There is little question that healthcare facilities are critically important for public health and safety. From gigantic medical campuses like the Texas Medical Center in Houston to smaller, stand-alone outpatient surgical centers, such facilities have specialized systems and technologies that require extra rigor and diligence from commissioning professionals during all phases of new construction or expansion projects.
Commissioning for healthcare facilities is different than commissioning for more conventional commercial facilities because of the often unique and specialized systems that support core services. Hospital systems needed for life saving functionality must be always-on with non-interruptible power supplies and supported by sophisticated heating, ventilation and air conditioning (HVAC) systems. In environments that must have sterile airflow, tight tolerances for humidity and no power fluctuations to disrupt sensitive equipment, commissioning rigor must clear a high bar.
Early Involvement Is Vital
Involvement of commissioning agents early in the project design and development cycle can translate into time savings, cost efficiency and the most important deliverable: a safe project.
With most medical facilities seeking accreditation and certification by The Joint Commission, while also meeting codes and standards set by the American Society for Health Care Engineers (ASHE), a solid commissioning team will create a commissioning process that is especially rigorous. The Joint Commission is a not-for-profit organization that sets the gold standard for excellence among medical facilities and healthcare organizations through its comprehensive certification and accreditation program. ASHE stipulates that commissioning processes verify that medical building systems “are installed and performing in accordance with the design intent” and that they meet the requirements of both the owner and operations and maintenance staff.
A robust commissioning process for these facilities can be particularly complex as the inspections must cover basic mechanical, electrical and plumbing (MEP) infrastructure as well as the integration and performance of highly specialized medical equipment that is often owner-furnished and contractor-installed. While the commissioning process covers many of the same datapoints required of other facilities, it becomes especially complex due to the specialized equipment often needed by larger medical campuses and individual facilities.
For example, hybrid operating surgical suites equipped with digital imaging technology that supports surgical procedures must have precise temperature and humidity settings with controls that can rapidly adjust environmental conditions. For many procedures, temperatures must be set relatively low with corresponding low room humidity as incisions are made and probes or instruments inserted. Then, at the end of the procedure, temperatures and humidity settings may need to be ramped up rapidly to mitigate risks of infection or biological growth on surfaces.
Any space with a humidifier and venturi air valves providing precise ventilation and humidity controls may be a source of special concerns. From beginning to end of medical procedures, temperature and humidity controls must be highly responsive to critical needs. Oftentimes, this equipment works well in steady state conditions, but the transient states provide a large challenge to maintain the proper pressure, temperature and humidity parameters. As such, it is vital that the commissioning team develop a commissioning plan that encompasses an approach to verify settings and that all related stepwise functions are performing optimally.
Holistic Perspective
The roles of commissioning agents become especially important as the HVAC power, lighting and fire alarm systems need to integrate with highly specialized and costly healthcare equipment. The integration, verification and validation of these specialty systems can be easily missed without a holistic commissioning effort.
For example, medical gas systems and nurse call networks must be designed with special functionality, mainly because they interact with many other systems. Even with the correct installation of individual systems, testing and inspection are needed to verify they are integrated and interacting correctly with other codependent systems.
In conventional offices or other types of commercial facilities, verification of settings, controls and connections can proceed in a straightforward sequence as the building envelope is completed. With a healthcare facility, however, the sequence of a large project or multistage program often means that buildings are turned over in phases. These situations add further complexity, as the planning for commissioning of utilities prior to a full campus load is almost always a pinch point.
With basic equipment like air handlers, emergency power and fire alarm systems, the commissioning process may be relatively straightforward. However, the special operational parameters of medical equipment are what pose special challenges to healthcare facility commissioning. For large buildings with multiple floors dedicated to unique specialties like oncology or cardiac care, many rooms have unique equipment or environmental conditions with special set points that must be on the radar of commissioning agents.
An experienced commissioning agent will have a broad view of the functionality of how all the disparate systems work together to meet the overall operational requirements of a medical facility.
Risks can be greatly mitigated with early preparation and planning by commissioning agents before the start of the project.