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9 Posts authored by: jonhart Employee


Failure to adequately maintain fire suppression systems in health care facilities is consistently ranked as a most frequently cited deficiency by accreditation organizations. In fact, the Joint Commission indicates that this was cited as “not compliant” in over 80% of surveys of hospitals and critical access hospitals during the first half of 2018.
 
In my recent NFPA Live I provided an overview of the code requirements and compared those with the expectations of surveyors when they are in a facility. I received this follow-up question from a member. I hope you find some value in it.
 

 

NFPA Live is an interactive video series in which members of NFPA staff address some of the most frequent topics they receive through the Member's Only Technical Question service. If you are currently an NFPA Member you can view the entire video by following this link. If you're not currently a member, join today!

 

Essential electrical systems are intended to ensure that when facilities lose normal power there is a reliable source of backup power that can quickly restore power to circuits and equipment needed for life safety purposes and those that affect the well-being of patients or are essential to the clinical functionality of the facility.
 
In my recent NFPA live session I discussed different branches of essential electrical systems, generator requirements, and their required testing and maintenance.

I received this follow-up question from a member. I hear this question a lot so I wanted to share it here. I hope you find some value in it.

 

NFPA Live is an interactive video series in which members of NFPA staff address some of the most frequent topics they receive through the Member's Only Technical Question service. If you are currently an NFPA Member you can view the entire video by following this link. If you're not currently a member, join today!

 

The storage and management of gas cylinders in health care facilities is an ongoing compliance issue. During my recent NFPA Live presentation I provided an overview of the requirements in NFPA 99, Health Care Facilities Code for their storage. I addressed the differing requirements based on volume stored as well as the criteria for the small volume of gas that is allowed to be stored outside of an enclosure.  nfpa 99 - medical gas cylinder storage for healthcare facilities

 

During the live event I received these two follow-up questions from members. I'm now sharing them with you. I hope you find some value in it.

 

Also, I've attached a brand new fact sheet that you can download on this same topic.


NFPA Live is an interactive video series in which members of NFPA staff address some of the most frequent topics they receive through the Member's Only Technical Question service. If you are currently an NFPA Member you can view the entire video by following this link. If you're not currently a member, join today!

NFPA 99
Each year ECRI Institute releases an annual list of the top 10 technologies and patient care developments it recommends hospital executives pay attention to. The 2018 list includes at least two items that have implications on how fire and life safety codes, such as NFPA 101, Life Safety Code, and NFPA 99 Health Care Facilities Code, must be applied. 
The two trends which building and life safety professionals should be most aware of are a trend toward acuity-adaptable rooms and the construction of microhospitals.
Acuity-adaptable Rooms
Risks in health care are much more than just fire and life safety issues. Hospital acquired infections, medication errors, and patient falls are just some of these additional risk and those are increased each time a patient must be moved from one unit or area of a hospital to another, such as from an intensive care unit to a step down unit. What some facilities have begun to implement are acuity-adaptable rooms which can allow for hospitals to keep patients in the same room from admission to discharge regardless of their acuity level. 
While this approach has several benefits to facilities and is a patient-centered care model it will also introduce many complex challenges that will have to be addressed in order to successfully implement. While many of these relate to staffing, equipment logistics, and clinical issues, we’ll take a look at the NFPA codes and standards impact. 
In looking at NFPA codes and standards, the most immediately impacted code application will likely be NFPA 99 in how these rooms will need to be designed in order to meet gas and vacuum system requirements and electrical system requirements. 
The application of NFPA 99 is based on risk to patients. Rooms with higher acuity patients, where the risk of a system failure can have significant impacts, require more protection. All rooms designed to accommodate the acuity-adaptable approach will have to meet the requirements for the higher level of risk. This will likely mean a higher number of rooms that need to meet the increased requirements for the higher risk. Some of the impacts this could have would be additional medical gas and vacuum outlets and inlets, increased number of electrical receptacles at patient beds, additional zone valve boxes, and increased loads on the critical branch of essential electrical systems.
Microhospitals
Typically designed with 15,000 to 25,000 square feet of space, microhospitals are a concept which has gained a lot of traction over the past couple of years. These buildings are neither urgent care centers nor full-service hospital but act as a way for health care providers to increase community access by distributing care throughout the system’s region without undertaking huge infrastructure projects. There is no definition of what a microhospital is or what services it provides. Many will provide a range of services typically found in traditional hospitals, including inpatient services and emergency care, but generally have a lower acuity patient population.
For some, these facilities, which are a fraction of the size of traditional hospitals, might seem to be buildings which can have a lower level of protection than what is expected in full size hospitals. This is not the case based on the services and patient population expected in these microhospitals.
They will need to be classified as a health care occupancy per NFPA 101 if providing care to 4 or more patients on an inpatient basis who are incapable of self-preservation. This threshold is just 1 or more patients based on Centers for Medicare & Medicaid -CMS- interpretations. The classification as a health care occupancy will require automatic sprinkler protection throughout the building and each story used by inpatients for sleeping or treatment to be subdivided into at least two smoke compartments. This could result in relatively small smoke compartments given the condensed footprint of these building but is necessary to provide the “defend in place” concept needed for  building occupants who are in a compromised state.
Medical gas and vacuum systems and electrical system requirements will be based on the risk assessment approach defined in NFPA 99. If failure of these systems are likely to result in major injury or death of patients or caregivers, then the most stringent requirements will need to be followed. A multidisciplinary committee should be brought together to look at the expected services and patient populations to determine the inputs into such a risk assessment.
NFPA Technical Committees and the future of health care
The technical committees for NFPA 101 and NFPA 99 will continue to monitor trends and changes in health care delivery to ensure that the codes are still providing adequate levels of safety to patients and other occupants of health care facilities in a flexible manner that allows improvements in health care delivery models of the future. Both codes are currently accepting public input for their 2021 editions until June 27th. 
For more information on NFPA resources for health care facilities see www.nfpa.org/cms
NFPA has launched a new online training course on medical gas and vacuum systems. The four-hour course provides a detailed review of the medical gas and vacuum requirements in the 2018 edition of NFPA 99, Health Care Facilities Code. It will satisfy criteria for ASSE 6000 series recertification, which requires a four-hour course on new editions to the code. The training also serves as an excellent overview for those looking to gain a greater understanding of the requirements for medical gas and vacuum systems.
The training addresses all topics in Chapter 5 of NFPA 99, including source requirements, valve requirements, installation specifics, installer performed test, and system verification. Changes to the 2018 edition are also addressed, including allowance for oxygen concentrator supply systems, changes to pressure regulation, and information on corrugated medical tubing as a permitted piping material.

While many health care facilities across the country are still adjusting to last year’s adoption of the 2012 edition of NFPA 99 by CMS, the code revision process at NFPA has continued. We are now only a short time away from the final approval and issuance of the 2018 edition of the Health Care Facilities Code. These changes may affect health care facilities that start new construction projects in jurisdictions with building codes that reference the 2018 edition. These changes may also come into play through the use of categorical waivers or when a newer edition is adopted by CMS.

 

Join me for a webinar detailing many of these changes on July 20 at 12:30 pm ET.

 

      I will discuss the most noteworthy changes that will be found in the 2018 edition. Topics discussed will include:

  • New language on risk assessments

  • New permissible material for medical gas piping

  • Reorganized electrical systems chapter

  • Revised medical gas storage requirements

  • New chapter on dental gas systems

  • Revised hyperbaric facility requirements

NFPA 99-15 Code Cover Front 2015While those involved in health care engineering and life safety for health care facilities are still awaiting CMS adoption of the 2012 editions of NFPA 99, Health Care Facilities Code and NFPA 101, Life Safety Code®, believe it or not, it’s already time to look towards the 2018 editions of each of these important documents.

It may be hard to get overly excited for a 2018 edition while still being held to the 2000 Life Safety Code, but the changes made for this edition will certainly impact health care facilities at some point in the future. Whether it’s through an eventual outright adoption of later editions of the codes or categorical waivers, which CMS has lately been using to bridge the gap between adoptions, these changes will have an impact.

Your voice is an important part of this process. Both documents are open for Public Input until July 6th. Submit your Input to NFPA 99 and NFPA 101  to have your say in what the future of these important codes should look like.

6a0133f27f7a03970b017ee803c544970d-450wi.pngOne question that I have received quite often since the publishing of the 2012 edition of NFPA 99, Health Care Facilities Code, is whether or not windowless anesthetizing locations still require smoke purge systems. The answer to this is that the 2012 edition does not require it. What had previously been in NFPA 99 and previously NFPA 56A was language that remained essentially the same for years and was in the 2005 edition as follows:

 

“6.4.1.2 Supply and exhaust systems for windowless anesthetizing locations shall be arranged to automatically vent smoke and products of combustion.

6.4.1.3 Ventilating systems for anesthetizing locations shall be provided that automatically (1) prevent recirculation of smoke originating within the surgical suite and (2) prevent the circulation of smoke entering the system intake, without in either case interfering with the exhaust function of the system.”

 

My research shows this requirement to have first appeared in NFPA 56A in the 1960 edition. The way it was presented and worded has been slightly altered throughout the years but the intent that the smoke and products of combustion be vented and that recirculation be prevented had remained. When NFPA 99 was reorganized for the 2012 edition the requirement was not incorporated in the new Chapter 9, Heating, Ventilating, and Air Conditioning.

In the current revision process the technical committee on Mechanical  Systems has proposed language that specifically states smoke purge is not required in windowless anesthetizing locations. The main substantiation for this is that the requirement is considered to be a relic as when it was first incorporated into an NFPA requirement the use of flammable anesthetics was common and therefore the fire hazards in these rooms was much higher.

99 12 Code Cover Front

While it seems like NFPA 99 was revised for the first time in seven years only yesterday by approval at NFPA’s June 2011 Annual Meeting in Boston, the development of the 2015 edition of the Health Care Facilities Code is already beginning. 

The public input period closed on June 22nd and now the Technical Committees  responsible for the code are preparing for their First Draft meetings in San Diego next month. The seven technical committees consist of experts in the various fields that are addressed within NFPA 99 including:

-          Electrical Systems

-          Fundamentals

-          Health Care Emergency Management and Security

-          Mechanical Systems

-          Medical Equipment

-          Medical Gas and Vacuum Piping Systems

-          Hyperbaric Facilities

Guests are always welcomed at NFPA technical committee meetings and if you’re in the San Diego area and would like to attend one of the meetings simply let me know. For those who’ll miss out on all of the in-person action but still want to stay informed, the NFPA 99 “Next Edition” tab will contain all of meeting agendas, ballots, and drafts of the revised documents, will keep you up to date with the changes throughout the revision cycle.

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