4/18/2017. *2012 edition of NFPA 99 has gone through a major overhaul. *This document is now a Code.
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1 Carsten Lunde, ASSE 6050 Instructor April 20, 2017 Carsten s Yearly Analysis, Inc. Any opinions expressed verbally by the speaker before you and all text in this presentation should be considered the speakers opinion. These statements are NOT official views or opinions of the NFPA, ASSE or MGPHO Committees. VP Credentials, MGPHO (Former) Medical Gas Professional Healthcare Organization Credential Medical Gas Verifier edition of NFPA 99 has gone through a major overhaul. This document is now a Code. Prior editions were a Standard. 1999, 2002 and 2005 NFPA 99, 1999 edition organized by gas and vacuum systems. Occupancy based document. NFPA 99, 2005 edition contents and structure reflect an occupancy based document. Reorganized by Level of Risk piping systems. Medical gas and vacuum moved to Chapter 5. NFPA 99, 2012 edition contents and structure reflect a risk management document. Fewer chapters based on systems. Only Chapter 14 is based on occupancy Hyperbaric Oxygen Facilities
2 The significant statement found within the NFPA 99, 2012 document: The risk to a patient receiving a procedure is the same whether the procedure is performed in a Doctors Office or a Hospital. The premise regarding the change to risk management. Occupancy Chapters contained in NFPA 99, 2005 have been eliminated. Chapters 11 Laboratories 13 Hospital Requirements 14 Other Health Care Facilities 17 Nursing Home Requirements 18 Limited Care Facility Requirements 19 Electrical and Gas Equipment for Home Care 21 Freestanding Birthing Centers 5 6 Risk based Chapters in NFPA 99, 2012 Fundamentals Chapter 4 Electrical Systems Chapter 6 Information Technology and Communications Systems for Health Care Facilities Chapter 7 Plumbing Chapter 8 Heating, Ventilation and Air Conditioning Chapter 9 Electrical Equipment Chapter 10 Gas Equipment Chapter 11 Emergency Management Chapter 12 Security Management Chapter 13 Hyperbaric Facilities Chapter 14 Features of Fire Protection Chapter 15 Annexes contained in NFPA 99, 2005 have been eliminated. Annex Nature of Hazards (B) Safe Use of High-Frequency Electricity in Health Care Facilities (D) Flammable Anesthetizing Locations (E) 7 8 2
3 Annexes contained in NFPA 99, 2012 Annex A Explanatory Material The same B Additional Explanatory Material Was Annex C C Sample Ordinance Adopting NFPA 99 Was Annex F D Informational References Was Annex G Chapter One The scope of work in 1.1 has been expanded from 4 sub-sections to 13 sub-sections in (1) States Chapter 4 establishes criteria for levels of health care services based on risk to: Patients Staff Visitors Chapter 5 covers non-flammable medical gases sources and piping distribution systems with operating pressures less than 300 psig. Performance Maintenance Installation Testing
4 1.1.3 (2) (3) Chapter 5 covers vacuum source and distribution piping systems. Performance Maintenance Installation Testing Chapter 5 covers Waste Anesthetic Gas Disposal (WAGD) source and distribution piping systems. Performance Maintenance Installation Testing (4) Chapter 5 covers Manufactured Assemblies. Performance Maintenance Installation Testing Chapter 6 covers Electrical Systems. Performance Maintenance Testing
5 Chapter 6 DOES NOT cover: (1) Wiring requirements and equipment installation is referred to NFPA 70. (2) Illumination and identification of means of egress is referred to NFPA 101. (3) Installation, testing and maintenance of fire protection signaling systems are referred to NFPA 72. (4) Requirements for installation of Fire Pumps are covered in NFPA 20. (5) Stationary Engines and Gas Turbines are covered in NFPA Chapter 7 covers Information Technology and Communications Systems in Health care Facilities. Performance Maintenance Testing Chapter 8 covers Plumbing Systems in Health care Facilities. Chapter 9 covers heating, cooling and ventilation in Health care Facilities. Performance Maintenance Testing Performance Maintenance Testing
6 Chapter 10 covers electrical equipment in Health care Facilities. Chapter 11 covers gas equipment in Health care Facilities. Performance Maintenance Testing Performance Maintenance Testing Chapter 12 establishes criteria for emergency management in developing a programs within Health care Facilities for: Effective disaster Preparedness Response Mitigation Recovery Chapter 13 covers Security equipment and systems in Health care Facilities Performance Maintenance Testing
7 Chapter 14 covers Hyperbaric Facilities This is still an occupancy based Chapter. Minimum requirements for Hyperbaric Facilities to prevent Explosion Implosion Fire Electrocution Chapter 15 covers fire protection equipment in Health care Facilities. Performance Maintenance Testing Purpose of NFPA Code Provide minimum requirements for Facilities, material, equipment and appliances Installation Inspection Testing Maintenance Performance Safe Practices This code applies to all health care facilities other than home care
8 This code document is intended for use by those persons involved in Health care Facilities Design Construction Inspection Operation An existing system that is not in strict compliance with the provision of this code shall be permitted to be continued in use, unless the Authority Having Jurisdiction (AHJ) has determined that such use constitutes a distinct hazard to life Patient Care Rooms The governing body of the FACILITY or its designee shall establish the following areas in accordance with the type of patient care ANTICIPATED and with the following definitions of the classifications: (Usually Risk Management Committees or Chairperson of the committee) (1) Critical Care Rooms (2) General Care Rooms (3) Basic Care Rooms (4) Support Rooms
9 Anesthesia Wet Procedure Locations. It is the responsibility of the governing body of the health care organization to designate anesthetizing locations. Historically not easy to recognize. Usually the Anesthesia and Surgical Staff Responsibility of the governing body of the health care organization to designate wet procedure locations. Burn Units Sitz baths Dental vacuum applications Equivalency Nothing in this code is intended to prevent the use of systems, methods or devices prescribed by this code that are: Equivalent or superior Quality Strength Fire resistance Effectiveness Durability Safety Authority Having Jurisdiction shall be permitted to grant exceptions to this code determine the effective date of application of this code administer and enforce this code. Who?
10 Authority Having Jurisdiction: CMMS Oversight for existing facilities. The Joint Commission TJC (Sub contractor) State of Washington Construction for new facilities and Public Health oversight. Local Jurisdictions Construction for new facilities Fire Marshall Construction for new facilities and Fire Prevention oversight. Chapter 3 Definitions Not much change. Merriam-Webster s Collegiate Dictionary, 11 th Edition shall be the source for ordinary meaning of words not found in this Chapter Chapter Building System Categories Category 1 Failure of either equipment or system is likely to cause MAJOR injury or death of patients or caregivers Category 2 Failure of such equipment is likely to cause MINOR injury or death of patients or caregivers Category 3 Failure of such equipment is NOT likely to cause injury or death of patients or caregivers, but can cause discomfort to patients Category 4 Failure of such equipment would have not impact on patient care. Chapter Risk Assessment. Categories shall be determined by following and documenting a defined risk assessment procedure. 4.3 Application. Categories definitions shall apply to Chapters 5 through
11 Chapter Category 1 Piped Gas and Vacuum Systems 5.2 Category 2 Piped Gas and Vacuum Systems 5.3 Category 3 Piped Gas and Vacuum Systems Applicability Nature of Hazards of Gas and Vacuum Systems Category I Sources Nitrous Oxide and Carbon Dioxide shall be stored in areas that do not allow the ambient temperature to go below -20 F (5) Shall be compliant with NFPA 70 for ordinary locations. (5 foot above floor not required if protected for electric appliances in manifold rooms) Ventilation The language in 2012 regarding indoor manifold location mechanical ventilation has been moved out of this chapter and is located within Chapter Control Equipment This section allows the following control equipment to be remote from the supply system Final Line Pressure Regulators Relief Valves Multiple Pressures
12 Compressors for Medical Air. (C) Liquid ring compressors shall comply with the following: (1) Service water and seal water of a quality recommended by the compressor manufacturer shall be used. (2) Reserve medical air standby headers or a backup compressor shall be installed. (3) When installed, the header shall comply with (4) When installed, the number of attached cylinders shall be sufficient for 1 hour normal operation Permitted Locations for Medical Gases. Central Supply Systems and medical gas outlets for oxygen, medical air, nitrous oxide, carbon dioxide and all other patient medical gases shall be piped only into areas where the gases will be used under the direction of Licensed Medical Professionals for the purposes congruent with the following: 1. Patient respiration 2. Clinical application of the gas to a patient 3. Medical device applications directly related to respiration. 4. Power for medical devices used directly on patients 5. Calibration of medical devices intended for 1 through
13 Figure has been removed from Chapter 5, This figure was the distances required between Bulk Oxygen Systems and Exposures. This figure was originally in NFPA 50 editions prior to the publication of NFPA Bulk Cryogenic liquid Systems Shall be located and installed in accordance with NFPA 55. This edition has only 4 sub-sections where the 2005 edition had 11 sub-sections Category 1 Medical Air Supply Systems (1) allows medical air to be reconstituted from Oxygen USP cylinder Nitrogen NF cylinder
14 Medical Air Dryers (1) Shall be designed to provide air at a maximum dew point that is below the frost point of 32 F at psig at any level of demand. (2) Shall be sized for 100 percent of the system peak calculated demand at design conditions. Community consensus is this standard eliminates refrigerated dryers from the medical air systems Compressor Intake (B) The medical air intake shall be located a minimum of 25 feet from ventilating system exhausts, fuel storage vents, combustion vents, plumbing vents, vacuum and WAGD discharges or areas that can collect vehicular exhausts or other noxious fumes. 20 feet above the ground and 10 feet from any door, window or other opening in the building
15 Category 1 Medical Air Proportioning System. An automatic mixing system that generates medical air from Oxygen USP and Nitrogen NF sources continuously. Cryogenic Oxygen USP and Cryogenic Nitrogen NF mixed to 20.9% O2/79.1% Nitrogen through a mixing device with alarms and Compressed Air USP reserves per this section Zone Valves (1) The zone valve shall be placed such that a wall intervenes between the valve and outlets/inlets that it controls. (2) The zone valve shall serve only outlets/inlets located on the same story. (3) The zone valve shall not be located in a room with station outlets/inlets that it controls
16 In-Line Check Valves. (2) Shall have brazed extensions Pressure and Vacuum Indicators The scale range of positive pressure analog indicators shall be such that the normal operating pressure is within middle third of the total range. E.g. 0 to 300 psig range shall have a middle third range of 100 to 200 psig The accuracy of digital indicators shall be +5% of operating pressure
17 (2) Anesthetizing locations where moderate sedation, deep sedation or general anesthesia is administered shall have the sensors installed either on the source side of any of the individual room zone valve box assemblies or on the patient side of each of the individual zone valve box assemblies Performance Criteria and Testing Category 1 (Gases, Medical Surgical Vacuum, and WAGD) Inspection and testing shall be performed on all new piped gas systems, additions, renovations, temporary installations, or repaired systems to ensure, by a documented procedure, that all applicable provisions of this document have been adhered to and system integrity has been achieved or maintained Inspection and testing shall include all components of the system, or portions thereof Performance Criteria and Testing Category 1 (Gases, Medical Surgical Vacuum, and WAGD) The inspection and testing reports shall be submitted directly to the party that contracted for the testing, who shall submit the report through channels to the responsible facility authority and any others that are required Reports shall contain detailed listings of all findings and results. All relevant tests included in sections through and Report details will include a Pass or Fail statement regarding all tests performed
18 Performance Criteria and Testing Category 1 (Gases, Medical Surgical Vacuum, and WAGD) The responsible facility authority shall review these inspection and testing records prior to the use of all systems to ensure that all findings and results of the inspection and testing have been successfully completed All documentation pertaining to inspections and testing shall be maintained on-site within the facility Category 1 Operation and Management Special Precautions Patient Gas, Vacuum, WAGD, and Medical Support Gas Systems Maintenance of Medical Gas, Vacuum, WAGD, and Medical Support Gas Systems Maintenance Programs Inventories Inspection Schedules Inspection Procedures Maintenance Schedules Category 1 Operation and Management Inspection and Testing Operations Manufactured Assemblies Employing Flexible Connection(s) Between the User Terminal and the Piping System Medical Gas and Vacuum Systems Information and Warning Signs Medical Gas and Vacuum Systems Maintenance and Record Keeping Category 1 Operation and Management. Troubleshooting: Know how components work normally first. Maintain a library of Owner s Manual for all medical gas and vacuum components. Read the Theory of Operations for each component. Learn about the GAUGES KNOW THEIR NAMES Left bank, Right bank, main line, zone, primary regulator, Observe, record and trend: Daily, weekly, monthly and regularly review all pressures, temperatures, vibrations, hour meters and other pertinent parameters. AMP readings Alternation Oil Filters Drains
19
20 Category 1 Operation and Management. Troubleshooting: Know what source equipment component(s) are directly tied to each Master alarm panel indicator Reserve in use Main Liquid Level Low Reserve Liquid Level Low Reserve Failure (Pressure Low) Secondary in use High Line Pressure Low Line Pressure Medical Air Malfunction Vacuum Malfunction Dew Point High
21 Category 1 Operation and Management. Troubleshooting: Know how your area alarm panels work: Silence buttons Test buttons Proper alarm settings Sensor and switch locations Know where the area alarm panels are required: Life Support Locations What does this mean? How often should you test them? Monthly? Risk assessment? How do you test them? Push a button? Cycle a pressure sensor?
22 Recognized Individual qualifications in NFPA 99: ASSE 6010 Professional Qualification Standard for Medical Gas System Installers Required ASSE 6030 Professional Qualification Standard for Medical Gas System Verifiers Required (2) ASSE 6040 Professional Qualification Standard for Medical Gas System Preventive Maintenance Personnel Recommended
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