Exhibit N VA_Leased_CBOC_Design_Narrative_Appendix A.pdf

June 9, 2024

VA Leased CBOC Design Narrative

EXHIBIT N

SECTION 1

INTRODUCTION

VA Leased CBOC Design Narrative June 9, 2024 Section 1 - Page 1

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

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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

June 9, 2024 Section 1 - Page 3

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.

VA Veterans Affairs

VHA Veterans Health Administration

VISN Veterans Integrated Services Network

RDM Room Data Matrix

SECTION 2

GENERAL REQUIREMENTS

June 9, 2024 Section 2 - 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.

2.2 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.

Additional Code information:

• Applicable to NFPA 99, the facility is considered Category 3. The Lessor will maintain utilities and equipment as prescribed by local codes and references listed in Appendix D.

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

2.3 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

June 9, 2024 Section 2 - Page 2

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.

EXHIBIT N

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

June 9, 2024 Section 2 - Page 3

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.

June 9, 2024 Section 2 - Page 4

Base Building Occupant Areas

Base structure and building enclosure components

(windows with exterior finishes) and any required enhancements (canopies, progressive collapse, etc.)

are complete.

Broom-clean concrete floor slab, with a flat and level floor.

Base building electrical and plumbing systems (e.g., central fire alarm, chiller plant, cooling tower) are complete and functional.

Gypsum wallboard, spackled and prime painted, on exterior perimeter walls and tenant demising walls, without suite entry door.

Entire HVAC system is complete and functional. Conditioned space per the RDM.

All common areas, such as lobbies, elevators, fire egress corridors and stairwells, garages, and service areas are complete.

Suspended acoustical ceiling system including grid and lay-in tiles (or other building standard). Lighting luminaires should be installed in the ceiling grid for an open office plan at the rate of fixtures per 80

USF. Lighting controls with ambient lighting adjusted per daylight availability, occupancy, vacancy, or other building automation system signals.

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.

Designated connection point to the central fire alarm system for extension to tenant demised areas.

All fire alarm devices necessary required by tenant layout and AHJ.

Fire suppression system ready for extension to tenant demised areas.

Sprinkler mains and distribution piping in a protection layout (open plan) with heads turned down, concealed with an escutcheon or trim plate, are installed.

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.

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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 3

PLANNING AND DESIGN CRITERIA

May 1, 2024 Section 3 - 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.

https://www.cfm.va.gov/til/dGuide/dgSurg.pdf https://www.cfm.va.gov/til/dGuide/dgDigestiveEndoscopy.pdf

SECTION 4

TECHNICAL NARRATIVE

June 9, 2024 Section 4 - Page 1

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.

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 10% of the total required spaces unless more is required by local code.

Additional Parking Requirements:

Parking spaces should accommodate 135 cars with 14 spaces being accessible spaces and 2 being van accessible.

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.

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.

June 9, 2024 Section 4 - Page 2

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

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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”

June 9, 2024 Section 4 - Page 4 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

June 9, 2024 Section 4 - Page 5 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

June 9, 2024 Section 4 - Page 6 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.

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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:

Provide curtain track locations on design documents.

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:

June 9, 2024 Section 4 - Page 8

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.

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.

4.4.4.3 Patient isolation rooms and armory shall have dedicated exhaust system.

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

June 9, 2024 Section 4 - Page 9 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

June 9, 2024 Section 4 - Page 10 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 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.

4.4.13.4 Sterile Processing Services

4.4.13.4.1 The SPS suite air system shall operate continuously to maintain required room pressurization requirements. Rooms requiring positive or negative pressurization shall be provided with room pressurization monitors and alarms to alert the SPS staff in the event the room pressure raises/falls

June 9, 2024 Section 4 - Page 11 above or below the room pressure requirements.

4.4.13.4.2 EtO gas monitors and alarms shall be placed both inside and outside the EtO Gas Sterilization Room and EtO Gas Sterilization Abator

Room to alert the occupants in the event of a leak of EtO gas, if provided.

4.4.13.4.3 The decontamination area shall be provided with NFPA 99C-

Level clean compressed air system that is separate from patient and other medical air systems provided at the facility.

4.4.13.5 Surgical and Endovascular Services

4.4.13.5.1 Air Handling Units serving the surgical suite shall have the capacity for utilizing 100% outside air where required by building code to meet purge requirements.

4.4.13.5.2 There shall be a minimum of four (4) low return air grilles located at each corner of each surgical operating room and/or endovascular procedure room. The height to the bottom of each grille from the floor shall be

8 inches.

4.4.13.6 Digestive Diseases – Endoscopy Services

4.4.13.6.1 Corridors shall not be used to supply or return/exhaust air from adjacent rooms. Except that they may be used to ventilate Housekeeping

Aid’s Closets and small electrical or telephone closets opening directly onto them.

Additional Special Mechanical Conditions:

Additional Mechanical Requirements:

All HVAC systems shall operate 24 hours per day, 7 days per week.

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 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

June 9, 2024 Section 4 - Page 12 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 Medical Gases

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

4.5.3.2 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.

4.5.4 Special Conditions

4.5.4.1 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.

4.5.4.2 Dental Facilities:

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

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

4.5.4.3 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.

4.5.4.4 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.

4.5.4.5 Surgical and Endovascular Services:

4.5.4.5.1 All open sources of water including but not limited to sinks, floor drains, and floor sinks shall not be installed in: Surgical Operating Rooms, Endovascular

Procedure Rooms, All aseptic areas, Semi-restricted Corridor, Clean Core, Clean

Utility Rooms.

4.5.4.5.2 Where medical compressed air, oxygen, and medical vacuum systems are provided, a separate medical gas zone valve box for each operating room shall be provided and located in the semi-restricted corridor adjacent to the room it serves.

4.5.4.5.3 When Nitrous Oxide is provided, a Waste Anesthesia Gas Disposal system must also be present.

4.5.4.6 Digestive Diseases – Endoscopy Services:

4.5.4.6.1 A hot water return system shall be provided to ensure the design

June 9, 2024 Section 4 - Page 13 temperate is maintained at the fixture furthest from the source.

4.5.4.6.2 Plumbing fixtures and drains shall be drained by gravity through sanitary waste stacks, including required vent stacks. Fixtures located below gravity drain line shall be pumped as required by a duplex ejector system. Any special acidic waste should be drained through corrosion-resistant, flame-retardant piping into either a local or centralized acidic dilution tank.

Additional Special Plumbing Conditions :

Additional Plumbing Requirements:

• Where drinking fountains are required by the lease, they shall include bottle fi l lers and should provide fi ltered water.

• Specimen collection toilets in Lab shall have water shut off valve.

• All toilets should be floor mounted.

4.6 Electrical

4.6.1 Standby Generator requirements in the absence of a code required Essential Electrical System

4.6.1.1 Packaged Engine Generator

4.6.1.1.1 An exterior diesel fuel…