Presented by
David Dagenais, SASHE, CHFM, CHSP
Tuesday September 27th, 2011
 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
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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
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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
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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
•
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.
•
To provide minimum requirements for the:
• Performance
• Maintenance,
Testing and
Inspection
• Safe practices based on risk
 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
 All
Referenced publication material has
been updated to most current version
 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
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 3.3.109
Medical support gas
 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.
 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.
 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.
 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.
 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.
• New Section on Cryogenic Systems
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Working with NFPA 55 on bulk
oxygen requirements
Tested for proper function
For purity, alarm sensors
Operation of the control sensors
 Adding
testing and inspection requirements
on existing non-stationary medical booms
Testing per manufacturers
recommendations, every 18
months or based on risk
assessment.
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5.1.3.8* Instrument Air Supply Systems.
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5.1.3.8* Optional Instrument Air Supply
Systems.
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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.
 “Wet
Location” changes to “Wet Procedure
Location” throughout the entire document
 Permits
isolated power or ground fault
protection within operating rooms
 Requires
that overcurrent
protection devices only be
accessible to authorized personnel
and not permitted in public access
spaces
 Increases
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minimum number of receptacles
General Care – From 4 to 8
Critical Care – From 6 to 14
Operating Rooms – New requirement of 36
 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)
Monthly
Generator Testing - 10
second transfer not required
(Annual Confirmation)
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
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New section on campus electrical
systems being added
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Attempts to
clear up
conflicts
with NEC
 Requires
all operating rooms to be wet
procedure locations (unless risk assessment is
done)
 Eliminates
emergency system heading and
equipment system heading and utilizes branches
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Life Safety
Critical
Equipment
Submitters are attempting to retain
the emergency system language
 Added
text to permit a 0.1 second delay for
selective coordination
New chapter covers
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IT rooms
Fire protection
Nurse call
Emergency call
Staff emergency assistance
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TIA will cover plumbing requirements
Essentially will refer to other
model codes or standards
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New TIA will cover oxygen transfilling room
requirements
Waste Anesthesia Gas Disposal (WAGD)
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Chapter reorganized
Testing requirements have been updated
Leakage requirements have been updated
•
11.3.2.5 Temperature limitations to
storage of cylinders must comply with
5.1.3.3.1.7 (temperatures not to
exceed 54o C or 130o F.
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11.4.3.1.1 Specifies the requirements
for carts and hand trucks that transport
cylinders (must be self supporting and
have appropriate chains.)
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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
•
Completely rewritten and expanded for 2012
▫ Two categories of risk
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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
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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
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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
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Customer Service
Emergency Procedures
Use of Force
De-escalation
Use of Restraints
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Requires procedures for
Hostage
Bomb Threat
Workplace Violence
Disorderly Conduct
Restraining Orders
Identifies known security sensitive areas
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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
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Other subjects covered
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Media control
Crowd control
Security equipment – follow
NFPA 731
Employee practices
Security operations
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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
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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
David Dagenais, SASHE, CHFM, CHSP
Dave.Dagenais@wdhospital.com