Building Engineering Services

POLICY AND SERVICE CONTEXT

Overview

Many of the Building Engineering Services of a health facility have specialised needs within the context of healthcare provision and infection prevention and control. Specialist needs may include a combination of hygiene, redundancy and contamination-control requirements over and above the normal best engineering practice. The Building Engineering Services dealt with in this document include: ventilation systems, wet services, gas and vacuum services, electrical services and electronic services. The primary function of this document is to provide terms of reference to designers who are contacted to develop building engineering services systems. This document does not serve as a principal facility planning guide but as a best-practice guide within any planned level of healthcare service.

“This document describes engineering design, installation and commissioning principles in terms of current specialist clinical, contamination control and maintenance requirements“

Policy and Service Context

Context This document serves as guidance in the development of all levels of the healthcare facility. Certain sections may not be applicable to all considered levels of facility although, where a certain engineering service is supplied, that service shall be developed in accordance with the guiding principles contained herein. Design principles This document will detail design principles within the scope of services described in the Engineering Council of South Africa’s gazetted Guideline scope of services and tariff of fees in terms of the Engineering Professions Act (46 of 200). This document will also describe design, installation and commissioning principles in terms of current specialist clinical, contamination-control and maintenance requirements. While this document details design requirements and acceptance criteria which have an impact on clinical services, these requirements are prescribed within the framework of the entire IUSS set of guidance documents, and cannot be viewed in isolation. The following documents should be complied with, together with this document:

Within the South African healthcare context, many clinical and administrative zones may be subject to infection prevention and control measures with particular consideration for airborne contamination control.

Service Context

Levels of care

1. “Levels of Care” is discussed in detail in the Project Planning and Briefing document. The Building Engineering Services document does not prescribe levels of care within the healthcare system and does not delineate the application of technology within these levels. It intends only to describe the building engineering services and technical aspects that should be considered from the concept development to the closeout and handover stages of the project. It is not incumbent on the engineer to prescribe appropriate levels of care and this subject is therefore not addressed herein. The allocation of appropriate technologies and services within the prescribed levels of care is a function of the engineer during the facility-planning stage as described by this document.
2. In this document, where three distinct options are made describing system quantities or capacities, these are to be interpreted as the minimum acceptable standard, recommended best practice, and maximum practical limit respectively. Where only two options are given, these are to be interpreted as the minimum standard and best practice respectively. Where only one option is given, this is to be interpreted as the minimum acceptable standard. The reader is cautioned not to interpret these capacity standards as levels of care.

King George V (KZN 2013)

PLANNING AND DESIGN

Overview

The national and provincial service and policy context should be the basic determinant of planning and design principles in the public sector

The national and provincial service and policy context (Part A of this document) is the basic determinant of planning and design principles in the public sector. In the private sector, planning and design will have determinants as defined by the service provider, within certain minimum prescribed limits. Part B describes the scope of planning and design guidance, design considerations and functional relationships between engineering systems. These principles are subsequently developed into a series of Design Specifications (Part C), Commissioning, Handover and Decommissioning (Part D) including some case studies (Part E). Parts C, D and E are intended to demonstrate how the principles prescribed in Part B should be applied. Parts C and D, if used directly, are deemed to satisfy the principles developed in Part B, but are not the only acceptable solutions. Case studies (Part E) are for illustrative purposes, to demonstrate worked solutions and should not be adopted without appropriate contextual adaptation

Stages of design and implementation

1. It is critical that building engineering services professionals involve themselves in the early stages of a project’s initial planning, studies, investigations and assessments. Exclusion or late inclusion of an engineering team from the planning stages of a multi-disciplinary construction project presents a considerable risk of resulting, not in savings, but fruitless expenditure, design delays and ultimately compromises in the functional and build quality of the product.
2. The scoping and broad coordination of services is invaluable during concept development, and the value-added through the early inclusion of building services professionals is frequently underestimated.
3. Briefing authorities or developers are therefore encouraged to ensure that the client’s representative consults with a team of engineering professionals during the earliest project-planning stages. The deliverables of the concept and viability study stages should, therefore, include the following:
   1. Summaries of collated information
   2. Reports on technical feasibility, benefits and risks
   3. Reports on regulatory compliance issues
   4. Reports on financial feasibility and risks
   5. List of consents and approvals required
   6. Schedule of additional surveys, tests, analyses, studies and investigations.
4. The Guideline Scope of Services and Tariff of Fees for Persons Registered in Terms of the Engineering Profession Act 46 of 2000 (2012) defines the following as within the Normal Scope of Professional Services.
   1. INCEPTION
      1. At the inception stage, the client’s requirements and needs are established. The project brief is established and the professional team is appointed. The professional team should contribute towards developing the project brief and concluding the terms of its appointment. Here the professional team should advise on criteria that could significantly impact on the project life cycle cost.
   2. CONCEPT AND VIABILITY STUDY
      1. At the Concept and Viability study stage, the preliminary design details and cost estimates should be finalised. This should be concluded in accordance with the project brief.
      2. A Preliminary design report would include the:
         1. Concept design
         2. Process design
         3. Schedule of design assumptions, required surveys, tests, reports and investigations
         4. Preliminary design details
         5. Installation and life cycle cost estimates
   3. DESIGN DEVELOPMENT / DETAIL DESIGN
      1. During design development the design team will further develop the concept to realise the following:
         1. Finalised design
         2. Detail specification outline
         3. Financial plan
         4. Project programme.
   4. DOCUMENTATION AND PROCUREMENT
      1. This stage is often combined with the design development stage.
      2. Its deliverables include:
         1. Procurement and construction documentation and specifications
         2. Application of timeous procurement strategies appropriate for the project
         3. Assisting in the tender evaluation of detailed services and samples for compliance with the design intent.
   5. CONTRACT ADMINISTRATION AND INSPECTION
      1. This stage includes the management and administration of the construction contracts and works to facilitate practical completion in accordance with the design intent.
   6. CLOSEOUT
      1. Closeout deliverables include:
         1. Final works-completion lists
         2. Financial reports and final accounts
         3. Facilitation in development of Operation and Maintenance Manuals (O&Ms), warranties and guarantees.
         4. As-built drawings

Design Questions

In order for the engineer to satisfactorily fulfil the user’s requirements, the following list of questions should be asked, answered and understood by the professional services team.

“Engineers responsible for the design of environmental control systems require guidelines and standards, in order to derive at and to specify appropriate solutions to the problem of building related illness (BRI) in occupied spaces.” -Dr S. A Parsons 2002

1. Is the building service required, and why?
2. What options are available?
3. What is the service’s required performance?
4. What is the service’s expected lifespan?
5. What is needed in terms of energy management?
6. What are the expected service consumption rates?
7. What are the expected occupancy profiles per planning unit, considering:
   1. Patient and staff numbers?
   2. Peak occupancy times?
   3. Airborne infection risk profile?
   4. Seasonal occupancy profiles?
8. What are service distribution constraints, considering:
   1. Location
   2. Space?
   3. Fire protection and regulations?
   4. Services coordination?
   5. Access for maintenance and operations?
   6. Repair replacement and refurbishment?
9. What are the minimum component/system requirements?
10. What are the specific requirements regarding functional controls?
11. What are validation and testing requirements
12. What are the Maintenance and operational requirements?
13. Commissioning and handover requirements
14. Special requirements for test and balance documents and certificates

Design considerations

Deep buildings

Deep buildings inevitably result in some measure of ventilation being required within the core areas. Where deep buildings cannot be avoided, the extent of building ventilation can be minimised by planning the deep-core areas as those that require specialist ventilation systems and which could not be served by natural ventilation.

Plant and plant room size and location

Noisy and vibrating equipment shall not be placed near, above or below sensitive areas such as operating rooms and ICUs. They shall be designed and located so as to give sufficient reduction in noise and vibration. Plant rooms shall be designed such that there is safe access to equipment for maintenance and repair activities. Plant rooms shall be located away from possible heat and contamination sources. Plant rooms shall be located in an accessible area which is secured from unauthorized entry Where plant room equipment presents a potential source of airborne contamination (e.g. Legionella and vacuum exhaust) the location of the plant room shall be such that contaminated air is not carried into occupied spaces and air inlets.

Life cycle cost determination

When planning and designing building engineering services, the engineer shall take cognisance of the service context within which the facility is placed. As part of the financial plan, outlined in the concept and viability study stage, the engineer will assist in developing the facility’s life cycle cost by giving input into the life cycle cost estimates for the services within the engineer’s responsibility. This financial plan shall be finalised as a deliverable of the detail design stage.

Environmental life cycle planning is a critical element of the life cycle planning but should be considered as a service additional to the scope of the normal prescribed services.

Site-survey requirements

In order for the engineer to plan adequately, a detailed site survey will need to be conducted to present essential planning information. These factors need to be weighed against the level of service to be provided.

The National Department of Public Works has developed a comprehensive site-survey model for the completion of this task (Citation needed). The following list summarises the information that needs to be developed.

1. Geotechnical considerations
2. Availability, quantity and quality of mobile phone reception
3. Availability, quantity and quality of services such as:
   1. Electricity
   2. Water supply
   3. Drainage conditions
   4. Gas
   5. Land and air transport
   6. Outsourced laundry and catering services
   7. Proximity to additional social services

Maintenance Considerations

Maintenance failures within the building services of the healthcare environment have the potential for severe consequences. Services should be designed with this in mind.
The design should consider the financial and environmental impact of disposable and reusable components within the planned maintenance regime. Reporting on the financial aspects of the life cycle plan is required within the normal scope of services of the planning and design project stages.
In the development of healthcare building engineering services the designer should consider the following maintenance challenges when designing systems and planning maintenance regimes: Where highly specialised services are installed in remote areas, it becomes difficult to source the requisite level of technical skills and, as a result, either maintenance costs rise or the serviceable life of these systems is decreased.
The availability of spares and contracted technical services becomes problematic in remote locations and this leads to difficulties with unscheduled maintenance and extended callout response times. Routine and unscheduled maintenance may need to be performed with a system in operation, with minimal down-time. This should be considered when planning levels of redundancy.
Routine and unscheduled maintenance should not have a negative impact of the service levels of healthcare. Where IPC and cross-infection risks are high, systems should be designed such that the maintenance staff can complete their work without affecting staff or patient safety.
For further guidance on health-facility maintenance, the IUSS Health Facilities Maintenance guidance document should be referred to.

Planning for retrofitting& decommissioning

While engineering systems may have a functional life of 20 to 25 years, healthcare buildings could have a life of 50 years. It is therefore likely that engineering services would need to be decommissioned, retrofitted, and replaced at least once during the life of a building, and these interventions should be planned for.
Projects with a retrofitting element shall include for the formal decommissioning of equipment or services which become redundant or obsolete as a result of the retrofitting project or can be conveniently decommissioned within the project. Decommissioning of any assets shall be undertaken in accordance with the Public Finance Management Act 1 of 1999, the Generally Accepted Accounting Practice, the Companies Act of 2006 and principles of good corporate governance.

When planning for retrofitting and decommissioning, consideration should be given to the following aspects:

1. Development and implementation of a risk assessment and hazard control plan.
2. Identification of clinician and IPC manager with authority to approve or halt construction activities under defined conditions.
3. Power requirements for future expansions and installations.
4. Emerging healthcare technologies.
5. Space for removal and refitting of equipment.
6. Materials of construction for recycling potential and disposal.
7. Toxicity and environmental impact of gases, paints and polymers.
8. Specific healthcare services risks (IPC, etc).
9. Occupational Health and Safety Regulations and requirements.
   

A risk assessment shall consider the following aspects:

1. Identification of occupancy groups which are susceptible to risks.
2. Identification of building services, such as ventilation, in the proximity of the construction activity and the potential impact on function. Specific consideration should be given to specialist ventilation systems.
3. Need for supplementary protection or support systems for building services.
4. Impact on fire-protection and -response systems, and action plans.
5. Impact of noise and vibration on occupants and equipment.
   

Opportunistic environmental or airborne microorganisms and allergens, which are liberated or distributed during retrofitting and decommissioning activities, can present a significant hazard to patients and employees unusually at risk. Where the environmental and risk assessments identify the need for intervention or mitigating controls, the following shall be considered:

1. Establishment of rigid non-permeable barriers between patients or staff and construction activities during construction, with the inclusion of appropriate “airlocks” where traffic between occupied and construction areas is required.
2. Increased ventilation rates and ventilation efficiency to areas at risk.
3. Extraction and filtration systems serving the construction area. Where there is chance of re-entrainment of diluted exhausted air, a minimum of an EN779-F9 filter should be installed as the final filtration stage. Where air is actively re-circulated it should be filtered with at least an EN1822-H13 final filter.
4. Establishment of a protective pressure cascade or airflow direction between zones.
   

For further guidance on the decommissioning of health facilities, the IUSS Health Decommissioning and Disposal of Health Facilities and Health Technology guidance document should be referred to.