1. Health Care Codes and Standards Updates FHEA Pick-A-Bone-With AHCA Skip Gregory, Bureau Chief Office of Plans and Construction September 17, 2009

2. Florida Building Code March 1, 2009: 2007 Edition of FBC with 2009 Supplements October 1, 2009 Supplements (Part II) NFPA 70 (NEC) 2008 edition effective date October 1, 2009 2010 Edition to open for comments spring of 2010 to be adopted in 2011 Can view at www.floridabuilding.org

3. Florida Building Code 2007 Florida Building Code: Change to toilet fixtures inside of ICU rooms. Not permitted. Use of flex duct in the operating rooms: See requirements Sliding doors to toilets. Not permitted but will give alternate method of compliance…use of “barn door” sliding doors will be permitted. Fire/Smoke damper operation inside of ducts that traverse smoke walls not at door openings…mechanical code…must comply

4. Florida Building Code 2009 Supplement Glitch Code: 913.1 Carbon monoxide protection. Every building for which a permit for new construction is issued having a fossil-fuel-burning heater or appliance, a fireplace, or an attached garage shall have an operational carbon monoxide alarm installed within 10 feet of each room used for sleeping purposes. Exception: An approved operational carbon monoxide detector shall be installed inside or directly outside of each room or area within a hospital, inpatient hospice facility or nursing home facility where a fossil-fuel burning heater, engine, or appliance is located. The carbon monoxide detector shall be connected to the fire-alarm system of the hospital, inpatient hospice facility, or nursing home facility as a supervisory signal.

5. NFPA 101 Life Safety Code March 1, 2009: 2006 Edition of NFPA 101 Life Safety Code adopted by State Fire Marshall Rule 69A-3.012 F.A.C. are the state fire codes to be used for all projects that have not received a Stage II Preliminary Plan approval prior to March 1, 2009. NFPA 72-2002 edition, National Fire Alarm Code NFPA 99-2005 edition, Health Care Facilities NFPA 110-2005 edition, Standard for Emergency and Standby Power Systems NFPA 90A-2002 edition, Standard for the Installation of Air Conditioning and Ventilating Systems For a full listing: http://www.ahca.myflorida.com/MCHQ/Plans / http://www.ahca.myflorida.com/MCHQ/Plans /

6. NFPA 101 Life Safety Code NFPA 80, 2007 edition, Standard for Fire Doors and Other Opening Protectives Chapter 19 Installation, Testing, and Maintenance of Fire Dampers 19.4* Periodic Inspection and Testing. 19.4.1 Each damper shall be tested and inspected 1 year after installation. 19.4.1.1 The test and inspection frequency shall then be every 4 years, except in hospitals, where the frequency shall be every 6 years. Although the state has not yet adopted the 2007 edition, AHCA will accept the every 6 year frequency since JCAHO is also accepting

7. NFPA 101 Life Safety Code NFPA 105, 2007 edition: Standard for the Installation of Smoke Door Assemblies and Other Opening Protectives 6.5.2 Each damper shall be tested and inspected one year after installation. The test and inspection frequency shall then be every 4 years, except in hospitals, where the frequency shall be every 6 years. 6.5.5 The damper shall be actuated and cycled as part of the associated smoke detector testing in accordance with NFPA72, National Fire Alarm Code. Where a fusible link is installed on a combination fire/smoke damper, the fusible link shall be removed for testing the damper for full closure simulating a fire condition per the requirements and frequencies of 19.5.4 of NFPA 80, Standard for Fire Doors and Other Opening Protectives. Although the state has not yet adopted the 2007 edition, AHCA will accept the every 6 year frequency since JCAHO is also accepting

8. NFPA 101 Life Safety Code NFPA 99, Standard for Health Care Facilities, 2005 edition, Chapter 17, Nursing Homes A Tentative Interim Amendment (TIA) was issued by the Standards Council on August 6, 2009 with an effective date of August 26, 2009. This TIA revises Chapter 17.3.8.1 and requires that all “Electrical equipment utilized for the treatment of patients shall conform to Chapter 8.” This section was marked as “Reserved” before. However, CMS uses the 1999 edition of NFPA 99 and the State Fire Marshal does not adopt any TIAs to modify the 2005 edition of NFPA 99. THEREFORE, THIS TIA CANNOT BE ENFORCED FOR NURSING HOMES

9. NFPA 101 Life Safety Code Under Stair Storage of Emergency Water Supplies. Storage located under exit stairs not permitted. NFPA 101 Chapter 7.2.2.5.3. Under Stair Storage of Emergency Water Supplies. However, Emergency Water Storage will be permitted under stairs if all of the following are met: Water stored only on first or bottom level of stair and does not obstruct the travel path or exit Water is stored on non-combustible (metal) pallets or metal shelving. The containers may be plastic or glass. No combustible material may be present such as plastic wrapping, cardboard boxes, and etc

10. NFPA 101 Life Safety Code Emergency Evacuation Education and Drills as required by NFPA 99, 1999 edition Chapter 11-5.3.8 and 11-5.3.9. Requires every staff member to be trained in the emergency evacuation of the facility on hiring and annually thereafter. Requires a emergency evacuation drill semi-annually to practice the emergency evacuation plan. There is no requirement that every staff person must participate in these drills. Also no requirement that drills are held on every shift as required for fire drills.

11. NFPA 101 Life Safety Code The 2010 edition of NFPA 99 Health Care Facilities Code was returned to Committee. The document will be presented to the Association’s voting membership at the 2011 NFPA meeting in Boston. There was intense debate regarding the Isolated Power Systems for all operating rooms. The Document was returned for other reason but after it became apparent the issue of wet locations was going to require Isolated Power Systems in ALL ORs unless a risk assessment was conducted by the Hospital.

12. NFPA 101 Life Safety Code An example of an exit door that is clearly obstructed

13. NFPA 101 Life Safety Code An example of an Exit door that is not obstructed

14. 2010 Facility Guidelines Institute Revision Committee General: FGI revision committee reviewed about 1,300 comments that were made on about 1,400 proposals received last year. Publishing Date: 2010 Guidelines to be published January 1, 2010.

15. PART 1 SUMMARY OF COMMENTS 254 comments were received of which: 56 were accepted 22 “ accepted as modified ” 83 rejected 32 batched with other comments 59 not acted on (Acoustics) 2 deferred to Steering Committee

16. 2010 Facility Guidelines Institute Revision Committee General: FGI revision committee reviewed about 1,300 comments that were made on about 1,400 proposals received last year. Publishing Date: 2010 Guidelines to be published January 1, 2010.

17. 1.2 ENVIROMENT OF CARE 37 comments Majority of comment re: patient safety risk assessment (PSRA) was moved to appendix. Two comments were addressed that were not included on EOC focus list. Two related to terminology

18. 1.5 Planning, Design and Construction 103 comments Comments addressing surfaces from both EOC and Surface groups. Mostly appendix material Patient Handling and Movement Assessment (PHAMA) has been added to the document

19. 1.5 Planning, Design and Construction (continued) Many appendix comments on bariatrics 1.6 comments related to sink design were combined and moved to 1.5

20. 1.6 Common Requirements 93 comments 53 comments were on Acoustics Combined several comments re: sinks, faucets, splash to 1.5 8 comments re: boilers/heating/fuel source

21. Part 2 Summary of Comments Acoustics 19 Bariatrics 40 Emergency 75 Engineering 61 Env. of Care 29 Funct. Program 11 Imaging/OR 83 Infection Control 147 Information Tech. 22 OB 15 Oncology 62 Patient Movement 2 Patient Safety 32 Psychology 6 Surfaces 3 Part 2 Only 75 From Chapter 1.6 6 TOTAL 688

22. Categories of Comments Glossary Issues Editorial Issues Issues for Steering Committee Resolution Rejected Proposals Substantive Improvements in Shaded Text Recommendations Final Recommendations for Your Consideration

23. Part 2 Summary of Guideline Issues Impact of Bariatrics on Design & Cost Cost Impact of Certain Proposals Acoustics Standards Consideration Information Technology Impact on Design Energy Savings Issues Infection Control and Patient Safety

24. Engineering Energy Conservation Measures in Isolation Rooms Anterooms and AII/PE Room Designs and Airflow Issues Location of Terminal HEPA Filters at PE Rooms and Suites Agreement with ASHRAE 170 committee to insert the 170 document as a referenced chapter in the Guidelines

25. Infection Control Numerous Glossary and Terminology Issues No support for standards to include inanimate surfaces with antimicrobial coatings/ treatments/compositions, metal surfaces that imply infection prevention/control No removal of sinks from room and toilet room in private rooms in new construction Critical Care Toilets and Flushing Fixtures Use AII for routine care whether pt infected or not. No change in ventilation. Hotly debated and was revised to permit change from negative to neutral to save energy

26. Behavioral Health Location of Doors to Patient Toilets (Patient Room or Hallway) As defined by the functional program Developing a white paper “Psychiatric Facilities in a Long Term Care Setting”

27. O.R. RELATED COMMENTS Largely editorial or clarifications KEY AREAS REQUIRING DISCUSSION FLASH STERILIZATION BARIATRIC REQUIREMENTS CORRELATION WITH OUTPATIENT SECTION TO MAKE CLEARANCES FOR RECOVERY STATIONS CONSISTENT

28. FLASH STERILIZATION Consensus was that flash sterilization is not a recommended practice so rather than require a space for sterilization in the OR, language was added to state, “If required by the functional program”

29. BARIATRIC REQUIREMENTS Consensus was that these need to be inserted into the document as a whole and not repeated in every section since storage and provision of equipment in a location that can serve many areas may be preferable especially when these large items may not be regularly used in every area

30. IMAGING COMMENTS The majority were related to space requirements for MRI. Consensus was that present language which defers to manufacturer’s specifications was more appropriate since there is considerable variability in available MRI imaging systems.

31. IMAGING COMMENTS-2 Imaging section has been extensively revised, and divided into two categories of imaging: diagnostic and interventional “Radiology” changed to “imaging” Specialties other than radiology are involved with imaging Imaging modalities have expanded to use modalities other than X-rays

32. IMAGING COMMENTS-3 Guidelines for diagnostic imaging are essentially unchanged with minor exceptions Guidelines for interventional imaging areas are essentially similar to those for operating rooms with the addition of a control room to view images.

33. IMAGING COMMENTS-4 Section has new material on PET and MRI Reorganized to reflect diagnostic vs. interventional Updated to reflect more digital rather than film imaging

34. Oncology (New section) Relocating cancer treatment areas to the Diagnostic/Treatment part of the Document Clarifying Cancer Treatment as Cancer Infusion Therapy Defining user areas where Cancer Care ca be located (IP/OP Units, Facilities, or areas in hospitals

35. OB 15 comments related to Part 2 Mostly Modified text related to:  Infant Formula Rooms Cesarean & Recovery Rooms LDRs and LDRPs

36. Bariatrics Accommodated both Complete Units and Partial Environments If Rooms are Designated Bariatric, the “Path of Travel” must accommodate Flow of Patient and Equipment Extensive Coordination with Patient Movement and PHARMA Distinct Separation between Bariatric Care spaces and ADA Rooms/Toilets

37. Emergency Services Clarify Initial vs. Definitive Emergency Care Definitions and Requirements Lots of Correlation with Bariatric Proposals

38. PART THREE OUTPATIENT FACILITIES

39. 3.1 COMMON REQUIREMENTS Majority were editorial or clarifications Proposal to increase corridor width to 6 feet was rejected, maintaining 5 foot corridors Balance were terminology clarifications

40. 3.6 FREE STANDING BIRTHING CENTERS NEW CHAPTER 12 comments were received on original text, one of which was a complete re- write of 3.6 by the focus group The final re-write incorporates all comments submitted and was recommended to go to PART 4

41. 3.7 OUTPATIENT SURGICAL FACILITIES A, B and C classification was replaced by ASA 1, 2, 3 levels for ambulatory surgical center operating rooms. RATIONALE: There is no longer a published reference for the A, B and C classes. The ASA classification is clearly defined in the appendix and available as a published reference.

42. 3.7. CONTINUED Many proposals addressed reversion to A,B,C and were rejected. Substantive language was added to provide specific guidelines. These were correlated with similar areas of Part 2. Comments to eliminate the added language were rejected because we felt these additions were addressing a criticism of the 2006 guidelines.

43. 3.9 GASTROINTESTINAL ENDOSCOPY FACILITIES Language was added to clarify issues raised regarding 2006 text. Comments to eliminate this language were rejected. Added requirements for hand-washing and surfaces were accepted. Spatial requirements for recovery areas were added and correlated with requirements for similar spaces in other locations.

44. 3.10 RENAL DIALYSIS CENTERS Decision was to keep 4-ft spaces between stations vs. proposed increase to mandate 5- ft distances between stations. Accepted recommendations from engineering and infection control for proposals reviewed by their focus groups (2/4).

45. 3.12 MOBILE, TRANSPORTABLE and RELOCATABLE UNITS 9 comments: 5/9 editorial/clarifications Interior and exterior surface requirements were added. Fire protection requirements were clarified and references to existing codes were simplified.

46. Reorganization of the Document Section 1.6 will be moved to each PART and document reorganized Document will may have 6 Parts: Part 1: General Part 2: Hospitals Facilities Part 3: Out Patient Facilities Part 4: Residential Facilities Part 5: Other Health Care Facilities Part 6: ASHRAE 170

47. Reorganization of the Document (other issues) Each Section, Subsection and paragraph will be identified with chapter Better coordination of terms More Space between chapter headings? Edge coloring of pages? Optional Tabs? On line document? Handbook? New Title of Document?

48. 2009 Legislative Actions and Other News Return of the 80% surveys Insertion of Language to permit tweaking of Chapter 4 Sections during the Glitch Code Cycles (Bill did not pass…This session??? ) Annual Seminar and Trade Show, October 26-27 th at the Rosen Centre, Orlando.

49. THANKS For ALL YOU DO!! Skip Gregory, NCARB Bureau Chief Office of Plans and Construction Agency for Health Care Administration Building 1, Suite 145 Tallahassee, Florida, 32308 Ph: 850- 922-6469 Fx: 850 922-6483 http://www.ahca.myflorida.com/MCHQ/Plans /