A Collaboration – Patient Care Area Classifications and Risk Assessments

There is an aspect of healthcare facility design that neither the design team nor the healthcare facility can avoid in any project – the classification of patient care areas and associated risk assessments. The Facility Guidelines Institute (FGI) Design and Construction for Hospitals, and FGI Design and Construction for Outpatient Facilities, and NFPA 99, The Health Care Facilities Code, are the codes primarily used for this exercise. The FGI books provide clear definitions of various patient care areas, as well as the associated electrical receptacle, nurse call, medical gas, and select HVAC system requirements. ASHRAE Standard 170, Ventilation of Health Care Facilities, referenced in the FGI books, defines HVAC requirements. While these patient care space classifications seem straight-forward, design teams and Owners can be challenged by instances where the activities or uses of some spaces can fall into definitions of other spaces where MEP requirements can significantly differ.

For example, what starts out in the programming stages of a project as a Procedure Room can end up being classified as an Operating Room (OR). The definition of an OR includes invasive procedures, or any other procedure, which requires general anesthesia, physiological monitoring, or anticipated active life support. The design professionals must request that the facility’s healthcare professionals determine if any procedures or activities to be performed in this space would fall under one or more of the defined attributes of an OR. If so, then the MEP systems associated with this Procedure Room must be designed to comply with those listed for an Operating Room.

Another instance is when an originally identified Class 2 Imaging Room evolves into a Class 3 Imaging Room. Like that of an OR, the definition of a Class 3 Imaging Room includes invasive procedures, the use of general anesthesia, physiological monitoring or anticipated active life support beyond that of the standard diagnostic and therapeutic procedures of a Class 2 Imaging Room. If the healthcare facility’s healthcare professionals determine if any procedures or activities to be performed in this space fall under one or more of the defined attributes of a Class 3 Imaging Room, then the MEP systems associated with this space must be designed to comply with those required for a Class 3 Imaging Room, which are essentially the same as an OR (e.g. Cardiac Catheterization, and Interventional Radiography).  To clarify, Class 3 Imaging Rooms are not Hybrid ORs, which are spaces that meet the definition of an OR with permanently installed diagnostic imaging equipment.

Once these patient care spaces are classified as an OR, Hybrid OR, or Class 3 Imaging Room, the design team must turn to NFPA 99 to determine additional electrical system requirements. Chapter 6 in NFPA 99 states that ORs shall be considered wet procedure locations, unless a risk assessment conducted by the health care governing body determines otherwise. Wet Procedure Locations require either isolated power systems, Ground Fault Circuit Interrupters (GFCI), or a combination thereof. While isolated power systems are considered industry standard practice, some healthcare facilities may believe these systems are unnecessary, or even excessive, in certain scenarios. Isolated power systems do increase construction cost and require specialized maintenance and testing over standard electrical systems.

If a healthcare facility wishes to obtain an exemption from providing either isolated power or GFCI protection, it must demonstrate to the Area Having Jurisdiction (AHJ) that the patient care space is not considered a Wet Procedure Location. The health care facility’s governing body must perform a specific wet procedure location risk assessment, which includes input from all relevant parties, including, but not limited to, healthcare professionals, clinicians, biomedical engineering staff, and facility safety engineering staff. One option is a template available online from the American Society for Healthcare Engineering (ASHE); however, no matter the formal process chosen by the Healthcare Facility, this risk assessment must be maintained onsite for record, and provided to the AHJ at the time of permit review.

Chapter 4 of NFPA 99 outlines the general risk categories pertaining to the activities, systems and equipment associated with a patient care space in four levels – categories 1 through 4, ranked from the most critical in nature to the least, respectively. When the risk category for a patient care space is uncertain, the design professionals must rely on the health care facility’s governing body to determine the associated risk category per NFPA 99. These risk categories are crucial in defining specific essential electrical system types and medical gas system categories for the facility as well as the individual patient care space.

When it comes to patient care area classifications and risk assessments, a collaborative effort between the design professionals and the Healthcare Facility is vital for a successful, and code compliant, project design. It is strongly recommend that healthcare organizations preemptively form the necessary governing bodies and develop internal standards and procedures for use during future design projects.  Barton Associates, Inc. has experience in this area and can help your organization navigate such challenges to find the right solution. For information, please contact Michael Ginder, PE, LEED AP at 717-845-7654 or mhg@ba-inc.com.

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