 Alzheimer’s and Other Dementia Units Secure outdoor gardens and lounge areas shall be available
for residents of the Alzheimer’s/dementia resident unit.
APPENDIX
A2.6.1.4 This toilet may also serve as the toilet-training facility. themselves within space. The environment should provide atten-
tion-grabbing landmarks and wayfinding cues and information to
A3.1 Since subacute care comprises programs in various settings, the
aid in navigation from point to point. Sensory cuing that is used in
design of such units/facilities should focus on two major components:
other long-term care resident areas should be incorporated for per-
a. The unit/facility should comply with all applicable nursing home sons with dementia. Dementia program activities may include
requirements contained in this chapter to the extent these do not memory stimulation, music therapy, art therapy, horticultural thera-
conflict with the clinical program. py, etc. Space for dining and activities in dedicated dementia units
may be provided within the unit or in a location directly accessible
b. The facility/unit should comply with the requirements dictated
to the residents of the unit per the minimum standards described
by the functional program required by Section 1.2-2.
elsewhere in Chapter 4.1. Consideration should be given to:
A3.2.1 The latest edition of the Life Safety Code recognizes the need
a. Landmarks. Design elements that provide clear reference
to lock doors in Alzheimer’s units. Consideration should be given to
points in the environment (e.g., a room, a large three-dimensional
making locks on wardrobes, closets, or cupboards inconspicuous.
object, large picture, or other wall-mounted artifact).
A3.2.3 Outdoor spaces may include gardens on grade or on roof
b. Signs. When appropriate, large characters and redundant
decks, or solaria, porches, balconies, etc. Lounge space may be a win-
word/picture combinations should be used on signs.
terized sun room, a designated lounge space separate from the dining
room, or a day room, where other residents may be sitting. Secure, c. Environmental design challenge. Residents with mental impair-
accessible outdoor space can provide a calming change in environ- ment often find it difficult to sit for long periods of time or to sit at all
ment and also a convenient place for agitated residents to walk. without becoming restless. Although it is not a universal trait, it is so
common and requires so much staff time that environmental solu-
A3.2.4 Major characteristics of persons with Alzheimer’s and other
tions should be explored in all areas to give cognitively impaired peo-
dementias are lack of attention span and an inability to orient
ple interesting places and things on which to focus their attention.
2006 Guidelines for Design and Construction of Health Care Facilities 259
4 . 1 N U R S I N G FA C I L I T I E S
*3.2.4 Activity Space *4.1.1.2 In new construction, the total area set aside
Activity space for resident use in dementia programs for dining, resident lounges, and recreation shall be
shall be provided. at least 35 square feet (3.25 square meters) per bed
with a minimum total area of at least 225 square feet
(20.90 square meters). At least 20 square feet (1.86
4 Resident Living Areas square meters) per bed shall be available for dining.
*4.1 Resident Dining and Recreation Areas *4.1.1.3 For renovations, at least 14 square feet (1.30
square meters) per bed shall be available for dining.
4.1.1 Space Requirements
4.1.1.1 The space needed for dining and recreation *4.2 Activity Areas
shall be determined by considering the following:
4.2.1 Space Requirements
(1) The needs of residents to use adaptive equipment If required by the functional program, the minimum
and mobility aids and receive assistance from sup- requirements for new construction shall include the
port and service staff following. However, nothing in these Guidelines is
intended to restrict a facility from providing additional
(2) The extent to which support programs shall be square footage per resident beyond what is required
centralized or decentralized herein for activities.
(3) The number of residents to be seated for dining at 4.2.2 Activity Spaces
one time, as required by the functional program Space and equipment shall be provided for carrying out
each of the activities defined in the functional program.
Note: Nothing in these Guidelines is intended to
restrict a facility from providing additional square 4.2.3 Small Group Activity Space
footage per resident beyond what is required herein A space for small group and “one-on-one” activities
for dining rooms, activity areas, and similar spaces. shall be readily accessible to the residents.
APPENDIX
A4.1 It is important to provide outdoor views from dining, recre- generally responsible for coordination of activities for large groups
ation, and living spaces. as well as small groups and personalized individual programs
involving one resident and one therapist. These activities may be
A4.1.1.2 While the guidelines provide a minimum requirement of
conducted in other portions of the building (e.g., dining rooms,
20 square feet (1.85 square meters) per bed for dining space, it
recreation spaces, lounges, etc.), but dedicated spaces are pre-
is likely that facilities designed to this standard will be required to
ferred for efficient operation of quality programs. Large space
serve the resident population in more than one shift. In practice,
requirements (e.g., libraries, chapels, auditoriums, and confer-
the dining room should be sized at a minimum of 28 net square
ence, classroom, and/or training spaces) depend upon the pro-
feet (2.60 square meters) per resident seated at one time.
gramming decisions of the sponsors as reflected in the functional
Additional space may be required for outpatient day care programs.
program for the facility.
A4.1.1.3 Additional space may be required for outpatient day care
A4.2.4 If required by the functional program, include space for
programs.
files, records, computers, and administrative activities; a storage
A4.2 Activity programs focus on the social, spiritual, and creative space for supplies and equipment; and a quiet space for residents
needs of residents and clients and provide quality, meaningful to maximize conversations. This quiet space may be incorporated
experiences for them. These programs may be facility-wide or for within space for administrative activities.
smaller groups.
Note: Hearing loss in the elderly is well documented. Quiet space
If included in the functional program, the activity department is is very important to enable conversation.
260 2006 Guidelines for Design and Construction of Health Care Facilities
4 . 1 N U R S I N G FA C I L I T I E S
*4.2.4 Activity Storage (1) Space for files, records, and administrative activities
Storage for large items used for large group activities
(e.g., recreation materials and exercise equipment; sup- (2) Equipment and supply storage
plies for religious services) shall be placed near the loca-
tion of the planned activity and at the point of first use. (3) Housekeeping rooms, in or near unit
5.1 Rehabilitation Therapy (2) Facilities for dressing and lockers for storing
Each nursing facility that provides physical and/or patients’ clothing and personal effects
occupational therapy services for rehabilitating long-
term care residents shall have areas and equipment (3) Toilet facilities dedicated for outpatient use
that conform to program intent. Where the nursing
facility is part of a general hospital or other facility, (4) Showers, if required by the functional program
services may be shared as appropriate.
5.1.1.1 Space and equipment for carrying out each 6.1.1 General
type of therapy that may be prescribed Food service facilities and equipment shall conform
with these standards and other applicable food and
5.1.1.2 Hand-washing stations. These shall be within sanitation codes and standards and shall provide food
the therapy unit. service for residents.
2006 Guidelines for Design and Construction of Health Care Facilities 261
4 . 1 N U R S I N G FA C I L I T I E S
6.1.1.1 Food receiving, storage, and preparation areas shall be easily cleanable and convenient to the dietary
shall facilitate quality control. function.
6.1.1.2 Provision shall be made for transport of hot 6.1.2.5 Assembly and distribution. Facilities for assem-
and cold foods as required by the functional program. bly and distribution of patient meals
6.1.1.3 Separate dining areas shall be provided for staff 6.1.2.6 Dining space. Separate dining spaces shall be
and for residents. provided for residents and staff.
6.1.1.4 The design and location of dining facilities 6.1.2.7 Ware-washing space. Ware-washing space shall
shall encourage resident use. be provided in a room or an alcove separate from the
food preparation and serving area.
6.1.1.5 Facilities shall be furnished to provide nourish-
ment and snacks between scheduled meal service. (1) Commercial-type ware-washing equipment shall
be provided.
6.1.1.6 The dietary facility shall be easy to clean and to
maintain in a sanitary condition. (2) Space shall be provided for receiving, scraping,
sorting, and stacking soiled tableware and for
6.1.2 Functional Elements transferring clean tableware to the using areas.
If the dietary department is on-site, the following
facilities, in the size and number appropriate for the (3) Convenient hand-washing stations shall be provided.
type of food service selected, shall be provided:
6.1.2.8 Pot-washing facilities
6.1.2.1 Control station. A control station shall be
provided for receiving and controlling food supplies. 6.1.3 Support Areas for Dietary Facilities
6.1.3.1 Offices(s). Office(s) or desk spaces for dieti-
6.1.2.2 Hand-washing station(s). Hand-washing sta- tian(s) and/or a dietary service manager.
tion(s) shall be located in the food preparation area.
6.1.3.2 Storage
6.1.2.3 Food preparation facilities. These facilities
shall be provided to accommodate the method of *(1) Food storage. Storage space, including cold
food preparation specified in the functional program. storage, shall be provided for at least a four-day
supply of food.
(1) Conventional food preparation systems require space
and equipment for preparing, cooking, and baking. (2) Storage areas and sanitizing facilities for cans,
carts, and mobile-tray conveyors.
(2) Convenience food service systems using frozen
prepared meals, bulk packaged entrees, individual (3) Waste, storage, and recycling facilities (per local
packaged portions, or those using contractual requirements) located in a separate room easily
commissary services require space and equipment accessible to the outside for direct pickup or disposal.
for thawing, portioning, cooking, and baking.
6.1.3.3 Housekeeping room. A housekeeping room
6.1.2.4 Ice-making facilities. These may be located in shall be located within the dietary department. It shall
the food preparation area or in a separate room. They include a floor receptor or service sink and storage
space for housekeeping equipment and supplies.
APPENDIX
6.1.4 Support Areas for Staff
A6.1.3.2 (1) Facilities in remote areas may require proportionally 6.1.4.1 Staff toilet. Toilet for dietary staff shall be
more food storage facilities. provided convenient to the kitchen area.
262 2006 Guidelines for Design and Construction of Health Care Facilities
4 . 1 N U R S I N G FA C I L I T I E S
6.2 Linen Services 6.2.3.2 Central clean linen storage. A central clean linen
storage and issuing room(s) shall be provided in addition
6.2.1 General to the linen storage required at individual resident units.
Each facility shall have provisions for storing and pro-
cessing clean and soiled/contaminated linen for resi- 6.2.3.3 Linen carts
dent care. Processing may be done within the facility,
in a separate building on- or off-site, or in a commer- (1) Storage. Provisions shall be made for parking of
cial or shared laundry. At a minimum, the following clean and soiled linen carts separately and out of
elements shall be included: traffic.
6.2.2 Laundry Facility (2) Cleaning. Provisions shall be made for cleaning of
6.2.2.1 General linen carts on premises (or exchange of carts off
premises).
(1) Layout. Equipment shall be arranged to permit an
orderly work flow and minimize cross-traffic that 6.2.3.4 Hand-washing stations. Hand-washing stations
might mix clean and soiled operations. shall be provided in each area where unbagged, soiled
linen is handled.
(2) If linen is processed in a laundry facility within
the facility, the following shall be provided: 6.2.4 Support Areas for Off-Site Processing
If linen is processed off-site or in a separate building
6.2.2.2 Receiving, holding, and sorting room. A receiv- on-site, the following shall be provided:
ing, holding, and sorting room shall be provided for
control and distribution of soiled linen. Discharge 6.2.4.1 Service entrance. A service entrance, protected
from soiled linen chutes may be received within this from inclement weather, for loading and unloading of
room or in a separate room adjacent to it. linen. This can be shared with other services and serve
as the loading dock for the facility.
6.2.2.3 Washers/extractors. Washers/extractors shall be
located between the soiled linen receiving and clean 6.2.4.2 Control station. A control station for pickup
processing areas. Personal laundry, if decentralized, and receiving shall be provided. This can be shared
may be handled within one room or rooms, as long as with other services and serve as the receiving and
separate, defined areas are provided for handling clean pickup point for the facility.
and soiled laundry.
6.3 Materials Management
6.2.2.4 Supply storage. Storage shall be provided for
laundry supplies. 6.3.1 Waste Management
Facilities shall be provided for sanitary storage of
6.2.2.5 Inspection and mending area. An area shall be waste and recyclables using techniques and capacities
provided for linen inspection and mending. acceptable to the appropriate health and environmental
authorities.
6.2.3 Support Areas for Internal Processing
6.2.3.1 Soiled holding room(s). Separate central or Note: For waste treatment and disposal requirements,
decentralized room(s) shall be provided for receiving see Section 4.1-9.3.
and holding soiled linen for pickup or processing.
6.4 Environmental Services
(1) Such room(s) shall have proper ventilation and
exhaust. 6.4.1 Housekeeping Rooms
6.4.1.1 Location. Housekeeping rooms shall be provid-
(2) Discharge from soiled linen chutes shall be ed throughout the facility as required to maintain a
received in a separate room. clean and sanitary environment.
2006 Guidelines for Design and Construction of Health Care Facilities 263
4 . 1 N U R S I N G FA C I L I T I E S
6.4.1.2 Number. At least one housekeeping room shall 7.1.1 Vehicular Drop-Off and Pedestrian Entrance
be provided for each floor. This shall be at grade level, sheltered from inclement
weather, and accessible to the disabled.
6.4.1.3 Facility requirements. Each housekeeping room
shall contain a floor receptor or service sink and stor- 7.1.2 Administrative/Public Lobby Area
age space for housekeeping equipment and supplies. This shall include the following:
6.5 Engineering Services and Maintenance 7.1.2.1 A counter or desk for reception and information
The following shall be provided as necessary for
effective service and maintenance functions: 7.1.2.2 Public waiting area(s)
264 2006 Guidelines for Design and Construction of Health Care Facilities
4 . 1 N U R S I N G FA C I L I T I E S
8.2 General Standards for Details and Finishes ensure proper functioning of the ceiling-mounted
equipment.
8.2.1 General
8.2.1.1 Resident facilities require features that encour- (3) Boiler rooms. Boiler rooms shall have ceiling
age ambulation of long-term residents. clearances of at least 2 feet 6 inches (76.2 cen-
timeters) above the main boiler header and con-
8.2.1.2 Signage and other wayfinding features shall be necting pipe.
provided to aid self-ambulating residents and avoid
confusing or disorienting them. (4) Clearances. Building components and suspended
tracks, rails, and pipes located along the path of
*8.2.1.3 Potential hazards to residents, such as sharp normal traffic shall be not less than 7 feet (2.13
corners, slippery floors, loose carpets, and hot surfaces meters) above the floor.
shall be avoided.
(5) Renovation. In renovation projects, all new work
8.2.1.4 Renovations shall not diminish the level of shall comply, insofar as practical, with subpara-
compliance with these standards below that which graphs 8.2.2.2 (1) through (4) above. Where
existed prior to the renovation. However, features in existing conditions make compliance impractical
excess of those for new construction are not required or impossible, exceptions shall be considered. How-
to be maintained in the completed renovation. ever, in no case shall ceiling heights be reduced
more than 4 inches (2.54 centimeters) below the
8.2.2 Details minimum requirement for new construction.
8.2.2.1 Corridors
(6) Doorways and other openings. Architecturally
(1) Width. The placement of drinking fountains, pub- framed and trimmed openings in corridors and
lic telephones, and vending machines shall not rooms shall be permitted, provided a minimum clear
restrict corridor traffic or reduce the corridor opening height of 7 feet (2.13 meters) is maintained.
width below the minimum stipulated in NFPA 101.
8.2.2.3 Doors. Doors to all rooms containing bathtubs,
*(2) Handrails. Where corridors are defined by walls, sitz baths, showers, and toilets for resident use shall be
handrails shall be provided on both sides of all hinged, sliding, or folding.
corridors normally used by residents.
8.2.2.4 Windows. Resident rooms or suites in new
(a) A minimum clearance of 1-1/2 inches (3.81 construction shall have window(s).
centimeters) shall be provided between the
handrail and the wall. (1) Operable windows or vents that open from the
inside shall be restricted to inhibit possible resi-
(b) Rail ends shall be returned to the wall or floor. dent escape or suicide.
2006 Guidelines for Design and Construction of Health Care Facilities 265
4 . 1 N U R S I N G FA C I L I T I E S
(2) Windows shall have sills located above grade, but for convenient use by both wheelchair occupants
no higher than 36 inches (91.44 centimeters) and ambulatory persons. Tops and bottoms may
above the finished floor. be at levels usable by individuals either sitting or
standing, or additional mirrors may be provided
8.2.2.5 Screens. Windows and outer doors that may be for wheelchair occupants. One separate full-length
left open shall have insect screens. mirror may serve for wheelchair occupants.
*8.2.2.6 Glazing materials (3) Hand drying. Provisions for hand drying shall be
included at all hand-washing stations. These shall
(1) Glazing in doors, sidelights, borrowed lights, and be paper or cloth towels enclosed to protect against
windows where glazing is less than 18 inches dust or soil and to ensure single-unit dispensing.
(45.72 centimeters) from the floor shall be con-
structed of safety glass, wire glass, tempered glass, 8.2.2.8 Grab bars
or plastic glazing material that resists breaking and
creates no dangerous cutting edges when broken. (1) Grab bars shall be installed in all resident toilets,
showers, tubs, and sitz baths.
(2) Similar materials shall be used in wall openings in
activity areas (such as recreation rooms and exer- *(2) For wall-mounted grab bars, a minimum 1-1/2
cise rooms) if permitted by local requirements. inch (3.81 centimeters) clearance from walls shall
be provided.
(3) If doors are provided for shower and tub enclo-
sures, glazing shall be safety glass or plastic. (3) Bars, including those which are part of fixtures
such as soap dishes, shall have the strength to
8.2.2.7 Hand-washing stations sustain a concentrated load of 250 pounds
(113.4 kilograms).
(1) Clearances. Hand-washing stations shall be
constructed with sufficient clearance for blade- *(4) Toilets used by residents shall be provided suffi-
type operating handles. cient clearance on both sides of the water closet
to enable physical access and maneuvering by
(2) Mirror(s). Each resident hand-washing station staff, who may have to assist the resident in
shall have a mirror. Mirror placement shall allow wheelchair-to-water-closet transfers and return.
APPENDIX
A8.2.2.6 Where local requirements permit, wire-free, fire-rated staff mobility and access, and can result in injury. There are ongo-
safety glazing should be used to enhance the home-like residential ing efforts aimed at educating regulators and advisory panels to
appearance preferred by residents and visitors. the difficulties caused by inappropriate standards required within
environments serving frail and geriatric populations.
A8.2.2.8 (2) Consideration should be given to increasing clear-
ances for arthritic residents. Alternative grab bar configurations should address the following
scenarios:
A8.2.2.8 (4). While ADAAG, UFAS, and ANSI accessibility standards
were all developed with the intention of providing greater access a. When a resident is capable of independent transfer facilitated
for individuals with disabilities, their standards are based upon by the grab bar and side-wall location required by accessibility
assumed stature and strength, whereby dimensional and grab bar standards, a removable/temporary wall structure and grab bar
requirements are intended to facilitate wheelchair-to-toilet transfers can be installed alongside the toilet.
by individuals with sufficient upper body strength and mobility to
b. When a resident requires partial assistance in transfer, fold-
effect such a transfer. The typical nursing home resident is unlikely
down grab bars on one or both sides of the toilet would facilitate
to have such capabilities, thus requiring the assistance of one or
such transfers.
more staff. Insufficient clearance at the side of the toilet can restrict
266 2006 Guidelines for Design and Construction of Health Care Facilities
4 . 1 N U R S I N G FA C I L I T I E S
When independent transfers are feasible, alterna- 8.2.3.3 Penetrations and joints. Floor and wall openings
tive grab bar configurations shall be permitted. for pipes, ducts, and conduits shall be tightly sealed to
resist fire and smoke and to minimize entry of pests.
8.2.2.9 Thresholds and joints. Thresholds and expan- Joints of structural elements shall be similarly sealed.
sion joint covers shall be designed to facilitate use of
wheelchairs and carts and to prevent tripping. 8.2.3.4 Ceilings
8.2.2.10 Anchorage. Lavatories, hand-washing stations, (1) The finishes of all exposed ceilings and ceiling
and handrails that a resident could use for support structures in resident rooms and staff work areas
shall be securely anchored. shall be readily cleanable with routine housekeep-
ing equipment.
8.2.2.11 Insulation and ventilation. Rooms containing
heat-producing equipment (such as boiler rooms, (2) Finished ceilings shall be provided in dietary and
heater rooms, and laundries) shall be insulated and other areas where dust fallout might create a problem.
ventilated to prevent the floors of occupied areas
overhead and the adjacent walls from exceeding a 8.2.3.5 Signage. Directional and identification signage
temperature of 10ºF (6ºC) above the ambient room shall comply with Americans with Disabilities Act
temperature of such occupied areas. (ADA) guidelines.
(2) Floors in areas used for food preparation and (2) Carpet. Carpet and padding in resident areas shall
assembly shall be water-resistant. Floor surfaces, be glued down or stretched taut and free of loose
including tile joints, shall be resistant to food acids. edges or wrinkles that might create hazards or
interfere with the operation of wheelchairs, walk-
(3) In all areas subject to frequent wet-cleaning meth- ers, wheeled carts, etc.
ods, floor materials shall not be physically affected
by germicidal cleaning solutions. Floors subject to (3) Drapery. Cubicle curtains and draperies shall be
traffic while wet (such as shower and bath areas, noncombustible or flame-retardant as prescribed in
kitchens, and similar work areas) shall have a slip- both the large- and small-scale tests in NFPA 701.
resistant surface.
2006 Guidelines for Design and Construction of Health Care Facilities 267
4 . 1 N U R S I N G FA C I L I T I E S
268 2006 Guidelines for Design and Construction of Health Care Facilities
4 . 1 N U R S I N G FA C I L I T I E S
Note: For waste collection and storage requirements, (a) Systems shall be protected against cross-
see Section 4.1-6.3. connection in accordance with American
Water Works Association (AWWA)
Recommended Practice for Backflow
10 Building Systems Prevention and Cross-connection Control.
(1) All piping, except control-line tubing, shall be 10.1.2.4 Drainage systems
identified.
(1) Piping. Insofar as possible, drainage piping shall
(2) All valves shall be tagged, and a valve schedule not be installed within the ceiling or exposed in
shall be provided to the facility owner for perma- food preparation centers, food serving facilities,
nent record and reference. food storage areas, central services, electronic data
processing areas, electric closets, and other sensi-
10.1.2.2 Hot water systems. See Section 1.6-2.1.2.1 and tive areas. Where exposed overhead drain piping
Table 4.1-3. in these areas is unavoidable, special provisions
shall be made to protect the space below from
10.1.2.3 Potable water supply systems leakage, condensation, or dust particles.
(1) Capacity. Systems shall be designed to supply (2) Sewers. Building sewers shall discharge into
water at sufficient pressure to operate all fixtures community sewerage. Where such a system is
and equipment during maximum demand. not available, the facility shall treat its sewage in
Supply capacity for hot- and cold-water piping accordance with local and state regulations.
shall be determined on the basis of fixture units,
using recognized engineering standards. When the (3) Grease traps. Kitchen grease traps shall be located
ratio of plumbing fixtures to occupants is propor- and arranged to permit easy access.
tionally more than required by the building occu-
pancy and is in excess of 1,000 plumbing fixture 10.1.3 Plumbing Fixtures
units, a diversity factor shall be permitted. In addition to the requirements of Section 1.6-2.1.3,
the following standards shall apply:
(2) Valves. Each water service main, branch main, riser,
and branch to a group of fixtures shall have valves. 10.1.3.1 Clinical sinks. Clinical sinks shall have an
integral trap wherein the upper portion of the water
(a) Stop valves shall be provided for each fixture. trap provides a visible seal.
(b) Appropriate panels for access shall be provided 10.1.4 Medical Gas and Vacuum Systems
at all valves where required. Any installation of nonflammable medical gas, air, or
clinical vacuum systems shall comply with the require-
(3) Backflow prevention ments of NFPA 99. When any piping or supply of
medical gases is installed, altered, or augmented, the
2006 Guidelines for Design and Construction of Health Care Facilities 269
4 . 1 N U R S I N G FA C I L I T I E S
altered zone shall be tested and certified as required by (2) Air-handling systems
NFPA 99.
(a) Where appropriate, controls for air-handling
10.2 Heating, Ventilating, and Air-Conditioning systems shall be designed with an economizer
(HVAC) Systems cycle that uses outside air to reduce heating
and cooling system loads. Innovative design
10.2.1 General that provides for additional energy conserva-
10.2.1.1 Mechanical system design tion while meeting the intent of these stan-
dards for acceptable resident care shall be
(1) Efficiency. The mechanical system shall be subject considered. (Filtering will be necessary when
to general review for operational efficiency and outside air is used as part of the mechanical
appropriate life-cycle cost. Details for cost-effec- ventilation system.)
tive implementation of design features are interre-
lated and too numerous (as well as too basic) to *(b) Non-central air-handling systems (i.e., indi-
list individually. vidual room units that are used for heating
and cooling purposes, such as fan-coil units,
(a) Recognized engineering procedures shall be heat pump units, etc.). These units may be
followed for the most economical and effec- used as recirculating units only. All outdoor
tive results. A well-designed system can gen- air requirements shall be met by a separate
erally achieve energy efficiency with minimal central air-handling system with the proper
additional cost and simultaneously provide filtration, as noted in Table 4.1-2.
improved resident comfort.
(3) System valves. Supply and return mains and risers
(b) In no case shall resident care or safety be for cooling, heating, and steam systems shall be
sacrificed for conservation. equipped with valves to isolate the various sec-
tions of each system. Each piece of equipment
(c) Facility design consideration shall include shall have valves at the supply and return ends.
site, building mass, orientation, configura-
tion, fenestration, and other features relative (4) Renovation. If system modifications affect greater
to passive and active energy systems. than 10 percent of the system capacity, designers
shall utilize pre-renovation water/air flow rate
APPENDIX
A10.2.1.1 (2)(b) It is recommended that when practical, ventilation b. If duct humidifiers are located upstream of the final filters, they
requirements be met by a central air-handling system with filtration should be at least 15 feet (4.56 meters) upstream of the final fil-
and humidification provisions. This system may be designed for ven- ters. Ductwork with duct-mounted humidifiers located down-
tilation only, with heating and cooling accomplished by non-central stream of the final filters should have a means of water removal.
air-handling equipment (e.g., fan coil units, heat pumps). For venti- An adjustable high-limit humidistat should be located down-
lation purposes, these units may be used as recirculating units only. stream of the humidifier to reduce the potential for condensation
inside the duct. All duct takeoffs should be sufficiently down-
A10.2.1.2 (2) Humidity Control
stream of the humidifier to ensure complete moisture absorption.
a. ASHRAE Standard 55 recommends 30 to 60 percent relative
Steam humidifiers should be used. Reservoir-type water spray or
humidity for comfort. In cold or arid climates, achieving relative
evaporative pan humidifiers should not be used.
humidities as high as 30 percent may not be practical. Where
central ventilation systems are not utilized, these humidity require- c. For more information about humidity control, see Chapter 25,
ments may not be achievable. Additional data are needed to “Eldercare Buildings,” in Lew Harriman, Geoff Brundrett, and
establish a consensus on the cost/benefit of maintaining humidity Reinhold Kittler, Humidity Control Design Guide for Commercial
within the recommended range. and Institutional Buildings (ASHRAE, 2001).
270 2006 Guidelines for Design and Construction of Health Care Facilities
4 . 1 N U R S I N G FA C I L I T I E S
measurements to verify that sufficient capacity is corridor restrictions of NFPA 90A, the pressure
available and that renovations have not adversely requirements of NFPA 96, or the maximum
affected flow rates in non-renovation areas. defined in Table 4.1-1.
10.2.1.2 Ventilation and space conditioning require- 10.2.2.2 Fuel-fired equipment rooms. Rooms with
ments. All rooms and areas in the facility shall have fuel-fired equipment shall be provided with sufficient
provision for positive ventilation. outdoor air to maintain equipment combustion rates
and to limit workstation temperatures.
(1) Ventilation rates. The ventilation systems shall be
designed and balanced, as a minimum, according 10.2.3 Thermal and Acoustical Insulation
to the requirements shown in Table 4.1-1. The In addition to the requirements of Section 1.6-2.2.1,
ventilation rates shown in Table 4.1-1 do not pre- the following requirement shall apply:
clude the use of higher rates as appropriate.
10.2.3.1 In facilities undergoing major renovations,
*(2) Temperature and humidity. Space temperature existing accessible insulation shall be inspected,
and relative humidity shall be as indicated in repaired, and/or replaced as appropriate.
Table 4.1-1.
10.2.4 HVAC Air Distribution
(3) Air movement direction. To maintain asepsis con- 10.2.4.1 HVAC ductwork. See Section 1.6-2.2.2.1.
trol, airflow supply and exhaust should generally
be controlled to ensure movement of air from 10.2.4.2 Exhaust systems
“clean” to “less clean” areas.
(1) To enhance the efficiency of recovery devices
(4) Although use of natural window ventilation shall required for energy conservation, combined
be permitted when weather and outside air quali- exhaust systems shall be permitted.
ty permit, mechanical ventilation shall be provid-
ed for all rooms and areas in the facility. (2) Fans serving exhaust systems shall be located at
the discharge end and shall be readily serviceable.
10.2.2 Requirements for Specific Locations
10.2.2.1 Food preparation centers 10.2.4.3 Air outlets and inlets
(1) Exhaust hoods handling grease-laden vapors in food (1) Fresh air intakes
preparation centers shall comply with NFPA 96.
(a) Fresh air intakes shall be located at least 25
(2) All hoods over cooking ranges shall be equipped feet (7.62 meters) from exhaust outlets of
with grease filters, fire-extinguishing systems, and ventilating systems, combustion equipment
heat-actuated fan controls. stacks, medical vacuum systems, plumbing
vents, or areas that may collect vehicular
(3) Cleanout openings shall be provided every 20 feet exhaust or other noxious fumes. (Prevailing
(6.10 meters) and at changes in direction in the winds and/or proximity to other structures
horizontal exhaust duct systems serving these may require greater clearances.)
hoods. Horizontal runs of ducts serving range
hoods shall be kept to a minimum. (b) The bottom of outdoor air intakes serving
central ventilating systems shall be as high
(4) Food preparation facilities shall have ventilation as practical, but at least 6 feet (1.83 meters)
systems whose air supply mechanisms are inter- above ground level or, if installed above
faced appropriately with exhaust hood controls or the roof, 3 feet (91.44 centimeters) above
relief vents so that exfiltration or infiltration to or roof level.
from exit corridors does not compromise the exit
2006 Guidelines for Design and Construction of Health Care Facilities 271
4 . 1 N U R S I N G FA C I L I T I E S
(2) Exhaust outlets. Exhaust outlets from areas that 10.3.1.2 Testing and documentation. All electrical
may be contaminated shall be above roof level, installations and systems shall be tested to verify that
arranged to minimize recirculation of exhaust air the equipment has been installed and that it operates
into the building. as designed.
(2) Noncentral air-handling systems shall be equipped (a) A minimum of one dedicated essential sys-
with permanent (cleanable) or replaceable filters tem circuit per bed for ventilator-dependent
rated at a minimum efficiency of MERV 3 (68 patients shall be provided in addition to the
percent arrestance). These units may be used as normal system receptacle at each bed loca-
recirculating units only. tion required by NFPA 70. This circuit shall
be provided with a minimum of two duplex
(3) Filter efficiencies, tested in accordance with receptacles identified for emergency use.
ASHRAE Standard 52.1, shall be average.
(b) Additional essential system circuits/receptacles
10.2.5.2 Filter frames shall be provided where the electrical life
support needs of the patient exceed the mini-
(1) Filter frames shall be durable and proportioned to mum requirements stated in this paragraph.
provide an airtight fit with the enclosing duct-
work. All joints between filter segments and the (2) Essential electrical system connections
enclosing ductwork shall have gaskets or seals to
provide a positive seal against air leakage. (a) Heating equipment provided for ventilator-
dependent patient bedrooms shall be connected
(2) Provisions shall be made to allow access for field to the essential electrical system. This paragraph
testing. shall apply to both new and existing facilities.
10.2.6 Steam and Hot Water Systems (b) Task lighting connected to the essential electri-
10.2.6.1 Boilers. See Section 1.6-2.2.3. cal system shall be provided for each ventilator-
dependent patient bedroom. This paragraph
10.3 Electrical Systems shall apply to both new and existing facilities.
(1) All material and equipment, including conduc- (1) Applicable standards. At a minimum, nursing facili-
tors, controls, and signaling devices, shall be ties or sections thereof shall have emergency electri-
installed to provide a complete electrical system cal systems as required in NFPA 101 and Chapter
in accordance with NFPA 70 and NFPA 99. 16, Nursing Home Requirements, of NFPA 99.
(2) Electrical systems for nursing facilities shall com- (2) Shared service. When the nursing facility is a dis-
ply with applicable sections of NFPA 70. tinct part of an acute care hospital, it may use the
emergency generator system for required emergency
272 2006 Guidelines for Design and Construction of Health Care Facilities
4 . 1 N U R S I N G FA C I L I T I E S
lighting and power if such sharing does not reduce tions, mufflers, and vibration isolators) for internal
hospital services. Life support systems and their combustion engines shall be designed and installed to
respective areas shall be subject to applicable stan- minimize objectionable noise. Where a generator is rou-
dards of Section 2.1-10.3. tinely used to reduce peak loads, protection of patient
areas from excessive noise may become a critical issue.
(3) Lighting. An emergency electrical source shall
provide lighting and/or power during an inter- 10.3.4 Lighting
ruption of the normal electrical supply. 10.3.4.1 General
(4) Stored fuel (1) Lighting shall be engineered to the specific appli-
cation. Unless alternative lighting levels are justi-
(a) Where stored fuel is required, storage capaci- fied by the approved functional program, Table
ty shall permit continuous operation for at 4.1-4 shall be used as a guide to minimum
least 24 hours. required ambient and task lighting levels in all
rooms, spaces, and exterior walkways.
(b) Fuel storage for electricity generation shall be
separate from heating fuels. (2) Recommended lighting design practices, includ-
ing minimum lighting levels for nursing facilities
(c) If the use of heating fuel for diesel engines is and other senior living environments, developed
considered after the required 24-hour supply by the Illuminating Engineering Society of North
has been exhausted, positive valving and fil- America (IESNA) shall be considered. Refer to
tration shall be provided to avoid entry of ANSI/IESNA RP-28, Lighting and the Visual
water and/or contaminants. Environment for Senior Living.
10.3.3.2 Generators. Exhaust systems (including loca- *(3) Approaches to buildings and parking lots, and all
APPENDIX
2006 Guidelines for Design and Construction of Health Care Facilities 273
4 . 1 N U R S I N G FA C I L I T I E S
occupied spaces within buildings, shall have fix- (a) At least one task light shall be provided for
tures for lighting. Consideration shall be given to each resident.
both the quantity and quality of lighting, includ-
ing the following: (b) Task light controls shall be readily accessible
to residents.
(a) Even and consistent lighting levels
(c) At least one low-level night light fixture in
(b) Glare control each room shall be located close to the floor
and controlled at the room entrance. When
(c) Special lighting needs of the elderly the approved functional program stipulates
staff shall use portable light sources, omis-
(d) Area-specific lighting solutions sion of night lights in resident rooms shall
be permitted.
(e) Use of daylighting in all resident rooms and
resident use areas (d) All light controls in resident areas shall be
quiet-operating.
(f) Life-cycle costs of lighting
(2) Resident unit corridors
(g) Other lighting design practices as defined
and described in ANSI/IESNA RP-28 (a) Resident unit corridors shall have general
illumination with provisions for reducing
10.3.4.2 Lighting requirements for specific locations light levels at night. Corridors and common
areas used by residents shall have even light
*(1) Resident rooms. Resident rooms and toilet rooms distribution to avoid glare, shadows, and scal-
shall have general lighting, task lighting, and night loped lighting effects.
lighting.
(b) Highly polished flooring or floors with glossy
sheen shall not be used.
APPENDIX
10.3.5 Receptacles
A10.3.4.2 (1) Receptacles (convenience outlets) shall be provided as
follows:
a. Care should be taken to avoid injury from lighting fixtures. Light
sources that may burn residents or ignite bed linen by direct con-
10.3.5.1 Receptacles in resident rooms. Each resident
tact should be covered or protected.
room shall have duplex-grounded receptacles. There
b. Ambient light levels are determined on a horizontal plane above shall be one at each side of the head of each bed and
the floor. The use of this method in the types of areas described one on every other wall. Receptacles may be omitted
should result in values of average illuminance within 10 percent of from exterior walls where construction makes installa-
the values that would be obtained by dividing the area into 2-foot tion impractical.
(0.6-meter) squares, taking a reading in each square, and averaging.
10.3.5.2 Receptacles in corridors. Duplex-grounded
c. The measuring instrument should be positioned so that when
receptacles for general use shall be installed approxi-
readings are taken, the surface of the light-sensitive cell is in a
mately 50 feet (15.24 meters) apart in all corridors and
horizontal plane and 30 inches (760 millimeters) above the floor.
within 25 feet (7.62 meters) of corridor ends.
This can be facilitated by means of a small portable stand of wood
or other material that will support the cell at the correct height and
10.3.5.3 Emergency system receptacles. Electrical
in the proper plane. Daylight may be excluded during illuminance
receptacle coverplates or electrical receptacles supplied
measurements. Readings can be taken at night or with shades,
from the emergency system shall be distinctively col-
blinds, or other opaque covering on the fenestration.
ored or marked for identification. If color is used for
274 2006 Guidelines for Design and Construction of Health Care Facilities
4 . 1 N U R S I N G FA C I L I T I E S
identification purposes, the same color shall be used (3) The signal shall activate an annunciator panel or
throughout the facility. screen at the staff work area or other appropriate
location and at other areas defined by the func-
10.3.5.4 Ground fault interrupters. Ground fault inter- tional program. In addition, the signal shall acti-
rupters shall comply with NFPA 70. vate either a visual signal in the corridor at the
resident’s door or other appropriate location or a
10.3.6 Call System staff pager indicating the calling resident’s name
A nurse/staff call system shall be provided. and/or room location.
10.3.6.2 Patient room call station 10.4.1.2 A space shall be provided for central equip-
ment locations. Special air conditioning and voltage
(1) Each bed location and/or resident shall be provid- regulation shall be provided when recommended by
ed with a call device. Two call devices serving the manufacturer.
adjacent beds or residents may be served by one
calling station. 10.5 Electronic Safety and Security
(2) Calls shall be initiated by a resident activating 10.5.1 Fire Alarm System
either a call device attached to a resident’s call sta- Fire alarm and detection systems shall be provided in
tion or a portable device that sends a call signal to compliance with NFPA 101 and NFPA 72.
the call station and shall either:
2006 Guidelines for Design and Construction of Health Care Facilities 275
4 . 1 N U R S I N G FA C I L I T I E S
Table 4.1-1
Ventilation Requirements for Areas Affecting Resident Care in Nursing Facilities1
RESIDENT UNITS
Resident room — 2 2 — — —7 70-75 (21–24)
Resident unit corridor — — 4 — — —7 —
Resident gathering areas — 4 4 — — — —
Toilet room In — 10 Yes No — —
RESIDENT LIVING AREAS
Dining rooms — 2 4 — — — 75
Activity rooms, if provided — 4 6 — — — —
Personal services (barber/beauty) In 2 20 Yes No __ __
DIAGNOSTIC AND TREATMENT LOCATIONS
Physical therapy In 2 6 — — — 75 (24)
Occupational therapy In 2 6 — — — 75 (24)
SUPPORT AREAS
Soiled workroom or soiled holding In 2 10 Yes No — —
Clean workroom or clean holding Out 2 4 — — (Max) 70 75 (24)
Bathing rooms In — 10 Yes No — 75 (24)
SERVICE AREAS
Sterilizer exhaust room In — 10 Yes No — —
Linen and trash chute room, if provided In — 10 Yes No — —
Laundry, general, if provided — 2 10 Yes No — —
Soiled linen sorting and storage In — 10 Yes No — —
Clean linen storage Out — 2 Yes No — —
Food preparation facilities9 — 2 10 Yes Yes — —
Dietary warewashing In — 10 Yes Yes — —
Dietary storage areas — — 2 Yes No — —
Housekeeping rooms In — 10 Yes No — —
1 4
The ventilation rates in this table cover ventilation for comfort, as well as for asepsis and Number of air changes may be reduced when the room is unoccupied if provisions are
odor control in areas of nursing facilities that directly affect resident care and are deter- made to ensure that the number of air changes indicated is reestablished any time the
mined based on nursing facilities being predominantly “no smoking” facilities. Where space is being utilized. Adjustments shall include provisions so that the direction of air
smoking may be allowed, ventilation rates will need adjustments. Areas where specific movement shall remain the same when the number of air changes is reduced. Areas not
ventilation rates are not given in the table shall be ventilated in accordance with ASHRAE indicated as having continuous directional control may have ventilation systems shut down
Standard 62, Ventilation for Acceptable Indoor Air Quality, and ASHRAE Handbook—HVAC when space is unoccupied and ventilation is not otherwise needed.
Applications. Occupational Health and Safety Administration standards and/or National 5
Institute for Occupational Safety and Health criteria require special ventilation require- Air from areas with contamination and/or odor problems shall be exhausted to the outside
ments for employee health and safety within nursing facilities. and not recirculated to other areas. Note that individual circumstances may require special
consideration for air exhaust to outside.
2
Design of the ventilation system shall, insofar as possible, provide that air movement is from 6
“clean to less clean” areas. However, continuous compliance may be impractical with full uti- Because of cleaning difficulty and potential for buildup of contamination, recirculating
lization of some forms of variable air volume and load-shedding systems that may be used for room units shall not be used in areas marked “No.” Isolation rooms may be ventilated by
energy conservation. Areas that do require positive and continuous control are noted with reheat induction units in which only the primary air supplied from a central system passes
“Out” or “In” to indicate the required direction of air movement in relation to the space through the reheat unit. Gravity-type heating or cooling units such as radiators or convec-
named. Rate of air movement may, of course, be varied as needed within the limits required tors shall not be used in special care areas.
for positive control. Where indication of air movement direction is enclosed in parentheses, 7
See 4.1-A10.2.1.2 (2) for additional information.
continuous directional control is required only when the specialized equipment or device is in
8
use or where room use may otherwise compromise the intent of movement from clean to less Where temperature ranges are indicated, the systems shall be capable of maintaining the
clean. Air movement for rooms with dashes and nonpatient areas may vary as necessary to rooms at any point within the range. A single figure indicates a heating or cooling capacity
satisfy the requirements of those spaces. Additional adjustments may be needed when space of at least the indicated temperature. This is usually applicable where residents may be
is unused or unoccupied and air systems are de-energized or reduced. undressed and require a warmer environment. Nothing in these Guidelines shall be con-
strued as precluding the use of temperatures lower than those noted when the residents’
3
To satisfy exhaust needs, replacement air from outside is necessary. Table 4.1-1 does not comfort and medical conditions make lower temperatures desirable. Unoccupied areas
attempt to describe specific amounts of outside air to be supplied to individual spaces except such as storage rooms shall have temperatures appropriate for the function intended.
for certain areas such as those listed. Distribution of the outside air, added to the system to
balance required exhaust, shall be as required by good engineering practice.
276 2006 Guidelines for Design and Construction of Health Care Facilities
4 . 1 N U R S I N G FA C I L I T I E S
Table 4.1-2
Filter Efficiencies for Central Ventilation and Air-Conditioning Systems in Nursing Facilities
Notes
1. MERV = minimum efficiency reporting value. MERVs are based on ASHRAE 52.2.
2. The filtration efficiency ratings are based on average dust spot efficiency per ASHRAE 52.1.
Table 4.1-3
Hot Water Use—Nursing Facilities
ence minimums and shall not substitute for accepted engineering design (may be by separate booster) unless a chemical rinse is provided.
procedures using actual number and types of fixtures to be installed. Design
will also be affected by temperatures of cold water used for mixing, length of
4
Provisions shall be made to provide 160ºF (71ºC) hot water at the laundry
run and insulation relative to heat loss, etc. As an example, total quantity of equipment when needed. (This may be by steam jet or separate booster
hot water needed will be less when temperature available at the outlet is heater.) However, it is emphasized that this does not imply that all water
very nearly that of the source tank and the cold water used for tempering is used would be at this temperature. Water temperatures required for accept-
relatively warm. able laundry results will vary according to type of cycle, time of operation,
and formula of soap and bleach as well as type and degree of soil. Lower
2
The range represents the maximum and minimum allowable temperatures. temperatures may be adequate for most procedures in many facilities but
higher temperatures should be available when needed for special condi-
tions. Minimum laundry temperatures are for central laundries only.
2006 Guidelines for Design and Construction of Health Care Facilities 277
4 . 1 N U R S I N G FA C I L I T I E S
Table 4.1-4
Minimum Maintained Average Illuminance
Resident room
Entrance 300 30
Living room 300 30 750 75
Bedroom 300 30 750 75
Wardrobe/closet 300 30
Bathroom 300 30
Makeup/shaving area 300 30 600 60
Shower/bathing rooms 300 30
Kitchen area 300 30 500 50
1
Use of daylight is encouraged in entryways to provide a transition between outside and inside illumination levels.
Notes
1. Ambient light levels are minimum averages measured at 76 cm (30 in.) above the floor in a horizontal plane. Task light levels are absolute
minimums taken on the visual task. For makeup/shaving, the measurement is to be taken on the face in a vertical position.
2. It should be understood that the values listed are minimums. The optimum solution for task lighting is to give users control over the intensity
and positioning of the light source to meet their individual needs.
Reproduced with permission from ANSI/IESNA RP-28-01, Recommended Practice for Lighting and the Visual Environment for Senior Living.
278 2006 Guidelines for Design and Construction of Health Care Facilities
4.2 Hospice Facilities
Appendix material, which appears in shaded boxes at the bottom of the page, is advisory only.
1.2 Auxiliary Services Each facility shall comply with the following:
See Section 4.1-1.2.
*2.1 Unit Size
1.3 Environment of Care In the absence of local requirements, consideration
See Section 4.1-1.3. shall be given to restricting the size of the care unit to
25 beds.
1.4 Functional Program
See Section 4.1-1.4. APPENDIX
1.5 Shared Services A2.1 Overwhelming fatigue is the most predominant complaint
See Section 4.1-1.5. of hospice residents. Use of assistive devices is often humiliating
for residents. Arranging groups of resident rooms adjacent to
1.6 Site decentralized service areas, optional satellite staff work areas,
and optional decentralized resident support areas is desirable.
2006 Guidelines for Design and Construction of Health Care Facilities 279
4 . 2 H O S P I C E FA C I L I T I E S
2.2.2.3 Access shall be provided to both sides of the 3 Resident Living Areas
resident bed.
3.1 Resident Kitchen and Dining Areas
*2.2.3 Windows See Section 4.1-4.1. Where locally allowed, residential
See Section 4.1-6.3.3. “homelike” kitchen and dining facilities shall be per-
mitted to accommodate residents and their visitors.
2.2.4 Resident Privacy
See Section 4.1-2.2.5. 3.2 Personal Services (Barber/Beauty) Areas
If these services are required by the functional program,
2.2.5 Hand-Washing Station see Section 4.1-4.3.
See Section 4.1-2.2.6.
*3.3 Outdoor Spaces
APPENDIX Outdoor areas shall be available for residents.
280 2006 Guidelines for Design and Construction of Health Care Facilities
4 . 2 H O S P I C E FA C I L I T I E S
5.1.1.2 The physical environment for food service and 7.2 Heating, Ventilating, and Air-Conditioning
food service equipment shall comply with locally (HVAC) Systems
adopted food and sanitary regulations. See Section 4.1-10.2.
5.1.3 Distribution
Provision shall be made for transport of hot and cold
foods, as required by the functional program.
6 Construction Standards
6.1.1 Doors
See Section 4.1-8.2.2.3.
2006 Guidelines for Design and Construction of Health Care Facilities 281
4.3 Assisted Living
Appendix material, which appears in shaded boxes at the bottom of the page, is advisory only.
282 2006 Guidelines for Design and Construction of Health Care Facilities
4.3 ASSISTED LIVING
pharmacy, linen, and laundry in accordance with the 1.5 Shared Services
functional program may be contractually provided or When a facility shares or purchases services, appropri-
shared insofar as practical with other licensed or unli- ate modifications or deletions in space and parking
censed entities. requirements shall be permitted.
APPENDIX
A1.9 Codes and Standards d. Resident waiting areas. The therapeutic and programmatic ben-
a. Appropriate code. There has been a great deal of discussion efits of providing waiting areas and similar spaces open to the cor-
about which building code or life safety code is appropriate for ridor have long been recognized within long-term care facilities.
the design and construction of assisted living facilities. Facilities Spaces open to the corridor significantly enhance resident mobility
serving similar resident groups and providing similar services are and accessibility to programs, encouraging resident participation.
considered residential occupancies in some jurisdictions and
Spaces open to corridors should be allowed within assisted living
institutional occupancies in others.
facilities utilizing residential occupancy and construction types
The model codes do not adequately recognize the unique nature of where the following criteria are met:
assisted living as a distinct occupancy classification. Institutional
The spaces are not used as sleeping rooms or hazardous or inci-
codes place overly restrictive and costly requirements on facility
dental use areas, and the space is arranged so access to required
construction. Residential codes, however, may not require ade-
exits is not obstructed.
quate protection.
The corridors and areas open to corridors are equipped with quick
b. Residential construction type. To provide the flexibility needed to
response sprinklers and an automatic smoke detection system,
serve residents whose physical and mental capabilities may
which automatically notifies emergency forces.
change over time, to eliminate the requirement for authorities hav-
ing jurisdiction to continually monitor the evacuation capabilities of e. Programmatic considerations may call for the control of egress
residents within assisted living facilities, and to provide additional from some facilities or portions of facilities. Where such egress
protection for facilities occupied by physically and mentally frail control is desired, the following should be followed:
occupants who may require physical assistance from others, use of
The means of egress should not be locked except when clinical
a “Residential Plus” construction type is recommended for assisted
reasons are well documented and when such egress control is not
living facilities with 24-hour staff. A “Residential Plus” occupancy
a substitute for appropriate staffing.
allows use of residential construction, with the addition of several
technological and institutional requirements. These additional When the means of egress is locked, a keyed or electronically
requirements provide for prompt detection, notification, and sup- released locking device must automatically open upon activation
pression of fire within a facility and allow use of a “defend-in-place” of the fire alarm system or loss of power.
approach that minimizes the need for evacuation of occupants.
No device operation sign should be posted when 24-hour awake
c. Safety features. Assisted living facilities utilizing residential and trained staff supervises the locking device.
occupancy and construction types should be permitted with the
f. Accessibility. Assisted living facilities should consider residents
addition of the following safety features:
with varying and possibly increasing levels of acuity. To maximize
Protection of the facilities throughout with a supervised automatic the potential for aging in place, particular attention should be paid
fire suppression system with quick-response sprinklers in smoke to overall accessibility. Locations where individuals may not require
compartments containing sleeping rooms. Automatic fire suppres- physical assistance from others in emergency situations typically
sion systems in facilities with more than 16 occupants should be require compliance with standards for multifamily housing (a spe-
installed in accordance with NFPA 13. cific subset is now used as “safe harbor” for Fair Housing architec-
tural requirements). In addition, the Uniform Federal Accessibility
Smoke barriers subdividing every story into at least two smoke
Guidelines shall apply for structures built with federal assistance.
compartments. Such smoke compartments should be not more
Locations where individuals require physical assistance from oth-
than 22,500 square feet (6,858 square meters), and the travel
ers in emergency situations may require compliance with the
distance from any point in each smoke compartment to a smoke
Americans with Disabilities Act Accessibility Guidelines (ADAAG).
barrier door should not exceed 200 feet (61 meters).
2006 Guidelines for Design and Construction of Health Care Facilities 283
4.3 ASSISTED LIVING
Group living model. Group living model facilities provide smaller 1.11 Planning, Design, and Construction
private spaces that are sometimes limited to a private or shared See Chapter 1.5.
resident bedroom area. The focus of daily life is provided within
shared activity spaces that are residential-scaled and organized 1.12 Record Drawings and Manuals
similar to a typical house. These smaller-scale “homes” may be See Section 1.5-5.
freestanding or grouped together in attached or detached configu-
rations. At times, commons or community facilities are provided to
allow residents to participate in activities outside of their “home.” 2 Resident Living Environment
Alternative models. Many alternative facility configurations have
*2.1 General
been created that incorporate aspects from each of these
approaches. These guidelines are intended to allow and encour-
2.1.1 Space Requirements
age the continued evolution of this facility type without locking into
Facility spatial requirements shall be determined by
a particular program or model.
the functional program.
284 2006 Guidelines for Design and Construction of Health Care Facilities
4.3 ASSISTED LIVING
2.1.2 Layout 2.2.5.2 The toilet room shall contain a water closet,
Areas for the care and treatment of users not residing lavatory, and a horizontal surface for the personal
in the facility shall not interfere with or infringe upon effects of each resident.
the space of residents living in the facility.
2.2.6 Resident Storage
2.2 Resident Rooms or Apartments Each resident shall be provided separate and adequate
The facility shall provide adequately sized bedrooms enclosed storage volume within the resident room.
or apartments (dwelling units) that allow for sleeping,
afford privacy, provide access to furniture and belong- 2.3 Support Areas for Resident Rooms/Apartments
ings, and accommodate the care and treatment
provided to the resident. 2.3.1 Staff Work Area(s)
These areas shall be provided in accordance with the
2.2.1 Capacity functional program.
Bedrooms shall be limited to single or double occupancy.
2.3.1.1 Lockable storage shall be provided for resident
*2.2.2 Space Requirements records.
2.2.2.1 Resident room size (area and dimensions) shall
permit resident(s) to move about the room with the 2.3.1.2 Direct visualization of resident rooms or corri-
assistance of a walker or wheelchair, allowing access to dors from staff work areas is not required.
at least one side of a bed, window, closet or wardrobe,
chair, dresser, and nightstand. 2.3.2 Medication Preparation
When required by the functional program, provision shall
2.2.2.2 Room size and configuration shall permit be made for 24-hour distribution of medications. A medi-
resident(s) options for bed location(s) and shall cine preparation room, a self-contained medicine dispens-
comply with spatial requirements of the authority ing unit, or other system may be used for this purpose.
having jurisdiction.
APPENDIX
*2.2.2.3 Where cooking is permitted in resident rooms
(apartments), additional floor area shall be provided A2.2.2 In cases where double-occupancy resident rooms are
for cooking and dining. The cooking area shall be provided, configurations should be utilized that provide individual
equipped with a dedicated sink and cooking and privacy and control of the environment. The design should not
refrigeration appliances. restrict access to shared, common elements within the room.
2006 Guidelines for Design and Construction of Health Care Facilities 285
4.3 ASSISTED LIVING
(1) The medicine preparation room, if used, shall 2.5.1 Bathing facilities
provide for security. 2.5.1.1 Location. Bathing facilities shall be provided on
each floor where resident sleeping areas are located.
(2) It shall contain a work counter, sink, refrigerator,
and locked storage for controlled drugs. 2.5.1.2 Number. One bathtub or shower shall be pro-
vided for every eight residents (or fraction thereof)
2.3.2.2 Medicine dispensing unit. A self-contained not otherwise served by bathing facilities in resident
medicine dispensing unit, if used, may be located at rooms. A bathtub shall be provided for resident use
the staff work area, in the clean workroom, in an when required by the functional program.
alcove, or in other space convenient for staff control.
(Standard “cup” sinks provided in many self-contained 2.5.1.3 Space requirements. Bathing fixtures shall be
units are not adequate for hand-washing.) located in individual rooms or enclosures with space
for private use of the bathing fixture and for drying
2.4 Support Areas for Staff and dressing, as well as convenient access to a grooming
location with a lavatory, mirror, and counter or shelf.
2.4.1 Staff Lounge Area
When required by the functional program, a staff 2.5.1.4 Toilet. A toilet shall be provided within or
lounge area shall be provided. directly accessible to each resident bathing facility
without requiring entry into the general corridor.
2.4.2 Toilet Room(s)
Toilet room(s) for staff and public use shall be provided.
3 Special Care Facilities
2.4.2.1 These shall contain water closets with a hand-
washing station. *3.1 Alzheimer’s and Other Dementia Units
A secure unit is a distinct living environment designed
2.4.2.2 Toilet rooms may be unisex and shared by public for the particular needs and behaviors of residents
and residents. with dementia. Dementia units within assisted living
facilities shall, in addition to the assisted living
2.4.3 Staff Storage requirements, comply with the following:
Lockable closets, drawers, or compartments shall be
provided for safekeeping of staff personal effects such 3.1.1 Controlled Egress
as handbags. Dementia units shall provide an appropriate controlled-
egress system on all required exit doors and doors
leading to other areas of the facility unless prior
APPENDIX approval of an alternative method for prevention of
resident elopement from the unit has been obtained
A3.1 Dementia Units from the authority having jurisdiction.
These are secure units specifically designed for individuals with
dementia. However, in some assisted living facilities, a significant 3.1.2 Windows
percentage of individuals with some level of dementia may not All operable windows shall be equipped with mecha-
reside in a dementia unit. Thus, the entire assisted living facility nisms to limit exterior window openings, to prevent
should be designed to facilitate the highest level of functioning for elopement and accidental falls.
all residents. The living environment should be equipped with spe-
cial features such as personalized resident bedrooms, features 3.1.3 Leisure and Dining Space
that support resident orientation to their surroundings, secured A dementia unit operated as a portion of an assisted
storage, safe outside areas, and security considerations to living facility must provide self-contained leisure and
support individuals with varying levels of cognitive impairment. dining room space, unless it can be demonstrated to
286 2006 Guidelines for Design and Construction of Health Care Facilities
4.3 ASSISTED LIVING
4.1.2.2 In a facility with more than 16 residents, dining 5.2.1.1 An area for soiled linen awaiting pickup
and social areas shall not be confined to a single room.
5.2.1.2 A separate area for storage and distribution of
4.1.3 Toilet Rooms clean linen
Toilet room(s) shall be provided convenient to dining
and social areas. 5.2.2 On-Site Linen Services
If on-site services are provided, the facility shall provide
4.2 Activity and Social Areas the following:
4.2.1 Space Requirements 5.2.2.1 Areas dedicated to laundry that are separate
4.2.1.1 Activity areas shall accommodate both group from food preparation areas
and individual activities.
5.2.2.2 A laundry area for facility-processed bulk laundry.
4.2.1.2 A minimum of 20 square feet (1.86 square This shall be divided into separate soiled (sort and
meters) per facility resident shall be provided for washer area) and clean (drying, folding, and mending
activity areas for socialization, passive and active area) rooms.
recreation, and social activities.
2006 Guidelines for Design and Construction of Health Care Facilities 287
4.3 ASSISTED LIVING
288 2006 Guidelines for Design and Construction of Health Care Facilities
4.3 ASSISTED LIVING
APPENDIX
A9.4.2 Lighting has been demonstrated that deliberately camouflaged door hard-
a. Excessive differences in lighting levels should be avoided in ware may help control wandering and elopements by some cogni-
transition areas between parking lots, building entrances and lob- tively impaired residents in Alzheimer’s care facilities.)
bies, or corridors; in transition zones between driveways and park-
e. Care should be taken to avoid injury from lighting fixtures. Light
ing garages, etc. As the eye ages, pupils become smaller and less
sources that may burn residents or ignite bed linen by direct con-
elastic, making visual adaptation to dark spaces slower. Upon
tact should be covered or protected.
entering a space with a considerably lower lighting level, elderly
residents may need to stop or move to one side until their eyes f. Ambient light levels are determined on a horizontal plane above
adapt to excessive lighting changes. Elderly pedestrians may need the floor. The use of this method in areas such as those listed in
several minutes to adjust to significant changes in brightness Table 4.1-4 should result in values of average illuminance within
when entering a building from a sunlit walkway or terrace. 10 percent of the values that would be obtained by dividing the
area into 2-foot (0.6-meter) squares, taking a reading in each
b. Consideration should be given to increasing both indoor and out-
square, and averaging.
door illumination levels in such transition spaces to avoid excessive
differences between electric lighting levels and natural daytime and The measuring instrument should be positioned so that when
nighttime illumination levels. In addition, it is very helpful for pedes- readings are taken, the surface of the light-sensitive cell is in a
trians to have conveniently located places to wait, giving them time horizontal plane and 30 inches (760 millimeters) above the floor.
to adjust their eyes to different lighting environments. This can be facilitated by means of a small portable stand of wood
or other material that will support the cell at the correct height and
c. Care should be taken to minimize extremes of brightness within
in the proper plane. Daylight may be excluded during illuminance
spaces and in transitions between spaces. Excessive brightness
measurements. Readings can be taken at night or with shades,
contrast from windows or lighting systems can disorient residents.
blinds, or other opaque covering on the fenestration.
d. Lighting that creates glare and colors that do not differentiate
A9.4.2.1 (1) The Illuminating Engineering Society of North
between horizontal and vertical planes, or between objects and
America (IESNA) has developed recommended lighting design
their backgrounds (such as handrails or light switches from walls,
practices, including minimum lighting levels for senior living envi-
hardware from doors, faucets from sinks, bathroom fixtures from
ronments. Refer to ANSI/IESNA RP-28, Lighting and the Visual
wall colors, or control knobs from appliances) should be avoided,
Environment for Senior Living, for additional information.
unless therapeutic benefits can be demonstrated. (For example, it
2006 Guidelines for Design and Construction of Health Care Facilities 289
4.3 ASSISTED LIVING
(b) Glare control (a) Resident unit corridors shall have general
illumination with provisions for reducing
(c) Special lighting needs of the elderly light levels at night.
(d) Area-specific lighting solutions (b) Corridors and common areas used by residents
shall have even light distribution to avoid glare,
(e) Use of daylighting in all resident rooms and shadows, and scalloped lighting effects.
resident use areas
(c) Highly polished flooring or floors with glossy
(f) Life-cycle costs of lighting sheen shall not be used.
*(1) Resident rooms and toilet rooms 9.6 Fire Alarm and Detection Systems
Fire alarm and detection systems shall be provided in
(a) Resident rooms and toilet rooms shall have accordance with applicable codes and regulations. See
provisions for general lighting and task lighting. Section 4.1-10.5.
APPENDIX
290 2006 Guidelines for Design and Construction of Health Care Facilities
4.4 Adult Day Health Care Facilities
Appendix material, which appears in shaded boxes at the bottom of the page, is advisory only.
Adult day health care (ADHC) services are group participants as required by the functional program.
programs designed to meet the needs of functionally This space shall include designated area(s) to be uti-
and/or cognitively impaired adults. Adult day health lized when the privacy of the participants requires it.
care facilities provide a caring, non-institutional setting
for individuals who, for their own safety and well-being, 1.2.3 Participants are defined as the number of people
can no longer be left at home alone. Adult day health exclusive of staff occupying the space at the same time.
care facilities offer protected settings and include a
mixture of health and support services. Many offer *1.3 Facility Access
specialized services such as programs for individuals When possible, the ADHC facility shall be located on
with Alzheimer’s disease, developmental disabilities, the street level or shall be equipped with ramps or ele-
traumatic brain injury, mental illness, HIV/AIDS, and vators to allow easy access for persons with disabilities.
vision and hearing impairments. Adult day health care
facilities are an integral component of the continuum
of care for the elderly and disabled. 2 Care Locations
2006 Guidelines for Design and Construction of Health Care Facilities 291
4 . 4 A D U LT D AY H E A LT H C A R E F A C I L I T I E S
292 2006 Guidelines for Design and Construction of Health Care Facilities
4 . 4 A D U LT D AY H E A LT H C A R E F A C I L I T I E S
APPENDIX
4 Service Areas
A2.5.2 Access to a washer and dryer is preferable when the
*4.1 Dining Areas participants have incontinence or physical limitations that
predispose them to soiling with blood, body fluids, or food spills
4.2 Environmental Services (e.g., swallowing or chewing problems, shakes or tremors).
2006 Guidelines for Design and Construction of Health Care Facilities 293
4 . 4 A D U LT D AY H E A LT H C A R E F A C I L I T I E S
7 Building Systems
7.1 Plumbing
7.2.1 Ventilation
Ventilation by mechanical means shall be provided.
Air conditioning and heating equipment shall be
adequate and capable of maintaining the temperature
in each room used by participants between 72º F
(22º C) and 78º F (26º C).
*7.3.1 Lighting
Lighting shall be engineered to the specific applica-
tion. Table 4.1-4 shall be used as a guide to minimum
required ambient and task lighting levels in all rooms,
spaces, and exterior walkways.
APPENDIX
294 2006 Guidelines for Design and Construction of Health Care Facilities
Glossary
Specific terms and definitions are provided below to screens. Cubicles should be designed to accommodate
facilitate consistency in the interpretation and applica- patient privacy, mobility, flexible use, and ease of access.
tion of the Guidelines.
Documentation area: A work area associated with or
Administrative areas: Designated spaces such as offices near a patient care area where information specific to
and meeting rooms that accommodate admission and patients is recorded, stored, and reviewed to facilitate
discharge processes, medical records storage, medical ready access by authorized individuals.
and nursing administration, business management
and financial services, human resources, purchasing, Differential pressure: A measurable difference in air
community services, education, and public relations. pressure that creates a directional airflow between
adjacent spaces.
Airborne infection isolation room: A single-occupancy
room for patient care in which environmental factors Emergency call system: Devices that are activated to
are controlled to minimize transmission of infectious indicate the need for staff assistance. Such devices pro-
agents spread from person to person by droplet nuclei duce an audible or visual indication (or both) or may
associated with coughing and inhalation. (Such rooms be connected or transmit to an area alert monitor.
typically have specific requirements for controlled ven-
tilation, air pressure, and air filtration.) Environment of care: Those features in a built health
care facility that are created, structured, and main-
Ambulatory care: A defined health care encounter of tained to support and enhance quality health care.
less than 24 hours in duration that requires direct pro-
fessional health care support within a specific facility. Facility: A discrete physical entity composed of various
functional units as described within these Guidelines.
Ambulatory surgical facility: Any surgical facility
organized for the purpose of providing invasive surgi- Hand-washing station: An area that provides a sink
cal care to patients with the expectation that they will with hot and cold water supply and a faucet that facili-
be recovered sufficiently to be discharged in less than tates easy on/off/mixing capabilities. The station also
24 hours. provides cleansing agents and means for drying hands.
Bed size: Minimum rectangular dimensions for planning Hand sanitation station: A dispensing location for a
minimum clearances around beds—40 inches (101.6 waterless, antiseptic hand rub product that is applied
centimeters) wide by 96 inches (2.43 meters) long. to reduce the number of microorganisms present on
the hands.
Bioterrorism: The use, or threat of use, of biological
agents to intimidate a political entity or population Health care facility: Any facility type listed in the table
group. of contents of this book.
Clear floor area: The built floor area available for func- Housekeeping: Services anywhere within a health care
tional use in a defined space. Such area shall not facility that provide general cleaning and tidying and
include other defined spaces (e.g., anterooms, supply identified cleaning materials (e.g., soaps, tow-
vestibules, toilet rooms, closets, alcoves) or built-in els). (While routine disinfection protocols can be
equipment (e.g., lockers, wardrobes, fixed casework). included in such a definition, the definition is not
intended to include complex, non-routine disinfection
Cubicle: A patient location that is used for short-term procedures nor the non-routine disposition of haz-
patient-focused activities (e.g., observation or recovery) ardous materials such as potentially toxic drugs or
and can be delineated by ceiling-hung curtains or other chemicals and radioactive wastes.)
2006 Guidelines for Design and Construction of Health Care Facilities 295
GLOSSARY
Infection control risk assessment: A multidisciplinary Patient care area: An area used primarily for the provi-
organizational process that focuses on reducing risk sion of clinical care to patients. Such care includes
from infection throughout facility planning, design, monitoring, evaluation, and treatment services.
and construction (including renovation) activities.
The environment, infectious agents, and human fac- Perioperative: Referring to patient care and other
tors and the impact of the proposed project are con- related support activities immediately before, during,
sidered by a multidisciplinary team that includes, at or after an operative procedure.
minimum, those with expertise in infectious disease,
infection control, patient care, epidemiology, facility Protective environment: A specialized patient care area
design, engineering, construction, and safety, as cir- that can safely accommodate highly immunosup-
cumstances dictate. pressed patients (patients with severe neutropenia,
bone marrow transplant patients, or patients with
Invasive procedure: For the purposes of this docu- childhood acute AML).
ment, any procedure that penetrates the protective
surfaces of a patient’s body (i.e., skin, mucous mem- Provision of drinking water: Availability of readily
brane, cornea) and that is performed within an aseptic accessible potable water for patient, staff, and visitor
field (procedural site). Not included in this category needs. This may be provided in a variety of ways,
are placement of peripheral intravenous needles or including fountains and bottled water.
catheters, dialysis, bronchoscopy, endoscopy (e.g., sig-
moidoscopy), insertion of urethral catheters, and simi- Public areas: Designated spaces freely accessible to the
lar procedures. public. These include parking areas, secured entrances
and areas, entrance lobbies, reception and waiting areas,
Minimum clearance: The shortest unencumbered dis- public toilets, snack bars, cafeterias, vending areas, gift
tance between the outermost dimensions of a specified shops and other retail locations, health education
object (often a patient bed) and specified, fixed refer- libraries and meeting rooms, chapels, and gardens.
ence points (e.g., walls, cabinets, sinks, and doors).
Restricted area: A designated space with limited access
Monolithic ceiling: A ceiling constructed with a sur- eligibility. Such space has one or more of the following
face free of fissures, cracks, and crevices. Any penetra- attributes: specific signage; physical barriers; security
tions such as lights, diffusers, and access panels shall controls and protocols that delineate requirements for
be sealed or gasketed. (“Lay-in” ceilings are not con- monitoring, maintenance, attire, and use. (The term is
sidered “monolithic.”) often applied to operating rooms and suites.)
Nursing locations: Departments, units, rooms, spaces, Sealed (tight) room: A room that meets specific venti-
or areas in which patient observation, nursing care, lation requirements and has minimum air leakage to
and treatment services rendered involve direct contact achieve a particular designed air quality, airflow direc-
between patients/residents and staff. tion, and pressure differential.
Observation unit: An area usually associated with an Service areas: Designated spaces that house auxiliary
emergency department where one or more patients functions that do not routinely involve contact with
can be clinically monitored, assessed, and treated by patients, residents, clients, or the public (e.g., supply,
staff for up to 24 hours. processing, storage, and maintenance services such as
pharmacy, dietary, bulk sterile processing, laundry
Operating room: A room specifically designed for the processing and storage, housekeeping, engineering
performance of surgical procedures. (This includes operations, and waste storage/holding facilities).
most types of surgical procedures but especially those
involving administration of anesthesia, multiple per- Subacute care: A category of care requiring less inten-
sonnel, recovery room access, and a fully controlled sity of care/resources than acute care. It falls within a
environment.) continuum of care determined by patient acuity, clini-
cal stability, and resource needs.
296 2006 Guidelines for Design and Construction of Health Care Facilities
GLOSSARY
2006 Guidelines for Design and Construction of Health Care Facilities 297
Index
Note: Numbers preceded by ‘A’ indicate information pre- American Institute of Architects, 1.1-1.2
sented in the appendix. Information presented in tables is Americans with Disabilities Act (ADA)
indicated by t. handrails and, 2.1–3.9.6.1
overview of, 1.1–4.1.1.1
Anesthesia scavenging systems
Activity areas in general hospitals, 2.1–10.2.4.3 (2),
in nursing facilities, 4.1–4.2, 4.1–A4.2 2.1–A10.2.4.3 (2)
for pediatric units in psychiatric hospitals, in outpatient facilities, 3.1–7.2.5.3 (2),
2.3–2.3.2 3.1–A7.2.5.3 (2)
in rehabilitation facilities, 2.4–3.2 Anesthesia storage rooms, 3.1–7.2.3.3
Administrative areas Anesthesia workrooms
in birthing centers, 3.6–4.2 for delivery suites, 2.1–4.3.6.3 (4)
for gastrointestinal endoscopy facilities, 3.9–4.2 HVAC system considerations for, 2.1–10.2.2.6
in general hospitals, 2.1–7.2 for surgical suites, 2.1–5.3.5.11
in nursing facilities, 4.1–7.2 Angiography facilities, 2.1–5.5.2
in outpatient facilities, 3.1–4.2 Aquariums, 1.2–A2.1.2.5 (8)
in outpatient surgical facilities, 3.7–4.2 Artificial lighting strategies, 1.2–A2.1.2.5 (1). See also Lighting
in psychiatric outpatient centers, 3.11–3.2 Art therapy, in psychiatric hospitals, 2.3–3.4.3,
in rehabilitation facilities, 2.4–6.2 2.3–A3.4.3.2 (1)
in small hospitals, 2.2–5.2 Assisted living facilities. See also Nursing facilities;
Admissions area, in hospitals, 2.1–7.2.1 Rehabilitation facilities
Adult day health care facilities, 4.4 accessibility of, 4.3–A1.9 (f)
Airborne infection isolation rooms Alzheimer’s units in, 4.3–3.1, 4.3–A3.1
in dialysis centers, 3.10–2.3.1 bathing facilities in, 4.3–2.5.1
in general hospitals, 2.1–3.2.2, 2.1–A3.2.2.4 (4) call systems in, 4.3–9.4.3, 4.3–A9.4.3
in critical care units, 2.1–3.4.2.2 HVAC systems in, 4.3–9.3, 4.3–A9.3
for dialysis units, 2.1–5.9.2.8 lighting in, 4.3–9.4.2, 4.3–A9.4.2
in emergency room, 2.1–5.1.2.6, linen services in, 4.3–5.2
2.1–5.1.3.8 parking for, 4.3–1.6.3
HVAC considerations for, 2.1–10.2.2.2 resident rooms/apartments in, 4.3–2.2
for immunosuppressed hosts, 2.1–A3.2.3 space requirements, 4.3–A2.1
in intermediate care units, 2.1–3.3.3 supportive environment of, 4.3–1.3.1
in NICU, 2.1–3.4.6.2 toilet rooms in, 4.3–2.2.5, 4.3–A2.2.5
in nurseries, 2.1–3.6.3 waiting areas in, 4.3–A1.9 (d)
in obstetrical unit, 2.1–4.2.2 Autoclaves, high-speed, 2.1–A4.3.6.3 (5)
in outpatient facilities, 3.1–2.1.5 Autopsy rooms, 2.1–5.12.2, 2.1–A5.12.2
in psychiatric hospitals, 2.3–2.2.2 Autopsy table drains, 2.1–10.1.2.5 (3)
in rehabilitation facilities, 2.4–2.2.1 Barber/beauty areas
Air conditioning. See HVAC systems in nursing facilities, 4.1–4.3, 4.1–A4.3
Air-handling systems. See also HVAC systems in rehabilitation facilities, 2.4–3.3
in general hospitals, 2.1–10.2.1.1 (2) Bathing facilities
in nursing facilities, 4.1–10.2.1.1 (2) in assisted living facilities, 4.3–2.5.1
in outpatient facilities, 3.1–7.2.2.1 (2), in general hospitals, 2.1–3.1.5.9, 2.1–3.3.2.8
3.1–A7.2.2.1 (2) in medical/surgical nursing units, 2.1–3.1.5.9
in psychiatric hospitals, 2.3–8.2.1.1 (2) in psychiatric hospitals, 2.3–2.9.2, 2.3–6.2.2.4
in rehabilitation facilities, 2.4–9.2.1.1 (2) in rehabilitation facilities, 2.4–2.1.5.2
Air quality nonslip surfaces for, 1.6–2.1.3.3
environmental pollution control and, 1.3–4.1 Bedpan-flushing devices, 2.1–10.1.2.3 (4)
environment of care and, 1.2–3.1.5, 1.2–A 3.1.5 Beds, swing, in general hospitals, 2.1–1.2.2, 2.1–A1.2.2
renovation and, 1.5–3.3 Bereavement area, in emergency room, 2.1–A5.1.3.11 (1)
Air supply, for HVAC system, 2.1–10.2.2.4 (1) Biological warfare disaster, 1.1–5.2
Alzheimer’s units Birthing centers. See also Obstetrical units
in assisted living facilities, 4.3–3.1, 4.3–A3.1 administrative areas in, 3.6–4
in nursing facilities, 4.1–3.2 birthing rooms in, 3.6–2.1
in psychiatric hospitals, 2.3–2.4 laundry facilities in, 3.6–3.2
298 2006 Guidelines for Design and Construction of Health Care Facilities
INDEX
2006 Guidelines for Design and Construction of Health Care Facilities 299
INDEX
combined with critical care units, 2.1–3.4.4 electrical receptacles in, 2.1–10.3.7.2 (10)
privacy in, 2.1–3.4.3.1 equipment storage in, 2.1–5.9.4.10
Cough-inducing procedure areas, 2.1–5.8.1, 2.1–10.2.2.5 examinations rooms in, 2.1–5.9.3
Critical care units hand-washing stations for, 2.1–5.9.2.5
airborne infection isolation rooms in, 2.1–3.4.2.2 in hospitals, 2.1–5.9
call systems in, 2.1–3.4.2.1 (5) humidity control for, 2.1–5.9.8.2, 2.1–A5.9.8.2
combined with coronary care units, 2.1–3.4.4 nourishment stations for, 2.1–5.9.4.3
documentation areas in, 2.1–3.4.2.4 (2), patient support area for, 2.1–5.9.6
2.1–A3.4.2.4 (2) plumbing for, 2.1–5.9.8.1, 2.1–10.1.2.2, 2.2–8.1.1,
doors in, 2.1–3.4.2.1 (7)(a) 2.1–A5.9.8.1
electrical receptacles in, 2.1–10.3.7.2 (3) soiled workroom for, 2.1–5.9.4.9
elevators and, 2.1–3.4.1.5, 2.1–A3.4.1.5 staff support area for, 2.1–5.9.5
environment of care in, 2.1–3.4.1.2 stat labs for, 2.1–5.9.2.7
in general hospitals, 2.1–3.4 support areas for, 2.1–5.9.4
hand-washing stations in, 2.1–3.4.2.1 (6) Dialyzer reprocessing rooms, 2.1–5.9.4.4, 3.10-3.1
housekeeping rooms in, 2.1–3.4.2.4 (13) Dietary facilities. See also Nourishment areas
linen storage in, 2.1–3.4.2.4 (12)(a) in general hospitals
location of, 2.1–3.4.1.4 ceilings in, 2.1–8.2.3.4 (2)
medication stations in, 2.1–A3.4.2.4 (5) floor drains in, 2.1–10.1.2.5 (2)(c)
nourishment areas in, 2.1–3.4.2.4 (8) grease traps in, 2.1–10.1.2.5 (5)
observation of patients in, 2.1–3.4.2.4 (1)(b), in hospitals, 2.1–6.2 See also
2.1–A3.4.2.4 (1) Nourishment areas
office space in, 2.1–3.4.2.4 (3) HVAC considerations for, 2.1–10.2.2.8
patient monitoring equipment in, 2.1–A3.4.2.4 (6) walls in, 2.1–8.2.3.3 (2)
pediatric, 2.1–3.4.5 in nursing facilities, 4.1–6.1, 4.1–10.2.2.1
privacy in, 2.1–3.4.2.1 (4) in psychiatric hospitals, 2.3–8.2.2.3
in small hospitals, 2.2–2.3.4 in rehabilitation facilities, 2.4–5.2
soiled workrooms in, 2.1–3.4.2.4 (11) Disasters
staff support areas in, 2.1–3.4.2.5 construction standards and, 2.1–8.1.3
support areas for, 2.1–3.4.2.4 and continued operation, 1.1–5.3.2
visitor areas in, 2.1–3.4.2.6 emergency supplies, 1.1–5.5
windows in, 2.1–3.4.2.1 (3) facility assessment, 1.1–5.1.1
x-ray viewing facility in, 2.1–3.4.2.4 (7) facility planning, 1.1–5.1.2
Cryogen storage, for MRI, 2.1–A5.5.5.7 flood, 1.1–5.4
Cultural concerns, environment of care and, 1.2–2.1.2.5 (7), NBC hazards, 1.1–5.2
1.2–A2.1.2.5 (7) needs assessment, 1.1–5.1
Cystoscopy operating rooms, drains in, 2.1–10.1.2.5 (2)(b), roof considerations, 1.1–5.3.4
2.1–A10.1.2.5 (2)(b) Disclaimers, 1.1–1.2.2
Darkroom. See also Film processing room Dishwashing facilities, 2.1–6.2.2.8, 2.1–6.2.2.9
for MRI, 2.1–5.5.5.6, 2.1–A5.5.5.6 Documentation areas
for nuclear medicine area, 2.1-5.6.4.5 (4), in general hospitals, 2.1–2.3.2
2.1-A5.6.4.5 (4) in critical care units, 2.1–3.4.2.4 (2),
ventilation requirements, 2.1-2t 2.1–A3.4.2.4 (2)
Day care facilities, adult health, 4.4 in NICU, 2.1–3.4.6.4 (1)
Decontamination area in nurseries, 2.1–3.6.5.1
for ER, 2.1–5.1.3.7 (5), 2.1–A5.1.3.7 (5) in psychiatric hospitals, 2.3–2.7.2
for gastrointestinal endoscopy facilities, 3.9–3.2.2 Doors
Design, health facility closers for, 2.3–6.2.2.1 (3)
data, 1.5–5.3 for gastrointestinal endoscopy facilities,
environment of care considerations and, 1.5–1.2 3.9–5.2.1.2
infection control risk assessment and, 1.5–.2.2.1 in general hospitals
Design development documents. See Drawings, architectural in critical care units, 2.1–3.4.2.1 (7)(a)
Diagnostic outpatient facilities, freestanding, 3.4 elevator, 2.1–9.2.3.2, 2.1–A9.2.3.2
Dialysis centers, 3.10 for ER trauma rooms, 2.1–5.1.3.7 (2)(e)
Dialysis units hardware of, 2.1–8.2.2.3 (4)
airborne infection isolation rooms for, 2.1–5.9.2.8 in NICU, 2.1–3.4.6.1 (7)(b)
clean workroom for, 2.1–5.9.4.8 in patient rooms, 2.1–8.2.2.3 (2)(b)
diagnostic area in, 2.1–5.9.7 size of, 2.1–8.2.2.3 (2)
dialyzer processing rooms for, 2.1–5.9.4.4 swing of, 2.1–8.2.2.3 (3)
300 2006 Guidelines for Design and Construction of Health Care Facilities
INDEX
2006 Guidelines for Design and Construction of Health Care Facilities 301
INDEX
for mobile, transportable, and relocatable units, in critical care units, 2.1–3.4.2.4 (12),
3.12-3.1.1, 3.12-A3.1.1 2.1–A3.4.2.4 (12)(b)
for psychiatric outpatient centers, 3.11–3.1.4 in dialysis units, 2.1–5.9.4.10
for small hospitals, 2.2–5.1.1 for dietary facilities, 2.1–6.3.2
for urgent care facilities, 3.5–3.1.1 in emergency room, 2.1–5.1.3.9 (8)
Environmental impact statement (EIS), 1.3–4.1.3.1 for gastrointestinal endoscopy facilities,
Environmental pollution control, 1.3–4 3.9–3.3
federal standards for, 1.3–4.1.1 for hyperbaric suites, 2.1–A5.10 (i)
Environmental services. See also Housekeeping rooms in medical/surgical nursing units,
in hospitals, 2.1–6.6 2.1–3.1.5.12
in outpatient facilities, 3.1–3.1 in small hospitals, 2.2–2.5.10, 2.2–4.3.1
in rehabilitation facilities, 2.4–5.6 in surgical suites, 2.1–5.3.5.14
Environment of care technical, major, 1.4–3.1, 1.4–A3.1
components, 1.2–2.1.2 in urgent care facilities, 3.5–2.4.3
cultural concerns and, 1.2–2.1.2.5 (7), Ethylene oxide (ETO) sterilizers
1.2–A2.1.2.5 (7) general hospital sterilization room, 2.1-A6.3.1.2 (d)
definition of, 1.2-A1.2 ventilation requirements for, 2.1–10.2.2.7,
design and, 1.5–1.2 3.1-7.2.3.3, 2.4-9.2.2.2
finishes and, 1.2–2.1.2.5 (6), 1.2–A2.1.2.5 (6) Examination rooms
in general hospitals in dialysis center, 3.10-2.1
in critical care units, 2.1–3.4.1.2 in dialysis unit, 2.1-5.9.3
in psychiatric nursing units, 2.1–3.8.1.3 Examination and treatment rooms
light and, 1.2–2.1.2.5 (1), 1.2–A2.1.2.5 (1) in general hospitals
nomenclature, 1.2–2.2 definitive emergency care, 2.1-5.1.3.7 (1)
in nursing facilities, 4.1–1.3 in fast-track area, 2.1-A5.1.3
in outpatient facilities, 3.1–1.4 neonate exam area, 2.1-3.6.4
in gastrointestinal endoscopy facilities, in nursing unit, 2.1-3.1.3
3.9–1.3, 3.9–A1.3 pediatric critical care, 2.1-3.4.5.3,
in outpatient surgical facilities, 3.7–1.3 2.1-A3.4.5.3
for patient/family-centered care rooms, 2.1-A3.1.2 in outpatient care facilities, 3.1–2.1, 3.2-A2.1,
physical environment and, 1.2–2.1.2.5 3.3-2.1
privacy and, 1.2–2.1.2.5 (4), 1.2–A2.1.2.5 (4) in gastrointestinal endoscopy facilities,
in psychiatric hospitals, 2.3–1.5, 2.3–A1.5 3.9–2.2
requirements, 1.2–2.1 in outpatient surgical facilities, 3.7–2.2
safety and security and, 1.2–2.1.2.5 (5), in urgent care facilities, 3.5–2.1
1.2–A2.1.2.5 (5) in nursing facilities, 4.1-4t
sustainable design and, 1.2–3, 1.2–A3 in psychiatric hospitals, 2.3-3.1
water features and, 1.2–2.1.2.5 (8), 1.2–A2.1.2.5 (8) receptacles for, 2.1-10.3.7.2 (7), 2.1-10.3.7.2 (8)
wayfinding, 1.2–2.1.2.5 (2), 1.2–A2.1.2.5 (2) in rehabilitation facilities, 2.4–2.1.2
Equipment in small hospitals, 2.2–3.1
on architectural drawings, 1.4–1.3 ventilation requirements, 2.1-2t
building service, 1.4–2.1 Exits, 3.1-5.2.1.3
classification of, 1.4–2 Expansion joint covers, 2.1–8.2.2.4, 2.4-7.2.2.4, 3.1-5.2.1.7,
for dietary facilities, 2.1–6.2.3.2 4.1-8.2.2.9
electronic, 1.4–3.2 Facility Guidelines Institute (FGI), 1.1–1.2, 1.1-2.2.2
fixed, 1.4–2.2, 1.4–2.2.2 Family-centered care rooms, 2.1–A3.1.2
fixed medical, 1.4–2.2.1 Federal standards
fuel-fired, 2.1–10.2.2.9 for the disabled, 1.1–4.1
list, 1.4–1.2 for environmental pollution control, 1.3–4.1.1
locations for, 2.1–6.7.2 Film processing rooms, for imaging suites, 2.1–5.5.8.7
manuals, 1.5–5.2 Film storage areas, 2.1–5.5.8.13
movable, 1.4–2.3 Filter efficiencies
for patient monitoring, 2.1–A3.4.2.4 (6) for general hospitals, 2.1-10.2.5.1, 2.1–3t
requirements, 1.4–3 for nursing facilities, 4.1-10.2.5.1, 4.1–2t
shops for repair of, 2.1–6.7.4, 2.1–6.7.5 for outpatient facilities, 3.1–1t
space requirements for, 1.4–4 in psychiatric hospitals, 2.3-8.2.5.1
storage, 2.1–2.3.9 in rehabilitation facilities, 2.4–9.2.5.1
in birthing centers, 3.6–2.1.6 Filters, in HVAC system
for central services, 2.1–6.3.2 during construction, 1.5-A3.2
302 2006 Guidelines for Design and Construction of Health Care Facilities
INDEX
2006 Guidelines for Design and Construction of Health Care Facilities 303
INDEX
304 2006 Guidelines for Design and Construction of Health Care Facilities
INDEX
2006 Guidelines for Design and Construction of Health Care Facilities 305
INDEX
306 2006 Guidelines for Design and Construction of Health Care Facilities
INDEX
2006 Guidelines for Design and Construction of Health Care Facilities 307
INDEX
308 2006 Guidelines for Design and Construction of Health Care Facilities
INDEX
2006 Guidelines for Design and Construction of Health Care Facilities 309
INDEX
310 2006 Guidelines for Design and Construction of Health Care Facilities
INDEX
2006 Guidelines for Design and Construction of Health Care Facilities 311
INDEX
312 2006 Guidelines for Design and Construction of Health Care Facilities
INDEX
2006 Guidelines for Design and Construction of Health Care Facilities 313
INDEX
314 2006 Guidelines for Design and Construction of Health Care Facilities
Relocation Matrix
Since the 2006 edition has been totally reorganized, the following matrix has been provided to help users of previous
editions find information that has been moved to a different location.
2006 Guidelines for Design and Construction of Health Care Facilities 315
RELOCATION MATRIX
316 2006 Guidelines for Design and Construction of Health Care Facilities
RELOCATION MATRIX
2006 Guidelines for Design and Construction of Health Care Facilities 317
9.30.A 3.1-6.1 11.3.A 2.3-1
9.30.B 3.1-6.2 11.3.B 2.3-2.3.2
9.30.C 3.1-3.3.1; 3.1-6.3 11.3.C 2.3-2.3.3
9.31.A–D 3.1-7.2 11.4 2.3-2.4
9.31.E 3.1-7.1 11.4.A 2.3-2.4.1
9.32A–H 3.1-7.3 11.4.B 2.3-2.4.2
9.32.I 3.1-7.6 11.5 2.3-2.5
9.32.J 3.1-7.5 11.6 2.3-3.2
11.1 2.3-1 11.7 2.3-3.3
11.1.A 2.3-1.1 11.9 2.3-3.4
11.1.B 2.3-1.2 11.9.A 2.3-3.4.1
11.1.C 2.3-1.6.1 11.9.B 2.3-3.4.7
11.1.D 2.3-1.4 11.9.B1 2.3-3.4.7.4
11.1.E 2.3-3.1.3 11.9.B2 2.3-3.4.7.1
11.1.F 2.3-1.5; 2.3-7.2; 2.3-7.2.3.1; 11.9.B3 2.3-3.4.7.2
2.3-6.3.2; 2.3-8.2.5.2 11.9.B4 2.3-3.4.9
11.2 2.3-2 11.9.B5 2.3-3.4.7.5
11.2.A 2.3-2.1.1 11.9.B6 2.3-3.4.8.2
11.2.B 2.3-2.7 11.9.B7 2.3-3.4.8.1
11.2.B6 2.3-2.8.2 11.9.B8 2.3-3.4.7.4
11.2.B7 2.3-2.8.1 11.9.C 2.3-3.4.2
11.2.B8 2.3-2.8.3 11.9.D 2.3-3.4.3.
11.2.B9 2.3-2.7.9 11.9.E 2.3-3.4.4
11.2.B10 2.3-2.7.10 11.9.F 2.3-3.4.5
11.2.B11 2.3-2.7.6 11.9.G 2.3-3.4.6
11.2.B12 2.3-2.7.11.1 11.10 2.3-5.1
11.2.B13 2.3-2.7.7 11.11 2.3-5.2
11.2.B14 2.3-2.7.8 11.12 2.3-6
11.2.B15 2.3-2.9.2 11.13 2.3-6.1
11.2.B16 2.3-2.9.1 11.14 2.3-4.3
11.2.B17 2.3-2.7.4.5 11.15 2.3-4.5.1
11.2.B18 2.3-2.9.3 11.16 2.3-4.4
11.2.B19 2.3-2.9.4 11.17 2.3-4.6.1
11.2.B20 2.3-2.7.11.2 11.18 2.3-6.2
11.2.B22 2.3-2.7.11.3 11.19 2.3-4.6.2
11.2.B23 2.3-2.7.12 11.20 2.3-4.7
11.2.B24 2.3-2.7.4.1 11.21 2.3-4.5.2; 2.3-7.3
11.2.B25 2.3-2.7.4.2 11.22 2.3-7.2
11.2.B26 2.3-2.7.4.3 11.23 2.3-7.1
11.2.B27 2.3-2.7.4.4 11.30 2.3-8
11.2.C 2.3-2.2.1 11.30.A 2.3-8.1
11.2.D 2.3-2.2.2 11.30.B 2.3-8.2
11.3 2.3-2.3 11.30.C 2.3-8.3
318 2006 Guidelines for Design and Construction of Health Care Facilities
11.31.A 2.3-8.2.1
11.31.B 2.3-8.2.3
11.31.C 2.3-8.2.6
11.31.D1 2.3-8.2.1.2
11.31.D2 2.3-8.2.4.3
11.31.D3 2.3-8.2.4.4
11.31.D4 2.3-8.2.5
11.31.D5 2.3-8.2.1.4 (2)
11.31.D6 2.3-8.2.4.1
11.31.D8 2.3-8.2.4.1 (3)
11.31.D9 2.3-8.2.2.3
11.31.D10 2.3-8.2.2.4
11.31.D11 2.3-8.2.4.4 (4)
11.31.D12 2.3-8.2.1.1(2)(b)
11.31.D13 2.3-8.2.2.1
11.31.D14 2.3-8.2.2.2
11.31.D15 2.3-8.2.1.1 (2) (c)
11.31.E 2.3-8.1.2
11.31.E1 2.3-8.1.3
11.31.E2 2.3-8.1.2.2
11.31.E3 2.3-8.1.2.3
11.31.E4 2.3-8.1.2.4
11.31.E5 2.3-8.1.4.1
11.31.E6 2.3-8.1.4.2
11.31.E7 2.3-8.1.2.1
11.31.E8 2.3-8.1.2.5
11.31.E9 2.3-8.1.2.6
11.32 2.3-8.3
11.32.B 2.3-8.3.2.1
11.32.C 2.3-8.3.2.2
11.32.D 2.3-8.3.4
11.32.E 2.3-8.3.6
11.32.F 2.3-8.3.5
11.32G 2.3-8.3.7
11.32.H 2.3-8.3.3.1
11.32.I 2.3-8.5.2
11.32.J 2.3-8.4
11.32.K 2.3-8.5.1
12.1 3.12-1 through 3.12-4
12.31 3.12-5.1 through 3.12-5.2
12.32 3.12-5.3 through 3.12-5.5
2006 Guidelines for Design and Construction of Health Care Facilities 319
Form for Requests for Formal Interpretations of the
Guidelines for Design and Construction of Health Care Facilities
Name _________________________________________________________________________________________
Company/organization __________________________________________________________________________
Address _______________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
Question:
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
Visit www.fgi-guidelines.org or www.aia.org/aah for instructions on requesting an interpretation. Rules for requesting a
formal interpretation are also posted on both Web sites.
2006 Guidelines for Design and Construction of Health Care Facilities 321
Form for Proposals to Change the Guidelines for Design and
Construction of Health Care Facilities, 2006 ed.
Name _________________________________________________________________________________________
Company/organization __________________________________________________________________________
Address _______________________________________________________________________________________
All proposals must refer to specific parts of the 2001 edition of the Guidelines. Each separate proposal requires a sep-
arate copy of this form. Only proposals that appear on this form (or in this format) can be considered.
3. Proposals (Make a clear statement of what you want done in the document; be specific! Provide new or edited lan-
guage that will accomplish your goal.):
4. Substantiation for proposal (State why you think your proposed addition, change, or deletion of text is necessary.
Explain how your proposal solves the problem you identify.):
I agree to give FGI all and full rights—including rights of copyright—in this proposal, and I understand that I acquire
no rights in any publication of the AIA in which this proposal in this manner or similar or analogous form is used.
Visit the Facility Guidelines Institute Web site at www.fgi-guidelines.org. Instructions for making a proposal can be found
on the site.
2006 Guidelines for Design and Construction of Health Care Facilities 323
Facility Guidelines Institute (FGI)—the Author
2006 Guidelines for Design and Construction of Health Care Facilities 325
Health Facilities Cover F2 5/30/06 1:24 PM Page 1
PA R T 4
Other Health Care Facilities
■ Revised chapter on nursing facilities
■ Completely new chapters on assisted living,
hospice, and adult day health care facilities