Managing risk: a look at the NFPA 99 standard for healthcare facilities

The vital signs for the NFPA 99 Standard for Health Care Facilities was released as a first edition in 1984, the current edition in 2005, and the next edition is due in 2010. Its scope covers electrical, gas/vacuum, and environmental systems for healthcare facilities, including hospitals, laboratories, nursing homes, and limited care facilities.


The vital signs for the NFPA 99 Standard for Health Care Facilities was released as a first edition in 1984, the current edition in 2005, and the next edition is due in 2010. Its scope covers electrical, gas/vacuum, and environmental systems for healthcare facilities, including hospitals, laboratories, nursing homes, and limited care facilities.

NFPA 99 establishes criteria to minimize fire, explosion, and electrical hazards in healthcare facilities. Amended approximately every three years, NFPA 99 stands as the voice of risk management and prevention for today's healthcare facilities.

But the standard isn't just a thing unto itself. NFPA 99 complements other major NFPA standards, including the National Electrical Code (NFPA 70), the Life Safety Code (NFPA 101), the National Fire Alarm Code (NFPA 72) and Standard for Emergency and Standby Power Systems (NFPA 110).

Sustaining healthcare power

Chapters 4 through 6 of the standard's 2005 edition are dedicated to the performance, maintenance, installation, and testing of electrical, gas/vacuum, and environmental systems.

Both the normal and essential power systems, including common elements such as circuiting, grounding, circuit protection, and device types within patient care areas, as well as ground fault protection and isolated power systems, are addressed in this section. Defining how essential power sources should be configured and how distribution systems must be arranged, NFPA 99 includes parameters for the following:

  • What loads can and must be connected to a standby generator

  • How a healthcare facility's separateelectrical distribution branches—life-safety, critical, and equipment—are used

  • What alarms are required and the required scope of ongoing testing.

But electrical hazards aren't the only danger in a healthcare environment. Extensive use of gas and vacuum systems present many other risks.

Gas and vacuum systems

Gas and vacuum systems covered by NFPA 99 include the following:

  • Oxygen

  • Medical-surgical vacuum and compressed air

  • Nitrogen

  • Nitrous oxide

  • Carbon dioxide

  • Waste anesthesia gas disposal

  • Instrument compressed air.

NFPA 99 looks at these systems as combinations of a source and as a distribution network. The sources can be outdoor bulk cryogenic tank plants that hold oxygen; a set of indoor cylinders that hold a high pressure gas such as for nitrogen or nitrous oxide; or air compressor and vacuum pump plants, each of which has specific redundancy and local alarming requirements.

The distribution networks for gas and vacuum systems include piping, valves, gauges, inlets and outlets, zone valve boxes, and area alarm panels. The list also includes specialty devices such as wall-mounted, low-pressure emergency oxygen supply connections, used only when the outdoor bulk cryogenic tank plant is out of product or out of service.

The HVAC connection

NFPA 99 also plays a role in how environmental HVAC systems are designed for anesthetizing locations. Here, the standard requires the relative humidity of an anesthetizing location to be controlled within the 35% to 55% range in order to avoid hypothermia in patients and to reduce incidents of wound infections.

NFPA 99 also requires HVAC systems that support anesthetizing areas to automatically vent smoke and products of combustion, and to prevent smoke recirculation to any of the rooms that the particular system serves. In order to perform this function, HVAC systems must be organized in a way where they can exhaust contaminated air outdoors, when needed. If the system cannot be configured in this way, the anesthetizing locations will need to be continuously exhausted, while outdoor air then becomes the supply air.

Also, although beyond the scope of this article, don't overlook Chapters 7 through 10 of NFPA 99, which address the equipment and materials that make up these systems.

Defining the application

After becoming familiar with the engineered systems and other pertinent details, the application must be addressed. Hospitals are the primary target of NFPA 99, followed by laboratories, nursing homes, limited care facilities, home care, hyperbaric facilities, and freestanding birthing centers.

As is crucial to the successful implementation of every standard, the most important point to make to engineers is that they read the standard. Yes, read it—cover to cover—and the state and local codes that complement it as well. There is no substitute for taking the time to become familiar with the details including the context in which requirements are defined, such as proposed versus adopted changes.

Bringing NFPA 99 up to date

The standard's current edition, released in 2005, reveals some significant changes in systems design. For example, NFPA 99 now allows a building automation system (BAS) to be used as one of the two required master alarm panels in a healthcare facility. In the past, designers typically placed one master alarm panel near the security desk in a hospital's emergency department and the other next to the facility's telephone operators, both locations typically staffed 24/7. Allowing the use of BAS as one of the panels would appear to be a design breakthrough for the specifying engineer, but implementing this allowance isn't as simple as it seems. For example, the power source and wiring arrangement between various sensors and the BAS computer must be configured as though the computer were an independent master alarm panel.

The second significant modification involves treating nitrogen like instrument air—i.e., medical support gas or utilities—rather than treating it like oxygen, medical-surgical compressed air, nitrous oxide, and carbon dioxide, all of which are considered pharmaceuticals for patient care applications.

One other change in the 2005 edition is a list of allowable configurations of manifold assemblies using cylinders holding gas under high pressure, containers holding liquid under high pressure and hybrids of cylinders and containers. The good news is that system configurations are now more flexible to fit any application. The bad news, however, is that the design effort now becomes more involved in order to help the owner achieve the safest and most economical system configuration.

Diagnosis: a need for change

As health care technology evolves, industry codes and standards must follow suit. And so, a comprehensive restructuring of NFPA 99, including the scope and membership of its technical committees (TC), is underway. The restructuring process began in 2006 and concludes with its next edition in 2010.

“The radical changes were necessary as NFPA 99 is a 25-year-old document that was a compilation of even older standards,” said Technical Correlating Committee chair Douglas S. Erickson. “In reviewing the document, there were chapters and annexes that had not been referenced for over a decade. With the dramatic changes in healthcare technology, electronic medical records, natural disasters and a sicker patient population, NFPA 99 needs to be reinvented to fit this modern-day delivery system.” (“Restructuring NFPA 99,” NFPA Journal, Sept./Oct. 2007)

The focus of the restructuring lies in the hands of NFPA 99's TCs, which will iron out the details of each subject matter within the document's scope. Here is a look at how some of these committees are taking shape:

  • TC on Fundamentals. Previously called TC on Administration, this committee will now also be responsible for determining the relative risk level of various medical procedures in order to specify the level of service, in addition to existing responsibilities.

  • TC on Medical Equipment. This new committee will merge the existing TC on Electrical Equipment with the TC on Gas Delivery Equipment.

  • TC on Electrical Systems. This committee will expand its scope by adding electrical power and low voltage systems, including electronic information data bases.

  • TC on Mechanical Systems. This new committee will address existing performance operations, testing, and maintenance requirements for air quality failure management criteria, in addition to addressing temperature and humidity control and critical space pressure relationships for infection control water and wastewater.

  • TC on Emergency Management and Security. This committee will expand its scope to include security issues in healthcare facilities as well.

Look for some major changes to the NFPA standard in 2010.

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