Researching Codes and Reference Materials
Codes are designed to ensure life safety. As healthcare services have become more complex and sophisticated, the design and construction of these facilities have become more specialized. Paralleling the increasing complexity of diagnostic and treatment procedures is the development of numerous codes and standards designed to limit risk and make buildings relatively safe.
The problem is that codes occasionally contradict one another, and the language is frequently subject to interpretation. Often, the level of protection is a value judgment. The minimum standards per code may be inadequate for a facility serving the elderly, for example. Or the corollary may be true: The minimum standards may occasionally be excessive for a particular project. The cost of implementing them may make the project unfeasible. Thus, codes must be evaluated in terms of the following: (1) What is an acceptable level of risk in terms of life safety? (2) Is the cost of that level of protection warranted or within the budget for the facility? (3) Are the codes or standards applicable to that facility redundant?
Further complicating these issues is the fact that codes are written by one body and enforced by another. The local inspector, who is responsible for interpretation and compliance, does not always understand the intent of the codes, and inspectors within the same office may disagree on interpretations. Nevertheless, codes are an important part of healthcare design, and designers need to be familiar with them. If anything, the next 10 years will bring more codes and regulations, not fewer. However, the introduction of the International Building Code, which is in use or has been adopted by 50 states, will do much to minimize the differences in codes among jurisdictions.
Codes cover the general areas outlined below.
- Flammability of Materials: especially carpet, wallcoverings, draperies, upholstery fillings and fabrics, and carpet and wallcovering adhesives
- Exiting Requirements: number of exits, travel distances between doors of exit, corridor separations, sizes of doors and stairwells, construction of doors and walls, and illumination of fire exits
- Storage: how and where medical gases are to be used and stored; storage of combustible solid supplies
- Fire-Fighting Equipment: locations of wet and dry standpipes; chemical fire extinguishers; and, in high-rise buildings, smoke evacuation shafts and central control station for fire department use
- Electrical Systems: standards for wiring, equipment, and emergency power systems
- Fire Detection Devices: locations of sprinklers, smoke detectors, and alarms
The Americans with Disabilities Act of 2009
Disabled persons are defined broadly to include the visually and hearing impaired; those with motor or neurological disorders; and individuals with arthritis, asthma, and cardiac insufficiency. The goal is to create spaces that are universally accessible to persons of different stature (height), age, and abilities. The Americans with Disabilities Act (ADA) is civil rights legislation enacted to ensure equal access in public accommodations. Title III contains accessibility guidelines specifically related to building access. (Both federal and state codes provide for creating accessible places.) Note that some jurisdictions enforce ANSI over ADA. Some states have adopted ANSI as state accessibility standards. In designing accessible toilet rooms (see Appendix) it is wise to add a few inches to the required clearances since the thickness of materials like ceramic tile will impinge on the space.
The ADA is enforced through the U.S. Department of Justice (DOJ) through complaints of private citizens and other organizations. There is no “ADA police,” but there are individual citizens or organized citizen groups and attorneys who file complaints with the DOJ. There are also disabled attorneys who “test” the accessibility of public places. Architects and owners who fail to provide the required access may find themselves at a settlement conference.
The ADA affects the following facilities: restaurants and cafeterias; medical care facilities; businesses; retail shops, civic buildings, libraries; transient lodging; transportation; judiciary, legislative, and regulatory facilities; detention and correctional facilities; public housing; and public right-of-way areas.
- Location of ramps, curb cuts, parking stalls; placement of exits and design configurations
- Dimensions of elevators and restrooms, door widths and setbacks, and placement of restroom fixtures and accessories
- Heights of countertops and work surfaces, sinks, public telephones, and drinking fountains
- Audible and visible warnings at elevators and stairs
- Elimination of protruding objects in corridors or lobbies
- Cleanability of wallcovering, flooring, and other interior finishes
- Asepsis (ability to support bacteria) of interior finish materials
- Homogeneous character of materials to eliminate pores or cracks that may support bacterial growth
- Minimum sizes of rooms and minimum sizes of various departments (within a licensed clinic or hospital, for example), location and number of windows, minimum ceiling heights, and relationship of various rooms to one another
- Planning and programming decisions with regard to function (e.g., separation of clean and soiled functions in surgical facilities)
- Accommodation of equipment: spaces for gurneys, drinking fountains, and public telephones. Minimum requirements for laundries, kitchens, laboratories, operating rooms, and so forth
State and local codes govern energy conservation and the ecological impact of a proposed building on its environment.
National Codes and Standards
The aforementioned code classifications may fall under the jurisdiction of city, county, state, or federal codes, in addition to the following nationally recognized standards: