1. Presented by David Dagenais, SASHE, CHFM, CHSP Tuesday September 27 th, 2011

2.  Please silence all pagers and cell phones.  Not Speaking on behalf of NFPA or NFPA Technical Committees  Document is final and the NFPA Standards Council has approved  Available now, will ship in November

3.  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

4.  Standard becomes a Code  Fundamentals Chapter on Risk  Information Technology and Communication Systems  Plumbing  Heating  Emergency Management (new requirements)  Security  Fire Protection unique to Health Care Facilities

5.  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

6. Scope: The scope of this code is to establish criteria to minimize the hazards of fire, explosion, and electricity in healthcare facilities providing services to human beings.

7. To provide minimum requirements for the: Performance Maintenance, Testing and Inspection Safe practices based on risk

8.  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

9.  All Referenced publication material has been updated to most current version

10.  3.3.9 Anesthetizing location – General anesthesia  3.3.17 Battery powered lighting units – NFPA 70  3.3.63 General anesthesia and levels of sedation  Deep sedation  General anesthesia  Minimal sedation  Moderate sedation  3.3.109 Medical support gas

11.  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.

12.  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.

13.  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.

14.  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.

15.  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.

16.  Working with NFPA 55 on bulk oxygen requirements  Tested for proper function  For purity, alarm sensors  Operation of the control sensors New Section on Cryogenic Systems

17.  Adding testing and inspection requirements on existing non-stationary medical booms Testing per manufacturers recommendations, every 18 months or based on risk assessment.

18.  5.1.3.8* Instrument Air Supply Systems.  5.1.3.8* Optional Instrument Air Supply Systems.

19.  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 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.

21.  “Wet Location” changes to “Wet Procedure Location” throughout the entire document

22.  Permits isolated power or ground fault protection within operating rooms

23.  Requires that overcurrent protection devices only be accessible to authorized personnel and not permitted in public access spaces

24.  Increases minimum number of receptacles  General Care – From 4 to 8  Critical Care – From 6 to 14  Operating Rooms – New requirement of 36

25.  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)

26.  Monthly Generator Testing - 10 second transfer not required (Annual Confirmation)

27.  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

28.  New section on campus electrical systems being added  Attempts to clear up conflicts with NEC

29.  Requires all operating rooms to be wet procedure locations (unless risk assessment is done)

30.  Eliminates emergency system heading and equipment system heading and utilizes branches Life Safety Critical Equipment Submitters are attempting to retain the emergency system language

31.  Added text to permit a 0.1 second delay for selective coordination

32.  New chapter covers  IT rooms  Fire protection  Nurse call  Emergency call  Staff emergency assistance

33.  TIA will cover plumbing requirements  Essentially will refer to other model codes or standards

34.  New TIA will cover oxygen transfilling room requirements  Waste Anesthesia Gas Disposal (WAGD)

35.  Chapter reorganized  Testing requirements have been updated  Leakage requirements have been updated

36. 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.)

37.  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

38. 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

39.  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

40.  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

41.  Requires procedures for  Hostage  Bomb Threat  Workplace Violence  Disorderly Conduct  Restraining Orders

42.  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

43.  Other subjects covered  Media control  Crowd control  Security equipment – follow NFPA 731  Employee practices  Security operations

44.  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

45.  Chapter applies to new and existing  Pulls most of text from NFPA 101  Fire alarm and detection  Protection of gas cylinder storage  HVAC detection requirements  Defend in place requirements  Closets sprinkler exception (less than 6 sq. ft.)  Orientation and training requirements

46. David Dagenais, SASHE, CHFM, CHSP Dave.Dagenais@wdhospital.com