Comment Period Extended for Guidelines on Healthcare Construction

The coment period for the draft 2006 edition of the Guidelines for Design and Construction of Hospitals and Health Care Facilities has been extended through February 28, 2005. Commonly referred to as the AIA Guidelines, the document is updated every three to four years to keep pace with new concepts and capabilities in the delivery of healthcare. The AIA Guidelines are referenced by JCAHO and 42 states. To view the 2006 draft manuscript, go to www.aia.org/aah_gd_hospcons. You may submit comments electronically at http://198.76.191.18/guidelines/default.asp. Comments will only be accepted for additions or changes to the 2001 document.

ASHE members are encouraged to review and comment on the proposed changes. To assist in navigating throught the numerous proposals, ASHE has reviewed and organized certain specific draft language by priortiy.

Comments Need - these are the items which may have the most impact - your comments are needed to assure that validate the change or challenge the value of the change.
Review for Acceptability - these are items that need reviewed to assure that the change is acceptable, and if not, that comments are submitted
Informational - these are items that you should be aware of for the 2006 edition

Top Priority - Comments Needed on these issues:
#1 - Chapter 7, Hospitals - Section 7.2.A.1
The Health Guidelines Revision Committee (HGRC) has concluded that all newly constructed facilities shall have as its minimum single patient bedroom for medial can surgical nursing units. There is an exception for when the functional program demonstrates a need for semiprivate rooms and for renovation projects. For additional information on this controversial issue and the shaded text, click here

Action: Should this be a requirement of the Guidelines?

#2 Chapter 5, Construction - Section 5.1.A3
This new section will require the owner to ensure that construction-related requirements are incorporated into the project. It further specifies the need for the owner to inspect the initial installation and to provide continuous monitoring of the ICRMR effectiveness.
For the shaded text on this issue, click here.

Action: This could place a substantial burden on the shoulders of our members and the language is such that anything that fails could come back to being our responsibility in a court of law. We all know that things happen in construction and no matter how good our programs are something may happen outside of our control.

#3 Chapter 7, Hospitals - Section 7.30.A.9
Fire pumps and ancillary equipment will be required to be separated from other functions by 2 hour rated construction. The fire pump location shall be readily accessible with direct access to the exterior. Proposed new text:

Where required in new construction, fire pumps and ancillary equipment shall be separated from other functions by construction having a 2-hour fire resistance rating. The fire pump shall be installed in a readily accessible location with direct access from the exterior.

Action: Is it a good idea to separate these types of devices by fire rated construction. Our ability to quickly perform a visual inspection is hampered when walls are constructed around the equipment. Also, the space provision to work on equipment needs to be considered in this room.

#4 Table 7.5
Medical Gas Station Intlets and Outlets
A couple of line items were changed and/or added. Click here to view the table.

A new line item on intermediate care units.
The number of vacuum and oxygen inlet/outlets in LDR and LDRP was decreased in each case from 2 to 1 per room.
A line item was added that MRIs will now need to have 1 outlet of oxygen, vacuum, and medical air.
Medical air was dropped as a requirement in autopsy rooms.

Action: Is there a need for piped oxygen, vacuum, and medical air in all MRI locations? This will require all of the units set up outside of the perimeter walls of the hospital building to have these services run to them. Is this a minimum requirement we want to promote?

#5 - Chapter 7, Hospitals - Section 7.3
This is a whole new section on intermediate care units, frequently referred to as stepdown units. For additional information and proposed new language, click here.
Some key issues are:

Bedroom size is 120 sq. ft. per bed in a semi private bedroom configuration and 150 sq. ft. for a single bedroom configuration.
Maximum capacity of a room is four patients.
Separate nursing management area.
Each patient room shall have a window.
Examination/Treatment rooms shall be located immediately adjacent to the unit.

Action: Review for acceptability and for exceeding maximums.

#6 - Chapter 7, Hospitals - Section 7.10.A4
The size of a LDR and LDRP room is being increased to a minimum of 300 sq. ft. of clear floor area. Renovations of space shall make every effort to achieve this number but if not possible a minimum of 200 sq. ft. is permitted. Proposed changes in red:

(1) In new construction, these rooms shall have a minimum clear floor area of 300 square feet (27.87 square meters) with a minimum dimension of 13 feet (3.96 meters), exclusive of toilet room, closet, alcove, or vestibules. Where required by the functional program, there shall be enough space for a crib and reclining chair for a support person. An area within the room but distinct from the mother's area shall be provided for infant stabilization and resuscitation. Each LDR or LDRP room shall be for single occupancy and have direct access to a private toilet with shower or tub.

Action: Is increasing the size of this space from 250 to 300 sq. ft. necessary?

#7 - Chapter 2, Environment of Care - Section 2.3
Adds a new section on sustainable design. Most of the new material is common sense and good engineering practice. Click here to view the new section.

Action: Specific attention should be focused on the appendix language that does set some higher levels of recommendations. Is this level of recommendation proper in a document trying to achieve a base level of design and construction for all healthcare facilities?

#8 - Chapter 7, Hospitals - 7.34.E3.d
This new provision will require removing dead-end piping legs in renovation projects. New language: d. Dead-end piping (risers with no flow, branches with no fixture) shall not be installed. In renovation projects, dead-end piping shall be removed. Empty risers, mains, and branches installed for future use shall be permitted.

Action: How is this going to be applied by the enforcing community and how far downstream will we need to go to comply? This could be a very costly remediation if it extends outside the boundaries of the construction site in order to comply.

#9 - Chapter 14, Assisted Living
This is a brand new chapter in the Guidelines and it may have a significant impact on organizations developing and building this type of occupancy. Many state authorities having jurisdiction have been looking for standards in assisted living and this may give them what they are looking for in the form of regulation. Click here to view the new section.

Action: For those organizations considering assisted living facilities it would be a good idea to carefully review this chapter and see if the proposed text is acceptable as minimal standards.

#10 - Chapter 15, Adult Day Health Care Facilities
This is a brand new chapter in the Guidelines and it may have a significant impact on organizations developing and building this type of occupancy. Many state authorities having jurisdiction have been looking for standards in adult day health care and this may give them what they are looking for in the form of regulation. Click here to view the new section.

Action: For those organizations considering adult day health care it would be a good idea to carefully review this chapter and see if the proposed text is acceptable as minimal standards.