Mar 28 2018

Sleep Labs

Category: BlogBKeyes @ 12:00 am
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Q: Are sleep labs considered healthcare occupancies or business occupancies? I have a fire marshal who says it has to be a healthcare occupancy.

 A: These types of things are interpretations. There is not a firm paragraph in the Life Safety Code that says “Sleep labs are business occupancies”. But, if you (or the AHJ) examines the different definitions of occupancies in the Life Safety Code, then one draws the conclusion that it is a business occupancy. For example:

Healthcare occupancy consideration:

“A healthcare occupancy is used to provide medical or other treatment or care simultaneously to four or more patients on an inpatient basis, where such patients are mostly incapable of self-preservation due to age, physical or mental disability, or because of security measures not under the occupants control.” (6.1.5.1 of the 2012 LSC)

“The healthcare facilities regulated by this chapter shall be those that provide sleeping accommodations for their occupants and are occupied by persons who are mostly incapable of self-preservation because of age, because of physical or mental disability, or because of security measures not under the occupants control.” (18.1.1.1.5)

So, let’s examine how a sleep Lab meets this criteria:

  • A patient in a sleep lab is not an inpatient of the facility;
  • A patient in a sleep lab is not being provided medical care, or other treatment. The sleep lab is monitoring the patient… not providing care.
  • A patient in a sleep lab is fully capable of self-preservation.
  • The sleep lab does provide sleeping accommodations, but that alone does not make it a healthcare occupancy because the patients are not inpatients, are not receiving care or treatment, and are not incapable of self-preservation. If just providing sleeping accommodations makes the sleep lab a healthcare occupancy, then all residential, hotels, dormitories and apartment facilities would have to be designated a healthcare occupancy.

Therefore… the conclusion is a sleep lab is not a healthcare occupancy. Now, a sleep lab may be located in a hospital that is a healthcare occupancy and that would be a mixed occupancy situation. But if the sleep lab is located offsite from the hospital, it does not have to be considered a healthcare occupancy.

 Ambulatory healthcare occupancy consideration:

  • “An occupancy used to provide services or treatment simultaneously to four or more patients (one or more patients per CMS) that provides, on an outpatient basis, one or more of the following:
  • Treatment for patients that renders the patients incapable of taking action for self-preservation under emergency conditions without the assistance of others;
  • Anesthesia that renders the patients incapable of taking action for self-preservation under emergency conditions without the assistance of others;
  • Emergency or urgent care for patients who, due to the nature of their injury or illness, are incapable of taking action for self-preservation under emergency conditions without the assistance of others.” (6.1.6.1)

While a patient in a sleep lab is an outpatient, that person is not receiving services or treatment that renders them incapable of self-preservation.

  • The sleep lab patient is not under anesthesia.
  • The sleep lab patient does not have an illness or injury that prevents them to take self-preservation action under emergency conditions without the assistance of others.
  • The sleep lab patient is not receiving emergency or urgent care.

 

Therefore, the conclusion is a sleep lab is not an ambulatory healthcare occupancy. To further this discussion… a sleep lab is not a hotel or dormitory, and is not a residential board & care occupancy. So, the conclusion is, a sleep lab is a business occupancy… not unlike your typical physician-office exam room. A patient in a sleep lab is being examined… not treated. That is how the Life Safety Code is interpreted. The challenge many facility managers have is convincing state or local AHJs that a sleep lab is a business occupancy. Once they see ‘sleeping accommodations’ and ‘healthcare’ they automatically want to lump it in with healthcare occupancy. If you have this situation, then you need to educate those AHJs so they understand that sleep labs are business occupancies.

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Mar 07 2018

Fire Alarm Activation for Fire Drills in Business Occupancies

Category: BlogBKeyes @ 12:00 am
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Q: I’m responsible for doing annual fire drills in our blood draw stations located throughout several communities. Some are in physician’s offices and some are in office buildings. I can find nothing in NFPA 101, 2012: 4.7 or in 38 or 39 New or Existing Business Occupancy. Can you help with the code requiring alarm activation?

A: Well… according to NFPA Life Safety Code, there are no requirements to activate the fire alarm system during a drill for business occupancies. Where the confusion comes into play, most accreditation organizations requires sub-stations of hospital departments to follow the hospital requirements regarding operations. The healthcare occupancy chapter requires activation of the fire alarm system for fire drills, and some surveyors likely require the same for any offsite department that is an extension of the hospital to comply. If they are requiring the fire alarm system to be activated during a fire drill for a blood draw station located in a business occupancy, that would be a mistake by my opinion. This is an easy mistake for a surveyor to make, as all other aspects of the blood draw station must comply with the hospital’s policies and procedures if it is an extension of the hospital department. So, I can see how a surveyor could expect the fire alarm system to be activated for a fire drill in an offsite blood draw station.

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Mar 25 2016

Fire Alarm System in a Business Occupancy?

Category: BlogBKeyes @ 12:00 am
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Q: We have a physician practice that currently has fire extinguishers and a “panic button” that contacts 911. We do not have fire alarms, smoke detectors or a sprinkler system. Are we required to have any of those in the practice?

A: The answer is… maybe yes and maybe no. Sorry; that’s not much of an answer, but not all offsite small business occupancies actually require a fire alarm system.

If the physician practice is truly a business occupancy, meaning there is no procedures being conducted where patients are rendered incapable of self-preservation, then section 39.3.4.1 of the 2000 Life Safety Code says this for existing conditions:

A fire alarm system in accordance with section 9.6 shall be provided in any business occupancy where any one of the following conditions exists:

  • The building is two or more stories in height above the level of exit discharge
  • The occupancy is subject to 100 or more occupants above or below the level of exit discharge
  • The occupancy is subject to 1,000 or more total occupants.

For new construction in business occupancies (meaning new construction or renovation documents approved by local authorities after March 11, 2003), section 38.3.4.1 of the 2000 Life Safety Code says this:

A fire alarm system in accordance with section 9.6 shall be provided in any business occupancy where any one of the following conditions exists: 

  • The building is two or more stories in height above the level of exit discharge
  • The occupancy is subject to 50 or more occupants above or below the level of exit discharge
  • The occupancy is subject to 300 or more total occupants.

 

The occupant capacity is calculated by taking the total gross area of the floor (or building) in square feet, and dividing it by 100 square feet per person. So, a 5,000 square foot story would have an occupant load of 50 persons.

So, as you can see, if the physician practice is a business occupancy and meets the requirements for a new or existing occupancy, then a fire alarm system is not required, according to the Life Safety Code.

Sprinkler systems are not required in business occupancies, whether they are new construction or existing construction.

Now, there may be other codes or standards that you need to comply with, so please check with your local and state authorities to determine what their requirements are.

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Feb 19 2016

Required Width of an Excess Access Corridor

Category: BlogBKeyes @ 12:00 am
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Q: What is the required width for an exit access corridor in an office building?

A: That depends on the occupancy classification of the building. If the building is classified as business occupancy, then sections 38/39.2.3.2 of the 2000 Life Safety Code (LSC) would apply. The clear width of an exit access corridor in a business occupancy (office building) serving an occupant load of 50 or more, is 44 inches. But for occupant loads less than 50 persons, section 7.3.4.1 of the LSC would apply and the clear width is lowered to 36 inches.

When the Life Safety Code talks about the occupant load of a room or area, it is always calculated per section 7.3. Table 7.3.1.2 has occupant load factors that are used along with the gross area to determine the number of persons allowed. For a building classified as business occupancy the occupant load factor is 100 square feet per person. This means in order to have an occupant load of 50 persons you need 5,000 square feet of area.

If the office building is classified as an ambulatory health care occupancy, then according to section 20/21.2.3.2, the required width of the corridor is limited to just 44 inches. There are no deviations for less than 50 occupants.

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Dec 13 2012

Fire Drills in Offsite Patient Care Locations

Category: BlogBKeyes @ 6:00 am
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Here is a scenario: A hospital has multiple ‘quick draw’ blood stations scattered across the community in which they are located. These blood draw stations are situated in other occupancies, and strategically located in shopping malls and other high-traffic areas for the convenience of their patients. Hospital staff occupy and manage these blood draw stations, although the actual area is approximately 250 square feet, or the size of an average patient room in a hospital.

The hospital failed to conduct fire drills in these blood draw stations because they did not feel they qualified since they were so small in size. A Joint Commission surveyor discovered the fact that fire drills were not conducted and wrote them up for failure to do fire drills in an offsite business occupancy environment.

I think the finding is valid as the TJC standard EC.02.03.03, EP 2 is very clear: “The hospital conducts fire drills every 12 months from the date of the last drill in all freestanding buildings classified as business occupancies and in which patients are seen or treated.”  The situation described sounds like a business occupancy to me, and the act of drawing blood from a patient is certainly ‘treatment’. So, they got hit from two different angles.

I would agree with the surveyor that a fire drill should have been conducted annually at the draw stations, regardless of their size. It’s one disadvantage for the hospital having their own staff and quick draw station, rather than sub-contracting it out. They also have to do annual emergency response drills at these locations as well, which really doesn’t amount to much at all. In addition, all of the 6 EOC management plans have to apply to these quick draw stations and, the SOC Basic Building Information (BBI) has to list these locations as well. The cost to ‘manage’ the Environment of Care at these offsite locations is extensive, and probably wasn’t considered when they wanted to open them up.  The organization has to manage these locations in a similar way they would manage a clinic.

A fire drill is not an easy proposition at these types of small locations, situated within another building. The Life Safety Code requires the activation of the building’s fire alarm system whenever a fire alarm is conducted. This would have to be coordinated with the building owner.

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Sep 20 2012

Life Safety Assessments in Business Occupancies

Category: BlogBKeyes @ 5:00 am
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Many hospitals have facilities located offsite or adjacent to the main building which are classified as business occupancies. These buildings may be physician’s offices, clinics, administrative buildings and storage faclities. All too often, the facility manager for the hospital is assigned the responsibility of plant operations and maintenance for these business occupancies, which typically includes life safety compliance.

While these non-healthcare occupancy buildings are classified as a business occupancy, the approach to a life safety assessment would be similar as conducting a life safety assessment for the healthcare occupancy (hospital), but you do not assess them to the same set of standards as you would the hospital. Healthcare occupancies must comply with the core chapters of the Life Safety Code (LSC), which are chapters 1-4, and 6 – 11, and they have to comply with the occupancy chapters 18 and 19. Business occupancies likewise have to comply with chapters 1 – 4, and 6 – 11, but they have a different set of occupancy chapters to comply with; chapters 38 & 39.

Chapter 38 is for new construction and chapter 39 is for existing construction. A facility is considered new construction if its construction plans and documents were approved by the local authorities on or after March 11, 2003. A facility is considered existing construction if its construction plans and documents were approved by the local authorities before March 11, 2003. Also, any renovation conducted in existing construction buildings on or after March 11, 2003 must comply with new construction requirements. Why the date of March 11, 2003? Because that is the date that the Centers for Medicare & Medicaid Services adopted the 2000 edition of the LSC.

Assuming the business occupancies qualify for existing construction occupancy, you must assess the building for compliance with chapter 39. You will find that the life safety requirements are far less restrictive for business occupancies as compared to healthcare occupancies. Examples were there will be significant differences (and leniencies) in compliance, are:

  • Construction Type                          (39.1.6)
  • Overhead Rolling Fire Doors       (39.2.2.2.7)
  • Means of Egress Arrangement     (39.2.5)
  • Emergency Lighting                        (39.2.9)
  • Hazardous areas                              (39.3.2)
  • Fire alarm systems                          (39.3.4)
  • Sprinkler systems                            (39.3.5)
  • Corridor walls                                   (39.3.6)
  • Smoke compartments                     (39.3.7)
  • Fire Drills                                           (39.7.1)
  • Fire Extinguisher Training             (39.7.2)

There are other life safety requirements found in the healthcare occupancy chapters (such as elevator recall testing) that are not found in the business occupancies. However, while fire damper testing in healthcare occupancies enjoys a 6-year cycle, that is not the case in business occupancies, which requires a 4-year testing interval.

To make sure that you are assessing your business occupancies correctly, you will have to research each issue individually to determine your level of compliance.

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Aug 23 2012

Compressed Gas Cylinders in Business Occupancies

Category: BlogBKeyes @ 5:00 am
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I was recently asked what the requirements were for storing compressed gas cylinders in a business occupancy. According to section 1-2, NFPA 99 (1999 edition) applies to all health care facilities, and section 2-1 defines a health care facility where medical care is provided. Therefore a clinical business occupancy such as those which provides services for cardiac rehab, physical therapy, physician’s office, and pulmonary rehab programs is considered to be a health care facility. Assuming you are either Joint Commission accredited, or receive federal reimbursement monies for Medicare or Medicaid services, you are required to comply with NFPA 99 (1999 edition) Health Care Facilities standard.

Chapter 13 in NFPA 99 is the chapter for “other” health care facilities which are not hospitals, nursing homes and limited care facilities. Section 13-3.8 requires all gas equipment to conform to chapter 8. Section 8-3.1.11 lists the storage requirements for nonflammable gases greater than 3000 cubic feet and quantities less than 3000 cubic feet which are similar (but not the same) as those requirements for hospitals.

For storage of quantities of nonflammable gas greater than 3000 cubic feet, the requirements are the same as those for hospitals, which are found in section 4-3.1.1.2 of NFPA 99. However, for quantities less than 3000 cubic feet, there is a difference in storing nonflammable gas cylinders is in the 300 cubic feet or less quantity. Hospitals have the advantage of having a special dispensation granted by The Centers for Medicare & Medicaid Services (CMS), in the form of S&C Letter 07-10, published January 12, 2007. In this letter, CMS allows hospitals (but not medical offices or clinics) the advantage of following the 2005 edition of NFPA 99, which permits quantities up to 300 cubic feet of nonflammable gas per smoke compartment to not be stored in any special rooms or areas. This exception for ‘up to 300 cubic feet’ is not found in the 1999 edition of NFPA 99. Therefore, your business occupancy must store all nonflammable gas cylinders in quantities from 0 to 3000 cubic feet in accordance with section 8-3.1.11.2, which requires a specially designated room which has a door capable of being locked, and all oxidizing gases in this room must be separated from combustibles by 20 feet (or 5 feet if the room is protected with automatic sprinklers), or the oxidizing gases are to be stored in a flammable cabinet with a fire rating of at least 30 minutes.

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