Natural VentilationWhile operable hospital windows are primarily intended

for emergency use in the case of fire, there are other

situations in which patients, nurses or other staff may

desire natural ventilation. Nasty spills or smells may need

to be quickly “aired out”, a power failure or equipment

failure may temporarily disable fans or a breath of fresh

air on a pleasant day may simply be “just what the doctor

ordered”. Even when windows have access control locking

devices, keys are commonly available at the nursing station.

With recent reports of “sick building” syndrome,

indoor air quality is certainly a topic of concern for anyone

in building management or the construction industry.

DaylightingIn other building types, studies have documented the

salutary effects that natural daylight and ventilation

have on office worker productivity and wellness, as well

as student learning. There is no reason to doubt that a

similar phenomenon would be noted in patient recoveries.

Recognizing this, the AIA’s 2001 Guidelines for Design

and Construction of Hospital and Health Care Facilities

paragraph A7.2.A3 states, “Windows are important for

the psychological well-being of many patients, as well

as for meeting fire safety code requirements.”

CleaningCertain operable windows are designed so that maintenance

personnel can clean the outside glass surface from the

interior. This ease of maintenance not only improves

building appearance and staff safety, but may also represent

a life cycle cost savings since product maintenance may

increase service life.

A Balanced ApproachAs a standard setting organization, AAMA recognizes that

due to the general nature of any code or standard, it is

difficult to prescribe whether operable or fixed windows

are the appropriate choice for all hospital applications.

However, a balanced assessment of operable windows

versus “break out” fixed glazing or mechanical emergency

ventilation is in the best interest of the building team,

owner, staff, occupants, and local protective services,

especially in a hospital environment.

Code Change ReferencesThe American Institute of Architects (AIA) 2001 Guidelines

for Design and Construction of Hospital and Health Care

Facilities, and the National Fire Protection Association

(NFPA) 2000 Life Safety Code Handbook have eliminated

requirements for operating windows to provide emergency

ventilation for patient rooms in the case of fire.

AIA 1996: “Patient rooms or suites in new construction

intended for 24–hour occupancy shall have windows or vents

that can be opened from the inside to vent noxious fumes

and smoke products and to bring in fresh air in emergencies.

Operation of such windows shall be restricted to inhibit possible

escape or suicide. Where the operation of windows or vents

requires the use of tools or keys, these shall be on the same

floor and easily accessible to staff. Windows in existing buildings

designed with approved engineered smoke control systems may

be of fixed construction.”

AIA 2001: “Operable windows are not required in patient

rooms. If operable windows are provided in patient rooms or

suites, operation of such windows shall be restricted to inhibit

possible escape or suicide.”

NFPA 1985: Every patient sleeping room shall have an

outside window or outside door arranged and located so that it

can be opened from the inside to permit the venting of products

of combustion and to permit any occupant to have direct

access to fresh air in the case of emergency. The maximum

allowable sill height shall not exceed 36 in. (91 cm)… keys

shall be located on the floor involved…accessible to staff.”

By NFPA 1997, the specific requirement for operable

windows had been removed, but the commentary below

had not yet been added.

NFPA 2000: “Paragraphs 18.3.8.1 and 19.3.8 requires an

outside door or outside window in each room where patients

sleep. The window is not required to be operable. A maximum

allowable sill height of 36 in. (91 cm) is specified for new health

care occupancies…. Sill height is limited in new construction

to ensure access to the window should it ever need to be used

for ventilation purposes…”

OPERABLE WINDOWSIN HEALTHCARE FAC IL I T I E S

P L A N N I N G F O R

PatientSafety

AMERICAN ARCHITECTURAL MANUFACTURERS ASSOCIATION

The Source of Performance Standards, Product Certification,

and Educational Programs for the Fenestration Industry.SM

WWW.AAMANET.ORG

AMERICAN ARCHITECTURAL MANUFACTURERS ASSOCIATION

1827 Walden Office Square, Suite 550

Schaumburg, IL 60173-4268

(847)303-5664

FAX (847)303-5774

WWW.AAMANET.ORG

An Architect’s PerspectiveRegistered Architect Gene Wells of Marshall Erdman

& Associates, a leading national health care design and

construction firm, offers the following: “In today's hospital,

huge efforts are being made to create a healing environment

for patients and their families. A non-institutional approach

lessens the stress level for people who already

have too much stress and leads to better

outcomes. Patient's rooms, in particular,

are often designed to reflect local

culture, connect with nature or create

a hotel-like environment. Operable

windows can be an integral part of

this atmosphere.”

She adds, “The issue of control is

also important. Operable windows can

give patients a small controllable

piece of an environment

in which they may feel

like they have very

little control. This can

increase patient satisfaction, even if

they never actually open the window.”

Operable WindowsBEYOND F IRE SAFETY

Energy Savings and Environmental ImpactIn many parts of the U.S., natural ventilation offers a

seasonal opportunity for air-conditioning energy savings

if included as part of the HVAC design, balancing and

operating plan. Recognizing their sustainable design

benefits, the U.S. Green Building Council LEED™

Rating System awards points for operable windows

in the “Ventilation Effectiveness” and “Controllability

of Systems” credit categories.

Fire Safety AlternativesThe AAMA “Window Selection Guide” (WSG.1-95) states,

“Most deaths occur in fires because of suffocation, not

because of burning.” This fact becomes especially important

in hospital patient rooms considering that, according to

the NFPA Life Safety Code® Handbook, 2000 edition,

“Unlike most other buildings and use groups addressed

by the Code, the least desirable emergency action in a

health care occupancy is the wholesale relocation and

evacuation of patients. For this reason, a defend-in-place

strategy is used … During a fire, the emergency evacuation

of patients in health care facilities is an inefficient, time-

consuming process.” This suggests that smoke control

options should be key considerations when designing

hospital patient rooms.

Operable WindowsIt is the condition of the patient nearest the fire that

is most relevant when considering the use of operable

emergency ventilation windows, which may relieve

smoke in the immediate area without spreading

it into previously unaffected areas.

Smoke DampersThough often considered the “first line of defense” against

the spread of smoke from room-to-room, dampers are not

always required by code in ducted barrier penetrations in

hospitals. Some provisions are designed to protect occupants

in other areas such as the Florida Administrative Code

(ACHA) Chapter 59A-3 which states, "During a fire

alarm, fan systems and fan equipment shall be stopped

or controlled to prevent the movement of smoke by

mechanical means from the zone in alarm.” However,

stopping fans also naturally slows the exhaust ventilation

of the area near the fire.

Engineered Smoke ControlIn some local code jurisdictions, complex “engineered

smoke control” systems may be used. As an example, the

Massachusetts State Board of Building Regulations and

Standards 780 CMR 921.2 states, “[Mechanical] provisions

[can] be made for smoke removal from the space at a rate

of not less than two changes per hour … moved directly

to the outside without re-circulation to other areas of the

building.” The Florida Building Code Section 412.5

requires six changes per hour and adds, “…the air handling

equipment [must be] connected to the standby power and

light system.” NFPA requires that such smoke control

systems be fully tested on a periodic basis and designed

as “fail-safe” in a power outage or equipment failure.

Paragraph A7.2.A3 of the AIA’s Guidelines for Design

and Construction of Hospital and Health Care Facilities,

2001 edition, states, “Windows … are also essential for

continued use of the area in the event

of mechanical ventilation

system failure.”

Evaluating CostsIn the absence of operable windows, the designer must

pay particular attention to special mechanical requirements

and assess the incremental costs involved in analysis,

equipment and installation, as well as the adequacy of

the smoke exhaust rate in a fire emergency.

An operable side-hinged in-swing casement vent at

every third lite usually adds about 10% to the average

installed cost of a fixed strip window system of comparable

performance and features. This added cost should be

weighed against the cost of the “engineered smoke control

system,” recognizing that operable windows offer more

benefits than just those related to fire safety.

n Fully Tempered Safety Glass – This glass is even more

difficult to break since it is at least four times as strong

as annealed glass, although it does shatter into small,

relatively harmless fragments. If the force of a blunt

object fails to break tempered glass, a sharp pointed

instrument or object is typically effective.

n Special Glass Types – In some cases, laminated acoustical

glass, hurricane impact-resistant glass, psychiatric glass

or polycarbonate are required and will present an

effectively impenetrable barrier to occupants and staff.

In these cases, glass breakage cannot be expected and

emergency ventilation must be accommodated another

way.

Irreversible – In some instances involving differential

atmospheric pressure, the introduction of added oxygen

from an open window could actually make a small fire

more difficult to contain. Since operable windows can

be re-closed, the flow of oxygen exacerbating the fire

can be stopped.

Glass RemovalArchitectural framing systems require specialized knowledge

and tools to deglaze and, in most cases, cured sealants

must be cut. While complete glass removal might appear

to be a preferred alternative to glass breakage, it is simply

not realistic.

Registered Nurse Margaret Zvoda notes,

“In the case of fire, it is the nurse’s

primary responsibility to calm patients

and ensure their safety. Whether they are

ambulatory or in need of complete bed rest,

it takes time for a nurse to prepare them

to move out of a smoke-filled room.” She

adds, “Instant access to fresh air would

help immeasurably. Either patients or

nurses could be asthmatic, adding to

the urgency of the situation.”

A Nurse’s Perspective

The Practical Side of Glass Breakage or RemovalIt is assumed that fixed glass could be broken out in case

of emergency for ventilation in typical patient rooms.

While professional emergency responders, with special

tools and training, may meet fewer challenges when

attempting this, it is typically a member of the nursing

staff who is first on the scene and may have difficulty

breaking the glass in commercial windows.

Glass Breakage ChallengesGlass Thickness – To ensure structural integrity, 1/4”

(6mm) or thicker glass is typically specified for non-resi-

dential applications. Even non-heat-treated annealed 1/4”

glass is difficult to break unless employing a heavy object

or other tool with a sharp, tough edge. Panic, confusion,

integral Venetian blinds, window coverings and reduced

visibility in a smoky room all add to the difficulty.

Broken Glass – Injury hazards may exist when glass is

broken out of a window.

n Standard Annealed and Heat Strengthened Glass – These

types of glass lites break into large fragments which

may remain in the opening and the sharp edges pose

a serious hazard to people on the inside and outside.

WindowsWindows are expected to meet a variety of

objectives in building projects – lighting,

ventilation, aesthetics, security, building

envelope protection, thermal performance,

emergency escape and rescue, and more.

To meet these objectives, numerous factors

must be considered when selecting windows

for any building application; however,

healthcare facilities, like hospitals, require

some additional attention considering the

purpose and occupants of the building.

Based on this concept, architects should

carefully evaluate and accommodate fire

safety needs for hospital applications.