Building Standards

(1) A hospital shall construct, arrange, and maintain the condition of the physical plant and the overall hospital environment in such a manner that the safety and well-being of the patients are assured. (2) After the applicant has submitted an application and licensure fees, the applicant must submit the building construction plans to the Commission. All facilities shall conform to the current edition of the following applicable codes as approved by the Commission: International Building Code (excluding Chapters 1 and 11) including referenced International Fuel Gas Code, International Mechanical Code, and International Plumbing Code; National Fire Protection Association (NFPA) NFPA 101 Life Safety Code excluding referenced NFPA 5000; Guidelines for Design and Construction of Health Care Facilities (FGI) including referenced Codes and Standards; U.S. Public Health Service Food Code; and Americans with Disabilities Act (ADA) Standards for Accessible Design. When referring to height, area or construction type, the International Building Code shall prevail. Where there are conflicts between requirements in local codes, the above listed codes, regulations and provisions of this chapter, the most stringent requirements shall apply. (3) The codes in effect at the time of submittal of plans and specifications, as defined by these rules, shall be the codes to be used throughout the project. (4) A licensed contractor shall perform all new construction and renovations to hospitals, other than minor alterations not affecting fire and life safety or functional issues, in accordance with the specific requirements of these regulations governing new construction in hospitals, including the submission of phased construction plans and the final drawings and the specifications to each. (5) No new hospital shall be constructed, nor shall major alterations be made to an existing hospital without prior written approval of the Commission, and unless in accordance with plans and specifications approved in advance by the Commission. Before any new hospital is licensed or before any alteration or expansion of a licensed hospital can be approved, the applicant must furnish two (2) complete sets of plans and specifications to the Commission, together with fees and other information as required. Plans and specifications for new construction and major renovations, other than minor alterations not affecting fire and life safety or functional issues, shall be prepared by or under the direction of a licensed architect and/or a licensed engineer and in accordance with the rules of the Board of Architectural and Engineering Examiners. (6) Final working drawings and specifications shall be accurately dimensioned and include all necessary explanatory notes, schedules, and legends. The working drawings and specifications shall be complete and adequate for contract purposes. (7) Detailed plans shall be drawn to a scale of at least one-eighth inch equals one foot (1/8” = 1’), and shall show the general arrangement of the building, the intended purpose and the fixed equipment in each room, with such additional information as the Commission may require. An architect or engineer licensed to practice in the State of Tennessee shall prepare the plans the Commission requires. (a) The project architect or engineer shall forward two (2) sets of plans to the Commission for review. After receipt of approval of phased construction plans, the owner may proceed with site grading and foundation work prior to receipt of approval of final plans and specifications with the owner’s understanding that such work is at the owner’s own risk and without assurance that final approval of final plans and specifications shall be granted. The project architect or engineer shall submit final plans and specifications for STANDARDS FOR HOSPITALS CHAPTER 0720-14 review and approval. The commission must grant final approval before the project proceeds beyond foundation work. (b) Review of plans does not eliminate responsibility of owner and/or architect to comply with all rules and regulations. (8) Specifications shall supplement all drawings. They shall describe the characteristics of all materials, products and devices, unless fully described and indicated on the drawings. Specification copies should be bound in an 8½ x 11 inch folder. (9) Drawings and specifications shall be prepared for each of the following branches of work: Architectural, Structural, Mechanical, Electrical and Sprinkler. (10) Architectural drawings shall include where applicable: (a) Plot plan(s) showing property lines, finish grade, location of existing and proposed structures, roadways, walks, utilities and parking areas; (b) Floor plan(s) showing scale drawings of typical and special rooms, indicating all fixed and movable equipment and major items of furniture; (c) Separate life safety plans showing the compartment(s), all means of egress and exit markings, exits and travel distances, dimensions of compartments and calculation and tabulation of exit units. All fire and smoke walls must be identified; (d) The elevation of each facade; (e) The typical sections throughout the building; (f) The schedule of finishes; (g) The schedule of doors and windows; (h) Roof plans; (i) Details and dimensions of elevator shaft(s), car platform(s), doors, pit(s), equipment in the machine room, and the rates of car travel must be indicated for elevators; and (j) Code analysis. (11) Structural drawings shall include where applicable: (a) Plans of foundations, floors, roofs and intermediate levels which show a complete design with sizes, sections and the relative location of the various members; (b) Schedules of beams, girders and columns; and (c) Design live load values for wind, roof, floor, stairs, guard, handrails, and seismic. (12) Mechanical drawings shall include where applicable: (a) Specifications which show the complete heating, ventilating, fire protection, medical gas systems and air conditioning systems; (b) Water supply, sewerage and HVAC piping systems; STANDARDS FOR HOSPITALS CHAPTER 0720-14 (c) Pressure relationships shall be shown on all floor plans; (d) Heating, ventilating, HVAC piping, medical gas systems and air conditioning systems with all related piping and auxiliaries to provide a satisfactory installation; (e) Water supply, sewage and drainage with all lines, risers, catch basins, manholes and cleanouts clearly indicated as to location, size, capacities, etc., and location and dimensions of septic tank and disposal field; and (f) Color coding to show clearly supply, return and exhaust systems. (13) Electrical drawings shall include where applicable: (a) A seal, certifying that all electrical work and equipment is in compliance with all applicable codes and that all materials are currently listed by recognized testing laboratories; (b) All electrical wiring, outlets, riser diagrams, switches, special electrical connections, electrical service entrance with service switches, service feeders and characteristics of the light and power current, and transformers when located within the building; (c) An electrical system that complies with applicable codes; (d) Color coding to show all items on emergency power; (e) Circuit breakers that are properly labeled; and (f) Ground-Fault Circuit Interrupters (GFCI) that are required in all wet areas, such as kitchens, laundries, janitor closets, bath and toilet rooms, etc, and within six (6) feet of any lavatory. (14) The electrical drawings shall not include knob and tube wiring, shall not include electrical cords that have splices, and shall not show that the electrical system is overloaded. (15) In all new facilities or renovations to existing electrical systems, the installation must be approved by an inspector or agency authorized by the State Fire Marshal. (16) Sprinkler drawings shall include where applicable: (a) Shop drawings, hydraulic calculations, and manufacturer cut sheets; (b) Site plan showing elevation of fire hydrant to building, test hydrant, and flow data (data from within a 12-month period); and (c) Show “Point of Service” where water is used exclusively for fire protection purposes. (17) The licensed contractor shall not install a system of water supply, plumbing, sewage, garbage or refuse disposal nor materially alter or extend any existing system until the architect or engineer submits complete plans and specifications for the installation, alteration or extension, to the Commission demonstrating that all applicable codes have been met and the Commission has granted necessary approval. (a) Before the hospital is used, Tennessee Department of Environment and Conservation shall approve the water supply system. STANDARDS FOR HOSPITALS CHAPTER 0720-14 (b) Sewage shall be discharged into a municipal system or approved package system where available; otherwise, the sewage shall be treated and disposed of in a manner of operation approved by the Department of Environment and Conservation and shall comply with existing codes, ordinances and regulations which are enforced by cities, counties or other areas of local political jurisdiction. (c) Water distribution systems shall be arranged to provide hot water at each hot water outlet at all times. Hot water at shower, bathing and hand washing facilities shall be between 105°F and 115°F. (18) It shall be demonstrated through the submission of plans and specifications that in each hospital: (a) A negative air pressure shall be maintained in the soiled utility area, toilet room, janitor’s closet, dishwashing and other such soiled spaces, and a positive air pressure shall be maintained in all clean areas including, but not limited to, clean linen rooms and clean utility rooms; (b) Rooms and areas containing radiation producing machines or radioactive material must have primary and/or secondary barriers to assure compliance with Regulations for Protection Against Radiation and security for materials. Radiation material shall be required to be stored and security must be provided in accordance with federal and state regulations to prevent exposure of the material to theft or tampering. (19) When constructing new facilities or during major renovations to the operating suites, the hospital shall ensure that male and female physicians and staff have equitable proportional locker facilities including equal equipment, and similar amenities, with equal access to uniforms. Existing hospitals shall strive to have equitable male and female facilities. If physical changes are required, the additional areas shall maintain the flow and divisions in the sterile environments. (20) The Commission shall acknowledge that it has reviewed plans and specifications in writing with copies sent to the project architect, the project engineer, the owner, the manager or other executive of the institution. The Commission may modify the distribution of such review at its discretion. (21) In the event submitted materials do not appear to satisfactorily comply with 0720-14-.08(2), the Commission shall furnish a letter to the party submitting the plans which shall list the particular items in question and request further explanation and/or confirmation of necessary modifications. (22) The licensed contractor shall execute all construction in accordance with the approved plans and specifications. (23) If construction begins within one hundred eighty (180) days of the date of Commission approval, the Commission’s written notification of satisfactory review constitutes compliance with 0720-14-.08(2). This approval shall in no way permit and/or authorize any omission or deviation from the requirements of any restrictions, laws, regulations, ordinances, codes or rules of any responsible agency. (24) Prior to final inspection a CD Rom disc, in TIF or PDF format, of the final approved plans including all shop drawings, sprinkler, calculations, hood and duct, addenda, specifications, etc., shall be submitted to the Commission. (25) The Commission requires the following alarms that shall be monitored twenty-four (24) hours per day: STANDARDS FOR HOSPITALS CHAPTER 0720-14 (a) Fire alarms; (b) Generators (if applicable); and (c) Medical gas alarms (if applicable). (26) Each hospital shall ensure that an emergency keyed lock box is installed next to each bank of functioning elevators located on the main level. Such lock boxes shall be permanently mounted seventy-two inches (72”) from the floor to the center of the box, be operable by a universal key no matter where such box is located, and shall contain only fire service keys and drop keys to the appropriate elevators.