NFPA 99 2012 EDITION OVERVIEW AND DISCUSSION

1. NFPA 99 2012 EDITION OVERVIEW AND DISCUSSION Presented by Dave Dagenais, BS, SASHE, CHFM, CHSP Thursday, February 17, 2011 Not Speaking on Behalf of NFPA

2. NFPA Process Overview(Document Cycle) • Proposal period • NFPA generates a Report On Proposal • Comment period • NFPA generates a Report on Comments • Notice of Intent to Make A Motion • NFPA publishes the NITMAMs • Annual meeting with Technical Session • Membership Votes

3. NFPA 99 History • NFPA Standards Council allowed a complete rewrite of NFPA 99 following the 2005 edition • ASHE set up task forces to submit proposals • Committees met on proposals • Comments were submitted by public • Committees met on comments • Sent back to Committee at NFPA 2009 annual meeting

4. NFPA 99 (2nd cycle)Specific Opportunities to Influence Code Anyone can submit proposals na Proposal Closing Date was – na Technical Committees met December, 2009 (previous proposals) (Report on Proposals posted – 6/25/2010) Anyone can submit comments Comment Closing Date – 9/3/2010 (over 330 comments) Technical Committees met Fall 2010 (Report on Comments posted – 2/25/2011 Notice of Intent to Make A Motion NITMAM closing date – 4/8/2011 NFPA Conference with Technical Session June 2011 BOSTON Opportunity

5. New Items Overview • 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

6. Scope • Establish criteria to minimize: • The hazards of fire, • Explosion, and • Electricity • Applies to facilities providing services to human beings only Comment to Delete Committee Rejected

7. Purpose • To provide minimum requirements for the: • Performance • Maintenance, Testing and Inspection • Safe practices based on risk Committee Rejected Comment to Delete

8. Application • Applies to all health care facilities • 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. How the Code Works • 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

10. Categories • Category 1 - System Failure that would probably cause patients or caregivers major injury or death. • Category 2 - System Failure that would most likely cause minor injury to patients or caregivers. Many Comments to Change Committee Rejected

11. Categories • Category 3 - System Failure that would most likely cause discomfort to patients or caregivers. • Category 4 - System failure has no impact on patients or caregivers. Many Comments to Change Committee Rejected

12. Definition of Healthcare Facility • 3.3.68 • Buildings or portions of building in which medical, dental psychiatric, nursing, obstetrical, or surgical care is provided. (ADM) • (Non-residential) Buildings or portions of building in which medical, dental psychiatric, nursing, obstetrical, or surgical care is provided. (ADM) Comment Change Committee Exempted Home Health

13. Gas and Vacuum Systems(Chapter 5) • New Section on Cryogenic Systems • Working with NFPA 55 on bulk oxygen requirements • Tested for proper function • For purity, alarm sensors • Operation of the control sensors • Installers need 6015 qualification Several Comments Committee Rejected

14. Gas and Vacuum Systems(Chapter 5) • Technical Committee rejectedannual outlet/inlet testing requirement OK No Comments

15. Gas and Vacuum Systems(Chapter 5) • Rejected requiring ASSE 6040 (certification of maintenance workers) but recommended it in the annex Comments to Add Back Committee Rejected

16. Gas and Vacuum Systems(Chapter 5) • Continue to prohibit the use of medical air for any other purpose • Scope cleaning • Decontamination • Laser plume, etc. • Med gasses may only be used for human consumption and calibration Several Comments Committee Rejected

17. Gas and Vacuum Systems(Chapter 5) • Adding testing and inspection requirements on existing non-stationary medical booms (annually) Comments to Make it Periodic Committee Changed to: Per manufacturer’s recommendations, every 18 months, or based on risk assessment

18. Electrical Systems(Chapter 6) • Definition of “Wet Location” changes to “Wet Procedure Located” throughout the entire document OK-No Comments

19. Electrical Systems(Chapter 6) • Requires all operating rooms to be wet procedure locations (unless risk assessment is done) Comments to Change Committee Rejected

20. Electrical Receptacle Testing • Revise 4.3.4.1.2 to read: “ Additional testing of receptacles in patient care areas shall be performed at intervals defined by documented performance data, but not exceeding 5 years.” Committee Rejected Comment to Add

21. Electrical Systems(Chapter 6) • Permits isolated power or ground fault protection within operating rooms Comments to limit use of GFCIs Committee Rejected

22. Electrical Systems(Chapter 6) • Requires that overcurrent protection devices only be accessible to authorized personnel and not permitted in public access spaces OK-No Comments

23. Electrical Systems(Chapter 6) • Increases number of receptacles • General Care – From 4 to 8 • Critical Care – From 6 to 14 • Operating Rooms – New requirement of 36 OK-No Comments

24. Electrical Systems(Chapter 6) • Eliminates emergency system heading and equipment system heading and utilizes branches • Life Safety • Critical • Equipment • This should exempt us from the 700 chapter in the NEC Comments to Comply with 700 Committee Rejected

25. Electrical Systems(Chapter 6) • 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) OK-No Comments

26. Electrical Systems(Chapter 6) • Added text to permit a 0.1 second delay for selective coordination Several Comments Committee Rejected

27. Electrical Systems(Chapter 6) • MonthlyGenerator Testing - 10 second transfer not required (Annual Confirmation) OK- No Comments

28. Electrical Systems(Chapter 6) • In existing facilities with no separate grounding conductor – annual test requirement • Voltage readings • Impedance measurements with conductive surfaces in the areas Committee Dropped “Annual” Comments on This

29. Electrical Systems(Chapter 6) • 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 OK-No Comments

30. Electrical Systems(Chapter 6) • New section on campus electrical systems being added • Clears up conflicts with NEC Comments on This Committee Rejected

31. IT and Communication (Chapter 7) • New chapter covers • IT rooms • Fire protection • Nurse call • Emergency call • Staff emergency assistance Several Comments Committee Rejected: Requirements for cable race way protection was removed.

32. Plumbing(Chapter 8) • New chapter based on categories • Potable water • Non-potable water • Heating water • Water conditioning • Black waste water • Grey waste water • Clear waste water Several Comments Committee Rejected – Will require redundant systems

33. Heating(Chapter 9) • New chapter addresses • Heating, cooling and ventilation • Humidity control • Ventilation system requirements • Airborne contaminant controls • Ventilation for waste anesthetic gases disposal system Several Comments Committee Rejected – Will require redundant systems

34. Medical Equipment(Chapter 10) • Patient Care Vicinity • The Technical Committee rejectedexpanded definition of the patient vicinity Proposal stated: an electrical appliance that is intended to be used for diagnostic, therapeutic or monitoring purposes Several Comments Committee Rejected: Still uses the term “Patient Vicinity”

35. Gas Equipment(Chapter 11) • New standard allows use of piped 02 for ozone sterilizers • Equipment using medical grade oxygen from the piped distribution system shall meet the following requirements • Not permanently attached • Connected using wall outlet or flexible hose • Medical device listed by FDA • The TCC will have to address the conflict with Med Gas Several Comments Committee Rejected

36. Emergency Management(Chapter 12) • 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 OK-No Comments

37. Emergency Management(Chapter 12) • 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 Comments to Delete Committee Rejected

38. Security Management(Chapter 13) • 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 OK-No Comments

39. Security Management(Chapter 13) • Requires procedures for • Hostage • Bomb Threat • Workplace Violence • Disorderly Conduct • Restraining Orders OK-No Comments

40. Security Management(Chapter 13) • 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 OK-No Comments

41. Security Management(Chapter 13) • Other subjects covered • Media control • Crowd control • Security equipment – follow NFPA 731 • Employee practices • Security operations OK-No Comments

42. Features of Fire Protection(Chapter 15) • Fire alarm and detection • Protection of gas cylinder storage • HVAC detection requirements • Comments on sprinklers in closets (6 sq. ft.) • Comments on defend in place concepts • Comments on mobile storage units (50 sq. ft.) Several Comments

43. Next Steps • Report on Comment next week • NFPA 99 Goes to annual NFPA meeting in 2011 for adoption in BOSTON • I predict that 30 items or more will go to a floor vote.

44. It’s Time for All of Us to Get Involved • Identify NFPA members • Go to Boston for the vote on June 14 and 15, 2011 • Support Healthcare on the floor

45. Your Vote Can Make a Difference • In 2009, we removed the 5-year requirement for an obstruction inspection from NFPA 25; the vote was 43 to 35 • Weekly fire pump test was eliminated with a vote of 40 to 40 • 2009 NFPA 99 was sent back to committee with a vote of 73 to 50 This Membership alone could blow those votes out of the water

46. Thank you for your time.Questions? Dave Dagenais, BS, SASHE, CHFM, CHSP Dave.Dagenais@wdhospital.com