S02 - Att8 - Design Alerts.pdf

HEFP/10NA5G/29APR20

SOCAMES 6 Design Alert 1

Problem

During a recent construction activity of cable upgrades to an existing telecommunication room (TR) at an Initial Operating Capability (IOC) site, it was discovered during cable testing procedures that some of the cables being upgraded were greater in length to the end user device than standards allows.

Background

ANSI/TIA-568.D, “Balanced Twisted-Pair Telecommunications Cabling and Components” (Sep 2018) version of industry standards for telecommunication room fixed cabling installation, limits the total length of a network Unshielded Twisted Pair (UTP) cable segment to 100 meters. The 100 meters is broken down as 10 meters for patch cables and 90 meters for total fixed cabling. Cable length requires a three-dimensional assessment to ensure that the fixed cables being installed do not exceed the specified UTP cable segment of 90 meters of fixed cable length.

There are several scenarios that require an assessment to occur to ensure that a telecommunication rooms UTP cable segments do not exceed 90 meters.

Scenario 1: The installation of a new telecommunication room to serve an area.

Scenario 2: The relocation of an existing telecommunication room to serve an area.

Scenario 3: The installation of new cabling upgrades in a telecommunication room that will remain in place to serve an area.

Scenario 4: An existing telecommunication room that will not receive any cabling upgrades.

Solution

To ensure that an assessment is performed for each of the four telecommunication room scenarios listed above, our office in conjunction with the SD-DCIE team is providing a recommended three-dimensional estimation approach that can be shared with your respective facility leads and design team to verify all telecommunication rooms do not exceed the specified UTP cable segment of 90 meters.

Step 1: Ensure you have an accurate floor plan that depicts the locations of the telecommunication rooms serving the facility.

Step 2: Utilizing AutoCAD or rule, center on the location of the telecommunication room being assessed.

From the center of the room project out lines, 80 meters in length from that point, in the plan north, south, east and west respectively.

Step 3: At the end each of the 80 meters lines created, connect a line 45 degrees from that point out to the next end point creating a diamond.

Step 4: Validate that all areas served by that telecommunication room fall within the parameters of the diamond overlay.

HEFP/10NA5G/29APR20

Step 5: If the area served by that telecommunication room is within the diamond overlay then the distance, as provided by the estimation tool, is adequate for that telecommunication room.

Step 6: If the area served by that telecommunication room is outside the diamond overlay then the distance, as provided by the estimation tool, is inadequate for that telecommunication room and further investigation is required by electronically testing the cable lengths to see if they pass or physical measurement. Any UTP cabling that does not pass testing protocols and is too long will need to have further design considerations to remedy the distance issue.

Notes

Since it is necessary to account for vertical cable distance, installation of slack for bypassing obstructions, cable management, bend radii and other in-situ obstacles 80 meters is utilized instead of the 90 meters acceptable length. This is to provide a realistic estimation of coverage of the representative telecommunication room.

This estimation tool is a recommended approach to validate fixed cable lengths meet the standards.

Designers and installers remain responsible for ensuring actual cable distances do not exceed the limits in the standards.

Below is a diagram of an example demonstrating the use of the estimation tool.

HEFP/10NA5G/16MAR21

VA OEHRM previously required an on-site or near campus Help Desk during Go-Live. To better serve facilities during Go-Live, the Help Desk will now be remote and supported out of Kansas City.

VHA HEFP SEP provided guidance in the Electronic Health Record Modernization Training and Support Space, HEFP SEP Space Planning Job Aid, 11/10/2020 revised 1/27/2021, that required 1,800 square feet of space for the Help Desk as part of the Command Center.

The Electronic Health Record Modernization Training and Support Space, HEFP SEP Space Planning Job Aid, has been updated to reflect the new requirements. The requirement for Help Desk space within the Go-Live Command Center was deleted, therefore, space is not needed for this activity.

Please use this link, Electronic Health Record Modernization Training and Support Space, HEFP SEP Space Planning Job Aid, 11/10/2020 revised 3/16/2021 to find the most up-to-date information.

HEFP SEP (SOCAMES 6) Design Alert 2

Problem

Background

Solution

Notes https://dvagov.sharepoint.com/sites/VHAOCAMESEHRM/VHA%20Site%20Assessment%20Resources/Forms/AllItems.aspx?viewid=d14511ba%2D8bd6%2D461a%2D9a61%2D472a9277303c&id=%2Fsites%2FVHAOCAMESEHRM%2FVHA%20Site%20Assessment%20Resources%2FGuides https://dvagov.sharepoint.com/sites/VHAOCAMESEHRM/VHA%20Site%20Assessment%20Resources/Forms/AllItems.aspx?viewid=d14511ba%2D8bd6%2D461a%2D9a61%2D472a9277303c&id=%2Fsites%2FVHAOCAMESEHRM%2FVHA%20Site%20Assessment%20Resources%2FGuides

HEFP/10NA5G/20APR21

VA OEHRM previously planned for 3.5 classes per end user and either 8 seats per class with social distancing or 15 seats per class without social distancing. However, during the recent VHA EHRM Strategic Review, it was determined that each end user shall have 5 classes and that there will be either 8 seats per class with social distancing or 12 seats per class without social distancing. The changes described result in a larger space need.

VHA HEFP SEP provided guidance in the Electronic Health Record Modernization Training and Support Space, HEFP SEP Space Planning Job Aid, 11/10/2020 revised 1/27/2021, that required

3.5 classes per end user and either 8 seats per class with social distancing or 15 seats per class without social distancing. VA OEHRM and VHA determined that more class time per end user and a decrease in the overall class size are needed.

The Electronic Health Record Modernization Training and Support Space, HEFP SEP Space Planning Job Aid, has been updated to reflect the new requirements. The following classroom calculations were revised.

Previous classroom calculations:

Standard Room Calculations

VAMC Total rooms = Number of end users x 3.5 classes per end user / 15 seats per class / 8 weeks of EUT / 5 days of training per week

CBOC Total rooms = Number of end users x 3.5 classes per end user / 15 seats per class / 8 weeks of EUT / 5 days of training per week.

Social Distanced Room Calculations

VAMC Total rooms = Number of end users x 3.5 classes per end user / 8 seats per class / 8 weeks of EUT / 5 days of training per week

HEFP SEP (SOCAMES 6) Design Alert 3

Problem

Background

Solution

HEFP/10NA5G/20APR21

CBOC Total rooms = Number of end users x 3.5 classes per end user / 8 seats per class / 8 weeks of EUT / 5 days of training per week.

New classroom calculations:

Standard Room Calculations

VAMC Total rooms = Number of end users x 5 classes per end user / 12 seats per class / 8 weeks of EUT / 5 days of training per week

CBOC Total rooms = Number of end users x 5 classes per end user / 12 seats per class / 5 weeks of EUT / 5 days of training per week.

Social Distanced Room Calculations

VAMC Total rooms = Number of end users x 5 classes per end user / 8 seats per class / 8 weeks of EUT / 5 days of training per week

CBOC Total rooms = Number of end users x 5 classes per end user / 8 seats per class / 5 weeks of EUT / 5 days of training per week.

Please use this link, Electronic Health Record Modernization Training and Support Space, HEFP SEP Space Planning Job Aid, 11/10/2020 revised 4/20/2021 to find the most up-to-date information.

Notes https://dvagov.sharepoint.com/:b:/r/sites/VHAOCAMESEHRM/VHA%20Site%20Assessment%20Resources/Training%20and%20Support%20Space%20Updates/20211115-Rev%204-Training%20and%20Admin%20Support%20Space-Planning%20Job%20Aid.pdf?csf=1&web=1&e=J2LgUr

HEFP/10NA5G/07JUN21

Clarification to the field is needed regarding the design of space for Telecommunications Rooms (TRs) in existing facilities for the Electronic Health Record Modernization (EHRM) initiative. The design reference, Infrastructure Standards for Telecommunications Spaces – Version 3.0 requires 170 sq ft TRs for clinical spaces. However, due to existing space and structural constraints, HEFP SEP requires, at a minimum, only 100 sq ft TRs for clinical spaces in existing buildings.

The Infrastructure Standards for Telecommunications Spaces – Version 3.0 was developed by the Solution Delivery-Data Center and Infrastructure Engineering (OIT SD-DCIE) team and published to the TIL August 21, 2020. HEFP SEP identifies the following references as standards for all Information Technology (IT) physical infrastructure design and construction projects:

Infrastructure Standards for Telecommunications Spaces – Version 3.0 and VA OEHRM Site

Infrastructure and End User Device Requirements. These references are discussed and provided to each station during and after their scheduled scoping session to identify the work needed to modernize IT infrastructure across the enterprise.

During the site scoping sessions, HEFP SEP uses the Generic Floor Plan for TRs (Two Rack Requirement), detail 3, page 155 in Appendix B-7 of the Infrastructure Standards for

Telecommunications Spaces – Version 3.0 to communicate and coordinate space requirements for existing TRs to support EHRM. The baseline TR template is a 10 ft x 10 ft (100 sq ft) generic floor plan with two 2 ft x 4 ft racks to house the IT infrastructure.

Infrastructure Standards for Telecommunications Spaces – Version 3.0 specifies that a clinical TR should have a generic floor plan layout of 170 sq ft to support four 2 ft x 4 ft racks. This specification for clinical TRs has created a conflict with the standardized baseline TR of 100 sq ft that HEFP SEP works with the sites to achieve.

HEFP SEP discussed the conflict in TR size requirements with the OIT SD-DCIE team. HEFP SEP identified that due to VAMC/CBOC space deficits, existing building footprints, and the number of TRs, it is difficult to meet the 170 sq ft space requirement without a detrimental impact to healthcare operations. Furthermore, based on the average number of end users associated with each TR, most TRs only house 2 racks and require 100 sq ft of space. HEFP SEP and OIT SD- DCIE agreed that the 100 sq ft baseline standard was the practical approach in existing buildings.

HEFP SEP (SOCAMES 6) Design Alert 4

Problem

HEFP/10NA5G/07JUN21

All EHRM projects that require TR work in existing spaces shall minimally use the Generic Floor

Plan for TRs (Two Rack Requirement), detail 3, page 155 in Appendix B-7 of the Infrastructure Standards for Telecommunications Spaces – Version 3.0 which requires a 10 ft x 10 ft space to support two 2 ft x 4 ft racks. Room dimensions shall be increased by 20 sq ft for any additional 2 ft x 4 ft racks.

All new construction of clinical spaces should adhere to the standards as written.

Please use this link, https://www.cfm.va.gov/til/dguide/OIT-InfrastrucStdTelecomSpaces.pdf to locate the current version of Infrastructure Standard for Telecommunication Spaces – Version

3.0 published August 21, 2020.

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

HEFP SEP/19HEFG/17AUG21

Clarification is required regarding the need to replace or install new fire suppression systems in the data center during design and construction of Electronic Health Record Modernization (EHRM) facility infrastructure projects and the need for a third-party fire engineer review of HEFP SEP EHRM Infrastructure Upgrades Projects.

On June 1, 2021 the new Fire Protection Design Manual was published and posted to the Technical Information Library (TIL). The manual contains fire protection engineering design for Department of Veterans Affairs facilities. EHRM facility infrastructure projects, and specifically work conducted in the Data Centers, may require an upgrade or replacement of the existing fire suppression system in accordance with NFPA 75 as stated in the Fire Protection Design Manual Paragraph 3.7.

VHA field engineers are required to ensure that the Architect-Engineer designer of record applies all applicable NFPA 75 requirements for work needed in the Data Center. Field engineers should use the Healthcare Environment and Facilities Programs (HEFP) Fire Code Plan Review Contract to review all EHRM Infrastructure Upgrades and Data Center projects. The fire code plan review should focus on compliance with the newly published Fire Design Manual dated June 1, 2021 and ensure that all associated NFPA fire and life safety codes are indicated in the designs.

Guidance to the Architect-Engineer is as follows:

For EHRM Infrastructure Upgrade and Data Center projects, the work conducted in the Data Centers (which will upgrade spaces to an ANSI/TIA-942-B, Rating 3) generally requires compliance with all requirements of NFPA 75. The most design intensive of these requirements is the addition of a gaseous fire suppression system as described in the Fire Protection Design Manual, Paragraph 3.7. Compliance with NFPA 75 is also likely to involve, but not necessarily be limited to, these additional retrofit requirements:

• Revise the sprinkler protection in the computer room to a dedicated sprinkler zone.

• Ensure a minimum 1-hour boundary around the computer room.

HEFP SEP Design Alert 5

Problem

Background

Solution https://www.cfm.va.gov/til/dManual.asp https://www.cfm.va.gov/til/dManual.asp https://www.cfm.va.gov/til/dManual.asp https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.cfm.va.gov%2Ftil%2FdManual.asp&data=04%7C01%7C%7C0ab21bb7b9c5449d291d08d94b250560%7Ce95f1b23abaf45ee821db7ab251ab3bf%7C0%7C0%7C637623444673999189%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=3yUyM1ip7G49zrHDa6BgnvSbRWaJzKybj4D%2FuiV9vVc%3D&reserved=0 https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.cfm.va.gov%2Ftil%2FdManual.asp&data=04%7C01%7C%7C0ab21bb7b9c5449d291d08d94b250560%7Ce95f1b23abaf45ee821db7ab251ab3bf%7C0%7C0%7C637623444673999189%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=3yUyM1ip7G49zrHDa6BgnvSbRWaJzKybj4D%2FuiV9vVc%3D&reserved=0

HEFP SEP/19HEFG/17AUG21

• Combination smoke/fire dampers at the duct penetrations through the 1-hour boundary of the computer room.

• Electrical power off button(s) at computer room exit(s).

• HVAC power off button(s) at computer room(s).

Please use this link, Fire Code Plan Reviews | Healthcare Environment and Facilities Programs (va.gov) to request third-party fire engineer review for your EHRM upgrades projects.

Notes http://vaww.hefp.va.gov/occupational-safety-health-gems/fire-code-plan-reviews-bpa-fire-protection-task-order-0 http://vaww.hefp.va.gov/occupational-safety-health-gems/fire-code-plan-reviews-bpa-fire-protection-task-order-0

DESIGN

ALERT

OCTOBER 19, 2023

DESIGN ALERT INDEX - CURRENT

Design Alert Number Issue Date Subject

Verify or Modify Date

003C2B-DA-154 10-19-2023 Interstitial Space – Interim Guidance

003C2B-DA-153 09-27-2023 Biosafety Level 3 (BSL-3) Architectural and Engineering Considerations Update

003C2B-DA-152 10-14-2022 Medical Gases for Surgical ORs and Endovascular Procedure Rooms

003C2B-DA-151 12-15-2021 Cast Iron Fittings/Valve Housings, Prohibition of Use in High and Medium Pressure Steam Distribution Systems

003C2B-DA-150 11-29-2021 Testing, Adjusting, and Balancing Firm Certification

003C2B-DA-149 10-01-2018 Patient Privacy and Women Veterans’ Health, Design for

003C2B-DA-148 06-01-2017 VA Standards Application and User Design Input Requirements

003C2B-DA-147 09-01-2016 VA Project Design Principles – Foundation of Design 003C2B-DA-142 06-01-2014 For Immediate Application on All Current Projects

Patient Safety in VHA Bathrooms 11-01-2014

CONTACT: Facilities Standards Service at til@va.gov mailto:til@va.gov

JUNE 1, 2014, REV NOVEMBER 1, 2014

003C2B-DA-142

For Immediate Application on all Current Projects Patient Safety in VHA Bathrooms ISSUE: The VA National Center for Patient Safety has identified three recent VA projects with the following patient safety issues: a lack of slip resistant flooring and water ponding in Inpatient Bathrooms and Tub rooms. These conditions increase the potential for patient and staff falls.

DISCUSSION: CFM standards are consistent in calling for slip resistant flooring materials in bathrooms. The current VA Master Specification for Ceramic & Porcelain Tiles for Bathroom Floors (09 30 13, CERAMIC/PORCELAIN TILING) calls for Slip Resistance with a coefficient of friction equal to or greater than 0.42 for interior tile floors when wet in accordance with ANSI A137.1.

VA combats ponding and standing water in accessible bathrooms by calling for 3” slab depressions coupled with a maximum floor slope of a ¼” per foot tapered to a floor drain. This VA standard is found in section 4.30.2 entitled Shower Floors, under Chapter 4 of the Architectural Design Manual of PG 18 10. The intent is to have the slab depression for the entire bathroom floor area to allow for a gentle taper to a floor drain in the shower.

CONCLUSION: Patient & staff safety is a very serious concern. VA Design Criteria and Construction Standards in the Technical Information Library (TIL) are in place to assure the safety, security, and quality of optimum healthcare. VA Standards are required for all VA projects, whether new, renovation, or retrofit projects. Architects, Engineers, Designers, Contracting Officers, Project Managers, and Administrators should work closely with CFM to apply Standards appropriately to every project, to ensure consistency and safety to every VA project. The need for bathroom floors made of slip resistant materials and a proper slope to drain needs to be clearly understood as an essential design component.

CORRECTIVE ACTIONS: Revise Peer Review Checklist to include verification of slip resistant material and verification of floor slope to drain in submittal requirements for entire bathroom and tub room floor areas.

Revise Spec. Section 09 30 13, CERAMIC/PORCELAIN TILING. Under Article 3.3, Paragraph C, add Subparagraph 6 requesting verification of slope to drain.

https://www.cfm.va.gov/til/

DESIGN ALERT 142 June 1, 2014 For Immediate Application on all Current Projects Rev. November 1, 2014 Patient Safety in VHA Bathrooms

Revise appropriate Design Guides, Manuals, and other criteria for consistency and enforcement of standard.

ACKNOWLEDGEMENTS: This Design Alert was developed by a mutual collaborative effort which included the following VA Participants:

• National Center for Patient Safety

• CFM, Consulting Support Service

• CFM, Facilities Standards Service

SEPTEMBER 1, 2016

003C2B-DA-147

VA Project Design Principles – Foundation of Design (VAIQ 7657742) ISSUE: In all VA planning, design and construction it is imperative that all parties acknowledge Veterans and taxpayers as the ultimate customer and avoid spectacle, branding, and unwarranted customizations which result in elaborate, complex, and expensive building elements. All parties in the planning, design, and construction process must embrace the foundation principles set forth herein as fundamental in providing optimum environments for Veterans care and services in fulfilling VA’s mission.

BACKGROUND: The Department of Veterans Affairs (VA) design and construction program is an essential element of commitment to effectively and efficiently accomplish VA's missions. VA is entrusted with extraordinary taxpayer resources and designers and constructors are obligated to not only our Nation's Veterans but also the Nation's taxpayers to make the most effective and efficient use of these resources.

DISCUSSION: The Office of Construction and Facilities Management supports the Department's mission through disciplined planning, design and construction of VA facilities.

Following the VA Foundation of Design principles throughout all projects will ensure VA provides high quality, high performance, flexible facilities within scope, on budget, and on time.

REQUIREMENT: The attached memoranda define the Foundation of Design and the mission, values and obligations upon which our project designs must be grounded. All parties in the design and construction process must follow the Foundation of Design and VA Project Design Principles as fundamental in all VA planning, design and construction.

CONTACT: Don Myers (202-632-5388), Donald.Myers@va.gov mailto:Donald.Myers@va.gov

Department of Veterans Affairs Memorandum

Date: NOV 2 4 2015 From:

Executive Director, Office of Construction & Facilities Management (003C)

Subj: Foundation of Project Design (VAIQ 7657742)

To: Office of Construction & Facilities Management Staff

1. The Department of Veterans Affairs (VA) design and construction program is an essential element of commitment to effectively and efficiently accomplish VA's missions.

This memorandum outlines the required basic principles to follow in the design of VA projects. These principles reinforce what is expected and required of VA staff and consulting architects and engineers.

2. VA's prime mission is to fulfill President Lincoln's promise "To care for him who shall have borne the battle, and for his widow, and his orphan" by serving and honoring the men and women who are America's Veterans. VA accomplishes this mission by following VA's principles of Integrity, Commitment, Advocacy, Respect, and Excellence

(I-CARE).

3. The Office of Construction & Facilities Management (CFM) mission supports our Nation's Veterans by planning, designing, constructing, and acquiring facil ities; setting effective life cycle design and construction standards; and being trusted leaders in delivering health care facilities and other facilities.

4. VA is entrusted with extraordinary taxpayer resources to accomplish its mission .

There is a fundamental obligation to Veterans and the public trust for the most effective and efficient use of resources. This obligation requires that every dollar be used to its maximum benefit. VA facilities must deliver exceptional value by producing high quality, high performance and flexible facilities, on budget and on time. CFM's Technical Information Library (TIL) publishes the standards established to help achieve these attributes.

5. Architectural form and style must be firmly grounded on function, technology, and context. Designs must embody contemporary American architectural thought and technology, consider local context and regional architectural traditions, and provide a safe and healthy environment. Designs should avoid architectural and engineering exhibitionism and spectacle; fleeting style, trends, and fashion; firm-branded features;

elaborate, complex, difficult, and expensive to construct and maintain building elements such as curved facades and rooflines; monumental interior and exterior features; unduly expansive atriums; and other superfluous architectural finishes and details.

Constructability, flexibility, security, sustainability, durability, maintenance, and life cycle cost shall be carefully integrated for maximum value.

Page 2.

Subj: Foundation of Project Design (VAIQ 7657742)

6. In summary, VA staff and consulting architects and engineers must help realize the VA missions through design and construction that honors and serves our Nation's Veterans by providing world class health care, benefits, and memorial facilities that embody optimum performance in functionality, flexibility, quality, safety, security, accessibility, wayfinding, resilience, sustainability, maintainability, and economy.

JUNE 1, 2017

003C2B-DA-148

VA Standards Application and User Design Input Requirements ISSUE: There have been reports that clinicians, users and stakeholders have not been included to provide critical input in the design process, and VA Planning, Design, and Construction Standards have not been consistently applied as a basis of planning and design to VA projects, resulting in partial or complete functional and operational failures of completed and/or recently activated projects.

BACKGROUND: VA Program Offices, project teams, designers and constructors, are obligated to our Nation's Veterans and taxpayers to make the most effective and efficient use of resources, by providing a continuum of safe, secure, high quality, high performance, and high value environments of care and service for Veterans. The Office of Construction & Facilities Management (CFM) supports the Department's mission through development and application of standards as a basis for disciplined planning, design, and construction of VA facilities.

DISCUSSION: Following VA Technical information Library (TIL) Standards (https://www.cfm.va.gov/TIL ) and active participation of facility user/stakeholder groups in the application of Standards for all projects will ensure VA provides optimally functional, high quality, high performance, and flexible facilities within scope, on budget, and on time in accomplishment of VA’s missions.

REQUIREMENT: In all phases of Planning, Design, and Construction, for all VA projects it is required:

1) All applicable VA Standards published in the VA Technical Information Library (TIL) (https://www.cfm.va.gov/TIL ) shall be applied as a basis, foundation, and framework in planning, design, and construction. Any substantial variance from Standards shall be considered only as required to accommodate specific site, functional, and operational conditions. Upon consideration of variance CFM shall be consulted, and each Administration will function as Authority Having Jurisdiction for decision. Each substantial variance shall have a basis rationale and be documented in the project record;

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

DESIGN ALERT 148 June 1, 2017 VA Standards Application and User Design Input Requirements

2) Clinicians, providers, primary users, and other stakeholders shall be involved in all phases of project development to best adapt Standards for specific functional, operational, and site conditions, and to provide optimum service environments for Veterans. This also includes installations and modifications of systems or technology involving safety, security, functionality, or environmental quality. Stakeholder involvement shall be documented in the project record.

All parties in the planning, design, and construction process must embrace these requirements as fundamental in providing optimum environments for Veterans’ care and services, in fulfilling VA's mission.

OCTOBER 1, 2018

003C2B-DA-149

Design for Patient Privacy and Women Veterans’ Health ISSUE: Per VHA Directive 1330.01, dated (February 15, 2017- Amended: July 23, 2018) Health Care Services for Women Veterans and direction given by the Principal Executive In Charge Veterans Health Administration, in meeting on April 9, 2018, changes in VA Design Guides and other criteria are necessary to implement environment of care requirements for Women Veterans and to extend these requirements to healthcare environments for all Veterans.

BACKGROUND: VHA Program Offices, VAMCs, project teams, designers and constructors, are obligated to our Nation's Veterans and taxpayers to make the most effective and efficient use of resources and provide safe, secure, quality, and high value environments of care. The Office of Construction & Facilities Management (CFM) supports the Department's mission through development and application of Standards as a basis for disciplined planning, design, and construction (PDC) of VA facilities. PDC Standards are published in the VA Technical Information Library (TIL) (https://www.cfm.va.gov/TIL ). Pursuant to the revised Directive and VHA Executive direction it is necessary to make adjustments to certain VA PDC standards including PG-18-12 Design Guides (https://www.cfm.va.gov/til/dGuide.asp ).

DISCUSSION: VA Planning Design and Construction (PDC) Standards are required as a basis of design for all new, renovation and retrofit projects. The following outlines changes to basic Standards for planning and design of the environment of care supporting patient privacy and dignity Illustrations are provided showing the basic principles of patient privacy and modifications to selected room templates. Many of the elements listed below are confirmations of existing criteria and its importance in meeting the privacy and dignity requirements. The basic principles driving these changes are included so-as-to provide a vehicle for adaptation of standards to existing environments.

REQUIREMENT:

1) Design Principles for Patient privacy/dignity.

a) Door Hardware/Privacy Locks- Specify all locksets shall allow a safe exit from a locked room without the use of a key or code. Staff members shall be provided key(s) or code(s) to allow operation of locks for emergency access into the room. Ref. VA https://www.cfm.va.gov/til/dGuide.asp

DESIGN ALERT 149 October 1, 2018 Design for Patient Privacy and Women Veterans’ Health

PG-18-14 Room Finishes/Door and Hardware Schedule (https://www.cfm.va.gov/til/spclRqmts.asp#room ). Locksets are required on the rooms identified for the rooms, but not limited to those, listed below:

(1) Private toilets, baths, and showers: appropriate, function specific, privacy locks (either electronic or manual) are required at entry door(s), allowing staff members to have key or code access in case of emergency.

(2) Examination, procedure, and treatment rooms: appropriate privacy locks (either electronic or manual) are required at entry door(s), allowing staff members to have key or code access in case of emergency.

(3) Resident sleeping rooms: appropriate privacy locks (either electronic or manual) are required at entry door(s).

Exception: Inpatient Acute Care and Intensive Care patient rooms do not require privacy locks.

b) Privacy Curtains / Screens – See attached Room Illustrations. In extenuating conditions, disposable privacy curtains, portable screens, integrated blinds in glass, or other similar systems must be considered. If, due to specific existing conditions or operational requirements, it is not possible to provide a visually private patient changing area, the facility must establish a policy to ensure patient privacy while changing.

(1) Examination, procedure, and treatment rooms- 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.

Exception: Patient care rooms where a patient does not have potential for exposure of breast or genital areas.

(2) In-patient rooms (private / semi-private / multi-patient) - Provide privacy curtains to encompass adequate space for healthcare provider to perform bed-side examination unencumbered by the curtain. In these rooms the primary purpose of the bedside curtain is to provide the patient visual privacy from the room entry door during an examination or treatment and secondarily a visually private patient changing area where the provider, or other healthcare staff, can remain in the room.

Exception: Patient rooms in: Mental Health in-patient units, Intensive Care Units, Recovery, Emergency Departments, dedicated airborne infection isolation rooms, and other rooms with infection control concerns. In these rooms, provide disposable privacy curtains, portable screens, integrated blinds in glass, or other similar systems.

(3) Resident sleeping rooms (multi-bed sleeping rooms) – provide privacy curtains which encompass adequate space for healthcare provider to perform bed-side examination unencumbered, and provide a visually private patient changing area where the provider or other healthcare staff can remain in the room.

Exception: Private resident sleeping rooms do not require curtains.

https://www.cfm.va.gov/til/spclRqmts.asp#room

c) Diaper Changing Tables and Signage

(1) Provide diaper changing tables in designated public male, female, unisex, toilet rooms /restrooms, and all family restrooms; Provide a minimum of one per floor in male, female, and unisex restrooms. Toilet rooms/restrooms shall be no more than 300 feet within a building from areas accessible to a patient.

(2) Public toilet rooms/restrooms with changing tables must be appropriately identified in accordance with the VA’s Signage and Wayfinding Design Guide https://www.cfm.va.gov/til/spclRqmts.asp#SIGN .

(3) Public toilet rooms/restrooms without diaper changing tables shall have signage directing users to the nearest appropriate facility with a changing table. Signage shall be posted outside near the toilet room/restroom entrance and conspicuously within the toilet room/restroom.

(4) Toilet rooms/restrooms that include Baby Changing Stations must include the appropriate identification on the signage. Below are the VA signage graphics that comply with the VA Signage Design Guide. CFM Signage Manual requirements. Ref.

https://www.cfm.va.gov/til/spclRqmts.asp#SIGN , Chapter 09: Interior Signs: pages 9-4-3 and 9-5-29.

https://www.cfm.va.gov/til/spclRqmts.asp#SIGN https://www.cfm.va.gov/til/spclRqmts.asp#SIGN

(5) For restrooms not designated as containing Diaper Changing Tables, signage shall be placed to indicate to users where the nearest available diaper changing table can be accessed. Signage shall be posted outside the restroom, near the restroom entrance and conspicuously within the restroom.

d) Tampon/Sanitary Napkin Dispensers and Disposal Bins – Applicable to toilet rooms / restrooms listed below:

(1) Public toilet rooms/restrooms- sanitary napkin/tampon dispensers and disposal bins are required in each Women, Unisex, and Family toilet room/restroom.

(2) Non-public toilet rooms/restrooms accessible from or adjacent to examination rooms where pelvic examinations are performed- sanitary napkin/tampon dispensers and disposal bins are required in each restroom.

(3) Multi-stall public female toilet rooms/restrooms- disposal bins are required in each stall.

e) Gender Specific Clothing – Provide space, shelving, or casework required to stock appropriate clothing (e.g. robes, pajamas, patient gowns, etc.) for distribution for use in all healthcare settings.

f) Exam/Treatment/Procedure/Diagnostic Table Orientation - See attached Room Illustrations. All examination, treatment, procedure, and diagnostic tables must be placed in such a way that the genital area is not visible from the doorway.

Exception: Treatment/procedure bays (e.g. PACU, ED, Dental) and immovable diagnostic tables in imaging rooms including: Radiology, R & F, Mammography, Ultra- Sound, PET, CT, MRI, Nuclear Medicine, and Surgical Suites are exempted from this requirement.

g) Visual Privacy in Reception/Check-in/Waiting Areas - Veterans must be provided adequate visual privacy at clinic check-in, waiting areas and non-public clinic areas. This privacy includes the following:

(1) Patient names or other PII information shall not be posted in corridors or in public and restricted access clinic areas.

(2) At check-in locations a designated “queue line” is to be marked to provide an identifiable physical distance separation between the person checking in and the queue. The minimum distance from the front edge of the Check-in/Reception desk to the queue line shall be five (5) feet.

(3) Acoustical partitions are to be installed to provide visual privacy at multi-patient check-in counters.

(4) Provide a private room/area (e.g. private interview room, separate interview station) to accommodate private discussions such as conversations requiring more details than basic patient identification

2) Design Guides and Room Templates will be systematically revised to include the requirements of this Design Alert.

3) All parties in the planning, design, and construction process must comply with these requirements as fundamental in providing optimum environments for Veterans’ care and services, in fulfilling VA's mission.

October 1, 2018Page 5 Illustration 1

October 1, 2018 Page 6 Illustration 2

Illustration 3 October 1, 2018Page 7 003C2B-DA-149

October 1, 2018Page 8 Illustration 4

October 1, 2018Page 9 Illustration 5

October 1, 2018Page 11 Illustration 7

October 1, 2018Page 12 Illustration 8

October 1, 2018Page 13 Illustration 9 003C2B-DA-149

October 1, 2018Page 14 Illustration 10 003C2B-DA-149

October 1, 2018Page 15 Illustration 11 003C2B-DA-149

DECEMBER 1, 2021

003C2B-DA-150

Testing, Adjusting, and Balancing Firm Certification ISSUE: Prior to February 2020, the Veterans Affairs only allowed Associated Air Balance Council (AABC) or National Environmental Balancing Bureau (NEBB) as the standard under which the Testing Adjusting and Balancing (TAB) firm’s qualifications were approved in accordance with VA Master Construction Specification Section 23 05 93, TESTING, ADJUSTING, AND BALANCING FOR HVAC.

DISCUSSION: The National Energy Management Institute’s (NEMI) Testing, Adjusting and Balancing Bureau (TABB) contractor certification program, which is only available to Sheet Metal Contractors National Association (SMACNA) members and chapters, was added to VA specification section 23 05 93, TESTING, ADJUSTING, AND BALANCING FOR HVAC as a third optional standard for certifying TAB firms. The VA specification change was effective February 1, 2020.

REQUIREMENTS: Program offices shall coordinate with contracting officers to ensure specifications are updated on existing contracts and included in solicitations for new requirements. Program officers shall also ensure that Designers include the new criteria in future designs. Refer to VA specification section 23 05 93, TESTING, ADJUSTING, AND BALANCING FOR HVAC (https://www.cfm.va.gov/til/spec.asp).

ACKNOWLEDGEMENTS: If there are any questions on this CFM Design Alert, please contact Don Myers, Director of Facilities Standards Service, (202) 632-5388.

CONTACT: Facilities Standards Service at til@va.gov https://www.cfm.va.gov/til/spec.asp

DECEMBER 15, 2021

003C2B-DA-151

Cast Iron Fittings/Valve Housings, Prohibition of Use in High and Medium Pressure Steam Distribution Systems ISSUE: The VA has generally prohibited the use of Cast Iron fittings and pipe components (valves, steam traps, etc.) due to the risk of failure with shock loading. A recent accident involving the loss of human life has heightened the concern with the use of cast iron material on steam systems.

DISCUSSION: Based on the brittle nature of cast iron and the accident at a VA Medical Center, VA and VHA leadership has made the decision to discontinue the use of any cast iron or malleable fittings and components in high and medium pressure steam systems, whether existing or new. Facilities shall always use due diligence to avoid any sudden shocks to the steam distribution system, such as water hammer or energizing a cold steam system without a proper warm-up sequence.

REQUIREMENTS: New Construction, NRM, or any repair or replacement project must not use cast iron fittings and components or malleable fittings anywhere in the high-pressure and medium pressure steam system (15psi or above). All new construction must use cast steel or forged steel fittings only.

ACKNOWLEDGEMENTS: If there are any questions on this CFM Design Alert, please contact Douglas Ryan, Consulting Support Service, at douglas.ryan@va.gov.

mailto:douglas.ryan@va.gov

OCTOBER 14, 2022

003C2B-DA-152

Medical Gases for Surgical OR’s and Endovascular Procedure Rooms ISSUE: Discrepancies in the number and types of medical gases between room criteria and graphic templates utilized for surgical and endovascular projects:

The current Surgical and Endovascular Design Guide was found to have discrepancies between the written Room Data Sheets for room templates and the graphical representation indicated within the Reflected Ceiling Plans (RCP).

DISCUSSION: While reviewing each specific design data sheet against its accompanying graphical template, coordination issues between the two were found that require clarification.

The Room Data Sheet medical gases indicated do not correspond with the count and type of medical gases required by the Reflected Ceiling Plan. Therefore, to alleviate these discrepancies, all types, quantities, and locations of medical gas outlets will be as indicated on the Reflected Ceiling Plan. The Room Data Sheet will NOT be utilized regarding location, type and number of gas outlets.

Additionally, all proposed medical gases shall be reviewed and verified by local VA Medical Center Clinical Team Members as to type, quantity and location.

REQUIREMENTS: Refer attached Surgical and Endovascular Design Guide Template Corrections.

CONTACT: Zoltán János Nagy, RA-NCARB-AAH-AORN at Zoltan.Nagy@va.gov Facilities Standards Service at til@va.gov mailto:Zoltan.Nagy@va.gov mailto:Zoltan.Nagy@va.gov

REMOVE QUANTITY

4.2. PATIENT BAY, PRE-OPERATIVE HOLDING/ PHASE II RECOVERY (RRPR1)

4.3. PATIENT ROOM, PRE-OPERATIVE HOLDING/ PHASE II RECOVERY (RRPR2)

REMOVE QUANTITIES

4.5. OPERATING ROOM, GENERAL (ORGS1)

4.6. OPERATING ROOM, ORTHOPEDIC (OROS1)

4.7. OPERATING ROOM, UROLOGY / CYSTOSCOPY (ORCS1)

4.8. OPERATING ROOM, CARDIOTHORACIC (ORCT1)

4.10. OPERATING ROOM, NEUROSURGICAL (ORNS1)

4.11. OPERATING ROOM, ROBOTICS (ORRB1)

4.12. OPERATING ROOM, TRANSPLANT (ORTR1)

4.13. OPERATING ROOM, MONOPLANE HYBRID (ORHY1)

4.14. OPERATING ROOM, BIPLANE HYBRID (ORHY2)

ADD WAGD

4.16. CARDIAC CATHETERIZATION LABORATORY (XCCE1)

INTERVENTIONALRADIOLOGY (IR) LABORATORY (XACR1)

4.17. PROCEDURE ROOM, ELECTROPHYSIOLOGY (XCEP1)

4.18. TRANSESOPHAGEALECHOCARDIOGRAPH (TEE) PROCEDUREROOM (TRTE1)

SEPTEMBER 27, 2023

003C2B-DA-153

Biosafety Level 3 (BSL-3) Architectural & Engineering Considerations Update ISSUE: Engineering and Architectural Considerations in Biosafety Level 3 (BSL-3) Laboratories.

DISCUSSION: Due to safety and security protocols of BSL-3 laboratories, this design alert updates the BSL 3 requirements from the Mycobacterial Laboratories – BSL 3 Labs Architectural and Engineering Controls Update design alert (003C2B-DA-121) dated September 15, 2004.

Design Alert 121 is hereby rescinded.

REQUIREMENTS: For new construction or major renovation of clinical infectious diseases, infection control and epidemiology testing laboratories, the following architectural and engineering controls are recommended as per the following:

1. The BSL-3 laboratory area shall be identified based on discussions with the medical center personnel and Office of Research and Development program office.

2. The architectural and engineering design/contract documents shall identify the area requiring BSL-3 compliance.

3. Laboratory Facilities (Secondary Barriers) for Biosafety Level 3 Laboratories must comply with, but not limited to the following, VA directives and standards, along with nationally recognized standards:

a. VA Handbook 1106.01 – Pathology and Laboratory Medicine Service (P&LMS) Procedures

b. VA Handbook 1200.06 – Control of Hazardous Agents in VA Research Laboratories

c. VA Directive 1200.08 – Safety of Personnel and Security of Laboratories Involved in

VA Research

d. Biosafety Level (BSL) 3 Research Laboratory Physical Security Inspections, dated

March 23, 2007

e. VA Electrical Design Manual

f. VA HVAC Design Manual

g. VA Plumbing Design Manual

h. VA PG 18-14 - Room Finishes, Door, & Hardware Schedule

i. VA Physical Security and Resiliency Design Manual

j. VA Research and Development Design Guide

DESIGN ALERT 153 September 27, 2023 BSL-3 Architectural and Engineering Considerations Update

k. VA Structural Design Manual

l. National Institute of Health (NIH) Design Requirements Manual

m. Biosafety in Microbiological and Biomedical Laboratories (BMBL)

The following list of specific sections for the above references is intended to assist with navigating the documents for BLS-3 specific planning and design criteria but is not all inclusive.

a. VA PG 18-14 - Room Finishes, Door, & Hardware Schedule

i. Chapter 278 Research and Development, FA3: Biomedical Research Unit

Biosafety Laboratory Area.

b. VA Physical Security and Resiliency Design Manual must be followed with specific attention to the following sections for BSL-3 laboratories, 5 Functional Areas – 5.15 Research Laboratory and Vivarium:

i. 5.15.2.2 Interior Entry and Emergency Egress Doors

ii. 5.15.3 Construction

iii. 5.15.3.2 Interior Construction

iv. 5.15.3.3 Partitions

v. 5.15.3.5 HVAC

vi. 5.15.4.1 SSTV

vii. 5.15.4.2 Intercom

viii. 5.15.4.3 Biometric

ix. 5.15.4.5 Alarm

x. 5.15.6 Alteration/Renovation of Existing Facilities – Research Laboratory and

Vivarium

xi. 7.4 Prevention of Progressive Collapse

c. VA Research and Development Design Guide must be followed with specific attention to the following sections for BSL-3 laboratories:

i. 3.0 Building Technical Considerations: 3.5.6 Exhaust Hoods

d. NIH – Design Requirements Manual (DRM) must be followed with specific attention to the following sections for BSL-3 laboratories:

i. Chapter 1 – Administration, section 1.13 Security Requirements and Procedures:

Applicable for VA leased facilities. For VA owned facilities, follow VA’s PSRDM, VA Handbook 0730 and the references listed within.

ii. Chapter 2 – Planning and Programming, section 2.5 Biocontainment Facility Predesign

iii. Chapter 4 – Architectural Design, section 4.4.5 Wall and Ceiling Finishes for Aseptic Facilities, BSL-3, ABSL-3 and Similar Facilities

iv. Chapter 4 – Architectural Design, section 4.9 BSL-3 and ABSL-3

v. Chapter 6 – Mechanical Design, section 6.6 BSL-3 and ABSL-3

vi. Chapter 7 – Building Automation Systems, section 7.7 BSL-3 and ABSL-3

DESIGN ALERT 153 September 27, 2023 BSL-3 Architectural and Engineering Considerations Update

vii. Chapter 8 – Plumbing Design, section 8.6 BSL-3 and ABSL-3

viii. Chapter 10 – Electrical Design, section 10.8.4 Lighting BSL-3 and ABSL-3

Biocontainment

Notes:

i. NIH’s DOHS BioRisk Program: VA equivalent is Institutional Biosafety

Committee (IBC).

ii. NIH’s Division of Fire Marshal (DFM): VA equivalent is HEFP Fire

Protection Engineer.

iii. NIH’s Division of Occupational Health & Safety (DOHS): VA Environmental

Programs Services

iv. NIH’s Design Requirements Manual (DRM): VA’s Research and

Development Design Guide

v. NIH’s Division of Technical Resources (DTR): VA, CFM Offices of Facilities

Standards Service and Consulting Support Services

vi. NIH’s Office of Research Facility (ORF): VA equivalent is Office of

Research and Development

e. Biosafety in Microbiological and Biomedical Laboratories (BMBL) must be followed with specific attention to the following sections for BSL-3 laboratories:

i. Section IV - Laboratory Biosafety Level Criteria - Biosafety Level 3, D Laboratory Facilities (Secondary Barriers)

CONTACT: Don Myers, Director, Facilities Standards Service at 202-632-5388 Facilities Standards Service at til@va.gov

OCTOBER 19, 2023

003C2B-DA-154

Interstitial Space – Interim Guidance ISSUE: Minimum requirements for Interstitial Space need to be published for implementation in the design and construction of VA projects.

DISCUSSION: This Interim Guidance provides minimum requirements for the design and construction of Interstitial Space for VA medical facilities and will be in effect until the design standard is completed and updated. Implementation of this Interim Guidance shall be in coordination with applicable national/local building codes, standards, and VA criteria.

REQUIREMENTS: See attached document entitled Interstitial Space – Interim Guidance, October 19, 2023.

CONTACT: Fred Lau at Fred.Lau@va.gov Facilities Standards Service at til@va.gov mailto:Fred.Lau@va.gov?subject=Design%20Alert%20Interstitial

Interstitial Space – Interim Guidance

October 19, 2023

I. Introduction and Background:

This Interim Guidance provides minimum requirements for the design and construction of Interstitial Space for VA medical facilities and will be in effect until the design standard is completed and updated. Implementation of this Interim Guidance shall be in coordination with applicable national/local building codes, standards, and VA criteria.

The Interstitial Space is the unfinished or non-habitable space utilized for building service subsystems, of sufficient size to accommodate workers and permit maintenance and alteration without disruption of activities in functional spaces. The term usually refers to the portion of the service zone between the finished ceiling and the floor above. Equipment (e.g., building service equipment such as pumps, air handlers, etc.) is not to be placed within the interstitial space.

Infrastructure distribution, branches, and terminations to point of use occurs in the interstitial space. The ceiling is suspended below a shallow girder-and-beam structure rather than from a truss and is designed as a continuous platform to allow workmen to move freely over its entire surface. Minimum clearance under the beams is required to provide full headroom between beams.

The interstitial space is highly organized into reserved subzones for various services. The utilities in the area must be coordinated to provide clear access and passage for all trades, to minimize crossovers and other conflicts, for future extensions and additions, and to permit positive location of all components. While developing specific designs for the integrated subsystems, it is imperative that each decision be made in the context of its possible effects on the characteristics of all other subsystems. Early coordination is critical for an efficient and successful design. BIM modeling and associated clash detection are required to be utilized and demonstrated throughout the design process. Subzone organization of various subsystems is discussed and detailed throughout the VA Hospital Building Development Study. These examples are not intended provide a prescribed resolution to the total service module distribution challenge but attempt to show a general approach to a solution.