“Lunch & Learn” August, 2015

2015 Webinar Series

NFPA 99
RISK ASSESSMENTS

Presented By: Lauzon Life Safety Consulting, LLC

Bill Lauzon 262-945-4567
Heather Werner Lauzon.LSC@gmail.com
 NFPA 99
RISK ASSESSMENTS

Lauzon Life Safety Consulting, LLC

262-945-4567
Lauzon.LSC@gmail.com 2
 NFPA 99
RISK ASSESSMENTS
Presented by:
Bill Lauzon
Heather Werner

Lauzon Life Safety Consulting, LLC

262-945-4567
Lauzon.LSC@gmail.com
3
CURRENTLY
USE NFPA 99
1999 EDITION

4
BIGGEST IMPACT:
• NEW HOSPITALS
IF 2012 LSC GETS ADOPTED:

5
IF 2012 LSC GETS ADOPTED:

MAY APPLY TO
ALL
HOSPITALS
&
NURSING
HOMES

6
 TOTALLY RE-WRITTEN

Requirements
Change From:

Occupancy-Based
to
Risk-Based

7
 TOTALLY RE-WRITTEN

Requirements
Change From:

Occupancy-Based “You DO IT if the

to space is health care,
Risk-Based regardless if there is
a need”

8
 TOTALLY RE-WRITTEN

Requirements
Change From:

Occupancy-Based
to
Risk-Based “You DO IT if the
space is health care,
regardless IF there is
a need”
9
 TOTALLY RE-WRITTEN

In other words:

You get to evaluate

which requirements
apply to your
situation

10
REORGANIZED CHAPTERS

11
 Re-Organized Chapters
1999 2012
3 – Electrical Sys 4 – Risk Assessment
4 – Gas & Vacuum 5 – Gas & Vacuum
5 – Envir 6 – Electrical Sys
6 – Materials 7 – Info Technology
7 – Elec Equipment 8 – Plumbing
8 – Gas Equipment 9 – HVAC
9 – Mfr Requirements 10 – Elec Equipment
10 – Laboratories 11 – Gas Equipment
11 – Emergency Prep 12 – Emergency Mgmt
12 – Hospital 13 – Security Mgmt
13 – Other Health 14 – Hyperbaric
16 – Nursing Home 15 – Features of Fire Prot
17 – Limited Care
18 – Home Care
19 - Hyperbaric 12
 1999
9 Gone 2012
3 – Electrical Sys 4 – Risk Assessment
4 – Gas & Vacuum 5 – Gas & Vacuum
5 – Envir 6 – Electrical Sys
6 – Materials 7 – Info Technology
7 – Elec Equipment 8 – Plumbing
8 – Gas Equipment 9 – HVAC
9 – Mfr Requirements 10 – Elec Equipment
10 – Laboratories 11 – Gas Equipment
11 – Emergency Prep 12 – Emergency Mgmt
12 – Hospital 13 – Security Mgmt
13 – Other Health 14 – Hyperbaric
16 – Nursing Home 15 – Features of Fire Prot
17 – Limited Care
18 – Home Care
19 - Hyperbaric 13
 1999
6 New 2012
3 – Electrical Sys 4 – Risk Assessment
4 – Gas & Vacuum 5 – Gas & Vacuum
5 – Envir 6 – Electrical Sys
6 – Materials 7 – Info Technology
7 – Elec Equipment 8 – Plumbing
8 – Gas Equipment 9 – HVAC
9 – Mfr Requirements 10 – Elec Equipment
10 – Laboratories 11 – Gas Equipment
11 – Emergency Prep 12 – Emergency Mgmt
12 – Hospital 13 – Security Mgmt
13 – Other Health 14 – Hyperbaric
16 – Nursing Home 15 – Features of Fire Prot
17 – Limited Care
18 – Home Care
19 - Hyperbaric 14
 1999
6 Re - Arranged 2012
3 – Electrical Sys 4 – Risk Assessment
4 – Gas & Vacuum 5 – Gas & Vacuum
5 – Envir 6 – Electrical Sys
6 – Materials 7 – Info Technology
7 – Elec Equipment 8 – Plumbing
8 – Gas Equipment 9 – HVAC
9 – Mfr Requirements 10 – Elec Equipment
10 – Laboratories 11 – Gas Equipment
11 – Emergency Prep 12 – Emergency Mgmt
12 – Hospital 13 – Security Mgmt
13 – Other Health 14 – Hyperbaric
16 – Nursing Home 15 – Features of Fire Prot
17 – Limited Care
18 – Home Care
19 - Hyperbaric 15
 HIGHLY RECOMMENED
Buy the Handbook
Explanations of the
many changes

• Expert insights
• Descriptive photos
• Helpful tables & charts

More expensive, but

well worth it
16
 NFPA Members:
10% discount

$70.50 – Book or PDF

$151 – Book or PDF

17
 BOOK
• Easy to flip to referenced sections
• Can copy & show others

PDF
• Easy to search for topics

NFPA Free Access

• Free
• Non-seachable
• Non-copiable
• Non-flippable
18
 TODAY’S FOCUS

Chapter 4

Risk
Assessment

19
 RISK ASSESSMENT

It guides the use of the

other chapters

Not: IT, Emerg & Security

Mgmt, Fire Protection
20
 2012
4 – Risk Assessment
Chapter 4 5 – Gas & Vacuum
6 – Electrical Sys
RISK 7 – Info Technology
ASSESSMENT 8 – Plumbing
Applies to: 9 – HVAC
10 – Elec Equipment
11 – Gas Equipment
12 – Emergency Mgmt
13 – Security Mgmt
Not to: 14 – Hyperbaric
15 – Features of Fire Prot

21
4.1 – Building Systems Categories

1
High Patient
Impact

2
Consider equipment
Minor Patient operation
Impact
NOT
3
Slight Patient
Intervention by
Impact people
4
No Patient
Impact
22
4.1 – Building Systems Categories
Consider equipment operation
NOT intervention by people

SEVARITY OF FAILURE
• Harm to Patients
• Harm to Staff & Visitors

RELIABILITY
• Importance of redundancy
• Probability of system failure
• Levels of sedation
• Complexity of treatment
23
4.1 – Building Systems Categories
Consider worst-outcome scenario
of a failure impact

Major/ No
Death Minor Discomfort Harm

Factor A - HARM to PATIENTS

j k l m
Factor B – RELIABILITY EXPECTED
Always Highly Normally No Impact
Available Reliable Reliable on Pt Care
24
4.1 – Building Systems Categories
Evaluate effect of failure,
Based on harm to patients, staff & visitors

1 2
Failure may cause Failure limited to
death or serious injury minor injuries

3 4
Failure may cause No impact on patients
discomfort or caregivers

25
4.1 – Building Systems Categories
Evaluate potential for failure,
Based on system reliability

1 2
System must always
High Reliability
work (life support)
Expected

3 4
Normal No Impact on
Reliability Needed Patient Care

26
 Category 1
Failure likely to cause major injury/death

Major injury
1 • Any amputation
Available at all times • Loss of sight, or injury to eye
for life-support
systems
• Unconsciousness that requires
resuscitation, medical
System must always
treatment, or hospital admit
work (life support) • Acute illness from biological
agents

27
 Category 1
Failure likely to cause major injury/death

Examples of Failures
1 In this category
Available at all times
for life-support
systems
• Emergency power to OR's
• Medical gas system in ICU
System must always • Ventilator-assisted procedure
work (life support) in a MOB
• Cardiac cauterization imaging
equipment
28
 Category 2
Failure likely to cause minor injury

Minor injury
2 • Not serious
Failure limited to • Not involving risk to life
minor injuries

High Reliability
Expected

29
 Category 2
Failure likely to cause minor injury

Examples of Failures
2 In this category
Failure limited to
minor injuries • Task or procedural lighting in
patient rooms
High Reliability • Potable water in the patient
Expected care areas

30
 Category 3
Failure not likely to cause injury, but may
cause discomfort

Examples of Failures
3 In this category
Failure may cause
discomfort • Heating system in southern US
• Humidity control in non-
operating areas
Normal Reliability • Dental drill
Needed
• Motorized bed adjustments
• Cooling tower makeup water in
nw US
31
 Category 4
Failure would have no impact on
patient care

Examples of Failures
3 In this category
Failure may cause
discomfort • Gray water lawn sprinkling
• Seasonal lighting systems
• Public address system
Normal Reliability • Pneumatic tube systems
Needed
• Vacuum systems in a research
area

32
 RISK ASSESSMENT
Must follow & document
according to a DEFINED
risk assessment procedure
Examples:

ISO 31010 – Risk Assessment Techniques

NFPA 551 – Guide for Eval of Fire Risk Assessments
SEMI S10-0307E – Guidelines for Risk Assess & Eval

Other formal process

ASHE Risk Tool

33
ISO 31010 - RISK ASSESSMENT
Risk assessment is part of the core elements of risk management

• Communication and Consultation

• Context establishment
• Risk Assessment, includes:
Risk identification,
Risk analysis &
Risk evaluation
• Risk treatment
• Monitoring and review

Risk can be assessed at

any level of a facility’s
operations or goals.

34
ISO 31010 - RISK ASSESSMENT
There are 31 risk assessment techniques in Annex B of ISO/IEC 31010
Amazon
• Brainstorming • Cause & effect analysis
$298
• Full & semi-structured interviews • Layer protection analysis
192 pages
• Dephi method • Decision tree
softcover
• Checklist • Human reliability analysis
• Preliminary hazard analysis • Bow tie analysis
• Hazard & operability study • Reliability centered maintenance
• Hazard analysis & critical cont pts • Sneek circuit analysis
• Toxicity assessment • Markov analysis
• Structured “What-If” technique • Monte Carlo simulation
• Scenario analysis • Bayesian statistics & Bayes nets
• Business impact analysis • FN curves
• Root cause analysis • Risk index
• Failure mode & effects analysis • Consequence/probability matrix
• Fault tree analysis • Cost/benefit analysis
• Event tree analysis • Multi-criterial decision analysis
• Cause & consequence analysis
35
ISO 31010 - RISK ASSESSMENT
There are 31 risk assessment techniques in Annex B of ISO/IEC 31010
Amazon
• Brainstorming • Cause & effect analysis
$298
• Full & semi-structured interviews • Layer protection analysis
192 pages
• Dephi method • Decision tree
softcover
• Checklist • Human reliability analysis
• Preliminary hazard analysis • Bow tie analysis
• Hazard & operability study • Reliability centered maintenance
• Hazard analysis & critical cont pts • Sneek circuit analysis
• Toxicity assessment • Markov analysis
• Structured “What-If” technique • Monte Carlo simulation
• Scenario analysis • Bayesian statistics & Bayes nets
• Business impact analysis • FN curves
• Root cause analysis • Risk index
• Failure mode & effects analysis • Consequence/probability matrix
• Fault tree analysis • Cost/benefit analysis
• Event tree analysis • Multi-criterial decision analysis
• Cause & consequence analysis
36
NFPA 551- FIRE RISK ASSESSMENT

$45 at NFPA
30 pages
softcover
37
SEMI S10-0307E -RISK ASSESSMENT
SUPERSEDED BY SEMI S10-0215

SEMI:
Semi-Conductor Equipment & Materials International

$300 at SEMI online

download

38
ASHE- RISK ASSESSMENT

INSTRUCTIONS
&
3 WORKSHEETS
Free download of
Excel Spreadsheet to
ASHE members

39
ASHE- RISK ASSESSMENT

“Instructions” explains how to

use the 3 worksheets

40
ASHE- RISK ASSESSMENT

1. “Systems “worksheet is used

to enter & record the Risk
Category # for the various
systems within a given space

41
ASHE- RISK ASSESSMENT

2. “Equipment” worksheet is used to

enter & record the Risk Category #
for facility equipment

42
ASHE- RISK ASSESSMENT

3. “Emergency Mgmt” worksheet

used to enter & record the Risk
Assessment for buildings

43
 ASHE- HAZARD
VULNERABILITY ANALYSIS

Similar to H-V Tool of 2014

44
ASHE- RISK ASSESSMENT
Article from:
“Inside ASHE”
Summer 2015 issue

ASHE Conference
presentation by
George Mills, TJC

Hospitals need to do risk

assessments NOW for
compliance with:
EC.02.01.01 EP 1 – Identify Risks
EC.02.01.01 EP 3 – Take Action

45
ASHE- RISK ASSESSMENT

Let’s take another

look at the ASHE
spreadsheet

46
ASHE- RISK ASSESSMENT

Step 1 – List EVERY room

& space in the facility
47
ASHE- RISK ASSESSMENT

Step 2 –Evaluate & document the risk for

EACH utility system

48
ASHE- RISK ASSESSMENT

1. Grab a floor plan

49
 ASHE- RISK ASSESSMENT

    

  

  2. Methodically list every room
 



50
ASHE- RISK ASSESSMENT

List every room

51
ASHE- RISK ASSESSMENT

3. Methodically evaluate the risk

(1-4) for EVERY Utility in every
room

52
ASHE- RISK ASSESSMENT

ASHE Form is missing documentation of

HOW you figured the Risk Categories …
1. Evaluation of patient impact
2. Evaluation of system reliability

53
LLSC- RISK ASSESSMENT
ROOMS

Changes from the ASHE form:

Switched H & V to fit on a letter sheet
SYSTEMS

54
LLSC- RISK ASSESSMENT

Added lines to document the “harm”

& “reliability” evaluations

55
LLSC- RISK ASSESSMENT

Excel file available via e-mail request to:

Lauzon.LSC@gmail.com

56
NFPA 99 - RISK ASSESSMENT
Develop a uniform Risk Assessment process

Best to coordinate with:

• Quality Improvement
• Infection Prevention
• Environment of Care

They usually have experience in risk assessments

57
ASHE- RISK ASSESSMENT

WHAT do you do
with this
jumble of numbers?

58
 Now let’s
Apply the Risk Categories
To the NFPA 99 Chapters

1 2
High Patient Impact Minor Patient Impact

3 4
Slight Patient Impact No Patient Impact

59
 Applying the Risk Categories

5 – Gas & Vacuum

6 – Electrical Sys
7 – Info Technology
8 – Plumbing Apply
9 – HVAC
10 – Elec Equipment
11 – Gas Equipment
12 – Emergency Mgmt
13 – Security Mgmt
Not Apply
14 – Hyperbaric
15 – Features of Fire Prot

60
 NFPA 99 – CHAPTER 5
GAS & VACUUM SYSTEMS

Organized by Risk
Category requirements

(not retroactive, except for operation

& management requirements)
61
 NFPA 99 – CHAPTER 5
GAS & VACUUM SYSTEMS

62
 NFPA 99 – CHAPTER 5
GAS & VACUUM SYSTEMS

2012 1999
1
Level 1
High Patient
Hospital
New
Impact Risk Categories
Level 2
are similar to
2
Minor Patient Hospital the former
Impact ASC Level 1
Level 2
3 Level 3
Level 3
Slight Patient
Dental
Impact

4
No Patient
Impact
63
 NFPA 99 – CHAPTER 5
GAS & VACUUM SYSTEMS

2012 1999
1
High Patient
Level 1 Under the 1999
Hospital
Impact edition
hospitals had
2 Level 2
Hospital
to follow this
Minor Patient
Impact ASC

3
Level 3 Under the 2012
Slight Patient
Impact
Dental edition HEALTH
CARE FACILITIES
4 can do any of these
No Patient (depending on the
Impact patient risk)
64
 NFPA 99 – CHAPTER 5
GAS & VACUUM SYSTEMS
5.X.14 - MAINTENANCE

1 Inventory includes all sources,

High Patient 5.1 control valves, alarms & mfr
Impact
assemblies
2
Minor Patient 5.2 Must have scheduled inspections
Impact based on risk assessment & OEM
recommendations (minimum
3
Slight Patient 5.3 annual). Very prescriptive lists of
Impact what must be included.

4 Maintainers must be qualified by

No Patient NA training or credentialing
Impact
65
 NFPA 99 – CHAPTER 6
ELECTRICAL SYSTEMS
Not organized by Risk Categories
Similar to 1999 standard

Still organized by the

“Type” of EES

Code lists which sections are retroactive,

such as GFI, # receptacles, OR wet locations
66
 NFPA 99 – CHAPTER 6
ELECTRICAL SYSTEMS
BIG change: ORs are now a
“wet” environment by default

Unless a Risk Assessment

determines otherwise

6.3.2.2.8.4 (not retroactive)

67
 NFPA 99 – CHAPTER 7
INFO TECHNOLOGY SYSTEMS
NEW Chapter
Organized by Risk Categories

Low-voltage voice, data,

communications &
biomed systems
NURSE CALL is now regulated!

(Code does not say chapter is not

retroactive, so many inspectors may
apply it to existing)
68
 NFPA 99 – CHAPTER 7
INFO TECHNOLOGY SYSTEMS

1
High Patient 7.3
Impact

2
75% of the Chapter
Minor Patient
Impact
7.4 deals with Risk
Category 1
3
Slight Patient 7.5
Impact

4
No Patient NA
Impact
69
 NFPA 99 – CHAPTER 7
INFO TECHNOLOGY SYSTEMS
7.3.1 – Infrastructure
• Building Entrance
1
High Patient • Data Center
Impact • Telecom Equip Rm
• Power Requirements
• Pathways
7.3.2 – Systems 7.3.3 – Nurse Call
No requirements • Patient Call
(reserved for future • Emergency Call
code development)
• Staff Assist Call
• Emergency Resuscitation
• (many other sys reserved for
future code development)
70
 NFPA 99 – CHAPTER 8
PLUMBING SYSTEMS
NEW Chapter
(very short)

• Potable Water
• Nonpotable Water
• Special Use Water
• Grease Interceptors
• Black Waste Water
• Gray Waste Water • Non-med Compressed Air
• Clear Waste Water • Water Conditioning
• Fuel • Water Heating
(not retroactive) 71
 NFPA 99 – CHAPTER 8
PLUMBING SYSTEMS

1
High Patient
Impact 8.2 For each plumbing component
system, the facility must designate risk
2
Minor Patient category for each building space.
Impact
8.2.1 The risk category of each
3 plumbing system shall be
Slight Patient
Impact
independent of the category applied to
other systems that serve the same
4 space.
No Patient
Impact
72
NFPA 99 – CHAPTER 8 Sample
PLUMBING SYSTEMS Table

73
 NFPA 99 – CHAPTER 9
HVAC SYSTEMS
NEW Chapter (short)

• Heating
• Cooling
• Ventilation
• Process

(not retroactive)
74
 NFPA 99 – CHAPTER 9
HVAC SYSTEMS

1
High Patient
Impact 9.2 For each HVAC component
system, the facility must designate risk
2
Minor Patient category for each building space.
Impact
9.2.1 The risk category of each HVAC
3 system shall be independent of the
Slight Patient
Impact
category applied to other systems that
serve the same space.
4
No Patient
Impact
75
 Sample
Table

SYSTEMS
NFPA 99
CH 9
HVAC

76
 NFPA 99 – CHAPTER 9
HVAC SYSTEMS

ADOPTED BY REFERENCE

• ASHRAE 170 for spaces listed in that std

• ASHRAE 90.1 for energy & commissioning
• NFPA 90A for ductwork
• NFPA 55 for transfilling
• NFPA 110 for emergency power room

77
 NFPA 99 – CHAPTER 10
ELECTRICAL EQUIPMENT
Not organized by Risk Categories
Similar to 1999 standard

Primarily on TESTING
• Patient-Care related equip
• Non-Patient equipment
• Laboratory equipment

(retroactive)

78
 NFPA 99 – CHAPTER 11
GAS EQUIPMENT
Not organized by Risk Categories
Similar to 1999 standard

• Cylinder Requirements
• Cylinder Storage
• Gas Equipment Testing
• Transfilling & Liquid Oxygen
• Testing Requirements

(retroactive)

79
 NFPA 99
RISK ASSESSMENTS

ARE YOU
READY ?
(Get started now)

80
 “Lunch & Learn”
2015 Webinar Series NFPA 99
RISK ASSESSMENTS

Lauzon Life Safety Consulting, LLC

262-945-4567
Lauzon.LSC@gmail.com
81