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"2006 NFPA 101, Life Safety Code - A review of the healthcare occupancy-related revisions", (c) Michael A. Crowley, PE, and William M. Dorfler, Facility Care, (8/06)

The 2006 edition of NFPA 101, Life Safety Code (LSC), became effective on Aug. 18, 2005, and was published by the National Fire Protection Association (NFPA) in March 2006. The 2006 LSC contains some important revisions that may impact new and existing healthcare facilities. Following is an outline of some of the major revisions related to the healthcare industry.

Suite Requirements

The LSC has added new Sections 18.2.5.6 and 19.2.5.6, entitled Suites, to specifically address suites in healthcare occupancies. These new sections rewrite the previous requirements for suites in healthcare occupancies. The previous editions of the LSC listed suite requirements under the section titled Arrangement of Means of Egress.

In addition, healthcare occupancy suites are now specifically defined under Section 3.3.241. The new definition for healthcare occupancies reads: "A series of rooms or spaces or a subdivided room separated from the remainder of the building by walls and doors." Healthcare occupancies contain non-sleeping suites for patients not sleeping overnight and sleeping suites for those patients who are staying overnight.
Suite separation walls and doors are allowed to be constructed following the same requirements used for corridor walls and doors. Sleeping suites require constant staff supervision. However, if direct supervision is not possible, smoke detection located throughout the suite must be provided. Sleeping suites of more than 1,000 square feet and nonsleeping suites of more than 2,500 square feet require a second means of exit.

New sections on suites address exiting through adjacent suites. One means of egress must be directly into the corridor. However, the second means of egress can exit directly into another suite. Previous editions of the code did not specifically address exiting through adjoining suites. Travel distances from within the suites to an exit access door end at the door to the corridor or an adjacent suite.
A new modification to sleeping suite size will allow the 5,000-square-foot suite to be increased to a 7,500-square-foot maximum. This increase is allowed where the following three provisions are provided:

bulletDirect supervision for the suite area
bulletSmoke detection throughout the suite
bulletAutomatic sprinkler protection throughout the building or smoke zone

Corridor Projections
The LSC has added new Section 7.3.2.3, which permits projections into corridors of healthcare and ambulatory healthcare occupancies. Sections 18.2.3.4, 18.2.3.5 and 19.2.3.4 have been revised to allow projections into new and existing 8-foot and 6-foot wide corridors on both sides with the following four provisions:

bulletThe projection will not exceed a depth of 6 inches.
bulletThe projection will not exceed a length of 36 inches.
bulletThe projection will be at least 40 inches above the floor.
bulletThe projection will have at least 48 inches of horizontal separation from other projections.

These revisions will allow the installation of alcohol-based hand-rub dispensers and patient fold-down charts along the corridor walls of a facility.

Alcohol-Based Hand-Rub Dispensers
The LSC has added new Sections 18.3.2.6, 19.3.2.6 and 20.3.2.6 addressing the use of alcohol-based hand-rub dispensers in corridor and patient rooms. Following is an outline of the new provisions:

bulletDispensers may only be installed in corridors with a minimum width of 6 feet.
bulletThe maximum dispenser size is 1.2 liters, or 0.32 gallons, in rooms, corridors and areas open to the corridor and 2.0 liters, or 0.53 gallons, within room suites.
bulletThe dispenser must have at least 48 inches of horizontal separation from another dispenser.
bulletThe maximum amount of alcohol-based hand-rub solution outside a storage cabinet per smoke zone is 37.8 liters, or 10 gallons.
bulletStorage amounts of 18.9 liters, or five gallons, or more of alcohol-based hand rub solution must comply with NFPA 30, Flammable and Combustible Liquids.
bulletDispensers shall not be installed directly over or adjacent to ignition sources, such as light switches or electrical outlets.
bulletDispensers installed over carpeted areas must be in a smoke zone with full automatic sprinkler protection.

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) addressed alcohol-based hand-rub dispensers with foam in the April 2006 edition of the Environment of Care News. Pending further review, JCAHO will allow the use of foam dispensers as long as the same code requirements outlined for the gel dispenser are followed.

Horizontal Sliding Doors
The LSC has added new Section 7.2.1.4.1.6, which addresses horizontal sliding doors for rooms of 10 or fewer healthcare occupants. These horizontal sliding doors are no longer required to have a swinging breakaway feature. This revision of the code has been added to address critical care units in hospital facilities that have specialty patient care rooms with the use of support medical equipment in and around the patient.

Horizontal sliding doors are used throughout hospitals to address this critical patient need. Previous editions of the LSC required the horizontal sliding doors to have a breakaway feature. Most of the horizontal sliding doors require a track or guide for the doors to function properly. The new revision will allow the smooth transport of critical care patients.

Protective Plates on Smoke Barrier Doors
Sections 18.3.7.7 and 19.3.7.7.1 have been revised to allow non-rated, factory- or field-applied protective plates to be unlimited in height when added to smoke barrier doors. The previous editions of the LSC set the height of protective plates installed on smoke barrier doors at 48 inches. This revision has been added because smoke barrier doors are not required to carry a rating. As in previous editions of the code, smoke barrier doors are required to have a substantial core, such as 1.75-inch solid-bonded wood.

Interior Nonbearing Walls
Sections 18.1.6.7, 18.1.6.8, 19.1.6.7 and 19.1.6.8 have been revised to allow interior nonbearing walls to be constructed using fire retardant-treated wood enclosed within noncombustible or limited combustible materials, provided that the walls are not used for vertical shaft enclosure. This revision was primarily made to follow building construction standards and currently is allowed in model building and fire codes.

Nursing Home Sprinkler Protection
Section 19.3.5.1 has been revised to require existing nursing homes to be protected throughout by automatic sprinkler protection. This revision was made in response to the 2003 nursing home fires that occurred in Hartford, Conn., and Nashville, Tenn., where a total of 24 people died. Existing nursing homes would require automatic sprinkler protection upon adoption of the 2006 edition of the LSC in their jurisdictions.

New and existing healthcare facilities should verify if their local jurisdictions have adopted the 2006 edition of the LSC. The 2000 edition of the LSC is still being enforced by both the Centers for Medicare & Medicaid Services (CMS) and JCAHO. The 2000 edition of the LSC was adopted by both CMS and JCAHO in March 2003. However, if a facility believes that the revisions in the 2006 edition will impact it in a positive way, CMS and JCAHO will allow the facility to adopt the 2006 edition of the code.

To adopt the 2006 LSC, CMS requires that a facility complete and submit a formal waiver request. JCAHO requires a facility to make a notation on the Basic Building Information form, which is part of the facilities Statement of Conditions documentation, as well as notify the survey team upon their arrival. CMS and JCAHO require that a facility adopt the entire 2006 edition of the code and not just specific code sections.

While the 2006 edition of the LSC has been available for adoption, few authorities having jurisdiction have done so. The LSC is published on a three-year revision cycle. The NFPA revision cycle for the 2009 edition of the LSC has already begun. The first step in the revision cycle is public comments, which are due to NFPA by Aug. 25, 2006.

To view the 2006 edition of the NFPA 101, Life Safety Code, visit the NFPA Web site at nfpa.org, and click on the Codes & Standards tab.

Thus, environmental issues should be addressed in the planning stages of a project, and it is recommended that an in-house or contracted environmental expert help with this assessment.

Adverse impacts

During a construction and renovation project, chemical contamination and improper hazardous materials management can be the source of many adverse environmental impacts. Historical contamination in a health care facility or mismanagement of C&D waste during a project can open the door to penalties and fines from both state and federal environmental agencies. Paperwork trails can also cause significant compliance headaches, cost overruns and project delays.

Many hospitals predate the existence of the Environmental Protection Agency (EPA) or any of its associated statutes. As a facilities manager, it can be difficult to know how the laboratory and other departments are handling hazardous materials now, never mind how materials management practices were controlled generations ago. Historical contamination is extremely common in old hospital buildings and is a potential budget buster, whether it be in soil, infrastructures or a workspace targeted for renovation.

Contamination in internal workspaces or infrastructures could potentially come from many more places than one might imagine. Many chemicals used in the various departments of a hospital can potentially be a source of historical or chronic contamination in a health care facility.

If any laboratory space is being renovated (clinical, pharmacy/oncology or research), for instance, on-site contractors will often refuse to work in that laboratory space without written certification that all surfaces have been properly decontaminated. The same may be true for any lab equipment being relocated to new or temporary space. This might mean bringing in a crew of environmental specialists to decontaminate the space and provide written documentation. These services can sometimes be quite expensive if they are contracted at the last minute.

Before large-scale demolition begins, it is necessary to identify what lies in the building infrastructure. For instance, one of the most pervasive chemicals on old hospital sites is mercury. Mercury’s harmful properties are well-documented and most facilities strive to be “mercury-free.” However, old cast-iron or glass piping in buildings generally contain enough mercury to raise serious concern about contamination unless every line between the laboratories and the final discharge has been replaced in recent years.

Mercury can be present not only from historical use, but from current practices. Occasionally, there is certain equipment for which staff do not want to utilize mercury-free alternatives. Laboratory and/or medical staff are sometimes reluctant to change procedures for fear of impacting patient care. Mercury thermometers, for example, are often still used in laboratories to monitor temperatures in water baths.

If contractors are surprised by the presence of mercury, the project could be shut down until a decontamination occurs. The associated costs of an urgent decontamination and having contractors on hold can be significant.

Do not repeat others’ mistakes by tearing down a building without first removing contaminated piping, draining cooling systems and removing all window air conditioners. Damaging this equipment during demolition can turn large amounts of debris into hazardous waste. All thermostats, fluorescent lamps and ballasts should also be removed before bringing in the heavy equipment. Window casings from older buildings have a high probability of lead paint and may need to be removed separately and disposed of as hazardous waste. Failure to do so can also create contamination in ordinary construction debris waste.

External contamination may not only entail waste disposal, but possible impacts to the environment. This can lead to extensive cleanup costs and fees or fines issued by state, local and federal agencies.

For instance, if a project includes any type of excavation, it may impact storm drains. Storm drains often contain evidence of automotive fluids and, if not maintained routinely, a disturbed catch basin can release contaminants into the groundwater and sewer systems. Likewise, if a project entails demolition work on or in a parking garage, oil/water separators must be decontaminated before demolition to avoid contaminating soil or debris.

Additionally, if any underground storage tank is being removed, risk of having contaminated soil is high. Tanks must be properly cleaned before removal and, if being replaced, must be installed by a licensed contractor. This will ensure compliance with state and federal requirements for underground chemical and oil storage.

Job site decisions

A contractor is never responsible for any hazardous wastes generated on a job site. The contract agreement may indicate that waste disposal is the contractor’s responsibility, and the contractor may live up to the agreement, but any waste created on-site at a health care facility is linked to that property; therefore, it is tied to the hospital’s EPA generator’s identification number. 

This means that it is the hospital’s responsibility and liability, and any hazardous waste generated during a project counts toward monthly and annual waste generation. The hospital’s name appears on the shipping papers, not the contractor’s, so it is necessary to be certain that only approved hospital personnel are signing the papers.

It is also necessary to confirm that the waste is being characterized and stored properly as well as being shipped to a fully permitted disposal facility. If the hospital is registered with the EPA as a small quantity generator of hazardous waste, the project can potentially cause limits to be exceeded and subject the hospital to additional fees, requirements and even fines on a state or federal level.

Still, a project manager should fully understand the contractor’s training, capabilities and requirements for working in a potentially contaminated area. If they require certificates of decontamination, these procedures should be appropriately planned. Typically, a plumbing contractor will not be trained to manage hazardous materials, and should not work with chemically contaminated piping. Clear, concise communication and proper planning will ensure that the appropriate contractor is employed on each phase of the project. If expectations and qualifications are clear, costly delays can be avoided.

For example, a hospital in New England recently removed an underground storage tank and, in turn, had to ship several tons of contaminated soil to be properly disposed. Although state contingency plans require off-site shipment of the soil, the material did not meet the definition of a hazardous waste in this case. When the contractor arranged disposal through its hazardous waste subcontractor, the soil was improperly characterized as hazardous waste. The improper characterization of the soil caught the attention of the state agency, and caused the additional requirement of completing and submitting an EPA biennial report. Ultimately, the shipment caused the hospital to exceed its generator limits for the year and this waste management error became the source of unbudgeted consulting services and increased scrutiny by the state.

Many states perform their own on-site inspections for environmental compliance. Events like this one can put a facility under the microscope and increase chances of a state inspection.

Regulatory permitting

If a project involves adding or replacing boilers, it will certainly have an effect on the air emissions during and after the project. To avoid Clean Air Act violations, it may be necessary to go through a new source registration process and update air emissions permits.

Permits also come into play under the Clean Water Act. A project involving excavation will likely require a storm water discharge permit. With significant amounts of additional mobile equipment on-site, storm water runoff can potentially be the cause of groundwater contamination. Inside buildings, engineering staff is responsible for maintaining wastewater neutralization systems. These systems were designed as a result of the Clean Water Act regulations and associated permits. Project managers should consider how the project may impact current wastewater permits. Will there be flow increases during or after the project? Is the current system adequate to handle the changes? Will there be new processes that require new treatment or collection systems to be installed? Any significant changes could potentially cause a violation of the hospital’s wastewater discharge permit. Individual state and local agencies may have other permit requirements related to environmental issues. Be sure to understand all local as well as federal requirements.

Additionally, many states have a ban on certain C&D materials from disposal at municipal landfills. For example, Massachusetts will not allow municipal landfill disposal of cathode ray tubes, lead-acid batteries, asphalt, brick or concrete. Nor will wood or metal waste be accepted in any significant quantities at solid waste landfills. These materials must be recycled and the list continues to grow, including white goods such as stoves and refrigerator units. It is a good idea to check individual state requirements.

Potential pitfalls

There are many potential pitfalls of a C&D project, and any of the issues mentioned above could result in compliance enforcement and fines as well as project delays and cost overruns. Of course, it all equates to bad publicity that does not go unnoticed by potential customers, benefactors and the Joint Commission.

Making the extra effort to identify and address environmental issues prior to the project commencing is highly recommended. A proactive approach can help ensure that projects stay on time, on budget and will minimize liability by foreseeing the potential environmental impacts. 

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