Codes And Regulations

Codes and Regulations

by Frank Zilm

Emergency service designs must comply with building codes and regulations established by authorities having jurisdiction at the community and state levels. Architects and administrations should confirm with state agencies and local governments which specific codes are applicable.

2006 Guidelines for Design and Construction Health Care Facilities

The Guidelines frequently referred to as the “AIA Guidelines,” establish recommendations for minimum space and functional requirements for hospital and many other types of healthcare facilities. Most states have incorporated the current edition, or prior editions, into their minimum guidelines and standards. Copies of the 2006 Guidelines can be purchased through the American Institute of Architects and ASHE.


Section 5.1 (pages 68 – 76) address basic definitions, minimum facility requirements and “Appendix” recommendations for hospital based emergency services, observation services, and freestanding emergencies. Tables 2.1-2 (page 130), and 2.1-5 (page 134) in the report list ventilation and outlet minimum requirements for components of these areas. Minimum areas and requirements are provided for new construction and for renovations.

Among the minimum requirements are the follows:

  • Treatment rooms – “This shall have not less than 120 square feet (11.15 square meters) of clear area, exclusive of toilets, waiting area, and storage.” It is not clear in this definition what is meant by “waiting area,” since it is common to include space for families to be we patients.
  • For “open bay” configurations – “Multiple bed treatment rooms shall provide a minimum of 80 square feet (7.43 square meters) per patient cubicle.
  • – “At least one air-borne infection isolation room shall be provided as described in table 2.1-2 and section 2.1-, 2,1- and (b) and (4).” This is obviously a minimum which should be evaluated carefully against typical needs and the institution’s strategy for addressing potential epidemic scenarios. Airborne infection isolations rooms are reference specifically in the “Nursing Unit” section of Table 2.1-2, but not in the “Emergency, Surgery and Critical Care” component of the table. Assuming the “Nursing Units” requirements apply, the minimums include at least 2 air changes of outdoor air per hour, with a minimum of 12 total air changes per hour. Air should be exhausted directly to the outdoors, with no recirculation.
  • Examination and Treatment Rooms – (a) “each examination room shall have a minimum clear area of 120 square feet (11.15 square meters), exclusive of fixed casework.” (b) “Each examination room shall contain work counter(s); cabinets; hand-washing stations ;supply storage facilities; examination light; a desk, counter, or shelf space for writing; and a vision panel adjacent to and/or in the door. “ The standard for renovation allow a clear minimum room size of 100 sq. ft.. Treatment cubicles have a minimum requirement of 80 nsf. Hand washing stations are required for every four open-bay cubicles. Table 2.1-2 requires a minimum of 6 air changes per hour, with no restriction on recirculation of air or requirement for direct outdoor air exhaust. Table 2.1-5 requires at least one oxygen, vacuum and medical air outlet per treatment area.
  • Trauma/Cardiac rooms are required to have at least 250 nsf clear area in new construction and 240 nsf in remodeling. Among the specific requirements for this room type are 5 foot wide entry doors. Remodeling for trauma space can be 240 nsf. Scrub stations are required in, or adjacent, to trauma or orthopedic rooms.
  • Decontamination areas must be at least 80 nsf (7.43 meters), equipped with two hand-held shower heads. The Appendix sections recommend that the access to decontamination be at least 30 feet from the ambulance entrance and ideally 150 feet. Phone access to the hospital system is also suggested. Water runoff containment through holding tanks or collection system is also suggested. (Appendix sections of the Guidelines are advisory only).
  • Observation Units – no minimum on area around a bed are in the Guidelines section. Area for a patient bed and bedside area for visitors. Handwashing stations are required for every four beds ( (2) (b)), one toilet for every eight beds and one shower for every 16 beds.
  • Secured holding areas are address in section (3). If required, this area must have tamper resistant finishes and fixtures, no electrical or gas outlets, no sharp corners, edges, or protrusions. Doors must allow an outward swing and have hardware on the exterior side only.
  • At least one toilet room per eight examination/treatment rooms.
  • The section on freestanding emergency services (5.2) add requirements for diagnostic imaging, observational beds, laboratory, pharmacy and other support services.
  • The Appendix sections associated with this section provide recommendations for pediatric units, observation and other functions.

This review is intended to highlight the author’s observations regarding the Guidelines and should not be interpreted as a definitive documentation of all requirements.. Readers are encouraged to review the Guidelines prior to programming and design.

Other Codes and Standards

(to be developed)

Contacts for additional information:

American Society of Civil Engineers
1801 Alexander Bell Drive
Reston, VA 20191-4400
Tel. 1-800-548-2723, 703-295-6300

American Society of Heating, Refrigerating and
Air-Conditioning Engineers
1791 Tullie Circle, N.E.
Atlanta, GA 30329
Tel. 1-800-527-4723, 404-636-8400

American Society of Mechanical Engineers (ASME)
Three Park Avenue
New York, NY 10016-5990
Tel. 1-800-843-2763

Building Seismic Safety Council
National Institute of Building Sciences
1090 Vermont Avenue, N.W., Suite 700
Washington, DC 20005-4905
Tel. 202-289-7800

Centers for Disease Control and Prevention
Hospital Infection Control Practices (HICPAC)
Center for Infection Control
1600 Clifton Road
Atlanta, GA 30333
Tel. 404-639-3311, 1-800-311-3435

General Services Administration
1800 F Street, N.W.
Washington, DC 20405

International Code Council
5203 Leesburg Pike, Suite 600
Falls Church, VA 22041-3401
Tel. 703-379-1546

National Council on Radiation Protection and
7910 Woodmont Avenue, Suite 400
Bethesda, MD 20814-3095
Tel. 301-657-2652

National Fire Protection Association (NFPA)
1 Batterymarch Park
P.O. Box 9101
Quincy, MA 02169-7471
Tel. 617-770-3000

Occupational Safety and Health Administration
U.S. Department of Labor
200 Constitution Avenue, N.W., Room N3647
Washington, DC 20210
Tel. 1-800-321-6742

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