Mechanical, electrical, and plumbing system design for the total renovation of the fourth floor of VCU Health Systems Main Hospital. The 56,000 SF project included patient rooms, negative pressure rooms with monitoring, an apheresis clinic and various support spaces. The mechanical scope included supply and return fan motor replacement of the existing air handling unit for compatibility with new variable frequency drives to provide controllable variable air volume operation. A steam humidifier was also added to the existing air handling unit to improve comfort conditions on the 4th floor. Ventilation calculations were performed for the 100 zones and over 200 spaces to ensure compliance with FGI Healthcare Guidelines. Plumbing design included new patient and staff toilet rooms, resident and faculty sleeping quarters and shower spaces, specialty lab and clinical sinks, lounge and break areas, and major modifications and expansion of the existing medical gas systems (piping, zone valves and alarm panels) and the separation of the 3rd and 4th floor medical gas systems. Electrical design included modifications to the existing emergency power distribution system to accommodate additional loads. Existing lighting, fire alarm, nurse call, and paging systems were replaced to accommodate the new 4th floor layout.