!~ GUIDELINES FOR

1 :".~ j~!~IiI :rt1I,~II)" ~GUIDELINESFORDESIGNANDCONSTRUCTIONOFHOS PITALANDHEALTHCAREFACILITIES ArchitectsPress1735 NewYorkAvenue, , 1996byTheAmericanInstituteof (AcuteandChronic) , (Barber/Beauty) ' (MedicalandSurgical) ~ (forInpatients) (Neighborhood) , ,Alzheimer's, , ,Recreation, (s) ,Transportable, , (Suction), thelatestina ,1947, ,thedocumentwasretitledMinimumRequiremen tsofConstructionandEquipmentforMedicalFa cilitiestoemphasizethattherequirementswe regenerallymini-mum, (b)and1620(2)ofthePublicHealthServiceAct requiretheSecretaryoftheDepartmentofHeal thandHumanServices(HHS)toprescribebyregu lationgeneralstandardsofconstruction,ren ovation,andequip-mentforprojectsassisted underTitleVIandTitleXVI,respectively, ,thereis ,HHSremovedfromregulationtherequirements relatingtominimumstandardsofconstruction ,renova-tion,andequipmentofhospitalsando thermedicalfacili-ties,ascitedintheMinim umRequirements,DHEWP ublicationNo.

2 (HRA) , ,thetitlehasbeenamendedtoreadGuidelinesf orDesignandConstructionofHospitalandHeal thCareFacilitiestoreflectthescope,conten t, ,designers,andregulatorsina recognizedthatmanyhealthcareservicesmayb eprovidedinfacilitiesnotsubjecttolicensu reorregulation,andit is furtherintendedthat,whenusedasregu-Prefa cevilations,somelatitudebegrantedincompl yingwiththeseGuidelines, , , ,whichis (HCFA)andtheHealthResources ServicesAdministration(HRSA),whicharebot hintheDepartmentofHealthandHumanServices , ' notadoptingtheGuidelinesasregulations, ,state,andfederalsectors,rep-resentingex pertiseindesign,operation, ,revis-ingdetailsasnecessarytoaccommodat ecurrenthealthcareproceduresandtoprovide a desirableenvironmentforpatientcareat a ,wheregiven, ,experiencehasshownthatit wouldbeextremelydifficulttodesigna ,it ,doorwidthsforinpatienthospitalroomsaren otedas3 feet8 inches( ),whichsatisfiesmostapplicablecodes, ,widerwidthsof3 feet10inches( )oreven4 feet( ) ,theGuidelinesmaybeconsidereda , federaldocu-ment,theAmericanInstituteofA rchitectshasmadeita (HRS-M-HF)84-1,DHEWP ublicationNo.

3 (HRA)79-14500,DHEWP ublicationNo.(HRA)76-4000, :AmericanInstituteofArchitectsAcademyofA rchitectureforHealth1735 NewYorkAvenue, , ,RoomllA-14 Rockville,Maryland20857 OfficeofEngineeringServicesRegionllRoom3 30926 FederalPlazaNewYork,NewYork10278 PrefaceADDITIONSVISIONST oreflectthescope,content,andusageofthisd ocument, ,ingeneral,followthepreviousdocument,Gui delinesforConstructionandEquipmentofHosp italandMedicalFacilities, ( , , , ,etc.); , , , , , , , (*)precedinga numberorletterdesignatinga ,typesofiso-lation requirements, ,these changesconformtothemostcurrentCentersfor DiseaseControlandPrevention"Guidelinesfo rPre-ventingtheTransmissionofMycobacteri umTuberculo-sisinHealthCareFacilities"an d"GuidelinesforPreventionofNosocomialPne umonia,1994."Threepatientsegregationcate gorieshavebeenidentified: Airborneinfectionisolationroom Protectiveenvironmentroom Immunosuppressedhostinairborneinfectioni solationA newprocesscalled"infectioncontrolriskass ess-ment"is anessentialcomponentofanyfacility'sfunct ionalormasterprogramming, multidiscipli-narypanelwithexpertiseinar easofinfectiousdisease,facilitydesignand construction,ventilationandepi-demiology , theintentofthisprocesstoallowflexibility inmeetingindividualorganizationalneedsfo rcreatinga saferenvironmentforpatients,staff, ,ConstructionPhasing,hasbeencom-pletelyc hangedtoreflectinfectioushazardsthatmayb eencounteredduringhealthcarefacilityplan ning,design,constructionphasing,andcommi ssioning, ( )to130squarefeet( meters)forsingle-patientrooms(orcubicles )andfrom100squarefeet( )to110squarefeet( ) , newrequirementhasbeenaddedthateachpatien tspaceina newbornintensivecareunitshallhavea minimumof100squarefeet( ).

4 Leastoneairborneinfectionisolation (3).Permissiontocontinueinuseexistingthr ee-orfour-bedroomsinrenovation ,patients, ,CardiacCatheterizationLab, ,RenalDialysisUnit,anentirenewsec-tion, feet( )wideand7 feet6inches( )deepto5 feet8 inches( )wideand9 feet( ) newrequirementhasbeenaddedforroomsusedfo rsputuminduction,aerolizedpentamidinetre atments, , , , ,NursesCallingSystems, -75 F(21 -24 C)to68 -73 F(20 -23 C).Changeairborneinfectiousisolationroom totalairchangesfrom6 temperaturerequirementof75 F(24 C)togenerallaboratory,biochemistry,histo logy,microbiology,nuclearmedicine,pathol ogy, ' hasbeenchangedtoaddrequirementsfor: Protectiveenvironmentandairborneinfectio usisolation. :Residentcareareas:frommaximum110 F(43"C)tomaximum95 -110 F(35"-43 C).Dietary:fromminimum120 F(49 C)tominimum140 F(60 C).Laundry:fromminimum160 F(71 C)tominimum140 F(60 C). ,llluminationsValuesforNursing, ,SubacuteCareFacilities,and13,HospiceCar e, , formforpublicproposalsforfuturechangesto theGuidelinesis (AAH)oftheAmericanInstituteofArchitects( AIA) thethirdrevi- majorroleinthepreparationofthisedition, ,pro-fessionalorganizations, ,000proposalsforchangeandcommentsonpropo sedchanges werereceivedandprocessedatthreemeetingsh eldinBaltimore,SanDiego, ,FAIAC hainnanHKSA rchitects, ,FASHEViceChainnanAmericanHospitalAssoci ationJ.

5 ArmandBurgun,FAIAC hainnanEmeritusRodgersBurgunShahine&Desc hlerMichelleDonovan, , , ,NIHNeilKellman, , , , ,HRSA, ,FAIAJMGR, , , , , , , , , , , , , , , ,FAIAF orumforHealthCarePlanningWalterCollins, ,FacilitiesServicesEdDenton, , , , , , , ,AlAQuoromHealthResources, , ,FloridaKenGurtowskiCalumetCoachCompanyJ illHallInstituteforFamily-CenteredCareMa ureenHarvey, , , , , , , , , , , , ,CEPRAMTRACH ealthRiskConsul-tantsofSchenectady,NY!ii IIIIJ uanitaMildenberg, , ,NCARBB aylorCollegeofMedicine,HoustonRobertMull an, , , , , , , ,CCE,SASHELaPorteHospital, , , , , , ,AIASBNS teffianBradleyAssociates, , , , , ' , ,CSPN ationalAssociationofPsychiatricHealthcar eSystemsGradySmith,Architect,AIAJ udithSmithSmithHagerBajo, ,AIA,CHCL ammers+GershonAssocs., Streifel, , , , , , , , , , ,includingthoseofstate,local, ,individualprojectrequirementsshouldbeve rified, , "codelanguage." , , ,theprevailingmodelcodeusedwithinthegeog raphicareaisherebyspecifiedforallrequire mentsnototherwisespecifiedintheseGuideli nes.

6 ( )WhereASCE7-93isreferenced, (*) , , ,whichisresponsibleforMedicareandMedicai dreimbursement,hasadoptedtheNationalFire ProtectionAssociation101 LifeSafetyCode(NFPA101). ,theprojecteddemandorutilization,staffin gpatterns,departmentalrelationships,spac erequirements,andotherbasicinfonnationre latingtofulfillmentoftheinstitution' ;theoperationalspacerequiredforeachfunct ion;thenumberofstafforotheroccupantsofth evariousspaces;thenumbers,types,andareas (innetsquarefeet)ofallspaces;thespeciald esignfeatures;thesystemsofopera-tion; ,allnewworkoradditions,orboth,shallcompl y,insofaraspractical,withapplicablesecti onsoftheseGuidelinesandwithappropriatepa rtsofNFPA101, , ,butdoesattempttominimizerestrictionsonI ntroductionthoseimprovementswheretotalco mpliancewouldnotsubstantiallyimprovesafe ty, singlephaseofimprovement.(Forexample,a facilitymayplantoreplacea flammableceilingwithnoncombustiblemateri albutlacksfundstodoothercorrectivework.)

7 However,theyarenotintendedasanencouragem enttoignoredeficiencieswhenresourcesarea vailabletocorrectlife-threateningproblem s.( ) complete,thefacilityshallsatisfyfunction alrequirementsfortheappropriateclassific ation(generalhospital,skillednursingfaci lity,etc.) , ,aswellasexistingbuildingareasthatreceiv elessthansubstan-tialamountsofnewworksha ll,ata minimum, buildingis convertedfromoneoccupancytoanother,it ,a conversionfromahospitaltoa nursinghomeorviceversais notconsidereda , ,includingnewadditions,shallnotdiminisht hesafetylevelthatexistedpriortothestarto fthework;however,safetyinexcessofthatreq uiredfornewfacili-tiesis facilitythatchoosestodoworkoralterations aspartofa emphasizedthatallhazardstolifeandsafetya ndallareasofnoncompliancewithapplicablec odesandregu-lations,shouldbecorrectedass oonaspossibleinaccor-dancewitha (ADA) ,public,private,andpublicservicehospital sandotherhealthcarefacilitieswillneedtoc omplywiththeAccessibilityGuidelinesforBu ildingsandFacilities(ADAAG) (UFAS) : CompliancewithUFAS CompliancewithADAAG Compliancewitha designforthedisabledis theAmericanNationalStandardsInstitute(AN SI) ,UFAS, ,therefore,mustassumeresponsibil-ityforv erificationofallapplicablerequirements.

8 * recognizedpotentialforhurri-canes,tornad oes,flooding,earthquakes,orotherregional disasters,planninganddesignshallconsider theneedtoprotectthelifesafetyofallhealth carefacilityoccupantsandthepotentialneed forcontinuingservicesfollowingsucha disaster,specialdesignis requiredtoprotectsystemsandessentialbuil dingservicessuchaspower,water,medicalgas systems,and,incertainareas, ,specialconsiderationmustbegiventothelik elihoodoftemporarylossofexternallysuppli edpower,gas,water, 'sinstructions,theseGuidelines, ,particularattentionshallbegiventoroofin g,entryways,glazing,andflash-ingdesignto minimizeuplift,impactdamage, usedit shallbedesignedsoasnottobecomea , , , , unavoidable, ,thefacilityshallprovideadequatestoragec apacityfor,ora functionalpro-gramcontingencyplantoobtai n,thefollowingsupplies:food,sterilesuppl ies,pharmacysupplies,linen, ,personnel, ,generally, 'sstandards,especiallytheNFPA101,aretheb asiccodesofreference; ,theprojectshallcomplywith approvednationallyrecognizedbuildingcode sexceptasmodifiedinthelatesteditionofthe NFPA101 ,inaccordancewiththe usuallya codeadoptedbya ,theseminimumstandardshavebeenestablishe dtoobtaina ,whengiven,suchasexactmini-mumdimensions orquantities,describea conditionthatis commonlyrecognizedasa ,referencetoa roomareaisforpatient,equipment,andstaffa ctivities; , mannerotherthanthatwhichis prescribedbythisdocument,providedthatnoo thersafetyelementorsystemis (NFPA)documentlOlAis a (FSES)hasbecomewidelyIntroductionrecogni zedasa methodforestablishinga , partofthisdocument, ;however, ( ).

9 ( ), ,Refrigerating,andAir-ConditioningEngine ers(ASHRAE). ,Refrigerating, ( ), ,Refrigerating, (ASHRAE55-92), ,Refrigerating, (ASHRAE62-89), ,Refrigerating, , , (CDC)."GuidelinesforPreventingtheTransmi ssionofMycobac-teriumTuberculosisinHealt hCareFacilities."MorbidityandMortalityWe eklyReview1994:43( ).CentersforDiseaseControlandPrevention( CDC)."GuidelinesforPreventionofNosocomia lPneumonia,1994."AmericanJournalofInfect ionControl(22:247-292). ,parts20and35, ,part1910, (CGA). ,FilterUnits,ProtectiveClothing,Gas- ,DepartmentofDefense,DepartmentofHousing andUrbanDevelop-ment, (UFAS). (FDA)78-2081(availablethroughGPO), :I-B-R,CastIron, ( ,Applications). , , (ICBO). (PHCC). ,DraftSeismicStandardsforFederalBuilding sPreparedbyInteragencyCommitteeonSeis-mi cSafetyinConstruction( ).NationalCouncilonRadiationProtection(N CRP). (NCRP). (NCRP). , ,Maintenance, , , , , (GPO),Washington, , , , ,Refrigerating,andAir-ConditioningEngine ers1741 TullieCircle,NEAtlanta, (ATBCB)OfficeofTechnicalServices330C Street,SWWashington, (ASTM)1916 RaceStreetPhiladelphia, , ,TIL60477 CompressedGasAssociation1235 JeffersonDavisHighwayArlington, , (IESNA)IESP ublicationSales345 East47thStreetNewYork, , , ,Suite1016 Bethesda, , (NTIS)5285 PortRoyalRoadSpringfield, , (forDOPP enetrationTestMethod)SouthernBuildingCod eCongressInternational, , , , ,aswellasefficientutilizationofspaceandc limaticcharacteristics, ,however, ,safety, ,includingfireprotectionapparatus,etc.

10 * ,families,personnel, (water,gas,sewer,electricity). (fordeliverytrucks). , ,families,personnel,andthepublic, ,construction,renovation,expansion,equip -ment, ,manystateshaveenactedsub-stantiallyequi valentormorestringentstatutesandregu-lat ions,therebyimplementingnationalprioriti esunderlocaljurisdictionwhileadditionall yincorporatinglocalpriorities( ,airqualityrelatedtoincineratorsandgasst erilizers;undergroundstoragetanks;hazard ousmateri-alsandwastesstorage,handling,a nddisposal;stormwatercontrol;medicalwast estorageanddisposal;andasbestosinbuildin gmaterials.)Theprincipalfederalenvironme ntalstatutesunderwhichhospitalsandmedica lfacilitiesmayberegulatedinclude,mostnot ably,thefollowing: NationalEnvironmentalPolicyAct(NEPA) ResourceConservationandRecoveryAct(RCRA) SuperfundAmendmentsandReauthorizationAct (SARA) CleanAirAct(CAA) SafeDrinkingWaterAct(SDWA) OccupationalSafetyandHealthAct(OSHA) MedicalWasteTracking Act(MWTA) (HHS) (EPA)regionalofficesand anyotherfed-eral,state,orlocalauthoritie shavingjurisdictionforthelatestapplicabl estateandlocalregulationspertainingtoenv ironmentalpollutionthatmayaffectthedesig n,construction,oroperationofthefacility, includingthemanagementofindustrialchemic als,pharmaceuticals,radionuclides,andwas testhereof,aswellastrash,noise,andtraffi c(includingairtraffic).