Influencing health care facility codes

The National Fire Protection Association’s 2019 NFPA Technical Meeting presented a perfect example of why health care organizations must be involved with the NFPA code development process and participate in this year’s annual NFPA Technical Meeting.

Typically, the Technical Meeting currently occurs on the last day of the NFPA Conference & Expo, which this year has been cancelled due to the COVID-19 pandemic. However the association will still hold the Technical Meeting virtually so members can participate in the code development process. 

Reactive nature

The health facilities management profession is very reactive. This is often due to limited resources for travel and continuing education allotted to the professional development budget within hospitals. 

Given the field’s reactive nature, only a small group of individuals usually take a progressive stance on evolving codes. As a result, new code requirements are continually placed on hospitals from outside entities, including vendors and manufacturers.

Often, these changes are made without evidence-based data and cost hospitals unnecessary capital and other resources. The American Society for Health Care Engineering (ASHE) has taken a proactive stance and is advocating for what is best for health care facilities but is often overrun by the other stakeholder groups due to lack of its representation and attendance.

The Health Care Section, an NFPA member section comprised of NFPA members who are active in the health care community, also has volunteers who review the code changes for the impact to the health care field and advise the Health Care Section on positions to take on proposed code revisions.

Out of the approximate 600 attendees at last year’s NFPA Technical Meeting, the health care field had approximately two dozen NFPA voting members represented, less than 5% of the voting attendance. Every vote that ended up in opposition to the Health Care Section’s stance was lost by at least 5 to 1.

To proactively change codes and drive them toward what is best for the health care field, hospitals and health care systems must not only allow but also encourage facilities management teams to attend each year’s NFPA Technical Meeting.

Health care is the most regulated field outside of the nuclear industry, and much time, money and resources are spent adhering to codes and regulations that are not bettering the patient experience or increasing patient safety.

One example of how a code requirement should be revised is the monthly requirement to visually inspect fire extinguishers. Documented evidence from numerous hospitals across the nation indicates that monthly fire extinguishers produce a failure rate of less than 0.02%. At approximately five minutes per extinguisher each month, this produces one hour of unproductive time each year per extinguisher due to a code requirement that should be eliminated (just think how many extinguishers are in any given hospital).

ASHE, along with the others in the health care field, are working to get this requirement revised to a more reasonable yet still reliable frequency. However, due to the impact of the fire extinguisher industry, it would not be surprising if it ended up as a vote at the 2021 NFPA Technical Session.

Equipment example

Last year’s NFPA Technical Meeting was no different; one of the hottest topics was regarding reconditioned electrical equipment.

Reconditioned equipment really didn’t enter the NFPA 70^®, National Electrical Code^® (NEC^®), until the 2017 edition. The 2017 edition not only stated that equipment within the code could be reconditioned, it further defined the term “reconditioned equipment,” whereas previous editions lacked this clarification.

Since the input process of the 2017 edition, the topic of reconditioned equipment has been heavily discussed. Several manufacturers, vendors, electrical unions and others supported removing the ability to recondition electrical components or assemblies.

Some of this support is due to claims that the equipment lacks suitability and safety; however, there are organizations such as the Professional Electrical Apparatus Reconditioning League (PEARL), an American National Standards Institute (ANSI)-accredited standards developer, whose mission revolves around developing standards that advance and promote safe reconditioning practices for electrical equipment.

Further, the financial benefits associated with eliminating the ability to recondition electrical components or assemblies must be viewed from a wide perspective.

By the NFPA bylaws, technical committees are structured and balanced across 10 different classifications of committee members, which include manufacturer (M), user (U), installer/maintainer (I/M), labor (L), applied research/testing laboratory (R/T), enforcing authority (E), insurance (I), consumer (C), utility (UT) and special expert (SE). However, when looking at each of these classifications from the perspective of who would financially benefit from the elimination of the ability to use reconditioned equipment, it is quickly apparent that it is not as balanced.

Because individuals often are representing their respective companies, it can be difficult to separate what is best for the industry from what is best for their companies due to personal perspective and interest. For example, NEC’s Code-Making Panel 9 (NEC-P09) is comprised of 12 of the 20 classifications that would benefit from the elimination of the ability to use reconditioned equipment.

Diving in deeper into the 2020 NEC edition and the topic of reconditioning, there were 52 total certified amending motions (CAMs) for the NEC, and 20 of these CAMs revolved around reconditioning. This wave of what can and can’t be reconditioned stemmed from 11 public inputs (PIs) introducing the requirements of, or the restrictions of, using reconditioned equipment.

Particularly, several references are made to PI-2935, submitted by a UL employee in August 2017 to Section 110.21(2). The input revised the section to state “Reconditioned equipment shall be identified listed as ‘reconditioned’ and approval original listing marks removed. Approval of the reconditioned equipment shall not be based solely on the equipment’s original listing.”

Coupled with the other 10 PIs on reconditioning, this led to several public comments and committee discussions. The NEC correlating committee recognized the global impact to the NEC by this topic and felt that the use of reconditioned equipment should be researched in greater depth. As a result, the NEC correlating committee formed a task group to explore the capabilities of reconditioning various types of electrical equipment.

The task group was comprised of the following four individuals, listed with their NFPA classification of committee member abbreviations:

• Safety coordinator with the International Brotherhood of Electrical Workers (L).
• Principal engineer manager at UL (R/T).
• Senior technical director of certification at Intertek (R/T).
• Electrical inspector from Michigan (E).

The primary document the task group used to identify equipment that is suitable for reconditioning is the National Electrical Manufacturers Association’s (NEMA’s) “Policy on Reconditioned Electrical Equipment.” However, NEMA’s policy was not followed explicitly. The task group stated that it based its public comments on the “complexity of the product, the manufacturing process, or the level of knowledge the company performing the reconditioning may need, etc.”

An example of where the task group deviated from the NEMA policy is industrial and commercial panelboards. The NEMA policy identifies industrial and commercial panelboards as assemblies that may be reconditioned. However, in second revision (SR) No. 8172-NFPA 70-2018, the NEC Code-Making Panel (NEC-P09) (which does not have any health care representation and is responsible for the scope of Article 408 – Switchboards, Switchgear, and Panelboards) decided to go against the NEMA policy in the 2020 NEC by adding language in a new section in 408.8(A) specifically prohibiting the reconditioning of panelboards.

It must be noted that NEC-P09 contains three users as defined by the NFPA classification of committee members. Two of these users voted in opposition to (SR) No. 8172-NFPA 70-2018.

The Health Care Codes & Standards Review Committee recognized that removing the original listing mark or revoking the ability to recondition several different types of electrical components and assemblies could have a detrimental impact on the health care community. As a result, The Health Care Codes & Standards Review Committee made a recommendation at the conference’s Health Care Section Annual Business Meeting to support the Article 517 (Health Care Facilities) technical committee’s recommendation to allow for the ability to recondition electrical equipment in all aspects.

The Health Care Section agreed that if reconditioning allows for continued safe operation, it should be continued to be permitted. The committee’s stance was based on established standards that ensure reconditioned equipment is safe for use and based on the fact that established, industry-trusted companies stood by these reconditioned products and, therefore, the code should not engage in the restraint of trade.

The Health Care Codes & Standards Review Committee extensively researched the ability to recondition electrical components or assemblies and noted during the Health Care Section Annual Business Meeting that several of the CAMs related to reconditioning were submitted by PEARL.

The 2020 edition of NFPA 70 establishes the definition of reconditioned as “Electromechanical systems, equipment, apparatus, or components that are restored to operating conditions.”

The ANSI/PEARL electrical equipment reconditioning standard takes this definition a step further by stating reconditioning is defined as “the process of returning electrical equipment to a safe operating condition as recommended by the original equipment manufacturer’s instructions or industry standards and tested by recognized industrial testing standards.”

However, despite PEARL’s attempts and the Health Care Section’s support, several electrical components or assemblies are now prohibited from being reconditioned.

The list of prohibited reconditioning for electrical components and assemblies includes equipment that provides ground-fault protection of equipment; low-voltage fuseholders and low-voltage nonrenewable fuses; medium-voltage fuseholders and medium-voltage nonrenewable fuses; receptacles; attachment plugs, cord connectors and flanged surface devices; panelboards; luminaires, lampholders and retrofit kits; listed low-voltage lighting systems or a lighting system assembled from listed parts; fire pump controllers and transfer switches; automatic transfer switches; transfer equipment; molded-case circuit breakers; and low-voltage power circuit breaker electronic trip units. (Switchboards and switchgear can be reconditioned; however, the original listing marks shall be removed, which will remove the preserved history as to which standard the equipment was originally listed. This might also present potential accreditation survey issues.)

Based on the action taken at the annual technical meeting, the Health Care Section formally appealed the standards council on Aug. 6, 2019. In accordance with NFPA regulations, the standards council listens to appeals based on “procedural issues” and generally does not weigh in on the “technical merits,” which are left to the technical committee and the membership at the annual technical meeting.

The Health Care Section submitted multiple arguments that the appropriate procedures were not followed, the correlating committee overstepped their authority and that the technical committee (CMP15) was not given the proper notices for review. Unfortunately, the standards council did not support the Health Care Section’s appeal.

The Health Care Section then petitioned the NFPA board, which will only take appeals if an action can be detrimental to the association. The chair of the Health Care Section executive board received a letter on Dec. 20 from the legal adviser to the NFPA board that the appeal request did not have merit and the appeal was dismissed.

The Health Care Section is currently exploring several options on how to address reconditioning in health care facilities.

Costs and operations

By not allowing reconditioning of certain electrical equipment, facilities infrastructure costs could significantly increase. But even more important is the potential for downtime of critical equipment while waiting for new equipment to be installed. If NEC 2020 is adopted by the local or state government of the hospital, the hospital will not be able to use reconditioned equipment upon failure of critical electrical components.

This will especially impact older facilities where new components for older equipment are not available. In lieu of utilizing a perfectly safe reconditioned component or assembly, the hospital will have to purchase a replacement that may trigger the need for a whole new assembly. The procurement process might take weeks or months before the new assembly is installed, exposing the hospital to risk of a potential danger.

There is one last action that hospitals can pursue. Hospitals must work with their state hospital association and department of health to prevent the adoption of the 2020 NEC. This will allow reconditioned components and assemblies to continue to be used.

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Joshua Brackett, PE, SASHE, CHFM, is special projects manager for facilities management for Baptist Health in Little Rock, Ark. He can be reached at jbrackett29@gmail.com.