A better way

Codes and standards regulating the health care physical environment help keep the nation's hospitals safe for patients, staff and visitors. Yet overlapping, conflicting, outdated and unnecessary codes siphon money from hospitals' top priority — patient care.

Recent proposals approved by the International Code Council (ICC) will help save hospital resources without diminishing safety, marking major successes for those working to improve codes and standards.

Among the proposals approved were many suggested by a group formed by the American Society for Healthcare Engineering (ASHE) and the ICC. ASHE and the ICC partnered to create the ICC ad hoc Committee on Health Care, which set a goal of examining portions of the ICC codes affecting health care facilities and propose changes when necessary.

"We've been working for more than three years on these proposals," says ASHE Director of Codes and Standards Chad Beebe, AIA, SASHE. "We know the changes will have a big impact on hospitals around the country."

Facility savings

The changes, adopted into the 2015 edition of the International Building Code, represent movement toward the ultimate goal of one set of unified codes regulating the health care physical environment.

The changes are more than symbolic, however. ASHE estimates that the health care industry spends billions of dollars a year dealing with unnecessary, outdated and conflicting codes.

For example, a proposal exempting hospitals from a requirement for duct smoke dampers will save hospitals the cost of the dampers along with maintenance costs, while maintaining the level of protection for occupants. The University of Arkansas for Medical Sciences (UAMS) reports that the recent passage of that proposal will allow it to avoid costs of $117,450 by not having to put dampers into a proposed replacement building. UAMS estimates the cost avoidance from that proposal alone is 81 cents per square foot of all new construction.

"This proposal will not only save UAMS and the health care industry costs for many years to come — thus helping to lower overall health care costs — but will also maintain the level of safety and improve the functionality of our facilities," says Jonathan Flannery, MHSA, CHFM, FASHE, executive director of engineering and operations at UAMS.

Approved proposals

The ICC considered many proposals at its final action hearings in October, and full results of those hearings are available online at www.iccsafe.org/cs/codes/Pages/portland-results.aspx. Among the other proposals that were approved are:

Smoke dampers. This proposal will exempt hospitals from requirements for duct smoke dampers if the hospital meets certain conditions, such as being equipped with automatic, quick-response sprinklers and having a fully ducted HVAC system. Smoke dampers are not required by other model codes in this situation and have shown a history of success without additional dampers.

Compartment size. This proposal allows an increase in the maximum smoke compartment size from 22,500 square feet to 40,000 square feet. The current maximum is based on an old travel distance requirement of 150 feet. This proposal simply updates that requirement using the current 200-foot travel distance. The change accommodates the needs of a modern hospital, in which patient rooms have expanded to hold more equipment but the number of occupants in the space has not increased.

Door locks and child abductions. Doors are required to unlock if the automatic sprinkler system or fire detection system is set off, but this proposal allows an exemption to that rule in areas where egress control systems are used to prevent the abduction of infants and children. This could help prevent infant or child abduction in cases in which the abductor sets off the fire alarm as a distraction and way to get doors open. The National Fire Protection Association's NFPA 101, Life Safety Code, currently has provisions for delayed egress components that could be integrated into an infant abduction system — these still would provide for emergency evacuation while slowing the progress of an abduction.

Delayed egress locks. Facilities using delayed egress locks are required to post signs near the door with instructions stating that the door should be pushed until an alarm sounds to open. This proposal will allow an exemption to that requirement for hospitals in instances where posting such a sign would interfere with patient safety. This exemption is needed to protect occupants such as first-stage Alzheimer's patients who can still read but may wander away from the facility if they open the doors alone.

Changes not approved

Several other proposals suggested by the ad hoc Committee on Healthcare did not pass. Those proposals include:

Lay-in ceiling tiles. Current interpretations require ceiling systems to be monolithic and this proposal would have allowed lay-in ceiling systems designed to limit the transfer of smoke. Monolithic ceilings are not feasible in a hospital setting because main utility and ductwork lines run in the corridor to keep them out of patient care areas. Hospitals need many penetrations (i.e., lights and sprinkler heads) and access panels in the ceiling, which compromise the intent for monolithic ceilings to be smoke-tight.

However, lay-in tiles would provide a smoke-tight system with no open portions or gaps in the ceiling. The 2012 edition of NFPA 101 allows lay-in ceiling tiles in these situations because reports have shown that the ceiling system does limit the transfer of smoke. Hospitals have fully ducted HVAC systems so the need for partitions to extend to the deck above is limited and should not be required by the building code.

Elevator lobbies. Prior to the 2009 edition of the International Building Code, hospitals were not required to provide elevator lobbies if the building was equipped with fire sprinklers. The justification for requiring elevator lobbies in the code addressed problems found typically in business occupancies such as office buildings and skyscrapers. The reports that were used to justify this requirement in 2009 did not specifically address hospital buildings and typical defend-in-place strategies.

This proposal would have exempted hospitals from this requirement because elevator lobbies serve no purpose on floors of facilities that defend in place. The addition of required elevator lobbies could complicate the movement of patients to adjacent smoke compartments.

Occupancy sensors. This proposal would have allowed the use of occupancy sensors that activate the required illumination for means of egress if they meet certain conditions, including operating as fail-safe devices in the event of a power failure to the emergency lighting system. These sensors would reduce energy use and have been allowed in some jurisdictions.

The illumination requirements in the code changed with the added requirement for photoilluminescence in the stairwells. Photoilluminescent strips were added to the code requirements to ensure that some illumination was provided for occupants trying to exit the building after battery-powered illumination expired. Unfortunately, hospitals and their continuous supply of power to the stairwell lighting from the essential electrical system were not specifically considered in this report.

The proposals that did not pass during this cycle likely will be raised again in the future. Beebe notes that the code development process hinges largely on teaching ICC voting members about the complexities of the health care environment. For example, to comprehend the reasoning behind the elevator lobby proposal, ICC members first need to understand how hospitals use defend-in-place techniques.

"This is all about education," Beebe says. "It's important for ASHE members and others involved with the health care physical environment to let their local authorities having jurisdiction and other ICC voting members know about key concepts for hospitals. Then they can understand why the proposals we're suggesting make sense, and how they will keep patients safe without wasting resources."

Flannery says it was rewarding to see so many successes at the final action hearings. "We still have a long way to go to bring about our ultimate goal of unified codes and the reduction of costs due to conflicting and unnecessary code requirements," he adds.

What's next?

The ad hoc Committee continues to work on code proposals for future code-development cycles. The group is working on proposals the ICC will consider next year for the 2015 edition of the International Fire Code. Although the process takes years, ASHE and the members of the ad hoc Committee on Healthcare remain committed to creating responsible codes.

To get involved, contact Beebe at cbeebe.aha@gmail.com.

Deanna Martin is senior communications specialist for the American Society for Healthcare Engineering. She can be reached at dmartin@aha.org.