david b.uhaze, ra chief - bureau of construction project review nj dept. of community affairs vice...

Health Facilities Design:An Overview of the Code Requirements

David B.Uhaze, RAChief - Bureau of Construction Project ReviewNJ Dept. Of Community Affairs

Vice Chairman – FGI Health Guidelines Revision Committee

Introduction 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: Healthcare Facilities 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

DCA – Bureau of Construction Project Review

Health Care Plan Review Unit

Performs both a UCC and Licensing review on all

projects submitted

Will comment on Licensing requirements, but cannot

grant waivers to those requirements

20 day review cycle for new projects with complete

applications

7 day review cycle for re-submitted projects

Permitting and inspections are done at the local level

May grant permission for a local review of certain projects


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

released• Applicant prints plans, signs and seals them, then submits for permits thru

municipality


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

and you can access all of the necessary forms for

submission at the Bureau’s website:


www.nj.gov/dca/divisions/codes/offices/bcpr.html

NJ Uniform Construction CodeNJ Uniform Construction Code Permit Extension Act

The original act of 2008 has been extended again.

Extends all permits & DCA releases that were open and valid as of January 1, 2007 until July 1, 2015

Applies to New Jersey permits only, does not include Federal permits

Includes UCC permits and other permits such as:

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

NJ Department of HealthNJ Department of Health

NJ HealthNew Jersey Department of Health

No major proposals or adoptions at this time

NJDOH Acute Care Assessment & Survey will be continuing to survey to and use the 2000 Edition of the NFPA 101 Life Safety Code until a newer edition is adopted by CMS

The FGI Guidelines 2014 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

http://www.fgiguidelines.org/index.php

The FGI Guidelines 2014 Major changes this cycle:

Two separate volumes: 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


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:

The FGI Guidelines 2014


The FGI Guidelines 2014 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 added.

more than 400 references to the functional program in the body of the text were eliminated, and more appropriate language added.



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.



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.


The FGI Guidelines 2014 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


The FGI Guidelines 2014 Changes Part 2: Surgical Suite The surgical suite now defined as two designated areas: semi-restricted and

restricted

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 department.


The FGI Guidelines 2014 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 appendix.

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


The FGI Guidelines 2014 Part 4: ANSI/ASHRAE/ASHE 170

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 editionVisit this page to read an introduction to the series and to access PDFs of the articles.

http://www.fgiguidelines.org/2014articles.php




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


National Fire Protection Association 2012 Codes Life Safety Code 101 Health Care Facilities Code 99These 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.

NFPA 101- Life Safety Code2012 EditionIn 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 non-fuel-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 7.1.3.2.1(9)(c) of the 2012 LSC.

Will allow new sleeping suites up to 10,000 square feet if the facility is in compliance with 18/19.2.5.7 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.

NFPA 101- Life Safety Code2012 Edition

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 18/19.2.2.2.4 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 18/19.2.2.2.2 through 18/19.2.2.2.6 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 18/19.7.5.7.2 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 motor-driven 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 one hour and 30 minutes (1-1/2 continuous hours), 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 8.4.2.3 of the 2010 NFPA 110.

NFPA 101- Life Safety Code2012 EditionCategorical Waivers cont.

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.

NFPA 101- Life Safety Code2012 Edition When the 2012 LSC is adopted, these changes will

also be effective: At 18.2.3.4(4) – 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 18.2.3.4(5) – 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

NFPA 99 – Health Care Facilities Code2012 Edition

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 ≥ 20 percent. 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 5.1.9.4 of the 2012 NFPA 99.

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:

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.

International Building Code 2015

International Building Code 2015Section 202 DefinitionsAdded definitions for:

Custodial Care – Assistance with day to day living, slow evacuation time or mental/psychiatric complications

Care Suite – A group of treatment rooms patient sleeping rooms and support space in an I-2 use with attendant staff

Medical care – Care involving medical or surgical procedures, nursing or for psychiatric purposes

24 Hour Care – The actual time that a person is given care, not the amount of time a facility is open

Incapable of Self-preservation – Persons that because of age, physical or mental limitations, chemical dependency or medical treatment can not respond to an emergency situation

International Building Code 2015Section 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

International Building Code 2015Chapter 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 407.4.4.6.1 – 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.

International Building Code 2015Chapter 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 protection

In Group I-2, laundry rooms over 100 sf 1 hour

In Group I-2, physical plant maintenance shops

1 hour

In ambulatory care facilities or Group I-2 occupancies, storage rooms greater than 100sf

1 hour

International Building Code 2015Chapter 9 Fire Protection Systems At Section 903.2.2 – Ambulatory Care Facilities

Changed “fire area” to “entire floor”

At item #1 added the sentence “whether rendered incapable of self preservation by staff or already incapable of self preservation”

Added “ If the ACF is on a floor other than the level of exit discharge, all floors below & all floors between the ACF and the level of exit discharge must be sprinklered”

At Section 903.2.6 – Group I-4 Day Care

The sprinkler requirement noted above is also required for Day Care

2009 IBC Section 903.2.2



2015 IBC Section 903.2.2

International Building Code 2015Chapter 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 maintenace.

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 new Section 1607.6 – Helipads

• 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.


International Codes CouncilAd 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

Where To Get More Information: FGI Guidelines

1.800.242.2626 www.ashestore.com

NJ Uniform Construction Code & Uniform Fire Code 609.984.0040 www.nj.gov/dca/codes/forms/pubsandsubs.htm

International Codes 1.800.786.4452 [email protected]

National Fire Protection Association 1.800.344.3555 [email protected]

FGI Guidelines 1.800.242.2626 www.ashestore.com

NJ Uniform Construction Code & Uniform Fire Code 609.984.0040 www.nj.gov/dca/codes/forms/pubsandsubs.htm

International Codes 1.800.786.4452 [email protected]

National Fire Protection Association 1.800.344.3555 [email protected]

david b.uhaze, ra chief - bureau of construction project review nj dept. of community affairs vice...

Documents

bureau review

plan review application

construction project

applicant project

paperless review process

review hcpr reviewers

automated review process

wetlands review water