Health care facilities have unique commissioning requirements

Most building owners and facility managers understand the importance and value of systems commissioning. Comprehensive commissioning offers quality assurance and risk management that ensures the systems efficiently and effectively meet the owners’ and users’ requirements. While commissioning guidelines and standards are appropriate for most buildings, some facilities have unique requirements. Health care facilities face different conditions than most commercial buildings. Many operate 24 hours a day, 365 days a year, have a vulnerable population and often require different HVAC systems.

The American Society for Healthcare Engineering (ASHE) developed health facility commissioning (HFCx), a process for hospitals and other health care facilities. ASHE published “Health Facility Commissioning Guidelines” in 2010 and “Health Facility Commissioning Handbook” in 2012. While the phased process is similar to ASHRAE’s commissioning process, there are differences, including:

  • The entire project team, including the commissioning authority, is accountable for the actual building performance.
  • A business plan should be developed for every HFCx project. ASHE stresses the value derived from commissioning activities and defines it as value = benefits/cost. In addition, ASHE stresses the importance of establishing performance criteria and energy targets for each project.
  • The design review process is more intense, with an emphasis on the review of the control system sequences of operation. Design documents are reviewed with a focus on commissionability (ASHE’s term), completeness, cost effectiveness, coordination of trades and energy efficiency.
  • The HFCx authority (HFCxA) is recommended to review the control system programming before implementation and startup.
  • Pressure testing is recommended for all areas requiring positive and/or negative pressure rooms. There are steps required to test these, as well as pressure testing of the building envelope.
  • The HFCxA must lead facility operations and maintenance (O&M) personnel on regular tours of the construction site, documenting their comments.

For more information about health facility commissioning, please contact Bob Knoedler at or Tom Goodman at

Posted on October 16, 2015