2012 Edition of NFPA 99 What you should know NEHES New England Healthcare Engineer’s Society 2012 Edition of NFPA 99 What you should know September 27, 2016 I Jason D’Antona, PE I Jonathan Hart, PE

About the Speakers Jonathan Hart, PE Staff Liaison to NFPA 99 TC’s for 5 Years Degreed Fire Protection Engineer Senior Engineer with NFPA, Quincy, MA Jason D’Antona, LEED® AP, PE Member of NFPA 99 TC 11 Years / ELS Chair Degreed Electrical Engineer Principal with Thompson Consultants Inc., Marion, MA

Disclaimer Although both speakers are members of the NFPA 99 Technical Committees, the views and opinions expressed in this presentation are purely those of the speakers and shall not be considered the official position of NFPA or any of its Technical Committees and shall not be considered to be, nor be relied upon as, a Formal Interpretation. You are encouraged to refer to the entire texts of all referenced documents. NFPA members can obtain staff interpretations of NFPA standards at www.nfpa.org.

Discussion Topics Introduction NFPA 99 Overview NFPA 99 History Risked Based Approach New System Requirements New Chapters Summary / Questions

NFPA 99 Scope & Application Healthcare Facilities Acute Care Hospital  Out Patient Medical Office Long-term Care Facility Dental Care Facilitates Psychiatric / Rehabilitation Care Facilities New Construction – Unless Specified

99 Application – New Construction Enforced by: Bldg Inspector Dept Public Health Fire Marshall Latest Edition of 99 May differ from 2012 Check with local AHJ New operating room during construction

99 Application – Continuous Compliance 2012 Now Enforced by CMS DNV TJC Effective Enforcement Date: 11/1/2016 New operating room during construction

CMS Enforcement

CMS Enforcement NFPA 99 – 2012 Edition Including TIAs Available at www.nfpa.org/CMS TIA-2 TIA-3 TIA-4 TIA-5 TIA-6

CMS Enforcement Not adopting some Chapters Chapter 7 – IT and Communication Systems Chapter 8 – Plumbing Chapter 12 – Emergency Management Chapter 13 – Security Management

NFPA 99 History Pre-1979 several NFPA HCF documents 1979 – NFPA decides to combine all HCF documents into one guideline (NFPA 56F, 76A, 76B-T, etc.) 1984 - First issuance of NFPA 99 Focus: Minimizing the hazards of fire, explosion, and electricity HCF. 1987 - Integrated individual documents into chapters 2005 – 2012 complete rewrite 2012 – New Code with expanded focus & methodology

New Methodology Prescriptive Code Risk Based 2012 Edition 2005 Edition & Earlier Risk Based 2012 Edition

Risk Based Approach

Risk Based Approach Major Injury (Annex A.4.1.1. examples) Amputation Loss of sight (temporary or permanent) Electric shock or burns Heat induced illness Loss of consciousness Ingestion of harmful substances Exposure to biological agents Minor Injury Not serious No risk to life

NEHES Function Dom H2O Non Pot Dom H2O Heating Cooling Room New England Healthcare Engineer’s Society Function Dom H2O Non Pot Dom H2O Heating Cooling Room Ventilation Steam Process Airborne infection isolation room 2 N/A 3 Ambulance garage Biomedical waste holding Bone marrow transplants 1 Burn patient care rooms Business office/administration 4 Central sterile room Class A surgical procedures Class B surgical procedures Class C surgical procedures Critical care rooms (Cat 1 room) ED trauma room Intensive care Medical-gas storage room Medical records Morgue Occupation therapy Oxygen transfilling PACU Patient education Pharmacy Physical therapy Protective environment room Radiology Speech therapy Waiting Rooms

Risk Assessment Categories determined by following and documenting a defined risk assessment procedure CMS: “CMS does not require the submission of risk assessment methods to CMS. However, CMS, will confirm that facilities are using risk assessment methodologies when conducting onsite surveys…”

Risk Assessment ISO/IEC 31010, Risk Management – Risk Assessment Techniques NFPA 551, guide for the Evaluation of Fire Risk Assessments SEMI S10-0307E, Safety Guideline for Risk Assessments and risk Evaluation Process

Chapter 5 Gas and Vacuum Systems Page: 99-25

Navigating Chapter 5.1 Category 1 Systems 5.2 Category 2 Systems

New vs. Existing TIA 12-4 The following subsections… shall apply… in existing facilities: 5.1.2 5.1.3.3.4 5.1.3.1 5.1.3.6.2 5.1.3.2 5.1.3.8.5.2 5.1.3.3.1.7 5.1.14 5.1.3.3.1.8 5.1.15 5.1.1.6 Tentative Interim Amendment (TIA) TIA 12-4: Added the list applicable to existing facilities.

New vs. Existing TIA 12-4 The following subsections… shall apply… in existing facilities: 5.1.2 5.1.3.3.4 5.1.3.1 5.1.3.6.2 5.1.3.2 5.1.3.8.5.2 5.1.3.3.1.7 5.1.14 5.1.3.3.1.8 5.1.15 5.1.1.6 Tentative Interim Amendment (TIA) TIA 12-4: Added the list applicable to existing facilities.

New vs. Existing TIA 12-4 The following subsections… shall apply… in existing facilities: 5.1.1.6 Tentative Interim Amendment (TIA) TIA 12-4: Added the list applicable to existing facilities.

New vs. Existing TIA 12-4 The following subsections… shall apply… in existing facilities: 5.1.1.6 Tentative Interim Amendment (TIA) TIA 12-4: Added the list applicable to existing facilities.

Central Supply Room – Construction If outdoors, noncombustible enclosure, with a minimum of two exits Electrical devices at or above 5 feet from floor protected from damage NFPA 70 for ordinary locations Page: 99-26 (5.1.3.3)

Zone Valves 5.1.4.8

Centralized Computer System Computer systems permitted to substitute for one of the required master alarm panels 5.1.9.4 This is new from the 1999 edition. CMS has permitted this for a few years now through a Categorical Waiver. Need continuous, uninterrupted power, continuously monitored or provide remote signaling, devices are supervised, others. Software: Medical gas shall have the same status as life safety, medical gas has higher priority than lesser signals provide an audible alert, alert the condition and activate any signaling protocols.

Operation and Management Maintenance (new section) Extensive new material – 5.1.14 Based upon risk assessment Minimum qualifications Certified by health care facility ASSE 6040 Professional Qualification Standard fro Medical Gas Maintenance Personnel ASSE 6030 Professional Qualification Standard for Medical Gas Verifiers. 5.1.14 All of 5.1.14 is applicable to existing facilities/systems. Walk through the different sections and requirements.

Chapter 6 Electrical Systems Page: 99-25

New vs. Existing The following subsections… shall apply… in existing facilities: 6.3.2.2.4.2 6.4.2.2.6.2(C) 6.3.2.2.6.1 6.4.2.2.6.3 6.3.2.2.6.2(F) 6.4.4 6.3.2.2.8.5 (B)(2-4) 6.5.4 6.3.2.2.8.7 6.6.2.2.3.2 6.3.4 6.6.3.1 6.4.1.1.17.5 6.6.4 6.1.2

Existing Requirements Compliance Required Retroactively GFCI Requirements Tamper-proof Receptacles in Pediatric Areas Wet-Procedure Location (WPL’s) Requirements Operation Maintenance & Testing Grounding Requirements 5.1.14 All of 5.1.14 is applicable to existing facilities/systems. Walk through the different sections and requirements.

Risk Based Approach Critical Care Room Type 1 EES General Care Room Category 1 Critical Care Room Type 1 EES Category 2 General Care Room Type 1 or Type 2 EES Category 3 Basic Care Room No EES Required 6.3.2.2.10 It is a little deeper into the Chapter, but the risk based approach employed by Chapter 6 is demonstrated in this section.

Essential Electrical System 6.4 Talk about changes in terminology from “Emergency System” to the specific branches. We’re not going to address Type 2 or 3 on their own, so mention the differences here.

Essential Electrical System (Old) Normal Power Source Emergency Power Supply Emergency System Non-essential Electrical System Equipment System Life Safety Branch Critical Branch ATS(s) EPSS 6.4 Talk about changes in terminology from “Emergency System” to the specific branches. We’re not going to address Type 2 or 3 on their own, so mention the differences here.

Essential Electrical System (New) Normal Power Source Emergency Power Supply Non-essential Electrical System Equipment Branch Life Safety Branch Critical Branch ATS(s) EPSS 6.4 Talk about changes in terminology from “Emergency System” to the specific branches. We’re not going to address Type 2 or 3 on their own, so mention the differences here.

Wet Procedure Locations Revised from “Wet location” to “Wet Procedure Location” (WPL) WPLs do not include bathrooms, toilets, showers, etc. Routine housekeeping / incidental spillage ≠ WPL “…area where procedure is performed that is normally subject to wet conditions while patients are present…” (3.3.184*) 5.1.14 All of 5.1.14 is applicable to existing facilities/systems. Walk through the different sections and requirements.

OR’ ARE* WPL’s * Unless “6.3.2.2.8.4* Operating rooms shall be considered to be wet procedure locations, unless a risk assessment conducted by the healthcare governing body determines otherwise.” New operating room during construction Operating Room

Electrical Safety in WPL’s Isolated Power or GFCI No Preference on Either Method of Protection Isolated Power Panel GFCI Receptacle or 5.1.14 All of 5.1.14 is applicable to existing facilities/systems. Walk through the different sections and requirements.

Headwall Receptacles General Care (Category 2) 4  8 / 4 duplex Critical Care (Category 1) 6  14 / 7 duplex Operating rooms  36 / 18 duplex

Monthly Generator Testing LS & CB 10 Second Transfer No Longer Required During Monthly Testing Alternate Annual Compliance Method Provided EPSS Generators

Generator Feeders HCF Bldg. A HCF Bldg. A G G 6.4.2.2.2.1 A single feeder supplied by a local or remote alternate source shall be permitted to supply the essential electrical system to the point at which the life safety, critical and equipment branches are separated. 6.4.2.2.1.2 The division between the branches shall occur at the transfer switch where more than one transfer switch is required HCF Bldg. B HCF Bldg. B CB EQ LS PRE 2012 NFPA 99 POST 2012 NFPA 99

Chapter 7 – Information Technology & Communications New Chapter / Not Adopted by CMS Addresses the Performance of LV, Data and Communication Systems Defines Requirements for MDF and IDF Closets Defines Requirements for Nurse Call Systems Reserved Sections for Future Systems MDF or Telecommunications Equipment Room (TER)

Chapter 8 – Plumbing New Chapter Not adopted by CMS Mostly references to plumbing codes

Chapter 9 – HVAC References ASHRAE 170, Ventilation of Health Care Facilities Medical gas storage and transfilling location ventilation

Operating Room Smoke Purge No longer required

Chapter 10 – Electrical Equipment Relocatable Power Taps (RPTs) Permitted for use with patient care equipment Eliminates need for Categorical Waiver No requirements or limitation on use with equipment other than patient care-related

Chapter 11 – Gas Equipment

Other Chapters Chapter 12 – Emergency Management Chapter 13 – Security Management Chapter 14 – Hyperbaric Facilities Chapter 15 – Features of Fire Protection

Recap 2012 NFPA 99 Rewrite Edition Now Enforced by AHJ’s, TJC & CMS Now a Code Risk Based Approach Contains Retroactive Requirements Contains New Chapters

Questions?

Thank You! jhart@nfpa.prg jdantona@thompson-consultants.com Jonathan Hart, PE jhart@nfpa.prg Jason D’Antona, PE, LEED® AP jdantona@thompson-consultants.com