How to utilize suites under NFPA 101 requirements

NFPA 101 insights

• Suites in health care facilities offer design flexibility and exemptions from certain requirements, allowing for patient-centered room grouping.
• Corridors are not required within suites, leading to more efficient use of space and fewer restrictions on corridor width and features. This can simplify facility design and reduce the need for corridor walls and doors, improving operational efficiency.

For health care facilities complying with the conditions of participation for Centers for Medicaid & Medicare Services (CMS), the 2012 edition of NFPA 101: Life Safety Code is required to address life safety requirements within a facility. NFPA 101 provides a flexible design and an operational option for a collection of rooms, called suites.

While this option is also described in the International Building Code, this article will be focused only on NFPA 101 requirements. The use of suites is unique to health care occupancies and is often a term that is used generally and misunderstood.

What is a suite?

In general, a suite is a collection of rooms that are grouped together or adjacent to each other. NFPA 101 Section 3.3.272.5 defines a patient care suite as, “a series of rooms or spaces, or a subdivided room separated from the remainder of the building by walls and doors.” While this definition has been tweaked in newer editions of NFPA 101, it remains somewhat general to allow flexibility in its use.

Figure 1: Suites within a hospital facility are used to comply with NFPA 101 requirements while keeping patient comfort and care as a top priority. Courtesy: Jacia Phillips, Henderson Engineers

By grouping rooms together in a suite, the code permits certain exemptions from other requirements typical to a health care occupancy that may otherwise negatively impact patient care procedures, increase cost or result in additional inspection, testing and maintenance impacts for certain features of the facility.

NFPA 101 defines three different types of suites — patient care sleeping suites, patient care nonsleeping suites and nonpatient care suites:

• Patient care sleeping suites: Thes will contain “one or more sleeping beds intended for overnight sleeping” as defined by NFPA 101. An example in a hospital may include an intensive care unit (ICU).

• Patient care nonsleeping suites: These are used for treating patients, but are not intended for overnight sleeping, according to NFPA 101. Examples in a hospital may include a radiology department, an outpatient clinic within a hospital or, potentially, an emergency department.

• Nonpatient care suites: These are for suites that do not treat patients. Examples in a hospital may include administration departments, staff locker rooms or the facilities department.

Each suite type has specific requirements because of the different occupants located within each suite.

Why utilize suites?

Habitable rooms: NFPA 101 Section 18.2.5.6.1 requires, “every habitable room to have an exit access door leading to an exit access corridor.” This is because most occupants in a health care facility are incapable of self-preservation and require a defend-in-place evacuation strategy. Staff is required to support evacuation, either horizontally or vertically in the facility.

Corridors, which lead to exits, become a very critical component of egress, and this requirement for discharge limits how certain departments/units in hospitals can be designed. One way to get around this requirement is by utilizing suites. Suites permit occupants to exit through several rooms to get to a point where an exit access door is required, meaning that not every habitable room within the suite is required to have direct access to a corridor. This allows designers and staff more flexibility to support patient care while still maintaining a safe environment.

Corridors: An important feature of suites is that corridors are not required within suites. In new health care facilities, corridors are required to be a minimum of 8 feet wide with limited allowances for fixed furniture, wheeled equipment or projections.

In a suite, these circulation spaces (often called halls or something similar) indicate to the authority having jurisdiction that corridors are not part of the suite and that those requirements do not need to be met. This allows these circulation spaces to be reduced to a width that is needed for evacuation, to functionally support the space or is at least 36 inches. This also allows for some amount of equipment to be located within the space so long as there is a plan to promptly remove or relocate during an evacuation event), which is not allowed in a corridor.

Figure 2: This diagram shows a suite of rooms grouped together, in this case for a specific modality of treatment. Courtesy: Henderson Engineers

Every corridor also requires access to two approved exits, without passing through any intervening rooms or spaces other than corridors or lobbies per NFPA 101. Suites will allow intervening rooms to be utilized before entering a corridor.

Operationally, the removal of corridors and their associated requirements are a positive for facilities staff. In a corridor, walls must be sealed to limit the transfer of smoke under NFPA 101.

Additionally, corridor doors are required to:

• Resist the passage of smoke.

• Maintain an undercut of 1 inch or less.

• Maintain positive latching.

For rooms located around a circulating space in a suite, there are no corridor walls or doors, which allows for doors that meet the functional requirements of the space (e.g., pressurized spaces) without requiring the additional inspection, testing and maintenance listed above. Walls may contain gaps for equipment or other items required for patient care or treatment.

Figure 3: Every corridor requires access to two approved exits, without passing through any intervening rooms or spaces other than corridors or lobbies, per NFPA 101. Courtesy: Geoffrey Lyon, Henderson Engineers

For example, it is common to see ICU patient rooms utilizing horizontal sliding doors in lieu of traditional swinging doors. These types of doors can be provided with a latching function, but run into challenges operationally due to the need to move beds in and out of these spaces often. By utilizing suites, these doors are allowed to only meet the requirements needed for functionality or for other code requirements (pressurization, etc.).

Flexibility: Rooms in a suite do not require separation from the circulating space (unless for other code reasons, such as a hazardous room). If these rooms were outside a suite, they would need to be located directly off a corridor, which has a requirement for physical separation with a wall and door.

An example may include an opening area with treatment bays that would require walls and doors (physical separation) for each bay if located directly on a corridor. There are some exceptions for nurse stations or waiting spaces that are allowed in a corridor, but the flexibility of a suite will allow many other spaces to also be open within the suite.

Specific suite requirements

Separation: NFPA 101 requires that all suites are separated from other portions of the building by walls and doors meeting the requirements for corridor separation. Internal walls within the suite are required to be noncombustible, limited-combustible or partitions constructed with fire-retardant treated wood enclosed with noncombustible or limited-combustible materials. They shall not be required to be fire rated unless required by other portions of the code (e.g., hazardous area).

Patient care sleeping suites: This suite type allows for patients that will be sleeping overnight; therefore, requirements are enhanced to address additional defend-in-place and/or evacuation time required.

Criteria includes the following:

• Constant staff supervision is required.

• Direct supervision is required from a “normally attended location within the suite” for the patient sleeping rooms. Any patient sleeping rooms without direct supervision requires smoke detection.

• Maximum size of 7,500 square feet or 10,000 square feet where both direct visual supervision and total smoke detection is provided.

• Sleeping suites exceeding 1,000 square feet require two remotely located exit access doors. One exit access door shall be direct to a corrido. The other can be into an adjacent suite, an exit stairway, exit passageway or an exterior door.

• Exit travel distance from any point of the sleeping suite to an exit access door is limited to 100 feet. However, the number of intervening rooms within the suite is not limited.

Figure 4: Nonpatient care suites have specific requirements outlined in NFPA 101. Courtesy: Henderson Engineers

Patient care nonsleeping suites: Patients treated in this suite type do not sleep overnight, which means requirements differ somewhat from patient care sleeping suites. Some considerations include the following:

• Maximum size of 10,000 square feet. Newer editions of NFPA 101 have modified this requirement to allow up to 12,500 square feet or 15,000 square feet. However, this is not currently allowed by CMS.

• Nonsleeping suites exceeding 2,500 square feet require two remotely located exit access doors. One exit access door shall be direct to a corridor. The other can be into an adjacent suite, an exit stairway, exit passageway or an exterior door.

• Exit travel distance from any point of the nonsleeping suite to an exit access door is limited to 100 feet. However, the number of intervening rooms within the suite is not limited.

Nonpatient care suite: This suite type does not contain patient treatment or sleeping uses. NFPA 101 requires that the egress provisions for this suite type follow the primary use and occupancy contained within. For example, Figure 4 shows a pharmacy suite and an office suite (staff only, no patients) that are permitted to follow business occupancy requirements for egress.

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