Hospital CX Requirements - bcxa.org · Hospital CX Requirements. Presenters: Paul Mulyk, PE, BCxA - NYU Langone Health. Michael Dooley, PE, CEM, CCP - AKF Group

Hospital CX Requirements

Presenters:Paul Mulyk, PE, BCxA - NYU Langone HealthMichael Dooley, PE, CEM, CCP - AKF Group

AIA Quality Assurance

The Building Commissioning Association is a Registered Provider with The American Institute of Architects Continuing Education Systems (AIA/CES). Credit(s) earned on completion of this program will be reported to AIA/CES for AIA members. Certificates of the Completion for both AIA members and non-AIA members are available upon request.

This program is registered with AIA/CES for continuing professional education. As such, it does not include content that may be deemed or construed to be an approval or endorsement by the AIA of any material of construction or any method or manner of handling, using, distributing, or dealing in any material or product.

Questions related to specific materials, methods, and services will be addressed at the conclusion of this presentation.

BCxA Conference – Chicagoland, IL – 2019 2

Learning Objectives

BCxA Annual Conference – Chicagoland, IL – September 2019 3

• CX requirements in codes and standards

• Important testing requirements for code specific hospital items

• Real world example

What is NYU Langone Health


• US News and World Report ‘Best Hospitals’ 2019

▪ Named to Honor Roll at #9 in the nation. Ranked #2 in New York State and the New York metropolitan area.

History of NYU Langone Health CX Program


• CX program created in 2013

• 5 internal members of the team + 13 on call CX firms

• 215 projects

• 5.3 million square feet CX’ed

• 16,000 issues opened, around 15,000 closed (~94% close rate)

CX Code/Standards Requirements in Hospitals


• FGI 2014 Guidelines

• NFPA 99 2012- Healthcare Facilities Code

• NFPA 3 - Standard for CX of FP and LS systems

• NIH Design Requirements Manual



FGI 2014 Guidelines:1.2-7.1 Commissioning RequirementsOn projects involving installation of new or modification to existing physical environment elements critical to patient care and safety or facility energy utilization at minimum the following systems shall be commissioned:

HVACAutomatic Temperature ControlDomestic Hot WaterFire Alarm and Fire Protection Systems (integration with other systems)Essential Electrical Power Systems



FGI 2014 Guidelines:A1.2-7.3 Commissioning AgentAn independent commissioning agent with healthcare experience compensated directly by the owner and not affiliated or associated with either the design team or the contractor should lead the commissioning process



NFPA 99 2012- Healthcare Facilities Code

• Required by CMS and other AHJ

• Requires HVAC systems serving health care functions to be commissioned in accordance with ASHRAE 90.1 and shall follow ASHRAE Guideline 0 and Guideline 1.1

Commissioning to meet NFPA 99 - 2012

12



NFPA 3 2018 - Standard for CX of FP and LS systems

• Applies to passive and active FP and LS equipment and systems

• 2018 changed from a recommended practice into a standard



NIH Design Requirements Manual 2016:

The NIH requires Commissioning (CX) for all projects including new buildings, renovations, and expansions. The level or scope of Cx for any single project shall be determined by the complexity of the project.

Depending on the scope and complexity of the project, CX may be required for the exterior envelope, interior finishes, and other components and systems which have an impact on the performance and function of the building.



Other Codes/Standards:

• NYS/NYC Energy Conservation Codes• International Energy Conservation Code• LEED• ASHRAE Standard 0 - The Commissioning Process

Testing Requirements for Code Specific Hospital Items


• HVAC▪ Air Pressure▪ Temperature▪ Humidity▪ Air Change Rates

• Life Safety▪ Fire Smoke Dampers▪ Fire Doors▪ Smoke Control

• Medical Gas and Vacuum Systems

• Electrical• Fire Protection

NYU Langone Health Kimmel Pavilion

17

© Jeff Goldberg/Esto © Jeff Goldberg/Esto

CxA Not Just Cx

18

• Owners Advocate

• CM’s Conscience

• Schedule Driver

• Trade’s Enforcer

• EOR Partner

NYULH Kimmel Pavilion Real World Example Cx Systems


System Quantity System Quantity System Quantity Systems Quantity

AHU 19 Expansion Tanks 8 Kitchen Hood 1 Medium Voltage Switch Gear

2

Air Curtain 1 EF 58 Air Flow Stations 24 UPS 2

Fan Coils 15 Stair Press Fans 3 Steam Meter 1 Single Ended Substations

5

VAV 1600 FPB 9 Monitoring Systems

172 Double Ended Substations

4

CRAC 98 Air Cassion Filter 8 Pumps 45 Paralleling Gear 1

Chillers 1350 tons 5 FO System 1 Steam PRV 2 Transformers 21

Chiller 412 tons 1 P&F Hx 4 Unit Heaters 46 HW Heaters 11

Air Cooled Chillers 2 S&T Hx 4 ATS 35 FSD 782

Cooling Towers 5 MRI Hx 1 Distribution PanelBoards

37 VESDA 12

Clean Steam Generators

3 Heat Trace System 1 Emergency Generators

3 Legionella Systems

2

ASHRAE 170 2013 - Ventilation of Healthcare Facilities


• FGI references Standard 170 to meet requirements

• Standard that specifies pressure, humidity, temperature and air change rates▪ Table 7.1 - Design Parameters

ASHRAE 170 - Ventilation of Healthcare Facilities


Airborne Infection Isolation (Aii) Rooms

• Required minimum -0.01” wc across envelope

• If installed with an anteroom:▪ Aii to be negative to Anteroom▪ Anteroom to be negative to corridor

◦ Specific pressure not provided for anteroom to corridor◦ AHJ require a tissue test, -0.003” wc passes a tissue test

Airborne Infection Isolation (Aii) Rooms

22



Protective Environment (PE) Rooms

• Required minimum +0.01” wc across envelope

• If installed with an anteroom:▪ PE to be positive to Anteroom▪ Anteroom to be positive to corridor

◦ Specific pressure not provided for anteroom to corridor◦ AHJ require a tissue test, +0.003” wc passes a tissue test

Protective Environment (PE) Rooms

24



Combination Aii/PE Room

• Anteroom shall be positive to Aii/PE and Corridoror

• Anteroom shall be negative to Aii/PE and Corridor

▪ Find out from your client what kind of patients will be in room

PE / AII Rooms

26

• CFM off sets

• Door seals

• Door operators

• All penetrations sealed

• Painting over sensors



Operating Rooms• Required minimum +0.01” wc to adjoining spaces

Morgue and Autopsy Rooms, Bronchoscopy • Required minimum -0.01” wc to adjoining spaces

All other rooms that required pressurization• Recommend to +/-0.003” to pass “tissue test”

Operating Rooms

28



Key items for CxA’s:

Design Stage:• Ensure all fixtures and outlets are specified to be installed with proper

gasket material to avoid air leakage• Ensure Architect specifies full height walls in critical areas requiring

strict pressure requirements




Construction Stage• To meet all required pressures, take care during walkthroughs to make

sure all penetrations above ceiling are sealed.◦ Penetrations such as conduits, pipework, ductwork, etc. that enter

and leave the room need to be sealed with an approved product.• Work closely with TAB to obtain pressures.




Confirm required humidity levels are met during all seasons and keep data.

Keep testing documentation and confirm trending set up for AHJ reviews

Life Safety


Hospitals employ a “defend in place” model

Test:• Fire-rated assemblies• Smoke barriers• Smoke Partitions• Stair Pressurization

NFPA 80 - Standard for Fire Doors and Other Opening Protectives


Fire Dampers and Combination Dampers to be tested during CX (as close to occupancy as possible)

• Test for full unobstructed access to dampers and actuators

• If equipped with fusible link, remove link and test for full closure▪ Confirm fusible link temperature per NFPA 90A

• Actuate motorized damper to full close and full open during full operation of HVAC system• Test with fire alarm devices as well

• FSD’s

• Angle

• Operation

• Verification

• Access!

• Continual Verification

34

Meeting Fire Protection and Fire Alarm Requirements

• Plan out how to test

• Installation runs

• Location

• Access

35

Very Early Smoke Detection Apparatus - VESDA

NFPA 99 - Electrical Items


Battery Powered Lighting -During Construction, test monthly for 30 seconds and annually (if required per construction schedule) for 90 minutes

Grounding System -Measure effectiveness by voltage and impedance measurements in new construction

• Voltage limit 20mV• Impedance limit 0.2ohm for isolated ground, 0.1 ohm for all others

NFPA 99 - Electrical Items


Receptacles in Patient Care verify:• Visually verify physical integrity of each receptacle• Continuity of grounding circuit• Correct polarity• Retention force of grounding blade not less than 115g

Medical Gas, Instrument Air and Vacuum

38

Required to be tested by a certified medical gas verifier

• Tests to NFPA 99 - Health Care Facilities Code Section 5 - Gas and Vacuum Systems

Fire Protection Systems

39

Review sprinkler installation to confirm no foreign objects/equipment are touching, laying or hanging from any sprinkler system in reference to NFPA 25-2011: 5.2.2.2 & Joint Commissioning Standard LS.02.01.35 EP4

NYULH Kimmel Lessons Learned


• Don’t run AHUs prior to occupancy (dirty ducts, added cost to client to clean)

• Access to all DSD during coordination▪ Don’t trust BIM

• If there is no schedule, failure is imminent• C&S & Fit Out Supers need to talk• Carpenters and Sheet Rockers do not know how to build

a pressure vessel

Any Questions?

41

Hospital CX RequirementsSlide Number 2Learning ObjectivesWhat is NYU Langone HealthSlide Number 5Slide Number 6History of NYU Langone Health CX ProgramCX Code/Standards Requirements in HospitalsCX Code/Standards Requirements in HospitalsCX Code/Standards Requirements in HospitalsCX Code/Standards Requirements in HospitalsCommissioning to meet NFPA 99 - 2012CX Code/Standards Requirements in HospitalsCX Code/Standards Requirements in HospitalsCX Code/Standards Requirements in HospitalsTesting Requirements for Code Specific Hospital ItemsNYU Langone Health Kimmel PavilionCxA Not Just CxNYULH Kimmel Pavilion Real World Example Cx SystemsASHRAE 170 2013 - Ventilation of Healthcare Facilities ASHRAE 170 - Ventilation of Healthcare Facilities Airborne Infection Isolation (Aii) Rooms�ASHRAE 170 - Ventilation of Healthcare Facilities Protective Environment (PE) RoomsASHRAE 170 - Ventilation of Healthcare Facilities PE / AII RoomsASHRAE 170 - Ventilation of Healthcare Facilities Operating Rooms�ASHRAE 170 - Ventilation of Healthcare Facilities ASHRAE 170 - Ventilation of Healthcare Facilities ASHRAE 170 - Ventilation of Healthcare Facilities Life SafetyNFPA 80 - Standard for Fire Doors and Other Opening ProtectivesMeeting Fire Protection and Fire Alarm RequirementsVery Early Smoke Detection Apparatus - VESDANFPA 99 - Electrical ItemsNFPA 99 - Electrical ItemsMedical Gas, Instrument Air and VacuumFire Protection SystemsNYULH Kimmel Lessons LearnedAny Questions?

Hospital CX Requirements - bcxa.org · Hospital CX Requirements. Presenters: Paul Mulyk, PE, BCxA - NYU Langone Health. Michael Dooley, PE, CEM, CCP - AKF Group

Documents