NFPA 99 changes 2005 to 2012 editions

NFPA 99 changes 2005 to 2012 editions
Jim Lucas

Disclaimer Page The speaker is a Principal member of the Health Care Facilities Technical Committee on Piping Systems. The views and opinions expressed in this presentation are purely those of the speaker and shall not be considered the official position of NFPA or any of it’s technical committees and are not considered to be, nor relied upon as, Formal Interpretation.

Promoted from a “Standard” to a “Code”
As a code, NFPA 99 can now be incorporated into law by itself

NFPA 99 Adopted by CMS Effective July 5, 2016 Centers for Medicare & Medicaid (CMS) adopted the 2012 version of the NFPA 99, Healthcare Facilities Code®. Additionally, all applicable CMS deemed status accreditation firms, such as: Joint Commission, included in Jan 9, 2017 standards update DNV-GL, included in Dec 2016 standards update AOA/HFAP, included in Feb 2017 standards update CIHQ included in July 2017 standards update

NFPA 99 Adopted by CMS Why do we care?
Centers for Medicare and Medicaid Services (CMS) is a Federal program, however it is State administered. Each State set’s its own guidelines based around the Conditions of Participation (CoP Physical environment). CMS determines funding reimbursements to healthcare entities who treat medicare/medicaid patients.

Applies to all Health Care Facilities (excludes home & veterinary) Health Care Facilities. Buildings, portions of buildings, or mobile enclosures in which medical, dental, psychiatric, nursing, obstetrical, or surgical care is provided.

Conditions of Participation (CoP Physical environment). The hospital must be constructed, arranged and maintained to ensure the safety of the patient, and to provide facilities for diagnosis and treatment and for special hospital services appropriate to the needs of the community. (a) Standard: Buildings. The condition of the physical plant and the overall hospital environment must be developed and maintained in such a manner that the safety and well-being of patients are assured.

Conditions of Participation (CoP Physical environment). (Continued) (1) There must be emergency power and lighting in at least the operating, recovery, intensive care, and emergency rooms, and stairwells. In all other areas not serviced by the emergency supply source, batter lamps and flashlights must be available. (2) There must be facilities for emergency gas and water supply.

NFPA 99 changes 2005 to 2012 editions
Nearly 400 changes were proposed – we will cover only a portion

Who can propose changes?
Anybody FOR MEDICAL GAS SYSTEM IMPROVEMENT IDEAS !

How do I propose changes?
Use the “Form for proposals on NFPA Technical committee documents” found in the back of the 2012 NFPA 99C booklet and on the NFPA website

Sequence of events leading to publication of an NFPA committee document
Call goes out for proposals to amend existing document or for recommendations on new document Committee meets to act on proposals, to develop its own proposals, and to prepare it’s report Committee votes on proposals by letter ballot. If 2/3rds approve, report goes forward. Lacking 2/3rds approval, report returns to committee. Report on proposals (ROP) is published for public review & comment. Committee meets to act on each public comment received. Committee votes on comments by letter ballot. If 2/3rds approve, supplementary report goes forward. Lacking 2/3rds approval, supplementary report returns to committee.

Sequence of events leading to publication of an NFPA committee document
Report on comments (ROC) is published for public review NFPA membership meets (annual or fall meeting) and acts on committee report (ROP or ROC) Committee votes on any amendments to report approved at NFPA annual or fall meeting Appeals to standards council on association action must be filed within 20 days of the NFPA annual or fall meeting. Standards council decides, based on all evidence, whether or not to issue standard or to take other action, including upholding any appeals.

What is the NFPA 99 Technical Piping Committee?
A diverse group of appointed volunteer professionals . Verifiers Consumers (Hospitals) Installers Special experts Manufacturers Insurance Enforcers

NFPA 99 Committee Membership Classifications
M = Manufacturer U = User I/M = Installer/Maintainer L = Labor representative R/T = Applied research/testing laboratory E = Enforcing authority I = Insurance C = Consumer SE = Special expert

What is the NFPA 99 Technical Piping Committee’s Job?
This committee shall have primary responsibility for documents or portions of documents covering the performance, maintenance, installation, and testing of medical and dental related gas piping systems and medical and dental related vacuum piping systems.

What Does NFPA 99 Cover? 5.1.1 Applicability
5.1 Category 1 Piped Gas and Vacuum Systems 5.1.1 Applicability These requirements shall apply to health care facilities that require Category 1 systems as referenced in Chapter 4. An existing system that is not in strict compliance with the provisions of this code shall be permitted to be continued in use as long as the authority having jurisdiction has determined that such use does not constitute a distinct hazard to life. Subsection through and shall apply to new health care facilities making changes that alter the piping. Paragraph through and through shall apply to existing health care facilities. Paragraph and shall apply to new and existing health care facilities.

What Does NFPA 99 Cover? Central Supply Systems – shall be permitted to consist of the following: Cylinder manifolds Manifolds for cryogenic liquid containers Medical air compressors Medical-surgical vacuum producers WAGD producers Instrument air compressor systems Proportioning systems for medical air USP

What Does NFPA 99 Cover? Central Supply Systems – common elements
Operations Locations Design & construction Ventilation Storage Control equipment Permitted piping locations Support gases Materials Final line regulators Relief valves Multiple pressures Local signals Headers

What Does NFPA 99 Cover? Central Supply Systems – equipment requirements
Manifolds for gas cylinders Manifolds for cryogenic liquid containers Bulk cryogenic liquid systems Emergency oxygen supply connection In-building emergency reserves Medical air supply systems Medical air proportioning systems Medical-surgical vacuum sources WAGD producers Instrument air supply systems Valves Zone valves In-line check valves Station outlets/inlets Manufactured assemblies Medical gas rails Pressure & vacuum indicators Warning systems Master alarms Area alarms Master alarms by computer systems Local alarms

What Does NFPA 99 Cover? Central Supply Systems – Distribution (pipeline) requirements
Piping materials for positive pressure medical gas systems Piping materials for medical-surgical and WAGD systems Joints Brazed joints Cutting tube ends Cleaning joints for brazing Brazing dissimilar metals Nitrogen purge Assembling and heating brazed joints Inspection of brazed joints Welded joints Memory metal fittings Axially swaged fittings Threaded fittings Special fittings Dielectric fittings Prohibited joints Pipe sizing Location of piping Pipe support Underground piping Hose & flexible connectors Prohibited system interconnections Pipe labeling

What Does NFPA 99 Cover? Central Supply Systems – Testing requirements (pipeline)
Performance criteria & testing General Installer performed tests Initial piping blow down Initial pressure test Initial cross-connection test Initial piping purge test Standing pressure test System verification General Standing pressure test Cross-connection test Valve test Alarm test Piping purge test Piping particulate test Verifier piping purity test Final tie-in test Operational pressure test Medical gas concentration test Medical air purity test

What Does NFPA 99 Cover? Central Supply Systems – Testing requirements (Source Equipment Verification) Source Equipment Verification General Gas supply sources Medical air compressor systems Proportioning systems for medical air Medical-surgical vacuum system Nature of Hazards Support Gas System Valves Outlets Manufactured assemblies Pressure indicators Warning systems Distribution Labeling & identification Performance testing

What Does NFPA 99 Cover? Central Supply Systems – Operation & Management
Maintenance of medical gas, vacuum, WAGD and medical support gas systems General Inventories Inspection schedules Inspection procedures Maintenance schedules Qualifications Inspection and testing operations Manufactured assemblies employing flexible connections between the user terminal and the piping system Medical gas and vacuum systems information and warning signs Medical gas and vacuum systems maintenance and record keeping Category 1 maintenance

NFPA Edition Changes

NFPA 99 2012 edition Chapter 4 Fundamentals
4.1 Building System Categories. Building systems in health care facilities shall be designed to meet system Categories 1 through 4 requirements as detailed in this code. 4.2 Category 1 Facility systems in which failure of such equipment or system is likely to cause major injury or death of patients or caregivers… 4.3 Category 2 Facility systems in which failure of such equipment is likely to cause minor injury to patients or caregivers… 4.4 Category 3 Facility systems in which failure of such equipment is not likely to cause injury to patients or caregivers, but can cause patient discomfort… 4.5 Category 4 Facility systems in which failure of such equipment would have no impact on patient care…

NFPA 99 2012 edition Chapter 3 Definitions
Note: The definitions have been enhanced tremendously. There are more links to Annex A for additional explanations of the intent of the standard and visual aids.

Changes to NFPA 99 2005 edition Chapter 3 Definitions
Deep Sedation/Analgesia – Ability to independently maintain ventilatory function is often impaired Patients may require assistance in maintaining a patent airway Spontaneous ventilation may be inadequate Cardiovascular function is usually maintained General Anesthesia – Positive pressure ventilation may be required Cardiovascular function may be impaired Minimal Sedation (Anxlolysis) – Ventilatory & cardiovascular functions are unaffected Moderate Sedation/Analgesia (conscious sedation)- No interventions are required to maintain patient airway

Who is the Authority Having Jurisdiction?
3.2.2 Authority Having Jurisdiction (AHJ). An organization, office, or individual responsible for enforcing the requirements of a code or standard, or for approving equipment, materials, an installation, or a procedure. Where public safety is primary the AHJ may be a federal, state, local or other regional department or individual such as a fire chief, fire marshal, chief of a fire prevention bureau, labor dept, or health dept, building official, electrical inspector, or others having statutory authority. For insurance purposes, an insurance inspection dept, rating bureau or other insurance company representative may be the authority. In many circumstances, the property owner or their agent assumes the AHJ role. At government installations, the commanding officer or dept official may be the AHJ

Category 2 Differences vs Category 1
4.3 Category 2 Facility systems in which failure of such equipment is likely to cause minor injury to patients or caregivers… Medical air, medical-surgical vac and WAGD systems may all be simplex Warning systems – permitted to be a single combination alarm located in an area of continuous surveillance Category 2 maintenance – facilities shall have a routine maintenance program for their piped medical gas and vacuum systems

Changes to NFPA 99 2005 edition to be effective in 2012
Cylinders & containers shall be designed, constructed & maintained in accordance with NFPA 55 (was DOT). (Deleted & replaced) Wooden racks will no longer be permitted for cylinder storage

Design & Construction – locations for central supply systems & storage of positive pressure gases (3) (New) Outdoor enclosures for medical gas sources now must have two egress gates. (5) (New) Locations for central supply systems shall be compliant with NFPA 70 & (10) electrical devices (10) (New) shall protect electrical devices from physical damage

Ventilation requirements have been moved to Chapter 9 – Natural ventilation of manifold rooms shall be to the outside atmosphere without ductwork. Mechanical exhaust fans shall provide not less than 50 cfm or more than 500 cfm. Size is based on gas contained in the largest single vessel in the room or in one header bar of cylinders or dewars.

Central Supply Systems. Central supply systems shall be permitted to consist of the following: (8) Proportioning systems for medical air USP (new)

(1) Materials. In those portions of systems intended to handle oxygen at gauge pressures greater than 2413 kPa (350 psi), interconnecting hose shall contain no polymeric materials. Was 300 psi

Final Line Pressure Regulators (5) Each regulator shall be sized for 100% of the peak calculated demand Was worded ambiguously – could have been interpreted that in aggregate the two final line regulators were required to be sized for 100% of the peak calculated demand (50% each). Final line regulators may now be located remote from the source within a secure location.

A variant on the cryogenic liquid container manifold shall be permitted having three headers of cylinders. Deleted Bulk Cryogenic Liquid Systems…shall be in accordance with NFPA 55 (6) Have a minimum clearance of 3 ft around the storage container, vaporizer(s), and pressure regulating manifold for system maintenance and operation. NEW (7) A minimum of 3 ft of clearance around the EOSC for connection of temporary auxiliary source. NEW

(c) Liquid ring compressors shall comply with the following: (2) Reserve medical air standby headers or a backup compressor shall be installed. NEW

Compressor Intake (A) The medical air compressors shall draw their air from a source of clean air. (B) The medical air intake shall be located a minimum of 25 ft from ventilating system exhausts, fuel storage vents, combustion vents, plumbing vents, vacuum & WAGD discharges, or areas that can collect vehicular exhausts or other noxious fumes. (c) The medical air intake shall be located a minimum of 20 ft above ground level. (no longer required to be above roof level) (d) The medical air intake shall be located a minimum of 10 ft from any door, window, or other opening in the building. NEW

(4) Liquid hydrocarbons shall be monitored on a continuous basis by pigment indicator or other type of instrument permanently installed downstream of each compressor and shall be inspected & documented daily. DELETED

Medical Air Quality Monitoring (1) Dew point shall be monitored and shall activate a local alarm and all master alarms when the dew point at system delivery pressure exceeds + 2 degrees C (+35 degreed F) Was +4 C / +39 F

Category 1 Medical Air Proportioning System New

WAGD networks shall provide a WAGD inlet in all locations where nitrous oxide or halogenated anesthetic gas is intended to be administered. New

Zone Valve – Mostly re-written 5.1.6 Manufactured Assemblies – Requirement to be DISS has been dropped Manufactured Assembly A factory-assembled product designed for aesthetics or convenience that contains medical gas or vacuum outlets, piping, or other devices related to medical gases.

5.1.9 Category 1 Warning Systems – All references to “wired” have been changed to “communicate” Media Cost Scalability Mobility Flexibility Reliability Speed Security Wired High Poor Wireless (RF) Medium Very Good Medium/High Ethernet Low Not Bad Medium/Low

Pro’s & Con’s of a Wired system:
Secure Fast Reliable Independent network Con’s High installation cost Low flexibility, mobility & scalability Occasionally disrupted due to contractor mistakes A Tri-Tech Medical Presentation

Wireless Master Alarms
Broadcast up to ½ mile thru steel, brick & mortar or up to 2 miles with a clear line of sight. Secure – utilizes FCC regulated bandwidths ( MHz) and unique hopping and network I.D.’s (5 digit encryption code) Mesh-network transceivers Repeater panels available – if needed. Independent network – designed for ease of installation & service. A Tri-Tech Medical Presentation A Tri-Tech Medical Presentation

Wireless Mesh Networking
A = Bulk oxygen B = Manifold room C = Source room M1 = Master alarm #1 M2 = Master alarm #2 R1 = Repeater 1 R2 = Repeater 2 A Tri-Tech Medical Presentation A Tri-Tech Medical Presentation

5.1.9 Category 1 Warning Systems – Other new technologies now available – master alarms that work with transducers Digital pressure display More accurate Lower cost Easier to set / adjust Improve safety

5.1.9 Category 1 Warning Systems Other new technologies now available – master alarms that work with 4 – 20 mA sensors Monitor liquid levels of bulk source gas(es) Monitor; flow rates, concentrations, humidity, levels Graphic display Easier to set / adjust Improve safety

(14) (New) Alarm switches/sensors shall be installed so as to be removable.

(New) Area alarm panels for medical gas systems shall provide visual & audible indication in the event a mismatch occurs between transducer(s) and its associated circuit board(s).

E Z Find™ vs Hard to Find Is this how you want to look for and test your transducers? Wouldn’t it make more sense to install them in the zone valve box? Presentor: Jim Lucas - Tri-Tech Medical

Check Valves (New) New or replacement in-line check valves shall be as follows: (1) brass or bronze construction (2) have brazed extensions (3) permit inline serviceability (4) shall not have threaded connections

5.1.10.11.12 Breaching or Penetrating Medical Gas Piping
(New) Positive pressure patient medical gas piping and medical support gas piping shall not be breached or penetrated by any means or process that will result in residual copper particles or other debris remaining in the piping or affect the oxygen-clean interior of the piping. (New) The breaching or penetrating process shall ensure that any debris created by the process remains contained within the work area.

(E) (F) (G) (New & revised E) Medical air compressor air quality tests now performed after 12 elapsed hours at 25% duty. (Was 24 hours and it was not clear whether that meant 24 accumulated running hours or 24 elapsed (not necessarily running) hours)

(New) Nonstationary booms & articulating assemblies, other than headwalls, utilizing flexible connectors shall be tested for leaks, per manufacturer’s recommendations, every 18 months or at a duration as determined by risk assessment.

(New) Maintenance of medical gas, vacuum, WAGD and medical support gas systems. (This is the first attempt to address the maintenance related problems, who is permitted to perform the maintenance and provide a minimum list of requirements). (New) Medical gas and vacuum systems maintenance & record keeping. (Similar to above)

(New) Medical gas/vacuum systems maintenance & record keeping – was under NFPA chapter 9 – now has been brought under chapter 5 5.3 – Level 3 systems has been completely re-written - some of the noteworthy changes are: verification is required by a 6030, ventilation requirements same as for Level 1 & 2, requirements for: shut-off valves, labeling of the medical gas supply system, cylinder storage & handling, pipe support, underground piping, verification tests.

Talking Points

5.1.3.3 Central Supply System Locations
1.1 Any of the following systems shall be permitted to be located together in the same outdoor enclosure: (1) Manifolds for gas cylinders without reserve supply (see ) (2) Manifolds for gas cylinders with reserve supply (3) Manifolds for cryogenic liquid containers (see ) (4) Bulk cryogenic liquid systems (see ).

1.2 Any of the following systems shall be permitted to be located together in the same indoor enclosure: (1) Manifolds for gas cylinders without reserve supply (see ) (2) Manifolds for gas cylinders with reserve supply (3) Manifolds for cryogenic liquid containers (see ) (4) In-building emergency reserves (see ) (5) Instrument air standby headers (see )

1.3 Any of the following systems shall be permitted to be located in the same room: (1) Medical air compressor supply sources (see ) (2) Medical –surgical vacuum sources (see ) (3) Waste anesthetic gas disposal (WAGD) sources (see ) (4) Instrument air compressor sources (see ) (5) Any other compressor, vacuum pump, or electrically powered machinery.

1.4 Any system listed under shall not be located in the same room with any system listed under or except instrument air reserve headers complying with and shall be permitted to be in the same room as an instrument air compressor. 1.5 Locations shall be chosen to allow access by delivery vehicles and management of cylinders (e.g., proximity to loading docks, access to elevators, and passage of cylinders through public areas).

1.6 Indoor locations for oxygen, nitrous oxide, and mixtures of these gases shall not communicate with the following: (1) Areas involved in critical patient care (2) Anesthetizing locations where moderate sedation, deep sedation, or general anesthesia is administered (3) Locations storing flammables (4) Rooms containing open electrical contacts or transformers (5) Storage tanks for flammable or combustible liquids (6) Engines (7) Kitchens (8) Areas with open flames

Adiabatic Compression
Oxygen & N2O are both oxidizers and will greatly intensify a fire Cylinder valves on manifolds should always be opened very slowly – at least 10 seconds for full cylinder pressure to be achieved on the high pressure gauge of the regulator Tri-Tech Medical Inc.

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 the outlets/inlets that it controls (2) The zone valve shall serve only outlets/inlets located on that same story. (3) The zone valve shall not be located in a room with station outlets/inlets that it controls.

Area Alarms and Zone Valve Boxes Where are they required?
Both an area alarm and a corresponding zone valve box are required for rooms/areas utilizing general anesthesia and for rooms/areas utilizing minimal sedation. A zone valve box (with no corresponding area alarm) is required for rooms/areas utilizing moderate sedation.

5.1.9 Category 1 Warning Systems
Master alarms monitor the ‘trunk’ source equipment Area alarms monitor the ‘branches’ zones or areas – typically downstream of zone valve boxes

Master Alarms A master alarm system shall be provided to monitor the operation and condition of the source of supply, the reserve source (if any), and the pressure in the main lines of each medical gas and vacuum piping system.

Master Alarms The master alarm system shall consist of two or more alarm panels located in at least two separate locations, as follows: (1) One master alarm panel shall be located in the office or work space of the on-site individual responsible for the maintenance of the medical gas and vacuum piping systems. (2) In order to ensure continuous surveillance of the medical gas and vacuum systems while the facility is in operation, the second master alarm panel shall be located in an area of continuous observation (e.g., the telephone switchboard, security office, or other continuously staffed location).

Master Alarms Each of the two mandatory alarms shall be wired independently to the initiating device(s) for each signal. The wiring between each mandatory alarm(s) and the initiating device(s) shall not utilize common conductors that, if interrupted, would disable more than one signal. The mandatory master alarm panels shall not be arranged such that failure of either panel would disable any signal on the other panel.

Area Alarms Area alarm panels shall be provided to monitor all medical gas, medical-surgical vacuum, and piped WAGD systems supplying the following: (1) Anesthetizing locations where moderate sedation, deep sedation, or general anesthesia is administered (2) Critical care areas Area alarm panels for medical gas systems shall provide visual and audible indication in the event a mismatch occurs between the transducer(s) and its associated circuit board(s).

Area Alarms Area alarms shall be located at a nurse’s station or other similar location that will provide for surveillance.

5.1.9.4 Master Alarms by Computer Systems
Computer systems used as substitute master alarms as required by (2) shall have the mechanical and electrical characteristics described in and the programming characteristics described in To the best of my knowledge, no manufacturer has developed a ‘stand alone’ computer software + hardware system that meets the requirements.

5.1.14.2 Maintenance of Medical Gas, Vacuum, WAGD, and Medical Support Systems
General. Health care facilities with installed medical gas, vacuum, WAGD or medical support gas systems, or combinations thereof, shall develop and document periodic maintenance programs for these systems and their subcomponents as appropriate to the equipment installed.

5.1.14.2 Maintenance of Medical Gas, Vacuum, WAGD, and Medical Support Systems
Maintenance Programs. Inventories Inspection Procedures. Maintenance Schedules. Qualifications.

What is the Life Safety Survey (LSS) looking for?
In a limited amount of time the surveyor is trying to determine the following from a healthcare organization: Compliance with the applicable CMS, Accreditation Agency, State, and/or Local codes & standards compliance. Building & building systems are installed & maintained per applicable code Patient safety practices Employee safety practices Documentation defining all of the above processes and how they are to be performed Records indicating that all of the above processes were performed per documentation requirements

A “document” is some type of instruction or mandate as to how the quality system will operate. A “record” is maintained to establish proof of conformity to the documentation and/or process.

Design documentation and records format to insure the following: Insure that ANYONE that has to display the information to a surveyor can do so easily & efficiently. YOU may not be the one at the facility that has to display & explain your reports. Minimal display of only the pertinent information Minimize the time a surveyor needs to take in order to get a feel for how the organization is running their programs Minimize the time it takes facility staff to review for accuracy The facility staff has to create confidence in their processes. This is key to a successful survey from any entity It is up to you as the facilities installation, maintenance, & testing resource to provide documentation that supports the hospital’s mission.

Thank You

NFPA 99 changes 2005 to 2012 editions

Similar presentations

Presentation on theme: "NFPA 99 changes 2005 to 2012 editions"— Presentation transcript:

Similar presentations

About project

Feedback

Log in

Auth with social network:

NFPA 99 changes 2005 to 2012 editions

Similar presentations

Presentation on theme: "NFPA 99 changes 2005 to 2012 editions"— Presentation transcript:

Similar presentations

About project

Feedback