2014 Twin state seminar

2014 TWIN STAT

E

SEMINAR

J ULY 1

8 , 20 1 4 Impact of CMS’

Adoption of 2012 NFPA 101 & 99

Dave Dagenais, CHFM, CHSP, FASHE

CMS IS PROPOSING TO ADOPT NFPA 101 & NFPA 99 WITH THE FOLLOWING MODIFICATIONS

ADOPTION, CHANGE IN DEFINITIONChanges definition of “health care

occupancy” from applying to “4 or more patients” to “regardless of the number of patients served”

Could apply to hospital outpatient depts.Based on billing of hospital-based provider services in outpatient buildings

ROLLER LATCHESDoes not allow the exception

in the LSC that permits use of roller latches

CMS standards have permitted use of roller latches for more than 20 years

Roller latches have become common in behavioral health

ALCOHOL BASED HAND RUBS2012 LSC allows ABHRsAccepts 2012 LSC requirements but

adds “if installed to prohibit inappropriate access”

– Interpretive guidance is needed to determine what this means.

SPRINKLER 4-HOUR RULENFPA 25 formerly required evacuation or fire

watch of facilities if a sprinkler system was out of service for more than 4 hours in a 24-hour period.

This has been changed in NFPA 25 to 10 hours to accommodate a “work day.”

CMS proposes going back to the 4-hour period.

CMS WILL REQUIRE OR SMOKE VENTSRequired when flammable anesthetics were

usedRemoved as operating room ACH increased,

sprinkler requirements were added, severity of fire risk and extent decreased

36" SILL HEIGHTOkay for new constructionAs written will apply to existing constructionHow many existing facilities will this affect?What is the cost to fix this condition?Is it worth it?Staff should not break out windows during a fire

Patients should not be evacuated through windows

ADOPTION OF NFPA 99, 2012 EDITIONDirectly adopts NFPA 99: Health Care

Facilities CodeExcept chapters:

Chapter 7 = IT and Nurse CallChapter 8 = PlumbingChapter 12 = Emergency

PreparednessChapter 13 = Security

CATEGORICAL W

AIVERS

S&C 13-58Issued August 30th, 2013

Covers several “categorical waivers”

Allows substitution of a centralized computer system for (one) Category 1 medical gas master alarm.

MEDICAL GAS MASTER ALARMS

Permits existing openings in exit enclosures to mechanical equipment spaces if they are protected by fire-rated door assemblies.

OPENINGS IN EXIT ENCLOSURES

Reduces the annual diesel-powered generator exercising requirement from two (2) continuous hours to one hour and 30 minutes.

EMERGENCY GENERATORS AND STANDBY POWER SYSTEMS

Allows more than one delayed-egress lock in the egress path where the clinical needs require specialized security measures or when a patient requires specialized protective measures for safety.

DOORS

Allows: 1. Suite to suite egress2. Allows one of the two

required exits to enter an exit stair

3. Increase the sleeping room suite size up to 10,000 sq. ft.

SUITES

Allows:1. Reduction in the

testing frequencies for sprinkler system vane-type and pressure switch type waterflow alarm devices to semiannual,

2. Electric motor-driven pump assemblies to monthly.

EXTINGUISHING REQUIREMENTS

Allows the increase in 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

CLEAN WASTE & PATIENT RECORD RECYCLING CONTAINERS

Corridor WidthNew “Effective”

Corridor widthFixed furniture allowed

Rolling carts, equipment and movement aids allowed

S&C 12-21

Bench c.c.

5’-0

”

8’-0

”

DECORATIONSIncreases the amount of wall space that may

be covered by combustible decorations20% Not Sprinklered30% Sprinklered50% Sprinklered in patient room (less than 4)

FIREPLACESAllows the installation of direct vent gas

fireplaces in smoke compartments containing patient sleeping rooms and the installation of

solid fuel burning fireplaces in areas other than patient sleeping areas

S&C 13-25OR Relative Humiditylowering the humidity requirement for

operating rooms and other anesthetizing locations from at least 35percent to at least 20 percent.

HOW TO REQUEST A CATEGORICAL WAIVERDocument your desire and that you comply with the

waiver provisions in your policy and procedures manual.

Verbally announce that you are requesting the waivers at each entrance interview of a survey

Check with your State Agency and verify the waivers will be accepted for licensing

Indicate Life Safety waiver requests in your BBIIndicate Environment of Care waiver requests in your

management plan

NFPA 99

2012 EDITION OVERVIEW

AND DISCUSSION

ITEMS DELETED-OVERVIEWLaboratory requirementsManufacturers’ requirements on electrical

equipment Annexes B, D, & E are deleted. They are

technology not used any longer.All of the Occupancy Chapters

NEW ITEMS-OVERVIEWStandard becomes a CodeFundamentals Chapter on RiskInformation Technology and Communication SystemsPlumbingHeatingEmergency Management (new requirements)SecurityFire Protection unique to Health Care Facilities

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

ADMINISTRATION(CHAPTER 1)To provide minimum requirements for the:PerformanceMaintenance, Testing and InspectionSafe practices based on risk

ADMINISTRATION(CHAPTER 1)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 existingEmergency Management and Security apply

to existing

REFERENCED PUBLICATIONS (CHAPTER 2)All Referenced publication material has been

updated to most current version

DEFINITIONS(CHAPTER 3)3.3.9 Anesthetizing location – General

anesthesia 3.3.17 Battery powered lighting units – NFPA

703.3.63 General anesthesia and levels of

sedationDeep sedationGeneral anesthesiaMinimal sedationModerate sedation3.3.109 Medical support gas

FUNDAMENTALS(CHAPTER 4)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.

FUNDAMENTALS(CHAPTER 4)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.

FUNDAMENTALS(CHAPTER 4)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.

FUNDAMENTALS(CHAPTER 4)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.

FUNDAMENTALS(CHAPTER 4)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.

GAS AND VACUUM SYSTEMS(CHAPTER 5)Adding testing and inspection requirements

on existing non-stationary medical booms

Testing per manufacturers recommendations, every 18 months or based on risk assessment.

GAS AND VACUUM SYSTEMS(CHAPTER 5)5.1.4.8 Zone Valves. All station outlets/inlets

shall be supplied through a zone valve as follows:

The zone valve shall be placed such that a wall intervenes between the valve and outlets/inlets that it controls.

“Wet Location” changes to “Wet Procedure Location” throughout the entire document

ELECTRICAL SYSTEMS(CHAPTER 6)

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

ELECTRICAL SYSTEMS(CHAPTER 6)

ELECTRICAL SYSTEMS(CHAPTER 6)Increases minimum number of receptaclesGeneral Care – From 4 to 8Critical Care – From 6 to 14Operating 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)

ELECTRICAL SYSTEMS(CHAPTER 6)

ELECTRICAL SYSTEMS(CHAPTER 6)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

ELECTRICAL SYSTEMS(CHAPTER 6)

ELECTRICAL SYSTEMS(CHAPTER 6)New section on campus electrical systems

being addedAttempts to

clear up conflicts

with NEC

ELECTRICAL SYSTEMS(CHAPTER 6)Requires all operating rooms to be wet

procedure locations (unless risk assessment is done)

ELECTRICAL SYSTEMS(CHAPTER 6)Permits isolated power or ground fault

protection within operating rooms

ELECTRICAL SYSTEMS(CHAPTER 6)Eliminates emergency system heading and

equipment system heading and utilizes branches

Life SafetyCritical Equipment

ELECTRICAL SYSTEMS(CHAPTER 6)Added text to permit a 0.1 second delay for

selective coordination

IT AND COMMUNICATION (CHAPTER 7)New chapter covers IT roomsFire protectionNurse callEmergency callStaff emergency assistance

PLUMBING(CHAPTER 8)TIA will cover plumbing requirementsEssentially will refer to other

model codes or standards

TIA8.1.4.1 Nonmedical Compressed Air8.3.1 Potable Water. Potable water systems shall comply with applicable

plumbing codes.8.3.2 Nonpotable Water. Nonpotable water systems shall comply with

applicable plumbing codes.8.3.3 Water Heating. Maximum hot water temperatures shall comply with

applicable plumbing codes.8.3.4 Water Conditioning. Water shall be treated or heated to control

pathogens in the water.8.3.5 Nonmedical Compressed Air.8.3.7 Grease Interceptors.8.3.10 Grey Waste Water.8.3.11 Clear Waste Water.

HEATING, VENTILATION AND AIR CONDITIONING(CHAPTER 9)New TIA will cover oxygen transfilling room

requirementsWaste Anesthesia Gas Disposal (WAGD)

TIA9.3.3 Commissioning9.3.7 Medical Gas Storage or Transfilling.9.3.7.5.2 Natural Ventilation9.3.7.5.3 Mechanical Ventilation.9.3.8 Waste Gas.9.3.9 Medical Plume Evacuation

ELECTRICAL EQUIPMENT(CHAPTER 10)Chapter reorganizedTesting requirements have been updatedLeakage requirements have been updated

MULTIPLE OUTLET CONNECTIONS(POWER TAPS)10.2.3.6• Allows power taps that meet the followingo Permanently attachedo Some of load not over 75%o Cord meets NFPA 70o Electrical integrity is regularly verified and

documentedo When new equipment is attached,

integrity must be verified again.

GAS EQUIPMENT(CHAPTER 11)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.

11.4.3.1.1 Specifies the requirements for carts and hand trucks that transport cylinders (must be self supporting and have appropriate chains.)

EMERGENCY MANAGEMENT(CHAPTER 12)Completely rewritten and expanded for 2012Two categories of risk

In-patient facility is expected to be operableIn-patient and out-patient areas that augment the critical mission but not receive in-patients

Requires a Hazard Vulnerability Analysis (HVA)Natural HazardsHuman-caused EventsTechnological Events

EMERGENCY MANAGEMENT(CHAPTER 12)Requires plans to manage resources and

assetsRequires ExercisesRequires Evaluation of Exercises

Special Care was taken to avoid conflicts with the Joint Commission and CMS

SECURITY MANAGEMENT(CHAPTER 13)Planning for protection of the Staff and Facility beyond

disastersRequires a Security Vulnerability Assessment (SVA)Requires a responsible personEducation requirements of security staffCustomer ServiceEmergency ProceduresUse of ForceDe-escalationUse of Restraints

SECURITY MANAGEMENT(CHAPTER 13)Requires procedures for HostageBomb ThreatWorkplace ViolenceDisorderly ConductRestraining Orders

SECURITY MANAGEMENT(CHAPTER 13)Identifies known security sensitive areas Emergency DepartmentsPediatric and Infant Care unitsMedication StorageClinical LabsForensic Patient Treatment AreasDementia or Behavior Health UnitsCommunications, data infrastructure and medical records

SECURITY MANAGEMENT(CHAPTER 13)Other subjects coveredMedia controlCrowd controlSecurity equipment – follow NFPA 731Employee practicesSecurity operations

HYPERBARIC FACILITIES(CHAPTER 14)Piping requirements have been updatedNew requirements for location of shutoff

valveUpdated requirements for reserve to central

supply systemNew requirements for hyperbaric medical air

system

FEATURES OF FIRE PROTECTION(CHAPTER 15) Chapter applies to new and existingPulls most of text from NFPA 101Fire alarm and detection Protection of gas cylinder storageHVAC detection requirements Defend in place requirementsClosets sprinkler exception (less than 6 sq. ft.)Orientation and training requirements

NFPA 101

2012 EDITION OVERVIEW

AND DISCUSSION

Normally occupied building service equipment support area

People not present on a regular basis

DEFINITIONS(CHAPTER 3)

7.2.1.5.1• Door leaves shall open

readily from the egress side.

7.2.1.5.2• The requirements of

7.2.1.5.1 shall not apply when door is exposed to elevator temperature in compliance with listing.

MEANS OF EGRESS(CHAPTER 7)

MEANS OF EGRESS(CHAPTER 7)7.2.1.5.10.6Two release operation is permitted on

existing doors when an occupant load does not exceed three providing it does not require simultaneous operation.

EXISTING HEALTHCARE OCCUPANCY(CHAPTER 19)19.2.2.2.5.1• Door locking is permitted for clinical or security

needs provided staff can readily unlock doors.o Provisions must exist for rapid removal• Remote control locks• Keys carried by staff• Other reliable means

o Only one lock per dooro More than one permitted with AHJ

DELAYED EGRESS LOCKS(CHAPTER 19)• More than one delayed egress lock is

permitted in the egress path

DELAYED EGRESS LOCKS(CHAPTER 19)19.2.3.4• Permits items in corridor such as wheeled

equipment, carts in use, medical emergency equipment, patient lift and transport equipment and fixed furniture as long as it does not reduce the corridor width to less than 5 feet.

SUITES(CHAPTER 19)19.2.5.7.2.3• Permits sleeping suites to be 7500 sq. ft.

where protected with sprinklers.• Can go to 10,000 sq. ft. o Direct visual supervisiono Supervised sprinkler system o Automatic smoke detection

SUITES(CHAPTER 19)Permits suites to egress through adjoining suite and more than one intervening room.

ALCOHOL BASED HAND RUB(CHAPTER 19)19.3.2.6• Exempts one dispenser per room from the

10-gallon per smoke compartment requirement.

DECORATIONS(CHAPTER 19)19.7.5.6Increases the amount of wall space that may

be covered by combustible decorations• 20% Not Sprinklered• 30% Sprinklered• 50% Sprinklered in patient room (less

than 4)

SPRINKLERS(CHAPTER 19)19.3.5.10Sprinklers not required in clothes closets in

patient sleeping rooms where the area does not exceed 6 sq. ft.

CONTAINERS FOR RECYCLING, CLEAN WASTE OR PATIENT RECORDS (CHAPTER 19)19.3.5.10May be between 32 – 96

gallons if they meet FM standard 6921.

Thank You

Questions?

Dave Dagenais, CHFM, CHSP, FASHE