Staying Up-To-Date on Life Safety
November 01, 2010

By Richard Peck and Shannon Powers-Jones
Appeared in Healthcare Building Ideas

Healthcare designers have become accustomed to viewing facility planning and fit-out as a moving target, as healthcare technology and its space and connectivity requirements evolve constantly. There is no more vital moving target to contend with, however, than maintenance of life safety during construction and operations. Spurred by well-publicized disasters, the need for carefully planned fire management, infection control, and other “defend in place” protocols has come under the spotlight. The evolution of codes and safety systems has been constant, requiring architects, engineers, and facility owners and maintenance personnel to stay abreast of requirements and involved in best practice implementation. Recently, Healthcare Building Ideas Contributing Editors Richard L. Peck and Shannon Powers-Jones questioned some of those key players on how they're meeting this crucial challenge in healthcare project delivery.


Todd Gritch, FAIA, FACHA

Principal, HKS, Dallas

As a designer, what is the overall challenge posed to you in meeting life safety requirements?

Healthcare is unique in that we must meet the needs of three distinct populations: families/visitors, patients, and staff. The most critical population is the patient population, who are unable to leave their beds, much less the building. For that reason, the building must employ augmented construction geared toward defense in place. We approach this in two ways: by designing into the building passive and active life safety systems. The passive approach involves improving fire resistance in various ways, such as using non-combustible materials for the structural frame, containing hazards within fire-resistive construction, and compartmentalizing the facility to allow fire-resistive time periods for occupied areas to be protected. You stop a fire by denying it fuel, oxygen, or heat.

Compartmentalization aims to achieve that by using fire-resistant walls and floors and fire-resistant finish materials, and by sealing wall penetrations. Fire is not the only hazard; smoke also has to be mitigated. Compartmentalization applies also to smoke control. Smoke compartments are the foundation of “defend in place.” Smoke compartments allow people who cannot leave to be moved to areas of refuge. Hospitals are required to have travel distances of no more than 200 feet between any occupied area and the nearest smoke barrier. Another fundamental piece of passive fire protection is relatively short travel distances to exit the building for those who can and should leave. The most prominent form of active fire safety is fire sprinklers throughout the hospital. Today's quick-response systems are recommended for all new additions or construction.

Does renovation pose a problem in keeping up with the new life safety systems and requirements?

Yes, more so than one might think, although some people say you should start applying the codes at the schematic design phase, when you're programming and blocking out spaces. The reason for this is that exiting takes circulation space that does not show up in functional planning. Also, with a major addition, you risk blocking out or lengthening fire exit routes. For example, today's typical new structure will have a large diagnosis-and-treatment podium and a patient tower extending above it, with exit stairs that have to exit to the outside. As you develop and expand the podium over time, maintaining fire exits for the patient tower becomes a problem, a problem that is too often dealt with after the design is set. We try to alert our programmers to be aware of this potential and avoid it upfront. Another problem with renovation is the unforeseen costs of a fire alarm system upgrade required with a renovation, because fire departments like unified systems and severely dislike having different systems serving the same building complex. Often the costs of these upgrades aren't foreseen or planned for, and that's an expensive surprise.

How have the new technologies affected design for new construction?

The newer quick-response sprinkler and smoke detection systems have allowed us to move away from drab-looking, one-hour fire-rated corridors toward more noninstitutional, hospitality-type spaces. If it weren't for these new technologies, hospitals would still look much like they did 50 years ago, for life safety reasons alone.

What about the impact of trends toward decentralized nursing and smoke removal via the HVAC system?

With decentralized nurse stations and computers on wheels, more and more equipment is being placed in the corridor, and you have to make sure you have space available both for modern technology and for the sacrosanct 8-foot corridor. Why 8 feet? Because the typical hospital bed is over seven feet, six inches long, and when rolling it out of a patient room you need space to make a tight turn into the corridor. You also need space for two-way traffic in the corridor, which in an emergency would include a fire lane for egress and firefighting operations. Other than in atriums, the mechanical smoke removal systems you mention are still pretty unusual in healthcare facilities, where it's preferred to contain the smoke to the zone of origin until it can be removed by the fire department. Atria are open, multi-storied spaces where mechanical smoke removal is required. Atria are excellent examples of where modern technologies have significantly changed healthcare design for the better.


Pamela Ward-O'Malley, AIA, CHC

Project Executive, Center of Excellence for Healthcare Construction, Gilbane Building Com., Providence, Rhode Island

What are some important new trends in life safety system design in healthcare?

Recently, the American Society of Healthcare Engineers (ASHE) began a certification process for healthcare constructors. The Certified Health Care Constructor (CHCC) exam was first released last March and, after some refinements of the measuring and scoring system, became available online. Along with the certification comes a continuing education requirement to maintain the credential. Trends in healthcare are continually developing and evolving. The purpose of the exam is to certify that architects, engineers, and others involved in healthcare capital construction have a broad knowledge of issues related to fire safety, interim life safety, infection control, and construction issues specific to this market sector. Because the codes and technology are always changing, sometimes the right thing to do and what you need to do by code are not the same. That's why the CHCC exam is an important gauge of competency, and why some healthcare institutions are now requiring this certification of their contractors.

What are some important contemporary issues that designers need to be aware of?

Designers need to develop the awareness that they're working to achieve code compliance not just for the specific area or space where they're working, but to look at the design as it affects the life safety systems of the building, or the campus, as a whole. For example, if a renovation plan creates a suite that blocks a required fire exit for another area of the floor, that is a problem. If a space plan ignores the requirement that a single smoke compartment may be no greater than 22,500 square feet, and that every patient unit must have access to at least two such compartments, that plan will be in potential need of major revision.

On one project I worked on recently, the new construction was blocking the exterior exit from two existing fire towers immediately contiguous with the construction area. The interior corridors had to be reoriented to avoid directing egress to the area of construction. In three years, when the new construction will be complete, the initially proposed corridors will be compliant. During construction, however, when building occupants need to be redirected, the timing and phasing of life safety systems has to be considered. Life safety issues during construction, and steps contractors will need to take to maintain life safety, must be developed for each phase of construction. If a renovation, for example, must remove fire sprinklers during fit-out construction, for a while, interim life safety planning may require provision of some temporary equivalent-perhaps a “Christmas tree” set-up of a fire pull station on portable poles at the entrances to and from the construction area.

National Fire Protection Association 241 requires during moderate-to-heavy renovation a one-hour fire separation between the construction area and the occupied hospital. The Guidelines for the Design and Construction of Healthcare Facilities also requires an infection control barrier. Often the life safety barrier and the infection control barrier are one and the same. Under the guidelines, every hospital is required to do an Infection Control Risk Assessment. The project design team, including the constructors, are required to develop the Infection Control Risk Mitigation Requirements. The latter may involve measure to ensure that the occupied hospital environment is not negatively impacted by the construction. This may involve HVAC changes in air pressure, filtration, and custodial measures such as an air lock vestibule and walk-off mats.

Is the hospital ultimately responsible for life safety planning?

Well, I'll put it this way: Back in 2002, when I was a facility owner, I gave a life safety talk at ASHE titled “This is Our House, and You Need to Play by Our Rules.” The hospital is ultimately responsible, and the architects, engineers, and constructors must work in unison with the hospital facility's staff to ensure patient safety. All construction activities must occur with the full knowledge and permission of the hospital. No single entity can do the life safety planning alone-you need collaboration among all parties. This is especially true in healthcare, which is a particularly challenging, complex building type, and often involves multiple buildings spanning decades in age. With a hodge-podge like this, healthcare architects often call on code consultants to work out the multitude of code issues in building connections, penetrations combining buildings, and ensuring that the life safety systems are up-to-date and always functional.

Fire alarm systems, for example, will likely be on a 10-to-15-year cycle of replacement as facilities evolve over time. This is a cost complication that, unfortunately, is often overlooked. I remember one New York City facility that had the old-fashioned red fire alarm bell in one area and a new system of strobe signal lights and horns meant to accommodate deaf occupants in the other areas. They were cited by the New York City Building Department for not being ADA-compliant. Usually on the cutting edge of life safety planning are urban-based tertiary academic medical centers. They have led the way in sophisticated approaches to life safety design, if only because so many of these institutions have undertaken major design and construction projects over the past 20 years and have been forced to confront these issues. This is a vitally important area of study for healthcare designers and constructors who want to remain at the head of the field, particularly in these tough financial times. Taking the new CHCC exam is a great first step in establishing their credentials in this area.

What are some newer approaches to infection control using air handling systems?

As an example, we always design the OR suite with HEPA filtration-not a code requirement-and use ultra-violet light on the downside of the cooling coils to prevent bacterial growth due to condensation. We recommend 100% outside air with energy recovery for ORs and EDs to exhaust airborne contaminants. This creates a double-layer of protection while still practicing energy minimization and keeps in compliance with the requirements of many of our client's infection control teams.

What about otherwise directing air flow to minimize infection?

In recent years, we've acquired new computerized tools that enable us to create, model, and visualize airflow conditions, including temperature, volume, and particulate matter, by graphs and animation. Computerized fluid dynamics (CFD) allows us to, for example, design a patient room and predict the results for various kinds of air flow in that space. It used to be that the patient room was rectilinear, had an 8-foot ceiling, a window of thick glass, and a toilet room next to the corridor, with a code requirement of six air changes per hour. Today's room is bigger, with a higher ceiling or even a coffered ceiling of multiple heights, with a large outside window, a toilet room along the exterior with a window of its own, and a family area near the room window. These varying volumes and window sizes leave a lot to consider. In fact, we have in effect a two-zone area for which we can exactly define the cooling requirements. It's quite possible that the code-level six air changes per hour won't be nearly enough to maintain comfort and safety. With CFD we can model and test variables in air flow to upgrade the environment. This is good not only for patients, who are already sick, but for staff and for visitors, who often “hold their breath” these days for fear of secondary infections.

What kind of acceptance is CFD receiving out in the field?

Interestingly, the state of Indiana, where we're building a public hospital, has stated that it doesn't want paper forms for the filing of our energy systems needed by the building. It wants us to file our Energy (E-Quest) models so that it can directly visualize how the systems work. I can't recall seeing anything like this before. Of course, there are problems with acceptance of CFD as well. You might get a contractor who reports to the client that going by code will save money. This immediately begs the need to integrate the design and construction team to offer the client a united vision. Our technology tools and knowledge of medical facility design needs to be incorporated into a cost model that manages the client's expectations, having the client understand the cost benefits of an upgraded system, such as reduced exposure to litigation due to infection and reduced insurance premiums. Finally, it's a fact of life that not everyone in the industry is up-to-speed with newer approaches to computerized design; if this were a football game, you might say we're still in the first quarter. I can say, though, that if you're not doing this sort of thing in healthcare design, you are behind the eight ball. The demand for it is growing.

Are these tools helping you to collaborate more closely with architects in designing safer hospitals?

Absolutely. Engineers are, by nature, very conservative, but these tools are opening the door to more involvement by them in design. We're designing buildings today that operate vastly differently from buildings designed just a few years ago, and I want the architects to understand that I understand what they want to do. I call it “engineering the architecture.” One example is that we're designing the mechanical equipment rooms in advanced graphic detail to justify space requirements for these very expensive areas. In general, if you want a building that looks good, uses the latest technology, and works well, you have to talk to your engineer early on. We have the tools now that can have a dramatic impact on the design. HBI