healthcare facilities codes standards for design and construction

1. HEALTHCARE FACILITIES CODES & STANDARDSFORDESIGN AND CONSTRUCTION

2. HEALTCARE FACILITIESPresented by: Jon Cechvala, Architect, AHJ Emeritus Eppstein Uhen Architects, Milwaukee/Madison Dave Soens, P.E,- R. A. AHJ/Consultant Provider Regulation Quality Assurance Section- BQA State of Wisconsin Wade Rudolph, CBET Wisconsin Health Care Engineer Codes & Standards Committee Chairman

3. Health Care Facilities Hyperbaric Chambers Design and Installations

4. Classifications of Chambers Class A- Human, Multiple Occupancy Class B- Human, Single Occupancy Class C- Animal, no Human Occupancy Note: If animal, but, access for personal care, then classified as Class A

5. Hyperbaric Oxygenation Defined as: The application of pure oxygen or an oxygen enriched gaseous mixture to a subject at elevated pressure Used to treat variety of nonhealing conditions such as diabetic ulcers, failing skin flaps, and osteoradionecrosis of the mandible (Rotting of the jaw bone)(Rotting of the jaw bone)

6. Hyperbaric Definition : Pressures above the Atmospheric Pressure

7. Noncombustible (hyperbaric) Defined as a Substance that will Not Burn In 95% + 5 % Oxygen Concentration at Pressures up to 3 ATA (44.1 psia).

8. Oxygen Toxicity (Hyperbaric) Physical impairment resulting from Breathing Gaseous Mixtures containing Oxygen Enriched Atmospheres at Elevated Partial Pressures for extended periods of time. Two types: Pulmonary Central Nervous System Easily controlled with well established safety practices

9. Electrical Hazards Electrical Hazard Potential Ignition sources includes: Broken Light Bulb Elements Switches Overheated Motors Electrical Thermostats Static Sparks Children�s sparking type Toys

10. Fire Hazards Due to Increase of Oxygen Levels: -Flammability and Combustibility Increase Products normally not a Risk will become One: Human Tissue becomes Combustible 20 seconds or less to Burn Clothes Oil based Cosmetics become Extremely Flammable

11. Other Hazards Explosive Hazards: Fires create Heat and Additional Pressures that Exceed the Structural Limits of the Vessel Implosive Hazards: Collapse of Light Bulbs Overloading Fan Motor Health Hazards: Oxygen Toxicity

12. Construction Requirements Class A Chambers inside of a Building: Required 2 -hour Fire Rated Construction Fire Barrier Fire Doors 1 � hour Fire Rating Wet pipe Sprinkler System per NFPA 13 Chamber Room Heads shall be Fusible, as low temperature rating as possible, consistent with protection against false operation Flooring shall be Noncombustible and Antistatic Finishes and Furnishings shall be Flame Resistant

13. Construction Requirements Class A and B Chambers: Room or Rooms shall be Exclusive for this use. Supporting Foundation shall support Chamber which includes an on Site Hydrostatic Test. Illumination: Provided from Outside the Pressure Vessel unless specially designed i.e. explosion proof. Emergency Lighting shall be provided

14. Construction Requirements Chamber ventilation Class A and Class B If used for operations, vessel shall meet minimum requirements for Anesthetizing locations Recommend Humidity Controls of 50 �70% for Static Control Minimum shall be 3cfm actual per Occupant If Anesthetic Agents used, must provide Closed Anesthetic System with Gas Scavenging No Flammable Anesthetics allowed Individual Breathing Apparatus required for Each Occupant in and Key Staff Outside of Chamber Special Issues regarding Air used in the Chamber: Compressors shall produce Medical Air and be monitored Dual Compressors served from 2 Electrical Branches

15. Construction Requirements Fire Protection in Class A: Independently supplied Handline and Deluge System shall be installed, which, upon activation shall activate Visual and Audible Indicators at Operators Console And Disconnects Ungrounded Leads in Chamber. But not the Communication systems. Emergency Lighting and Communications shall be activated. Fire alarm Signaling Device(s) shall be at the Operators Station Booster pumps, Control Circuit for Fire Suppression shall be connected to the Critical Electrical Branch

16. Deluge System RequirementsClass A Manual Activation and Deactivation Controls inside Chamber and at Control Console Water shall be delivered in less than 3 Seconds at a minimum of 2 gal/ sq. ft for at least one minute Shall have stored Pressure to Operate for 15 Seconds without Electrical Branch Power Deluge System shall be Tested Annually.

17. Handline System RequirementsClass A Shall be at least � inch internal diameter with rated working pressure greater than the supply pressure of the system Activated by quick opening � turn valve located within the chamber Shall have override valves outside chamber Shall have supply pressure 50 psi over chamber maximum pressure Shall provide minimum of 5 gpm for two lines at maximum chamber pressure Tested annually

18. Automatic Detection SystemClass A Are optional, but if provided must meet the following: Shall respond within 1 second of flame origination Number of detectors depends on configuration and sensitivity of detector Shall have automatic battery back up power or be supplied by critical branch of emergency electrical system Can be used to active deluge system Shall include self monitoring functions for fault alarms

19. Fire Protection for Class B and C No requirements for fire protection Has not been proven to be effective in these applications Chamber must be vented to the outside of the building

20. Electrical System RequirementsClass A All controls shall be outside of and in the vicinity of the chamber. All components (line fuses, circuit breakers, controllers, relays, transformers, ballasts, lighting panels, power panels) shall be located outside of pressure chamber. If sprinkler is activated the electrical equipment shall be protected so to safely decompress the chamber. Two sources of power are required If unit not in hospital, then NFPA 70 article 700 applies

21. Electrical System RequirementsClass A Equipment for Life Support shall be connected to Critical Branch circuits of Emergency Power System (restored in less than 10 seconds) Compressors, motors, and equipment located outside of chamber shall be connected to the Equipment system or the Emergency system Designed such to Prevent Hazardous condition during outage or Restoration of Power

22. Electrical System RequirementsClass A Conductors inside the Chamber must be Insulated with Flame Resistant Materials Fixed Wiring shall be in threaded RMC or IMC conduit using Waterproof Materials and Methods Means to Drain Conduits shall be Provided Receptacles and Switches shall be Waterproof and Prohibit Sparks in the Chamber In Healthcare Facilities power require isolated Power All Permanent Furniture shall be Grounded

23. Electrical System RequirementsClass B Electrical Equipment inside Chamber limited to Communication and Physiological Monitoring only.

24. Communications and Monitoring Intercommunications Combustible gas detection Oxygen monitoring Carbon Dioxide monitoring Chamber gas supply monitoring

25. AIA Guidelines for Construction and Design of Health Care Facilities Hyperbaric Suite Recommendations Included in Appendix Section

26. AIA-General Requirements Chambers constructed according to ASME PVHO-1 Safety Standard for Pressure Vessels for Human Occupancy and carry a �U� stamp Shall meet NFPA 99 chapter 20 Shall meet NFPA 101 chapter 12

27. AIA- Suggested Service Areas Reception/Control Desk Patient Waiting area Holding Area (room or alcove outside of normal traffic flow) Patient Records storage area Patient Restroom Patient Dressing Room Staff Toilet Room Consultation/Treatment Room Storage Space Soiled Holding Area Staff Hand Washing Station Housekeeping Room Gas Cylinder Room Compressor Room

28. AIA-Multiplace (Class A) Chambers Facility should be Designed to allow Rapid Evacuation The Rapid Removal of One Chamber Occupant shall not restrict the Simultaneous Removal of Patients from all other Chambers/Compartments

29. AIA-Multiplace (Class A) Chambers Minimum Clearances Chamber entry should accommodate Gurney Access: 10 feet If Access Ramps provided it shall be Flush with Chamber Entry Door Chambers be designed to allow Immediate Removal of Patients upon Depressurization Chamber Man Lock Entries shall have 4 feet clear Access between the Chamber and Control Console shall be 4 feet wide

30. AIA-Monoplace (Class B) Chambers The Rapid Removal of One Chamber�s Occupants shall not Restrict the Simultaneous Removal of Patients from all other Chambers or Chamber Compartments A Minimum of 2 Exits shall be provided from Chamber Room unless a Direct Exit is Provided to an Exit Access Corridor Exit door shall be 46 inches minimum opening Space shall comply with NFPA 99 Chapter 20

31. AIA-Monoplace (Class B) Chambers Minimum Clearances Chamber and Sidewall: 18 inches Chamber and Sidewall -if Controls present on Wall Side: 36 inches Between 2 Chambers: 4 feet Between Backside of 2 Chambers: 2 feet At Foot of Chamber: 14 inches At Head of Chamber: 8 feet 6 inches Any Electrical Receptacle within 10 feet of Chamber shall be located no less than 36 inches AFF