Contents. Preface Acknowledgments About this Document Major Additions and Revisions. List of Acronyms. Part 1 General 1

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1 Contents Preface Acknowledgments About this Document Major Additions and Revisions Glossary List of Acronyms xv xvii xxiii xxix xxxiii xxxix Part 1 General Introduction General Application Minimum Standards for New Facilities and Major Renovations New Construction Renovation General Facilities Subject to Compliance with the Guidelines Undiminished Safety Long-Range Improvement Government Regulations Design Standards for Accessibility Regulations for Earthquake-Resistant Design for New Buildings Flood Protection National Standards for the Protection of Patient Health Information Environmental Regulations Building Codes and Standards Safe Environment Code Compliance Equivalency Concepts English/Metric Measurements Codes, Standards, and Other Documents Referenced in the Guidelines Planning, Design, Construction, and Commissioning General Application Multidisciplinary Project Team Environment of Care and Facility Function Considerations Functional Program General Functional Program Content Safety Risk Assessment General Infection Control Risk Assessment Patient Handling and Movement Assessment Patient Fall Prevention Medication Safety Behavioral and Mental Health Patient Immobility Security Risks Environment of Care Requirements Delivery of Care Model Concepts Patients, Visitors, Physicians, and Staff Accommodation and Flow Building Infrastructure and Systems Design Criteria Physical Environment Elements Planning and Design Considerations and Requirements Acoustic Design Sustainable Design Wayfinding Bariatric-Specific Design Considerations Provisions for Disasters Renovation Phasing Isolation Maintenance of Air Quality and Utilities Existing Conditions Commissioning Commissioning Requirements Commissioning Activities Commissioning Agent Record Drawings and Manuals Drawings Equipment Manuals Design Data 2014 Guidelines for Design and Construction of Hospitals and Outpatient Facilities v

2 1.3 Site General Application Location Availability of Transportation Security Availability of Utilities Site Features Roads Pedestrian Walkways Parking Emergency Access Landscape Design Features Transfer Support Features Environmental Pollution Control Equipment General Application Equipment List Drawing Requirements Equipment Classification Requirement Equipment Types Equipment Requirements Major Technical Equipment Electronic Equipment Space Requirements for Equipment Fixed and Building Service Equipment Movable Equipment Part 2 Hospitals Common Elements for Hospitals General Application Functional Program Site Nursing Units and Other Patient Care Areas General Patient Room Reserved Special Patient Care Rooms Support Areas for Patient Care General Support Areas for Nursing Units and Other Patient Care Areas Support Areas for Staff Support Areas for Families, Patients, and/or Visitors Diagnostic and Treatment Areas Reserved Examination Room or Emergency Department Treatment Room Hand Scrub Facilities Patient Support Facilities Laboratory Services Pharmacy Services Food and Nutrition Services General Support Facilities Central Services Linen Services Materials Management Waste Management Environmental Services Engineering and Maintenance Services Morgue Services Public and Administrative Areas General Public Areas Administrative Areas Support Areas for Staff and Volunteers Design and Construction Requirements Building Codes and Standards Architectural Details, Surfaces, Building Systems Reserved Heating, Ventilation, and Air- Conditioning Systems Electrical Systems Plumbing Systems Communications Systems Electronic Safety and Security Systems Special Systems 2.2 Specific Requirements for General Hospitals General Application Functional Program Site Nursing Units General Medical/Surgical Nursing Unit Oncology Nursing Unit Pediatric and Adolescent Oncology Nursing Unit Intermediate Care Unit Critical Care Unit Coronary Critical Care Unit Combined Medical/Surgical Critical Care and Coronary Critical Care Unit Pediatric Critical Care Unit Neonatal Intensive Care Unit Obstetrical Unit Nursery Unit Pediatric and Adolescent Unit Psychiatric Nursing Unit vi 2014 Guidelines for Design and Construction of Hospitals and Outpatient Facilities

3 In-Hospital Skilled Nursing Unit Bariatric Care Unit Diagnostic and Treatment Facilities Emergency Services Observation Unit Surgical Services Imaging Interventional Imaging Nuclear Medicine Radiation Therapy Rehabilitation Therapy Respiratory Therapy Renal Dialysis Endoscopy Chemotherapy Infusion Hyperbaric Suite Patient Support Facilities Laboratory Services Pharmacy Services Food and Nutrition Services General Support Facilities Central Services Linen Services Materials Management Waste Management Environmental Services Engineering and Maintenance Services Morgue Public and Administrative Areas Design and Construction Requirements Building Systems Reserved Heating, Ventilation, and Air- Conditioning Systems Electrical Systems Plumbing Systems Communications Systems Electronic Safety and Security Systems Special Systems 2.3 Specific Requirements for Freestanding Emergency Departments General Application Functional Program Site Reserved Diagnostic and Treatment Areas General Observation Beds Imaging Services Reserved Support Areas for Patient Care General Support Areas for the Freestanding Emergency Department Support Areas for Staff Patient Support Facilities Laboratory Services Pharmacy Services Nourishment Area General Support Facilities Reserved Linen Services Materials Management Waste Management Environmental Services Engineering and Maintenance Services Public and Administrative Areas Entrance Public Waiting Area Design and Construction Requirements Building Systems Specific Requirements for Critical Access Hospitals General Application Functional Program Site Nursing Unit General Critical Access Nursing Unit Reserved General Psychiatric Nursing Unit Child Psychiatric Unit Alzheimer s and Other Dementia Unit Forensic Psychiatric Unit Diagnostic and Treatment Areas General Emergency Services Surgical Services Imaging Telemedicine Mobile/Transportable Units Patient Support Facilities Laboratory Services Pharmacy Food and Nutrition Services General Support Facilities Reserved Linen Services Materials Management Waste Management Environmental Services Engineering and Maintenance Services Public and Administrative Areas Design and Construction Requirements Guidelines for Design and Construction of Hospitals and Outpatient Facilities vii

4 Reserved Corridor Width Building Systems Reserved Heating, Ventilation, and Electrical Systems Plumbing Systems Reserved Electronic Safety and Security Systems 2.5 Specific Requirements for Psychiatric Hospitals General Application Functional Program Site Shared Services Environment of Care Nursing Units General General Psychiatric Nursing Unit Child Psychiatric Unit Alzheimer s and Other Dementia Unit Forensic Psychiatric Unit Diagnostic and Treatment Areas Examination Room Imaging Reserved Rehabilitation Therapy Electroconvulsive Therapy Patient Support Facilities Laboratory Services Pharmacy Services Food and Nutrition Services General Support Facilities Central Services Linen Services Materials Management Waste Management Environmental Services Engineering and Maintenance Services Public and Administrative Areas Design and Construction Requirements Building Codes and Standards Architectural Details, Surfaces, Building Systems General Reserved Electrical Systems Plumbing Systems Communications Systems Electronic Safety and Security Systems Special Systems 2.6 Specific Requirements for Rehabilitation Hospitals and Other Facilities General Application Functional Program Site Nursing Unit and Living Areas General Rehabilitation Nursing Unit Patient Living Areas Diagnostic and Treatment Areas Medical Evaluation Unit Other Required Units Optional Units Patient Support Facilities Laboratory Services Pharmacy Services Food and Nutrition Services Home Health Service General Support Facilities Public and Administrative Areas Design and Construction Requirements Building Codes and Standards Architectural Details, Surfaces, Building Systems Reserved Heating, Ventilation, and Air- Conditioning Systems Electrical Systems Plumbing Systems Reserved Electronic Safety and Security Systems Special Systems 2.7 Specific Requirements for Children s Hospitals General Application Functional Program Site Nursing Units General Pediatric Medical/Surgical Nursing Unit Oncology Nursing Unit Reserved Pediatric Critical Care Unit Pediatric Cardiac Critical Care Unit Reserved Neonatal Intensive Care Unit Obstetrical Unit Nursery Unit Reserved Pediatric Psychiatric Nursing Unit viii 2014 Guidelines for Design and Construction of Hospitals and Outpatient Facilities

5 Reserved Bariatric Care Unit Diagnostic and Treatment Areas Emergency Services Observation Unit Surgical Services Imaging Interventional Imaging Nuclear Medicine Radiation Therapy Rehabilitation Therapy Respiratory Therapy Renal Dialysis Endoscopy Chemotherapy Infusion Hyperbaric Suite Patient Support Facilities Laboratory Services Pharmacy Services Food and Nutrition Services General Support Facilities Central Services Linen Services Materials Management Waste Management Environmental Services Engineering and Maintenance Services Public and Administrative Areas General Public Areas Administrative Areas Design and Construction Requirements Building Systems 258 Part 3 Outpatient Facilities Common Elements for Outpatient Facilities General Application Functional Program Site Facility Layout Reserved Diagnostic and Treatment Areas General Examination Rooms Hand Scrub Facilities Special Patient Care Rooms Support Areas for Patient Care General Support Areas for Examination Rooms Reserved Support Areas for Patients Imaging Services Patient Support Facilities Laboratory Services General Support Facilities Reserved Linen Services Materials Management Waste Management Environmental Services Engineering and Maintenance Services Public and Administrative Areas Reserved Public Areas Administrative Areas Support Areas for Staff Design and Construction Requirements Building Codes and Standards Reserved Architectural Details, Surfaces, Building Systems Reserved Heating, Ventilation, and Air- Conditioning Systems Electrical Systems Plumbing Systems Communications Systems Fire Alarm System Special Systems 3.2 Specific Requirements for Primary Care Facilities General Application Functional Program Site Reserved Diagnostic and Treatment Areas Reserved Examination Rooms Diagnostic Services Patient Support Facilities Laboratory Services General Support Facilities Primary Care Center Small Neighborhood Clinics Public and Administrative Areas General Public Areas Administrative Areas Support Areas for Staff Design and Construction Requirements Building Systems Guidelines for Design and Construction of Hospitals and Outpatient Facilities ix

6 General Heating, Ventilation, and Electrical Systems Plumbing Systems 3.3 Specific Requirements for Freestanding Outpatient Diagnostic and Treatment Facilities General Application Functional Program 3.4 Specific Requirements for Freestanding Birth Centers General Application Functional Program Site Birth Center Facilities General Birthing Room Newborn Care Area Reserved Support Areas General Support Areas for the Birth Center Support Areas for Staff Reserved Patient Support Facilities Reserved Food and Nutrition Services General Support Facilities Reserved Materials Management Waste Management Reserved Engineering and Maintenance Services Reserved Design and Construction Requirements Building Codes Architectural Details and Surfaces Building Systems Reserved Heating, Ventilation, and Air- Conditioning Systems Electrical Systems Plumbing Systems Reserved Security Systems Special Systems 3.5 Specific Requirements for Freestanding Urgent Care Facilities General Application Functional Program Site Reserved Diagnostic and Treatment Areas Reserved Examination and Procedure Rooms Observation Facilities Reserved Support Areas for Patient Care General Support Areas for Diagnostic and Treatment Areas Support Areas for Staff Reserved Imaging Services Patient Support Facilities Laboratory Services General Support Facilities Reserved Environmental Services Room Public and Administrative Areas General Public Areas Administrative Areas Support Areas for Staff Design and Construction Requirements Reserved Architectural Details, Surfaces, Building Systems Specific Requirements for Freestanding Cancer Treatment Facilities General Reserved Functional Program Site Reserved Diagnostic and Treatment Areas Reserved Cancer Treatment Area Reserved Special Patient Treatment Rooms Reserved Support Areas for the Cancer Treatment Facility Support Areas for Staff Support Areas for Patients Reserved General Support Facilities Reserved x 2014 Guidelines for Design and Construction of Hospitals and Outpatient Facilities

7 Environmental Services Room Public and Administrative Areas Reserved Public Areas Administrative Areas Design and Construction Requirements Reserved Architectural Details, Surfaces, Building Systems Specific Requirements for Outpatient Surgical Facilities General Application Functional Program Site Reserved Diagnostic and Treatment Areas General Procedure Room Outpatient Operating Rooms Pre- and Postoperative Patient Care Areas Support Areas for Patient Care Support Areas for the Surgical Suite Support Areas for Staff Support Areas for Patients Reserved General Support Facilities Sterilization Facilities Linen Services Reserved Environmental Services Public and Administrative Areas General Public Areas Administrative Areas Support Areas for Staff Design and Construction Requirements Building Codes and Standards Reserved Architectural Details, Surfaces, Building Systems Reserved Heating, Ventilation, and Electrical Systems Plumbing Systems Communications Systems Fire Alarm System Special Systems 3.8 Specific Requirements for Office-Based Procedure and Operating Rooms Application Reserved Diagnostic and Treatment Areas Office-Based Procedure Room Office-Based Operating Room Reserved Pre-Procedure and Recovery Patient Care Areas Support Areas for Patient Care General Support Areas for Procedure and Operating Rooms Support Areas for Staff Support Areas for Patients Reserved Design and Construction Requirements Building Systems Reserved Heating, Ventilation, and Electrical Systems Plumbing Systems 3.9 Specific Requirements for Endoscopy Facilities General Application Functional Program Site Reserved Diagnostic and Treatment Areas Examination Room Endoscopy Procedure Suite Pre-Procedure and Recovery Patient Care Areas Reserved Support Areas for Patient Care General Support Areas for the Endoscopy Procedure Suite and Other Patient Care Areas Support Areas for Staff Support Areas for Patients Patient Support Facilities Laboratory Services General Support Facilities Instrument Processing Room Reserved Environmental Services Public and Administrative Areas Reserved Public Areas 2014 Guidelines for Design and Construction of Hospitals and Outpatient Facilities xi

8 Administrative Areas Support Areas for Staff Design and Construction Requirements Building Codes and Standards Reserved Architectural Details, Surfaces, Building Systems Reserved Heating, Ventilation, and Electrical Systems Plumbing Systems Communications Systems Fire Alarm System Special Systems 3.10 Specific Requirements for Renal Dialysis Centers General Application Functional Program Site Reserved Diagnostic and Treatment Areas Examination Room Hemodialysis Treatment Area Home Training Room Special Patient Care Rooms Support Areas for Patient Care General Support Areas for the Renal Dialysis Center Support Areas for Staff Support Areas for Patients Reserved General Support Services and Facilities Dialysis Support Facilities Public and Administrative Areas Reserved Public Areas Administrative Areas Reserved Building Systems Reserved Heating, Ventilation, and Electrical Systems Plumbing Systems Communications Systems Fire Alarm System Special Systems 3.11 Specific Requirements for Outpatient Psychiatric Centers General Application Functional Program Site Reserved Diagnostic and Treatment Areas General Areas for Patient Services Electroconvulsive Therapy Facilities Reserved Support Areas for the Outpatient Psychiatric Center Support Areas for Staff Reserved General Support Facilities Reserved Environmental Services Room Public and Administrative Areas Reserved Public Areas Administrative Areas Design and Construction Requirements Security Architectural Details Building Systems Reserved Heating, Ventilation, and Electrical Systems Plumbing Systems Communications Systems Electronic Safety and Security Systems Special Systems 3.12 Specific Requirements for Outpatient Rehabilitation Therapy Facilities General Application Functional Program Site Reserved Diagnostic and Treatment Areas General Physical/Occupational Therapy Treatment Space Other Patient Care Areas Facilities for Other Services xii 2014 Guidelines for Design and Construction of Hospitals and Outpatient Facilities

9 Support Areas for Patient Care General Support Areas for Treatment and Other Patient Care Areas Reserved Support Areas for Patients Reserved General Support Facilities Reserved Environmental Services Public and Administrative Areas Reserved Public Areas Administrative Areas Design and Construction Requirements Reserved Architectural Details, Surfaces, Building Systems Reserved Heating, Ventilation, and Electrical Systems Plumbing Systems Communications Systems Fire Alarm Systems Special Systems 3.13 Specific Requirements for Mobile, Transportable, and Relocatable Units General Application Reserved Site Reserved Diagnostic and Treatment Areas Mobile Units Transportable Units Relocatable Units Reserved Support Areas for Patient Care General Support Areas for Mobile, Transportable, and Relocatable Units Support Areas for Patients Reserved Public and Administrative Areas General Public Areas Design and Construction Requirements Building Codes and Standards Architectural Details and Surfaces for Unit Construction Building Systems Reserved Heating, Ventilation, and Electrical Systems Plumbing Systems Communications Systems Safety and Security Systems 3.14 Specific Requirements for Dental Facilities General Application Functional Program Site Reserved Dental Treatment Areas General Family Pediatric Dentistry Examination and Treatment Space Family/Pediatric Dentistry Hygiene Space Treatment and Recovery Spaces for Anesthesia Use Support Areas for Patient Care General Support Areas for Dental Examination and Treatment Spaces Support Areas for Staff Support Areas for Patients Patient Support Services Laboratory Services Reserved Public and Administrative Areas General Public Areas Administrative Areas Reserved Building Systems Reserved Heating, Ventilation, and Part 4 Ventilation of Health Care Facilities 367 ANSI/ASHRAE/ASHE Standard : Ventilation of Health Care Facilities Index Guidelines for Design and Construction of Hospitals and Outpatient Facilities xiii

10 List of Tables Part 1 Table 1.2-1: Safety Risk Assessment Components Table 1.2-2: Infection Control Risk Assessment Design Considerations Table 1.2-3: Categorization of Health Care Facility Sites by Exterior Ambient Sound Table 1.2-4: Minimum Design Room Sound Absorption Coefficients Table 1.2-5: Maximum Design Criteria for Noise in Interior Spaces Caused by Building Systems Table 1.2-6: Design Criteria for Minimum Sound Isolation Performance Between Enclosed Rooms Table 1.2-7: Design Criteria for Speech Privacy for Enclosed Rooms and Open-Plan Spaces Table 1.2-8: Maximum Limits on Floor Vibration Caused by Footfalls in Health Care Facilities Table A1.2-a: Safety Risk Assessment Team Member Expertise Table A1.2-b: Approximate Distance of Noise Sources for Use in Categorization of Health Care Facility Sites by Exterior Ambient Sound Part 2 Table 2.1-1: Electrical Receptacles for Patient Care Areas in Hospitals Table 2.1-2: Locations for Nurse Call Devices in Hospitals Table 2.1-3: Hot Water Use General Hospital Table 2.1-4: Station Outlets for Oxygen, Vacuum, and Medical Air Systems in Hospitals Table A2.1-a: Sound Transmission Loss or Attenuation Through Horizontal and Vertical Barriers in NICUs Table A2.1-b: Maximum Length of Hot Water System Pipe or Tube Part 3 Table 3.1-1: Electrical Receptacles for Patient Care Areas in Outpatient Facilities Table 3.1-2: Locations for Nurse Call Devices in Outpatient Facilities Table 3.1-3: Station Outlets for Oxygen, Vacuum, and Medical Air Systems in Outpatient Facilities Table : Stair Requirements for Mobile and Transportable Units xiv 2014 Guidelines for Design and Construction of Hospitals and Outpatient Facilities

Contents. Preface Acknowledgments About the Guidelines Major Additions and Revisions Glossary List of Acronyms. Part 1 General 1.

Contents. Preface Acknowledgments About the Guidelines Major Additions and Revisions Glossary List of Acronyms. Part 1 General 1. Contents Preface Acknowledgments About the Guidelines Major Additions and Revisions Glossary List of Acronyms xi xiii xxi xxv xxix xxxv Part 1 General 1 1.1 Introduction 3 1.1-1 General 3 1.1-1.1 Application