HOSPITAL 2001 HEALTH CARE AND FACILITIES
2001 EDITIOGUIDELINESD E S I G NFORA N DCONSTRUCTIONOFHOSPITALANDHEALTH CAREFACILITIESThe American Institute of Architects Academyof Architecture for HealthThe Facility Guidelines InstituteWith assistance from the U.S. Department ofHealth and Human Services
2001 EDITIOGUIDELINESD E S I G NFORA N DCONSTRUCTIONOFHOSPITALANDHEALTH CAREFACILITIESThe American Institute of Architects Academyof Architecture for HealthThe Facility Guidelines InstituteWith assistance from the U.S. Department ofHealth and Human ServicesThe American Institute of ArchitectsWashington, D.C.
This publication supersedes the Guidelines for Designand Construction of Hospital and Health Care Facilities,1996-97 edition.To order prepaid copies of the Guidelines, call(202) 626-7541 or 1-800-AIA-3837, press 4.For orders using a purchase order or that mustbe billed, call 1-800-365-ARCH (2724).Facility Guidelines Institute1919 McKinney AvenueDallas, TX 75201(214) 969-3344Contents 2001 by the Facility Guidelines InstituteAll rights reservedThe American Institute of Architects1735 New York Avenue, N.W.Washington, DC 20006Compilation 2001 by The American Institute of ArchitectsAll rights reservedPrinted in the United States of AmericaFirst Printing: April 2001Second Printing: October 2001ISBN 1-57165-002-4
CONTENTSPrefaceMajor Additions and IntroductionGeneralInterpretations of RequirementsRenovationDesign Standards for the DisabledProvisions for DisastersCodes and Standards2.2.1Environment of CareEnergy and Other Resource Conservation 103.3.13.23.3SiteLocationFacility Site DesignEnvironmental Pollution sificationMajor Technical EquipmentEquipment Shown on DrawingsElectronic ing and DesignPhasingCommissioningNonconforming Conditions151616176.6.16.26.3Record Drawings and ManualsDrawingsEquipment ManualsDesign Data1818187.7.17.27.37.47.57.67.77.8General HospitalGeneral ConsiderationsNursing Unit (Medical and Surgical)Critical Care UnitsNurseriesPediatric and Adolescent UnitPsychiatric Nursing UnitSurgical SuitesObstetrical 68.78.88.98.108.118.128.13Emergency ServiceImaging SuiteNuclear MedicineLaboratory SuiteRehabilitation Therapy DepartmentRenal Dialysis Unit (Acute and Chronic)Respiratory Therapy ServiceMorguePharmacyDietary FacilitiesAdministration and Public AreasMedical RecordsCentral ServicesGeneral StoresLinen ServicesFacilities for Cleaning and SanitizingCartsEmployee FacilitiesHousekeeping RoomsEngineering Service and EquipmentAreasGeneral Standards for Details andFinishesDesign and Construction, includingFire-Resistant StandardsSpecial SystemsMechanical StandardsElectrical StandardsHyperbaric SuiteNursing FacilitiesGeneral ConditionsResident UnitResident Support AreasActivitiesRehabilitation TherapyPersonal Services (Barber/Beauty) AreasSubacute Care FacilitiesAlzheimer’s and Other Dementia UnitsDietary FacilitiesAdministrative and Public AreasLinen ServicesHousekeeping RoomsEngineering Service and EquipmentAreas8.14 General Standards for Details 365666874778485888889898989909191929292
CONTENTS8.15 Finishes8.16 Construction Features8.17-8.29 Reserved8.30 Special Systems8.31 Mechanical Standards8.32 Electrical Standards9.9.19.2Outpatient FacilitiesGeneralCommon Elements for OutpatientFacilities9.3 Primary Care Outpatient Centers9.4 Small Primary (Neighborhood)Outpatient Facility9.5 Outpatient Surgical Facility9.6 Freestanding Emergency Facility9.7 Freestanding Birthing Center9.8 Freestanding Outpatient Diagnosticand Treatment Facility9.9 Endoscopy Suite9.10 Cough-Inducing and AerosolGenerating Procedures9.11-9.29 Reserved9.30 Special Systems9.31 Mechanical Standards9.32 Electrical .2010.2110.2210.2310.2410.25Rehabilitation FacilitiesGeneral ConsiderationsEvaluation UnitPsychological Services UnitSocial Services UnitVocational Services UnitDining, Recreation, and Day SpacesDietary DepartmentPersonal Care Unit for InpatientsActivities for Daily Living UnitAdministration and Public AreasEngineering Service and EquipmentAreasLinen ServicesHousekeeping Room(s)Employee FacilitiesNursing Unit (for Inpatients)Sterilizing FacilitiesPhysical Therapy UnitOccupational Therapy UnitProsthetics and Orthotics UnitSpeech and Hearing UnitDental UnitImaging SuitePharmacy UnitDetails and FinishesDesign and Construction, includingFire-Resistant 0.29 Reserved10.30 Special Systems10.31 Mechanical Standards10.32 Electrical sychiatric HospitalGeneral ConditionsGeneral Psychiatric Nursing UnitChild Psychiatric UnitGeriatric, Alzheimer’s, and OtherDementia Unit11.5 Forensic Psychiatric Unit11.6 Radiology Suite11.7 Nuclear Medicine11.8 Laboratory Suite11.9 Rehabilitation Therapy Department11.10 Pharmacy11.11 Dietary Facilities11.12 Administration and Public Areas11.13 Medical Records11.14 Central Services11.15 General Storage11.16 Linen Services11.17 Facilities for Cleaning and SanitizingCarts11.18 Employee Facilities11.19 Housekeeping Room11.20 Engineering Service and EquipmentArea11.21 Waste Processing Services11.22 General Standards for Details andFinishes11.23 Design and Construction, includingFire-Resistant Standards11.24-11.29 Reserved11.30 Special Systems11.31 Mechanical Standards11.32 Electrical 3313313313313413413413412.Mobile, Transportable, andRelocatable Units12.1 General12.2-12.30 Reserved12.31 Mechanical Standards12.32 Electrical Standards15816016016013.Hospice Care16214.Assisted Living16415.Adult Day Care Facilities165Glossary166136Index167
CONTENTSTables7.1Sound Transmission Limitations inGeneral Hospitals78Ventilation Requirements for AreasAffecting Patient Care in Hospitalsand Outpatient Facilities79Filter Efficiencies for CentralVentilation and Air ConditioningSystems in General Hospitals827.4Hot Water Use—General Hospital827.5Station Outlets for Oxygen, Vacuum(Suction), and Medical Air Systemsin Hospitals837.27.38.1Pressure Relationships and Ventilationof Certain Areas of Nursing Facilities101Filter Efficiencies for CentralVentilation and Air ConditioningSystems in Nursing Facilities1028.3Hot Water Use—Nursing Facilities1029.1Filter Efficiencies for CentralVentilation and Air ConditioningSystems in Outpatient Facilities127Station Outlets for Oxygen, Vacuum,and Medical Air in OutpatientFacilities1278.29.211.1 Filter Efficiencies for CentralVentilation and Air ConditioningSystems in Psychiatric Hospitals157
PREFACEThis is the latest in the 54-year history of this guidelines document to aid in the design and constructionof hospital and other health care facilities.The original General Standards appeared in theFederal Register on February 14, 1947, as part of theimplementing regulations for the Hill-Burton program. The standards were revised from time to timeas needed. In 1974 the document was retitledMinimum Requirements of Construction and Equipmentfor Hospital and Medical Facilities to emphasize thatthe requirements were generally minimum, ratherthan recommendations of ideal standards. The 1974edition was the first to request public input and comment. It also removed any requirements relating tothe preparation of plans, specifications, and estimatesor to site survey and soil investigation, which hadbeen a part of all previous editions. These requirements were published in a document entitledTechnical Manual on Facility Design and Constructionpublished by the Department of Health, Education,and Welfare’s (DHEW) Office of FacilitiesEngineering.In 1984 the Department of Health and HumanServices (DHHS) removed from regulation therequirements relating to minimum standards of construction, renovation, and equipment of hospitals andmedical facilities, as cited in the MinimumRequirements DHEW Publication No. (HRA) 8114500. Since the federal grant and loan programs hadexpired, there was no need for the federal government to retain the guidelines in regulation format. Toreflect the non-regulatory status, the title waschanged to Guidelines for Construction and Equipmentof Hospital and Medical Facilities. However, the document was, and still is, used by many state authoritieshaving jurisdiction for licensure or registration.Further, the Guidelines are used by DHHS staff toassess Department of Housing and UrbanDevelopment applications for hospital mortgageinsurance and for Indian Health Service constructionprojects. Therefore, regulatory language has beenretained. This was the last year the document wasrevised and published by DHHS; at the same time,they published and distributed an addendum to theGuidelines entitled Energy Considerations for HospitalConstruction and Equipment.viIn 1984 DHHS asked the American Institute ofArchitects Committee on Architecture for Health(AIA/CAH) to form an advisory group to work with,and be funded by, the Public Health Service for thenext revision. When the revisions to the documentwere complete, the federal government declined topublish it. The AIA/CAH asked several nonprofitagencies and professional associations to publish anddistribute the Guidelines. They finally reached anagreement with the American Institute of Architects(AIA) to publish the 1987 edition.At this point, the Guidelines would have ceasedbeing revised, or even to continue to exist, if threepeople had not taken it upon themselves to approachthe Public Health Service and the Health CareFinancing Administration and request a federal grantto fund a revision cycle. These same three people,working with AIA/CAH, put together the firstSteering Committee, who in turn set up the firstHealth Guidelines Revision Committee (HGRC)not under the aegis of the federal government. Themembers of this multidisciplinary group came fromthe federal and state governments and the privatesector and offered expertise in design, operation, andconstruction of health facilities. The 1992-93 editionof the Guidelines was published and distributed bythe AIA.The Steering Committee from the 1992-93 cyclerequested and received federal funding from DHHSfor another cycle. Substantial funding was also provided by the American Hospital Association and theAIA/CAH. The consensus process was enhanced andthe input base broadened by asking the public to propose changes to the Guidelines and then to commenton these proposals. Approximately 2,000 proposalsand comments were received and processed. ThreeRevision Committee meetings—one on the EastCoast, one on the West Coast, and one in the middleof the country—were held to discuss the merits of allproposals and comments. More than 65 expertsattended these sessions and reached a consensus onthe content of the 1996-97 edition of the Guidelines.A letter ballot was sent to all eligible members of theHealth GRC and the document was approved by aunanimous vote. To better reflect its content, the titleof the document was changed to Guidelines for Designand Construction of Hospital and Health Care Facilities.
P R E FA C EIt was during this revision cycle that the AlACommittee on Architecture for Health became theAIA Academy of Architecture for Health(AIA/AAH).In an effort to create a more formal procedure andprocess, and to ensure the document is kept current,the Facility Guidelines Institute (FGI) was formed in1998. The main objective and thrust of FGI is to seethat the Guidelines are reviewed and revised on a regular cycle with a consensus process by a multidisciplinary group of experts from the federal, state, andprivate sectors. In this role, FGI acted as the contracting agent between the AIA and the AAH for the2001 edition of the Guidelines. In the future, FGIwill continue to serve as the contracting agent for theAlA in its role as a promulgator of guidelines andstandards, whether with the Academy of Architecturefor Health or other AIA Professional Interest Areas(PIAs) that want to develop facility guidelines.FGI is primarily interested in consensus methodology and in having the responsibility for overseeingthe revision process. Specifically, FGI wants to makesure the Health Guidelines Revision Committee is properly funded, has a balance of representation from interest groupswith expertise or jurisdiction, uses the consensus process, requests public input in the form of proposals forchange and comments on proposed changes, reviews and revises the Guidelines on a timely basisin order to maintain a balance between a minimumstandard and the state of the art in health caredesign and construction, and operates under a formal set of bylaws governing itspurpose, scope, membership, and goals, to includeinformation regarding “Duties and Responsibilities”and “Appointments, Terms, and Officers.”FGI will act as the day-to-day contact with the public to monitor requests for interpretations. Goals areto make sure that requests are answered in a timelymanner, that interpretations are rendered by thoseindividuals best equipped to reflect the intent of thecommittee when the document was written, and thatinterpretations are made public.This edition of the Guidelines was the first cycle tobe completed under the aegis and direction of FGI.It received major funding from DHHS/Health CareFinancing Administration and the AIA/AAH. TheAmerican Society for Healthcare Engineering(ASHE), the National Institutes of Health (NIH),and the AIA provided staff and technical support.The Health Guidelines Revision Committee(HGRC) met in Arlington, Virginia, and reviewedthe 1996-97 edition of the Guidelines line by line toascertain areas that needed to be addressed, includinginfection control, safety, and environment of care.The membership for this revision cycle included anincreased number of state authorities, consistent withthe increasing number of states utilizing all or portions of the Guidelines as state regulation by adoption. The work of the HGRC was greatly enhancedby the attendance and participation of these authorities having jurisdiction (AHJs).At the beginning of this revision cycle, a notice thatthe document was being revised was publicized tointerested parties along with a request that theymake proposals for change. The committee receivedand gave serious consideration to 539 proposals tomodify the document. After its meeting in Irvine,California, a document containing proposed changeswas made available to all who requested it for publiccomment. The HGRC received and gave carefulconsideration to 1,030 comments on the proposedchanges. For the first time the Internet was usedextensively to distribute the document and to receiveproposals and comments.These revised Guidelines are the result of many hoursspent at three different meetings, on the East Coast,the West Coast, and in middle America, eachattended by 82-86 members of the 97-memberHGRC. Committee members also spent countlesshours in subcommittee and focused task groups aswell as at home reviewing the proposals for changeand comments on them. The 2001 edition of theGuidelines was formally adopted at the Denver,Colorado, meeting to be sent out for letter ballot. Theresult of the letter ballot was unanimous endorsementof the document. The adopted Guidelines wereapproved by FGI and turned over to the AIA forpublishing and distribution. A major change in format was adopted for this edition, as well as a glossaryof terms and a form to request an interpretation.When possible, the Guidelines standards are performance oriented for desired results. Prescriptive measurements, when given, have been carefullyconsidered relative to generally recognized standards.For example, experience has shown that it would beextremely difficult to design a patient bedroomsmaller than the size suggested and still have spacefor the normally expected functions and procedures.vii
P R E FA C EAuthorities adopting the Guidelines should encourage design innovation and grant exceptions where theintent of the standard is met. These standards assumethat appropriate architectural and engineering practice and compliance with applicable codes will beobserved as part of normal professional service.These Guidelines change to keep pace with evolvinghealth care needs and in response to requests for upto-date guidance from providers, designers, and regulators. It is recognized that many health care servicesmay be provided in facilities not subject to licensureor regulation, and it is intended that these Guidelinesbe suitable for use by all health care providers. It isfurther intended that when used as regulation, somelatitude be granted in complying with theseGuidelines so long as the health and safety of theoccupants of the facility are not compromised.In some facilities, areas, or sections, it may be desirable to exceed the Guidelines standards for optimumfunction. For example, door widths for inpatient hospital rooms are noted as 3 feet 8 inches (1.11 meters),which satisfies applicable codes, to permit the passageof patient beds. However, wider widths of 3 feet 10inches (1.22 meters) may be desirable to reduce damage to doors and frames when beds and large equipment are moved frequently. More or all private roomsmay be desirable to achieve effective infection control, to improve the environment of care, or toincrease the percentage of occupancy. The decision toexceed the standards should be made part of thefunctional program of the health care facility.The Guidelines and the methodology for revisingthem have been, and still are, in an evolutionaryprocess. When first published, they were a set of regulations developed by a single department of the federal government as a condition to receive a federalhospital construction grant under the Hill-BurtonAct. Even in those early days, the document washighly respected and influential throughout theworld. From the time it was first issued and enforced,U.S. hospitals have become the ideal and the goal tobe achieved by those building hospitals in all nations.viiiGradually, state hospital authorities and other federalagencies were added to the HGRC, then private,non-governmental health care professional societies,practitioners, and designers. Educational programsand seminars were introduced in the 1980s to informthe public about the subjects addressed in theGuidelines and the reasons behind inclusion of certain requirements. Also, very slowly, public input wasrequested by the committee in the form of commenton proposed changes. This has now exploded into thecurrent avalanche of proposals and comments. Ineach succeeding cycle, the committee has beengreatly enlarged to increase the base of expertise andto allow more public representation. Further, the consensus procedure was adopted for all decision-making.As the process became more complex, as the committee grew larger and larger, as more and more public proactive and reactive input was requested andreceived, as the practice of health care delivery andthe buildings that house them began to change at anever-increasing rate, the need for a more formal andexpeditious process became mandatory. Adding tothe complexity of the process is the expansion in thescope of the document from covering acute generalhospitals only to including nursing homes, rehabilitation centers, ambulatory care facilities, psychiatrichospitals, mobile health care units, hospice care,assisted living, etc.It is the desire of the Health Guidelines RevisionCommittee to continue working in its relationshipwith the American Institute of Architects and theFacility Guidelines Institute to make certain theG
A letter ballot was sent to all eligible members of the Health GRC and the document was approved by a unanimous vote. To better reflect its content, the title Guidelines for Design .
23 Eastman Dental Hospital 24 Royal National Throat, Nose & Ear Hospital 25 The Nuffield Hearing and Speech Centre 26 Moorfields Eye Hospital 27 St. Bartholomew's Hospital 28 London Bridge Hospital 29 Guy's Hospital 30 Churchill Clinic 31 St. Thomas' Hospital 32 Gordon Hospital 33 The Lister Hospital 34 Royal Hospital Chelsea 35 Charter .
3. Benishiekh General Hospital 4.Biu General Hospital 5. Shani General Hospital 6. Gubio General Hospital 7. Magumeri General Hospital 8. Konduga General Hospital 9. Dikwa General Hospital 10. Mamman Shuwa Memorial Hospital 11. Mafa General Hospital Those rehabilitated but not fully equipped are: 1. Damb
designing and developing new systems for digital tadio eommunkralaju in the Amateur Radio Sen. icc. and for disseminating information required duimg. and obtained from. Such research. Article submission deadlines for upcoming issues: Spring 2001 March IS, 2001 Summer 2001 June 15,2001 Fall 2001 September 15,2001 Winter 2001 December 15,2001
32. appolo hospital, Delhi 33. naraya hrudayalaya 34. kanpur medical Centre, U.P 35. narayana nathralaya 36. Sparsh narayana hridyalaya 37. Videhi medical College hospital 38. manipal hospital 39. Trinity hospital 40. Rajarajeshwari hospital 41. Raveendanath Tagor hospital 42. appolo hospital (Bilaspur) 43. Thrivanathapuram hospital Placement .
home health of harrison county hospital harrison county hospice harrison county community hospital harrison county community hospital-snf dialysis clinic clinton kansas avenue dialysis golden valley memorial hospital hha twin lakes hospice golden valley memorial hospital golden valley memorial hospital rehab unit royal oaks hospital and clinics
2 Adventist Medical Center, Portland. 3 Castle Medical Center. 4 Central Valley General Hospital. 5 Feather River Hospital. 6 Glendale Adventist Medical Center. 7 Hanford Community Medical Center. 8 Howard Memorial Hospital. 9 Redbud Community Hospital. 10 St. Helena Hospital. 11 San Joaquin Community Hospital. 12 Selma Community Hospital, Inc.
Religare Health Insurance Co. Ltd. State City Hospital Name Address Pin code Alternate Hospital Name MAHARASHTRA Mumbai Dr.Mahajan's Hospital R-831,Rabale TTC,Thane,Belapur Road,Navi Mumbai 400708 Sanjivani Hospital/Sai Seva Hospital & ICU/Mody Hospital and
Northside Hospital: Northside Gwinnett Joan Glancy, Northside Hospital Cherokee, Northside Hospital Duluth, Northside Hospital Forsyth, Northside Hospital Gwinnett, Prime Healthcare: Southern Regional Medical Center, Southern Cresent Hospital Specialty Care, Piedmont Hospital System: Piedmont Athens Regional Medical
