Health Facilities Management Health Facilities Design: What’s New, What’s Coming David B.Uhaze, RA Former Chief - Bureau of Construction Project Review NJ Dept. Of Community Affairs Vice Chairman – FGI Health Guidelines Revision Committee Health Facilities Management Society of New Jersey November 19, 2015

Introduction Bureau of Construction Project Review E-Plan Review Guidelines for Design and Construction of Hospitals and Outpatient Facilities NFPA 101 & 99 2015 International Codes

DCA – Bureau of Construction Project Review The Bureau Functions as the construction office for all building types or projects reserved to the State at NJAC 5:23-3.11 This includes such projects as: Healthcare Facilities Casinos State Buildings (State colleges, NJTPA, NJT, NJSEA, etc.) Special Projects (Electrical Generating, Solid Waste Treatment, Incineration Plants) Prototypes (Big box stores, banks, etc.) Schools

DCA – Bureau of Construction Project Review Health Care Plan Review Unit Performs both a UCC and Licensing review on all projects submitted Will comment on Licensing requirements, but cannot grant waivers to those requirements 20 day review cycle for new projects with complete applications 7 day review cycle for re-submitted projects Permitting and inspections are done at the local level May grant permission for a local review of certain projects

DCA – Bureau of Construction Project Review Electronic Plan Review The Department of Community Affairs has implemented an almost paperless review process. They are now able to do all of the following electronically: Accept project applications Review Plans Issue Releases All of this is being done through an on line system called ProjectDox by Soon to Come: Electronic Fee Payment

DCA – Bureau of Construction Project Review Electronic Plan Review Avolve – ProjectDox is a Web hosted, secure site with a fully Automated review process that provides Automatic notifications, complete project tracking and extensive Project archiving

DCA – Bureau of Construction Project Review Electronic Plan Review Benefits System is accessible 24 hours a day, 7 days a week from any device with internet access Eliminates printing, delivery and storage costs associated with paper plans Provides easy tracking of projects throughout the process Significant time savings by eliminating shipping and delivery delays Easy retrieval of Construction Documents at any time

DCA – Bureau of Construction Project Review Electronic submission of plans will become mandatory starting Jan. 1, 2016 DCA is offering Webinars for those interested in learning more about the system The DCA website also has a “Frequently Asked Questions” tab in addition to How-To Guides and Technical Manuals DCA will be hiring a dedicated Technical Support Specialist who will be available for questions from 9:00 to 5:00 every day.

DCA – Bureau of Construction Project Review John Paluchowski is the new Supervisor for the Health Care Plan Review Unit Electrical Engineer 18 years experience in healthcare plan review John Terry is the new Chief for the Bureau of Construction Project Review Building Codes Expert Chairman ICC Building Codes Revision Committee

DCA – Bureau of Construction Project Review You can find additional information about the Bureau including: Bureau mailing addresses and phone numbers, a listing of when a Bureau review and release is required, answers to frequently asked questions about the plan review and release process, the Procedures for Submission to Health Care Plan Review & E-Plan Review Procedures manuals and you can access all of the necessary forms for submission at the Bureau’s website: www.nj.gov/dca/divisions/codes/offices/bcpr.html

NJ Uniform Construction Code Permit Extension Act The original act of 2008 has been extended again. (3rd time) Extends all permits & DCA releases that were open and valid as of January 1, 2007 until July 1, 2016 Applies to New Jersey permits only, does not include Federal permits Includes UCC permits and other permits such as: Local Planning and Zoning County Planning and Zoning Coastal Area Facilities Review Pinelands Commission Freshwater and Wetlands Review Water and Sewer service extensions Soil Erosion and Sediment Control

The FGI Guidelines 2014 The Hospital and Outpatient Facilities edition and the new Residential Health, Care, and Support Facilities edition were released in the spring of 2014 NJDOH and NJDCA adopted both editions August 1, 2014 Both editions became mandatory on February 1, 2015

The FGI Guidelines 2014 Major changes this cycle: Two separate volumes: Guidelines for Design and Construction of Hospitals and Outpatient Facilities Includes Chapters 1, 2, 3 & 5 (except for Medical Day Care) Guidelines for Design and Construction of Residential Health, Care, and Support Facilities Includes Chapters 1 & 4 (plus Medical Day Care) Both volumes contain Chapter 6 ASHRAE/ASHE 170

The FGI Guidelines 2014 ANSI/ASHRAE/ASHE 170 FGI continues to work with ASHRAE and ASHE to revise and update this standard. FGI members are included in the 170 committee ASHRAE 170 is under a continuous maintenance process, which permits official changes to be made over the life cycle of the document. The 2013 edition of ASHRAE 170, with all addenda approved through November 2013, has been incorporated as Part 4 of this edition of the FGI Guidelines. At Table 6.4 the MERV efficiency of 17 was deleted for PE rooms At Table7.1 design relative humidity in surgical suites was revised to reflect NFPA 99 at a range of 20 - 60

The FGI Guidelines 2014 http://www.fgiguidelines.org/2014articles.php To help users of the FGI Guidelines learn more about this edition of the standard, the Facility Guidelines Institute has producied a series of articles on major changes and new material in the 2014 edition Visit this page to read an introduction to the series and to access PDFs of the articles. http://www.fgiguidelines.org/2014articles.php

The FGI Guidelines 2018 2014 Edition of the Guidelines was separated into separate editions for Hospitals & Outpatient Facilities and Residential Health, Care and Support Facilities to more clearly differentiate the needs of these facility types. This was a significant undertaking that forced FGI to re-evaluate our process of reviewing, amending and producing the Guidelines.

The FGI Guidelines 2018 At the end of the 2014 Cycle, the FGI Board undertook two Colloquiums focused on the future of Healthcare and the Guidelines. These colloquiums brought together a diverse group of healthcare futurists who were tasked with envisioning the range of healthcare environments and trends that may emerge by the year 2026 and to help FGI lay out a roadmap of the steps that we need to take to stay relevant over that time period.

The FGI Guidelines 2018 The panel noted that : Healthcare organizations are struggling to manage/reduce costs while working to improving clinical quality and the patient experience That they will continue to face challenges such as: Evolving healthcare reform Shifting reimbursement policies An aging population An explosion in demand from newly insured patients New information technologies And the pursuit of new models of healthcare over the coming years. Hospitals and other healthcare facilities will, of necessity, be forced to rethink their planning, design, and operations

The FGI Guidelines 2018 The first thing recommended to FGI, was that the Guidelines documents should be split into two parts: Fundamental Requirements – Baseline standards that can be adopted as code by AHJ’s Beyond Fundamentals – Emerging Practices that exceed basic requirements The second recommendation was to have FGI focus on primary care/outpatient facilities for the coming revision cycle as the trend in health care delivery will continue to move in that direction.

The FGI Guidelines 2018 After much deliberation, it was decided that: For 2018, in keeping with our intent to more clearly differentiate the needs of each facility type, we will publish a third document by splitting the Hospital & Outpatient Guidelines into separate books. In addition the committee will be working toward producing both Fundamentals and Beyond Fundamentals versions of each of the three documents.

The FGI Guidelines 2018 At the conclusion of the 2018 Cycle it is intended that the following documents will be published: Hospital Fundamentals Hospital Beyond Fundamentals Outpatient Fundamentals Outpatient Beyond Fundamentals Residential Book Residential Handbook

The FGI Guidelines 2018 The Fundamentals Documents will include only those requirements that are deemed essential to provide safe, effective, cost efficient care environments. (Baseline requirements that meet the needs of the patients and staff without compromising quality outcomes & safety and have been proven to be cost effective) Evidence based Cost/Benefit balanced

The FGI Guidelines 2018 The Beyond Fundamental Documents will include those items which constitute forward thinking, advanced concepts and practices which exceed basic requirements and which encourage design innovation. (Much of this will be information that is currently included in the appendix and other supporting documents ie: white papers, studies, etc.)

The FGI Guidelines 2018 New Outpatient Document The New Outpatient Document will, at a minimum, cover those ambulatory categories that are currently addressed in the 2014 Hospital & Outpatient Guidelines It may include additional categories and information as deemed necessary by the Outpatient Document group.

The FGI Guidelines 2018 Each of the documents will be:   A separate stand-alone document. Will be independent from the other documents and will not contain references back to any of the other documents. Each Document will be in the same basic format as the 2014 Guidelines, with modifications as necessary.

National Fire Protection Association 2012 Codes Life Safety Code 101 Health Care Facilities Code 99 On April 16, 2014 CMS published a proposal to revise the edition of the LSC & NFPA 99 referenced in Requirements, Conditions of Participation and Conditions for Coverage to the 2012 Editions. Until that happens they will grant waivers to allow the use of certain 2012 code sections.

NFPA 101- Life Safety Code 2012 Edition In Technical Bulletins issued March 9, 2012, April 19, 2013 & August 30, 2013 CMS announced that it will allow categorical waivers of the current LSC requirements found in the 2000 edition of the LSC for the following items : Will allow existing openings in exit enclosures to mechanical equipment spaces that are protected by fire-rated door assemblies. These spaces must be used only for non- fuel-fired equipment, must contain no storage of combustible materials, and must be located in sprinklered buildings. This waiver will be permitted if the facility is in compliance with section 7.1.3.2.1(9)(c) of the 2012 LSC. Will allow new sleeping suites up to 10,000 square feet if the facility is in compliance with 18/19.2.5.7 of the 2012 LSC. Will allow one of the required means of egress from sleeping and non-sleeping suites to be through another suite, provided adequate separation exists between suites and one of the two required exit access doors from sleeping and non-sleeping suites to be into an exit stair, exit passageway, or to the exterior.

NFPA 101- Life Safety Code 2012 Edition Categorical Waivers cont. Will allow more than one delayed-egress lock in the egress path, but only if the facility is in compliance with all other applicable 2000 LSC door provisions, as well as with sections 18/19.2.2.2.4 of the 2012 LSC. Will allow door locking where justified by clinical needs, patients pose a security risk, or where patients require specialized protective measures for their safety, if the facility is in compliance with sections 18/19.2.2.2.2 through 18/19.2.2.2.6 of the 2012 LSC. Will allow an increase in the size of containers used solely for recycling clean waste or for patient records awaiting destruction outside of a hazardous storage area to be a maximum of 96-gallons, if the facility is in compliance with sections 18/19.7.5.7.2 of the 2012 LSC. Will allow a testing interval of 6 years rather than 4 years for the maintenance testing of fire and smoke dampers as long as the testing system conforms to the requirements under 2007 NFPA 80 and the 2007 NFPA 105

NFPA 101- Life Safety Code 2012 Edition Categorical Waivers cont. Will allow for the reduction in the testing frequencies for sprinkler system vane-type and pressure switch type waterflow alarm devices to semiannual, and electric motor-driven pump assemblies to monthly. This waiver allowance will be permitted only if the facility is in compliance with all other applicable 1998 NFPA 25 (as referenced in section 9.7.5 of the 2000 LSC) testing provisions, as well as with sections 5.3 and 8.3 of the 2011 NFPA 25. Will allow for a reduction in the annual diesel-powered generator exercising requirement from two (2) continuous hours to one hour and 30 minutes (1-1/2 continuous hours), but only if the provider/supplier is in compliance with all other applicable 1999 NFPA 110 operational inspection and testing provisions, as well as with section 8.4.2.3 of the 2010 NFPA 110. Will allow for the use of power strips in existing and new health care facility patient care areas/rooms, if they comply with all applicable 2012 NFPA 99 power strip requirements and with all other 1999 NFPA 99 and 2000 LSC electrical system and equipment provisions.

NFPA 101- Life Safety Code 2012 Edition When the 2012 LSC is adopted, these changes will also be effective: At 18.2.3.4(4) – Equipment will be allowed to be kept in corridors that are a minimum of 8’-0” in width and as long as 60” of clear with is maintained. This will include in-use carts (laundry, food service, housekeeping), emergency equipment and portable lifts. At 18.2.3.4(5) – Furnishings (tables, chairs and other seating) will be allowed on one side of corridors that are a minimum of 8’-0” in width and as long as 60” of clear width is maintained. Each furniture location is limited to 50sf or less and furniture locations must be separated by a minimum of 10ft.

NFPA 99 – Health Care Facilities Code 2012 Edition In a Technical Bulletin issued April 19, 2013 CMS announced that it will allow a categorical waiver of the current NFPA 99 requirement for the following item: Will allow Hospitals and Critical Access Hospitals with new and existing ventilation systems supplying anesthetizing locations, as defined by the 1999 edition of NFPA 99, to operate with a Relative Humidity level of ≥ 20 percent. CMS will strongly recommend that facilities maintain RH in a range of ≥20 – ≤60 percent in all anesthetizing locations. Will allow a centralized computer system to substitute for one of the Category 1 medical gas master alarms, but only if the provider/supplier is in compliance with all other applicable 1999 NFPA medical gas master alarm provisions, as well as with section 5.1.9.4 of the 2012 NFPA 99.

International Building Code 2015 The 2015 codes were adopted on September 21, 2015. The 6 month grace period runs until March 21, 2015 The NJ edited editions are available from the ICC

International Building Code 2015 Section 202 Definitions Added definitions for: Custodial Care – Assistance with day to day living, slow evacuation time or mental/psychiatric complications Care Suite – A group of treatment rooms patient sleeping rooms and support space in an I-2 use with attendant staff Medical care – Care involving medical or surgical procedures, nursing or for psychiatric purposes 24 Hour Care – The actual time that a person is given care, not the amount of time a facility is open Incapable of Self-preservation – Persons that because of age, physical or mental limitations, chemical dependency or medical treatment can not respond to an emergency situation

International Building Code 2015 Section 308 Institutional Group I At Section 308.1 – Added “ Incapable of Self-preservation” to the general charging statement defining Use Group I At Section 308.4 – Added “ Medical care on a 24 Hour basis for those Incapable of Self-preservation” to the defining statement for Institutional Group I-2 At Section 308.4.1 – Added occupancy conditions for I-2 uses: 308.4.1.1 Condition 1 – Nursing and medical care, but no ER, surgery, obstetrics, psych or detox 308.4.1.2 Condition 2 – Nursing and medical care, with ER, surgery, obstetrics, psych & detox Made nomenclature changes such as: Patients – now referred to as Care Recipients Nurses station – now referred to as Care Provider Station Mental health – now referred to as Psychiatric

International Building Code 2015 Chapter 4 Special Use & Occupancy Added new Section 407.4.1 Direct Access to a Corridor - Requires all rooms in I-2 uses to have a door directly to a corridor with the exception of those rooms in a “Care Suite”. Added new Sections 407.4.1 thru 407.4.4.6.1 – These sections deal with Care Suites and will now mirror the sections in Chapter 18 of the 2012 Life Safety Code dealing with travel distance, access to corridors, doors, fire separation and size of sleeping and non-sleeping suites. Modified section 407.5.1 Refuge Area - Revised this section to mirror Chapter 18 of the 2012 Life Safety Code. Modified Section 407.8 Automatic fire Detection - Included specifics for Condition 1 and Condition 2. Added Section 407.10 Electric Systems – References the Electrical Subcode and NFPA 99 for essential electrical systems.

International Building Code 2015 Chapter 5 General Building Height & Area Made changes at Table 509 Incidental Uses Room or Area Separation and/or Protection In ambulatory care facilities, laboratories not classified as Group H 1 hour and provide automatic sprinkler protection In Group I-2, laundry rooms over 100 sf 1 hour In Group I-2, physical plant maintenance shops In ambulatory care facilities or Group I-2 occupancies, storage rooms greater than 100sf

International Building Code 2015 Chapter 9 Fire Protection Systems At Section 903.2.2 – Ambulatory Care Facilities Changed “fire area” to “entire floor” At item #1 added the sentence “whether rendered incapable of self preservation by staff or already incapable of self preservation” Added “ If the ACF is on a floor other than the level of exit discharge, all floors below & all floors between the ACF and the level of exit discharge must be sprinklered” At Section 903.2.6 – Group I-4 Day Care The sprinkler requirement noted above is also required for Day Care

International Building Code 2015 2009 IBC Section 903.2.2

International Building Code 2015 2015 IBC Section 903.2.2

International Building Code 2015 2015 IBC Section 903.2.2

International Building Code 2015 Chapter 9 Fire Protection Systems A new Section 915 – Carbon Monoxide Detection has been added This section includes requirements for I-2 Use Groups using any type of fuel burning appliances. The section specifies where the detection must be located, the power source and system maintenece. Chapter 10 Means of Egress A new Section 1008.2.2 – Exit Discharge Illumination has been added This section requires a minimum lighting level of 1 footcandle at all exit discharge doorways and landings in Group I-2 Uses even if the required lighting unit fails.

International Building Code 2015 Chapter 10 Means of Egress – cont. At Section 1010.1.9.6 – Controlled Egress in I-2 Uses Added an additional exception (#2) allowing doors to nurseries and obstetrics areas the same locking conditions as psych treatment areas Chapter 16 Structural Design At Section 1607 – Live Loads Added new Section 1607.6 – Helipads This is a new section specifically for roof top helipads Designates design loads based on the maximum take-off weight of helicopters using the pad Provides other parameters for helipad design.

International Codes Council Ad Hoc Committee on Healthcare The objective of this committee is to develop code change proposals which will result in the most contemporary and efficient provisions for hospital and ambulatory care facilities. Most of the work that they are doing will bring the IBC in line with the requirements already in place in the LSC They are looking at 4 different areas throughout the code with regard to requirements for health care facilities : Means of Egress Fire/Life Safety General Code Requirements Occupancy

Where To Get More Information: FGI Guidelines 1.800.242.2626 www.ashestore.com NJ Uniform Construction Code & Uniform Fire Code 609.984.0040 www.nj.gov/dca/codes/forms/pubsandsubs.htm International Codes 1.800.786.4452 order@iccsafe.org National Fire Protection Association 1.800.344.3555 www.custserv@nfpa.org

609. 516. 8978 dbuhaze@optonline.net