Health Facilities Design:What’s New in New Jersey David B.Uhaze, RA Chief - Bureau of Construction Project Review NJ Dept. Of Community Affairs Health Facilities Management Society of New Jersey November 2010 Meeting
Introduction • Bureau of Construction Project Review Overview • Guidelines for Design & Construction of Health Care Facilities • NJ Dept. of Health and Senior Services • NJ Uniform Construction Code • International Codes – NJ Editions
DCA – Bureau of Construction Project Review The Bureau • Functions as the construction office for all building types or projects reserved to the State at NJAC 5:23-3.11 • This includes such projects as: • Healthcare Facilities • Casinos • State Buildings (State colleges, NJTPA, NJT, NJSEA, etc.) • Special Projects (Electrical Generating, Solid Waste Treatment, • Incineration Plants) • Prototypes (Big box stores, banks, etc.)
DCA – Bureau of Construction Project Review Health Care Plan Review Unit • Performs both a UCC and Licensing review on all projects submitted • Will comment on Licensing requirements, but cannot grant waivers to those requirements • 20 day review cycle for new projects with complete applications • 7 day review cycle for re-submitted projects • Permitting and inspections are done at the local level • May grant permission for a Local review • To contact call: Frank Kiani, Supervisor at609.633.8151
DCA – Bureau of Construction Project Review You can find additional information about the Bureau including Bureau mailing addresses and phone numbers, a listing of when a Bureau review and release is required, answers to frequently asked questions about the plan review and release process, and you can access all of the necessary forms for submission at the Bureau’s website: http://www.nj.gov/dca/divisions/codes/offices/bcpr.html
Facility Guidelines Institute Guidelines for Design and Construction of Health Care Facilities • Established as a Federal Standard in 1947 • Published through the American Institute of Architects from 1984 to 2008 • No longer affiliated with the “AIA” • Now partnered with ASHE • Adopted by NJ Sept 1, 2010 • This is the 3nd edition to be published under the FGI
Facility Guidelines Institute The Facility Guidelines Institute (FGI) was formed in 1998 in an effort to create a more formal procedure and process of review and revision, and to ensure the document is kept current. The FGI Guidelines Revision Committee welcomes comments and language revision proposals from all interested parties. www.fgiguidelines.org
Significant Changes: • A Patient Handling and Movement Assessment (PHAMA) was added, and Patient Handling and Movement language was added throughout the document. • New section on Bariatric Units was added and Bariatric design language was added throughout the document. • New section on Acoustics was added. • Updated and expanded language was added to the section on Commissioning. • Chapter 1.6 – Common Requirements, was expanded • A new section on Oncology Nursing was added. • A new Cancer Treatment/Infusion Therapy Service section was added.
Significant Changes: • New section on Technology Equipment Centers was added. • A new section on Outpatient Cancer Treatment Centers was added. • A new section on Outpatient Rehabilitation Centers was added. • The section on Freestanding Birth Centerswas been expanded. • The section on Gastrointestinal Endoscopy Facilities was expanded. • The section on Mobile, Transportable and Relocatable Units was moved and expanded. • Two new chapters, 5 & 6, have been added. • A handbook, with diagrams and explanatory material is in the works. • “White papers’” on PHAMA, acoustics and other topics are now be available through the FGI.
NJ Dept. of Health & Senior Services • Hospital Licensing Standards • Standards for Licensure of Ambulatory Care Facilities You can view these standards and any code change proposals on the DHSS website at : http://www.state.nj.us/health/healthfacilities/index.shtml
NJ Dept. of Health & Senior Services Significant proposed substantive amendments to the Hospital Licensing Manual: • Identifying psychiatric hospitals as being among the types of facilities to which the manual applies. • Suspension of biennial inspections, with reliance instead on a facility’s achievement of accreditation from an accrediting body (ie: JCAHO, NIAHO) recognized by the Centers for Medicare and Medicaid Services. The Department would continue to retain the option to perform random survey visits and investigations. • Rulemaking addressing the performance of anesthesia in hospitals by certified nurse anesthetists. • Amendments to the employee tuberculosis screening rules
NJ Dept. of Health & Senior Services • Issues during Inspections There are times when, NJDHSS inspectors will cite deficiencies based on a facility’s compliance with the Uniform Construction Code and its adopted standards. The NJDHSS does not have the authority to make “building code” citations. In addition, because of the complexity of these codes, they are sometimes incorrectly cited. If you have a question regarding a NJDHSS citation which relates to a “building code” issue, please call the DCA-HCPR office for clarification before making any corrections
NJ Uniform Construction Code • Established January 1, 1977 to eliminate inconsistent and conflicting local codes • Incorporates adopted national standards as well as NJ specific standards such as the Rehabilitation Subcode, the Barrier Free Subcode, the Asbestos Subcode, etc. • Establishes uniform administrative procedures for enforcing those standards • Establishes licensing standards and organizational standards for all NJ Construction Code Officials and construction departments
NJ Uniform Construction Code • The original act of 2008 has been extended. • Extends all permits & DCA releases that were open and valid as of January 1, 2007 until July 1, 2013 • Applies to New Jersey permits only, does not include Federal permits • Includes UCC permits and other permits such as: Permit Extension Act • Local Planning and Zoning • County Planning and Zoning • Coastal Area Facilities Review • Pinelands Commission • Freshwater and Wetlands Review • Water and Sewer service extensions • Soil Erosion and Sediment Control
NJ Uniform Construction Code • The following codes were adopted on September 7, 2010: • 2009 International Building Code • 2009 International Mechanical Code • 2009 International Fuel Gas Code • 2009 National Standard Plumbing Code • 2009 International Energy Code • 2007 ASHRAE 90.1 • 2009 International Residential Code
International Building Code NJ Edition At Chapter 2, the following new definition was added: Ambulatory Health Care Facility Buildings or portions thereof used to provide medical, surgical, psychiatric, nursing or similar care on a less than 24-hour basis to individuals who are rendered incapable of self-preservation.
International Building Code NJ Edition The following amendments were made to Chapter 3, Use Group Classifications : 304.1 Business Group B: “Ambulatory health care facilities” was inserted as a typical occupancy 304.1.1 Definitions: A new definition was added Clinic, Outpatient Buildings or portions thereof used to provide medical care on less than a 24 hour basis to individuals who are not rendered incapable of self-preservation by the services provided.
International Building Code NJ Edition • 308.3 Group I-2: • The wording of this section shall continue to match the 2006 NJ Edition. • 308.3.1 Definitions: The following new definitions were added • Hospitals and Mental Hospitals • Buildings or portions thereof used on a 24 hour basis for medical, psychiatric, obstetrical or surgical treatment of inpatients who are incapable of self-preservation. • Nursing Homes • Nursing homes are long term care facilities on a 24 hour basis, including both intermediate care facilities and skilled nursing facilities, serving more than 5 persons and any of the persons are incapable of self-preservation.
International Building Code NJ Edition The following amendments were made to Chapter 4, Special Use & Occupancy: Section 403 High Rise Buildings was expanded as a result of the Terror Resistant Building Study 403.2.3 Structural integrity of exit enclosures and elevator hoistways.In all high rise buildings in Occupancy category III or IV, wall materials used for the construction of exit enclosures and elevator hoistways must meet ASTM C 1629/1629M Level 2 – Soft body impact test. 403.2.4 Spray fire retardant materials (SFRM).Materials must meet the requirements in new Table 403.2.4.
International Building Code NJ Edition Section 403 High Rise Buildings cont. 403.3.2 Water supply to fire pumps. Required fire pumps shall be supplied by connections to a minimum of 2 water mains located in different streets. Separate supply piping shall be provided between each connection to the water main and the pumps. Each connection and the supply piping between the connection and the pumps shall be sized to supply the flow and pressure required for the pumps to operate. Exception: If the main is valved to isolate interruptions, a single main is OK
International Building Code NJ Edition Chapter 4, Special Use & Occupancy cont. 403.4.4 High rise emergency responder radio coverage.Emergency responder radio coverage shall be provided in accordance with Section 510 of the International Fire Code. Section 510 requires the installation of approved emergency responder radio coverage systems unless the fire official determines the system is not needed. The building shall be considered to have acceptable emergency responder radio coverage when 95 percent of all areas on each floor of the building meet the signal strength requirements of 95dB min. in building, and 100dB min. when transmitted out of the building. 403.6.1 Fire service access elevator. A fire service access elevator meeting the requirements of Section 3007 shall be provided in every building with occupiable floors higher than 120ft above fire dept. access.
International Building Code NJ Edition Chapter 4, Special Use & Occupancy cont. Section 422 Ambulatory Health Care Facilities was added 422.1 General. Occupancies classified as Group B ambulatory health care facilities shall comply with the provisions of this section and other applicable provisions of this code. 422.2 Smoke barriers. Smoke barriers shall be provided to subdivide every ambulatory health care facility greater than 10,000sq.ft. into a minimum of two smoke compartments per story. The travel distance from any point in a smoke compartment to a smoke barrier door shall not exceed 200ft. The smoke barrier shall be installed in accordance with Section 710.
International Building Code NJ Edition Section 422 Ambulatory Health Care Facilities cont. 422.1 Refuge area. At least 30 net sq.ft. per non-ambulatory patient shall be provided within the aggregate area of corridors, patient rooms, treatment rooms, lounge or dining areas and other low hazard areas on each side of each smoke barrier. 422.2 Independent egress. A means of egress shall be provided from each smoke compartment created by smoke barriers without having to return through the smoke compartment through which means of egress originated. 422.5 Automatic sprinkler systems. Automatic sprinkler systems shall be provided for ambulatory care facilities in accordance with Section 903.2.2 422.6 Fire alarm systems. A fire alarm system shall be provided in accordance with Section 907.2.2.1
International Building Code NJ Edition • The following amendments were made to Chapter 7, Fire & Smoke Protection Features: • 703.6 Marking & identification - fire and smoke separation walls. • Fire walls, fire barriers, fire partitions, smoke barriers and smoke partitions or any other wall required to have protected openings or penetrations shall be permanently identified with signs or stenciling. Identification shall: • Be located in accessible concealed floor, floor/ceiling or attic spaces • Be repeated at intervals not exceeding 30ft. Horizontally • Include lettering min. ½ in. high, incorporating the suggested wording: • FIRE AND/OR SMOKE BARRIER-PROTECT ALL OPENINGS • or other similar wording
International Building Code NJ Edition The following amendments were made to Chapter 9, Fire Protection Systems : 903.2.2 Group B ambulatory health care facilities. An automatic sprinkler system shall be installed throughout all fire areas containing a Group B ambulatory health care facility occupancy, when either of the following conditions exist at any time: 1)Four or more care recipients are incapable of self preservation. 2)One or more care recipients who are incapable of self preservation are located at other than the level of exit discharge serving such an occupancy.
International Building Code NJ Edition • 906.1 Portable fire extinguishers. Portable Fire Extinguishersshall be installed throughout all new A, B, E, F, H, I, M, R & S occupancies. • 907.2.2 Group B. A manual fire alarm system shall be installed in Group B occupancies where one of the following conditions exists: • The combined Group B occupant load of all floors is 500 or more. • The Group B occupant load is more than 100 persons above or below the lowest level of exit discharge. • Fire areas containing a Group B occupancy classified as an ambulatory health care facility. • Exception: Manual fire alarm boxes are not required where the building • is equipped throughout with an automatic sprinkler system installed in • accordance with Section 903.3.1.1 and the occupant notification • appliances will activate throughout the notification zones upon sprinkler • water flow.
International Building Code NJ Edition 907 Fire Alarm and Detection Systems 907.2.2.1 Group B ambulatory health care facilities. Fire areas containing Group B ambulatory health care facilities shall be provided with an electrically supervised automatic smoke detection system installed within the ambulatory health care facility and in public use areas outside of tenant spaces, including public corridors and elevator lobbies. Exception: Buildings equipped throughout with an automatic sprinkler system in accordance with Section 903.3.1.1 provided the occupant notification appliances will activate throughout the notification zones upon sprinkler water flow.
International Building Code NJ Edition The following amendments were made to Chapter 10, Means of Egress : 1002.1 Definitions: A new definition was added Suite A group of patient treatment rooms or patient sleeping rooms within Group I-2 occupancies where staff are in attendance within the suite for supervision of all patients within the suite, and the suite is in conformance with the requirements of Section 1014.2.2 through 1014.2.7.
International Building Code NJ Edition 1008.1.9.4 Bolt locks. Self latching edge or surface mounted bolts are permitted to be used on the inactive leaf where the pair of doors serves patient care rooms in a Group I-2 occupancy and where the inactive leaf is not needed to meet egress width requirements. 1008.1.9.6 Special locking arrangements in Group I-2. Approved delayed egress locks shall be permitted in a Group I-2 occupancy where the clinical needs of persons receiving care require such locking. Delayed egress locks shall be permitted in such occupancies where the building is equipped throughout with an automatic sprinkler system in accordance with Section 903.3.1.1 1. The doors unlock upon actuation of the automatic sprinkler system or automatic fire detection system. 2. The doors unlock upon loss of power controlling the lock or lock mechanism.
International Building Code NJ Edition 1008.1.9.6 Special locking arrangements cont. 3. The door locks shall have the capability of being unlocked by a signal from the fire command center, a nursing station or other approved location. 4. The procedures for the operation of the unlocking system shall be described and approved as part of the emergency planning and preparedness required by Chapter 4 of the International Fire Code. 5. All clinical staff shall have the keys, codes or other means necessary to operate the locking devices. 6. Emergency lighting shall be provided at the door. Exception: Items 1 through 3 shall not apply to doors to areas where persons which because of clinical needs require restraint or containment as part of the function of a mental hospital.
International Building Code NJ Edition 1014.2.3 Suites in patient sleeping areas. Patient sleeping areas in Group I-2 Occupancies shall be permitted to be divided into suites with one intervening room if one of the following conditions is met: 1. The intervening room within the suite is not used as an exit access for more than eight patient beds. 2. The arrangement of the suite allows for direct and constant visual supervision by nursing personnel. 1014.2.3.1 Area. Suites of sleeping rooms shall not exceed 5,000 sf. 1014.2.3.2 Exit access. Any patient sleeping room or suite that contains patient sleeping rooms, of more than 1,000 sf., shall have at least two remote means of egress. 1014.2.3.3 Travel distance. Travel distance between any point in the suite and an exit door shall not exceed 100 ft.
International Building Code NJ Edition 1014.2.4 Suites in areas other than patient sleeping areas. Areas other than patient sleeping areas in Group I-2 Occupancies shall be permitted to be divided into suites. 1014.2.4.1 Area. Suites of rooms, other than patient sleeping rooms, shall not exceed 10,000 sf. 1014.2.4.2 Exit access. Any room or suite of rooms, other than patient sleeping rooms, of more than 2,500 sf., shall have at least two remote means of egress. 1014.2.4.3 One intervening room. Suites of rooms are permitted to have one intervening room if the travel distance between any point in the suite and an exit door does not exceed 100 ft. 1014.2.4.3 Two intervening rooms. Suites of rooms are permitted to have two intervening rooms is if the travel distance between any point in the suite and an exit door does not exceed 50 ft.
International Building Code NJ Edition 1014.2.2.5 Exit access through suites. Exit access from all other portions of a building not classified as a suite in a Group I-2 occupancy shall not pass through a suite. (this section has been deleted) 1014.2.7 Separation. Suites in Group I-2 occupancies shall be separated from other portions of the building by a smoke partition complying with Section 711. 1018.2 Corridor width. Item #5 Corridors in out patient areas were patients are not capable of self preservation shall be 72 in. minimum.
International Mechanical Code NJ Edition At Chapter 2, new definitions were added for the following terms : • Air dispersion system • Breathing zone • Combination fire/smoke damper • Fire damper • Net occupiable floor area • Occupiable space
The following amendments were made to Chapter 3, General Regulations : 306.1 Clearances for maintenance and replacement. Added the following: A level working space at least 30in. x 30in. shall be provided in front of the control side to service an appliance Table 307.2.2 Condensate drain sizingwas added:
International Mechanical Code NJ Edition • The following amendments were made to Chapter 4, Ventilation: • Section 403Mechanical ventilation. This section was expanded and heavily modified • The concept of a “breathing zone” • was introduced • Tables for Minimum Ventilation Rates, • Zone Air Distribution Effectiveness and System • Ventilation Efficiency were added
International Mechanical Code NJ Edition • The following amendments were made to Chapter 5, Exhaust Systems: 504.8 Common dryer exhaust. This new section addresses common dryer exhaust ducts and the shafts requirements for those ducts. 506.4.2 Type II hood terminations.This section was expanded to include detailed requirements for exhaust outlets. 510.4 Hazardous exhaust systems. The final paragraph is modified as follows: Contaminated air shall not be recirculated to occupiable areas. “ unless contaminants have been removed” has been deleted.
International Mechanical Code NJ Edition • The following amendments were made to Chapter 6, Duct Systems: 601.2 Air movement in egress elements. Exception #4 added: Incidental air movement from pressurized rooms within health care facilities, provided that the corridor is not the primary source of supply or return to the room. 602.2.1.1 Wiring. Is deleted and the following language substituted: Wiring, cable and raceways installed in a plenum shall be listed and installed in accordance with the electrical subcode. 602.2.1.4Electrical equipment in plenums. Is deleted and the following language is substituted: Combustible electrical equipment exposed within a plenum shall be listed and labeled and shall be installed in accordance with the electrical subcode.
International Mechanical Code NJ Edition • Chapter 6 amendments cont.: 607.2.1 Smoke control system. Language added: Where mechanical systems including ducts and dampers used for normal building ventilation serve as part of the smoke control system, the expected performance of these systems in smoke control mode shall be addressed in the rational analysis as per 909.4 of the IBC. 607.3.3.1 Fire damper actuation device. Item #2 Upped the min. operating temperature from 286°F to350°Fwhen located in a smoke control system complying with Section 909 of the IBC. 607.5.1.1Horizontal exits. A listed smoke damper designed to resist the passage of smoke shall be provided at each point that a duct or air transfer opening penetrates a fire wall that serves as a horizontal exit.
International Mechanical Code NJ Edition • The following amendments were made to Chapter 7, Combustion Air: • This chapter was deleted in its entirety. The following language was inserted: 701.1 Scope. Solid fuel burning appliances shall be provided with combustion air in accordance with the appliance manufacturer’s installation instructions. Oil fired appliances shall be provided with combustion air in accordance with NFPA 31. The methods of providing combustion air in this chapter do not apply to fireplaces, fireplace stoves and direct-vent appliances. The requirements for combustion and dilution air for gas-fired appliances shall be in accordance with the International Fuel Gas Code.
International Mechanical Code NJ Edition • The following amendments were made to Chapter 11, Refrigeration: • 1103.1.1 Acceptable refrigerants.Only refrigerants listed by the US Environmental Protection Agency (EPA), pursuant to the Significant New Alternatives Program (SNAP) under section 612 of the Clean Air Act Amendments, as acceptable substitutes for the particular use shall be permitted. Table 1103.1 has been re-titled “Refrigerant Classification, Amount and OEL”. This table has also been expanded and heavily modified. Section 1107 Refrigerant pipinghas been expanded to provide specific requirements for piping locations and penetrations. Section 1109 Periodic testinghas been deleted.
International Mechanical Code NJ Edition • The following amendments were made to Chapter 12, Hydronic Piping: • Section 1203 Joints and connections.This section has been expanded to include specific requirements for new piping materials such as: • Polypropylene plastic (PP) • Raised temperature polyethylene plastic (PE-RT) • Polyethylene/aluminum/polyethylene pressure pipe (PE-AL-PE) • Cross linked Polyethylene/aluminum/cross linkedpolyethylene pressure pipe (PEX-AL-PEX)
International Fuel Gas Code NJ Edition • The following amendments were made to Chapter 3, General Regulations: • 306.1 Access for maintenance. A level working space at least 30in. x 30in. shall be provided in front of the control side to service an appliance. This matches the revision in the IMC 310.1.1 Gas pipe bonding has been added to 310.1 to note that corrugated stainless steel gas piping shall be bonded to the electrical service grounding system. This shall be accomplished with a minimum 6 AWG cooper wire or equivalent.
International Fuel Gas Code NJ Edition • The following amendments were made to Chapter 4, Gas Piping Installations: • 404.4 Underground penetrations. This section was changed to prohibit any underground penetration of building foundations by gas piping. 409.5.3 Shut-off valves. Where a shut off valve is installed at a manifold, it must be within 50ft of the appliance served, readily accessible and permanently identified.
International Fuel Gas Code NJ Edition • The following amendments were made to Chapter 6, Specific Appliances: • 614.8 Common exhaust for dryers. Where a common duct system is used to vent commercial clothes dryers all of the following must be met: • Shafts housing exhaust duct must be rated as per the IBC • Dampers are prohibited in the exhaust duct • Duct work must be a minimum 26 gage rigid steel • Ducts may not have any offsets • The exhaust fan for the duct must run continuously • There must be an alarm (audio or visual) at a central location to signal any shut down of the exhaust fan
National Standard Plumbing Code NJ Edition The following amendments were made to Chapter 4, Joints and Connections: 4.2.17 Split couplings b) Galvanized steel pipe may be jointed using rolled or cut groves. Other interior coated pipe shall not be joined using rolled grooves. Previously, the use of rolled grooves was not permitted on galvanized piping.
National Standard Plumbing Code NJ Edition • The following amendments were made to Chapter 6, Liquid Waste Treatment: • Section 6.2 Grease interceptorshas been expanded to individually address: • Type I Hydro-mechanical grease interceptors • Type II gravity grease interceptors • Grease removal (or recovery) devices (GRD) • Fixture venting Section 6.2.10 Interceptor sizing was added including a new table 6.2.10
National Standard Plumbing Code NJ Edition • The following amendments were made to Chapter 10, Water Supply & Distribution: • 10.2 Identification of potable water and non-potable water • This section has been re-written and expanded. All color coding is to be in accordance with ANSI A13.1. A listing of system designations and background colors is included in the section. 10.15.6 Mixed water temperature control. In the exception to part a) of this section, the maximum temperature has been changed from 120°F to 105°F.
ASHRAE 90.1-2007 • The following are some of the major changes: • Increased envelope insulation requirements • New pipe insulation requirements • New air leakage requirements • New and increased cooling tower efficiency requirements • New chiller efficiency requirements • New PTAC efficiency requirements • Revised damper leakage requirements • New controls requirements for VAV and other devices • Expanded requirements for variable speed controls on pumps
ASHRAE 90.1-2007 • Major changes continued: • New requirements for energy recovery • New requirements for kitchen hoods • New transformer requirements • New computer room HVAC requirements • New controls requirements for lighting • New day lighting requirements • New light test requirements • New sub-metering requirements • Revised building modeling requirements