Transcript PART THREE - SMPS North Florida

Health Care
Codes and Standards Updates
FHEA
Pick-A-Bone-With AHCA
Skip Gregory,
Bureau Chief
Office of Plans and Construction
September 17, 2009
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
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
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.
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/
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
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
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
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
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.
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.
NFPA 101 Life Safety Code
An example of an exit door that is clearly obstructed
NFPA 101 Life Safety Code
An example of an Exit door that is not obstructed
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.
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
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.
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
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
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
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
Part 2
Summary of Comments
•
•
•
•
•
•
•
•
•
Acoustics
Bariatrics
Emergency
Engineering
Env. of Care
Funct. Program
Imaging/OR
Infection Control
Information Tech.
19
40
75
61
29
11
83
147
22
•
•
•
•
•
•
•
•
OB
Oncology
Patient Movement
Patient Safety
Psychology
Surfaces
Part 2 Only
From Chapter 1.6
• TOTAL
15
62
2
32
6
3
75
6
688
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
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
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
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
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”
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
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”
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
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.
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
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.
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
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
OB

15 comments related to Part 2

Mostly Modified text related to:
 Infant Formula Rooms


Cesarean & Recovery Rooms
LDRs and LDRPs
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
Emergency Services


Clarify Initial vs. Definitive Emergency
Care Definitions and Requirements
Lots of Correlation with Bariatric
Proposals
PART THREE
OUTPATIENT FACILITIES
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
3.6 FREE STANDING
BIRTHING CENTERS



NEW CHAPTER
12 comments were received on original
text, one of which was a complete rewrite of 3.6 by the focus group
The final re-write incorporates all
comments submitted and was
recommended to go to PART 4
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.
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.
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.
3.10 RENAL DIALYSIS
CENTERS


Decision was to keep 4-ft spaces between
stations vs. proposed increase to mandate 5ft distances between stations.
Accepted recommendations from engineering
and infection control for proposals reviewed
by their focus groups (2/4).
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.
Reorganization of the
Document


Section 1.6 will be moved to each PART
and document reorganized
Document will may have 6 Parts:






Part
Part
Part
Part
Part
Part
1:
2:
3:
4:
5:
6:
General
Hospitals Facilities
Out Patient Facilities
Residential Facilities
Other Health Care Facilities
ASHRAE 170
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?
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 26-27th at the Rosen Centre,
Orlando.
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/