Specifications in the new standard are game-changers for pathways and work areas in healthcare environments.
By Brian Ensign, RCDD, NTS, OSP, CSI Legrand Ortronics and Carol Everett Oliver, RCDD, ESS Berk-Tek a Nexans Company
Ratified in August 2010, the ANSI/TIA-1179 Healthcare Infrastructure Standard is the culmination of work that took place within the TIA TR-42 Engineering Committee. It is an example of the newer generation of standards from the TIA that address cabling infrastructure within specific areas or environments. A healthcare facility has different types of workspaces, including labs, patient rooms and other spaces in addition to areas that resemble more-traditional workspace environments.
While the TIA-568 series of standards effectively addresses cabling in traditional premises environments, the connectivity needs of healthcare facilities are far more complex than commercial buildings, and can be optimized only through a standard that recognizes their particular and often unique requirements. TIA-1179 does just that. In fact the standard was initiated by a group of healthcare-facility end-users who approached the TIA and stated that although they liked the then-current TIA-568-B standard, healthcare facilities had design, installation and construction considerations that 568-B did not address. Approximately half the members of the group that drafted and ultimately approved the TIA-1179 standard were healthcare-facility users.
The standard can be described as a game-changer in how designers, installers and users of structured cabling systems look at the spaces in those systems.
Market drivers
A combination of market, technical and regulatory drivers have brought healthcare facilities to the forefront, from a business standpoint, for the cabling industry. For more than a decade some provisions in the Health Insurance Portability and Accountability Act (enacted in 1996) have driven the electronic capture and storage of patient medical records. More recently the Health Information Technology for Economic and Clinical Health (HITECH) Act reinforced and even expanded security provisions of HIPAA, and further prompted healthcare facilities of all kinds to store medical records electronically.
With a significant amount of patient data now available electronically, medical professionals have been finding ways to use this data to conduct trend analysis and data mining while maintaining the mandated privacy and confidentiality of HIPAA and HITECH. Medical researchers are now able to aggregate patient data to assist in their diagnosis and prevention efforts. The idea of patient data as a tool for medical research comes with it the need for storage networks in which this data is housed.
Another growing trend in the medical-research field that is also driving the need for more robust networks is long-distance collaboration. A prime example is a surgical procedure being transmitted via video. Today when a patient is undergoing surgery, the on-site surgeon may be accompanied by a consulting surgeon who is at a remote location but can view the surgical procedure via video.
Pathways in focus
The TIA-1179 standard specifies requirements for telecommunications infrastructure intended to support a wide range of healthcare facilities and systems to include cabling, topology, pathways and work areas, and the devices attached to it. As mentioned earlier, pathways and work-area spaces within healthcare facilities are significantly different from those found in commercial buildings and the 1179 standard addresses this reality.
The standard recommends a minimum of two diverse pathways from the entrance facility to the equipment room. Doing so allows the user to segregate more-traditional network-type applications such as voice and data from other critical applications that are more specific to healthcare, such as imaging and diagnostic communications. Additionally, this type of pathway redundancy is crucial because in these healthcare environments, the network supports not only data or information flow, but often it quite literally supports the life and health of hospital patients.
The TIA-1179 standard also recommends larger equipment rooms and telecommunications rooms (TRs) than we're used to seeing. The standard recommendation allows for 100 percent growth when planning these spaces. That may initially sound excessive, but a significant consideration behind this recommendation is to prevent future disruption of rooms, hallways and other areas within a hospital. Hand-in-hand with this consideration is the standard guideline that the cabling-system pathways should not compromise the facility's operation.
Infection control requirements (ICRs) are a key factor in how much, or how little, access cabling-system technicians and managers will have to pathways in healthcare facilities. Consequently the 1179 standard advises that users may want to implement enclosed pathways, especially in air-handling spaces, to meet these ICRs. In general cabling-system designers are accustomed to using these open plenum spaces in which to route cables. In many cases they will find themselves without that luxury in healthcare facilities, challenging these design professionals to develop alternative system designs.
Another recommendation in the standard is to segregate cables for different networks and applications due to safety protocols. In practice this means keeping cables separate in accordance with the networks the cables are serving, the specific part of the network they're serving, or the work-area classification.
Redefining the work area
Perhaps the most significant difference between a healthcare facility and a commercial office building–and, not coincidentally, a major difference between TIA-1179 and the TIA-568 series of standards–is the treatment of work area spaces. Very much in contrast to the work area of a commercial office building, in which a communications outlet might service a computer, phone, printer and perhaps another user-administered device, a work area in a healthcare facility can take many forms. TIA-1179 addresses this reality by defining 11 work-area classifications. Each of those 11 classifications is further broken down into subgroups, and in total there are 75 work-area types defined in the standard.
The 11 work-area classifications defined in TIA-1179 are: Patient Services, Surgery/Procedure/Operating Rooms, Emergency, Ambulatory Care, Women's Health, Diagnostic and Treatment, Caregiver, Service/Support, Facilities, Operations, and Critical Care.
Each of these 11 work-area classifications and the subgroup work areas within them is characterized in the standard as a low-, medium- or high-density work area. The standard calls for 2 to 6 outlets, or ports, in a low-density work area; 6 to 12 outlets in medium-density work areas; and more than 14 outlets in high-density work areas.
For several high-density work areas, the need for redundancy is a driving force behind the number of outlets recommended. At the same time, many of these work-area spaces must be equipped to handle multiple temporary connections, such as test apparatus. Picture, for example, a patient room in which tests are conducted on the patient a handful of times per day. The diagnostic equipment used to conduct these tests travels from patient to patient and is plugged in only for the duration of the test being conducted. It is then unplugged and moved to another patient room. Yet the communications outlet must be available and ready at all times.
The redundancy inherent in some of these high-density work areas helps to ensure that network connectivity contributes to, rather than detracting from, patient care. Conversations with healtchcare-facility end users have confirmed that many of them have been planning high outlet counts in their most-critical work areas for these and other reasons. The many users who have faced this situation for some time now have in TIA-1179 a standard to which they can refer as an industry-agreed-upon figure for the number of outlets in these areas.
Of the 75 total work-area types recognized in the standard, 45 percent are designated as low-density, 25 percent are designated as medium-density and 30 percent are designated as high-density.
Putting the standard into practice
Many real-life examples exist of the principles in TIA-1179 being put into practice in a hospital or other healthcare facility. One example is Johns Hopkins Hospital in Baltimore, MD. In fact, next month's issue of this magazine will include an article focusing exclusively on the structured cabling system at Johns Hopkins Hospital. For now, we will concentrate on some of the practical applications of TIA-1179 that can be put in place in many hospital and healthcare environments.
Many new hospitals can have more than two dozen different low-voltage systems and while not all of those systems are necessarily Internet Protocol (IP)-based at the current time, convergence is rapidly taking place. Many facilities are being cabled today to support the eventual transition of these low-voltage systems to IP.
The new TIA healthcare infrastructure standard recommends a minimum of Category 6 copper cabling for horizontal runs, as well as 50-micron multimode fiber-optic cabling for high-bandwidth transmissions such as computed tomography (CT) scans and magnetic resonance imaging (MRI) exams. For backbones, the standard recommends multimode and singlemode fiber-optic cabling. As mentioned earlier, these backbones should be redundant.
Several factors make retrofitting a healthcare facility a difficult prospect, including the aforementioned ICRs and the TIA-1179 recommendation to use enclosed pathways to name just a couple. With these and other contributing factors in mind, as well as the bandwidth requirements and mission-critical nature of communications within healthcare facilities, it is recommended to design cabling systems to support the longest possible lifecycle.
While retrofitting is a difficult task, it is the reality for the many facilities that do not have the luxury of building a new system with the proverbial blank canvas. The TIA-1179 standard recommends the use of multi-user telecommunications outlet assemblies (MUTOAs) to provide the flexibility of adding up to 24 additional outlets to a work area. One important fact to keep in mind is that although MUTOAs provide flexibility, they also represent an additional potential point of failure in a system. So installers must take care when retrofitting a workspace with MUTOAs as the standard does not recommend this practice for new facilities. Also, notably, the TIA-1179 standard does not recommend the use of consolidation points (CPs) to add outlets to a work area.
Power over Ethernet (PoE) is also a consideration to make when cabling healthcare work areas. As mentioned earlier, some of the low-voltage applications used in healthcare facilities today are not IP-based but may transition to IP in the future. The ability to power these devices using the copper conductors of an unshielded twisted-pair cable, or the copper conductors within a composite copper/fiber cable construction, allows a facility to accommodate any PoE-enabled applications deployed today and provides the infrastructure needed for future PoE-enabled applications. Because of the critical nature of this environment, backup power via redundant uninterruptible power supply systems is recommended for all PoE injection systems.
Some other best-practice recommendations that are likely to apply in healthcare facilities include considering multifiber cable, preferably preterminated, in high-density work areas. These cable constructions will be cost-effective, reliable and the least disruptive in sensitive environments. Also, cables installed in hospitals will be subject to high levels of electromagnetic interference (EMI), temperature swings from area to area, and the possibility of contact with chemicals and other gases. These considerations may affect your choice of cables and may affect the manner in which those cables are installed.
Exposure to chemicals and other gases once again brings up the issue of pathways. The pathways in which these exposures may happen are crowded with specialized air and gas-delivery systems as well as more-traditional HVAC and other systems. Cables installed in these pathways must be able to withstand these environments without degradation.
One of TIA-1179's recommendations, mentioned earlier, is to segregate cables based on the applications or services they are supporting. One practical way to accomplish this is to color-code cables and connectors so they can be identified easily. While the TIA-1179 standard recommends color-coding cable, the standard does not specifically designate certain colors for services or applications.
Finally, as with all cabling installations, those that take place in hospitals must meet approval by the local authority having jurisdiction (AHJ). It is certainly in the best interest of everyone involved to research state, regional and local safety codes.
Brian Ensign is director of training and technology with Legrand Ortronics (www.ortronics.com) and Carol Everett Oliver is market analyst with Berk-Tek (www.berktek.com).
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