Physical environment experts share their perspectives on advocacy

One of the highlights of the American Society for Health Care Engineering’s (ASHE’s) Annual Conference, the “Just Ask ASHE” general session features codes and standards experts discussing emerging compliance issues facing health care facilities. The following transcript was excerpted from the session held during ASHE’s Annual Virtual Conference in October.

Chad Beebe (moderator), AIA, CHFM, CFPS, CBO, FASHE: This is my 10th year hosting Just Ask ASHE, and this year proves to be unique, as COVID-19 has presented many challenges for the field as well as for all of us here at ASHE. So, I’d like to introduce my first guest. David Dagenais is a past ASHE president who represents many of you on National Fire Protection Association (NFPA) committees as well as serves as your voice on the Facility Guidelines Institute Guidelines. He’s also lead faculty for ASHE’s survey readiness courses. Dave, what’s it like being a committee member, and what value does that bring to you?

David Dagenais, CHFM, FASHE, CHSP: Sometimes it’s very rewarding, other times it’s extremely frustrating, but the bottom line is that we just can’t lay down and take the codes as they are given to us. Waiting for the next code or requirement to come out and not having any input becomes very frustrating because all of us find ourselves dealing with conflicting codes, and codes that don’t make sense. When I realized I needed to get involved in the code-development process and craft what the codes should look like and do for us in the field as well as for our patients and visitors, it really became enjoyable in that I could begin to craft my own destiny.

Beebe: The committees for the most part, especially NFPA 99, Health Care Facilities Code, all have the same goal, and that is to try to make sure that the patient benefits from the code. Every once in a while, we come across a code that doesn’t seem to align or where the patient’s needs are not necessarily addressed, and we saw that to some extent with the NFPA 70^®, National Electrical Code^®, here this last cycle, especially when it came to reconditioned equipment. As you said, some days are frustrating. Can you tell us a little bit more about that?

Dagenais: There are multiple different codes and different versions of the code depending on where your adoption level is within your local municipality or your local authority having jurisdiction (AHJ), but even within the codes themselves, there are several different committees that develop the code, and it’s impossible for one individual to be on those committees. So, what we saw happen with the National Electrical Code was there were some provisions that were put in the last code based around this concept of can you or can’t you recondition electrical equipment. So, we looked at it from a health care perspective — how it’s going to impact our patients, what can we recondition within the health care world and what can’t we recondition — and we have an entire part of the National Electrical Code, Article 517, that deals specifically with health care, so we would think that the health care experts who sit on that committee would be able to make decisions of what’s best for their patients based on reconditioning. We put in some suggested code language that would have predetermined what could be reconditioned. The frustrating part came as other committees did their work; they either circumvented those provisions that we put in or they were overridden through a correlating issue. That’s the process we have to accept, but it’s an example of a lot of work that was put in by people who are experts in the field, yet the final product turned around and came out not the way we asked. Now, it causes us to regroup, which we’ve already begun, on how we deal with this end result we didn’t want to see. 

Beebe: One of the things we saw especially through this pandemic is the value of being able to utilize reconditioned electrical equipment. I know that call has come up several times during this pandemic as we’ve put existing facilities back into service to accommodate patient load. If we weren’t able to do that, there’d be a lot of patients we wouldn’t have been able to care for, or the delay in care would have been quite some time. It’s a lot of work, we’ve just got to manage it, and from the perspective of our average member, there’s a team working on their behalf. But, at the end of the day, we still need support from all the members, and that usually comes in the form of asking people to attend the voting sessions and getting involved because, even though we feel like we did everything we could, there were maybe a couple of things that we missed that could have changed the outcome if we had a lot of members show up to address that on the floor vote.

Dagenais: I would add it’s not just the voting but each and every one of us can put suggested code changes in. More often than not, the suggested code changes come from committee members. That’s not necessarily a bad thing, but every person who uses a document or code has a tremendous amount of insight and, if they have a suggested code change, I recommend they put that code change in, then reach out to us at ASHE, explain their rationale and we can begin to champion around that change if it makes sense. 

Beebe: Our next guest, Mike Crowley, is chair of NFPA 99 and also serves as ASHE faculty. He is with Jensen Hughes. Mike, how has your firm’s business changed with the pandemic, and what are you seeing out there as far as levels of compliance?

Michael Crowley, PE, FASHE, FSFPE: We spent a lot of time doing surveys, helping ASHE members with their preparedness, and everything came to a screeching halt in March as people got their hands around the pandemic issues — positive pressure rooms, how to deal with transmission, all of that stuff — and it took a lot of effort by the maintenance and engineering staffs to get a hold of that. In that interim, we realized that a lot of the maintenance things — fire alarm checks, things like that — may or may not have been done. Fortunately, we did have that 1135 waiver, and I think ASHE did an excellent job of pushing that out and getting the documentation there for people to use. Now, we’re getting calls from our clients to come out and start catching up.

Beebe: You mentioned that a lot of them weren’t able to do some of the inspection, testing and maintenance. Are you starting to see that they are also preparing now differently for future emergencies like pandemics or fires or hurricanes? Are there lessons being learned and incorporated into emergency management plans? 

Crowley: I work in a lot of the acute care facilities, but we have a group that also does a lot of nursing homes and we’re already starting to see some nursing home regulations coming out on the pandemic. The safety committees and infection control committees are on top of this. We’re seeing a lot of rules on controlling visitors. From last year’s fire season, we’re seeing a bunch of people getting ready mostly on the West Coast for total evacuations. We also see on the wildfire side they have been collaborating more with the fire services. So, are we going to see that in regulations in the future? I don’t know, but I know they are being incorporated into emergency plans in those regional areas.

Beebe: Our next guest, Jon Hart, is a fire protection engineer who works for NFPA and got his start in the trenches with us working on NFPA 99, learning everything he could about health care. Jon, if somebody had some questions about NFPA 99, how would they go about asking NFPA or trying to contact the technical committee?

Jonathan Hart, PE, SASHE, CHC: There’s a few different ways that we do that. We have a platform, it’s NFPA Xchange, where anybody can come in and ask questions. It’s similar to the ASHE community where there’s a lot of good back and forth on technical questions. I know you encourage ASHE members to also join NFPA and, for those people who become NFPA members, there’s an opportunity to submit questions on any code-related issue they have, whether it’s NFPA 101^®, Life Safety Code^®, NFPA 99, or any of our other 300-plus codes or standards. And one of our engineers on staff provides a code interpretation. It’s informal — you can’t necessarily run back to the AHJ and slam it on the table like some people want to — but we have a big network of people we can reach out to, and we try to put together valuable code interpretations through that opportunity.

Beebe: So, you can get a sense of what the rule is supposed to say or what it was trying to say. You can’t really address the intent, but you also have all the notes on all of the changes, so you’re able to kind of correlate an answer, right?

Hart: Yes, we can go back through the record and also revisit all those conversations the committees have. There are formal committee statements, but then we also have the people who were in the room with those discussions, so we can provide a little bit more background than what might be on the official record without going too far one way or the other because what the committees come up with is a consensus process.

Beebe: With the pandemic and the increased awareness of washing your hands and wearing masks, the use of alcohol-based hand rubs has increased probably tenfold. Are there any fire and life safety issues with the increased use?

Hart: We’ve received a lot of interesting questions and are seeing a lot of kind of scary situations being brought up because of this increased use of flammable liquids. I’d say overall it’s a bigger concern among other occupancies like schools and businesses because they paid no attention over the years, whereas health care has a pretty good awareness of the requirements. But, yeah, there’s increased volumes in storage; we need to be careful with that. Some health care facilities and others were making their own alcohol-based hand rubs. We’ve seen an increase in dispensers around a lot of facilities, and we’ve also seen a lot of manufacturers coming out with larger dispensers to cut back on the need for refills. We’ve seen up to a gallon, which the Life Safety Code would not permit. So, there’s a lot of things to pay attention to.

Beebe: As we discussed with Mike [Crowley], we have a new edition of NFPA 99, which should be almost off the presses if it’s not already. Any major changes coming forward? 

Hart: The biggest philosophical change was the allowance of microgrids, and it’s not just the allowance to use microgrids and all these distributed energy sources in general, which I could argue has always been allowed, although it hasn’t always been interpreted that way, but you’re actually now allowed to use a microgrid and all these different sources as part of the essential electrical system. 

So, I call it a big philosophical change because it doesn’t have an impact necessarily on facilities unless they choose to go that route, but now it’s something that’s allowed, and in California and in some areas, there’s probably some extra push in that direction from regulations.

The other two big things are that a responsible facility authority is going to be named for medical gas systems, and there’s going to be an entirely new section on electrical system preventive maintenance. I think both of those are probably already set up within our facilities, but now they’re going to be formalized in the code, so it’s something to be aware of as we move toward adoption of a newer edition someday.

Beebe: One of the chapters of NFPA 99 specifically adopts ASHRAE/ASHE Standard 170, Ventilation of Health Care Facilities, so I’m very excited to introduce Michael Sheerin, who is the chair of ASHRAE/ASHE 170. Michael, what is going on with ASHRAE/ASHE 170? Do we see potential changes due to COVID-19?

Michael Sheerin, PE, LEED AP: As the co-sponsor of the standard, ASHE knows how frequently we are making changes. We’re a continuous maintenance document, so it’s a little different than NFPA. We get input from users all the time and also, obviously, from the committee members themselves. At present, there are no new or proposed changes as a result of the pandemic, and a little bit of that is hopefully because ASHRAE/ASHE 170 works. It is foundationally solid and strong. I think certainly as we move forward there will be a reevaluation. I’ve got a spreadsheet of 20 items that we’ve solicited and talked through with our committee members about things that we’ve seen and would think about. But, like anything else, it’s going to stand the same scrutiny and public review process. Ultimately, there are a lot of best practices that owners will do, but the standard needs to define a minimum benchmark that everybody needs to do. I think it will also be creating a tighter focus on what might change in the standard over the course of time, but it isn’t something that we would change at the drop of a hat.

Beebe: Our last guest is Bill Koffel. Bill, you’re very involved with NFPA and the NFPA committees, and I’m curious what you see in the standards, especially when it comes to inspection, testing and maintenance. There was a time when it was really confusing whether we should be continuing to do inspection, testing and maintenance. In a lot of places, it was prohibited for third-party contractors to go into places and, a lot of times, in-house staff don’t have the equipment or the abilities to do that. Is there stuff already in the standards, or are there plans to adjust the standards, to help address that?

William Koffel, PE, FSFPE, SASHE: As somebody said earlier, we haven’t really written these codes and standards to address a pandemic like COVID-19, and we’ve learned some things from that. Some of the standards, such as NFPA 25, Standard for the Inspection, Testing, and Maintenance of Water-Based Fire Protection Systems, and NFPA 72^®, National Fire Alarm and Signaling Code^®, for years had language about the ability to defer certain inspection and test activities due to safety considerations, but the language goes on to say the task will be performed during the next shutdown — that’s really for a nuclear power plant or something like that. I introduced a public input based upon everything I was seeing back in March and April to NFPA 25. I limited it to NFPA 25 because it was the only one that was in the right place of the cycle — and I’m going to encourage that we look at this for other documents as well — and the proposal is to take the text that’s in NFPA 25 and move it up to Chapter 4 so it applies to all water-based fire protection systems but then add an additional allowance that says “based upon a risk analysis and with the approval of the AHJ that inspection and testing activities can be deferred when the safety of either the occupants in the building or the people performing the tasks are at a greater risk than the risk associated with a system or component that might fail.” The task group to which I was assigned met the last week and, when there was no dissenting discussion at all, that’s the paradigm shift that I’ve seen. [Editor’s note: Since this session, the technical committee has issued a tentative recommendation for approval, subject to a formal ballot of the full committee.]

When this first happened, the contractors all wanted to be considered essential workers so they could continue to perform inspection, testing and maintenance. But then we got into a situation where contractors were saying they didn’t want to come into the facilities, and the facilities were questioning whether they wanted them in the facility, and state health departments were saying “No, we don’t want people coming into the facility if they’re not directly associated with medical care.” This puts the owners in a bad position because these standards assign that responsibility to the owner. And you mentioned whether the internal staffs are capable of doing it, but they also were already stretched. They were doing as much as they could to make sure that patient care was being provided, so I don’t think many facilities had the resources. So, we’ll see what happens. 

Meet the panelists

These panelists took part in the American Society for Health Care Engineering’s (ASHE’s) “Just Ask ASHE” session during ASHE’s annual conference, from which this article was excerpted:

• Moderator: Chad Beebe, AIA, CHFM, CFPS, CBO, FASHE, deputy executive director at ASHE. Beebe serves on many national panels and committees that develop regulations for the design and construction of health care facilities, including as a highly active member of the National Fire Protection Association (NFPA), serving on over 20 technical committees and as a member of the NFPA standards council.
• David Dagenais, CHFM, FASHE, CHSP, senior director of plant operations, clinical engineering, emergency management and safety officer at Wentworth-Douglass Hospital, Dover, N.H. Dagenais has been involved in the health care field and code development process for more than 18 years and serves on several NFPA committees.
• Michael Crowley, PE, FASHE, FSFPE, director of industry relations at Jensen Hughes, Baltimore. A licensed professional engineer in five states, Crowley has more than 40 years of fire protection engineering consulting experience and professional organization involvement with the Society of Fire Protection Engineers, NFPA and ASHE.
• Jonathan Hart, PE, SASHE, CHC, technical lead at the National Fire Protection Association. Hart previously served as principal engineer and dealt extensively with all issues involving fire and life safety of health care facilities as staff liaison for NFPA 99, Health Care Facilities Code. He has developed and delivered numerous training programs and has acted as technical editor for several NFPA handbooks.
• Michael Sheerin, PE, LEED AP, CEO at TLC Engineering Solutions Inc. Sheerin is actively involved in the codes and standards development process that impact the health care field. He presently serves as chair of ASHRAE/ASHE Standard 170, Ventilation for Health Care Facilities, and  is past chair of ASHRAE Standard 189.3, Design, Construction & Operation of Sustainable High-Performance Health Care Facilities. 
• William Koffel, PE, FSFPE, SASHE, president of Koffel Associates Inc., Columbia, Md. Koffel is a former code official and a recognized expert in the fire protection and life safety aspects of codes and standards who is active in the development process of the field’s governing codes, standards and design guidelines, including the International Code Council, NFPA, Society of Fire Protection Engineers and Underwriters Laboratory.