The vocal and sometimes contentious debates of the 1980s and 1990s on healthcare facility fire and electrical safety criteria have swung back to more normal and reasonable debating, particularly on electrical safety in the patient care environment. However, there is still much interest and differences of opinion on the subject of safety requirements for piped gas and vacuum systems. This is evidenced by the number of proposals on the subject since major changes were first made for these systems in the National Fire Protection Association's (NFPA) 1993 and 1996 editions of NFPA 99, Standard for Health Care Facilities.

NFPA 99 is being referenced Ñ in whole and in part Ñ by more agencies and organizations each year, which means different editions of the document are being enforced. One must first determine which edition is being enforced in the area or state where a healthcare facility is being built or renovated.

It should also be noted that NFPA 99 contains requirements for both new and existing healthcare facilities Ñ performance criteria for new facilities and operational and maintenance requirements for existing facilities. Again, facility managers must learn which edition needs to be followed.

Following is a brief explanation of some of the significant changes to the 2005 edition of NFPA 99, as voted on by the NFPA healthcare technical committees responsible for NFPA 99 and subsequently approved by NFPA's membership and board of directors.

Covered, Not Covered

An unorthodox inclusion, by standards development practice, in Chapter 1 of NFPA 99 might be helpful as a starting point in understanding what NFPA 99 covers, and that is an abridged list of what is not covered. However, the technical committees have also noted where requirements are to be found if they are covered in another NFPA code or standard. For example, section 1.1.4.1(4) in NFPA 99 states that NFPA 99 does not cover fire pumps requirements. These requirements are contained in NFPA 20, Standard for the Installation of Stationary Pumps for Fire Protection. (See sections 1.1.2 through 1.1.11 in NFPA 99.)

Chapter 3

Following are explanations of pertinent terms and changes referred to in Chapter 3 of NFPA 99:

Wet locations. While the term "wet locations" was changed only grammatically, concerns were expressed that the same term is listed in both NFPA 70 and 99. However, the way the term is defined and used in NFPA 99 is not the same as in NFPA 70, National Electrical Code. The one exception to this is in Article 517 of NFPA 70, where the term is defined and used the same as in NFPA 99. A proposal to modify the term wet location as used in NFPA 99 was rejected by the technical committee responsible for the term.

A proposal to address the issue again has been submitted for the next revision of NFPA 99. Readers of both documents should be aware of this difference when they see or use the term wet location.

Critical care areas; invasive procedures. More than 20 years ago, "patient care areas" were categorized into "general" care areas and "critical" care areas. This was done mainly to address patient electrical safety needs, which had been increasing as patients were being subjected to more and more procedures involving patient care-related appliances.

The definition of the term critical care area included reference to "invasive procedure" as one of the criteria for categorizing a patient care area as a critical patient care area. However, there was no definition for "invasive procedure." This made for differences in interpretation. With the 2005 edition of NFPA 99, a definition for the term invasive procedure was developed and approved. It will be interesting to see how well the definition meets the needs of designers, regulators and healthcare facility administrative and technical personnel when designating patient care areas as either general or critical patient care. (See sections 3.3.138 and 3.3.183 in Chapter 3 of NFPA 99.)

Nursing Homes

As nursing homes admit persons who are really "patients" rather than residents, the technical committees responsible for nursing home electrical system requirements have been reviewing what this shift means in terms of the safety of patients who are more dependent on electricity than residents. With regard to emergency power requirements, the healthcare facility technical committee responsible for electrical system requirements approved new text that requires new nursing homes that admit persons who need to be sustained by electrical life support equipment to install a Type 1 essential electrical system (EES) "from the source to that portion of the facility where such patients are treated." Currently, nursing homes are required to install a Type 2 EES, or a battery system, if they meet certain criteria. (See section 17.3.4.2.2, in addition to 17.3.4.2.4, in NFPA 99.)

Electrical Systems

Anesthetizing locations. Wiring requirements specifically for anesthetizing locations have been relocated from Chapter 4 to Chapter 13, section 13.4.1.2.6, so that all wiring requirements specifically for anesthetizing locations are in one section of NFPA 99. It should be noted that anesthetizing locations, being patient care areas, also must meet the general wiring requirements for patient care areas, as listed in section 4.3.2.2 of Chapter 4 of NFPA 99.

Type 1 essential electrical system. Because NFPA 110, Standard for Emergency and Standby Power Systems, now has responsibility for general safety requirements for generator sets, the technical committee responsible for these requirements in NFPA 99 has utilized more text from NFPA 110 in section 4.4.1.1 of NFPA 99 either by requiring it by reference or by reprinting it per the NFPA Extract Policy. This includes both manufacturer requirements for generator sets and remote annunciator alarm panels, and facility requirements for ventilation and room temperature for generator sets.

Medical/Dental Piped Gas and Vacuum Systems

Piped vacuum systems. Changes to make piped medical vacuum system requirements for both performance and installation similar to, if not the same as, piped medical gas systems continue to take place in Chapter 5 of NFPA 99. This is, in part, to be more in concert with International Standards Organization (ISO) requirements on the subject and to reduce installation costs and confusion/errors. This evolution has not been without controversy within and without the NFPA technical committee responsible for this material. One issue noted has been that of vacuum systems operating under negative pressure, as opposed to positive pressure of piped gas systems, and thus not presenting the same level of hazards as medical piped gas systems.

Master alarm panels. Two separate master alarm panels are required for Level 1 piped gas and vacuum systems. Alarm initiating devices, such as gas pressure indicators, low-level gas supply and dew-point indicators, are to be connected directly to each master alarm panel. These devices cannot to be daisy-chained from one master alarm panel to another panel. For 2005, one of the master alarm panels can now be a centralized computer system. (See sections 5.1.9.2.2 and 5.1.9.4 in NFPA 99.)

Medical gas. Some medical gases are intended to be ingested by patients, some are used to power medical devices that will be used in a patient's mouth or other body cavity and some are used to power devices that will raise or lower medical equipment near a patient. As a result of these different uses, the categorization of medical gases was created for the 2005 edition of NFPA 99. Gases are now divided into two categories: patient medical gas and medical support gas. Care is required when installing piping systems because the same gas could be used for both categories. (See definitions 3.3.109, 3.3.111 and 3.3.143 in Chapter 3.)

Instrument air. Instrument air is a distinct subcategory of "medical support gas," and is intended for powering medical devices not related to human respiration. An entire section is included in Chapter 5 on performance criteria for such air and for the equipment associated with it. (See 3.3.80 in Chapter 3, and section 5.1.3.8 in Chapter 5.)

Location of gas and vacuum sources. Text in section 5.1.3.3.1 of Chapter 5 has been added to help in determining which sources can be placed in the same room with another system source.

Level 1 medical air source. In order not to restrict new configurations and materials that would be acceptable for medical air sources, such as filters, dryers and regulators, a paragraph was added permitting "any design or construction appropriate for the service as determined by the manufacturer." (See section 5.1.3.5.3.2(7).)

Joining of piping in piped systems. Two methods for joining piping were added in 2005. One method involved welding, and the other involved fittings. Criteria for each method are included. (See section 5.1.10.6 for welded joints; and section 5.1.10.7(4) for axially swaged, elastic strain preload fittings.)

Pipe labeling. Labeling for new piping systems was modified to require the name or chemical symbol for the gas or vacuum; the color code for the gas or vacuum per a table included in NFPA 99; and the pressure of the gas if it is not standard gauge pressure.

Testing of patient care-related electrical appliances. A statement was added in

Chapter 8 cautioning that leakage-current testing of these medical devices is not to be conducted on the load side of isolated power systems or isolation transformers. (See section 8.4.1.3.3.2.) The value indicated on the meter being used will not be correct if the reading is made on the secondary, or load, side.

Cylinders. Several changes have been made regarding storage of cylinders. One change is regarding securing of stored cylinders, which now can be done individually or collectively as long as it prevents cylinders from falling. (See section 5.1.3.3.2(7) in Chapter 5.) The other change covers whether storage of cylinders in patient care areas must be in an enclosure. If the total volume in a zone is less than 300 cubic feet, cylinders do not have to be stored in an enclosure. If the total volume in a zone is greater than 300 cubic feet, cylinders must be stored in an enclosure. (See section 9.4.3 in Chapter 9).

The other cylinder issue addressed is that of using cylinder valves that, when first opened, slow initial opening pressurization. This type of valve is permitted but is not required. (See section 9.3.1 in Chapter 9.) The hazard involves the opening of cylinder valves too quickly, which can result in the heating of any plastic inside the valve to the point of ignition.