Structured Cabling Standards for Hospitals

The drafting committee for a TIA standard for hospital and healthcare cabling will address many issues, including pathways and spacing.

A working group within the Telecommunications Industry Association (TIA; www.tiaonline.org) TR-42.1 is nearly ready to deliver a specification document for cabling in healthcare environments, including hospitals. The final document will become the healthcare standard, and by the time of its publication, it will be the culmination of years of research and effort.

The Working Group's origins date back to 2003, "when the first requests for a standard on healthcare facilities were leaked in TR-42.1," recalls Herb V. Congdon II, PE, market manager with AMP Tyco Electronics Netconnect (www.ampnetconnect.com), who chairs the working group and is the lead author of the document. "After some cursory market research, the subcommittee concluded that it was a worthwhile project and launched a working group.".

Congdon explains that around the same time, TR-42.1 began working on the TIA/EIA-568-C Series of Standards. Because the simultaneous development of the series and a standard for healthcare facilities could lead to duplication of effort, the Healthcare Working Group remained inactive until Standard 568-C.0 was published. Late last year, the working group was reactivated to begin work on a new standard, which is based on 568-C.

IP Applications

The working group members, in their official research for this standard, as well as in the performance of their professional duties over the years, encountered several fundamental issues affecting the design and installation of cabling systems in healthcare environments. One of these is the current and future migration of Internet Protocol (IP) communication applications and the corresponding need for structured cabling systems to support current and future applications. Indeed, this reality is evident to many cabling professionals who dedicate time and effort to supporting healthcare environments, regardless of whether they are involved in the standards development process.

“Unifying IP as a standard for every device in a hospital has great potential for the environment,” says Roger Jette, president of SnakeTray (www.snaketray.com). Patient appointment rooms serve as an example: “IP telemetry devices and other devices used for patients are now part of the network.”.

Simon Cowley, North American sales technical director for CommScope (www.commscope.com), cites All Children's Hospital in St. Petersburg, FL—a recent new construction project utilizing CommScope cabling systems—as an example of current, IP-based communications devices, as well as those to come. “Every hospital can be considered to have a convergence in its design,” he says. “They have IP phones and cameras, which bring many benefits, but you also need to plan the cabling for the applications.”.

One of the new IP applications being used in the facility is an alarm management alert system, which incorporates personal communication equipment for caregivers, allowing users to respond through the use of voice from remote intercoms via IP devices.

“In general, the medical environment is very fertile ground for messaging and intelligence convergence,” says Cowley. “I attended a recent healthcare summit where this theme of convergence resonated with the CIOs. Many of these are 20- to 25-volt systems environments. Not all applications are ready to go IP yet, but in the coming years, as systems migrate to IP, I see this type of convergence only accelerating.” 

Ways and spaces

Planning pathways and spaces for healthcare facilities has proven to be an important task in the daily life of designing wiring systems and installation, as well as in creating the document that will become the TIA standard.

Jette from SnakeTray says: “Hospital spaces are probably the most complex in the world. In addition to the traditional live voltage, you have both traditional and non-traditional HVAC systems. Some patients are in negative pressure areas, while other areas will receive medical air, nitrogen, and oxygen. It's a huge volume of specialized areas, and hospitals are probably where the most critical aspects of facility pathway design occur. They must be designed into the building from the very beginning.”

Jette recalls a new hospital construction project on Long Island, where “the architects compressed the building’s height, which complicated all these issues and forced us to fabricate specialized trays to fit spaces no one had anticipated.” He suggests that, looking a bit further ahead, hospitals may be among the first facilities to be viewed in three-dimensional building design “to create an engineered building that can have all these services coexist without conflict.”

Although the standard will originate from the TIA TR-42.1 group, a specialized subcommittee, the significant differences between healthcare and commercial building environments add to the challenges the working group has faced thus far. For one thing, healthcare facilities and hospitals, in particular, are long-term structures that will remain in place for decades once occupied. From a practical cabling perspective, this impacts the planning of pathways and spaces.

Ehvert de Maloney commented, “From my perspective, the real benefit of this document will be to have an industry standard that supports the struggles consultants, cable plant designers, and end users have been facing. It's getting people to think 25 to 30 years ahead, and as such, the supply pathways and spaces that today seem large but will certainly be needed 10 to 15 years from now, let alone 20 to 25 years from now. Wireless is becoming increasingly integrated into healthcare facilities, but that doesn't lessen the need for cabling and the associated pathways and spaces.”

Congdon also explains the differences between a traditional office environment and that of a healthcare facility. In an office-oriented setting, workspaces may vary and include cubicles, walled offices, and conference rooms. But these different spaces all contain similar types of equipment and have similar cabling outlet requirements. 

Clarifying Terms

“When we started looking in healthcare facilities—hospitals, across all services—one of the biggest challenges was identifying what we call the equivalent of work areas,” he reflects. “If I go to a hospital in one city and ask to see a patient room, you might see a place where the patient waits to speak with a doctor. In a different hospital in a different city, what they call the patient room might be closer to an operating room. It’s been difficult to find a clear definition of what a patient room is.”.

The working group ultimately narrowed it down to nine room type categories, for example, "Diagnostic and Treatment" and "Means of Care." These nine categories are further broken down into workspace categories; in total, the group came up with more than 50 individual room types.

“We’re not trying to define all these types,” Congdon explains. “Firstly, it’s not our area of expertise. And secondly, if you define it one way, there will be other facilities that have different areas. There’s a wide variety of rooms in a healthcare setting,“ he emphasizes.

The working group categorizes the dozens of room types according to the media concentration required. “For example, a reading room or waiting room might need a low concentration,” says Congdon. “Once you get to a pharmacy or a procedure room, you’re likely to have a higher concentration.”

The document recommends two to six outlets in a low-concentration room, six to 14 outlets in a medium-concentration room, and 14 or more outlets in a high-concentration room. “If you have 14 or more outlets in a room, then we don’t all have to go to a single faceplate,” says Congdon. “On one wall, you can have outlets for nurse call and other communications. On another wall, it could be a TV input, perhaps for video. Also, in a space like an operating room, outlets can be in the ceiling so that cables don’t run across the floor.”

Given the number of rooms with high concentrations of these communication outlets, coupled with the expectation that more communication systems will be IP-based in the future, the need for adequate space in telecommunications rooms to accommodate these cabling systems is underscored. This also makes a case for pre-installing cabling to meet future needs. 

Building for the Future

Congdon concludes, “In a healthcare facility, it’s important to analyze the provision of sufficient space for pathways and spaces. Relocations, additions, and changes are very difficult in healthcare settings. Care control restrictions force you to take many considerations into account before drilling a hole through a wall or inserting a ceiling tile in an emergency room. Pathways and spaces is a topic we’ve discussed in the working group, and the discussion has been along the lines of sizing the facility for what will be needed over time.“.

The standard for healthcare facilities is currently in draft 0.1 and has not yet been officially adopted as TR-42.1. It has been under review by professionals who recommend, design, install, and use structured cabling systems in these environments. As such, it is intended to serve as an essential planning tool for the construction of these facilities.