D135 Archives - Standards Michigan

Today we break down regulations, codes, standards and open-source literature governing the safety and sustainability of university-affiliated medical research and healthcare delivery facilities. Because of the complexity of the topic we break down our coverage:

Health 200. Survey of all relevant codes, standards, guidelines and recommended practices for healthcare settings.

Health 400. All of the above with special consideration needed for obstetrics, gynecological and neonatal clinical practice and research.

Today we confine our interest to systems — water, power, telecommunication and security; for example — that are unique to campus-configured, city-within-city risk aggregations. Electrotechnologies (voltage stability, static electricity control, radio-interference, etc.) in these enterprises are subtle, complex and high risk. Sample titles from legacy best practice literature in this domain are listed below:

American College of Obstetricians and Gynecologists: Levels of Maternal Care

Provision of Care, Treatment, and Services standards for maternal safety

Since our interest lies in the habitable spaces for these enterprises we usually start with a scan of the following titles:

International Building Code Section 407 (Institutional Group I-2) identifies requirements specific to healthcare settings, covering aspects such as fire safety, means of egress, and smoke compartments. Maternity and obstetric facilities within hospitals fall under this classification.

K-TAG Matrix for Healthcare Facilities

NFPA 70 National Electrical Code Article 517

NFPA 99 Healthcare Facilities Code

NFPA 101 Life Safety Code Chapters 18 & 19

ASHRAE 170 Ventilation of Healthcare Facilities

ASHRAE 189.3: Design, Construction and Operation of Sustainable High Performance Health Care Facilities

Relevant Institute of Electrical and Electronic Engineers research

Towards Deeper Neural Networks for Neonatal Seizure Detection

A System to Provide Primary Maternity Healthcare Services in Developing Countries

Deep Learning for Continuous Electronic Fetal Monitoring in Labor

Reorganizing of University Hospital of Oran’s operating theatre: Simulation approach

Finally, we collaborate with the IEEE E&H Committee on the following IEC committee projects from IEC/TC 62 Electrical equipment in medical practice:

– Common aspects of electrical equipment used in diagnostic imaging equipment

– Equipment for radiotherapy, nuclear medicine and radiation dosimetry

– Electromedical equipment for neonatal care

More

Doula International

A relatively new publisher of related standards is the Facility Guidelines Institute. We are monitoring its catalog and its processes. The healthcare facility industry is likely large enough for another non-profit but we have yet to see meaningful leading practice discovery and promulgation that is unrelated to the literature that is already out there.

Journal of Healthcare Management Standards: Operational Resilience of Hospital Power Systems in the Digital Age

Health Insurance Portability and Accountability Act (HIPAA)

Health care cost as percentage of Gross Domestic Product for six representative nations.

Association of Academic Health Centers

International Conference on Harmonization: The ICH guidelines provide guidance on the development of pharmaceuticals and related substances, including clinical trials, drug safety, and efficacy.

Animal Welfare Act and the Institutional Animal Care and Use Committee

Good Laboratory Practice: GLP is a set of principles that ensure the quality and integrity of non-clinical laboratory studies. It ensures that data generated from non-clinical laboratory studies are reliable, valid, and accurate.

International Code Council Representation of Interests

University of Chicago

In the early to mid-1900s, some US colleges used orphaned babies in home economics programs to teach child-rearing skills

These children were referred to as "practice babies" pic.twitter.com/FZCkeu0p2m

— UberFacts (@UberFacts) August 17, 2023

Healthcare Occupancies

Safety and sustainability for any facility, not just university-affiliated healthcare facilities, usually begin with an understanding of who, and how, shall occupy the built environment. University settings, with mixed-use occupancy arising spontaneously and temporarily, often present challenges and they are generally well managed.

First principles regarding occupancy classifications for healthcare facilities appear in Section 308 of the International Building Code, Institutional Group I; linked below:

2021 International Building Code Section 308 Institutional Group I

university of michigan cardiovascular october medical health 1921 721

Gold_Coast_University_Hospital_Blocks_A,_B_and_C new zealand health intern NZ wiki 1921

glen_panotamic mcgill university canada international medical health aerial needs attribution 1922 719

Moffitt_Cancer_Center_viewed_from_east university of south florida medical center 1922 721

Cooper_lobby_2009 hospital new jersey interior wiki 1919 721

aubuilding augusta university hospital alabama may need attribution 1921 721

Children's_Hospital_Pittsburgh university of pittsburgh health wiki 1921 721

Cork_university_hospital_2017_stitch IRELAND INTERNATIONAL 1923 723

Sahlgrenska Universitetssjukhuset sweden facebook international health hospital photo by Marie Ullnert needs attribution october 1919 721

There are thousands of healthcare code compliance functionaries and instructors; most of them supported by trade associations and most of them authoritative. Hewing to our market discipline to track only the concepts that will affect university-affiliated healthcare enterprises only. There are a few noteworthy differences between corporate healthcare businesses and university affiliated healthcare enterprises (usually combined with teaching and research activity) that we identify on this collaboration platform.

We collaborate closely with the IEEE Education & Healthcare Facilities Committee which takes a far more global view of the healthcare industry. That committee meets online 4 times monthly in European and American time zones.

Finally, we encourage our colleagues to participate directly in the ICC Code Development process. Contact Kimberly Paarlberg ([email protected]) for more information about its healthcare committees and how to participate in the ICC code development process generally. Tranches of ICC titles are developed according to the schedule below:

2024/2025/2026 ICC CODE DEVELOPMENT SCHEDULE

LIVE: I-Code Group B Public Comment Hearings

Issue: [18-166]

Category: Architectural, Healthcare Facilities, Facility Asset Management

Colleagues: Mike Anthony, Jim Harvey, Richard Robben

More

The ICC Code Development Process

K-TAG Matrix for Healthcare Facilities

American Society of Healthcare Engineers

Healthcare Facilities Code

“The Doctor” 1891 Sir Luke Fildes

The NFPA 99 Healthcare Facilities Code committee develops a distinct consensus document (i.e. “regulatory product”) that is distinct from National Electrical Code Article 517; though there are overlaps and gaps that are the natural consequence of changing technology and regulations. It is worthwhile reviewing the scope of each committee:

NFPA 99 Scope: This Committee shall have primary responsibility for documents that contain criteria for safeguarding patients and health care personnel in the delivery of health care services within health care facilities: a) from fire, explosion, electrical, and related hazards resulting either from the use of anesthetic agents, medical gas equipment, electrical apparatus, and high frequency electricity, or from internal or external incidents that disrupt normal patient care; b) from fire and explosion hazards; c) in connection with the use of hyperbaric and hypobaric facilities for medical purposes; d) through performance, maintenance and testing criteria for electrical systems, both normal and essential; and e) through performance, maintenance and testing, and installation criteria: (1) for vacuum systems for medical or surgical purposes, and (2) for medical gas systems; and f) through performance, maintenance and testing of plumbing, heating, cooling , and ventilating in health care facilities.

NFPA 70 Article 517 Scope: The provisions of this article shall apply to electrical construction and installation criteria in healthcare facilities that provide services to human beings. The requirements in Parts II and III not only apply to single-function buildings but are also intended to be individually applied to their respective forms of occupancy within a multi-function building (e.g. a doctor’s examining room located within a limited care facility would be required to meet the provisions of 517.10) Informational Note: For information concerning performance, maintenance, and testing criteria, refer to the appropriate health care facilities documents.

In short, NFPA 70 Article 517 is intended to focus only on electrical safety issues though electrotechnology complexity and integration in healthcare settings (security, telecommunications, wireless medical devices, fire safety, environmental air control, etc.) usually results in conceptual overlap with other regulatory products such as NFPA 101 (Life Safety Code) and the International Building Code.

Several issues were recently debated by the Article 517 technical committee during the 2023 National Electrical Code Second Draft meetings

The conditions under which reconditioned electrical equipment be installed in healthcare settings; contingent on listing and re-certification specifics.
Relaxation of the design rules for feeder and branch circuit sizing through the application of demand factors.
Application of ground fault circuit interrupters.
“Rightsizing” feeder and branch circuit power chains (Demand factors in Section 517.22)
Patient care space categories
Independence of power sources (517.30)

There are, of course, many others, not the least of which involves emergency management. For over 20 years our concern has been for the interdependency of water and electrical power supply to university hospitals given that many of them are part of district energy systems.

We need to “touch” this code at least once a month because of its interdependence on other consensus products by other standards developing organizations. To do this we refer NFPA 99 standards action to the IEEE Education & Healthcare Facilities Committee which meets online four times monthly in European and American time zones.

The transcript of NEC Article 517 Public Input for the 2023 revision of NFPA 70 is linked below. (You may have to register your interest by setting up a free-access account):

Code-Making Panel 15 (NEC-P15) Public Input Report

Code-Making Panel 15 (NEC-P15) Public Comment Report

Technical committees will meet in June to endorse the 2023 National Electrical Code.

~~Public consultation on the Second Draft closes May 31st.~~ Landing page for selected sections of the 2024 revision of NFPA 99 are linked below:

Electrical Systems (HEA-ELS)

Fundamentals (HEA-FUN)

Health Care Emergency Management and Security (HEA-HES)

Second Draft Comments are linked below:

Electrical Systems (HEA-ELS)

Fundamentals (HEA-FUN)

Health Care Emergency Management and Security (HEA-HES)

~~NITMAM closing date: March 28, 2023~~

We break down NFPA 70 and NFPA 99 together and keep them on the standing agenda of both our Power and Health colloquia; open to everyone. See our CALENDAR for the next online meeting.