VA_Leased_CBOC_Design_Narrative_LDN_6_9_24.docx

June 9, 2024 VA Leased CBOC Design Narrative

1. INTRODUCTION

2. GENERAL REQUIREMENTS

2.1 General

2.2 Codes

2.3 Standards

2.4 References

2.5 Pricing Standards

3. PLANNING AND DESIGN CRITERIA

3.1 Background

3.2 PACT Guiding Principles

3.3 Community Based Outpatient Clinics (CBOC) Planning Approach

3.4 Room Data Matrix

3.5 Surgical Design Criteria

4. TECHNICAL NARRATIVE

4.1 Site/Civil

4.1.1 Pedestrian, Vehicle Access & Circulation

4.1.2 Parking

4.1.3 Site Grading

4.2 Architecture

4.2.1 General Criteria

4.2.2 Accommodations for Care of Patients of Size

4.2.3 Acoustics

4.2.4 Equipment/Accessories/Furnishings

4.2.5 Signage and Wayfinding

4.2.6 Critical Dimensions

4.2.7 Entry Canopies

4.2.8 Elevators

4.2.9 Slab Depressions and Thickened Slabs

4.2.10 Millwork

4.2.11 Joint Sealant Systems

4.2.12 Doors and Frames

4.2.13 Hardware

4.2.14 Pharmacy Dispensing Windows

4.2.15 Radiation Shielding

4.2.16 Radio Frequency Shielding and Magnetic Shielding

4.3 Interior Design

4.3.1 General Criteria

4.3.2 Acoustic Ceiling Tile

4.3.3 Concrete Floor Treatment

4.3.4 Fiberglass-Reinforced Panels

4.3.5 Painting

4.3.6 Wall Protection

4.3.7 Window Shades

4.3.8 Privacy Curtains / Screens

4.3.9 Flooring, Carpet

4.3.10 Special Architectural Conditions for Surgical and Endovascular Services

4.4 Mechanical

4.4.1 References

4.4.2 HVAC Design Basis

4.4.3 Air Handling Units (AHUs)

4.4.4 Exhaust Systems

4.4.5 Cooling System

4.4.6 Humidification System

4.4.7 HVAC Piping Systems

4.4.8 Air Distribution and Duct Systems

4.4.9 HVAC Insulation Systems

4.4.10 Testing, Adjusting and Balancing

4.4.11 Automatic Temperature Control Systems

4.4.12 Temperature, Humidity and Pressure Monitoring

4.4.13 Special Conditions

4.5 Plumbing

4.5.1 References

4.5.2 Plumbing Design Basis

4.5.3 Medical Gases

4.5.4 Special Conditions

4.6 Electrical

4.6.1 Standby Generator

4.6.2 Special Conditions

4.7 Lighting

4.7.1 General

4.7.2 Indoor Lighting Specifics

4.7.3 Lighting Controls

4.7.4 LED Drivers

4.7.5 Special Conditions

4.8 Telecommunications

4.8.1 Scope of Work

4.8.2 Pathways

4.8.3 Spaces

4.8.4 Telecommunications Bonding and Grounding

4.8.5 Equipment Racks and Equipment Cabinets

4.8.6 Power Distribution Units and Uninterruptable Power Supplies

4.8.7 Telecommunications Infrastructure Plant

4.8.8 Special Systems

5. Hardware Groups and Modifiers

SECTION 1 - INTRODUCTION

1.1 The purpose of this Leased CBOC Design Narrative is to consolidate the governing codes, standards, references, and guidelines in a document that provides performance-based standards for a VA leased CBOC.

1.2 The governing codes, standards, and references are based on a VA affiliated outpatient clinic.

1.3 The design of the VA leased CBOC shall be based on the Prototype for Standardized Design and Construction of Community Based Outpatient Clinics which is described in Part 3 Planning and Design Criteria.

1.4 This document, and the associated Room Data Matrix (RDM), provides performance-based standards for rooms/functions that are a part of the project’s Program for Design. If there are standards covered by this document, or room types in the RDM, that are not a part of a specific project’s Program for Design, those standards are considered not applicable to that specific project. However, standards added to the grey “additional requirements” boxes in this document are project specific and are applicable.

1.5 Commonly Used Acronyms and Definitions:

PCMH Patient Centered Medical Home A team based, comprehensive, coordinated patient care model (refer to PACT) PACT Patient Aligned Care Team Provides service to veterans that is patient-centered with the right care at the right time by the right person. A typical “teamlet” serving a veteran consists of four caregivers: A Primary Care Provider – physician (MD), physician assistant (PA) or nurse practitioner (NP); a Registered Nurse (RN); a clinical staff assistant (LPN or Medical Assistant) and an administrative staff member (Clerk).

CBOC Community Based Outpatient Clinic Is VA-operated, VA-funded, or VA-reimbursed site of care which is located separate from a VA Medical Facility. A CBOC can provide primary, specialty, subspeciality, mental health, or any combination of healthcare delivery services that can be appropriately provided in an outpatient setting.

PFD Program for Design Net square feet (NSF) listing of all spaces and rooms that are to be included in a construction project.

SECTION 1 INTRODUCTION

Section 1 - Page 1

SECTION 2 – GENERAL REQUIREMENTS

2.1 General

2.1.1 The codes and standards listed below indicate minimum performance requirements. Minimum requirements or standards may be exceeded by site specific project design.

2.1.2 Compliance is required with applicable codes and standards throughout the process of design, construction, acceptance, and on-going maintenance of the facility.

2.1.3 Design and construction of the CBOC shall be in compliance with the requirements of the GSA Form L100 Global Lease as well as the codes and standards listed below. This Leased CBOC Design Narrative covers construction materials and standards not fully addressed by the codes, standards, and references below.

2.1.4 Use the most current edition at the date and time of bid submission.

2.1.5 Construction Observation Office - The lessor shall provide one (1) office space not less than 120 SF for the sole use of the VA and its delegate, when present. The office space shall be within three (3) miles of the jobsite and may be within the prime contractor’s trailer. Offsite locations must be approved by the Senior Resident Engineer (SRE) considering safety and security.The office space shall have conditioned air and electricity for proper lighting and receptacles in accordance with typical office area standards. Access to high speed wireless internet shall be provided. The space shall be near a restroom, break room, copy room, and conference room in which the RE is able to use as needed. The break room shall contain a shared microwave, refrigerator, and coffee pot. The conference room shall be able to seat a minimum of 10 people. The office space shall contain the following items:

One (1) Office desk, double pedestal, executive size One (1) Swivel chair with arms Two (2) Arm chairs One (1) 5-drawer file cabinet, letter size Two (2) Drawing rack, with 12-30 inch “Plan Hold” drawing holders, freestanding Two (2) Apple I PAD Pro 12” Tablets, Wi-Fi + 4G service, 510 GB and Word app, with Signed/Numbered awarded SFO loaded. Loading of all drawings and specifications when “completed” after acceptance of final drawings should be up-loaded / accomplished at that time frame.

2.1.6 Photographic Documentation - During the construction period through completion, a 3rd party shall provide photographic documentation of construction progress and at selected milestones (such as blocking in walls, stub-up connection points for equipment, security mesh in wall (if required), walls going to deck (where required)) including electronic indexing, navigation, storage and remote access to the documentation, as per these specifications. The commercial photographer or the subcontractor used for this work shall meet the following qualifications:

Demonstrable minimum experience of five (5) years in operation with at least 500 projects documented to date providing documentation and advanced indexing/navigation systems including a representative portfolio of construction projects of similar type, size, duration and complexity as the Project.

Demonstrable ability to service projects throughout North America with operational resources within 150 miles of project, which shall be demonstrated by a representative portfolio of active projects of similar type, size, duration and complexity as the Project.

Photographic Specifications - Each digital image shall be taken with a professional grade camera with minimum size of 6 megapixels (MP) capable of producing 200x250mm (8 x 10 inch) prints with a minimum of 2272 x 1704 pixels and 400x500mm (16 x 20 inch) prints with a minimum 2592 x 1944 pixels.

Indexing and navigation system shall utilize actual AUTOCAD construction drawings, making such drawings interactive on an on-line interface. For all documentation referenced herein, indexing and navigation must be organized by both time (date-stamped) and location throughout the project.

Documentation shall combine indexing and navigation system with inspection-grade digital photography designed to capture actual conditions throughout construction and at critical milestones. Documentation shall be accessible on-line through use of an internet connection. Documentation shall allow for secure multiple-user access, simultaneously, on-line.

Construction progress for all trades shall be tracked at pre-determined intervals, but not less than once every thirty (30) calendar days throughout the project upon commencement of vertical construction (“Progressions”). Progression documentation shall track both the exterior and interior construction of the building. Exterior Progressions shall track 360 degrees around the site and each building. Interior Progressions shall track interior improvements beginning when stud work commences and continuing until Project completion.

Miscellaneous events that occur during any Contractor site visit, or events captured by the Department of Veterans Affairs independently, shall be dated, labeled and inserted into a Section in the navigation structure entitled “Slideshows,” allowing this information to be stored in the same “place” as the formal scope.

Customizable project-specific digital photographic documentation of other details or milestones. Indexing and navigation accomplished through interactive architectural plans.

Monthly exterior progressions (360 degrees around the project) and slideshows (all elevations and building envelope). The slideshows allow for the inclusion of Department of Veterans Affairs pictures, aerial photographs, and timely images which do not fit into any regular monthly photo-path.

Regular (5 max) interior progressions of all walls of the entire project to begin at time of substantial framed or as directed by the Resident Engineer through to completion.

Images shall be taken by a commercial photographer and must show distinctly, at as large a scale as possible, all parts of work embraced in the picture.

Coordination of photo shoots is accomplished through Resident Engineer or other designated on-site point of contact. Contractor shall also attend construction team meetings as necessary. Contractor’s operations team shall provide regular updates regarding the status of the documentation, including photo shoots concluded, the availability of new Progressions or Exact-Builts viewable on-line and anticipated future shoot date.

Contractor shall provide all on-line domain/web hosting, security measures, and redundant server back-up of the documentation.

Contractor shall provide technical support related to using the system or service.

Upon completion of the project, final copies of the documentation (the “Permanent Record”) with the indexing and navigation system embedded (and active) shall be provided in an electronic media format, typically a DVD or external hard-drive. Permanent Record shall have Building Information Modeling (BIM) interface capabilities

2.2 Codes

2.2.1 All VA leased CBOC facilities are to conform to the most recent applicable codes, which include but is not limited to following:

2.2.1.1 State and local codes as required by the local Authority Having Jurisdiction (AHJ).

2.2.1.2 National Fire Protection Association (NFPA), NFPA 101 Life Safety Code and those codes and standards referenced by NFPA 101. (NFPA 99 Health Care Facilities Code, etc.)

2.2.1.3 NFPA 70B Standard for Electrical Equipment Maintenance, NFPA 70E Workplace Electrical Safety, NFPA 75 Standard for the Fire Protection of Information Technology.

2.2.1.4 Architectural Barriers Act Accessibility Standards (ABAAS), current edition.

2.2.1.5 International Building Code (IBC): The latest edition shall be used for structural, wind load and seismic design.

***Note*** IPT should input number of patients incapable of self-preservation.

Additional Code information:

· Lessor shall work with AHJ to properly determine occupancy type, with the following considerations:

· List rooms or procedures that are planned that may render a patient incapable of self-preservation.

· Applicable to NFPA 99, the facility is considered Category (Insert determined category from risk assessment or insert table that shows different categories for different departments.)

2.3 Standards

2.3.1 All leased CBOC facilities are to conform to the following standards:

2.3.1.1 FGI Guidelines for the Design and Construction of Outpatient Facilities, current edition (referred to as FGI Guidelines herein).

2.3.1.2 The Joint Commission (TJC) accreditation standards apply to the facility under the affiliated VA medical center license. Building construction and on-going maintenance procedures shall meet TJC standards. Lessor shall provide and submit all documentation that is required for TJC requirements.

2.3.1.3 Facility Security Level (FSL) shall be as outlined in GSA Form L100 Global Lease.

2.3.1.4 Sustainability standards shall be as outlined in GSA Form L100 Global Lease.

2.3.1.5 American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) Standard 170, Ventilation of Health Care Facilities, current edition (referred to as ASHRAE 170 herein)

2.3.1.6 ASHRAE Standard 12, Minimizing the Risk of Legionellosis Associated with Building Water Systems, current edition.

2.3.1.7 ASHRAE Standard 188, Legionellosis: Risk Management for Building Water Systems, current edition.

2.3.1.8 ASHRAE Standard 62.1, Ventilation for Acceptable Indoor Air Quality, current edition (referred to as ASHRAE 62.1 herein)

2.3.1.9 ANSI/ASHRAE/IES Standard 90.1-2019 -- Energy Standard for Buildings Except Low-Rise Residential Buildings

2.3.1.10 Sheet Metal and Air Conditioning Contractors National Association (SMACNA) Standard, HVAC Duct Construction Standards - Metal and Flexible.

2.3.1.11 USP General Chapter 795 Pharmaceutical Compounding – Nonsterile Preparations

2.3.1.12 USP General Chapter 797 Pharmaceutical Compounding – Sterile Preparations

2.3.1.13 USP General Chapter 800 Hazardous Drugs - Handling in Healthcare Settings

2.3.1.14 Association for the Advancement of Medical Instruments (AAMI) standards as applicable to SPS and RME storage

2.3.1.15 Illuminating Engineering Society North America (IESNA) Handbook - latest edition

2.3.1.16 VA Signage Design Manual PG 18-12

2.3.1.17 H 18-8 Seismic Design Handbook is required when the clinic includes Ambulatory Surgery

2.3.1.18 VA HVAC Design Manual (Specifically regarding the AHU design requirements for Pharmacy Compounding Suite, Sterile Processing Service (SPS), and Surgical Suite)

2.4 References

2.4.1 The following guides, manuals, and other references developed by VA are for reference only:

2.4.1.1 VA Enterprise Facility IT Support Infrastructure Standard, most current.

2.4.1.2 Prototype for Standardized Design and Construction of Community Based Outpatient Clinicshttps://www.cfm.va.gov/til/prototypes.asp#CBOC

2.4.1.3 PACT Space Module Design Guide https://www.cfm.va.gov/til/dGuide/dgPACT.pdf

2.4.1.4 Room Templates, Leased Community Based Outpatient Clinics https://www.cfm.va.gov/til/rTemplate/LeasingCBOCw.asp

2.4.1.5 VA Design Guides (PG18-12)

2.5 Pricing Standards

2.5.1 Building Shell Definition

2.5.1.1 Building shell is the complete enveloping structure, the base building systems, the complete HVAC system, and the finished common areas (building common and floor common) of a building that adjoin the occupant areas.

2.5.1.2 Any demolition cost necessary shall be included in the building shell rental rate.

2.5.1.3 Third-party green building certification do not change what elements are considered part of building shell or tenant improvements. Instead, building elements may be required to have certain attributes, such as low volatile organic compound emissions.

2.5.1.4 Section 3 of the L-100 provides minimum requirements of the shell. Any further requirements identified in this LDN to items in Section 3 shall remain shell unless specifically designated as TI.

2.5.1.5 The following table shows the Shell requirements of the Base Building and the Occupant Areas.

Building common restrooms are complete and operational.

Tappable domestic water riser, service sanitary drain, sanitary vent, ready for extension to tenant demised areas.

All electrical power distribution panels and circuit breakers available in electrical closets, with capacities at 120/208 volt, 3- phase, 4-wire and 277/480 volt, 3-phase, 4-wire.

Any portion of a code required alternate power source (emergency generator, Essential Electrical System, etc.), required to support building life safety requirements including but not limited to transfer switches and distribution.

Conduit pathways to distribution backboard within a demarcation room for connection to tenant telecommunications MCR or TR.

All security requirements designated as “Shell” in the Facility Security Level (FSL) Appendix are complete.

Proposed and required exterior site (property) improvements required for VA’s use of the premises and local municipality required off-site improvements are complete.

2.5.2 Tenant Improvement Definitions

2.5.2.1 TIs are the finishes and fixtures that typically take space from the shell condition to a finished, usable condition. The resulting space is complete and meets applicable building codes.

2.5.2.2 TIs are typically items in addition to the items listed in the table above.

2.5.2.3 Section 5 of the L-100 provides minimum requirements of the TI. Any further requirements identified in this LDN to items in Section 5 shall remain TI unless specifically designated as Shell.

2.5.2.4 Typical Tenant Improvements include:

2.5.2.4.1 Electrical wiring, outlets, and horizontal conduit, including cable trays and hooks, within the demised premises. Telephone jacks, data, jacks, and horizontal conduit, including cable trays and hooks, within the demised premises.

2.5.2.4.2 Carpeting or other floor covering; raised access flooring.

2.5.2.4.3 Plumbing fixtures withing the demised premises and all distribution, drainage and vent piping connecting to the building core – except for common bathrooms.

2.5.2.4.4 Partitioning and wall finishes

2.5.2.4.5 Doors, sidelights, frames, and hardware.

2.5.2.4.6 Millwork

2.5.2.4.7 Window treatments

2.5.2.4.8 Adjustments or repositioning of fire sprinkler to avoid conflict with partitioning; additional sprinklers required by code to meet layout.

2.5.2.4.9 VA required signage on site, in the common areas and within the demised premises.

2.5.2.4.10 Additional lighting over the open office layout at a rate of fixtures per 80 USF.

2.5.2.4.11 Exterior site amenities required such as therapy gardens, gait training therapy areas and dining areas (site amenities proposed as building improvements by the lessor shall be shell).

2.5.2.4.12 Interior and exterior components of special systems required such as nurse call and duress systems.

2.6 CPM Schedule Requirements

CPM Schedules must include the following milestones.

2.6.1 Permits Received

2.6.2 Structure Complete (steel erection)

2.6.3 Dry-in (skin and windows)

2.6.4 Conditioned Space (HVAC equipment startup)

SECTION 2 GENERAL REQUIREMENTS

Section 2 - Page 1

SECTION 3 – PLANNING AND DESIGN CRITERIA

3.1. Background

3.1.1. VHA has committed to the development of a patient-centered medical home model for enhanced outpatient primary care services to veterans. The result was a patient care delivery model and a set of planning and design standards.

3.2. PACT Guiding Principles

3.2.1. An operational and planning design guide was developed which identified key principles and objectives. Refer to PACT Space Module Design Guide under References Section 2.4.

3.3. Community Based Outpatient Clinics (CBOC) Planning Approach

3.3.1. The development of the PACT Planning Module was complimented by the development of a Prototype for Standardized Design and Construction of Community Based Outpatient Clinics. Using the PACT Module as the building block, prototypes were developed for three types and sizes of outpatient facilities.

3.4. Health Care Centers (HCC) Planning Approach

3.4.1. HCCs include outpatient Ambulatory Surgical and Endovascular services and/or Digestive Diseases – Endoscopy services within the program for design in addition to other typical CBOC services.

3.4.2. The Surgical and Endovascular Service Design Guide must be referenced and used to incorporate the VA typical departmental layout and workflow when the PFD includes these services.

3.4.3. The Digestive Diseases – Endoscopy Services Design Guide must be referenced and used to incorporate the VA typical departmental layout and workflow when the PFD includes these services.

3.5. Room Data Matrix

3.5.1. A collection of typical rooms within leased CBOCs. It lists the required finishes, STC ratings, ceiling heights, door size and type, hardware sets, HVAC space ventilation, number of electrical receptacles, lighting controls and fixture types, and number of standard density work area outlets for each room type.

3.5.2. The Lessor shall associate rooms listed on the program for design with the room data matrix by room name. Use department level room names and types when available, otherwise use general room/space for like room function.

3.5.3. FGI Equivalent for ASHRAE 170 – Where HVAC space ventilation requirements are omitted, ASHRAE 170 Tables 8-1 and 8-2 shall be followed. Column “FGI Equivalent for ASHRAE 170” lists the equivalent room name for use in the tables.

3.5.4. FGI Equivalent for Table 1.2-5 “Minimum Sound Isolation” - Where Column “STC” in the Room Data Matrix states “See FGI”, Column “FGI Equivalent for Table 1.2-5 Minimum Sound Isolation” lists the equivalent room name for use in FGI Table 1.2-5.

3.5.5. Additional Requirements in this LDN take precedence over the standard in the RDM.

SECTION 3 PLANNING AND DESIGN CRITERIA

Section 3 - Page 1

May 1, 2024

SECTION 4 – TECHNICAL NARRATIVE

4.1 Site/Civil

4.1.1 Pedestrian and Vehicle Access & Circulation

4.1.1.1 Minimum traffic lane width is 12 feet, and minimum sidewalk width is 4 feet. Curves for traffic lanes and radii at intersections must be adequately sized to prevent vehicles from encroaching on an opposing lane of traffic.

4.1.1.2 Primary pedestrian access and circulation paths shall comfortably accommodate two-way wheelchair traffic.

4.1.1.3 An accessible route must be provided from the public right-of-way abutting the site to the accessible building entrance.

4.1.1.4 For one way traffic lanes that are used as fire and emergency equipment access the minimum width shall be 20 feet.

4.1.1.5 Provide a service/loading area designed to accommodate truck (WB-62) maneuverability. Provide canopy for unloading in adverse weather conditions with 14 feet of clearance from grade to the underside of the canopy.

***Alternate upgraded dock requirement*** Provide a service area with a loading dock designed to accommodate truck (WB-62) maneuverability. Loading dock shall be 4 feet above the driveway. Platforms shall have a minimum depth of 8 feet front to back or between dock lift/leveler and back wall. Provide canopy over the platform with 14 feet of clearance from grade to the underside of the canopy. Canopy shall extend minimum of 4 feet beyond the edge of the dock for weather protection. Provide stair or ramp to the platform. Provide hydraulic dock levelers with 10,000 pounds capacity for recessed installation at loading dock.

4.1.1.6 Service area shall accommodate vehicles that pick-up trash and recycled materials. Locate service area away from public and patient areas.

4.1.2 Physical Security

4.1.2.1 The physical security requirements are listed in the FSL Appendix as developed by the ISC process.

4.1.3 Parking

4.1.3.1 Parking lots with 90-degree stalls must have minimum parking stall dimensions of 9 feet by 18 feet, and a minimum drive aisle width of 24 feet. Angled parking must have one-way drive aisles with the same stall sizes as 90-degree parking. Angled parking drive aisle width must comply with a published design standard for a designated parking angle.

4.1.3.2 The total amount of accessible parking spaces provided shall be 6% of the total required spaces unless more is required by local code.

Additional Parking Requirements:

Add project specific parking requirements here. (Such as percentage breakdown of staff vs. visitor parking)

4.1.4 Roadway & Walkway Cross Slopes

4.1.4.1 Roads and walks should have a typical cross slope of 2% unless adequate surface drainage is provided by other slope conditions.

· Electric Vehicle Service Equipment (ESVE) – Provide, install, operate and maintain ---insert total #--- of EVSE Level (1,2 or 3, or specify a combination) chargers compatible with GSA Fleet Wright Express, Inc. usage.

Additional Site/Civil Requirements:

4.2 Architecture

4.2.1 General Criteria

4.2.1.1 Refer to Appendix: Room Data Matrix for Door, Hardware and Acoustic requirements listed by Room Type.

4.2.2 Accommodations for Care of Patients of Size

4.2.2.1 Refer to FGI Guidelines for Outpatient Facilities for accommodations for care of patients of size. Minimum requirements are to provide access to a Procedure Room and Procedure Room Toilet in one PACT Module. A 750lb capacity must be used for the design of the space and its contents to include but not be limited to the lavatory, toilet, patient lifts, and necessary infrastructure to support. Additional capacity may be required and listed in the project specific requirements.

4.2.2.2 Rooms that are designed for access by individuals of size as noted on the PFD as Bariatric must have space for bariatric wheelchairs along the whole accessible route from the front doors to the bariatric spaces, to include elevators and lobby doors.

4.2.2.3 Turning Radius, Bariatric must be 1830 mm (6’0”)

4.2.2.4 T-Shaped Turning Space, Bariatric must be 1830 mm (6’0”) x (6’0”)

4.2.2.5 Distance from edge of toilet to side wall, Bariatric must be 915 mm (3’0”)

4.2.2.6 Grab bar configuration must have double swing-up bars with integral toilet paper dispenser.

4.2.2.7 Minimum width of doors in route to bariatric space must be 1220 mm (4’0”)

4.2.3 Acoustics

4.2.3.1 Refer to FGI Guidelines for Outpatient Facilities for acoustics requirements for enclosed rooms. Refer to the Room Data Matrix-Interior Construction for information on rooms not covered under FGI or rooms with special acoustics requirements.

4.2.4 Equipment/Accessories/Furnishings

4.2.4.1 Refer to CBOC Project Contents List and Room Template sheets provided with the RLP for equipment, accessories, and furnishings descriptions and locations. Items to be provided and/or installed by Lessor are noted on the list. Provide partitions, partition backing, and above ceiling structural support as required for wall and/or ceiling mounted equipment, accessories, and furnishings. Provide required utility connections for scheduled equipment.

4.2.5 Signage and Wayfinding

4.2.5.1 Refer to VA Signage Design Guide in Section 2.4 for signage standards and requirements.

Additional Signage Requirements:

4.2.6 Critical Dimensions

4.2.6.1 Patient-use corridors are to be 6 feet minimum. Staff corridors for transport of supplies from loading dock area to services shall be 6 feet minimum.

4.2.6.2 Patient-use corridor doors must be a minimum of 42 inches wide.

4.2.6.3 Refer to Room Data Matrix – Interior Construction for required ceiling heights by room type.

4.2.7 Entry Canopies

4.2.7.1 Provide non-combustible canopies over the following locations: patient entry to clinic, ambulance building access point and receiving area/loading.

4.2.7.2 At patient entry, provide a covered patient drop-off zone with space for at least one full size passenger vehicle (19 feet long). The drop-off zone must have minimal change in level from drive isle to walkway for a minimum length of 20 feet.

4.2.7.3 At ambulance building access point, provide a covered patient drop-off zone with space for at least one ambulance (typical size used in area) and an accessible access aisle.

4.2.7.4 Provide clearance from grade to underside of canopy with for typical emergency and transport vehicles used in the area.

4.2.8 Elevators

4.2.8.1 Where elevators are provided in a leased facility, not less than one elevator car shall accommodate an ambulance stretcher of 24 inches by 84 inches in the horizontal open position and shall be identified by the international symbol for emergency medical services (star of life). The symbol shall be not less than 3 inches high placed inside on both sides of the hoist way door frame.

4.2.8.2 Where bariatric spaces are above ground level, elevator doors must open minimum 48 inches.

4.2.9 Slab Depressions and Thickened Slabs

4.2.9.1 At new construction, provide slab depression and thickened slabs as required to provide flush threshold installation at audiology booths, MRIs, and other equipment requiring recessed installation or additional structure as recommended by equipment manufacturer. At these equipment locations, concrete slab levelness shall be level and true to meet vendor requirements and shall have a minimum flatness and levelness of FF=45 and FL=35. At existing construction, provide ramp to meet ABAAS.

4.2.10 Millwork

4.2.10.1 Quality compliance to conform to Architectural Woodwork Institute (AWI) and Woodwork Institute (WI) quality standards.

4.2.10.2 Wood Veneer Casework Construction: Combination of custom wood casework and countertops to conform to program and functional requirements. (Location: Lobby, Reception)

4.2.10.2.1 Construction: Flush overlay construction with concealed hinges. AWI custom grade.

4.2.10.3 Plastic Laminate Casework Construction: Custom plastic laminate casework to conform to program and functional requirements. (Location: Typical).

4.2.10.3.1 Construction: Flush overlay construction with concealed hinges, AWI Custom Grade.

4.2.10.3.2 Cabinet Hardware:

4.2.10.3.2.1 Concealed hinges, all metal, 110 degree opening, self-closing.

4.2.10.3.2.2 Full extension drawer guides, 100 lbs. capacity.

4.2.10.3.2.3 Door and drawer pulls: 4” center to center wire pull, 5/16” diameter round, 1 ¼” projection, satin chrome.

4.2.10.4 Solid Surface Fabrications: Hard, solid, non-porous mineral-filled acrylic resin (methyl methacrylate) material in color to be selected by designer. Thickness: 1/2” minimum.

4.2.10.4.1 Locations:

4.2.10.4.1.1 Transaction tops at nurse stations and reception desks.

4.2.10.4.1.2 All counters in patient treatment areas to have solid surface countertop with 4” high minimum integral coved side and backsplash.

4.2.10.4.1.3 Where scheduled as wall protection, provide ¼” thick material with welded seams.

4.2.10.5 Heavy gauge stainless steel (SS): fully welded with a work surface load capacity of at least 300 lbs. per linear foot and antimicrobial.

4.2.10.5.1 Locations:

4.2.10.5.1.1 SPS Decontamination, Scope Processing, Preparations and Assembly, and Sterilization Areas.

4.2.11 Joint Sealant Systems

4.2.11.1 Joints at plumbing fixtures, ceramic tile to be mildew resistant silicone.

4.2.12 Doors and Frames

4.2.12.1 Refer to Room Data Matrix for door and hardware requirements by room type.

4.2.12.2 Minimum width of any door for patient use not specified in the RDM must be 42”.

4.2.12.3 Finish: Prefinished in compliance with AWI Section 1500.

4.2.12.4 Access Panels:

4.2.12.4.1 Flush stainless steel at toilet areas.

4.2.12.4.2 Flush gypsum board surface with concealed hinges at public and office areas.

4.2.12.4.3 Fire rated steel at rated construction.

4.2.13 Hardware

4.2.13.1 General Note

4.2.13.1.1 Hardware sets shall be provided as per RDM and Section 5 Hardware Groups and Modifiers. Provide extra heavy duty, Grade 1 hardware for all components.

4.2.13.2 Major components and finishes are as follows:

4.2.13.2.1 Cylinders and Keying: Key locks/cylinders in groups with new master key or grandmaster key system as directed by Owner. Provide three (3) keys per lock. Provide construction master keying. Cylinders shall meet the requirements of ANSI/BHMA A156.5-14.

4.2.13.2.2 Electronic access control: Electronic access control system/device(s), power supplies (unless otherwise noted in hardware group) and monitoring/alarm(s) are provided with Security System. General Contractor to coordinate the provision and installation of the products. Refer to documents with Security Information for location(s) and type(s) of control(s). Connection by Electrical.

4.2.14 Pharmacy Dispensing Windows

4.2.14.1 Provide secure transaction drawer/pass through cabinet and window with amplified speak thru at Pharmacy Dispense/Consult windows for staff to patient transactions.

4.2.14.2 Provide stainless steel, type 304, #4 finish, pass-through cabinet with mechanical interlock doors with clear tempered safety glass windows to comply with USP 800 clean air requirements at Pharmacy pass-through windows. (location: Clean Room-Chemotherapy Compounding)

4.2.14.3 Provide protection for dispensing windows, and for walls around windows, window and the wall around a dispensing window shall meet U.L. Standard 752 for Class III Ballistic level via the use of concrete block walls with cores filled with sand, or appropriately rated metal panels, and extension of perimeter walls to structure above.

4.2.15 Radiation Shielding

4.2.15.1 For Radiology, Fluoroscopy, Mammography, CT scan, and Dental X-Ray Rooms, obtain the services of a physicist to design, specify the level of radiation protection required, test and certifies the installations.

4.2.15.2 Comply with requirements of the National Council on Radiation Protection and Measurement (NCRP) Report #49.

4.2.15.3 Provide lead lining of gypsum wall board, wood doors and hardware, hollow metal frames, and lead glass view window.

4.2.15.4 Lead sheet to be FS QQ-L-201, Grade C, thickness as required by physicist report but not less than 1/16 inch.

4.2.16 Radio Frequency Shielding and Magnetic Shielding

4.2.16.1 Magnetic Resonance Imaging (MRI) Radio Frequency Interference Shielding: It is required that the RF shielded room and all penetrations through the RF Shielding, i.e., electrical plumbing, and venting be electrically isolated by 1000 ohms or greater and RFI filtered to meet the minimum attenuation level of 100dB (10 MHz- 100 MHz) for plane wave and 90 dB (10 MHz-30 MHz) for magnetic wave.

4.2.16.1.1 Material should be brass-copper or aluminum which has been treated to prevent oxidation and all joints should be either welded or lapped and bolted.

4.2.16.1.2 Shielding to include wall, floor, door, and windows.

4.2.16.2 Magnetic Shielding System: Annealed steel plate, accessories, and coordination of shielding work.

4.2.16.3 Applicable Standards: Comply with requirements of State and Local regulating agencies where standards and criteria apply. Comply with MIL-STDS-220A and 285.

4.2.16.4 Employ Independent Testing Laboratory (ITL), experienced in testing and design of RF and magnetic shielded rooms, to review fabrication, design, and installation, and perform tests of radio frequency shielding as required to ascertain correct functioning of shielding.

4.3.20.4.1 Correct part of work which is found to be deficient in electromagnetic shielding.

4.3.20.4.2 Provide second test of RF enclosure after construction is complete.

4.3.20.4.3 Submit certified test results.

4.3 Interior Design

4.3.1 General Criteria

4.3.1.1 Refer to Appendix: Room Data Matrix – Interior Construction for finish requirements listed by room type.

4.3.2 Acoustic Ceiling Tile

4.3.2.1 AT: Acoustical ceiling tile, standard size to be 24”x24”x 1”.

4.3.2.2 AT-SP: Acoustical, scrubbable ceiling tile, standard size to be 24”x24”x 1”, with vinyl- laminated or sealed face and sealed edges.

4.3.3 Concrete Floor Treatment

4.3.3.1 Concrete Sealer (CS): 30 percent clear, non-yellowing, waterborne, membrane- forming curing and sealing compound: ASTM C1315, Type 1, Class A, minimum 30 percent total solids. Comply with ACI 301.

4.3.4 Fiberglass-Reinforced Panels

4.3.4.1 Fiberglass-reinforced panels (FRP): Gelcoat-finished, glass-fiber reinforced plastic panels complying with ASTM D 5319. Fire-Rating per ASTM E 84: Class A. Nominal thickness: 0.09 inch.

4.3.5 Painting

4.3.5.1 Interior painting: Paint (P) and Epoxy Paint (EP): Paint surfaces with primer and two finish coats that are compatible with one another as demonstrated by manufacturer or field experience, unless otherwise indicated.

4.3.5.2 Materials: Use low VOC, low odor latex topcoats where indicated. Paint the following items and surfaces:

4.3.5.2.1 Ceilings: Flat latex.

4.3.5.2.2 Walls - gypsum wallboard: Satin latex.

4.3.5.2.3 Walls - concrete block: Semi-gloss latex with block filler.

4.3.5.2.4 Hollow metal doors and frames: Semi-gloss latex over alkyd primer.

4.3.6 Wall Protection & Handrails

4.3.6.1 Rigid Wall Covering (RWC): Nominal thickness .060 inch, high-impact, PVC-free, standard texture, chemical and stain resistant, with vertical, inside, and outside trims. To comply with ASTM E84, ASTM F476 and ASTM D543.

4.3.6.2 Corner Guard (CG): Surface mounted assembly for angled corner consisting of a continuous aluminum retainer and vinyl/alloy extrusion in standard texture with ¼ inch corner radius. Size to be 2” width each way from corner. Height to be 7’ from top of base.

4.3.6.2.1 Location: Provide at all outside exposed corners in all clinic corridors outside of public areas as defined by FGI.

4.3.6.3 Corner Guard – Stainless Steel (CG-SS): Surface mounted stainless steel, 3-1/2” wing size, 7’ height, 16 gauge in Kitchen and/or Standard Grade, #4 satin finish.

4.3.6.3.1 Location: Provide at all outside exposed corners in food service areas, loading dock area and heavy use equipment storage areas.

4.3.6.4 Handrails:

4.3.6.4.1 Location: Provide on both walls in all patient corridors.

4.3.7 Window Shades

4.3.7.1 Manually operated window shade, chain driven, vertical roll-up, stainless steel bead chain with hold down clips, extruded aluminum rollers, and bottom slats. Aluminum headbox with endcaps and fascia with powder coat finish. Light gap reduction channels available for black out shades. PVC-free shades, Flame-Resistance Ratings: NFPA 701. Comply with WCMA A100.1. Window treatments should not compromise patient safety.

4.3.7.1.1 Locations:

4.3.7.1.1.1 Semi-Transparent to be typical, unless otherwise noted.

4.3.7.1.1.2 Black-out at conference rooms, tele-medicine rooms, optometry exam rooms.

4.3.8 Privacy Curtains / Screens

4.3.8.1 Provide curtain tracks with carriers and hooks (curtains shall be provided by the VA). Tracks shall be of extruded aluminum, ASTM B221, alloy 6063, temper T5 or T6, channel shaped, with smooth inside raceway for curtain carriers. End stop connectors, ceiling flanges and other accessories shall be fabricated from the same material with the same finish as the tracks or from nylon.

4.3.8.2 Provide privacy curtains/screens to encompass adequate space for the healthcare provider to perform examination unencumbered by the curtain and provide a visually private patient changing area that allows the provider to remain in the room.

4.3.8.2.1 Locations shall be per the room contents list.

4.3.9 Flooring, Carpet

4.3.9.1 Rooms specified to receive carpet and contain a sink shall a minimum 4’ x 4’ area of LVT installed at the sink location.

4.3.10 Special Architectural Conditions for Surgical and Endovascular Services

4.3.10.1 Minimum corridor width shall be 8 feet in patient areas to accommodate passage of equipment or beds, non-patient areas where gurneys are not utilized can be a minimum of 5 feet.

4.3.10.2 The Clean Core shall have a ceiling height minimum of 9 feet above finished floor and shall be monolithic and scrubbable.

Additional Architectural Requirements:

4.4 Mechanical

4.4.1 References

4.4.1.1 The following publications shall be referenced for applicable systems calculations and design information.

4.4.1.1.1 ASHRAE Handbooks.

4.4.2 HVAC Design Basis

4.4.2.1 Indoor design conditions:

4.4.2.1.1 Health care function design conditions shall be in compliance with the requirements of ASHRAE Standard 170, with the Room Data Matrix taking precedence and/or indicating required space design conditions when ASHRAE 170 do not fully address a space or room type.

4.4.2.1.2 Imaging Equipment Space Design Conditions

4.4.2.1.2.1 Equipment manufacturer requirements shall be followed.

4.4.2.1.2.2 Provide a dedicated computer room type AC unit to cool and control humidity for separate equipment rooms for radiology equipment.

4.4.2.1.2.3 Provide a computer room type AC unit to cool UPS rooms when segregated from other spaces.

4.4.2.1.3 Basic MEP Equipment Room Design Conditions:

4.7.2.1.5.1 Design conditions shall be as required to ensure tenant space design conditions are maintained.

4.4.2.1.4 Loading Docks:

4.4.2.1.4.1 Space shall have provisions to limit the intrusion airborne particulate and insects through dock door openings.

4.4.2.2 Outdoor design conditions:

4.4.2.2.1 ASHRAE 99.6% (winter) and 0.4% (summer) conditions associated with the site-specific location.

4.4.3 Air Handling Units (AHUs)

4.4.3.1 For overall building capacity needs greater than 50,000 cfm, multiple AHUs shall be provided.

4.4.3.2 For building programs that have a Production Kitchen/Food Preparation, a dedicated air handling unit shall be provided capable of serving the conditioning and ventilation needs of the Kitchen space, including capability for a high percentage of outside air to accommodate the make-up air needs of the space.

4.4.3.3 The design criteria of the dedicated AHUs for Pharmacy Services, Pharmacy Compounding Suite, Sterile Processing Service (SPS), and the Surgical Suite shall be as required in the VA HVAC Design Manual. Where air handling units are combined the design shall be based on the aggregate of the most stringent requirements for the units being combined so that the selected unit meets all requirements of the combined units.***Note*** If the risk assessments determine that the Dental, Laboratory, Imaging and or any other department’s HVAC requirements are critical and or require pandemic mode then the IPT shall add an additional requirements section here stating that these departments shall meet the requirements in section 4.4.3.4.

4.4.4 Exhaust Systems

4.4.4.1 Provide exhaust fans to provide general exhaust for toilet rooms, janitor’s closets, soiled utility rooms and similar spaces.

4.4.4.2 Dedicated exhaust fans shall be provided for Pharmacy, Sterile Processing Service (SPS), Laboratory, Kitchen/Cafeteria areas, and similar specialized spaces.

4.4.5 Cooling System

4.4.5.1 Chillers shall employ multiple, independent refrigerant circuits, and shall have capacity control provisions to achieve at least 4 to 1 turndown.

4.4.5.2 Provide unit supported screen wall panels if roof supported structural screen wall elements are not incorporated.

4.4.5.3 Variable Refrigerant Flow (VRF) systems shall not be considered for VA CBOC projects due to various concerns such as inappropriate system type for healthcare facility applications due to higher amounts of fresh air requirement as well as safety risk to building occupants due to use of high refrigerant volumes and associated potential leaks.

4.4.6 Humidification System

4.4.6.1 Centralized humidification shall be provided when necessary to maintain 30%-60% relative humidity in all seasons. Each air handling unit shall have a dedicated humidifier.

4.4.7 HVAC Piping Systems

4.4.7.1 Provide isolation valves on branch and lateral lines to reduce the amount of space that can be disrupted for maintenance and repair efforts. Provide isolation valves at each equipment connection.

4.4.7.2 For hydronic systems utilized in specific sites with freezing climate considerations, use of propylene glycol and/or proven freeze protection methodologies must be incorporated.

4.4.7.3 When propylene glycol is used, the freezing point of the glycol solution shall be at least 5°F lower than the minimum annual extreme daily temperature, to prevent the formation of crystals.

4.4.8 Air Distribution and Duct Systems

4.4.8.1 Duct construction shall be as follows:

4.4.8.1.1 Non-ducted Return Air Plenum is not allowed. Flexible duct is prohibited except for the last five feet to connect diffusers.

4.4.8.1.2 Ductwork shall be rectangular, round, or flat oval constructed to SMACNA standards.

4.4.8.1.3 Ductwork shall be constructed and tested with leakage classifications and pressure ratings and based on at least 125% of the actual operating pressure of the duct system.

4.4.8.2 Grilles, registers, and diffusers shall be steel, aluminum, or extruded aluminum with factory finish.

4.4.9 HVAC Insulation Systems

4.4.9.1 All exposed (visible in space) supply and return ductwork in the occupied conditioned spaces shall be provided with rigid insulation with proper seals. Painting and finish requirements shall be coordinated with the finish schedule.

4.4.10 Testing, Adjusting and Balancing

4.4.10.1 An independent third-party NEBB, ABBC or TABB certified test and balance contractor shall be hired by the general contractor to balance and document all air and hydronic systems within project scope. All ductwork shall be constructed and properly sealed in accordance with applicable energy code requirements. All ducts operating at 2 inches water gauge (wg) or greater shall be pressure tested based on code requirements for 3 in wg or greater pressure classification.

4.4.10.2 The balance contractor shall review all plans, components, access, etc. to ensure balancing activities may be successfully performed.

4.4.11 Automatic Temperature Control Systems

4.4.11.1 The system shall provide control of the environment and other parameters and collect historical data on the performance and deviations (alarms).

4.4.11.2 Dedicated thermal control zoning (thermostats) shall be provided for the following:

· each corner space,

· each conference room (or similar),

· each Imaging room,

· each Procedure room (or similar dedicated spaces),

· each Pharmacy space,

· Pharmacy Compounding Rooms.

· SPS soiled transition drop-off anterooms,

· SPS PPE Alcoves and rooms,

· SPS Preparation and Assembly Area,

· And SPS Sterilization Area

· For typical blocks of rooms arranged together, every 3 exterior offices or exam rooms, or every 4 interior offices or exam rooms shall be permitted on a single zone.

4.4.12 Temperature, Humidity and Pressure Monitoring

4.4.12.1 In addition to monitoring the temperature, humidity and pressure with the BAS, the following room types must have touchscreen local display units mounted on the outside of the room. Units must display the current temperature, humidity and pressure of the room and include visual/audible local alarms when the room is outside of the required parameters.

· Clean and Soiled Rooms (supply, utility, storage, workroom)

· All Decontaminations, Processing, Preparation and Assembly, Sterilization, Storage, Receiving and Dispatch areas withing SPS.

· Operating Rooms

· A-II Rooms

4.4.13 Special Conditions

4.4.13.1 Room Pressurization: Health care function design conditions shall be in compliance with the requirements of ASHRAE 170, with the Room Data Matrix taking precedence and/or indicating required space design conditions when ASHRAE 170 does not fully address a space or room type.

4.4.13.1.1 Positive air balance is designated as (+)

4.4.13.1.2 More positive air balance is designated as (++)

4.4.13.1.3 Negative air balance is designated as (-)

4.4.13.1.4 More negative air balance is designated as (--)

4.4.13.1.5 If the room is not indicated with a specific pressure relationship (blank) or is indicated with NR, then there is no requirement.

4.4.13.2 Imaging Areas:

4.4.13.2.1 For HVAC ducts, pipes and devices penetrating shielded walls and ceilings, ensure coordination with the architectural discipline and provide treatment as specified by the equipment manufacturer and medical physicist.

4.4.13.2.2 Provide booster humidification systems as may be necessary to comply with acceptable environmental ranges as prescribed by equipment manufacturers.

4.4.13.2.3 For MRI areas, provide cryogen quench vent systems, and dedicated emergency exhaust systems in accordance with manufacturers recommendations.

4.4.13.2.4 Coordination with the MRI vendor is critical, as the mechanical system requirements shall depend upon the actual make and model number. Obtain project-specific scope of work and ensure the HVAC system is compatible with MRI Suite requirements.

4.4.13.3 Pharmacy Clean Rooms: Evaluate the use of dedicated or additional air moving…