Health Facilities Design -- An Overview of the Code Requirements

download report

Transcript 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
 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
The Bureau
 Functions as the construction office for all building
types or projects reserved to the State at
NJAC 5:23-3.11
 This includes such projects as:
 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
Health Care Plan Review Unit
 Performs both a UCC and Licensing review on all projects
Will comment on Licensing requirements, but cannot grant
waivers to those requirements
20 day review cycle for new projects with complete
7 day review cycle for re-submitted projects
Permitting and inspections are done at the local level
May grant permission for a
of certain
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
 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
 Electronic Plan Review Process Overview
Applicant submits plan review application through e-mail 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
Applicant prints plans, signs and seals them, then submits for permits thru
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
you can access all of the necessary forms
for submission at the
Bureau’s website:
Permit Extension Act
The original act of 2008 has been extended again.
Applies to New Jersey permits only, does not include Federal
Includes UCC permits and other permits such as:
Extends all permits & DCA releases that were open and valid
as of January 1, 2007 until
 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
No major proposals or adoptions at this
NJ Health
New Jersey Department of Health
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,
2014 as the adoption date for
both editions.
The 6 month grace period for
voluntary use will end on
February 1, 2015
Major changes this cycle:
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
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.
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
more than 400 references to the functional program in the body of
the text were eliminated, and more appropriate language added.
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
2014 Guidelines.
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.
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
Changes Part 2: Surgical Suite
 The surgical suite now defined as two designated areas: semi-restricted and
 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
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
 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
 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 20 - 60
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.
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
 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
2012 Editions.
Until that happens they will grant waivers to allow the use of
certain 2012 code sections.
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 nonfuel-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 of the 2012 LSC.
Will allow new sleeping suites
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.
if the facility is in compliance
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 2007
NFPA 105
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 motordriven 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
9.7.5 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
, 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.
When the 2012 LSC is adopted, these changes will
also be effective:
 At – 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 – 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
50sf or less and furniture locations must be separated by
a minimum of 10ft
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
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.
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.
Section 202 Definitions
Added definitions for:
– Assistance with day to day living, slow
evacuation time or mental/psychiatric complications
– A group of treatment rooms patient sleeping rooms
and support space in an I-2 use with attendant staff
– Care involving medical or surgical procedures,
nursing or for psychiatric purposes
– The actual time that a person is given care, not
the amount of time a facility is open
– Persons that because of age,
physical or mental limitations, chemical dependency or medical
treatment can not respond to an emergency situation
Section 308 Institutional Group I
At Section 308.1 – Added “ Incapable of Self-preservation” to the
general charging statement defining Use Group I
At Section 308.4 – 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 308.4.1 – Added occupancy conditions for I-2 uses:
 308.4.1.1 Condition 1 – Nursing and medical care, but no ER, surgery,
obstetrics, psych or detox
 308.4.1.2 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
Chapter 4 Special Use & Occupancy
Added new Section 407.4.1 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 407.4.1 thru 407. – These sections deal
with Care Suites and will now mirror the sections in Chapter 18 of the
2012 Life Safety Code dealing with travel distance, access to corridors,
doors, fire separation and size of sleeping and non-sleeping suites.
Modified section 407.5.1 Refuge Area - Revised this section to mirror
Chapter 18 of the 2012 Life Safety Code.
Modified Section 407.8 Automatic fire Detection - Included specifics for
Condition 1 and Condition 2.
Added Section 407.10 Electric Systems – References the Electrical
Subcode and NFPA 99 for essential electrical systems.
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
In Group I-2, laundry rooms over 100 sf
1 hour
In Group I-2, physical plant maintenance
1 hour
In ambulatory care facilities or Group I-2
occupancies, storage rooms greater than
1 hour
Chapter 9 Fire Protection Systems
At Section 903.2.2 – Ambulatory Care Facilities
 Changed “fire area” to “
 At item #1 added the sentence “
 Added “
At Section 903.2.6 – Group I-4 Day Care
 The sprinkler requirement noted above is also required for Day
2009 IBC Section 903.2.2
2015 IBC Section 903.2.2
2015 IBC Section 903.2.2
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
Chapter 10 Means of Egress
A new Section 1008.2.2 – 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.
Chapter 10 Means of Egress – cont.
At Section 1010.1.9.6 – 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
• 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.
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
FGI Guidelines
NJ Uniform Construction Code & Uniform Fire Code
International Codes
[email protected]
National Fire Protection Association
[email protected]