27th Annual AHCA Seminar NFPA 99 2012 Edition Overview and Discussion Presented by James Peterkin, PE Sr. Fire Protection Engineer Heery International Monday September 26, 2011
Disclaimer Not Speaking on behalf of NFPA or NFPA Technical Committee
Approved 2012 edition issued by the Standards on August 11, 2011 TIA s for Chapters 8 and 9 issued by the Standards on August 11, 2011 Approved as an ANSI Standard on August 31, 2011. CMS has indicated it will look at the 2012 edition of NFPA 101 which references this edition of NFPA 99
Standard to Code 1999 -NFPA 99 Currently enforced by CMC and TJC 2005 -NFPA 99 Currently enforced by State of Florida (AHCA) 2012 NFPA 99
2012 Edition Overview Items Deleted Laboratory requirements Manufacturers requirements on electrical equipment Annexes B, D, & E are deleted. They are technology not used any longer. All of the Occupancy Chapters
2012 Edition Overview New Items Fundamentals Chapter on Risk Information Technology and Communication Systems Plumbing HVAC Emergency Management (new requirements) Security Fire Protection unique to Health Care Facilities
How the 2012 Code Works Determine the worst case procedure. Select the Risk Category. Select the systems or procedures in the Code that are prescribed by that level of risk Category
Administration (Chapter 1) Scope: The scope of this code is to establish minimum criteria for: Fundamentals Gas and Vacuum Systems and Gas Equipment Electrical Systems and Electrical Equipment Information Technology and Communications Systems Plumbing Systems HVAC Systems Security Management Hyperbaric Facilities Features of Fire Protection
Definitions (Chapter 3) 3.3.9 Anesthetizing location General anesthesia 3.3.17 Battery powered lighting units NFPA 70 3.3.28 Compact Storage 3.3.35 Defend in Place 3.3.63 General anesthesia and levels of sedation Deep sedation General anesthesia Minimal sedation Moderate sedation 3.3.109 Medical support gas
Administration (Chapter 1) To provide minimum requirements for the: Performance Maintenance, Testing and Inspection Safe practices based on risk
Administration (Chapter 1) Applies to all health care facilities (other than home health) Applies to NEW construction and equipment only altered or renovated or modernized Some testing and maintenance requirements apply to existing Emergency Management and Security apply to existing
Referenced Publications (Chapter 2) All Referenced publication material has been updated to most current version
Fundamentals (Chapter 4) Category 1 -Facility systems in which failure of such equipment or system is likely to cause major injury or death of patients or caregivers shall be designed to meet system Category 1 requirements as defined in this code.
Fundamentals (Chapter 4) Category 2 -Facility systems in which failure of such equipment is likely to cause minor injury to patients or caregivers shall be designed to meet system Category 2 requirements as defined in this code.
Fundamentals (Chapter 4) Category 3 -Facility systems in which failure of such equipment is not likely to cause injury to the patients or caregivers, but can cause patient discomfort shall be designed to meet system Category 3 requirements as defined in this code.
Fundamentals (Chapter 4) Category 4 -Facility systems in which failure of such equipment would have no impact on patient care shall be designed to meet system Category 4 requirements as defined in this code.
Fundamentals (Chapter 4) Examples from the Annex (A4.1). (1) Ambulatory surgical center, two patients with full Operating Room services -Category 1 (2) Reconstructive surgeon s office with general anesthesia - Category 1 (3) Procedural sedation site for outpatient services - Category 2 (4) Cooling Towers in Houston, TX, Category 2 (5) Cooling Towers in Seattle, WA, Category 3 (6) Dental office, no general anesthesia, Category 3 (7) Typical doctor s office/exam room, Category 4 (8) Lawn sprinkler system, Category 4
Fundamentals (Chapter 4) 4.2* Risk Assessment. Categories shall be determined by following and documenting a defined risk assessment procedure. A.4.2 Risk assessment should follow procedures such as those outlined in ISO 31010, NFPA 551, SEMI S10-0307 or other formal process. The results of the assessment procedure should be documented and records retained.
Gas and Vacuum Systems (Chapter 5) New Section on Cryogenic Systems Working with NFPA 55 on bulk oxygen requirements Tested for proper function For purity, alarm sensors Operation of the control sensors
Gas and Vacuum Systems (Chapter 5) Adding testing and inspection requirements on new and existing non-stationary medical booms Testing per manufacturers recommendations, every 18 months or based on risk assessment. Maintenance schedules for the remaining equipment is based on risk assessment
Gas and Vacuum Systems (Chapter 5) 5.1.3.8* Instrument Air Supply Systems. 5.1.3.8* OptionalInstrument Air Supply Systems.
Gas and Vacuum Systems (Chapter 5) 5.1.4.8 Zone Valves. All station outlets/inlets shall be supplied through a zone valve as follows: (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 be placed such that a wall intervenes (2) The zone valve shall be placed such that a wall intervenes between the valve and outlets/inlets that it controls. The intervening wall shall be arranged such that it interrupts the line of site between the outlet/inlet and the zone valve.
Gas and Vacuum Systems (Chapter 5)
Electrical Systems (Chapter 6) Requires that overcurrent protection devices only be accessible to authorized personnel and not permitted in public access spaces
Electrical Systems (Chapter 6) Increases minimum number of receptacles General Care From 4 to 8 Critical Care From 6 to 14 Operating Rooms New requirement of 36
Electrical Systems (Chapter 6) Permits fuel transfer pumps, receptacles, ventilation fans, louvers and cooling systems related to generators to be added to the life safety or critical branch (deleted from equipment branch)
Electrical Systems (Chapter 6) MonthlyGenerator Testing -10 second transfer not required (Annual Confirmation)
Electrical Systems (Chapter 6) New section which permits switches in lighting circuits connected to Life Safety and critical branch as long as they don t serve as illumination of egress as required by NFPA 101
New section on campus electrical systems being added Attempts to clear up conflicts with NEC Electrical Systems (Chapter 6)
Electrical Systems (Chapter 6) Wet Location changes to Wet Procedure Location throughout the entire document
Electrical Systems (Chapter 6) Permits isolated power or ground fault protection within operating rooms
Electrical Systems (Chapter 6) In the 2012 Edition By default, an OR will be considered a wet location unless a RISK ASSESSMENT STUDY, by the HeathcareGoverning Body, is done and concludes that all or certain ORs are to be considered dry locations. If determined to be a Wet Location: Isolated Power System GFCI
Electrical Systems NFPA 99 and Isolated Power Historical Development 1940s Isolated Power Systems were introduced to reduce the occurrence of sparks in the OR 1977 -With the development of nonflammable anesthetics, the argument was made to delete the requirements for IPSs.
Electrical Systems NFPA 99 and Isolated Power Historical Development NFPA 99, 1984 Edition Deleted the mandatory requirement for IPSs in nonflammable anesthetizing locations. However, this led to subsequent discussions regarding the need for IPSs in a wet location.
Electrical Systems NFPA 99 and Isolated Power Historical Development NFPA 99, 1987 Edition Defined a wet location as a patient care area that is normally subject to wet conditions while patients are present including standing water on the floor or routine dousing and drenching of the work area It is the responsibility of the individual health care facility to decide which, if any, anesthetizing locations should be considered wet locations.
Electrical Systems NFPA 99 and Isolated Power Historical Development NFPA 99, 1990 Edition Redefined a wet location as a patient care area that is normally subject to wet conditions while patients are present, including standing fluids on the floor or drenching of the work area, either of which condition is intimate to the patient or staff.
Electrical Systems NFPA 99 and Isolated Power Historical Development NFPA 99, 2005 Edition Redefined a wet location as the area in a patient care area where a procedure is performed that is normally subject to wet conditions while patients are present including standing fluids on the floor or drenching of the work area, either of which condition is intimate to the patient or staff. Routing housekeeping procedures and incidental spillage of liquids do not define a wet location.
Electrical Systems NFPA 99 and Isolated Power Historical Development Summary Previously all areas considered a dry location unless designated as Wet by the Hospital. Now All Operating Rooms to be considered a Wet location unless determined otherwise by Risk Assessment. Annex note further indicates that the risk assessment should include all relevant parties and should involve, but not be, limited to clinicians, bio-medical engineering and facility safety engineering staff.
Electrical Systems (Chapter 6) Eliminates emergency system heading and equipment system heading and utilizes branches Life Safety Critical Equipment
Electrical Systems (Chapter 6) Added text to permit a 0.1 second delay for selective coordination
IT and Communication (Chapter 7) New chapter covers IT rooms Nurse call Emergency call Staff emergency assistance
IT Requirements: EF Entrance Facility IT and Communication (Chapter 7) Minimum of two physically separated service entrance pathways required Specific room requirements Prohibit Electrical, Mechanical, Plumbing, Pneumatic tube, etc that do are not directly related to the support of the EF. Also no underground utilities running below. Minimum 12 ft. from electromagnetic interference Room not subject to flooding
IT Requirements: IT and Communication (Chapter 7) TER Telecommunications Equipment Room Houses the Main Networking Equipment Can be combined with the EF Specific room requirements Prohibits items not directly related to the support of the TER. Minimum 12 ft. from electromagnetic interference Areas prone to tornados or hurricanes away from exterior Located in a Non-sterile area Restricted access
IT Requirements: IT and Communication (Chapter 7) TR Telecommunications Room Houses telecommunications equipment Provide sufficient number of TRs such that any data or comm. outlet can be reached within 90m (292 ft) Minimum of one TR per floor. Limited to serving a maximum of 20,000 sq. ft of usable space. Specific room requirements (Same as TER)
IT and Communication (Chapter 7) IT Requirements: OSP Outside Plant Infrastructure Consists of conduits, vaults and other pathways used to connect buildings on a campus and to provide services from off campus service providers Dual telecommunications service entrance pathways shall be provided to the EF. Service entrances shall be a minimum of 20 ft. apart
Plumbing (Chapter 8) TIA 12-1 covers plumbing requirements Essentially refers to other model codes or standards.
Heating, Ventilation and Air Conditioning (Chapter 9) TIA 12-2 covers HVAC requirements HVAC Systems to be provided in accordance with ASHRAE 170 (99 no longer addresses humidity ) Laboratories in accordance with NFPA 45 Energy and commissioning to comply with ASHRAE 90.1 Piping to comply with applicable Plumbing Code. Ductwork to comply with NFPA 90A or applicable Mechanical Code
Heating, Ventilation and Air Conditioning (Chapter 9) TIA 12-2 covers HVAC requirements Covers Medical Gas Storage and Transfillingroom requirements. Ventilation requirements (Natural and Mechanical are based on the quantity of fluid with a minimum) Waste Anesthesia Gas Disposal (WAGD) Medical Plume exhaust Plumes from medical procedures, including the use of lasers, must be captured using one of three methods. HVAC of Emergency Power System enclosures.
Electrical Equipment (Chapter 10) Chapter reorganized Testing requirements have been updated Leakage requirements have been updated
Gas Equipment (Chapter 11) 11.3.2.5 Temperature limitations to storage of cylinders must comply with 5.1.3.3.1.7 (temperatures not to exceed 54 o C or 130 o F. 11.4.3.1.1 Specifies the requirements for carts and hand trucks that transport cylinders (must be self supporting and have appropriate chains.)
Gas Equipment (Chapter 11) 9.5.2.4* Medical devices not for patient care and requiring oxygen USP shall meet the following: (1) Be listed for the intended purpose by the United States Food & Drug Administration (2) Be under the direction of a licensed medical professional, if connected to the piped distribution system (3) Be connected using a wall outlet and a flexible hose, if connected to the piped distribution system (4) Not be permanently attached to the piped distribution system (5) Be installed and used per the manufacturer's instructions (6) Be equipped with a backflow prevention device
Emergency Management (Chapter 12) Completely rewritten and expanded for 2012 Two categories of risk In-patient facility is expected to be operable In-patient and out-patient areas that augment the critical mission but not receive in-patients Requires a Hazard Vulnerability Analysis (HVA) Natural Hazards Human-caused Events Technological Events
Emergency Management (Chapter 12) Requires plans to manage resources and assets Requires Exercises Requires Evaluation of Exercises Special Care was taken to avoid conflicts with the Joint Commission and CMS
Security Management (Chapter 13) Planning for protection of the Staff and Facility beyond disasters Requires a Security Vulnerability Assessment (SVA) Requires a responsible person Education requirements of security staff Customer Service Emergency Procedures Use of Force De-escalation Use of Restraints
Security Management (Chapter 13) Requires procedures for Hostage Bomb Threat Workplace Violence Disorderly Conduct Restraining Orders
Security Management (Chapter 13) Identifies known security sensitive areas Emergency Departments Pediatric and Infant Care units Medication Storage Clinical Labs Forensic Patient Treatment Areas Dementia or Behavior Health Units Communications, data infrastructure and medical records
Security Management (Chapter 13) Other subjects covered Media control Crowd control Security equipment follow NFPA 731 Employee practices Security operations
Hyperbaric Facilities (Chapter 14) Piping requirements have been updated New requirements for location of shutoff valve Updated requirements for reserve to central supply system New requirements for hyperbaric medical air system
Features of Fire Protection (Chapter 15) Chapter applies to new and existing Permits existing system to remain unless deemed AHJ determines a distinct hazard to life. Pulls most of text from NFPA 101 (Extract Text) Defend in Place Fire Alarm Notification zones must coincide with the smoke compartments unless addressed in the Facility Fire Plan. Sprinkler zones must coincide with the smoke compartments unless addressed in the Facility Fire Plan.
Features of Fire Protection (Chapter 15) Closets sprinkler exception (less than 6 sq. ft.) Compact mobile storage Storage units greater than 50 ft 2 must be protected by smoke detection in accordance with NFPA 72 and automatic sprinklers in accordance with NFPA 13. Fires in Operating rooms Hazard Assessment Germicides and Antiseptics Emergency Procedures Orientation and training requirements
Thank you for your time. Questions? James Peterkin, PE jspeterki@heery.com