Exhibit A.1_Agency Specific Requirements.pdf

May 16, 2024

VA Leased CBOC Design Narrative/ Agency Specific Requirements for St. Louis County VA Clinic New/Replacing Lease

LEASED CBOC DESIGN NARRATIVE - AGENCY SPECIFIC

REQUIREMENTS

VA Leased CBOC Design Narrative/ASR for St. Louis County VA Clinic

Table of Contents - Page 1

1. INTRODUCTION

2. GENERAL REQUIREMENTS

2.1 General

2.2 Codes

2.3 Delineated Area

2.4 Standards

2.5 References

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 and 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

LEASED CBOC DESIGN NARRATIVE - AGENCY SPECIFIC

REQUIREMENTS

Table of Contents - Page 2

4.3.8 Privacy Curtains / Screens

4.3.9 Flooring, Carpet

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 Hot Water Heating System

4.4.7 Humidification System

4.4.8 HVAC Piping Systems

4.4.9 Air Distribution and Duct Systems

4.4.10 HVAC Insulation Systems

4.4.11 Testing, Adjusting and Balancing

4.4.12 Automatic Temperature Control Systems

4.4.13 Special Conditions

4.5 Plumbing

4.5.1 References

4.5.2 Plumbing Design Basis

4.5.3 Materials

4.5.4 Medical Gases

4.5.5 Special Conditions

4.6 Electrical

4.6.1 Standby Generator

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

SECTION 1 - INTRODUCTION

1.1 The purpose of this Leased CBOC Design Narrative / Agency Specific Requirements document 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 is 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 Lessor shall provide architectural design services for Tenant Improvements (TI) in accordance with VA Architectural Design Manual. dmARhosp.pdf (va.gov)

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.

VA Veterans Affairs VHA Veterans Health Administration VISN Veterans Integrated Services Network https://www.cfm.va.gov/til/dManual/dmARhosp.pdf

SECTION 2

GENERAL REQUIREMENTS

SECTION 2 – GENERAL REQUIREMENTS

2.1 General

2.1.1 These Agency Specific Requirements are in addition to, or supersede any contradiction to, the requirement listed in VA’s Request for Lease Proposal or the VA Lease.

2.1.2 The Department of Veterans Affairs is interested in leasing 14,965 (contiguous) net square feet (plus circulation space) not to exceed a maximum of 22,448 net useable square feet (including circulation) of clinic space for a Veterans Health Administration outpatient clinic in the vicinity of St Louis County, MO.

2.1.3 Space shall be available for use by Tenant (VA) for personnel, furnishings, and equipment to meet the needs and requirements for an Outpatient VA Clinic in the St.

Louis County, MO area as referenced in this document and at www.cfm.va.gov/TIL.

2.1.4 The codes, standards, and references listed below indicate minimum performance requirements. Based on input from Owner representatives and recommendations from the architectural/engineering firm, minimum requirements or standards may be exceeded by site specific project design.

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

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

2.1.7 For the Lessor to properly determine occupancy type, VA intends to simultaneously treat 0 patients at any given time who are incapable of self-preservation. Compliance is required with applicable codes and standards throughout the process of design, construction, acceptance, and on-going maintenance of the facility.

2.1.8 Lessor shall maintain utilities and equipment as prescribed by local codes, as outlined within this document and all referenced and provided Appendices. Lessor will provide records of the maintenance in the format and frequency required by the VAMC and Life Safety Code to ensure compliance with TJC.

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 National Fire Protection Association (NFPA) 70 National Electric Code, NFPA 75 Standard for the Fire Protection of Information Technology (applicable when CBOC contains a Data Center), NFPA 99 Health Care Facilities Code and all standards referenced therein, NFPA 101 Life Safety Code, NFPA 110 Standard for Emergency and Standby Power Systems, current editions.

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

2.2.1.3 International Building Codes (IBC): 2018 or latest edition (within 2 years of release). The latest edition shall be used for structural and seismic design.

2.2.1.3.1 International Building Code

2.2.1.3.2 International Energy Code

2.2.1.3.3 International Mechanical Code

2.2.1.3.4 International Plumbing Code

http://www.cfm.va.gov/TIL

2.2.1.4 State and local codes as required by the local Authority Having Jurisdiction

(AHJ).

2.3 Delineated Area

2.3.1 The property shall be within the delineated area, and have municipal utilities available, within the boundaries listed below:

2.3.2 Northern Border – Old Jamestown Road

2.3.3 Eastern Border – Columbia Bottom Road

2.3.4 Southern Border – I-270

2.3.5 Western Border – Howdershell Road/Shackelford Rd.

2.3.6 Graphic of the Delineated Area:

2.3.7 Location: Facility must be highly visible and located in a high traffic area accessible to and from main thoroughfares.

2.4 Standards

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

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

2.4.1.2 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.

See attached TJC checklist.

2.4.1.3 Facility Security Level (FSL) shall be as outlined in GSA Form L100 Global Lease. Per VASTLHCS Police, this lease requirement is determined to be a FSL Level 3.

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

2.4.1.5 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)

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

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

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

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

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

2.4.1.11 USP General Chapter 795 Pharmaceutical Compounding – Nonsterile Preparations

2.4.1.12 USP General Chapter 797 Pharmaceutical Compounding – Sterile Preparations

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

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

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

2.4.1.16 VA Signage Design Manual PG 18-10

2.4.1.17 H 18-8 Seismic Design Handbook

2.4.1.17.1 Seismic Facility Criticality Designation (FCD) for this requirement is defined as Ancillary.

2.4.1.17.2 Offeror required to complete the Seismic Form per the Exhibit titled “Seismic Safety Forms” for High Seismic Zone.

2.5 References

2.5.1 The following guides, manuals, and other references developed by VA are for reference only, however, they are applicable to VA leased CBOCs:

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

2.5.1.2 Prototype for Standardized Design and Construction of Community Based

Outpatient Clinicshttps://www.cfm.va.gov/til/prototypes.asp#CBOC

2.5.1.3 PACT Space Module Design Guide

https://www.cfm.va.gov/til/dGuide/dgPACT.pdf

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

2.5.1.5 VA Signage and Design Guide: dmSignage.pdf (va.gov)

https://www.cfm.va.gov/til/dManual/dmSignage.pdf https://www.cfm.va.gov/til/etc/seismic.pdf https://www.cfm.va.gov/til/prototypes.asp#CBOC https://www.cfm.va.gov/til/dGuide/dgPACT.pdf https://www.cfm.va.gov/til/rTemplate/LeasingCBOCw.asp https://www.cfm.va.gov/til/dManual/dmSignage.pdf

SECTION 3

PLANNING AND DESIGN CRITERIA

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. Lessor shall utilize and incorporate Patient Aligned Care Team (PACT) Facility Design concept model into existing or new space design and provide required tenant improvements that meet PACT model requirements. An operational and planning design guide was developed which identified key principles and objectives. Refer to PACT Space Module Design Guide under References Section 2.5.

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. Room Data Matrix

3.4.1. See Exhibit titled “PFD_STLCO CLINIC with Room Requirements_20231010” for furnishings, equipment and HVAC requirements for each room of the Clinic. Equipment marked “CC” is Contractor procured, Contractor installed; others marked “VC” are VA procured, Contractor installed. The following provides a cross-referencing method to validate the contents of the Exhibit.

3.4.2. 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.

3.4.3. 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.

3.4.4. 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.

3.4.5. 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.

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

3.5. Surgical Design Criteria

3.5.1. Projects including operating rooms shall follow all requirements in the Surgical and

Endovascular Services Design Guide. Surgical and Endovascular Service Design Guide https://www.cfm.va.gov/til/dGuide/dgSurg.pdf

SECTION 4

TECHNICAL NARRATIVE

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

4.1.1.3 Public access to the facility should be restricted to a limited number of entrances.

The public entrance is to the main lobby of the facility. Staff entrances shall be located independently of main entrance lobbies and be convenient to staff parking.

4.1.1.4 Public transportation must be available and within 660 feet from the facility.

4.1.1.5 All concrete curbs must be painted high visible yellow and maintained as such. At minimum, all curbs shall be repainted every three years, or as needed.

4.1.1.6 Provide necessary curb cuts with truncated domes at all major pedestrian intersections with vehicle pathways.

4.1.1.7 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 25,000 pounds capacity for recessed installation at loading dock.

4.1.1.8 Service area shall accommodate vehicles that pick-up trash and recycled materials.

Locate service area away from public and patient areas.

4.1.1.9 Provide reflective traffic control signs as required for intersections, no parking lanes, and guidance of site traffic.

4.1.1 Parking

4.1.1.1 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.

4.1.1.2 Parking spaces should accommodate 100 cars. This includes 6 handicap spaces and 1 designated van drop off/loading area and 93 staff parking spaces.

4.1.2 Site Grading

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

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 using a 650lb capacity design requirement. Additional capacity may be required and listed in the project specific requirements.

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.

4.2.4.2 Lessor is responsible for providing all utilities to government furnished equipment.

4.2.5 Signage and Wayfinding

4.2.5.1 Refer to VA Signage Design Guide in Section 2.5 for signage standards and 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 8 feet minimum.

4.2.6.2 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 dock.

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) and an accessible access aisle.

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.

4.2.9 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 Finish: Prefinished in compliance with AWI Section 1500.

4.2.12.3 Automatic Sliding Doors: Single Slide Automatic Sliding Door, Class 1 Clean Room

Certified, narrow stile, 84” wide w/ 35.3” nominal clear door opening, trackless, clear anodized finish, and touchless actuators.

4.2.12.3.1 Comply with BHMA Standard ANSI A156.10 (BHMA 1601), Power Operated Pedestrian Door Standard and UL Standard UL 325, Electric Door, Drapery, Gate, Louver and Window Operators and Systems.

4.2.12.3.2 Service Life: Provide automatic sliding doors capable of operating without failure of any component, for not less than 300,000 open and close cycles, with normal maintenance as defined in manufacturer's standard operating manual.

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 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 Low Energy Automatic operators, ANSI A156.19-07. Heavy duty commercial grade. Provide complete with drop plates, bracket, or adapters for arms as required to suit details. Provide a terminal strip in an enclosed box near or above door that indicates connections for Security and Fire Alarm equipment and for electrified hardware items associated with proper door operation, as indicated by hardware group operational description. Refer to floor plans for type of actuation devices and bollards if required. Coordinate with Security Contractor for doors actuated by electronic access control system.

4.2.13.2.3 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

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.

4.3.7 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. The window blinds must have non-corroding mechanisms and synthetic tapes. 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 also contain a sink shall a minimum 4’ x 4’ area of LVT installed at the sink location.

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 the FGI Guidelines and ASHRAE Standard 170, with the Room Data Matrix taking precedence and/or indicating required space design conditions when the FGI Guidelines 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 Air handling units shall consist of, but not be limited to, the following:

4.7.3.1.1 The units shall be constructed of double wall, insulated metal panels with an overall U-value and necessary features to meet/exceed energy code (and prevent condensation based on the site-specific outdoor design conditions).

4.7.3.1.2 Incorporate supply, return and outdoor air flow measuring stations for proper control feedback and ensure minimum ventilation needs.

4.7.3.1.3 For AHU’s that are in excess of 15,000 cfm, SA/RA Array fans (minimum 2 fans per system) with backdraft isolation dampers shall be employed.

4.7.3.1.4 VSD controllers for fan array systems shall be provided in quantities that will provide no less than a 50% loss of nominal fan capacity if a single VSD were to fail.

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

4.4.3.3 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.

4.4.3.4 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.

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 The pumping system for the chilled water supply shall consist of variable speed pumps providing variable primary flow, arranged in a headered approach. Variable speed pumps shall each have a variable speed drive controller.

4.4.5.3 DX systems:

4.4.5.3.1 AHUs packaged with DX cooling sections shall have compressors/condensing units with direct drive scroll or screw compressors, all-aluminum microchannel condenser coils, and direct drive TEFC condenser fans. Units shall employ multiple, independent refrigerant circuits, and shall have capacity control provisions to achieve at least 4 to 1 turndown.

4.4.5.3.2 Provide spring isolated mounting curbs for vibration attenuation, if applicable.

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

4.4.5.5 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 Hot Water Heating System

4.4.6.1 Hot water heating shall be generated by direct vent, sealed combustion, condensing type boilers.

4.4.6.2 The heating water system distribution shall be a variable/primary pumping system.

The pumping system will consist of variable speed pumps providing variable primary flow. Variable speed pumps shall each have a variable speed drive controller.

4.4.7 Humidification System

4.4.7.1 Centralized humidification shall be provided when necessary to maintain 20%-60% relative humidity in all seasons. Each air handling unit shall have a dedicated humidifier.

4.4.7.2 Water treatment shall be provided for humidifier feedwater as required by the humidifier equipment manufacturer.

4.4.8 HVAC Piping Systems

4.4.8.1 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.

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

4.4.8.3 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.

4.4.9 Air Distribution and Duct Systems

4.4.9.1 Duct construction shall be as follows:

4.4.9.1.1 All supply return and exhaust air ductwork shall be constructed of G90 galvanized steel. Non-ducted Return Air Plenum is not allowed. Flexible duct is prohibited except for the last three feet to connect diffusers.

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

4.4.9.1.3 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.

4.4.9.2 Grilles, registers, and diffusers shall be steel, aluminum or extruded aluminum with appropriate finish.

4.4.10 HVAC Insulation Systems

4.4.10.1 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.

4.4.10.2 Building must have evening and weekend set back thermostat. The heating, air conditioning and ventilating systems shall meet city, state and national codes and be designed to meet ASHRAE minimum recommendations.

4.4.10.3 Certain space types, such as Medical Supply, Clean Storage, OIT Closet, AII room, etc., require temperature tracking and have specific HVAC requirements (number of air exchanges per hour, relative humidity range, temperature range, and positive or negative pressure to surrounding spaces, etc.). These areas are to maintain air metrics 24x7 with no energy-efficient setback settings. See Exhibit in RLP titled “PFD_STLCO CLINIC with Room Requirements”, HVAC Requirements Tab, derived from the HVAC Design Manual. The building will be provided with enough thermostats and VAVs to adequately control the space per the HVAC Requirements – see Notes on above Exhibit. HVAC shall be a certified and commissioned system with a Testing and Balancing (TAB) report as a deliverable showing all air metrics are met.

4.4.10.4 The Telecom Room will be provided an independent HVAC unit or controls to maintain temperature and humidity in accordance with (IAW) Infrastructure Standard for Telecommunication Spaces.

4.4.11 Testing, Adjusting and Balancing

4.4.11.1 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.

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

4.4.12 Automatic Temperature Control Systems

4.4.12.1 The temperature controls shall be direct digital control (DDC) system with industry open protocol compatibility. The system shall provide control of the environment and other parameters and collect data on the performance and deviations (alarms).

4.4.12.2 For all rooms indicating a specific pressure, temperature and/or humidity requirement, real time monitoring of these conditions shall be provided through the HVAC direct digital control system, providing alarms via the control system when rooms are out of the specified acceptable range, triggering a lessor response.

4.4.12.3 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

• Each G.I.P room (logistics storage)

• 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.

https://www.cfm.va.gov/til/dManual/dmHVAC.pdf https://www.cfm.va.gov/til/dguide/OIT-InfrastrucStdTelecomSpaces.pdf https://www.cfm.va.gov/til/dguide/OIT-InfrastrucStdTelecomSpaces.pdf

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 equipment in lieu of a common AHU only, to isolate the stricter temperature/humidity needs and high-static branch circuit to avoid penalizing the entire air handling unit.

4.5 Plumbing

4.5.1 References

4.5.1.1 The following publications shall be referenced for applicable systems calculations and design information:

4.5.1.1.1 ASPE Handbooks

4.5.2 Plumbing Design Basis

4.5.2.1 Domestic Water Service

4.5.2.1.1 Incoming service water pressure shall be ascertained to determine if adequate pressure is available on site to serve the facility without the use of booster pumps. Coordinate with the water supplier to provide and evaluate historical water data during all seasons.

4.5.2.1.2 SINKS: The lessor shall provide and install wall-mounted electronic liquid antimicrobial soap dispenser, per VA requirement, and paper towel dispenser for each sink. The sinks shall also be equipped with Anti-scald mix valves and wrist blades. Joints at plumbing fixtures, ceramic tile to be mildew resistant silicone. Plumbing fixtures shall be commercial or institutional grade. *Lessor shall refer to the VA’s Plumbing requirements found on the VA TIL to ensure all restrooms meets the VA’s requirements: PG 18-10 - Plumbing Design Manual (va.gov)

4.5.2.1.3 DRINKING FOUNTAIN: An accessible public refrigerated; wall hung drinking fountain will be provided in the waiting room. Drinking fountain model shall contain a bottle filter feature.

4.5.2.1.4 If booster pumps are required, they shall utilize variable speed drives for pressure control.

4.5.2.2 Domestic Water Heating

4.5.2.2.1 If storage type heaters are utilized, they shall be set to 140 degrees F and a thermostatic mixing valve incorporated to temper the water to 115 degrees for domestic use.

4.5.2.2.2 Provide point of use mixing valves to ensure water temperature is no greater than 110F.

4.5.2.2.3 A looped hot water recirculation system with a bronze in-line recirculation pump shall be provided.

4.5.2.3 Domestic Water Treatment

4.5.2.3.1 The facility water system shall have a building program for risk assessment and Legionella mitigation provisions as needed to comply with ASHRAE Standard 188.

4.5.2.3.2 Water systems suppling critical water for SPS, or water for Dialysis shall meet the requirements of AAMI.

4.5.2.4 Sump Pumps and Sewage Ejectors

4.5.2.4.1 If required, 50/50 duplex submersible sump pump and/or sewage ejector systems shall be utilized.

4.5.3 Materials

4.5.3.1 Domestic Water Piping:

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

4.5.3.2 Sanitary, Storm, Vent, and Clear Water Waste Systems

4.5.3.2.1 Aboveground:

4.5.3.2.1.1 Cast-Iron pipe, with compatible joints and fittings.

4.5.3.2.1.2 Type DWV Copper Tube, with compatible joints and fittings.

4.5.3.2.1.3 Type 304 or 316 stainless steel pipe, with compatible joints and fittings.

4.5.3.2.1.4 Schedule 40 PVC pipe, solid wall, with compatible joints and fittings.

4.5.3.2.2 Underground:

4.5.3.2.2.1 Cast-Iron pipe, with compatible joints and fittings.

4.5.3.2.2.2 Type DWV Copper Tube, with compatible joints and fittings.

4.5.3.2.2.3 Type 304 or 316 stainless steel pipe, with compatible joints and fittings.

4.5.3.2.2.4 Schedule 40 PVC pipe, solid wall, with compatible joints and fittings.

4.5.3.3 Provide overflow roof drain inlets and piping system independent to storm water piping serving roof drains.

https://www.cfm.va.gov/til/dManual/dmPlbg.pdf https://www.cfm.va.gov/til/dManual/dmPlbg.pdf

4.5.3.4 Floor drains shall not be provided in single user toilet rooms unless required by local or state code provisions.

4.5.3.5 Plumbing Fixtures

4.5.3.5.1 Fixtures shall be commercial or institutional grade.

4.5.3.6 Hot Water Supply and Recirculation Piping:

4.5.3.6.1 Insulation systems shall conform to applicable Energy Code requirements and current NAIMI standards.

4.5.3.6.2 Insulation on hot piping shall have thickness sufficient to prevent skin injury due to excessive temperature.

4.5.3.7 Cold Water Supply Piping: Insulation shall include vapor retarders and shall have thickness sufficient to prevent condensation.

4.5.3.8 Rainwater Piping: Insulation shall include vapor retarders and shall have thickness sufficient to prevent condensation.

4.5.3.9 Outdoor exposed insulation shall be protected from the elements with a fully sealed outer covering that is UV protected and has a minimum puncture resistance rating of 55 lbs.

4.5.4 Medical Gases

4.5.4.1 Central piped medical gases shall be provided where required by FGI or as required by the project specific requirements.

4.5.4.2 All Medical Gas piping shall be maintained and tested as outlined in VA Directive

7515(1). All Medical Gas and vacuum distribution systems and alarms shall be tested by a qualified third-party contractor annually for compliance with NFPA 99, and copies of these tests to be provided to the project COR.

4.5.5 Special Conditions

4.5.5.1 Imaging Areas: For 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.

4.5.5.2 Dental Facilities:

4.5.5.2.1 Provide a central piped dental oral evacuation distribution system, with vacuum pump package, as necessary to support the program.

4.5.5.2.2 Provide a central piped dental air distribution system, with compressor package, as necessary to support the program.

4.5.5.3 Provide connections to and pipe distribution systems for high purity water systems for use in laboratory and other special use areas, as necessary to support the program.

4.5.5.4 Provide connections to and pipe distribution systems for specialty gases for use in laboratory and other special use areas, as necessary to support the program.

4.6 Electrical

4.6.1 Standby Generator requirements in the absence of a code required Essential Electrical System. Standby generator is not required for this St. Louis County VA Clinic.

4.6.2 Lessor to provide one 120VAC duplex receptacle in the center of the group clinic and conference rooms above the ceiling for future projector mounting provided and installed by the VA. Corridors will have outlets at least every 15 feet. All outlets in all rooms to be set ground plug up. Exam rooms, lab and other patient care areas will have hospital-grade “green dot” receptacles. VA requires all 20A circuits to have hospital-grade receptacles. All electrical systems shall meet and be in compliance with the National Electric Code (NFPA 70). Lessor shall refer to the VA Electrical Design Manual found at the following link: Electrical Design Manual (va.gov) for all Electrical related requirements that must be met.

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