Changes within NFPA 99 - 2012

Health

Care Facilities Code

Bob Kroening

Over 25 years designing, inspecting, and verifying

plumbing systems in Healthcare Facilities
President of Medical Gas Systems , Inc., A medical
gas system consulting and verification company.

MGS has been consulting, inspecting, testing, and certifying medical gas
systems in the United States and Canada since 1975

Currently credentialed:

Medical Gas System Installer (ASSE 6010) by National Inspection Testing

Certification Corporation
Medical Gas System Inspector (ASSE 6020) by National Inspection Testing
Certification Corporation
Medical Gas Verifier (ASSE 6030) by National Inspection Testing Certification
Corporation
Medical Gas Bulk System Verifier (ASSE 6035) by Medical Gas training Institute
Credentialed Medical Gas Verifier (CMGV) by Medical Gas Professional
Healthcare Organization
Medical Gas System Instructor (ASSE 6050) by National Inspection Testing
Certification corporation

NFPA = National Fire Protection Association

NFPA 99 Health Care Facilities Code, is updated by the NFPA

Technical Committee approximately every three years. (The
latest version, 2012 Edition Health Care Facility Code was
released in October 2011 and is widely viewed as the most
comprehensive medical gas system document with patient
safety at its highest).
NFPA 99 is adopted by states, most commonly through, the
Centers for Medicare & Medicaid Services(CMS) adoption of
NFPA 101 Life Safety Code

NFPA 101 Life Safety Code 2000 Edition

Chapter 18 NEW HEALTH CARE OCCUPANCIES

18.3.2.4 Medical Gas.
Medical gas storage and administration areas shall be
protected in accordance with NFPA 99, Standard for
Health Care Facilities.

Minnesota and Wisconsin have adopted NFPA 101 -2000 . Because a

code document cannot reference a newer version than the year of its
issuance, NFPA 99 1999 is considered the enforceable code document.

CMS has started the process of adopting NFPA 101-2012 Life

Safety Code (in the statement announcing this, they also
identified that this would include the newer version of NFPA 992012

 NFPA typically issues a new version of NFPA 99 every three years.

This version was delayed several years due to some changes to the
layout of the document.
They removed some of the Chapters and added other Chapter,
specifically Plumbing, and Heating, Ventilating, and Air
Conditioning (HVAC).
The committee changed the building types from Levels to
Categories. This was to bring this document in line with other
NFPA codes.
NFPA changed the name of NFPA 99 from Health Care Facilities
to Health Care Facilities Code. This was requested by
municipalities and other code writing agencies to allow them to
adopt this document more readily.

This presentation is not intended to identify all of the minor

changes within the NFPA 99 -2012 document, but rather the major
changes that will effect the designer in their day to day design of
healthcare facilities.
We recommend that you get a copy of NFPA 99 -2012 from
National Fire Protection Association (www.NFPA.org)
Mark Allen (a member of the NFPA 99 technical committee) also
has issued a document with the changes identified. This can be
downloaded from his company web page.
(www.beaconmedaes.com)
NFPA has also issued a new Handbook, in lieu of a NFPA 99C
document, that has additional technical committee comments to
help the designer understand the intent of the information within
the code.

NFPA 99 now identifies the four different building types as

Categories 1 thru 4.
Category 1. Facility systems in which failure of such
equipment or system is likely to cause major injury or death of
patients or caregivers shall be designed to meet system
Category 1 requirements as defined in this code.
Category 2. Facility systems in which failure of such
equipment is likely to cause minor injury to patients or
caregivers shall be designed to meet system Category 2
requirements as defined in this code.
Category 3. Facility systems in which failure of such
equipment is not likely to cause injury to patients or
caregivers, but can cause patient discomfort, shall be
designed to meet system Category 3 requirements as
defined in this code.
Category 4. Facility systems in which failure of such
equipment would have no impact on patient care shall be
designed to meet system Category 4 requirements as
defined in this code.

What do these categories mean?

Category 1. Hospitals, Surgery Centers
Category 2. Medical Office Buildings, Dialysis Treatment Centers,
Clinics, Oral Surgery Facilities (The key to determining if a facility is
Category 1 or 2, is what is the level of injury to patient or caregiver
if the system is lost. If the system is designed to Category 2, the
facility needs to have an emergency plan to deal with the loss of
medical air, medical vacuum, and WAGD.)
Category 3. Dental Facilities (Category 3 facilities only have
Oxygen, Nitrous Oxide, Dental Air, Dental Vacuum, WAGD
systems. If the facility requires additional gases, they should be
considered Category 1 or 2)
Category 4. Laboratories

NFPA 99 1.3.4 Patient Care Rooms

1.3.4.1 The governing body of the facility or its designee shall
establish the following areas in accordance with the type of
patient care anticipated and with the following definitions of
the classification:
1) Critical care rooms
2) General care rooms
3) Basic care rooms
4) Support rooms
1.3.4.2 Anesthesia. It shall be the responsibility of the governing
body of the health care organization to designate
anesthetizing locations.
1.3.4.3 Wet Procedure Locations. It shall be the responsibility of
the governing body of the health care organization to
designate wet procedure locations.
(The engineer no longer has to guess where within the facility
these areas are located)

Application
1.3.1 This code shall apply to all health care facilities other than home care.
1.3.2.1 If the alteration, renovation, or modernization adversely impacts the existing
performance requirements of a system or component, additional upgrading shall be
required.
1.3.2.3 An existing system that is not in strict compliance with the provisions of this code
shall be permitted to be continued in use, unless the authority having jurisdiction has
determined that such use constitutes a distinct hazard to life.
1.3.4 Patient Care Rooms - The governing body of the facility or its designee shall establish
the following areas in accordance with the type of patient care anticipated and with the
following definitions of the classification:
(1) Critical care rooms (3.3.138.2)
(2) General care rooms (3.3.138.3)
(3) Basic care rooms (3.3.138.1)
(4) Support rooms (3.3.138.4)
1.3.4.2 Anesthesia. It shall be the responsibility of the governing body of the health care
organization to designate anesthetizing locations. Four Levels of Anesthesia
Deep Sedation/Analgesia (3.3.63.1)
General Anesthesia (3.3.63.2)
Minimal Sedation (3.3.63.3)
Moderate Sedation (3.3.63.4)

5.1.3.3 Central Supply System Locations

5.1.3.3.1.8 The temperature minimum for CO2 and N2O
systems is reduced. It will now be manufacturers
recommendation but not less than -29C (-20F).
(See also 9.3.7.7 and 9.3.7.8)

5.1.3.3.2 (3) Outdoor enclosures for medical gas sources now

must have two egress gates.

5.1.3.3.2(10) Electrical devices in manifold rooms must be

protected from damage, but no longer necessarily
1,520 mm (5 feet) above finished floor (AFF)

5.1.3.4 New
Controls (regulators and their associated valves and
gauges) can be mounted remotely from the source
equipment if all other rules are observed.

5.1.3.5.13.2 (6) and 5.1.3.5.14.2 (7) New

Requirement for clearance of 1m (3ft) around
all serviced elements (container, vaporizers and
regulating controls), including the EOSC.
5.1.3.5.14.3(1) Gas cylinder header per 5.1.3.5.9 with sufficient
cylinder connections to provide for at least an average days
supply with the appropriate number of connections being
determined after consideration of the delivery schedule, the
proximity of the facility to alternate supplies, and the facilitys
emergency plan
5.1.3.5.14.5 In-building emergency reserves shall have a local signal
that visibly indicates the operating status of the equipment and an
alarm at all master alarms when or just before the reserve begins to
serve the system

5.1.3.6.2 Uses of Medical Air. Medical air sources shall be

connected to the medical air distribution system only and shall
be used only for air in the application of human respiration and
calibration of medical devises for respiratory application
5.1.3.6.3.4 (B) New
Liquid Ring compressor seal water must be treated.
5.1.3.6.3.4 (C) 2 - 4 New
Liquid Ring compressors must be provided with
cylinder backup. (see Detail )

5.1.3.6.3.12 Revised 5.1.3.5.13

Medical Air intake Location
5.1.3.6.3.12(F) Change 5.1.3.5.13.4

5.1.3.6.3.15 New
A new source system for air has been added. These
are proportioning systems which blend oxygen and
nitrogen to make synthetic air

5.1.4.8 (3) New

Zone valves may not be in the same room as the
outlet/inlet they control.
5.1.4.8.7 Clarification 5.1.4.8.7 (zone valve located outside vital life
support areas, critical care areas, and anesthetizing locations)
Adds the qualifiers anesthetic location of moderate
sedation, deep sedation or general anesthesia to the
anesthetizing location rule.

5.1.4.11 In-line Check Valves. New or replacement check valves

shall be as follows:
1) They shall be of brass or bronze construction
2) They shall have brazed extensions
3) They shall have inline serviceability
4) They shall not have threaded connections
5) They shall have threaded purge points of 1/8 NPT

5.1.9.1 (5) Change 5.1.9.1 (5)

5.1.9.1 (12) New
Allows for communication technology other than
classic wire to be considered.

5.1.9.1 (11) Change 5.1.9.1 (11)

Methods for protecting the wiring for alarms are
listed.

5.1.9.2.3 Change 5.1.9.2.3

Wiring for Master alarms is more completely detailed

5.1.9.3.5 New
Wiring must preserve non-interchangeability of
sensors.
This additional requirement reflects the fact that most
alarm installations today mount the sensor on the
pipe and wire to the panel (as opposed to piping to
the panel and mounting the sensors there). Therefore,
not only can the sensor be mounted on the wrong
pipe (a pneumatic cross connection), but the sensor
can be wired to the wrong alarm (an electrical cross
connection). This provision attempts to deal with this.
This has been a standard feature of Beacon Meds
alarms since the 1980s.

5.1.10.8 Clarification
Allowance for threads in jointing (see also 5.1.10.8)
are narrowly limited.
The use of threading as a jointing technique in the
pipeline is now strictly limited to the points where
indicators are attached to the piping (e.g. pressure
sensors, gauges) Threading is prohibited in all other
locations. A big change which allows this is the
elimination of the threaded check valve (see 5.1.4.11).
Note that this is one difference between piping on the
source side and the patient side of the source valves threading is common and entirely acceptable on the
source side.
5.1.10.10 New
Push fit connections (e.g. ProBite, SharkBite)
are prohibited in the pipeline. Under some
circumstances, they can be used on source
equipment.

Deleted 5.1.10.10.6
Branch piping takeoffs no longer must come out
above the centerline of the main.
5.1.10.11.6.3 New
Flexible connections in pipelines are defined and if
equal to these requirements, permitted.
5.1.10.11.10.3 New
Installers must be individually qualified. A qualified
person may not supervise unqualified people and
have them be qualified by proximity.
5.1.13.2 New (see also 5.1.13.4)
Maintenance, periodic testing and qualifications for
maintenance personnel

5.1.14 Category 1 Operation and

Management

With recent strict changes for qualification and

training of installers, the industry has identified that
the biggest problems reported with medical gases
have shifted from installations problems, to
inadequate maintenance.
The addition of this section strives to address all of
the major elements of a maintenance plan,
including goals, timing, and the work to be
included.
This section also identifies the qualifications of
persons maintaining medical gas systems.

5.1.14.1.4 The medical-surgical vacuum

and WAGD systems shall not be used for
nonmedical applications (e.g., vacuum
steam condensate returns).
A.5.1.14.1.4 Other examples of prohibited
use of medical-surgical vacuum would be
scope cleaning, decontamination, and
laser plume.

5.1.14.2 Maintenance of Medical Gas,

Vacuum, WAGD, and Medical Support Gas
Systems
Health

care facilities with installed

medical gas, vacuum, WAGD, or medical
support gas systems, or combinations
thereof, shall develop and document
periodic maintenance programs for these
systems and their subcomponents as
appropriate the equipment installed.
The facility should retain a written or an
electronic copy of all findings and any
corrections performed.

 Facilities

that already have preventative

maintenance programs for its medical
gases will most likely meet the
requirements of this section.
No schedules are given by NFPA. This
allows the facility to determine the
frequency of maintenance based on the
original quality, age and longevity, and
known characteristics of the equipment it
uses.

Maintenance Programs
Inventories

Inventories of medical gas, vacuum,

WAGD, and medical support gas systems
shall include at least all source subsystems,
control valves, alarms, manufactured
assemblies containing patient gases, and
outlets

Inspection

Schedules

Scheduled inspections for equipment and

procedures shall be established through the
risk assessment of the facility

Maintenance Programs
Inspection

Procedures

The facility shall be permitted to use any

inspection procedure(s)or testing methods
established through its own risk assessment.

Maintenance

Schedules

Scheduled maintenance for equipment

and procedures shall be established
through the risk assessment of the facility

Maintenance Programs
Qualifications

Persons maintaining these systems shall be

qualified to perform the operations.
Training

and certification through the health

care facility by which such persons are
employed to work with specific equipment as
installed in that facility.
Credentialing to the requirements of ASSE
6040, Professional Qualification Standard for
Medical Gas Maintenance Personnel
Credentialing to the requirements of ASSE
6030, Professional Qualification Standard for
Medical Gas Systems Verifiers

Inspection and Testing Operations

Medical

air source

Room temperature
Shaft seal condition
Filter condition
Presence of hydrocarbons
Room ventilation
Water quality, if so equipped
Intake location
Carbon monoxide monitor calibration
Air purity
Dew point

Inspection and Testing Operations

Medical

Exhaust location

WAGD

vacuum source

source

Exhaust location

Manifold

source

Ventilation
Enclosure labeling

Bulk

cryogenic liquid source

Inspected I accordance with NFPA 55

Inspection and Testing Operations

Final

line regulation for all positive pressure

systems

Delivery pressure

Valves

Labeling

Alarms

and warning systems

Lamp and audio operation

Alarms

and warning systems

Master alarm signal operation

Area alarm signal operation
Local alarm signal operation

Inspection and Testing Operations

Station

outlet/inlets

Flow
Labeling
Latching/delatching
Leaks

Manufactured Assemblies Employing Flexible

Connection(s) Between the User Terminal and
the Piping System
Nonstationary

booms and articulating

assemblies, other than head walls utilizing
connectors, shall be tested for leaks, per
manufacturers recommendations, every
18 months or at a duration as determined
by a risk assessment.
DISS connectors internal to the boom and
assemblies shall be checked for leakage.

Medical Gas and Vacuum Systems

Maintenance and Record Keeping
An

annual review of bulk system capacity

shall be conducted to ensure the source
system has sufficient capacity
Central supply systems for medical gases
shall conform to the following
Inspected annually
Be maintained by qualified person
Records of annual inspection shall be
maintained.

Medical Gas and Vacuum Systems

Maintenance and Record Keeping
A

periodic testing procedure for

nonflammable medical gas and vacuum
and related alarm systems shall be
implemented

Medical Gas and Vacuum Systems

Maintenance and Record Keeping
Procedures

shall be established

Maintenance program for the medical air

compressor supply system in accordance
with the manufacturers recommendations
Facility testing and calibration procedure
that ensures carbon monoxide monitors are
calibrated at least annually
Maintenance program for medical-surgical
vacuum piping system
Maintenance program for WAGD system

Medical Gas and Vacuum Systems

Maintenance and Record Keeping
Audible

and visual alarm indicators

Periodic testing to determine that they are

functioning
Records shall be maintained

Medical-surgical

vacuum station inlet

terminal performance

Based on flow of free air into a station inlet

while simultaneously checking the vacuum
level

ASSE Series 6000 Professional Qualification Standard

With the publication of the new Health Care Facility Code, ASSE
has issued a new Medical Gas systems Personnel Professional
Qualification standard

Standard #6005 - Medical Gas Systems Generalists

Provides general knowledge of medical gas and vacuum systems
for the purpose of providing continuing education. Eligible
individuals include any person with an interest in medical gas and
vacuum systems and equipment.
Standard #6010 - Medical Gas Systems Installers
Applies to any individual who installs medical gas and vacuum
systems.
Standard #6015 - Bulk Medical Gas Systems Installers
Applies to any individual who installs bulk systems for medical gas
at health care facilities.
Standard #6020 - Medical Gas Systems Inspectors
Applies to any individual who inspects the installation of medical
gas and vacuum distribution systems.

Standard #6030 - Medical Gas Systems Verifiers

Applies to any individual who tests and verifies the operation of
medical gas and vacuum systems.
Standard #6035 - Bulk Medical Gas Systems Verifiers
Applies to any individual who tests and verifies the operation of bulk
systems for medical gas at health care facilities.
Standard #6040 - Medical Gas Systems Maintenance Personnel
Applies to any individual who maintains medical gas and vacuum
systems.
Standard #6050 - Medical Gas Systems Instructors
Applies to any individual who trains or teaches installers, inspectors,
verifiers and healthcare facility maintenance personnel regarding
medical gas and vacuum distribution systems.
Standard #6055 - Bulk Medical Gas Systems Instructors
Applies to any individual who trains or teaches Bulk Medical Gas
Systems Installers (6015), Verifiers (6035) and Instructors (6055).

NFPA has developed new companion documents to

help the designer understand the intention of the
Technical Committees

Health Care Facility Code Handbook (the full companion

document to the Health Care Facility Code)
The complete text of the 2012 NFPA 99, including medical
gas and vacuum system requirements formerly found in
NFPA 99C*
Explanations of the intent behind requirements
Practical guidance and examples of how to apply
provisions in specific situations
FAQs that highlight key concerns from the field
500+ full-color tables, photos, and other visuals that clarify
concepts.
New supplements on Security in Health Care and Disaster
Recovery

Medical Gas and Vacuum Systems Installation Handbook (the

replacement for the NFPA 99C document)
Chapters 1-5 from the 2012 NFPA 99 plus expert commentary
that explains Code intent and practical application insights
100+ full-color photos, tables, and charts that clarify concepts
Three information-packed supplements on qualifications for
personnel performing medical gas work and general brazing
procedures, cleaning for oxygen service and preparing a joint
for brazing, and installation testing and documentation

Beacon Medaes, Mark Allen

www.beaconmedaes.com

This booklet will focus on the changes to Chapter 5

respecting medical gas and vacuum, and within that,
Category 1 and 2 systems. It will attempt to detail the
scope of a change as well as our view of the justification
behind and impact of the change. Where a particular
risk in implementing a change exists, we will attempt to
describe the risk and offer some ideas on managing it.
The reader should please understand that comments
here represent the opinion of the author and are not
necessarily that of NFPA or of the committee in general

Questions?