1. Health Facilities Management
Health Facilities Design: An Overview of the Code Requirements
David B.Uhaze, RA
Chief - Bureau of
Construction Project Review
NJ Dept. Of Community Affairs
Vice Chairman – FGI Health Guidelines Revision Committee
Health Facilities Management
Society of New Jersey
November 2014 Meeting

2. Introduction Bureau of Construction Project Review
Department of Health & Senior Services
Guidelines for Design and Construction of Hospitals and Outpatient Facilities
NFPA 101 & 99
International Codes

3. DCA – Bureau of Construction Project Review
The Bureau
Functions as the construction office for all building types or projects reserved to the State at NJAC 5:
This includes such projects as:
Healthcare Facilities
Casinos
State Buildings (State colleges, NJTPA, NJT, NJSEA, etc.)
Special Projects (Electrical Generating, Solid Waste
Treatment, Incineration Plants)
Prototypes (Big box stores, banks, etc.)
Schools

4. DCA – Bureau of Construction Project Review
Health Care Plan Review Unit
Performs both a UCC and Licensing review on all projects submitted
Will comment on Licensing requirements, but cannot grant waivers to those requirements
20 day review cycle for new projects with complete applications
7 day review cycle for re-submitted projects
Permitting and inspections are done at the local level
May grant permission for a local review of certain
projects

5. DCA – Bureau of Construction Project Review
Electronic Plan Review
The Department of Community Affairs has implemented an almost paperless review process. We are now able to do all of the following electronically:
Accepting project applications
Reviewing Plans
Issuing Releases
All of this is being done through an on line system called
ProjectDox by
Going paperless will reduce costs, cut time from the process, provide better tracking and be more efficient

6. DCA – Bureau of Construction Project Review
Electronic Plan Review
Avolve – ProjectDox is a Web hosted, secure site with a fully Automated review process that provides Automatic notifications, complete project tracking and extensive Project archiving

7. DCA – Bureau of Construction Project Review
Electronic Plan Review Process Overview
Applicant submits plan review application through to BCPR Intake Unit
BCPR Intake provides applicant with login information for access to Avolve
Applicant uploads project to Avolve
Avolve notifies BCPR that project has been uploaded
BCPR Intake screens project for completeness and sends confirmation to applicant
Project is assigned to the HCPR Review Team
HCPR reviewers perform review and attach any comments, then re-file back to Avolve
Avolve notifies applicant that review has been completed
Applicant reviews comments and makes appropriate corrections, then re-files thru Avolve
Avolves notifies HCPR that corrected documents are ready for review
HCPR reviewers perform review and issue release for project, then re-file thru Avolve
Avolve notifies applicant that review has been completed and documents are released
Applicant prints plans, signs and seals them, then submits for permits thru municipality

8. DCA – Bureau of Construction Project Review
You can find additional information about the Bureau including:
Bureau mailing addresses and phone numbers, a listing of
when a Bureau review and release is required, answers to frequently asked questions about the plan review and release process, the Procedures for Submission to Health Care Plan Review & E-Plan Review Procedures manuals
and
you can access all of the necessary forms for submission at the
Bureau’s website:

9. NJ Uniform Construction Code
Permit Extension Act
The original act of 2008 has been extended again.
Extends all permits & DCA releases that were open and valid as of January 1, 2007 until July 1, 2015
Applies to New Jersey permits only, does not include Federal permits
Includes UCC permits and other permits such as:
Local Planning and Zoning
County Planning and Zoning
Coastal Area Facilities Review
Pinelands Commission
Freshwater and Wetlands Review
Water and Sewer service extensions
Soil Erosion and Sediment Control

10. NJ Department of Health
No major proposals or adoptions at this time
NJDOH Acute Care Assessment & Survey will be continuing to survey to and use the 2000 Edition of the NFPA 101 Life Safety Code until a newer edition is adopted by CMS NJ
Health
New Jersey Department of Health

11. The FGI Guidelines 2014
The Hospital and Outpatient Facilities edition and the new Residential Health, Care, and Support Facilities edition were released in the spring of 2014
NJDOH and NJDCA set August 1, as the adoption date for both editions.
The 6 month grace period for voluntary use will end on February 1, 2015

12. The FGI Guidelines 2014 Major changes this cycle:
Two separate volumes:
Guidelines for Design and Construction of Hospitals and Outpatient Facilities
Includes Chapters 1, 2, 3 & 5 (except for Medical Day Care)
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
Includes Chapters 1 & 4 (plus Medical Day Care)
Both volumes contain Chapter 6 ASHRAE/ASHE 170

13. The FGI Guidelines 2014 Changes Part 1: New vs. Renovation
Changes have been made to improve the application of the Guidelines to existing facilities.
Only the altered, renovated, or modernized portions of an existing building system—or an individual component that has been altered, renovated, or replaced—are required to meet the installation and equipment requirements in the Guidelines.
A list of exceptions has been added to help clarify when existing systems or building equipment must be updated.

14. The FGI Guidelines 2014 Changes Part 1: Functional Program
The functional program was determined to be a critical aspect of planning and designing health care and residential facilities and was mandated for inclusion in the 2014 Guidelines documents.
Requirements were streamlined by moving substantial material into the appendix.
A requirement for an executive summary of key elements was added.
more than 400 references to the functional program in the body of the text were eliminated, and more appropriate language added.

15. The FGI Guidelines 2014 Changes Part 1: Safety Risk Assessment
An overarching risk identification process, with multiple considerations.
Intended to identify hazards & risks and mitigate underlying conditions of the environment that contribute to adverse safety events, including infections, falls, medication errors, immobility-related outcomes, security breaches, and musculoskeletal or other injuries.
The goal of the SRA is to integrate all considerations for a safe environment by coordinating conflicting or overlapping recommendations, identify vulnerabilities, identify features that contribute to risk and mitigate or eliminate facility risks.
Although some components of the SRA are new (falls, security, medication safety, and immobility), it also incorporates language from prior editions of the Guidelines about infection control, patient handling, and psychiatric injury.
The Center for Health Design is creating an online tool to support the SRA in the Guidelines.

16. The FGI Guidelines 2014 Changes Part 1: Commissioning
Requirements were added for developing the owner’s project requirements, preparing a commissioning plan, and developing commissioning specifications and construction checklists.
The types of systems to be commissioned now include domestic hot water, fire alarm and fire protection, essential electrical power systems, HVAC systems and automatic temperature controls.

17. The FGI Guidelines 2014 Changes Part 2: General
New Appendix language on design elements to enhance opportunities for patient ambulation and mobility
A requirement to place components of electronic health records systems on an uninterruptible power supply
Cooling for technology equipment rooms must be on emergency power
New children’s hospital chapter addressing the special needs of acute pediatric care
New language on family zone support features
Clarification of requirements for the critical care patient toilet room
Added a requirement for built-in mechanical lifts in all newly constructed bariatric nursing unit rooms (10 percent of the rooms in renovation projects)
New requirements and appendix language for hybrid operating rooms
Revisions and additions to the imaging services section (e.g., MRI, gamma camera, PET, proton therapy)
Unsealed (open) water features are no longer permitted inside a hospital or a licensed outpatient health care occupancy

18. The FGI Guidelines 2014 Changes Part 2: Surgical Suite
The surgical suite now defined as two designated areas: semi-restricted and restricted
No requirement for a sub-sterile room between every two operating rooms
Revised facility requirements for sterilization processes conducted in the surgical suite
A minimum of 1.5 PACU stations per operating room (previously APFP)
Pre- and post-op space and clearance requirements modified for consistency
The new requirements state only that a staff changing area and lounge must be provided, which allows these functions to be shared with another department.

19. The FGI Guidelines 2014 Changes Part 3: Outpatient Facilities
The most significant change in outpatient facility requirements is the revision to requirements for operating rooms and support areas in surgical facilities.
New definitions have been provided in the glossary for invasive procedures, procedure room, and the semi-restricted and restricted areas.
The distinction between an operating room and a procedure room in the ambulatory surgery setting has been defined.
The outdated Class A–C levels based on anesthesia use have been deleted.
The minimum size for an ambulatory OR was set at 250 square feet, and recommendations for ORs that may need to be larger are included in the appendix.
The former Class A operating room is now termed a procedure room.
The cancer treatment area size and configuration requirements were modified
A new chapter on dental facilities was added

20. The FGI Guidelines 2014 Part 4: ANSI/ASHRAE/ASHE 170
FGI continues to work with ASHRAE and ASHE to revise and update this standard.
FGI members are included in the 170 committee
ASHRAE 170 is under a continuous maintenance process, which permits official changes to be made over the life cycle of the document.
The 2013 edition of ASHRAE 170, with all addenda approved through November 2013, has been incorporated as Part 4 of this edition of the FGI Guidelines.
At Table 6.4 the MERV efficiency of 17 was deleted for PE rooms
At Table7.1 design relative humidity in surgical suites was revised to reflect NFPA 99 at a range of

21. The FGI Guidelines 2014 http://www.fgiguidelines.org/2014articles.php
To help users of the FGI Guidelines learn more about this edition of the standard, the Facility Guidelines Institute is producing a series of articles on major changes and new material in the 2014 edition
Visit this page to read an introduction to the series and to access PDFs of the articles.

22. The FGI Guidelines 2018
Work on the next cycle has already begun. The following are the major changes already under consideration:
Separate Volume for Outpatient Services
Fundamental Requirements vs. Optimal Requirements
Document Scrubbing
Cost/Benefit Analysis

23. National Fire Protection Association 2012 Codes
Life Safety Code 101
Health Care Facilities Code 99
These new NFPA editions must be adopted by the
Center for Medicare & Medicaid Services (CMS)
before they can be used in NJ for health care facility design.
On April 16, 2014 CMS published a proposal to revise the edition of the LSC & NFPA 99 referenced in Requirements, Conditions of Participation and Conditions for Coverage to the Editions.
Until that happens they will grant waivers to allow the use of certain 2012 code sections.

24. NFPA 101- Life Safety Code 2012 Edition
In Technical Bulletins issued March 9, 2012, April 19, 2013 & August 30, 2013 CMS announced that it will allow categorical waivers of the current LSC requirements found in the 2000 edition of the LSC for the following items :
Will allow existing openings in exit enclosures to mechanical equipment spaces that are protected by fire-rated door assemblies. These spaces must be used only for non- fuel-fired equipment, must contain no storage of combustible materials, and must be located in sprinklered buildings. This waiver will be permitted if the facility is in compliance with section (9)(c) of the 2012 LSC.
Will allow new sleeping suites up to 10,000 square feet if the facility is in compliance with 18/ of the 2012 LSC.
Will allow one of the required means of egress from sleeping and non-sleeping suites to be through another suite, provided adequate separation exists between suites and one of the two required exit access doors from sleeping and non-sleeping suites to be into an exit stair, exit passageway, or to the exterior.

25. NFPA 101- Life Safety Code 2012 Edition
Categorical Waivers cont.
Will allow more than one delayed-egress lock in the egress path, but only if the facility is in compliance with all other applicable 2000 LSC door provisions, as well as with sections 18/ of the 2012 LSC.
Will allow door locking where justified by clinical needs, patients pose a security risk, or where patients require specialized protective measures for their safety, if the facility is in compliance with sections 18/ through 18/ of the 2012 LSC.
Will allow an increase in the 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, if the facility is in compliance with sections 18/ of the 2012 LSC.
Will allow a testing interval of 6 years rather than 4 years for the maintenance testing of fire and smoke dampers as long as the testing system conforms to the requirements under 2007 NFPA 80 and the NFPA 105

26. NFPA 101- Life Safety Code 2012 Edition
Categorical Waivers cont.
Will allow for the reduction in the testing frequencies for sprinkler system vane-type and pressure switch type waterflow alarm devices to semiannual, and electric motor-driven pump assemblies to monthly. This waiver allowance will be permitted only if the facility is in compliance with all other applicable 1998 NFPA 25 (as referenced in section of the 2000 LSC) testing provisions, as well as with sections 5.3 and 8.3 of the 2011 NFPA 25.
Will allow for a reduction in the annual diesel-powered generator exercising requirement from two (2) continuous hours to one hour and 30 minutes (1-1/2 continuous hours), but only if the provider/supplier is in compliance with all other applicable 1999 NFPA 110 operational inspection and testing provisions, as well as with section of the 2010 NFPA 110.
Will allow for the use of power strips in existing and new health care facility patient care areas/rooms, if they comply with all applicable 2012 NFPA 99 power strip requirements and with all other 1999 NFPA 99 and 2000 LSC electrical system and equipment provisions.

27. NFPA 101- Life Safety Code 2012 Edition
When the 2012 LSC is adopted, these changes will also be effective:
At (4) – Equipment will be allowed to be kept in corridors that are a minimum of 8’-0” in width and as long as 60” of clear with is maintained This will include in-use carts (laundry, food service, housekeeping), emergency equipment and portable lifts.
At (5) – Furnishings (tables, chairs and other seating) will be allowed on one side of corridors that are a minimum of 8’-0” in width and as long as 60” of clear width is maintained. Each furniture location is limited to sf or less and furniture locations must be separated by a minimum of 10ft

28. NFPA 99 – Health Care Facilities Code 2012 Edition
In a Technical Bulletin issued April 19, 2013 CMS announced that it will allow a categorical waiver of the current NFPA 99 requirement for the following item:
Will allow Hospitals and Critical Access Hospitals with new and existing ventilation systems supplying anesthetizing locations, as defined by the 1999 edition of NFPA 99, to operate with a Relative Humidity level of ≥ 20 percent. CMS will strongly recommend that facilities maintain RH in a range of ≥20 – ≤60 percent in all anesthetizing locations.
Will allow a centralized computer system to substitute for one of the Category 1 medical gas master alarms, but only if the provider/supplier is in compliance with all other applicable 1999 NFPA medical gas master alarm provisions, as well as with section of the 2012 NFPA 99.

29. International Building Code 2015
The Department of Community Affairs has reviewed and proposed modifications to all of the 2015 International Codes. These changes have been sent to the State Legislature but have not been acted on at this time.

30. International Building Code 2015
Section 202 Definitions
Added definitions for:
Custodial Care – Assistance with day to day living, slow evacuation time or mental/psychiatric complications
Care Suite – A group of treatment rooms patient sleeping rooms and support space in an I-2 use with attendant staff
Medical care – Care involving medical or surgical procedures, nursing or for psychiatric purposes
24 Hour Care – The actual time that a person is given care, not the amount of time a facility is open
Incapable of Self-preservation – Persons that because of age, physical or mental limitations, chemical dependency or medical treatment can not respond to an emergency situation

31. International Building Code 2015
Section 308 Institutional Group I
At Section – Added “ Incapable of Self-preservation” to the general charging statement defining Use Group I
At Section – Added “ Medical care on a 24 Hour basis for those Incapable of Self-preservation” to the defining statement for Institutional Group I-2
At Section – Added occupancy conditions for I-2 uses:
Condition 1 – Nursing and medical care, but no ER, surgery, obstetrics, psych or detox
Condition 2 – Nursing and medical care, with ER, surgery, obstetrics, psych & detox
Made nomenclature changes such as:
Patients – now referred to as Care Recipients
Nurses station – now referred to as Care Provider Station
Mental health – now referred to as Psychiatric

32. International Building Code 2015
Chapter 4 Special Use & Occupancy
Added new Section Direct Access to a Corridor - Requires all rooms in I-2 uses to have a door directly to a corridor with the exception of those rooms in a “Care Suite”.
Added new Sections thru – These sections deal with Care Suites and will now mirror the sections in Chapter 18 of the Life Safety Code dealing with travel distance, access to corridors, doors, fire separation and size of sleeping and non-sleeping suites.
Modified section Refuge Area - Revised this section to mirror Chapter 18 of the 2012 Life Safety Code.
Modified Section Automatic fire Detection - Included specifics for Condition 1 and Condition 2.
Added Section Electric Systems – References the Electrical Subcode and NFPA 99 for essential electrical systems.

33. International Building Code 2015
Chapter 5 General Building Height & Area
Made changes at Table 509 Incidental Uses
Room or Area
Separation and/or Protection
In ambulatory care facilities, laboratories not classified as Group H
1 hour and provide automatic sprinkler protection
In Group I-2, laundry rooms over 100 sf
1 hour
In Group I-2, physical plant maintenance shops
In ambulatory care facilities or Group I-2 occupancies, storage rooms greater than 100sf

34. International Building Code 2015
Chapter 9 Fire Protection Systems
At Section – Ambulatory Care Facilities
Changed “fire area” to “entire floor”
At item #1 added the sentence “whether rendered incapable of self preservation by staff or already incapable of self preservation”
Added “ If the ACF is on a floor other than the level of exit discharge, all floors below & all floors between the ACF and the level of exit discharge must be sprinklered”
At Section – Group I-4 Day Care
The sprinkler requirement noted above is also required for Day Care

35. International Building Code 2015
2009 IBC Section

36. International Building Code 2015
2015 IBC Section

37. International Building Code 2015
2015 IBC Section

38. International Building Code 2015
Chapter 9 Fire Protection Systems
A new Section 915 – Carbon Monoxide Detection has been added
This section includes requirements for I-2 Use Groups using any type of fuel burning appliances. The section specifies where the detection must be located, the power source and system maintenace.
Chapter 10 Means of Egress
A new Section – Exit Discharge Illumination has been added
This section requires a minimum lighting level of 1 footcandle at all exit discharge doorways and landings in Group I-2 Uses even if the required lighting unit fails.

39. International Building Code 2015
Chapter 10 Means of Egress – cont.
At Section – Controlled Egress in I-2 Uses
Added an additional exception (#2) allowing doors to nurseries and obstetrics areas the same locking conditions as psych treatment areas
Chapter 16 Structural Design
At Section 1607 – Live Loads
Added new Section – Helipads
This is a new section specifically for roof top helipads
Designates design loads based on the maximum take-off weight of helicopters using the pad
Provides other parameters for helipad design.

40. International Codes Council
Ad Hoc Committee on Healthcare
The objective of this committee is to develop code change proposals which will result in the most contemporary and efficient provisions for hospital and ambulatory care facilities.
Most of the work that they are doing will bring the IBC in line with the requirements already in place in the LSC
They are looking at 4 different areas throughout the code with regard to requirements for health care facilities :
Means of Egress
Fire/Life Safety
General Code Requirements
Occupancy

41. Where To Get More Information:
FGI Guidelines
NJ Uniform Construction Code & Uniform Fire Code
International Codes
National Fire Protection Association