NFP�

10-

Health Care Facilities Code

2021

II]
NFPA1
 ADDITIONAL IMPORTANT NOTICES AND DISCLAIMERS CONCERNING NFPA® STANDARDS

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 IMPORTANT NOTICES AND DISCIAIMERS CONCERNING NFPA® STANDARDS
19
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Users of NFPA codes, standards, recommended practices, and guides ("NFPA Standards") should he
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intended that through regular revisions and amendments, participants in the NFPA standards
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corrected by Errata, visit the "Codes & Standards" section at www.nfpa.org.
 99-1

Copyright© 2020 National Fire Protection Association 1D. All Right� Reserverl.

NFPA® 99

Health Care Facilities Code

2021 Edition

This edition of NFPA 99, Hfallh Carp Farilitifs Cnde, was preparerl by the Technical Committees on
Electrical Systems, Fundamentals, Health Ca1·e Eme1·gency Management and Secu1·ity, Hyperbaric
and Hypobaric Facilities, Mechanical Systems, Medical Equipment, anrl Piping Systems, released by
the Correlating Committee on Health Care Facilities, and acted on by the NFPA membership during
the 2020 NFPA Technical Meeting held June 8-29. It was issuerl by the Stanrlards Council on August
11, 2020, with an effective date of August 31, 2020, anrl supersedes all previous editions.
This edition of NFPA 99 wa� approved as an American National Standard on August 31, 2020.

Origin and Development of NFPA 99

The idea for this rlocument grew a� the number of document� unrler the original NFPA
Committee on Hospitals grew. By the enrl of 1980, the1·e existerl 12 documents on a variety of
subjects. 11 rli1·ectly addressing fi1-e-1·elated problems in and about health care facilities. These
rlocument� cove1·ed health care emergency preparedness, inhalation anesthetics, 1·espirntory therapy,
laboratories in health-related institutions, hyperharic facilities, hypobaric facilities, inhalation
anesthetics in ambulatory care facilities, home use of respiratory therapy, merlical-surgical vacuum
systems in hospitals, essential electrical systems (EES) for health ca1·e facilities, safe use of electricity
in patient care areas of health care facilities, and safe use of high-frequency electricity in health care
facilities.
A history on the documents that covererl these topics a1·e in the "Origin anrl Development of
NFPA 99" in the 1984 erlition of NFPA 99. What was then the Health Care Facilities Correlating
Committee 1·eviewerl the matter beginning in late 1979 and concluded that combining all the
rlocument� unde1· it�jurisdiction woulrl be beneficial to those who userl those document� fo1· the
follov.�ng reasons:
(1) The refe1·enced document� we1·e 1-evised independently. Combining the documents into one
would place them on the same 1·evision cycle.
(2) It woulrl place in one unit many documents that referencerl each othec
(3) It would be an easier and more complete reference for the various users of the document
(e.g., hospital engineers, medical pe1·so1111el, designern and architects, and various enfo1·cing
authorities).
In January 1982, a compilation of the latest edition of each of the 12 documents unrler the
jm·isdiction of the correlating committee was published a� NFPA 99. Hmlth Carr Faalities Cnde. The
rlocument wa� formally adopterl at the 1983 Fall Meeting.
For the 1984 edition, technical, administrative, and organizational changes were made.
Fm· the 1987 edition, the thi1·rl and final step in the process of combining the p1·evious individual
document� took place - that of integrating the content of these indi\irlual document� into a
cohesive document. Technical changes were marle, and NFPA 56F, Standard on Nnnflanmial!lf A1fdical
Piped Gas Systnns, was incm·porated into the rlocument.
Fm· the 1990 edition, some structural changes we1·e made anrl some modifie1·s we1·e added to
make it ea�ier to determine where requirements apply. Technical changes includerl correlation with
NFPA 101® , Lip Sripty Cndifo, changes for compressed medical air systems on the use of gas-powered
medical devices operating at a 6'<1.uge pressure of 200 psi anrl piped gas systems in general,
clarification that patient care areas and wet locations are mutually exclusive, anrl further guidance on
the effect� of a rlisaster on staff.
Fm· the 1993 edition, further effm·t� made the rlocument mm·e user friendly (e.g., placing all
"recommenrlerl'' guidance either in notes or in the appendix). Significant technical changes
included adrling requirements and recommenrlations to further prevent or minimize fires in

NFPA and Nationa) Fire Prot.t'rtion Association are reghaered t.rdde1narks oft.he Nationa] Fire Protect.ion A"isociation. Quincy. fvlas.sachusett.s 0216!-l.
99-2 HEALTH CARE FACILITIES CODE

operating rooms. There were also major changes to requirements for installing, testing, inspecting, verifying, and maintaining
nonflammable medical piped gas systems. New sections on dental compressed air and dental vacuum requirements were
adder!.
For the 1996 erlition. funhe1· changes to make the document easier to use includerl 1·estructuring Chapte1·s 3 anrl 4 so that
all requirements for a Type 1, Type 2, or Type 3 essential electrical system, or a Level 1, Level 2, Level 3, or Level 4 piper! gas or
vacuum system, were in one section. Other technical changes included moving requi1·ement� on flammable anesthetizing
locations and the use of flammable inhalation anesthetics to a new Appendix 2. Guidance on emergency p1·epa1·edness was
mover! to a new mandatory chapter. A new chapter on home health care was added. Requirement� for storage rooms
containing gas cylinders anrl containers totaling less than 3000 ft� we1·e also added.
For the 1999 erlition, some significant technical and structural changes we1·e made. Chapters on ambulatory health care
centers. clinics, anrl medical/dental offices were replaced completely by a new Chapter 13 covering health care facilities other
than hospitals, nursing homes, anrl limited care facilities as rlefined in the document. A new chapter on freestanding birthing
cente1·s was adrled.
The 2002 erli tion included format anrl technical revisions in accordance with the 2000 edition of the Manual of StylPfar
NFA111'i:h-niral CmnmittM Dornmmts. Occupancy Chapters 13-21 stated what was requirer!, while Chapters 4-12 prescriber! how
those requirements were to be achieved.
The changes made to the 2005 edition were mainly for clarity and were editorial in nature. A centralized computer was
allowed to be used in lieu of one of the master alarms for medical gas and vacuum systems. Stainless steel tubing was anded as
an approver! matet-ial for vacuum systems.
The 2012 edition went through a major revision. NFPA 99 was changed from a standard to a code to reflect how the
rlocument was used and arlopted and to indicate how health care is delivered. The risk to the patient does not change for a
given procedure; if the procedure is performer! in a doctor's office vei-sus a hospital, the risk remains the same. The1·efore,
NFPA 99 eliminaterl the occupancy chapters anrl transitionerl to a 1·isk-based approach. The new Chapter 4 outlinerl the
parameters for this approach. The code reflected the risk to the patient in rlefinerl categories of risk.
Chapter 5 went through erlitorial changes in the 2012 edition as well, with the arldition of new matet-ial on the testing anrl
maintenance of gas anrl vacuum systems. In arldition, the administrative rletails fot· the ca1·e, maintenance, anrl hanrlling of
cylinders wa� moved to chapters under the responsibility of the new Technical Committee on Medical Equipment, formed by
the combination of the Technical Committee on Gas Deliveq1 Equipment and the Technical Committee on Electrical
Equipment. Seve1·al new chapters we1·e adrlerl fot· the 2012 edition on information technology and communications systems;
plumbing; heating, ventilation, and ai1· conditioning; security management; anrl features of fire protection. Many of these
systems, not previously addresser! by NFPA 99. are important systems and protection features in health care. The hyperbaric
chaplet· also had minor changes fot· clarity.
The 2015 erlition of NFPA 99 built on the major changes of the 2012 edition. The way risk categmies were rlefined was
revised to be more inclusive, and the categories coulrl then be applier! to equipment and acti,ities rather than only to chapters
that rleal with systems. The requirements for Catego1y 3 medical gas and vacuum systems, while originally aimer! specifically for
dental applications, were expanded to include the possibility that other gases might fall under Category 3, ba�ed on the
facility's risk assessment.
The Technical Committee on Elect1·ical Systems continued the task of con·elating requi1·ement� with NFPA. 7{fi, National
.t.'l£ctriml Codi', anrl Chaplet· 6, anrl they 1·emoved the requirements for Level 3 EES, determining that if the1·e wa� not a need
for a Level l or Level 2 EES, then the requirement� in NFP,1 70 that apply to all builrlings woulrl provirle the necessar y level of
safety. Each of the technical committees made a concerterl effort to specifically identify how each chapter was to apply to
existing buildings or installations and to list the sections that applier!.
The 2018 erlition of the cone featured numerous technical changes as well as pro,isions for new technologies and materials.
Some major or notewol'thy changes were as follows:
(1) The 1·equirement� arlrl1·essing the risk a�sessment in Chapter 4 we1·e reviser! to clarify the 1·esponsibility fot· conducting
a risk a�sessment anrl rletermining risk categories. It further stresserl, through annex language, that determining risk
should be a collaborative effort.
(2) Chapter 5 included 1·equi1·ements that allow for the use of oxygen concentrators as central supply sources for piped
systems.
(3) Corrugated medical tubing wa� made a permitted material for medical gas and vacuum systems.
(4) Chapter 6 was reorganized to be structured in a more logical manner. This bette1· grouper! related requirement5 anrl
allowerl for the deletion of rluplicated 1·equi1·ement� for different types of EES.
(5) Chapter 7 included requirement� for wireless phone anrl paging integration and for clinical information systems.
(6) Chapter 14 compiler! all of the requirements for inspection, testing, and maintenance for hyperbaric facilities into one
section.

2021 Edition
 ORIGIN & DEVELOPMENT 99-3

(7) A new Chapter 15 was added to the code. Afte1· several editions of trying to w01·k the requi1·ement� for dental systems
into Chapter 5, a decision ,vas made to create a chapter dedicated to the application of piped ga� and vacuum systems
fo1· these sy;tems that do not always readily fall unde1· the requi1-ements for medical gas and vacuum as add1·essed in
Chaplet· 5.
The 2021 edition of NFPA 99 introduces several substantial changes to the code. Some of the most notable changes a.re as
follows:
(1) The scope has changed to include hyperbaric chambe1-s for veterinary ca re.
(2) New guidance describes what to do when clinical spaces are converted to nonclinical spaces with regard to medical gas
inlets and outlet�.
(:I) The tern1 responsiblPfacility authority has been introduced into the standard \\�th 1·equi1·ement� for 1·esponsibilities and
qualifications.
(4) Existing language in Chapter 5 on c1yogenic fluid central supply systems ha� been 1·emoved, and extract5 from NFPA
55 have replaced it because NFPA 55 now covers this.
(5) A new section on health care microg.rids has been added to Chapter 6.
(6) Requirements for electrical equipment site acceptance testing and electrical preventative maintenance have been
added to Chapte1· 6.
(7) Procedtu-es fo1· 1·emoving flammable liquid-soaked materials from the operating room have been altered to 1·equi1·e
those materials to be removed only from the patient ca.re vicinity.
(8) Requirements for the fire protection of heliports wa� added to Chapter 16 by referencing NFPA 418.

2021 Edition
99-4 HEALTH CARE FACILITIES CODE

Correlating Committee on Health Care Facilities

Michael A. Crowley, Chair
JENSEN HUGHES, TX [SE]

Chad E. Beebe, ASHE - AHA, WA [U] Ken L. Gregory, TSIG Consulting. TN [SE]
Constance Bobik, B&E flre Safery Equipment Inc., FL [IM] Robert Hijazi, Dearhorn, Ml [M]
Wayne L. Brannan, Medical Universiry of South Carolina, SC [U] Rep. A5socialion for the Advancement of Medical
Rep. American Society of Safct)' Professionals Insrrui-nentalion
Gordon D. Burrill, Teegor Consulting Inc., Canada [lJ] Dale L. Lyman, Greeley Fire Department, CO [El
Rep. Canadian Healthcare Engineering Society Denise L. Pappas, Valcom, Inc., VA [M)
David A. Dagenais, Partners/Wentworth-Douglass Hospital. NH [lJ) Rep. National Electrical Manufacturers Association
Rep. NFPA Health Care Section Ronald A. Schroeder, ASCO Power Technologies, LP, NI [M)
Keith Ferrari, Praxair, Inc., NC [M) Robert Sontag, State of Colorado, CO [El
Daniel P. Finnegan, Siemens Industry, Inc., IL (M] Rep. Fire Marshal's Association of Colorado
Robert M. Gagnon, Gagnon Engineering, MD [SE) Joseph H. Versteeg, Versteeg A5sociates, CT [El
Ronald E. Galloway, Moses Cone Health System. NC [ U) Rep. DNV Health Care Inc.
Sharon S. Gilyeat, Kotlel Awlciates, Inc., MD [SE]

Alternates
H. Shane Ashby, West Tennessee Healthcare, TN [U) Rodger Reiswig,Johnson Controls, FL [M)
(Alt. to Wayne L. Brannan) (Alt. to Denise L. Pappa5)
Chad Kennedy, Schneider Electric, SC [M] Eric R. Rosenbaum,JENSEN HUGHES, IL [SE)
(Alt. to Ronald A. Schroeder) (Alt. to Michael A. Crowley)
William E. Koffel, Koffel Associates, Inc., MD [SE)
(AIL to Sharon S. Gilyeat)

Nonvoting
Richard C. Batty, Healogics, FL [SE] Susan B. McLaughlin, MSL Health Care Partners, IL [U]
Rep. TC on Hyperharic and Hn,oharic Facilities Rep. TC on Health Care Emergency Management & Security
David P. Klein, US Department of Veterans Affairs, DC [U) Michael P. Sheerin, TLC Engineering for Architecture, Fl, [SE)
Rep. TC on Fundamentals Rep. TC on Mechanical Systems
James K Lathrop, Koffel Associates, Inc., CT [SE] MarvinJ. Fischer, Monroe Township, NJ [SE]
Rep. TC on Piping Systems (Member Emeritus)

Richard P. Bielen, NFPA Staff Liaison

Thi.r lirl represents lhe nil!mbmhip al lhe lime lhe Cmnmiuee was balloled on ihefinn.l IP.xl ofthis l'tiilio11.
Since thal lime, changes in lhe membership ma� have occurred. A kCj lo classijicalions i.rfound al /he
bark of the docu-menl.

NOTE: Membership on a committee shall not in and of itself constitute an endorsement of

the A5socialion or any document developed by the committee on which the member serves.

Committee Scope: This Committee shall have primary responsibility for documents that
contain criteria for safeguarding patients and health care personnel in the delivery of health
care services within health care facilities: a) from fire, explosion, electrical, and related
hazards resulting either from the use of anesthetic agents;, medical gas equipment, electrical
apparatus, and high fre<]uency electricity, or from internal or external incidents that disrup1
normal patient care; h) from fire and explosion hazards; c) in connection with the use of
hyperbaric and hypobaric facilities for medical purposes; d) through performance,
maintenance and testing criteria for electrical systems, both normal and essential; and e)
through performance, maintenance and resting, and installation criteria: (I) for vacuum
systems for medical or surgical purposes, and (2) for medical gas systems; and f) through
performance , maintenance and testing of plumbing. healing, cooling, and ventilating in
health care facilities.

2021 Edition
 COMMITl"EE PERSONNEL 99-5

Technical Committee on Electrical Systems

Jason D'Antona, Chair
Thompson Consultants, Inc., MA [SE ]

David M. Campbell, AFC Cable Systems, Inc.. l\iL\ [Ml
Rep. The Aluminum Association, Inc.
H. David Chandler, Newcomb & Boyd. GA [SE)
Rep. NFPA Health Care Section
Nancy W. Chilton, Schneider Electric, NC [Ml
Dan Chlsholm,Jr., MG! Systems, Inc., FL [IM)
Charles Cowles, American Society Of AnesthesiologisLs, TX [Cl
David A. Dagenais, Partners/Wentworth-Douglass Hospital, NH [Ul
Richard L. Day, Michigan State Fire Marshal's Office, Ml [El
Vincent Della Croce, Siemens, FL [Ml
Chris M. Finen, Eaton Corporation, TN [M]
Pamela Gwynn, UL LLC, NC [RT)
Ja.�on RyanJamil, Cleveland Clinic, OH [U)
GaryJ. Krupa, US Department ofVeterans Affairs. NE [U)
Stephen M. Lipster, SNAG Consulting, OH [SE]
Terrance L. McKinch, Mortenson Construction, Ml [IM)
T homasJ. Parrish, Telgian Corporation, Ml [SE)
John W. Peterson, Utility Service Corporation. AL [IM)
Rep. InterNational Electrical Testing Association
Kevin T. Porter, Encore Wire Corporation, TX [Ml
Rep. Narional Electrical Manufacturers Association
Don Rabel, Mid-West Electric Company, TX [IM)
Rep. National Electrical Contractors Association
Vincent M. Rea, TLC Engineering for Architecture, FL [SE]
Keith Riechers, Hill Rom Company, IN [Ml
Brian E. Rock, Hubbell Incorporated, CT [Ml
Steve R . Sappington, Caterpillar Inc., GA [M)
Kevin A. Scarlett, Washington State Deparm1ent of Health, WA [El
Ronald M. Smidt, Atrium Health, NC [Ul
Rep. American Society for Healthcare Engineering
Joshua Vann, MB Healthcare, NJ [U)
Walter N. Vernon, IV, Mazzeni, CA [SE ]
Leonard W. White, Stanford White Associates Consulting Engineers,
Inc., NC [SE)
Robert Wolff, BRE Engineers, NC [SE)

Alternates

Cristina Aragon Vandenbent, Telgian, GA [SE) Paul David Evers, UL LLC, FL [RT)
(Ah. to Thomas .J . Parrish) (Alt. to Pamela Gwynn)
Jesse Avery, Mazzetti, CA [SE) Lury Geyer, Quality Electric Inc., ID [IM)
(AIL to Walter N. Vernon, IV) (Alt. to Don Rabel)
Gary A. Beckstrand, Utah Electrical .JATC, UT [L) Chad Kennedy, Schneider Electric, SC [M]
(Voting Alt.) (Alt. to Nancy W. Chilton)
Chad E. Beebe, ASHE -AHA, WA [U J Taw North, TLC Engineering for Architecture, FL [SE]
(Alt. to Ronald M. Smidt) (Alt. to Vincent M. Rea)
Dan Chisholm, Sr., MGl Systems, Inc., FL [IM] John Schutte, Mortenson Construction, TX [IM]
(Ah. to Dan Chisholm,.Jr.) (Alt. to Terrance L. McKinch)
Herbert H. Daugherty, Electric Generating Systems Association, FL Edward Treveiler, Eaton, NC [M)
[M] (Alt. to Chris M. Finen)
(Voting AIL) John L. Williams, Washington State Department of Health. WA [El
Jan Ehrenwerth, Yale University, Cr [C) (Alt. to Kevin A. Scarlett)
(Alt. to Charles Cowles)
f
Steven A. Elliott, US Department of Veterans Afairs, CA [ LT)
(Alt. to Gary·.J. Krupa)

Richard P. Bielen, NFPA Staff Liaison

This /isl rejrrosenls the membership al lhe lime the Commillee was balloted on llw/inal wxl of lhis edition.
Since l/,al lime, clumg;s in lhe mer,,bership may have or.curred. A lie)• lo classi/icaliom is found al lhe
back of lhe documenl.

NOTE: Membership on a commiuee shall 1101 in and ofiL�elf constirnte an endorsement of

the A�sociation or any document developed hy the committee on which the member serves.

Committee Scope: This Committee shall have primary responsibility for documents or
portions of documents covering the minimum requiremenrs for performance, testing,
maintenance, operations, and failure management of electrical systems, low voltage systems,
wireless technologies, informatics, and telemedicine to safeguard patiencs, staff; and visitors
within health care facilities based on established risk categories.

2021 Edition
99-6 1-JEALTI-l CARE FACILITIES CODE

Technical Committee on Fundamentals

David P. Klein , Chair
US Department of Veterans Affairs, DC [U]
Rep. US Department of Veterans Aflairs

Bruce L. Abell, US Army Corps of Engineers, VA [U]
Chad E. Beebe, ASHE · AHA, WA [U]
Rep. American Society for Healthcare Engineering
JeffN. Besel, Obermiller Nelson Engineering, MN [Ml
Rep. Automatic Fire Alarm A�sociation, Inc.
Bruce D. Brooks, Noelker and I-lull Associates. Inc., VA [SE]
Rep. American Institute of ArchitecL�
Gordon D. ButTill, Teegor Consulting Inc., Canada [U]
Rep. Canadian 1--Jeahhcare Engineering Society
Michael A. Crowley,JENSEN HUGHES, TX [SE]
Roger N. Dahozy, US Deparanent of Health & 1-luman Services, AZ
[E]
Richard L. Day, Michigan State Fire Marshal's Olli.ce, Ml [El
CarlJ. Ferlitch, Jr., Chubb (;roup of Insurance Companies. PA [I]
Henry Kowalenko, Illinois Department of Public Healt.h, IL [El
James K. Lathrop, Koffrl Associates, Inc., CT [SE]
Dale L. Lyman, Greeley Fire Department, CO [El
Bret M. Martin, CNA Insurance, NC [I]
Michele Mucia,Johnson Controls, IL [M]
Rep. National Electrical Manufacturers A�sociation
James S. Peterkin, TLC Engineering, PA [SE]
Milosh T. Puchovsky, Worcester Polytechnic Institute.. MA [SE]
Pamela Reno, Telgian, OH [SE]
Joe Sdbetta, BuildingRepom, GA [M]
Robert Sontag, State of Colorado, CO [El
Frank L. Van Overmeiren, Fire Protec Lion & Code Consultants,
LLc., IN [SE]
Joshua Vann, 1\-18 Healthcare, NJ [U]
John L. Williams, Wa�hington State Department of Health, WA [El

Alternates
Gary A. Beckstrand, Utah Electrical JATC, UT [L] Kevin A. Scarlett, Washington State Depanment of Health, WA [ El
(Voling Alt.) (Alt. to.John L. Williams)
Allison C. Elli�, Koffel Associates, Inc., MD [SE] Dennis L. Schmitt, Illinois Department of Public Healrh (IDPH), IL
(Alt. to .James K. Lathrop) [El
Daniel P. Finnegan, Siemens Industry, Inc., IL [Ml (Aft. to Henry Kowalenko)
Justin A Schwartz, U.S. Army Corps Of Engineers. vi\ [U]
f
(Alt. to Jef N. Besel)
Amy L. Flower, Fire Protection & Code Consultam�, IN [SE] (Alt. to Bruce L. Abell)
(Alt. to Frank L. Van Overmeiren) Sean Schwartzkopf, State of Colorado, CO [El
Shaine M Grogan,.Jensen Hughes, J\,1A [SE] (Alt. to Robert Sontag)
(Aft. to Michael A. Crowley) Jennifer A. Wetzel, Telgian Corporation, DE [SE]
Peter Leszczak, US Department of Veterans Affairs, CT [ U] (Alt. to Pamela Reno)
(Alt. to David P. Klein)

Richard P. Bielen, NFPA Staff Liaison

Thi< li<t nfmmmts lhe rnembershifi at the time lhe CommiUt£ was balloted on lhe/inal texl ofthi.< editio11.
Sinre that time, chan[!,I!.< in the membership may have occurmd. A key to clc,,sificaliom i<found at the
back of the document.

NOTE: Membership on a committee shall not in and of iLself constitute an endorsement of

the A�sociaLion or any document developed by the committee on which the memher serves.

Committee Scope: This Committee shall have primary responsibility for document5 or
portions of documents on the scope, application, and intended use of documents under the
Health Care FaciliLies Prqject, including reference standards, performance, the protect.ion
from fire and explosion hazards, protect.ion of special hazards, establishing criteria for levels
of health care services based on risk, a� well as definiLions not assigned to other committees
in the Health Care Facilities Project.

2021 Edition
 COMMITl"EE PERSONNEL 99-7

Technical Committee on Health Care Emergency Management and Security

Susan B. McLaughlin, Chair
MSL Health Care Partners, IL [U]
Rep. American Society for Healthcare Engineering

Ro bert M. Becker, Incident Management SoluLions, Inc., NY [SE)
Pete Brewster, US Department of Veterans Affairs, WV [U)
David A. Dagenais, Partners/Wentworth-Douglass Hospi1<-i.l, NH [U]
NicholasE. Gabriele,.JENSEN HUGHES, CT [SE)
Sharon S. Gilyeat, Koffel Associates, Inc., MD [SE)
KennethJ. Hebert, The.Joint Commission, IL [E]
Dale L. Lyman, (;reeley Fire Departn1ent. CO [El
James L . Paturas, Yale New Haven Heahh System, CT [U)
Jack Poole, Poole Fire Protection, Inc., KS [SE]
Pamela Reno, Telgian, OH [SE]
Patrick C. Rhinehart, Northside Hospital, GA [U)
Kevin A. Scarlett, Washington State Departn1ent of Health, WA [El
James P. Simpson, Electrical Training Alliance. MN [L)
Rep. International Brotherhood of Electrical Workers
Jerry Spickler,.Johnson Controls, OH [M)
Michael D. W iddekind, Zurich Services Corporal.ion, MD [I)

Alternates
ChadE. Beebe, ASHE -AHA, WA [U] Valerie Miller, Zurich North America, PA (I]
(Alt. to Su.san B. McLaughlin) (Alt. to Michael D. Widdekind)
Myron Lee Draper, Koffel Associates, I\IID [SE) John Pelazza, Yale New Haven Health System, CT [U]
(Aft. to Sharon S. Gilyeat) (Alt. to James L. Paturas)
Zachary Goldfarb, Incident Management SoluLions, Inc., NY [SE] Eric Reed, Poole Fire Protect.ion, Inc., KS [SE)
(Alt. to Robert M. Becker) (Aft. to Jack Poole)
Andrew D. Mcguire,.JENSEN H{J(;HES, GT [SE] Jennifer A. Wetzel, Telgian Corporation, DE [SE)
(Alt. to Nicholas E. (;abriele) (Aft. to Pamela Reno)

Nonvoting
Reginald D.Jackson, US Departn1ent of Labor. DC [El

BrianJ. O'Connor, N FPA Staff Liaison

This list r,firesenls the membership al lM time the Commillm was ball,iied on the/inal /Rx/ �f this edition.
Since that lime, chan�s in the membership may have orcurmd. A keJ' to clas.si/icalions i� found at the
back of lhe document.

NOTE: Membership on a committee shall not in and ofit�elf constitute an endorsement of

the AssociaLion or any document developed by the committee on which the member sen'es.

Committee Scope: This Committee shall have primary responsibility for documents or
portions of documents covering the framework for emergency management and security of
health care faciliti es proportionate to the risk ofthe paLient and health care staff. This
Committee shall have primary responsibility for the elements of planning over a conLinuum
from minor incidences 10 catastrophic events, inclllding: management controls, mitigation
f
practices, incident response, continuity of services, re covery·, stored capacity. staf training,
and program evaluation based on established risk categories.

2021 Edition
99-8 1-JEALTI-l CARE FACILITIES CODE

Technical Committee on Hyperbaric and Hypobaric Facilities

Richar d C. Barry, Chair
1-lealogics, FL [SE]

Chad E. Beebe, ASHE · AHi\, WA [U]
Rep. American Society for Healthcare Engineering
W. Robert Bryant, Perry Baromedical Corporation, TX [Ml
Francois Burman, Divers Alert Network, NC [SE]
Mario Caruso, Hyperbaric Consulting LLC, FL [SE]
Mark Chlpps, Life Support Technologies Group Inc.. NY [U]
Jolene E. Cormier, Baylor Medical Center. TX [U]
Keith Ferrari, Praxair, Inc., NC [M]
Adrian Garay, HYPERBARIC MODULAR SYST EMS, Inc., CA [M]
Derail Garrett, Undersea Hyperbaric Medical Society (UHMS), FL
[U]
Barry E. N ewton, WH&.. International. Inc., NJ\'i [SE]
Dennis Nosldn, Dennis Noskin Architects, NY [SE]
Robert B. Sheffield, International ATMO, Inc., TX [U]
John M. Skinner, Medical Equipment Technology, Inc.. GA [IM]
Deepak Talati, Sechrist Industries. Inc., CA [M]
Nam To, US Food and Drug Administration, MD [E]
John L. Williams, Washington State Department of Health, WA [El
Rep. NFPA Health Care Section

Alternates
Justin Callard, Hyperbaric Technicians & Nurses Association Inc., Kevin I. Posey, International ATMO, Inc., TX [U]
Australia [C] (Alt. to Robert B. Sheflield)
(Voling Alt.) Kevin A. Scarlett, \,\-'ashington State Department of Health, 'WA [El
Paul Mario Caruso, Hyperbaric Consulting LLC. FL [SE] (Alt. toJohn L. Williams)
(Alt. to Mario Caruso)
Gwenael Chiffoleau, WHA International, NM [SE]
(Alt. 10 Barry E. Newton)

Nonvoting
Wilbur T. Workman, Undersea & Hyperharic Medical Society, TX
[U]
Rep. Undersea & Hyperharic Medical Society
(Member Emeritus)

BrianJ. O'Connor, NFPA Staff Liaison

Thi< li<l wpreseniS the nwm.be,shifi at the time the CommillM was balloted on the final wxl ofthi.< editio'II.
Since that time, changes in the nwmbe,shiji may have ocw-rred. A ke)• to cir,ssifications i< found at the
bark of the doru,nrmt.

NOTE: Membership on a committee shall not in and of itself constitute an endorsement of

Lhe Association or any document developed hy the committee on which the member serves.

Committee Scope: This Committee shall have primary responsibility for documenLs or
portions ofdocumenLs covering the construction, installation, testing, performance, and
maintenance of hyperharic and hypoharic facilities for safeguarding staff and occupants of
chambers.

2021 Edition
 COMMITl"EE PERSONNEL 99-9

Technical Committee on Mechanical Systems

Michael P. Sheerin, Chair
TLC Engineering for Archirecture, FL [SE]

Chad E. Beebe, ASHE -AH-'\, WA [UJ Ronald E. Galloway, Moses Cone Healrh System, NC [U]
Christop her Bernecker, H. T. Lyons, Inc., PA [IM] Jonathan Hartsell, .Rodgers, NC [IM]
Gordon D. Burrill, Teegor Consulring Inc., Canada [U] Sean Hutchinson, Siemens- Building Technologies, NJ [M]
Rep. Canadian 1-Icalrhcare Engineering Society Roger W. Lautz, Affiliared Engineers, Inc., WI [SE]
Luke Cummings, Mayo Clinic, MN [U] Charles Seyffer, Camfil Farr, NY [M]
Raj Daswani, Arup, CA [SE] Allan D. Volz, OSF HealthCare Sysrem, IL [U]
Keith Ferrari, Praxair, Inc., NC [M]
f
Brian J. O'Connor, N FPA Staf Liaison

Thi, li<l repre.<m/s lhe ·membership al lhe lime ihe Commille,e wa.< balloled 011 the.final /,exl oflhis ,'flilion.
Since lhal linue, change.< in lhe membership may hrme orcurnd. A key lo da.<.<i/icaliom i,found at lhe
back oflhe doc1win11.

NOTE: Memhership on a comminee shall not in and of iL�elf constirute an enctorsemem of

rhe Association or any documelll developed hy the comminee on which rhe member serves.

Committee Scope: This commiuee shall have primary responsibiliry for documents or
portions of document.s covering the performance, operations, testing, and maintenance, for
air quality, temperature, humidiry, critical space pressure relationships, waler and waqe
warer. and their associated systems based on established risk categories.

2021 Edition
99-10 HEALTH CARE FACILITIES CODE

Technical Committee on Medical Equipment

Pamela Gwynn, Chair
UL LLC. NC [RT]
Rep. UL LLC

JohnJ. Anicello, Airgas Inc., WA [M) Alan Llpschultz, HealthCare Technology Consulting LLC, MD [M)
Chad E. Beebe, ASHE -AHA, \VA [U) Rep. Association for the Advancement of Medical
lnstru1nentation
Llsa C arr, Chrisliana Care Health Services, DE [lJ)
Brian E. Rock, Hubbell Incorporated, CT [Ml
Char les Cowles,American Society OfAnesthesiologisL�, TX [CJ f
Ezra R. Safdie, US Department of Veterans Afairs, DC [U)
David A. Dagenais, Partners/Wentworch-Dou�la�s Hospital, NH [U)
Rep. NFPA Health Care Section Lawrence S. Sandler, Bonita Springs, FL [SE]
Keith Ferrari, Praxair, Inc., NC [M) Kevin A. Scarlett, Washington State Deparm1ent of Health. WA [E]
Rep. Compressed Gas Association Robert M. Sutter, B&R Compliance Associates, FL [ SE)
Gerald R. Goodman, Texas Woman's Universicy, TX [SE)

Alternates

Gary L. Bean, Air ProducL� & Chemicals, Inc.. GA [M) Kenneth Gerard Funk, Environmental Technologies Associates
(Alt. 10 Keith Ferrari) (ETA), Inc., GA [SE]
Paul David Evers, UL LLC, FL [RT] (Alt. to Robert M. Suner)
(Alt. 10 Pamela Gwynn) Robert Hijazi, Dearborn, MI [M]
(Alt. 10 Alan Lipschultz)

BrianJ. O'Connor, NFPA Staff Liaison

Thi, l�t rtcpmsents the membershiji at the time the Commitltt was balloled on the final li!xt of this ediliou.
Sinre lhnt time, chang,,s iu the rnnnbershifi -may have occurmd. A key to classificntiom i,.fmrnd al /he
bark of the document.

NOTE: Membership on a comminee shall not in and of iL�elf constitute an endorsement of

the A�socialion or any document developed by the committee on which the memher sen•es.

Committee Seope: This comminee shall have primal)' responsibility for documents or
portions of document� covering the maintenance, performance, and testing of electrical
medical equipment and portable patient-related gas equipment for the purpose of
safeguarding palients and health care personnel within pat ient care areas of health care
facililies from the hazards of lire, explosion, electricity, nonionizin� radiation, heat, and
electrical interference based on established risk categories.

2021 Edition
 COMMITTEE PERSONNEL 99-11

Technical Committee on Piping Systems

J ames K Lathrop, Chair
Koffel Associmes, Inc., Cr [SE]

Mark W. Allen, Beacon Medaes, SC [Ml
Grant A. An derson, Bard, Rao & A1hanas Consulting Engineers,
LLC, MA [SE]
Chad E. Beebe, ASHE -AHA, WA [UJ
Rep. American Sociecy for Healthcare Engineering
David Braidich, US Army Corps of Engineers, VA [U)
Dana A. Colombo, PIPE/Na1ional ITC Corporation, L-\ [L)
Charles Cowles, American Sociecy OfAnes1hesiologisls, TX [ CJ
Mark Fasel, V iega LLC, IN [M]
Keith Ferrari, Praxair, Inc., NC [M)
Rep. Compressed Gas Association
Michael Frankel, Utility Sys1ems Consul tanLs, FL [SE]
Rep. American Society of Plumbing Engineers
Andrew Fuchs, Local 137, IL [L)
Neil Gagne, ,vm. G. Frank Medical Gas Testing & Consulting, LLC,
NH [SE]
Ed Golla, TRI/ Air Testing, TX [RT)
John C. Gregory, Henderson Engineers_. AZ [SE)
Scott Hamilton, ASSE Imeruational, IL [U)
Rep. Imernaiional Association ofPlumbing & Mechanical
Officials
Edward A Litvin, US Depar1men1 ofVe1erans Affairs, DC [U)
Rep. US Depar1me111 of Veterans Affairs
Anthony Lowe, Allied Hospital Sys1ems, MD [IM]
James L. Lucas, Tri-Tech Medical Inc., OH [M]
Bret M. Martin, CNA Insurance, NC [I)
Jeffer y F. McBride, Red Lion Medgas Consultams, Inc., DE [SE]
Douglas Miller, Loe al 190, Ml [L)
David B. Mobile, Medical Engineering Sei,ices, LLC, WV [SE)
Dave Preble, American Dental Association, IL [U)
Rep. American Demal Associa1ion
Kevin A. Scarlett, Washing1on Stale Depanmem ofHealth, WA [El
Sean Schwartzkopf, S1a1e ofColorado, CO [El
RonaldJ. Schwipps, WinRock HeahhCare. IN [M)
E. Daniel S hoemaker, Accmron Inc., AZ [�1)
Allan D. Volz, OSF HealthCare System, IL [U]
KevinJ. Walsh, EM Duggan Inc., MA [IM]
Rep. Mechanical ComracrnrsAssociation ofAmerica, Inc.
Jonathan C. Willard, Acute Medical (;as Services. NH [SE)

Alternates
Gary L. Bean, Air ProducLs & Chemicals, Inc., (;A [M] Robert G. Loeb, Universi1v ofArizona.· AZ [C]
(Alt. 10 Keith Ferrari) (Alt. 10 Charles Cowie;)
Gary Currence, Allied Hospital Systems, MD [IM] EdwardJ. Lyczko, The Cleveland Clinic, OH [U]
(All. 10 Amhony Lowe) (Voling Alt.)
David A Dagenais, Parrners/Wemworth-Douglass Hospirnl, NH [U) Paul Rumbos, Major Medical Hospital Services, Inc., NJ [SE)
(Alt. 10 Chad E. Beebe) (Alt. lO Jonathan C. Willard)
Marc Dodson, (>Scan Technologies, Inc.. AZ [SE] Ronald M. Smidt, Atrium Health. NC [U)
(Voting Alt.) (Voling All.)
Mark T. Franklin, Sherman Engineering Company, PA [M] John L. Williams, Washingwn Srnte Depar1me111 ofHeahh. WA [El
(Alt. to Mark W. Allen) (Alt. 10 Kevin A. Scarlett)
Enrique Trejo Gonzalez, International Association of Plumbing &
Mechanical Officials (IAPMO), CA [U]
(Alt. 10 Scon Hamihon)

Richard P. Bielen, NFPA Srnff Liaison

This li�l represenls lhe nwtttbershijl al lhe lime the Commillee was balfoled on lheJina[ U!Xl oflhis edition.
Since that time, clwn�s in the nwmbershiji may have occurred. A key lo classifications isfoumd al the
back �f the document.

NOTE: Membership on a committee shall not in and ofiLself constitute an enctorsemem of

the A'>.socialion or any documem developed by the committee on which the member serves.

Committee Scope: This Comminee shall have primary responsibility for documents or
portions of documenLS covering the performance, maintenance, insrnllmion. and testing of
medical and dental related gas piping systems and medical and dental related vacuum piping
systems based on established risk categories.

2021 Edition
99-12 HEALTH C A RE FACILIT IES CODE

Contents

Chapter I Administration ............................................... . 99-14 9.5 Category 2. (Reserved) .......................................... . 99-99

l. l Scope. ....................................................................... 99-14 9.6 Caregory 3. (Reserved) .......................................... . 99-99
l.2 Purpose. ................................................................... 99-15
l.3 Application.............................................................. 99-15 Chapter 10 Electrical Equipment ...................................... 99-99
l.4 Eq uivalency. ............................................................. 99-15 10.1 Applicability. ............................................................ 99-99
l.5 U nits . ........................................................................ 99-15 10.2 Performance Criteria for Patient Care-Related
l.6 Code Adoption Re<]uirements. .............................. 99-15 Electrical Appliances and Equipment. .................. 99-99
10.3 Testing Requirements - Patient Care-Related
Chapter 2 Referenced Publications ............................... . 99-15 Electrical Appliances and Equipment. .................. 99-100
2.1 General. ................................................................... 99-15 10.4 Nonpatient Electrical Appliances and
2.2 NFPA Publications . ................................................ . 99-16 Equipment. .............................................................. 99- IOI
2.3 Other Publications . ................................................. 99- l(j 10.5 Administration........................................................ 99- IOI
2.4 References for Extracts in Mandatory Sections . ... 99- 18
Chapter 11 Gas Equipment ............................................... 99-106
Chapter 3 Definitions ...................................................... 99-19 I I.I Applicability . ............................................................ 99-106
3.1 General. .................................................................. . 99-19 I1.2 Porrable Cylinder and Container S ource. ............. 99-106
3.2 NFPA Official Definitions ....................................... 99-19 11.3 Cylinder and Container S torage Requirements . . .. 99-106
3.3 General Definitions. .............................................. .. 99-19 11.4 Performance Criteria and Testing . ........................ 99-108
3.4 BICSI Definitions. .................................................. . 99-27 I1.5 Administration. ....................................................... 99-108
11.6 Operation and Management of Cylinders . ............ 99-110
Chapter 4 Fwtdamentals ................................................. 99-27 11.7 Liquid Oxygen EquipmenL ................................... . 99-112
4.1 Risk Categories. ....................................................... 99-27
4.2 Risk A�sessment. ...................................................... 99-27 Chapter I 2 Emergency Management ................................ 99-113
4.3 Application.............................................................. 99-27 12.1 Applicability. ........................................................... 99-113
4.4 Materials .................................................................. 99-28 12.2 Responsibilities . ...................................................... . 99-113
12.3 Emergency Management Categories. .................... 99-113
Chapter 5 Gas and Vacuum Systems .............................. . 99-28 12.4 General. ................................................................... 99-113
5.1 Category 1 Piped Gas and Vacuum Systems . ......... 99-28 12.5 Emergency Management Category 1 and
5.2 Category 2 Piped Gas and Vacuum Systems. ......... 99-72 Emergency Management Category 2
5.3 Category 3 Piped Gas and Vacuum Systems. ......... 99-73 Requirements. ......................................................... 99-113
Chapter 6 Electrical S)-Stems ......................................... .. 99-75 Chapter 13 Security Management ..................................... 99-117
6.1 Applicability. ............................................................ 99-75 13.1 Applicahili ty. .......... ..... .................... .......... ............... 99-117
6.2 Nature of Hazards . .................................................. 99-75 13.2 Security Management Plan. .................................... 99-117
6.3 General . .................................................................. . 99-75 13.3 Security Vulnerability Assessment (SVA). .............. 99-117
6.4 Category I Spaces. ................................................. . 99-80 13.4 Responsible Person. ................................................ 99-117
6.5 Category 2 Spaces. .................................................. 99-80 13.5 Security-Sensitive Area�. ......................................... 99- 118
6.6 Category 3 and 4 Spaces. ........................................ 99-80 13.6 Access and Egress Security Measures. .................... 99- 118
6. 7 Essential Electrical Systems . ................................... 99-80 13.7 Media Control. ........................................................ 99-119
6.8 Site Acceptance Testing. ......................................... 99-88 13.8 Crowd Control. ....................................................... 99-119
6.9 Electrical Preventive Maintenance (EPM) . ........... 99-89 13.9 Access Control Equipment..................................... 99-119
6.10 Health Care l\,licrogrids . ......................................... 99-89 13.10 Employment Practices. ........................................... 99-119
6.11 Classification of Emergency Power Supply 13.11 Security Operations. ............................................... 99-119
Systems (EPSSs) . ..................................................... 99-91 13.12 Program Evaluation. ............................................... 99-119
Chapter 7 Information Technology and Chapter 14 Hyperbaric Facilities ...................................... 99- I I 9
Communications Systems .............................. 99-92 14.1 Scope. ....................................................................... 99-119
7.1 Applicability. ............................................................ 99-92 14.2 Consrruction aod Equipment . ............................... 99-120
7. 2 Reserved . ................................................................. 99-92 14.3 Administration and Maintenance. ......................... 99-128
7. 3 Category 1 Systems . ............................................... .. 99-92
7.4 Category 2 Systems. ................................................ . 99-9!'i Chapter 15 Dental Gas and Vacuum S)-Stems ................... 99-132
7. 5 Category 3 Systems . ................................................ . 99-96 15.1 Applicability. ............................................................ 99-132
15.2 Nature of Hazards of Ga� and Vacuum Systems . ... 99-133
Chapter 8 Plumbing ......................................................... 99-96 15.3 Category I Dental Gas and Vacuum Systems. ....... 99-133
8.1 Applicability. ............................................................ 99-96 15.4 Category 2 Dental Gas aod Vacuum Systems. ....... 99- 136
8. 2 System Category Crireria . ....................................... 99-96 15.5 Category 3 Dental Ga� aod Vacuum Systems. ....... 99-149
8.3 General RequiremenL�. ........................................... 99-97
8.4 Caregory 1. (Reserved) ........................................... 99-97 Chapter I 6 Features of Fire Protection ............................ 99-153
8.5 Caregory 2. (Reserved) ........................................... 99-97 16.1 Applicability. ............................................................ 99- 153
8.6 Caregory 3. (Reserved) ........................................... 99-97 16.2 Construction and Compartmentation. .................. 99-153
16.3 Special Hazard Protection for Flammable Liquids
Chapter 9 Heating, Ventilation, and Air Condjtjoning and Ga�es. ........ ..... ..... ..... ..... ..... ............... .......... ...... 99-153
(HVAC) ........................................................... 99-97 I 6.4 Laboratories. ................. .......................................... 99-153
9.1 Applicability. ............................................................ 99-97 16.5 Utilities. .................................................................... 99- 153
9.2 System Caregory Criteria . ....................................... 99-97 16.6 Wa�te Chutes, Incinerators, and Linen Chutes. .... 99- 154
9.3 General . .................................................................. . 99-97 16.7 Fire Detection, Alarm, and Communications
9.4 Category 1. (Reserved) ........................................... 99-99 '-ystems .................................................................... 99- 154

2021 Edition
 CONTENTS 99-13

16.8 Heliports. ................................................................. 99- 15:, Annex A Explanatory Material ..... ............... ..... .......... ... 99- 156
16.!J Automatic Sprinklers and Other Extinguishing
Equipment. .............................................................. 99- 155 Annex B Additional fa:.planatory Noles .............. ......... 99-215
16.10 Manual Extinguishing Equipment. ........................ 99- 155
Annex C Sample Ordinance Adopting NFPA 99 ......... 99-233
16.11 Compact Storage . .................................................... 99- 155
16.12 Compact Mobile Storage. ....................................... 99- 155 1\nnex D htformational References ............................. 99- 234
16.13 Maintenance and Testing ....................................... 99- 155
16.14 Fire Loss Prevention in Operating Rooms. ........... 99- l'i6 Index 99-239

2021 Edition
99-14 HEALTH CARE FACILITIES CODE
NFPA99
Health Care Facilities Code
2021 Edition
IMPORTANI' NOTE: This NFPA document is made available for
use subject to imporlant notices and legal disclaimers. These notices
and disclaimers appear in all publications containing this document
and may be found under the heading "Imporlant Notices and
Disclaimers Concerning NFPA Standards. " They can also be viewed
at www. njj,a.orgldisclaimers or obtained on requestfrom NFPA.
UPDATES, ALERTS, AND FUTURE EDITIONS: New editions of
NFPA codes, standards, rerommended practices, and guides (i.e.,
NFPA Standards) are released on scheduled revision cycles. This
edition may be superseded by a later one, or it may be am ended
outside of its scheduled revision cycle through the issuance of Tenta­
tive Interim Amendments (TIAs). An oJJicial NFPA Standard at any
point in time consists of the current edition of the document, together
with all TIAs and Errata in effect. To verify that this document is the
current edition or to determine if it has been amended by TIAs or
En-ata, please consult the National Fire Codes® Subscription Seroire
or the ''List of NFPA Codes & Standards" at www.nfpa.org/docinfo.
In addition to IIAs and En-ata, the document information pages also
include the option to sign up for alerts for individual documents and
to be irroolved in the development of the next edition.
NOTICE: An asterisk (*) follm\�ng the numher 01- lette1-
designating a paragraph indicates that explanat01y mate1·ial on
the paragraph can be found in Annex A.
A reference in brackets r l following a section or paragraph
indicates material that has been extracted from another NFPA
<locument. Extracted text may be edite<l for consistency an<l
style and may include the revision of internal paragraph refer­
ences and other references as appropriate. Requests for inter­
pretations 01· revisions of extracte<l text shall be sent to the
technical committee responsihle for the source document.
Information on reference<l an<l extracted publications can
be found in Chapte1· 2 an<l Annex D.
Chapter I Adminislration
I.I Scope.
I.I.I The scope of this code is to establish minimum criteria
as follows in 1.1.2 through 1.1.14.
1.1.2 FWidamentals. Chapter 4 establishes c1·ite1·ia for levels of
health care sen,ices or systems ba�ed on risk to the patient�.
staff, 01· visito1·s in health care facilities.
1.1.3 Gas and Vacuum Systems.
1.1.3.1 Chapter 5 covers the performance, maintenance,
installation, and testing of the following:
( 1) Nonflammahle me<lical ga� systems with opei-ating pres­
sures below a gauge pressure of 2068 kPa ( 300 psi)
( 2) Vacuum systems in health ca1·e facilities
( 3) ,vaste anesthetic gas disposal (WAGD) systems, also refe1·­
red to as scavenging
(4) Manufactm·e<l assemblies that are intended fo1· connec­
tion to the me<lical gas, vacuum, or \VAGD systems (also
1·efen-ed to as scavenging)
1.1.3.2 Requirements for po1·table comp1·essed gas systems are
covere<l in Chapter 11.
2021 Edition
1.1.3.3 Requirement� fo1· piped gas an<l vacuum systems 111
h)perbaric facilities are covered in Chapter 14.
1.1.3.4 Requirement� for piped dental gas an<l vacuum
systems are cove1·ed in Chapte1· 15.
1.1.4 Electrical Systems.
1.1.4.1 Chapte1· 6 covers the performance, maintenance, and
testing of electrical systems (hoth normal an<l essential) in
health care facilities.
1.1.4.2 The following a1-eas are not ad<lressed in this code, but
are addressed in other NFPA documents:
(1) Specific 1·equi1·ement5 for wising and installation of elec­
tt·ical systems and component� thereof are covered 111
NFPA. 70.
(2) Requirement5 for illumination an<l identification of
means of egress in health ca1·e facilities are cove1·ed 111
NFPA 101.
(3) Requirement5 for installation, testing, an<l maintenance
of fit·e protection signaling systems a1·e covere<l in
NFPA 72.
(4) Requi1·ement5 fo1· installation of fire pumps are cove1·ed
in NFPA 20, except that the alternate power source is are
pe1·mitted to he the essential electrical system.
(5 ) Requi1·ement� fo1· installation of stationaty engines and
gas turbines are covered in NFPA 37.
1.1.5 Informa tion Technology and Communications Systems.
Chapter 7 covei-s the perfo1·mance, maintenance, an<l testing of
information technology and communications systems in health
care facilities.
1.1.6 Plumbing. Chapter 8 covers the perforntance, mainte­
nance, and testing of plumhing systems in health care facilities.
1.1.7 HVAC Systems. Chapter 9 cove1·s the perfo1·mance,
maintenance, and testing of heating, cooling, and ventilating
in health care facilities.
1.1.8 Electrical Equipment.
Chapter 10 cove1·s the perform­
ance, maintenance, and testing of electrical equipment in
health care facilities.
1.1.9 Gas Equipment. Chapter 11 covers the performance,
maintenance, and testing of gas equipment in health ca1-e
facilities.
LI.IO* Emergency Management. Chapter 12 establishes crite-
1·ia fo1· emergency management in the development of a
program for effective disa.�ter preparedness, response, mitiga­
tion, an<l recovery in health ca1·e facilities.
1.1.11 Security Management. Chapter 13 establishes criteria
for security management, including management controls,
mitigation practices, staff training, and program evaluation in
health care facilities.
1.1.12* Hyperbaric Facilities. Chapter 14 establishes criteria
for design an<l operation of hype1·baric chambe1·s and facilities.
Chapter 14 cove1·s electrical, fire, pressm·e, and gas hazards
a�sociated with hype1·baric facilities that are used. or intended
to be use<l, for medical an<l experimental procedures at gauge
p1·essures from O kPa to 690 kPa (0 psi to 100 psi).
1.1.13 Dental Gas and Vacuum System. Chapter 15 covers the
performance, maintenance, and testing of <lental gas and
vacuum systems in health care facilities.
 REFERENCED PUBLICATIONS
1.1.14 Features of Fire Protection. Chapte1· 16 covers the
performance, maintenance, anrl testing of fire protection
equipment in health ca1-e facilities.
1.2 Purpose. The purpose of this code is to provide minimum
requirement� for the installation, inspection, testing, mainte­
nance, pei-formance, and safe practices for facilities, mate1-ial,
equipment, anrl appliances.
1.3 Application.
1.3_1 This code shall apply to all health care facilities other
than home care and vete1·ina1·y care, except as requi1·erl by
1.3.1.1.
1.3.1.1 Hyperbaric chambers for veterinary care shall be in
acc01·rlance with the 1·equi1·ements ofChapte1· 14.
1.3.1.2 This code is intended for use by those pe1·sons involved
in the design, construction, inspection, and operntion of health
ca1-e facilities and in the rlesign, manufacture, anrl testing of
appliances anrl equipment userl in patient care rooms of health
can· facilities.
1.3.1.3* Facilities that employ systems, equipment, 01· applian­
ces that are subject to regulation by this code shall not be
1-equirerl to be subject to any other provisions of this corle
unless so rli1·ected by the scope of the indivirlual chapte1·(s) of
this code or as directerl by the authority having jurisdiction's
adoption of this corle.
1.3.2 Construction anrl equipment 1·equirement� shall be
applied only to new construction and new equipment, except
as modified in inrlividual chapters.
1.3.2.1 Only the alte1·ed, 1·enovaterl, 01· morlernizerl portion of
an existing system or indivirlual component shall be required
to meet the installation and equipment requirements stated in
this corle.
1.3.2.2 If the alteration, renovation, or morlernization
adversely impacts the existing performance requirements of a
system 01· component, additional upgrnding shall be requi1-erl.
1.3.2.3 A.n existing system that is not in strict compliance with
the provisions of this corle shall be permitted to be continued
in use, unless the autho1·ity having jurisdiction has dete1·minerl
that such use constitutes a rlistinct hazard to life.
1.3.2.4 Rerlucing safety features in existing systems shall not
be permitted where such is requi1·ed for new construction or
equipment.
1.3.3 Polici es.
1.3.3.1 The health care organization shall ensure that policies
are established and maintainerl that permit the attenrling merli­
cal professional to supersede the requirements of this code in
01·de1· to satisfy the eme1·gency neerls of any patient.
1.3.3.2 Each application of the provisions of 1.3.3.1, where
this code's requirement� are superserlerl to satisfy the emer­
f
gency needs o a patient, shall be clearly documented anrl
1·eviewed with the intent of meeting similar futu1·e neerls within
the requirements of this code.
1.3.4 Patient Care Spaces.
1.3.4.1 The health care facility's governing body or it� desig­
nee shall establish the following areas in accorrlance with the
type of patient care anticipated (sf¥' 3.3.140, Patifnt Carf Space):
99-15
( l) Category l spaces
(2) Category 2 spaces
(3) Category 3 spaces
(4) Category 4 spaces
1.3.4.2 Anesthesia. It shall be the responsibility of the health
ca1·e facility's governing body to designate anesthetizing loca­
tions.
1.3.4.3 Wet Procedure Locations. It shall be the responsibility
of the health care facility's governing borly to rlesignate wet
procedure locations.
1.4 Equivalency.
1.4.1 Nothing in this code is intenderl to prevent the use of
systems, methorls. 01- devices of equivalent or superior quality,
strength, fire resistance, effectiveness, durability, anrl safety to
those prescribed by this corle. Technical rlocumentation shall
be submitted to the authm·it:y having ju1·isdiction to rlemon­
strate equivalency. The system, method, or rlevice shall be
approved for the intended purpose by the authority having
jurisrliction.
1.4.2 Alternative systems, methorls, or devices approved as
equivalent by the authority having jurisdiction shall be recog­
nized as being in compliance with this code.
1.4.3 The authority having jurisdiction shall be permitted to
grant exceptions to this code.
1.5* Units. Prima1y unit� will be trnde units, and secondaty
units will be the conversion.
1.6 Code Adoption Requirements.
1.6.1 The effective <late of application of any provision of this
code is not rletermined by the National Fire Protection Associa­
tion. All questions related to applicability shall be di1·ected to
the authority having jurisdiction.
1.6.2 Enforcement. This corle shall be administered and
en.forcerl by the authority havingjurisrliction. (SPP A.nnPx Cfor a
smnplP wnrdingfor enabling legislatinn.)
Chapter 2 Referenced Publications
2.1 * General. The document� referencerl in this chapter, or
portions of such rlocuments, are referenced within this code
anrl shall be conside1·ed part of the 1-equirement� of this code,
and the following shall also apply:
(1) Document� referencerl in this chapter, or portion of such
document�, shall only be applicable to the extent called
for within other chapters of t his code.
(2) Where the requirements of a referenced code or stanrl­
ard dille1· from the requi1·ements of this code, the
1·equi1·ements of this code shall govern.
(3) Existing builrlings or installations that do not comply with
the provisions of the codes or standards referenced in
this chapter shall be permitted to be continued in sen-ice,
provirlerl that the lack of conformity with these docu­
ment� rloes not present a serious hazarrl to the occupant�
as rleterminerl by the authority having jurisdiction.
f J0J:2.1 l
2021 Edition
99-16 HEALTH CARE FACILITIES CODE
2.2 NFPA Publications. National Fi1·e Protection A�sociation.
1 Batterym arch P ark, Quincy, MA 021G9-7471.
NFPA 10, Standard for Portable Fire Extinguishns, 2018 edition.
NFPA 13, Standard for the lnslallatinn of SprinldM Systl'1m, 2019
edition.
NFPA 14, Standard for the installation of Standpipe and HnsP
-�vstnm, 2019 edition.
NFPA 20, Standard for the Installation of Statinnary Pumps for
Hre Pmtertinn, 2019 edition.
NFPA 25, Standard for the Inspertinn, ]ps/ing, and Mainte nrm1:e
nf Water-BasNl Fire Pmtfftinn Systnn�. 2020 edition.
NFPA 30, Fla11111wble and Cmnbustible Liquids Cnde, 2021
edition.
NFPA 31, Standard for the Installation nf Oil-Burning 1.'quipment,
2020 edition.
NFPA 37, Standard for the Installation and u�e nf Statinnary
Cmnlmslinn Engi.rws and (',as Turbine.1, 2018 edition.
NFPA 45, Standard nnFire Pmtfftinn fnr Laboratnril'-1 U�ing Chm1-
iral1, 2019 edition.
NFPA 54, National Fuel (',as Cnde, 2021 edition.
NFPA 55, Cmnpressed (',ases and Cr yngenir Ruid� Cnde, 2020
edition.
NFPA 58, Liquefied Petmlewn (',a_1 Cnde, 2020 edition.
NI-PA 7rP, National E!Pdriral ('nde ®, 2020 edition.
NFPA 7:P, 1\lational Fire 1tlarm and Signaling Cndl", 2019
edition.
NFPA 82, Standard nn Inrinemlor.1 and Waste and Linen
Handling Syste111s and 1.'quipmmt, 2019 edition.
NFPA 90A, Standard for the Installation nf ,4ir-Conditinning and
Vmtilating Systmns, 2021 edition.
NFPA 91, Standard for Exhaust Syste111sf"r Air Cnnveying nf
Vapors, C11sl'-1, 1'iist1, and Partirulate Snlids, 2020 edition.
NFPA 96, Standard for l1Pntilatinn Cnntml andFire Pmtn:tinn nf
Cmmnerrial Cnnking Operatinns, 2021 edition.
NFPA IOI ®, Life Saffty Cnde®, 2021 edition.
NFPA 110, Standardfor fanergenry and Standby Pawer Systnn1,
2019 edition.
NFPA 111, Standard on Stnred Elertriml Energy Emergm1y and
Standby Pnwer Systems, 2019 edition.
NFPA 170. Standard for Fire Safety and Eml'lgency Symbol1, 2018
edition.
NFPA 211, Standard for ('.,himn1ys, Fireplarl'-�, Vent1, and Solid
hll'l-Buming.4pplianas, 2019 edition.
NFPA 259, Standard Test Aiffhnd for Potmtial Hmt of Building
Material,, 2018 edition.
NFPA 2G0, Standard Methods of1Pst� and ClaHijit:ation System for
CigarPtte Ignition Resi1tanrP of Cmnponenl1 nf Uphol,tered h1miture,
2019 edition.
NFPA 261, Standard lvlNhnd of ]pst fnr Detmnining Resistance nf
Mnrk-Up Uphnl1tered Furniture IHaterial Assnnblil'-1 tn Ignition by
SmoldPring Cigamttes, 2018 edition.
NFPA 28G, Standard I'>lethnd1 nf Fire ]psts for Evaluating Contri­
lmtion nf Wall and Ceiling InteriorFinish tn Rnmn Fire Grnwth, 2019
edition.
NFPA 418, Standard for Heliports, 201 G edition.
NFPA 400, Hm.a,dnm Material1 Cnde, 2019 edition.
NFPA 495, Expln.tive Material� CodP, 2018 edition.
NFPA 701. Standard Alethnd1 nf Fire ]psts for Flame Propagation
nflPxtiles andFilms, 2019 edition.
NFPA 750, Standard n n Water Mi,t Fire Prntertinn Systnns, 2019
edition.
2021 Edition
NFPA 853, Standard fnr the Installatinn of Statinnar y Fill'l Cell
Pnwer Systems, 2020 edition.
NFPA 1600®, Standard nn Cnntinuity, Emergen,y, and Cri'iis
Management, 2019 edition.
NFPA 2001, Standard nn Clean ,4g1>ntFire Extinguishing Systems,
2018 edi tion.
NFPA 5000®, Building Gmstruction and Safety Coders, 2021
edition.
2.3 Other Publications.
2.3.1 AAMI Publications. Associ ation for the Advancement of
Medical Instrnmentation, North Glehe Road, Suite 300, Arling­
ton. VA 22203.
ANSI/AAMI ESfi0G0l-1, I\,fediml electrii:al equipment - Part 1:
(',eneral requirements for ba1i1.· safety and essmtial f>erformanre, 2012.
2.3.2 ANSI Publications. American National Standards Insti­
tute, Inc., 25 West 43rd S treet, 4th Floor, New York, NY 10036.
ANSI B57.l, Cnmpressed (',as Cylinder Valve OutlPI and Inlet
Cnnnertinns, 19G5.
ANSI Zl3G.3, Ameriran National Standard for Safe U,e nf La1ers
in Health Care, 2018.
2.3.3 ASHRAEPublications. ASHRAE, 1791 Tullie Circle, NE,
Atlanta, GA 30329-2305.
ASHR-\E 90.1, EnPrgy Standard for Buildings Exmpt Low-Rise
&.tidential Buildings, 20lG.
ASHRA.E 170, Ventilatinn nf Health Care Fat:ilities, 2017, includ­
ing Addenda a.
2.3.4 ASME Publications. American Society of Mechanical
Engineers. Two Park Avenue. New York. NY l00lG-5990.
ASME Al7.l/CSA B44. Safety Code fnr Elevators and fai:alatnrs.
2016.
ASME Al7.:>, Safety Cnde fnr Existing Elroators and li.scalatnrs,
2015.
ASME Bl .20.1, Pipe Thrpad,, General Purpose, Inch, 2013.
ASME Blfi.22, Wmught CoppPr and Cnpper Alloy Snlder-joint Pm�­
sure Fittings, 2013.
ASME Bl G.2G, Cast Cnpper Alloy Fittings for H1md Copper Tubes,
2013.
ANSI/ASME Bl6.50, Wrought Cnppn and Copper ,4llny Brm.e-
Joint PrPssureFittings, 2013.
ASME B31.:>, Pmre.�� Piping, 2016.
ASME B40. l 00, Pre.mtre Gauges and Gaugp Attarhments, 2013.
ASME PVHO-1, Safety Standard for Pressure ie.uel, fnr Human
Oi:rnpanry, 2016.
Boiler and PrfssurP Vfssel Code, 2017.
2.3.5 ASSE Publications. Ame1·ican Society of S anitaty Engi­
neering, 18927 Hickory Creek Drive, Suite 220, Mokena, IL
60448.
AS SE GO 10, PmJe.��innal Qualifii:atinns Standard for I\,fpdiral Gos
Systmns Installe rs, 2018.
AS SE 6015, Pmfe.�1innal Qualifiratinns Standard for Bulk Mediral
Gns Systmns Imtallers, 2018.
 REFERENCED PUBLICATIONS
ASSE 6020. Professional Qzwlifimtinns Standard fnr Mediml Gas
Systnns Inspttor:-;, 2018.
ASSE 6030, Pmfessirmal Qualifimtions Standard for Mediral Ga�
Systems V!>rijien, 2018.
ASSE 603.">, Professional Qualifiratiom Standard for Bulk Mediral
Gas Systnns \frijim, 2018.
ASSE 6040, Prnfessional Qualifirations Standard for Medical Ga�
Alaintmanre Pl'rsonnPl, 2018.
2.3.6 ASTM Publications. ASTM International, 100 Barr
Harbor Drive, P.O. Box C700, West Conshohocken, PA
19428-2959.
ASTM A269/A269M, Standard Sperifimtion for Seamless and
VVelded iwstn1itir Stainles� Steel Tubing for (',eneral Servia, 2015a.
ASTM A.�12/A312M, Standard SpPCifiration for Semnless,
Welded, and Hmvily Cold Worked A.mtmiti,: Stainle.�� Steel Pipes,
2018a.
ASTM B32, Standard Spnijiration for Solder Metal, 2008, 1·eap­
prnved 2014 .
ASTM B88, Standard Spedfiratinn for Seamles.� CoppPr Water
Tube, 2016.
ASTM Bl03/B103M, Standard Sperifiration for Phosphor Brnnu
Plllte, ShPPt, Stiip, and Rnlled Bar, 2015.
ASTM B280, Standard Sprifimtion for Semnles� Copper 111/Je for
A.ir Conditioning and RPfrigm1tinn Field Service, 2018.
ASTM B819, Standard Sprifiration for Seamle.�� Copper Tube fnr
Aifdiml Gas Systems,2018.
ASTM B828, Standard Practire for II-laking Capillary jnint.1 by
Soldering nf Cnpper and Copper Allny Tube and Fittin�, 2016.
ASTM D5/D5M, Standard Test 1',Jetlwdfor Penetratinn nf Bitmni­
nous Alaterial�. 2019.
ASTM Dl785. Standard Sperifimtinn fnr Pn(v(Vinyl Chlnride)
(PFC) Plmtir Pi(x', Sr.hedules 40, 80, and 120, 2015el.
ASTM D24(i6, Standard SpN:ifiration fnr Poly(Vinyl Chloride)
(PVC) Plmtir Pi{x' Fitting1, Sdiedule 40. 2017.
ASTM D2467, Standard Spffijiration fnr Poly(Vinyl Chloride)
( PVC) Pla�tir. Pip Fittin�, S,:hedule 80, 2015.
ASTM D2672, Standard Sper.ijimtinn fnr Jnints fnr JPS PVC Pipe
u�ing Snlvent Cement, 2014.
ASTM D2846/D2846M, Standard Sperifiratinn for Chlminated
Pnl}>(Vinyl Chlnride) (CPVC) Plllstir Hnt- and Cnld-Watfr Distributinn
Systnns, 2019.
ASTM D4359, Standard Test 1't1.etlwd for Dftn-mining Whether a
Material I.I a Liquid nr a Snlid, 1990, 1·eapprnved 2019.
ASTM E84, Standard Test Mftlwd for Surfat:P Burning Charar.ter­
i�tirs of Building Material�. 2019a.
ASTM E136. Standard Test Alethnd for AuP.uing Cnmlmstibility nf
l'llaterial� llring a Fertiral Tube fornace at 750 °C, 2019.
ASTM El5:l7, Standard Test Method for Hre Testing nf Uphnl�tmd
Fumitzm, 2016.
ASTM El590, Standard Test Method fnr Fire ]!'sting nf Mattresses,
2017.
99-17
A.�TM E2652. Standard ]psi Methnd for Assessing Cmubustibility
nf Matfrial� U.ring a Tube Fumare with a Cnne-shaf1ed Airflow Stabil­
iur, at 75D °C, 2018.
ASTM E2965, Standard Test Mfthnd for Detmninatinn nf Lnw
L1,vel� nf Heat RPlmse RfLtP fnr Material� and Prndw:t� U�ing an
O:-:ygen Cnnrnmptinn Calnrimeter, 2017 .
ASTM F438, Standard Spffijiratinn fnr Snr.ket-Type Chlorinated
Pnly(Vinyl Chloride) (CPl'C) Pla�tir Pip Fittin�, Sr.hedule 40, 2017.
ASTM F439, Standard Sperifiratinn for Chlnrinated Pnly (Vinyl
Chlnride) (CPVC) Plllstir. Pipe F'ittin�, Srhedule 80, 2013.
ASTM F441/F441M, Standard Sperifiratinn for Chlorinated
Pn�v(Vinyl Chlnride) (CPVC) Pla�tir Pip, Sr.hedules 40 and 80, 2015.
ASTM F493, Standard Specifiratinn for Sn/vent Cements for Chlmi­
nated Poly(Vinyl Chlnride) (CPVC) Plastii: Pipe and Fittings. 2014.
2.3. 7 AWS Publications. American Welding Society. 8669 NW
3G Street,# 130, Miami, FL 33166-6672.
ANSI/AWS A5.8M/A5.8, Sperifiratinn fnr Filler Metal� for Bra2.­
ing and Braze Welding, 2011. Addenctum 1, 2014.
AWS B2.2/B2.2M, Spfrijiration for Brm.ing Pml.'fdure and
Performana Qualifiration, 2010.
2.3.8 BICSI Publications. BICSI, 8610 Hidcten River Parkway,
Tampa, FL 33637-1000.
T he BICSI lnfnrmatinn Transpnrt Systems ( ITS) Dirtinnarv, 31·ct
edition.
2.3.9 CDA Publications. Coppe1· Development Association
Inc., 260 Madison Avenue, #17, New York, NY 10016.
Cnpper Tube Handbnnk, 2010.
2.3.10 CGA Publicalions. Compressed Gas Association, 14501
Gemge Caner \'\'ay, Suite 103, Chantilly, VA 20151-2923.
CGA C,.7, Guide to Cla�sifiratinn and La/Jf'ling of Compre.��ed
GmP.�. 2014.
CGA G-4. Oxygen, 2015.
CGA G-4.1. Cleaning Equipment fnr Oxygen Servire. 2009.
CGA G-6.1. Standard fnr Inmlated Liquid Carbnn Dinxide Systnm
at Consumer Sites, 2013.
CGA G-6.5, Standard fnr Small Statinnary Inrnlllted Carbnn Dinx­
ide Supply Systnn�, 2013.
CGA G-8.1, Standard for Nitrous Oxide SystmH at Custmner Sill's,
201,\.
CGA M-1, Standard fnr Medical Ga� Supply Systm1s at Health
Ca re Frll'ilitil's, 2018.
CGA P-2.5, Tramfilling nf High Press1m Gmenm Oxygen u�ed fnr
RPspiratinn, 2011.
CGA P-2.6, Transfilling of Liquid Oxygm Used for RPspiratinn,
2011.
CGA P-18, Standard for Bulk Inert Ga� Syste;ns at Conswner Sitl's,
2013.
CGA V-1, Strmdard fnr Cmnpressed Gm C}•lindn Valve Outlet and
Inlet Cnnnfftinns (ANSI B57.l), 2013.
2021 Edition
99-18 HEALTH CARE FACILITIES CODE
CGA V-5. Diameter Index Safety System (NoninlPffhangrable Low
Press11re Connertions for Medical (',as Applimtionsj, 2008, reaf'.
fit·med 2013.
2.3.11 CSA Group Publications. CSA Group, 178 Rexdale
Bl vd., Toronto, ON M9W 1R3, Cana<la.
CSA C 22.2 No. 0.3, ]psf Metlwd� for E!Prtrir:al Wires and Cables,
2009, i·eaffirmed 2014.
2.3.12 FGI Publications. Facilitv Guidelines Institute, 1919
McKinney Avenue, Dallas, TX 75201.
Guidelinesfor Desi gn and Construrtion of Hospital�. 2018.
Guidelines for Design and Construrtion of Outpatient Facilities,
2018.
Guidelim's for Design and Construttion of &sidential Health, Care,
and Support Facilities, 2018.
2.3.13 ISA Publications. International Society of Automation,
67 TW. Alexander Drive. P.O. Box 122i7. Research Triangle
Pad,, NC 27709.
ANSI/ISA S-7.0 .01, Quality Standard for lnstrmnent A. ir, 1996.
2.3.14 MSS Publications. Manufacturn's Standat·dization
Society (MSS) of the Valve an<l Fittings Industry, 127 Park
Street NE, Vienna, VA 22180-4602.
MSS SP-58, Pipe Hangn-s and Support� - lv!aterial�, Design,
lv!anzifarture, SPlertion, App!iration, and Installation, 2009.
2.3.15 State of C alifornia Publicalions. State of California,
Department of Consumer 1�Jfairs, 3485 O1·ange Grove Avenue,
Nmth Highlan<ls, CA 95660-5595.
California Technical Bulletin 117, Requimnent�. 1Pst Proad1m
and Apparatus for TPsting the Flmne &tardar11:e of &silimt Filling
I\,faterinl� u�ed in Uplwl�tPredFumiturP, 2000.
California Technical Bulletin 129, Flammability Test Pmredure
for I\1.attresse.�for u�e in Publir Building�, 1992.
California Technical Bulletin 133, Fl,mmnability Tes/ Proadure
for Seating Fumitim for u�e in Public Ou:upanries, 1991.
2.3.16 TC Publications. Trnnspon Canada, 330 Spat·b Street,
Ottawa, ON KlA ON!',, Canada.
Transportation <ifDangmmt Good� &gulatiom.
2.3.17 TIA Publications. Telecommunications Industry A�so­
ciation, 1320 North Courthouse Road, Suite 200, Arlington, VA
22201.
TL-\/EL'\ 568-B, t..()111mercial Building TPlPmmmunirations
Cabling Standard, 2012.
TL-\/EIA 606-B, Administration Standard for Cmnmerrial 1elP­
rmmnuniratiom Infmstr11rture, 2009.
2.3.18 USP Publications. U.S. Pharmacopeia, 12601 Twin­
brook Parkway, Rock\ille, MD 20852-1790.
Monograph: Oxygen USP.
Monograph: Oxygen USP 93.
2021 Edition
2.3.19 UL Publications. Underwriters Laborntories Inc.. 333
Pfingsten Road, Northbrook, IL 60062-2096.
UL 723, Standard for Tes/ for Surfare Burni ng Cham,:teri,tfrs of
Building MatPrial�, 2018.
UL 1069, Standard for Hospital Signaling and Nurse Call Equifr
men/, 2007, re\ise<l 2018.
UL 1685, Standard for VPrtiml-Tray Firl'-Pmpagation and Smokl'­
&!Pa�e Ttstfor Elerttiral and Optiral-Fiber Cables, 2015.
2.3.20 U.S. G overnment Publications. U.S. Government
Publishing Office, 732 North Capitol Street, NW, Washington,
DC 20401-{)001.
DOE-STD-3020, Sperijiration for HEPA. Filten Used by DOE
t..()ntrarton, Department of Energ)', 2005.
Title 16, Co<le of Federnl Regulations, Part 1632, "Stann­
ard fot· the Flammability of Matu·esses and Mattress Pads (FF
4-72) ..,
T itle 21, Co<le of Fe<leral Regulations, Part 210, "CutTent
Good Manufactut·ing Practice in Manufacturing, Processing,
Packing, or Holding of Drugs - General."
Title 21, Co<le of Fe<leral Regulations, Part 211, "CutTent
Good Manufacturing Practice fot· Finished Pharmaceuticals."
Title 21, Unite<l States Code, Chapter 9, "Fe<leral Food,
Drug, and Cosmetic Act."
2.3.21 Other Publications.
Mfrrimn-lYPbster\ Collegiate Dictionary, 11th edition, Merriam­
Webste1·, Inc., Sp1-ingfield, MA, 2003.
2.4 References for Extracts in Mandatory Se ctions.
NFPA 10, Standard for Portabw Fire .Extinguishers, 2018 edition.
NFPA 13, Standard for the installation of SprinklPr Svstnn,, 2019
edition.
NFPA 30, Flammable and Cmnbmtible Liquid� Code, 2021
edition.
NFPA 55. Comprmed (',ase.1 and Cryagmi,: Fluid� Code, 2020
edition.
NFPA 70®, National Elertriral Codi", 2020 edition.
NFPA 70B, &rmnmmded Pmdir·e for E!Prtrir:al .Equipment Main-
tenanre, 2019 e<lition.
NFPA 99B, Standard for Hy pobatir Farilities, 2021 edition.
NFPA 101®, LifPSajfty Code®, 2021 edition.
NFPA 110, Standard for Enmgm,:y and Standby Power Systmns,
2019 edition.
NFPA Hi70. Standard on Opemtiom and Training for 1Prhniml
Sean:h and &srue lnrident�, 2017 edition.
NFPA 5000®, BuildingConstrnrtion and SafPty Codl\ 2021
edition.
 DEFINITIONS
Chapter 3 Definitions
3.1 General. The <lefinitions containe<l in this chapte1· shall
apply to the tei-ms use<l in this code. Where te1·ms are not
defined in this chapter or within another chapter, they shall be
<lefined using their ordinarily accepted meanings within the
context in which they are used. Merriam-HWister\ Col!Rgi,ate
Dirtionar_\', 11th e<lition, shall be the source for the or<linarily
accepted meaning.
3.2 NFPA Official Definitions.
3.2.1 * Approved. Acceptable to the authority having jurisdic­
tion.
3.2.2* Authority Having Jurisdiction (AHJ). An organization,
office, or individual responsible for enforcing the requirement�
of a co<le or stan<lar<l, or for apprming equipment, materials,
an installation, or a pt·ocedure.
3.2.3* Code. A standar<l that is an extensive compilation of
provisions covering broad subject matter or that is suitable for
adoption into law in<lependently of othe1· codes and standatTls.
3.2.4 Guide. A document that is advisory or informative in
nature and that contains only nonmandatory provisions. A
guide may contain mandatory statement� such a� when a guide
can be used, but the document as a whole is not suitable for
adoption into law.
3.2.5 Labeled. Equipment 01· materials to which has been
attached a label, symbol, or othe1· i<lentifying ma1·k of an organ­
ization that is acceptable to the authority ha,ing jurisdiction
an<l concerned with product evaluation, that maintains pe1·i­
o<lic inspection of pro<luction of labele<l equipment 01· mate1·i­
als, and by whose labeling the manufactm·e1· in<licates
compliance ·with appropriate sta.n<lards or performance in a
specified manner.
3.2.6* Listed. Equipment, mate1·ials, or services inclu<le<l in a
list published by an organization that is acceptable to the
auth01·ity ha,ingjm·isdiction and concerned with evaluation of
product� or services, that maintains periodic inspection of
production of listed equipment or materials or periodic e\-alua­
f
tion o se1·vices , an<l whose listing states that either the equip­
ment, matet-ial, or service meet� appropt-iate <lesignate<l
stan<lar<ls 01· ha� been teste<l and found suitable for a specified
purpose.
3.2.7 Shall. In<licates a mandat01·y requi1·ement.
3.2.8 Should. Indicates a recommendation or that which is
advised but not requi1·e<l.
3.2.9 Standard. An NFPA Standar<l, the main text of w hich
contains only man<latoty provisions using the wor<l "shall" to
in<licate 1·equirements an<l that is in a form gene1·ally suitable
for mandatoty reference by another standat·d <ff co<le or for
adoption into law. Nonmandatory provisions are not to be
considered a part of the requirement� of a standard an<l shall
be \ocate<l in an appendix, annex, footnote, infornrntional
note, or other means a� pennitted in the NFPA Manuals of
Style. \'\'hen used in a generic sense, such as in the phrase
"standards development process" or "stan<lar<ls <levelopment
activities," the term "standards" includes all NFPA Standards,
including Codes, Standards, Recommen<le<l Practices, and
Guides.
99-19
3.3 General Definitions.
3.3.1 Adiabatic Heating. The heating of a gas caused by it5
comp1·ession. (HYP)
3.3.2 Aerosol. An intimate mixture of a liquid or a solid in a
gas; the liqui<l m solid, called the dispe1·se<l pha�e. is uniformly
distt·ibuted in a finely divi<le<l state throughout the gas, which is
the continuous phase or dispersing medium. (MED)
3.3.3 Alarm System. (PIP)
3.3.3.1 Area Alarm System. A warning system within an area
of use that provides continuous visible and audible surveil­
lance of Categ01y l an<l Catego1y 2 medical gas and vacuum
svstems. (PIP)
3.3.3.2 Category 3 Alarm System. A warning system within an
area of use that provides continuous \isible and audible
surveillance of Catego1y 3 medical gas systems. (PIP)
3.3.3.3 Local Alarm System. A warning system that provides
continuous visible and audible surveillance of medical gas
and "-acuum system som·ce equipment at the equipment site.
( PIP)
3.3.3.4 Master Alarm System. A wan1ing system that moni­
tors the operntion an<l condition of the source of supply, the
f
1·eserve source (i any), an<l the presstu-e in the main lines of
each me<lical gas an<l vacuum piping system. (PIP)
3.3.4 Alternate Power Source. One 01· more generator set�, 01·
battery systems where permitted, inten<le<l to provide power
during the interruption of the normal electrical service; or the
public utility electrical service intende<l to provide powe1·
<luring intetTuption of senice normally provided by the gener­
ating facilities on the premises. (ELS)
3.3.5 Ambulatory He alth Care Occupancy. A..11 occupancy
used to provide services or treatment simultaneously to four 01·
more patient� that provides, on an outpatient basis, one or
more of the following: (1) treatment for patients that renders
the patients incapable of taking action for self-pt·eservation
unde1· emergency con<litions without the assistance of others;
(2) anesthesia that ren<lers the patient� incapable of taking
action fot· seu:presermtion un<le1· emergency con<litions with­
out the assistance of others; (3) tt·eatment for patients who,
due to the nature of their injuty rn· illness, are incapable of
taking action for self-preservation under emergency con<litions
without the assistance of others. f 101, 2021 l (FUN)
3.3.6 Ampacity. The maximum current, in amperes, that a
conductor can carry continuously under the conditions of use
without exceeding it� temperature rating. f70, 20201 (EL'I)
3.3. 7 Anesthetic. A� use<l in this code, applies to any inhala­
tional agent used to produce sedation, analgesia, or general
anesthesia. (MED)
3.3.8 Appliance. Utilization equipment, generally othe1· than
industrial, normally built in standardized sizes or types, that is
installe<l or connected as a unit to perform one or more func­
tions. (MED)
3.3.9 Applicable Code. The building co<le, fire co<le, or
NFPA 101 adopte<l by the jurisdiction, or NFPA J OJ where no
such code has been adopted by the jurisdiction. (FUN)
2021 Edition
99-20 HEALTH CARE FACILITIES CODE
3.3.10* Applicator. A means of applying high-frequency
energy to a patient other than by an electrically comluctive
connection. (MED)
3.3.11 Area of Administration. Any point within a room
within 4.3 m (15 ft) of oxygen equipment or an enclosure
containing 01- intended to contain an oxygen-e1u-iched atmos­
phere. (MED)
3.3.12* Atmosphere. The pressure exerted by, and gaseous
composition of, an environment. (HYP)
3.3.12.1 Atmosphere Absolute (ATA). The pressure of the
earth"s atmosphere, 760.0 mmHg, 101.325 kPa, or 14.7 psia.
Two ATA = l:\vo atmospheres. (SPe alsn 3.3.12, AtmnsphPrP.)
(HYP)
3.3.12.2* Atmosphere of Increased Burning Rate. Any atmos­
phe1·e containing a percentage of oxygen or oxygen and
nitrous oxide greater than the quotient of 23.4:, divided by
the squa re root of the total pressure in atmospheres. (HYP)
3.3.12.3 Chamber Atmosphere. The emironment inside a
chamber. (HYP)
3.3.13 Automatic. Providing a function without the necessity
of human inten,ention. (ELS)
3.3.14 Bathrooms. An area including a basin with one 01-
more of the following: a toilet, a urinal, a tub, a shower, a bidet,
or similar plumbing fixtures. r10, 20201 (FON)
3.3.15 Battery-Powered Lightin g Units. Individual unit equip­
ment for backup illumination consisting of a rechargeable
battery, battery-<:harging means, provisions fo1· one 01· more
lamps mounted on the equipment, or with te1·minals fo1·
remote lamps, or both, and relaying device arranged to ener­
gize the lamps automatically upon failure of the supply to the
unit equipment. r10, 20201 (ELS)
3.3.16 Bends. Decompression sickness; caisson worker's
disea�e. (HYP)
3.3.17 Branch Circuit. The circuit conductors between the
final overcurrent device protecting the circuit and the
outlet(s). r10, 20201 (ELS)
3.3.18 Branch Line. See 3.3.146, Piping. (PIP)
3.3.19 Bulle System. An assembly of equipment for supplying
comp1·essed ga� (consisting of, but not limited to. sto1·age
containers, pressure 1·egulat01·s, pressm·e relief devices, vaporiz­
f
ers, mani olds, and interconnecting piping) that terminates
where the gas, at service pressure, first enters the main line.
The stornge containe1·s are either· stationary or movable and
include unconnected reserves on hand at the site, and the
source gas is stored as a compressed gas or cryogenic fluid.
(PIP)
3.3.19.1 Bulk Inert Gas System. A bulk system with a stornge
capacity of more t11an 566 m� r20,ooo ft� (sd) l of inert gas.
(PIP)
3.3.19.2 Bulk Nitrous Oxide System. A bulk system with a
stornge capacity of more than 1452 kg (3200 lb) rapproxi­
mately 793 m3 (28,000 ft') at normal tempernture and pres­
sure.I of nitrous oxide (PIP).
2021 Edition
3.3.19.3* Bulk Oxygen System. A bulk system with a stornge
capacity of mon, than :,66 m' (20,000 ft:3) at normal temper­
atm·e and pressur·e of oxygen. (PIP)
3.3.20 Category 3 Vacuum System. A Category 3 vacuum
distribution system that can be either a wet system designed to
1·emove liquids, air-gas, or solids from the treated area; 01· a dry
system designed to trnp liquid and solids before the senice
inlet and to accommodate air-gas only through the service
inlet. (PIP)
3.3.21* Central Suppl y System_ The complete source of
supply for a medical ga� or vacuum system or a medical support
gas system. (PIP)
3.3.22 Clean Agent. Electrically non-conducting, volatile, or
gaseous fire extinguishant that does not leave a residue upon
evaporation. r10, 20181 (FUN)
3_3.23* Clinical IT Network. An information technology
video, voice, and data communication nel:\\/ork that is dedica­
ted for shared use by medical devices, nur·se call, clinical info1·­
mation systems, patient-<:ritical applications . and clinical
wireless communication equipment. (ELS)
3.3.24 Combustible. Capable of unde1·going combustion.
(MED)
3.3.25* Combustible Liquid. Any liquid that was a closed-cup
flash point at or above 37.8'C (I0O O F). Combustible liquids ar·e
classified as follows: (a) Class II liquid. A.ny liquid that ha� a
flash point at or above 37.8 ° C ( lOOOF) and below 60'C (14-0"F);
(b) Class IIL<\ liquid. Any liquid that has a fla�h point at or
above 60'C (140'F) and below 93"C (2000F); (c) Class IIIB
liquid. Any liquid that has a flash point at 01· above 93'C
(200'F). (FUN)
3.3.26* Combustion. A chemical process of oxidation that
occtlt"s at a rnte fast enough to produce heat and usually light
in the form of either a glow or flame. r5000, 2021 l (HYP)
3.3.27 Compact Storage. Stornge on solid sheh·es not exceed­
ing 0.9 m (36 in.) in total depth, arranged as part of a compact
storage module, witl1 no more tl1an 0.76 m (30 i n.) bel:\veen
shelves venically and with no inten1al venical flue spaces other
than those between i ndividual shelving sections. [13, 20191
(FON)
3.3.28* Compressed Medical Gases (CMG). Any liquefied or
vaporized gas alone or in combination with other· gases that is
classified as a drug. r55, 20201 (PIP)
3.3.29 Container. A low-pressure, vacuum-insulated vessel
containing gases in liquid form. (MED)
3.3.29.1 Liquid Oxygm Base Reservoir Container. A container·
used for liquid oxygen not exceeding 60 L (15.8 gal) specifi­
cally designed for use as a medical device as defined by 21
OSC 9, "Federal Food, Drug and Cosmetic Act," that is
intended to deliver gaseous oxygen for therapeutic use.
transfilling, or both. (MED)
3.3.29.2 Liquid Oxygen Portable Container. A container· used
fot· liquid oxygen not exceeding 1.5 L (0.396 gal) specifi­
cally designed for use as a medical device as defined by 21
OSC 9, "Federal Food Drug and Cosmetic Act," that is inten­
ded for p01·table thernpeutic use and to be filled from its
companion base unit, which is a liquid oxygen base reser­
voir container. (MED)
 DEFINITIONS
3.3.30 Critical Branch. A system of feeciers and branch
circuits supplying power for task illumination, fixed equip­
ment, select receptacles, and select powe1· ci1·cuit� sening areas
and fi.mctions related to patient care that a1·e automatically
connected to alternate power sources by one or more transfer
switches during interruption of the normal power source.
(ELS)
3.3.31 Critical Equipment. That equipment essential to the
safety of the occupanl� of the facility. (HYP)
3.3.32 Cryogenic Fluid Central Supply System. An assembly
of equipment for suppl)'ing compressed ga�. incluciing. but not
limited to, a stationa1·y tank(s) that is permanently installed
thrnugh anchoring to a foundation, pressure regulators, p1-es­
s111·e relief cievices, vaporizers, manifolds, anci interconnecting
piping that is designed to be filled at the health care facility
with a cryogenic fluid and that terminates at the source valve.
(PIP)
3.3.32.l Bulk Nitrous Oxide Central Supply System. A central
supply system with a stornge capacity of more than 1452 kg
(3200 lb) fi.e., apprnximately 793 m3 (28,000 ft�) at normal
tern perature and pressure l of nitrous oxide. (PIP)
3.3.33 Cylinder. A supply tank containing high-p1·ess111·e gases
01· gas mixtures at p1·essu1·es that can be in excess of 13.8 kPa
gauge (2000 psi gauge). (MED)
3.3.34 Decompression Sickness. A syndrome due to evolved
gas in the tissues 1·esulting from a 1-eduction in ambient pt·es­
sure. (HYP)
3.3.35* Defend in Place. The operntional response to an
emergency in a builrling. in which the initial action does not
involve evacuation of the building occupant�. (FUN)
3.3.36 Demand Check. A pai1·ed set of fittings that pe1·mit ga�
flow when correctly mateci hut interrupt flow when separateci.
(PIP)
3.3.37 Dental Air. Comp1·esseci gas to drive dental cievices,
supplied by compressed air systems, pressurized cylinde1·s of air,
or nitrogen. (PIP)
3.3.38 Dental Office. A building or part thereof in which the
following occtu-: (I) examinations anci minor t1-eatment�/
procedures performed under the continuous supervision of a
ciental professional; (2) use of limited to minimal sedation and
treatment 01· p1·oceci111·es that do not 1·ender the patient incapa­
ble of self-preservation under emergency conditions; and (3)
no overnight stays for patient� or 24-hour operations. (PIP)
3.3.39 Dental Vacuum/Scavenging. A system used in dentistry
for oral evacuation anci nitrous oxicie/oxygen scavenging.
(PIP)
3.3.40 Detonation. An exothe1·mic 1·eaction whe1·ein the 1·eac­
tion propagates through the unreacted material at a rate
exceeding the velocity of sound, hence the explosive noise.
(MED)
3.3.41* Direct Electrical Pathway to the Heart_ An external­
izeci conciuctive pathway, insulated except at it� encis, one end
of which is in direct contact with heart muscle while the other
is outside the body and is accessible for inacivertent or inten­
tional contact with groundeci objects or energized, grounci-
1·eferenced sou1·ces. (MED)
99-21
3.3.42* Disaster. \Vithin the context of this code. any unusual
occurrence or unforeseen situation that seriously overtaxes or
threatens to se1·iously overtax the routine capabilities of a
health care facility. (HES)
3.3.43 D .I.S.S. Connector. A system of noninterchangeable
medical gas and vacuum connect01·s complying with CGA V-5,
Dimn�tn Indrx Safety System (Noninterrhangral1le Low Pre.uure
Connfftinm for Medii:al Gas A.pplii:atinm). (PIP)
3.3.44* Double-Insulated Appliances. Appliances whe1·e the
primaty means of prntection against electrical shock is not
grounding. The primary means is by the use of combinations of
insulation anci separation spacings in accordance with an
apprnveci stanciard. (MED)
3.3.45 Electrical Life Support Equipment. Electrically
powered equipment whose continuous operation is necessa1y
to maintain a patient's life. (ELS)
3.3.46 Electrical Preventive Maintenance (EPM). A manageci
program of inspecting, testing, analyzing, and servicing electri­
cal systems and equipment with the put·pose of maintaining
safe operations anci production by 1·educing or eliminating
system interruptions anci equipment breakdowns. f70B, 20191
(ELS)
3.3.47 Electrode. An electt·ically conductive connection to a
patient. (MED)
3.3.48 Emergency Management. The act of developing proce­
ciures anci plans to create effective preparedness, mitigation,
response, and recovery during a disaster aflecting a health care
facility. (HES)
3.3.49 Emerge ncy Oxygen Supply Connection (EOSC). An
f
assembly o equipment that permits a gas supplier to make a
temp01·a1y connection to supply oxygen to a building that has
had iL� mffmal smu-ce of oxygen inte1n1pted. (PIP)
3.3.50 Equipment Branch. A system of feeders and branch
cit-cuit� arrangeci fo1· delayed, automatic, or manual connection
to the alternate power source and that serves prima1·ily 3-phase
power equipment. (ELS)
3.3.51 Equipment Grounding Bus. A grounding te1·minal bus
in the feede1- ci1·cuit of the branch circuit distribution panel
that sen;es a particular area. (MED)
3.3.52* Es.sential Electrical System. A system comp1·ised of
alternate powe1· sou1·ces anci all connected distribution systems
and ancillary equipment, designed to ensure continuity of elec­
trical power to designated areas anci functions of a health care
facility during disruption of nonnal power smu-ces, anci also to
minimize ciisruption within the inten1al v.�ring system. (ELS)
3.3.53 Evacuation - Waste Gas. See 3.3.185, Wa�te Anes­
thetic Gas Disposal. (PIP)
3.3.54 Exposed Con ductive Surfaces_ T hose surfaces that are
capable of carq,ing electric current and that are unprotected,
uninsulated, unenclosed, or unguarded, permitting pe1·sonal
contact. (ELS)
3.3.55* Facility Fire Plan. A plan developed by the health
ca1·e facility to ciesc1·ibe the actions to be taken dut·ing a fire
emergency. (FUN)
3.3.56 Fault Current. A current in an accidental connection
between an energized anci a g1·ouncieci or other conductive
2021 Edition
99-22 HEALTH CARE FACILITIES CODE
element 1·esulting from a failure of insulation. spacing. or
containment of conrluctors. (ELS)
3.3.57 Feeder. All circuit conrluctors betw·een the service
eguipment. the som-ce of a separately rle1·ived system, m· othe1·
power supply source anrl the final branch-circuit overcurrent
rlevice. (ELS)
3.3.58* FGI Guidelines. A collection of rlocuments that
includes the following: (1) Guidtlines for Design and Comtrurtion
of Hospital�; (2) GuidPlinPs for Design and Comtrurtion of Outpa­
tient Farilitifs; anrl (3) GuidPlims for Dtsign and Comtrnrtion of
&sidential Hmlth, Cart, and Support FadlitiPs.
3.3.59* Flammable. A combustible that is capable of easily
being igniterl anrl rapidly consumerl by fire. (FUN)
3.3.60 Flammable Gas. Any substance that exist� in the
gaseous state at normal atmosphe1·ic tempernture and pressure
anrl is capable of being ignited anrl burned when mixed with
proper proportion of air, oxygen, or other oxirlizers. (HYP)
3.3.61 Flammable Liquid. A liguid that has a closed-cup flash
point that is below 37.8'C (I0OO F) and a maximum vapor pres­
sure of 2068 mmHg (40 psi absolute) at 37.S"C (I0OOF). (FUN)
3.3.62* Flash Point. The minimum temperatm·e at which a
liquid m· a solid emits vapor sufficient to fonn an ignitable
mixture with air near the surface of the liguid or the solid.
(FUN)
3.3.63 Flow-Control Valve. A valve, usually a needle valve, that
precisely controls flow of ga�. (MED)
3.3.64* Flowmeter. A device fo1· measuring volumetric flow
rates of ga�es and liquids. (MED)
3.3.65* Frequency_ The number of oscillations, per unit time,
of a panicular cutTent m· voltage waveform. 1l1e unit of
freguencv is the henz. (MED)
3.3.66* Fume Hood_ An enclosure designed to rlraw air
f
inwatTI by means o mechanical ventilation. (EL�)
3.3.67 Gas-Powered Sy..tem. A Level 3 gas rlistribution system
comprised of component part� including but not limited to
cylinders. manifolds. air compressor. motor. 1·eceivers. controls.
filters, dryers, valves, and piping that rlelive1·s compresserl air m·
nitrogen at pressures less than 1100 kPa (less than 160 psi)
gauge to power rlevices (e.g., hanrl pieces, syringes, cleaning
rlevices) as a powe1· sou1·ce. (PIP)
3.3.68* G eneral Anesthesia and Levels of Sedation/Analgesia.
3.3.68.1 General Anesthena. A drug-induced loss of
consciousness during which patient� are not arousable, even
by painful stimulation. The ability to inrlependently main­
tain ventilatory function is often impaired. Patients often
1·eguire assistance in maintaining a patent airway. and posi­
tive pressm·e ventilation may be regui1·ed because of
rlepressed spontaneous ventilation or drug-induced depres­
sion of neuromuscular function. Carrliovascular function
may be impai1·ed. (PIP)
3.3.68. 2 Deep Sedation/Analgena. A drug-induced depres­
sion of consciousness rlm·ing which patient� cannot be easily
aroused but responrl pm-posefully following repeated 01-
painful stimulation. The ability to independently maintain
ventilatory fimction may be impairerl. Patient� may reguire
assistance in maintaining a patent ainvay, anrl spontaneous
2021 Edition
ventilation may be inadeguate. Ca1·diovascula1· function 1s
usually maintai ned. (PIP)
3.3.68.3 Moderaie Sedation/Analgesia (ConscioUII Sedation). A
rlrug-induced depression of consciousness rlu1·ing which
patients respond purposefully to verbal commanrls, either
alone or accompanied by light tactile stimulation. No inte1·­
ventions are regui 1·ed to maintain a patient airway, and
spontaneous ventilation is arleguate. Cardiovascula r func­
tion is usually maintainerl. (PIP)
3.3.68.4 Minimal Sedation (Aru:iolyns). A rlrug-inrlucerl state
during which patient� respond normally to verbal
commands. AJthough cognitive function and coordination
may be impai1·ed, ventilat01·y and ca1·diovascular fi.mctions
are unaffecterl. (PIP)
3.3.69* Growid-Fault Circuit Interrupter (GFCI). A rlevice
intended for the protection of per·sonnel that functions to de­
ene1·gize a circuit 01· portion the1·eof wi.tl1in an established
period of time when a current to ground exceeds the values
established for a Cla�s A device. r10, 20201 (ELS)
3.3.70 Grounding. See �.3.71, Grounding Sys tem. (ELS)
3.3.71 * Growiding System. A sys tem of conrluctors that
prnvirles a low-impedance return path fo1· leakage and fault
currents. (ELS)
3.3. 72 Hazard Current. For a given set of connections in an
isolaterl power system, the total cm-rent that would flow
through a low imperlance if it we1·e connecterl between either
isolaterl conductor anrl ground . (ELS)
3.3. 72.1 Fault Hazard Current. The hazard cmTent of a
given isolated power system with all rlevices connected
except the line isolation monitor. (ELS)
3.3. 72.2 Monitor Hazard Current. The hazard cmTent of the
line isolation monit01· alone. (ELS)
3.3.72.3 Total Hazard Current. The hazarrl current of a
given isolated system with all rlevices. including the line
isolation monitor, connected. (ELS)
3.3. 73* Health Care Facilities. Buildings, portions of build­
ings, or mobile enclostu-es in which human merlical, dental,
psychiatric, nursing, obstetrical, 01· sm·gical care is provided.
(FUN)
3.3_74* Health Care Facility's G overning Body. The person 01·
persons who have the overnll legal responsibility for the opera­
tion of a health care facility. (FUN)
3.3.75* Health Care Microgrid. A group of interconnected
loarls anrl rlistributed energy resources within cleady defined
boundaries that act� a� a single controllable entity with respect
to the utility. (ELS)
3.3.76 Health Care Microgrid Control System. A system
including health care microgrid control functions that can
manage it�elf; ope1·ate autonomously, arni. connect to and
disconnect from the utility for the exchange of power and the
supply of ancillary services. (ELS)
3.3.77* Home Care. Medical se1·vices or equipment prnvided
in residential settings that pm-posely facilitate the provision of
merlical or custodial care; excludes commercial facilities.
(FUN)
 DEFINITIONS
3.3.78 Hospital. A building or portion the1·eof used on a 24-
hour basis for the merlical, psychiatric, obstetrical, or surgical
ca1·e of four or mme inpatient�. f IOI, 20211 (FUN)
3.3.79 Humidifier. A rle,ice userl fo1· adding water vapor to
inspirerl gas. (MED)
3.3.80 Hyp erbaric Facility. Building, structure, or space used
to house hype1·ba1·ic chambers anrl auxiliary service equipment
for medical applications and procedures at pressures above
normal atmospheric pressm·e. (HYP)
3.3.81* Hyp erbaric Operations. Procedures conrlucterl on
the patient receiving hyperbaric treatment. (HYP)
3.3.82 Hyp erbaric Stand-Alone Oxygen S ystem. The oxvgen
system is entirely separate from the hospital's Category l
Oxygen System or is a freestanding hyperbaric facility. (HYP)
3.3_83 Hyp obaric Facility. Builrling, structm·e, 01· space used
to house hypobaric chambe1·s and auxiliary service equipment
for medical applications anrl procerlures at pressures below
atmospheric pressu1·e. (HYP)
3.3.84 Hyp oxia. A state of inadequate oxygenation of the
f
blood and tissue su ficient to cause impairment of function.
f99B, 2021 l (HYP)
3.3.85 Immediate Restoration of Service. Automatic restora­
tion of operation with an interruption of not more than
10 seconrls. (ELS)
3.3.86* Impedance. Impedance is the ratio of the voltage
rlrop across a circuit element to the current flowing through
the same circuit element. The unit of impedance is the ohm.
(MED)
3.3.87 Incident Command System (ICS). The combination of
facilities, equipment, personnel, procedures, and communica­
tions operating within a common 01·ganizational structu1·e that
ha� responsibility for the management of assigned resources to
effectively accomplish staterl objectives pertaining to an inci­
rlent or trnining exercise. fl 670, 20171 (HES)
3.3.88* Instrument Air. A merlical support gas that falls unrler
the general requirement� for medical gases. Merlical air and
instrument air are distinct systems for mutually exclusive appli­
cations. (PIP)
3.3.89 Intermittent Positive-Pressure Breathing (IPPB). Venti­
lation of the lungs by application of intermittent positive pt·es­
sure to the ainvay. (MED)
3.3.90* Intrin sically Safe. A� applied to equipment and
wiring, equipment and wiring that are incapable of releasing
sufficient electt·ical energy under n01·mal or abnormal condi­
tions to cause ignition of a specific hazardous atmospheric
mixture. (HYP)
3.3.91 Invasive Procedure. Any procedu1·e that penetrntes the
protective surfaces of a patient's body (i.e., skin, mucous
membrane, cornea) anrl that is pedormed with an aseptic field
(procedural site). fNot included in this category· are placement
of peripheral intravenous needles or catheters used to adminis­
ter fluids anrl/or merlications, gastrointestinal endoscopies
(i.e., sigmoidoscopies), insertion of m·ethrnl cathete1·s, anrl
other similar procedures.] (ELS)
3.3.92 Isolated Patient Lead. A patient lead whose impedance
to ground or to a powe1· line is sufficiently high that connecting
99-23
the lead to grounrl, or to either conductor of the power line,
result� in current flow below a hazardous limit in the lead.
(MED)
3.3.93* Isolated Power System. A system comprising an isola­
tion transformer or its equivalent, a line isolation monitor, anrl
its ungrounrled cit-cuit conductors. (ELS)
3.3.94 Isolation Transformer. A transfm·mer of the multiple­
winding type, with the prima1y and secondary windings physi­
cally separated, that inrluctively couples it� ungrounded
secondary winding to the grounded feeder system that ene1·gi­
zes its primary winding. (ELS)
3.3.95* Laboratory. A building, space, room, or group of
rooms intended to serve activities involving procedures fot·
investigation, diagnosis, or treatment in which flammable,
combustible, or oxidizing materials are to be userl. (FUN)
3.3.96 Leak Detectant. For purposes of this standard, a
reagent, a solution, or an electronic or mechanical device suita­
ble for the detection or visualization of escaping gas. (PIP)
3.3.97 Life Safety Branch. A system of feeders and branch
circuit� supplying power for lighting, receptacles, and equip­
ment essential for life safety that is automatically connected to
alternate power sout·ces by one or m01·e transfer switches
during interrnption of the nm·mal powe1· source. (ELS)
3.3.98* Limited-Combustible (Material). See 4.4.2. (FUN)
3.3.99 Line Isolation Monitor. A test instrument rlesigned to
continually check the balancerl and unbalanced impedance
from each line of an isolaterl circuit to ground anrl equipperl
with a built-in test ci1·cuit to exet-cise the ala1·m without adrling
to the leakage current hazard. (ELS)
3.3.100* Liquid. Any material that ( 1) has a fluidity greater
than that of 300 penetration asphalt when tested in acco1·rlance
with ASTM D5, Standard ]"'pst A1Ptlwd f(jr PPnPfratinn of Bituminom
I\,fatfrial�. or (2) is a \iscous substance for which a specific melt­
ing point cannot be determinerl but that is dete1·mined to be a
liquid in accmdance with ASTM D43:,9, Standard Test for Deter­
mining H'liethl'T" a Afatnial is a Liquid ora Solid. f30, 2021 I (FUN)
3.3.101* Local Signal. A visible inrlication of the operating
status of equipment. (PIP)
3.3.102 mA. Milliampere. (FUN)
3.3.103 Manifold. A device for connecting the outlets of one
or more gas cylinde1·s to the central piping system for that
specific gas. (PIP)
3.3.104* Manufactured Assembly. A factory-assembled prorl­
uct rlesignerl fot· aesthetics or convenience that contains medi­
cal gas or vacuum outlets, piping, or other rlevices related to
medical gases. (PIP)
3.3.105 Mask. A device that fits over the mouth and nose
(oronasal) or nose (nasal) used to administer gases to a
patient. (MED)
3.3.106* Medical Air. For purposes of this code, merlical ai1· is
air supplied from cylinders, hulk containers, or merlical air
comp1·esso1·s or reconstituted from oxygen USP and oil-free,
dry· nitrogen NF. (PIP)
3.3.106.l Proportinning System for Medical Air USP. A central
supply that produces medical air (USP) reconstituted from
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99-24 HEALTH CARE FACILITIES CODE
m,')'gen USP and nitrngen NF by means of a mixer or blen­
der. (PIP)
3.3.107 Medical Air Compressor. A comp1·essor that is
designed to exclude oil from the air stream and comp1-ession
chamber and that does not under normal operating conrlitions
or any single fault adrl any toxic 01· flammable contaminants to
the compresserl air. (PIP)
3.3.108 Medical Gas. A patient medical gas or medical
support gas. (Spe alrn 3.3.144, Patient i\,1.fdii:al C',a.1, and 3.3.111,
Mediral Suppart (',as.) (PIP)
3.3.109 Medical Gas System. An assembly of equipment anrl
piping for the distribution of nonflammable medical gases
such as oll.·ygen, nitrous oxirle, comp1·esserl ai1·, carbon dioxirle,
and helium. (PIP)
3.3.110* Medical Office. A building 01· part thereof in which
the following occu1·: (1) examinations and min01· treatmenl�/
procedures performed under the continuous supervision of a
medical professional; (2) the use of limited to minimal seda­
tion anrl treatment or procedu1·es that do not 1·ender the
patient incapable of self�preservation unde1· emergency conrli­
tions; anrl (3) no overnight stays for patients or 24-hour opera­
tions. (FUN)
3.3.111 Medical Support Gas. Niu·ogen or instrnment ai1·
used for any medical support purpose (e.g., to remove excess
moisture from instrnmenl� before furthe1· processing, or to
opernte medical-surgical tools, ai1--driven booms, pendanl�, 01-
similar applications) and, if approp1·iate to the procedures,
used in laboratories and are not respirerl as part of any treat­
ment. Medical support gas falls under the general require­
menl� for merlical gases. (PIP)
3.3.112 Medical-Surgical Vacuum. A method used to provide
a source of drninage, aspiration, and suction in 01·der to
remove body fluirls from patienl�. (PIP)
3.3.113 Medical-Surgical Vacuum System. An assembly of
central vacuum-producing equipment anrl a netw01·k of piping
for patient suction in medical, medical-surgical, anrl waste
anesthetic gas disposal (WAGD) applications. (PIP)
3.3.114 Multiple Treatment Facility- A diagnostic or treatment
complex unde1· a single management comprising a number of
single treatment facilities, which can be accesserl one from the
othe1- without exiting the facility (i.e., rloes not involve widely
separaterl locations 01· separate rlistinct practices). (FUN)
3.3.115 mV. Millivolt. (FUN)
3.3.116 Nasal Cannula . Device consisting of two short tubes to
he inserted into the nostrils to arlminister oxygen or other the1·­
apeutic ga�es. (MED)
3.3.117 Nebulizer. A de,ice used for prorlucing an aerosol of
water and/or medication within inspi1-ed gas supply. (MED)
3.3.118 Nega tive Pressure. Pressure less than atmospheric.
(MED)
3.3.119 Nitrogen. An element that, at atmosphe1·ic tempera­
tures and pressures, exisl� a� a clear, colorless, anrl ta�teless gas;
it comprises approximately fotll'-fifths of the earth's atmos­
phere. (MED)
3.3.119.1 Nitrogen NF. Nitrogen compl)'ing as a minimum
with nitrogen NF. (PIP)
2021 Edition
3,3-120 Nitrogen Narcosis. A conrlition 1·esembling alcoholic
inebriation, which resull� from breathing nitrogen in the air
under significant pt·essure. (HYP)
3.3.121 Nitrous Oxide. An inorganic compounrl, one of the
oxirles of nitrogen. It exisl5 as a gas at atmospheric pressure
and temperatm·e , possesses a sweetish smell, and is used for
inducing anesthesia when inhalerl. The oxygen in the
compound will he releaserl under conditions of combustion,
creating an oxygen-enriched atmosphere. (MED)
3.3.122 Noncombustible (Ma terial). See 4.4.1. (FUN)
3.3.123 Nonflammable. Not rearlily capable of burning with a
flame and not liable to ignite and burn when exposed to flame.
(FUN)
3.3.124 Nonflammable Anesthetic Agent. Refers to those
inhalation agenl� that, because of thei1· vap01· pressure at 37'C
(98.6'F) anrl at atmospheric pt·essure, cannot attain flammable
concentrations when mixerl with air, oxygen, or mixtures of
oxygen and nitrous oxide. (MED)
3_3_125* Nonflammable Medical Gas System_ See 3.3.109,
Merlical Gas System, and Chapter 5. (PIP)
3.3.126 Nonmedical Compressed Air. A...ir that is used for
put-poses other than patient care 01· merlical rlevices that
provirle direct patient care. (MEC)
3.3.127 Nursing Home. A building 01· portion of a building
used on a 24-hour basis fot· the housing and nu1·sing care of
four or more persons who, because of menlal or physical inca­
pacity, might he unable to prmiirle fo1· their own needs and
safety without the assistance of another pe1·son. r IOI, 2021 l
(FUN)
3.3.128 Opportunity for hnprovement. An identified gap or
shortfall with the potential to raise something to a more desira­
ble or oul�tanding quality or condition. (HES)
3.3.129* Oxidizing Gas. A gas that supports combustion.
(HYP)
3,3-130* Oxygen. A chemical element that, at normal atmos­
pheric tempe1·atures and pressu1·es, exists as a colorless, orlm·­
less, and tasteless ga� and comp1·ises about 21 pet-cent by
volume of the earth's atmosphe1·e. (MED)
3.3.130.1 Gaseous Oxygen. A colorless, odorless, tasteless,
anrl nontoxic gas, comprising about 21 percent of n01·mal
air by volume, that is about 10 percent heavier than air; also
the physical state of the element at atmospheric tempera­
ture anrl pressm·e. (MED)
3.3.130-2* Liquid Oxygen. Exisl� at cryogenic temperatme,
approximately -184.4 °C (-300'F) at atmospheric pressure.
It retains all of the properties of gaseous oxygen, but, in
addition, when allowed to warm to 1·oom temperature at
atmospheric pt·essure, it will evaporate anrl expanrl to fill a
volume 860 times it� liquirl volume. (MED)
3,3-131 Oxygen Concentrator Unit. A...11 enginee1·ed assembly
f
o components that operate to raise the concentration of
oxygen, providing oxygen as a drug product. (PIP)
3.3.132" Oxygen Delivery Equipment. A.ny rlevice used to
transport and deliver an oxygen-enricherl atmosphere to a
patient. (MED)
 DEFINITIONS
3.3.133* Oxygen Hood. A device encapsulating a patient's
hearl anrl used for a purpose similar to that of a mask. (Sfe alrn
3.3.105, Mask..) (HYP)
3.3.134 Oxygen 93 USP. Oxygen complying with Oxygen USP
93 Monograph. (PIP)
3.3.135* Oxygen Toxicity (Hyperbaric). Physical impairment
1·esulting from bt·eathing ga�eous mixtu1·es containing oxygen­
enriched atmospheres at elevated partial pressures for exten­
rlerl pet-io<ls of time. (HYP)
3.3.136 Oxygen USP. Oxygen complying with Oxygen USP
Monograph. (PIP)
3.3.137 Oxygen-Enriched Atmosphere (OEA). For the purpo­
ses of this code, an atmosphere in which the concentrntion of
oxygen exceerls 23.5 percent by volume. (HYP)
3.3.138 Patient Bed Location. The location of a patient sleep­
ing bed, 01· the bed or procerlure table of a Category 1 space.
(ELS)
3.3.139 Patient Care-Related Electrical Equipment. Electrical
equipment appliance that is intenrlerl to be used for diagnostic,
therapeutic, or monitoring purposes in a patient care vicinity.
(MED)
3.3.140* Patient Care Space. Any space of a health ca1·e
facility wherein patient� are intenrlerl to be examined or trea­
ted. (FUN)
3.3.140.1* Category 1 Space. Space in which failure of
equipment or a system is likely to cause major i1tjury or
f
death of patients, staf , or visitors. (FUN)
3.3.140.2* Category 2 Space. Space in which failure of
equipment or a system is likely to cause minor injuty to
patients, staff, or visitors. (FUN)
3.3.140.3* Category 3 Spare. Space in which the failure of
equipment or a system is not likely to cause injury to
patient�, staff, or visitorn but can cause discomfort. (FUN)
3.3.140.4* Category 4 Space. Space in which failure of
equipment or a sys tem is not likely to have a physical impact
on patient care. (FUN)
3.3.141 Patient Care Vicinity. A space. within a location inten­
rlerl for the examination and treatment of patient�, extending
1.8 m (6 ft) beyond the n01·mal location of the bed, cha.it·,
table, treadmill, 01· other device that support� the patient
<luring examination and treatment anrl extending vertically to
2.3 m (7 ft 6 in.) above the floor. (MED)
3.3.142 Patient Equipment Grounding Point. A jack or termi­
nal that serves as the collection point for redundant grounding
of electric appliances serving a patient care vicinitv or for
grounding othe1· items in or<le1· to eliminate elecu·omagnetic
intede1·ence problems. (MED)
3.3.143* Patient Lead. Anv deliberate electrical connection
that can carq; cmTent bet\�een an appliance and a patient.
(MED)
3.3.144 Patient Medical Gas. Piperl ga�es such as oxygen,
nitrous oxirle, helium, carbon rlioxi<le, anrl medical air that a1·e
userl in the application of human respirntion and the calibrn­
tion of merlical devices userl for human respiration. (PIP)
99-25
3.3.145 Piped Distribution System. A pipeline network assem­
bly of equipment that starts at anrl inclurles the source valve,
warning systems (ma�te1·. a1·ea, local ala1·ms), bulk gas system
signal actuating switch wi1·ing, inte1·c01111ecting piping. anrl all
other component� up to and including the station outlet�/
inlets. (PIP)
3.3.146 Piping. The tubing or conduit of the system. The
three general classes of piping are main lines, risers, and
branch (lateral) lines. (PIP)
3.3.146.1 Branch (Lateral) Lines. Those sections or portions
of the piping system that serve a room or group of rooms on
the same story of the facility. (PIP)
3.3.146.2 Main Lines. The piping that connect� the source
(pumps, receivers, etc.) to the risers or branches, or both.
(PIP)
3.3.146.3 Risers. The vertical pipes connecting the system
main line (s) with the branch lines on the various levels of
the facility. (PIP)
3.3.147 Plug (Attachment Plug, Cap). A device that, by inset··
tion in a receptacle, establishes connection bet\veen the
conductors of the attacherl flexible cord anrl the conductors
connected permanently to the 1·eceptacle. (MED)
3.3.148 Plume (Medical). The smoke by-product consisting of
vapors, smoke, and particulate debris prn<lucerl <luring the
thermal rlestruction of tissue by energy-baserl devices such as
lasers, elecu·osut·gical generators, and broa<lbanrl light sou1·ces.
(MEC)
3.3.149 Pressure.
3.3.149.1 Absolute Pressure. The total pressure in a system
with reference to zero pressure. (HYP)
3.3.149.2 Ambient Pressure. Refers to total pressure of the
environment referenced. (HYP)
3.3.149.3 Gauge Pressure. Refe1·s to total p1·essure above (01·
below) atmospheric. (HYP)
3.3.149.4 High Pressure. A pressure exceeding 1.:-18 kPa
(200 psi) gauge (215 psia). (MED)
3.3.149.5* operating Pressure. The press11l'e that a particu­
lar piping system is set to operate at. (PIP)
3.3.149.6* Partial Pressure. The pressut·e, in absolute unit�,
exerted by a particula r gas in a ga� mixtme. (HYP)
3.3.149.7 Positive Pressure. Pressure g1·eater than ambient
atmospheric. (MED)
3.3.149.8 Working Pressure (Rated). The maximum raterl
operating p1·essure for a pipe, tube, 01· vessel based on it�
material, its allowable stress in tension, its outside diamete1·
and wall thickness, the operating tempernture, the joining
method, anrl industry safety factors. (PIP)
3.3.150* Pres.sure-Reducing Regulator. A device that automat­
ically rerluces ga� un<le1· high pressure to a usable lower work­
ing pressure. (MED)
3.3.151 Procedure Room. \Vl1e1·e the procerluralist is using
instrumentation that requires constant observation anrl
control. (MED)
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99-26 HEALTH CARE FACILITIES CODE
3.3.152* Producer. The machine(s) or device(s) that gene1·­
ate the flow and suction required for vacuum, \,v'AGD, anrl
plume evacuation systems to opernte. (PIP)
3.3.153 psia. Pounds per square inch absolute, a unit of pres­
sure measurement with zero pressure as the base or reference
pressure. (HYP)
3.3.154* psig. Pounrls pet· square inch gauge, a unit of pres­
sure measurement with atmospheric pressure as the base or
reference pressure. (HYP)
3.3.155 Qualified Person. A person who, by possession of a
recognizerl degree, certificate, professional standing, or skill,
and who. by knowledge. training, and experience, has demon­
strated the ability to pedorm the wmk. (HYP)
3.3.156 Reactance. The component of impedance contrib­
uted by inductance or capacitance. The unit of 1·eactance is the
ohm. (MED)
3.3.157 Receptacle. A receptacle is a contact device installerl
at the outlet fot· the connection of an attachment plug. A single
receptacle is a single contact device with no othe1· contact
device on the same yoke. A multiple receptacle is two or more
contact rlevices on the same yoke. [70, 20201 (ELS)
3.3.158 Reference Grounding Point. The grounrl bus of the
panelboard or isolated power system panel supplying the
patient care room. (MED)
3.3.159 Relocatable Power Tap (RPT). A device for indo01·
use consisting of an attachment plug on one enrl of a flexible
corrl and tlu-ee or more receptacles on the opposite enrl. (SPP
W2.3.6.) (MED)
3.3.160* Remote. A Level 3 source of supply that is accesserl
by exiting the single or multiple treatment facility. (PIP)
3.3.161 Reserve Supply. Where existing, that portion of the
supply equipment that automatically supplies the system in the
event of failure of the operating supply. The reserve supply
only functions in an eme1·gency and not a� a normal opernting
procerlure. (PIP)
3.3.162 Risk Categories. (FUN)
3.3.162.1 Category I. Activities, systems, or equipment
whose failure is likely to cause major ittjury or death to
f
patient�, staf , or "isitors. (FUN)
3.3.162.2 Category 2. Activities, systems, or equipment
whose failure is likely to cause minor injury to patients, staff,
or visitors. (FUN)
3.3.162.3 Category 3. Activities, systems, or equipment
whose failure is not likely to cause injuty to patient�, staff, or
visitors but can cause rliscomfon. (FUN)
3.3.162.4 Category 4. Activities, systems, or equipment
whose failure would have no impact on patient care. (FUN)
3.3.163 Scavenging. Evacuation of exhaled mixtures of
oxygen and niu·ous oxirle. (PIP)
3.3.164 Selected Receptacles. A minimal number of recepta­
cles selecterl by the health care facility's governing borly as
necessary to provirle essential patient ca1·e and facility senices
during loss of normal power. (ELS)
2021 Edition
3.3.165 Self-Extinguishing. A characteristic of a mate1·ial such
that, once the source of ignition is removed, the flame is
quickly extinguished without the fuel 01· oxidizer being exhaus­
ted. (HYP)
3.3.166 Semipermanent Connection. A noninterchangeable
connection, usually a D.I.S.S. connector, which is the te1·mina­
tion of the pipeline and that is intended to be detached only
for sen•ice. It is not the point at which the user makes connec­
tions or disconnections. (PIP)
3.3.167 Service Inlet. l11e pneumatic terminus of a Level 3
piped vacuum system. (PIP)
3.3.168 Service Outlet. The pneumatic te1-minus of a piped
gas system fot· other than critical, continuous duty, nonflamma­
ble medical life support-type gases such as oxygen, nitrous
oxirle, or medical air. (PIP)
3.3.169* Single lreatment Facility. A diagnostic or t1·eatment
complex unrler a single management comprising a number of
use points, but confined to a single contiguous group of use
point� (i.e., does not involve wirlely separaterl locations 01· sepa­
rate distinct practices). (PIP)
3.3.170* Site of Intentional Expulsion. All points within 0.:1 m
( l ft) of a point at which an oxygen-em·iched atmosphere is
intentionally venterl to the atmosphe1·e. (MED)
3.3.171 Space. A portion of the health care facility designated
by the health care facility's governing borly that serves a specific
purpose. (FUN)
3.3.172 Standard Cubic Feet per Minute (SCFM). Volumetric
flow rate of gas in units of standa1·rl cubic feet per minute.
(PIP)
3.3.173 Station Inlet. An inlet point in a piperl medical/surgi­
cal vacuum distt·ilmtion system at which the use1· makes connec­
tions and disconnections. (PIP)
3.3.174 Station Outlet. An outlet point in a piped medical gas
distribution system at which the user makes connections and
disconnections. (PIP)
3.3.175 Supply Source. Those portions of the central supply
system that act a� a self:contained supply. (PIP)
3.3.175.1 operating Suppl.y. The portion of the central
supplv svstem that is supplying the piping system at the time
f
o obsen•ation. (PIP)
3.3.175_2 Primary Supply. l11e portion of the central supply
system that is the default supply for the piping system. (PIP)
3.3.175.3 Reseroe Supply. Where provided, the portion of
the central supply system that will supply the piping system
when the primary and secondary supplies are exhausterl or
are not operative. (PIP)
3.3.175.4 Serondary Supply. Where provirlerl. the portion of
the central supply system that will supply the piping system
when the primaty supply is exhausterl or is not operative.
(PIP)
3.3.176* Surface-Mounted Medical Gas Rail Systems. A
surface-mounted gas delivery system intended to provide 1·eady
access fot· two or m01·e gases through a common delivery·
system to provide multiple gas station outlet locations within a
single patient room or Categoq' l Space. (PIP)
 FUNDAMENTALS
3.3.177 Task Illumination. Provisions for the minimum light­
ing required to cany out necessary tasks in the area� described
in Chapter 6. including safe access to supplies and equipment
and access to exits. (ELS)
3.3.178 Terminal. The enrl of a flexible hose or tubing used
in a manufactured assembly whe1·e the use1· is intended to
make connection anrl disconnection. (PIP)
3.3.179 Touch Current. Leakage current flowing from the
enclosu1·e 01· from part� thereof, excluding patient connec­
tions, accessible to any operntor or patient in normal use,
through an external path other than the protective grounding
(earth) conductor to earth or to another part of the enclosure.
(MED)
3.3.180 Transfilling. The process of transferring a medical ga�
in gaseous or liquid state from one container or cylinder to
anothe1· container or cylinder. (MED)
3.3.181 Tube.
3.3.181.1 * Endutracheal Tube. A tube for insertion through
the mouth or nose into the upper portion of the trachea
(windpipe). (MED)
3.3.182 Use Point. A location with any number of station
outlets anrl inlets arranged for access by a practitioner <luring
treatment of a patient. (PIP)
3.3.183 Vaporizer. A heat exchange unit designed to convert
cryogenic liquid into the gaseous state. (PIP)
3.3.184 Ventilation. The mechanical or natural movement of
air. (MEC)
3.3.185 Waste Anesthetic Gas Disposal (WAGD). The process
of capturing anrl canying away gases vented from the patient
b1·eathing circuit during the nm·mal operation of gas anesthe­
sia or analgesia equipment. (PIP)
3.3.186 Waste Water. fMEC)
3.3.186.1 Black Waste Water. Grossly contaminated and
contain pathogenic, toxigenic, or other harmful agents.
(MEC)
3.3.186.2 Clear Waste Water. Originates from a sanitary
water source and rloes not pose substantial risk from
dermal, ingestion, or inhalation exposure. (MEC)
3.3.186.3 Gmy Waste Water. Contains significant contami­
nation and has the potential to cause rliscomfon or sickness
if contacted or consumed by humans. Can contain poten­
tially unsafe levels of microm·ganisms 01· nutt·ient5 for micro­
org-anisms, as well as other m·ganic 01· inorganic matter
(chemical or biological). (MEC)
3.3.187* Wet Procedure Locations. The area in a patient ca1·e
space whe1·e a procedure is perfo1·med that is normallv subject
to wet conditions while patients are present, including standing
fluids on the floor or drenching of the work area, either of
which condition is intimate to the patient 01· staff. (FUN)
3.4 BICSI Definitions. These terms are defined in Tltf BJCSI
Infarmation Transport Systems (ITS) Dictionary.
3.4.1 Telecommunications Entrance Facility (EF). An
entrance to a building for both public and private network.
service cables that includes the building entrance point and the
entrance room or space at the point of demarcation between
99-27
campus 01· utility se1vice and building interim· distribution of
communications systems. (ELS)
3.4.2 Telecommunications Equipment Room (TER). An envi­
ronmentally controlled centralized space for telecommunica­
tions equipment, typically including main or intermediate
cross-connect equipment and cabling. (ELS)
3.4.3 Telecommunications Room (TR). An enclosed a1-chitec­
tural space for housing telecommunications equipment, cable
terminations, anrl c1·oss-connect cabling, serving a floor 01· an
area of a flom. (ELS)
01.apter 4 FW1damentals
4.1 * Risk Categories. All activities, as well as sy stems or equip­
ment that are new or altered, shall be designerl to meet Cate­
go1y 1 through Category 4 requi1·ements, a� detailed in this
code.
4.1.1* Category I. Activities, systems, or equipment whose
failure is likely to cause majm· i1�ury or death of patients, staff,
or visitors shall be designed to meet Categmy I 1·equi1·ements,
a� detailed in this code.
4. 1.2* Category 2. Activities. systems. 01· equipment whose
failure is likely to cause minm· injm·y of patients, staff, 01· visi­
tors shall he designed to meet Category 2 requirements, as
detailed in this code.
4.1.3 Category 3. Activities, systems, or equipment whose fail­
ure is not likely to cause i1�ury to patient�, staff, or visitors, but
can cause discomfort, shall be designed to meet Categm·y 3
requi1·ement�, as detailed in this code.
4.1.4 Category 4. Activities, systems, or equipment whose fail­
ure woulrl have no impact on patient care shall be designed to
meet Category 4 1·equirements. as detailed in this code.
4.1.5* Acti\ities, systems, and equipment shall be permitted to
be rlesignerl to a highe1· 1·isk category.
4.2* Risk Assessment.
4.2.1 The health care facility's governing borly shall establish
the processes anrl operations that are planned fo1· the health
care facility.
4.2.1.1 The governing borly shall conduct risk assessment� anrl
shall determine risk catego1·ies baserl on the characte1· of the
processes and operations conducted in the health care facility.
4.2.2* Risk categories shall be classifierl by the health care
facility's goven1ing body by following and documenting a
rlefinerl 1·isk. assessment procedure.
4.2.2.1 Where requirerl by the authority having jurisdiction,
the risk assessment shall be provided to the authm·ity having
jurisdiction for review based on the characte1· of the processes
and operations conducted in the health care facility.
4.2.3 A documented 1·isk assessment shall not be required
where Catego1y 1 is selected.
4.3 Application. The Category definitions in Chapter 4 shall
apply to Chapters 5 through 11, 14, and 15, except as modified
in those chapters.
2021 Edition
99-28 HEALTH CARE FACILITIES CODE
4.4 Materials_
4.4.1* Noncombustible Material.
4.4.1.I A material that complies with any of the following shall
be consirlererl a noncombustible material:
(1) A mate1·ial that, in the fot·m in which it is used and unde1·
the conditions anticipated, will not ignite, burn, support
combustion, or release flammable vapors when subjected
to fire or heat
(2) A material that is reported as passing ASTM El 36, Stand­
ard Test Methnd fnr Behavior nf Matm:aL� in a Vfrtiral T11/Je
Furnace at 750° C
(3) A material that is 1·epmted as complying with the pass/fail
critet-ia of ASTM El36 when tested in acc01·dance with
the test method and procedure in ASTM E2652, Standard
Test l\iethnd fnr Behavior nf Material� in a Tube I-i1maa with a
Cnne-shaped liirjlnw Stabilizer, at 75WC
4.4.1.2 Where the term limited-rmnlmstible is userl in this code,
it shall also include the term nnncmnbmtible. r5000:7.l.4.1.2l
4.4.2* Limited-Combustible Material. A material shall be
considered a limited-combustible material where one of the
following is met:
(1) The conditions of 4.4.2.1 and 4.4.2.2, and the conditions
of eithe1· 4.4.2.3 m 4.4.2.4, shall be met.
f
(2) The conrlitions o 4.4.2.6 shall be met.
4.4.2.1 The material shall not comply with the requirement�
for noncombustible mate1·ia l in accor·rlance with 4.4.1.
4.4.2.2 The material, in the f01·m in which it is used, shall
exhibit a potential heat value not exceerling 3500 Btu/lb (8141
kJ/kg) where testerl in accordance with NFP,i\. 259.
4.4.2.3 The material shall have the structu1·al base of a
noncombustible material with a surfacing not exceerling a
thickness of ¼ in. (3.2 mm) where Lhe surfacing exhibit� a
flame sp1·earl inrlex not greate1· than 50 when tested in acco1·d­
ance with ASTM E84, Standard Test Metlwd fnr Surfaa Burning
Chamcteri�tirs nf Building Material�. or UL 723, Standard fnr Test
Jar Surfaa Burning Characteristics nf Building Material�.
4.4.2.4 The material shall be composed of materials that, in
the form and thickness used, exhibit neither a flame sprearl
index greate1· than 25 nor evirlence of continuerl prng1·essive
combustion when tested in accordance with ASTM E84, Stand­
ard 1;,s1 Metlwd for Surfare Burning Chami:teristii:s nf Building Mate­
rial�. or UL 723, Standard fnr Test Jar SurfaCP Burning
Chararteristirs nf Building Material�. anrl shall be of such composi­
tion that all surfaces that would be exposed by cutting through
the material on any plane would exhibit neither a flame sprearl
index greate1· than 25 1101· exhibit evidence of continuerl
progressive combustion when testerl in accordance with ASTM
E84 or UL i23.
4.4.2.5 Mate1·ials shall be considered limited-combustible
materials whe1·e tested in accordance with ASTM E2965, Stand­
ard ]�st Methnd far Determinatinn nf L nw Level� nf Heat &!Pase Rnte
fnr Material� and Pmdw:t� U�ing an Oxygen Cnnsumptinn Calarime­
fPT, at an incident heat flux of 75 k\V/m� for a 20-minute expo­
sure anrl both of the follov,':ing conditions are met:
(1) The peak heat release rate shall not exceed 150 HV/m 2
for \onge1· than 10 seconds.
(2) The total heat 1·eleased shall not exceed 8 MJ/ m2 .
2021 Edition
4.4.2.6 Where the term limitPd-rmnbustiblP is used in this CndP, it
shall also include the term nnncmnbustiblP. r5000:7.l.4.2.4l
Chapter 5 Gas and Vacuum Systems
5.1 Category 1 Piped Gas and Vacuum Systems.
5_Ll * Applicability.
5.1.1.1 These requi1·ement� shall apply to health care facilities
that require Category 1 systems as 1·eferenced in Chapter 4.
5.1.1.2 Category 1 piped gas or piperl vacuum system require­
ment� shall be applierl where any of the following crite1·ia is
met:
( 1) General anesthesia, a� definerl in 3.3.68.1, or deep seda­
tion, as defined in 3.3.68.2, is performerl.
(2) The loss of the piperl gas m piperl vacuum systems is
likely to cause major i1tjury or death of patients, staff, or
visitors.
5.1.1.3* Whe1·e the te1·ms mediral gns or mediral suppart gm
occut·, the provisions shall apply to all piped systems for
oxygen, nitrous oxide, medical air, carbon dioxide, helium,
nitrogen, instrument ai1·, and mixtures thereof. \Vherever the
name of a specific ga� service occurs, the prmision shall apply
only to that gas.
5.1.1.4* An existing system that is not in strict compliance
v,':ith the provisions of this code shall be permitterl to be contin­
ued in use, unless the au1h01·itv having jurisdiction has dete1·­
minerl that such use constitutes a rlistinct hazard to life.
5.1.1.5 The following sections of this chapter shall apply to
the operntion, management, and maintenance of Category
1 medical gas and vacuum systems in both new and existing
facilities:
(1) 5.1.2
(2) 5.1.3.1
(3) 5.1.3.2
(4) 5.1.3.3.4
(5) 5.1.3.6.2
(6) 5.1.3.6.3.lO(A) (2)
(7) 5.1.3.7.6(A) (2)
(8) fU .3.8.4.1 (2)
(9) 5.1.14
5_1.J.6 Category 1 systems shall be pe1·mitted to se1·ve spaces
i den tifi erl as Category 1, Categoq; 2, or Category 3.
5.1.2 Nature of Hazards of Gas and Vacuum Systems. Poten­
tial fire and explosion hazards associated with positive p1·essut·e
gas central piping systems anrl medical-sm·gical vacuum
systems shall be considered in the design, installation, testing,
ope1·ation, and maintenance of these systems.
5.1.3* Category I Sources.
5.1.3.1 Central Supply System Identification and Labeling.
5.1.3.1.1* Cylinde1·s, containers, and tanks shall be designed,
fabricated, testerl, anrl marked (stamped) in accordance with
1·egulations of DOT, Transport Canada (TC) Tmnspnrtatinn nf
Dangnnus (',ands &gulatinm, or the ASME Bnilfr and Prl's.mre
VP.�vl CndP, "Rules fot· the Construction of Unfirerl Pressure
Vessels," Section VIII. r55:7.l.5.l l
 c;As AND VACUUM SYSTEMS
5.1.3.1.2* Cylinde1· contents shall be identified by attached
labels or stencils naming the content5 in accordance with the
manrlatory 1·equi1·ement� of CGA C-7, Guide tn Classifimtion and
La/Jfling nf CmnfrrPssPd GrLSPS.
5.1.3.1.3 Liquid containers shall have additional prorluct irlen­
tification visible from all directions with a minimum of 51 mm
(2 in.) high letters such as a 360-degree wraparound tape for
medical liquirl containers.
5.1.3.1.4 Cqugenic liquirl containe1·s shall be provirlerl with
ga�-specific outlet connections in accm·dance with the manrla­
tory requirements of CGA V-5, Diameter Index Sajfty Systnn
(Nnninterrhangmble Lnw Pre.mtre Connertinns fm- .Mediral (',as A.ppli­
r:atinns ), or CGA V-1, Standard Jm- CnmpressPd (',as Cylinder Valve
Outlft and Inlft Cnnnectinns.
5.1.3.1.5 Cylinder anrl cryogenic liquirl container outlet
connections shall be affixed in such a manner· as to be integral
to the ,,ilve(s), unremovable with ordinaty tools, or so
rlesigned a� to render the attachment point unusable when
1·emoverl.
5.1.3.1.6 The content� of cylindei-s and ct"Vogenic liquirl
containers shall be verified prior to use.
5.1.3.1.7 Labels shall not be defaced, alte1·ed, or removerl, and
connecting fittings shall not be modified.
5.1.3.1.8 Source locations containing positive pressure gases
other than oxygen anrl medical air shall have thei1· doors
labeled as follows:
Positive Pressure Gases
NO Smoking or Open Flame
Room May Have Insufficient Oxyge n
Open Door and Allow Room to Ventilate Before Entering
5.1.3.1.8.1 Existing signage that is not in strict compliance
"�th the provisions of this code shall be permitted to be contin­
uerl in use as long as the authority having jurisrliction has
rletermined that such use does not constitute a rlistinct hazard
to life.
5.1.3.1.9 Source locations containing only oxygen or medical
air shall have thei1· rloors labeled as follows:
Medical Gases
NO Smoking or Open Flame
5.1.3.1.9.1 Existing signage that is not in strict compliance
with the provisions of this code shall be permitted to be contin­
uerl in use as long as the authority having jurisrliction has
dete1·mined that such use does not constitute a rlistinct hazarrl
to life.
5.1.3.2 Central Supply System Operations.
5.1.3.2.1 The use of arlapters 01· conversion fittings to adapt
one gas-specific fitting to another shall be prohibited.
5.1.3.2.2 Cylinrlers anrl containers shall be handled in strict
acco1·dance with 11.6.2.
5.1.3.2.3 Only gas cylinders, reusable shipping containers, anrl
their accessories shall be permitted to be storerl in rooms
containing central supply systems or gas cylinde1·s.
5.1.3.2.4 No flammable materials , cylinders containing flam­
mable gases, or containers containing flammable liquids shall
be storerl in rooms with gas cylindern.
99-29
5.1.3.2.5* If cylinde1·s at·e \Happen when received, the wrap­
pers shall be removerl prior to storage.
5.1.3.2.6 Cylinde1·s without cotTect markings or whose mark­
ings and gas-specific fittings do not match shall not be userl.
5.1.3.2.7 C1yogenic liquid storage uniL� intended to supply gas
to the facility shall not be used to transfill other liquirl storage
vessels.
5.1.3.2.8 Ca1·e shall be exercised when handlin g cylinder·s that
have been exposed to freezing temperatut·es or containe1·s that
contain cryogenic liquids to p1·event injury to the skin.
5.1.3.2.9 Cylinde1·s containing compresserl gases and contain­
e1·s fot· volatile liquids shall be kept away from radiators, steam
piping, and like sources of heat.
5.1.3.2.10 When cylinrler valve protection caps ar·e supplied,
they shall be securerl tightly in place unless the cylinde1· i s
connecterl for use.
5.1.3.2.11 Cylinders in use and in storage shall be p1·eventerl
from 1·eaching temperatut·es in excess of 52° C ( 125 ° F).
5.1.3.2.12 Central supply systems for nitrous oxide and carbon
dioxirle using cylinders or portable containe1·s shall be p1·even­
ted from 1·eaching temperatures lower than the recommenda­
tions of the central supply system's manufacturer, but shall
never be lower than -7'C (20'F) or greater than 52'C ( 125'F).
5.1.3.3* Central Supply System Locations.
5.1.3.3.1 General. Central supply systems shall be located to
meet the criteria in 5.1.3.3. l through 5.1.3.3.1.10.
5.1.3.3.1.1 Any of the following central supply systems shall be
permitted to be located together in the same outdoor enclo­
sure:
( l) Manifolds fix g-as cylinde1·s (sPP 5.1.3.5.10)
( 2) Manifolrls for ctyogenic liquirl containers (seP 5.1.3. 5.11)
(3) C ryogenic fluid central supply (SPP 5.1.3.5.12)
(4)* Individual components on the oxygen sirle of concentra­
tor sources (sPe 5.1.3. 9)
5.1.3.3.1.2 A.ny of the following systems shall be permitterl to
be located togethe1· in the same indoor enclosure:
(1) Manifolds for g-as cylinde1·s (sPP 5.1.3.5.10)
(2) Manifolrls for ctyogenic liquirl containers (sPP 5.1.3. 5.11)
(3) In-building eme1·gency reserves (see 5.1.3.5.14)
(4) Instrument air stanrlby headei-s (.w 5.1.13.3.7.6)
(5 )* Individual components on the oxygen side of concentra-
tor sources (see 5.1.3.9)
5.1.3.3.1.3 Any of the following central supply systems shall be
permitted to be locaterl together in the same room:
(1) Medical air central supply compressor supply sources (sPP
5.1. 3.6.3)
(2) Medical-surgical vacuum central supply sources (SfP
5.1.3.7)
(3) VVaste anesthetic ga� disposal ('VAGD) central supply
sout-ces (stt 5.1.3.8)
( 4) Instrument air compressor central supply sources (see
5.1.13.3.7)
(5 ) 1\ny othe1· com p1·ess01·, vacuum pump, or electrically
powererl machinery
(6)* Compressors, dryers, and air receivers used to supply
oxygen concentrators (sPe 5.1. 3. 9)
2021 Edition
99-30 HEALTH CARE FACILITIES CODE
(7) Concentrator unit� with ai1· an<l oxygen sides in an inte-
gral unit (m5.1.3.9)
5.1.3.3.1.4 Any central supply system listed uncier 5.1.3.3.1.3
shall not be located in the same room with any central supply
system listed under 5.1.3.3.l. l or 5.1.3.3.1.2, except instrument
ai1· 1·eserve headers complying with 5.1.3.2.11 an<l 5.1.1 3.3. 7.6
shall be permitted to be in the same room as an instrument ai1·
compressor.
5.1.3.3.1.5 In<loo1· locations fot· oxygen, nitrous oxide, and
mixtu1·es of these gases shall not communicate with the follow­
ing:
( l) Areas involve<l in critical patient ca1·e
(2) Anesthetizing locations whe1·e mo<lerate sedation, deep
sedation, or genei-al anesthesi a is administered
(3) Locations storing flammables
(4) Rooms containing open electrical contacts 01· transform-
e1·s
(5) Storage tanks for flammable or combustible liquids
(6) Engines
(7) Kitchens
(8) Areas with open flames
5.1.3.3.1.6 Cryogenic fluid central supply s ystems for oxygen
shall comply with NFPA 55.
5.1.3.3.I.7 Bulk nitrous oxi<le central supply systems shall
comply with NFPA 55 and with the man<latory 1·equi1·ements of
CGA G-8.1, Standard Jar Nitmm Oxide .\)stems at Customer Sitfs.
5.1.3.3.1.8 Central supply systems for carbon dioxi<le using
pe1·manently installed containers with product capacities
g1·eater than 454 kg (1000 lb) shall comply with NFPA 55 an<l
with the man<lat01·y 1·equirement� of CGA G-6.1, Standard for
Inmlated Liquid CarlJon Dioxide Systems at Gmsiwter Sites.
5.1.3.3.1.9 Central supply systems fot· carbon dioxide using
pe1·manently installed containers with product capacities of
454 kg (1000 lb) or less shall comply with NFPA 55 and with
the man<latory 1·equi1·ement� of CGA G-6.5, Standard for Small
Stationan• Insulated Car/Jon Dioxide Supp�,• Systems.
5.1.3.3.1.10* C ry ogenic fluid central supply systems for inert
gases shall comply \\�th NFPA 55 and with the mandat01·y
requirements of CGA P-18, Standard for Bulk Inert Gas Systnm al
Consumer Sites.
5.1.3.3.2* Design and Conslruction.
5.1.3.3.2.1 Locations for central supply systems, excluding
cryogenic fluid central supply systems, and for the storage of
positive-pressure gases shall meet the following 1·equirements:
(l) They shall be constructed with access to move cylinders,
equipment, and so forth in and out of the location on
hand trucks complying with 11.4.3.l.l .
(2) They shall he provided with lockable doors or gates 01·
othetwise able to be secure<l.
(3) If outdoors, they shall be well drained and provi<led with
an enclosure (e.g., wall or fencing) constructed of
noncombustible matet-ials.
(4) If out<loors, cylinders an<l containers shall be protecte<l
from prolonged contact with soil.
(5) If in<lo01·s, they shall have inte1·i01· finishes of noncom­
bustible 01· limited-combustible materials.
(6)* If indoors, rooms containing oxygen, nitrous oxi<le, or
other oxidize1-s shall be separated from the 1·est of the
2021 Edition
buil<ling by walls and f1001·s having a 1-hour fit·e resist­
ance rating with doors an<l other opening protectives
having a ?\-hour fire protection rating.
(7)* They shall comply with NIP.A. 70 for or<linar y locations.
(8)* Fuel-fired equipment shall not he located in the room.
(9) If they require heat, the maximum allowable tempera-
tu1·e of the in-room heating element shall be 130'C
(266'F).
(10) They shall be provi<led \,nth racks, chains, or other
fastenings to secure all cylin<lers from falling, whether
connecte<l, unconnected, full, 01· empty.
(11 )* They shall he supplied with elect1·ical powe1· compliant
with the requirement� for essential electrical systems as
describe<l in Chapte1· 6.
(12) They shall have racks, shelves, and support�, whe1-e
provi<le<l, constructed of noncombustible materials or
limited-combustible materials.
(13) 1l1ey shall protect elect1-ical <levices from phys ical
damage.
(14)* They shall allow access by delivery vehicles an<l manage­
ment of cylinders.
(15) 1l1ey shall be designed to meet the operational requi1·e-
f
ment� o 5.1.3.2 with regard to room temperature.
5.1.3.3.2.2 Design an<l construction of locations fot· ct"yogenic
fluid central supplv S\'litems shall comply \\lith 5.1.3.5.12.
5.1.3.3.3 Ventilation.
5.1.3.3.3.1 Ventilation for Indoor Locations. Central supply
system locations, medical gas storage rooms, and transfilling
room ventilation shall comply with 9.3.6.
5.1.3.3.3.2 Venting of Relief Valves. In<loor supply systems
shall have all relief valves vented pet· 5.1.3.5.6. l(4) through
5.1.3.5.6.1(9).
5.1.3.3.3.3 Ventilation for Motor-Driven Equipment. The
following soui-ce locations shall be ventilate<l to prevent accu­
mulation of heat:
(1) Medical air central supply systems sources (sep 5.1.3.6)
(2) Me <lical-surgical vacuum central supply systems sou1·ces
(Sl'i' 5.1.3. 7j
(3) Waste anesthetic gas disposal (''\'AGD) centt·al supply
systems sources (s!'I' 5.1.3.8.1)
(4) Instrument air central supply systems som·ces (.�l'I'
5.1.13.3.7)
5.1.3.3.3.4 Ventilation for Outdoor Locations.
(1) Outdoor locations surrounded by impermeable walls,
except fit·e ba1Tie1· walls, shall have protected ventilation
openings locate<l at the base of each \\"all to allow free
circulation of air within the enclosure.
(2) Walls that are shared with other enclosures or with build­
ings shall be pe1·mitted to not have openings.
(3) 1l1e fit·e barrie1· wall shall not have openings or peneti-a­
tions, except conduit or piping shall be permitted, provi­
<led that the penetration is protecte<l with a firestop
system in accor<lance with the building code.
5.1.3.3.4 Storage.
5.1.3.3.4.1 Full or empty me<lical gas cylindei-s, when not
connected, shall be st01·ed in locations com plying with 5.1.3.3.2
through 5.1.3.3.3 and shall he permitted to he in the same
rooms 01· enclosures as their respective central supply systems.
 c;As AND VACUUM SYSTEMS
Apprnved existing installations shall be permitte<l to be contin­
uect in ser,.,ice.
5.1.3.3.4.2* Cylinde1·s, whether h.tll or empty, shall not be
st01·ed in enclosures containing mot01·-driven machinery, ½1th
the exception of cylin<lers intended for instrument air reserve
hea<lers complying with 5.1.13.3. 7.G, which shall be permitted
to be placed in the same location containing an instrument air
compressor when it is the only motor-driven machinery located
\\1thin the room. Only cylinders intended for instrument air
1-eserve headers complying \\1th 5.1.13.3.7.6 shall be permitted
to be store<l in enclosures containing instrument air comp1·es­
sors.
5.1.3.4 Control Equipmen t. Fo1· control eguipment, as speci­
fied in 5.1.3.5.5, 5.1.3.5.G, anct 5.1.3.5.7, that is physically
remote from the supply system, the control eguipment shall be
installed \\1thin a secure enclosure to prevent unautho1·ized
access in accor<lance with 5.1.3.3.2. l (2).
5.1.3.4.1 The enclosure shall prmicte enough space to
perfo1·m maintenance and 1·epair.
5.1.3.4.2 The location of the enclosure for contrnl eguipment
other than for medical air shall not communicate with combus­
tible 01· flammable mate1·ials.
5.1.3.5* Central Supply Sys tems. Centrnl supply systems shall
be permi tte<l to consist of the following:
(l ) Cylinder manifolds for gas cylinders pet· 5.1.3.5.10
(2) Manifolds for Cl'yogenic liguid containet's per 5.1.3.5.11
(3) Cryogenic fluict central supply systems per 5.1.35.12
( 4) Medical air comp1·essor systems per 5.1.3.6
(5) Medical-surgical vacuum producers pet· 5.1.3.7
(G) WAGD pro<lucers pet· 5.1.3.8
(7) Instrument air compressor systems per 5.1. l :\.3.7
(8) Proportioning systems for medical air USP per
5.1.3. 6.3.14
(9) Oxygen central supply systems using concentrators per
5.1.3.9
5.1.3.5.1 General. Ce11tt·al supply systems shall be ohtaine<l
from a supplier or manufacturer familiai· with their proper
construction a11d use and installect in accordance with the
manufactu1·e1·'s instructions.
5.1.3.5.2 Permitted Locations for Medical Gases. Central
supply svstems for o>..-ygen, me<lical air, nitrous oxide, carbon
dioxide, and all other patient medical gases shall he piped only
to medical g-ds ouLlets complying with 5.1.5, into areas whe1·e
the gases will be used under the direction of licensed me<lical
professionals for put·poses congruent with the following:
(l ) Direct respiration hy patient�
(2) Clinical application of the ga� to a patient, such as the use
of an insufflat01- to i1-uect carbon dioxide into patient
bocty cavities ctm·ing laparoscopic surgery a11d carbon
dioxide use<l to prn·ge hean-lung machine blood flow
ways
(3) Medical de,ice applications di1·ectly 1·elated to respiration
( 4) Powe1· fo1· medical devices usect directly on patient�
(5) Calibration of me<lical <levices intended for 5.1.3.5.2(1)
through 5.1.3.5.2( 4)
(6) Simulation centers for the education, training, and a�sess­
ment of health cai·e professionals
99--31
5.1.3.5.3 Medical Support Gases. Centt·al supply systems for
medical support gases shall not be piped to, or used for, any
purpose except medical suppon application.
5.1.3.5.4* Materials. Materials use<l in central supply systems
shall meet the following reguirements:
In those ponions of systems intended to han<lle oxygen at
(1)
gauge pressures greater tha11 2 413 kPa (350 psi), inte1·­
connecting hose shall contain no polymeric materials.
In those portions of systems intended to handle oxygen
(2)
or nitrous oxi<le matet-ial, construction shall be compati­
ble with oxygen unde1· the temperatm·es and pressu1·es to
which the component� can be exposed in the contain­
ment and use of oxygen, nit1·ous oxide, mixtures of these
gases, 01· mixttl!'es containing more than 23.5 percent
oxygen.
(3) If potentially exposed to cryogenic tempe1·atures, materi­
als shall be designe<l for low temperatut·e service.
(4) If intended for outdo01· installation, materials shall be
installed per the manufacturer's reguiremenK
5. 1.3.5.5 Controls for Line Pressure.
5.1.3.5.5.1* All positive-pressure supply systems shall be prmi­
ded with means to control the final line pressm·e at the source
with all the following charncteristics:
(1) Able to maintain stable pressures within the limit� of
Table 5.1.11
(2) Each control mechanism able to flow 100 percent of the
peak calculate<l demanct
(3) Rectundant, such that each component of the control
mechanism can be isolated for senice or replacement
while maintaining normal operntion
(4) Protected against overpressure (.�PP 5.1.3.5.6)
(5) Be constructed of materials deemed suitable by the
m.an ufac tut·er
5.1.3.5.5.2 The line pressure 1·egulat01·s reguire<l un<le1·
5.1.3.5.5.1, where used for cryogenic fluict central supply
systems, shall be of a balancect design.
5.1.3.5.6 Relief Valves.
5.1.3.5.6.1 All pressure relief valves shall meet the following
1-egui1·ement�:
(l ) They shall be of brass, bronze, or stainless steel construc­
tion.
(2 ) They shall be designe<l fo1· the specific gas service.
(3) They shall have a 1·elief pt·essure setting not higher tha11
the maximum allowable working pressure (MAWP) of the
component \,�th the lowest working pressure 1·ating in the
portion of the system being protected.
f
( 4) They shall be vented to the out�ide o the building,
except that relief valves for compressed air systems having
less than 84,950 L (3000 ft'l ) at STP shall be permitted to
be diffused locally by means that will not restt·ict the flow.
(5) They shall have a vent ctischai·ge line that is not smaller
than the size of the relief valve outlet or 20 mm (1/,NPS),
whicheve1· is la1-ger.
(6) Where two or more relief valves discharge into a common
vent line, the internal cross-sectional area of the common
line shall be not less than the aggregate cross-sectional
ai·ea of all relief valve vent discha1·ge lines served.
(7) They shall not discharge into locations creating potential
haza1·ds.
2021 Edition
99-32 HEALTH CARE FACILITIES CODE
(8) They shall have the rlischarge terminal turned down and
screened to prevent the entry ofrain, snow, or vermin.
( 9) They shall be <lesigne<l in accor<lance with ASME B31.3,
Pmuss Piping.
5.1.3.5.6.2 Pressure relief valves for cryogenic flui<l central
supply systems shall be in accor<lance with 5.1.3.10.10.
5.1.3.5.6.3 \'\'hen vented to out<lom·s, materials an<l constrnc­
tion for relief \'alve discharge lines shall be the same as
required for positive presstll'e gas <listt·ibution. (See 5.1.10.1.)
5.1.3.5.6.4 C.entrnl supply systems fot· positive pt·essure gases
shall inclu<le one or more relief valves, all meeting the follow­
ing 1·equirements:
(1) They shall be located between each final line regulato1·
and the source valve.
(2) They shall have a relief setting that is 50 pe1·cent above
the nm·mal system operating p1·essure, as indicated in
Table 5.1.11.
5.1.3.5.6.5 v\-'hen vented out�i<le, 1·eliefvalve vent lines shall be
labeled in accordance with 5.1.11.1 in any manner that will
distinguish them from the medical gas pipeline.
5.1.3.5.7 Multiple Pressures. \'\'here a single centt·al supply
system supplies separate pipe<l <listribution networks operating
at different presstlt"es, each pipe<l <listribution network shall
comply with 5.1.3.5.5 for pressure controls, 5.1.3.5.6 for relief
\'alves, 5.1.4.2 for the source valve, and 5.1.9.2.4(7) fot· the
master ala rm.
5.1.3.5.8 Local Signals.
5.1.3.5.8.1 The follo"�ng centrnl supply systems shall have
local signals located at the source equipment:
(1) Manifolds for ga� cylinders without resenre supply (.w
5.1.3.5.10)
(2) Manifolds for gas cylinde1·s with reserve supply
(3) Manifolds for cryogenic liquid containers (.w 5.1.3.5.11)
(4) Cryogenic flui<l central supply systems (.fff 5. 1.3.5.12)
(5) In-buil<ling eme1·gency 1·esen,es (sef 5.1.3.5.14)
( 6) Instrument air headers (.w 5.1.13.3. 7.6)
5.1.3.5.8.2 The local signals shall meet the following require­
ment�:
(1) Provision of visual in<lication only
(2) Labeling for the service and condition being monitore<l
(3) If intended for outdom· installation, be installe<l pet·
manufacturer's requirement�
5.1.3.5.9* Headers. In central supply systems using cylindei-s
containing either gas or liquid. each hea<ler shall include the
following:
( l)* C.ylinde1· connections in the number required fot· the
hea<le1·'s application
(2) C.ylinde1· lead for each cylinde1· constrncte<l of mate1·ials
compl�ng with 5.1.3.5.4 and provided with end fittings
pe1·manently attached to the cylin<ler lead complying
with the mandatm·y 1·equi1·ements of C.GA V-1, Standard
for Cmnpm��ed C',rl� Cylinder lizlve Outli!t and Inlet Connn:­
tions (ANSI B57.1)
(3) Filter of a material complying with 5.1.3.5.4 to prevent
the intrnsion of deb1·is into the manifold controls
(4) Hea<ler shutoff valve <lownstream of the nearest cylin<ler
connection, but upstt·eam of the point at which the
hea<le1· connect� to the central supply system
2021 Edition
(5) Pressure indicator indicating the pressure of header
content�
(6) Check valve to prevent backflow into the header and to
allow service to the heade1·
(7) Ifintended for gas cylinder service, a check valve at each
connection for the cylin<ler lead in 5.1.3.5.9(2) to
prevent loss ofga� in the event of damage to the cylinder
lead or operation of an individual cvlinder 1·eliefvalve
(8) If intended for gas cylin<ler senice, a pressure regulator
to 1·educe the cylinder p1·essu1·e to an intermediate pres­
sure to allow the proper operation of the pt·imary and
secon<la1·y headern
(9) If intended for service with cryogenic liquid containers,
a pressure relief valve
(10) Vent valves, if fitted on a heade1·, vented outside of the
building per 5.1.3.5.6. l (5) through 5.1.35.6. l (9) and
5.1.3.5.6.3
5.1.3.5.10* Manifolds for Gas Cylinders.
5.1.3.5.10.1 The manifolds in this category shall be located in
acco1·dance with 5.1.3.3.1 an<l shall meet the following:
(1) Iflocate<l outdom·s, they shall be installed in an enclostu-e
used only for this purpose and sited to comply with mini­
mum <listance 1·equirements in Table 5.1.3.5.11.1.
(2) If located in<loors, they shall be installed within a room
use<l only for enclosure of such manifol<ls.
5.1.3.5.10.2 The manifold locations for this categoq• shall be
con strncte<l in accordance with 5.1.3.3.2.
5.1.3.5.10.3 The manifolds in this category shall have their
pt·imary an<l secon<lary heade1·s locate<l in the same enclosure.
5.1.3.5.10.4 The manifol<ls in this category shall consist of the
following:
(1 ) Two equal headers in acco1·<lance with 5.1.3.5.9, each with
a su fficient numbe1· of gas cylinder connections for one
average day"s supply, but not fewer than two connections.
and with the headers connected to the final line pt·esstlt'e
1·egulat01· assembly in such a manner that either header
can supply the system
(2) Vent valves, if fitted on a hea<ler, vented out�ide of the
building per 5.1.3.5.6. l (5) through 5.1.3.5.6. l (9) and
5.1.3.5.6.3
(3) Interme<liate relief valve(s), piped to the out�i<le in
accordance \\1th 5.1.3.5.6.1( 5) through 5.1.3.:>.6.1(9).
that protects the piping between the heade1· pt·essure
1·egulat01· an<l the line pressure regulator a�sembly. and
protect� the line pressure regulators from overpressure in
the event of a hea<ler regulator failu1·e
5.1.3.5.10.5 The manifolds in this category shall include an
automatic means of alternating the two headers to accomplish
the following in normal operation:
(1) One heade1· is the prima1·y and the other is the secondary.
"1th either being capable of either role.
(2) When the pt·imarv header is supplying the system, the
secon<lary header is prevented from supplying the system.
(3) \'\'hen the pt·imary hea<ler is depleted, the secondary·
hea<ler automatically begins to supply the system.
5.1.3.5.10.6 The manifol<ls in this category shall have a local
signal that visibly indicates the operating status of the equip­
ment and shall activate an indicator at all master alarm panels
when or at a p1·edetermined set point befo1·e the secondary
 c;As AND VACUUM SYSTEMS
header begins to supply the system. indicating changeove1· has
occurrerl or is about to occur.
5.1.3.5.10. 7 If manifolrls are located out of doors, they shall be
installed pet· the manufacture1·'s requirements.
5.1.3.5.11 Manifolds for Cryogenic Liquid Containers.
5.1.3.5.11.1 Manifolds fm cryogenic liquirl containers shall be
located in accordance ,-.nth 5.Ul.3.1 anrl shall meet the follow­
ing:
( 1) If located outdoors, they shall be installerl in an enclosut·e
used only for the enclosure of such containers and sited
to comply \\'ith minimum distance requirement� in Table
.'d.3.5.11.1.
(2) If located inrloors, they shall he installed within a room
used only for the enclosure of such containers .
Table 5.1.3.5.11.1 Minimum Separation Distance Between
Portable Cryogenic Containers and Exposures
Mirumum Distance
Exposure ft m 5.1.3.5.11.6 The manifolds in this category shall be equipped
( 1) Building exits 1() 3.1
(2) \'\'all openings 1 0.3
(3) Air intakes 10 3.1
(4) Property lines 5 1.5
(5) Room or a1·ea exit� 3 0.9
(6) Combustible mate1-ials,
(e.g., paper, leaves, weeds,
dry grass, debris) 15 4.5
(7) Incompatible hazarrlous
materials 20 6.1
[55:Tahle H.7.'.I]
5.1.3.5.11.2 The manifolds in this category shall have their
pt·imary anrl seconrla1·y heade1·s locaterl in the same enclosure.
5.1.3.5.11.3 The reserve header shall he permitterl to he loca­
ted in the same enclosure as the primary and secondary hearl­
ers or in another enclosure compliant with 5.1.3.5.11.1.
5.1.3.5.11.4 The manifolds in this category shall consist of the
following:
(1) Two equal heade1·s in accordance ,-.nth 5.1.3.5.9, each
having sufficient internal or external vaporization
capacity to meet the requirerl peak flow rate and each
having sufficient number of liquid container connections
fot· one average day's supply, and \\'ith the headers
connected to the final line pressure regulator assembly in
such a manner that either header can supply the system
(2) Rese1·ve heade1· in accorrlance ,vith 5.1.3.5.9 having suffi­
cient numhe1· of gas cylinrler connections for one average
day's supply, hut not fewer than three connections, anrl
connected downst1·eam of the primary/seconrlar y hearl­
ers and upstream of the final line pressure regulators
(3) Pressure relief installed downstream of the connection of
the rese1-ve header and upstream of the final line p1·es­
sure regulating a�semblv and set at !",O percent above the
nominal inlet pressure
(4) If provided with one liquid container header (primary),
one gas cylinrler heade1· (secondary), and a 1·eserve ga�
cvlinrler heade1· (a hybrid arrnngement). a seconrlary gas
99--33
cylinde1- supply having equal capacity to meet the
required peak flow rate of the primary hearler, and a
rese1·ve gas cylinde1· hearler in acc01·dance \\'ith 5.1.3.5. 9
having sufficient number of gas cylinrler connections fot·
one average day's supply, but not fewer than three
connections
5.1.3.5.11.5 The manifolds in this categ01·y shall include an
automatic means of controlling the three headers to accom­
plish the following during normal operation:
(1) If provirlerl ,vith two liquid containe1· hearle1·s, one cry�
genie liquirl header shall be the prima1·y anrl the othe1·
shall he the secondary, \\'ith either being capable of either
role .
(2) If provided ,vith one liquirl containe1· header and one gas
cylinder header (a hybrid arrangement), the liquirl
containe1· header is the pt·imary anrl the gas cylinrle1-
heade1· is the secondary.
(3) When the primary heade1· is supplying the system, the
secondary hearler is prevented from supplying the system.
( 4) When the primary heade1· is depleted, the secondary
heade1· automatically begins to supply the system.
with a means to conserve the gas produced by evaporation of
the cryogenic liquid in the secondary header (when so prmi­
detl). This mechanism shall rlischarge the conserved gas into
the system upst1·eam of the final line regulator a�sembly.
5.1.3.5.1 I. 7 The manifolds in this category shall include a
manual or automatic means to place either header into the
role of primary header and the other into the role of seconrlary
header, except where a liquirl/gas hyb1·irl manifold ts
employed.
5.1.3.5.11.8 The manifolds in this category shall include a
means to automatically activate the rese1·ve hearle1· if fot· any
reason the prima1·y anrl secondary heade1·s cannot supply the
system.
5.1.3.5.11.9 The manifolds in this categmy shall have a local
signal that visibly indicates the operating status of the equip­
ment and activates an indicator at all ma�ter alarms under the
follmving conditions:
(1) When or at a p1·edetermined set point befo1·e the secon­
rlary header begins to supply the system, indicating
changeover
(2) Whe1·e a hyb1·id arrangement is employerl, when or at a
pt·edeterminerl set point before the secondary (cylindet')
hearler contents fall to one average rlay's supply, inrlicat­
ing secondary low
(3) When or at a predete1·mined set point befo1·e the reserve
hearler begins to supply the system, indicating reserve is
in use
(4) When or at a prerletern1inetl set point befo1-e the reserve
heade1· content� fall to one average day's supply, inrlicat­
ing reserve low
5.1.3.5.12 Cryogenic Fluid Central Supply Systems. The stor­
age, use, anrl hanrlling of cryogenic fluid centrnl supplv systems
that deliver compresserl medical gases (CMGs) to health care
facilities shall be in accorrlance with 5.1.3.10.
5.1.3.5.13* Emer gency Oxygen Supply Connection (EOSC).
Emergency oxygen supply connections (EOSCs) shall be in­
stallerl to allow connection of a tern pot·ary auxiliary source of
2021 Edition
99-34 HEALTH CARE FACILITIES CODE
supply for emergency or maintenance situations w here either
of the following con<litions exist:
The bulk liquid S)llltem or cryogenic fluid central supply
(1)
system is outside of and remote from the building that
the oxygen supply serves, and there is no connected in­
building oxygen 1·eserve sufficient fot· one ave1·age day's
supply. (SI'!' 5.1. 3.5.14 for rNJUirnnmtsfor sw:h resPrvPs.)
(2) Multiple freestan<ling buil<lings are served from a single
oxygen source such that damage to the interconnecting
o>-ygen line could result in one or more buildings losing
oxygen supply, in which ca�e each building is requin�d to
be provided with a sepa rate emergency connection.
5.1.3.5.13.1 EOSCs shall be located as follows:
( 1) Located on the exterim· of the buil<ling being serve<l in a
location accessible by emergency supply vehicles at all
times in all weather conditions
(2) Connected to the main supply line immediately clown-
f
stream of the main shutof valve
5.1.3.5.13.2 EOSCs shall consist of the following:
( 1) Ph)lllical protection to prevent unauthorize<l tampe1·ing
(2) Female DN (NPS) inlet for connection of the emergency
oxygen source that is size<l for 100 pet-cent of the system
demand at the eme1·gency source gas pt·essure
(3) Manual shutoff valve to isolate the EOSC when not in use
( 4) Two check valves, one downstream of the EOSC and one
downstream of the main line shutoff valve, with both
upstt·eam from the tee connection for the two pipelines
( 5) Relief valve sized to protect the downstream piping
system an<l related equipment from exposure to p1·essures
in excess of 50 percent highe1· than normal line pt·essure
(6) Any valves necessary to allow connection of an eme1·gency
supply of oxygen an<l isolation of the piping to the
no1·mal source of supply
(7) Minimum of 1 m (3 h:) of clearnnce around Lhe EOSC fot·
connection of temporaty auxiliaty source
(8)* Four alarm connection point� installed to both master
alarm panels to allow the tempornry supply to be moni­
tored while in use
5.I .3.5. I 4 In-Building Emergency Reserves ( IBERs).
5.1.3.5.14.1 IBERs shall not be used a� substitutes for the bulk
gas reserve system that is require<l in 5.1.3.10.3.4.
5.1.3.5.14.2 When an IBER is provi<le<l insi<le the building as a
substitute for the EOSC or for othe1· put·poses, it shall be loca­
ted in accordance with 5.1.3.3 as follows:
( 1) In a room 01· enclostffe constructe<l pet· 5.1.3.3.2
(2) In a mom 01· enclostu-e ventilate<l per 5.1.3.3.3
5.1.3.5.14.3 IBER� shall consist of either of the following:
( 1) Ga� cylin<ler heade1· per 5.1.35.9 with sufficient cylinde1·
connections to pt·ovide fot· at least one average day"s
supply with the appropriate number of connections being
determine<l afte1· consideration of the <lelivery sche<lule,
the proximity of the facility to alternate supplies, and the
facility's emergency plan
(2) Manifold for gas cylinders complying with 5.1.3.5.10
5.1.3.5.14.4 IBERs shall include a check valve in the main line
placed on the distribution system side of the ordinaty source's
main line valve to prevent flow of gas from the emergency
reserve to the or<lina ry source.
2021 Edition
5.1.3.5.14.5 IBER� shall have a local signal that visibly imli­
cates the operating status of the equipment and an alarm at all
maste1· ala1·ms when or just befo1·e the reserve begins to serve
the system.
5.1.3.6* C ategory I Medical Air Central Supply S ys tems.
5.1.3.6.1" Quality of Medical Air. Medical alt" shall be
required to have the following characte1·istics:
( 1) It shall be supplied from cylinders, bulk containers, or
medical air comp1·essor som·ces, or it shall be reconstitu­
ted from oxygen USP an<l oil-free, <lry nitrogen NF.
(2) It shall meet the requirement� of medical air USP.
(3) It shall have no detectable liquid hydrocarbons.
(4) It shall have less than 25 ppm gaseous hydrocarbons.
( 5) It shall have equal tom less than 1 mg/m� (6.85 x 10-;
lb/y<l 3) of permanent particulates sized 1 micron or
la1·ger in the air at no1·mal atmosphe1·ic pt·essure.
5.1.3.6.2* Uses of Medical Air. Me<lical air sources shall be
connected to the medical air distribution system only and shall
be used only for ai1· in the application of human respiration
and calibration of me<lical devices for respiratoty application.
5.1.3.6.3* Medi cal Air Compressor Supply Sources.
5.1.3.6.3.1 Location. Medical ai1· comp1·essor S)llltems shall he
located per 5.1.3.3 as follows:
(1) Indoors in a <le<licated mechanical equipment area,
adequately ventilated an<l with any 1·equired utilities ( e.g.,
electricity, <lrains, lighting)
(2) In a room ventilated per 5.1.3.3.3.:1
For ai1°coole<l equipment, in a room designe<l to main­
(3)
tain the ambient tempernture range as recommended by
the manufacturer
5.1.3.6.3.2 Required Components. Medical air compressor
S)llltems shall consist of the following:
(1) Component� complying with 5.1.3.G.3.4 through
5.1.3.6.3.8, atTange<l pet· 5.1.3.G.3.9
Automatic means to pt·event backflow from all on-cycle
(2)
comp1·essors through all oH�cycle compressm·s
f
(:I) Manual shutof valve to isolate each compressor from the
centrally piped system and from othe1· compressors for
maintenance or repai1· without loss of pressure in the
S)llltem
(4) Intake filter-muffler(s) of the dq• type
( 5) Pressure 1·elief valve(s) set at 50 percent above line pres­
sure
(G) Piping an<l components between the compressor and the
f
source shutof valve that do not contt·ibute to contami­
nant levels
(7) Except as defined in 5.1.3.G.:l.2 (1) through (G), materials
and <levices used between the me<lical air intake and the
medical air source valve that are of any design or
construction appropriate for the service as <letermined by
the manufacturer
5.1.3.6.3.3 Air Drying Equipment. Medical air compressor
systems shall pt·eclude the condensation of wate1· vapm· in the
piping distt·ihution system by air drying equipment.
5.1.3.6.3.4 Compres.sors for Medical Air.
(A)* Compressors for medical air shall be designed to prevent
the introduction of contaminants or liquid into the pipeline by
any of the following metho<ls:
 c;As AND VACUUM SYSTEMS
(1) Elimination of oil anywhere in the compressor (e.g.,
liqui <l ring and permanently sealed bearing compressors)
(2) Reciprocating compt·essors provi<le<l with a separation of
the oil-<:ontaining section from the comp1·ession chamber
hy at least two seals creating an a rea open to atmosphere
that allows the following:
(a) Direct an<l unobstructed visual inspection of the
interconnecting shaft through vent and inspection
openings no smaller than 15 shaft diameters in size
(b) Confit-mation hy the facility operatot·s of prope1· seal
operation by di1·ect \isual inspection through the
above-shaft opening, without disassembly of the
compt·essor (e.g., extended hea<l compresso1·s with
an atmospheric vent between the compression
chambe1· and the crankcase)
(3) Rotating element compressors provided with a compres­
sion chamber free of oil that provide the following:
(a) Separation of each oil-containing section from the
compression chamber by at lea5t one seal having
atmosphet·ic vent5 on each sine with the vent closest
to the oil-containing section supplied ,vith a gravity
drain to atmosphere
(h) Unobstructed visualization of the atmospheric
vent(s), closest to each oil-<:ontaining section, that is
accessible fot- inspection without disa�sembling the
compressor
(c) Entry of the rotating shaft into each compression
chambet· at a point that is above atmospheric pt·es­
sut·e
(d) Confirmation by the facility operators of proper seal
operation by direct visual inspection of the atmos­
pheric vents
(B) For liquid ring compressors, service water and seal water
shall be treate<l to control waterborne pathogens and chlorine
from hyperchlorination from entering the medical a.it·.
(C) Liquid ring compressors shall comply with the following:
Service watet· and seal water of a quality t·ecommen<le<l by
(l )
the compressor manufacturer shall be used.
(2) Reserve me<lical air standby hea<lers or a backup
compresso1· shall be installed.
(3) When installed, the headet· shall comply with 5.1.3.5.9.
(4) \'\'hen installed, the number of attached cylinders shall be
sufficient for l hour normal operation.
(D) Compt·ess01-s shall he constructed of matet·ials deemed
suitable by the manufactut·el'.
(E) Antivibt·ation mountin� shall be installed ftx compressors
as t·equired by equipment <lynamics 01· location and in accord­
ance ,vith the manufacturer's t·ecommendations.
(F) Flexible connectors shall connect the air compt·essot·s ,vith
thei1· intake and outlet piping.
5.1.3.6.3.5 Aftercoolers.
(A) Aftercoolers, whet-e 1·equired. shall he prmide<l ,vith indi­
vidual condensate traps.
(B) The receiver shall not he used as an aftercooler or al"ter­
cooler trap.
(C) Aftercoolers shall be constructed of materials deemed
suitable by the manufacturer.
99--35
(D) Antivibration mountings shall be installed for afte1·coolers
a� required by equipment dynamics or location and in accord­
ance with the manufacturer's 1·ecommendations.
5.1.3.6.3.6 Medical Air Receivers. Receivers for me<lical ait·
shall meet the following requirement5:
(l ) They shall he made of corrosion-resistant materials 01-
othenvise be made coITosion resistant.
(2) They shall comply with Section VIII. "Unfired Pressure
Vessels," ofthe ASME Bniler and PrPss1;rf VP.��fl CndP.
(3) They shall be equipped with a p1·essure 1·eliefvalve, aut�
matic drain, manual drain, sight glass, an<l pt·essure indi­
cator.
(4) They shall be of a capacity sufficient to pt·event the
compressors from short-cycling.
5.1.3.6.3.7 Medical Air Dryers. Medical air dryers, where
t·equi1·ed, shall meet the following requi1·ements:
(1) Be designed to prnvide a.it· at a maximum dew point that
is helow the frost point f O"C (32 ° F) l at 345 kPa to
380 kPa ( 50 psi to 55 psi) at any level of demand
(2) Be sized for 100 pet·cent of the system peak calculated
deman<l at <lesign conditions
(3) Be constructed of materials deeme<l suitable by the
manufactu1·er
(4) Be provi<le<l ,vith antivihration mountings installed as
required by equi pment dynamics or location an<l in
accot·dance with the manufacturer's 1·ecommendations
5.1.3.6.3.8 Medical Air Filters. Medical air filtet·s shall meet
the following requirement5:
(1) Be apprnpt·iate for the intake ait· conditions
(2) Be located upstrean1 (source sine) of the final line regula­
tors
(3) Be size<l for 100 pet-cent of the system peak calculate<l
deman<l at design conditions and be rated for a mini­
mum of98 pel'Cent efficiency at l micron or gt·eatet·
(4) Be equipped with a continuous visual indicator showing
the status of the filter element life
(5) Be constructed of materials deeme<l suitable by the
manufacturer
5.1.3.6.3.9 Piping Arrangement and Redundancies.
(A) Component arrangement shall be as follows:
( l) Components shall he arrange<l to allow senice an<l a
continuous supply of medical air in the event of a single
fault failure.
(2) Component arrangement shall be permitted to vary· as
t·equire<l by the technology(ies) employed, prnvided that
an equal level of operating re<lun<lancy and medical ait­
quality is maintaine<l.
(B) Medical ait· compt·essot·s shall be sufficient to serve the
peak calculated demand ,vith the lat·gest single compressor out
of service. In no case shall there he fewer than t\vo compres­
sors.
(C) When aftercoolers at·e provided, they shall he arranged to
meet eithet· one of the following:
(1) A1Tanged as a duplex or multiplex set, sized to serve the
peak calculate<l deman<l with the largest single aftet·­
cooler out of service. an<l prmide<l ,vith valves a<leguate,
to isolate any single aftercooler from the system without
shutting down supply of medical air
2021 Edition
99-36 HEALTH CARE FACILITIES CODE
(2) ,\!Tanged one per comp1·ess01·. size<l to handle the output
of that compressor, an<l valve<l as appropriate to allow
1·epair or replacement with that comp1·essor out of service
but without shutting down supply of medical air
(D)* A medical air receiver(s) shall be prmi<le<l with proper
valves to allow the flow of compr·essed air to enter and exit out
of separate receiver ports during normal operntion and allow
the receiver to be bypasse<l <luring service without shutting
down the supply of me<lical air.
(E) Dryers, filtei-s, an<l 1·eb•1..ilat01·s shall be at least duplexed,
with each component sized to serve the peak calculated
demand with the la1·gest of each component out of service.
(F)* Dryers, filtei-s, and 1·egulat01·s shall be provided with
manual valves upstream and manual valves or check valves
<lownstream to allow service to the component� without shut­
ting down the system in either one of the following ways:
( 1) They shall be installed for each component, upstt·eam
and downstream of each component, allowing each to be
individually isolate<l.
(2) They shall be installed upstt·eam (sout-ce si<le) an<l down­
stream of component� in series so as to create re<lun<lant
pa1·allel branches of components.
(G) A tlu·ee-way valve (tlu-ee-port), indexed to flow, full port
shall be permitted to be used to isolate one branch or compo­
nent fo1· the purposes of 5. l.3.6.3.9(C), 5. l.3.6.3.9(D),
5.1.3.6.3. 9(E), an<l 5. l.3.6.3.9(F).
(H) Under normal operation, only one aftercooler shall be
open to ait-flow with the othe1· afi:e1·cooler valved off.
(I) Un<ler normal operation, only one <l1·ye1·-filter(s)-regula­
tor sequence shall be open to airflow with the other sequence
valve<l off.
(J) If the relief valve require<l 111 5.1.3.6.3.2(5) an<l
5. U\.6.3.6(3) can be isolate<l from the system by the valve
aLTangement used to comply with 5. l.3.6.3.9(F), then a 1·e<lun­
da11t 1·elief valve(s) shall be installed in the parallel sequence.
(K) A DN8 (NPS 1/,) valve<l sample port shall be provided
downstream of the final line pressure regulatm·s, dew point
monitor, and carbon monoxi<le monitor and upstream of the
source shutoff valve to allow fot· sampiing of the me<lical air.
(L) Medical ai1· source systems shall be provi<le<l with a source
valve per :,.1.4.2.
(M) Whe1·e medical air piping systems at diffe1·ent opernting
pressu1·es are required, the piping shall separate after the filters
but shall be provided witl1 separate line regulators, dew point
f
monitors, relief valves, and source shutof valves.
5.1.3.6.3.10* Electrical Power and Control.
(A) Medical air· source systems shall be controlled to ensure
continuous supply of me<lical air at pressures consistent with
Table 5.1.11 under all conditions of system use as follows:
(1) Automatic activation of comp1·essoi-(s) as necessary to
supply the <lemand.
Managing the operation to equalize wear on all compres­
(2)
sors. \'\'here this equalization is achieved manually, the
facility staff shall arrange a schedule for manual alterna­
tion.
(B) Controls shall provi<le the following functions:
2021 Edition
(1) \\'he1·e me<lical air source systems having two 01· m01·e
compressors employ any electrical circuit device that
upon failure coul<l prevent supply of medical ai1·, the
controls shall be provided with an automatically activated
alternative method for ensuring supply (e.g., redundant
component(s), an alternate electrical supply path, or
other equivalent method).
(2) Control circuit� shall be aLTanged in such a manner that
isolation of one compressor or component from the
system (e.g., for maintenance 01· 1·epair) does not inte1·­
rupt the operation of othe1· comp1·ess01·(s) or compo­
nent(s).
(3) Automatic restart function shall be included, such that
the supply of me<lical ai1· will resume n01·mally after
power inten-uption without manual intervention.
(C) Each compressor motor shall be provided with electrical
component� including, but not limited to, the following:
( 1) Dedicated disconnect S\\�tch installed in the electrical
circuit ahead of each motor starter
(2) Motor starting device
(3) Overload protection
(D) Me<lical air compressor system conu·ols shall be provided
with electrical systems including, at a minimum:
(1) Built-in disconnect means shall be inclu<le<l to allow
appropriate operation of multiple compressor systems
an<l protect senice personnel from exposut·e to live
voltages.
(2) Control ci1·cuits shall be an-anged so that failure of any
component of the control circuit, or shutdown of one
comp1·esso1· (e.g., for service), <loes not interrupt auto­
matic operntion of the standby comp1·essoi-.
(3) An automatic restart function shall be included, such that
the comp1·esso1·(s) will restart al'ter power interrnption
without manual inte1·vention.
(4) \Vhere components are common to more than one
control circuit (e.g., autodrains) t he common device shall
be provi<le<l with electrical protection to prevent loss of
the control ci1·cuit�(s) in the event of shon ci1n1it in the
device.
(E) Electt·ical installation and wi1·ing shall conform to the
requirement� of NFPA 70.
(F) Emergency electrical service for the compressors shall
confo1·m to the requi1·ement� of the essential electrical system
a� <lesct"ibed in Chapter 6.
5.1.3.6.3.11 Compressor Intake.
(A) The me<lical air comp1·ess01·s shall draw their ai1· from a
sout-ce of clean ai1·.
(B) The medical air intake shall be located a m1111mum of
7.6 m (25 ft) from ventilating system exhausts, fuel storage
vent�, combustion vent�, plumbing vent�, vacuum and WAGD
discharges, or area, that can collect vehicular exhausts or other
noxious fomes.
(C) The medical air intake shall be located a minimum of 6 m
(20 ft) above ground level.
(D) The medical air intake shall be located a minimum of
3.0 m (10 ft) from any <loor, \\�ndow, or other opening in the
buil<ling.
 c;As AND VACUUM SYSTEMS
(E) If an air source equal to or bette1· than out�ide ai1· (e.g., air
already filtered for use in operating room ventilating systems)
is available, it shall be pern1itted to be used for the medical air
compressors with the following prmisions:
(l ) This alternate source of supply air shall he available on a
continuous 24hout'-pet'-day, 7-<lay-pet'-week basis.
(2) Ventilating systems having fans with mot01·s or drive belt�
located in the airstt·eam shall not be used as a source of
medical air intake.
(F) Compressor intake piping shall he permitted to be made
of materials and use a joining technique as permitted umler
5.1.l 0.2 and 5.1.l 0.3.
(G) Air intakes for separate compressors shall be permitted to
be joined together to one common intake where the following
conditions are met:
(l) The common intake is sized t o minimize back p1·ess1u-e in
accordance v.ith the manufactu1·e1·'s recommendations.
(2) Each compressor can be isolated by manual or check
valve, blind flange , 01· tube cap to prevent open inlet
piping when the compressor(s) is removed for service
from the consequent backflow of room air into the other
compressor(s).
(H) The end of the intake shall be turned down and sct"eened
or otherwise be protected against the entry of vermin, debris,
or precipitation by screening fabricated or composed of a
noncon-oding material.
(I) Medical air intake shall be labeled in accordance v.ith
5.1.1 1.l v.ith any method that would distinguish it a� a medical
air intake.
5.1.3.6.3.12 Operating Alarms and Local Signals. Medical air
systems shall be monitored fo1· conditions that can affect air
quality during use or in the event of failure, based on the type
of compressor(s) used in the system.
(A) A local alarm complving with 5.1.9.5 shall be provided for
the medical air comp1·ess01· sout·ce.
(B) i' Vhere liquid ring air compressors, compressors having
watet-cooled
f
heads, or watet'-cooled a tercoolers are used, air
' (2)
1·eceive1·s shall he equipped with a high water level sensor that
shuts down the compressor system and activates a local ala1·m
indicator. [.'ieP 5.1.9.5.4(8j.J
(C) i' \, 'he1·e liquid ring comp1·essors are used, each compressor
shall have a liquid level sensor in each air-water separator that,
when the liquid level is above the design level, shut� down it�
compressor and activates a local ala1·m indicat01·. [See
5.1. 9.5.4(9).}
(D) Where nonliquid ring compressors compliant \\1th
5.l .3.6.3.4(A) ( l ) are used, the ai1· temperattu-e at the immedi­
ate outlet of each comp1·essor cylinder shall be monitored by a
high-temperature sens01· that shuts down that compressor and
activates a local alarm indicator {�Pe 5.1. 9.5.4(10)}. The temper­
ature setting shall be as recommended by the compressor
man ufacttu-e 1·.
(E) Where compressors compliant with 5.l .3.6.3.4(A) (2) and
5.l.3.6.3.4(A)(3) are used, the following requirement� shall
apply:
( 1) The air temperature at the immediate outlet of each
comp1·ess01· chambe1· shall be monitored by a high-
99--37
temperature sens01· that shut� down that compressor and
activates a local alarm indicator (.�Pe 5.1. 9.5.4 ), the temper­
atm·e setting shall be as 1·ecommended by the comp1·ess01·
manufactu1·er.
(2) Coalescing filters with element change indicator shall be
provided.
(3) Cha1·coal absorber shall he provided.
( 4) Gaseous hydrocarbons shall be monitored on a quartedy
basis.
(F) When the capacity of the medical ai1· system not in use is
less than the equivalent capacity of one compressor, a local
ala rm shall activate [�Pf 5.1. 9.5. 4( ])}. This signal shall require
manual reset.
5. 1.3.6.3.13 Medical Air Quality Monitoring. Medical air qual­
ity shall be monitored downstream of the medical air regula­
t01·s and upstream of the piping system a.� follows:
(1) Dew point shall be monitm·ed and shall activate a local
alarm and all master alarms when the dew point at system
<lelive1·y p1·essure excee<ls +2'C (+3 5 ° F).
(2) CadJon monoxide shall be monitored and shall activate a
local alarm when the CO level exceeds 10 ppm. [Sep
5.1.9.5.4(2).}
(3) Dew point and carbon monoxide monitors shall activate
their individual monitor's signal at the alarm panels
where their signals are required when their power is lost.
5. 1.3.6.3.14 Category I Medical Air Proportioning Supply
Sources.
(A) General.
( l )* Medical air 1·econstituted from oxygen USP and nitro­
gen NF, produced using a proportioning system(s) , shall
be required to meet the follov.ing:
(a) The quality of medical ai1· shall be in acc01·dance
v.ith 5.1.3.6.1.
(b) l11e system shall be capable of supplying this qual­
ity of medical air, in accot·dance with 5.1.3.6.1, ove1-
the entire range of flow.
(c) The system shall produce medical ai1· with an
oxygen content of 19.5 percent to 23.5 percent.
The medical air proportioning system shall operate auto­
matically.
( 3) The mixture shall he analyzed continuously, and a
recording capability shall be provided (e.g., via data
port).
(4) l11e analyzing system specified in 5.l .3.6.3.1 4(A)(3)
shall be a dedicated and independent analyzer used to
control the medical air proportioning system.
( 5) If the mixture goes out of specification, an alarm shall
be activated automatically, the prima1·y medical ai1·
proportioning system shall he disconnected, and the
1·ese1·ve supply shall he activated.
( 6) l11e system shall be arrnnged such that manual interven­
tion is necessary to correct the composition of the
mixtm·e before reconnecting the medical ai1· proportion­
ing svstem to the health care facility pipeline system.
(7) If dedicated sout-ces of oi.-ygen USP and nitt·ogen NF
supply the medical air proportioning system, reserve
sources fot· the oxygen and nitrogen shall not he
1·equi1·ed.
(8) If dedicated sources of oxygen USP and niu·ogen NF
supply the medical air proportioning system, they shall
not be used as the 1·eserves for oxygen and nitt·ogen
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99-38 HEALTH CARE FACILITIES CODE
systems supplying the pipelines of the health care
facility.
(9)* If the sources of oxygen USP and nitrogen NF that
supply the meciical ai1· proportioning svstem a1·e the
same sources that supply the health care facility, engi­
neering controls shall be provided to pt·event cross
contamination of oxygen and nitrogen supply lines, as
prnvided in 5.1.3.5.7.
(10) A risk analysis anci approval from the authority having
jmisdiction shall be requit·ed.
(B) Location. The medical air proportioning system shall be
located per 5.1.3.3 as follows:
(1) The meciical air proportioning system's supply of m..-ygen
USP and nitrogen NF shall he locateci pet· 5.1.3.3 and
NFPA 55, as applicable.
(2) The mixing device anci contrnls, analyz ers. and t·eceivers
shall be located indo01·s within a room or at·ea pet·
5.1.3.3.1.
(3) The indoor location shall include atmospheric monitor­
ing fot· oxygen concentrntion.
(4) The incioot· location shall be constructed with all
required utilities (e.g., electricity, cirains, lighting) per
NFPA 5000.
(5) The indoor location shall be ventilateci and heated pet­
Chapter 9 and the manufacturer's recommendations.
(C) Required Components. The medical air prnportioning
system shall consist of the following:
(1) Supply of oxygen USP and supply of nitrngen NF a�
follows:
(a) The supply lines shall be filte1·eci to t·emove partic­
ulate entering the prnportioning system.
(h) The minimum safe supply gas temperature anci
t·ecommended local signal shall be specified hy the
medical air proponioning system manufacturer.
(2) Mixing device with analyz ers and engineering controls
per manufacturer's recommendations to include, as a
minimum. the following:
(a) At lea�t nvo oxygen analyzers capable of independ­
ently monitoring oxygen concentration
(b) Mechanism where each analyz e•· based upon
nonconforming oxygen concentrntion is capable,
directly or via other medical air proportioning
system contrnls. of automatically shutting off the
supply from the medical ait· proportioning system
to the medical air pipeci ciistt·ibution system anci
activating the reserve supply
(c) Mechanism where each analyzer, ba5ed upon
nonconforming oxygen concentrntion, is capable,
directly or via other proportioning system controls,
of automatically shutting off the supply of m..-ygen
and nitrngen to the proportioning system and acti­
vating the reserve supply
(d) Provision for manual resetting of the proportion­
ing system aftet· detection of nonconforming
oxygen concentrntion and subsequent shutciown
once conforming m..-ygen concentrntion is estab­
lisheci, in orcier to re-establish flow to the medical
ai1· piping system
(e) Means of verifying the pedormance of the
analyzers by reference to an air standarci, with
known tt·aceable oxygen content
2021 Edition
(3) Minimum of one recorder for recording the medical air
proportioning system performance anci air quality for a
period of not less than 24 hours
( 4) Continuous analvsis of the mixtm·e and a recording
capability provicieci (e.g., via a data port)
(5) Mechanism for isolating the prima ry medical ait· prop01·­
tioning system from the t·ese1-ve supply and the meciical
ait· piping distribution system by employing sequential
valves for redundancy
(6) Capability of the t·eserve supply to automatically activate
if the primat·y supply is isolateci
(7) Reserve supply of medical ait· USP sizeci, at minimum,
for one average day·s supply and consisting of one of the
following:
Additional medical ait· proportioning unit with a
(a)
dedicated supply of oxygen USP and nitrogen NF
(b) Medical air compressor system per 5.1.3.6.3, with
the exception of the allowance of a simplex mecii­
cal air compressor system
(c) Medical air cvlinder manifold per 5.1.3.5.10
(8) Receivet· fitted with a pressu1·e t- elief valve and p1·esslu-e
gauge as follows:
(a) The receiver shall he constructed of corrosion­
resistant materials.
(b) The receivet-, relief valves, and pressure gauges
shall comply with ASME Boi.ll'r and Pre.�mre le.ufl
Code and manufactm·er's t·ecommendations.
(9)* Warning systems pet· 5.1.9, including a local signal and
mastet· alat·m that inciicates nonconfo1·ming oxygen
concentration per manufacturer's recommendations
(10) Final line pressure regulators complying with 5.1.3.5.5
(11) Pressure relief complying with 5.1.3.5.6
(12) Local signals complying with 5.1.3.5.8.2
5.1.3.7* Medical-Surgical Vacuum Central Supply Syste:ms.
5.1.3.7.1 Medical-Surgical Vacuum Central Sources. Medical­
surgical vacuum central supply systems shall be located per
5.1.3.3 a� follows:
(1) Indoors in a cieciicateci mechanical equipment area,
adequately ventilated and with any required utilities
( 2) In a room ventilated per 5.1.3.,\.3.3
(3) For air-cooleci equipment, in a mom designed to main­
tain the ambient tempernture range as recommended by
the equipment manufacturer
5.1.3.7.1.1 Medical-sm·gical vacuum central supply systems
shall consist of the following:
(1) Two 01· m01·e vacuum pumps sufficient to serve the peak
calculateci demanci with the largest single vacuum pump
out of senice
(2) Automatic means to prevent backflow from any 01Hycle
vacuum pumps through any ofl:.Cycle vacuum pumps
(:I) Shutoff valve 01· othe1· isolation means to isolate each
vacuum pump from the centrally piped system and other
vacuum pumps for maintenance or repair without loss of
vacuum in the system
(4) Vacuum receiver
(5) Piping between the vacuum pump(s), ciischarge(s),
f
receiver(s), and Vdcuum sout·ce shutof valve in acc01·d­
a11ce with 5.1.10.2, except bra�s. galvanizeci, 01· black steel
pipe, which is permitteci to be used a, recommendeci by
the manufacturer
 c;As AND VACUUM SYSTEMS
(6) Except as define<l in 5.1.3.7.1.1(1) through 5.1.3.7.1.1(5),
materials and de�ices used between the medical vacuum
exhaust and the medical vacuum som·ce that are permit­
ted to be of any design or consu·uction appropt-iate for
the service as determine<l by the manufacturer
(7) Vacuum filtration per 5.1.3.°7.4
5.1.3.7.2 Vacuum Pumps.
5.1.3.7.2.1 Vacuum pumps shall be consu·ucted of materials
<leemed suitable by the manufacttll'er.
5.1.3.7.2.2 Antivibration mountings shall be installed for
vacuum pumps as required by equipment <lynamics or location
an<l in acco1·dance with the manufacturer's recommen<lations.
5.1.3.7.2.3 Flexible connectors shall connect the vacuum
pumps with their intake an<l outlet piping.
5.1.3.7.2.4 Fm· liquid ring vacuum pumps, seal water shall be
of a quality recommen<led by the vacuum pump manufactut·er.
5.1.3.7.3 Vacuum Receivers. Receivers fo1· vacuum shall meet
the follov,,jng requirements:
( 1)They shall be ma<le of materials deeme<l suitable by the
manufacturer.
(2) They shall comply with Section VIII. "Unfi1·ed P1·essme
Vessels," of the ASME BnilPr and PrPs.mre \1,,ssel CodP.
(3) They shall be capable of withstanding a gauge pressure of
415 kPa (60 psi) an<l 760 mm (;\O in.) gauge HgV.
(4) They shall be equipped with a manual drain.
(5) They shall be of a capacity ba�ed on the technology of the
pumps.
5.1.3.7.4 Vacuum Filtration. Central supply systems for
vacuum other than liquid ring pumps shall be provided \\,jth
inlet filtration \\,jth the following characteristics:
(1) Filtration shall be at least <luplex to allow one filter to be
exchanged without impai1·ing the vacuum system.
(2) Filtration shall be locate<l on the patient side of the
vacuum p1·o<luce1·.
(3) Filte1·s shall be efficient to 0.3 µ and 99.97 pe1·cent HEPA
or better, per DOE-STD-3020, SpPrijiwtirmfnr HEPA FiltPl':'i
U�ed l,y Dot.· Cnntmrtors.
(4) Filtration shall be size<l fo1· 100 percent of the peak
calculated deman<l while one filte1· or filte1· bundle is
isolated.
(5) It shall be pe1·mitted to group multiple filters into
bun<lles to achieve the 1·equired capacities.
(6) The system shall be prmide<l with isolation valves on the
source side of each filter or filter bun<lle an<l isolation
valves on the patient side of each filte1· or filte1· bundle,
permitting the filters to be isolate<l without shutting off
flow to the central supply system.
(7) A means shall be available to allow the use1· to observe
any accumulations of liquids.
(8) A vacuum relief petcock shall he provided to allow
vacuum to be relieve<l in the filter canister during filter
replacement.
(9) Filte1· element� an<l caniste1·s shall be pe1·mitte<l to be
constructed of materials a� <leemed suitable by the
manufacturer.
(10) In normal operation, one filte1· 01· filte1· bundle shall be
isolate<l from the system to be available for service
should a blockage in the operating filter occur or rota­
tion of the filters be <lesi1·ed after filter element
exchange.
99--39
5.1.3.7 .5 Piping Arrangement and Redundancies.
5.1.3.7.5.1 Piping an-angement shall be as follows:
(1) Piping shall be a rrange<l to allow service an<l a continu­
ous supply of medical-surgical vacuum in the event of a
single fault failure.
(2) Piping arrangement shall be permitte<l to vary based on
the technology(ies) employed, provi<le<l that an equal
level of operating redundancy is maintaine<l.
(3) Whe1·e only one set of vacuum pumps is available for a
combined medical-sm·gical vacuum system an<l an analy­
sis, a resea1·ch, or a teaching laboratory vacuum system,
such laboratories shall be connected separately from the
me<lical-surgical system di1·ectly to the 1·eceive1· tank
through its own isolation valve an<l fluid trap located at
the receiver, an<l between the isolation valve an<l flui<l
trap. a scrubber shall be pe1·mitted to be installed.
5.1.3.7.5.2 The medical-surgical vacuum 1·eceive1·(s) shall be
serviceable without shutting down the medical-surgical
vacuum system by any method to ensm·e continuation of se1·v­
ice to the facility's me<lical-surgical pipeline <listt·ibution
system.
5.1.3.7.5.3 Medical-surgical vacuum central supply systems
f
shall be provided \\,jth a som·ce shutof valve per 5.1.4.2.
5. 1.3. 7.6 Electrical Power and Control.
(A) Medical vacuum source systems shall be controlled to
enslu-e continuous supply of suction at pressures consistent
with Table 5.1.11 under all con<litions of system use as follows:
(1) Automatic activation of pump(s) as necessary to supply
the deman<l.
(2) Managing the operation to equalize wear on all pumps.
\Vhere this equalization is achieved manually, the facility
f
staf shall arrange a sche<lule for manual alternation.
(B) Controls shall provide the following functions:
( 1) Whe1·e medical vacuum sou1·ce systems having two 01·
mm·e pumps employ any electt·ical circuit device that
upon failure coul<l prevent supply of me<lical vacuum, the
controls shall be provided with an automatically activate<l
alternative method for ensuring supply (e.g., redundant
component(s), an alternate electt·ical supply path, 01·
other equivalent method).
(2) Control ci1·cuits shall be atTange<l in such a manner that
isolation of one pump or component from the system
(e.g. for maintenance 01· 1·epair) does not interrupt the
operation of other pump(s) or component(s).
(3) An automatic restart function shall be included, such that
the supply of medical vacuum will 1·esume n,ffmally afte1·
power interruption without manual intervention.
(C) Each pump motor shall be provi<le<l with electt·ical
components including, but not limite<l to:
(1) Dedicated disconnect switch installed in the electrical
ci1-cuit ahea<l of each mot01· staner
(2) Mot01· staning <levice
(3) Overload protection
(D) Vacuum som·ce system controls shall be provided with
electrical systems inclu<ling, at a minimum:
(1) Control circuit5 shall be arrange<l so that failure of any
component of the control circuit, or shut<lown of one
2021 Edition
99-40 HEALTH CARE FACILITIES CODE
pump (e.g.. fot· service). <loes not intet-n1pt automatic
operation of the standby pump.
(2) Controls shall be provi<le<l v.1th built-in disconnect means
to allow appropt·iate operation of multiple pump systems
and protect service personnel from exposure to live
voltages.
(3) ,\!here component� are common to more than one
control circuit, the common device shall be provided \\1th
electrical protection to prevent loss of the control
circuits(s) in the event ofshon circuit in the device.
(4 ) An automatic restan function shall be included, such that
the pump(s) will restart after power interruption without
manual intervention.
(E) Electt·ical installation and wiring shall confot·m to the
requirements of NI-PA 70.
(F) Emergency electrical service for the pumps shall conform
to the requit·emenl� of the essential electt·ical system as de­
scribed in Chapter 6.
5.1.3.7.7 Medical-Surgical Vacuum Exhaust.
5.1.3.7.7.1 The medical-sut·gical vacuum pumps shall exhaust
in a manner and location that minimizes the hazards of noise
an<l contamination to the facility and it� environment.
5.1.3.7.7.2 The exhaust shall be located as follows:
( 1) Outdoors
(2) At least 7.5 m (25 ft) from any <loot·, winnow, air intake,
01· other openings in buildings or places of public assem­
bly
(3) At a level different from air intakes
(4 ) Where pt·evailing winds, adjacent buildings, topogrnphy,
01· other influences will not <liven the exhaust into occu­
pied areas or prevent dispersion of the exhaust
5.1.3.7.7.3 The end of the exhaust shall be turned down an<l
screened or otherwise be protected against the entry of vermin,
debris, or precipitation by screening fabricated or composed of
a noncorroding mate1·ial.
5.1.3.7.7.4 Vacuum exhaust shall be labeled in acc01·<la.nce
with 5.1.11.1 with anv method that woul<l distinguish it as a
vacuum exhaust.
5.1.3.7.7.5 The exhaust shall be free of dips an<l loops that
might u·ap condensate or oil or provi<le<l with a <lrip leg an<l
valved drnin at the bottom of the low point.
5.1.3.7.7.6 Vacuum exhausts from multi ple pumps shall be
permitted to be joined together to one common exhaust where
the following conditions are met:
( 1) The common exhaust is sized to minimize back pressure
in accordance with the pump manufacturer's recommen­
dations.
(2) Each pump can be isolated by manual or check valve,
blind flange, or tube cap to prevent open exhaust piping
when the pump(s) is removed for service from conse­
quent flow of exhaust ai1· into the room.
5.1.3.7.7.7 Vacuum exhaust piping shall be permitted to be
made of materials an<l use a joining technique as permitted
under 5.1.10.2 and 5.1.10.3.
5.1.3.7.8 Operating Alann.s. When the capacity ofthe medical
vacuum supply system not in use is less than the equivalent
2021 Edition
capacity of one pump. a local alat·m shall activate [�Pe
5.1.9.5.4(4j]. This signal shall require manual reset.
5.1.3.8"' Waste Anesthe tic Gas Disposal (WAGD) Central
Supply Systems.
5.1.3.8.1"' Supply Sources. WAGD supply somces shall be
f
chosen in consultation with the medical staf ha\ing knowledge
of the requirement� to determine the type of system, number
and placement of terminals, an<l other required safety and
opernting devices.
5.1.3.8.1.1 WAGD shall be permitted to be produced through
the medical-surgical vacuum source, by a dedicated producer,
or by venturi.
5.1.3.8.1.2 If WAGD is produced by the medical-surgical
vacuum source, the following shall apply:
(1) lhe medical-surgical vacuum sout-ce shall comply with
5.1.3.7.
(2) The total concentration of oxygen shall be maintained
below 23.6 pet-cent, or the vacuum pump shall comply
with 5.1.3.8.2.1.
(3) ll1e medical-su1·gical vacuum source shall be sized to
accommodate the additional volume.
5.1.3.8.1.3 If WAGD is pro<luce<l by a de<licate<l WAGD
producet· with a total powet· equal to 01· greater than l horse­
power in total (both producers), the following shall apply:
(l ) The WAGD source shall be located in accordance with
5.1.3.3.
(2) 1l1e WAGD source shall be located indoors in a <le<licated
mechanical equipment area with any requit·ed utilities.
(3) 1l1e WAGD source shall be ventilated pet· 5.1.3.3.3.,l.
(4) For air-<:.ooled equipment, the WAGD source shall be
located to maintain the ambient temperature range as
t·ecommended by the manufactm·et·.
(5) The WAGD producers shall comply with 5.1.3.8.2.
5.1.3.8.1.4 If WAGD is pro<luce<l by a de<licate<l WAGD
pro<lucet· with a total power less than l horsepower in total
(both producers), the following shall apply:
(1) 1l1e WAGD source shall be permitted to be located near
the inlet(s) served.
(2) For ait·-<:ooled equipment, the WAGD sou1·ce shall be
located to maintain the ambient temperature range as
recommended by the manufact111·et·.
5.1.3.8.1.5 For liquid t·ing pumps in WAGD service. seal water
shall be of a quality as recommended by the pump manufac­
tm·er.
5.1.3.8.1.6 The WAGD somce shall consist of the following:
(l ) Two or more WAGD producers sufficient to serve the
peak calculated demand with the largest single WAGD
producer out of service
(2) Automatic means to prevent b ackflow from any on-<:yde
WAGD producers through any ofl:cyde WAGD producers
f
(3) Shutof valve to isolate each WAGD producet· from the
centrnlly piped system and othe1· WAGD pro<lucern for
maintenance or repair without loss of ,-vAGD in the
system
(4) Piping between the ,-vAGD producet"s an<l the som·ce
f
shutof valve compliant with 5.1.10.2, a� t·ecommended by
the manufacturer
 c;As AND VACUUM SYSTEMS
(5) Antivibration mountings installed for \\'ACD producers as
required by equipment dynamics or location and in
accordance v.�th the manufactu1·e1·'s recommendations
(6) Flexible connectm·s interconnecting the producers with
their intake and outlet piping as required by equipment
dynamics or location and in accordance with the \VAGD
producer manufacttu-e1·'s recommendations
5.1.3.8.1.7 If WAGD is produced by a venturi, the following
shall apply:
( l) The ventut·i shall not be use1·-adjustable (i.e., requi1·e the
use of special tools).
(2) The venturi shall be driven using water, inert gas, instru-
ment air, or other dedicated air source.
(3) Medical air shall not be used to powe1· the venturi.
5.1.3.8.2 WAGD Producers.
5.1.3.8.2.1 Vacuum pumps dedicated for WAGD service shall
be a� follows:
(1) Compliant with 5.1.3.i.2
(2) Designed of mate1·ials and using lubricants and sealant�
that are inen in the presence of oxygen, nitrous oxide,
and halogenated anesthetics
5.1.3.8.2.2 Vacuum produce1·s (e.g., fans or blowers) designed
fot· operation at vacuums below 130 mm (5 in.) HgV shall be as
follows:
( l) Permitted to be made of any mate1·ials dete1·mined by the
manufacturer as suitable fot· the senice
(2) Provided with anti'l,ibration mountings as required by
equipment dynamics or location and in accordance ,vith
the manufactu1·e1·'s 1·ecommendation
(3) Connected ,,1th their intake and outlet piping through
flexible connections
( 4) Used only for WAGD se1·vice and not employed fot· other
services
(5) Interconnected via piping, ducnvork, and so forth, made
of materials dete1-mined by the manufacturer as suitable
to the service
5.1.3.8.3 WAGD Alarms.
5.1.3.8.3.1 i'\'hen the WAGD system is served by a cenu·al
som·ce(s), a local alarm complying with 5.1.9.5 shall be provi­
ded for the WAGD source.
5.1.3.8.3.2 i'Vl1e1·e WAGD som·ce systems have two or mm·e
produce1·s. and the capacity of the iVAGD system not in use is
less than the equivalent capacity of one producer, a local alarm
shall activate {�ff 5.1. 9.5.4( 5)}. This signal shall require manual
1·eset.
5.1.3.8.4 Electrical Power and Control.
5.1.3.8.4.1 i'\'AGD som·ce systems shall be controlled to ensu1·e
continuous flow under all conditions of system use as follows:
(1) Automatic activation of producer(s) as necessat)' to
supply the demand.
(2) Managing the operation to equalize wear on all produc­
ers. Where this equalization is achieved manually, the
facility stalf shall arrange a schedule for manual alterna­
tion.
5.1.3.8.4.2 Controls shall provide the follo,,1ng functions:
(1) i'Vl1e1·e WAGD source systems having two or mm·e produc­
ers employ any electrical ci1·cuit device which upon fail-
99-41
m·e could stop the WAGD. the controls shall be provided
,,1th an automatically activated alternative method for
ensuring supply (i.e.. redundant component(s), an alter­
nate electrical supply path 01· othe1· equivalent method).
(2) Control circuit� shall be arranged in such a manner that
isolation of one producer 01· component from the system
(e.g., for maintenance or repair) does not inten-upt the
operntion of othe1· pump(s) 01· com ponent(s).
(3) An automatic restart fimction shall be included, such that
the supply of WAGD ,viii resume no1·mally after powe1·
intetTuption without manual intervention.
5.1.3.8.4.3 Each producer motor shall be prmided with elec­
trical components including, but not limited to, the following:
(1) Dedicated disconnect s,,1tch installed in the electrical
circuit ahead of each motor starter
(2) Motor sta1·ting device
(3) Ovedoad protection
5.1.3.8.4.4 WAGD source system controls shall be provided
with electt·ical systems including at least:
(1) Control circuit� shall be arranged so that failure of any
component of the control circuit, or shutdown of one
producer (e.g. for se1vice) does not interrupt automatic
operation of the standby producer.
(2) Controls shall be provided ,vith built in disconnect means
to allow appropriate operation of multiple producer
systems and protect senice personnel from exposure to
live voltages.
(3) Whe1·e component� are common to more than one
control circuit, the common device shall be provided with
electt·ical protection to prevent loss of the control
circuiL�(s) in the event of short ci1·cuit in the device.
(4) Au automatic restart function shall be included, such that
the pump(s) \viii resta rt after power interruption \vithout
manual intervention.
5.1.3.8.4.5 Electrical installation and v.fring shall conform to
the 1-equirement� of NFP./1 70.
5.1.3.8.4.6 Emergency electrical senice for the produce1-s
shall conform to the requirement� of the essential electrical
system as described in Chapter 6.
5.1.3.8.5 WAGD Exhaust. The WAGD pumps shall exhaust in
compliance with 5.1.�.7.7.
5.1.3.9* Oxyge n Central Supply Systems Using Con centrators.
A.ny oxygen central supply system that includes one 01· more
oxygen concentrator supply systems shall comply with 5.1.3.9. l
through 5.1.3.9.:,.
5.1.3.9.1* Oxygen Concentrator Supply Units.
5.1.3.9.1.1 Oxygen concentrator supply unit� for use ,vith
medical gas pipelines shall produce oxygen meeting the
requi1·ement� of Oxygen 93 USP 01- Oxygen USP.
5.1.3.9.1.2 O utput shall have less than or equal to l mg/m3
(1.685 x 10-G lb/yd3 ) of permanent particulates sized l micron
or large1· at normal atmospheric pressu1·e.
5.1.3.9.1.3 Materials of construction on the ai1· sirle of the
oxygen concentrato1- unit shall be suitable fo1· the se1vice as
dete1·mined by the manufacture1·.
5.1.3.9.1.4 Materials of construction on the oxygen side of the
oxygen concentrato1· unit shall comply with 5.1.3.5.4.
2021 Edition
99-42 HEALTH CARE FACILITIES CODE
5.1.3.9.1.5 The component� that make up the oxygen concen­
trator unit shall be as follows:
(1) The manufactu1-e1· of the concentrnt01· unit shall be
permitted to use such components and atTangement of
such component� a� needed to produce oxygen comply­
ing with 5.1.3.9.1.1 in the quantity as required by the
facility, except whe1·e otherwise specifically defined in this
code.
(2) Air receivers and oxygen accumulators, where used, shall
comply v.1th Section VIII, "Unfi1·ed P1·essm·e Vessels," of
the ASME Bnil,,r and PrPs.rnre l'es�fl� Cndf and be provided
with overpressure relief valves.
5.1.3.9.1.6 The supply air to the concentratol"(s) shall be of a
quality to ensure the oxygen concentrnto1· unit can produce
m..-ygen complying \\1th 5.1.:1.9.1.1 and shall not be subject to
normally anticipated contamination (e.g., vehicle or othe1-
exhausts, gas leakage, discharge from vents, flooding).
5.1.3.9.I.7 The oxygen concentrator supply unit and any asso­
ciated electrical equipment shall be provided with, at a mini­
mum, the following electrical components:
(1) Either a disconnect switch for each major electrical
component or a single disconnect that deactivates all
elecu-ical component� in the concentt·at01· unit
(2) Mot01·-..tarting de,ices with ovedoad protection fix any
component with an electrical motor over 2 hp
5.1.3.9.1.8 A vent valve shall be provided as follow11:
(1) Located on the source side of the concentt·ator outlet
isolation valve to permit the operation of the oxygen
concentrator unit for validation, calibrntion, and testing
while the unit is isolated from the pipeline system
(2) Sized to allow for at least 25 percent of the oxygen
concentrator unit flow
(3) Vented to a location compliant with 5.1.3.3.3.2
5.1.3.9.1.9 A DN8 (NPS 1/,) valved sample pmt shall be provi­
ded near the oxygen concentt·ation monitor sensor connection
for sampling of the gas from the oxygen concentrator unit.
5.1.3.9.1.10 At least one 0.1 micron filter suitable for oxygen
service shall be provided at the outlet of the oxygen concentra­
tor supply unit.
5.1.3.9.1.11 A check valve shall be prmided at the outlet of
the oxygen concentrat01· supply unit to prevent backflow into
the oxygen concentrator supply unit and to allow service to the
unit.
5.1.3.9.1.12 An outlet valve shall be provided to isolate all
component� of the oxygen conce11tt·ator from the pipeline ,,1th
the following charncteristics:
(1) The valve shall have both manual and automatic actua­
tion with "isual indication of open or closed.
(2) The valve shall close automatically whenever the oxygen
concentrator unit is not producing oxygen of a concen­
tration equal to that in 5.1.3.9.1.1.
(:I) Continuing operation of the oxygen concentrator supply
unit through the vent mode shall be pe1·mitted with the
isolating valve closed.
( 4) The isolating valve, when automatically closed due to low
concentration, shall requi1·e manual reset to ensure the
oxygen concentrat01· supply unit is examined p1·ior to
1·eturn to service.
2021 Edition
(5) Closing the isolating valve, whether automatically or
manually, shall activate an alarm signal at the master
alarms (.�ef 5.1.9.2) indicating that the oxygen concentra­
t01· supply unit is disconnected.
5.1.3.9.1.13 The oxygen concentrator supply unit shall be
provided with an oxygen concentration monito1· with the
following characteristics:
(1) 1l1 e monitor shall be capable of monitoring 99 percent
oxygen concentration v.1th 1 percent accm·acy.
(2) The monitor shall continuously display the oxygen
conce11tt·ation and shall activate local alarm and ma�ter
alarms in accordance with 5.1.3.9.5 when a concentration
lower than 91 pe1·cent is observed.
(3) The monit01· shall continuously display the oxygen
conce ntrati on.
(4) It shall be permitted to inse1·t the monitor into the pipe-
line without a demand check.
5.1.3.9.2 Location. An oxygen central supply system using a
concentrato1·(s) shall be locaterl in acc01·dance with 5.1.3.3 and
as follows:
(I) Indoors in a dedicated mechanical equipment area, venti­
lated, anrl with any required utilities (e.g., electricity,
drains, lighting).
(2)* In a room ventilated in accordance ,,1th 5.1.3.3.3.:1.
(3) For air cooled equipment, in a room designed to main­
tain the ambient tempe1·ature range as recommended by
the manufactu1·e1-.
( 4) A room containing an oxygen central supply system using
a concentrator(s) that does not have the concentrator
purge gas vented to the out�ide shall be equipped with
oxygen depletion monit01·s with alarm indicat01·s at the
entrance(s) that will indicate ambient oxygen levels in
the room below 19.5 percent.
(5)* Individual elements of the o},.-ygen central supply system
using a concentrntor(s) shall be pe1·mitted to be located
in separate rooms or enclosures a� necessar y to meet
5.1.3.9.2(1) through 5.1.3.9.2(4).
5.1.3.9.3 Arrangement and Redundancies. An oxygen centrnl
supply system using a concentrator(s) shall be permitted to
consist of tw-o or tlu·ee supply sources, as follows:
(1) If tw-o supply sources are provided, one shall be an
oxygen concentrator supply unit and the second shall be
a cylindei- header complying with 5.1.:1.5.9 with suffi­
cient cylinder connections fo1· one average day's supply.
Containers shall not be used as a supply smu-ce.
(2) If three supply sources are provided, each shall be capa­
ble of independently supplying the full system demand
in the event of the unavailability of one or both of the
other sources. The three sources shall be permitted to
be eithe1· of the following:
(a) An oxygen concentrnt01· supplv system complying
with 5.1.:1.9.1.
(b) A cylinder header complying with 5.1.3.5.9 with
sufficient cylinder connections for one average
day's supply. Containers shall not be used as a
supply source.
(:I) Use of oxygen concentt·ator supply systems as all three
sources shall only be permitted after a documented risk
analysis by the governing auth01·ity of the health care
facility indicating understanding of the inherent risks
and defining how those 1·isks shall be mitigated.
 c;As AND VACUUM SYSTEMS
(4) An isolation valve and automatic check valve shall be
provided to isolate each of the three sources from the
othe1·s and from the pipeline. The valves in 5.1.35.9(4),
5.1.3.5.9(6), 5.1.3.9.1.11, and 5.1.3.9.1.12 shall be
permitted to be used for this purpose.
(5) Each of the three supply sources shall be provided with a
pressure relief valve complying with 5.1.35.6 on the
source side of it� respective isolating valve.
(6) The three supply sources shall join to the pipeline
systems through control aITangement� with at least the
following characteristics:
(a) Able to maintain stable pressures within the limit�
of Table 5.1.11
(b) Able to flow 100 pe1·cent of the peak calculated
demand
(c) Redundant, such that each component of the
conu·ol mechanism can be isolated for service or
replacement while maintaining nm·mal operation
(d) The cascade of sources described in 5.1.3.9.4
(e) Protected against overp1·essure (.w 5.1.3.5.6)
(7) A p1·essure 1·elief valve shall be provided in the common
line bet\veen the so1u-ces and the line pressure contt·ols.
(8) A source valve in accordance with 5.1.4.2 shall be provi­
ded on the patient side of the line pt·essure controls.
(9) A gauge and switch or sensor shall be located bet\veen
the three sou1·ces and the line p1·essure controls to moni­
tor the pressure feeding the line pressure controls.
( 10) An oxygen concentration monitor, sampling the gas on
the patient side of the line pressu1·e controls and on the
source side of the source valve, shall be provided with
the following cha1·acte1·istics:
(a) The monito1· shall be capable of monitoring
99 percent oxygen concentration with :tl.O percent
accuracy.
(b) The monitor shall be attached to the pipeline
through a demand check in accm·dance with
5.1.8.2.3.
(c) The monitor shall continuously display the oxygen
concentration and shall activate local ala1·m and
maste1· alarms when an oxygen concentration
lower than 91 percent is obse1ved.
( 11) A DN8 (NPS Yi) Vdlved sample pon shall be provided on
the patient side of the line p1·essu1·e controls and source
side of the source valve for sampling the oxygen.
( 12) An auxilia r y sou1·ce connection shall be provided
complying with 5.1.4.10.
( 13) Electrical installation and wi1·ing shall conform to the
requirement� of NFPA. 70.
(14) Emergency electt·ical senice for all components of the
oxygen supply system shall conform to the 1·equirement�
of the essential electrical system as described in Chap­
ter 6.
5.1.3.9-4 Operating Controls. i\.J1
oxygen central supply
system using a concentrator(s) shall include means to provide
the following functions:
( l) Selection of an appropriate prima r y supply source. \'\'hen
the primary supply Sotffce is in operation and oxygen
quality is suitable, the secondary and rese1ve supply sour­
ces shall be prevented from supplying the system.
(2) Automatic activation of the secondary supply som·ce shall
be available if the prima r y supply source is not able to
maintain p1·essm·e or concentration of oxygen.
99-43
(3) Automatic activation of the reserve supply source shall be
available if the primaty and secondaty supply source are
not able to maintain supply pressu1·e or concentration of
oxygen.
(4) Where t\vo or more concentrator supply sources are
included in the system, the oxygen concentrator supply
som·ces shall be pe1·mitted to rotate as the primary supply
SOlU-Ce.
(5) Automatic operation such that the supply of gas will
continue through intern1ption of the main electt·ical
sou1·ce.
(6) The oxygen concentrator supply sou1·ce(s) in the system
shall be capable of automatically returning to normal
ope.-ation following a power intetTuption. If required by
the technology, it shall be permitted to isolate the
concentrator supply sonrce(s) using the automatic
valve (s) to restore normal oxygen concent1-ation prior to
1·econnecting the oxygen concentrat01· supply sout·ce to
the system by opening the automatic valve. The valve can
be actuated automatically for this purpose as an excep­
tion to 5.1.3.9.1.1 2(4).
5.1.3.9.5 Operating Alarms and Local Signals.
5.1.3.9.5.1 For each oxygen concentrato1- supply source in the
system, the supply som·ce's concentration monitor (.�Pf
5.1. 3. 9.1.13) s hall be able to pedo1-m the following:
(1) Indicate low oxygen concentration when a concentration
lowe1· than 91 percent is observed
(2) Activate a local alarm (see 5.1. 9.5)
(3) Activate an alarm signal at the master alarm (sw 5.1.9.2)
indicating that the oxygen concenu·ation from that
supply source is low
(4) Activate the automatic isolating valve for that oxygen
concentrator supply source (sw 5.1.3.9.1.12) to prevent
supply from that oxygen concentrator supply source
(5) Close the automatic isolating valve for that oxygen
concentrator supply source (sff 5.1.3.9.1.12), which acti­
vates an alarm signal at the master alarm (.�PP 5.1.9.2) indi­
cating that the oxygen concentrator supply source is
disconnected
5.1.3.9.5.2 For the entire oxygen central supply system, the
system concentration monit01· [�ee 5.1.3.9.3( 10)] shall be able to
pedorm the following:
(1) Indicate low oxygen concentration when a concentration
lowe1· than 91 percent is obse1·ved
(2) Activate a local alarm (see 5.1. 9.5)
(3) Activate an alarm signal at the master ala rm (see 5.1.9.2)
indicating the m,-ygen concentration is low
5.1.3.9.5.3 For each heade1· source (s1¥i 5.1.3.5.9) in the supply
system, local signals and alarms shall be provided as follows:
(1) A p1·essure gauge fot· delive1·y p1·essure
(2) A means to activate an alarm signal at the ma�ter alarm
(.�PP 5.1.9.2) indicating the oxygen cylinders are in use
(3) A means to activdte an ala rm signal at the ma�ter alarm
(s1¥i 5.1.9.2) indicating the content of the oxygen cylinde1·
heade1· is reduced below one average day's supply
5.1.3.9.5.4 An O}..ygen central supply system using a concentt·a­
t01·(s) shall be provided with operating alarms as follows:
(1) Owngr of Source. An operating alarm shall be provided as
follows:
2021 Edition
99-44 HEALTH CARE FACILITIES CODE
(a) If the supply source in use fails to supply the system
and is changed in accordance with 5.1.3.9.4(2) or
5.1.3.9.4(3), a local alarm and a signal at the maste1·
ala1·m shall be activated, indicating an oxygen
supply change has occurred.
(b) The signal in 5.l .3.9.5.4( l )(a) shall not be activated
if the system has rotated sotu-ces in accordance with
5.1.3.9.4(6).
(2) Internal Prl'ssurP Low. A local ala.rm and a signal at the
maste1· ala1·m shall be activated when or just before the
pt·essure falls below the pressu1·e 1·equired to drive the
calculated requi1·ed flow rate through the line pressure
controls indicating the oxygen supply internal pressure is
low {.w 5.1.3.9.3(9) for snisar location].
5.1.3.10* C ryogenic Fluid Central Supply Systems.
5.1.3.10.1 General.
5.1.3.10.1.1* The storage, use, and handling of cryogenic
fluid central supply systems that deliver compressed medical
gases (CMGs) to health care facilities shall be in accm·dance
with the requi1·ements of this section. f55:l 7. l . !"I
5.1.3.10.1.2 Applicability.
(A) The so111·ce valve shall be the line separnting the applica­
bility between NFPA 55 and this code. f55: l 7. l.2. l l
(B) C ryogenic fluid central supply system installations up to,
but not including, the source valve shall be covered by
NFPA 55. f55:l 7. l .2.2l
(C) The source valve and all downstream piping and compo­
nents , including wiring to storage system alarms, shall be
covered by this code. f55:l 7. l .2.3l
5.1.3.10.2 Cryogenic Fluid Central Supply Systems Installation.
5.1.3.10.2.1 Ctyogenic fluid central supply systems shall be
installed by personnel qualified in accordance with C GA M-1,
Standard far Medical Gas Supply Systmis at Hmlth Carp Farilitil's, or
ASSE 6015, Projl'ssional Qualifications Standard for Bulk A1Pdiral
{',as Systnm lnstallm. f55:17.2.1l
5.1.3.10.2.2 C1yogenic fluid central supply systems shall be
installed in compliance with the Food and Drug Administra­
tion (FDA) CutTent Good Manufactu1·ing Practices pet· 21 CFR
210 and 21 CFR 211. f55:17.2.21
5.1.3.10.2.3 Cryogenic fluid central supply systems shall be
anchored with foundations in accordance with CGA M-1, Stand­
ard far Mediml Gas Supply Systl'ms at Hmlth Care Facilities.
f55:17.2.3l
5.1.3.10.2.4 Cryogenic fluid cenu·al supply systems shall have a
minimum wm·k space clearance of 3 ft (1 m) around three
sides of the storage container, three sides of the vaporizer(s),
and the cabinet opening or front side of the pressure­
regulating manifold for system maintenance and operation.
5.1.3.10.2.5 Inert oyogenic fluid central supply systems shall
be sited in accordance with Chapter 8 of NFPA 55 and CGA
P-18, Standard for Bulk lnPrt {',as Systl"lns at ConsumPr Sites.
f55:17.2.51
5.1.3.10.2.6 Oxygen cryogenic fluid central supply systems
shall be sited in accm·dance with Chapters 8 and 9 of NFPA 55,
as applicable, and C GA M-1, Standard far Medical {',as Suf1ply
Systnn� at Hmlth Carp Farilities. f55:17.2.6l
2021 Edition
5.1.3.10.2.7 Carbon dioxide 1·efrigerated liquid central supply
systems shall be sited in accordance w · ith Chapter 13 of
NFPA :,5 and CGA G-6.1, Standard far lnmlnted Liquid Carbon
D£m:ide SystP111s at Con.mm.Pr Sites. f55:17.2.7l
5.1.3.10.2.8 Nitrous oxide refrigerated liquid central supply
systems shall be sited in accordance with Chapter 16 of
NFPA 55 and CGA G-8.1, S tandard far Nitmm O:xidP Systnns at
Customer Sites. f55:17.2.81
5.1.3.10.3 Cryogenic Fluid Central Supply Systems Operation.
5.1.3.10.3.1 The following components of the ct"yogenic fluid
central supply system shall be accessible and visible to delivery
personnel during filling operntions:
(1) Fill connection
(2) Top and bottom fill valves
(3) Hose purge valve
(4) Vent valve
(5) Full trycock valve
(6) Liquid level indicator
(7) Tank pressut·e indicato1·
f55: l 7.3. ll
5.1.3.10.3.2 Cryogenic fluid central supply systems shall
consist of the following:
(1) One or more main supply vessel, with capacitv deter­
mined after conside1·ation of the customer usage requi1·e­
ment�, delive ry schedules, proximity of the facilitv to
alternative supplies, and the emergency plan
(2) A content� gauge on evety main vessel
(3) A 1·ese1·ve supply sized for g1·eater than an avernge day's
supply, with the size of \·essel or numbe1· of cylinders
determined after consideration of delivery schedules,
proximity of the facility to alternative supplies, and the
emergency plan
(4) At least tW'O main vessel 1·elief valves and rnptu1·e discs
installed downstream of a three-way (i.e., three-port) valve
(5) A check valve located in the p1·imary supply piping
upstream of the intersection \\�th a seconda ry supply or
reserve supply
f55: l 7.3.2l
5.1.3.10.3.3 Reserve CMG supply systems consisting of eithe1· a
second cryogenic fluid source or a compressed gas source shall
include the following:
(1) \Vhe1·e the rese1·ve source is a compressed gas sou1·ce, the
reserve shall be equipped with the following:
(a) A cylinder manifold having not less than three gas
cvlinde1· connections 01· as otherwise required for
f
an average o one day's gas supply
(b) A pressm·e switch to monitor the pressure in the
cylinde1· manifold
(2) ,vhere the 1·ese1·ve sou1·ce is a second ct"yogenic fluid
vessel, the reserve tank shall be equipped with the follow­
ing:
(a) An actuating s,,�tch or sens01· to monitm· the inter­
nal tank pressure
(b) A contents gauge to monitor the liquid level
(3) ',,\'he1·e the 1·esen:e sout·ce is either a ctyogenic fluid or
comp1·essed gas source, a check valve shall be provided to
prevent backflow into the reserve system.
f55:I 7.3.3l
 c;As AND VACUUM SYSTEMS
5.1.3.10.3.4 Bulk ct"yogenic liquict sources shall include auto­
matic means to provide the following functions:
(l ) When the main supply is supplying the system, the
reserve supply shall be prevented from supplying the
system until the main supply is rectucect to a level at or
below the rese1·ve activation p1·essure.
(2) When the main supply cannot supply the system, the
reserve supply shall automatically begin to supply the
system.
(3) \'\'he1·e there is more than one main supply vessel, the
system shall operate as follows for prima ry, secon<lary, and
reserve operation:
(a) If ptu,icted with tw-o liquict containe1· heade1·s, one
cryogenic liquict hea<ler shall be the primary and
the other shall be the secon<lary, with either being
capable of either role.
f
(b) f provided with one liquid container heade1· and
one ga� cylinde1· header (i.e., a hyb1·id arrange­
ment ), the liquict container header shall be the
p1·imary and the gas cylinde1· header shall be the
secondary.
(c) When the prima1y header is supplying the system,
the secondary heacter shall be prevente<l from
supplying the system.
(d) \Vhen the primary heade1· is depleted, the secon­
daty header shall automatically begin to supply the
system.
( 4) \'\'l1e1·e the1·e are two or more ctyogenic vessels, thev shall
be permitted to alternate (e.g., on a timed basis) in the
f
roles o primary, seconda1y, and reserve, provided that an
opernting ca�cade (i.e., primary-secon<la1·y-reserve) is
maintained at all times.
(:,) Where a cryogenic vessel is use<l a� the rese1ve, the
rese1ve vessel shall include a means to conserve the gas
produced by evaporntion of the ct"yogenic liquid in the
reserve vessel and to discha1·ge the gas into the line
upstream of the final line regulator assembly.
[55:17.3.41
5.1.3.10.4 Main Supply System. 1l1e main supply vessel for a
cryogenic flui<l central supply system shall be a etyogenic stor­
age tank. [55:17.41
5.1.3.10.5 Reserve Supply System.
5.1.3.10.5.1 A CMG resetve supply system shall consist of
either of the following:
(l ) A secondar y cryogenic vessel
(2) A high-pt·essure comp1·essed gas source
[55:17.5.ll
5.1.3.10.5.2 A crvogenic source reserve supply shall have a
switch or senso1· to monitor the tank pt·essure. f55: 17.5.21
5.1.3.10.5.3 A compressed ga� reserve supply shall meet the
following requirement�:
(l ) It shall be manifolcted \,�th no fewe1· than three gas cylin­
ders.
(2) It shall have a pressure switch or sensor to monitor the
contents using manifold p1·ess1u-e.
(3) It shall have a check valve to prevent backflow into the
system.
99-45
(4) It shall have a check valve at each connection on the
cylinder heacter to minimize loss of gas from the rese1ve
system.
[55:17.5.31
5.1.3.10.6 Cryogenic Fill System. C1yogenic flui<l central
supply systems shall include a fill mechanism consisting of the
following components:
(1) A nonremovable product-specific fill connection in
compliance with CGA V-6. Standard Bulk RPfrigfratPd Liquid
1'ranspr Cnnnertirms
(2) A means to cap and secure the fill connection inlet
(3) A check ,,alve to pt·event product backflow from the fill
inlet
(4) A fill hose purge valve
f
(5) Support� that hold the fill piping of the grounct
(6 ) A secure connection bet\veen the bulk tank and the fill
p1p111g
(7) Support�, as necessary, to hold the fill line in position
<lm-ing all operations associated with the filling procedure
[55:17.61
5.1.3.10.7 Vaporizers.
5.1.3.10.7.1 Vaporizers used to convei-t nyogenic CMG to a
gaseous state shall meet the follm,�ng requirements:
( 1) Vapo1·ize1·s shall be pern1itted to ope1·ate by either ambi­
ent heat transfr1· or external the1·mal smu-ce (e.g., electric
heater, hot water, steam).
(2) Vaporizers using a heat source other than ambient air
shall he protected in the event of a loss of the ene1·w,
SOUi-Ce.
[55:17.7.ll
5.1.3.10.7.2 Vaporizers shall be <lesigned to pro\ide capacity
fot· the customer's use under the following conditions:
(1) Customer's ave1·age and peak flows
(2) Local conditions (e.g .. structures that obstrnct air ci1·cula­
tion or sunlight)
Seasonal con<litions ( e.g.. freeze periods)
(3)
[55:17.7. 21
5.1.3.10.7.3 A system design that uses switching vaporizers
shall meet a.II of the following requirement�:
( 1) Valves shall be pe1·mitte<l to be manual 01· automatic.
(2) Valves and piping shall allow an operating vaporizer 01· an
operating section of a vaporizer to be s,�tched to a
nonoperating condition for deicing.
(3) The system design shall provide continuous flow of CMG
to the health care facility during vaporizer s,�tchover.
(4) The system design shall provide continuous flow of CMG
to the health ca.re facility ifvaporize1· switchove1· fails.
[55:17.7.31
5.1.3.10.7.4 \'\'here a vaporize1· uses an external thermal
source, the flow of the CMG shall be unalfecte<l by the loss of
the external thermal source by one of the following methods:
(l ) Reserve ambient heat trn.nsfer vaporizers sized for at least
one <lay"s a\·erage supply and piped so that the flow of the
CMG is una!lecte<l by flow stoppage through the external
thermal source vaporizer
2021 Edition
99-46 HEALTH CARE FACILITIES CODE
(2) A noncryogenic source capable of providing at least one
day's average supply
r55:17.7.4l
5.1.3.10.7.5 Where vaporizers are used in the reserve system,
they shall be as follows:
( l) Sized by the supplie1· to provide a source of vaporized
CMG from the reserve bulk liguid storage vessel during
times when the reserve system is operational
(2) Able to provide a flow rate egual to at least that of the
main system vap01·ize1·(s); however, the duration of flow
might be diflerent
(3) Indin,ctly heated by ambient air
r55:1 1.1.51
5.1.3.10. 7.6 Low-temperatun, protection systems that inter­
rupt or 1-educe flow shall not be used on the resen,e system of
cryogenic fluid central supply systems. r55:l7.7.Gl
5.1.3.10.8 High-Pres.sure Manifolds.
5.1.3.10.8.1 Manifold assemblies shall be fit for service and
shall have support� that are independent of the cylinders.
r55:1 7.8.ll
5.1.3.10.8.2 Cylinders on the manifold shall be secured
against falling.'r55:17.8.21
5.1.3.10.8.3* Cylindei-s on the manifold shall have the same
sen,ice p1·essu1·e rating 01· the filled pressure of each cylinde1·
shall not exceed the service pressure rating of the lowest rated
cylinder on the manifold. r55:l7.8.3l
5.1.3.10.9 Pres.sure Control Devices. The final pressure
control device assembly or assemblies shall not be fabricated
on-site. r55:17.9l
5.1.3.10.10 Pres.sure Relief Devices.
5.1.3.10.10.1 Pressure relief devices (PRDs ) shall meet the
following 1·eguirement�:
(l) PRDs shall have a 1·elief pt·essure setting not higher than
the maximum allowable working pressure (MA"\VP ) of the
component with the lowest wo1·king pressm·e 1·ating in the
ponion of the system being protected.
(2) PRDs shall be of brass 01· bronze construction.
(3) PRDs shall be designed for the specific gas service.
(4) PRDs shall have the discharge protected to prevent the
entry of rain or snow.
(5) PRDs shall be designed in accordance with ASME B3 1.3,
ProrPss Piping.
r55:11.10.11
5.1.3.10.10.2 PRDs shall have an identifier that contains the
date of manufactut·e or test. r55:17.10.2l
5.1.3.10.10.3 The final line pt·essure relief valves shall he
approved by a nationally recognized organization and shall
have a relief capacity g1·eater than or egual to the maximum
throughput of the final line 1·egulator. r55:17.10.3l
(A) The pressure relief valve shall be set at 50 percent above
the normal wod<ing pressure , but no highe1· than the MA"\'\'P, of
the health ca1·e facility pipeline. r55:l7.10.3.ll
2021 Edition
(B) The 1·elief valve info1·mation shall be permanently identi­
fied either on the name plate of the relief valve or on a perma­
nently attached metal tag. r55:17.10.3.2l
5.1.3.10.11 Tubing and Valves.
5.1.3.10.11.1 New, hard-d1·awn Type Kor L copper tube shall
be used fo1· all process piping. r55:l7.l 1.1 l
(A) Tubing shall comply with ASTM B8 1 9, Standard Spn:ifira­
tion for SPamlPs.1 CoppPr TubP for MPdiral Gas Systnns.
r55:17.l l.l.ll
(B) Tubing shall be capped and bear the marking OXY or
MEDICAL oi- be othenvise packaged and labeled to indicate it
is clean fot· oxvgen service according to the supplie1·'s policy.
155:17.1 1.1.21
5.1.3.10.11.2
(A) Instrumentation tubing shall be constructed of annealed
copper tubing or seamless stainless steel tubing. r55:17.1 1.2. ll
(B) Copper tubing shall comply with ASTM B8 8, Standmd Sper:­
ifimtion for Seamle.u CoppPr Vl'rltfr Tithe. r55:l7.l l.2.2l
5.1.3.10.11.3 Valves of guick-open or guarter-turn designs,
such a� ball or plug valves, shall not be permitted in the
ponion of an oxygen piping system opernting above 4 3 5 psi
r 3000 k Pal. r55:17.l 1.3l
5.1.3.10.11.4
(A)* Alternate materials of construction fot· piping, tubing,
valves, and instruments shall be permitted for installation at the
reguest of the health care facility or the supplier. r55:17.ll.4.l ·1
(B) Technical documentation of alternate materials shall be
submitted to the health ca1·e facility QA rep1·ese11tative to
demonstrate eguivalency. r55:17.l l.4.2l
5.1.3.10.12* Alarms. The cryogenic fluid central supply
system shall have a local signal that visibly indicates the operat­
ing status of the eguipment and an indicator at all master
alarms under the following conditions:
(l ) "\Vhen, or at a predetermined set point before. the main
supply reaches an average day's supply, indicating low
content�
(2) When, or at a predetermined set point before, the reserve
supply begins to supply the system, indicating 1-ese1·ve is in
use
(3) "\Vhen, or at a predetermined set point before, the 1·eserve
supply content� fall to one day's average supply, indicat­
ing low reserve
(4) If the rese1·ve is a Ct"yogenic vessel, when, or at a predeter­
mined set point before. the reserve internal pressure falls
too low fot· the 1·esen,e to operate propedy, indicating
reserve failure
(5) Where the1·e is more than one main supply vessel, when,
01· at a pt·edetermined set point before, the secondary
vessel begins to supply the system, indicating changeove1·
r55:17.1 2l
5.1.4* Valves.
5.1.4.1 General.
5.1.4.1.1 Gas and Vacuum Shutoff Valves. Shutoff valves shall
be provided to isolate sections or portions of the piped distri-
 c;As AND VACUUM SYSTEMS
bution system for maintenance. repaic or planned futu1·e
expansion need and to facilitate periodic testing.
5.1.4.1.2 Security. All valves, except valves in zone valve box
assemblies. shall be secu1·ed hy any of the following means:
(1) Located in secured areas
(2) Locked or latched in thei1· opernting position
(3) Located above ceilings, but remaining accessible and not
obstructed
5.1.4.1.3 Labeling. All valves shall be labeled as to ga5
supplied and the area(s) contrnlled, in acco1·dance with
5.1.11.2.
5.1.4.1.4 Accessibility.
(A) Zone valves shall be installed in valve boxes with remova­
ble covers large enough to allow manual operation of valves.
(B) Zone valves fot· use in certain areas, such as psychiatt·ic or
pediatric area5, shall be permitted to be secured with the
approval of the authoritv having jurisdiction to prevent inap­
prnpriate access.
5.1.4.1.5 Flammable Gases. Valves for nonflammable medical
ga�es shall not be installed with valves for flammable ga�es in
the same zone valve box a5sembly with flammable ga�es.
5.1.4.1.6 Valve Types. New or replacement valves shall be
permitted to be of any type as long as they meet the following
conditions:
(l) They have a minimum Cv factor in acc01·dance with
either Table 5.1.4.1.G(a) or Table 5.l.4.l.6 (b).
They use a quartet· turn to off.
(2)
They a1·e constructed of materials suitable for the service.
(3)
They are provided with copper tube extensions by the
(4)
manufacturer for brazing 01· with corrngated medical
tubing (C:MT) fittings.
(f>) They indicate to the operator if the valve is open or
closed.
(G) They pe1·mit in-line serviceability.
(7) They are cleaned for m.-ygen service by the manufacturer
if used for any positive-pressure service.
They have threaded purge port5 on the patient side and
(8)
the source side.
(9) They have a minimum working pt·essure equal to or
greater than the relief valve protecting the piping system
on which the valve is installed for any positive-pressure
sen1ce.
Table 5.l.4.I.6(a) Po sitive Pressure Gases
Valve Size M.inimumCv
(in.) (full open)
½ 17
'Vi 31
l GO
l 1/1 110
l½ 169
2 357
2½ 390
3 912
4 1837
99--47
Tobie 5.l.4.I.6(b) Vacuum and WAGD
Valve Size MinimumCv
(in.) (full open)
Y,, 17
% 31
l 60
11/1 110
l½ 169
2 357
2½ 196
3 302
4 GOO
5 1022
6 1579
8 3136
5.1.4.2 Source Valve.
f
5.1.4.2.1 A shutof valve shall be placed at the immediate
connection of each central supply system to the piped distribu­
tion system to allow the entire central supply system, including
all accessory devices (e.g., ai1· dqrers, final line 1·egulators). to
be isolated from the fac ility.
5.1.4.2.2 The source valve shall be located in the immediate
vicinity of the central supply system.
5.1.4.3* Main Line Valve.
5.1.4.3.1 A shutoff \·alve shall be provided in the main supply
line inside of the buildings being setved, except where one 01·
more of the following conditions exist:
(l) The sou1·ce and source valve are located inside the build­
ing se1·ved.
(2) The source system is physically mounted to the wall of the
building served, and the pipeline enters the building in
the immediate vicinity of the source valve.
5.1.4.3.2 The main line valve shall be located on the facility
side of the source valve and out5ide of the source room, the
enclosure. 01· whe1·e the main line first ente1·s the building.
5.1.4.4 Riser Valve. Each riser supplied from the main line
shall be provided with a shutoff valve in the riser a(ljacent to
the main line.
5.1.4.5 Service Valves.
5.1.4.5.1 Service valves shall he installed to allow setvicing 01·
modification of lateral branch piping from a main 01· riser with­
out shutting down the entire main, 1·iser, or facility.
5.1.4.5.2 Only one service valve shall be requin�d for each
f
branch of of a riser, rega1·dless of how many zone valve boxes
are installed on that lateral.
5.1.4.5.3 Service valves shall he placed in the branch piping
prim· to any zone valve box assembly on that branch.
5.1.4.6 Zone Valves.
5.1.4.6.1 All station outlet�/inlet5 shall be supplied through a
zone valve. which shall be placed as follows:
(1) It is installed so that a wall intervenes between the valve
and the outlet�/inlet5 that it controls.
2021 Edition
99-48 HEALTH CARE FACILITIES CODE
(2)* It is 1·eadily operable from a standing position.
(3)* It is installed where it is visible and accessible at all times.
( 4) It is not installed where it can be hidden from plain view,
such as behind n01·mally open 01· n01·mally closed noo1·s.
(5) It is not installed in a room with the station outlets/inlet,
that it controls.
(6) It is not installed in rooms, a1·eas, or closet, that can be
closed 01· locked.
5.1.4.6.2 A zone valve in each medical ga, or vacuum line shall
be provinen for each Category 1 space ann anesthetizing loca­
tion for moderate sedation, deep sedation, 01· general anesthe­
sia specific for the occupancy, and shall he locaten as follows:
(1) They are installed immeniately outsine the area control-
led.
(2) They are installed where they are visible and accessible at
all times.
5.1.4.6.3 Piping on the patient side of zone valves shall be
arranged to provide the following:
( 1) Shutting off the supply of medical gas or vacuum to one
zone will not affect the supply of medical gas or vacuum
to another zone or the rest of the system.
(2) Service will only be to outlet,/inlets located on that same
story.
(3) All gas delive1·y columns, hose 1·eels, ceiling tracks,
control panels, pennant,, booms, or other special installa­
tions are located on the patient side of the zone valve.
5.1.4.6.4 A presstu-e/vacuum innicator shall be prnvided on
the station outlet/inlet side of each zone valve.
5.1.4.7 In-Line Shutoff Valves. Optional in-line valves shall be
f
pe1·mitten to be installed to isolate or shut of piping fot· servic­
ing of innividual rooms or areas.
5.1.4.8 Valves for Future Connections.
5.1.4.8.1 Future connection valves shall be labeled as to gas
content.
5.1.4.8.2 Downstream piping shall be closen with a brazen cap
with tubing allowance for cutting ann rebrazing.
5.1.4.9 In-Line Check Valves. New or replacement check
valves shall be as follows:
(1) They shall be of brass or bronze construction.
(2) They shall have brazed extensions.
(3) They shall have in-line se1·viceabili ty.
(4) They shall not have tlu·eaden connections.
(5) They shall have threaded purge point, of¼ in. NPT.
(6) They shall be sized to have a maximum velocity which
does not exceen the manufacturer's recommennations.
5.1.4.10 Auxiliary Source Connection. All etyogenic fluin
central supply systems shall be provinen with an auxilia ry
source connection point of the same size as the main line,
which shall be located immediately on the patient side of the
source valve.
5.1.4.10.1 The connection shall consist ofa tee, a valve, and a
removable plug or cap.
5.1.4.10.2 The auxilia1·y sout-ce connection valve shall be
normally closed and secured.
2021 Edition
5.1.5* Station Outlets/Inlets.
5.1.5.1 Each station outlet/inlet fo1· me<lical gases 01- vacuums
shall be gas-specific, whether the outlet/inlet is th1·eaded or is a
noninte1·changeable quick couplet·.
5.1.5.2 Each station outlet shall consist of a primary an<l a
secon<la1·y valve ( or assembly).
5.1.5.3 Each station inlet shall consist of a prima1y valve (or
assembly) and shall be permitte<l to include a secondary valve
(or assembly).
5.1.5.4 The seconda ry valve (or assembly) shall close automat­
ically to stop the flow of gas (or vacuum, if prnvided) when the
p1·imary valve (or assembly) is 1·emoved.
5.1.5.5 Each outlet/inlet shall be legibly identifie<l in accord­
ance with 5.1.11.3.
5.1.5.6 Threaded outlet�/inlet� shall be noninte1·changeable
connections complying with the mandatory requirement, of
CGA V-5, Dimllfler Index Safety System (Noninten-hangmble Low
Pressure Conmctions for M.edi,:al Gm Appli,:ations).
5.1.5.7 Each station outlet/inlet, inclu<ling those mounte<l in
columns, hose 1·eels, ceiling tracks, or other special installa­
tions, shall be designed so that parts or components that are
requiren to he gas-specific for compliance with 5.1.5.1 and
5.1.5.9 cannot be interchange<l between the station outlet/
inlet for rlifferent gases.
5.1.5.8 The use of common pa1·t� in outlet s/inlet�, such as
springs, O-rings, fasteners, seals, an<l shutoff poppet�, shall be
permitten.
5.1.5.9 Component., of a vacuum station inlet necessa ry for
the maintenance of vacuum specificity shall be legibly marked
to identify them as component, 01· pa1·t5 of a vacuum or suction
system.
5.1.5.10 Components of inlets not specific to a vacuum shall
not be requi1·ed to he marked.
5.1.5.11 Factory-installed copper inlet tubes on station outlet�
exten<ling no further than 205 mm (8 in.) from the body of the
terminal shall be not less than DN8 (NPS Y,) (% in. O.D.) size,
with 8 mm (0.3 in.) minimum inside <liamete1·.
5.1.5.12 Factory-installed copper outlet tubes on station inlet�
exten<ling no further than 205 mm (8 in.) from the bo<ly of the
te1·minal shall be not less than DN l0 (NPS %) (½ in. O.D.) size,
with 10 mm (0.4 in.) minimum insi<le diameter.
5.1.5.13 Station outlets/inlets shall be permitted to be
recessed or otherwise prntected from damage.
5.1.5.14 \-\'hen multiple wall oullet,/inlets are installed, they
shall be spaced to allow the simultaneous use of adjacent
outlets/inlet� with any of the various types of therapy equip­
ment.
5.1.5.15 Station outlet� in systems ha\ing nonstanda1·d operat­
ing pressures shall meet the following ad<litional requi1·ements:
(1) TI1ey shall be ga,-specific.
(2) TI1ey shall be pt·essure-specific where a single gas is piped
at more than one operating pressm-e r e.g., a station
outlet for oxygen at 550 kPa (80 psi) shall not accept an
adapte1· for m--ygen
.. at 345 kPa (50 psi) l.
 c;As AND VACUUM SYSTEMS
(3) If operated at a pressure in excess of 550 kPa (80 psi),
they shall be either D.I.S.S. connectors or comply with
.",.1.5.1.">( 4).
(4) If operatect at a gauge presstu-e hetween 1,\80 kPa and
2070 kPa (200 psi and 300 psi), the station outlet shall he
designed so as to prevent the removal of the adapter until
the pressure has been relieved to prevent the actapter
injuring the user or others when removed from the
outlet.
5.1.5.16 WAGD netw01·ks shall provide a WAGD inlet in all
locations where nitrous oxide 01· halogenated anesthetic gas is
intenctect to he actministerect.
5.1.5.16.1 Station inlet� for V11AGD sen,ice shall have the
following actditional charactet·istics:
( l) They shall not be interchangeable with an y other systems,
inducting mectical-sut·gical vacuum.
(2) Component� necessa1·y for the maintenance of \\'AGD
specificity shall be legibly markect to ictentify them as
componenl� of a WAGD inlet.
(3) They shall he of a type appropriate for the flow and
vacuum level reguirect by the facility's gas anesthetic
machines.
( 4) They shall be located to avoid physical ctamage to the
inlet.
5.1.5.17 ,-\-11ere installed in a down-facing position, such as in
a ceiling or ceiling column. station outlets/inlet� shall be
D.I.S.S. connectors.
5.1.6* Manufactured Assemblies.
5.1.6.1 Manufactured assemblies shall be pretested by the
manufactm·e1· prior to atTival at ilie installation site in accorct­
ance with the following:
(1) Initial hlowctown test per 5.1.12.2.2
(2) Initial pressure test pet· 5.1.12.2.3
(3) Piping purge test per 5.1.12.2.5
( 4) Standing pressure test per 5.1.12.2.6 01· :,.1.12.2.7, except
as permittect under 5.1.6.2
(5) Operational pt·essure test pet· 5.1.12.4.10, except that the
test gas is permitted to be in accorctance with the manu­
facture1·'s process regui1·ements
5.1.6.2 The leakage from a completed manufactured assembly
shall not exceect 0.006 cm�/sec (0.00037 in.�/sec) when tested
at 20 percent ahove operating pressu1·e fot· pt·esstu-e pipelines
and shall not exceect 0.002 cm�/sec (0.00012 in.�/sec) for
vacuum and \\'AGD systems when staned at 635 mm (25 in.)
HgV.
5.1.6.3 The manufacturer of the assembly shall provicte ctocu­
mentation certifying ilie peti·01·mance and succe��ful comple­
tion of ilie tests reguirect in 5.1.6.1.
5.1.6.4 Manufactured assemblies employing flexible hose shall
use hose and flexible connectors v.�th a minimum but·st gauge
p1-essure of 6895 kPa ( 1000 psi).
5.1.6.5 The manufacturer of the assembly shall provide docu­
mentation certifying that the flexible hose assembly has a mini­
mum burst gauge pressure of 6895 kPa (1000 psi).
5.1.6.6 Components of manufacttu-ed a�semhlies shall have a
flame spread index of not greater than 2 00 when tested in
accot·dance with A ST M E84, Standard ]psi Method for Sur/are
Burning Chararteristin of Building MatPrial�. m UL 723. Standard
99-49
for Test for Sur/are Burning ChamdPri�tic� of Building Material�. m
shall comply with the reguirement� for heat release in accord­
ance with NFPA 286 as described in Section 10.2 ofNFPA 101.
5.1.6.7 Manufactured assemblies employing flexible hose 01·
tuhing shall he attachect to the pipelines using station outlet�/
inlets.
5.1.6.8 Manufacturect assemhlies employing hose or flexible
connectors, where the station outlet/inlet attached to the
piping is not h.tlly anct immectiately accessible (i.e., cannot be
manipulatect without the removal of panels, do01·s, anct so
forili). shall have station outlets/inlet� \\�th ilie following adcti­
tional characteristics:
(1) TI1ey shall be ga�-specific connections v.�th positive lock­
ing mechanisms that ensure the connector is firmly
seated and cannot ctetach without intentional actuation
of the release (e.g., D.I.S.S. connectot·s).
(2) In pressut·e gases. they shall be permitted to omit the
secondary valve (or assembly) reguired in 5.1.5.2.
(3) In vacuum and WAGD, they shall he pe1·mitted to omit
hoth primar y anct seconctar y vah·es (or a�semblies) ftx
minimum restriction to flow.
(4) They shall be provided with a second terminal at which
the user connect� anct disconnects that complies with
5.1.5.
5.1.6.9 Hose or flexihle connectors employed in manufac­
tured assemblies shall be labeled by stenciling or acthesive
markers that identify the patient medical gas, the medical
support gas, or the vacuum system and inclucte the following:
(1) Name of the ga� 01· vacuum system or the chemical
symbol pe1· Table 5.1.11
(2) Gas or vacuum system color code per Table 5.1.11
(3) Where positive-pressure piping systems operate at pres­
su1·es other than the standard gauge pressure in Table
5.1.11, the operating pt·essm-e in addition to the name of
the gas
(4) Date of installation
5.1.6.10 Station outlets/inlets installect in manufacturect
a�semblies connected to the pipeline by brazing shall comply
with 5.1.5.
5.1.6.11 The installation of manufacturect assemhlies shall be
tested in accorctance \\1th 5.1.12.
5.1.7* Surface-Mounted Medical Gas Rails (MGR).
5.1.7.1 Medical gas rail (MGR) assemblies shall be pet·mittect
to be installed where multiple uses of medical gases and
vacuum at a single patient location at·e 1·egui1·ed or anticipated.
5.1.7.2 MGR a�semblies shall be entit·ely visible in ilie mom,
not pa�sing into or through walls, partitions, anct so forth.
5.1.7.3 MGR assemblies shall be made of materials wiili a
melting point of at least 538° C ( lO0O OF).
5.1.7.4 MGR a�semblies shall be cleanect per 5.1 10.1.1.
5.1.7.5 Station outlets or inlets shall not be placed on the encts
of MGR assemhlies.
5.1.7.6 Openings for station outlets/inlet� in the MGR shall
be gas-specific.
5.1.7.7 Openings in the MGR not occupied by station outlets/
inlet� (e.g., fot· fi.1tut·e use) shall be capped or plugged so that a
2021 Edition
99-50 HEALTH CARE FACILITIES CODE
special tool is required fot· removal (i.e .. cannot be 1·emoverl by
a wrench, pliers, a screwdriver, or other common tool).
5.1.7.8 MGR assemblies shall connect to the pipeline through
fittings that are brazed to the pipeline.
5.1.7.9 Where the pipeline and the MGR assembly are of
dissimilar metals, the connections shall be plated or othetwise
protected from interaction between the metals.
5.1.7.10 1he installation of the MGR shall be testerl in accoi-d­
ance with 5.1.12.
5.1.8 Pressure and Vacuum Indicators.
5.1.8.1 General.
5.1.8.1.1 P1·essure indicatm·s and manometers fo1· medical gas
piping systems shall be cleanerl for oxygen service.
5.1.8.1.2 Gauges shall comply with ASME B40.100, PrP.mm
(',r,ugps nnrl GaugP AttnrlmtPnt�.
5.1.8.1.3* The scale range of positive pressm·e analog inrlica­
tors shall be such that the normal operating p1·essu1·e is within
the middle third of the total range fe.g., an indicator of O to
2070 kPa (0 to 300 psi) would have a lower third of 0 to
690 kPa (0 to 100 psig), a mirldle third of 690 kPa to 1380 kPa
( 100 psig to 200 psig), and a top thi1·d of 1380 kPa to 2070 kPa
(200 psig to 300 psig) l .
5.1.8.1.4 The accuracy of digital indicators shall be ±5 percent
of the operating pressm·e at which they are userl.
5.1.8.1.5 The scale range of vacuum indicators shall he O to
760 mm (0 to 30 in.) gauge HgV. Indicatm·s with a noi-mal
range display shall indicate normal only above 300 mm (12 in.)
gauge HgV.
5.1.8.1.6 Indicators a<"!jacent to ma�te1· ala1·m actuators anrl
area alarms shall be lahelerl to identify the name of, or chemi­
cal symbol for, the particular piping system that they monitor.
5.1.8.2 Locations.
5.1.8.2.1 Pressm·e/vacuum inrlicators shall he rearlahle from a
standing position.
5.1.8.2.2 Pn�ssu1·e/vacuum indicatot·s shall be prnvided at the
following locations, as a minimum:
( 1) Arljacent to the ala1-m-initiating rle\ice for source main
line pt·essure and vacuum alarms in the master alarm
system
(2) At or in area alarm panels to inrlicate the pressure/
vacuum at the ala1·m-activating device for each system that
is monitored by the panel
(3) On the station outlet/inlet sirle of zone valves
5.1.8.2.3 All pressure-sensing devices anrl main line pressure
gauges downst1·eam of the source valves shall be provided \\ith
a g-ds-specific demanrl check fitting to facilitate service testing
or replacement.
5.1.8.2.3.1 Ga�-specific demand check fittings shall not be
required on zone \a.Ive pressure inrlicators.
5.1.8.2.4 Demand check fittings shall he prmided fot· all
monitors.
2021 Edition
5.1.9 Category I Warrung Systems.
5.1.9.1 General. All master. area. and local alarm systems used
for medical gas anrl ,-a.cuum systems shall include the following:
( 1) Separate visual indicators for each conrlition monitored,
except as permitted in 5.1.9.5.2 for local alarms that are
displayerl on master ala1·m panels
(2) Visual inrlicators that remain in alarm until the situation
that has caused the ala rm is resolved
(3) Cancelable audible inrlication of each alarm condition
that produces a sounrl with a minimum level of 80 dBA
at 0.92 m (3 ft)
( 4) Means to indicate a lamp or LED failure anrl audible
f ailme
(5) Visual and audible indication that the communication
with an alarm-initiating de\ice is disconnected
(6) Labeling of each inrlicator, indicating the condition
monitot·ed
(7) Labeling of each ala1·m panel for it� area of surveillance
(8) Reinitiating of the audible signal if another alarm condi­
tion occurs while the audible alarm is silenced
(9) Powe1· for master ala1·ms, area alarms, sensors, and
switches from the life safety branch of the essential elec­
t1·ical system as rlescribed in Chapter 6
(10) Powe1· fo1- local alam1s, dew point sensm·s. anrl carbon
monoxirle sensm·s permitted to be from the same essen­
tial electrical branch a� is used to power the air compres­
sm· system
(11) ,vhere used for communications, wi1-ing from switches
or sensors that is supervised 01· protected as required by
f
517.30(C)(3) o NFPA. 70 for life safety anrl critical
branches ci1·cuit� in which protection is any of the
following types:
(a) Conduit
(b) Free air
(c) Vfo·e
(rl) Cable tray
(e) Raceways
(12) Communication rle\ices that do not use electrical wiring
for signal transmission and are supervised such that fail­
ure of communication initiates an alarm
(13) A�surance by the 1·esponsible authm·ity of the facility that
the labeling of ala1-ms, whe1·e mom numbers or rlesigna­
tions are used, is accurate and up-to-date
(14) Provisions for automatic restart after a power loss of
10 seconrls (e.g., during generator start-up) without
giving false signals 01· 1·equi1·ing manual reset
(15) Alarm switches/sensors installed so a� to be removable
and accessible fo1· service anrl testing
5.1.9.2* Master Alarms. A maste1· alarm system shall be prmi­
rlerl to monitor the operation anrl conrlition of the source of
supply, the 1·eserve sout-ce (if any), and the p1·essm·e in the
main lines of each medical gas and vacuum piping system.
5.1.9.2.1 The master alarm system shall consist of two or more
alarm panels located in at least two separate locations, as
follows:
(1) One master alarm panel shall be located in the office or
work space of the on-site indivirlual responsible for the
maintenance of the medical gas and vacuum piping
systems.
(2) In orrler to ensure continuous surveillance of the merlical
gas and vacuum systems while the facility is in operation,
 c;As AND VACUUM SYSTEMS
the secon<l master alarm panel shall be locate<l in an are a
of continuous observation (e.g., the telephone switch­
f
boar<l, secu1·ity office, 01· other continuously staf e<l loca­
tion).
5.1.9.2.2 A centralize<l computer system shall be permitte<l to
be substituted for one of the master ala1·ms required in
f
5.1.9.2.1 i the compute1· system complies with 5.1.9.3.
5.1.9.2.3 The master alarm panels required in 5.1.9.2.1 shall
communicate di1·ectly to the alarm-initiating de\ices that they
monit01·.
5.1.9_2_3.l If communication is achieve<l by wires, the follow­
ing shall apply:
(A) Each of the two mandatory alarms shall be wire<l inde­
pendently to the initiating device(s) for each signal.
(B) The wiring bet\veen each mandatory alarm (s) and the
initi ating device(s) shall not utilize common conductm·s that, if
interrupte<l, woul<l disable more than one signal.
(C) Each set of wi1·es (in whateve1· number a� 1·equi1·e<l by the
al,ll'm) shall run to tl1e initiating <levice(s) without interruption
other than in-line splices necessary to complete the necessary
length of½fre.
(D) Vihere initi ating <levices are remote from the building
and the ,\/:iring is to run u ndergroun<l in compliance with
i\lFPA 70, the following e xceptions shall be pe1·mitted to be
use<l:
(1) Wiring from the initiating device and through the under­
ground section shall be permitted to be run to a junction
box located whe1·e the wiring first ente1·s the building.
(2) A single set of ,,fres complying ,,�th 5.1.9.2.3. l(B) an<l
5.1.9.2.3.l(C) for each signal shall be permitte<l to
connect the initiating <levice an<l the junction box.
(3) Between the junction box and the two mandatory ala1·m
panels, wiring shall comply mth 5.1.9.2.3.1(A) through
5.1.9.2.3.l(C), 5.1.9.2.3.4, and 5.1.9.2.3.5 in all respect�.
5.1.9.2-3.2 If communication is achieved by means other than
,\/:ires, the follmving shall apply:
(A) Each of the mandatory ala1·ms shall communicate inde­
pen<lently to the initiating device(s) fo1· each signal.
(B) The me ans of communication between each man<latory
ala1·m(s) an<l the initiating device(s) shall not utilize a common
communication <levice that, if interrupted, would <lisable the
signal from another initiating device(s).
5.1.9.2.3.3 A single initiating device shall be permitte<l to
actuate multiple master ala1·ms.
5.1.9.2.3.4 The man<latory master alarm panels shall not be
arrnnge<l such that failm·e of eithe1· panel would <lisable any
signal on the other panel .
5.1.9.2-3.5 'Where a relay is required to ensure correct opera­
tion of an initiating device, the control powe1· for the 1·elay shall
not be such that <lisabling any master alarm panel woul<l disa­
ble the relay.
5.1.9_2_3.6 Master alarm signals shall not be relayed from one
maste1· alarm panel to another.
5.1.9-2.3.7 'Where multi-pole alarm relays are used to isolate
the alarm-initiating signals to master ala1·m panels, the control
99-51
power source for the 1·elays shall be indepen<lent of any of the
master alarm panels.
5.1.9.2.3.B Multiple ma�ter ala1·ms shall be pe1·mitted to moni­
t01· a single initiating <le\ice.
5.1.9.2.4 Maste1· ala1·m panels for medical gas an<l vacuum
systems shall each include the follomng signals:
(1) Alarm indication when, or just before, changeover
occurs in a medical gas system that is supplie<l by a mani­
fold or other alternating-type bulk system that has as a
p art of it� 1101·mal operntion a changeover from one
portion of the operating supply to another
(2) Alarm indication fm a cryogenic fluid centrnl supply
sptem when the main supply reaches one average day"s
supply, in<licating low content�
(3) Alarm indication when, or just before, the changeover to
the 1·ese1ve supply occurs in a medical gas system that
consists of one or more unil� that continuously supply
the piping system while another unit remains as the
1·ese1·ve supply and ope1·ates only in the ca�e of an emer­
gency
( 4) Alarm indication for cylin<ler reserve pressure low when
the content of a cylinder rese1ve header is reduced
below one avernge <lay's supply
(5) Fm· c1yogenic fluid centrnl supply systems, an alarm
when or at a predetermine<l set point before the rese1ve
supply content5 fall to one average day's supply, in<licat­
ing low rese1ve
(6) \-\'he1·e a c1yogenic liqui<l storage unit is use<l as a reserve
for a cryogenic fluid central supply system, an alarm
indication when the ga.� pressm·e available in the rese1ve
unit is below that 1·equire<l for the medical gas system to
function
(7) Alarm indication when the pressure in the main line of
each separnte medical gas system increa5es 20 pet-cent 01·
deueases 20 percent from the normal operating pres­
sure
(8) Alarm indication when the medical-sm·gical vacuum
pressm·e in the main line of each vacuum system drops
to or below 300 mm (12 in.) gauge HgV
(9) Alarm indication(s) from the local alarm panel(s) as
desCl"ibe<l in 5.1.9.5.2 to indicate when one 01· more of
the conditions being monitore<l at a site is in alarm
(10) Medical air <lew point high alarm from each compressor
site to in<licate when the line pressure <lew point is
g1·eater than +2"C ( +35"F)
(11) \VACD low ala1·m when the \'VAGD vacuum level or flow
is below effective operating l imits
(12) An instrument ai1· dew point high alarm from each
compressor site to indicate when the line p1·essu1·e dew
point is g1·eater than -30"C (-22"F)
(13) Alarm indication if the primary or rese1ve production
stops on a proportioning system
(14) \Vhen oxygen is supplied from an oxygen central supply
system using concentrators (.�ff 5.1. 3. 9j, the follm,1ng
signals shall be provi<le<l:
(a) For each concentrat01· unit use<l in the oxygen
central supply system, an alarm in<lication that
oxygen concentration from that m..-ygen concentra­
tor unit is below 91 percent
(b) For each oxygen concentrat01· unit used in the
oxygen central supply system, an alarm indication
that the isolating valve fo1· that oi.-ygen concentrn­
tor unit is close<l and the unit is isolated
2021 Edition
99-52 HEALTH CARE FACILITIES CODE
(c) Fo1· each cylinder hearler userl as a source. an
alarm indication that the header is in use
(d) Fo1· each cylinder header userl as a smll"ce. an
ala1·m inrlication that the cylinder contents are
below one average day's supply
(e) If the sou1·ce in use changes because of a failure to
apprnpt-iately supply the system, an alarm indica­
tion that an unexpected oxvgen supply change ha�
occurred
(f) An alarm inrlication that the p1·essm·e in the
common line on the source side of the line pres­
sure controls is low
(g) An alarm indication that the oxygen concentration
from the supply system is below 91 pe1·cent
5.1.9.2.5 The ala1·m inrlications 1·equired in 5.1.9.2.4(7) and
5.1.9.2.4(8) shall originate from sensors installed in the main
lines immerliately downstream (on the patient 01· use side) of
the source valves. \\!here it is necessary to install a main line
valve in addition to a source valve (WP 5.1.4.Jj, the sensors shall
be located downstream (on the patient or use side) of the main
valve.
5.1.9.3 Master Alarms by Computer Systems. Computer
systems userl as substitute master alarms as 1·equired by
5.1.9.2. l (2) shall have the mechanical and electrical characte1·­
istics described in 5.1.9.3. l and the programming characteris­
tics rlescrihed in 5.1.9.3.2.
5.1.9.3.1 Computer systems used to substitute for alanns shall
have the following mechanical and electrical characteristics:
(I) The computer system shall he in continuous uninterrup­
terl operation anrl prnvirlerl with power supplies as
needed to ensure such reliability.
(2) The computer system shall be continuously attenrlerl by
1·esponsible indivirluals 01· shall provide remote signaling
of 1·esponsible parties (e.g .. through pagers. telephone
autodialers, or other such means).
(3) ,111h.ere computer systems rely on signal interface rle,ices
(e.g., electronic interfaces, othe1· ala1·m panels, 4 mA to
20 IJLJ\ cards), such intedaces shall be supervised such
that failure of the device(s) shall initiate an alarm(s).
(4) If the compute1· system does not power the signaling
switches/sensors from the same power supply 1·equirerl in
5.1.9.3.1(1). the power supply fm the signaling switches/
sensors shall be powered from the life safety branch of
the essential electt·ical system a� desn·ibed in Chapter 6.
(5) Computer systems shall be permitted to communicate
directly to the sensors/switches in 5.1.9.2.3 in the same
manner as an ala.rm panel if operation of another alarm
panel(s) is not impai1·ed.
(6) Communication from the compute1· svstem to the signal­
ing switches or sensors shall be supervised such that fail­
m·e of communication shall initiate an alarm.
(7) Computer systems shall be providerl with an aurlio alen
per f>.1.9.1(:\), except the aurlio alert shall he pe1·mitterl
to be only as loud a� needed to alert the system operator.
(8) The facility shall ensure compliance with 5.1.9. l (13).
5.1.9.3.2 The operating program for compute1· systems used
to substitute for alarms shall inclurle the following:
(1) The medical gas alarm shall be allocated the p1·iority of a
life safety signal.
(2) A merlical gas alarm signal shall interrupt any other activ­
f
ity o a lesse1· priority to run the alar m algorithm(s).
2021 Edition
(3) 1l1e ala1·m algorithm shall include activation of an audi­
ble alert, activation of any remote signaling protocol, and
display of the specific condition in alarm.
(4) 1l1e alarm algorithm shall provirle fo1· compliance ½':ith
5.1.9.1(1) through 5.1.9.1(5), anrl 5.1.9.1(8).
5.1.9.4* Area Alarms. Area alarm panels shall be provirlerl to
monitor all medical gas, medical-surgical vacuum, and piped
WAGD systems supplying the following:
(1) A.nesthetizing locations whe1·e moderate sedation, deep
sedation, 01· general anesthesia is administererl
(2)* Category l space
5.1.9.4.1 * Area alarms shall be locaterl at a nm·se's station or
othe1· simila1- location that \\':ill provirle for surveillance.
5.1.9.4.2 Area alarm panels for medical gas systems shall indi­
cate if the p1·essu1·e in the lines in the area being monito1·ed
inct·eases or rlec1·eases by 20 percent from the n01·mal line p1·es­
sure.
5.1.9.4.3 A1·ea ala1·m panels for merlical-surgical vacuum
systems shall indicate if the vacuum in the a rea drops to or
below 300 mm (12 in.) gauge HgV
5.1.9.4.4* A.lann sensors for a1·ea alarms shall be located as
follows:
( l)* Category l spaces, other than anesthetizing locations
addressed in 5.1.9.4.4(2), shall have the ala1·m sensors
installerl on the patient or use side of each of the indivirl­
ual zone valve box assemblies.
(2)* Anesthetizing locations where moderate sedation, deep
sedation, or general anesthesia is administered shall have
the sensors installed either on the source side of each of
the individual room zone valve box assemblies or on the
patient or use side of each of the indi,idual zone valve
box assemblies.
5.1.9.4.5 One area alarm panel shall be acceptable to monitor
multiple rooms located \\':ithin an immerliate vicinity meeting
the requirement� of 5.1.9.4.4(2).
5.1.9.4.6 Area alarm panels for medical gas systems shall
provirle visual and aurlible indication in the event a mismatch
occt\l"s between the transducer(s) anrl it� a�sociated ci1·cuit
hoa1·rl(s).
5.1.9.5* Local Alarms. Local alarms shall be installerl to
monitor the function of the ai1· compressor system(s), medical­
surgical vacuum pump system(s), ''\'AGD systems, instrument
air systems, and proportioning systems.
5.1.9.5.1 The signals referencerl in 5.1.9.5.4 shall be permitted
to be located as follows:
(1) On or in the control panel(s) for the central supply
system or supply som·ce being monitored
(2) Within a monitoring device (e.g., dew point monitor or
carbon monoxide monitor)
(3) On a sepa1·ate alarm panel(s)
5.1.9.5.2 The master alarm shall inclurle at least one signal
from the source equipment to indicate a problem with the
som·ce equipment at this location. 1l1is master alarm signal
shall activate when any of the required local ala1·m signals for
this som-ce equipment activates.
5.1.9.5.3 If the1·e is mot·e than one centt·al supply system, fix a
specific gas 01· vacuum pipeline or more than one central
 c;As AND VACUUM SYSTEMS
supply system and pipeline for the same gas in the building,
then it shall be necessary for each location to have separate
local alarms per 5.1.9.5.4 and signals at the master panels per
5.1.9.2.4.
5.1.9.5.4 The following functions shall be monitored at each
local ala1-m site:
(1) Low medical air resen,e capacity, to indicate when the
medical air source is operating under a demand that
coul<l not be managed if one compressor ceased to oper­
ate
(2) High carbon monoxide level, to indicate when the
carbon monoxi<le level in the medical air system is 10
ppm or highe1·
(3) Me<lical ai1· <lew point high, to indicate when the line
pressure dew point is greater than +2 ° C (+35'F)
( 4) Low medical vacuum rese1·ve capacity, to indicate when
the medical vacuum sou1·ce is operating un<le1· a
<lemand that could not he managed ifone pump cease<l
to operate
(5) Low WAGD rese1-ve capaci ty, to indicate when the '"'AGD
source is operating under a demand that could not be
manage<l if one producer cea�e<l to operate
(G) Instrument air dew point high, to indicate when the line
pressure dew point is greater than -30'C (-22'F)
(7) Low instrument air reserve capacity, if instrument ai1· is
pr0vide<l by a source with more than one compressor, to
in<licate when the instrument air sou1·ce is operating
f
un<le1· a demand that coul<l not be managed i one
compressor ceased to operate
(8) For compressor systems using liquid ring compressors or
compressors with wate1°cooled components, high water
in the receive1· tank. to indicate when the water level in
the receiver tank has reached a level determine<l to be
<letrimental to the operation ofthe system
(9) Fo1· comp1·esso1· systems using liqui<l ring comp1·ess01·s,
high wate1· in the separator
( 10) For compressor systems using other than liquid ring
compressors, high discha1·ge air temperatm·e
( 11) Proportioning systems high/low in<licator when the
O}.')'gen concentration is out5i<le the 19.5 percent to
23.5 percent oxygen range
( 12) Proportion systems 1·eserve system in operation
(13) ,'\'hen oxygen is supplie<l from an oxygen central supply
system using concentrators (sff 5.1.3.9), the following
signals shall be provided at the system's local ala1·m
site(s):
(a) For each cylin<ler header used as a source, an
alarm indication that the header is in use
(b) For each cylinde1· heade1· used as a source, an
alarm indication that the cylinde1· contents a1-e
below one average day's supply
f
(c) If the source in use changes because o a failm-e to
appropriately supply the sv11tem, an alarm indica­
tion indicating an unexpecte<l 0}.')'gen supply
change has occurred
(d) An alarm in<lication that the pressure in the
common line on the sou1·ce si<le of the line pt·es­
sure controls is low
(e) An ala1·m indication that the oxygen concentration
from the supply system is below 91 percent
99-53
5.1.10 Category I Distribution.
5.1.10.1 Piping Materials for Field-Installed Positive Pressure
Medical Gas Systems.
5.1.10.1.1 Tubes, valves, fittings, station outlet�, an<l other
piping componenl� in medical gas systems shall have been
cleaned for o}.-ygen service by the manufacture1· prior to instal­
lation in accordance with the mandatory requirements of CGA
G-4.1, Clfrming Equipnwnt for Oxygen Sfrvirf, except that fittings
shall he permitted to be cleaned by a supplie1· or agency othe1-
than the manufacture!".
5.1.10.1.2 Each length of tube shall be delivere<l plugged or
cappe<l by the manufacture1- an<l kept sealed until p1·epa1·ed fo1-
installation.
5.1.10.1.3 Fittings, valves, and other component5 shall be
delive1·ed sealed and labele<l and kept seale<l until p1·epa1-e<l fix
installation.
5.1.10.1.4* Tubes shall be one of the following:
( 1) Har<l-drawn seamless copper in acc01·dance with ASTM
8819, Standard Spl'cijialtion for Sramles.1 Copµ,r Tube for
Medir:al (',as Systm1s, medical ga� tube. Type L. except Type
K shall be used where operating pressm·es a1·e above a
gauge pt·essme of 127:> kPa ( 185 psi) and the pipe sizes
a1·e large1· than DN80 fNPS 3 (3¼ in. O.D.) l.
(2)* Listed corrugate<l medical tubing (CMT) fabricated from
copper alloy No. 51000 st1·ip, meeting ASTM 8103/
8103M, Standard SpPCijication far PhosphM BmnZP Plate,
Sheet, Strip, and Rolled Bar, with a design margin of 3.5,
exten1ally coated with a nonmetallic sheath ma1·ked with
the manufacturer's marking. The listing shall inclu<le test­
ing to <lemonstrate that CMT S)'litems can be consistently
gas-purged with results equivalent to comparable medical
gas copper tubing.
5.1.JO_J.5 CMT shall have a flame spread index of 25 or less
and a smoke developed index of 50 or less a� determined by
ASTM E84, Standard Tl's/ kiethod for Surfar;, Burning Oiararteri.1-
tir:s of Building MatPriall.
5.1.10.1.6 CMT shall be identified by the manufacturer as suit­
able for m..--ygen set·vice at a minimum ofeveqr 0.92 m (3 ft).
5.1.10.1.7 ASTM B819, Standard Sper:ification fM Smmll'ss CoppPr
7lihe far Medical (',as Systems, medical ga5 tube shall be i<lentifie<l
by the manufacture1·'s markings "OXY," "MED," ·'OXY/MED,"
"OXY/ ACR," or "ACR/MED" in blue (Typ e L) 01· g1·een (Type
K).
5.1.JO_J.8 The installer shall furnish documentation cenifying
that all installed piping mate1·ials comply with the 1·equirements
of5.l .10.l.l .
5.1.10.2 Piping Materials for Field-Installed Medical-Surgical
Vacuum and WAGD Systems.
5.1 .I 0.2.1 Tubes for Vacuum_ Piping for vacuum systems shall
be constructed ofany ofthe following:
( l) Hard-drnwn seamless copper tube in acc01·dance with the
following:
(a) ASTM B88, Standard Sper:ifiration fM Seamless CoppPr
Water Tube. copper tube (Type K. Type L. or
Type M)
2021 Edition
99-54 HEALTH CARE FACILITIES CODE
(h) ASTM B280, Standard Spnifii:ation for Smmles s CoppPr
Tubefor Air ('.onditioningand &frig'f!ration FiPld Servit:P,
copper ACR tube
(c) ASTM B819, Standard Spn:ifirationforSmmless Copper
Tube for Mediral Gas SystPni�. copper medical ga�
tubing (Type Kor Type L)
(2) Stainless steel tube in accorrlance with the following:
(a) ASTM A269/A2G9M, Standard SperifirationforSeam­
lPt� and M'l'ldPd Austenitir Stainless Stefl Tubingfor
Gmeral Serviff, TP304L 01· 316L
(b) ASTM A312/A312M, Standard Speiifiration far Seam­
less, Welded, and Heavily Cold Worked Austmitir Stain­
less Stt'!'l PipPs, TP304L 01· 316L
(c) A312 TP 304L/316L, Sch. :>S pipe, anrl
A403 WP304L/316L, Sch. 5S fittings
(3) CMT meeting the requirement� of 5.1.10.1.4(2)
5.1 .I 0.2.2 Vacuum Tube Marking Where R eq uired.
5.1.10.2.2.1 If copper or CMT vacuum tubing is installerl
along with any medical gas tubing, the vacuum tubing shall,
prior to installation, be prominently labeled 01· othenvise irlen­
tified to pr·eclude using materials 01· installation prncedm·es in
the medical gas system that are not suitable for oxygen service.
5.1.10.2.2.2 If merlical gas tube in accot·dance with ASTM
B8 l 9, Standard Specijiratirm far SmmlPss Capper Tube far A1ediral
(',as Sy stems, is userl for vacuum piping, such special marking
shall not be 1·eguired.
5.1.10.2.3 WAGD System Piping. WAGD systems shall be
piped as follows:
(1) Using materials compliant with 5.1.10.2.1 01· 5.1.10.2.2
(2) In systems opernterl unde1· 130 mm (5 in.) HgV maxi­
mum vacuum only, using any noncorrorling tube or rluct­
work
5.1.10.2.3.1 If joined to the vacuum piping, ,-v-AGD system
piping shall be connected at a minimum distance of 1.5 m
(5 ft) from any vacuum inlet.
5.1.10.2.3.2* Systems meeting 5.1.10.2.3.1 shall be labeled a�
indicaterl in 5.1.11 for both WA.GD and vacuum.
5.1.10.3 Joints.
5.1.10.3.1 * Positive pressure patient gas systems, medical
support gas systems, vacuum systems, anrl WAGD systems
constructed of hard-rlrawn seamless copper or stainless steel
tubing shall have all turns, ofE�ets, and other changes in direc­
tion made using fittings or techniques appropriate to any of
the follmving acceptable joining methorls:
(1) Brazing. as described in 5.1.10.4
(2) Welrling, a� described in 5.1.10.5
(3) Memory metal fittings, a� described in 5.1.10.6
(4) Axially swagerl, elastic p1·eload fittings, as desc1·ibed 111
5.1.10.7
(5) Threaded, as describerl in 5.1.10.8
5.1.10.3.2 Positive p1·esst11"e patient ga� systems, medical
suppot·t g-as systems. vacuum systems. and WAGD systems
constructed of CMT shall have turns, offsets, anrl other changes
in direction made by benrling the tubing up to the minimum
bend rndius 01· by fittings in accorrlance \vith 5.1.10.3.1.
5.1.10.3.3 Vacuum systems and WAGD systems fahricaterl from
coppe1· tubing shall be pe1·mitterl to have branch connections
2021 Edition
made using mechanically formerl. drilled, anrl extruded tee­
branch connections that are formed in accordance with the
tool manufactut·er's instntctions. Such branch connections
shall bejoined by brazing, as rlesc1·iherl in 5.1.10.4.
5.1.10.3.4 Branch connections marle using mechanically
formed, drilled, and extrurle rl tee-hrnnch connections shall be
prnhibited in CMT systems.
5.1.10.3.5 WAGD systems designed for operation below
130 mm (5 in.) HgV shall be pe1·mitted to bejoined using any
method that will 1·esult in a leak-free netw·ork when tested per
5.1.12.4.2.
5.1.10.4 BrazedJoints.
5.1.10.4.1 General Requirements.
5.1.10.4.1.1 Fittings shall be wrought copper capilla1·y fittings
complying \vith ASME BlG.22, Wrought CappPr and Coptier Alloy
SoldM-joint PrPsszm Fittin�, or hrazerl fittings complying with
ANSI/ASME B lG.50, Wrought CoppPr and Copper Alloy Bmzf-joint
Pressure Fzttin�.
5.1.10.4.1.2 Cast copper alloy fittings shall not be permitterl.
5.1.10.4.1.3 Brazed joints shall be made using a brazing alloy
that exhibits a melting temperatu1·e in excess of 538'C
( lO0OOF) to retain the integrity of the piping system in the
event of fire exposure.
5.1.10.4.1.4 Brazed tube joint� shall be the socket type.
5.1.10.4.1.5 Filler metals shall bond with and be metallurgi­
cally compatible with the base metals beingjoined.
5.1.10.4.1.6 Fillet· metals shall comply with ANSI/AWS
A5.8M/A5.8, Sfrdfiration for Filler I\1etal1 far Brazing and Braze
Wdding.
5.1.10.4.I.7 Coppet"-to<opper joint� shall he hrnzerl using a
copper-phosphorus or copper-phosphorus-silver brazing filler
metal (BCuP se1·ies) without flux.
5.1.10.4.1.8 Brazing performed between cryogenic fluid
central supply system vessels and their ,-aporizers (i.e., subject
to cq'Ogenic exposure) shall be permitted to be lxazed using
BAg brazing alloy with flux by a brazer qualified to the manda­
tory 1·eguirement� of CGA M-1, Standard far Alediral Gas Supply
Sy sll'lns at Hmlth Care FarilitiP s.
5.1.10.4.1.9 Joints to be brnzed in place shall be accessible for
necessary p1·eparntion, assem hly, heating, filler application,
cooling, cleaning, and inspection.
5.1.10.4.1.10 Braze joints shall he continuously purgerl with
nitrogen NF.
5.1.10.4.2 Cutting Tube Ends.
5.1.10.4.2.1 Tube ends shall be cut square using a sharp
tubing cutter to avoid deforming the tube.
5.1.10.4.2.2 The cutting wheels on tubing cutters shall he free
from grea�e, oil, 01· other lubricant not suitable for oxygen serv­
ice.
5.1.10.4.2.3 The cut ends of the tube shall be rollerl smooth
or debutTed with a shat-p, clean deburring tool, taking care to
pt·event chips from ente1·ing the tube.
 c;As AND VACUUM SYSTEMS
5.1.10.4.3 OeaningJoints for Brazing.
5.1.10.4.3.1 The interior sul'faces of tubes, fittings, and other
component� that are cleaned fot· oxygen service shall be st01·ed
and handled to avoid contamination prim· to assembly and
brazing.
5.1.10.4.3.2 1l1e exterior sudaces of tube ends shall be
deaned pt·ior to brazing to remove any surface oxides.
5.1.10.4.3.3 \¾11en cleaning the exte1·ior surfaces of tube ends,
no matter shall be allowed to enter the tube.
5.1.10.4.3.4 If the interior surfaces of fitting socket� become
contaminated p1·io1· to brazing, they shall be recleaned for
m..-ygen in accordance with 5.1.10.4.3. IO and be cleaned for
bt·azing with a clean. oil-free, stainless steel or brass wire brush.
5.1.10.4.3.5 Clean, nonshedding, abrasive pads shall be used
to clean the exterior surfaces of the tube ends.
5.1.10.4.3.6 1l1e use of steel wool or sand cloth shall be
prohibited.
5.1.10.4.3. 7 The cleaning process shall not 1-esult in grooving
of the surfaces to be joined.
f
5.1.10.4.3.8 A ter being abraded, the sul'faces shall be wiped
using a clean, lint-free white cloth .
5.1.10.4.3.9 Tubes, fittings, valves, and other components shall
be visually examined internally befo1·e being joined to verify
that they have not become contaminated for oxygen service
and that they are free of obstructions or debris.
5.1.10.4.3.10 The inte1·io1· surfaces of tube ends, fittings, and
other component� that we1·e cleaned fot· oxygen service by the
manufacturer, but that became contaminated prior to being
installed, shall be permitted to be recleaned on-site by the
installer by thoroughly scrubbing the interim· surfaces with a
dean, hot wate1·-alkaline solution, such as sodium carbonate or
trisodium phosphate, using a solution of 450 g (I lb) of sodium
ca1·bonate or tt·isodium phosphate to 11 L (3 gal) of potable
wa.te1·, and thoroughly rinsing them with clean, hot, potable
water.
5.1.10.4.3.11 Othe1· aqueous cleaning solutions shall be
permitted to be used for on-site recleaning pe1·mitted in
5.1.10.4.3.10, provided that they are in accordance with the
mandatory requirement� of CGA G-4.1, ClPaning Eq mp,nmt for
O:rygm Smlir:e.
5.1.10.4.3.12 Material that ha� become contaminated inter­
nally and is not clean for oxygen service shall not be installed.
5.1.10.4.3.13 Joints shall be brazed within 8 hou1·s afte1· the
surfaces are cleaned for brazing.
5.1.10.4.4 Brazing Dissimilar Metals.
5.1.10.4.4.1 Flux shall only be used when bt·azing dissimilar
metals, such as copper and bronze or brass, using a silver (BAg
series) brazing filler metal.
5.1.10.4.4.2 Sul'faces shall be cleaned for brazing in accord­
ance with 5.1.10.4.3.
5.1.10.4.4.3 Flux shall be applied spat-ingly to m1111m1ze
contamination of the inside of the tube with flux.
99-55
5.1.10.4.4.4 The flux shall be applied and worked over the
cleaned surfaces to be brazed using a stiff bristle brush to
enstlt'e complete cove1·age and wetting of the sui-faces v.�th flux.
5.I. 10.4.4.5 Where possible, short sections of copper tube
shall be brazed onto the noncopper component, and the inte­
rim· of the subassembly shall be cleaned of flux prior to installa­
tion in the piping system.
5.1.10.4.4.6 On joint� DN20 (NPS %) (¾ in. O.D.) size and
smaller, flux-coated brazing rods shall be permitted to be used
in lieu of applying flux to the surfaces beingjoined.
5. I.I 0.4.5* Nitrogen Purge.
5. I.I0.4.5.1 '\,\'hen brazing, J01t1ts shall be continuously
purged with oil-free, dry niu·ogen NF to prevent the formation
of copper oxide on the inside surfaces of the joint.
5.1.10.4.5.2 The source of the purge gas shall be monitored,
and the installer shall be audibly alened when the source
content is low.
5.1.10.4.5.3 The purge gas flow rate shall be controlled by the
use of a pressure regulator and flowmeter, or combination
thereof.
5.1.10.4.5.4 Pressure regulators alone shall not be used to
control purge gas flow rates.
5.1.10.4.5.5 In m·der to ensm·e that all ambient air ha� been
removed from the pipeline prior to brazing, an oxygen
analyzer shall be used to verify the effectiveness of the purge.
The oxygen analyzer shall 1·ead below l pe1·cent oxygen
concentration before brazing begins.
5.I.I 0.4.5.6 Dm·ing and afte1· installation, openings in the
piping system shall be kept sealed to maintain a nitrogen
atmosphere within the piping to prevent debris or other
contaminants from entering the system.
5.1.10.4.5.7 While ajoint is being brazed, a discl1a1·ge opening
shall be provided on the opposite side of the joint from where
the pu1·ge gas is being introduced.
5.1.10.4.5.8 The flow of purge gas shall be maintained until
the joint is cool to the touch.
5.1.10.4.5.9 Afte1· the joint has cooled, the purge discha1·ge
opening shall be sealed to prevent contamination of the inside
of the tube and maintain the nitrogen atmosphere within the
piping system.
5.1.10.4.5.10 The final brazed connection of new piping to an
existing pipeline containing the system gas shall be permitted
to be made without the use of a nitrogen pu1·ge.
5.1.10.4.5.11 After a final brazed connection in a positive pres­
sure medical gas pipeline is made without a nitrogen purge, an
outlet in the immediate downstream zone of the affected
portion(s) of both the new and existing piping shall be tested
in accordance with the final tie-in test in 5 .1.12.4.9.
5.1.10.4.5.12* When using the autogenous 01-bital welding
process, joint� shall be continuously purged inside and outside
with inert gas(es) in accordance with the qualified welding
procedure.
2021 Edition
99-56 HEALTH CARE FACILITIES CODE
5.1.10.4.6 A<.sembling and Heating Brazed Joints.
5.1.10.4.6.1 Tube ends shall be inserted into the socket, eithe1·
fully or to a mechanically limited depth that is not less than the
minimum cup depth (overlap) specified by ANSI/ASME
B l6.50. Wrought Coppl'r and Copper Alloy Brtl7..fjoint Pmmm
Fittinff>.
5.1.10.4.6.2 \'\'hei-e flux is permitted, the joint shall be heate<l
slowly until the flux has liquefied.
5.1.10.4.6.3 Afte1· flux is liquefied, or where flux is not pe1·mit­
te<l to be used, the joint shall be heated quickly to the brazing
temperature, taking care not to overheat the joint.
5.1.10.4.6.4 Techniques for heating the joint, applying the
brazing filler metal. an<l making horizontal. vertical, and la1·ge­
diameter joint� shall be a� state<l in sections on applying heat
and bt·azing and hm·izontal and venical joint� in Chaplet· VII,
''Braze<ljoint�," in the C DA Coppl'r Titbf Handbook
5.1.10.4.7 Inspection of Brazed Joints.
5.1.10.4.7.1 Afte1· brnzing, the outside of all joint� shall be
cleaned by washing with water and a wire bmsh to remove any
residue and allow clear visual inspection of the joint.
5.1 .I 0.4. 7.2 \'\1he1·e flux has been use<l, the wash water shall be
hot.
5.1.10.4.7.3 Each bt·azed joint shall be visually inspected afte1·
cleaning the out�ide surfaces.
5.1.10.4.7.4 Joint� exhibiting the following con<litions shall
not be permitted:
( l) Flux or flux residue (when flux or flux-coated BAg sei-ies
rods are used with dissimilar metals)
(2) Base metal melting or erosion
(3) Unmelte<l filler metal
( 4) Failtu-e of the filler metal to be clearly visible all the \\"dY
aroun<l the joint at the interface between the socket and
the tube
(5) Cracks in the tube or component
(6) Cracks in the braze filler metal
(7) Failure of the joint to hol<l the test pressure under the
installe1·-pedo1·med initial pt·essure test (see 5.1.12.2.3)
and stan<ling pressu1·e test (sPP 5.1.12.2.6 or 5.1.12.2. 7)
5.1.10.4.7.5 Braze<l joints that are i<lentified as defective
under the con<litions of 5.1 10.4.7.4(2) or 5.1.10.4.7.4(5) shall
be 1·eplaced.
5.1.10.4.7.6 Braze<l joints that are i<lentified as defective
under the conditions of 5.1.10.4.7.4(1), 5.1.10.4.7.4(3),
5.1.10.4.7.4( 4), 5.1.10.4.7.4(6), or 5.1.10.4.7.4(7) shall be
permitted to be repaired, except that no joint shall be reheate<l
mo1·e than once before being replaced.
5.1.10.5 Weldedjoints.
5.1.10.5.1 Gas Tungsten Arc Welding (GTAW) for Copper and
Stainless Tube.
5.1.10.5.1.1 Welded joints for me<lical gas and medical-surgi­
cal vacuum systems shall be permitted to be made using a gas
tunb�ten a1·c welding (GTA\V) autogenous m·bital proce<lu1·e.
5.1.10.5.1.2 The GTAW autogenous m·bital proce<lure and the
welder qualification procedure shall be qualified in accordance
2021 Edition
with Section IX. "Welding an<l Brazing Qualifications," of the
ASME Boiler and Pressure Ve.uel Code.
5.1.10.5.1.3 Welder qualification procedures shall include a
bend test an<l a tensile test in accordance with Section IX,
"Wel<ling and Brazing Qualifications;· of the ASME Boill'f and
Pres.mre l-Pssel (',odeon each tube size diametel'.
5.1.10.5.1.4 Each welder shall qualify to a welding procedure
specification (WPS) for each tube diameter.
5.1.10.5.1.5* GTAW autoge nous orbital welded joints shall be
purge<l <luring welding with a comme1·cially available mixttll"e
of 75 percent helium (±5 percent) an<l 25 percent argon
(±5 percent).
5.1.10.5.1.6 T he shield gas shall be as requi1-ed in 5.1.10.5.1.5.
5.1.10.5.I.7 Test coupons shall be welde<l an<l inspected. as a
minimum, at stan of work and every 4 hours the1·eafte1·, or
when the machine is idle for mm·e than 30 minutes, and at the
en<l of the work period.
5.1.10.5.1.8 Test coupons shall be inspecte<l on the I.D. and
O.D. by a qualified quality control inspectol'.
5.1.10.5.1.9 Test coupons shall also be welded at change of
operator, weld head, welding power supply, or ga� source.
5.1.10.5.1.10 All production welds shall be \isually inspected
on the O.D. by the operato1·, and any obvious wel<l failures shall
be cut out and re-welded.
5.1.10.5.2 Welding for Stainless Tube.
5.1.10.5.2.1 Stainless tube shall be welded using metal inen
gas (MIG) welding. tungsten inert gas (TIC) wel<ling, or other
welding techniques suited to joining stainless tu be.
5.1.10.5.2.2 Welders shall be qualifie<l to Section IX, "Welding
and Brazing Qualifications," of the ASME Boiler and Pressure
¼swlCode.
5.1.10.6 Memory Metal Fittings.
5.1.10.6.1 Memory metal fittings ha,ing a temperature rating
not less than 538 ° C (I000 ° F) and a pressure rating not less
than 2070 kPa (300 psi) shall be pe1·mitted to be used to join
copper 01· stainless steel tube.
5.1.10.6.2 Memory metal fittings shall be installe<l by qualified
technicians in accor<lance with the manufacttlt'et·'s instt·uctions.
5.1.10.7 Axially Swaged Fittings.
5.1.10.7.1 Axially swage<l fittings provi<ling metal-to-metal
seals, suitable for sen,ice at 2070 kPa (300 psig) and able to
withstand a temperature of 538'C (l00O O F) and that, when
complete, are permanent and nonseparable, shall be permitted
to be use<l to join coppe1· or stainless steel tube.
5.1.10.7.2 Axially swaged fittings shall be installe<l by qualified
technicians in accordance with the manufacturer's instructions.
5.1.10.8 Threaded Fittings. Tiu·eaded fittings shall meet the
following criteria:
(l ) They shall be limited to connections fot· pressure and
vacuum indicators, alarm devices, gas-specific demand
check fittings, and source equipment on the source si<le
of the sou1·ce valve.
 c;As AND VACUUM SYSTEMS 99-57

(2) They shall be tapered pipe threads complying with ASME
Bl . 20. 1, Pipe Threads, (',eneral Purpose, lnrh.
(3)* They shall be made up with polytetrnfluornethylene
(PTFE) tape or othe1· thread sealant 1·ecommended for
oxygen service, with sealant applied to the male threads
only and care taken to ensure sealant does not enter the
pipe.
5.1.10.9 Special Fittings.
5.1.10.9.1 Listed 01· apprnve<l metallic gas tube fittings that,
when ma<le up, provide a pe1·manent joint having the mechani­
f
cal, thermal, and sealing integrity o a brazed joint shall be
permitted to be used.
5.1.10.9.2 Dielectric Fittings. Dielectric fittings that comply
with the following shall be permitte<l only where require<l by
the manufacturer of special me<lical equipment to electrically
isolate the equipment from the system distribution piping:
(l ) They shall be of brass or copper construction \\1th an
appropriate dielectric.
(2) They shall be permitte<l to be a union.
(3) They shall be clean for oxygen where use<l for medical
gases and medical support gases.
5.1.10.10 Prohibited Joints. The following JOmts shall be
prohibite<l throughout medical gas an<l vacuum disu·ibution
pipeline systems:
(l )Flare<l and comp1·ession-type connections. including
connections to station outlet5 and inlet5, ala1·m devices,
and other component5
(2) Other straight-threa<le<l connections, including unions
(3) Pipe-crimping tools used to permanently stop the flow of
medical gas and vacuum piping
(4) Removable an<l nonremovable push-fit fittings that
em ploy a quick assembly push fit connect01·
5.1.10.11 Installation of Piping and Equipment.
5.1.10.11.1 Pipe Sizing.
5.1.10.11.1.1 Piping systems shall be designed and size<l to
<leliver the required flow rates at the utilization pressures.
5.1.10.11.1.2 Mains and branches in medical gas and \\'AGD
piping systems shall be not less than DN15 (NPS ½) (% in.
O.D.) size.
5. I. IO.I 1.3 Location of Piping.
5. I. IO.I 1.3.1 Piping 1·isers shall be pe1·mitte<l to be installed in
pipe shaft� if protected from phys ical <lamage, effect� of exces­
sive heat. corrosion, or contact ...�th oil.
5. I.I0.11.3.2 Piping shall not be installe<l in kitchens, stai1·­
wells, elevator shafts, elevat01· machine rooms, areas with open
flames, electrical senice equipment over 600 volts, and areas
prohibited under Nl-PA 70 except for the follm,1ng locations:
(1) Room locations for me<lical air comp1·ess01· supply
systems and me<lical-sm·gical vacuum pump supply
systems
(2) Room locations for secon<lary distribution circuit panels
and b1·eake1·s having a maximum voltage rating of
600 volt�
5. I.10.11.3.3 Me<lical gas pi ping shall be pe1·mitted to be
installe<l in the same service trench 01· tunnel with fuel gas
lines, fuel oil lines, electrical lines, steam lines, and similar util­
ities, pro,i<le<l that the space is ventilate<l (naturally or mechan­
ically) an<l the ambient tempernture around the medical gas
piping is limited to 54"C( 130° F) maximum.
5.1.10.11.3.4 Medical gas piping shall not be located where
subject to contact mth oil, including a possible flooding area in
the ca�e of a major oil leak.
5.1.10.11.4 Pipe Support.
5.1.10.11.4.1 Piping shall be supported from the buil<ling
structure.
5.1.10.11.4.2 Hangers and supports shall comply with and be
installe<l in accordance with MSS S P-5 8, Pipe Hangers and
Support� - Matl'riafr, DPsign, Manufactim, SPlPrtion, A.ppliration,
and installation.
5.1.10.11.4.3 Support� for copper tube shall be size<l fm
coppe1· tube.
5.1.10.11.4.4* Suppmt� for CMT shall be in accor<lance \\1th
the CMT manufacturer's installation instructions.
5.1.10.11.4.5 In potentially <lamp locations, copper tube hang­
e1·s 01· supports that are in contact mth the tube shall be plastic­
coated 01· otherwise be electrically insulated from the tube by a
material that will not absorb moisture.

5.1.10.11.1.3 Mains and branches in me<lical-surgical vacuum 5.1.10.11.4.6 Maximum support spacing shall be in accord­
systems shall be not less than DN20(NPS 1/1) (¼ in.O.D.) size. ance with Table 5.1.10.1 1.4.6.

5.1.10.11.1.4 Drops to indi,i<lual station outlets and inlet�

shall be not less than DN15(NPS ½) (% in.O.D.) size. Table 5.1.10.11.4.6 Maximum Pipe Support Spacing
5.1.10.11.1.5 Runouts to ala1·m panels and connecting tubing
for gauges an<l alarm <le,ices shall be permitte<l to be DN8 Hange r Spacing
(NPS Y1) (¾ in.O.D.) size. Pipe Size nun ft
5.1.10.11.2 Protection of Piping. Piping shall be protecte<l DN8 (NPS Y1 ) (¾ in. O.D.) 15 20 5
against freezing, corrosion, and physical <lamage.
DNI0(NPS ½) (1,1.: in.O.D.) 1830 6
5.1.10.11.2.1 Piping exposed in corri<lors an<l other area5 DN15(NPS ½) (% in.O.D.) 1 830 6
whe1·e subject to physical damage from the movement of carts, DN20(NPS 1/1) (7/4 in. O.D.) 2 130 7
stretchers, portable equipment, or vehicles shall be protected. DN25(NPS 1) ( lY,in.O.D.) 2440 8
DN3 2(NPS 1 Y,) (1% in.O.D.) 2740 9
5.1.10.11.2.2 Piping un<lerground within buildings or embed­
DN40(NPS l½)(1%in.O.D.) 3050 10
<le<l in conCl'ete floors or walls shall be installe<l in a continu­
and large1·
ous con<luit.
Venical risern, all sizes, every 4570 15
floor. but not to excee<l

2021 Edition
99-58 HEALTH CARE FACILITIES CODE
5.1.10.11.4.7 Where requi1·ed, medical gas and vacuum piping
shall be seismically restrained against earthquakes in accord­
ance with the applicable building code.
5.I.IO.11 .5 U nderground Piping Outside of Buildings.
5.I.10.11.5.1 Buried piping out�ide of buildings shall be
installed below the local level of frost peneu·ation.
5.1.10.11.5.2 The installation procedure for underground
piping shall protect the piping from physical damage while
being backfilled.
5.1.10.11.5.3 If underground piping is protected by a conduit,
cover, or other enclosure, the following 1-equirement� shall be
tnet:
(1) Access shall be provided at the joints for visual inspection
and leak testing.
(2) The conduit, cove1·, or enclosure shall be self-draining
and not retain gmundwate1· in prolonged contact with
the pipe.
5.1.10.11.5.4 Buried p1pmg that will be subject to surface
loads shall be btu-ied at a depth that will protect the piping 01·
its enclosure from excessive stresses.
5.1.10.11.5.5 The minimum backfilled cover above the top of
the pipe 01· it� enclosure for buried piping out�ide of buildings
shall be 900 mm (36 in.), except that the minimum cover shall
be pe1·mitted to be 1·educed to 450 mm (18 in.) whe1·e the1·e is
no potential for damage from sudace loads 01· sui-face condi­
tions.
5.1.10.11.5.6 T1·enches shall be excavated so that the pipe 01·
its enclosure has fi1·m, substantially continuous bearing on the
bottom of the t1·ench.
5.1.10.11.5.7 Backfill shall be clean, free from mate1·ial that
can damage the pipe. and compacted.
5.1.10.11.5.8 A continuous tape or marker placed immedi­
ately above the pipe or it� enclosut·e shall clearly identify the
pipe line by specific name.
5.1.10.11.5.9 A continuous warning means shall also be provi­
ded above the pipeline at approximately one-half the depth of
burial.
5.I.I0.11.5.10 \'\>l1ere underground p1pmg is installed
through a wall sleeve, the outdoor end of the sleeve shall be
sealed to prevent the entrance of groundwater into the build­
ing.
5.1.10.11.6 Hose and Flexible Connectors.
5.1.10.11.6.1 Hose and flexible connectors, both metallic and
nonmetallic, shall be no longer than necessary and shall not
penetrate or be concealed in walls, floors, ceilings, or pani­
tions.
5.1.10.11.6.2 Flexible connectors, metallic or nonmetallic,
shall have a minimum btu-st pt·essure, with a gauge p1·essu1·e of
6895 kPa (1000 psi).
5.1.10.11.6.3 Metallic flexible joints shall be permitted in the
pipeline whe1·e required for expansion joints, seismic protec­
tion, thermal expansion, 01· vibration control and shall be as
follows:
(1) For all wetted sudaces, made of bronze, copper, or stain­
less steel
2021 Edition
(2) Cleaned at the factory for oxygen service and received on
the job site with certification of cleanliness
(3) Suitable fm se1·vice at 2070 kPa (300 psig) or above and
able to withstand temperatures of 538 ° C ( I00O"F)
(4) Provided with brazing extensions to allow brazing into
the pipeline per 5.1.10.4
(5) Supponed with pipe hangei-s and support� as requi1·ed
fot· their additional weight
5.1.10.11.6.4 Metallic flexible joints in accordance with
5.1.10.11.6.3 shall be permitted to be concealed in walls. ceil­
ings, or partitions.
5.1.10.II.7 Prohibited System I nterconnections.
5.1.10.II.7.I Two 01· more medical gas 01· vacuum ptprng
systems shall not be interconnected for installation, testing, or
any other reason, except as permitted by 5.1.10.11.7.2.
5.1.10.11.7.2 Medical ga� and vacuum systems with the same
content� shall be permitted to be interconnected with an in­
line valve installed between the systems.
5.I.10.11.7.3 Leak testing shall be accomplished by separately
charging and testing each individual piping system.
5.1.10.11.8 Manufact urer's Instr uctions.
5.1.10.11.8.1 The installation of i ndividual components shall
be made in accordance with the instructions of the manufac­
tu1·er.
5.1.10.11.8.2 Manufacturer's insu·uctions shall include di1-ec­
tions and information deemed by the manufacturer to be
adequate fot· attaining proper ope1·ation, testing. and mainte­
nance of the medical gas and vacuum systems.
5.1.10.11.8.3 Copies of the manufacturer's instructions shall
be left with the system owner.
5.1.10.11.9 Changes in System Use.
5.1.10.11.9.1 \,Vhere a positive pressure medical ga� piping
distribution system 01·iginally used 01· constructed fot· use at
one pt·essure and fot· one gas is converted for operation at
another pressure or for another gas, all provisions of 5.1.10
shall apply as if the system were new.
5.1.10.11.9.2 A vacuum system shall not be permitted to be
converted for use as a gas system.
5.1.10.1 I.IO Qualification of Installers.
5.I.IO.II.10.1 TI1e installation of medical gas and vacuum
systems shall be made by qualified, competent technicians who
are expet·ienced in pedorming such installations, including all
personnel who actually install the piping system.
5.1.IO.II.I0.2 Installers of medical gas and vacuum piped
distribution systems, all appurtenant piping supporting pump
and comp1·ess01· source systems , and appunenant piping
supporting source gas manifold systems not including perma­
nently installed bulk sout-ce systems. shall be cenified in
accmdance with ASSE 60 l 0, Pmfessinnal Qualifiratinm Standard
Jar l'viftlit:al (',as Systnns lnstallPrs.
5.I.I0.11.10.3 CMT systems shall be installed by ASSE 6010-
qualified installe1·s using the CMT manufactm·e1·'s instructions.
 c;As AND VACUUM SYSTEMS
5.1.10.11.10.4 Installe1·s of medical gas and vacuum systems
shall not use their certification to oversee installation by
noncenifien pe1·sonnel.
5.1.10.11.10.5 Brazing shall be pedormed by indi\inuals who
are qualified in accordance with the prmisions of 5.1.10.11.11.
5.1.10.11.10.6 P1·i01· to any installation wo1·k, the installe1· of
medical ga� and vacuum piping shall provide and maintain
nocumentation on the job site for the qualification of brazing
procenm·es ann indi\idual braze1·s that is requi1·en unner
5.1.10.11.11.
5.1.10.11.10.7 Health care organization personnel shall be
f
permitten to install piping systems i all of the requirement� of
5.1.10.11.10 a1·e met during the installation.
5.1.I0.11.1I Qualification of Brazing Procedures and Brazing.
5.1.10.11.11.1 Brazing procenures ann braze1· perfo1·mai1ce
fot· the installation of menical gas ann vacuum piping shall be
qualified in accordance with either Section IX, "Welding and
Brazing Qualifications,'' of the ASME Boill'r and Prrss1aP Vr.i�Pl
CodP, or AWS B2.2/B2.2M, Spnijiration for Brazing PmrPdurP and
PerformanrR Qualifimtion, both as monified by 5.1.10.11.11.2
through 5.1.10.11.11.5.
5.1.10.11.11.2 Brazers shall be qualified by visual examination
of the test coupon followed by sectioning.
5.1.10.11.11.3 The brazing procedure specification shall
adnress cleaning, joint cleai·ance, ovedap, internal pm·ge ga�,
purge ga� flow rate, and filler metal.
5.1.10.11.11.4 The brazing procedu1·e qualification recorn
and the record of brazer pedormance qualification shall docu­
ment filler metal usen, base metals, cleaning, joint clearat1ce,
overlap, internal purge gas and flow rate during brazing of
coupon, and absence of internal oxination in the completed
coupon.
5.1.10.11.11.5 Brazing procenures qualified by a technically
competent group or agency shall be pern1itted unde1· the
following conditions:
( l) The brazing procedure specification at1d the procedure
qualification records meet the requirement� of this code.
(2) The employer obtains a copy of both the brazing proce­
dure specification and the supporting qualification
recmTls from the group or agencv and signs ann dates
these recm·ds, thereby accepting 1·esponsibility for the
qualifications that were pedormen by the group or
agencv.
( 3) The employer qualifies at least one braze1· following each
brazing procedure specification used.
5.1.10.11.11.6 An employer shall be permitted to accept
bt·azer qualification recorns of a previous employer unne1· the
following conditions:
( l) The brazer has been qualified following the same or an
equivalent procenure that the new employer uses.
(2) The new employe1· obtains a copy of the recm·d of brnzer
performance qualification tests from the pre\ious
employer and signs and nates these records, thereby
accepting responsibility for the qualifications pedormen
by the pt·evious employe1·.
5.1.10.11.11.7 Performance qualifications of brazers shall
1·emain in effect indefinitely, unless the brazer does not braze
99-59
with the qualifien procedure for a period exceeding 6 months
or there is a specific reason to question the ability of the brazer.
5.1.10.11.12 Breaching or Penetrating Medical Gas Piping.
5.1.10.11.12.1 Positive pressure patient menical gas piping
and medical support gas piping shall not be hreachen or pene­
trated by any means 01· process that will result in 1·esinual
coppe1· pat·ticles or other debris 1·emaining in the piping or
affect the oxygen-cleat1 interior of the piping.
5.1.10.11.12.2 1l1e breaching 01· penetrating process shall
ensm·e that any deb1·is createn by the process 1·emains
contained ,vi thin the work area.
5.1.11* Labeling, Identification, and Operating Pressure.
Color and pt·essm·e requirement� shall be in accordat1ce with
Table 5.1.11.
5.1.11.1 Pipe Labeling.
5.1.11.1.1 Piping shall be labeled by stenciling or anhesive
markers that inentify the patient menical gas, the medical
support gas, or the vacuum system and inclune the following:
( 1) Name of the ga� or vacuum system or the chemical
symbol per Table 5.1.11
(2) Gas or vacuum system color cone per Table 5.1.11
5.1.11.1.2 '\'here positive pressure gas piping systems operate
at p1·essures other than the standarn gauge pressure in Table
5.1.11, the operating pt·essure in adnition to the name of the
gas shall he labeled.
5.1.11.1.3 Where vacuum svstems are used to serve WAGD
systems in accordance with 5.1.10.2.3.1, piping in the immedi­
ate a1·ea of the \,\!AGD system shall be labeled to innicate both
systems.
5.1.11.1.4 Pipe labels shall be locaten as follows:
At intervals of not more than 6.1 m ( 20 ft)
( 1)
(2) At least once in or above every room
(3) On both sines of walls or partitions penetrated by the
piping
(4) At least once in evety stoty height traversed by risers
5.1.11.1.5 Medical ga� piping shall not be painted.
5. I.I 1.1.6 Labeling of piping fot· compressor intakes, vacuum
exhaust�, ann relief valve vent lines shall meet the require­
men l� of 5.1.11.1. l ann state the specific function to distin­
guish them from the patient supply piping.
5.1.11.2 Shutoff Valves.
5.1.11.2.1 Shutoff valves shall be inentified with the following:
( 1) Name or chemical symbol for the specific medical gas or
vacuum system
( 2) Gas or vacuum system col01· code in acc01·nance with
Table 5.1.11
(3) Room or areas served
(4) Caution to not close 01· open the valve except in eme1·-
gency
5. I.I 1.2.2 VVl1ere positive pressure gas piping sylltems operate
at pt·essures othe1· than the standat·d gauge pressure of 345 kPa
to 380 kPa ( 50 psi to 55 psi) 01· a gauge pt·essure of 1100 kPa to
1275 kPa ( 160 psi to 185 psi) for nitrogen or instrument air,
the valve identification shall also inclune the nonstandard
operating p1·essu1·e.
2021 Edition
99-60 HEALTH CARE FACILITIES CODE

Table 5_1.l I Standard Designation Colors and Operating Pressures for Gas and Vacuum Systems

Colors Standard Gauge Pressure

Gas Service Abbreviated Name (Background/Text) kPa psi
�ledical air :\1ed air Yellow/black 345-380 50-55
Carbon dioxide CO: Gray/black or 345-380 50-55
gray/white
Helium He Brown/white 345-380 50-55
Nitrogen N, Black/white 345-1275 55-185
Nitrous oxide NP Blue/white 345-380 50-55
Oxygen Green/white or 345-380 50-55
white/green
Oxygen/ carbon clioxicle 01/CO,n% Green/white 345-380 50-55
mixtures (n= % of CO,)
Medical-surgical vacuum :\1ed vac l,,\'hite/black 380 mm to 760 mm
(15 in. to 30 in.) HgV
1,,\/aste anesthetic gas WAGIJ Violet/white Varies with system type
disposal
�ledical-,urgical vacuum/ :\1ed-mrg/ White/black and 380 mm to 760 mm
WAGIJ combination WAGIJ violet/white (15 in. lo 30 in.) HgV
Othe,· mixtures Gas A%/Gas B% Color- as above None
Major gas for
background/minm·
gas for text
Nonmedical air Yellow and white None
and dental air diagonal stripe/black
Nonmedical vacuum and 1,,\/hite and black None
dental vacuum diagonal stripe/hlack
boxed
Laboratory air Yellow and white None
checkerboarcl/hlack
Laboratm·y vacuum White and black None
checkerboard/black
boxed
Instrument air Red/white 345-1275 50-185

5.1.11.2.3* "Whet·e vac uum systems are use<l to senre "WAGD
systems in ac cm·dance with 5.1.10.2.3.1, valves that are on the
source si<le of the connection to the WAGD system shall be
labeler! to in<licate both systems.
5.1.11.2.4 Sou1·ce valves shall be labeled in s ubstance as
follows:
SOURCE VALVE
FOR THE (SOURCE NAME).
5.1.11.2.5 Main line valves shall be labeled in substance as
follows:
MAIN LINE VALVE FOR THE (GAS/VACUUM NAME)
SERVING (NAME OF THE BUIIDING).
5.1.11.2.6 1he rise1- valve(s) shall be labeled in substance as
follows:
RISER FOR THE (GAS/VACUUM NAME) SERVING
(NAME OF THE AREA/BUILDING SERVED BY THE
PARTICULAR RISER).
5.1.11.2.7 T he service valve(s) shall be labeler! in substance as
follows:
SERVICE VALVE FOR THE (GAS/VACUUM NAME)
SERVING (NAME OF THE AREA/BUILDING
SERVED BY THE PARTICULAR VALVE).
5.1.11.2.8* Zone valve box assemblies shall be labeled with the
1·ooms, areas, or spaces that they contt·ol a� follows:
ZONE VALVES FOR THE (GAS/VACUUM NAME)
SERVING (NAME OF ROOMS OR SPACES SERVED
BY THE PARTICULAR VALVE).
labeling shall either be visible from outside the zone valve
box assembly through the covet· or be replicated on the
out�i<le. but not affixe<l to the removable cover.
5.1.11.3 Station Outlets and Inlets.
5.1.11.3.1 S tation outlets and inlet� shall be i<lentified as to
the name 01· chemical symbol for the specific medical gas or
vac uum provider! and shall in clu<le the following:
(I) Name of the ga� or vacuum system or the chemical
spnbol in ac c01·<lance with Table 5.1.11

2021 Edition
 c;As AND VACUUM SYSTEMS
(2) Ga� 01· vacuum system color code in accordance with
Table 5.1.11
5.1.11.3.1.1 In sleep labs, whe1·e the outlet is downstt·eam of a
flow contrnl device, the station outlet identification shall
include a warning not to use the outlet for ventilating patient�.
5.1.11.3.2 Where medical gas systems opernte at pt·essut·es
other than the standard gauge pr·essm·e of 345 kPa to 380 kPa
(50 psi to 55 psi) or a gauge pressure of 1100 kPa to 1275 kPa
(160 psi to 185 psi) for nitrngen, the station outlet identifica­
tion shall include the nonstandat·d operating pressu1·e in addi­
tion to the name of the gas.
5.1.11.4 Alarm Panels.
5.1.11.4.1 Labeling of alarm panels fot· each indicat01· shall
indicate the condition monitored and its area of surveillance.
5.1.11.4.2* A.i-ea alarm panels shall be identified with the
following:
(1) Name or chemical symbol of the specific medical gas or
vacuum system being monito1·ed
(2) Ga� or vacuum system color code, in accm·dance with
Table 5.1.11. of the specific medical gas or vacuum system
being monito1·ert
(3) Area(s) monit01·ert by the ala1·m panel
5.1.11.4.3 Vihere medical gas systems operate at pressures
other than the standard gauge pressut·e of 345 kPa to 380 kPa
(:"JO psi to 55 psi), or a gauge pressure of I 100 kPa to 1275 kPa
(160 psi to 185 psi) fo1· nitrngen or instrument air, the area
alarm panel identification shall include the nonstanrtard oper­
ating pressut·e in artrtition to the name of the ga�.
5.1.11.4.4 Where vacuum systems are used to serve WAGD
systems per 5.1.10.2.3. l, an area alarm panel (s) monitoring the
area in which the WAGD system is used shall be labelert to indi­
cate both systems.
5.1.11.5 Source Equipment.
5.1.11.5.1 Source equipment shall be labelert or taggert to
irtentify the patient mertical gas, the mertical support gas, or
the vacuum system and include the following information:
(l) Name o f the gas o r vacuum system
(2) Ga� or vacuum system color code
(3) Rooms, areas, or buildings served
(4) Eme1·gency contact information for the department or
indivirtual 1·esponsible for maintaining the equipment
5.1.11.5.2 Where vacuum systems are usert to serve \VAGD
systems in acc01·dance with 5.1.10.2.3.1, labeling for the medi­
cal-surgical vacuum source shall indicate that it series both
systems.
5.1.12* Performance Criteria and Testing - Category 1
(Gases, Medical-Surgical Vacuum, and WAGD).
5.1.12.1 General.
5.1.12.1.1 Inspection and testing shall be pedormert on all
new piped mertical gas and vacuum systems, additions, 1·enova­
tions, temporary installations, or repaired systems to ensure, by
a rtocumentert prncess and prncedure, that all applicable provi­
sions of this rtocument have been arthe1·ed to anrt svstem integ­
rity has been achievert or maintained.
99-61
5.1.12.1.2 Inspection and testing shall include all component�
of the system, or portions thereof, including, but not limitert
to, gas hulk source(s); manifolds; comp1·essert air source
systems (e.g., comp1·ess01·s, rtrye1·s, filters, regulators); source
alarms and monitoring safeguards; master alarms; pipelines;
isolation valves; a1·ea alarms; zone valves; and station inlets
(vacuum) anrt outlets (pressure gases).
5.1.12.1.3 All systems that are breachert anrt component� that
are subject to additions, renovations, or replacement (e.g., new
gas sout-ces: bulk, manifolds, com pressors, dtyern. alarms) shall
be inspected anrt testert.
5.1.12.1.4 Sys tems shall be deemert breached at the point of
pipeline intrusion by physical separntion 01· by system comp�
nent removal, replacement, 01· artrtition.
5.1.12.1.5 B1·eachert portions of the systems subject to inspec­
tion anrt testing shall be confinert to only the specific alterert
zone and component� in the immediate zone or area that is
locatert upstream for vacuum systems anrt downstream for pres­
sure gases at the point 01· a1·ea of intrusion.
5.1.12.1.6 The inspection anrt testing reports shall be submit­
ten directly to the party that contracted for the testing, who
shall submit the 1·eport thrnugh channels to the Responsible
Facility Auth01·ity and any others that a1·e 1·equired.
5.1. 12.1. 7 Report� shall contain detail en listings of all finrtings
anrt results.
5.1.12.1.8 The Responsible Facility Authority shall review
these inspection anrt testing records prior to the use of all
systems to ensure that all findings and 1·esults of the inspection
and testing have been successfully completed.
5.1.12.1.9 All documentation pertaining to inspections and
testing shall be maintained on-5ite within the facility.
5.1.12.1.10 Before piping systems are initially put into use, the
facility authority shall be responsible for ascertaining that the
gas/vacuum deliverert at the outlet/inlet is that shown on the
outlet/inlet label and that the prnpe1· connecting fittin� are
installed for the specific gas/vacuum senice.
5.1.12.1.11 Acceptance of the ve1·ifier's final report shall be
pe1·mitted to satisfy the requirement� in 5.1.12.1.10.
5.1.12.1.12 The removal of component� within a source
system for 1·epai1· and reinstallation, 01· the 1·eplacement of
component� like for like, shall be treated a� new work for the
purposes of testing whenever such work involves cutting 01·
brazing new piping. or both.
5.1.12.1.12.1 ·where no piping is changed. functional testing
shall be performed a� follows:
( l) To ve1·ify the function of the 1·eplaced device
(2) To ensure no othe1· equipment in the system has been
artve1·sely impactert
5.1.12.1.12.2 Vihere no piping is changert, in art<lition to test�
of genernl fi.mction required by 5.1.12.1.12.1, testing shall be
pei-formert as follows:
( l) Pressure gas sources shall be tested for compliance with
:"J. l.12.4.14.2 as applicable to the equipment type.
(2) Medical air and instrument air sources shall be testert to
5.1.12.4.14.3.
(3) Vacuum anrt ,VAGD systems shall be tested to
5.1.12.4.14.6.
2021 Edition
99-62 HEALTH CARE FACILITIES CODE
(4) Alarm systems shall be teste<l to 5.1.12.4.5.2 and
5.1.12.4.5.3.
(5) All affected component� shall be teste<l as appropriate to
that specific component (e.g., a replace<l dew point moni­
tor would be tested to 5.1.3.6.3.13).
5.1.12-1.13 The rated accurncy of p1·essm·e and vacuum indica­
tors used fo1· testing shall be l percent (foll scale) 01· bette1·.
5.1.12.2 Installer-Performed Tests.
5.1.12.2.1 General.
5.1.12.2.1.1 TI1e test� required by 5.1.12.2 shall be performed
and documented by the installer p1·io1· to the test� liste<l in
5.1.12.4.
5.1.12.2.1.2 The test gas shall be oil-free, <l ry nitrogen NF.
5.1.12.2.1.3 Whe1·e manufactured assemblies are to be in­
stalle<l, the test� required by 5.1.12.2 shall be pel"formed a�
follows:
( l) After completion of the distribution piping, but before
the standing pressure test
(2) Prior to installation of manufactured assemblies supplied
through flexible hose or flexible tubing
(3) At all station outleN/inlet� on installe<l manufactured
assemblies supplied through coppe1· tubing
5.1 .I 2.2.2 Initial Piping Blowdown. Piping in medical gas an<l
vacuum distribution systems shall be blown clear by means of
oil-free, dry nitrogen NF after installation of the <listribution
piping but before installation of station outlet/inlet rough-in
assemblies and othe1· system component� (e.g., pressure/
vacuum alarm <levices, pressu1·e/vacuum in<licat01·s, pressure
relief valves, manifolds, source equipment).
5.1.12.2.3 In.iiial Pressure Test.
5.1.12.2.3.1 Each section of the piping 111 medical ga� an<l
vacuum systems shall be pressure teste<l.
5.1.12.2.3.2 Initial pressu1·e test� shall be conducted as follm11S:
( l) After blowdown of the distribution piping
(2) After installation of station outlet/inlet rough-in assem­
blies
f
(3) P1·io1· to the installation o components of the <listribution
piping system that woul<l be damaged by the test pressure
(e.g .. pressure/vacuum alarm <le,ices, p1·essm·e/vacuum
indicat01·s, line p1·essure relief valves)
f
5.1.12.2.3.3 The source shutof valve shall remain close<l
during the test� specified in 5.1.12.2.3.
5.1.12.2.3.4 The test pressm·e fo1· presstu-e gases and vacuum
systems shall be 1.5 times the system operating pressure but not
less than a gauge p1·essure of 1035 kPa (150 psi).
5.1.12.2.3.5* The test p1·essure shall be maintained until each
joint has been examined for leakage by means of a leak detec­
tant that is safe for use with oxygen an<l does not contain
ammonia.
5.1.12.2.3.6 Leaks, if any, shall be located, repaired (if permit­
te<l). 1·eplace<l (if requi1·ed). and 1·eteste<l.
5.1.12.2.4 Initial Cross-Connection Test. It shall be <lete1·­
mined that no cross-connections exist between the various
medical gas and \acuum piping systems.
2021 Edition
5.1.12.2.4.1 All p1pmg systems shall be reduce<l to atmos­
pheric pressure.
5.1.12.2.4.2 Som·ces of test gas shall be disconnecte<l from all
piping systems, except for the one system being tested.
5.1.12.2.4.3 The system un<ler test shall be cha1·ge<l with oil­
free, dry nitrogen NF to a gauge pressure of 34!"'> kPa (50 psi).
5.1.12.2.4.4 After the installation of the in<lividual faceplates
with appropriate a<lapters matching outlet/inlet labels, each
individual outlet/inlet in each installed me<lical gas and
vacuum piping system shall be checked to <letennine that the
test ga� is being dispensed only from the piping system being
tested.
5.1.12.2.4.5 The crnss-connection test 1·efe1·ence<l in 5.1.12.2.4
shall be repeate<l for each installed me<lical gas and vacuum
piping system.
f
5.1.12.2.4.6 The proper labeling and i<lentification o system
outlet�/inlets shall be confirmed <luring these test�.
5.1.12.2.5 Initial Piping Purge Test. The outlet� in each medi­
cal gas piping system shall be pu1·ged to remove any particulate
matter from the <listribution piping.
5.1.12.2.5.1 Using appropriate adapters, each outlet shall be
purge<l with an intermittent high-volume flow of test ga� until
the purge produces no discoloration in a clean white cloth.
5.1.12.2.5.2 The purging 1·equire<l in :U .12.2.5. l shall be star­
te<l at the closest outlet/inlet to the zone valve and continue to
the furthest outlet/inlet within the zone.
5.1.12.2.6 Standing Pressure Test for Positive Pres.sure Medi­
cal Gas Piping. After successful completion of the initial pt·es­
sure test� under 5.1.12.2.3, me<lical gas distribution piping shall
be subject to a standing p1·essm·e test.
5_1.12.2.6.1 * Tests shall be conducted al ·ter the final installa­
tion of station outlet valve bo<lies, faceplates, and all other
<listribution system components.
5.1.12.2.6.2 The source valve shall be closed <lu1·ing this test.
5.1.12.2.6.3 The piping systems shall be subjected to a 24-hour
standing p1·essu1·e test using oil-free, dq; nitrogen NF.
5.1.12.2.6.4 Test pressures shall be 20 percent above the
normal system operating line pressure.
5.1.12.2.6.5* The leakage ove1· the 24-houi· test shall not
exceed 0.5 percent of the starting pressure r e.g., 2 kPa (0.3 psi)
starting at 415 kPa (60 psig) l. except that attributed to specific
changes in ambient tempernture.
5.1.12.2.6.6 Leaks,f if any, shall be locate<l, repaired (if permit­
ted) or 1·eplaced (i requi1·ed), an<l retested.
5_1.12.2.6.7 The 24-hour standing p1·essu1·e test of the positive
pressure system shall be witnessed by an ASSE 6020 inspector,
an ASSE 6030 ve1·ifier, 01· the authority having jurisdiction or it�
designee. A form indicating that this test has been ped·ormed
and witnessed shall be provide<l to the verifier at the start of
the test� require<l in 5.1.12.4.
f
5.1.12.2.7 Standing Vacuwn Test for Vacuwn Piping. A ter
successful completion of the initial p1·essu1·e tests under
5.1.12.2.3, vacuum distribution piping shall be sul?jecte<l to a
standing vacuum test.
 c;As AND VACUUM SYSTEMS
5.1.12.2.7.1 Test� shall be conducted after installation of all
component� of the vacuum system.
5.1.12.2.7.2 The piping systems shall be subjected to a 24-hour
standing vacuum test.
5.1.12.2.7.3 Test pressure shall be between 300 mm (12 in.)
HgV and full vacuum.
5.1.12.2. 7.4 Dming the test, the source of test vacuum shall be
disconnected from the piping system.
5.1.12.2.7.5* T he leakage ove1· the 24-hour test shall not
exceed 0.5 percent of the starting pressure f e.g., 0.3 mm
(0.125 in.) HgV sta1·ting at 635 mm (25 in.) HgVl except that
attributed to specific changes in ambient tempernture.
5.1.12.2. 7.6 1l1e 24-hour standing pressure test of the vacuum
system shall be witnessed by the authority havingjurisdiction or
it� designee. A fo1·m indicating that this test has been
perfo1·med and witnessed shall be provided to the verifie1· at
the start of the test� required in 5.1.12.4.
f f
5.1.12.2. 7.7 Leaks, i any, shall be located. 1·epai1·ed (i permit­
t
ted) or 1·eplaced (if -equi1·ed), and retested.
5.1.12.3 System Inspection.
5.1.12.3.1 General.
5.1.12.3.1.1 System inspections shall be performed prior to
concealing piping distribution sptems in walls, ceilings, chases,
trenches, undeq;round, or otherwise hidden from view.
5.1.12.3.1.2 The test gas shall he nitrogen NF.
5.1.12.3.1.3 Inspections shall be conducted by a party techni­
cally competent and experienced in the field of medical ga�
and vacuum pipeline inspections and testing and meeting the
1·equirement� of ASSE 6020, Prnfessinnal Qualifiratinns Standard
fnr MPdiral Gm Systnm Inspertars, or ASSE 6030, PmJe.��itinal Qual­
ifiratinns Standard far Mtdiral Gas Systnm ¼rifiPrs.
5.1.12.3.1.4 Inspections shall be performed by a party other
than the installing contract01·.
5.1.12.3.1.5 ,<\l1ere systems have not been installed by in­
house personnel, inspections shall be pe1·mitted by pe1·sonnel
of the organization who meet the 1·equirements of 5.1.12.3.1.3.
5.1.12.3.2 Inspections.
5.1.12.3.2.1 The initial p1·essure test� pel'formed by the instal­
ling contrnctor shall be \\�tnessed by an ASSE 6020 inspect01·,
an ASSE 6030 verifier, or the authority having jurisdiction or it�
designee. A form indicating that this test has been pedormed
and witnessed shall he provided to the ve1·ifier at the start of
the tests required in 5.1.12.4.
5.1.12.3.2.2 1l1e presence and cotTectness of labeling and
valve tagging required by this code fo1· all concealed compo­
nents and piping distribution systems shall be inspected.
5.1.12.4 System Verification.
5.1.12.4.1 General.
5.1.12.4.1.1 Verification tests shall be performed only after all
test� required in 5.1.12.2, Installe1·-Pedormed Test�. have been
completed.
5.1.12.4.1.2 1l1e test ga.� shall be oil-free, d1·y nitrogen NF or
the system gas whe1·e permitted.
99-63
5.1.12.4.1.3 Testing shall be conducted by a party technically
competent and experienced in the field of medical gas and
\acuum pipeline testing and meeting the requi1·ement� of
ASSE 6030, Professional Qualifimtinns Standard fnr NlPdiral Gas
Systnns Verijifrs, except as required by 5.1.12.4.1.4.
5.1.12.4.1.4 Testing of the cryogenic fluid central supply
system shall be conducted by a panv technically competent and
experienced in the field of cryogenic fluid systems and meeting
the requirement� of ASSE 6035, Pmfe.t�innal Qualifirations Stand­
ard fnr Bull!. Afrdiral Gm Systnm Vi!rifirrs. in accordance with the
mandatory 1·equi1·ements in CGA M-1, Standard for Nledi,:al (',as
Suppl,• Systmis at Hmlth Cam Farilities.
5.1.12.4.1.5 Testing shall he performed by a pa1·ty other than
the installing contractol'.
5.1.12.4.1.6 \<\'hen systems have not been installec-J. by in-house
pe1·sonnel. testing shall be permitted by personnel of that
organization who meet the requi1·ement� of 5.1.12.4.1.3.
5.1.12.4.1.7 All test� required under 5.1.12.4 shall be
pel'fonned after installation of any manufactured assemblies
supplied through tubing or flexible hose.
5.1.12.4.1.8 ,-v11ere there a1·e multiple possible connection
point� fo1· terminals. each possible position shall be tested inde­
pendently
5.1.12.4.1.9 The ga.� of system designation shall be permitted
to he used fo1· all test�. regardless of the size of the system,
which include the following:
(1) Standing pressure (sPe 5.1.12.4.2)
(2) Cross-connection (see5.1.12.4.3)
(3) Ala rms (sed.1.12.4.5)
(4) Piping purge (�Pe 5.1.12.4.6j
(5) Piping particulates (se,, 5.1.12.4. 7)
5.1.12.4.2* Standing Pressure Test. Piping systems shall he
subjected to a !().minute standing pressure test at operating
line pressure using the following procedm-e:
(l ) ,\fter the system is filled \\�th nitrogen or sou1·ce ga.�. the
source v-alve and all zone Vdlves shall be closed.
(2) The piping system shall show no decrease in pressure
afi:e1· 10 minutes.
(3) Any leaks found shall be located, repaired, and 1·etested
per 5.1.12.2.6.
5.1.12.4.3 Cross-Connection Test. After the closing of walls
and completion of the 1·equirement� of 5.1.12.2, it shall be
determined that no cross-<:onnection of piping systems exists by
either of the methods detailed in 5.1.12.4.3. l or 5.1.12.4.3.2.
5.1.12.4.3.1 Individual Pressurization Method.
(A) All medical gas and vacuum piping systems shall be
1·educed to atmospheric pressm·e.
(B) All sources of test ga.� from all of the medical ga.� and
vacuum systems, with the exception of the one system to be
checked, shall be disconnected.
(C) The system being checked shall he pressurized to a gauge
pressure of 345 kPa (50 psi).
(D) With adapte1·s matching outlet labels, each individual
station outlet/inlet of all medical ga.� and vacuum systems
installed shall be checked to determine that test gas is being
2021 Edition
99-64 HEALTH CARE FACILITIES CODE

dispense<l only from the outlet�/inlet� of the piping system
being tested.
(E) The source of test gas shall be disconnecte<l, an<l the
system tested re<luce<l to atmosphet-ic pressu1·e.
(F) Proceed to test each additional piping system until all
medical ga� and vacuum piping systems a1·e free of cross­
connections.
5.1.12.4.4.1 Records shall be made listing the rooms 01· a1·eas
controlled by each valve for each gas.
5.1.12.4.4.2 The information shall be utilize<l to a�sist and
verify the proper labeling of the valves.
5.1.12.4.5 Alarm Test.
5.1.12.4.5.1 General.

5.1.12.4-3.2 Pressure Differential Method.
(A) The pr·essure in all medical ga� systems shall be reduced to
atmospheric.
(B) The test gas pt·essure in all medical gas piping systems
shall he inct'ease<l to the values indicate<l in Table
5. l.12.4.3.2(B), simultaneously maintaining these nominal
pressu1·es throughout the test.
(A) All warning systems for each medical gas and vacuum
system(s) shall be tested to ensut·e that all components func­
tion properly prim· to placing the system in service.
(B) Permanent records of these test� shall be maintained.
(C) Warning systems that are part of an addition to an existing
piping system shall be tested prim· to the connection of the new
piping to the existing system.

(C) Systems with nonstandat·d opernting pt·essut·es shall be
teste<l at a gauge pressure of at least 70 kPa ( 10 psi) higher or
lowe1· than any other system being teste<l.
(D) Any vacuum systems shall be in operation so that these
vacuum systems are tested at the same time the medical ga�
systems are teste<l.
(E) Following the a<ljustment of pt·essures in acc01·dance with
5. l.12.4.3.2(B) and 5. l.12.4.3.2(C), each station outlet for each
medical gas system shall be teste<l using the gas-specific connec­
tion for each system with test gauge attached to ve1·ify that the
co1Tect test pt·essm·e/vacuum is pt·esent at each outlet/inlet of
each system as liste<l in Table 5.l.12.4.3.2(B).
(F) Each test gauge used in pedo1·ming this test shall be cali­
brated v.�th the p1·essure in<licator use<l for the line pressure
regulator use<l to provi<le the source pressure.
(D) Tests of warning systems fo1· new installations (initial test�)
shall be performed a1·ter the cross-connection testing (.�ff
5.1.12.4.3), but before purging the piping (sPe 5.1.12.4.6) and
perfo1·ming the 1·emaining verification tests. (See 5.1.12.4. 7
through 5.1.12.4.14.)
(E) Initial tests of warning systems that can he include<l in an
ad<lition or extension to an existing piping system shall be
completed before connection of the addition to the existing
system.
(F) Test gases for the initial test� s hall be oil-free, <l1·y nitrogen
NF, the gas of system <lesignation, or opernting vacuum.
(G ) w·here computer systems are used a� substitutes for a
1·equired alann panel as pern1itte<l under 5.1.9.2.2, the
computer system shall be included in the alarm test� as modi­
fied in 5.1.9.3.

(G) Each station outlet shall he i<lentified by label (and col01· 5.1-12.4.5.2 Master Alanns.
marking, if used). and the pressure indicate<l on the test gauge (A) The master alarm system test� shall be performe<l for each
shall be Lhat listed in Table 5.l.12.4.3.2(B) for the system being of the me<lical gas and vacuum piping systems.
teste<l.
(B) Permanent recm·ds of these tests shall be maintained with
5.1.12.4.4 Valve Test. Valves installe<l in each medical gas and those requi1·ed un<le1· 5.1.12.l. 7.
vacuum piping system shall be tested to verify proper operation
and rooms or areas of control. (C) 1l1e audible and noncancelahle visual signals of 5.1.9.1
shall indicate if the pressur·e in the main line increases or
decreases 20 percent from the normal operating pt·essm·e.
Table 5.l.12.4.3.2(B) Alternate Test Pressures
(D) 1l1e operation of all master· alarm signals refe1·enced in
5.1.9.2.4 shall be verified.
Pressure Vacuum
Medical Gas (Gauge) (HgV) 5.1.12.4.5.3 Area Alanns. The warning signals for all me<lical
gas piping systems shall be tested to verif)' an alarm condition if
Ga5 mixtm·es 140 kPa (20 psi) the pressut·e in the piping system increa�es 01· dect'ea�es
Nitrogen/ 210 kPa (30 psi) 20 percent from the normal operating pressure fo1· positive
instrument air pressure ga�es, or when the vacuum system(s) drops below a
Nitrous oxide 275 kPa (40 psi) gauge pt·essure of300 mm (12 in.) HgV.
Oxygen 345 kPa ( 50 psi)
Medical ai1· 415 kPa (60 psi) 5.1-12.4.6 Piping Purge Test_ In order to remove any traces of
Systems at 70 kPa (10 psi) particulate matter deposited in the pipelines as a result of
construction, a heavy, intermittent purging of the pipeline shall
nonstandard g1·eater 01· less
be done.
pressures than any othe1·
system 5.1.12.4.6.1 The appropriate adapter shall be obtained from
Vacuum 510 mm (20 in.) the facility 01· manufactut·e1·, and high purge rntes of at least
HgV 225 NI/min (8 SCFM) shall be put on each outlet.
380 mm (15 in.)
HgV (if.so
designed)

2021 Edition
 c;As AND VACUUM SYSTEMS
5.1.12.4.6.2 After the purge is started. it shall be rapidly inter­
rupted several times until the purge produces no discoloration
in a white cloth loosely hel<l over the adapter during the purge.
5.1.12.4.6.3 In 01·de1· to avoid possible damage to the outlet
and its component�, this test shall not be con<lucte<l using any
implement other than the proper adapter.
5.1.12.4.6.4* No pronounce<l or objectionable ocl01· shall be
<liscernible from any positive pressure outlet.
5.1.12.4. 7 Piping Particulate Test. For each positive pressut·e
gas system, the cleanliness of the piping system shall be ve1·i­
fie<l.
5.1.12.4.7.1 A minimum of 1000 L (35 ft3) of gas shall be
filtered through a clean, white 0.4:> micron filter at a minimum
flow rnte of 100 NI/min (3.5 SCFM).
5.1.12.4.7.2 Twenty-five pe1·cent of the zones shall be tested at
the outlet most remote from the source.
5.1.12.4. 7.3 The filter shall accrue no mo1·e than 0.001 g
( l mg) of matter from any outlet tested.
5.1.12.4. 7.4 If any outlet fails this test, the most remote outlet
in every zone shall be teste<l.
5.1.12.4. 7.5 The test shall be perform eel with the use of oil­
free, dry nitrogen NF.
5.1.12.4.8* Verifier Piping Purity Test. For each medical gas
system, the purity of the piping system shall be verified in
accordance with 5.1.12.4.8.
5.1.12.4.8.1 TI1ese test� shall be ped,xme<l with oil-free, d ry
nitrogen NF or the system gas.
5.1.12.4.8.2 The outlet most remote from the sou1·ce shall be
teste<l fot· total nonmethane hydrocarbons an<l halogenated
hydrocarbons and compared to the source gas.
5.1.12.4.8.3 If the s�tem gas is use<l a� the source ga�, it shall
be tested at the source equipment.
5.1.12.4.8.4 The difference between the two tests shall in no
case excee<l :> ppm of total non-methane hydrocarbons.
5.1.12.4.8.5 TI1e diffe1·ence between the twu tests shall m no
case exceed :> ppm halogenated hy<lrocarbons.
5.1.12.4.8.6 TI1e moisture concentration of the outlet test
shall not exceed 500 ppm or an equivalent pt·essttl'e clew point
of-12"C (10 ° F) at a gauge pt·essure of 345 kPa ( 50 psi).
5.1.12.4.9 Final Tie-In Test.
5.1.12.4.9.1 P1·i01· to the connection of any wo1·k or any exten­
sion or a<ldition to an existing piping system, the test� in
5.1.12.4.l through :>.1.12.4.8 shall be successfully performed on
the new work.
5.1.12.4.9.2 Each joint in the final connection between the
new work and the existing system shall be leak-teste<l with the
gas of s�tem designation at the normal operating pressure by
means of a leak detectant that is safe for use with oxygen and
noes not contain ammonia.
5.1.12.4.9.3 Vacuum joint� shall be tested using an ultrasonic
leak detect01· or other means that will allow detection of leaks
in an active vacuum s�tem.
99-65
5.1.12.4.9.4 Fm· pressure gases. imme<liately after the final
brazen connection is mane an<l leak-tested, an outlet in the
new piping and an outlet in the existing piping that a1·e imme­
<liately downstream from the point 01· a1·ea of intrusion shall be
purged in accordance with the applicable requirements of
5.1.12.4.6.
5.1.12.4.9.5 Befo1·e the new work is used for patient ca1·e, posi­
tive pressure gases shall be teste<l for operational pressure and
gas concentration in accor<lance with :i.1.12.4.10 and
5.1.12.4.11.
5.1.12.4.9.6 Permanent records of these tests shall be main­
tained in accordance with 5.1.14.7.
5.1.12.4.10 Operational Flow Pressure Drop Test. Opera­
tional flow pressure drop tests shall be petformed at each
station outlet/inlet or terminal where the user makes connec­
tions and disconnections.
5.1.12.4.10.l Tests shall be performed with the gas of system
designation or the operating vacuum.
5.1.12.4.10.2 All gas outlets with a gauge pressure of 34:i kPa
(50 psi), including, but not limited to, oxygen, nitrous oxide,
medical air, and carbon dioxide, shall deliver 100 SLPM
(3.5 SCFM) with a pt·essure drop of not mc)l'e than 35 kPa
( :> psi) and static pt·essure of 345 kPa to 380 kPa ( 50 psi to
:i5 psi).
5.1.12.4.10.3 Medical support gas outlets shall delive1· 140
f
SLPM ( 5.0 SCFM) with a pressure drop o not mm·e than
35 kPa (:i psi) gauge and static pressure of 1100 kPa to
1275 kPa (160 psi to 185 psi) gauge.
5.1.12.4.10.4 Medical-surgical vacuum inlets shall draw
85 NI/min (3 SCFM) without reducing the vacuum pressure
below 300 mm (12 in.) gauge HgVat any adjacent station inlet.
5. 1. 12.4.10.5 Oxygen and medical ai1· outlet� serving Cate­
gory l space shall allow a u·ansient flow rate of 170 SLPM
(6 SCFM) for 3 seconds.
5.1.12.4.10.6* \\'he1·e outlets are being fed with non-standat·d
line pressure, volume, or gas content, for clinical reasons, they
shall be labeled in accordance with 5.1.11.
5.1.12.4.11 Medical Gas Concentration Test. .'\..li:er purging
each system with the gas of system designation, the following
shall be pnformed:
(1) Each presstu-e gas source and outlet shall be analyzed fot·
concentration of gas, by volume.
(2) Analysis shall be conducted with instrument� designed to
measttl'e the specific gas dispensed.
(3)* Allowable concentrations shall be as indicated in Table
5.1.12.4.11.
5.1.12.4.12 Medical Air Purity Test for Compressor Sources.
5.1.12.4.12.l The medical air source shall be analyzed for
concentt·ation of contaminant� by volume prior to the source
valve being opened.
5.1.12.4-12.2 A sample(s) shall be taken for the air system test
at the system sample port.
5.1.12.4.12.3 The test result� shall not exceed the paramete1·s
in Table 5.1.12.4.12.3.
2021 Edition
99-66 HEALTH CARE FACILITIES CODE

Table 5_1.12.4.11 Gas Concentrations 5.1.12.4.14.3 Medical Air Compressor Systems.

(A) Test� of the medical ai1· compressor system shall include
Medical Gas Concentration the purity test for ai1· quality, and the test of the alarm sensors
Oxygen USP �99% oxygen after calihrntion and setup per the manufacturer's instructions,
Oxygen 93 USP �90% oxygen s96% a� well as reserve capacity controls.
Nitrous oxide USP �99% nitrous oxide (B) Test� shall be conducted at the sample pon of the medical
Nitrogen NF sl % oxygen or �99% nitrogen air system.
Medical air USP 19.5%-23.5% oxygen
Othe1· gases Named gases by ±1 %, or per (C) The ope1·ation of the system control senso1·s, such as dew
specification point, ai1· temperature, and all otl1e1· air quality monit01·ing
sensors and controls, shall he checked fot· prope1- opei-ation
and function before the system is put into service.
(D) The quality of medical air a� delivered by the compressor
Table 5.1.12.4.12.3 Contaminant Parameters for Medical Air
air supply shall be verified after installation of new components
prior to use by patient�.
Parameter Limit Value
°
(E) The air quality test� in 5. l.12.4.14.3(D) shall be conducted
Pressure clew point 2 C (35'F) a1·ter the medical air soul'Ce system ha� been opernting
Carbon monoxide 10 ppm normally hut with the source valve closed under a simulated
Carbon dioxicie 500 ppm load for an elapsed time of at least 12 hours.
Ga�eous hydrocarbons 25 ppm (as methane)
Halogenated hydrocarbons 2 ppm (F) The aggregate run time on the compressors shall not be
used to determine the elapsed time.
(G) Loading shall be simulated by continuously venting air at
approximately 25 pet-cent of the rated system capacity.
(H) A demand of approximately 25 pel'Cent of the 1·ated
5.1.12.4.13 Labeli ng. The pt·esence and correctness of label­ compressor capacity shall be Cl'eated to cause the compressors
ing required by this code for all components (e.g., station to cycle on and off continuously and the d1ye1·s to operate for
f
outlets/inlet�, shutof valves, and alarn1 panels) shall be veri­ the 12-hour period.
fied.
5.1.12.4.14.4 Oxygen Central Supply System Using Concentra­
5.1.12.4.14 Source Equipment Verification. tors. The oxygen centrnl supply system using concentrators
shall be tested according to the following:
5.1.12.4.14.1 General. Sout·ce equipment ve1·ification shall be
pei-formed following the installation of the intei-connecting (1) The oxygen central supply system shall be tested for
pipelines, accessories, and source equipment. purity of the oxygen.
(2) Tests of the alarms after calibration and setup per the
5.1.12.4.14.2 Gas Supply Sources. manufacture1·'s instrnctions shall be conducted as well as
(A) The system appai-atus shall be testeci fot· proper firnction, test� of the operntional controls.
including the changeover from primaty to seconda1y supply (3) Each concentrat01· supply system shall he operateci with
(with it� changeover signal) and the operation of the reserve the supply system's isolating valve closed and the unit
(with its reserve-in-use signal), before the system is put into venting at a flow of 25 percent or more of nameplate
service. capacity for an elapsed time of at lea�t 12 houi-s prior to
tlle tests in 5.1.12.4.14.4(4).
(B) If the system ha� an actuating switch and signal to monit01· (4) ll1e oxygen quality from each concentt·ator supply system
the content� of the rese1·ve, its fi.mction shall he tested before shall be validated as follows:
the system is put into senice.
(a) 1l1e operation of all control sensors/switches and
(C) If the system has an actuating switch and signal to monit01· the oxygen monitor shall be checked for proper
the pressure of the reserve unit, its function shall be tested operntion and fimction.
before the system is put into service. (b) The quality of the oxygen shall be confirmed to
meet the USP monograph appropriate for the tech­
(D) Testing of the bulk supply signal and the maste1· signal nology in use.
panel installations shall be ari-anged with the owner or the (c) The accuracy of the oxygen monitor shall be valida­
organization responsible for the operation anti maintenance of ted against oxygen of known concentration, and the
the supply system fix the testing of the bulk supply signals to monitor calibrated in accordance with the manufac­
ensure proper identification and activation of the master signal turer's specifications.
panels so that the facility can monit01· the status of that supply (5) The central supply system shall be tested for con-ect ope1·­
system. ation of the cascade (i.e., primaty - secondaty -
(E) The test� requi1·ed in 5.l.12.4.14.2(D) shall also be reserve). It shall be permitted to test source rotation for
conducted when the storage unit� a1·e changed or replaced. systems so constructed.
(6) The operation of all ala1·ms [�ef 5.1.9.2.4(14) and
5.1. 9.5.4( 13)} shall be tested.

2021 Edition
 c;As AND VACUUM SYSTEMS
(7) The accurncy of the central system oxygen monitor shall
be calibrated in acconfance ,vith the manufacturer's spec­
ifications.
(8) Test5 in 5.1.12.4.14.4(3) to 5.1.12.4.14.4(5) shall be
performed when any concentrator supply system ha5
been opened to atmosphere (e.g., during service or
replacement).
5.1.12.4.14.5 Proportioning Sr.,tems for Medical Air USP.
(A) The system apparatus shall be testerl for proper fimction,
inclurling the changeover from primary to secondaty (if appli­
cable) and operation of the resetve, before the system is put
into setvice.
(B) Test5 shall include the purity of the ai1· quality and test of
the alarm sensors after calibration and setup per the manufac­
turer's instructions.
(C) Tests shall be conrlucterl at the sample port of the propor­
tioning system.
(D) The operntion of the control sensoi·s anrl all quality moni­
toring sensors and controls shall be checked for proper opern­
tion anrl function before the system is put into service.
5.1.12.4.14.6 Medical-Surgical Vacuum Systems. The proper
functioning of the merlical-sm·gical vacuum source system(s)
shall be tested before it is put into service.
5.1.13 Category 1 Medical Support Gases.
5.1.13. 1 * Applicability.
5.1.13.1.1 Merlical suppo1·t gases consist of nitrogen NF or
instrument air and are userl prima1·ily for powering equipment
used in patient ca1·e procedm-es. Medical support gas applica­
tions require rlelivery at pressures, cleanliness, or purities
specific to their intended function (s) (e.g., to operate merlical­
sm·gical tools). Medical support gases shall be permitted to be
piped into areas intenrlerl for any merlical support purpose
and, if appropriate to the procedures, to be piped into labm·a­
to1·ies.
5.1.13.1.2* Medical support ga5 sources shall be permitted to
be used for many general utility uses.
5.1.13.1.3 Merlical suppon gas systems shall not convey oxirliz­
ing gases other than air or gases intended for patient or staff
1·espiration.
5.1.13.2 Nature of Hazards. Design, installation, and opern­
tion of merlical support gas systems shall consider all hazards
involved with any pressurizerl gas except those associaterl ,vith
oxidizing gases and haza1·rls associaterl with the elevated pt·es­
f
sut·es typical o these systems.
5.1.13.3 Medical Support Gas Central Supply Systems_
5.1.13.3.1 General. Medical support gas centrnl supply
systems shall be locaterl to meet the requirements of 5.1.3.3. l
through 5.1.3.3.1.10.
5.1.13.3.2 Desi gn and Construction.
5.1.13.3.2.1 Locations for medical support gas central supply
systems , excluding cryogenic fluirl centrnl supply systems, anrl
fo1· the stornge of positi\·e-pressure gases shall meet the 1·equi1·e­
ments of 5.1.3.3.2.
99-67
5.1.13.3-2.2 Design and construction of locations for ct)'O­
genic fluid central supply systems shall meet the requirement�
of 5.1.3.10.
5.1.13.3_3 Ventilation. Ventilation for medical suppon gas
central supply systems shall meet the requirements of 5.1.3.:l.3.
5.1.13_3.4 Storage- Storage fot· merlical support gas central
supply systems shall meet the 1·equi1-ements of 5.1.3.3.4.
5.1.13.3.5 Control Equipment. Control equipment for medi­
cal suppon gas central supply systems shall meet the 1·equire­
ment� of 5.1.3.4.
5.1.13.3.6 Nitrogen NF Central Supply Systems. Nitrogen NF
centrnl supply systems shall be permitted to consist of the
following:
( l) Manifolrls for gas cylinrlers in accorrlance with 5.1.3.5.11
(2) Manifolds fot- cryogenic liquid containers in accot·dance
with 5.1.3.5.12
(3) Cryogenic fluirl central supply systems in accorrlance with
5.1.3.10
5.1.13.3.6_1 General.
(A) Nitrogen NF central supply systems shall be obtained from
a supplie1· or manufacturer familia1· with their proper construc­
tion anrl use.
(B) Nitrogen NF central supply systems shall be installed in
accordance with the manufacture1··s instructions.
5.1.13.3.6.2 Medical Support Gases. Nitrogen NF central
supply systems for medical support ga�es shall not be piperl to,
or used for, any purpose except medical support application.
5.1.13.3.6_3 Materials. Materials userl in nitrogen NF central
supply systems shall meet the requirement� of 5.1.3.5.4.
5.1.13.3.6.4 Controls for Line Pressure. Controls for line
pressure userl for nitrogen central supply systems shall meet
the criteria in 5.1.:1.5.5.
5.1.13.3.6.5 Relief Valves. Relief Valves used for nitrogen
central supply systems shall meet the criteria in 5.1.3.5.6.
5.1.13.3.6.6 Multiple Pressures. Whe1-e a single nitrogen
cenu·al supply system supplies separate piped distt·ibution
networks, operating at different pressures, each piperl distribu­
tion netw-ork shall meet the criteria in 5. Ul.5.7.
5.1.13_3,6. 7 Local Signals-
(A) The following nitrogen NF central supply systems shall
have local signals locaterl at the sout·ce equipment:
( l) Manifolds fot· gas cylinrlers ,vithout reserve supply (.�ef
5.1.3.5.11)
Manifold� fix cryogenic liquid containers (se;, 5.1.3.5.12)
(2)
(3) Ctyogenic fluid centi-al supply systems (.�ef 5.1.3.10)
(B) Local signals shall meet the requirement� of 5.1.:1.5.8.2.
5.1.13.3.6.8 Headers. In nitrogen NF central supply systems
using cylinders containing eithet· gas 01· liquirl, each headet·
shall meet the requirement5 of 5.1.3.5.9.
5.1.13.3.6_9 Nitrogen NF Manifolds for Gas Cylinders. Mani­
folds fo1· ga� cylinders shall be in accordance with 5.1.3.3. l and
shall meet the requirement� of 5.1.3.5.11.
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99-68 HEALTH CARE FACILITIES CODE
5.1.13.3.6.10 Nitrogen NF Manifolds for Cryogenic Liquid
Containers. Manifolds for cryogenic liqui<l containers shall be
in acco1·dance with 5.1.3.3.1 and shall meet the requirement�
of5.l.3.5.l.
5.1.13.3.6.11 Nitrogen NF Cryogenic Fluid Central Supply
Systems. Cryogenic fluid central supply systems shall be in
accor<lance with 5.1.3.3.1 and shall meet the requirements of
5.1.3.10.
5.1.13.3. 7* Instrnment Air Supply Systems.
5.1.13.3.7.1 Quality of Instrument Air. The quality of instru­
ment air shall be a� follows:
( 1) Compliant with ANSI/ISA S-7.0.01, Quality Standard for
Imtnunmt Air
(2) Filtered to 0.01 micron
( 3) Free ofliquids (e.g., water, hydrocarbons, solvents)
( 4) Free of hydrncadJOn vapors
(5) Dry to a dew point of-400 C (-40'F)
5.1.13.3. 7.2 Instrument air supply systems shall be locate<l pet·
5.1.3.3 as follows:
(1) Indoors, in a <le<licated mechanical equipment a rea that
is adequately ventilated an<l with any required utilities
(2) In a room ventilated per 5.1.3.3.3.3
( 3) For air-cooled equipment, in a mom designe<l to main­
tain the ambient temperature range as recommended by
the equipment manufacturer
5.1.13.3.7.3 Instrument air sources shall prn,ide air with the
following characteristics:
( 1) A gauge pressm·e a<lequate for the intended line pressure
and pressu1·e controls (sl'i' Ta/;!,, 5.1.11)
(2) The quality ofinstrument air, as <lescribed in 5.1.13.3.7.1
5.1.13.3.7.4 Instn1ment ai1· sources shall be of eithe1· of the
follm,�ng fo1·mat�:
( 1) At least two compressors
(2) One compressor an<l a standby hea<ler complying with
:>.1.3.5.9
5.1.13.3. 7.5 Instrument air compressors shall be permitted to
be of any type capable of the output pressure needed for the
f
intended line p1·essure (see Tab!,, 5.1.11), and o providing ai1·
meeting the definition ofinstrument air in 5.1.13.3.7.1.
5.1.13.3. 7.6 Instrument Air Standby Headers. \'\'he1·e instru­
ment air systems are prnvi<le<l with a standby headec the
header shall meet the following requirements:
( 1) It shall comply with 5.1.3.5.9, except that the number of
attached cylinders shall be sufficient for 1 hour of normal
operation.
(2) It shall use connectors as for medical ai1· in the man<la­
to ry requi1·ement� of CGA V-1, Standard for CmnprPs.wf Gm
CylindPr l-alve Outlel and InlPt Connections (ANSI B57.1) .
( 3) It shall enter the system upstream of the final line filters.
( 4) It shall automatically se1·ve the system in the event of a
failu1·e of the compressor.
5.1.13.3. 7. 7* Intake Air. Intake air for instrument air
comp1·ess01·s shall be pe1·mitted to be drawn from out�ide, from
ducted ai1·, 01· from the equipment location.
5.1.13.3.7.8 Instrument Air Filters. Instrument air sources
shall be prnvided with filtt·ation size<l for 100 pe1·cent of the
2021 Edition
system peak calculated demand at design conditions an<l with
the following element� and characteristics:
Activated carbon filte1·s located upst1·eam (source side ) of
(1 )
t.he final line filte1·s
(2) line filters located upstream (source side ) of the final
line regulatm·s an<l <lownstream ofthe ca rbon filters rated
fo1· a minimum of 98 pe1·cent efficiency at 0.01 micron
(3) Equippe<l with a continuous visual indicatm· showing the
status of the line filter element life
(4) Constructed of materials deemed suitable by the manu­
factu1·er
(5) Filters combining the functions in 5.1.13.3.7.8(1) to
5.1.13.3.7.8( 4) in a single unit shall be pe1·mitte<l to be
used
5.1.13.3.7.9 Instrument Air Accessories. Accessories use<l for
instrument air sources shall comply with the following subpara­
graphs:
( 1) For aftercoolers, 5.1.3.6.3.!'>
(2) For air receivers, 5.1.3.6.3.6
(3) Fm· air rh-ye1·s, 5.1.3.6.3.7 r except 5.1.3.6.3.7(1)l
(4) Fm· requi1·ed component�, !'>.l.3.6.3.2
5.1.13.3.7.10 Instrument Air Piping Arrangement and Redun­
dancies. Instrument air sources shall comply with 5.1.3.6.3.9.
except fo1· the follo\,�ng:
(1 ) Systems employing a stan<lby header shall be permitted to
have simplex aftercoolers and d ryers.
(2) Systems employing a stan<lby hea<ler shall not 1·equire a
three-valve receiver bypass.
(3) Stan<lby headers. whe1·e prnvi<led, shall be isolated from
the compressor by a check valve to prevent backflow
through the comp1·ess01·.
5.1.13.3.7.11 Instrument Air Monitoring and Alarms.
(A) Instrument air sources shall include the following alarms:
( 1) A manual-reset local alarm that indicates when the
capacity ofthe instrument ai1· central supply system not in
use is less than the equivalent capacity of one compressor
(2) Local alarm and alarms at all master alarm panels that
activate when the dew point at system pressure exceeds
-30"C (-22'F), in<licating a high dew point
(B) For sources with standby hea<lers, the follm,fog additional
conditions shall activate a local alarm at the compressor site, a
local signal at the header location, and alarms at all ma�ter
alarm panels:
(1) Ala rm that activates when or just before the reserve
begins to supply the system, indicating reserve in use
(2) Ala rm that activates when or just before the reserve falls
below one average hour's supply, indicating reserve is low
5.1.13.3.7.12 Electrical Power and Control.
(A) Instrument air source systems with compressors shall be
controlled to ensure continuous supply of air at pressures
consistent with Table 5.1.11 unde1· all conditions of system use
as follows:
( 1) Automatic activation of compressor (s) a� necessary to
supply the demand.
(2) If provided with mm·e than one comp1·ess01·, managing
the operation to equalize wea r on all compressors. Where
f
this equalization is achieved manually, the facility staf
shall arrange a sche<lule for manual alternation.
 c;As AND VACUUM SYSTEMS
(B) Contrnls shall provide the following functions:
\�'here instrument air source systems having two or more
(1)
compr·essorn employ any elect1·ical ci1·cuit device that
f
upon failure could prevent supply o air, the contrnls
shall be provided with an automatically activated alterna­
tive method for ensut·ing supply (e.g., redundant compo­
nent(s). an alternate electrical supply path, or other
equivalent method).
(2) Control circuit� shall be arranged in such a manner that
isolation of one comp1·essor 01· component from the
system (e.g., for maintenance 01· 1·epair) does not inter­
rupt the operation of other compressor(s) or compo­
nent(s).
(3) An automatic 1·estart function shall be included, such that
the supply of air will resume n01·mally after power inter­
ruption without manual intervention.
(C) Each compressor motor shall be prnvided with electrical
component� including, but not limited to, the follov,�ng:
( l) Dedicated disconnect switch installed in the electrical
cit-cuit ahead of each motor starte1·
(2) Motor starting device
(3) Overload prntection
(D) Instrument air compressor system contrnls shall be prnvi­
ded with electrical systems including at a minimum:
( l) Bui lt-in disconnect means to allow appropriate operation
of multiple compressor systems and protect service
personnel from exposu1·e to live voltages
(2) Control circuits shall be arranged so that failure of any
component of the control cit-cuit, or shutdown of one
comp1·ess01· (e.g., fot· service), does not interrupt auto­
matic operation of the standby compress01·
(3) An automatic restart function such that the compres­
sor(s) will 1·estart afi.e1· powe1· interruption without
manual intervention
(4) Where component� are common to more than one
control circuit (e.g., autodrains), the common device
shall be prnvided with electrical prntection to pt·event loss
of the contrnl circuit�(s) in the event of short circuit in
the device
(E) Electrical installation and wi1·ing shall conform to the
1·equirement� of NFPA 70.
(F) Emergency electrical service for the compressors shall
conform to the 1·equirements of the essential electrical system,
as desc1·ibed in Chapter 6.
5.1.13.4 Valves. Requirement� for medical support gas valves
shall be in accordance with 5.1.4.1. l thrnugh 5.1.4.8.
5.1.13.5 Outlets. Requirement� for medical support ga�
outlets shall be in accordance with 5.1.5.1, 5.1.5.2, 5.1.5.4
thrnugh 5.15.8, 5.1.5.11, and 5.15.13 thrnugh 5.1.5.15.
5.1.13.6 Manufactured As.semblies. Requirement� for medical
support gases in manufactured assemblies shall be in accord­
ance with 5.1.6. l thrnugh 5.1.6.11.
5.1.13. 7 Pressure Indicators. Requirement� for medical
support gas pressure indicators shall he in accordance with
5.1.8.1.1 thrnugh 5.1.8.1.4, 5.1.8.1.6, and 5.1.8.2.
5.1.13.8 Line Pressure Control. Instrument air systems shall
be provided with means to contrnl line pressure at the source
with at lea�t the following characteristics:
99-69
(1) Ahle to maintain stable pressu1·es within the limit� of
Table 5.1.11
(2) Ahle to flow 100 pe1·cent of the peak calculated demand
(3) Redundant, such that each component of the control
mechanism can be isolated for service or replacement
while maintaining normal operation
(4) Prntected against ove1·pressure (sPP 5.1.3.5.6)
(:>) Be constructed of mate1·ials deemed suitable fot· the se1·v-
ice by the manufacturer
5.1.13.9 Warning Systems.
5.1.13.9.1 General requirement� for medical support gas
warning systems shall be in accordance with 5.1.9.1.
5.1.13.9.2 Master alarm requirements for medical support gas
shall be in accordance �th 5.1.9.2.
5.1.13.9.3 Area alarm 1·equi1·ement� fot· medical support gas
shall be in acc01·dance with 5.1.9.4.
5.1.13.9.4 Local alarm requirement� for medical support gas
shall he in accordance with 5.1.9.5.
5.1.13.10 Distribution. Requirement� fot· medical support gas
piping distribution shall be in accordance with 5.1.10.1,
5.1.10.3, 5.1.10.4, 5.1.10.4.1 thrnugh 5.1.10.4.6, 5.1.10.10,
5.1.10.10( 1), 5.1.10.10(2), 5.1.10.10(3), and 5.1.10.11.
5.1.13.11 Labeling and Identification. Requirement� for
medical support gas labeling shall be in accordance with
5.1.11.1 thrnugh 5.1.11.4.
5.1.13.12 Performance Testing. Requirement� for medical
support gas pedormance testing shall be in accordance with
5.1.12, with the following exceptions:
(1) The piping purity test (see 5.1.12.4.8) shall be permitted
to be omitted.
(2) The medical ga� concentration test (.w 5.1.12. 4.11) shall
be permitted to be omitted.
5.1.14* Category 1 Operation and Management.
5.1.14.1 Responsible Facility Authority.
5.1.14.1.1 General. Each health care facility shall designate
one 01· more individuals to be the Responsible Facility Author­
ity with 1·espect to the facility's medical gas and vacuum systems.
5. I.14.1.2 Responsibilities.
5.1.14.1.2.1 The Responsible Facility Authority shall have
primary responsibility for implementation of the piped medical
gas and vacuum system requirement� of this code for the
health care facility, including all medical gas, support gas,
medical vacuum, and WAGD svstems.
5.1.14.1.2.2 The Responsible Facility Authoritv shall be
responsible for the following:
( l) Advising on Section 1.3 and the risk assessment in accord­
ance with Section 4.2, as these apply to piped medical gas
and vacuum systems, and the interp1·etations of Sections
5.1 through 5.3, as they apply to the facility
(2) Writing and upkeep of the portions of the health care
facility's eme1·gency plan that might affect or be affected
by piped medical gas and vacuum quality, quantity, and
continuity of supply
(3) Ensuring that the health care facility's emergency plan
specifically addresses unusual or exceptional 1·equire-
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99-70 HEALTH CARE FACILITIES CODE
ment� necessary for patient an<l staff safety arising from
element� of design or construction of the building
( 4) Developing and enftxcing pern1it-to-wo1·k n!les penain­
ing to the piped medical gas an<l vacuum systems an<l
equipment to maintain patient, staff, an<l visitor safety
during repair, modification, or construction of those
systems
Evaluation an<l acceptance of the test 1·eports 1·equi1·ect in
(5)
accordance with 5.1.12
(6) Maintenance of the facility's 1·ecords on pipe<l medical
ga� and vacuum system installations an<l operations
5.1.14.1.3 Qualifications.
5.1.14.1.3.1 The person(s) designated as the Responsible
Facility Authority shall he qualifie<l to interpret, implement
and advise on this Co<le.
5.1.14_1.3.2 Appropriate qualification shall be demonsu·ate<l
by any of the following:
( l) Completion of an educational program acceptable to the
health care facility's governing body and substantially
equivalent 01· superior to either 5.1.1 4.1.3.2(2) 01·
5.1.14.1.3.2(3)
(2) Credentialing to the 1-equi1·ement� of ASSE 6010, Props­
sional Qualifirations Standard for Ivfrdiral Gm Systnns Instal­
lers, and technical competence on the specific equipment
an<l design of that facility
Credentialing to the 1·equi1·ement� of ASSE 6020, Profes­
(3)
sional Qualifirations Standard for Medi,:al Gas Systnn.� Inspff­
tors, and technical competence on the specific equipment
and <lesign of that facility
Credentialing to the 1-equi1·ement� of ASSE 6030, Props­
( 4)
sional Qiialifirations Standard for Mediral (',as Systnm Verifi­
ers, and technical competence on the specific equipment
an<l design of that facility
(5) Credentialing to the 1·equi1·ement� of ASSE 6040, Profes­
sional Qualifications Standmd for I\ledi,:al (',as Maintenana
Per.wmwl, and technical competence on the specific
equipment an<l design of that facility
5.1.14.2 Permit-to-Work System.
5.1.14.2.1* The Responsible Facility Authority of the health
care facility shall develop, maintain, and manage a permit-to­
work system ensuring uninterrupted quality, quantity, and
continuity of supply during all piped medical gas an<l vacuum
system maintenance, 1·epair, or const1uction wo1-k.
5.1.14.2.2 The Responsible Facility Authority's plan shall
include processes to assure at least the following:
f 5.1.14.4.2.4 Maintenance Schedules. Scheduled maintenance
(I) The affecte<l medical staf and facility a<lministration is
approp1-iately in communication prior to any work on
piped medical g"dS and vacuum systems
(2) Alternative supply 01· a<ljustment� in patient care arrange­
ment� are in place prior to system inte1n1ption, including
monitoring, a� appropriate, of the work being performed
and the alternate arrangements in use
(3) All work on piped me<lical gas and vacuum systems is
perftxmed by competent in<lividuals holding appropriate
qualifications for the work
( 4)* Procedut·es for shutdown and restoration of medical
gases a1-e <lescrihed, communicate<l, and ohserve<l by all
persons w01·king on 01· with the systems
(5) Safety procedures are in place and are observe<l for all
pe1·sons involve<l in working on the systems
2021 Edition
(6) This code is obsetved in the execution of maintenance,
repair, or construction procedures
(7) The affected portions of the systems are correctly tested
in acc01·dance with 5.1.12 and 5.1.13 an<l <lemonstrated
to be acceptable for patient use
5.1.14.3 Special Precautions - Patient Gas, Vacuum, WAGD,
and Medical Support Gas Systems.
5.1.14.3.1 * Piping systems shall not be used for the distribu­
tion of flammable anesthetic gases.
5.1.14.3.2 Piping systems shall not be use<l as a grounding
electro<le.
5.1.14.3.3* Liquid or deb1·is shall not be introduced into the
medical-surgical vacuum or WAGD systems for disposal.
5.1.14.3.4* The medical-surgical vacuum and WAGD systems
shall not be use<l for nonmedical applications (e.g., vacuum
steam condensate return).
5.1.14.3.5* When clinical spaces are converted to nonclinical
spaces, me<lical gas inlet� an<l outlets that are not accessible for
maintenance an<l testing shall be eithe1· 1-emoved 01· decommis­
sioned.
5.1.14.4 Maintenance of Medical Gas, Vacuum, WAGD, and
Medical Support Gas S)Stems.
5.1.14.4.1 * General. Health ca re facilities with installed medi­
cal ga�, vacuum, \\'AGD, 01· me<lical support gas systems, or
combinations thereof, shall <levelop and document periodic
maintenance programs for these systems an<l their subcompo­
nent� as appropriate to the equipment installe<l.
5.1.14.4.2 Maintenance Programs.
5.1.14.4.2.1 Inventories. lnvento1·ies of me<lical gas, vacuum,
WAGD, and medical support ga� systems shall inclu<le at least
all source subsystems, control \-alves, alarms, manufactut·ed
a�semblies containing patient gases, and outlets.
5.1.14.4.2.2* Inspection Schedules. Schedule<l inspections for
equipment and proce<lm·es shall be establishe<l through the
risk assessment of the facility and develope<l with consideration
of the original equipment manufactut·e1· recommendations and
othe1· 1·ecommendations a� required by the auth01·ity having
jurisdiction.
5.1.14.4.2.3 Inspection Procedures. The facility shall he
permitted to use any inspection proce<lure(s) 01· testing meth­
ods establishe<l through its own risk assessment.
for equipment and procedures shall be established thrnugh the
risk assessment of the facility an<l developed with consi<leration
of the original equipment manufacturer recommen<lations and
othe1· 1·ecommendations a� requi1·ed by the autho1-ity having
jtffis<liction.
5.1.14.4.2.5 Qualifications.
(A) Persons maintaining these systems shall be qualifie<l to
perform these operations.
(B) Apprnpriate qualification shall he demonstrated by any of
the following:
(1) A documented training program acceptable to the health
care facility by which such persons are employed or
 c;As AND VACUUM SYSTEMS
contracted to work with specific equipment as installed in
that facility
(2) Credentialing to the requirement� of ASSE 6040, Profes­
sional Qualifir:atiom Standard for Afrdiral Gas Afaintmanr.e
Personnel, and technically competent on the specific
equipment as installed in that facility.
(3) C1·edentialing to the requirement� of ASSE 6030, Profes­
sional Qualifications Standard for I'viediral Gas Systnn� Verifi­
ers, and technically competent on the specific equipment
as installed in that facility.
5.1.14.4.3* Inspection and Testing Operations.
5.1.14.4.3.1 Manufactured �ernblies Employing Flexible
Connection(s) Between the User Terminal and the Piping
System.
(A) Nonstationar y booms and articulating assemblies, other
than head walls utilizing flexible connectors, shall be tested for
leaks, per manufactu1·er's recommendations, every 18 months
or at a duration as determined by a risk assessment.
(B) The system pt·essure to nonstationary booms anrl articulat­
ing a1·ms shall be maintained at operating pressure until each
joint has been examinerl for leakage by effective means of leak
rletection that is safe fot· use with oxygen.
(C) Safe wmking condition of the flexible assemblies shall be
confirmerl.
(D) D.I.S.S. connectors internal to the boom anrl assemblies
shall be checkerl fot· leakage.
f
(E) Leaks, if any, shall be repairerl (i pe1·mitterl), or the
component� replaced (if requi1·ed), and the equipment retes­
ted prior to placing Lhe equipment back into service.
(F) Additional testing of nonstationa1-y booms or articulating
arms shall be pedormed at inte1·vals rlefined by documented
perfo1·mance data.
5.1.14.5 Medical Gas and Vacuum Systems Information and
Warning Signs.
5.1.14.5.1 1l1e gas content of medical gas and vacuum piping
systems shall be labelerl in accordance with 5.1.11.1.
5.1.14.5.2 Labels for shutoff valves shall be in acc01·rlance with
5.1.11.2 and updated when morlifications are made changing
the areas served.
5.1.14.5.3 Station inlets and outlets shall be irlentified in
accordance with 5.1.11.3.
5.1.14.5.4 Alarm panel labeling shall be in accordance with
5.1.11.4 and updaterl when modifications are made changing
the areas served.
5.1.14.6 Source equipment labeling shall be in accordance
with 5.1.11.5.
5.1.14. 7 Medical Gas and Vacuum Systems :Maintenance and
Record Keeping.
5.1.14.7.1 Permanent recorrls of all test� 1·equired by 5.1.12.4. l
through 5.1.12.4.14 shall be maintainerl in the organization's
files.
5.1.14. 7.2 The supplier of the ctyogenic fluid central supply
system shall, upon request, prmide rlocumentation of vapor­
izer( s) sizing Cl'itet-ia to the facility.
99-71
5.1.14.7.3 A.n annual 1·eview of cryogenic fluirl central supply
sy�tem capacity shall be conducterl to ensure the source system
has sufficient capacity.
5.1.14.7.4 Central supply systems fot· nonflammable medical
gases shall conform to the following:
( 1) They shall be inspected annually.
(2) Thev shall be maintainerl by a qualified 1·ep1·esentative of
the equipment owner.
(3) A reco1·d of the annual inspection shall be available fo1·
1·eview by the auth01·ity having jurisdiction.
5.1.14.7.5 A periodic testing procerlure for nonflammable
medical gas anrl vacuum anrl relaterl alarm systems shall be
implemented.
5.1.14.7.6 Whenever modifications are marle that breach the
pipeline, any necessar y installe1· and ve1·ificatio11 test specified
in 5.1.12 shall be conducted on the downsu·eam ponions of the
merlical gas piping system.
5.1.14.7.7 Procedut·es, as specifierl, shall be established for the
following:
(1) Maintenance program for the merlical air compressor
supply system in accorrlance with the manufacturer·s
1·ecommendations
(2) Facility testing and calibration procedm·e that ensures
carbon monoxide monitors are calibrated at lea�t annu­
ally 01· mclt'e often if 1·ecomme11rled by the manufacturer
(3) Maintenance prog1·am for both the medical-sm·gical
vacuum piping system anrl the seconrlaty equipment
attached to merlical-surgical vacuum station inlet� to
ensure the continued good performance of the entire
merlical-surgical vacuum system
(4) Maintenance program for the WAGD system to ensure
perfo1·mance
Facility testing and calibration procedut·e that ensures
(5)
that oxygen concentration monitors are calibrated at least
f
every three months, or more often i recommenrlerl by
the manufacturer
(6) Where oxygen sout·ces include concentrat01· units, main­
tenance programs for the oxygen concentrator units and
all essential subcomponent�
5.1.14.7.8 Audible and visual ala1·m indicators shall meet the
following requirement�:
( 1) They shall be pet-iodically testerl to dete1·mine that they
a1·e functioning propedy.
(2) Recorrls of the test shall be maintained until the next test
is performed.
5.1.14.7.9 Medical-surgical Yacuum station inlet terminal
performance, as required in 5.1.12.4.10.4, shall be testerl as
follows:
( 1) On a regular preventive maintenance schedule as dete1·­
f
minerl by the facility maintenance staf
(2) Based on flow of free air (NI/min or SCFM) into a station
inlet while simultaneously checking the vacuum level
5.1.14.7.10 Where oxygen central supply systems using
concentrators are userl and one or more of the three sources is
a cylinde1· header, the facility shall establish procerlut·es to
enstu-e the facility is always provirlerl with one average day's
supply of oxygen meeting the supply system product purity
specification in reserve, as follows:
2021 Edition
99-72 HEALTH CARE FACILITIES CODE

( 1) The facility shall establish a minimum cylinde1· pressure 5.2.3 Sources.

that will permit one average rlay's supply. That value will
be included as part of the standa1·d operating prncedure
for the oxygen supply system.
(2) The cylinders shall be inspected daily and any loss of pres­
sure noted.
(3) Vihen the cylinrle1·s are found to have lost pressure due to
use 01· leakage and thus are below the pre-establisherl
pressure, the cylinders shall be exchanged.
5.2.3.1 Central Supply System Identification and Labeling.
Category 2 systems shall comply with 5.1.3.1.
5.2.3.2 Central Supply Operations. Catego1y 2 systems shall
comply with 5.1.3.2.
5.2.3.3 Central Supply System Locations. Categ01y 2 systems
shall comply with 5.1.3.3.

5.1.14. 7.11 * Access to valves and alarms shall be made part of
the standa1·d operating prncedu1·es for the facility anrl shall
inclurle the following:
(1) No items are to be placed in front of 01· a!Rxed to any
alarm panel that woulrl restrict the view or diminish the
sounrl of the ala rm.
(2) Valves in secured a1·eas a1·e to be specified as follows:
(a)* The valve is visible from the intenrlerl operato1·'s
position.
(b) The valve is operable with no more than ordinary
airls, such as a larlrle1·.
(c) If the valve is provided with security hardwa1·e, such
hardware is visible and readily removeable when
needed.
5.2 Category 2 Piped Gas and Vacuum Systems.
5.2.1 * Applicability.
5.2.1.1 These requirement� shall apply to health care facilities
that qualify for Category 2 systems as referenced in Chapter 4.
5.2.3.4 Central Supply Systems. Category 2 systems shall
comply with f',.1.3.5.
5.2.3.5 Medical Air Supply Systems. Categ01y 2 systems shall
comply with 5.1.3.6, except as follows:
(1) Medical air compressors, rl1yers, aftercoolers. filters. and
regulators shall be permitted to be simplex.
(2)
f
The facility staf shall develop thei1· emergency plan to
rleal with the loss of medical ai1·.
5.2.3.6 Oxygen supply systems using concentrators shall be
permitted to consist of two sources, one of which shall be a
cylinder header with sufficient cylinrler connections for one
average rlay's supply.
5.2.3.7 Medical-Surgical Vacuum. Categoty 2 systems shall
comply with 5.1.3.7, except as follows:
(1) Merlical-surgical vacuum systems shall be permitted to be
simplex.
(2) The facility staff shall rlevelop their emergency plan to
deal with the loss of medical-surgical vacuum.

5.2.1.2 Category 2 piped gas or piped vacuum system require­ 5.2.3.8 WAGD. Categ01y 2 systems shall comply with 5.1.3.8,
ment� shall be pe1·mitted when all of the following criteria are except as follows:
met: (1) Merlical V,1AGD pumps shall be permitted to be simplex.
f
( 1) Only moderate sedation (as rlefined in 3.3.68.3), minimal (2) The facility staf shall develop theit· emergency plan to
serlation (as defined in 3.3.68.4). 01· no sedation is rleal with the loss ofWAGD.
perfo1·merl. Deep sedation and general anesthesia shall 5.2.3.9 Instrument Air Supply Systems_ Instrument air outlet�
not be permitted. in Category 2 spaces shall he supplied by any of the following:
(2) The loss of the piped ga� or piped vacuum systems is
likely to cause minor injury to patient�, staff'. or visitors. (I) i\n instrument ait· central supply system in accorrlance
(3) The facility piped gas or piped vacuum systems are inten- with 5.1.13.3.7, excluding 5.1.13.3.7.4 (Category 2 systems
ded for Category 2 patient care space per 3.3.140.2. a re permitted to consist of a single compressor)
(2) A cylinder manifolrl in accorrlance with 5.1.3.5.10
5.2.1.3 The following subsections of this chaptei- shall apply to (3) A cylinder hearler in accordance v.1th 5.1.3.5.9, pt·mided
the operation, management, and maintenance of Category with a means for pressure control in accorrla.nce \\1th
2 medical ga� and vacuum systems in both new and existing 5.1.3.5.5.1, excluding 5.1.3.5.5.1(3) (the pressure control
health care facilities: means for Category 2 systems at·e not 1·equired to be
(1) 5.1.3.6.2 rerlundant)
(2) 5.1.10.11.7. l 5.2.4 Valves. Categoq' 2 systems shall comply with 5.1.4.
(3) 5.2.3.1
(4) 5.2.3.2 5.2.5 Station Outlets and Inlets. Categoq' 2 systems shall
(5) 5.2.3.3 comply with 5.1.5.
(6) 5.2.3.5(2)
5.2.6 Manufactured Assemblies. Categoty 2 systems shall
(7) 5.2.3.7(2)
(8) 5.2.3.8(2) comply with 5.1.6.
(9) 5.2.13 5.2. 7 Surface-Mounted Medical Gas Rails. Categot)' 2 systems
(10) 5.2.14 shall comply with 5.1.7.
5.2.1.4 Category 2 systems shall be permitted to serve spaces 5.2.8 Pressure and Vacuum Indicators. Catego1y 2 systems
identifierl as Categ01y 2 or Category 3. shall comply with 5.1.8.
5.2.2 Nature of Hazards of Gas and Vacuum Systems. The 5.2.9 Warning Systems. Warning systems associaterl with Cate­
requirement of 5.1.2 shall apply to the natm·e of hazards of ga� go1y 2 systems shall provide the master, area, and local alarm
and vacuum systems. functions of a Categ01)' 1 system a� required in 5.1.9, except as
follows:

2021 Edition
 c;As AND VACUUM SYSTEMS 99-73

( l) Warning systems shall be permitted t o be a single ala1·m 5.3.3.2 Central Supply Operations.
panel.
5.3.3.2.1 Category 3 systems shall comply with the 1·equire­
(2) The ala1·m panel shall be located in an area of continuous
surveillance while the facility is in operntion. ment5 of 5.1.3.2 except for emergency electt·ical senice.
(3) Pressure and vacuum switches/sensors shall be mounted 5.3.3.2.2 Emergency electrical service shall conform to the
at the source equipment with a pressure indicator at the requi1·emenL5 of Section 6.6 and NFPA 70.
master alarm panel.
5.3.3.3 Central Supply System Locations. Categot)' 3 systems
5.2.10 Distribution. Category 2 systems shall comply with shall comply with 5.1.3.,\.
5.1.10.
5.3.3.4 Control Equipment. Category 3 systems shall comply
5.2.11 Labeling and Identification. Category 2 systems shall with 5.1.3.4.
comply with 5.1.11.
5.3.3.5 Central Supply Systems. Categot)' 3 central supply
5.2.12 Performance Criteria and Testing - Gas, Medical­ systems shall be permitted to consist of the following:
Surgical Vacuum, and WAGD. Categm·y 2 systems shall comply
with!',.l.12. ( l) Gas cylinder 01· cryogenic liquid container heade1·s in
accordance with 5.3.3.5.l0
5.2.13 Medical Support Gases. Categm·y 2 systems shall (2) Oxygen concentrato1· supply uniL5 in accordance with
comply with !'>.1.13. 5.3.35.11
(3) Cylinder manifolds for gas cylinders in accordance with
5.2.14* Operation and Management. Category 2 systems shall 5.3.3.5.12
comply with 5.1.1 4. ( 4) Manifolds fot· cryogenic liquid containei-s in acco1·dance
5.3 Category 3 Piped Gas and Vacuum Systems. with :>.3.3.5.13
(5) Ct)'ogenic fluid central supply systems in accordance
5.3.1* Applicability. with 5.3.3.5.14
5.3.1.1 These n�quirements shall apply to health care facilities (6) Medical air comp1·essor sptems in acc01·dance with
that require Category 3 systems as referenced in Chapter 4. 5.3.3.6
(7) Proportioning air systems in accordance with !',.3.3.6.2
5.3.1.2 Categot)' 3 piped gas and vacuum systems shall be (8) Medical-surgical vacuum systems in accordance with
permitted when all of the following criteria are met: 5.3.3.7
(l) Only minimal sedation, as defined in 3.3.68.4, or no seda­ (9) Waste anesthetic gas disposal systems (WAGDs) in
tion is pei-formed. Deep sedation, modernte sedation, accot·dance with 5.3.3.8
and genernl anesthesia are not performed. (10) Instrnment ai1· compressor systems in acco1·dance with
(2) The loss of the piped ga5 and vacuum systems is not likely 5.3.3.9
to cause injut)' to patients, staff, or visitors but can cause 5.3.3.5.1 General. Category 3 systems shall comply with
discomfort. 5.1.,\.5.1.
(3) The facility piped gas and vacuum systems a1·e i ntended
for Category 3 patient care rooms in accordance with 5.3.3.5.2 Permitted Locations for Medical Gases. Category 3
3.3.140.3. systems shall comply \,�th 5.1.3.5.2.

5.3.1.3 The following sections of this chapter sha ll apply to 5.3.3.5.3 Support Gases. Categot)' 3 systems shall comply with
the operation, management, and maintenance of the medical 5.1.3.5.3.
ga.5 and vacuum systems i n both new and existing health ca1·e 5.3.3.5.4 Materials. Category 3 systems shall comply with
facilities: 5.1.3.5.4.
(l) 5.1.3.6.2
(2) 5.1.10.11.7.l 5.3.3.5.5 Controls for Line Pressure. With the exception of
(3) 5.3.3.l through 5.3.3.3 final line controls, which shall be permitted to be simplex,
( 4) 5.3.3.6.l(2) Categm·y 3 systems shall comply with 5.1.3.5.
(5) 5.3.3.7(2) 5.3.3.5.6 Relief Valves. Category 3 systems shall comply with
(6) 5.3.3.8(2) 5.1.3.5.6.
(7) 5.3.14
5.3.3.5.7 Auxiliary S ource Connection. Categot)' 3 systems
5.3.1.4 Categot)' 3 systems shall be permitted to only serve shall comply with 5.1.4.10.
spaces identified as Categm·y 3.
5.3.3.5.8 Multiple Pressures. With the exception of each
5.3.2 Nature of Hazards of Gas and Vacuum Systems. The piped distribution network from the single centrnl supply
requirement of 5.1.2 shall apply to the nature of hazards of ga.5 system, the control mechanism components of which shall be
and vacuum systems. pe1·mitted to be simplex, Category 3 systems shall comply with
5.3.3 S ources. 5.1.3.5.7.

5.3.3.1 Central Supply System Identification and Labeling.
Categot)' 3 systems shall comply with 5.1.3.1.
5.3.3.5.9 Local Signals. Category 3 systems shall comply with
5.1.3.5.8.
5.3.3.5.10 Gas Cylinder or Cryogenic Liquid Container
Header. Categot)' 3 systems shall comply with 5.1.3.5 and
5.1.3.5.9, expect as follows:

2021 Edition
99-74 HEALTH CARE FACILITIES CODE
(1 ) Gas cylinder or ct"yogenic liquid containe1· headers shall
be in accordance with 5.1.3.5.9, with sufficient cylinder
connections to pt·o,ide fot· at least one average day's
supply, and with the apprnp1·iate numher of connections
determined only after consideration of the delivery
schedule, the proximity of the facility to alternate
supplies, and the facility's emergency plan.
(2) The header(s ) shall have a local signal that visibly inrli­
cates the operating status of the equipment and complies
with 5.1.3.5.8.
f
(3)* The facility staf shall rlevelop an eme1·gency plan to deal
,..nth the loss of the hearlers' medical gas.
5.3.3.5.11 Oxygen Cenlral Supply Systems Using Concenlra­
tors. Category 3 systems shall comply with 5.1.3.5, 5.1.3.9.1,
and 5.1.3.9, except as follows:
(1 ) Oxygen supply systems using concenu·atm·s shall be
permitted to consist of one sou1·ce.
f
(2) The facility staf shall rlevelop an eme1·gency plan to deal
,..nth the loss of oxygen .
(3) Emergency electt·ical sen'ice shall conform to the require-
ments of Section 6.6 and NfPA 70.
5.3.3.5.12 Manifolds for Gas Cylinders. Category 3 systems
shall comply with 5.1.3.5 and 5.1.3.5. l()_
5.3.3.5.13 Manifolds for Cryogenic Liquid Containers. Cate­
gory 3 systems shall comply with 5.1.3.5 and 5.1.3.5.11.
5.3.3.5.14 Cryogenic Fluid Central S upply Systems. Category
3 systems shall comply with 5.1.3.5 and 5.1.3.5.12.
5.3.3.6 Medical Air.
5.3.3.6.1 Medical Air Compres.sor Systems. Category 3
systems shall comply with 5.1.3.5 and 5.1.3.6, except as follows:
Medical air compressors, drye1·s, aftercoolers, filte1·s, anrl
(1)
1·egulators shall be permitterl to be simplex .
(2) The facility staff shall develop an emergency plan to rleal
with the loss of medical air.
Emergency electt-ical service shall confo1·m to the require-
(3)
ment� of Section 6.6 and NfPA 70.
5.3.3.6.2 Proportioning Air Systems. Category 3 systems shall
comply ,..nth 5.1.3.5, 5.1.3.6, and 5.1.3.6.3.14.
5.3.3.7 Medical-Surgical Vacuum Systems. Category 3 systems
shall comply v.�th 5.1.3.5 and 5.1.:\. i, except as follows:
(1 ) Medical-surgical vacuum systems shall be permitted to be
simplex.
f
(2) The facility staf shall develop an emergency plan to rleal
,,� th the loss of merlical-surgical vacuum .
( 3) Emergency electt·ical service shall confo1·m to the require-
ment� of Section 6.6 and NfPA. 70.
5.3.3.8 Waste Anesthetic Gas Disposal Systems (WAGDs).
Categmy 3 systems shall comply \vi th 5.1.3.5 and 5.1.3.8, except
as follows:
(1) Medical WAGD pumps shall be permitted to be simplex .
(2) The facility staff shall rlevelop an eme1·gency plan to rleal
,..nth the loss ofWAGD.
2021 Edition
(3) Emergency electrical se1·vice shall conform to the requi1·e-
ment� of Section G.6 and NfPA 70.
5.3.3.9 lnslrument Air Compres.sor Systems. Catego1y 3
systems shall comply ,..nth 5.1.3.5 and 5.1.13.3.7. except as
follows:
(1) Instrument ai1· compressor systems shall be permitted to
be simplex with no standby header.
(2) 1l1e facility staff shall develop an emergency plan to deal
with the loss of instrument ai1·.
(3) Emergency electrical sen,ice shall confo1·m to the requi1·e-
ments of Section 6.6 and NI·PA 70.
5.3.4 Valves. Categoq' 3 systems shall comply \..ith 5.1.4.
5.3.5 Station Outlets and Inlets. Categm·y 3 systems shall
com ply with :>.1.5.
5.3_6 Manufactured As.semblies. Categmy 3 systems shall
comply with 5.1.6.
5.3.7 Surface-Mounted Medical Gas Rails. Categot)' 3 systems
shall comply with 5.1.7.
5.3.8 Pressure and Vacuum Indicators. Category 3 systems
shall comply with f>.1.8.
5.3.9 Warning Systems. Warning systems associated \\�th Cate­
gory 3 systems shall provide the master, area, and local alarm
functions of a Catego1y 1 system as required in 5.1.9, except as
follows:
(1) \-\'arning systems shall be permitted to be a single ala1·m
panel (i.e., a comhination master/area alarm panel ).
(2) 1l1e ala1·m panel shall be locaterl in an area of continuous
surveillance while the facility is in operntion.
(3) Pressure anrl vacuum switches/sensors shall be mounted
at the smu-ce equipment with a pressut·e indicato1· at the
master ala1·m panel.
(4) Electrical power for warning systems shall be in accm-d­
ance \\�th Section 6.6 for Category 3 and Category· 4
spaces .
5.3.10 Dislribution. Category 3 systems shall comply with
5.1.10.
5.3.11 Labeling and Identification. Categmy 3 systems shall
com ply with 5.1.11.
5.3.12 Performance Criteria and Testing - Gas, Medical­
Surgical Vacuum, and WAGD. Categmy 3 systems shall comply
,..nth 5.1.12.
5.3.13 Medical Support Gases. Category 3 systems shall
comply with 5.1.13, except a� follows:
(1) Instrument air compressor systems shall be permitted to
be simplex with no standby header.
(2) 1l1e facility staff shall develop an emergency plan to deal
with the loss of instrument ai1·.
5.3.14 Operation and Management. Category zl systems shall
com ply with 5.1.14.
 ELECfRICAL !-,YSTEMS 99-75

Chapter 6 Electrical Systems 6.3.2.2 Receptacles.

6.1* Applicability.
6.3.2.2.1 * Types of Receptacles.

6.1.1 Electrical Installation. Installation shall be m accord­ (A) Each receptacle shall prmide at least one separate.
ance with NFPA 70. grounding terminal capable of maintaining low-contact resist­
ance with it� mating plug, despite severe elect1·ical ann mechan­
6.1.2 This chaplet· shall apply to new health care facilities as ical use of the receptacle. The grounding terminal of each
specified in Section 1.3. receptacle shall be connected to the 1·eference grounding point
by means of an insulated copper equipment grounding
6.1.3 The following pa1·ag1·aphs shall apply to new and existing conductor.
health ca1·e facilities:
(B) Special 1·eceptacles, such as the follo¼i.ng, shall be permit­
(1) 6.3.2.2.l
(2) 6.3.2.3.6(B) (2) ann G.3.2.3.G(B) (3) ted:
(3) 6.3.2.3.8 (l) Four-pole units providing an extra pole fot· 1·edunnant
(4) 6.3.2.6.8 grounding or ground continuity monito1·ing
(5) 6.3.2.8.5 (2) Locking-type receptacles
(6) 6.3.3.2.5 through 6 .3.3.2. 7
(7) 6.3.3.3.3 and 6.3.3.3.4 (C) All non-locking-type, 125-rnlt, 15- or 20-ampere single,
(8) 6.3.4 duplex, or quadruplex type receptacles, or any combination
(9) 6.7.1.2.7.2(H) thereof, located in operating rooms and at patient bed loca­
(10) 6.7.2.2.5(B) tions in Category l and Categoqr 2 spaces shall be listed ann
(11) 6.7.2.2.6 identified as "hospital grane."
(12) 6.7.4 (D) Receptacles that are located within patient rooms. bath­
6.1.4 Paragraph 6.3.2.5.1.3 shall apply only to existing facili­ rooms, playrooms, ann activity rooms of pedi.an-ic unit5 01·
ties. spaces with similar 1·isk as dete1·mined by the health care facili­
ty's governing body by conducting a risk assessment, other than
6.2 Nature of Hazards. infant nurseries, shall be listed and identified a5 "tamper resist­
ant"' 01· shall employ a listed tampe1·-resistant cover.
6.2.1* Fire and Explosions.
6.3.2.2.2 Minimum Number of Receptacles. The number of
6.2.2 Shock. (Reserved)
receptacles shall be determined by the intennen use of the
6.2.3 Thermal. (Reserved) spaces in accmdance with 6.3.2.2.2(A) through 6.3.2.2.2(E).

6.2.4* Location of Essential Electrical System Components.
6.2.4.1 Essential electt·ical system component5 shall be located
to minimize interruptions caused by natural forces common to
the area (e.g., storms, floods, earthquakes, or hazards created
by adjoining structures or acti\ities).
6.2.4.2 Installations of electrical seni.ces shall be located to
reduce possible interruption of normal electrical services
resulting from similar causes as well as possible disruption of
no1·mal electrical service due to internal wiring and equipment
failmes.
(A) Receptacles Serving Patient Bed Locations in Category 2
Spaces. Each patient bed location shall be provided with a
minimum of eight non-locking-type, 125-volt, 15- 01· 20-ampere
1·eceptacles. at least fou1· of which shall be connected to eithe1·
the normal branch circuit or a critical branch circuit supplied
by a diffe1·ent transfe1· switch othe1· than the receptacles at the
same location. These receptacles shall be permitted to be of
the single, duplex, or quadruplex type, or any combination
thereof. Other receptacles (e.g., portable x-ray receptacles)
serving special-pm·pose. cord-and-plug-connected equipment
shall be pe1·mitten to be of the locking or non-locking-type.

6.2.4.3 Feeders shall he located to provide phys ical separation
of the feeders of the alternate smu-ce and from the feede1·s of
the nm·mal electrical source to prevent possible simultaneous
interruption.
6.3 General.
6.3.l Sources. Each health care appliance requiring electrical
line power for operation shall be supported by power sources
that provide power adequate for each service.
6.3.1.1 Power/Utility Company. (Reserved)
6.3.1.2 On-Site Generator Set. (Reserved)
6.3.2 Distribution.
6.3.2.1* Distribution system arrangement5 shall be designed
to minimize interruptions to the electrical systems clue to inter­
nal failtu-es by the use of adequately rated equipment.
(B) Receptacles Serving Patient Bed Locations in Category I
Spaces Otber than Operating Rooms. Each patient bed loca­
f
tion shall be pro\ided with a minimum o 14 non-locking-tvpe,
125-volt, l:>- or 20-ampere receptacles, at least seven of which
shall be connected to either the normal branch circuit or a crit­
ical branch circuit supplied by a different transfer switch othe1·
than the receptacles at the same location. 1l1ese 1·eceptacles
shall be permitted to be of the single. duplex. or quadruplex
type, 01· any combination the1·eof. Othe1· receptacles (e.g., pon­
able x-ray receptacles) serving special-put-pose, co1·d-and-plug­
connecten equipment shall be permitted to be of the locking
or non-locking-type.
(C) Receptacles in Operating Rooms. Each operating room
shall be provided \,i.th a minimum of 36 12:>-volt, 15- or 20-
ampere receptacles, at least 12 of which shall be connected to
either the normal branch cit"Cuit or a c1·itical branch circuit
supplied by a niffe1·ent tt·ansfer switch othe1· than the 1·ecepta­
cles at the same location. They shall be permitted to be of the
single, duplex, or quadruplex type, 01· any combination of the
three. Other 1·eceptacles (e.g., ponahle x-ray receptacles) se1·v-

2021 Edition
99-76 HEALTH CARE FACILITIES CODE
ing special-put·pose, conl-and-plug-<"onnected eguipment shall
be permitted to be of the locking or non-locking-type.
(D) Receptacles in Bathrooms or Toilet Rooms. Receptacles
shall not be reguired in bathrooms 01· toilet rooms.
(E) Receptacles for Special Rooms. Receptacles shall not be
reguired in 1·ooms where medical reguirement� mandate othe1·­
wise (e.g., ce1·tain psychiau·ic, pediatt·ic, 01· hydrotherapy
rooms).
6.3.2.2.3 Polarity of Receptacles. Each receptacle shall be
wired in accm·dance with NFP/1. 70 to ensut·e c01-rect polarity.
6.3.2.2.4 Other Services Receptacles. Receptacles provided
for othe1· senices having diffe1·ent voltages, freguencies, 01·
types on the same premises shall be of such design that attach­
ment plugs and caps used in such receptacles cannot be
connected to circuit.� of a different voltage, freguency, 01· type,
but shall be interchangeable within each classification and
rating reguired for two-wire, 125-V, single-phase ac service.
6.3.2.2.5* Use of Isolated Ground Receptacles.
(A) A11 isolated grounti. receptacle, if useti., shall not defeat the
purposes of the safety features of the grounding systems
detaileti. in 6.3.2.8.4.
(B) An isolateti. ground receptacle shall not be installed within
a patient care vicinitv.
(C) Isolated grounding receptacles installeti. in brnnch circuit.�
for patient ca1·e spaces shall be connecteti. to an insulated
eguipment grounding conductor in accordance with
250.146(D) of NFPA 70 in ati.ti.ition to the two eguipment
grounding conti.uctor paths 1·egui1·ed in 6.:).2.5.1.4.
(D) The eguipment grounding conti.uctor installeti. for isola­
ted grounding receptacles in patient care area� shall be clearly
identified using g1·een insulation with one 01· more y ellow
stripes along it.� entire length.
6.3.2.2.6 Special-Purpose Outlets. Branch circuits sen,ing
only special-purpose outlet� 01· receptacles (e.g., p01·table x-rny
receptacles) shall not be reguireti. to conform to the reguire­
ment5 ofG.4.3.
6.3.2.2.7* □inical Laboratories. Outlet.� with two to fom
receptacles, or an eguivalent multioutlet assembly, shall be
installed eve1y 05 m to 1.0 m ( 1.6 ft to 3.3 ft) in instrument
usage areas, a..L1d eithe1· installation shall be at least 80 mm
(3.15 in.) above the countenop.
6.3.2.3 Wet Procedure Locations.
6.3.2.3.1 * \\'et procedure locations shall be provided wi Ll1
special protection against electric shock.
6.3.2.3.2 This special protection shall be proviti.ed a� follows:
( l) Power distribution system that inhe1·ently limits the possi­
ble ground-fault current due to a first fault to a low value,
without interrupting the powe1· supply
(2) Power distribution system in which the powe1· supply is
interrupted if the grounti.-fault current does, in fact,
exceed the trip value of a Class A GFCI
6.3.2.3.3 Patient beds, toilets, bidet�, and wash basins shall not
be reguireti. to be considered wet procedure locations.
2021 Edition
6.3.2.3.4* Operating rooms shall be conside1·ed to be a wet
procedure location, unless a risk assessment conducted by the
health care governing body determines othenvise.
6.3.2.3.5 If the risk assessment conducted by the health care
facility's governing body, as defined in Chapter 3, ti.etermines
that the operating room is not a wet procedun· location, then
the special protection of 6.3.2.3 shall not be 1·egui1·eti..
6.3.2.3.6 In existing consu·uction, the reguirements of
6.3.2.3. l shall not be reguired when a w1·itten inspection proce­
dtlt"e, acceptable to the authority having jut·isdiction, is
performed by a designated inti.i,idual at the hospital to imli­
cate that eguipment grounding conductors for 120-V, single­
phase. 15-A anti. 20-A receptacles; eguipment connecteti. by
corti. and plug; anti. fixeti. electrical eguipment are installeti. a..L1d
maintained in accordance with 1\/FPA. 70, the applicable
performance 1·eguirements of this chapte1·, and Chapter 10 of
this coti.e.
(A) The procedure shall incluti.e electrical continuity test� of
all reguired eguipment, grounding conductoi-s, and their
connections.
(B) Fixeti. receptacles, eguipment connected by cord a..L1d
plug, and fixed electt·ical eguipment shall be tested a� follows:
( l) iVhen first installed
(2) Where there is evidence of ti.amage
f
(3) A te1· any 1·epaii-s
6.3.2.3.7 The use of an isolated power system (IPS) shall be
permitteti. a� a protective means capable of limiting grounti.­
fault current without powe1· intetTuption. When installerl, such
a powe1· system shall confo1·m to the regui1·ement� ofG.3.2.9.
6.3.2.3-8* Operating rooms defined as wet proceti.ure loca­
tions shall be protected by either isolated power 01· grounrl­
fault ci1·cuit interrupters.
6.3.2.3.9 Where GFCI protection is used in an operating
room, one of the following shall apply:
( l) Each receptacle shall b e an individual GFCI device.
(2) Each receptacle shall be individually protected by a single
GFCI device.
6.3.2.4" Circuits.
6.3.2.4.1 Normal branch circuits serving a patient bed loca­
tion shall be fed from not more than one normal branch­
circuit distt·ibution panel.
6.3.2.4.2 Branch circuits sening a patient bed location shall
be permitteti. to be fed from m01·e than one critical branch­
circuit distt·ibution panel.
6.3.2.4.3 Only authorized personnel shall have access to over­
cut-rent protective devices serving Category l and Category 2
spaces.
6.3.2.4.4 Overcurrent protective devices serving Category l
and Category 2 spaces shall not be permitted to be located in
public access spaces.
6.3.2.4.5 Where used in locations such as in Category l spaces,
isolateti. power panels shall be pern1itted in those locations.
6.3.2.4.6 Low-voltage ,viring shall comply with either of the
following:
 ELECfRICAL !-,YSTEMS
(1) Fixe<l systems of 30 V (ck or ac rn1s) or less shall be
permitte<l to be ungroun<le<l, provi<le<l that the insula­
tion between each ungroun<le<l conductor and the
prima ry circuit, which is supplie<l from a conventionally
grounded distribution system, is the same protection as
required for the primary voltage.
(2) A grounded low-voltage system shall he permitted, provi­
ded that loa<l current� are not carrie<l in the grounding
conductors.
6.3.2.5 Grounding.
6.3.2.5.1 Grounding requirement� shall comply with the
1·equirement� in 6.3.2.5.1. l through 6.3.2.5.1.5.
6.3.2.5.1.1 Grounding Circuitry Integrity. Grounding ci1·cuit�
and conductors in patient care spaces shall be installed in such
a way that the continuity of other pa1·ts of those circuits cannot
be inte1-rupted nm· the 1·esistance rnised above an acceptable
f
level by the installation, removal, and replacement o any in­
stalled equipment, inducting power receptacles.
6.3.2.5.1.2 Reliability of Grounding. The equipment ground­
ing conductorn shall conform to NFPA. 70. Brnnch circuits serv­
ing electrical equipment within the patient care vicinity shall be
provided with effective ground-fault current paths dual-fe<l by a
wi1·ing method that qualifies as an equipment grounding
con<luctor and by an insulate<l coppe1· equipment grounding
con<luctor.
6.3.2.5.1.3 Separate Grounding Conductor. V17hen existing
consu·uction does not have a separate grounding conductor,
the continued use of the system shall be permitted, provided
that it meet� the perfo1·mance requirements in 6.3.3.1.
6.3.2.5.1.4 Grounding of Receptacles and Fixed FJectrical
Equipment in Patient Care Spaces.
(A) Wning Methods. A.JI branch ci1·cuit� sening patient ca1·e
spaces shall be provi<le<l with an effective ground-fault current
path by installation in a metal raceway system, or a cable having
a metallic armor or sheath assembly. 1l1e metal rnceway system,
01· metallic cable armor, or sheath assembly shall itseU' qualify as
an equipment grounding conductor.
(B) Insulated Equipment Grounding Conductors and Insulated
Equipment Bonding Jumpers. The following shall be <lirectly
connecte<l to an insulate<l copper equipment grounding
conducto1· that is clearly i<lentified along it5 entire length by
green insulation, with no yellow stripes, and installe<l with the
brnnch ciITuit conduct01·s in the v.fring methods a� provided in
6.3.2.5. l .4(A):
(l) The groun<ling terminals of all receptacles other than
isolated groun<l receptacles.
(2) Where receptacles are mounted in metal receptacle
outlet boxes, metal device boxes, or metal enclosm·es, the
performance of the connection between the 1·eceptacle
grounding te1·minal and the metal box or enclosm·e shall
he equivalent to the performance provided by copper
wire sized in acc01·<lance with 250.146 an<l Table 250.122
of NFPA 70, hut no smaller than 12 A\'\'G.
(3) All non-current-<:arrying conductive surfaces of fixed elec­
u·ical equipment likely to become energized an<l subject
to pe1·sonal contact, operating at over 100 volt�.
( 4) Metal faceplates. which shall be connected to the equip­
ment grounding conductor by means of a metal mount-
99-77
ing screw(s) securing the faceplate to a grounded outlet
box or groun<le<l v.�ring device.
(5) Luminaires more than 2.3 m (7½ ft) above the floor an<l
switches located out�i<le of the patient care vicinity, which
shall be permitted to he connected to an equipment
grounding return path complying \\�th 6.3.2.5. l .4(A) and
6.3.2.5. l.4(B).
6.3.2.5.1.5* Grounding Interconnects. In patient ca re spaces
supplie<l by the normal distribution system and any branch of
the essential electrical system. the groun<ling system of the
normal distribution system an<l that of the essential electt·ical
system shall he interconnected.
6.3.2.5.2 Patient Equipment Grounding Point. A patient
equipment grounding point comprising one or m01·e groun<l­
ing terminals or jacks shall he permitted in an accessible loca­
tion in the patient care vicinity.
6.3.2.5.3* Special Grounding in Patient Care Rooms. In ad<li­
tion to the grounding required to meet the performance
requi1·emenl� of 6.3.3.1, additional grounding shall be permit­
te<l whe1·e special ci1·cumstances so dictate.
6.3.2.6 Battery-Powered Lighting Units.
6.3.2.6.1 One or m01·e batte1·y-powered lighting unit� shall be
provided within locations where deep sedation and general
anesthesia is a<lministered .
6.3.2.6.2 The lighting level o f each unit shall be sufficient to
terminate proce<lures inten<le<l to he pedormed within the
operating room.
6.3.2.6.3 The sensor fo1· unit� shall he wi1·ed to the unswitche<l
portion of branch ciITuit(s) serving general lighting within the
room.
6.3.2.6.4 The Level l or Level 2 EPS f eme1·gency powe1·
supplyl equipment location(s) shall be provided with battery­
powered emergency lighting. This requirement shall not apply
to unil� located out<lo01·s in enclosures that do not incl ude
walk-in access. fll0:7.3. l l
6.3.2.6.5 The emergency lighting charging system and the
normal sen,ice room lighting shall he supplied from the loa<l
side of the transfer switch. fll0:7.3.21
6.3.2.6.6 The minimum average horizontal illumination prmi­
ded by normal lighting som·ces in the sepa1·ate building 01·
room housing the EPS equipment for Level l shall be 32.3 Lux
(3.0 ft-candles) measured at the floor level, unless otherwise
specified by a requirement recognized by the authority having
jurisdiction. fll0:7.3.31
6.3.2.6.7 Unit� shall be capable of providing lighting for
11/,, hours.
6.3.2.6.8 Unit� shall be tested monthly fo1· 30 seconds, an<l
annually fo1· 30 minutes.
6.3.2.7 Other Non-Patient CareAreas. (Reserved)
6.3.2.8 Ground Fault Protection.
6.3.2.8.1 Applicability. The requirement� of 6.3.2.8.2 shall
apply to health care facilities housing Category l spaces or
utilizing life-suppon equipment and buil<lings that provide
essential utilities or senices fo1· the operation of Category l
spaces or electrical life-support equipment.
2021 Edition
99-78 HEALTH CARE FACILITIES CODE
6.3.2.8.2 Vihere ground-fault prntection is provided for opera­
tion of the service or feeder disconnecting means, an addi­
tional step of ground-fault protection shall be provided in the
next level of feeder downstt·eam toward the load.
6.3.2.8.3 Ground-fault protection for operation of the sen,ice
and feeder disconnecting means shall be fully selective such
that the downstream device and not the upstream device shall
open for downstream ground fault�.
6.3.2.8.4* Equipment Protection. The main and downstt·eam
ground-fault protective devices (where 1·equired) shall be co01·­
dinated as required in 6.3.2.8.
6.3.2.8.5 Personnel Protection. If used, ground-fault ci1·cuit
interrupters (GFCls) shall be listed.
6.3.2.9* Isolated Power Systems.
6.3.2.9.1 Isolation lransformer. An isolated powe1· system
shall not be 1·equired to be installed in any patient care space,
except as specified in 6.3.2.3.
6.3.2.9.1.1 The isolation trnnsfo1·mer shall be listed and
approved for the put·pose.
6.3.2.9.1.2 The pt·imary winding shall be connected to a
power source so that it is not ene1·gized with mm·e than 600 V
(nominal).
(A) If present, the neutt·al of the pt·imary winding shall be
grounded in an approved manne1·.
(B) If an electrostatic shield is present, it shall be connected to
the refe1·ence grounding point.
6.3.2.9.1.3 Vfo·ing of isolated powe1· systems shall be in acc01·d­
ance with 5 17.160 of JVFPA. 70.
6.3.2.9.2 Impedance of Isolated Wiring.
6.3.2.9.2.I * The impedance (capacitive and resistive) to
ground of either conductor of an isolated system shall exceed
200,000 ohms when installed. l11e installation at this point
shall include 1·eceptacles but is not required to include lighting
fixtures or components of fixtures. This value shall be deter­
mined by energizing the system and connecting a low­
impedance ac milliammete1· (0 to l tIL'\. scale) between the
reference g1·ounding point and either conduct01· in sequence.
This test shall be permitted to be performed with the line isola­
tion monit01· (sl'f' 6.3.2. 9.3.1) connected, provided that the
connection between the line isolation monitor and the 1·efe1·­
f
ence grounding point is open at the time of the test. A ter the
test is made, the milliammeter shall be removed and the
grounding connection of the line isolation monit01· shall be
rest01·ed. When the installation is completed, including perma­
nently connected fixtures, the reading of the meter on the line
isolation monito1·, which cot-responds to the unloaded line
condition, shall be made. This meter 1·eading shall be 1·ecorded
as a 1·eference for subsequent line impedance e\<1luation. This
test shall he conducted with no phase conductors grounded.
6.3.2.9.2.2 An approved capacitance suppressor shall be
pet·mitted to be used to improve the impedance of Lhe perma­
nently installed isolated system; however, the resistive impe­
dance to ground of each isolated conduct01· of the system shall
be at least l megohm pt·ior to the connection of the suppres­
sion equipment. Capacitance suppressors shall be installed so
as to p1·event inadvertent disconnection dm·ing norn1al use.
2021 Edition
6.3-2.9.3 Line Isolation Monitor.
6.3.2.9.3.1 * In addition to the usual contrnl and prntective
devices, each isolated power system shall be provided with an
approved, continually opei-ating line isolation monitor that
indicates possible leakage or fault currents from either isolated
conduct01· to g1·ound.
6.3-2.9.3-2 The monit01· shall be designed such that a green
signal lamp, conspicuously visible in the area where t he line
isolation monitor is utilized. remains lighted when the system is
adequately isolated from ground; and an a�acent 1·ed signal
lamp and an audible warning signal (remote if desired) shall
be energized when the total hazard cut-rent (consisting of
possible 1·esistive and capacitive leakage cut-rent�) from either
isolated conductor to ground 1·eaches a th1·eshold value of
5.0 mA under normal line voltage conditions. l11e line isola­
tion monitor shall not alarm for a fault hazard cun-ent of less
than 3.7 mA.
6.3.2.9.3.3* The line isolation monitor shall comply with
eithe1· of the following:
(1) It shall have sufficient internal impedance such that.
when properly connected to the isolated svstem, the
maximum internal current that will flow through the line
isolation monito1·, when any point of the isolated system is
grounded, shall be l mA.
(2) It shall be permitted to be of the low-impedance type
such that the current through the line isolation monito1·,
when any point of the isolated system is grounded, will
not exceed twice the alarm threshold value for a period
not exceeding 5 milliseconds.
6.3.2.9.3.4* An ammete1· connected to indicate the total
hazard current of the system (contribution of the fault hazard
current plus monitor hazard current) shall be mounted in a
plainly visible place on the line isolation monitor with the
"alarm on" zone (total hazard cutTent = 5.0 m.A) at approxi­
mately the center of the scale. A line isolation monitor shall he
located in the ope1·ating room.
6.3.2.9-3.5 Means shall be provided for shutting off the audi­
ble alarm while leaving the red warning lamp activated. V1'hen
the fault is cot-rected and the green signal lamp is n,activated,
the audible ala1·m-silencing ci1·cuit shall reset automatically, or
an audible or distinctive \-isual signal shall indicate that the
audible alarm is silenced.
6.3.2.9.3.6 A 1·eliable test switch shall be mounted on the line
isolation monitor to test its capability to operate (i.e., cause the
alarms to operate and the meter to indicate in the "alarm on"
zone). This switch shall transfe1· the grounding connection of
the line isolation monitor from the reference grounding point
to a test impedance arrangement connected across the isolated
line; the test impedance (s) shall be of the appropriate magni­
tude to produce a meter 1·eading cot-responding to the rated
total hazard current at the nominal line voltage, 01· to a lesser
alarm hazard current if the line isolation monitor is so rated.
The operntion of this switch s hall break the grounding connec­
tion of the line isolation monit01· to the reference grounding
point before transferring this grounding connector to the test
impedance(s), so that making this test will not add to the
haza1·d of a system in actual use; nor will the test include the
eflect of the line-to-ground stray impedance of the system. The
test switch shall be of a self�restoring type.
 ELECfRICAL !-,YSTEMS
6.3.2.9.3.7 The line isolation monitor shall not generate
energy of suflicient amplitude or frequency, as measured by a
physiological monitor with a gain of at least 104 with a source
impedance of 1000 ohms connected to the balanced difleren•
tial input of the monitor, to create interference or artifact on
human physiological signals. TI1e output voltage !'rom the
amplifier shall not exceed 30 mV when the gain is 104. The
impedance of 1000 ohms shall be connected to the ends of
typical unshielded electrode leads that are a normal part of the
cable assembly furnished with physiological monitors. A 60 Hz
notch filte1· shall he used to reduce ambient interference, as is
typical in phvsiological monitor design.
6.3.2.9.4 Identification of Conductors for Isolated (Ungroun­
ded) Systems. The isolated conduct01·s shall be identified in
accordance with f>l 7.160(A) (5) of 1VJ·PA 70.
6.3.3 Performance Criteria and Testing.
6.3.3.1 Grounding System in Patient Care Spaces.
6.3.3.1.1* Grounding System Testing. The eflectiveness of the
grounding system shall be dete1·mined by voltage measu1·e­
ment� and impedance measu1·ement�.
6.3.3.1.1.1 For new construction, the eflectiveness of the
grounding system shall be evaluated before acceptance.
6.3.3.1.1.2 Small wall-mounted conductive surfaces not likely
to become energized, such as surface-mounted towel and soap
dispense1·s. mirrors. and so fonh, shall not be requi1·ed to be
intentionally grounded or tested.
6.3.3.1.1.3 La1·ge metal conductive surfaces not likely to
become energized, such as windows, door frames, and drains,
shall not be 1·equired to be intentionally grounded or periodi­
cally tested.
6.3.3.1.1.4" Viheneve1· the electrical system has been alte1·ed
01· replaced, that portion of the system shall be tested.
6.3.3.1.2 Reference Point. The voltage and impedance meas-
111·ements shall be taken with 1·espect to a refe1-ence point,
f
which shall be one o the following:
(l) Reference grounding point (sl'f ChaptPr 3)
(2) Grounding point, in 01· near the room under test, that is
electrically remote from receptacles (e.g., an all-metal
cold-water pipe)
Grounding contact of a receptacle that is powe1·ed from a
(3)
diffe1·e11t branch ci1·cui t from the 1·eceptacle unde1· test.
6.3.3.1.3* Voltage Measurements.
6.3.3.1.3.1 The voltage mea�urement� shall be made under
no-fault conditions between a 1·eference point and exposed
fixed electrical equipment with conductive surfaces in a patient
ca1·e vicinity.
6.3.3.1.3.2 The voltage mea�urement� shall be made with an
accuracy of :t 5 percent.
6.3.3.1.3.3 Voltage mea.�urements for faceplates of wi1·ing devi­
ces shall not be required.
6.3.3.1.4* Impedance Measu rements. The impedance meas-
111·ement shall be made with an accuracy of :t 5 percent.
6.3.3.1.4.1 Fm· new construction, the impedance measure­
ment shall be made between the reference point and the
99-79
grnunding contact of 10 percent of all receptacles within the
patient care vicinity.
6.3.3.1.4.2 The impedance measut·ement shall be the ratio of
voltage developed (either 60 Hz 01· de) between the point
under test and the reference point to the current applied
between these ti.vo points.
f
6.3.3.1.5 Test Equipment. Elecu'ical sa ety test instrument�
shall be tested periodically, but not less than annually, for
acceptable pe rfo1·mai1ce.
6.3.3.1.5.1 Voltage measurement� specified in 6.3.3.1.3 shall
be made with an instrument having at1 input resistance of
1000 ohms :t 10 percent at frequencies of 1000 Hz 01· less.
6.3.3.1.5.2 The voltage acrnss the te1·minals (01· between anv
terminal and ground) of resistance-measuring instrument�
used in occupied patient care rooms shall not exceed 500 mV
rms or 1.4 de or peak to peak.
6.3.3.1.6 Criteria for Acceptability for New Construction.
6.3.3.1.6.1 The voltage limit shall be 20 mV.
6.3.3.1.6.2 The impedance limit shall be 0.2 ohm for svstems
containing isolated ground 1·eceptacles and 0.1 ohm for all
others.
6.3.3.2 Receptacle Testing in Patient Care Spaces.
6.3.3.2.1 The phys ical integrity of each receptacle shall be
confirmed hy visual inspection.
6.3.3.2.2 The continuity of the grounding circuit in each elec­
trical 1·eceptacle shall be ve1·ified.
6.3.3.2.3 Con-ect polai·ity of the hot and neutral connections
in each elecu·ical receptacle shall he confirmed.
6.3.3.2.4 The 1·etention fot·ce of the grounding blade of each
electrical receptacle (except locking-type receptacles) shall be
not less than 115 g (4 oz).
6.3.3.2.5 Whe1·e hospital-grade receptacles a1·e requi1·ed at
patient bed locations and in locations where deep sedation 01·
general at1esthesia is administered, testing shall be performed
after initial installation, replacement, or servicing of the device.
6.3.3.2.6 Additional testing of receptacles in patient care
spaces shall be performed at intervals defined by documented
pedormance data.
6.3.3.2.7 Receptacles not listed as hospital-grnde, at patient
bed locations and in locations where deep sedation or general
anesthesia is administe1·ed, shall be tested at intenals not
exceeding 12 months.
6.3.3.3 Isolated Power Systems.
6.3.3.3.1 Patient Care Spaces. If installed, the isolated powe1·
sys tem shall be tested in accordance with 6.3.3.3.2.
6.3.3.3.2 Llne Isolation Monitor Tests. The line isolation
monit01- (LIM) circuit shall be tested after installation, at1d
prim· to being placed in service, by successively grounding each
line of the energized distribution system through a resistor
whose value is 200 x V (ohms), where V equals measured line
voltage. The visual and audible ala1·ms (.w 6.3.2. 9.3.2) shall be
activated.
2021 Edition
99-80 HEALTH CARE FACILITIES CODE
6.3.3.3.3 The LIM circuit shall be tester! at intervals of not
more than l month by actuating the LIM test switch (.�Pe
6.3.2.9.3.6). For a LIM circuit with automated self-test and self:
calibration capabilities, this test shall be pei-formed at intervals
of not more than 1 2 months. Actuation of the test switch shall
activate both visual and audible alarm indicators.
6.3.3.3.4 After any repair or renovation to an electrical distri­
bution system, the LIM circuit shall be tested in accorrlance
with 6.3.3.'.i.2.
6.3.3.4 Growid-Fault Protection Testing. When equipment
ground-fault protection is first installed, each level shall be
performance-tested to ensure compliance with 6.3.2.8.
6.3.4 Administration of Electrical System.
6.3.4.1 Record Keepi ng.
6.3.4.1.1 * A rec01·d shall be maintained of the test� requirer!
by this chapter anrl associaterl 1·epai1·s or morlification.
6.3.4.1.2 At a minimum. the 1·ecord shall contain the <late, the
rooms or a1·eas tested, anrl an indication of which items have
met, or have failed to meet, the pei-formance requir·ements of
this chapter.
6.3.4.1.3 Isolated Power System (Where Installed). A perma­
nent record shall be kept of the r·esults of each of the test�.
6.4 Category 1 Spaces.
6.4.1 Category l spaces shall be served by an essential electri­
cal system in accordance with 6.75.
6.4.2 Category l spaces shall not be server! by an essential
electrical system in accordance with 6.7.6.
6.4.3 Category l spaces shall be served by circuit� from a criti­
cal branch panel(s) se1·ved from a single automatic transfe1·
switch anrl a minimum of one circuit served by the n01·mal
power distribution system or by a system originating from a
seconrl critical branch automatic t1·ansfer switch.
6.4.4 A11 essential electrical system in accordance with 6.7.5
serving a Category l space shall be permitted to setve Category
2 spaces in the same facility.
6.5 Category 2 Spaces.
6.5.1 Category 2 spaces shall be served by a Type l or Type 2
EES.
6.5.2 Category 2 spaces serverl by a Type l 01· Type 2 EES shall
be served by circuit� from a branch panel(s) served from a
single automatic transfer switch anrl a minimum of one circuit
se1·ved by the n01·mal power distribution system or by a system
originating from a seconrl automatic transfer switch.
6.6 Category 3 and 4 Spaces.
6.6.1 Categnry 3 or Category 4 spaces shall not be 1·equi1·ed to
be served by an EES.
6.7* Essential Electrical Systems.
6.7.1 Sources.
6.7.1.1* Design Considerations. Dual sources of n01·mal
power shall not constitute an alternate power source as de­
scribe rl in this chapter.
2021 Edition
6.7.1.1.1 Current-sensing devices. phase and ground, shall be
selected to minimize the extent of interruption to the electrical
system due to abnormal cut-rent caused by overload 01· shon
circuit�, or both.
6.7.1.1.2 Essential electrical systems shall have a minimum of
the following tw-o inrlependent sources of power: a n01·mal
source generally suppl1ing the entire electrical system and one
or more alternate sources for use when the normal source is
interrupted.
6.7.1.1.3 Where the normal source of powe1· consist� of gener­
ating unit� on the premises, the alternate source shall be either
another generating set or an external utility service.
6.7.1.2 General. Alternate powe1· sout·ces fo1· essential electt·i­
cal systems shall be rlesignerl to meet the requirement� of such
service.
6.7.1.2.1" Power Source. Type l anrl Type 2 essential electt·i­
cal system power sources shall he classified as Type 10, Cla�s X,
Level l generator sets per NFPA 1 10.
6.7.1.2.2 Use for Essential Electrical System.
6.7.1.2.2.1 The alternate power source shall be either reserved
exclusively for such service 01· nornrnlly used for othe1· put·poses
of peak rlemand control, internal voltage control, loarl 1·elief
for the external utility, cogeneration, or other approved uses.
6. 7.1.2.2.2* An essential electrical system(s) shall be designed
to meet the maximum demand likely to be produced by the
connected loarl and he consistent with the facility's emergency
operations plan with any single power source of the system out
of setvice.
6. 7.1.2.2.3"
(A) Optional loads shall be permitted to be served by the
essential elecu·ical system generating equipment.
(B) Optional loads shall be served by their own transfer
means, such that they "'ill not be tra.nsfetTed onto the genernt­
ing equipment if the transfe1· woulrl overload the equipment
and will be shed prior to a generating equipment overloarl.
(C) Use of the generating equipment to setve optional loads
shall not constitute "othe1· pm·poses"' as rlesc1·ihed in 6.7.1.2.2.l
and, therefore, shall not require multiple generator set�.
6.7.1.2.2.4 ,.vhere optional loads inclurle contiguous 01· same­
site facilities not cove1·erl in this corle, provisions shall he marle
to meet the requirement� of NFPA 101 for emergency egress
unrler load-sherl conrlitions.
6.7.1.2.3 Location.
6.7.1.2.3.1 Indoor EPS Installations. The EPS shall be in­
stalled in a room dedicaterl to altenrnte power sout·ces for
Level l installations.
(A) The EPS room shall be separated from the rest of the
building by constrnction \\ith a 2-hout· fit·e resistance rating.
fll0:7.2.1.11
(B) EPSS femergency power supply system l equipment shall
be pe1·mitted to he installed in the EPS room. fll0:7.2.1.21
(C) No othe1· equipment, including at"Chitecturnl appurtenan­
ces, except those that serve this space, shall be permitted in the
EPS room. fll0:7.2.1.31
 ELECfRICAL !-,YSTEMS
6.7.1.2.3.2 Outdoor EPS Installations.
(A) The EPS shall eithe1· be installed in a suitable enclosure
located outside the building and capable of 1·esisting the
entrance of snow or rain at a maximum winrl velocity as
required by local builrling codes or be constructerl such that it
is capable of resisting the impacts of snow or min.
(B) EPSS equipment shall be pe1·mitted to be installed in the
EPS enclosure. r110:7.2.2.2l
(C) No other equipment, including architectural appurtenan­
ces, except those that serve this space, shall be permitted in the
EPS enclosure. r110:7.2.2.3l
6.7.1.2.3.3 Level I EPSS equipment shall not be installed in
the same room with the normal se1·vice equipment, where the
service equipment is rated over 150 volts to ground anrl equal
to or greater than 1000 amperes. ruo:7.2.31
6.7.1.2.3.4 The rooms, enclosures. 01· separate buildings hous­
ing Level l or Level 2 EPSS equipment shall be designerl and
located to minimize damage from flooding, including that
caused by the following:
(1) Flooding resulting from fire fighting
(2) Sewer wate1· backup
(3) Othe1· disa�te1·s or occurrences
r110:1.2.41
6.7.1.2.3.5 Minimizing the possibility of rlamage resulting
from intetTuptions of the eme1·gency sout·ce shall be a design
consideration for EPSS equipment. ruo:7.2.51
6.7.1.2.3.6 Design conside1·ations shall minimize the effect of
the failut·e of one ene1·gy converte1· on the continued operation
of other unit�. r110:7.2.7l
6.7.1.2.4* Capacity and Rating. The gene1·ator set(s) shall
have the capacity and rating to meet the maximum rlemand
likely to be produced by the connected load of the essential
electrical system(s) and be consistent with the facility's emer­
gency operations plan.
6.7.1.2.5 Load Pickup. The energy converte1·s shall have the
required capacity and response to pick up anrl cany the load
within the time specified in Table 4.1(b) ofNFPA 110 after loss
of pt·imary powe1·.
6.7.1.2.6 Heating, Cooling, and Ventilating. Design of the
heating, cooling, and ventilation system fo1· the EPS equipment
room shall inclurle provision fo1· factors including. but not limi­
ted to, the following:
(1) Heat
(2) Cold
(3) Dust
(4) Humidity
(5) Snow and ice accumulations around housings
(fl) Louvers
(7) Remote radiator fans, as applicable
(8) Prevailing winrls blowing against radiat01· fan discharge
au-
6.7.1.2.7 Alarm Annunciator.
6.7.1.2.7.1 A remote annunciator that is storage batte1·y­
powe1·erl shall be provided to operate outside of the generating
room in a location readily observed by operating personnel at a
1·egula1· work station.
99--81
6.7.1.2.7.2 The annunciator shall be hard-wired to indicate
alarm conditions of the emergency or auxiliary power source as
indicaterl in 6.7.l.2.7.2(A) through 6.7.1.2.7.2(1).
(A) Inrlivirlual visual signals shall indicate the following:
(l ) \Vhen the emergency or auxilia1y power source is operat-
ing to supply powe1· to load
(2) \,Vhen the battery charge1· is malfunctioning (if provirled)
(B)* A remote, common audible alarm shall be provided as
specified in G.7.1.2. 7.2(H). 1"110:5.6.6]
(C) For Level I EPS, at a minimum, local annunciation and
either facility or network remote annunciation shall be provi­
ded.
(D) For the purposes of defining the types of annunciation in
6.7. l.2.7.2(C), the following shall apply:
(1) Local annunciation is located on the equipment itself 01·
within the same equipment room.
(2) Facility remote annunciation is located on site but not
within the room whe1·e the equipment is located.
(3) Netw01·k remote annunciation is located off site.
rtl0:5.G.G.31
(E) A..11 alarm-silencing means shall be provided, and the panel
shall include repetitive ala1·m circuiuy so that, afte1· the audible
alarm ha� been silenced, it reactivates after the fault condition
has been clearerl and has to be rest01·erl to its normal position
to be silenced again. r110:5.6.G.4l
(F) In lieu of the requirement in 5.6.6.4 of NFPA 110, a
manual ala1·m-silencing means shall be permitted that silences
the audible alann afte1· the occut-rence of the alarm conrlition,
provided such means rlo not inhibit any subsequent alarms
from sounding the audible alarm again without further manual
action. r110:5.6.G.5.I
(G) Inrlividual alarm indication to annunciate any of the
conditions listed in Table 6. 7.1.3.8.2 shall have the following
characte1·istics:
(1) It shall be battery powe1·ed.
(2) It shall be visually indicaterl.
(3) It shall have additional con tact.� 01· ci1·cuits fot· a common
audible alarm that signals locally anrl remotely when any
of the itemized conditions occurs.
(4) It shall have a lamp test switch(es) to test the operation of
all ala1·m lamps.
(H)* A centralized computer system shall not be permitted to
be substituted for the alarm annunciat01· in G.7.1.2.7 but shall
be permitterl to be used to supplement the alarm annunciat01·.
f
(I) Wireless transmission o the EPS rlata required by
6.7.1.3.8.2 anrl G.7. 1.3.8.3 shall be permitted.
6.7.1.3 Generator Set.
6.7.1.3.1 General. A single generator set that operates the
essential electt·ical system shall be pern1itted to be part of the
system supplying the othe1· put·poses a� specifierl in 6.7.1.2.2.1,
provided that any such use will not decrease the mean periorl
between service overhauls to less than 3 years.
6.7.1.3.2 Location. The EPS equipment shall be installed in a
location that permits ready accessibility and a minimum of
0.9 m (% in.) from the skid rails' outermost point in the direc­
tion of access fo1· inspection, 1·epair, mai ntenance, cleaning, 01·
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99-82 HEALTH CARE FACILITIES CODE
replacement. This 1·ec1ui1·ement shall not apply to unil� Ill
outrloor housings. r110:7.2.Gl
6.7.1.3.3 Maintenance of Temperature. The EPS shall be
heaterl as necessaq; to maintain the water jacket and batteq;
temperature determined by the EPS manufacturer for colrl
start and I oarl acceptance fo1· the type of EPSS. r 110:5. 3.1 ·1
6.7.1.3.4* Heating, Cooling, and Ventilating. \'\'ith the EPS
running at rated loarl, ventilation airflow shall be provirlerl to
limit the maximum air temperature in the EPS room 01· the
enclosure housing the unit to the maximum ambient ai1·
temperature reguired by the EPS manufacturer. r110:7.7.fl
6.7.1.3.4.1 Considerntion shall be given to all the heat emitted
to the EPS eguipment room by the energy converter, uninsula­
ted or insulated exhaust pipes, anrl other heat-producing
eguipment. r110:7.7.1.1 l
6.7.1.3.4.2* If reguirerl by the manufactut·e1·, ventilation shall
be supplied to the alternate power source eguipment.
(A) Fm· EPS supplying Level l EPSS, ventilation air shall be
supplied directly from a source oul�ide the building by an exte­
rior wall opening or from a source out�irle the building by a
2-hour fire-rated air t1·ansfer system. r 110:7.7.2.1 l
(B) For EPS supplying Level 1 EPSS, rlischarge ai1· shall be
directed outside the building by an exterior wall opening or to
an exterim· opening by a 2-hour fire-rated air transfer system.
fl 10:7. 7.2.21
(C) Fire dampers, shutters. or other self-closing devices shall
not he permitterl in ventilation openings or rluctwork for
supply or retum/discha1·ge ai1· to EPS eguipment ftx Level 1
EPSS. r110:7.7.2.3l
6.7.1.3.4.3 Ventilation air supply shall be from outdoors or
from a source outside the builrling by an exterio1· wall opening
or from a som·ce outside the builrling by a 2-hour fire-rated ai1·
transfer system. r110:7.7.3l
6.7.1.3.4.4 Ventilation air shall be providerl to supply and
discharge cooling air fo1· rnrliator cooling of the EPS when
running at rated load. rno:7. 7.41
(A) Ventilation air supply and discha1·ge for radiato1"'-Coolerl
EPS shall have a maximum static 1·estriction of 125 Pa (0.5 in.
of water column) in the discharge rluct at the radiator outlet.
r110:7.7.4. l l
(B) Rarliato1· air discharge shall be ducterl outrloors 01· to an
exterior opening by a 2-hmu- raterl ai1· transfe1· system.
1110:7.7.4.21
6.7.1.3.4.5 Motm--opernted rlampers. when used. shall be
spring operated to open and motm· closed. Fi1·e dampers, shut­
ters. or other se!f:dosing devices shall not he permitterl in
ventilation openings or ductwork for supply or return/
discharge ai1· to EPS eguipment for Level 1 EPSS . r110:7.7.5.I
6.7.1.3.4.6 The ambient air temperature in the EPS eguip­
ment room or outdoor housing containing Level 1 rotating
eguipment shall stabilize at not less than 4.5 ° C ( 40'F) when the
eguipment is not opernting. fl 10:5.3.5]
6.7.1.3.5* Energy Converters. Internal combustion engine
energy converte1·s anrl associated cranking batte1·ies shall be in
accorrlance with the reguirements of NFPA 110.
2021 Edition
6.7.1.3.6 Compressed Air Starting Devices. Other types of
stored energy starting systems (except pyrotechnic) shall be
permitterl to be userl whe1·e recommended by the manufac­
tut·er of the prime mover and subject to approval of the authm·­
ity having jurisrliction, under the following conditions:
( l) Where two complete periods of cranking cycles are
completerl without replacement of the stm·ed ene1·gy
(2) \\There a means for automatic restoration from the emer­
gency source of the stored energy is providerl
(3) Whe1·e the stored energy system has the cranking capacity
specified in 5.6.4.2. l of NFPA 110
(4) Where the stored energy system has a "black start" capa-
bility in addition to normal discha1·ge capability
r110:5.6.4.1.2l
6.7.1.3.7 Fuel S upply. The fuel supply for the generator set
shall comply with Sections 5.5 and 7.9 of NFPA 110.
6.7.1.3.8 Requirements for Safety Devices.
6.7.1.3.8.l Internal Combustion Engines. Internal combus­
tion engines serving generato1· sets shall be eguipped with the
following:
(1) Sensor device plus visual warning device to indicate a
water:iacket temperatut·e below that 1·egui1·ed in 6.7.1.3.3
(2) Sensor devices plus visual p1·e-ala1·m warning device to
inrlicate the following:
(a) High engine temperature (above manufacture1·'s
1·ecommended safe operating temperatm·e rnnge)
(b) Low lubricating oil presstu-e (below manufacturer·s
recommenrlerl safe operating range)
(c) Lowwate1· coolant level
(3) Automatic engine shutdown device plus visual device to
inrlicate that a shutrlown took place due to the follmving:
(a) Ove1uank (failed to start)
(b) Ove1·speed
(c) Low lubricating oil pressure
(d) Excessive engine temperature
(4) Common aurlible alarm device to warn that one 01· mo1·e
of the p1·e-ala1·m 01· alarm conditions exist
6.7.1.3.8.2 Safety Indications and Shutdowns. Safety indica­
tions and shutdowns shall he in accm·dance with Table
G.7.1.3.8.2.
6.7.1.3.8.3 Indivirlual visual signals plus a common audible
signal to warn of an engine-generntm· alarm condition shall
indicate the following:
(1) Low lubricating oil pressure
(2) Low water temperattu·e (below that regui1·erl in 6.7.1.3.3)
(3) Excessive water temperatut·e
(4) Low foe! when the main foe! storage tank contains less
than a 4-hour operating supply
(5) Overcrank (failed to start)
(6) Overspeerl
6. 7.1.4 Battery. Batte1-y systems shall meet all 1·eguiremenl� of
NFPA 111.
6. 7.1.5 Fuel Cell Systems.
6. 7.1.5.1 Fuel cell systems shall be pe1·mitted to serve as the
alternate powe1· source for all or part of an essential electrical
system.
6.7.1.5.2 Installation shall comply v.�th NFPA 853.
 ELECfRICAL �YSTEMS 99--83

Table 6.7.1.3.8.2 Safety Indications and Shutdowns (1 ) Between ti-ansfo1·mer primary an<l secondary overcutTent
protective devices, where only one overcurrent protective
Level 1 <levice or set of overcurrent protective <levices exist� on
the transformer secondary
Indicator Function (2) Between overcurrent protective devices of the same size
(at Battery Voltage) CV s RA (ampere rating) in series
(a) Overcrank X X X 6. 7.2.1.2 Automatic Tuansfer Switch Features.
(b) Low waler Lemperatrn·e X X
(c) High engine lemperature X X 6. 7.2.1.2.1 Source Monitoring.
pre-alarm
(A)* Un<lervoltage-sensing devices shall be provided to moni­
(d) High engine temperalure X X X
tm· all ungrounded lines of the pt·imary source of power as
(e) Low luhe oil pncssure pre-alam1 X X
follows:
(f) Low lube oil pressure X X X
(g) Overspeed X X X (1 ) When the voltage on any phase falls below the minimum
(h) Low fuel main Lank X X opernting voltage of any load to be served, the transfet·
(i) Low coolant kvel X 0 X switch shall automatically initiate engine start and the
U) El'S suppl )' ing load X process of transfe1· to the emet·gency power supply (EPS).
(k) Control switch nol in aulomalic X X (2)* When the voltage on all phases of the pt·imary source
position returns to within specified limit� for a <lesignate<l perio<l
(I) High ha ttery volLage X of time, the process of transfer back to primary power
(m) Low cranking voltage X X shall be initiated.
(n) Low volLage in ballery X fll0:6.2.2.l l
(o) Battery charger ac failure X
(B) Both voltage-sensing an<l frequency-sensing equipment
(p) Lamp tesl X
shall he provided to monitot· one ungrounded line of the EPS.
(q) Contacls for local and remote X X
fll0:6.2.2.21
common alam1
(r) Audible alarm-silencing swilch X (C) Transfer to the EPS shall be inhibited until the voltage
(,) Low slarling ai1· pre,sure X and frequency are within a specified range to handle loads to
(l) Low staning hydraulic pressure X be served. fll0:6.2.2.31
(u) Air shul<lmm <lamper when use<l X X X
(v) Remo le emergency sLOp X
(D) Sensing equipment shall not be required in the transfer
switch, pro,ided it is inclu<le<l with the engine control panel.
CV: Control panel-moumect visual. S: Shutdown ofEPS indicatlon. RA: 1110:6.2.2.3.l l
Remote auctihle. X: Required. 0: Optional.
Notes: (E) Frequency-sensing equipment shall not be required for
( 1) Item (p) is to he pro,·icted. hut a separate remote audible signal is monitoring the public utility source whet·e used a� an EPS, as
not required when the regular work site in fi.6.6 ofNFPA I LO is staffed pet·mitted by 5.1.3 ofNFPA 1 10. fll0:6.2.2.3.21
24 hours a day.
(2) Item (h) is not requirect for comhustlon turbines.
6.7.2.1.2.2 Interlocking. Mechanical interlocking or an
approved alternate metho<l shall prevent the inadvertent inter­
(3) Item (r) or (s) is required only where usect as a starling method.
connection of the pt·imary powe1· supply an<l the EPS, or any
(4) Item (j): EPS ac ammeter is permiuect for this fi.mctlon.
two separate sources of power. f 110:6.2.3 l
(!'i) All required CV h.rnctlons are to he visually annunciatect by a
remote. common visual incticator. 6. 7.2.1.2.3* Manual Operation. Instruction an<l equipment
(6) All required li.mctions indicated in the RA column are to he shall be provi<le<l for safe manual nonelectric trnnsfer in the
annunciatect hy a remote, common audible alarm as required in event the transfer switch malfunctions. 1110:6.2.41
fi.6.5.2(4) ofNFPA llO.
(7) Item (i) requires a low gas pressure alarm on gaseous systems. 6.7.2.1.2.4* Time Delay on Starting of EPS. A time-delay
(8) Item (h) must he set at 11 'C ('.!O'F) helow the regulatect de,ice shall be prmi<le<l to delay staning of the EPS. The timet·
temperature determinect hy the EPS manufacturer. as required in 5.3.1 shall prevent nuisance starting of the EPS and possible subse­
of'NFPA 110. quent loa<l transfet· in the event of harmless momentary powet·
<lips an<l interruptions of the primary smu-ce. fll0:6.2.51

6.7.I.6 Health Care Microgrid. A health ca1·e micrngrid in 6.7.2.1.2.5 Time Delay at Engine Control Panel. Time <lelays
accordance with Section 6.10 shall he permitted to serve as the shall be permitted to be located at the engine control panel in
EPS for all or pat·t of an essential electrical system. lieu of in the transfer switches. I 110:6.2.61

6.7.2* Distribution. 6.7.2.1.2.6 Time Delay on Tuansfer to EPS. An aqjustahle

6.7.2.1 General Requirements.
6.7.2.1.1 * Coordination.
6.7.2.1.1.1 Overcurrent protective <levices ser,ing the essential
electrical system shall be co01-dinated for the period of time
that a fault's <lurntion extends beyond 0.1 second.
6.7.2.1.1.2 Coordination shall not be required a� follows:
time-<lelay device shall be provi<le<l to delay transfer and
sequence load trnnsfer to the EPS to avoid excessive voltage
drop when the transfet· switch is installed for Level l use.
fll0:6.2.71
(A) Time Delay Commencement. The time delay shall
commence when propet· EPS voltage an<l frequency are
achieve<l. fll0:6.2. 7.1 l

2021 Edition
99.84 HEALTH CARE FACILITIES CODE
(B) Time Delay at Engine Control Panel. Time delays shall be
permitted to be located at the engine control panel in lieu of
in the transfer switches. r110:6.2. 7.21
6.7.2.1.2.7* Time Delay on Retransfer to Primary Source. An
adjustable time-delay de\ice with automatic bypass shall be
provided to delay retransfer from the EPS to the primary
source of powe1·, and allow the primary source to stabilize
before retransfer of the load. r110:6.2.8l
6.7.2.1.2.8 Time Delay Byp� If EPS Fails. The time delay
shall be automaticall y bypassed if the EPS fails. r110:6.2.9l
(A) The transfer switch shall be permitted to be programmed
for a manually initiated 1·etransfer to the pt·imary source to
provide for a planned momentary interrnption of the load.
r110:6.2.9.l l
(B) If used, the an-angement in 6.2.9.l of NFPA 110 shall be
provided with a bypass feature to allow automatic retransfer in
the event that the EPS fails and the primary source is available.
6.7.2.1.2.9 Time Delay on Engine Shutdown. A minimum
time delay of 5 minutes shall be provided for unloaded
running of the EPS prior to shutdown to allow for engine cool­
down. r110:6.2.10l
(A) The minimum 5-minute delay shall not be 1·equi1·ed on
small (lf, kW or less) air-<:ooled prime movers. r110:6.2.10.l l
(B) A time-delay device shall not be requi1·ed, provided it is
included with the engine control panel, 01· if a utility feeder is
used as an EPS. r110:6.2.10.2l
6.7.2.1.2.10 Test Switch. A test means shall be provided on
each automatic u·ansfe1· switch (ATS) that simulates failure of
the primary power source and then transfers the load to the
EPS. r110:6.2.12l
6.7.2.1.2.11* Indication of lransfer Switch Position. Two
pilot lights with identification nameplates or other approved
position indicators shall be provided to indicate the transfer
switch position. r110:6.2.13l
6.7.2.1.2.12 Motor Loa d Transfer. Provisions shall be inclu­
ded to reduce currents 1·esulting from motor load transfe1· if
such current� could damage EPSS equipment or cause
nuisance tripping of EPSS ovetTurrent protective devices.
1110:6.2.141
6.7.2.1.2.13* Isolation of Neutral Conductors. Provisions
shall be included for ensuring continuity, transfe1·, and isolation
of the p1·ima1y and the EPS neutral conductors whe1·eve1· they
are sepa rately grounded to achieve ground-fault sensing.
fl 10:6.2.1 5 l
6.7.2.1.2.14 Retransfer. If the emergency power source fails
during a test, provisions shall be made to immediately retrans­
fer to the normal source.
6.7.2.1.2.15 Switch Rating. lhe rating of the transfer switches
shall be adequate for switching all cla�ses of loads to be served
and for withstanding the effect� of available fault currents with­
out contact welding.
6.7.2.1.2.16 Automatic Transfer Switch. Transfer of all loads
shall be accomplished using an automatic transfer switch(es).
Each automatic tra.11sfe1· switch of 600 V or less shall be listed
for the put-pose and approved fot· emer·gency electrical se1·vice
(.w Sfl:tion 700.3 of NFPA 70j as a complete assembly.
2021 Edition
6.7.2.1.2.17* Nonantomatic lransfer Switch Features. Switch­
ing devices s hall be mechanically held and shall be operated by
direct manual or elect1·ical 1·emote manual contt·ol.
r110:6.2.161
(A) Interlocking. Reliable mechanical interlocking, or an
approved alternate method, shall prevent the inadvertent inte1·­
connection of the pt·imary power source and the EPS.
r110:6.2.16.l l
(B) Indication of Switch Position. Two pilot light� with identi­
fication nameplates, 01· othe1· approved position indicat01·s,
shall be provided to indicate the switch position. r110:6.2.16.2l
6.7.2.1.3 Nonautomatic Transfer Device Cl�ification.
Nonautomatic transfe1· devices of 600 V 01· less shall be listed
for the purpose and approved.
6. 7.2.1.4 Nonautomatic lransfer Devic e Features.
6. 7.2.1.4.1 General. Switching devices shall be mechanically
held and shall be operated by direct manual or electrical
r·emote manual control. r110:6.2.16"1
6.7.2.1.4.2 Interlocking. Reliable mechanical intedocking, or
an approved alternate method, shall prevent the inadvertent
inte1·co1111ection of the p1·imary power source and the EPS.
r110:6.2.16.11
6. 7.2.1.4.3 Indication of Switch Position. Two pilot lights with
identification nameplates. or other approved position indica­
tors, shall be prmided to indicate the switch position.
r110:6.2.16.2l
6.7.2.1.5 Byp� and Isolating lransfer Switches. Bypa�s­
isolation switches shall be permitted fot· bypa�sing and isolating
the transfer switch and installed in accordance with 6.4.2, 6.4.3,
and 6.4.4 ofNFPA 110. 1110:6.4.l l
6.7.2.1.5. I Bypass-Isolation Switch Rating. The bypass­
isolation switch shall have a continuous current rating and a
current rating compatible with that of the associated t1·ansfer
switch. fl 10:6.4.2 I
6. 7.2.1.5.2 Bypass-Isolation Switch Oassification. Each bypa�s­
isolation switch shall be listed for emergency electrical service
a� a completely factory-assembled and factory-tested apparatus.
r110:6.4.3l
6.7.2.1.5.3* Operation. With the u·ansfer switch isolated or
disconnected, the bypass-isolation switch shall be designed so it
can function as an independent nonautomatic transfer switch
and allow the load to be connected to either powe1· source.
r110:6.4.4l
6.7.2.1.5.4 Reconnection oflransfer Switch. Reconnection of
the transfe1· switch shall be possible y.,jthout a load interrnption
greater than the maximum time, in seconds, specified by the
type of system. r110:6.4.5 l
6. 7.2.2 Branches.
6.7.2.2.1 The di'vision between the branches shall occur at
trnnsfer s\\,jtches where more than one u·ansfer switch ts
1·equired.
6. 7.2.2.2 Each branch shall be arranged for connection,
within time limits specified in this chapter, to an alternate
powe1· source following a loss of the n01·mal som·ce.
 ELECfRICAL !-,YSTEMS
6.7.2.2.3 The number of trnnsfer switches to be user! shall be
based upon reliability, design, and load consirlerations.
6.7.2.2.3.1 Each brnnch of the essential electrical system shall
have one or more transfe1· switches.
6.7.2.2.3.2 One transfer switch shall be permitted to se1·ve one
01· more brnnches in a facility with a continuous loarl on the
switch of 1 50 kVA ( 1 20 k\'\') or less.
6.7.2.2.3.3 \'\'here a single transfe1· switch is used, as permitted
in G. 7.2.2.:l.2 , rli,ision into separate branches shall not be
1-equirerl.
6.7.2.2.4 Feeders from Alternate Power Source.
6.7.2.2.4.1 A single feeder supplied by a local or remote alter­
nate power source shall be permitted to supply the essential
electrical system to the point at which the life safety. ci-itical,
anrl equipment branches are separnted.
6.7.2.2.4.2 Installation of the u·ansfer equipment shall be
permitted at locations othe1· than that of the alternate power
source.
6.7.2.2.5 Receptacles. The requirement� for receptacles shall
comply with 6. 7.2.2.S(A) and 6. 7.2.2.5(B).
(A) Branch-ci1·cuit ove1·cun-ent devices shall be 1·eadily accessi­
ble to authorized personnel.
(B)" The electrical receptacles or the covet· plates fot· the elec­
trical 1-eceptacles supplied from the life safety and Cl'itical
branches shall have a rlistinctive color or marking so as to be
1-eadily identifiable.
6.7.2.2.6 Switches. Switches of all types shall be permitterl in
the lighting circuit� connected to the essential electrical system
in accordance with NFPA JOI.
6.7.2.2.7 Secondary circuit� of transformer-powered commu­
nication or signaling systems shall not be required to be
enclosed in 1·aceways unless otherwise specified by Chapters 7
m 8 of NFPA 70.
6.7.3 Performance Criteria and Testing.
6.7.3.1 Transfer Switches. All ac-powered suppon anrl acces­
sory equipment necessary to the operation of the EPS shall be
supplied from the load sirle of the automatic transfer
switch(es). or the output terminals of the EPS, ahead of the
main EPS ove1·cu1Tent prntection to ensu1·e continuity of the
EPSS operntion and performance. fll0:7.1 2.51
6.7.3.2 The essential electrical system shall be served by the
1101·mal power source, except when the normal power sout-ce is
inten-upted or drops below a predetermined voltage level.
f
Settings o the sensors shall be determined by careful study of
the voltage 1·equi1·ements of the loarl.
6.7.3.3 Failure of the normal source shall automatically start
f
the alternate source generator a ter a short delay, as describer!
in 6.7.2.1.2.4. 'When the alten1ate powe1· sout-ce has attained a
voltage and frequency that satisfies minimum operating
f
requirement� o the essential electrical system, the load shall be
connected automatically to the alternate power source.
6.7.3.4 Upon connection of the alternate powe1· source , the
loads comprising the life safety anrl critical branches shall be
automatically re-energized. l11e load comprising the equip­
ment system shall be connected eithe1· automatically afte1· a
99--85
time delay. as rlescribed in 6.7.2.1.2.6, 01· nonautomatically and
in such a sequential manner as not to overload the generator.
6.7.3.5 When the nm·mal powe1· sou1·ce is restored, and after a
time delay, as described in 6.7.2.1.2.7, the automatic transfe1·
switches shall rlisconnect the alternate power source anrl
connect the loads to the normal powe1- som·ce. The alternate
power sotlt'ce generator set shall continue to run unloarlerl fot·
a preset time delay, a� describer! in 6.7.2.1.2.9.
6. 7.3.6 If the emergency power sou1·ce fails anrl the normal
power sou1·ce has been restored , 1·etransfe1· to the normal
source of power shall be immerliate, bypassing the retransfer
delay timer.
6.7.3.7 Nonautomatic transfer switching de,.,ices shall be
restored to the normal power source a� soon as possible alter
the return of the normal source or at the rliscretion of the
operatot·.
6.7.4 Administration.
6.7.4.1 Maintenance and Testing of Es.sential Electrica l System.
6.7.4.1.1 Ma intenance and Testing of Alternate Power Source,
Transfer Switches, and Associated Equipment.
6.7.4.1.1.1 Maintenance of Alternate Power Source. The
generator set or othe1· alte1·nate powe1· sout"Ce anrl associated
equipment, inclurling all appurtenance part�, shall be so main­
tained as to be capable of supplying service within the shortest
time practicable and within the 10-seconrl interval specifier! in
6.7.1.2.5 and 6.7.5.:l.l.
6. 7.4.1.1.2 The 10-second c1·ite1·ion shall not apply during the
monthly testing of an essential electrical system. If the 10-
second criterion is not met during the monthly test, a process
shall be provided to annually confirm the capability of the life
safety and critical branches to comply with 6.7.5.3.1.
6. 7.4.1.1.3 Maintenance shall be performer! in accorrlance
with Chapter 8 ofNFPA 1 10.
f
6.7.4.1.1.4 Maintenance o the electrical equipment for the
life safety branch, critical branch, and equipment branch shall
be maintained in accordance with the manufacturer's instruc­
tions and pt·eventative maintenance programs.
6.7.4.1.1.5 Inspection and Testing. Criteria, conditions, anrl
personnel requirements shall be in accorrlance with
G. 7.4.1.1..'>(A) thrnugh 6.7.4.l.l .5(C).
(A)* Test Criteria. Generator sets shall be tested 1 2 times a
year, with testing intervals of not less than 20 days nor more
than 40 rlays. Generator sel� serving essential electt-ical systems
s hall be tested in acco1·dance with Chapter 8 ofNFPA 1 10.
(B) Test Conditions. The scherluled test under load condi­
tions shall include a complete simulated cold start and appni­
priate automatic and manual transfer of all essential electrical
system loads.
(C) Test Personnel. The scherlulerl test� shall be conducterl
by qualified personnel to keep the machines rearlv to function
anrl, in addition, serve to detect causes of malfunction and to
train personnel in ope1·ating prncedures.
2021 Edition
99-86 HEALTH CARE FACILITIES CODE

6.7.4.1.2 Maintenance and Testing of Circuitry. 6.7.5.1.2.5 Ala rm and ale1·ting systems (othe1· than fi1·e alarm
systems) shall be connecterl to the life safety branch or critical
6.7.4.1.2.l* Circuit Breakers. Main and feede1· circuit break­ branch.
e1·s shall be inspected annually anrl maintainerl in accm·dance
with the manufacturer's instrnctions anrl inrlustry stanrlards. 6.7.5.1.2.6 Loads dedicated to a specific generatm·, including
the fuel transfer pump(s), ventilation fans, electrically operaterl
6.7.4.1.2.2 Insulation Resistance. The resistance 1·eadin� of louvers, controls, cooling system, and othe1· generator accesso-
main frerle1· insulation shall be taken p1·i01· to acceptance anrl 1·ies essential fot· generator operntion, shall be connected to the
whenever damage is suspected. life safety branch or the output terminals of the generator with
6.7.4.1.2.3 Maintenance of Batteries. Batteries fix on-site overcurrent protective devices.
generators shall be maintained in accordance with NFPA 110. 6.7.5.1.2.7 No functions other than those in 6.75.1.2.4,
6.7.4.2 Record Keeping. A written recorrl of inspection, 6. 7.5. 1.2.5, and 6.7.5.1.2.6 shall be connected to the life safety
pedormance, exe1·cising pe1·iod, and repairs shall be 1·egulady branch, except as specifically permitted in 6.7.5.1.2.
maintained anrl available for inspection by the authority having 6.7.5.1.3* Critical Branch.
j urisrliction .
6. 7.5.1.3.l The critical branch shall be permitted to be su bdi­
6.7.5* Type I F.ssential Electrical System Requirements. vided into two 01· m01·e branches.
6.7.5.l* Branches. 6.7.5.1.3.2 The ct"itical branch shall supply powe1· fot· task illu­
6.7.5.1.l The essential electrical system shall be rlivided into mination, fixed equipment, select receptacles, and select power
the following th1·ee branches: circuit� serving the following spaces and functions related to
patient care:
( l) Life safetv
(2) Critical (l) Category l spaces where deep sedation or general anes­
(3) Equipment thesia is administererl, task illumination, select recepta­
cles, and fixed equipment
6.7.5.1.2 Life Safety Branch. (2) Task illumination and select receptacles in the following:
6.7.5.1.2.l For the purposes of this corle, the provisions fo1· (a) Patient care spaces, including infant nu1·se1·ies,
eme1·gency systems in Article 700 of NFPt1 70 shall be applierl selected acute nursing areas, psychiatt·ic bed a1·eas
only to the life safety branch. (omit receptacles), anrl wanl treatment rooms
(b) Medication preparation spaces
6.7.5.1.2.2 The following pmtions of Article 700 of NFPA 70 (c) Pha1·macy rlispensing spaces
shall be amended as follows: (d) Nurses' stations - unless adequately lighterl by
(l) 700.4 shall not apply. corridor luminaires
(2) 700.lO(D)(l) shall not apply. (3) Additional specialized patient care task illumination and
(3) 700.17 shall be replacerl with the follm,'ing: Branch 1·eceptacles, whe1·e neederl
circuits that supply emergency lighting shall be installerl (4) Nurse call systems
to provide service from a source complying with 700.12 (5) Blood, bone, and tissue bank.�
when the n01·mal supply for lighting is intern1pterl 01· (6)* Telecommunications entrance facility, telecommunica­
whe1·e single ci1·cuits supply luminaires containing secon­ tions equipment rooms, and telecommunication 1·ooms
dary batte1·ies. a11d equipment in these rooms.
( 4) 700.32 shall not apply. (7) Task illumination, select receptacles, and select power
circuits for the following areas:
6.7.5.1.2.3 The life safety branch shall be limited to circuit�
essential to life safety. (a)Category l 01· 2 spaces \\'ith at least one duplex
receptacle per patient berl location, and task illu­
6.7.5.1.2.4 The life safety bt·anch shall supply power as follows: mination as required by the governing borly of the
( l) lllumination of means of egress in accm·dance with health care facility
NFPA 101 (b) Angiographic labs
(2) Exit signs and exit directional signs in accon1.ance with (c) Cardiac catheterization labs
NFPA JOI (rl) Coronaq; ca1·e unit�
(3)* Communications systems, whe1·e userl for issuing instrnc­ (e) Hemodial ysis rooms or areas
tion during emergency conditions (f) Emergency room treatment areas (select)
( 4) Generator set location as follows: (g) Human phy; iology labs
(h) Intensive care units
(a) Task illumination (i) Postoperative 1·ecove1·y rooms (select)
(b) Battery charger for emergency battery-powererl (8) Clinical IT-network equipment
lighting unit(s) (9) Wireless phone a11d paging equipment for clinical staf
f

(c) Select 1·eceptacles at the generator set location anrl communications

essential electrical system transfer switch locations
(5) Elevator cab lighting, control, communications, and
signal systems
(6) Elect1·ically powe1·ed doorn used for building eg1·ess
(7) Fire alarms and auxilia1y functions of fire alarm combina­
tion systems complying with NI-PA 72
(10) Additional task illumination, receptacles, and select
power cit-cuit� needed for effective facility operation.
inclurling single-phase fractional horsepower mot01·s,
which are permitted to be connecterl to the critical
branch

2021 Edition
 ELECfRICAL !-,YSTEMS
6.7.5.1.4 Equipment Branch.
6.7.5.1.4.1 General. The equipment lxanch shall be connec­
ted to equipment desct"ihed in fi.7.5.1.4.3 through G.7.5.1.4.4.
6. 7 .5.1.4.2 Connection to Alternate Power Source.
(A) The equipment branch shall be installed and connected
to the alternate power source, such that equipment described
in 6.7.5.1.4.3 is automatically restored to operation at appropri­
ate time-lag intervals following the energizing of the life safety
and c1·itical branches.
(B) The arrangement of the connection to the alternate
powe1· source shall also provide for the subsequent connection
of equipment described in fi.7.5.1.4.4.
6.7 .5.1.4.3* Equipment for Delayed-Automatic Connection.
(A) The following equipment shall be pe1·mitted to be
arranged for delayed-automatic connection to the alten1ate
power source:
( l) Cenu·al suction systems se1·ving medical and sm-gical func­
tions, including controls, with such suction systems
permitted to be placed on the critical branch
(2) Sump pumps and other equipment required to operate
fot· the safety of major apparatus, including associated
control systems and alarms
(3) Compressed air systems serving medical and surgical
functions, including controls, with such air systems
permitted to be placed on the c1·itical branch
(4) Smoke control and stai1· pressurization systems
(5) Kitchen hood supply or exhaust systems, or both, if
required to operate during a fire in or unde1· the hood
(6) Supply. return. and exhaust ventilating systems for the
following:
(a) i\.irborne infectious/isolation rooms
(b) Protective environment rooms
(c) Exhaust fans for laboratory fi.tme hoods
(d) Nuclear medicine areas where radioactive material
is used
(e) Ethylene oxide evacuation
(f) Anesthetic evacuation
(B) Where delayed-automatic connection is not appropriate,
the ventilation systems specified in 6.7.5. l.4.3(A)(6) shall he
permitted to be placed on the critical branch.
6.7.5.1.4.4* Equipment for Delayed-Automatic or Manual
Connection. The following equipment shall be pe1·mitted to
be arranged for either delayed-automatic or manual connec­
tion to the alternate power source (alm ser A.. 6. 7.5.1.4. 3):
(l) Heating equipment used t o prmide heating for operat­
ing, delivery, labor, recovery, intensive care, coronary
care, nurseries, infection/ isolation rooms, emergency
tt·eatment spaces, and general patient 1·ooms; and pt·es­
sure maintenance Gockey or make-up) pump(s) for
water-based fire protection systems
(2)* Heating of general patient rooms during disrnption of
the normal sou1·ce shall not be 1·equi1·ed under any of the
following conditions:
(a) Outside design temperature ts lower than -G.7'C
(+20'F)
(b) Outside design temperature is lower than -fi.7'C
(+20'F). where a selected room(s) is provided for
99--87
the needs of all confined patienl� rthen only such
room(s) need be heatedl
(3) Elevator(s) selected to provide service to patient, surgical,
obstetrical, and ground floors during
(4) Supply, return, and exhaust ventilating systems for surgi­
cal and obstetrical delive1y suites, intensive care, corona1y
ca1·e, nurseries , and eme1·gency treatment spaces
(:>) H yperbaric facilities
(fi) Hypobaric facilities
(7) Autoclaving equipment, which is pe1·mitted to be
an-anged fm· either automatic 01· manual connection to
the alternate source
( 8) Controls for equipment listed in fi. 7.5.1.3
(9)* Other selected equipment
6.7 .5.1.5 Generator load-shed circuits designed for the
purpose of load reduction or for load priority systems shall not
shed lif·e safetv branch loads, ct"itical branch loads sen,ing Cate­
gory l spaces. medical ai1· compressors. medical-sut·gical
vacuum pumps, fire pumps, the pressure maintenance (i.e.,
jockey) pump(s) for ,rater-based fire protection systems. gene1·­
ator fuel pumps, or other generator accessories.
6. 7.5.2 Wiring Requirements.
6. 7.5.2.1 * Separation from Other Circuits. The life safety
branch and critical branch shall be kept independent of all
other wiring and equipment.
6.7 .5.2.2 Mechanical Protection of the Life Safety and Critical
Branches. l11e wi1·ing of the life safety and ffitical branches
shall be mechanically protected by raceways, as defined in
NFPA 70.
6. 7.5.2.3 Flexible power co1·ds of appliances or other utiliza­
tion equipment connected to the life safety and critical
branches shall not he 1·equi1-erl to be enclosed in 1·aceways.
6.7.5.3 Performance Criteria and Testing.
6.7.5.3.1 Source. The life safety and critical branches shall he
installed and connected to the alternate power source specified
in 6.7.1.1.2 and 6.7.1.1.3 so that all functions specified herein
for the life safety and critical branches are automatically
restored to operation within 10 seconds after interrnption of
the nm·mal sou1·ce.
6.7.6* Type 2 Essential Electrical System Requirements.
6.7.6.1 Sources. The 1·equiremenl� for smu-ces fot· Type 2
essential elecu·ical systems shall confo1·m to those listed in
6.7. l.
6 .7.6.2 Distribution.
6. 7.6.2.1 * Branches.
6. 7.6.2.1.1 The numbe1· of t1·ansfer switches to be used shall
he based upon reliability, design, and load considerations.
6. 7.6.2.1.2 The essential electrical system shall he divided into
the following two branches:
(1) Life safety branch
(2) Equipment branch
6. 7.6.2.1.3 Each branch of the essential electt·ical system shall
have one 01· m01·e transfer switches.
2021 Edition
99-88 HEALTH CARE FACILITIES CODE
6.7.6.2.1.4 One trnnsfer switch shall be pe1·mitted to serve one
or more branches in a facility with a continuous load on the
switch of 150 kVA (120 kW) m less.
6.7.6.2.1.5 Life Safety Branch.
(A) F01· the pmposes of this code, i\sticle 700 of NFPA 70 shall
only be applied to the life safety brnnch.
(B) The f ollowing portions of Article 700 of 1'.'FPA 70 shall he
amended as follows:
(l) 700.4 shall not appl y.
(2) 700.l0(D)(l) through (D)(3) shall not apply.
(3) 700.l7 Branch circuits that supply emergency lighting
shall be installed to provide service from a source comply­
ing with 700.12 when the nmmal supply for lighting is
interrupted or where single circuits supply luminaires
containi ng secondary batte1·ies.
( 4) 700.32 shall not apply.
(C) The life safety branch shall supply power as follows:
(l) Illumination of means of eg1·ess in acco1·dance with
NFPA 101
(2) Exit signs and exit directional signs in accordance with
NFPA 101
(3) Alarm and alerting systems, including the following:
(a) Fire ala rms
(b) Alarms required for systems used for the piping of
nonflammable medical gases as specified in Chap­
ter 5
( 4)* Communications systems, where used for issuing instruc­
tions dut·ing eme1·gency conditions
(5) Task illumination and select 1·eceptacles at the generat01·
set location
(6) Elevator cab lighting, conu·ol, communications, and
signal systems
(D) No functions, other than those listed in G.7.6.2.l.5(C)(l)
through 6.7.6.2.l.5(C) (G), shall be connected to the life safety.
6.7.6.2.1.6 Equipment Branch.
(A) The equipment branch shall be installed and connected
to the alternate powe1· sou1·ce such that equipment listed in
G. 7.G.2.1.G(C) is automatically 1·estored to operation at appro­
priate time-lag intervals following the restoration of the life
safety branch to operation.
(B) The equipment branch arrangement shall also provide fot·
the additional connection of equipment listed m
6.7.6.2.l.6(D).
(C) AC Equipment for Nondelayed-Automatic Connection.
Generntor access01·ies including, but not limited to, the trans­
fer fuel pump, electrically operated louvers, and other genera­
tor accesso1·ies essential fot· generator operntion shall he
arrnnged for automatic connection to the alternate powe1·
source.
(D) Delayed-Automatic Connections to Equipment Branch.
The following equipment shall be permitted to be connected
to the equipment branch and shall be arranged for delayed­
automatic connection to the alternate powe1· sotu-ce:
(l) Task illumination and select 1·eceptacles in the following:
(a) Patient care spaces
(b) Medication p1·epa1·ation spaces
(c) Pharmacy dispensing spaces
2021 Edition
(d) Nurses' stations - unless adequately lighted by
corridor luminaires
(2) Supply, 1·eturn, and exhaust ventilating systems for
ai1·horne i nfectious isolation rooms
(3) Sump pumps and other equipment required to operate
for the safety of major apparatus and associated control
systems and alanns
( 4) Smoke control and stai1· pt·essm·ization systems
(5) Kitchen hood supply or exhaust systems, or both, i f
1·equired to ope1·ate during a fit-e in 01· under the hood
(6) Nu1·se call systems
(7) HVAC systems sening the EF, TER, and TR
(E)* Delayed-Automatic or Manual Connections to Equipment
Branch. The equipment in G. 7.6.2.l.6(E) (l) and
G.7.G.2.l.G(E)(2) shall be permitted to be connected to the
equipment branch and shall be arranged for either delayed­
automatic or manual connection to the alten1ate powe1· sout·ce:
(l) Heating Equipmml to Provide Hmting for (',eneml Patient
Rnmm. Heating of general patient rooms during disrup­
tion of the normal source shall not be required unde1· any
of the following conditions:
(a)* 1l1e out�ide design temperature is higher than
-6.7° C (+20° F).
(b) The out�ide design tempernture is lower than
-G.7'C (+2 0'F) and, where a selected room(s) is
f
provided for the needs o all confined patients, then
only such room (s) need be heated.
(c) The facility is se1·ved by a dual sout·ce of n01·mal
power. (See A.fi. 7.1.1Jar mm·e information).
(2)* fievatar Servia. In instances whe1-e interruptions of power
would result in elevat01·s stopping bet\veen flooi-s, throw­
over facilities shall he provided to allow the tempornry
operation of any elevator for the release of passengers.
(3) optional Connn:tiom to the Equipmmt Bmni:h. Additional
illumination, receptacles, and equipment shall be permit­
ted to be connected only to the equipment branch.
(4) J\lf.ultiple Systems. \\'here one switch serves multiple systems
as pe1·mitted in 6.7.6.2. trnnsfe1- for all loads shall be
nondelayed automatic.
6.7.6.3 Wiring Requirements.
6.7.6.3.1" Separation from Other Circuits. The life safety and
equipment branches shall he kept entirely independent of all
other wit-ing and equipment.
6.7.6.3.2" Receptacles. The electt·ical 1·eceptacles or the cover
plates for the electrical receptacles supplied from the life safety
and equipment branches shall have a distinctive color or mark­
ing so as to be readily identifiable.
6.7.6.4 Performance Criteria and Testing.
6.7.6.4.1 Source. The lif·e safety and equipment bt·anches
shall be installed and connected to the alternate power sout·ce
specified in 6. 7.1.1.2 and G.7.1.1.3 so that all functions specified
herein for the life safety and equipment branches are automati­
cally 1·esto1·ed to operntion within l 0 seconds after interruption
of the normal source.
6.8 Site Acceptance Testing.
6.8.1" Site acceptance testing shall be pe1-f01·med on the elec­
trical sy stem and all electrical component� se1ving Category l
and Catego1y 2 spaces.
 ELECfRICAL !-,YSTEMS
6.8.1.1 Acceptance testing is requirerl after initial installation
or major renovation prior to the system being placerl into serv­
ice.
6.8.2* Site acceptance testing procedures shall be in accorrl­
ance with inrlustry-recognizerl standards anrl practices for
equipment testing and system commissioning.
6.8.3 Site Acceptance Testing Records.
6.8.3.1 A recorrl of all site acceptance testing procedm-es
1·equirerl in 6.8.l and testing result� shall be maintained.
6.8.3.2 Site acceptance testing records shall be retained for 5
years.
6.8.3.3 Record Medium.
6.8.3.3.1 The recorrls shall be on a medium that will survive
the 1·etenti on pe riorl.
6.8.3.3.2 Pape1· or electronic media shall be permitted.
6.8.3.4 Record Reporting and Archiving.
6.8.3.4.1 The 1·ecord shall be available for examination and, if
requirerl, reported to the authority havingjurisrliction.
6.8.3.4.2 At·chiving of recorrls by any means shall be permitted
f
if hard copies o the rec01·ds can be provided promptly when
requesterl.
6.9 Electrical Preventive Maintenance (EPM).
6.9.1 EPM Program.
6.9.1.1 * All electt·ical component� which are part of an elect1·i­
cal system sening a Category l and Category 2 space shall be
part of an electrical preventive maintenance (EPM) program.
6.9.1.2 The EPM program shall include the following
element�:
(l) Listing of all equipment and systems included as part of
the prog1·am
(2) Schedule of inspection, testing, and servicing (mainte­
nance) of equipment
(3) Survey and analysis of electrical equipment and systems to
dete1·mine maintenance requirements and pt·iorities
( 4) Scherluled routine inspections and test�
(5) Review of inspection and test reporl� so that proper
CotTective measures can be prescribed
(6) Pedormance of necessa1·y work
(7) Complete 1-ecorrls
6.9.2 EPM Records.
6.9.2.1 A record of all testing anrl maintenance described in
6.9.4 shall be maintained.
6.9.2.2 EPM program inspection, testing, anrl maintenance
1-ecorrls shall be 1-etained fot· 5 yea1·s.
6.9.2.3 EPM Record Medium.
6.9.2.3.1 The records shall be on a merlium that will sun,ive
the retention period.
6.9.2.3.2 Papet· or electronic media shall be permitted.
6.9.2.4 EPM Record Reporting and Archiving.
6.9.2.4.1 The recorrl shall be available for examination and, if
1-equirerl, reported to the authority havingjurisrliction.
99--89
6.9.2.4.2 Archiving of 1·ecords by any means shall be permitted
if hard copies of the records can be provirlerl promptly when
requested.
6.9.3 Corrective Measures.
6.9.3.1 * Analysis of Inspection, Testing, and Maintenance
f
Reports. Analysis o inspection, testing, anrl maintenance
1-eports shall be followed by the implementation ofappropt-iate
corrective mea�ures.
6.9.3.2 All cotTective measures shall be documented in
accorrlance with the 1·equirement� of6.9.2.
6. 9.4 EPM Intervals.
6.9.4.1 * EPM inten•als shall be 111 accordance ,,�th Table
6.9.4.l.
6.9.4.2* Alternative Equipment Maintenance (AEM) Program.
6.9.4.2.1 EPM intervals shall be permitterl to be rleveloperl as
part of an alternative equipment maintenance (AEM)
program.
6.9.4.2.2 The AEM shall inclurle the following element�:
(1 )* l11e AEM program shall be based on accepted standanls
ofpractice fot· electt·ical equipment maintenance.
(2) The AEM program 1-equirements (including EPM scherl­
ules) shall be clearly documented and available for
inspection by the authority havingjtu-isdiction.
(3) The A.EM program shall be developed anrl administererl
by qualified personnel, regardless of whether they are
health care facility employees or contractors.
(4)* l11e AEM program shall consider the typical health anrl
safety risks associated witl1 the equipment's use, including
"critical equipment" for which there exist� a risk of seri­
ous i1�ury 01· rleath to a patient or staff person if the
equipment fails.
6.10 Health Care Microgrids.
6.10.1 General Requirements.
6.10.1.1 Applicability. (Reserved)
6.10.1.2* Purpose. The pu1-pose of Section 6.10 shall be to
describe 1·equirement� fot· multiple�out-ce health care micn>­
grid systems, ac or de, utilizerl as all or a portion of EPSSs for
health care facilities.
6.10.1.3* Campuses. Health care microgrirls shall be permit­
ted to serve ind i\irlual buildings or campuses consisting of
seve1·al buildings.
6.10.1.4 Non-Health Care Buildings. Health ca1·e microgrids
shall be permitted to sen'e builrlings that fall into multiple use
categories as rlescribed in Chapter 4.
6.10.2 Sources.
6.10.2.1 All sources shall meet the installation and mainte­
nance 1·equi1-ement� of the applicable NFPA code.
6.10.2.2 Any combination of generation, storage, or transfo1·­
mation assets shall be permitterl to serve as the essential power
source (EPS) for all or a portion of health care microg1·ids.
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99-90 HEALTH CARE FACILITIES CODE

Table 6.9.4.1 Electrical Preventive Maintenance (EPM) Intervals

Item Inspection Period Testing Period Maintenance Period

Medium-voltage switchgear Every 3 months Every 3 years Every 3 years
Power distt·ibution tt·ansfo1·mers Monthly Every 3 years Every 3 years
(� 750 kVA)
Generator (alternate source) (SPP Chaptl'r 8 ofNFPA. 110.) (Sep ChaptPr 8 of NFPA. 110.) (SP!' Chaptn 8 of NFPA. 110.)
Generntor paralleling switchgea1· Monthly Annually Every 3 years
Low-voltage switchgear/ switch boards Every 3 years Every 3 years Every 3 years
Overcurrent Protective Devices
Fuses (� 400 A) Every 3 years E\·ery 3 years Every 3 years
Low-voltage powe1· ci1·cuit b1·eake1·s Every 3 years Evety 3 years Every 3 years
(� 400 A)
Low-voltage mol<le<l-case circuit bt·eakern Every 3 years Every 3 years Every 3 years
(� 400 A)
Medium-voltage circuit breakers Every 3 years Every 3 years Every 3 years
Relays (inclu<ling polyphase ground-fault Every 3 years Eve1y 3 years Every 3 years
equipment protection)
Transfer equipment Monthly Every 3 years Every 3 years
Bus <luct Every 3 years Every 3 years Every 3 years
Uninterrnptihle power supplies (� LOO kW) Every 3 months Evety 6 months Every 6 months
Isolated powe1· panels (SPP 6.3.3.3.3.) (Se!' 6.3.3.3.3.) (SPP 6.3.3.3.3.J
Motor control equipment Annually Every 3 years Evety 3 years
Branch-circuit panelhoar<ls Annually Every 3 years N/A
Wi1·ing <levice s (SPP 6.3.3.2.) (SP!' 6.3.3.2.) (Sl'P 6.3.3.2.)
Batte1y-powere<l lighting unil� (SP!' 6.3.2.6.8.) (SP!' 6.3.2.6.8.) (SP!' 6.3.2.6.8.)
N/A: not applicable.

6.10.3 Reliability. 6.10.6.2 Source Monitoring. (Reserved)

6.10.3.1 Health care microgrid systems shall be <lesigned with
sufficient reliability to provide effective facility operation
consistent with the facility's emergency operations plan.
6.10.3.2* Health care microg1·id system components shall not
be compromised by failure of the normal source.
6.10.4 Interconnection to an Electrical Utility. Health care
microgri<ls that at·e interconnected to an extet·nal elect1·ical
utility shall comply with regulations relevant to the serving util­
ity.
6.10.5 Distribution System. (Reserved)
6.10.6* Control System. Health care microgri<l control
systems shall comply with the requirement� of this subsection.
6.10.6.1* Network Segregation.
6.10.6.1.1 Health care microgrid control system networks shall
be seg1·egated from other networks.
6.10.6.1.2 Intelligence and memory of health care microgrid
control systems shall not be <le pendent on ofl�site resources.
6.10.6.3 Design. The <lesign of health care microg1·i<l control
systems shall inclu<le a sequence of operations for manual
controlling of sources in the event of system failure.
6.10.6.4 Controller Backup Power. Health care microg1·id
controllers shall have a dedicated battery backup having a mini­
mum 90-minute capacity.
6.10.6.5 Annunciation.
6.10.6.5.1 Health care microgri<l control systems shall be capa­
ble of providing 1·eadout� that in<licates which sources are oper­
ating.
6.10.6.5.2 The amount of power prm,ided to the health care
microg1·id hy each sou1·ce shall be visible at all times.
6.10.6.6 Security. (Reserved)
6.10.7 Commissioning. Health care microgrid systems shall be
commissioned in accot·dance with their sequence of opern­
tions.
6.10.7.1 Verification of Means and Methods. Health care
micrngri<l system installers or commissioning agents shall
pt·epare a w1·itten commissioning plan that provides a desc1·ip-

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 ELECfRICAL !-,YSTEMS 99-91

tion of the means an<l metho<ls necessary to document and
verify that the system an<l iL� associated controls and safety
systems are in proper working condition.
6.10.7.2 Commissioning Plan. Commissioning plans shall
include the following:
(l ) An overview of the commissioning process developed
specifically fot· the health ca1·e microgri<l and it� control­
ler to be installe<l and a narrative description of the activi­
ties to be conducte<l
( 2)* Roles and responsibilities for all those itn-olved in the
planning, design, construction, installation, and opera­
tion of the health care microgri<l
( 3) Means and metho<ls whereby the commissioning plan will
he made available du1·ing the implementation of the
health care microgrid project
( 4) Plans and specifications necessary to undei-stand the
installation and operation of the health ca1·e microg1·id
and all a�sociated component�. operational controls, an<l
safety systems
(:,) A detailed description of each activity to be conducted
during the commissioning process, who will perfo1·m
each activity, and at what point in time each activity is to
be con<lucted
(6) Procedures to be used in documenting the prope1· opera­
tion of the health ca1·e microgrid an<l all associated
component�, operational controls, and safety systems
(7) Gui<lelines an<l fot·mat ftx a commissioning checklist,
relevant operational testing forms, and necessary commis­
sioning
(8) Means an<l methods whereby facility operation and main­
tenance staff will be trained on the system
(9) Identification of pe1·sonnel qualified to service. maintain,
and respond to incidents involving the system
6.10.7.3 Commissioning Report. A commissioning 1·eport
documenting the commissioning process and the results shall
be provided.
6.10.8.4 Health ca1·e microg1·i<l systems shall be 1·ecommis­
sioned for operation when the system configuration changes or
every five years, whichever occurs first.
6.11 Classification of Emergency Power Supply Systems
(EPSSs).
6.1 I.I General. The EPSS shall provide a source of electrical
power of requi1·ed capacity, 1·eliability, and quality to loads for a
f
length o time as specified in Table 6.11.l (a) and within a
specified time following loss 01· failure of the n01·mal powe1·
supply as specifie<l in Table 6.11.l (b). r110:4.ll
6.11.2 Class. The class <lefines the minimum time, in hours,
fot· which the EPSS is designe<l to operate at it� rated load \,�th­
out being 1·efuele<l or recharged. [See Table 6.11.l(a).J r110:4.2l
6.11.3 Type. The type defines the maximum time, in second�,
that the EPSS will permit the load terminals of the transfe1·
sv,�tch to be without acceptable elect1·ical powe1·. Table
6.11.l (h) provides the types defined by this standard. r110:4.3l
6.11.4 Level. This standat·d recognizes two levels of equip­
f
ment installation, pe1- orma11ce, an<l maintenance. r110:4.4l
6.11.4.l Level l systems shall be installe<l where failure of the
equipment to pei-form coul<l result in loss of human life or seri­
ous injmies. r110:4.4.ll
6.11.4.2 Level 2 systems shall be installed where failure of the
EPSS to pedorm is less critical to human life and safety.
r110:4.4.2l
6.11.4.3 A.ll equipment shall be permanently installed.
r110:4.4.3l
Table 6.11.l(a) Oa.s.sification ofEPSSs
Class Minimum Time

6.10.7.3.l l11e commissioning 1·epon shall he p1·epa1·e<l hy the Class 0.083 0.083 ht· (:, min)
health ca1·e microgrid system commissioning agent and summa­ Class 0.2 5 0.25 hr ( 15 min)
rize the commissioning process, the operation of the system, Class 2 2 ht·
the associated operational controls, and the safety systems. Class 6 6 hr
Class 4 8 48 hr
6.10. 7.3.2 The commissioning 1·eport shall include the final
Class X Other time, in hours, as required hy
commissioning plan an<l the results of the commissioning proc­
the application, code, or user
ess. as well as a copy of the plans and specifications associated
with the a�-built health care microg1·id system design and instal­ [I 10:Table 4.1 (a)]
lation.
6.10.7.3.3 The commissioning report shall inclu<le any issues
i<lentified <luring commissioning and the meamres taken to Table 6.11.l(b) Types ofEPSSs
1·esolve them.
6.10.8 Inspection, Testing, and Maintenance. Design ation Power Restoration
6.10.8.l l11e health care microgrid system shall be inspected, Type U Basically uninterrnptible (UPS
tested, and maintained by qualified personnel. systems)
T)'pe 10 10 sec
6.10.8.2 All health ca1·e microg1·id components shall be
Type 6 0 60 sec
inspected an<l maintained in acc01·dance with manufacture1·s·
instructions or annually, whichever occurs first. Typ e 1 20 1 20 sec
Type M Manual stationary or nonautomatic
6.10.8.3 Health ca1·e microgrid system component.� shall be - no time limit
teste<l in acc01·dance with the manufacturers· requirement�. [I 10:Tahle 4.1 (h)]

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99-92 HEALTH CARE FACILITIES CODE
6.11.4.4 Level 1 and Level 2 systems shall ensure that all loads
served by the EPSS are supplied with alternate power that
meet� all the following criteria:
(1) Of a quality within t.he operating limits of the load
(2 ) For a <luration specifie<l for the class as <lefined in Table
6.11. l(a)
(3 ) iVithin the time specified for the type as define<l in Table
fi.11. l(b)
fl 10:4.4.4 l
Chap ter 7 Information Technology and Communications
Systems
7.1* Applicability. This chaptet· shall apply to new health care
facilities as specified in Section 1.3.
7.2 Reserved.
7.3 Category I Systems.
7.3.1 Information Technology and Communications Systems
Infrastructure.
7.3.1.I Premises Distribution System (Fiber and Copper).
7.3.1.1.1 Cables and installation shall be in compliance with
NFPA 70 and TIA/EIA 568-B, Cmnmen:ial Building 1elPt:mmnuni­
rations Cabling Standard.
7.3.1.1.2 Distribution s ys tem cable labeling, t·ecord keeping,
an<l alphanumeric schemes shall be in accm·<lance with
TIA/EIA fi0fi-B, Administration Standard for Commm:ial 1;,zffm11-
munirations InfmstrudurP.
7.3.1.2* Telecommunications Sys tems' Spaces and Pathways.
7.3.1.2.1 Entrance Facility (EF).
7.3.1.2.1.1 General. The EF location shall be permitted to be
combined with the telecommunications equipment room
(TER).
7.3.1.2.1.2 Not less than two physically separnte<l sen:tce
entrance pathways into this location shall be required.
7.3.1.2.1.3 Remote Primary Data Cen ter. In a facility where
the primaty data centet· is locate<l t·emotely, two EFs and t·e<lun­
<lant telecommunications service entrances shall be pro,ided.
7.3.1.2.1.4 Location Requirements and Restrictions.
(A) The EF shall be permitted to be located with the TER.
(B) Whet·e the EF is combined with the TER, the space and
electrical power and cabling shall be a<lded to the TER to
accommodate the telecommunications service pt·ovidei··s space
and access requirement�.
(C)* The EF shall be dedicated to low-voltage communication
systems.
(D) Electrical equipment or fixtures (e.g., tt·a.nsformers, panel­
r
boards, conduit, wit·ing) that a e not dit·ectly relate<l to the
suppon of the EF shall not be installe<l in or pass thrnugh the
EF.
(E) Mechanical equipment and fixttu·es (e.g., water or drnin­
age piping of any kind, ductwork, pneumatic tubing) that are
not <lirectly related to the support of the EF shall not be in­
stalled in, pass through, ot· enter the EF.
2021 Edition
(F) The EF shall be locate<l in an area not sul�ect to flooding.
(G) The EF shall be as close as pt·acticable to the building
communications set·vice entrance point.
7.3.1.2.1.5 Working Space. (Reserved)
7.3.1.2.1.6 Security. Access to the EF shall be detet·mined
based on a security vulnerability a�sessment.
7.3.1.2.1.7 Power Requirements.
(A) Circuit� serving the EF shall be dedicate<l to serving the
EF.
(B) Circuits sening equipment in the EF shall be connected
to the critical branch of the essential electt·ical system.
(C) A minimum of one duplex receptacle served from normal
power shall be prmided on one wall of the EF for service and
maintenance.
7.3.1.2.1.8 Environmental Requirements.
(A) Tempernture and humidity in the EF shall be controlled
in accm·<lance with the manufacturer's equipment requit·e­
ment�.
(B)* HVAC systems sen,·ing the EF shall be connected to the
equipment branch of the essential electrical system.
(C)* A positive-pressure <lifferential v.-ith respect to surround­
ing areas shall be provided.
(D) Sprinklers shall be provide<l with wire cages or shall he
recesse<l to prevent accidental operation.
7.3.1.2.1.9 Other Requirements. (Reserved)
7.3.1.2.2 Telecommunications Equipment Room (TER). Each
facility shall have at least one TER space that meets the mini­
mum requirement� of this chapter.
7.3.1.2.2.1 General.
(A) The TER houses the main networking equipment and
shall be permitted to also house application servers and data
storage devices that serve the health care facilitv.
(B) Central equipment for other communications systems
shall be permitted to be housed in the TER.
7.3.1.2.2.2* The EF shall be permitted to be combined with
the TER space.
7.3.1.2.2.3 Reserved.
7.3.1.2.2.4 Location Requirements and Restrictions.
(A) Electrical equipment or fixtures (e.g., trnnsformers, panel­
boa rds, conduit, wiring) that are not <lirectly related to the
suppon of the TER shall not be installed in, pass through, or
enter the TER.
(B) Any mechanical equipment or fixtures (e.g., water or
drninage piping of any kind, <luctwork, pneumatic tubing) not
<lirectly t·elate<l to the support of the TER shall not be installed
in, pass through, or enter the TER.
(C) The TER shall be locate<l in a nonsterile at·ea of the
facility.
 INFORMATION TECHNOLO(;y AND COMMUNICATIONS SYSTEMS
(D) In geogi-aphic areas prone to huri-icanes or tornadoes. the
TER shall be located away from exterior curtain walls to
pi-event wind and ,11ater damage.
(E) The TER shall he located 01· designed to avoid vibi-ation
from mechanical equipment or other sources.
7.3.1.2.2.5 Working Space. \\'orking space about communica­
tions cabinets, i-ach, or othe1- equipment shall he in accont­
ance with l l0.26(A) of NFP.A. 70.
7.3.1.2.2.6 Security. Access to the TER shall be dete1·mined
ba�ed on a security vulnei-ability assessment.
7.3.1.2.2.7 Power Req uirements.
(A) Ci1·cuit� sening the TER and the equipment within the
TER shall be dedicated to serving the TER.
(B) Circuits serving other communications equipment in the
TER shall be connected to the essential electrical system.
(C) A minimum of one duplex outlet shall be provided on
each wall and shall be connected to normal power for service
and maintenance.
7.3.1.2.2.8 Environmental Requirements.
(A) Tempei-ature and humidity in the TER shall be controlled
in accordance with the manufacture1·'s equipment 1·equire­
ments.
(B) HVAC systems serving the TER shall be connected to the
equipment branch of the essential electrical system.
(C) A positive pressure differential with respect to surround­
ing areas shall be provided.
7.3.1.2.2.9 Other Requirements. (Reserved)
7.3.1.2.3 Telecommunications Room (fR).
7.3.1.2.3.1 General. A TR houses telecommunications equip­
ment, cable terminations, and cross-connect cabling.
7.3.1.2.3.2 Sufficient TRs shall be provided so that the hori­
zontal cable to any data or communications outlet in the build­
ing can be reached without exceeding 90 m (295 ft) maximum
cable length as tested electrically from the termination point in
the TR to the outlet.
7.3.1.2.3.3 Reserved.
7.3.1.2.3.4 Location Requirements and Restrictions.
(A) Switchboards, panelhoards, transformers, and similar elec­
trical equipment that a1·e not di1·ectly related to the suppon of
the TR shall not be installed in the TR.
(B) Any mechanical equipment or fixtures (e.g., water or
dt·ainage piping of any kind, ductwork, pneumatic tubing) not
directly related to the support of the TR shall not be installed
in, pa�s through. or enter the TR.
(C) In geogi-aphic a1-eas prone to huITicanes or tornadoes.
TR� shall be located away from exte1·i01· cunain walls to pt·event
wind and water damage.
(D) A minimum of one TR shall be on each floor of the
facility.
99-93
(E) A TR shall only se1·ve the floor where it is located and shall
be located so as to not exceed the maximum cable length in
7.3.1.2.3.2.
7.3.1.2.3.5 Working Space. Wm·king space about communica­
tions cabinet�, racks, or other equipment shall he in accord­
ance with l 10.26(A) of NFP/1. 70.
7.3.1.2.3.6 Security. Access to TR� shall be determined based
on a security vulnerability assessment.
7.3.1.2.3.7 Power Requirements.
(A) Circuits serving the TR and the equipment within the TR
shall be dedicated to se1·ving the TR.
(B) Cit"Cuit� serving the TR shall be connected to the critical
branch of the essential electrical system.
(C) A minimum of one duplex receptacle shall be prmided in
each TR and shall be connected to not·mal powe1· fix service
and maintenance.
7.3.1.2.3.8 Environmental Req uirements.
(A) Temperature and humidity in the TR shall be controlled
in accordance with the manufacturer's equipment require­
ment�.
(B) Spt·inklers shall be provided with wire cages or shall be
recessed to prevent accidental discharge.
7.3.1.2.3.9 Other Requirements. Suspended ceilings shall not
be 1·equired in the EF, TER, and TR.
7.3.1.2.4 Cabling Pathways and Raceway Requirements.
7.3.1.2.4.1 Backbone Distribution. Redundant pathways shall
be provided between the EF and TER.
7.3.1.2.4.2 Conduit� shall be provided for cabling in inaccessi­
ble ceiling spaces.
7.3.1.2.5 Outside Plant (OSP) Infrastructure.
7.3.1.2.5.1 General. OSP infrastn1cture shall consist of the
conduits, vault�. and other pathways and cabling used to
connect buildings on a campus and to provide services from
off-campus service providers.
7.3.1.2.5.2 Path.ways.
(A) Dual telecommunications service entrance pathways shall
be pt·mided to the EF.
(B) Service enu·ance pathways shall he a minimum of fl.I m
(20 ft) apart.
(C) Underground conduits for technology systems shall he a
minimum of 0.61 m (2 ft) from underground steam and water
piping if crossing perpendicularly, and a minimum of 1.83 m
( 6 ft) if parallel.
(D) Underground conduits for technology systems shall be a
minimum of 0.61 m (2 ft) below grade.
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99-94 HEALTH CARE FACILITIES CODE

f
7.3.1.3 Antennas. (Reserved) 7.3.3.1.3 Staff Emergency Call. 1l1e locations of staf emer­
gency call stations shall be in accordance with the requirements
7.3.2 Voice, Data, Communications, and Cable Television
set forth by ferleral, state, anrl local codes.
Systems.
7.3.3.1.3.1* A staff eme1·gency call shall be turned off only at
7.3.2.1 Voice/Telecommunications. (Reserved)
the station, room, or space from where it originates.
7.3.2.2 Local Area Networks (LANs). (Reserved)
7.3.3.1.4* Code Call. 1l1e nurse call system shall inclurle
7.3.2.3 Wireless Local Area Network (LAN) S ystems and Public p1·ovisions to summon a�sistance from medical emergency
WIFi Hot Spots. (Reserved) resuscitation teams in locations set forth by federal, state, and
local codes.
7.3.2.4 Wrreless Voice Systems and In-Building Cellular
Networks. (Reserved) *
7.3.3.1.4.1 A corle call shall be turnerl off only at the station,
room, or space from where it originates.
7 .3.2.5 UHF, VHF, 800 MHz, and 900 MHz R adio Communica­
tion Systems. (Reserved) 7.3.3.1.5 Call stations locaterl in areas whe1·e patient� are
unrler constant visual surveillance. such as pre-op, recovery.
7.3.2.6 Cable Television. (Reserved) and emergency units shall be permitted to be limited to the
staff eme1·gency call anrl the code call, and two-way communi­
7.3.3 Other Communications Systems.
cation with the patient bed location shall not be required.
7.3.3.I Nurse Call Systems.
7.3.3.1.6 Nurse call system prm,isions shall be provirlerl for
7.3.3.1.1* General. The nu1·se call systems shall communicate geriau·ic, A.lzheime1·'s, and othe1- dementia units whe1-e:
patient and staff calls for assistance and information in health
(I) i\11 call stations shall have tampe1·-resistant fa�teners.
care facilities.
(2) Provisions shall be marle for the removal or covering of
7.3.3.1.1.1 The nu1·se call systems shall he the audimisual type call buttons anrl outleL�.
or tone visual l:)•pe and listed fo1· the pm·pose. (3) Call corrls or pull stt-ings in excess of 152 mm (6 in.) shall
not be permitterl.
7.3.3.1.1.2 The recognized standard for a listed nurse call
system shall be UL 1069. Standard Jar Hnspital Signaling and 7.3.3.1.7 Nm·se call system provisions shall not be 1·equirerl in
Nurse Call .l!.'quipmmt. psychiatric unit�, except for psychiatt·ic seclusion ante/exam
rooms where stalf emergency call stations shall be provided:
7.3.3.1.1.3* The nurse call system shall provide event notifica­
(I) Call stations shall have tampe1°resistant fasteners.
tions f or one 01· more of the following: medical device alarn1s,
f Provisions shall be made for the 1·emoval 01· cove1·ing of
staff emergency calls, code calls, and staf or patient requests (2 )
call huttons anrl outlet�.
for help or assistance.
( 3) Call cords or pull su-ings shall not be permitterl.
7.3.3.1.1.4P1·imary notification of nurse call events shall be (4) Control to limit unauthorizerl use shall he permitterl.
provided by a listed nurse call system in accordance with
7.3.3.1.8.
7.3.3.1.8 Notification Signals. The nurse call system shall
annunciate each call visibly and audibly to all areas to w here
7.3.3.1.1.5* Supplemental features shall be permitted to calls neerl to be rli1·ected and as 1·equired by state anrl local
include call notification to alphanumeric pagers and othe1· codes.
wireless devices carried by health care facility staff.
7.3.3.1.8.1 Notification signals for a code call and staff emer­
7.3.3.1.2 Patient Area Call Stations. The locations of call gency call shall be individually identifiable and rlistinct from all
stations and calling devices shall be in accordance with the othe1· nu1·se call signals.
requirement� set forth hy federal, state, and local codes.
7.3.3.1.8.2 Activation of a call station including patient
7.3.3.1.2.1 * Each patient bed location shall he provided with a station. hath station, staff eme1·gency station, and code call
call station. station shall activate the following notification signals:

7.3.3.1.2.2* A single call station that provides nvo-way voice ( 1)
communications shall not serve m01·e than two adjacent berls
with calling devices. (2)
7.3.3.1.2.3* Call stations at patient bed locations shall be
pe1·mitterl to provide supplemental signaling of merlical device ( 3)
alarms.
(4)
7.3.3.1.2.4 v\1hen provided, supplemental signaling of a merli­
cal device alarm shall be in accorrlance with 7.3.3.1.8.
(5)
7.3.3.1.2.5 Bath stations shall be provided at each inpatient
toilet, bath, shower, or sitz bath and shall be accessible to a
patient lying on the floor.
Visual signal in the corridor at the patient room door or
care space
Visual signals at coITirlor i nte1·sections whe1·e individual
patient room door or care space signals a1·e not di1·ectly
visible from the associated nursing station
Visible anrl audible signals at the nurse maste1· station anrl
associated duty stations
Visible signals at the calling station from which the call
01·iginates
A \�sual or aural signal indication at each aurlio calling
station to indicate voice circuit operation

7.3.3.1.2.6 A pull corrl shall be pe1·mitterl to enable access by a

patient lying on the floor.

2021 Edition
 INFORMATION TECHNOLO(;y AND COMMUNICATIONS SYSTEMS
7.3.3.2 Patient Tracking. (Reserved)
7.3.3.3 Equipment and As.set Tracking. (Reserved)
7.3.3.4 Staff and Visitor Tracking. (Reserved)
7.3.3.5 Wireless Phone and Paging Integration.
7.3.3.5.1 Wi1·eless phone and paging systems that a1·e used for
enhanced clinical staff communications and that can be inte­
grated ,...,jth the nurse call system or with a shared interoperable
clinical IT network shall pro,ide listed electrical safety and FCC
certifications that a1·e appropt·iate fot· the intended use.
7.3.3.5.2* Wireless phone and paging systems that are used
for enhanced clinical stall communications and notification of
nurse call evenl� or interoperable clinical alarm evenl� shall he
managed and controlled as described in 7.3.3.7.1.
7.3.3.6 Patient and Equipment Monitori ng Systems.
(Reserved)
7.3.3.7 Clinical Information Systems.
7.3.3.7.1" The clinical IT network shall be managed and
controlled in accordance with the following:
(1) The overall responsibility for risk management of the
clinical IT netwo1·k shall be that of the 1·esponsible 01·gani­
zation.
(2) The responsible organization shall establish, maintain,
and be accountable for the clinical IT network risk
management file.
(3) The health care facility's governing body shall be account­
able fo1· all policies, resources, and risk management
processes.
(4) The health ca1·e facility's governing body shall appoint a
clinical IT network risk manager.
(5) The clinical IT network risk manager shall be responsible
fot· all duties.
(fl) Manufacturers for each device placed on the clinical IT
network shall provide all required documentation.
(7) The health ca1·e facility's governing body shall be account-
able for document control and procedures.
7.3.3.7.2* It shall be permitted for the nurse call system to
utilize the interoperable clinical IT netwo1·k provided that the
nurse call system is listed to UL l069, Standard for Hospital
Sign aling and Nurw Call Equipmmt, and identified for use in a
shared net\vork e11vit-onment.
7.3.3.7.3* The clinical IT net\vork shall provide at least t\vo
independent pathways where the operational capability of each
pathway to each device shall be verified through end-to-end
communication.
7.3.3.7.3.1 \\'here one single addressable device is served
(e.g., an end-point te1·minal device \,,jth a single connection to
the clinical IT network, which is not part of the net\vork infra­
strncture trnnsporting clinical inforniation bet\Veen end
points), only one pathway shall be required.
7.3.3.7.4 Conditions that affect the operation of the normal
and 1·edundant clinical IT net\vork pathways shall be annunci­
ated as a trouble signal when minimal operational require­
ment� cannot be met.
99-95
7.3.3.7.5* Requirement� for utilizing the independent 1·edun­
dant net\vork paths and monitoring the operational integrity of
the clinical IT net\vork s hall he established in the clinical IT
netwm·k risk management plan maintained by the health care
facility's governing body.
7.3.3. 7.6 An event management process fot· the clinical IT
net\Vot·k shall be documented by the health care facility's
governing body and include at least the following:
(1) Switchover from one pathway to the othe1· when deemed
necessary
(2) Record all negative events and 1·emediation actions
(3) Report of event�, actions, and findings by the clinical IT
net\vork 1·isk manage1·
(4) Evaluate evenl�, rea�sess risks, and propose appropt·iate
changes through change-release management processes
and, t1·ack all cotTective and p1·eventive actions
7.3.3.B Pharmacy. (Reserved)
7.3.3.9 Material Management Information Systems. (Reserved)
7.3.3.10 Electronic Medical Records and Dictation Systems.
(Reserved)
7.3.3.1I Medical Imaging Systems. (Reserved)
7.3.3.12 Archiving Systems. (Reserved)
7.3.4 Security Systems.
7.3.4.1 Internet Protocol (IP) Security Cameras Systems.
(Reserved)
7.3.4.2 Digital Video Recording. (Reserved)
7.3.4.3 Intrusion Detection Systems. (Reserved)
7.3.4.4 Sitewide Monitoring. (Reserved)
7.3.4.5 Access Control Systems. (Reserved)
7.3.4.6 ID Badging Systems Integrated with Point of Sales
Systems. (Reserved)
7.3.4.7 T hreat Protection Systems. (Reserved)
7.3.4.B Parking Access Systems. (Reserved)
7.4 Category 2 Systems.
7.4.1 InforllUltion Technology and Communications Systems
Infrastructure.
7.4.1.1 Requirements for information technology and
communications systems infra�tructure shall be in accordance
with 7.3.1, except as specified in 7.4.1.1.1.
7.4.I.I.I Redundant patlm0dys and cabling for the backbone
distribution system shall not be required.
2021 Edition
99-96 HEALTH CARE FACILITIES CODE
7.4.2 Voice, Data, Communications, and Cable Television
Systems.
7.4.2.1 Voice/Telecommunications. (Reserved)
7.4.2.2 Local Area Networks (LANs). (Reserved)
7.4.2.3 Wireles.s Local Area Network (LAN) S ystems and Public
WiFi Hot Spots. (Reserved)
7.4.2.4 Wrreles.s Voice Systems and In-Building
Networks. (Reserved)
7.4.2.5 Cable Television. (Reserved)
7.4.3 Other Communications Systems.
7.4.3.1 Nurse Call Systems.
7.4.3.1.1 General. The nurse call system shall be in accord­
ance with the 1·equi1·ements in 7.3.3.1.
7.4.3.1.2 Provisions for medical de'vice alarms and code calls
shall not be 1·equired. (Sff 7.3.3.1.1.3.)
7.4.3.2 Patient lracking. (Reserved)
7.4.3.3 Equipment and &set Tracking. (Reserved)
7.4.3.4 Staff and Visitor lracking. (Reserved)
7.4.3.5 Wrreles.s Phone and Paging Integration. Wireless
phone and paging integration systems shall be in acconfance
with 7.33.5.
7.4.3.6 Patient and Equipment Monitoring
(Reserved)
7.4.3.7 Clinical Information Systems. Clinical info1·mation
systems shall be in accordance with 7.:1.3. 7.
7.4.3.8 Electronic Medical Records and Dictation Systems.
(Reserved)
7.4.3.9 Medical Imaging Systems. (Reserved)
7.4.3.10 Archiving Systems. (Reserved)
7.4.4 Security Systems.
7.4.4.1 Internet Protocol (IP) Security Cameras Systems.
(Reserved)
7.4.4.2 Digital V ideo Recording. (Reserved)
7.4.4.3 Intrusion Detection Systems. (Reserved)
7 .4.4.4 Sitewide Monitori ng. (Reserved)
7.4.4.5 Access Control Systems. (Reserved)
7.4.4.6 ID Badging Systems Integrated with Point of Sales
Systems. (Reserved)
7.4.4.7 Threat Protection Systems. (Reserved)
7.4.4.8 Parking Access Systems. (Reserved)
7.5 Category 3 Systems.
7.5.1 Information Technology and Communications Systems
Infrastructure.
7.5.1.1 Requirements for i11fo1·mation technology and
communications systems infrastructure shall be in accordance
with 7.il. l, with exceptions as noted in 7.5.1.1.1 through
7.5.1.1.4.
2021 Edition
7.5.1.1.1 Dual service entrnnce pathways into the EF are not
required.
7.5.1.1.2 Power circuits serving equipment in the EF, the TER,
and TRs shall not be requi1·ed to be connected to the essential
electrical system.
7.5.1.1.3 HVAC systems serving the EF, the ER, and TR� shall
not be required to be connected to the essential electric al
Cellular system.
7.5.1.1.4 Redundant pathways and cabling for the backbone
distribution system shall not be requi1·ed.
7.5.2 Voice, Data, Communications, and Cable Television
Systems.
7.5.2.1 Voice/Telecommunications. (Reserved)
7.5.2.2 Local Area Networks (LANs). (Reserved)
7.5.2.3 Cable Television. (Reserved)
7.5.3 Other Communications Systems.
7.5.3.1 Nurse Call Systems. (Reserved)
7.5.3.2 Electronic Medical Records and Dictation Systems.
(Reserved)
7.5.3.3 Medical Imaging Systems. (Reserved)
7.5.3.4 Archiving Systems. (Reserved)
7.5.4 Security Systems.
Systems.
7.5.4.1 Internet Protocol (IP) Security Cameras Systems.
(Reserved)
7.5.4.2 Digital V ideo Recording. (Reserved)
7.5.4.3 Intrusion Detection Systems. (Reserved)
7.5.4.4 Access Control Systems. (Reserved)
Chapter 8 Plumbing
8.1 Applicability.
8.1.1 This chapter shall apply to construction of new health
care facilities, except as noted in 8.1.2 and 8.1.:l.
8.1.2 This chapter shall also apply to the alte1·erl, renovated,
or modernized ponions of existing systems 01· individual
component�.
8.1.3 A.n existing system that is not in sn·ict compliance with
the prmisions of this code shall be permitted to be continued
in use, unless the authority ha'vingjurisdiction has determined
that such use constitutes a distinct hazard to life.
8.2 System Category Criteria. The health care facility's
governing body that has the 1·esponsibility fo1· the building
system componenrn as identified in this chapter shall designate,
in accordance with the function of each space, building system
categories in accm·rlance with Sections 4.1 and 4.2.
8.2.1* The category of risk applied to each plumbing system
serving a space shall be independent of the categm·y of risk
applied to othe1· systems serving that same space.
 HEATIN(;, VENTILATION. AND AIR CONDITIONING (H\�C)
8.3 General Requirements.
8.3.1 Potable Water. Potable water systems shall comply with
applicable plumbing codes and the applicable volume of FGI
guidelines.
8.3.2 Nonpotable Water. Nonpotahle water systems shall
comply with applicable plumbing co,les and the applicable
volume ofFGl guidelines.
8.3.3 Water Heating. Maximum hot water temperatm·es shall
comply with applicable plumbing codes and the applicable
volume of FGI guidelines.
8.3.4 Water Conditioning. \,Vate1· shall be treated or heated to
control pathogens in the water.
8.3.5 Nonmedical Compres.sed Air.
8.3.5.1 Nonmedical ai1· compressors shall be listed or
approved.
8.3.5.2 Nonmedical compressed air shall not be used for
powe1·ing medical instrnmenl� 01· fo1· human respirntion.
8.3.5.3 Nonmedical compressed ai1· shall meet the quality and
pressure requirement� of the equipment connected to the
system.
8.3.6 Special Use Water Systems. \-\'hen special use water
systems are required, the applicable volume of FGI guidelines
01· the applicable ANSI-1·eviewed standard shall be followed.
8.3.7 Grease Interceptors.
8.3.7.1 Sizing for grease interceptors shall be pe1·mitted in
acc01·dance with local plumbing codes 01· an engineered calcu­
lation fact01·ing meals served per day.
8.3.8 Fixtures. Plumbing fixtures shall be in accordance with
the applicable volume of FGI guidelines.
8.3.9 Black Waste Water. Black waste water shall be
discha1·ged to a sanitary sewer or private on-site waste u·eatment
system as pe1·mitted by applicable plumbing codes.
8.3.10 Gray Waste Water.
8.3.10.1 Grny \\'aste water shall he permitted to he stored on­
site and used for nonpotable water systems as permitted by
applicable plumbing codes.
8.3.10.2 Grny waste water shall not be used f01· any system that
aerosolizes the water in a breathing zone 01· has direct contact
with humans.
8.3.10.3 Excess grny wa�te water shall be discharged to a sani­
tary sewe1· or private on-site wa�te treatment system as permit­
ted by applicable plumbing codes.
8.3.11 Oear Waste Water.
8.3.11.1 Clear waste water shall be permitted to be stored on­
site and used for nonpotable water systems as permitted by
applicable plumbing codes.
8.3.11.2 Clear wa�te water that has been treated to potable
water standards shall be permitted to be used as nonpotable
wate1·.
8.3.11.3 Clear waste water that has not been u·eated to potable
water standards shall not be used for any system that aerosol-
99-97
izes the \\'ater in a breathing zone or has direct contact with
humans.
8.3.11.4 Excess clear waste wate1· shall be discha1·ged to a
st01·m sewe1·. held in detention ponds, 01· recharged into the
water table as permitted by applicable plumbing codes.
8.3.12 Drainage S ystems. Drainage systems shall comply with
applicable plumbing codes and the applicable volume of FGl
guidelines.
8.4 Category I. (Reserved)
8.5 Category 2. (Reserved)
8.6 Category 3. (Reserved)
Ch.apter 9 Heating, Ventilation, and Air Conditioning (HVAC)
9.1 Applicability.
9.1.1 This chapter shall apply to construction of new health
ca1·e facilities, except as noted in 9.1.2 and 9.1.:1.
9.1.2 This chapter shall also apply to the altered, renovated,
or modernized portions of existing systems or individual
component�.
9.1.3 A..11 existing system that is not in su-ict compliance with
the provisions of this code shall be permitted to be continued
in use, unless the authority ha\ing jurisdiction has dete1·mined
that such use constitutes a distinct hazard to life.
9.2 S ystem Category Criteria. The health care facility's
governing body that ha� the responsibility for the building
system componenl� as identified in this chapter shall designate.
in accordance with the function of each space, building system
categ01·ies in accordance with Sections 4.1 and 4.2.
9.2.1 * The categ01·y of risk applied to each HVAC system se1·v­
ing a space shall be independent of the category of risk applied
to other systems sening that same space.
9.3 General.
9. 3. 1 Heating, Cooling, Ventilating, and Proces.s Systems.
9.3.1.1 Heating, cooling, ventilating, and process systems serv­
ing spaces or providing health care functions covered by this
code or listed within ASHAAE 170, Ventilation of Hmlth Cart
Facilities, shall be provided in accordance with ASHRAE 170.
9.3.1.2 Laborntories shall comply with NFPA 45.
9.3.1.3* Anesthetizing Locations. A.nesthetizing locations
shall not be 1·equi1·ed to have a smoke purge system.
9.3.2 Energy Conservation. Heating, cooling, and ventilating
srtems serving spaces 01· providing health care functions
covered by this code shall comply with ASHRA.E 90.1, EnPrgy
Standard for Buildings 1'.xa•pt Lm,,-Rw RPsidPntial Buildings, m
another locally adopted energy code.
9.3.3 Commissioning.
9.3.3.1 Heating. cooling, ventilating, and process systems serv­
ing spaces or providing health care functions cove1·ed by this
code shall be commissioned in acc01·dance with ASHRA.E 90.1,
EnPrgy Standardf()r Buildings Exapt Low-Ri�P RPsidmtial Buildings.
9.3.3.2* Commissioning shall follow any publicly 1·eviewed
document acceptable to the authority havingjm·isdiction.
2021 Edition
99-98 HEALTH CARE FACILITIES CODE
9.3.4 Piping. Heating. cooling, ventilating. aml process
systems serving spaces or providing health care functions
covered by this code shall utilize piping systems complying with
applicable mechanical co<les.
9.3.5 Ductwork. Heating, cooling, ventilating, an<l process
systems se1·ving spaces or providing health ca1-e functions
covered by this code shall utilize ductwm·k systems complying
with NFPA 90A or applicable mechanical codes.
9.3.6 Medical Gas Storage or Transfilling.
9.3.6.1 All ga�es, othe1· than medical gases, shall be provided
with ventilation per NFPA 55.
9.3.6.2 Outdoor stornge/installations fot· me<lical gases an<l
cryogenic fluids shall be provided with ventilation per
NFPA 55.
9.3.6.3* Medical ga�es and ct"yogenic fluids that are in use pet·
Chapter 11 shall not reguire special ventilation.
9.3.6.4 Transfilling a1·ea shall be provide<l with ventilation in
accordance with NFPA 55.
9.3.6.5 In<loor storage or manifold areas an<l storage or mani­
fold buildings fix medical gases and cryogenic fluids shall be
provided with natural ventilation or mechanical exhaust venti­
lation in acc01·<lance with 9.3.6.5.l through 9.3.6.8.
9.3.6.5.1 * For the purposes of this section the volume of fluid
(ga� and liguid) to be used in detennining the ventilation
reguirement� shall be the volume of the stm·ed fluid when
expande<l to st an<lard temperature an<l pressure (STP) of
either the largest single vessel in the enclose<l space or of the
entire volume of the connecte<l vessels that are on a common
manifold in the enclosed space, whichever is larger.
9.3.6.5.2 Natural Ventilation.
9.3.6.5.2.1 Natural ventilation shall consist of two nonclosable
louvered openings, each having an aggregate free opening area
of at lea�t 155 cm"/35 L (24 in.�/1000 ft1) of the fluid designed
to be store<l in the space and in no case less than 465 cm 2
(72 in.�).
9.3.6.5.2.2 One opening shall be locate<l within 30 cm ( l ft)
of the floor, and one shall be located within 30 cm (1 ft) of the
ceiling.
9.3.6.5.2.3 The openings shall be locate<l to ensure cross
ventilation.
9.3.6.5.2.4 Natural ventilation openings shall he <li1·ectly to the
out�ide atmosphe1·e without ductwork.
9.3.6.5.2.5 Mechanical ventilation shall he prmided if natural
ventilation reguirement� cannot he met.
9.3.6.5.3 Mechanical Ventilation.
9.3.6.5.3.1 Mechanical exhaust to maintain a negative pres­
sure in the space shall be provided continuously, unless an
alternative design is approved by the authority having jut·is<lic­
tion.
9.3.6.5.3.2 Mechanical exhaust shall be at a rate of l L/sec of
airflow for each 300 L (1 cfm per 5 ft3 of flui<l) designed to be
stored in the space and not less than 24 L/sec (50 din) nm·
mme than 235 L/sec (500 cfin).
2021 Edition
9.3.6.5.3.3 Mechanical exhaust inlets shall be unobstrncted
and shall draw air from within 300 mm (1 ft) of the floor and
adjacent to the cylinder 01· containers.
9.3.6.5.3.4 Mechanical exhaust air fans shall be supplied with
electrical power from the essential elecu·ical system. \-\'here an
essential electrical system is not provided, a risk assessment
shall be conducted to dete1·mine if continuous ventilation shall
be provi<le<l by alternate means.
9.3.6.5.3.5 De<licated exhaust systems shall not be regui1·ed,
prnvided that the system does not connect to spaces that
contain combustible or flammable materials.
9.3.6.5.3.6 The exhaust duct material shall be noncombusti­
ble.
9.3.6.5.3.7 A means of make-up air shall be prmided accord­
ing to one of the following:
( l) Air shall be permitted via noncombustible <luctwork to be
transferre<l from aqjacent spaces, from out�ide the build­
ing, or from spaces that do not contain combustible or
flammable mate1·ials.
(2) Air shall be pe1·mitted to be transferre<l from a corridor
under the door up to the greater of 24 L/sec (50 cfm) or
15 petTent of the room exhaust in accordance ½':ith
NFPA 90A.
(3) Supply air shall be permitted to be provi<le<l from any
building ventilation system that <loes not contain flamma­
ble m· combustible vapors.
9.3.6.6 Discharge from the natural an<l mechanical ventilation
systems shall be site<l by a minimum sepa1·ation distance in
accordance with NFPA 55.
9.3.6.7 A storage room shall maintain a temperature not
greate1· than 52"C ( 125'F).
9.3.6.8 A transfer or manifol<l room shall maintain a tempera­
ture not greater than 52 ° C (125'F) and not less than -i'C
(20 ° F).
9.3.7 Waste G�.
9.3.7.1 Removal of excess anesthetic gases from the anesthesia
circuit shall be accomplished by waste anesthetic gas disposal
(WAGD), as <lesc1·ihe<l in Chapter 5, m· by an active or passive
scavenging ventilation system.
9.3.7.I.I Active Systems. A dedicated exhaust system \\':ith an
exhaust fan shall be provided to interconnect all of the anes­
thesia gas circuit� to provide sufficient airflow and negative
pr·essure in the gas disposal tubing so that cross contamination
<loes not occut· in the other· ci1·cuit� connecte<l to the system.
9.3.7.1.2 Passive Systems.
9.3.7.I.2.I A dedicated exhaust system with an exhaust fan
shall be provided to exhaust snorkels at all of the anesthesia gas
circuits to provi<le sufficient airflow to capture the gases,
vapors, and pa1·ticles expelled from the gas <lisposal tubing.
9.3. 7.1.2.2 The snorkel shall include a minimum 25.4 mm
(1 in.) diameter tubing connecte<l to the exhaust system.
9.3. 7.2 All the exhausted ai1· shall be vented to the external
atmosphe1·e.
 ELECTRlCAL EQUlPMENT
9.3.7.3 The excess anesthetic ga�es shall be deposited into the
exhaust stream either at the exhaust grille or further down­
stt·eam in the exhaust duct.
9.3.8 Medical Plwne Evacuation.
9.3.8.1" Plumes from medical procedures, including the use
of lase1·s, shall he captut·ed by one of the following methods:
( l )* Dedicated exhaust system that discharges in accordance
with 9.3.8.2
(2) Connection and return or exhaust duct after air cleaning
through HEPA and gas phase filtration
(3) Point of use smoke evacuator for air cleaning and return
to the space
9.3.8.2 The exhaust shall be located as follows:
(I) Outdoors
(2) At least 75 m (25 ft) from any door, window, air intake,
or othe1· openings in buildings tll" places of public assem­
bly
(3) At an elevation diflerent from ai1· intakes
(4) \'\'he1·e prevailing winds, adjacent huildings, topography,
or other influences will not divert the exhaust into occu­
pied area� or prevent dispersion of the exhaust
9.3.9 Emergency Power System Room. Heating, cooling, and
ventilating of the emergency powe1· system shall be in accord­
ance with 6. 7.1.3.4.
9.3.10 Ventilation During Construclion. Ventilation during
construction shall comply with the applicable volume of FGI
guidelines.
9.4 Category I. (Reserved)
9.5 Category 2. (Reserved)
9.6 Category 3. (Reserved)
Chapter 10 FJectrical Equipment
10. I* Applicability.
IO.I.I TI1is chapter shall apply to the performance, mainte­
nance, and testing of electrical equipment in new and existing
health ca1·e facilities.
10.1.2 Experimental or research apparatus built to or<ler or
unde1· development shall be used unde1· qualifie<l supervision
an<l shall have a deg1·ee of safety that is equivdlent to that
<lescrihed herein or that has been deemed acceptable by the
facility.
10.1.3* Reserved.
10.2 Performance Criteria for Patient Care-Related FJectrical
Appliances and Equipment.
10.2.1 Perffillllently Connected - Fixed Equipment. Patient­
connected electric appliances shall be grounded to the equip­
ment grounding bus in the distribution panel by an insulated
grounding conduct01· run with the power conductors.
10.2.2 Cord- and Plug-Connected - Portable Equipment.
I 0. 2. 2.1 Grounding of Appliances.
10.2.2. I. I All cor<l-<:onnected electrically powered appliances
that a1·e not double insulated and are used in the patient ca1·e
99-99
vicinity shall be provided with a tlu·ee-wire powe1· cot·d and a
three-pin grounding-type plug.
10.2.2.1.2 Double-insulated appliances shall be pe1·mitted to
have two conductor cords and shall be rated as Class II devices.
10.2.2.2 Attachment Plugs. Attachment plugs listed for the
purpose shall be used on all cord-connected appliances.
10.2.2.3 Construction and Use. The attachment plug shall be
a tw"O--pole, three-wi1·e grounding type.
10.2.2.3.1 Appliances supplied by othe1· than 120-V single­
phase systems shall use the grounding-type plug (cap) appro­
priate fo1· the particula1· power system.
10.2.2.3.2 The grounding prong of the plug shall be the fit-st
to be connected to, and the la�t to be disconnected from, the
receptacle.
I0.2.2.3.3 If sct"ew terminals a1·e used, the stt·anded conduct01·
shall be twisted to prevent stray strand�. but the bundle shall
not be tinned after twisting.
I 0.2.2.3.4 If the conducto1· is not twisted, it shall be attached
hy an approved terminal lug.
10.2.2.3.5 The powe1· cord conduct01·s shall be arranged so
that the conductors are not under tension in the plug.
10.2.2.3.6 The grounding conductor shall be the last one to
disconnect when a failure of the plug's strain 1·elief allows the
energized conductors to be disrupted.
10.2.2.3. 7 Strain Relief. Strain relief shall be provided.
10.2.2.3.7.1 The strain relief shall not cause thinning of the
conductor insulation.
10.2.2.3.7.2 The strain relief of 1·eplaceable plugs shall be
capable of being disassembled.
10.2.2.3.7.3 Plugs shall be permitted to be integrally molded
onto the co1·djacket if the design is listed fot· the put·pose.
10.2.2.3.8 Tesling. The wiring of each cord assembly shall be
tested for continuity and polarity at the time of manufacture,
when assembled into an appliance, and when repaired.
10.2.3 Power Cords.
10.2.3.1 Material and Gauge.
10.2.3.1.1 The flexible cord, including the grounding conduc­
tor, shall be of a type suitable for the particular application;
shall be listed for use at a voltage equal to or greater than the
f
rated powe1· line voltage o the appliance; and shall have an
ampacity, as given in Table 400.5(A) of NFP./1. 70, equal to m
greater than the current rating of the device.
10.2.3.1.2 "Hard Service" (SO, ST. or STO). 'Junim Ha1·d
Se1·vice"' (SJO, SJf, or �TO), 01· equivalent listed flexible cmd
shall be used , except where an appliance with a cor<l of
anothe1· designation has been listed fot· the purpose.
I0.2.3.2 Grounding Conductor.
10.2.3.2.1 Each electric appliance shall be provided with a
grounding conduct01· in its powe1· cord.
10.2.3.2.2 The grounding conductor s hall be not smaller than
18AWG.
2021 Edition
99-100 HEALTH CARE FACILITIES CODE

I 0.2.3.2.3 1l1e groun<ling conductor· of co1·ds longer than 10.2.4 Adapters and Extension Cords.
4.6 m ( 15 ft) shall be not sm aller than 16 A\VG.
10.2.4.1 Tl11·ee-prong to twn-prong adapters shall not be
10.2.3.2.4* A grounding con<luctor in the power cord shall permitted.
not be 1·e(]uire<l for <louble-insulated appliances. but a func­
tional groun<l conductor (functional earth con<luctor) shall be
10.2.4.2 Adapters and extension cor<ls meeting the rerp1ire­
ment� of 10.2.4.2.1 through 10.2.4.2.3 shall be pe1·mitted.
pe1·mitted.

I 0.2.3.3 Detachable Power Cords. 10.2.4.2.1 All adapters shall be listed fm the purpose.

10.2.3.3.1 A <letachable powe1· cord shall he pe1·mitted if an

accidental disconnection would not present an unacceptable
hazatTI 01· if a mechanism that reliably prevents ina<lvertent
disconnection is used.
10.2.3.3.2 Detachable power cords shall be designed so that
the grounding conductot· is the first to be connected and the
last to be disconnected.
10.2.3.3.3 The cord set to the appliance shall be listed for the
purpose.
10.2.3.4 Connection to Circuit and Color Codes.
10.2.3.4.1Power cot·ds, rega1·dless of whether intended fot· use
on grounded or isolate<l power systems, shall he connected in
accordance "1th the conventions of a grounded system.
10.2.3.4.2 lhe circuit con<luctors in the cord shall be connec­
ted to the plug and the wiring in the appliance so Lhat any of
the follm\1ng devices, when used in the prima ry circuit, are
connected to the ungrounded conductm·:
( 1) Center contact of an Edison b ase lampholder
(2) Solitary fuseholder
(3) Single-pole, ovet-cun-ent protective <levice
(4) Any othe1· single-pole, current-inten-upting device
10.2.4.2.2 Attachment plugs an<l fittings shall be liste<l for the
purpose.
10.2.4.2.3 The cabling shall comply �th 10.2.3.
10.2.4.3 Oved1ead powe1· receptacles shall be permitte<l to be
supplied by a flexible cord with strain 1·elief (ceiling drop) that
is connected at a ceiling-mounted junction box in either of the
follm\1ng w ays:
(1) Pe1·manenti y
(2)* Utilizing a locking-type attachment plug cap an<l recepta-
cle combination, or other metho<l of retention
10.3 Testing Requirements - Patient Care-Related Electrical
Appliances and Equipment.
*
10.3.1 Physical Integrity. The physical integrity of the power
cord assembly composed of the power cord, attachment plug,
an<l cord-strain 1·elief shall be confirmed by visual inspection.
10.3.2* Resistance.
10.3.2.1 For appliances that a re used in the patient care vicin­
ity, the resistance between the appliance chassis, or any
exposed conductive sudace of the appliance, an<l the ground
pin of the attachment plug shall be less than 0.50 ohm un<ler
the following conditions:

10.2.3.4.3 A second fi.tseholder or other overcurrent protec­ (1) 1l1e cord shall be flexe<l at its connection to the attach­
tive <levice provi<le<l in the appliance shall be permitte<l to be ment plug or connector·.
placed in the grounded side of the line. (2) 1l1e cord shall be flexe<l at its connection to the strain
relief on the chassis.
I 0. 2.3. 5 Cord Strain Relief.
10.3.2.2 The re(Jui1·ement of 10.3.2.1 shall not apply to accessi­
10.2.3.5.1 Cor<l strain 1·elief shall be provide<l at the attach­
ble metal parts that achieve separation from main part� by insu­
ment of the power cord to the appliance so that mechanical
lation or metallic screening or that are unlikely to become
stress, either pull, twist, or bend, is not transmitte<l to internal
energized (e.g., escutcheons or nameplates, small sct"ews).
connections.
I 0.3.3* Leakage Current Tests.
10.2.3.5.2 A strain relief molde<l onto the cor<l shall be
bonded to the jacket an<l shall be of compatible m aterial. 10.3.3.1 General.
10.2.3.6* Relocatable Power Taps (RPTs). Relocatable powe1· 10.3.3.1.1 The 1·e(]ui1·ements i n 10.3.3.2 thrnugh 10.3.3.4 shall
taps (RPT�) shall be permitted to he used to supply power to apply to all tests.
plug-connected components of a movable e(]uipment assembly
that is pole-, rack-, table-, pe<lestal-, 01· c art-mounted, provided
10.3.3.1.2 Test� shall be performed �th the powe1· switch ON
and OFF.
that all of the following con<litions a1·e met:

( 1 )* The RPT is securely attached. 10.3.3.2 Resistance Test.The resistance tests of 10.3.2 shall be
(2)* The sum of the ampacity of all appliances connected to conducted before un<lertaking any leakage cut-rent measm·e­
the outlet� does not excee<l 75 percent of the ampacity of ment�.
the flexible cord supplying the RPT
10.3.3.3* Techniques of Measurement. The test shall not be
(3) The ampacity of the flexible cord is in accordance �th
made on the load side of an isolated powe1· system or separable
NFPA. 70. isolation transfrll"mer.
(4) The RPT attachment plug must not be connected to
another RPT or extension cord. 10.3.3.4 Leakage and Touch Current Limits. 1l1e leakage and
(5) The electrical and mechanical integ1·ity of the assembly touch current limits in 10.3.4.2 an<l 10.3.5.4 shall be followed.
and its securement metho<l are regularly verified an<l
docurnente<l.

2021 Edition
 ELECTRICAL EQUIP1"1ENT 99-101

10.3.4 Leakage Current - Fixed Equipment.
10.3.4.1 Permanently wfred appliances in the patient ca1·e
vicinity shall be tested p1·i01· to installation while the equipment
is temporarily insulated from ground.
10.3.4.2 The leakage current flowing through the ground
conductm· of the power supply connection to ground of perma­
nently wired appliances installed in Categmy l or Categmy 2
spaces shall not exceed IO.O mA (ac or de) with all grounds
lifted.
10.3. 5 Touch Current -Portable Equipment.
10.3.5.1 Single Power Cord Supplying Power. If multiple devi­
ces are connected together and one powe1· cm·d supplies
powe1·. the touch current shall be measu1·ed as an assembly.
10.3.5.2 Mult iple Power Cords Supplying Power. ·when multi­
ple devices are connected together and mm·e than one power
cm·d supplies power, the devices shall be separnted into groups
according to their power supply cord, and the touch current
shall he measured independently fo1· each group a5 an assem­
bly.
10.3.5.3 Touch Leakage Test Procedure. Measurement� shall
be made using the circuit, such as the one illustrated in Figm·e
10.!l.5.3, with the appliance ground brnken in tw'o modes of
appliance operation as follows :
( l) Powe1· plug connected 1101·mally with the appliance on
(2) Powe1· plug connected nmmally with the appliance off (if
f
equipped with an on/of switch)
10.3.5.3.1 If the appliance has fixed redundant grnunding
(e.g., permanently fastened to the grnunding system), the
touch leakage cmTent test shall be conducted with the redun­
dant grounding intact.
10.3.5.4"' Touch Current - Portable Equipment. The touch
cmTent for cord connected equipment shall not exceed 500 µA
,vith normaf polarity and the ground wire disconnected (if a
grnund wire is provided).
10.3.6* Lead Leakage Current Tests and Limits - Portable
Equipment.
10.3.6.1 1l1e leakage cuITent between all patient leads
connected together and ground shall be tested with the power
plug connected normally and the device powered on.
10.3.6.2 The leakage cutTent between all patient leads
connected together and ground shall be measured with the
ground switch open and ,vith the ground switch closed.
10.3.6.3 An acceptable test configurntion shall be as illustrnted
in Fi gu re l0.3.6.3.
10.3.6.4 The leakage cuITent shall not exceed LOO µA fo1·
ground wi1·e closed and 500 �Lo\ ac for ground ,\lire open.
10.4 Nonpatient Electrical Appliances and Equipment.
10.4.1 Permanently Connected -Fixed. (Reserved)
10.4.2 Cord- and Plug-Connected - Portable Equipment in
Patient Care Vicinity.
10.4.2.1 Nonpatient care-related electrical equipment, includ­
ing facility- or patient-owned appliances that are used in the
patient ca1·e vicinity and ,viii, in rnKmal use, contact patient�,
f
shall be visually inspected by the patient's care staf or othe1·
personnel.
10.4.2.2 Any equipment that appearn not to be in prnpe1·
working order or in a worn condition shall be 1·emoved from
service or reported to the appropriate maintenance staff
10.4.2.3 Household 01· office appliances not commonly e­
quipped with grounding conductors in their powe1· cords shall
be permitted, provided that they are not located \\/ithin the
patient ca re vicinity Double-insulated appliances shall be
pe1·mitted in the patient ca1·e "icinity.
10.5 Administration.
10.5.1 R esponsibilities of the Health Care Facility's Governing
Body. (Reserved)
10.5.2 Policies.
10.5.2.1 Testing Intervals.
10.5.2.1.1 The facility shaft establish policies and protocols to
identify what patient ca1·e-1·elated electrical equipment
1·equi1·es pe1·iodic inspection and. whe1·e applicable, the type of
test and intervafs of testing.
10.5.2.1.2 All patient ca1·e-1·elated electrical equipment used
in the patient care vicinity shall be tested in accordance with
I0.3.5.3 m 10.3.6 befo1·e being put into senice for the first time
and after any repair or modification that might have compro­
mised electrical safety.
Patient lead selector
This connection is at switch (if any) Patient-
the service entrance (activated as required) connected
leads
or on the supply side .
of a separately derived Appliance power s
syStem. ("closed")
H (black)

This connection is at Appliance power switch

the service entrance (use both "off" and "on" positions) Input line
or on the supply side voltage ---�
of a separately derived Appliance Building '----<li-"T""--<:r.-<>---' !Insulating surface!
system. H (black) ground ;
Grounding contact switch Current H = Hot
Input line (use in both "open" and meter N = Neutral (grounded)
voltage "closed" positions) G = Grounding conductor
Building
ground =
--��-o-,� 01----- llnsulating surface! FlGURE 10.3.6.3 Test Circuit for Measuring Leakage
Current H = Hot Current Between Patient Leads and Ground -Nonisolated.
Grounding contact switch meter N = Neutral (grounded)
(use in "open" position) G = Grounding conductor

FIGURE 10.3.5.3 Example Test Circuit for Measuring Touch

Leakage Current.

2021 Edition
99-102 HEALTH CARE FACILITIES CODE
I 0.5.2.2* Protection of Patients with Direct Electrical Pathways
to the Heart. Only equipment that is specifically designe<l for
the put-pose fi.e., prmide<l with suitable isolated patient lea<ls
or connections (ca1·diac floating, also known a� CF, acco1·<ling
to ANSI/AAMI ES60601- l, MNliral Plertriral equipm,mt - Part I:
(',eneral m1uirnnmt� for basir safety and essmtial pr,rfrmnanre) l shall
be connecte<l directly to electt-ically conductive pathways to a
patient's hean.
10.5.2.3 Adapters and Extension Cords.
10.5.2.3.1 A<lapters and extension c01·ds meeting the require­
ment� of 10.2.4 shall be permitted to be used.
10.5.2.3.2 1l1ree- to two-prong adapters shall not be pe1·mit­
ted.
I 0.5.2.3.3 The ·wiring shall be tested for all of the following:
( l) Physical integ1-ity
(2) Polarity
(3) Continuity of grounding at the time of assembly and peri-
odicall y the1·eafte 1·
10.5.2.4 Devices Likely to Be Used During De.fibrillation.
Devices that are critical to patient safety and that a re likely to
be attached to the patient when a defibrillat01· is use<l (such a�
ECG monitors) shall be marked as "defibrillation prnof," a�
<lefined in ANSI/ AAMI ES60601- l, lvlediral flfftriml NJ1tipment
- Part 1: (',eneral m1uimn,mts for basir sapty and r,ssmtial perform­
anre.
10.5.2.5* System Demonstration. Any system consisting of
several electric appliances shall be <lemonstrated to comply
with this code as a complete system.
I 0.5.2.6 Appliances Not Provided by the Facility. Policies shall
be established for the control of appliances not supplied by the
facility.
10.5.3 Servicing and Maintenance of Equipment.
10.5.3.1 The manufacturer of the appliance shall fi.m1ish
document.� containing at least a technical <lescription, instruc­
tions fo1· use, and a means of contacting the manufactu1·e1·.
10.5.3.2 The document� specifie<l in 105.3. l shall inclu<le the
following, where applicable:
( l) Illustrations that show the location of controls
( 2) Explanation of the fimction of each control
(3) Illustt·ations of prnpe1· connection to the patient 01·
other equipment, 01· both
( 4) Step-by-step proce<lures for testing an<l proper use of the
appliance
(5) Safety considerntions in use and servicing of the appli­
ance
(6) Precautions to be taken if the appliance is use<l on a
patient simultaneously with other electt·ic appliances
(7) Schematics, wiring diagrams, mechanical layout�. pa1·t�
list�. an<l other pertinent <lata for the appliance
(8) Instructions for cleaning. disinfection, or sterilization
(9) Utility supply requi1-ements (electrical, gas, ventilation,
heating, cooling, and so forth)
( 10) Explanation of figures, symbols, and abbreviations on
the appliance
( 11) Technical perforn1ance specifications
(12) Instructions for unpacking, inspection, installation,
adjustment, and alignment
2021 Edition
(13) Preventive an<l c01-rective maintenance. inspection. and
repair proce<lures
10.5.4 Administration of Oxygen Therapy.
10.5.4.1 Electrical Equipment in Oxygen-Enriched Atmos­
pheres. Appliances, or a part(s) of an appliance or a system
(e.g., pillow speaker, remote control, pulse oximete1· prnbe), to
be used in the site of intentional expulsion shall comply with
one of the following:
( l) They shall be listed for use in oxygen-enriched atmos­
phe1·es.
(2) They shall be sealed so as to prevent an m..-ygen-enriched
atmosphere from 1·eaching elec trical components, 'll>ith
sealing mate1·ial of the type that will still seal even after
repeated exposu1·e to water, oxygen, mechanical vibra­
tion, an<l heating from the external circuitry.
(:I) They shall be ventilate<l so as to limit the oxygen concen­
tration sut-rounding electt·ical components to below
23.5 percent by volume.
( 4) They shall have both of the following characte1·istics:
°
(a) No hot surfaces over 300'C (573 F), except for
small (less than 2 \'\') hermetic ally sealed heating
elements, such as light bulbs
(b) No expose<l switching 01· spa1·k.ing points of electt·i­
cal energy that fall to the 1·ight of the curve fo1· the
appropriate type of circuit illustrated in Figure
10.5.4. l (a) thrnugh Figure 10.5.4. l (f), with the <le
(or peak ac) open-ci1-cuit voltage and short-ci1·cuit
cuITent required to be used
10.5.4.2 When only the remote contrnl 01· signal leads of a
<levice are to be use<l in the site of intentional expulsion, only
the control 01· signal leads shall be 1·equired to comply with
10.5.4. l .
10.5.4.3 Subparagrnphs 10.5.4. l an<l 10.5.4.2 shall not apply
to small (less than 2 \Al), hermetically sealed heating element�
s uch as light bulbs.
10.5.4.4 Electrical equipment sold '111th the intent to be used
in oxygen-enriche<l atmospheres shall he liste<l for use in
oxygen-enriche<l atmospheres.
10.5.4.5* Elec trical equipment used \\1thin oxygen delivery·
equipment shall be listed for use in O>..')'gen-enriched atmos­
pheres in accor<lance with ANSI/AA.Ml ES60601- l, Mediral Plff­
triral equipmmt - Part 1: (',ennal requireml'nts fnr basir. sapty and
essential pPrfo rmanre.
10.5.4.6* High-energy-delivering probes (such as defibrillator
paddles) 01· othe1· electrical <levices that do not comply with
10.5.4. l an<l 10.5.4.2, that a1·e deeme<l es sential to the care of
an indivi<lual patient, an<l that must be use<l within an a<lminis­
tt·ation site or within oxygen-delivery· equipment shall be
permitted.
10.5.5 Laboratory.
10.5.5.1* The laboratory· shall establish policies and protocols
for the type of test an<l intei-vals of testing fo1· appliances.
I 0.5.6 Record Keeping - Patient Care Appliances.
10.5.6.1 Instruction Manuals.
10.5.6.1.1 Instruction and maintenance manuals shall be
accessible to the group 1·esponsible fo1· the maintenance of the
appliance.
 ELECTRICAL EQUIP1"1ENT 99-103

SA SA

'
I
\ \
\

2A 2A

'r-.
1A
' 1A
,._

,
\

500 rnA
' 500 rnA
�....
'
I\
200 rnA 200 rnA
\
�
100 rnA
\ 100 rnA

'\.
50 rnA
"" 50 rnA

20 rnA 20 rnA

10 rnA 10 rnA
10 20 50 100 200 10 20 50 100 200
V V

FIGURE 10.5.4.1 (a) Resistance Circuits (L < I mH): FIGURE 10.5.4.1 (b) Resistance Circuits (L < I mH):
Minimum Igniting Currents, Applicable to All Circuits Minimum Igniting Currents, Applicable to Circuits Where
Containing Cadmium, Zinc, or Magnesium. Cadmium, Zinc, or Magnesium Can Be Excluded.

10.5.6.1.2 Instruction and user maintenance manuals shall be
accessible to the user.
10.5.6.1.3 Any safety labels an<l condensed operating instruc­
tions on an appliance shall be maintaine<l in legible condition.
10.5.6.2* Documentation.
10.5.6.2.1 A 1·econi shall be maintaine<l of the tests requi1·ed
by this chapter and associated repairs or modifications.
10.5.6.2.2 At a minimum, the rec01·d shall contain all of the
following:
( l) Date
(2) Unique identification of the equipment tested
(3) In<lication of which items have met or have failed to meet
the performance requirements of Section l 0.2
10.5.6.3 Records Retention. l11e reco1·ds shall he maintained
an<l kept for a period of time in acc01·dance with a health ca1·e
facility's recor<l retention policy.
10.5.7 Use. (Reserved)
I 0.5.8 Qualification and Tuaining of Personnel.
10.5.8.1* Pe1·sonnel concerned for the application 01· mainte­
nance of electric appliances shall he trained on the risks associ­
ated \,�th their use.
10.5.8.1.1 The health care facilities shall provi<le programs of
continuing e<lucation for it� pe1·s01rnel.
10.5.8.1.2 Continuing e<lucation programs shall include peri­
odic review of manufacturers' safety guidelines and usage
requi1·ement� for electrosut·gical units and similar appliances.
10.5.8.2 Personnel involve<l in the use of energy-delivering
de½ces including, but not limited to, elecu·osut·gical, sut·gical
laser, and fihe1°optic <levices shall 1·eceive pe1·iodic training in
fire prevention an<l suppression.
10.5.8.3* Equipment shall be sen-ice<l by qualified personnel
only.

2021 Edition
99-104 HEALTH CARE FACILITIES CODE

1H 10
100µH
500 mH 200µH
330µH -
I
...._ l
--.....
200 mH \
<( 1 mH �
100 mH ....
1.0
' _Q)
50mH
_.. 10mH

20mH

10 mH 100mH
L -� 0.1
5mH ''
...
....
2mH
...
1 mH
0.01
500 µH 2.0 10 100 500
Open circuit voltage V5c : V

200 µH
FIGURE 10.5.4.1 (d) Inductance Circuits (L > I rnH):
100 µH Minimum Igniting Currents for Various Voltages, Applicable to
10mA 20mA 50mA 100mA 200mA 500mA 1 A All Circuits Containing Cadmium, Zinc, or Magnesium.
I

FIGURE I 0_5.4.1 (c) Inductance Circuits (L > I rnH):

Minimum I gn iting Currents at 24 V, Applicable to All Circuits
Containing Cadmium, Zinc, or Ma gn esium.

2021 Edition
 ELECTRICAL EQUIP1"1ENT 99-105

1H 10,000 µF

500mH
3000 r•F I

200mH 1000µF

100mH
\
300 µF

50mH
100 µF

20mH
� 30 µF
• 11 V
C+ 40Q \l?ol
10mH
10 µF
\�� I./ C + 15Q ((;a)

.'
C C+ 5-6Q (Co)
5mH
3 µF

'
2mH
C+ 0Q (Sn) �'r..'
\ 1.0µF

1 mH
C+ 0Q (Co)i '
. 0.3µF
"'"'
500 µH
0.1 fl
I\
200 µH
0.03 µF
100 µH
10mA 20mA 50mA 100mA 200mA 500mA 1 A 2A 5A 0.01µF
1 3 10 30 1 00 300 1 000 3000
I
V
FIGURE 10.5.4.1 (e) Inductance Circuits (L > 1 mH):
FIGURE 10.5.4.1 (f) Capacitance Circuits Minimum Ignition
Minimum Igniting Currents at 24 V, Applicable Only to Circuits
Voltages. (The curves correspond to values of current-limiting
Where Cadmium, Zinc, or M agnesium Can Be Excluded.
resistance as indicated. The curve marked Sn is applicable only
where cadmium, zinc, or magnesium can be excluded.)

2021 Edition
99-106 HEALTH CARE FACILITIES CODE
Chapter 11 Gas Equipment
11.1 Appli cability.
11.1.1 This chapter shall apply to the performance, mainte­
nance. and testing of gas equipment in new and existing health
care facilities.
11.1. 2* This chapter shall apply to the use, at nm·mal atmos­
f
pheric pressure, o all of the following:
( 1) Nonflammable medical g-ases
(2) Vapors and aerosols
(3) Equipment required for the administration of 11.1.2(1)
and 11.1.2(2)
11.1.3 When used in this chapter, the tet·m oxygim shall be
intended to mean oxygen USP as well as mixtures of oxygen
and air.
11.1.4* This chaplet· shall not apply to special atmospheres,
such as those encountered in hyperharic chan1bers.
11.1.5* Reserved.
11.2 Portable Cylinder and Container Source.
11.2.1 Cylinder valve outlet connections shall confonn to the
mandatory t·equit·ements of CGA V-1, Standard for Compressed
(',as Cylinder ValvP Outlet and Inlet Connedions (ANSI B57.1)
(includes Pin-Index Safety System for medical gases).
11.2.2 W'hen low-pressure tht·eaded connections are
employed, they shall be in accordance with the mandatory
requirement� of CGA V-5, Dianwtl'r Index Sajfty Systnn (Noninter­
i:hangeable Low Pre.mire ConnPrtiom Jar lvlfdir:al (',as lippliratiom),
for noninterchangeable, low-pressure connections fot· medical
gases, air, and suction.
11.2.3 Low-pressut·e quick couplet· connections shall
nonintet-changeable between gas services.
11.2.4 Pressure-reducing regulators and gauges intended for
use in high-pt·essure senice shall be listed for such ser,ice.
11.2.5 Pressure-reducing regulators shall be used on high­
pressure cylinders to reduce the cylinder pressure to operating
pressu t·es.
11.2.6 Approved pressure-reducing regulators or other gas­
flow control de..,ices shall he used to t·educe the cylinder pres­
sure of ever y cylindet· used for medical put-poses. 1\ll such
devices shall have connections so designed that they attach only
to cylinders of gas for which they are designated.
11.2. 7* Equipment that could allow the intermixing of diffrt··
ent gases, either through defect� in the mechanism 01· through
error in manipulation in any portion of the high-pressure side
of any system in which these gases might flow, shall not be used
for joining cylinders containing compressed gases.
11.2.8 Cylinder valve outlet connections for oxygen shall be
Connection No. 540 or Connection No. 870 as described in the
mandatory t·equit·ement� of CGA V-1, Standard Jar Compressed
(',as Cy!indrr Valve Outlet and Inlet Connertions (ANSI B57.l).
2021 Edition
11.2.9 Cylindet· valve outlet connections fot· nitrous oxide
shall be Connection No. 326 or Connection No. 910 as de­
sct"ibed in the mandatory t·equirement� of CGA V-1, Standardfor
Cmnpm��ed Gas Cylinder ValvP Out!Pt and InM Conntr.tions (ANSI
B57. l).
11.3 Cylinder and Container Storage Requirements.
11.3.1 For the put·pose of this section, the health care facility's
governing body shall define criteria for determining full cvlin­
ders and containet·s.
11.3.2 Full cylinders and containers shall be stored in accm·d­
ance with this section.
11.3.3 Full cylinders and containet·s shall be segt·egated from
all others.
11.3.4 Full and empty cylinders shall be pt·evented from reach­
ing temperatut·es in excess of 52'C (125"F).
11.3.5* Design and Construction.
11.3.5.1 Stornge fot· nonflammable gases equal to or gr:eater
than 85 m3 (3000 frl) at STP shall comply with 11.3.!'>.2 unless
such installations are approved existing installations, which
shall be permitted to he continued in sei·vice.
11.3.5.2 Locations for the storage of nonflammable ga�es shall
meet the following requirements:
( 1) l11ey shall he constructed with access to move cylinders
and containers in and out of the location on hand trucks
complying with 11.4.3.1.1.
(2) They shall be provided wilh lockable doors 01· gates or
otherwise able to be secured.
(3) If outdoors, they shall be provided with an enclosure
constructed of noncombustible materials.
(4) If indoors, they shall have interior finishes of noncom­
be
bustible or limited-<:ombustible matet-ials.
(5) * If indoors, the room shall be separated from the rest of
the building by walls and flom·s having a 1-hour fire
t·esistance rnting with dom·s and othet· opening protec­
tives having a ¾-hour fire protection rating.
(6)* l11ey shall comply with NFP.A. 70 for unclassified (non­
hazardous) locations.
(7)* Fuel-fit·ed equipment shall not be located in the room.
(8) If they require heat, the maximum allowable tempera­
tun, of the in-room heating element shall be 130'C
(266'F).
(9) They shall be provided with racks, chains, or other
fa�tenings to secure all cylinders from falling, whether
full or empty.
(10) They shall be supplied with electt·ical powet· compliant
v.'ith the requirement� for essential electrical systems as
described in Chaplet· 6.
(11) They shall have rncks, shelves, and support�, whet·e
provided, constructed of noncombustible materials or
limited-combustible materials.
(12) * They shall protect electt-ical de'1ices from phpical
damage.
(13)* They shall allow access by delivery vehicles and manage­
ment of cylinders.
(1 4) If indoors, ventilation for medical ga� storage rooms
shall com ply with 9.3.6.
 GAS EQUIPMENT
11.3.6* Storage for nonflammable gases greater than 8.5 m3
(300 ft 3), but less thau 85 m3 (3000 ft3), at STP shall comply
with the 1·equiremenl� in 11.3.6.1 through 11.3.6.8.
11.3.6.1 Stm·age locations shall he out<loors i n an enclosure or
within an enclose<l inte1·ior space of noncombustible or
limited-combustible construction. with doors (or gates
outdoors) that can be secured against unauthorized entry.
11.3.6.2 Oxidizing gases such as oxygen an<l nitrous oxide
shall not be stored with any flammable ga�. liquid, or vapor.
11.3.6.3 Oxidizing gases such as oxygen an<l nitrous oxide
shall he separated from combustibles or flammable materials
f 11.3.12.2 Signs fo1· inei-t ga�es shall include the follm,fog
by any o the following:
f
(1) Minimum distance o 6.1 m (20 ft)
(2) Minimum distance of 1.5 m (5 ft) if the entire storage
location is protected by an automatic sprin kler system
designe<l in accor<lance with NFPA 13
(3) A gas cabinet in acconiance with NFPA 55
11.3.6.4 Full and empty cylinders shall he pt·evente<l from
reaching temperatures in excess of 52 ° C (125 ° F).
11.3.6.5 Cylinde1· or container restraint� shall comply with
11.6.2.3.
11.3.6.6 Smoking, open flames, electric heating elements, and
other sources of ignition shall he prohibite<l v.�thin storage
locations and within 6.1 m (20 ft) of out�ide storage locations.
11.3.6. 7 Cylin<ler valve protection caps shall comply ,,�th
11.6.2.2(4).
11.3.6.8 Ventilation for indoor medical gas storage rooms
shall comply with 9.3.6.
11.3. 7 Stm·age for nonflammable gases with a total volume
equal to or less than 8.5 m3 (300 ft 3) shall comply ,,�th the
requirement� in 11.3.7.1 an<l 11.3.7.2.
11.3. 7.1 Individual cylinde1· storage a�sociate<l with a smoke
compartment in accordance with NFPA 101 shall not be
require<l to be stored in enclosures.
11.3. 7.2 P1·ecautions in han<lling cylinde1·s specifie<l
11.3.7.1 shall be in accordance ,,�th 11.6.2.
11.3.8* Storage ftx nonflammable gases less than 85 m3
(3000 fi.3) at STP shall be pe1·mitte<l to be stored in a ga� cabi­
net constrncte<l in acco1·<lance with NFPA 55. prmi<led that the
following also applies:
(1) Storage is limite<l to cylinde1·s.
(2) There a re no flammables or combustibles in the cabinet.
(3) The temperature limitations of 5.1.3.2.11 are met.
(4) The cylinders are secu1·ed.
(5) When st01·ing nitrous oxide, the cabinets are lockable.
11.3.9 "\,\Then small-.;ize (A, B. D, or E) cylinders are in use,
they shall be attached to a cylinde1· stand or to medical equip­
ment <lesigne<l to 1·eceive an<l hold comp1·esse<l ga� cylinders.
99-107
11.3.10 In<lividual small-.;ize (A. B. D. or E) cylinders available
for immediate use in patient care spaces shall not be consid­
e1·e<l to be in storage.
11.3.11 Cylinde1·s shall not be chaine<l to portable or movable
apparatus such as be<ls and oxygen tenl�.
11.3.12 Signs.
11.3.12.1 Storage locations meeting the requirement� of
11.3.5 or 11.3.6 shall have p1·ecautiona1·y signage, readable
from a distance of 1.5 m (5 ft), displayed on each door or gate
of the stoi-age room or enclosure.
w01·ding as a minimum:
CAUflON
NO Smoking or Open Flame
Positive Pressure Gases
Room May Have Insufficient Oxyge n
Open Door and Allow Room to Ventilate Before Entering
11.3.12.2.1 Existing signage that is not in strict compliance
with the prmisions of this code shall be pe1·mitted to be contin­
ue<l in use as long as the authority having jurisdiction has
<letermine<l that such use does not constitute a distinct hazar<l
to life.
11.3.12.3 In health care facilities whe1·e smoking is permitte<l,
signs shall inclu<le the following wording as a minimum:
CAUflON
NO SMOKING OR OPEN FIAME
OXIDIZING GAS (ES) STORED WITHIN
11.3.12.3.1 Existing signage that is not in stt·ict compliance
with the prmisions of this code shall be permitted to be contin­
ued in use as long as the authority having jurisdiction has
<lete1·mine<l that such use does not constitute a distinct haza1·<l
to life.
111 11.3.12.4 In health care facilities where smoking is prohibited,
signs shall inclu<le the following wo1·ding as a minimum:
CAUflON
NO OPEN FIAME
OXIDIZING GAS (ES) STORED WITHIN
11 .3.12.4.1 Existing signage that is not in stt·ict compliance
with the prmisions of this co<le shall be permitte<l to be contin­
ue<l in use as long as the authority having jurisdiction has
dete1·mined that such use does not constitute a distinct haza1·<l
to life.
11.3.12.5 Replacement of existing signage that inclu<les "No
Smoking" for health care facilities that prohibit smoking shall
not be 1·equired.
2021 Edition
99-108 HEALTH CARE FACILITIES CODE
11.4 Performance Criteria and Testing.
ll.4.1 Portable Patient Care Gas Equipment.
ll.4.1.1 * Anesthetic apparatus shall be subject to approval by
the authority having_jurisdiction.
I 1.4.1.2* Each yoke on anesthetic apparatus constructed to
allow attachment of a small cylinder equipped with a flush-l),-pe
valve shall have tw·o pins installed as specified in the mandatory
requirements of CGA V-1, Standard f11r Comprl'SSl'd Gas Cylindl'r
Valvl' Out!Pt and lnlPl Connfftions (ANSI B57. l ).
ll.4.1.3 Testing.
I 1.4.1.3.1 Interventions requmng testing shall include, but
not be limited to, the following:
(1) Alteration of pipeline hose or pipeline fittings
(2) Alteration of internal piping
(3 ) Adjustment of selector switches or flush valves
( 4) Replacement or repair of flowmeters or bobbins
f
11.4.1.3.2 A. te1· any adjustment or repai1- involving use of
tools, or any modification of the g-,1s piping supply connections
or the pneumatic power supply connections for the anesthesia
ventilator, or other pneumatically powered device, if one is
present, and befo1·e use on patienl�. the gas anesthesia appara­
tus shall be tested at the final common path to the patient to
determine that oxygen, an<l only m..-ygen, is delivered from the
oxygen flowmete1·s and the oxygen flush valve, if any.
ll.4.1.3.3 Befo1·e the gas anesthesia apparatus is returned to
service, each fitting and connection shall he checked to verify
its prnper indexing to the 1·espective ga� service involved.
ll.4.1.3.4 Before the gas anesthesia apparatus is returned to
service, an oxygen analyzer, or a simila r device, shall be used to
verify the oxygen concentt·ation.
ll.4.1.4* Yoke-type connections between anesthesia apparatus
and flush-type cyli nder valves (commonly use<l with anesthetic
gas cylinders) shall be of the Connection No. 860 type in
accordance with the mandatory requirement� of CGA V-1,
Standard for Crmiprl'svd (',as Cy lindl'r Hzlve Out!Pt and lnlft Conni'<'
tions (ANSI B5 7.1).
11.4.2 Apparatus for Administering Respiratory Therapy.
11.4.2.1 Oxygen-<lelivery equipment intended to rest on the
floor shall be equipped with a base designed to rende1· the
entire assembly stable <luring storage, transport, an<l use.
I 1.4.2.2 Oxygen enclosures of rigi<l materials shall be fabrica­
ted of noncombustible materials.
ll.4.2.3 Equipment supplied from cylinders or containei-s
shall be <lesigne<l and constructed for setvice at full cylinder or
container pressut·e or consn-ucte<l for use \,�th, or equipped
with, p1-essure reducing regulatot·s.
2021 Edition
11.4.2.4 Humidification or reservoir ja1·s containing liquid to
be dispersed into a gas stream shall be made of tt·ansparent or
translucent material, shall be impervious to contained solutions
an<l medications, an<l shall allow obsenation of the liquid level
and consistency.
ll.4.2.5 Humidifiers and nehulizers shall he equipped \\�th
prnvisions for overp1·essu1·e relief or ala1·m if the flow becomes
obstructed.
11.4.2.6 Humi<lifie1·s and nebulizers shall be incapable of
tipping 01· shall be mounted so that any tipping 01· alteration
from the vertical shall not interfere with function or accuracy.
11.4.3 Nonpatient Gas Equipment.
11.4.3.1 Carts and Hand Trucks.
11.4.3.I.I Construction. Cart� an<l hand trucks for cylinders
and containers shall be constructed fot· the intended purpose,
be self�supponing, and be prnvi<le<l with apprnpriate chains or
stays to retain cylinders or containers.
11.4.3.2 Medical Devices. Medical devices not for patient ca1·e
that requii-e medical gases or medical suppon gases shall meet
the following:
(1) Be listed for the intended pmpose by the U.S. Food and
Drug A<lministt·ation
(2) Be under the direction of a licensed medical professional
(3) Not be permanently attached to the piped distt·ibution
system (.�ff5.J.3.5.2)
Undet·go a risk assessment conducted by the health care
(4)
facility's governing bo<ly to determine the cha racter of
the processes and operntions conducted in the facilil),-·
an<l whether medical gases or medical support gases a1-e
acceptable for use by the medical device
11.5 Administration.
11.5.1 Policies.
11.5.1.I Elimination of Sources of Ign ition.
11.5.I.I.I Smoking mate1-ials (e.g., matches, cigarettes, light­
ers, lighter fluid. tobacco in any form) shall be removed from
patienl� recei,ing respiratory therapy.
I 1.5.I.I.2* \'\'hen a na�al cannula an<l il� associated supply
tubing are delivering oxygen out�ide of a patient care space, no
sources of open flame shall be permitted in the site of inten­
tional expulsion.
11.5.1.1.3* When any other oxygen delivery equipment not
specified in 11.5.1.1.2 is in use, no sout-ces of open flame shall
be pe1·mitte<l in the area of administration.
I 1.5.I.I.4* Solid fuel-burning appliances shall not be permit­
ted in the area of administration.
I 1.5.I.I.5* Sparking toys shall not be permitted in any patient
care space.
I 1.5.I.I.6 Nonmedical appliances that have hot surfaces or
spa rking mechanisms shall not he permitted within oxygen­
delivery equipment or within the site of intentional expulsion.
 GAS EQUIPMENT
11.5.1.2 Misuse of Flammable Substances.
11.5.1.2.1 Flammable 01· combustible aerosols or vapors, such
as alcohol, shall not be used in oxygen-e1u-iche<l atmosphe1·es.
11.5.1.2.2 Oil, grease, or other flammable substances shall not
be used on/in oxygen equipment.
11.5.1.2.3 Flammable an<l combustible liquids shall not be
permitte<l within the site of intentional expulsion.
11.5.1.3 Servicing and Maintenance of Equipment.
I 1.5.1.3. I Defrctive equipment shall he immediately removed
from service.
11.5.1.3.2 Areas designate<l for the servicing of oxygen equip­
ment shall be clean an<l free of oil, grease, 01· other flammable
substances.
11.5.1.3.3* A sche<luled preventive maintenance program
shall be followed.
I 1.5.2 Gases in Cylinders and Liquefied Gases in Containers.
I I. 5.2. I Qualification and Training of Personnel.
I 1.5.2. I. I* Personnel concerne<l with the application an<l
maintenance of medical gases and othe1·s who handle me<lical
ga�es and the cylin<lers that contain the medical gases shall be
traine<l on the risks associate<l with their handling and use.
I1.5.2. 1.2 Health ca1·e facilities shall provide programs of
continuing e<lucation for thei1· personnel.
11.5.2.1.3 Continuing e<lucation programs shall include peri­
odic 1·eview of safety guidelines and usage 1·equirement5 for
medical gases and their cylinders.
11.5.2.1.4 Equipment shall be serviced only by personnel
trained in the maintenance and operation of the equipment.
I1.5.2. 1.5 If a CJyogenic fluid central supply sys tem is present,
the supplier shall provi<le annual training on it� operation.
I 1.5.2.2 lransfilling Cylinders.
11.5.2.2.1 Mixing of compressed gases in cylinders shall be
prohibited.
I1.5.2.2.2* Transfilling of gaseous oxygen from one cylin<ler
to another shall be in accor<lance with the mandatory require­
ment� in the mandatory 1·equirement� of CGA P-2.5, Tmmjilling
of High PrPssurP Gase,im Oxygm U�fd Jar RPspiration.
I 1.5.2.2.3 Transfilling of any gases from one cylinder to
anothe1· in the patient care vicinity shall be prohibited.
I 1.5.2.3 lransfilling Liquid Oxygen. Transfilling of liquid
oxygen shall comply with 11.5.2.3. l or 11.5.2.3.2, as applicable.
11.5.2.3.1 Transfilling to liquid oxygen base reservoir contain­
ers or to liquid oxygen portable containers over 344.74 kPa
(50 psi) shall include the following:
(l ) A designated area is separated by a fire baITier of 1-hour
fi1·e-resistive constrnction from any portion of a facility
where patients are house<l, examined, or treated.
(2) The a1·ea is mechanically ventilated, is sp1·inklered, and
has cernmic or concrete flom·ing.
(3) The area is posted with signs in<licating that transfilling is
occurring and that smoking in the immediate area is not
permitte<l.
99-109
(4) The individual transfilling the container(s) has been
properly trained in the transfilling proce<lures.
I1.5.2.3.2* \\!here transfilling to liqui<l oxygen portable
containers at 344.74 kPa (50 psi) and un<ler, the following
conditions shall be met:
( l) The a1·ea is well ventilate<l and ha� noncombustible floo1·­
ing.
(2) The a rea is posted with signs indicating that smoking in
the area is not permitted.
(3) The individual transfilling the liquid oxygen portable
containe1· has been propedy trnine<l in the transfilling
procedure.
(4) The mandatory requirements of CGA P-2.6, Tmnsjilling of
Liquid Oxygen U�Pd for &spimtion, are met.
11.5.2.4* Filling Cylinders from Oxygen Concentrators. Fill­
ing cylinders from oxygen concentrntors, including in the
patient care vicinity, shall be in accordance with the manufac­
turer's instructions, not to exceed the limit� in 11.5.2.4. l
through 11.5.2.4.4.
I 1.5.2.4.1 The cylin<le1· content� shall not exceed 700 L
(25 f\.3).
I 1.5.2.4.2 The flow shall not excee<l :> L/min (0.2 ft�/min).
I 1.5.2.4.3 The pressure shall not excee<l the DOT rating of
the cylinder or 20,700 kPa (3000 psi), whichever is less.
I 1.5.2.4.4 The cylinders shall be in accordance with DOT
requi1·ement5 01· those of the applicable regulatory agency.
I 1.5.2.5 Ambulatory Patients. A1·eas where ambulat01·y
patient5 on oxygen therapy are permitted access shall be flame­
an<l smoke-free a rea�.
I 1.5.3 Use (Including Information and Warning Signs).
I 1.5.3.1 Labeling.
I 1.5.3.1.1 Equipment listed for use in oxygen-e111·iche<l atmos­
pheres shall he so labeled.
I 1.5.3.1.2 Oxy gen-metering equipment and pressure reduc­
ing 1-egulatoi-s shall be conspicuously labeled as follows:
OXYGEN - USE NO OIL
11.5.3.1.3 Flowmeters, pressure reducing regulators, and
oxygen-dispensing apparatus shall be cleady and permanently
labele<l , designating the g-ds 01· mixture of gases for which they
are inten<le<l.
I1.5.3.1.4 Apparatus whose calibration 01· fimction is <lepend­
ent on ga� density shall he labeled as to the proper supply gas
gauge pressure (kPa/ psi) for which it is intended.
I 1.5.3.1.5 Oxy gen-mete1-ing equipment, p1·essu1·e re<lucing
1-egulat01·s, humidifie1·s, and nebulizers shall be labeled with
the name of the manufacturer or supplier.
11.5.3.1.6 Cylinders and containers shall be labeled in accord­
ance with th� mandatory· 1·equirements of CGA C-7, Guide to
Clrmijiwtion and Labl'Nng of C01nprl'ssed Gases. Color co<ling shall
not be utilize<l as a prima r y method of <letern1ining cylinde1· 01-
container content.
2021 Edition
99-II0 HEALTH CARE FACILITIES CODE
11.5.3.1.7 All labeling shall be durnble and \\�thstand cleans­
ing or disinfection.
11.5.3.2* Si gns.
11.5.3.2.1 In health care facilities where smoking is not
prohibited, precautionary signs readable from a distance of
1.5 m (5 ft) shall he conspicuously displayed wherever supple­
mental oxygen is in use and in aisles and walkways leading to
such an area.
11.5.3.2.2 The signs shall be attached to adjacent doonvays 01·
to building walls 01· be supported by othe1· appropriate means.
11.5.3.2.3 In health ca1·e facilities whe1·e smoking is prohibited
and signs are prominently (strategically) placed at all maj01·
entrnnces. secondary signs with no smoking language shall not
be required.
11.5.3.2.4 The nonsmoking policies shall be strictly enfo1·ced.
11.5.3.3 Transportation, Storage, and Use of Equipment.
11.5.3.3.1 Flow-control valves on administe1·ing equipment
shall be closed p1·i01· to connection and when not in use.
11.5.3.3.2 Apparatus shall not he stored or transported with
liquid agents in resen,ui1·s.
11.5.3.3.3 Care shall be taken in attaching connections from
ga.� services to equipment and from equipment to patient�.
11.5.3.3.4 Fixed or adjustable orifice mechanisms, metering
,·alves, pressure reducing regulators, and gauges shall not be
connected directly to high pressure cylinders, unless specifi­
cally listed for such use and prm�ded with appropriate safety
devices.
11.5.3.3.5 Equipment shall only be serviced by qualified
pe1·sonnel.
11.6 Operation and Management of Cylinders.
11.6.1 Administration. Administrative auth01·ities of health
care organizations shall provide policies and procedm-es fot·
safe practices.
11.6.1.1 Purcha.�e specifications shall include the following:
(1) Specifications for cylinders
(2) Marking of cylinders, regulators, and valves
(3) Prope1· connections on the cylinders supplied to the
facility
11.6.1.2 Training procedures shall include the following:
(1) Maintenance programs in accordance with tl1e manufac­
turer's recommendations fot· the piped gas system
(2) Use and transport of equipment and the proper handling
of cylinders, containers, hand trucks, support�, and valve
protection caps
(3) Verification of ga� content and mechanical connection
specificity of each cylinder or container prior to placing it
into service
2021 Edition
11.6.1.3 Policies for enforcement shall include the following:
Regulations for the storage and handling of cylinders and
( 1)
containers of oxygen and nitrous oxide
(2) Prompt evaluation of all signal warnings and all necessary·
measures taken to re-establish the proper functions of the
medical gas and vacuum systems
(3) Organizational capability and 1·esout-ces to cope with a
complete loss of any medical gas or vacuum system
(4) Successful completion of all tesl� required in 5.1.12.4
prim· to the use of any medical gas or vacuum piping
system fot· patient care
(5) Locations intended for the delivery vehicle delivering
cryogenic liquid to cryogenic fluid centt·al supply systems
to remain open and not be used for any othe1· put·pose
(e.g., vehicle parking, stornge of trash containers )
11.6.2 Special Precautions for Handling Oxygen Cylinders and
Manifolds. Handling of oxygen cylinde1·s and manifolds shall
be based on the mandatory requirement� of CGA G-4, Oxygen.
11.6.2.1 Oxygen cylinders, containe1·s, and associated equip­
ment shall be protected from contact with oil 01· grease by
means of the following specific precautions:
(1) Oil, grease, or 1·eadilv flammable materials shall not be
pe1·mitted to come in contact with oxygen cylinde1·s.
valves, pressure reducing regulators, gauges, 01· fittings.
(2) Pressure reducing regulators, fittings, or gauges shall not
be lubricated with oil or any othe1· flammable substance.
(3) Oxygen cylinde1·s 01· apparatus shall not be handled witl1
oily 01· greasy hands, gloves, or rngs.
11.6.2.2 Equipment associated with oxygen shall be protected
from contamination by means of the following specific precau­
tions:
(1) Particles of dust and dirt shall he cleared from cylinder
valve openings by slightly opening and closing the valve
hefo1-e applying any fitting to tl1e cylinder valve.
(2) TI1e high pressure valve on the oxygen cylinder shall be
opened slowly before bringing the appa1·atus to the
patient or the patient to the apparntus.
(3) An oxygen cylinder shall not be draped with any materials
such as hospital gowns, masks, or caps.
(4) Cylinder-valve protection caps, where provided, shall he
kept in place and be hand-tightened, except when cylin­
ders are in use or connected for use.
(5) Valves shall be dosed on all empty cylinders in storage.
11.6.2.3 Cylinders shall be protected from damage by means
of the following specific procedures:
(1) Oxygen cylinders shall be protected from abnonnal
mechanical shock, which is liable to dan1age the cylin­
der, valve, or safety device.
(2) Oxygen cylinde1·s shall not he stored neat· elevat01·s or
gangways or in locations where heavy moving objects will
strike them or fall on them.
(3) Cylinders shall be protected from tampering by unau­
thorized individuals.
(4) Cylinders or cylinder valves shall not be 1·epaired, pain­
ted, or altered.
(5) Safety relief devices in valves or cylinders shall not be
tampe1·ed with.
(6) Valve outlets clogged with ice shall be thawed with wa1·m
- not boiling - water.
 GAS EQUIPMENT
(7) A torch flame shall not be pe1·mitted. under any circum­
stances, to come in contact with a cylinder, cylinder
valve, or safety de"ice.
(8) Sparks and flame shall be kept away from cylinde1·s.
(9) Even if they are considered to be empty, cylinders shall
not be used a� rollers, supports, or for any purpose other
than that fot· which the supplie1· intended them.
(10) La1·ge cylinders (exceeding size E) and containers larger
than 45 kg ( 100 lb) weight shall be transported on a
proper hand trnck 01· can complying with 11.4.3.1.
( 11) F1·eestanding cylinde1·s shall be propedy chained or
supported in a proper cylinder stand or cart.
( 12) Cylinders shall not be supported by radiators, steam
pipes, 01· heat duct�.
11.6.2.4 Cylinde1·s and their content� shall be handled with
care, which shall include the following specific procedures:
(1) Oxygen fittings, valves, pressu1·e 1·educing 1·egulators, or
gauges shall not be used for any service other than that
of oxygen.
(2) Ga�es of any type shall not be mixed in an oxygen cylin­
der or any othe1· cylindei-.
(3) Oxygen shall always be dispensed from a cylinder
through a pressure reducing regulator.
( 4) The cylinde1· valve shall be opened slowly, with the face
of the indicat01· on the pressure reducing 1·egulator
pointed away from all persons.
(5) Oxygen shall be refeITed to by it� proper name, oxygrn,
not air, and liquid oxygen shall be refetTed to by it�
proper name, not liquid air.
(6) Oxygen shall not be used as a substitute for compressed
311".
(7) The markings stamped on cylinde1·s shall not be
tampered with, because it is against federal statutes to
change these ma1·kings.
(8) Markings used for the identification of contents of cylin­
ders shall not be defaced or 1·emoved, including decals,
tags, and stenciled marks, except those labels/tags used
fm indicating cylinde1· status (e.g., foll, in use, empty).
(9) The owner of the cylinde1· shall be notified if any condi­
tion has occurred that might allow any foreign substance
to enter a cylinder or valve, gi"ing details and the cylin­
der number.
( 10) Neither cylinders nor containei-s shall be placed in the
proximity of radiators, steam pipes, heat duct�, or other
sources of heat.
( 11) Very cold cylinders or containers shall be handled with
care to avoid injury.
11.6.2.5 Oxygen equipment that is defective shall not be used
until one of the following tasks has been pedormed:
( 1) It ha� been repaired by competent in-house personnel.
(2) It has been 1·epaired by the manufactme1· or his or her
authorized agent.
(3) It ha� been replaced.
11.6.2.6 P1·essm·e reducing regulators that a1·e in need of
1·epair or cylinders having valves that do not operate properly
shall not be used.
99-ll l
11.6.3 Special Precautions for Making Cyli nder and Container
Connections.
11.6.3.1 Cylinder valves shall be opened and connected in
accordance with the following procedure:
( 1) Make certain that apparatus and cylinde1· valve connec­
tions and cylinder v...-enches are free of foreign matet-ials.
(2) Turn the cylinde1· valve outlet away from personnel
following these safety procedures:
(a) Stand to the side - not in front and not in back.
(b) Beftxe connecting the apparatus to the cylinde1·
valve, momentarily open the cylinder valve to elimi­
nate dust.
(3) Make connection of the apparntus to the cylinde1· valve,
and tighten the connection nut securely with a wrench.
(4) Release the low-pressure adjustment screw of the
p1·esstu-e-1·educing 1·egulator com pletely.
(5) Slowly open cylinde1· valve to the foll-open position.
(6) Slowly turn in the low-pressure a�ustment screw on the
pressure reducing regulator until the proper operating
pt·essm·e is obtained.
(7) Open the valve to the utilization apparatus.
11.6.3.2 Connections for containers shall be made in accord­
ance with the containe1· manufacturer's opernting instructions.
11.6.4 Special Precautions for the Care of Safety Mechanisms.
11.6.4.1 Personnel using cylindern aml containers aml othe1·
equipment cove1·ed in this chapter shall be familia1· with the
f
mandatory requirement� o CGA Pin-Index Safety System and
the CGA Diameter-Index Safetv System, which are both
f
designed to pt·event utilization o the wrong gas.
11.6.4 .2 Safety relief mechanisms, non interchangeable
connectors, and other safety features shall not be removed,
altei-ed, or 1·eplaced.
11.6.5 Special Precautions - Storage of Cylinders and
Containers.
11.6.5.1 Storage shall be planned so that cylinders can be used
in the order in which they are received from the supplier.
11.6.5.2 If empty and full cylinders are stored within the same
enclosure, empty cylinde1·s shall be segregated from full cylin­
ders.
11.6.5.2.1 ,'\'hen the facility employs cylinde1·s with integral
pressure gauge, it shall establish the threshold pressure at
which a cylinder is considered empty.
11.6.5.3 Empty cylinde1·s shall be marked to avoid confusion
and delay if a full cylinder is needed in a rapid manner.
11.6.5.4 Cylinders stored in exterior locations shall be as
follows:
(1) Seemed against falling or tipping
(2) Stored in a well-drained location and protected from
prolongen contact with soil
(3) P1·evented from reaching temperntures lower than the
recommendations of the medical gas supplier
( 4) Screen en against continuous exposure to direct rays of
the sun whe1·e the ambient temperatu1·e exceeds 52'C
(125'F)
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99-ll2 HEALTH CARE FACILITIES CODE
11.6.5.5* Storage of nitrnus oxide cylinders shall be secured
against unauthorized access.
11. 7 Liquid Oxygen Equipment.
11. 7.1 General. The storage and use of liquid oxygen in
liquid oxygen base 1·eservoir containers and liquid oxygen port­
able containe1·s shall comply v.'ith the following. or storage and
use shall he in acc01·dance with the adopted fit-e p1·evention
code.
11.7.2 Information and Instructions. The liquid oxygen selle1·
shall provide the user with documentation that includes, but is
not limited to, the following:
(1) Manufacttlt'et·'s instructions, including labeling for st01·­
age and use of the containe1·s
(2) Requirements for storage and use of containers away
from ignition sources, exits, electt-ical hazards, and high­
temperature devices
(il) Methods fo1· containe1· restraint to prevent falling
( 4) Requirements for container handling
(5) Safeguards for 1·efilli ng of contain e1·s
11. 7.3 Container Storage, Use, and Operation.
11. 7.3.1* Containe1·s shall be stm·ed, used, and operated in
accordance with the manufacture1·'s instructions and labeling.
11. 7.3.2 Containers shall not be placed in the following areas:
(1) '\Vhere they can be tipped ove1· by the movement of a
door
(2 ) v\-'here they interfere with foot traffic
(3 ) '\,\'here they a1·e subject to damage from falling objects
( 4) Where exposed to open flames and high-temperature
devices
11. 7.3.3* Liquid oxygen base reservoir containe1·s shall be
secu1·ed by one of the following methods while in storage 01·
use to prevent tipping ove1· caused by contact, vibration, or seis­
mic activity:
Securing to a fixed object ,,'ith one or more 1·estt·aints
( 1)
Securing within a framework, stand, or assembly designed
(2)
to resist container movement
(3) Resu·aining by placing the containe1· against two point� of
contact
11. 7.3.4 Liquid oxygen base reservoir containers shall be
transported by a cart 01· hand truck des igned for such use,
unless a containe1· is equipped with a rolle1· ba.�e.
2021 Edition
11.7.3.5* Liquid Oxygen Portable Containers.
11.7.3.5.1 Liquid oxygen pmtable containers shall be kept in
an up1·ight position.
11.7.3.5.2 Liquid oxygen portable containers shall not be
carried unde1· clothing 01· other covering.
11.7.3.5.3 Liquid oxygen portable containers shall he kept
away from ignition sources, electrical hazards, and high
tempe1·ature devices dut·ing filling and use.
11.7.3.6 The transfilling of containe1·s shall he in accordance
with the manufacturer's instructions and the requirements of
11.7.3.6.1 thrnugh 11.7.3.6.2.
11.7.3.6.1 Liquid oxygen containers shall be filled outdoors or
in compliance with 11.5.2.3.1.
11.7.3.6.1.1* A drip pan compatible with liquid oxygen shall
be prnvided unde1· the liquid oi.·ygen base resetvoir containe1·'s
filling and vent connections used during the filling process,
unless the filling is performed on a noncombustible surface
such as concrete.
11.7.3.6.2 Liquid oxygen portable containers shall be permit­
ted to be filled indoors when the liquid oxygen base 1·eservoir
containet' is designed fot· filling such containers and the written
instructions prmided by the container manufacturer a1·e
followed.
11.7.4 Maximum Quantity.
11.7.4.1 The maximum total quantity of liquid oxygen permit­
ted in storage and in use in a patient bed location 01· patient
care vicinity shall be 120 L (31.6 gal), prnvided that the patient
bed location or patient care vicinity, or both, a1·e separated
from the remainder of the facility by fire harriers and horizon­
tal assemblies having a minimum fit·e resistance rating of
1 hour in acc01·dance with the adopted building code.
11.7.4.2 One liquid oxygen portable container llimited to
1.5 L (0.396 gal) capacity l pet· patient is permitted to be stored
or used in a patient bed location or patient care 'vicinity \\'ith­
out having to meet the fire separation requirement� of 11.7.4.1.
 EMERGENCY MANAC;EMENT
Chapter 12 Emergency Management
12.1* Applicability. This chaplet· shall apply to new ancl exist­
ing health care facilities.
12.1.1* This chapter shall pr0vicle those with the responsibil­
ity for eme1·gency management in health ca re facilities with the
ct"ite1·ia to assess, mitigate, prepare for, 1·espond to, and recover
from emergencies of any origin.
12.1.2 1l1is chapter shall be the source for emergencv
management in health care facilities ancl is based on the foun­
clations of NfPA. 1600.
12.1.3 1l1is chapter shall aid in developing, maintaining, and
evaluating effective emergency management progrnms in new
and existing facilities.
12.2 Responsibilities.
12.2.1 * Authority Having Jurisdic lion.
12.2.1.1 The autho1·ity having jurisdiction shall be cognizant
of the requirement� of a health care facility with respect to it�
uniqueness for continuecl operation of the facility in an emer­
gency.
12.2.1.2 1l1e authority having ju1·isdiction shall ensure health
ca1·e facility eme1·gency management programs meet the
requirements of this chapter.
12.2.2 Senior Management.
12.2.2.1 The senior management shall actively participate in
ancl suppo1·t eme1·gency management planning.
12.2.2.2 Senior management shall provide the 1·equi1·ed
resources to develop ancl support the emergency management
prog1·am.
12.2.2.3 At least one representative of senior management
shall provide a clocumentecl re\iew of aftet'-action reports and
the annual evaluation of the eme1·gency operations plan
(EOP).
12.2.2.4 Senior management shall direct the prioritization of
opportunities for improvement identifiecl during exe1·cises and
actual event�.
12.2.2.5 Senior management shall appoint a program coordi­
nato1·.
12.2.3* Emergency Management Committee. The emergency
management committee shall include representatives of senior
management and clinical and suppon senices.
12.2.3.1* The membership of the emergency management
committee shall include a chairperson, the emergency
prog1·am co01·clinat01·, and leadership representatives of those
clepartments, services, and areas that have a significant role in
the facility's eme1·gency management activities.
12.2.3.2 The eme1·gency management committee shall have
the responsibility fot· the emergency management program
within the facility.
12.2.3.3* The eme1·gency management committee shall
moclel the eme1·gency operntions plan on an incident
command system (ICS) in coorclination with feclernl, state, ancl
local emergency response agencies, as applicable.
99-ll3
12.3 Emergency Management Categories. 1l1e application of
requirement5 in this chapter shall be based on the emergency
management category of the health ca1·e facility as clefined in
Table 12.3.
12.4 General.
12.4.1 * Health care facilities shall develop an eme1·gency
management program with a documented eme1·gency opern­
tions plan based on the category of the health care facility as
defined in Table 12.3.
12.4.1.1* The emergency management prngrnm shall include
elements as required to manage an emergency during all four
phases: mitigation. pt·epareclness, response. and recovery.
12.4.1.2 The eme1·gency management progrnm shall comply
with applicable regulations, directives, policies, ancl industty
standa1·cls of prnctice.
12.4.2* When cleveloping it� emergency management
program, the facility shall communicate its needs ancl vulnera­
bilities to community emergency n·sponse agencies and iden­
tify the capabilities of its community in supporting thei1·
llllSStOn.
12.4.3 The medical facility, in combination with the local 01·
federnl authorities, 01· both, shall establish the 1·equired eme1·­
gency management categoty as defined in Table 12.3.
12.5 Emergency Management Category 1 and Emergency
Management Category 2 R equirements.
12.5.1 All emergency management Categoty l and emergency
management Category 2 health care facilities shall be requirecl
to clevelop ancl maintain an eme1·gency management pt·ogram
that addresses all program elements as prescribed in 12.5.2 ancl
12.5.3.
12.5.2 The element� and complexity of the subsequent code
sections in this chapter shall apply, as appropriate to the hazard
vult1e1·ability analysis (HVA), the community's expectations,
and the leaclership's defined mission of the health care facility.
Table 12.3 Emergency Management Categories
Emergency
Management
Category Definition
Those inpaLient faciliLies I.hat remain operable to
provide actvanced life support services to injurect
responcters anct disasrer victims, or those inpatient
facilities that serve as a receiving facility for
evacualing health care facilities. These facilities
manage the existing inpalient load as wel l as plan
for the influx ofact ctitional patienL, as a result ofan
emergency.
2 Those inpatient or omparient faciliLies 1har augmem
1.he criLical mission. These facilities manage the
existing inpaLiem or outpa1ie111 loads hlll do 1101
plan to receive act ctilional patienL, a, a resuh of an
emergency or cto 1101 plan to remain operable
should essential ut iliries or services be lost.
2021 Edition
99-ll4 HEALTH CARE FACILITIES CODE

12.5.3 Program Elements. 12.5.3.3.2 The facilitv shall maintain a current, documented
inventory of the assern and resources it has on-site that would
12.5.3.1 Hazard Vulnerability Analysis (UVA). be needed during an emergency, such as medical, s urgical, and
12.5.3.1.1 A haza ni vulnerability analysis (HVA) shall be pharmaceutical 1·esou1·ces; water; fuel; staffing; foo<l; an<l linen.
conducted to identify an<l prioritize hazards that pose a threat 12.5.3.3.3 The facility shall identify the resource capability
to the facility and can affect the deman<l for it� services. f
shortfalls from 96 hours of sustainability and determine i miti­
r
12.5.3.1.2* The hazards to be conside1·ed shall include, but gation activities a e necessary and feasible.
not be limited to, the following: 12.5.3.3.4 The facility shall establish a protocol for monitoring
( 1) Natural hazards (geological, meteorological, and biologi- the quantity of assets and resources as they are utilize ct.
cal)
( 2) Human-cause<l events (accidental or intentional) 12.5.3.3.5 The facility shall write an eme1·gencv operations
(3) Technological events plan (EOP) that describes a command structure an<l the follow­
ing critical functions within the facility d uring an emergency:
12.5.3.1.3 The analyliis shall include the potential impact of ( 1) Communications
the hazards on conditions including, but not limited to, the (2) Resources and assets
following: (3) Safety and security
( 1)* Continuity of operations ( 4) Clinical support activities
(2) Ca1·e for new and existing patient�/ 1·esident�/ client� ( 5) Essential utilities
f
(3) Health, safety, and security of persons in the af ected area (6) Exterior connections
f
( 4) Support of staff (7) Staf roles
(5 ) Prope1·ty, facilities, and infra�tructure
(6) Environmental impact 12.5.3.3.6 Critical Function Strategies. During the develop­
(7) Economic an<l financial conditions ment of the EOP, the facility shall consider the strategies
(8) Regulat01y and contractual obligations 1·equire<l in 12.5.3.3.6.1 through 12.!'>.3.3.6.8 in or<le1· to
(9) Reputation of, 01· confidence in, the facility manage critical Ii.tnctions during an emergency within the
facility.
12.5.3.1.4 The facility shall p1-io1·itize the hazards and threat�
identified in the HVA with input from the community. 12.5.3.3.6.1 Communications. The facility shall plan for the
following <luring an eme1·gency:
12.5.3.2 Mitiga tion. ( 1) Initial notification and ongoing communication of infor­
12.5.3.2.1 The facilitv shall develop an<l implement a strategy mation and instntctions to staff
to eliminate hazards 01· mitigate the effects of hazards that (2) Initial notification and ongoing communication v.'ith the
cannot be eliminated. external authorities
(3) Communication ,,'ith the following:
12.5.3.2.2 A mitigation strategy shall be developed fot· pri01·ity
haza1·<ls <lefine<l by the HVA. (a) Patient� and their families (1·esponsible parties)
(b) Responsible parties when patient� are 1·elocated to
12.5.3.2.3 The mitigation strategy shall consider, but not be alternative care sites
limited to, the following: (c) Community an<l the me<lia
(1) lJse of applicable building construction stan<lar<ls (d) Suppliers of essential materials, se1·vices, and equip­
(2) Haza rd avoidance through appropriate land-use practi- ment
ces (e) AJternat.ive ca1·e sites
(3) Relocation, reu·ofitting, 01· 1·emoval of structu1·es at risk ( 4) Definition of when an<l how to communicate patient
(4) Removal or elimination of the hazard information to thi1·d parties
(5) Reduction or limitation of the amount or size of the (5)* Establishment of backup communications systems
hazard (6) Cooperative planning with other local or 1·egional health
(6) Segregation of the hazard from that which is to be care facilities, including the following:
protected (a) Exchange of information relating to command
(7) * Modification of the basic chai-acteristics of the haza1·d ope1·ations, including contact information
(8) Control of the rate of 1·elease of the hazatTl (b) Staffing an<l supplies that could be shared
(9) P1·mision of prntective systems 01· equipment fot· both (c) System to locate the victims of the event
cyber or physical risks
( 10) Establishment of haza1·<l warning an<l communications 12.5.3.3.6.2 Resow-ces and Assets. The facility shall plan for
procedures the following <luring an eme1·gency:
( 11) Redundancy or duplication of essential personnel, criti­ (1) Acquiring medical, pharmaceutical, and non medical
cal sy stems, equipment, information, ope1·ations, 01· supplies
mate1·ials (2) Replacing medical supplies an<l equipment that will be
use<l throughout response and recovery
12.5.3.3 Preparedness. (3) Replacing pharmaceutical supplies that will be consumed
12.5.3.3.1 The facility shall p1·epa1·e fm any emergency a� throughout 1·esponse an<l recovery
determined by the HVA by organizing and mobilizing essential ( 4) Replacing nonme<lical supplies that will he depleted
resources. throughout response and recovery

2021 Edition
 EMERGENCY MANAC;EMENT
(5) Managing staff support activities. such as housing. trans­
portation, incident stress debriefing, sanitation, hy<lra­
tion. nutrition, comfort, morale, an<l mental health
f
(6) Managing staf family support needs, such as child ca1·e,
elder care, pet care, and communication to home
(7)
f
Providing staf, equipment, and transportation vehicles
needed ftx evacuation
12.5.3.3.6.3* Safety and Security- The facility shall plan for
the following during an emergency:
( l) Inten1al secu1·ity and safety operations
f
(2) Roles of agencies such a� police, she1·if, an<l national
guar<l
(3) Managing hazardous matet-ials an<l wa�te
(4) Radioactive, biological, and chemical isolation and
decontamination
(5) Patients susceptible to wandering
(6) Controlling entrance into the health care facility during
emergencies
(7) Conducting a risk assessment with applicable authorities
f
i it becomes necessary to contrnl egress from the health
care facility
(8) Controlling people movement within the health care
facility
(9) Controlling traffic access to the facility
12.5.3.3.6.4 Oinical Support Activities. The facility shall plan
for the following during an emergency:
( l ) Clinical acti"ities that could need modification or
discontinuation during an eme1·gency, such as patient
scheduling, triage, assessment, treatment, admission,
transfer, discl1a1·ge, and evacuation
(2) Clinical senices for special needs populations in the
community, such a� pediatric, geriatric, disabled, and
chrnnically ill patients, and those with acidictions (Emer­
gency Management Category I only)
(3) Process to shelter patients in place
(4) Patient cleanliness and sanitation
(5) Behavioral needs of patients
(6) Mortuary services
(7) Evacuation both horizontally and, when requireci by
circumstances, vertically, when the environment cannot
support care, treatment, and senices
(8) Transportation of patient�, anci thei1· me<lications and
equipment, an<l staff to an alternative care site(s) when
the envi1·onment cannot support care, tt·eatment, and
serVIces
(9) Transportation of pertinent patient information, induct­
ing essential clinical and medication-relate<l informa­
tion, to an alternative cai·e site(s) when the environment
cannot support ca1·e, treatment, and setvices
( 10) Documentation and tracking of patient location and
patient clinical information
12.5.3.3.6.5* Fssential Utilities and Sr.-tems. The facility shall
plan for continuitv of operations during the loss or interrup­
tion of the following utilities anci systems <luring an eme1·gency,
as applicable:
(l) Electricity
(2) Potable water
(3) Nonpotable wate1·
( 4) Wastewate1·
(5) HVAC
(6) Fire prntection
(7) Fuel for building operations
99-ll5
(8) Fuel for essential transportation
(9) Medical gas anci vacuum
(10) Info1·mation technology
12.5.3.3.6.6 Exterior Connections. For essential utility systems
in Emergency Management Category l facilities only, anci
based on the facility's I-IVA, consideration shall be given to the
installation of exterior building connectors to allow fo1· the
attachment of portable emergency utility mociules.
12.5.3.3.6.7 St.if£ Roles.
(A) Staff roles shall be defineci for the a1·eas of communica­
tions, resources anci asset�, safety an<l securitv, essential utilities,
and clinical activities.
(B) Staff shall 1·eceive training fot· their assigned roles in the
EOP.
(C) 1l1e facility shall communicate to licensed indepen<lent
health care provi<lers their roles in the EOP.
f
(D) The facility shall ensure that staf, voluntee1·s, and othe1·
pe1·so1mel a1·e cre<lentialed by the facility for thei1· assignment
an<l wear visible identification demonstrating such Cl'edential­
ing while on-site at the facility.
(E) The facility shall include in its plan the alerting, manag­
ing, anci tracking of all staff in an eme1·gency.
(F) The facility shall inclucie in it� plan a process fo1· integrat­
ing the use of volunteers, including those of the federal govern­
ment, in their emergency response.
12.5.3.3.6.8 The facility shall inclucie the following in it� EOP:
( l )* Stancia1·ci commanci structure that is consistent with its
community
(2) Reporting structure consistent with the command struc­
trn·e
(3) Activation anci cieactivation of the response an<l 1·ecove1y
phases, including the authority and process
(4) Facility capabilities and appropriate response effo1·t�
when the facility cannot be supponed from the out�i<le
for extended pe1·iods in the six critical a1·eas v,':ith an
acceptable response, including examples such as the
following:
(a) Resource conservation
(b) Seni ce curtailment
(c) Partial or total evacuation consistent with the staff's
designateci role in community response plan
(5) Alternative treatment sites to meet the neecis of the
patients
12.5.3.3.7 St.if£ Education.
12.5.3.3.7.1 Each facility shall implement an educational
prngram in emergency management that includes training,
drills, and exercises.
12.5.3.3.7.2 The eciucational program shall inclucie an over­
view of the components of the emergency management
program and concepts of the incident command system (ICS).
12.5.3.3.7.3 Individuals who are expected to perform a5 inci­
dent commanders or to he a�signed to specific positions within
the command structure shall he u·aineci in an<l familia1· with
the ICS anci the particular levels at which they are expected to
perform.
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99-II6 HEALTH CARE FACILITIES CODE
12.5.3.3. 7.4 Education concerning the sta ff's specific duties
and responsibilities shall be conducted.
12.5.3.3. 7.5 General overview education of the eme1·gency
management program and the ICS shall he conducted at the
time of hire.
12.5.3.3. 7.6 Department- and staff'.specific education shall he
f
conducted upon appointment to depanment/staf a�signment�
or positions and annually thereafter.
12.5. 3.3. B* Testing Emergency Plans and Op erations.
12.5.3.3.B.I The facility shall test it� EOP at least twice annu­
ally, either through functional 01- full-scale exercises or actual
events.
12.5.3.3.B.2 Exercises shall be based on the HVA priorities
and be as realistic as feasible.
12.5.3.3.B.3 For Eme1·gency Management Category 1 only. an
influx of volunteer or simulated patient� shall be tested annu­
ally, either through a fonctional or full-scale exercise or an
actual event. (SPP TablP 12.3.)
12.5.3.3.B.4 Annual table top, functional, or full-scale exerci­
ses shall include the following:
(1) Community integration
(2) Assessment of sustainability
12.5.3.3.B.5 For Em ergency Management Category 1 only, if
so 1·equired by the community designation to 1·eceive infectious
patient�. the facility shall conduct at least one exercise a y ear
that includes a surge of infectious patient�. (SPP TablP 12.3.)
12.5.3.3.B.6 The irlentified exe1·cises shall be conrlucted inde­
pendently or in combination.
12. 5.3.3.9 Scope of Exercises.
12.5.3.3.9.1 Exe1·cises shall be monitorerl hy at least one desig­
nated evaluator who has knowledge of the facility's plan and
who is not involved in the exercise.
12.5.3.3.9.2 Exel'Cises shall monit01- the critical firnctions.
12.5.3.3.9.3 The facility shall conduct a rlebriefing session not
rn01·e than 72 hmll's afte1· the conclusion of the exe1·cise or the
event.
12.5.3.3.9.4 The rlebriefing shall include all key inrlivirluals.
including obse1·ve1·s; administration; clinical staf( including a
physician(s); and appropt·iate support staff.
12.5.3.3.9.5 Exe1·cises anrl actual event� shall he critiqued to
identify a1·eas fot· improvement.
12.5.3.3.9.6 The critiques requirerl hy 12.5.3.3.9.5 shall irlen­
tify deficiencies anrl opp01-tunities fo1· improvement baserl
upon monitoring activities anrl observations dut·ing the exe1·­
cise.
12.5.3.3.9. 7 Opportunities for improvement identifierl in
critiques shall be incot-pornterl in the facility's improvement
plan.
12.5.3.3.9.B* Improvement� made to the emergency manage­
ment program shall be evaluaterl in subsequent exercises.
2021 Edition
12.5.3.4 Response.
12.5.3.4.1 * The facility shall declare itself in an emergency
mode baserl on cu1Tent conrlitions that leadership considers
extraordinary.
12.5.3.4.2 Once an emergency mode has been decla1·ed, the
facility shall activate it� EOP.
12.5.3.4.3 The rlecision to activate the EOP shall he marle hy
the incident commande1- designated within the plan, in accm-d­
ance with the facilitv's activation cr iteria.
12.5.3.4.4 The decision to deactivate the EOP shall be made
by the incident commander in the health care m·ganization in
coordination with the applicable external command authority.
12.5.3.4.5* The organization shall make provisions for emer­
gency Ct'edentialing ofvoluntee1· clinical staff.
12.5.3.4.5.1 At a minimum, a pee1· evaluation of skill shall be
conducted to validate proficiency for volunteer clinical staff.
12.5.3.4.5.2 Prior to beginning wm·k, the identity of other
volunteers offering to assist dut·ing response activities shall he
verified.
12.5.3.4.5.3 Pe1·sonnel rlesignated or involverl in the EOP of
the health ca1·e facility shall be supplied with a means of irlenti­
fication, which shall be worn at all times in a visible location.
12.5.3.4.5.4 Irlentification issued to volunteers shall rlistin­
f
guish volunteers from staf members.
12.5.3.4.6 The commanrl staff shall actively monitor condi­
tions present in the environment and remain in communica­
tion with community eme1·gency 1·esponse agencies during an
emergency response.
12.5.3.4.7 When conrlitions approach untenable, the
command stafl; in combination with community emergency
response agencies, shall determine when to acti.-ate the facility
evacuation plan.
12.5.3.4.B Evacuation to the alternative care site shall follow
the planning conducted <luring the preparedness phase.
12.5.3.4.9* Crisis Standards of Care. C1·isis stanrlards of ca1·e
shall he developed through a communitywirle approach, as
approved by the authoritv havingjurisdiction.
12.5.3.4.9.1 The decision to implement crisis stanrlards of
care shall be coordinated with the community leadership.
12.5.3.4.9.2 Upon implementation of crisis standards of care
in a community, the following shall be consirlered:
(l) The triage process
f
The allocation o medical services across the population
(2)
12.5.3.4.9.3 Standards of ca1·e shall be returnerl to normal at
the earliest feasible time.
12.5.3.4.10 Medical Surge Capacity and Capability. The
requirement� of 12.5.3.4.10.1 and 12.5.3.4.10.2 shall apply only
to those facilities designated as Eme1-gency Management Cate­
gory 1 as defined by the HVA.
12.5.3.4.10.1 * TI1e facility shall plan for medical surge
capacity and capability.
 SECURllY lvL>.NA(;EMENT 99-ll 7

12.5.3.4.10.2 The triage process shall be implemented a� Chapter 13 Security Management

follows:
(l ) The atTiving victim shall be assessed into the following 13.1 * Applicability. This chapte1· shall apply to new and exist­
cohort�: ing health care facilities.

(a) Risk to others, as follows: 13.2* Security Management Plan.

1. Mentally unstable 13.2.1 A healtl1 care facility shall have a secu1·ity management
11. Contaminated plan.
111. Infectious
(b) Risk to self, as follows: 13.2.2* The scope, objectives, performance, and effectiveness
of the security plan shall be tested at a freguency shown to be
1. Emotionally impai1·ed necessa1y by 1·eview of the security vulnernbility assessment
ii. Suicidal (SVA) in accordance with Section 13.3.
(c) Risk of rleath 01· pe1·manent i1�ury, as follows:
13.3 Security Vulnerability �essment (SVA).
1. Walking wounrlerl
ii. Severely i1�ured but stable 13.3.1* At least annually, the health care facility shall conduct
111. Suffering from life-tlu·eatening injury a security vulne1·ability assessment (SVA).
iv. Beyond care
(2) Patient� shall be arlmitterl fo1· treatment depending on 13.3.2 The facility shall modify, as necessa1)', it� SVA as a 1·esult
facility capacity, the facility's specialty, anrl clinic al need. of exercises, national or local event�, and annual review.
(3) Creation of ancillary clinical space shall have adeguate 13.3.3 The SV.A shall evaluate the potential security 1·isks
utilitv support for the following: posed by the physical anrl operntional environment of the
(a) HVAC health care facility to all individuals in the facility.
(b) Sanitation 13.3.4 The facility shall implement procedures anrl controls in
(c) Lighting accordance with the 1·isks identified by the SVA.
(d) Proximity to operating mom (OR)
13.4 Responsible Person.
12.5.3.4.11 Health ca1·e facilities shall have a designaterl media
spokesperson to facilitate news releases during the response 13.4.1 A pe1·son (s) shall be appointerl by the leade1·ship of the
p1·ocess. health care facilitv to be 1·esponsible fo1· all security manage­
ment activities.
12.5.3.4.12 An area shall be designated for media representa­
tives to a�semble where they \\111 not interfe1·e with the opern­ 13.4.2 The rluties of the person assignerl as regui1·erl by 13.4. l
tions of the health care facility. s hall include, but not be limited to, the follm\111g, a� identifierl
in the SV..\:
12.5.3.5* Recovery.
(1) Provirle identification for patient�, staff, anrl other people
12.5.3.5.1 Plans shall 1·eflect measures neederl to restm·e entering the facility
operational capability to pre-rlisaster levels. (2) Control access in and out of security-sensitive areas
12.5.3.5.2 Fiscal aspects shall be consirle1-ed "1th respect to (3) Define and implement procerlures a� follows:
1·estoration cost� and possible cash flow losses associated with (a) Security incirlent
the disruption. (b) Hostage situation
(c)* Bomb (explosive rlevice or threat)
12.5.3.5.3 Facility leadership shall accept and accommorlate (d) C1-iminal tl11·eat
federal, state, anrl local a�sistance that will be beneficial for ( e) Labor action
recovery of operations. (f) Disorderly conduct
12.5.3.5.4 No party to 1·ecovery shall take action to unfairly (g) i'\'orkplace violence
limit lawful competition once recovery operntions are comple­ (h) Restrnining 01·de1·
ted. (i) Prevention of, and response to, infant or pediatric
abrluction
12.5.3.5.5 Recove1·y shall not be deemerl complete until infec­ (j) Situations involving VIPs 01· the media
tion control decontamination effort� are v alidated. (k) Maintenance of access to emergency area�
12.5.3.6 Admiruslration. (I) Civil disturbance
(m) Forensic patient�
12.5.3.6.1 The facility shall modify, as necessa1)', its I-IVA, EOP, (n) Patient elopement
supply chain (including the current emergency supplies inven­ (o) National Terrorism Advisory System (NTAS) or
to1y), anrl other component� of the emergency management eguivalent
p1-ogrnm, as a result of exercises, actual event�, anrl annual (p) Suspicious material or package
revie,v. (q) Suspicious powde1· 01· substance
(r) Use of force policy
12.5.3.6.2 TI1e facility shall maintain w1·itten recorrls of drills, (s) Security staffing augmentation
exercises, and trnining as regui1·ed by this chapter for a pe1·iod (t) Active shoote1·
of 3 yea1·s. (4) Provirle security at alternate care sites or vacated facilities
(5) Control vehicular traffic on the facility property

2021 Edition
99-IIS HEALTH CARE FACILITIES CODE

(6) Prntect the facility asset�, including prnperty and eguip­
ment
(7 ) Prnvide policy for inte1·action with law enforcement agen­
ctes
(8) Comply with applicable laws, regulations, and standards
regarding security management operations
(9) Educate and train the facility security force to address the
following:
(a) Customer senice
(b) Use ofphysical restrai nl�
(c) Use of.force
(d) Response criteria
(e) Fire watch prncedures
(f) Lockdown procedut·es
(g) Emer·gency notification procedut·es
(h) Emergency communications procedures
13. 5 Security-Sensitive Areas.
13.5.1 All security-sensitive area�, as identified by the SVA,
shall be protected as appropriate.
13.5.2 Emergency department secu1·ity shall include appropri­
ate protection, including the following:
(I)* Control and limitation of access by the general public
(2) P1·ivate dut·ess alarm at the nurses' station and 1·eception
for summoning immediate a�sistance
(3) Access-control of treatment area
( 4) Lockdown procedure to secure the area when conditions
th1·eaten the viability of the department
(5) Bullet-resisting glazing material, as deemed necessatJ1 by
1·eview of the SVA
13.5.3 Pediat1·ic and infant care areas shall have a security
plan for the prevention of, and response to, pediatric and
infant abduction that shall include appropt-iate protections,
such as the following:
(1) Control and limitation of access by the general public
(2) Screening by nursing pri01· to allowing persons access to
infant care area�
f
(3) Matching protocol with staf clearance to pair infant�
with parents
( 4) System to monitor and track the location of pediatric
and infant patient�
(5)* Facility alert system and lockdown procedures
(6) Use of electronic monitoring, tracking, and access
control eguipment
(7) Use of an automated and standat·dized facilitv-wide alert­
ing system to announce pediatric or infant abduction
(8) Remote exit locking 01· ala1·ming
f
(9) Staf observation of all persons and inspection of all
packages leaving the premises
f
(10) Prohibition on birth announcement� by staf
f
(11) Detection o the pt·esence of a nonidentified individual
constitutes a secut·ity breach
(12) Movement of infant� restricted to ba�inets only - no
hand ca1-ries
f
( 13) Health care staf wear unigue identification or unifo1·ms
(14) Secure storage of scrubs and unif01·ms, both clean and
dirty
(15) Education in pediatt·ic and infant abduction as follows:
(a) Health ca.re staff are familiar with infant abduction
scenarios
(b) Parents know not to leave a child 01· an infant unat­
tended or in the care of an unidentified pe1·son
(c) Parent� know that they have the right to refuse to
release their child to any individual without valida­
tion ofofficial hospital identification
(16) Visiting family and friends not permitted to enter any
nursery area with an infant or a newborn from the
outside
(17) Infant abduction dt·ills conducted pe1·iodically, based on
SV.A., to test effectiveness of chosen measu1·es
(18) Video surveillance eguipment, where it does not violate
HIPAA 01· othe1· patient ri ght�
13.5.4* Medication storage and w01·k areas shall be secu1·ed
against admittance of unauthorized personnel through the use
of the following:
(1) Access control
(2) Unigue identification for the area
(3) Secure storage and contrnlled dispensing of drngs
13.5.5 Clinical and 1·esearch laboratm·ies shall be secu1·ed
against admittance of unauthorized personnel through appro­
pt-iate protections, such a.� the following:
(1) Access control
(2) Unigue identification for the area
(3) Secure storage and controlled dispensing of regulated
chemical, biological, and radiological mate1-ials
(4) Video surveillance
13.5.6 Dementia or behavioral health unirn shall be secu1·ed
against the admittance or 1·elease of unauthorized pe1·sonnel
through approp1·iate protections, such as the following:
(1) Access control
(2) Unigue identification for the area
(3)* Procedure to pt·event entry of contraband prior to a
person being admitted into the unit or department
(4) Elopement pt·ecautions
(5) Maintenance of color photos with the medical informa-
tion of cut-rent patients to aid in identification
13.5.7 Forensic patient t1·eatment areas shall provide appro­
pt-iate protections, such a� the following:
(1)* Law enforcement attending the patient at all times
(2) Treatment performed in an area separate from other
patient�
(3) Restraints applied 01· removed only under forensic staff
control
13.5.8 Communications, data infrastrncture, and medical
1·ecords storage areas shall be secured against the admittance of
f
unauthorized personnel or unauthorized release o confiden­
tial information through the use of approp1·iate prntections,
such as the following:
(1) Access control
(2) Unigue iclentification for the area
(3) Su1·veillance eguipment
Data encryption and passw01·d protection
(4)
13.6 Acces.s and Egres.s Security Measures.
13.6.1 Public visitation controls shall be enforced.
13.6.2 A,:fte1�hours entrance by the public shall be restricted to
designated areas, such as entrance lobbies and emergency
department�.
13.6.3 Health care facility security controls and procedures
shall comply with life safety reguirement� fot· egress.

2021 Edition
 HYPERBARIC FACILITIES 99-II9

13.6.3.1* Security plans for health care occupancies shall
ad<lress access and egress control during perio<ls of quarantine
and other event.� in conjunction with eme1·gency agencies.
13. 7* Media Control.
13.7.1 The secm·ity management plan shall include proce­
du1·es to accommo<late me<lia 1·ep1·esentatives.
13.7.1.1* A person shall be designate<l to serve as media
contact an<l 1·ep1·esentative for the 01·ganization in 1·egard to
media interactions.
13. 12 Program Evaluation.
13.12.1 * Pe1·iodic drills shall be con<lucted at various times
an ct locations.
13.12.2 The drills shall be critique<l for plan effectiveness an<l
to identify opportunities for improvement.
13.12.3 Identified opponunities for improvement shall be
incorporate<l into the security plan.
13.12.4 The secu1·ity plan shall be evaluate<l at least annually.

13.7.2* An area shall be designated for a�sembly of me<lia 13.12.5 The evaluation of the secu1·it:y management plan shall
1·ep1·esentatives. inclu<le a review of laws, regulations, and standards applicable
to the secu1·ity program.
13.7.3 A secu1·ity or facility staff membe1· shall 1·emain with the
media representative(s) at all times.
Chapter 14 Hyperbaric Facilities
13.7.4 Me<lia 1·epresentatives shall be escorted when grnnte<l
access to the health care facility out.�ide of the area designated 14.1 * S cope. The scope of this chapter shall be as specified in
in 13.7.2. I.I.12.
13.8* Crowd Control. 14.1.1 App licab ility.
13.8.1 1l1e secm·ity management plan shall include processes 14.1.1.1 This chapter shall apply to new facilities.
and procedures for controlling access to the health care facility.
14.1.1.2 The following sections of this chapter shall apply to
13.8.2 The sectu-ity management plan shall p1·mide proce­ both new an<l existing facilities:
du1·es for cro wd control fo1· management of those <lemanding (I) 14.2.4.1 .I (excluding subsections)
access to a health care facility. (2) 14.2.4.1.1.l
13.8.3 The procedu1·es for crowd control shall pt·mi<le for the (3) 14.2.4.1.2
coordination and collaboration of security and law e11fo1-ce­ (4) 14.2.4.1.3 (exclu<ling subsections)
ment. (5) 14.2.4.1.3.3
(fl) 14.2.4.4 (and subsections)
13.9 Access Control Equipment. (7) 14.2.5.4
13.9.1 Exterior entrances shall be provided with locking devi­ (8) 14.2.G.l.4 (excluding subsections)
ces. (9) 14.2.G.l.5
(10) 14.2.G.l.7
13.9.2 Locking devices shall comply with applicable federal, (11) 14.3.4.3.5 (an<l subsections)
state, and local requirement.�. (12) 14.2.8.l
(13) 14.2.8.2 (an<l subsections)
13.9.3 Locking devices shall be properly installed and be 111 (14) 14.2.9.3.l through 14.2.9.3.4
good working order. (15) 14.2.9.3.8 (and subsection)
13.9.4* The facility shall ope1·ate a key control program. (16) 14.2.9.3.14.4
(17) 14.2.9.3.15.5
13.10* Employment Practices. Employe1·s shall ensu1·e a high (18) 14.2.9.3.16 (an<l subsections)
level of integrity in the workplace by using the following practi­ (19) 14.2.9.4.1.3
ces: (20) 14.2.9.6 (an<l subsections)
(l) Background checks of employees with access to ffitical (21) 14.2.10.3 through 14.2.10.G.3 (and subsections)
assets (22) 14.2.11.2.5
(2) Background checks of outsi<le contractors' employees (23) 14.3.l (an<l subsections)
(3) Drng testing progrnm fo1· employees (24) 14.3.2.1.l through 14.3.2.1.5
(25) 14.3.2.4 through 14.3.2.6 (an<l subsection)
13.11 * Security Operations. (26) 14.3.3 and 14.3.4 (and subsections)
13.11.1 * Post 01·<le1·s shall be w1·itten ftx security personnel. 14.1.1.3 This chapter shall also apply to the altered, renova­
13.11.2 Security pe1·sonnel trnining shall inclu<le, but not be ted, 01· mo<lernized pm·tion of an existing system or individual
limite<l to, the following: component.

(l) Customer service 14.1.1.4 Existing construction 01· equipment shall be permit­
(2) Eme1·gency procedures ted to be continued in use when such use does not constitute a
(3) Patrol methods distinct hazard to life.
(4) De-escalation training 14.1.2 Clas.sification of Chambers.
(5) Use of physical restraint.�
f
(fl) Use o force 14.1.2.1 General. Chambers shall be classified according to
occupancy in order to establish appropriate minimum essen­
tials in construction an<l operntion.

2021 Edition
99-120 HEALTH CARE FACILITIES CODE
14.1.2.2 Occupancy. Hyperharic chambe1·s shall be classified
accor<ling to the following criteria:
(1) Cla�sA- Human, multiple occupancy
(2) Cla�s B - Human, single occupancy
(3) Cla�s C -Animal, no human occupancy
14.1.3 Category.
14.1.3.1 Category I Hyperbaric Care.
14.1.3.1.1 Whe1·e interruption or failure of me<lical gas supply
f
is likely to cause major injury or death of patient�, staf, or visi­
tors. the medical gas system shall he Category 1 for use in this
chapter.
14.1.3.1.2 \'\'he1·e intetTuption or faihu-e of electt-ical sen,ice is
likely to cause major ittjury or death of patient�. staff, or visi­
tors, the electrical service shall he Category 1 for use in this
chaplet·.
14.1.3.2 Category 2 Hyperbaric Care.
14.1.3.2.1 Where interruption or failure of medical gas supply
f
is likely to cause minm· ittjmy of patienl�, staf, or visitm·s, the
medical gas system shall be consi<lered Category 2 for use in
this chapter.
14.1.3.2.2 \\'he1·e interruption or failu1·e of elect1·ical seP,ice is
likely to cause minor i1tju1y of patient�. staff, or visitors, the
electrical service shall be Category 2 for use in this chapter.
14.1.3.3 Category3 Hyperbaric Care.
14.1.3.3.1 \'\'here interruption or failure of me<lical gas supply
is not likely to cause i1tju1y to patient�, staff, 01· visitm·s, the
medical gas system shall be consi<lered Category 3 for use in
this chapter.
14.1.3.3.2 Where interruption or failure of elect1·ical se1·vice is
not likely to cause i1tju1·y to patients, staff, or visitors, the elec­
trical service shall be Category 3 for use in this chapter.
14.1.3.4 Category4 Hyperbaric Care. (Reserved)
14.1.4 Applicable Code. Hyperha1·ic facilities that are
conducting any form of treatment and are not located in a
designate<l health care facility. including 1·esidential occupan­
cies, shall comply w ith the 1·equi1·ement.� of the applicable code.
14.2 Co nstruction and Equipment.
14.2.1 Housing for Hyperbaric Facilities.
14.2.1.1 For Class A chambers located inside a building, the
chambei-(s) and all ancillary senice equipment shall be protec­
te<l by 2-hour fi1·e-1·esistant-rated construction.
14.2.1.1.1 * Freestan<ling, <le<licated buildings containing only
a Class A chamber(s) an<l ancillary se1·vice equipment shall not
be 1·equired to be protected by 2-hour fi1·e-resistant-rated
construction.
14.2.1.1.2 Class B an<l C chambers locate<l inside a huil<ling
shall not be 1·equired to be protected by 2-hour fit·e-1·esistant­
rated construction.
14.2.1.1.3 T1·ailer 01· vehicle-mounted facilities shall be pe1·mit­
ted without a 2-hour fire-resistant-rate<l pe1·imete1·.
14.2.1.1.4 \\'hen trailer or vehicle-mounted facilities are loca­
ted contiguous to a health ca1·e facility or another structure, a
2021 Edition
2-hour fire-1·esistant-rated ban-ier shall he placed between the
facility an<l the contiguous structure.
14.2.1.1.5 Whe1·e buil<ling exte1-io1· walls fmm part of the
facility boundary, that pmtion of the facility boundaty shall not
require 2-hour fire-resistant-rated construction.
14.2.1.1.6* If there are connecting <loors through such
common walls of contiguity, they shall he at least B-lahel,
I ½-hou1· fire <loors.
14.2.1.1.7 When use<l for hyperbaric proce<lures, the room or
rooms housing the Class A 01· Class B chambers shall be for the
exclusive use of the hyperbaric operation.
14.2.1.1.8 Senice equipment (e.g.. compressors) shall he
permitted to be locate<l in multi-use spaces meeting the
1·equirement� of 14.2.1.1.
14.2.1.1.9 The supporting foun<lation for any chamber shall
be <lesigne<l to support the chamber.
14.2.1.1.9.1 If on-site hy<lrostatic testing will he perfo1·med,
the chamber supporting foundation shall be designe<l to
support an a<lditional water weight.
14.2.1.2* The room housing a Cla�s A or Class B chamber and
any ancillary equipment rooms shall be provided protection by
one of the following systems:
( l) * A hydraulically calculate<l automatic wet pipe sp1·inkler
system meeting the requirements of NFPA 13
(2) A.11 automatic water mist fire protection system installed
in accordance with NFPA 750
(3)* A clean agent fire protection system in accordance with
NFPA 2001
14.2.1.2.1 Class A or Class B chambers not contiguous to a
health care facility an<l located in a mobile vehicle-mounted
facility shall not be required to be protected as specifie<l in
14.2.1.2.
14.2.1.2.2 The room housing a Class A, Class B, or Class C
chamber shall contain a minimum of one 2-A:10B:C portable
fit·e extinguisher.
14.2.1.3 H}Perbaric Piping Requirements.
14.2.1.3.1* Except where other-wise 1·equireci by this chapte1·,
piping systems dedicated to the hyperba1·ic chambe1· shall meet
the requirement.� of ASME PVHO-1, Sa/Ny Standard for PrPssurP
Vf.t�el� for Human Oaupanry, for hyperbaric facility piping
systems.
14.2.1.3.2 Shutoff valves accessible to facility p ersonnel shall
be provided for piping specified in 14.2.1.3.1 at the point of
entt-y to the room housing the chamber(s).
14.2.1.3.3 The supply piping for all air, oxygen, or other
breathing mixtures from certifie<l commercially supplie<l cylin­
ders and portable containers shall be provided with a particu­
late filte1· of 66 microns m· fine1·.
14.2.1.3.3.1 The particulate filter shall meet the construction
1·equirement.� of ANSI/ ASME PVH0-1, Sajfty Standard far PrPs­
surP VP.t�d�for Human Or,:.upanry.
14.2.1.3.3.2 The particulate filter shall be located as close as
p ractical to the sou1·ce.
 HYPERBARIC FACILITIES
14.2.1.4 Hyperbaric Medical Oxygen System Requirements.
14.2.1.4.1 \Vhere medical oxygen systems a1·e installed for
hyperba1·ic use, the hype1·ba1·ic area(s) 01· facility shall be tt·ea­
terl as a separate zone.
14.2.1.4.2 The 1·equirements of Chapte1· 5 shall apply to the
medical oxygen system for hyperbaric use, from the source of
supply to the fit-st in-line valve locaterl downstt·eam of the zone
valve(s).
14.2.1.4.3 l11e requi1·ements of ANSI/ASME PVHO-1, Sajfty
Standard Jar Prl'ssurl' ¼ssl'l1 for Human Orrupanry, shall apply to
the medical oxygen system for hyperbaric use, starting immedi­
ately downstream of the fit-st in-line valve located afte1· the zone
valve(s).
14.2.1.4.4 Hyperbaric oxygen systems for Category 1, Catego1y
2, and Categ01·y 3 hyp erba1·ic ca1·e connecterl directly to a
hospital's m..-ygen system shall comply with Section 5.1, as appli­
cahle, except as noterl in 14.2.1.4.4. l.
14.2.1.4.4.1 Central Supply Systems. Oxygen systems shall
comply with 5.1.3.5, as applicable, except as followli:
(1) An emergency oxygen supply connection (EOSC) shall
not be requirerl for the hyperbaric oxygen sy;tem.
(2) An in-building emergency reserve (IBER) shall not be
required for the hyperbaric m.-ygen system.
14.2.1.4.5 Hype1·haric stanrl-alone m..-ygen systems for Cate­
gory l anrl Categ01·y 2 hype1·ba1·ic care shall comply with
Section 5.1, a� applicable, except a� noted in I 4.2.1.4.5. l.
14.2.1.4.5.1 Central Supply Systems. Oxygen sylitems shall
comply with 5.1.3.5, as applicable, except as follows:
( l) An EOSC shall not be requirerl for the hyperbaric oxygen
system.
(2) An IBER shall not be 1·equi1·ed for the hyperbaric oxvgen
system.
14.2.1.4.6 Warning Systems.
14.2.1.4.6.1 Oxygen systems shall comply with 5.1.9, as appli­
cable, except that warning systems shall be permitterl to be a
single master/area alarm panel.
14.2.1.4.6.2 The alarm panel shall be located in the room
housing the chamber(s) to allow for easy audio and visual
monit01·ing by the chamber operator.
14.2.1.4.7 Hype1·baric stand-alone oxygen systems fo1· Cate­
gory 3 hyperbaric care shall comply with Section 5.2. as applica­
ble, except as noted in 14.2.1.4.7.1.
14.2.1.4.7.1 Central Supply Systems. Oxygen systems shall
comply with :U .3.5, as applicable, except as follows:
( l) If the ope1·ating oxygen supply consists of high p1·essm·e
cvlinders designerl with a primary anrl seconda1-y som·ce,
no reserve supply shall be requirerl.
(2) If the operating oxygen supply consists of liquid contain­
ers designerl with a primar y and seconrlary source, a
reserve with a minimum supply of 11' minutes shall he
required.
(3) If the operating oxygen supply consists of a bulk primai·y,
a 1·eserve with a minimum supply of 15 minutes shall he
required.
( 4) An EOSC shall not be required for the hyperbai·ic oxygen
system.
99-121
(5) An IBER shall not be required fo1· the hype1·baric oxygen
system.
14.2.1.5 Hyp erbaric Medical Air System Requirements.
14.2.1.5.1 \Vhere merlical air systems ai·e installed for hyper­
baric use, the hyp e1·ba1·ic area(s) 01· facility shall be treaterl as a
separate zone.
14.2.1.5.2 Chapter 1, requirements shall apply to the medical
air system fo1· hyperba1·ic use, from the source of supply to the
first in-line valve located downstream of the zone valve(s).
14.2.1.5.3 ANSI/ASME PVHO-1, Sajfty Standard for Pressurl'
lhsl'l1 Jar Human Oi:rupanry, requi1·ement� shall apply to the
rnerlical ai1· system for hyperbaric use, sta1·ting immerl:iately
downst1·eam of the first in-line valve located afi:e1· the zone
valve(s).
14.2.1.5.4 \Vl1ere a medical ai1· system is :installed fo1· hyper­
haric t1·eatment�, it shall comply with the requirement� for the
appropriate level as determinerl in 14.2.1.5.4.l through
14.2.1.5.4.7.
14.2.1.5.4.1 Hyp erbaric medical air systems for Category I,
Category 2, and Categoty 3 hyperbaric care connected rlirectly
to a hospital's merlical ai1· system shall comply with Section 5.2,
a, applicable.
14.2.1.5.4.2 Reserved.
14.2.1.5.4.3 Hyp erba1·ic stand-alone medical air systems fo1·
Categot·y l anrl Categor y 2 hyperbal"ic care shall comply with
Section 5.2. as applicahle.
14.2.1.5.4.4 Reserved.
14.2.1.5.4.5 Merlical air systems for Catego1y l anrl Catego1y 2
hype1·haric ca1·e shall comply with Section 5.2, as applicable,
except that warning systems shall be permitted to be a single
master/area alarm panel.
14.2.1.5.4.6 Hyp erbaric stanrl-alone medical systems for Cate­
gory 3 hype1·baric ca1·e shall com ply with Section 5.2, as applica­
ble, except as noterl in 14.2.1.5.4.7.
14.2.1.5.4.7 Medical air systems shall comply with Section 5.2
a, applicable, except as follows:
(1) Area anrl ma5ter alarms shall not be requirerl for Cate­
gory 3 hyperbaric cai·e.
(2) A gas cylinder hearler pe1· Section f>.2 with sufficient cylin­
der connections to provide for at least an average day's
supply with the appropriate number of connections being
rletermined after consideration of delivery schedule,
proximity of the facility to alternate supplies, anrl the
facility's emergency plan shall be pe1·mitted.
(3) A medical air cylinder directly connecterl to a Class B or
Class C chamber ai1rl used to provide air to that chambe1·
shall he permitterl to he in the same room as the cham­
ber.
(4) \Vhe1·e a cylinrler is used as rlesc1·ibed in 14.2.1.5.4.7(3),
the cylinde1· shall be consirle1·ed to be "in use" and shall
not be counted when determining the total volume of
merlical gas out�irle a storage area in Section 11.3.
14.2.1.6 Storage and Handling of Medical Gases. Storage anrl
handling of medical gases shall meet the applicable require­
ment5 of Chapter 5 anrl Chapter 11.
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99-122 HEALTH CARE FACILITIES CODE
14.2.2 Fabrication of the Hyperbaric Chamber.
14-2.2.1 * Chambe1·s for human occupancy and their support­
ing systems shall be designed and fabricated to meet ASME
PVH0-1, Sapty Standard for Pre.mire ¼>ssel� for Human Or.rupanr:y,
by personnel qualified to fabricate vessels under such codes.
14.2.2.1.1 Piping systems for hyp erha1·ic facilities shall he
required to meet only the requi1·ements of this chapte1· and
Section 4, "Piping Systems," of ASME PVHO-1, Sapty Standard
for Pmm1re Ve.1:�els for Human Or.rupanry.
14.2.2.1.2 Piping that is installed in concealed locations in the
building housing the hyperbaric facility, such a� inside building
walls 01· above false ceilings. shall use only those joining proce­
dures permitted by Chapter 5.
14.2.2.2 The chamber shall be stamped in accordance with
ASME PVH0-1, Sapty Standard for PrPss1ae Ve.1:sfls for Human
Oc,·upan,y.
14.2.2.3 Class C chambers shall he designed, fabricated, and
stamped to meet Division l 01· Division 2 code 1·equi1·ements of
Section VIII of the ASME Boiln and Pre.mlTP VPssPl Codi'.
14.2.2.4* The viewports for Class C chambers shall be
designed, fabricated, and ma1·ked to meet Section 2 of ASME
PVHO-1, Safety Standardfor PrPss1m Vessd�for Human Or.r:upanry.
14.2.2.5 The floor of a Class A chamber shall be designed to
suppon equipment and personnel necessa1·y for the operation
of the chamber according to it� expected purpose.
14.2.2.5.1 The floor of Class A chambers shall be noncombus­
tible.
14.2.2.5.2 If a bilge is installed, access to the bilge shall be
pro,ided for cleaning purposes.
14.2.2.5.3 If the interior f1001· of a Class A chamher consist� of
removable floor (deck) plates, the plates shall be mechanically
secured and electrically bonded to the chamber to ensure a
positive electrical ground and to prevent movement of the
plate, which could cause injury to personnel.
14.2.2.6 The interior surface of Class A chambers shall be
unfinished or u·eated with a paint/coating in accordance with
14.2.2.G. l.
14.2.2.6.1* Interior paint/coating shall meet the performance
criteria of NFPA 101, Class A interior finish, when tested in
accordance with ASTM E84, Standard Test IHethod for Suifaa
fluming Chamdrnstirs of Building Materials, or UL 723, Standard
for ]pst for Suiface Burning Chara,:tPrisli,:s of Building MatPriak
14.2.2.6.2* One additional application of paint shall be
pe1·mitted, provided total paint thickness does not exceed
½sin. (0.9 mm).
14.2.2.6.3 If the interior of a Class A chamber is treated (pain­
ted), the cure procedure and minimum duration for each layer
of paint/coating to off�ga s shall be in acco1·dance with the
manufacturer's application inst1·uctions.
14.2.2.6.4* If sound-deadening materials are employed within
a hyperba1·ic chamber, they shall be limited-combustible mate1·i­
als.
14.2.2. 7* Viewing ports, access ports for piping and wiring or
monitoring, and 1·elated leads shall be installed du1·ing initial
fabrication of the chamber.
2021 Edition
14.2.2.7.1 Access port� in Cla�s A chambers, access ports for
monitoring, and other electrical circuit� shall be housed in
enclosures that a1·e weatherproof. both inside and out�ide the
chambe1·, fot· protection in the event of sprinkler activation.
14.2.2.7.2 Viewport5 and penetrator plates shall be designed
and fabt·icated acco1·ding to ANSI/ASME PVHO-1, Sapty Stand­
ard for PrPssurP Vessel�for Human Oa:upanry.
14.2.3 Illumination.
14.2.3.1 Sources of illumination mounted outside the pres­
sure chamber and atTanged to shine through chamhe1· ports or
through chamber penetrators designed for fiber-optic or simi­
lar lighting shall meet the following requi1·ements:
( 1) lighting fixtures used in co1�unction with \iewports shall
he designed so that t emperature ratings for the viewport
matet-ial given in ASME PVHO-1, Sapty Standard for Pres­
sure VP.�sels for Human Ocrupanry, are not exceeded.
(2) Gasket material shall be of a type that allows the move­
ment of thermal expansion and shall be selected for the
temperatu1·es, pressures, and composition of ga�es
involved.
(3) Gasket5 or 0-rings shall he confined to grooves or enclo­
sures, which will prevent their being blown out or
squeezed from the enclosures or comp1·ession flanges.
14.2.3.2 Emergency lighting for the interior of the chamber
shall be provided.
14.2.4 Chamber Ventilation.
14.2.4.1 Ventilation of Class A Chambers.
14.2.4.1.1 The minimum ventilation rate fot· a Cla�s A cham­
ber shall be 0.085 m:'/min (3 ft�/min) of air per chamber occu­
pant who is not using a breathing-mask ove1·hoard dump system
that exhausts exhaled gases.
14.2.4.1.1.1 The minimum threshold rate shall be
0.085 m�/min (3 ft1/min).
14.2.4.1.1.2 Provision shall be made ftx ventilation dtu-ing
nonpressurization of Class A chambers as well as during pres­
surization.
14.2.4.1.2* Ventilation shall not be 1·equired when saturation
operations are conducted in the chamber, provided that
carbon dioxide removal and odor cont rol are accomplished
f
and that the monitoring requirements o 14.2.10.4.l and
14.2.10.5 are met.
14.2.4.1.3 Individual breathing apparatus shall be available
inside a Class A chambe1· for each occupant for use in the event
that the chamber atmosphe1·e is fouled by combustion or othe1·­
wise.
14.2.4.1.3.1 The bt·eathing mixtu1·e supplied to breathing
apparatus shall be independent of chamber atmosphe1·e.
14.2.4.1.3.2 The lxeathing gas supply shall be designed for
simultaneous use of all bt·eathing apparatus.
14.2.4.1.3.3 Breathing apparatus shall function at all pressures
that can be encountered in the chamber.
14.2.4.1.3.4 In the event of a fi1·e within a chambe1·, provision
shall be made to simultaneously switch all breathing apparatus
to an ai1· supply that is independent of the chamber atmos­
phere.
 HYPERBARIC FACILITIES
14.2.4.2 Sources of Air for Chamber Atmospheres.
14.2.4.2.1* Som·ces of ai1· for chambe1· atmosphe1·es shall be
such that toxic 01· flammable gases are not intro<luce<l.
14.2.4.2.2 Compressor intakes shall be located away f om air r
contaminated by exhaust from activities of vehicles, internal
combustion engines, stationa ry engines, 01· building exhaust
outlets.
14.2.4.2.3 Ai1· supply fo1· chamber atmosphere shall he moni­
tore<l as requi1·ed in 14.2.10.6.
14.2.4.2.4 The use of conventional oil-lubricate<l compressors
shall be permitted, provided that they a re fitted with ai1· tt·eat­
ment packages designe<l to meet the 1·equirement� of 14.2.10.6.
14.2.4.2.5 Air compressor installations shall consist of two or
more individual comp1·essors with capacities such that 1·equi1·ed
system flow rntes can be maintained on a continuous basis with
any single comp1·ess01· out of operation, unless 14.2.9.2.6 is
satisfied.
14.2.4.2.5.1 Each c01np1·ess01· shall be supplied from separnte
electrical hrnnch circuit�.
14.2.4.2.6 A.ii· compresso1· installations that supply medical air
to piped ga� systems a.� well as to hyperba1·ic facilities shall meet
the requi1·ements of 5.1.3.6.3 and this chapter.
14.2.4.2. 7 Ai1· comp1·esso1· installations that a re used exclu­
sively for hype1·baric facilities shall meet the requirements of
this chapter only.
14.2.4.3 Temperature and Humidity Control.
14.2.4.3.1 Warming or cooling of the atmosphe1·e within a
Cla�s A chamber shall be permitte<l by circulating the ambient
air within the chamber over 01· past coils through which a
constant flow of warm 01· cool \\'3.ter or wate1/glycol mixture is
circulated.
14.2.4.3.2 Dehumidification shall be pe1·mitted thrnugh the
use of cold coils.
14.2.4.3.3 Humidification by the use of an air0powered water
ne bulizer shall be pe1·mitte<l.
14.2.4.3.4 Noncombustible packing and nonflammable lub1·i­
cant shall be employed on the fan shaft.
14.2.4.4 Ventilation of Class B Chambers.
14.2.4.4.1* The minimum ventilation rate for a Class B cham­
ber shall be 0.0283 m'/min (1 ft'/min).
14.2.4.4.2 Class B chambers not <lesigned for 100 pe1·cent
oxygen environment shall comply with the monitoring requi1·e­
ment� of 14.2.10.4.
14.2.4.4.3 For Class B chambers equipped with a breathing
apparatus, the breathing apparatus shall function at all p1·es­
sures that can be encountered in the chamber.
14. 2. 5 Emergency Depressurization.
14.2.5.1 Class A chambers shall be capable of dep1·essmizing
from 3 ATA (304.0 kPa) to ambient pressure in not more than
6 minutes.
14.2.5.2 Class B chambers shall be capable of depressmizing
from 3 A.TA (304.0 kPa) to ambient pressure in not more than
2 minutes.
99-123
14.2.5.3 Class C chambe.-s shall be capable of rapi<l <lep1·essu­
rization.
14.2.5.4* A 1·isk assessment shall be ped·01·med to dete1·mine if
means for 1·espiratory and eye prntection from combustion
pro<lucts allowing unrestricted mobility is required to he availa­
ble outside all classes of hype1·haric chambers for use by
pe1·so11nel in the event the air in the vicinity of the chamber is
foule<l by smoke or other combustion product�.
14.2.6 Fire Protection in Class A Chambers.
14.2.6.1 General.
14.2.6.1.1 A fire suppression system consisting of in<lepen<l­
entlv supplie<l and opernting ha.n<lline- and deluge-type wate1·
spray systems shall be installed in all Class A chambern.
14.2.6.1.2 Design of the fire suppression system shall be such
that failure of component� in eithe1· the handline 01· deluge
system will not render the othe1· system inoperntive.
14.2.6.1.3 System design shall be such that activation of eithe1·
the handline 01· the deluge system shall automatically cause the
following:
(1) Visual and aural indication of activation shall occur at the
chambe1· operntor's console.
(2) ."'11 ungrounded electrical leads fix power and lighting
circuil� conta.ine<l insi<le the chamber shall be disconnec­
te<l.
(3) Emergency lighting (seP 14.2.3.2) and communication,
where used, shall be activated.
14.2.6.1.3.1 Intrinsicallysafe ci1·cuit�, including sound­
powered communications, shall be permitted to remain
connecte<l when either the handline or the <leluge system is
activated.
14.2.6.1.4 A means of communication shall be provi<le<l at the
chamber operator"s control console for notifying the fire
department.
14.2.6.1.4.1 Activation of the fire supp1·ession system shall
notify the facility's central fire alarm system, if present.
14.2.6.1.4.2 Trniler or vehicle-mounte<l facilities not conti gu­
ous to a health care facility shall confo1·m to one of the follow­
ing:
(1) They shall comply with 14.2.6.1.4.
(2) They shall have a means for imme<liately contacting the
local fire depa rtment.
14.2.6.1.5* Fi1·e blanket� and portable ca1·bon dioxide extin­
guishe1·s shall not be installed in 01· carried into the chamber.
14.2.6.1.6 Booster pumps, control circuitry, an<l other electri­
cal equipment involve<l in fire suppression system operation
shall be powered from a CI"itical branch of the essential elecu·i­
cal system as specified in 14.2.9. 2.1.2.
f
14.2.6.1.7 Signs prohibiting the intro<luction o flammable
r
liquids, ga�es, an<l othe1· a ticles not pe1·mitted by this chapte1·
into the chamber shall be posted at the chamber entrnnce(s).
14.2.6.1.8 The fit·e suppression system shall be permitte<l to be
supplied from the local potable water service.
14.2.6.2 Deluge S)Stem. A fixed water deluge extinguishing
system shall be installe<l in all chambe1· compartment� that are
designe<l for ma.nned operations.
2021 Edition
99-124 HEALTH CARE FACILITIES CODE
14.2.6.2.1 In chambern that consist of m01·e than one chamber
compartment (lock), the design of the deluge system shall
meet the requirement� of 14.2.6.2 when the chamber compart­
ment5 a1·e at diffr1·ent depths (pressures).
14.2.6.2.2 The deluge system in different compartments
(locks) shall operate independently or simultaneously.
14.2.6.2.3 Fixed deluge systems shall not be required in cham­
ber compartment5 that are used strictly as personnel trans fer
compartments (locks) and for no othe1· put-poses.
14.2.6.2. 4* Manual activation and deactivation deluge
controls shall be located at the operator's console and in each
chambe1· compartment (lock) containing a deluge system.
14.2.6.2.4.1 Controls shall be designed to pt·event unintended
activation.
14.2.6.2.5 \'Vate1· shall be delivered from the fixed discharge
nozzles as specified in 14.2.6.2. 7 within 3 seconds of activation
of any affiliated deluge control.
14.2.6.2.6* Average spray density at floor level shall be not less
than 81.5 L/min/m2 (2 gpm/ft 2), with no floor area larger
than l m2 (10.76 ft2) receiving less than 40.75 L/min/m 2
(1 gpm/ft2).
14.2.6.2. 7 \Vater shall be available in the deluge system to
maintain the flow specified in 14.2.6.2. 6 simultaneously in each
chambe1· compartment (lock) containing the deluge system fot·
l minute.
14.2.6.2. 7.1 The limit on maximum extinguishment duration
shall be governed by the chamber capacity (bilge capacity also,
if so equipped) or it� drainage system, or both.
14.2.6.2.B The deluge system shall have st01·ed p1·essu1·e to
opei-ate for at least 15 seconds without electrical branch powe1·.
14.2.6.2.9 All dedicated storage vessels used to pro.ide the
deluge system with water shall be fitted with a suitable \vate1·
level indicat01·, with the level displayed at the chambe1· console.
14.2.6.2.10 Deluge systems using pressurized water vessels
shall be designed to pt·event the driving gas supply from pres­
surizing the hype1·ba1-ic ch am bet· if all the water is dt·iven out of
the water vessel.
14.2.6.3 Handline System. A handline extinguishing system
shall be installed in all ch ambet· compartment5 (locks).
14.2.6.3.1 At lea5t two handlines shall be strategically located
in treatment compartment5 (locks).
14.2.6.3.2 At least one handline shall be located in each
personnel transfer compartment (lock).
14.2.6.3.3 If any chambe1· compartment (lock) is equipped
with a bilge access panel, at least one handline shall n�ach the
bilge area.
14.2.6.3.4 Handlines shall have a 12.7 mm (0.5 in.) minimum
internal diameter and shall have a i-ated operating pressure
greater than the highest supply pressure of the supply system.
14.2.6.3.5 Each handline shall be activated by a manual,
quick-0pening. quarte1·-turn valve located within the compart­
ment (lock).
14.2.6.3.5.1 A hand-operated sp1·ing-1·eturn to close valves at
the discharge end of handlines shall he permitted.
2021 Edition
14.2.6.3.6 Handlines shall be equipped with override valves
that are accessible to personnel outside the chamber.
14.2.6.3 .7 The \l/ate1· supply for the handline system shall be
designed to ensure a 345 kPa (50 psi) minimum \rate1· pi·essure
above the maximum chamber pressure.
14.2.6.3 .7.1 The system shall he capable of supplying a mini­
mum of 18.9 L/min (5 gpm) simultaneously to each of any two
f
o the handlines at the maximum chamber pressure for a
period of not less than 4 minutes.
14.2.6.4 Automatic Detection System. Automatic fit·e detec­
tion systems shall not be required.
14.2.6.4.1 Surveillance fire detect01·s responsive to the radia­
tion from flame shall be employed.
14.2.6.4.1.1 The type and arrangement of detectot·s shall he
such as to respond within l second of flame origination.
14.2.6.4.2* The number of detectors employed and their loca­
tion shall be selected to cover the chamber inte1·i01·.
14.2.6.4.3 The system shall be powered from the critical
branch of the essential electrical system or shall have automatic
battery hack.up.
f
14.2.6.4.4 I used to automatically activate the deluge system,
the requirements for manual activation/deactivation in
14.2.6.2.4 and deluge system response time in 14.2. 6.2.5 shall
still applv.
14.2.6.4.5 The system shall include self�monitoring functions
for fault detection anrl fault alarms and inrlications.
14.2.6.4.6 Automatic fire detection equipment. when used.
shall meet the applicable requirement� in 14.2.9.3.
14.2.7 Pneumatic Controls for Gass A Chambers. Class A
chambe1·s that utilize pneumatically opei-ated controls that are
related to fire suppression system operation, breathing gases,
or rapid exhaust valves shall be equipped with a means to ope1·­
ate such controls or intended function i n the event that the
pneumatic supply fails.
14.2.8 Fire Protection in Class B and Class C Chambers.
Class B and Cla�s C chambe1·s shall not be required to comply
with 14.2.6.
14.2.8.1 Signs prohibiting the introduction of flammable
liquids, ga�es, and othe1· articles not permitted by this chapter
into the chamber shall be posted at the chamber entrance(s).
14.2.8.2 A means for communication shall be pro.irled within
the room housing the chambe1·(s) for notifying the fire depart­
ment.
f
14.2.8.2.1 I the building housing the hyperba1·ic facility has a
central fire alarm system, the communication shall be a pull­
station connected to the system.
14.2.8.2.2 Traile1· 01· vehicle-mounted facilities not contiguous
to a health cai·e facility shall confo1·m to one of the follm,�ng:
(1) They shall comply with 14.2.8.2.
(2) 1l1ey shall have a means for immediately contacting the
local fir·e depai·tment.
 HYPERBARIC FACILITIES
14.2.9 Electrical Systems.
14.2.9.1 General.
14.2.9.1.1 1l1e requirement� of NFPA 70 or local electrical
codes shall apply to electrical wiring aml equipment in hyper­
baric facilities within the scope of this chapter, except as such
mies are modifierl in 14.2.9.
14.2.9.1.2 All hyp erbaric chamber service equipment, switch­
boa1·ds, panels, or control consoles shall be located out�ide of,
anrl in the vicinity of, the chamber.
14.2.9.1.3 Console or module spaces containing both oxygen
piping and electt·ical equipment shall be either one of the
following:
( l) Mechanically or naturally ventilated
(2) Continuously monitorerl fo1· excessive o-,.,.-ygen concentt·a-
tions whenever the electrical equipment is energized
14.2.9.1.4 For the fixed electrical installation, none of the
following shall be permitted inside the chamber:
( l) Ci1·cuit b1·eake1·s
(2) Line fuses
(3) Motor controllers
(4) Relays
(1,) Transformers
(6) Ballasts
(7) Lighting panels
(8) Powe1· panels
14.2.9.1.5 All electrical equipment connecterl to, or userl in
conjunction with, hyp e1·baric patient� shall comply \\ith the
1·equirement� of Chapter 10 anrl with the applicable subpara­
graphs of 14.2.9.3.
14.2.9.1.6 In the event of activation of the room sp1·inkler
system, electrical equipment shall be protected from sp1·inkler
f
wate1· but shall not be required to remain functional i manual
means to control and decompress the chamber are prmided.
14.2.9.2 Electrical Service.
14.2.9.2.1* All hyperbaric facilities equipped with any of the
following electrically driven feature shall be provided with
some means of backup electt·ic power:
( l)* Chamber room emergency lighting, installerl per
f
Section 7.9 o NFPA J()J_
(2)* Chamber emergency lighting, whether internally or exter-
nally mounterl
(3)* Chamber intercommunications
(4)* Alarn1 systems, including flame detectors
(5 )* Chamber fire supp1·ession system equipment and controls
(6)* Electrical controls used for chamber pressurization and
ventilation control
14.2.9.2.1.1 Electt·ical control and alarm system design shall
be such that hazardous conrlitions (e.g., loss of chamber p1·es­
sure control, deluge activation, spurious alarms) rlo not occur
rlm·ing powe1· interruption or during power 1·estoration.
14.2.9.2.1.2 Booster pumps in the chamber fit·e suppression
system shall be on separate branch circuit� serving no other
loads.
14.2.9.2.2 Article 700 of NFPA. 70 shall apply to hyp erbaric
systems locaterl in facilities other than health care facilities.
99-125
14.2.9.2.3 Hyp erbat·ic elect1·ical service fo1· Category l or 2
hyp erbaric care shall be supplied from two indepenrlent sour­
ces of electt·ic power.
14.2.9.2.3.1 Fm· hyperbat·ic facilities using a prime-mover­
rlriven generator set, they shall be designaterl as the life safety
anrl critical brnnches and shall meet the 1·equirement� of Chap­
ter 6 for hyperbaric systems based in health care facilities.
14.2.9.2.3.2 Electrical equipment associated with lile-support
functions of hype1·baric facilities shall be connecterl to the criti­
cal branch of the essential electrical system, which 1·equi1·es that
such equipment shall have electrical power restored within
10 seconrls of intermption of normal power.
14.2.9.2.4 Electt·ic mot01·-rl1·iven compressors and auxiliaty
electrical equipment normally located out�ide the chamber
anrl used for chamber atmosphe1·ic contt·ol shall be connecterl
to the equipment system (.�PP ChaptfT 6) 01· the life safety anrl
critical branches (.w ArtidP 700 nf JW·PA 70) as applicable.
14.2.9.2.5 Electt·ic moto1·-driven compressors and auxiliaty
electrical equipment shall be aiTanged fot· delayerl-automatic
or manual connection to the alten1ate power source so as to
prevent excessive current rlraw on the system <luring restarting.
14.2.9.2.6 Where reserve air tanks 01· a nonelectric compres­
sor(s) is provirlerl to maintain ventilation ait·flow within the
chamber and supply air for chamber pressurization, the
comp1·esso1·(s) and auxiliary equipment shall not be n,quirerl
to have an alternate powe1· sout·ce.
14.2.9.3* Wiring and Equipment Inside Class A Chambers.
The genet·al mies of 14.2.9.3.1 through 14.2.9.3.16.5 shall be
satisfie d in the use of electt·ical devices anrl equipment. T hese
requit·emenl� at·e intenrlerl to protect against the elevaterl fire
risks known to exist in a pressurized air environment anrl shall
not be construed as cla�sifying the chain bet· interior as a Class I
(as definerl in Article 500 of NFPA 70) hazai·rlous location.
14.2.9.3.1 Equipment or equipment component� installerl in,
or userl in, the chamber shall not present an explosion 01·
implosion haza1·d undet· the conditions of hyperbaric use.
14.2.9.3.2 All equipment shall be raterl, or tested anrl docu­
mented, for intenrlerl hyperbaric conditions prior to use.
14.2.9.3.3 Only the electt-ical equipment necessary fo1· the safe
operation of the chamber and for requirerl patient care shall
be pet·mitted in the chambet·.
14.2.9.3.4 Only portable equipment necessaty for the logisti­
cal anrl operational support shall be permitted in the chamber
during manned pressut·ization.
14.2.9.3.5 Wires and Cables. \'Vires and cables userl inside the
chamber shall be resistant to the spread of fire by complying
with 14.2.9.3.!'>.l or shall be contained within equipment rle­
scriberl in 14.2.9.35.2.
14.2.9.3.5.1 ,-v·ires and cables shall comply with the spread of
fire requirement� of "UL Flame Exposure, Vertical Tray Flame
Test" in UL 1685, Standard fnr Vertiral-Tray Fire-Pmpagatinn and
Smnkf-&lnw 'J!'sl fnr t:!Pt:triral and Gptiral-Fiber Cables, or shall
exhibit damage (cha1· length) not to exceed 1.5 m (4 ft 11 in.)
when perfot·ming the CSA "Venical Flame Test - Cables in
Cable Trays,'' as rlesct·ibed in CSA C22.2 No. 0.3, Test Metlwd� fnr
Elertriral WirP-� and Cables .
2021 Edition
99-126 HEALTH CARE FACILITIES CODE
14.2.9.3.5.2 Wires anrl cables that form an integrnl pan of
electrical equipment approved or listed specifically for use
inside hypet·baric chambers, including patient leads, shall not
be 1·equired to comply with the requi1·ement� of 14.2.9.3.5.l .
14.2.9.3.6 Wiring Methods.
14.2.9.3.6.1 Fixed wiring shall be installed in conrluit utilizing
the following waterproof component�:
( l) Threaded metal joint�
(2) Fittings
(3) Boxes
(4) Enclosures
14.2.9.3.6.2 A continuous grounrl shall be maintainer!
benveen all conrluctive sudaces enclosing electrical circuit� anrl
the chamber hull using approver! grounding means.
14.2.9.3.6.3 .'\11 threaded conrluit shall be tlu-eaded with an
NPT standard conrluit cutting die that provides a 19 mm tape1·
per 0.3 m (0.75 in. taper per l ft).
14.2.9.3.6.4 All threarlerl conrluit shall be marle wrench-tight
to prevent sparking when fault cut-rent flows through the
conduit system.
14.2.9.3.6.5 Wiring classified as intt·insically safe for any group
location anrl installed in accm·rlance with A..rticle 504 of
NFPA 70shall be permitted.
14.2.9.3.6.6 Threarlerl, liquidtight flexible metal conrluit
installed in accorrlance with Article 350 of NI-PA. 70 shall be
permitted when protected from rlamage by physical barriers
such as equipment panels.
14.2.9.3. 7 Drainage. Means of draining fixed conduit and
fixed equipment enclosures shall be provided.
14.2.9.3.B Flexible Electrical Cords. Flexible cords used to
connect portable utilization equipment to the fixer! elect1·ical
supply circuit shall meet all the following requirement�:
( l) They shall be of a type approver! for extra-ha1·rl use in
acco1·dance with Table 400.4 of NI-PA. 70.
(2) Electrically conductive casings of all portable equipment
for use insirle the chamber shall be grounded.
(3) They shall meet the 1·equirements of 501.140 of NFP/i 70.
14.2.9.3.B.l The normal cord supplier! with the portable
utilization equipment shall be permitted when the pot·table
device is rated at less than 2 A and the cm·d is positionerl out of
trnffic and protected from physical abuse.
14.2.9.3.9* Receptacles Installed Inside the Chamber.
14.2.9.3.9.1 Receptacles shall he waterproof.
14.2.9.3.9.2 Receptacles shall be of the type providing for
connection to the grounding conductor of the flexible cm·d.
14.2.9.3.9.3 Receptacles shall be supplied from isolated power
circuits meeting the requirements of 14.2.9.4.2.
14.2.9.3.9.4 The design of the 1·eceptacle shall be such that
sparks cannot be discha1·ged into the chamber environment
when the plug is inserted or withdrawn under electrical !oar!.
14.2.9.3.9.5 One of the following shall he satisfied to protect
against inadvertent withrlrnwal of the plug under electt·ical
load:
2021 Edition
(l) 1l1e 1·eceptacle-plug combination shall be of a locking
type.
(2) The receptacle shall caITy a label wan1ing against unplug­
ging unde1· load, anrl the power cm·rl shall not present a
trip hazard for personnel moving in the chamber.
14.2.9.3.10 Switches. S\,�tches in the fixer! wiring installation
shall be waterproof.
14.2.9.3.10.1 * Switch make and break contacts shall be
houser! in the electt·ical enclosure so that no sparks from a1-cing
contact� can 1·each the chamber environment.
14.2.9.3.11 * Temperature. No electrical equipment installed
or used in the chamber shall have an opernting surface tempe1·­
at1u-e in excess of 85"C (185"F).
14.2.9.3.12 Exposed Llve Eleclrical Parts. No exposer! live
electt·ical pa1·t� shall be permitted, except as specifier! in
14.2.9.,\.12. l anrl 14.2.9.3.12.2.
14.2.9.3.12.1 Exposed live electrical part� that are intrinsically
safe shall be permitted.
14.2.9.3.12.2 Exposed live electrical parts that constitute
patient monitoring leads, which are part of electromedical
equipment, shall be pe1·mitted, provided that they meet the
requirement� of 14.2.9.3.16.
14.2.9.3.13* Motors. Motors locater! in the chamber anrl that
a1·e not a component of medical equipment shall meet one of
the following 1·equirement�:
(1) 1l1ey shall comply with 501.125(A)( l ) of NFPA 70.
(2) 1l1ey shall be totally enclosed in accordance with
501.125(A)(2) or 501.125(A)(3) of 1vTPA. 70.
14.2.9.3.14* Lighting.
14.2.9.3.14.1 Lighting installed 01· used insirle the chamber
shall be of a type that is not damaged by exposure to l ½ times
the maximum allo\1,ahle wm·king pressm·e (MA\'\!J>).
14.2.9.3.14.2 Permanently installed fixtures shall meet the
following requirement�:
(l) They shall be rated and approved for Class I (Division l
or 2) classifier! areas.
(2) 1l1ey shall have lens guards installed.
(3) 1l1ey shall be located away from a1·eas where they would
experience phys ical damage from the normal movement
of people and equipment.
14.2.9.3.14.3 Balla�t� and other energy storage component�
that are pan of the lighting circuit shall be installer! out�irle the
chamber in accordance with 14.2.9.1.4.
14.2.9.3.14.4 Portable fixtures intended for spot illumination
shall be shatterproof or protected from physical damage.
14.2.9.3.15 Low-Voltage, Low-Power Equipment. The requi1·e­
ment� of 14.2.9.3.15. l through 14.2.9.3.15.5 shall apply to
sensors anrl signaling, alann, communications, and remote­
control equipment installer! or used in the chamber for opera­
tion of the chamber.
14.2.9.3.15.1 * Equipment shall be isolated from main power
by one of the following means:
(1) Design of the power supply circuit
(2) Opto-isolation
(:'I) Other electronic isolation means
 HYPERBARIC FACILITIES
14.2.9.3.15.2 Circuit� such as headset cables. sensor lea,ts. and
so forth, not encloserl as requirerl in 14.2.9.3 .G, shall meet one
of the following requirement�:
(I) They shall be part of approved intt·insically safe equip­
ment.
(2) They shall be limited by circuit design to not more than
28 V and 05 A unde1· normal or ci1·cuit-fault conditions.
14.2.9.3.15.3 Chamber speakers shall be of a design in which
the electrical ci1·cuitt·y anrl wiring is completely enclosed.
14.2.9.3.15.4 The electrical rating of chamber speakers shall
not exceed 28 V rms and 25 W.
14.2.9.3.15.5 Batte1·y-operated, portable intercom headset
units shall meet the requi1·ements of 14.2.9.3.IG.4 for battery­
operaterl devices.
14.2.9.3.16 Portable Patient Care-Related Electrical Applian­
ces.
14.2.9.3.16.1 The appliance shall be designed, constructed,
inspected, and maintainerl in acco1·dance with Chapter 10.
14.2.9.3.16.2 The electrical anrl mechanical integrity of the
appliance shall be verified and documenterl through an ongo­
ing maintenance program as required in Chapter 10.
14.2.9.3.16.3 Appliances that utilize oxygen shall not allow
oxygen accumulation in the electrical portions of the equip­
ment unrle1· nOL·mal anrl abnOL·mal conditions.
14. 2. 9. 3.16.4 Battery-Operated Devices. Bat tery-operaterl
devices shall meet the following requirements:
( l) Batteries shall be fully enclosed and secut·ed within the
equipment enclostll'e.
(2) Batteries shall not be damagerl by the maximum chamber
pressu1·e to which they a1·e exposed.
(3) Batteries shall be of a sealerl type that does not off-gas
during normal use.
( 4) Batteries or hattery-operaterl equipment shall not
unde1·go cha1·ging while located in the chambe1·.
(5) Batteries shall not be changerl on in-chambe1· equipment
while the chamber is in use.
(G) The equipment elecu-ical rating shall not exceed 12 V
and 48 \'\'.
14.2.9.3.16.5 Cord-Connected Devices. Cord-connected devi­
ces shall meet the following requirements:
( l) A.II portable, cm·d-connected equipment shall have an
on/off power switch.
(2) The equipment electt·ical rating shall not exceed 120 V
and 2 A. unless the electrical portions of the equipment
are inert-gas purged.
The plug of cord-connected rlevices shall not be used to
(3)
inteLTupt power to the device.
14.2.9.3.17* Gas Purging. Gas pmging of AC anrl DC equip­
ment used inside the chamber shall be permitterl using inert
gas or air.
14.2.9.4 Grounding and Ground-Fault Protection.
14.2.9.4.1 All chambe1· hulls shall be grounded to an electrical
ground or grounding system that meets the requirements of
Part III of Article 250 of 1WPA. 70.
14.2.9.4.1.1 Grounrling conrluctors shall be secut·erl
1·equirerl by Part III of Anicle 250 of 1\/I-PA 70.
99-127
14.2.9.4.1.2 The material. size, and installation of the ground­
ing conductor shall meet the requirement� of Part VI of Article
250 of NFP.!l. 70for equipment grounding conrluctm·s.
14.2.9.4.1.3 The resistance between the grounrlerl chambe1·
hull and the electrical grounrl shall not exceed l ohm.
14.2.9.4.2 All ac electrical power circuit� located within the
chamber shall be supplied from an ungrounded elecu·ical
system.
14.2.9.4.2.1 The ci1·cuit� specified in 14.2.9.4.2 shall meet the
requi1·ement� of 517. lG0(A) and 517. lG0(B) of NI-PA 70.
14.2.9.4.2.2 B1·anch circuit� shall not exceed 125 V or 15 A.
14.2.9.4.3 \A/iring located both inside and out�ide the cham­
ber, that serves line level circuit� anrl equipment locaterl insirle
the chamber, shall meet the grounding and bonding 1·equire­
ment� of 501.30 of NFPA. 70.
14.2.9.5 Wiring O utside the Chamber. Those electrical
component� that must remain firnctional for the safe termina­
tion of chamber operations following activation of the room
sprinkler system shall be enclosed in wate1·proof housing.
14.2.9.5.1 A.JI associated conduit� shall meet the following
requirement�:
( l) They shall be waterproof.
(2) They shall meet the requirements of NfPA 70.
(3) They shall he equipperl with approved drains.
14.2.9.5.2* All other electrical devices out�ide the chamber
shall meet the requirement� of NFPA. 70.
14.2.9.6 Additional Wn-ing and Equipment Requirements
Inside Class B and Oass C Chambers. The requirements in
14.2.9.6 shall apply to Class C chambers pressurized with
oxygen and to Class B chambers whethe1- they a1·e p1·essurized
with oxygen 01· with air.
14.2.9.6.1 Electrical equipment inside chambers shall be
1·esu·icted to communications functions and patient physiologi­
cal monit01·ing leads.
14.2.9.6.1.l* Each circuit shall be designed to limit the electri­
cal energy to wi1·e !earls into the chambe1· under n01·mal 01·
fault conditions to not more than 28 V anrl 4.0 \, V This 1·equire­
ment shall not exclurle more stringent requirement� imposerl
by other codes governing electromedical apparatus.
14.2.9.6.1.2 Communications wires shall be protected from
physical damage and from coming into contact with flammable
materials in the chamber by baLTiers or conduit.
14.2.9.6.1.3 Patient monitoring !earls shall be pan of
approved elecu·omedical apparatus meeting the requirement5
in 14.2.9.3.lG.
14.2.9.6.2 Lighting insirle the chamber shall be supplied from
external sources.
14.2.9.6.3 No materials shall be permitterl in a chamber whose
temperature exceeds 50"C ( l 22"F), nor shall any elecu·ical
ci1·cuit inside a chamber operate at a temperature exceeding
50'C (122'F).
as
2021 Edition
99-128 HEALTH CARE FACILITIES CODE
14.2.10 Communications and Monitoring.
14-2.10.I General.
14.2.10.1.1 Electt·ical monitoring equipment used inside the
chamber shall comply with the applicable requirement� of
14.2.9.
14.2.10.1.2 Detectors, sensors, trnnsducers, and communica­
tions equipment located insirle the chamber shall meet the
requirements of 14.2.9.3.15 for Class A chambers and 14.2.9.6
for Class B chambet·s.
14.2.10.1.3 Wiring methods in the chamber shall meet the
applicable 1·equirement� in 14.2.9.3.
14.2.10.1.4 The following equipment shall be installed outside
the chamber or shall meet the requirements of 14.2.9.3.15:
( 1) Control equipment
(2) Powe1· amplifiet·s
(3) Output transformers
(4) Monitors associated with communications and monitor-
ing equipment
14.2.10.2* Intercommuni cations.
14.2.10.2.1* A...11 intet·communications syi;tem shall connect all
pe1·s01111el companment� (locks) and the chamber operntor's
control console.
14.2.10.2.2* Closed-ci1·cuit television monit01-ing of the cham­
bet· inte1·i01· s hall be empl oyerl for chamber operatm·s who rlo
not have direct visual contact with the chamber interior from
their normal operating location.
14.2.10.2.3 Oxygen mask microphones shall be inu·insically
safe at the maximum proposed pressure and 95 :t 5 percent
m..-ygen.
14.2.10.3 Combustible Gas Detection.
14.2.10.3.1 The chamber atmosphere shall be continuously
monitored for combustible gas concentrations wheneve1· any
volatile agent� are userl in the chambet·.
14.2.10.3.1.1 The monitor shall be set to prmirle audible anrl
visual alarms at 10 percent lowe1· explosive limit (LEL) for the
particular gas used.
14.2.10.4 Oxygen Monitoring.
14.2.10.4.1 Oxygen levels shall be continuously monitorerl in
any chamber in which nitrogen is adderl to the chambet· or to
reduce the volumetric concentration of m.. -ygenin the atmos­
phere.
14.2.10.4.1.1 Oxygen monitors shall be equipped with audible
and visual alarms.
14.2.10.4.1.2 Sample 1·esponse time, at all treatment levels,
shall be no more than 30 seconrls.
14.2.10.4.2* Oxygen levels shall be continuously monitored in
Oass A chambet·s when breathing mixtm·es containing in
excess of 21 pet"Cent OJ,,.")'gen by volume are being bt·eathed by
patient� or attendant5, when any flammable agents are present
in the chamber, 01· when both conrlitions exist.
14.2.10.4.2.1 Audible and visual alarms shall indicate volumet­
ric oxygen concenu·ations i n excess of 23.5 percent range for
Class A chambet·s.
2021 Edition
14.2.10.4.2.2* At least one sample port shall be equipped with
a removable extension to allow for spot-checking of any loca­
tion within the chambe1·.
14.2.10.5 Carbon Dioxide Monitoring. The chamber atmos­
phere shall be monitorerl for carbon rlioxirle levels during satu­
rntion operntions whenever ventilation is not userl.
14.2.10.6* Chamber Gas Supply Monitoring.
14.2.10.6.1* As a minimum, the air supplied from compres­
sm·s to all classes of chambet·s shall meet the requi1·ements for
CGA Gracie E with the arlrlerl requirement that conrlensed
hyrlrocarbons and particulates shall be less than 0.1 mg/m3
14.2.10.6.2 W'hen ait· cylindet·s are used to prnvirle breathing
air in chambers, the breathing air shall be merlical air USP.
14.2.10.6.3 When cylinders are userl to provide oxygen m
chambern, the ga� shall be oxygen USP.
14.2.11 Other Equipment and Fixtures.
14.2.1 I.I All furnitu1·e permanently installerl m the hyper­
baric chamber shall be grounded.
14.2.11.2* Exhaust from all classes of chambe1·s shall be piped
out�ide of the building.
14.2.11.2.1 Each Class B and Class C chamber shall have an
independent exhaust line.
14.2.11.2.2 The point of exhaust shall not create a hazard.
14.2.I 1.2.3 The point of exhaust shall not allow reentry of
gases into the building.
14.2.11.2.4 The point of exhaust shall be protecterl by the
prnvision of a minimum of 0.3 cm (0.12 in.) mesh SCl'een and
situated to p1·event the intrusion of rain, snow, or airborne
debt·is.
14.2.I 1.2.5* The point of exhaust shall be irlentified as an
oxygen exhaust by a sign prohibiting smoking or open flame
and the sign shall include a pictograph indicating "no smok­
ing'· and "no open flame - flame" in accorrlance with
NFPA 170.
14.3 Administration and Maintenance.
14.3.I General.
14.3.1.1 Purpose. Section 14.3 contains requi1·ements for
administration and maintenance that shall be followed as an
a�junct to physical precautions specifierl in Section 14.2.
14.3.1.2* Recognition of Hazards. The natm·e anrl 1·ecogni­
tion of hyperbaric hazards at·e outlinerl in Annex B of this
rlocument and shall be 1·eviewerl by the safety rlirector.
14.3.1.3 Responsibility.
14.3.1.3.1 Pet·sonnel ha\ing 1·esponsibility for the hyperbat·ic
facility, and those responsible for licensing, accrediting, or
apprnving institutions or other facilities in which hyperba1·ic
installations at·e employerl, shall establish anrl enfot·ce
programs to fulfill the provisions of this chapter.
14.3.1.3.2* Each hypet·baric facility shall rlesignate an on-site
f
hyperbaric safety directot· to be in cha1·ge o all hyperbat·ic
equipment and the operntional safety requirement� of this
chapter.
 HYPERBARIC FACILITIES
14.3.1.3.2.1 1l1e safety di1·ector shall participate with facility
management personnel and the hyperbaric physician(s) in
developing procedtu-es for operation anci maintenance of the
hyperba1·ic facility
14.3.1.3.2.2 The safety director shall make recommendations
fo1· departmental safety policies and procedures.
14.3.1.3.2.3 The safety direct01· shall have the authmity to
restrict or remove any potentially hazardous supply or equip­
ment items from the chambe1·.
14.3.1.3.3* The governing boa1·ci shall be responsible fix the
care and safety of patient� and personnel.
14.3.1.3.4* By virtue of it� responsibility for the professional
f
conduct of membe1·s of the medical staf of the health ca1·e
facility, the organizeci medical staff shall adopt anci enforce
1·egulations with respect to the use of hype1·baric facilities loca­
ted in health care facilities.
14.3.1.3.4.1 1l1e safety director shall participate in the cievel­
opment of these regulations.
14.3.1.3.5* The safety director shall ensu1-e that electrical,
monitoring, life-support, protection, and ventilating arrange­
ment� in the hype1·baric chamber are inspected and testeci a�
part of the routine maintenance program of the facility.
14.3.1.4 Rules and Regulations.
14.3.1.4.1* General. The aciministrative, technical, anci
professional staffs shall jointly develop policies for manage­
ment of the hyperbaric facility.
14.3.1.4.1.1 Upon acioption, the management policies shall be
available in the facility.
14.3.1.4.2 The meciical directm· of hypedJaric medicine anci
the safety di1·ector shall jointly cievelop the minimum staff qual­
ifications, experience, and complement based on the following:
(I) Number and type of hype1·baric chambers in use
(2) Maximum treatment capacity
(3) Type of hyperbaric therapy normally provicieci
14.3.1.4.3 1\ll personnel, including those involved in mainte­
nance and repai1· of the hype1·baric facility, shall be trained on
the purpose, application, operation, and limitations of emer­
gency equipment.
14.3.1.4.4 When an inspection, test, or maintenance proce­
cim·e of the fire suppression system results in the system being
placed out of service, a protocol shall be followed that notifies
approp1·iate personnel anci agencies of the planned 01· emer­
gency impairn1ent.
14.3.1.4.5 A sign indicating the fire suppression system is out
of service shall be conspicuously pl.aced on the operating
console until the fire supp1·ession system is 1·estoreci to service.
14.3.1.4.6* During chamber operations with an occupant(s)
in a chamber, the ope1·ator shall be phys ically present anci shall
maintain visual or audible contact with the control panel or the
chamber occupant(s).
14.3.1.5 Emergency Procedures.
14.3.1.5.1 Eme1·gency procedures specific to the hyperba1·ic
facility shall be e stabl ishe rt.
99-129
14.3.1.5.2* All personnel shall be traineci in emergency proce­
dures.
14.3.1.5.3 Personnel shall be trained to conu·ol the chambe1·
and decompress occupants when all powereci equipment has
been renciered inoperative.
14.3.1.5.4* Eme1·gency proceciures anci fi1·e training drills
shall be conducted at least annually anci documented by the
sal"ety director.
14.3.1.5.4 .1 The time requi1·eci to evacuate all persons from a
hype1·baric area with a full complement of chamber occupant�
all at treatment pressure shall be measureci annually.
14.3.1.5.4.2 The occupanl� for the timeci evacuation drill shall
be permitteci to be simulated.
14.3.1.6 General.
14.3.1.6.1 Potential Ignition Sources.
14.3.1.6.1.1 * The following shall be prohibited from inside
the chamber and the immediate \�cinity out�ide the chamber:
(1) Smoking
(2) Open flames
(3) Hot objecL�
14.3.1.6.1.2 The following shall be prohibited from inside the
chamber:
(1) Personal warming de,ices (e.g., therapeutic chemical
heating pads, hand warmers, pocket v.,armers)
(2) Personal electrically powered devices (e.g., laptops, elec-
tronic tablets, cell phones, pagers)
(3) Sparking toyli
( 4) Personal entertainment devices
14.3.1.6.1.3* P1·ior to each hyperbaric treatment, a p1·etreat­
ment safety check to identify and remove prohibited items shall
be perfonned and ciocumenteci by a qualified pe1·son.
14.3.1.6.2 Flammable Gases and Liquids.
14.3.1.6.2.1 Flammable agents, including cievices such as labo­
ratory burners employing bottleci or natural gas and cigarette
lighters, shall be prohibiteci insicie the chamber anci from the
proximity of the comp1·ess01· intake.
14.3.1.6.2.2 For Class A chambers, flammable agents used for
patient care, such a.� alcohol swabs, parenteral alcohol-ba�ed
pha1-maceuticals, anci topical c1·eams, shall be pe1·mitted in the
chamber if the following conditions a1·e met:
(1) Such use is approved by the safety di1·ector or othe1·
autho1·ity ha\ing jurisdiction.
(2)* 1l1e quantities of such agenl� are limited so that they are
incapable of releasing sufficient flammable vapor into the
chambe1· atmosphe1·e to exceed the LEL for the material.
(3) A safety factor is includeci to account for the localizeci
concentrations, stratification, and the absence of ventila­
tion.
(4) The oxygen monitm·ing requirement of 14.2.10.4.2 is
obsen·eci.
14.3.1.6.2.3 Flammable liquids, gases, or vapors shall not be
pe1·mitted insicie any c:Ja�s B chamber.
2021 Edition
99-130 HEALTH CARE FACILITIES CODE
14.3.1.6.3* Personnel.
14-3.1.6.3.1 An tistatic procedures, as di1·ectetl by the safety
di1·ector, shall be employed wheneve1· atmosphe1·es containing
mm·e than 23.5 percent m..·ygen hy volume are used.
14.3.1.6.3.2 In Class A and Class B chambe1·s with atmos­
pheres containing more than 23.5 percent oxygen by volume,
electrical grounrling of the patient shall be ensured by the
provision of a high-impedance conductive pathway in contact
\\1th the patient's skin.
14.3.1.6.3.3 Shoes having ferrous nails that make contact with
the floor shall not be permitterl to be worn in Class A cham­
be1·s.
14.3.1.6.4* Textiles.
14.3.1.6.4.1 Except where permitted in 14.3.1.6.4.3, silk, wool,
or synthetic textile materials, or any combination thereof, shall
he prnhibiterl in Cla�s A or Class B chambers.
14.3.1.6.4.2* Garment� permitted insirle of chambers shall be
as follows:
( l) Ga rment� fabricated of 100 percent cotton or a blend of
cotton anrl polyeste1· fabric shall be permitterl in Class A
chambe1·s.
(2) Ga rment� falxicated of 100 percent cotton, 01· a blend of
cotton and polyester fabric containing no more than
50 percent polyeste1·, shall be pe1·mitted in Cla�s B cham­
be1·s.
14.3.1.6.4.3* The physician in charge, with the concurrence
of the safety director, shall be pe1·mitted to approve the use of
the follm�ng prohibiter! items in the chamber :
( l) Suture material
(2) Alloplastic devices
(3) Bae te1·ial haITiers
(4) Surgical d1·essings
(5) Biological interfaces
(6) Synthetic textiles
14.3.1.6.4.4 Physician and safety di1·ector approval to use
prohibited items shall be stated in writing for all prohibiter!
materials employer!. (See A..14.3.1.3.2.)
14.3.1.6.4.5 Upholstered Furniture.
(A) Upholste1·ed furniture (fixed or portable) shall be 1·esist­
ant to smolde1·ing (or cigarette) ignition in acc01·dance with
one of the following:
( l) The components of the upholstered furniture shall meet
the 1·egui1·ements for Class l when tested in accm·rlance
withNFPA 260.
(2) Mocked-up composites of the upholstered furniture shall
have a char length not exceeding 38 mm ( l 1/., in.) when
tested in accm·rlance withNFPA 261.
(B) Upholsterer! forniture shall have limited rates of heat
release when tested in accorrlance with ASTM El537, Standard
1Pst Nlfthod for Fire 1Psting of Upholstered Furniture, m \\1th Califm­
nia Technical Bulletin 133, Rmnmaliility 1Pst Pmad1ae for Seating
Furniture for Use in Publir, Ocrupanries, a� follows:
( l) The peak rnte of heat 1·elease for the single upholsterer!
furniture item shall not exceed 80 k\,I,'_
2021 Edition
(2) The total heat released by the single upholstered furni­
ture item <luring the first 10 minutes of the test shall not
exceerl 25 MJ.
14.3.1.6.4.6 Mattresses.
(A) Mattress componenl� shall have a cha1· length not exceerl­
ing 2 in. (51 mm) when tested in acco1·rlance with 16 CFR
1632, "Standa1·d for the Flammabilitv of Mattt·esses and
Mattress Pads (FF 4-72) ," or NFPA 260.
(B) Mattresses shall have limited rates of heat relea�e when
tested in accorrlance \\1th ASTM El 590, Standard Test Method for
Fire 1;,sting of Mattre.tses, or California Technical Bulletin 129,
Flammability Test Pmredure for MattTl'SSl'S for Use in Publir Buildings.
a5 follows:
(1) 1l1e peak rate of heat relea5e for the mattress shall not
exceed 100 kW.
(2) The total heat 1·eleased by the mattress <luring the first
10 minutes of the test shall not exceed 25 MJ.
14.3.1.6.4.7 Fill mate1·ials contained within upholsterer! furni­
tm·e anrl mattt·esses shall comply \�th the open flame test in
Section A-1 of the 2000 erlition of California Technical Bulletin
11 7, Requimnmts, 'll'st Pmadim and Apparatus for TPsting the
Rmne RetardanrP of RPsilimt Filling lvl.ate-rials U�Pd in UphoMered
Furniture.
14.3.1.6.4.8 For materials with fire-retardant coatings, the
mate1·ial shall be maintained in accordance \�th the manufac­
tm·er's instructions to retain the fi1·e-retardant properties.
14.3.1.6.4.9 Exposed foamed plastic materials shall he prohibi­
ted.
14.3.1.6.5 The use of flammable hair sprays, hair oils, anrl skin
oils shall be prohibited for all chamber occupant5/patienrn as
well a� personnel.
14.3.1.6.5.1 Wheneve1· possible, patient� shall be stripped of
all clothing, particularly if it is contaminaterl by dirt, grease, or
solvents, a.nrl then 1·eclotherl. (SeeA.14.3.1.6.4.)
14.3.1.6.5.2 All cosmetics, lotions, anrl oils shall be removed
from the patient ·s borly and hair.
14.3.1.6.6 All othe1· fah1·ics used in the chambe1·, such as
sheets, pillow ca5es, and blankets, shall conform to 14.3.1.6.4. l
anrl 14.3.1.6.4.2.
14.3.1.6.7 Drapes user! within the chamhe1· shall meet the
flame propagation perfo1·mance criteria contained in Test l or
Test 2, as appropriate, ofNFPA 701.
14.3.1.6.8 Clothing worn by patient� in Class A or Class B
chambers and personnel in Class A chambers shall, prior to
each treatment, conform to the follo\\1ng:
( l) They shall be issued by the hyp erbaric facility or specifi­
cally approver! by the safety rli1·ector fo1· hyperbaric use.
(2) They shall be uncontaminaterl.
( 3) They shall be devoid of prohibiter! anicles prior to cham­
ber pressurization.
14.3.1.6.9* Paper brought into the chamber shall be storer! in
a closed metal container.
14.3.2 Equipment.
14.3.2.1 All eguipment use<l in the hyperbaric chambe1· shall
comply with Section 14.2, including the follm�ng:
 HYPERBARIC FACILITIES
( l) All electrical and mechanical eguipment necessary for
the operation and maintenance of the h)'perbaric facilicy
(2) Any medical devices an<l instrument� used in the facility
14.3.2.1.1 Use of unapproved eguipment shall be prohibited .
14.3.2.1.2 The following <levices shall not be operated in the
hyperba1·ic chamhe1· unless approved fo1· such use by the safecy
director and medical director of hype1·baric medicine:
( l) Portable x-ray <levices
(2) Electrncaute1·y eguipment
(3) High-ene1·gy- de\ices
14.3.2.1.3 Photog1·aphic eguipment employing the following
shall not 1·emain in the chamber when the chamber is p1·essur­
ize<l:
( l) Photoflash
(2) Flood lamps
14.3.2.1.4 The use of Class l or Cla�s 2 lasers a� define<l by
ANSI Z136.3, American Natinnal Standard fm- SafP U�P of La.wrs in
Hmlth Care, shall be permitted.
14.3.2.1.5 Eguipment known to be, or suspecte<l of being,
defective shall not he introduced into any hyperbaric chamber
01· used in conjunction with the opei-ation of such chamber
until repai1·ect, tested, an<l accepted by gualifie<l pe1·sonnel and
approved by the safecy <lirector. (SI¥ 14.3.1.3.2.)
14.3.2.2* The following shall be all-metal to the extent possi­
ble:
( l) Oxygen containers
(2) Valves
(3) Fittings
(4) Interconnecting eguipment
14.3.2.3 1l1e following shall be compatible with oxygen under
senice conditions:
(1) Valve seat�
(2) Ga�kets
(3) Hose
(4) Lub1·icants
14.3.2.4 Eguipment use<l insi<le the chamber reguiring lub1·i­
cation shall he lubricated with oxygen-compatible mate1-ial.
14.3.2.4.1 Factory-sealed antifriction bearings shall he permit­
r
ted to be use<l with standa d hydrocarbon lulxicants in Cla�s A
chambers that do not employ atmospheres of inc1·ease<l oxygen
concentration.
14.3.2.5* Eguipment made of the following shall be prohibi­
ted from the chamber inte1·i01·:
(1) Cerium
(2) Magnesium
(3) Magnesium alloys
14.3.2.6* In the event that radiation e<Juipment is inu·oduced
into a hyperbaric chamber, hydrocarbon detectors shall he
installed.
14.3.2.6.1 In the event that flammable ga�es are detecte<l in
excess of 1000 ppm. radiation e(]uipment shall not be ope1·ated
until the chamber atmosphere is cleare<l.
99-131
14.3.3 Handling of Gases.
14.3.3.1 The institution's adminisu·ative personnel shall
develop policies for safe handling of gases in the hype1·baric
facility. (SN 14.3.1.6.2.)
14.3.3.2 Ox-ygen and other gases shall not be introduced into
the chamber in the liguid state.
14.3.3.3 Flammable gases shall not be used or store<l in the
chamber or in the hyp erba1·ic facility.
14.3.3.4* P1·essm·ized containe1·s of gas shall be permitted to
be introduced into the hyperbaric chamber, provided that the
container and its content� are approved fo1· such use by the
safecy direct01·.
14.3.4 Inspection, Testing, and Maintenance.
14.3.4.1 General.
14.3.4.1 .1 The hyperbaric safecy di1·ector shall ensme that all
valves, regulators, meters, an<l similar eguipment use<l in the
hype1·baric chambe1· are compensated fo1· use un<le1· hype1·baric
conditions and tested as part of the 1·outine maintenance
program of the facilicy.
14.3.4.1.1.1 P1·essure 1·elief valves shall he teste<l an<l calibra­
ted as part of the routine maintenance program of the facility.
14.3.4.1.2 The hyperharic safecy director shall ensure that all
gas oullets are labeled 01· stenciled in accordance with CGA
C-7, GuidP tn Cla�sijiration and Labeling of Cmnpressed Gases.
14.3.4_1.3 The reguirements set forth in Section 5.1 and
NFPA 55 concen1ing the stoi-age, location, an<l special p1·ecau­
tions 1·e(]uire<l for me<lical gases shall be followe<l.
14.3.4.1 .4 Storage areas for hazardous materials shall not be
located in the room housing the hyperbaric chambe1·. (See
14.2.1.)
14.3.4.1.4.1 Flammable gases, except as provided in
14 .3 .1.6.2.2(1), shall not he use<l 01· stored in the hype1·baric
room.
14.3.4.1 .5 All replacement part� an<l component� shall
conform to original design specification.
14_3.4_}.6* ..\i1· from compressors shall be sampled at least
every 6 months an<l after major repair or mo<lification of the
comp1·esso1·(s).
14.3.4.2 Maintenance Logs.
14.3.4.2-1 Installation, repairs, an<l modifications of eguip­
ment 1·elated to a chamber shall be evaluated bv engineering
pe1·so1111el, tested under pressm·e, and approve<l by the safety
director.
14.3.4.2.1.1 Logs of all test� shall he maintained .
14.3.4.2.2 Operating eguipment logs shall be maintaine<l hy
enginee1·ing personnel.
14.3.4.2.2.1 Opei-ating eguipment logs shall be signe<l before
chamber operation hy the person in charge. (SI¥ ,4.14.3.1.3.2.)
14-3.4.2.3 Operating e<Juipment logs shall not be taken inside
the chamber.
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99-132 HEALTH CARE FACILITIES CODE
14.3.4.3 Fire Protection Equipment for Class A Hyperbaric
Chambers.
14.3.4.3.1 Electrical switches, valves, and elect1·ical monitot·ing
eguipment associaterl ,v:ith fire prntection shall be ,is ually
inspecterl before each chamber pressurization.
14.3.4.3.1.1 \'\'he1·e provirlerl, wate1· level indicat01·s shall be
visually inspected before each chamber pr·essurization.
14.3.4.3.1.2 Whe1·e provided, air p1·essure gauges shall be visu­
ally inspected before each chambe1· pressut·ization.
14.3.4.3.2 Fire detection eguipment, if installed, shall be
testerl each week.
14.3.4.3.2.1 Testing shall include activation of trnuble circuil�
and signals.
14.3.4.3.3 Full testing, including discha1·ge of extinbruishing
media, shall be conrlucted annually.
14.3.4.3.4 Inspection, testing, anrl maintenance of the water
storage tanks fot· Cla�s A chambe1·s shall be in accordance with
applicable sections of Chapte1· 9 of NFPA 25.
14.3.4.3.5* Fire extinguishing systems shall be functionally
tested at least semiannually as follows:
(I) For deluge systems, in accordance with the reguiremenl�
of 14.2.6.2.5 and 14.2.6.2.7
(2) For handline systems. in accotTlance with the reguire-
menl� of 14.2.6.3.7.l
14.3.4.3.5.1 Following the test, all valves shall be placed in
their ba�eline position.
14.3.4.3.5.2 If a bypass system is used, it shall not 1·emain 111
the test mode after completion of the test.
14.3.4.3.5.3 During initial construction, or wheneve1· changes
ar·e marle to the installed deluge system that will affect the
spray pattern, testing of spray coverage to demonstrate
conformance to the reguiremenl� of 14.2.6.2.6 shall be
pedonnerl at surface pressure anrl at maximum opernting pres­
sure.
14.3.4.3.5.4 A detailerl 1·ecorrl of the test 1·esult5 shall be main­
tainerl and a copy sent to the hypet·baric facility safety rlirector.
14.3.4.3.5.5 Inspection, testing, and maintenance of hyper­
baric fire suppt·ession systems shall be perfo1·merl by a gualifierl
pe1·son.
14.3.4.4 FJectrical Safe guards.
14.3.4.4.1 All electrical ci1·cuits shall be testerl in acc01·rlance
with the routine maintenance program of the facility.
14.3.4.4.1.1 Electrical circuit test� shall include the following:
(l) Ground-fault check to ve1·ify that no conrluct01·s are
grounded to the chamber
(2) Test of normal functioning (sfe 14.2. 9.2.3.2)
14.3.4.4.1.2 In the event of fire, all nonessential elect1·ical
eguipment within the chamber shall be de-energizerl before
extinguishing the fire.
(A) Smolrlering, burning electrical eguipment shall be rle­
energized before extinguishing a localizerl fire involving only
the eguipment. (See 14.2.6.)
2021 Edition
14.3.4.5 Furniture and Grounding.
14.3.4.5.1 Conrluctive de,ices on furniture and equipment
shall be inspecterl to ensu1·e that they a1·e free of wax, lint, or
other extraneous material that could insulate them and defeat
the conductive properties.
14.3.4.5.2* Casters or furniture leg tips shall not be capable of
impact sparking.
14.3.4.5.3 Casters shall not be lulxicated with oils or other
flammable materials.
14.3.4.5.4 Lubricants shall be oxygen compatible.
14.3.4.5.5 Wheelchai1·s and gurneys with bea1·ings lubricated
anrl sealed by the manufacturer shall be pe1·mitted in Class A
chambers where conditions prescriberl in 14.2.10.4 are met.
14.3.4.6* FJectrostatic Safeguards.
14.3.4.6.1 Conductive accessories shall meet conrluctivity and
antistatic reguiremen L�.
14.3.4.6.2* Patient ground shall be verifierl in Class B cham­
be1·s p1·i01· to each chambe1· operation.
14.3.4.6.3* Patient grounrl shall be verified in Class A cham­
be1·s p1·i01· to chamber operation wheneve1· atmosphe1·es
containing more than 2,\.5 percent oxygen by volume are userl.
14.3.4.6.4 Chambe1· grounrl shall be verifierl to be in accord­
ance with 14.2.9.4.1.3 fot· Cla�s A anrl Class B chambe1·s as part
of the preventive maintenance program of the facility.
14.3.4.6.5* Materials containing rubber shall be inspected as
part of the routine maintenance program of the facility, espe­
cially at poinl� of kinking.
14.3.4.7* Housekeeping. A housekeeping program shall be
implemented, whether or not the facility is in regula1· use.
14.3.4.7.1 The persons assigned to the ta�k of housekeeping
shall be u·ainerl in the following:
(l) Potential rlamage to the eguipment from cleaning proce-
dures
(2) Potential personal injury
(3) Specific cleaning procerlures
(4) Eguipment not to be cleaned
Chapter 15 Dental Gas and Vacuum Systems
15.1 Applicability. This chapter shall apply to rlental health
care facilities that gualify to install dental ga� and vacuum
piping systems.
15.1.1 Category l dental piped gas and piped vacuum system
r·eguiremenl� shall be applied in facilities whe1·e general anes­
thesia and deep sedation is pel"formed, as defined in 3.3.68.1
and 3.3.68.2.
15.1.2 Category 2 rlental piped gas and piped vacuum system
reguiremenl� shall be applied in facili ties whe1·e only modernte
and minimal sedation is performerl, as definerl in 3.3.68.3 and
:\.3.68.4.
15.1.3 Category 3 rlental piped gas anrl piperl vacuum system
reguiremenl� shall be applied in facilities where minimal or no
sedation is performect, as definect in 3.3.68.4.
 DENTAL (;As AND \\'\CUllM �YSTEMS 99-133

15.1.4 A single facility shall be pe1·mitted to include dental gas 15.3.2.1.5 Medical Air Supply Syste1ILS. Categm·y I systems
and vacuum systems for more than one category of dental shall comply with 5.1.3.G, except as follows:
piped gas and vacuum systems.
( l) Medical air compressm·s, dryers, aftercoolei-s, filters, anrl
15.1.5 An existing system that is not in strict compliance ½1th regulators shall be permitted to be simplex.
the provisions of this code shall be permitterl to continue in (2) The facility staff shall rlevelop their emergency plan to
use unless the authority having jurisdiction has rlete1·mined deal ,\ith the loss of medical air.
f
that such use constitutes a distinct haza1·rl to li e. 15.3.2.1.6 Oxvgen supply systems using concenti-ators shall be
15.1.6 l11e requirements for Category l dental ga.� and permitted to consist of t wo sources. one of which shall be a
vacuum systems for the ope1·ation, management, anrl mainte­ cylinrle1· header ½1th sufficient cylinrle1· connections for an
nance of gas anrl vacuum piping systems shall apply to both average rlay's supply.
new a.nd existing facilities within the scope of this chapter and 15.3.2.1.7 Medical-Surgical Vacuum Syste1ILS. Category
in accordance \\1th 5.1.1.5. sy stems shall comply ,\ith 5.1.3.7, except a.� follows:
15.1.7 l11e following sections of this chapter shall apply to the (1) Medical-surgi cal vacuum systems shall be pern1itted to be
operation, management, and maintenance of Category 2 simplex.
dental gas anrl vacuum systems in both new and existing facili- (2) The facility staff shall rlevelop their eme1·gency plan to
ties: deal ½1th the loss of medical-sur·gical vacuum.
( l) 15.1.5 15.3.2.1.8 WAGD Systems. Category l systems shall comply
(2) 15.2 with 5.1.3.8, except as follows:
(3) 15.4.2.4.3
(4) 15.4.2.4.5 ( l) Medical \VAGD pumps shall be permitted to be simplex.
(5 ) 15.4.2.4.13 (2) The facility staff shall rlevelop their emergency plan to
(6) 15.4.2.5.14 deal ,\ith the loss ofWAGD.
(7) 15.4.2.6.4 15.3.2.2 Valves. Category l systems shall comply with 5.1.4.
(8) 15.4.9
15.3.2.3 Station Outlets and Inlets. Categoty l systems shall
15. 1.8 The following sections of this chapter shall apply to the comply with 5.1.5.
operation, management, and maintenance of Category 3
rlental gas and vacuum systems in both new and existing facili­ 15.3.2.4 Manufactured Assemblies. Category l systems shall
ties: comply with 5.1.6.
(1) 15.1.5 15.3.2.5 Surface-Mo unted Medical Gas Rails. Categmy
(2) 15.2 systems shall comply ,\ith 5.1.7.
(3) 15.5.8
15.3.2.6 Pressure and Vacuum Indicators. Catego1y l systems
15. 1. 9 v\!here the te1·m &spnnsihlr Facility A.utlwrity is userl, that shall comply with 5.1.8.
entity shall follow the requirement� of 5.1.14.1.
15.3.2.7 Warning Syste1ILS. Warning systems associaterl ,\ith
15.2 Nature of Hazards of Gas and Vacuum SystellLS. Poten­ Categm·y l systems shall prmide the master, area, anrl local
tial fit-e and explosion hazards associaterl ,\ith positive-p1·essu1·e alarm functions of a Catego1y l system as 1·equi1·ed in 5.1.9,
rlental gas systems and vacuum systems shall be conside1·ed in except as follows:
the design, installation, testing, operation, and maintenance of
these systems. ( 1) Warning systems shall be permitted to be a single alarm
panel.
15.3 Category 1 Dental Gas and Vacuum SystellLS. (2) The alarm panel shall be locaterl in an area of continuous
surveillance while the facility is in operation.
15.3.1 General. Facilities that perfo1·m deep sedation and
(3) Presstffe and vacuum s,,1tches/sensors shall be mounted
general anesthesia associaterl ,,1th dental treatment shall meet at the source equipment with a p1-essure indicator at the
the requi1·ement� for Category l dental gas and vacuum master alarm panel.
systems .
15.3.2.8 Medical Gas Distrib ution. Categoq' l systems shall
15.3.2 Categor y 1 Medical Gas Sys tellLS (Dental). comply with 5.1.10.
15.3.2.1 Medical Gas and Vacuum Sources. 15.3.2.9 Labeling and Identification. Category l systems shall
15.3.2.1.1 Central Supply System Identification and Labeling. comply with 5.1.11.
Category l systems shall com ply with 5.1.3.1. 15.3.2.10 Performance Cri teria and Testing (Medical Gas,
15.3.2.1.2 Central Supply Operations. Category l systems Medical-Surgical Vacuum, and WAGD). Category l systems
shall comply with 5.1.3.2. shall comply with 5.1.12.

15.3.2.1.3 Central Supply System Locations. Category 15.3.2.11 Support Gases. Categoty l systems shall comply
systems shall comply with 5.1.3.3. \\1th 5.1.13 except as follows:

15.3.2.1.4 Central Supply Sys tellLS. Catego1y l systems shall (1 ) Nitrogen som·ce equipment shall be pe1·mitted to be
comply ½1th 5.1.3.5. installed in enclosures fo1· Category 3 medical gases or in
a mechanical room.
(2) Nitrogen source equipment shall inclurle the fol10....1ng:

2021 Edition
99-134 HEALTH CARE FACILITIES CODE

(a) One or m01·e cylinders of nitrogen NF, sufRcient for
at least one average day's supply
(h) A manifokl, if p1·imar y and secondary cylinders are
prmided
(c) A lin e pressure regulating valve
(d) A check valve downstream from the pressure regu­
lating valve
(e) A presstll"e relief valve set at 50 pe1·cent above the
normal line pressure and located downstream from
the check valve
(f) A pressure relief valve discha1·ge piped to the
outdoors at a point that will not create a probahle
hazard and that is turned down to prevent the ent ry
of rain 01· snow
15.3.2.12 Medical Gas and Vacuum Operation and Manage­
ment. Category I systems shall comply with 5.1.14.
15.3.3 Categor y I Dental Air and Vacuum Piping Systems.
15.3.3.4* Dental Air.
15.3.3.4.1 General.
15.3.3.4.1.1 Dental ai1· shall be used as a support ga� for driv­
ing dental tools and shall be permitted to be used to supply air­
d1·iven eguipment. Dental compressed air shall not he used for
respiration.
15.3.3.4.1.2 Dental air outlet5 shall not be interchangeahle
with any other gas outlet�, including oxygen, nitrous oxide,
medical ai1·, instrument air, and nitrogen.
15.3.3.4.2 Dental Air Compres.sor Units.
15.3.3.4.2.1 Dental ai1· compressor units shall include dental
air compressors, vibration isolation, air receive1·s, coalescent air
filters, adsorption dryers, exhaust silencer/filters, moisture
indicators, and senice access manifolds. electt·ical disconnecL�.
mot01· wiring, and controls.

15.3.3.1 General. 15.3.3.4.2.2 Air compressors shall be scroll dental, reciprocat­

ing dental, 01· the oil-free dental types.
15.3.3.1.1 Dental air and vacuum piping systems shall include
dental support ga�es and dental vacuum systems. 15.3.3.5* Dental Vacuum.

15.3.3.1.2 Dental vacuum systems shall include dental vacuum 15.3.3.5.1 General.
and nitrous oxide scavenging. 15.3.3.5.1.1 Dental \acuum shall be used for oral evacuation
15.3.3.2 Equipment Locations for Dental Air and Vacuum and nitrous oxide scavenging.
Systems. 15.3.3.5.1.2 Dental vacuum inleL5 shall not he inte1·changeahle
15.3.3.2.1 General. Any of the following systems shall be with any other vacuum inlets, including dental-surgical
permitted to he located together in the same room: VdCUUm.
( 1) Medical air compressor supply som·ces 15.3.3.5.2 Dental Vacuum Units.
(2) Dental air compressor sources and rese1ve headers
(il) Dental-surgical vacuum sou1·ces 15.3.3.5.2.1 Dental vacuum units shall include dental vacuum
(4) Dental Vdcuum sources pumps, vibration isolation, separation tanks, vacuum inlet,
(5) WAGD somces vacuum exhaust, condensate drain, motor wiring, and controls.
(6) Any othe1· compressor, vacuum pump. or electt·ically 15.3.3.5.2.2 Dental vacuum pumps shall be dental d ry vacuum
powered machinery or dental liguid (wet) ring pumps. Pumps shall be oil-free or
15.3.3.2.2 Cylinders and Containers. Cylinde1·s and containe1·s oil-lubricated, and suitable for nitrous oxide scavenging.
for gases shall be handled in acc01·dance with Chapter 11. 15.3.3.6 Nitrous Oxide Scavenging.
15.3.3.2.3 Ventilation. The following source locations for 15.3.3.6.1 General.
motm'-<friven eguipment shall be adeguately ventilated to
prevent accumulation of heat: 15.3.3.6.1.1 The use of scavenging shall be limited to portions
of dental facilities where moderate or minimal sedation is
(I) Medical air sources administered. \VAGD shall be prmided where the dental treat­
(2) Instrument air sources ment involves general anesthesia or deep sedation.
(il) Dental compressed ai1· sources
(4) Dental-surgical vacuum sources 15.3.3.6.1.2 Active nitrous oxide scavenging shall include the
(5) Dental vacuum sources use of a nasal mask on the patient. The nasal mask shall be
(6) ,vAGD sources connected to a scavenging inlet in the dental vacuum system
through a flow-limiting adapte1·.
15.3.3.3 Dental Gas and Vacuum Source Equipment.
15.3.3.6.1.3 Nitrous oxide scavenging inlet� shall not be inter­
15.3.3.3.1 General. changeable with any other vacuum inleL�, including medical­
15.3.3.3.1.1 The capacity of source eguipment shall be based surgical vacuum, dental vacuum, and ,vAGD.
on the design reguirement� for the facility, including the 15.3.3.6.2 Connection to Dental Vacuum. Scavenging connec­
number of gas outleL5, vacuum inleL�. and other connections. tions to the dental vacuum system shall be a di1-ect high-volume
and thei1· individual capacities. evacuation (HVE) connection to a high-volume vacuum pon
15.3.3.3.1.2 The system design reguirement� shall be included with a capacity of45 L/min (1.6 cfm).
in the data used for testing and verifying the operation of the
gas and vacuum piping systems.

2021 Edition
 DENTAL (;As AND \\'\CUllM �YSTEMS
15.3.3.7 Piping for Dental Air and Vacuum Systems.
15.3.3.7.1 General.
15.3.3.7.1.1 Piping for dental comp1·essed att· systems shall
comply with 15.3.3.7.2.
15.3.3.7.1.2 Piping for dental vacuum systems and scavenging
systems shall comply with 15.3.3.7.3.
15.3.3.7.2 Piping for Dental Air Systems.
15.3.3.7.2.1 General. Pipe. fittings, and joint� in piping for
dental compressed air systems shall be in accordance with
15.3.3.7.2.2 through 15.3.3.7.2.5.
15.3.3.7.2.2 Pipe. Pipe under 15.3.3.7.2 shall comply with the
following:
( 1) ASlM B88. Standard SpPcifiration Jar SmmlPss CoppPr Watl'r
Ti1be, T)pe L m K
(2) ASlM B819, Standard SpPrifi,:atfon for SmmlP.�� CoppPr Tube
for MPdiral Gas Systnm, Type Lor K
(3) ASlM B280, Standa rd Spfl'ijiration for Smmlm CoppPr Tub!'
for Air Conditioning and RPfrigmllion Field Snuir.e, ACR tube
(O.D. size)
15.3.3.7.2.3 Coppe1· tube shall be hard temper 01· annealed
( soft tern pet·) .
15.3.3.7.2.4 Fittin gs. Fittings for piping under 15.3.3.7.2 shall
be permitted to be any of the following acceptable joining
methods:
(1) Brazed or soldered fittings conforming to ASME Bl6.22,
Wrought CoppPr and CoppPr Alloy SoldPr-joint PrPssurP Fittings
(2) Brazed fittings conforming to ANSI/ASME Bl6.50,
l-Vmught CoppPr and Coppl'r Alloy Braze-Joint Pressure Fittings
(3) Brazed fittings conforming to ASME Bl6.22 with socket
depths equal to 01· g1·eate1· than braze:joint p1·essu1·e
fittings in compliance with ANSI/ASME B1650
( 4) Flared fittings conforming to ASME BlG.26, Cast Copper
Alloy Fittin� for HarPd Coppn· TubPs
(5) Compression fittings (1/, in. maximum size)
15.3.3.7.2.5 Joints. Joints for piping under 15.3.3.7.2 shall
comply with the following:
( 1) Joint� shall be brazed, solde1·ed, threaded, flared, 01· the
compression type.
(2) Where joint� are brazed, they shall comply with the
requirements of 15.4.6.
(3) Solde1·ed joints shall be made in acc01·dance with ASTM
B828, Standard Practia for Alailing Capillary joints IY)' Sol.d!'r­
ing of Copp" and Coppn Allny Tube and Fittings, using a
"lead-free" solde1· fillet· metal containing not mot·e than
0.2 percent lead by volume that complies with ASTM B32,
Standard SpPrifiration far Solder Metal.
15.3.3.7.3 Piping for Dental Vacuum Systems and Scavenging
Systems.
15.3.3.7.3.1 General. Piping fot· dental vacuum systems and
scavenging systems shall be copper, PVC plastic, or CPVC plas­
tic .
15.3.3.7.3.2 Copper Piping. Coppet· piping unde1· 15.3.3.7.3
shall he m accordance with 15.3.3.7.3.2(A) through
153.3.7.3.2(D) .
99-135
(A) Copper Tube. Coppe1· tubing shall comply with the
following:
( 1)ASTM B88, Standard Spffijirntion for SPmnlP.�� CoppPr Wat Pr
TubP, Type L01· K
(2) ASTM B819, Standard SpPcifimtion for Smmll's.1 Copper fobp
for 111.Pdir.al Gas .�vste111s, Type Lor K
(3) ASTM B280, Standard Sperification for SeamlPs.1 Coppn J1.t!Je
for A.ir Conditioning and Refrigeration Fidd Snvi,:e, ACR tube
(O.D. size)
(B) Copper tube shall be hard temper or atrnealed (soft
temper).
(C) Copper Fittings. Coppe1· fittings shall comply with the
following:
Brazed or soldered fittings conforming to ASME Bl6.22,
(1)
Wrought CoppPr and CoppPr A. lloy SoldPrfoint PrPssim Fittings
(2) Brazed fittings conforming to ANSI/ASME BlG.50,
Wrought Copper and CoppM Alloy Braz.!'-joint PressurP Fittings
(3 ) Brazed fittings conforming to ASME BlG.22 with socket
depths equal to or greater than braze-:ioint pressure
fittings conforming to ANSI/ASME Bl6.50
(4) Flared fittings conforming to ASME Bl6.26, Cast Coppl'r
Alloy Fittings for Hared Coppl'r 111bl's
Compression fittings (1/, in. maximum size)
(5)
(D) Joints for Copper Piping. Joints in copper tubing shall be
in accordance with the following:
( 1) Joint� shall he brazed, soldered, tlu-eaded, flared, 01· the
compression type.
(2) ,.vnere joints are brazed, they shall comply with the
1·equireme11t� of 15.4.6.
(3) Solde1·edjoints shall be made in accordance with ASTM
B828, Standard Prartire for Making Capillary joints by Sol,lfr­
ing of Copper and CoppPr Alloy Tube and Fittings, using a
"lead-free" solde1· filler metal containing not more that1
0.2 pet"Cent lead by volume that complies with ASlM B32,
Standard Sperification for SoldPr MPtal.
15.3.3.7.3.3 PVC Plastic Piping. PVC plastic piping unde1·
15.3.3.7.3 shall be in accordance with the following:
(1) PVC plastic pipe shall be Schedule 40 or Schedule 80,
conforming to ASlM Dl785, Standard Sperifiration for
P"Zv(Vinyl ChloridP) (PVC) Plastic PipP, S,:hedulPs 40, 80, and
120.
(2) PVC plastic fittings shall be Schedule 40 m Schedule 80
to match the pipe, confonning to ASTM D2466, Standard
Specification for Poly (Vinyl ChloridP) (PVC) Plastir. PipP
Fittings, Srhedule 40. or ASTM D2467, Standard Spff ijiration
Poly (Finyl Chlo·ride) (PVC) Plastir Pifr Fittings, Srhedull' 80.
(3) Joint� in PVC pla�tic piping shall be solvent-cemented in
accordat1ce with ASTM D2672, Standard Spedfiration far
joint1for JPS PVC PipP U�ing Solvmt Cnnmt.
15.3.3.7.3.4 CPVC Plastic Piping. CPVC plastic piping unde1·
15.3.3.7.3 shall be in accordance with Lhe following:
(1) CPVC IPS pla�tic pipe shall be Schedule 40 or Schedule
80, confmming to ASTM F441/F441M, Standard Sper.ifira­
tfon for ChlorinatPd Poly(Vinyl Chloride) ( CPVCj Pia.stir Pipe,
Schfdules 40 and 80.
(2) CPVC IPS plastic fittings shall be Schedule 40 or Sched­
ule 80 to match Lhe pipe, confo1·ming to ASTM F438,
Standard Sperifiration for Sor:kfl-1ypP ('.hlorinated Poly (Vinyl
ChloridP) (CPVCJ Pl,astir Pipe Fittings, SrhPdulP 40, 01· ASTM
2021 Edition
99-136 HEALTH CARE FACILITIES CODE
F439, St andard SpPcifiration far Ch1nrinattd Poly(Vinyl Chlar­
ide) (CPVCJ Plastit PipP Fittings, Srhtdule 80.
(3) CPVC CTS pla�tic pipe and fittings ½ in. through 2 in.
size shall be SDR 11, confmming to ASTM D2846/
D2846M, Standard SpPtijiratinn for ChlnrinatPd Poly (Vinyl
ChlaridPJ (CPVC) Plastir Hot- and Cold-tt½tt'r Distribution
Sys tnns.
( 4) Solvent cement fm joint� in CPVC plastic piping shall
comply with ASTM F493, Standard SpPdjiration for Solvmt
Cem1ml.1 for ChlorinatPd Poly/Vi nyl ChlaridP)(CPVC) Plas tir
PipP and Fittings.
15.4 Categor y 2 Dental Gas and Vacuum Systems.
15.4.1 General.
15.4.1.1 Category 2 <lental ga� an<l vacuum system shall be
limite<l to facilities that, at most, provide moderate and mini­
mal sedation.
15.4.1.2 lhe me<lical gases shall be limited to oxygen an<l
nitrous oxide.
15.4.1.3 ll1e dental suppon gases shall be provided from a
dental air source system.
15.4.1.4 The vacuum systems shall be <lental vacuum and
nitrnus oxide scavenging.
15.4.1.5 All connections within Catego1y 2 me<lical gas
(oxygen an<l nitrnus oxide) shall be gas-specific to prevent
cross-connections with othe1· piping systems, including vacuum,
water, an<l dental air.
15.4.1.6 Station outlet� and pipe<l outlet� for Category 2 me<li­
cal gas an<l dental air having nonstandar<l operating pressures
shall comply with the following a<lditional requirement�:
( l) Be gas-specific.
(2) Be pressure-specific whe1·e a single gas is piped at more
than one operating pressure.
(3) Be a D.I.S.S connection if operated at a gauge pressure in
excess of 550 kPa (80 psi).
( 4) Be <lesigned to pr·event the removal of the adapte1- until
the pressure has been relieved, if operated at a gauge
p1·essure between 1380 kPa and 2070 kPa (200 psi and
300 psi).
15.4.I. 7 Requirement� for Catego1y 2 dental gas and vacuum
systems relating to the ope1·ation, management, an<l mainte­
nance of oxygen an<l nitrnus oxide piping sptems shall apply
both new an<l existing facilities as specifie<l in 15.1.7.
15.4.2 Medical Gas Systems (Oxygen and Nit rous Oxide).
15.4.2.1 Installer Qualificatious (Oxygen and Nitrous Oxide).
15.4.2.1.1 Installers of medical gas systems shall be certifie<l in
accordance with ASSE 6010 , Pmpssional Qualifir:ation Standard
for MPdiral Ga1 Systnm Instnlln,, regardless of the capacity of the
source equipment.
15.4.2.1.2 Installe1·s of medical gas systems shall not use thei1·
cenification to oversee installation by noncenified pe1·so1111el.
15.4.2.1.3 Brazing of me<lical ga� piping systems shall be
pedorme<l by indivi<luals who are gualifie<l in accordance "�th
15.4.6.1.
15.4.2.1.4 Prior to any installation work involving brazing, the
installer of the medical ga� piping systems shall prnvide docu-
2021 Edition
men tation 1·equired by 15.4.6. l for the qualifications of the
brazing procedures and in<livi<lual brazers.
15.4.2.2 Central Supply System Identification and Labeling
(Oxygen and Nitrous Oxide).
15.4.2.2.1 Cylin<le1·s, containers. and tanks shall be designe<l,
fab1·icate<l, teste<l, and marke<l (stampe<l) in accor<lance with
regulations of DOT, Transpon Canada (TC) Trans portation of
Dangerous (',nod� Rfgu lations, or the ASME BnilPr and Pressure
\fasel Code, ·'Rules fo1· the Constrnction of Unfire<l Pr·essure
Vessels," Section VIII. f 55:7.1.5. ll
15.4.2.2.2 Cylin<ler content� shall be i<lentified by attached
labels or stencils naming the contents in acc01·dance \\�th the
mandatmy 1·equirements of CGA C-7, GuidP tn Cla�sijiratinn and
LabPling nf Cmnpmwd (',ases.
15.4.2.2.3 Liqui<l containers shall have additional product
i<lentification ,isible from all directions with a minimum of
51 mm (2 in.) high letters such as a 360-degree wraparound
tape for medical liqui<l containers.
15.4.2.2.4 Cryogenic liquid containe1·s shall be provided with
gas-specific out.let connections in accor<lance with the manda­
tory requirement� of CGA V-5, DiamPtl'T Index Sapty Svstem
(NonintPrrhangmblP Low Pres.mre ConnPrtions far Afrdiwl (',as A.ppli­
mtinns), or CGA V-1, Standard far CmnprPssPd Gas CylindPr Valve
Outltt and InlPt Connections.
15.4.2.2.5 Cylin<le1· and Cl'yogenic liquid container outlet
connections shall be afRxe<l in such a manne1· as to be integral
to the valve(s), unremovahle with ordina1y tools, or so
designed as to ren<ler the attachment point unusable ,vhen
r·emove<l.
15.4.2.2.6 The contents of cylin<lers and cryogenic liquid
containe1·s shall be verified prior to use.
15.4.2.2.7 Labels shall not be defaced, altered, 01· remove<l,
and connecting fittings shall not be modified.
15.4.2.2.8 Locations containing positive-p1·essure gases other
than oxygen and me<lical ai1· shall have their door(s) labeled as
follows:
Positive-Pressure Gases
NO Smoking or Open Flame
Room May Have Insufficient Oxygen
Open Door and Allow Room to Ventilate Before Entering
15.4.2.2.9 Locations containing central supply systems or
cylinders containing only oxygen or medical air shall have their
dom(s) labele<l as follows:
Medical Gases
NO Smoking or Open Flame
15.4.2.3 Central Supply System Operatious (Oxygen and
Nitrous Oxide).
15.4.2.3.1 The use of adapters or conversion fittings to a<lapt
one gas-specific fitting to another shall be prohibited.
15.4.2.3.2 Cylinde1·s an<l containe1·s shall be handled in strict
accordance with 11.6.2.
15.4.2.3.3 Only gas cylinde1·s. 1·eusable shipping containe1·s,
and their accessories shall be permitted to be stored in rooms
containing central supply systems 01· ga� cylinders.
 DENTAL (;As AND \\'\CUllM �YSTEMS
15.4. 2.3.4 No flammable mate1·ials. cylinde1·s containing flam­
mable gases, or containers containing flammable liquirls shall
be stored in rooms with gas cylinde1·s.
15.4.2.3.5 If cylinde1·s are wrapperl when receiverl, the wrap­
pers shall be removed prior to storage.
15.4.2.3.6 Cylinrle1·s without correct markings or whose mark­
ings and gas-specific fittings do not match shall not be used.
15.4.2.3. 7 C1yogenic liquirl sto1·age units intended to supply
gas to the facilitv shall not be userl to transfill other liquirl stor­
age vessels.
15.4.2.3.8 Ca1·e shall be exerciserl when hanrlling cylinrlers
that have been exposed to freezing tempei-atures 01· containe1·s
that contain ctyogenic liquids to prevent injuty to the skin.
15.4. 2.3.9 Cylinde1·s containing compressed gases and
containers fot· volatile liquids shall be kept away from rndiat01·s,
steam piping, anrl like sources of heat.
15.4.2.3.10 \'\'here cylinder valve protection caps are supplierl,
they shall be secu1·ed tightly in place unless the cylinrler is
connected for use.
15.4.2.3.11 Containers shall not be sto1·erl in a tightly closed
space.
15.4.2.3.12 Cylinders in use and in storage shall be prevented
° °
from 1·eaching tempe1-atures in excess of 52 C ( 125 F).
15.4.2.3.13 Centt·al supply systems for nitrous oxirle and
carbon dioxide using cylinrlers or portable containers shall be
p1·evented from reaching tempe1·atures lower than the recom­
menrlations of the centi-al supply system's manufacturer but
shall never be lower than -7'C (200 F) 01· g1·eater than 52"C
(125'F).
15.4.2.4 Locations of Medical Gas Source Equipment (Oxygen
and Nitrous Oxide).
15.4.2.4.1 Gas stmage locations in facilities with Catego1y
2 medical ga� systems with a total of all gases in cylinde1·s or
containe1·s, except nitrogen, connecterl and in storage at one
time that rloes not exceerl 85 m 1 (;\000 h:3) at standa1·d temper­
ature and pressure (STP), m 142 m� (5000 ftR) (STP) if oxygen
is stored in a DOT specification 4 L (cryogenic liquirl)
container shall comply with 15.4.2.4.3 through 15.4.2.4.13.
15.4.2.4.2* Gas storage locations in facilities with Category
2 medical ga� systems with a total of all gases in cylinde1·s or
containers exceerling quantities listerl in 15.4.2.4.1 shall comply
with .'",.1.3.3.
15.4.2.4.3 Enclosut·es shall serve no put-pose other than to
contain the merlical gas source equipment (oxygen anrl nitrous
oxide), except that nitrogen sout-ce equipment and
compressed ai1· cylinrle1·s shall be pe1·mitted in the enclosure.
15.4.2.4.4 Storage of full or empty gas cylinders, or both. shall
be pe1·mitted in the same enclosu1·e.
15.4.2.4.5 Ai1· compressors, vacuum pumps, anrl othe1· equip­
ment shall not be located in enclosures for merlical ga� cylin­
rlers ( O>..)'gen anrl nitrous oxide source equipment).
15.4.2.4.6* If enclosures are outdo01·s or 1·emote from the
treatment facilities that they serve, they shall be kept locked.
99-137
15.4.2.4.7 Cylinders in use and in storage shall be pt·evented
from reaching temperatures in excess of 52'C (125'F). Nitrous
oxirle cylinders shall be prevented from reaching temperatures
lower than -7'C (20'F).
15.4.2.4.8 Only gas cylinders, reusable shipping containers,
anrl thei1· access01·ies shall be permitted to be storerl in rooms
containing central sup ply systems or ga� cylinde1·s.
15.4.2.4.9 No flammable materials, cylinders containing flam­
mable gases, or containers containing flammable liquirls shall
be sto1·ed in rooms with gas cylinde1·s.
15.4.2.4.10 Inrloor enclosures shall not communicate directly
with medical gas (oxygen and nitrous oxirle) use points 01· stor­
age locations for oxidize1·s.
15.4.2.4.11 Outdoor enclosures that are adjacent to a builrling
wall shall be located such that the distance to any window 01·
rloor of the adjacent builrling is g1·eater than 3.05 m (1() ft).
15.4.2.4.12 Enclosures for merlical gas (oxygen anrl nitrous
oxide) som·ce equipment shall be prmirlerl with do01·s 01- gates.
15.4.2.4.13 Cylinde1·s in senice or in storage shall be individu­
ally secured and located to prevent falling or being knocked
over.
15.4.2.5 Medical Gas Source Equipment (Oxygen and Nitrous
Oxide).
15.4.2.5.1 Mechanical means shall be providerl to ensure that
the medical gas sout-ce equipment is connected to the correct
medical gas distribution piping system.
15.4.2.5.2 Cylinder valve outlets fot· oxygen anrl nitrous oxide
shall comply with CGA V-1, Standardfnr CmnprPs.vd Gas Cylinder
l-alvP Outlft and InlPt Connections.
15.4.2.5.3 Threaded connections to manifolds shall comply
with CGA V-5, DiamPll'r lndl'x Sajl'ty Systmn (NonintPrrhangmblP
Low Pre.�surP Connl'l:tions for i1hdiml Gas Applimtions).
15.4.2.5.4 A check valve shall be prnvirled downstream of each
pressure 1·egulator.
15.4.2.5.5 A pressut·e relief valve set at 50 pet-cent above the
normal line pt·essure shall be locaterl downstream of the check
valve in 15.4.2.5.4.
15.4.2.5.6 Pressure relief valves shall be brass. bronze. or stain­
less steel anrl designed for oxygen senice.
15.4.2.5.7 Hose and flexible connectors shall have a gauge
pressure rating not less than 6895 kPa ( 1000 psi).
15.4.2.5.8 Materials used in central supply systems shall meet
the following requirement�:
(1) In those portions of systems intended to hanrlle oxygen at
gauge pt·essut·es equal to 01· g1·eater than 2413 kPa
( 3 50 psi). interconnecting hose shall contain no poly­
meric materials.
(2) In those portions of systems intenderl to handle oxygen
or nitrous oxirle matei-ial, construction shall be compati­
ble with oxygen under the temperatures and pressures to
which the components can be exposed.
(3 ) If potentially exposed to cryogenic temperatures, materi­
als shall be rlesignerl for low temperature service.
( 4) If intenrlerl for outdoor installation. materials shall be
installed per the manufacttu-e1·'s 1·equirement�.
2021 Edition
99-138 HEALTH CARE FACILITIES CODE
15.4.2.5.9 Nonmetallic hoses and flexible connectors shall not
exceed 1.52 m (5 ft) in length and shall not be concealed or
penetrate walls, flom·s, ceilings. or partitions.
15.4.2.5.9.1 Sou1·ce equipment shall not be connected to the
piping svstem through flexible connectors.
15.4.2.5.10 Meciical gas sout·ce equipment that serves one 01·
two tt·eatment facilities shall include two banks of one 01· more
cylinders of oxygen and (if used) two banks of one or more
cylinders of nitrous oxygen, each bank containing at least one
average day's supplv.
15.4.2.5.11 The two banks of each meciical gas source shall be
manifolded so that either bank can supply its distribution
piping system.
15.4.2.5.12 Where the source equipment is remote from a
single tt·eatment facility anci an in use bank is unable to supply
the system, the manifold shall automatically switch to the
secondary bank.
15. 4.2.5.13 '\,\There the source equipment series multiple treat­
ment facilities and an in use bank is unable to supply the
system, the manifold shall automatically switch to the secon­
da1y bank.
15.4.2.5.14 Whe1·e the source equipment is not 1·emote and is
accessible from a single treatment facility serveci and an in use
bank is unable to supply the system, the manifolci shall be
manually or automatically switched to the secondary bank.
15.4.2.6 Emer gency Shutoff Valves (O xygen and Nitrous
Oxide).
15.4.2.6.1* All Categoq• 2 medical gas systems shall have an
f
emergency shutof valve accessible from all use-point locations
in an emergency.
15. 4.2.6.2 'Where a central medical gas supply system supplies
two treatment facilities, each facility shall be provided with an
emergency shutoff valve locateci in that treatment facility so as
to be accessible from all use-point locations in an emergency.
f
15.4.2.6.3 Emergency shutof valves shall be labeleci to indi­
cate the gas controlled by the shutoff valve anci shall shut off
only the gas to the treatment facility that they serve.
15.4.2.6.4 A remotely activated shutoff valve at a gas supply
manifold shall not be used for emergency shutoff.
15.4.2.6.4.1 For clinical put-poses, such a remote valve actua­
tor shall not fail-close in the event of loss of electric power.
15.4.2.6.4.2 Whe1·e 1·emote actuatm·s are the type that fail­
open, it shall be mandatory that cylinder shutof valves be
f 15.4.3.1 General.
closed whenever the system is not in use.
15.4.2. 7 Station Outlets and Risers (Oxygen and Nitrous
Oxide).
15.4.2. 7.1 Each gas outlet shall be gas-specific.
15.4.2. 7.2 Gas outlets shall consist of a primary and a secon­
dary valve or assembly.
15.4.2. 7.3 Each gas outlet shall be legibly identified.
15.4.2.7.4 1l1readed outlet� shall be noninterchangeable
connections complying with the manciatoty requirement� of
CGA V-5, Dimnfter IndPx SafPty Systnn (Nonintm:hangeahle Low
PmHurP Connn:tions frrr MPdiral ('-.as Af1>li,:ations ).
2021 Edition
15.4.2.7.5 Factory-installed copper inlet tubes on station
outlets extending no further than 205 mm (8 in.) from the
hody of the terminal shall be not less than DN8 (NPS Vi) (½ in.
O.D.) size, with 8 mm (0.3 in.) minimum inside diameter.
15.4.2.8 Manufactured As.semblies (Oxygen and Nitrous
Oxide). Category 2 systems shall comply with 5.1.6.
15.4.2.9 Pressure and Vacuum Indicators (O xygen and Nitrous
Oxide). Categmy 2 systems shall comply with 5.1.8.
15.4.2.10 Warning Systems (Oxygen and Nitrous Oxide).
Category 2 warning systems shall comply \\�th 5.2.9, except as
follows:
(1) Warning systems shall he permitteci to he a single alarm
panel.
(2) 1l1e ala1·m panel shall be located in an area of continuous
surveillance while the facility is in operation.
(:!) Pressure and vacuum switches/sensors shall be mounted
at the smu-ce equipment with a pressut·e inciicatm· at the
master ala1·m panel.
( 4) Warning systems for medical gas systems shall provide the
following alarms:
(a) Oxygen main line pt·essure low
(b) Oxygen main line pressure high
(c) Oxygen changeove1- to secondar y bank or about to
changeover (if. automatic)
(d) Nitrous oxicie main line pressm·e low
(e) Nitrous oxide main line pressure high
( f) Nitrous oxide changeove1- to secondary bank or
about to changeover (if automatic)
(5) Auciible and noncancelable alarm visual signals shall indi­
cate if the pressure in the main line increases or decrea­
ses 20 pe1·cent from the nm·mal operating pressure.
(6) Visual indications shall remain until the situation that
causeci the alarm is resolveci.
( 7) Pressure switches/sensm·s shall he installeci ciownstream
of any eme1·gency shutoff valves and any other shutoff
valves in the system and shall cause an ala1·m fot· the medi­
cal g-,is if the pressure decreases or increases 20 percent
from the nm·mal operating pre��ure.
(8) A cancelable audible indication of each alarm condition
that produces a sounci at the alarm panel shall reinitiate
the audible signal if another ala1·m condition occm·s while
the audible signal is silenced.
15.4.2.1I Labeling and Identificati on. Category 2 systems
shall comply with 5.1.11.
15.4.3 Category 2 Dental Air and Vacuum Piping Systems.
15.4.3.1.1 Dental air and vacuum piping systems shall inclucie
dental support gases and dental vacuum systems.
15.4.3.1.2 Dental vacuum systems shall include dental vacuum
anci nitrous oxide scavenging.
15.4.3.2 Equipment Locations for Dental Air and Vacuum
Systems.
15.4.3.2.1 General. Any of the following systems shall be
permitted to be located together in the same room:
Dental air comp1·ess01· sout·ces and reserve heaciei-s
(1)
(2) Dental-surgical vacuum sources
(3) Dental vacuum sources
 DENTAL (;As AND \\'\CUllM �YSTEMS
(4) Any other comp1-essor. vacuum pump. or electrically
powered machinery
15.4.3.2.2 Cylinders and Containers. Cylinders and containers
fot· gases shall be handled in accordance with Chapter 11.
15.4.3.2.3 Ventilation for Motor-Driven Equipment. The
following source locations shall be adequately ventilated to
pt·event accumulation of heat:
( l) Medical air sources
(2) Instt·ument ai1· sotJt"ces
(3 ) Dental compressed air sout·ces
(4) Dental-surgical vacuum sources
(5) Dental \-acuum soutTes
(6) WAGD sources
15.4.3.3 Dental Gas and Vacuum Source Equipment .
15.4.3.3.1 General.
15.4.3.3.1.1 TI1e capacity of source equipment shall be based
on the design requirement� for the facility, including the
f
number o gas outlets , vacuum inlet5, and other connections,
and their individual capacities.
15.4.3.3.1.2 TI1e svMem design requirement5 shall be included
in the data used for testing and vet·ifying the operation of the
gas and vacuum piping systems.
15.4.3.3.2 Dental Air.
15.4.3.3.2. 1 General.
(A) Dental air shall be used as a support gas for driving dental
tools and shall be permitted to be used to supply air-dt·iven
equipment. Dental compt·essed air shall not be used for respi­
ration.
(B) Dental air outlet� shall not be intet·changeable with any
other ga� outlets, including m,·ygen. nitrous oxide, medical air,
instrument air, and nitrogen.
15.4.3.3.2.2 Dental Air Compressor Units.
(A) Dental air compressor units shall include dental air
compressors, vibration isolation. air receivers, coalescent air
filte.-s. adsm·ption dryers. exhaust silencet/filters. moistut·e
f
indicatm·s. service access mani olds, electrical disconnect�.
motor wiring. and controls.
(B) Air compressm·s shall be scroll dental, reciprocating
dental, or the oil-free dental types.
15.4.3.3.3 Dental Vacuum.
15.4.3.3.3.1 General.
(A) Dental vacuum shall be used for oral evacuation and
nitrous oxide scavenging.
(B) Dental vacuum inlet� shall not be interchangeable with
any other vacuum inlets, including dental-surgical v,1cuum.
15.4.3.3.3.2 Dental Vacuum Units.
(A) Dental vacuum unit� shall include dental vacuum pumps.
vibration isolation, separation tanks, vacuum inlet, vacuum
exhaust, condensate drain, motot· \,fring, and controls.
(B) Dental vacuum pumps shall be dental d ry vacuum or
dental liquid (wet) ring pumps. Pumps shall be oil-free or oil­
lubricated and suitable for nitrous oxide scavenging.
99-139
15.4.3.3.4 Nitrous Oxide Scavenging.
15.4.3.3.4.1 General.
(A) The use of scavenging shall be limited to ponions of
dental facilities where moderate or minimal sedation is admin­
iste1·ed. WAGD shall be provided whet·e the dental treatment
involves genernl anesthesia 01· deep sedation.
(B) Active nitrous oxide scavenging shall include the use of a
nasal mask on the patient. TI1e na5al mask shall be connected
to a scavenging inlet in the dental vacuum syi,tem through a
flow-limiting adapter.
(C) Nitrnus oxide scavenging inlets shall not be inte1·changea­
ble with any other vacuum inlets, including medical-sm·gical
vacuum, dental vacuum. and "WAGD.
15.4.3.3.4.2 Connection to Dental Vacuum. Scavenging
connections to the dental vacuum system shall be a direct high­
volume evacuation (HVE) connection to a high-volume
vacuum port with a capacity of 45 L/min ( l .G cfm).
15.4.3.4 Category 2 Warning Systems (Oxygen and Nitrous
Oxide).
15.4.3.4.1 General.
15.4.3.4.1.1 The warning systems in Category 2 dental gas and
vacuum syi,tems shall comply with applicable requirements of
5.2.9 and 15.4.3.4.2 through 15.4.3.4.4.
15.4.3.4.1.2 The mastet·, area, and local alarm functions shall
be permitted to be provided by a single alarm panel, as indica­
ted in 5.2.9.
15.4.3.4.2 Master Alarm Panels.
15.4.3.4.2.1 A master alarm panel shall be located in the
facility at a point of continuous surveillance when the facility is
in operation.
15.4.3.4.2.2 The master alarm panel shall indicate the follow­
ing:
( 1) Oxygen supply pressut·e :t:20 percent from normal
(2) Nitrous oxide supply pressure ±20 percent from normal
(3) Changeover of oxygen supply source
(4) Changeover of nitrous oxide supply som·ce
15.4.3.4.3 Area Alarm Panels.
15.4.3.4.3.1 An area alat·m panel shall be centrally located
whet·e two or mm·e treatment areas are supplied from the same
zoned dental gas and vacuum piping.
15.4.3.4.3.2 At·ea alarm panels shall indicate the following:
( l) Oxygen supply pressure :t:20 percent from normal
(2) Nitrous oxide supply pressure ±20 percent from normal
15.4.3.4.4 Local Alarms.
15.4.3.4.4.1 Local alarms shall be located in source equipment
contt·ol panels or separate control panels in the equipment
rooms for sout·ce equipment.
15.4.4 Pipi ng for Category 2 Medical Gas, Dental Air, and
Vacuum Systems.
15.4.4.1 General.
15.4.4.1.1 Piping for the following systems shall comply with
15.4.4.2:
2021 Edition
99-140 HEALTH CARE FACILITIES CODE
(1) Oxygen
(2) Nitrous oxi<le
15.4.4.1.2 Piping for dental air systems shall comply with
15.4.4.3.
15.4.4.1.3 Piping fix dental vacuum systems and scavenging
systems shall complv with 15.4.4.4.
15.4.4.2 Piping for Oxygen and Nitrous Oxide Systems_
15.4.4.2.1 Cleaning for Oxygen Service. Fm oxygen an<l
nitrous oxide, the pipe, fittings, valves, ga�/vacuum outlet�/
inlets, and other piping components shall be cleaned for
oxygen by the manufacturer prior to installation in accm·<lance
with CGA Cr-4.1, Clmning .Equipmmt for Oxygen SRrvia. Fittings
shall be permitted to be cleaned by a supplie1· or agency other
than the manufacturer.
15.4.4.2.2 Pipe. Pipe shall be ha1·d-<lrawn seamless coppe1·
tube conforming to ASTM B819, Standard SpPcifir:atinn for Seam­
lf.t� Cnppl'r Tube for Mediral GrL� Systmis, Type Lor K.
15.4.4.2. 3 Fittings.
15.4.4.2.3.1 Fittings shall be brazed, memo1y metal, or axially
swaged.
15.4.4.2.3.2 Brazed fittings shall be the wrought coppe1· capil­
lary type complying wilh the following:
( 1) ASME Bl 6.22. Wrought Copper and Coppl'T Alloy Soldl'r-joint
Pressure Fittings
(2) ANSI/ASME B1650, Wmuglit Copper and Coppr Alloy
Bm:u-joint PrPs.rnrP Fittings
(3) ASME Bl 6.22 with socket depths equal tom greate1· than
brazed joint pt·essut·e fittings in accordance with ANSI/
ASME B1650
15.4.4.2.3.3 Cast copper alloy fittings shall not he used with
field-braze<l joint�.
15.4.4.2.3.4 Memmy metal fittings shall be rate<l for not less
than 538° C (l 00O'F) and 2070 kPa (300 psi) and shall be in­
stalled by qualifie<l technicians in accm·<lance with the manu­
facturer's instructions.
15.4.4.2.3.5 Axially swaged couplin� shall include metal-to­
metal seats, shall be rated for not less than 538'C ( lO0O'F) an<l
2070 kPa (300 psi), and shall provide permanent, nonseparable
joint�. Fittings shall be installed by qualified technicians 111
accor<lance with the manufacture1·'s instructions.
15.4.4. 2.4 Join ts.
15.4.4.2.4.1 Brazed. Brazing of coppe1· joint� shall be 111
accordance with 15.4.6.
15.4.4.2.4.2 Threaded. Threaded joint� shall be limited to
connections to pressut·e in<licators, alarm devices, and source
equipment and shall com ply with the following:
(1) Threads shall be tapered complying with ASME Bl .20.1,
Pipe Thread�, Genl'Tal Purpose, Inrh.
(2) Th1·ea<ls shall be ma<le up with polytetrafluoroethylene
(PTFE) tape or other thread sealant recommended for
oxygen sen,ice, with the sealant applied to the male
th1·eacb only.
15.4.4.2.4.3 Prohibited Joints. The following joint� shall be
prohibited un<ler 15.4.4.2.4:
2021 Edition
( 1) Flared an<l comp1·ession connections, including connec­
tions to station out let�, alarm devices, and other compo­
nent�
(2) Push-lock connections
(3) Straight-threaded con nections, including unions
(4) Pipe crimping tools used to permanently stop the flow of
medical gas and vacuum piping
15.4.4.3 Piping for Dental Air Systeiru.
15.4.4.3.1 General. Pipe, fittings, and joints in piping for
dental compressed a.it· systems shall be in accordance with
1:,.4.4.3.2 through 15.4.4.3.4.
15.4.4.3.2 Pipe. Pipe un<ler 15.4.4.3 shall complv with the
following:
(1) ASTM B88, Standard Specijiration for SeamlP.t� CnppPr Water
Tube, Type Lor K
(2) ASTM B8l 9, Standard Spedfiration for SPllmlPss CoppPr 111/Jp
for Mediral (',as Systems, Type Lm K
(3) ASTM B280, Standard Specifiration for Smmless Coppl'r '.fobe
for Air Conditioning and Refrigeration Ffrld Servire, ACR tube
(O.D. size).
15.4.4.3.2.1 Copper tube shall he hard temper or annealed
( soft tern per) .
15.4.4.3.3 Fittings. Fittin� fot· piping under 15.4.4.3 shall be
per mitted to be any of the following acce ptahle joining meth­
ods:
(1) Brazed or soldered fittin� confmming to ASME Bl6.22.
Wrought Cof1per and Coppfr Alloy SoldPr-joint Pmsurf fzttings
(2) Brazed fittin� confo1·ming to ANSI/ASME Bl6.50,
Wmug:ht Copper and Copper Alloy Brau-joint Press1m Fittings
(3) Brazed fittin� conforming to ASME Bl 6.22 with socket
depths equal to or greater than braze-joint pressure
fittings in compliance with ANSI/ASME Bl6.50
(4) Flared fittinb.-s conforming to ASME B l6.26, Cast Coppl'T
,1lloy Fittings for Flared C',npper 'Jlibes
(5) Comp1·essio11 fittings (Y, in. maximum size)
15.4.4.3.4 Joints. Joints fot· piping un<ler 15.4.4.3 shall comply
with 15.4.4.3.4.1 through 15.4.4.3.4.3.
15.4.4.3.4.1 Joint� shall he hraze<l, soldered, tlu-ea<le<l, fla1·e<l,
or the compression type.
15.4.4.3.4.2 \Vhe1·e joints are braze<l, they shall comply with
the requirements of 15.4.6.
15.4.4.3.4.3 Soldered joint� shall be made in accordance with
ASTM B828, Standard Prai:tice for Making Capillary joint� by Solder­
ing of Copper and Copt>Pr A.Uoy Tube and Fittings, using a ''lead­
free" solder filler met al containing not more than 0.2 pe1·cent
lead by volume that complies with ASTM B32, Standard Spedfi­
ration for SolrlPr Metal.
15.4.4.4 Piping for Dental Vacuum Systems and Scavenging
Systems.
15.4.4.4.1 General. Piping for <lental vacuum systems and
scavenging systems shall be coppe1·, PVC plastic, 01· CPVC pla�­
tic.
15.4.4.4.2 C opper Piping. Copper piping un<le1· 15.4.4.4 shall
be in accordance with 15.4.4.4.2.1 through 15.4.4.4.2.3.
 DENTAL (;As AND \\'\CUllM �YSTEMS
15.4.4.4.2.1 Copper Tube. Copper tubing shall be hard
temper or annealed (soft temper) and shall comply with the
follov.fog:
ASTM B88, Standard Sppr,iji,ration Jar Seamless Copper Water
( l)
Tube, Type L or K
ASTM B819, Standard Specijiration for Seamless Copper Tube
(2)
for Atediral Ga� Systl'ln�, Type L or K
ASTM B280, Standard Sperijiration for Seamless Copper Tube
(3)
for Air Conditioni ng and Rffrigl'mtion Field Service, ACR tube
(O.D. size)
15.4.4.4.2.2 Copper Fttlings. Coppe1· fittings shall comply
with the following:
(1) Brazed m soldered fittings conforming to ASME Bl 6.22,
Wrought Copper and Capper Alloy SoldPr-joint Pn,ssure Fittings
(2) Brazed fittings conforming to ANSI/A';ME Bl 6.50,
Wrought Copper and Capper Allryr Brau-Joi n t PressurP Fittings
(3) Brazed fittings conforming to ASME Blfi.22 with socket
depths equal to or greater than hraze:ioi11t pressure
fittings conforming to ANSI/ASME B1650
(4) Flared fittings conforming to ASME Blfi.26, Cm/ Copper
A.lloy Fit tings for Hared Capper Tubes
(5) Compression fittings (Vi in. maximum size)
15.4.4.4.2.3 Joints for Copper Piping. Joint� in coppe1· tubing
shall be in accordance with the following:
(1) Joint5 shall be brazed, soldered, threaded, flared, or the
compression type.
(2) Whe1·e joint5 a1·e brazed, they shall comply with the
requirement� of 15.4.6.
(3) Solde1·ed joint5 shall be made in accoi·dance with ASTM
B828, Standard Pmrti,:e Jar Making Capillary JoinL� 1,y Solder­
ing of Capper and Capper Allny Tube and Fittin�, using a
''Iearl-free·· solder filler metal containing not more than
0.2 percent lead by volume that complies with ASTM B32,
Standard Sperifiration Jar Solder Mdal.
15.4.4.4.3 PVC Plastic Piping. PVC plastic piping under
15.4.4.4 shall be in accoi·dance with the follov.�ng:
(l) PVC pla�tic pipe shall b e Schedule 4 0 m Schedule 80,
conforming to ASTM D1785, Standard Spedfiration for
Poly(Vinyl Chloride) (PVC) Plastic Pip, Si:heduvs 40, 80 , and
120.
(2) PVC pla5tic fittings shall be Schedule 40 or Schedule 80
to match the pipe, conforming to ASTM D2466, Standard
Specifimtinn for PoZv(Finyl Chlnride) (PVC) Plmtii: Pipe
Fittin�, Schedule 40, m ASTM D2467. Standard Sperifiration
for Poly(Vinyl Ch laride) (PVCj Plmtir Pipe Fittings, Srhedule
80.
( 3) Joint5 in PVC plastic piping shall be solvent-cemented in
accordance with ASTM D2672, Standard Sprifimtion for
joint� for JPS PVC PipP U�ing Solvent Cnnmt.
15.4.4.4.4 CPVC Plastic Piping. CPVC pla5tic piping under
15.4.4.4 shall be in accm·dance with the follov.1ng:
(1) CPVC IPS plastic pipe shall be Schedule 40 or Scherlule
80, conforming to ASTM F441/F441M, Standard Spncifim­
tion for Chlnrinall'd Poly (Vinyl ChloridP) (CPVC) Plastic Pip,
Schedu/J,s 40 and 80.
(2) CPVC IPS plastic fittings shall be Schedule 40 or Sched­
ule 80 to match the pipe, conforming to ASTM F438,
Standard Sperifimtion for So,:kpt-Type ChlnrinatPd PoMViny l
ChloridP) (CPVC) Pla�ti,: Pipe Fittin�, Srhedule 40, or ASTM
99-141
F439, Standard Sperification for Ch1arina1Pd Poly(\!inyl Chlnr­
ide) (CPFC) Plastir Pipe Fitt in�, Srhedule 80.
(3) CPVC CTS plastic pipe and fittings ½ in. through 2 in.
size shall he SDR 11, confo1·ming to ASTM D2846/
D284fiM, Standard Sperifiration Jar Chlarinated Poly(Vinyl
Chlaride) (CPVC) Plastir Hot- and Cald-H'izter D istribution
Systl'lns.
(4) Solvent cement for joint� in CPVC plastic piping shall
comply with ASTM F493, Standard Sperifimtion for Solven t
t.R111ml.1 for Chlnrinated Poly(Viny l ChlrrridP) (CPVC) Plastir
PipI' and Fittings.
15.4.4.5 Piping for Nitrogen. Nitrogen piping in dental facili­
ties shall comply with 15.4.4.2, including cleaning for oxygen
service.
15.4.5 Installation of Medical Gas, Dental Air, and Vacuum
Piping.
15.4.5.1 General.
15.4.5.1.1 Gas and vacuum piping systems shall be as listed in
Section 15.4.
15.4.5.1.2 Piping materials shall be as listed in 15.4.4.
15.4.5.2 Pipe Sizing. Piping systems shall be designed and
sized to delive1· the 1·equi1·erl flow rates at the utilization pres­
sures.
15.4.5.3 Minimum Pipe Sizes. The minimum size of the
following piping shall be a� follows:
(1) Category 2 oxygen piping shall he not less than DN 10
(NPS ¾ in.) (½ in. O.D.) size.
(2) Category 2 nitrous oxide piping shall be not less than
DN8 (NPS Vi in.) (% in. O.D.) size.
(3) Category 2 oxygen piping shall be at least l size larger
than piping for nitrous oxide.
15.4.5.4 Location of Piping. Piping shall not be located where
subject to contact with oil.
15.4.5.5 Protection of Piping.
15.4.5.5.1 Piping shall be protected against freezing, corro­
sion, and physical damage.
15.4.5.5.2 Piping exposed in con-irlors anrl other locations
where subject to physical damage from the movement of equip­
ment shall be protected.
15.4.5.6 Pipe Support .
15.4.5.6.1 Piping shall be supported from the building struc­
ture.
15.4.5.6.2 Hangers and supports shall comply with anrl be
installed in accordance with MSS SP-58, Pipe Hangers and
Supports - Alaten·al�, Design, Manufacture, Selertion, A.pplimtinn ,
and Jnstallatian.
15.4.5.6.3 Hangers and supporrn shall be sized fo1· the tube or
pipe being supported.
15.4.5.6.4 In potentially damp locations, copper tuhe hangers
anrl supports that are in contact with the tube shall he plastic­
coated 01· othenvise electrically insulated from the tube.
15.4.5.6.5 The maximum support spacing for copper tube
shall be in accordance with Table 15.4.5.6.5.
2021 Edition
99-142 HEALTH CARE FACILITIES CODE

Table 15.4.5.6.5 Maximum Copper Tube Support Spacing 15.4.5.7.6 Trenches shall be excavated so that the piping or its
enclosure has firm, substantially continuous bearing on the
Hanger Spacing bottom of the trench.

Pipe Size mm ft 15.4.5.7.7 Backfill shall be clean, free from mate1·ial that can
tiamage the pipe , anti compacted.
DN8 (NPS 1/1 ) (½ in. O.D.) 1520 5
DNIO (NPS ¾) (½ in. O.D.) 1830 6 15.4.5.7.8 A continuous warning tape 01· ma1·ker shall be
DN15 (NPS ½) (% in. O.D.) 1830 6 placed immediately above the piping 01· it� enclosur·e to clearly
DN20 (NPS %) (½ in. O.D.) 2130 7 identify the pipeline by specific name.
DN25 (NPS I) (1\.;. in. O.D.) 2440 8 15.4.5.7.9 A continuous warning means shall also be placed
DN32 (NPS 11/i) (1% in. O.D.) 2740 g above the pipeline at approximately one-half the depth of
DN40 (NPS I½) (I½ in. O.D.) 3050 10 burial.
and large1·
Venical risers, all sizes, every 4570 15 15.4.5.7.10 V\'he1·e buried piping is extended into a building
floor, but not to exceed thrnugh a wall sleeve. the outtioor end of the sleeve shall be
sealed watertight to prevent the entrance of groundwater into
the building.
15.4.5.8 Underground Piping Within Buildings.
15.4.5.6.6 The maximum support spacing for plastic pipe shall
be in accordance with Table 15.4.5.6.6. 15.4.5.8.1 The installation prncedure fix undergrnund piping
shall p1·event physical tiamage to the piping while being back­
15.4.5.7 Underground Piping Outside of Buildings.
filled.
15.4.5. 7.1 Buried piping outside of buildings shall be installed f
15.4.5.8.2 I the underground piping is prntected by a
below the local level of frost penetration.
conduit , cove1·, 01· othe1· enclosure, access shall be provided at
15.4.5. 7.2 The installation prncedure fot· underground piping the joints tiuring construction fot· ,isual inspection and leak
shall prevent physical tiamage to the piping while being back­ testing.
filled.
15.4.5.8.3 The piping shall be backfilled with clean sand or
15.4.5.7.3 If the unde1·grounti piping is prntected by a gravel.
conduit, cover, or other enclosure, the following requirement�
15.4.5.9 Piping Within Floor Slab.s Prohibited. Dental gas and
shall be met:
vacuum piping shall not be installed within floor slabs.
( l) Access timing construction shall be prmitied at the joinN
for visual inspection and leak testing. 15.4.5.10 Hose and Flexible Connectors.
(2) The contiuit, cover, or enclosure shall be self-draining 15.4.5.10.1 Hose and flexible connectors, both metallic and
and not 1·etain grnundwate1· in prnlongeti contact with nonmetallic, shall be no longer than necessary and shall not
copper tubing. penetrate or be concealed in walls, floors, ceilings, or parti­
15.4.5.7.4 Buried piping that is subject to surface loads shall tions.
be buried at a depth that will protect the piping, its enclosure, 15.4.5.10.2 Hose anti flexible connectors, metallic 01· nonme­
or both, from excessive st1·esses. tallic, shall have a minimum burst gauge pressure of 6895 kPa
15.4.5.7.5 The minimum backfill cover above the top of the (1000 psi).
piping or it� enclosut·e shall be 900 mm (36 in.), except that 15.4.5.10.3 Medical gas hose and flexible connectors shall be
the minimum covet· shall be permitted to be reduced to oxygen compatible.
450 mm (18 in.) where there is no potential for damage from
surface loads or surface conditions. 15.4.5.10.4 Hose and flexible connect01·s shall be clearly itien­
tified a� to the ga� content.

Table 15.4.5.6.6 Maximum Plastic Pipe Support Spacing 15.4.5.10.5 Hose and flexible connectors for dental metiical
gases shall be gas-specific and not be permitted to contiuct any
other ga�. gas mixtut·e, or liquiti.
Hanger Spacing
Pipe Size mm ft 15.4.6 Brazing Copper Tubing.

DN15 (NPS ½) (% in. O.D.) 1220 4 15.4.6.1 Qualification of Brazing Procedures and Brazers.
DN20 (NPS 1/,) ('/" in. O.D.) 1220 4 15.4.6.1.1 Brazing prncedures anti brazer performance for the
DN25 (NPS 1) (11/s in. O.D.) 1320 4.33 installation of tiental piping shall be in accortiance with either
DN32 (NPS lY,) (11/, in. O.D.) 1320 4.33 Section IX, "Vl'elding and Brazing Qualifications," of the ASME
DN40 (NPS 11/,,) (1% in. O.D.) 1420 4.66 BoilPr and Pres.mrP \4>.wl Code, or AWS B2.2/B2.2M, Spn:ijii:atirm
DN50 (NPS 2) (2¾ in. O.D.) 1420 4.66 far Brazing Pmc!'dttrP and PfrfrmnanrP Qualijii:ation, both as modi­
DN65 (NPS 2½) (2½ in. O.D.) 1520 5 fied by 15. 4.6.
and large1·
15.4.6.1.2 Brazers shall be qualified by visual examination of
Venical rise1·s, all sizes, every 3040 10
the test coupons followed by sectioning.
floor, but not to exceed

2021 Edition
 DENTAL (;As AND \\'\CUllM �YSTEMS
15.4.6.1.3 1l1e bi-azing procedm·e specification shall addt·ess
cleaning.joint clearance, overlap, internal purge gas, purge gas
flow rate, anrl fillet· metal.
15.4.6.1.4 The brazing procedure qualification 1·eco1·d and the
recorrl of brazer performance qualification shall rlocument the
filler metal userl, cleaning, joint cleai-ance, ovedap, internal
pm·ge ga.� and flow rate during brazing of the coupon, and the
absence of internal oxirlation in the completerl coupon.
15.4.6.1.5 Brazing procerlures qualified by a technically
competent group or agency shall be permitterl unde1· the
following conrlitions:
(l ) The brazing procerlure specification and the procedu1·e
qualification recorrl meet the requirements of this code.
(2) The employer obtains a copy of both the brazing proce­
dure specification anrl the supporting qualification
rec01·d from the group or agency and signs anrl rlates
these reconls, thereby accepting 1·esponsibility for the
qualifications that were performerl by the group or
agency.
(3) The employe1· qualifies at least one hi-aze1· following each
brazing procedure specification userl.
15.4.6.1.6 An employer shall be permitted to accept bt·azer
qualification 1·ecords of a pt·evious employer unde1· the follow­
ing conditions:
(l ) The brazer has been qualified following the same proce­
dure that the new employer uses or an equivalent p1·oce­
dure.
(2) The new employer obtains a copy of the record of brazer
performance qualification tests from the previous
employer and signs and rlates these 1·ecords, thereby
accepting responsibility for the gualifications performerl
by the previous employer.
15.4.6.1.7 Pei-fom1ance gualifications of bi-azers shall remain
in effect indefinitely, unless the brazer rloes not bi-aze with the
qualifierl procedure for a period exceerling 6 months or there
is a specific 1·eason to guestion the ability of the bi-aze1·.
15.4.6.2 BrazedJoints.
15.4.6.2.1 Brazed tube joints shall be of the socket type.
15.4.6.2.2 Brazed joint� shall he marle using a brazing alloy
that exhihirn a melting temperature in excess of 538'C
(1000 ° F) to retain the integrity of the piping system in the
event of fi1·e expostu-e.
15.4.6.2.3 Filler metals shall bonrl with and he metallurgically
compatible with the base metal beingjoined.
15.4.6.2.4 Filler metals shal l comply with ANSI/A\,VS A5.8M/
A5.8, Spffijimtinn for Fzlln I\,fflrrl� for Brazing and Brau HWding.
15.4.6.2.5 Copper-to-copper joints shall be brazed using a
copper-phosphorus or coppet'-phosphorus-silver bi-azing filler
metal (i.e., BCuP series) without flux.
15.4.6.2.6 Joint� to be brazed in place shall he accessible for
necessary preparation, a�semhly, heating, filler application,
cooling, cleaning, and inspection.
15.4.6.3 Cutting Tube Ends.
15.4.6.3.1 Tube ends shall be cut square using a sharp tubing
cutter to avoid deforming the tube.
99-143
15.4.6.3.2 The cutting wheels on tubing cutters shall be free
from grease, oil, or other lubricant5 not recommenrlerl for
oxygen service.
15.4.6.3.3 The cut enrls of the tube shall be rolled smooth 01·
rleburred with a sharp, clean deburring tool, taking care to
prevent chips from entering the tube.
15.4.6.4 Cleaning Joints for Brazing.
15.4.6.4.1 The interior surfaces of tubes, fittings, anrl othe1-
components that a1·e deaned for oxygen se1·vice shall be stored
and handlerl to avoirl contamination prior to assembly and
brazing.
15.4.6.4.2 The exterior sudaces of tube ends shall be cleanerl
prim· to brazing to remove any oxides anrl surface dirt anrl to
roughen the surfaces to prepare them for brazing.
15.4.6.4.3 Nonabrnsive p ads shall be used to clean the exte1·i01·
surfaces of tube enrls.
15.4.6.4.4 The use of steel wool, sand cloth, or wire brushes
shall be prohibited.
15.4.6.4.5 The cleaning process shall not result in grooving
the sud"aces to he joined.
15.4.6.4.6 A.fte1· being abrnded, the surfaces shall be wiperl
using a dean, lint-free white cloth.
15.4.6.4.7 Tubes, fittin�. valves, and other component� shall
be visually examined internally befo1·e being joinerl to ve1·ify
that they have not become contaminated for oxygen service
and that they a1·e free of obstructions or debris.
15.4.6.4.8 Mate1·ial that has become contaminated internally
anrl is not clean for oxygen senice shall not be installed.
15.4.6.4.9 Joint� shall be brazed within 8 hout·s afte1· being
cleanerl for bi-azing.
15.4.6.5 Brazing Dis.similar Metals.
15.4.6.5.1 Flux shall only he userl when brazing dissimila1·
metals, such as coppet· and bronze or brass, using a silve1· hrnz­
ing filler metal (i.e., BAg series) .
15.4.6.5.2 Cast metals shall not be field brazed.
15.4.6.5.3 Surfaces shall be cleaned for brazing in accordance
with 15.4.6.4.
15.4.6.5.4 Flux shall be applied spat-ingly to minimize contam­
ination of the insirle of the tube with flux.
15.4.6.5.5 The flux shall be applierl and worked over the
f
cleanerl sudaces to be brazed using a stif bristle brnsh to
ensure complete coverage anrl wetting of the surfaces with flux.
15.4.6.5.6 \.\,'here possible, short sections of coppe1· tube shall
be brazed onto the noncopper component, anrl the interior of
the subassembly shall he cleanerl of flux prior to installation in
the piping system.
15.4.6.5.7 On joint� DN20 (NPS %) (¾ in. O.D.) size anrl
smaller, flux-coated brazing rorls s hall be permitted to be used
in lieu of appl)'ing flux to the surfaces to bejoined.
2021 Edition
99-144 HEALTH CARE FACILITIES CODE
15.4.6.6 Nitrogen Purge.
15.4.6.6.1 ·while being b1·azed, joint� shall be continuously
purged with oil-free, nry nitrogen NF to prevent the fot·mation
of coppet· oxide on the insirl.e surface of thejoint.
15.4.6.6.2 The source of the nitrngen purge gas shall be moni­
torerl., anrl. the installer shall be audibly alerterl. when the
content is low.
15.4.6.6.3 The nitrogen purge gas flow rate shall not he high
enough to prnduce a positive pt·essure in the piping system.
15.4.6.6.4 The nitrogen purge gas flow shall be controlled by
the use of both a p1·essure 1·egulator and a flowmeter or a
combination the1·eof
15.4.6.6.5 Pressure regulators alone shall not be userl. to
control nitrngen p111·ge gas flow 1·ates.
15.4.6.6.6 During and after installation, openings in the
piping system shall be kept capped or plugged to maintain a
nitrngen atmosphere within the piping and to prevent debris
or other contaminant� from ente1·ing the system.
15.4.6.6. 7 While a joint is being brazed, a discharge opening
shall be prnvided on the opposite side of thejoint from where
the niu·ogen purge gas is being inu·oduced.
15.4.6.6.8 1l1e flow of nitrogen purge gas shall be maintained
until the joint is cool to the touch.
15.4.6.6.9 Afte1· the joint ha.� coolerl., the purge discharge
opening shall be plugged or capped to prevent contamination
of the inside of the tube and maintain the nitrngen atmos­
phere within the piping system.
15.4.6. 7 Assembling and Heating Brazed Joints.
15.4.6.7.1 Tube ends shall be inserted either folly into the
depth of the fitting socket or to a mechanically limiterl. depth
that is not less than the minimum cup rl.epth (i.e., overlap)
specified in ANSI/ASME BlG.50, Wrought Coppn and Coppfr
A.Uoy BrazPfoint PressurP Fittings.
15.4.6. 7.2 \\'here flux is permitted, joints shall be heated
slowly until the flux has liquefied.
15.4.6.7.3 Afte1· flux has liquefied, 01· where flux is not pe1·mit­
ted to be userl., thejoint shall be beaten quickly to the brazing
temperatu1·e. taking ca1·e not to ove1·heat thejoint.
15.4.6.7.4 Techniques for heatingjoint�, applying the bt·azing
filler metal, and making the horizontal, vertical, and large­
diameter joints shall he as desc1·ibed in sections on applying
heat anrl. brazing horizontal anrl. verticaljoint� in Chapte1·VIII,
"Brazen.Joint�," in the CDA Copper fobe Handbook.
15.4.6.8 Inspection of BrazedJoints.
f
15.4.6.8.1 A te1· brnzing, the outside of all joints shall be
cleaned by washing with water and a wire brush to remove any
resirl.ue and allow clear visual inspection of thejoint.
15.4.6.8.2 \'\'he1·e flux has been userl., the wash wate1· shall be
hot.
15.4.6.8.3 Each joint shall be visually inspecterl. alter cleaning
the outsirl.e surfaces.
15.4.6.8.4 Joint� exhibiting the following conrl.itions shall not
he permitted:
2021 Edition
(l) Flux 01· flux residue (where flux or flux-coated BAg rods
are used with rl.issimilar metals)
(2) Base metal melting or erosion
(3) Unmelterl. filler metal
(4) Failure of the filler metal to be clearly visible all the way
around the joint at the interface between the socket and
the tube
(5) Cracks in the tube 01· component
(G) Cracks in the filler metal
(7) Fail111·e of the joint to hold the test press111·e unde1· the
installer-pedormed initial pressure test (.�Pf 15. 4. 7. 4. 4)
anrl. standing pressure test (.�PP 15.4. 7.4.6)
15.4.6.8.5 Joint� that are irl.entified as defective unrl.er conrl.i­
tions specified in 15.4.6.8.4(2) or 15.4.6.8.4(5) shall be
replaced.
15.4.6.8.6 Joints that are found to be defective under condi­
tions specifierl. in 15.4.6.8.4(1), 15.4.G.8.4(3), 15.4.6.8.4(4).
15.4.6.8.4(6), 01· 15.4.6.8.4(7) shall be permitted to be
repaired, except that no joint shall be reheated more than
once befixe being replaced.
15.4.7 Performanc e Criteria and Testing (Oxygen and Nitrous
Oxide).
15.4.7.1 Testing and Verification.
15.4.7.1.1 General.
15.4.7.I.I.l Inspection anrl. testing shall be pedormerl. on all
new piperl. oxygen anrl. nitrous oxirl.e systems, adrl.itions, 1·enova­
tions, temporary installations, or repairerl. systems to ensure, by
a documented procerl.ure, that the following have been
completed:
(1) All applicable prmisions of this code have been adhered
to.
(2) System integ1·ity ha.� been achieverl. or maintainerl..
(3) Piping systems are 1·eany fo1· testing and ve1-ification.
(4) Piping systems are performing in accordance with their
design requirement�.
15.4.7.I.I.2 The inspection and testing 1·epo1·t� shall be
submitted directly to the party that contracterl. for the testing,
who shall submit the 1·eports through channels to the Responsi­
ble Facility Authority and any others that are requi1·ed.
15.4.7.I.I.3 Report� shall contain detailerl. listings of all find­
ings and result�.
15.4.7.1.1.4 The Responsible Facility Authority shall 1·e,iew
the inspection anrl. testing records prior to the use of any
systems to ensu1·e that all findings and result� of the inspection
and testing have been successfully completed before use.
15.4.7.I.I.5 All documentation pertaining to inspections and
testing shall he maintainerl. on-site within the facility.
15.4.7.2 Required Testing and Verification.
15.4.7.2.1 Category 2 Medical Gas Systems (Oxygen and
Nitrous Oxide). All Category 2 oxygen and nitrous oxirl.e
piping systems indicated in 15.4.2 shall be initially testerl. in
accordance with 15.4.7.4.
15.4.7.2.2 The oxygen and niu·ous oxide piping systems shall
be verified in accordance with 15.4.7.5.
 DENTAL (;As AND \\'\CUllM �YSTEMS
15.4. 7.3 Qualification of System Testers and Verifiers (Oxygen
and Nitrous Oxide).
15.4. 7.3.1 Indi"iduals who perfo1·m the initial and final tests of
the m..·ygen and nitrous oxide piping systems shall be certified
to ASSE GO 10, ProJP.t�ional Qw1lijirations Standard for Mtdiml Gas
Systnns InstallPrs, 01· ve1·ifiers who comply with 15.4. 7.3.2.
15.4. 7.3.2 Individuals who verify the oxygen and nitrous oxide
piping systems shall be certified to ASSE 6030, ProjP.t1ional Qual­
ijirations Standard for I\1Pdiral C',a.1 Systems \frijin,.
15.4. 7.4 Initial Testing of Piping Systems (Oxygen and Nitrous
Oxide).
15.4.7.4.1 General.
15.4.7.4.1.1 1l1e initial tests required by 15.4.7.4 shall be
perforn1ed p1·io1· to either the final test� or the verification test�
listed in 15.4.7.5.
15.4.7.4.1.2 1l1e test gas for ga� piping systems shall be oil­
free, dry nitrogen NF.
15.4.7.4.1.3 Where manufactured assemblies are to be in­
stalled, the initial tests required by 15.4.7.4 shall be performed
as follows:
(l) Afte1· completion o f the <listrilmtion piping but befo1·e
the standing pressure test
(2) Prior to installation of manufactured assemblies supplied
through flexible hose or flexible tubing
Fm· all station outlet�/inlet� on installed manufactu1·ed
(3)
assemblies supplied through copper tubing
15.4.7.4.1.4 Where plastic vacuum and plastic scavenging
piping systems are installed, they shall be visually inspected for
cross-connections to positive-pressure systems before applying
positive test pressm·es to the copper piping systems.
15.4.7.4.1.5 Where braze<ljoint� in coppe1· tubing are found
to be defective, they shall be repaired if permitted by 15.4.6.8.6
m replaced if 1·equire<l by 15.4.G.8.5, and 1·eteste<l. The piping
shall be repurged if' necessary.
15.4.7.4.1.6 During the process of initial testing, the identifi­
cation and labeling of the medical gas and vacuum piping shall
be checked.
15.4.7.4.2 Initial Piping Blowdown (Oxygen and Nitrous
Oxide). Piping in dental air and vacuum distribution syi;tems
shall be blown clear by means of oil-free, dry nitrogen NF after
installation of the distribution piping but before installation of
station outlet/inlet rough-in assemblies and other system
component� (e.g., pressu1·e/vacuum alarm devices, p1·essm·e/
\-acuum indicatm·s, pressure 1·elief,-alves, manifolds, and source
equipment).
15.4. 7.4.3 Initial Cros.s-Connection Test for Copper Piping
Systems.
15.4.7.4.3.1 Copper piping shall not be tested before any plas­
tic piping.
15.4. 7.4.3.2 It shall be determined that no cross-connections
exist between the va rious medical gas and vacuum piping
systems.
15.4.7.4.3.3 All ptpmg systems shall be reduced to atmos­
pheric pressure.
99-145
15.4.7.4.3.4 Sources of test gas shall be disconnected from all
piping systems except for the one system being tested.
15.4.7.4.3.5 The system under test shall be charged with oil­
free, dry nitrogen NF to a gauge p1·essure of 345 kPa (50 psi).
15.4.7.4.3.6 A:fi.e1· the installation of the individual faceplates
with approp1·iate adapte1·s matching outlet/inlet labels, each
individual outlet/inlet in each installed medical gas and
vacuum piping system shall be checked to determine that the
test gas is dispensed only from the piping system tested.
15.4.7.4.3.7 The initial cross-connection test in 15.4.7.4.3 shall
be repeated for each installed medical gas and vacuum piping
system with coppe1· piping.
15.4.7.4.3.8 Any cross-connections shall be 1·emoved and the
a�sociate<l piping repaired and leak tested.
15.4.7.4.3.9 The prope1· labeling and identification of system
outlet�/inlet� shall be confirmed <luring these test�.
15.4.7.4.4 Initial Pres.sure Test.
15.4.7.4.4.1 Each section of the piping in positive-p1·essure gas
systems and copper vacuum systems shall be pressure tested.
Plastic vacuum and plastic scavenging piping shall not be pres­
sure tested.
15.4.7.4.4.2 Initial pressure test� shall be conducted as follows:
(l) After blowdown of the distribution piping
(2) After installation of station outlet/inlet rough-in assem­
blies
(3) Prior to the installation of components of the distribution
piping system that would be damaged by the test pressure
(e.g.. pressu1·e/vacuum alarm devices, pressu1·e/,-acuum
indicators, and line pressure re lief valves)
15.4.7.4.4.3 The sou1·ce shutoff valve shall 1·emain closed
<luring the pressure test�.
15.4.7.4.4.4 The test p1·essme for oxygen and nitrous oxide
piping shall be 1.5 times the system opernting p1·essure but not
less than a gauge p1·essure of 1035 kPa (150 psi).
15.4.7.4.4.5* The test pressure shall be maintained until each
joint has been examined for leakage by means of a leak detec­
tant that is safe fo1· use with oxygen and does not contain
ammonia.
15.4.7.4.4.6 Any leaks shall be located, 1·epaired (if permit­
ted), 01· replaced (if' required) by the installer, and retested.
15.4.7.4.5 Initial Piping Purge Test.
15.4.7.4.5.1 The outlet� in each oxygen and nitrous oxide
piping system shall be purged to remove any particulate matter
from the distribution piping.
15.4.7.4.5.2 Using approp1·iate adapte1·s, each outlet shall be
purged with an intermittent high-volume flow of test ga� until
the purge produces no discoloration in a clean white cloth.
15.4.7.4.5.3 The pm·ging shall be sta rted at the closest outlet
to the piping shutoff \alve and continue to the furthest outlet
from the shutoff valve.
2021 Edition
99-146 HEALTH CARE FACILITIES CODE
15.4.7.4.6 Standing Pressure Test for Oxy gen and Nitrous
Oxide Piping.
15.4.7.4.6.1 1\fte1· successful completion of the initial pressure
test� in 15.4.7.4.4, the gas distribution piping shall be subject to
a standing pressure test.
15.4. 7.4.6.2 Test� shall he conducted after the final installation
of station outlet valve bodies, faceplates, and other distribution
system components (e.g., pressure alarm devices, pressure indi­
cators, line pressm·e 1·eliefvalves, manufactured assemblies, and
hoses).
15.4. 7.4.6.3 The source valve shall be closed during this test.
15.4. 7.4.6.4 The piping systems shall be subjected to 24-hom
standing pressu1·e test� using oil-free, dry nitrogen NF.
15.4.7.4.6.5 Test pressures shall be 20 percent above the
normal system opernting line pressu1·e.
15.4.7.4.6.6 At the conclusion of the test5, there shall be no
change in the test pt·essure except that attributed to specific
changes in ambient temperattu-e.
15.4.7.4.6.7 Any leaks shall be located, repaired (if permit­
ted), or 1·eplaced (if required) hy the installer, and retested.
f
The piping shall be repurged i necessary.
15.4. 7.4.6.8 The 24-hour standing pressure tests shall be
\\�tnessed by the authority having jurisdiction or it� designee. A
form indicating that these test� have been performed and
,�tnessed shall be provided to the verifie1· at the start of the
verification test� in 15.4.7.5.
15.4.7.5 Verification of Piping Systems (Oxygen and Nitrous
Oxide).
15.4. 7. 5. I General.
15.4.7.5.1.1 The oxygen and nitrous oxide piping systems
requiring initial testing and verification shall be as indicated in
15.4.7.2 for the difle1·ent dental facilities.
15.4.7.5.1.2 Requi1·ed verification of m..,.gen and nitrous oxide
piping systems shall be performed only after all initial tests
required in 15.4.7.4 have been completed.
15.4.7.5.1.3 The test ga� shall be oil-free, dry nitrogen NF 01·
the system gas or vacuum where permitted.
15.4. 7.5.1.4 Ve1·ification shall be conducted by a party techni­
cally competent and expe1·ienced in the field of medical ga�
and vacuum piping system testing and certified for ASSE 6030,
Projfssional Qualijirations Standard for MPdiral Gas Systmns Verifiers.
15.4. 7.5.1.5 Ve1·ification shall be pedormed by a pa1·ty othe1·
than the installing contractor.
15.4.7.5.1.6 All required ve1·ification tests shall he perfo1·med
after installation of any manufactured assemblies supplied
through tubing or flexible hose.
15.4.7.5.1. 7 \'\IJ1e1·e there are multiple possible connection
points for tei-minals, each possible position shall be tested inde­
pendently.
15.4.7.5.1.8 Whe1·e brnzedjoint� in copper tubing a1·e found
f
to be defective, they shall be repaired i petmitted by l f>.4.6.8.6
or replaced if required by 15.4.6.8.5, and retested. The piping
shall be 1·epm·ged if necessary.
2021 Edition
15.4.7.5.1.9 During the process of vei-ification, the pt·esence
and proper labeling of source equipment, station outlets/
f
inlet�, zone valve boxes, shutof valves, and ala1·ms shall be
checked.
15.4.7.5.2 Verifier Standing Pressure Test. Oxygen and
nitrous oxide piping systems 1·equiring verification shall be
subjected to a LO-minute standing p1·essu1·e test at operating
line pressure using the following procedure:
(1) .<\fte1· the system is filled ,�th nitrogen 01· the som·ce gas,
the smu-ce valve shall be closed.
(2) The piping system shall show no decrease in pressure
after not less than 10 minutes.
f
(3) Any leaks shall be located, repaired (i permitted). or
replaced (if 1·equired) by the installe1·, and 1·etested.
15.4.7.5.3 Verifier Cross-Connection Test. The piping systems
shall be tested fot· cross-connections bel:\veen the systems using
the following procedure:
(l ) All medical ga� and vacuum piping systems shall be
reduced to atmospheric pressm·e.
(2) All sources of test gas for all of the gas and vacuum
systems, with the exception of the one system to be
checked, shall be disconnected.
(3) lhe system being checked shall be pressurized to a gauge
pressure of 345 kPa (50 psi) .
( 4) With adapters matching outlet labels, each individual
station outlet/inlet of all medical gas and "-acuum systems
installed shall be checked to determine that test gas is
dispensed only from the outlet�/inlets of the piping
system being tested.
(5) The sou1·ce of test gas shall be disconnected, and the
system that was tested reduced to atmospheric pt·essure.
(6) Each additional piping system shall be tested until all gas
and vacuum piping systems requiring ve1·ific ation are free
of cross-connections.
(7) Any cross-<"onnections shall be 1·emoved and the associ-
ated piping repaired and tested for leaks.
15.4.7.5.4 Verifier Piping Purge Test.
15.4.7.5.4.1 To remove any traces of particulate matter depos­
ited in the oxygen and nitrous oxide piping dtu-ing constrnc­
tion, a heavy, inte1·mittent pu1·ging of the piping shall be done.
15.4.7.5.4.2 The appropriate adapter shall be obtained and
high purge rates of at least 22f> NI/min (8 SCFM) shall be put
on each outlet.
15.4.7.5.4.3 After each purge is started, it shall be rapidly
inten-upted several times until the pm·ge produces no discolor­
ation in a white cloth loosely held ove1· the adapter dut·ing the
purge.
15.4.7.5.4.4 To avoid possible damage to the outlet and it�
components, this test shall not be conducted using any imple­
ment other than the prnper adapter.
15.4.7.5.4.5 No pronounced or objectionable odor shall be
discernible from any positive presstu-e outlet.
15.4.7.5.5 Verifier Piping Particulate Test.
15.4.7.5.5.1 For each oxygen and nitrous oxide system, the
cleanliness of the piping system shall be verified.
15.4.7.5.5.2 The test shall be performed with the use of oil­
free, dry nitrogen NF.
 DENTAL (;As AND \\'\CUllM �YSTEMS
15.4.7.5.5.3 A muumum of 1000 L (35 ft3) of gas shall be
filtere<l through a clean, white 0.45 micron filte1· at a minimum
flow rnte of 100 NI/min (35 SCFM).
15.4. 7.5.5.4 Twenty five percent of the zones shall be tested at
the outlet most 1·emote from the source.
15.4.7.5.5.5 The filter shall accrne no m01·e than 0.001 g
( l mg) of matter from any outlet teste<l.
15.4.7.5.5.6 If any outlet fails this test, the most remote outlet
in every zone shall be tested.
15.4.7.5.6 Verifier Piping Purity Test.
15.4.7.5.6.1 For each oxvgen and nitrous oxide system, the
purity of the piping system shall be verified in accordance with
15.4.75.G.
15.4.7.5.6.2 These test� shall be ped,xme<l with oil-free, d ry
nitrogen NF or the system gas.
15.4. 7.5.6.3 The outlet most remote from the sou1·ce shall be
teste<l fo1· total nonmethane hvdrocarbons an<l compare<l to
the test of the source gas.
15.4. 7.5.6.4 If the system gas is used a� the source ga�. it shall
be tested at the source equipment.
15.4.7.5.6.5 The difference between the two tests shall in no
case excee<l :> ppm of total nonmethane hy<lrocarbons.
15.4.7.5.6.6 The diffe1·ence between the two tests shall 111 no
case exceed 5 ppm of halogenate<l hydrocarbons.
15.4. 7.5.6.7 1l1e moisture concentration of the outlet test
shall not excee<l :i00 ppm or an equivalent p1·esstll'e dew point
of -12'C ( lO'F) at a gauge pressure of 345 kPa (50 psi).
15.4.7.5.7 Verifier Final Tie-in Test.
15.4.7.5.7.1 Prior to the connection of any work or any exten­
sion 01· addition to an existing piping system, the verification
tests in l!">.4.7.5 shall be successti.tlly pedormed on the new
work.
15.4.7.5.7.2 Each joint in the final connection bet ween the
new work and the existing system shall be leak-teste<l with the
gas of system designation at the normal operating pressure by
means of a leak detectant that is safe for use with oxygen an<l
noes not contain ammonia.
15.4. 7.5. 7.3 For oxygen an<l niu·ous oxi<le, imme<liately after
the final brazed connection is made and leak- tested, an outlet
in the new piping and an outlet in the existing piping that a1·e
immediately downstream from the point or a1·ea of intrnsion
shall be purged in accordance with the applicable require­
ment� of 15.4.75.4.
15.4.7.5. 7.4 Before the new work is used fo1· patient care,
m..-ygen and nitrous oxi<le shall be teste<l fo1· operntional p1·es­
s111"e and gas concentration in accor<lance with 15.4.7.5.8 and
15.4.75.9.
15.4.7.5. 7.5 Permanent reconi� of these test� shall be main­
taine<l.
15.4.7.5.8 Verifier Operational Pressure Test.
15.4.7.5.8.1 Operational pressu1·e tests shall be perforn1ed at
each station outlet or terminal where the user makes connec­
tions and disconnections.
99-147
15.4.7.5.8.2 Tests shall be performed with the gas of system
designation.
15.4.7.5.8.3 All medical gas outlet� with a gauge p1·essu1·e of
345 kPa (50 psi), including oxygen an<l nitrous oxide, shall
deliver :i0 SLPM (1.8 SC.FM) with a pressure drop of not more
than 3:i kPa (5 psi) and static pressme of 345 kPa to 380 kPa
(50 psi to :i5 psi).
15.4.7.5.9 Verifier Gas Concentration Test. After purging
each system with the gas of system designation, the follm\�ng
shall be pedonne<l:
( l) Each pressure gas source an<l outlet shall b e analyzed for
concentration of gas, by volume.
(2) Analysis shall be conducted with instrnment� designed to
meastlt"e the specific gas dispense<l.
(3) Allowable concentrations shall be as folio�:
(a) Oxygen 299 pe1·cent
(b) Nitrous oxide ;>99 percent
(c) Other gases ±1 percent unless othen\/ise specified
15.4.8 Performance Criteria and Testing (Dental Air and
Vacuum).
15.4.8.1 Dental Air and Vacuum SystellLS Testing.
15.4.8.1.1 General.
15.4.8.1.1.1 Inspection and testing shall be performed on all
new piped dental gas and \·acuum systems, additions, renova­
tions, temporary installations, or repai1·e<l systems to ensm·e, by
a documented procedure, that the following have been
completed:
( l) All applicable provisions of this code have been adhere<l
to.
(2) System integrity has been achieve<l or maintained.
(3) Piping systems are ready for testing and verification.
(4) Piping systems a1·e pedo1·ming in accm·dance with thei1·
design requirement�.
15.4.8.1.1.2 The inspection and testing report� shall be
submitte<l directly to the party that contracted for the testing,
who shall submit the report� through channels to the Responsi­
ble Facility Authority an<l any others that a1·e 1·equire<l.
15.4.8.1.1.3 Reports shall contain <letaile<l listings of all find­
ings and result�.
15.4.8.1.1.4 The Responsible Facility Authority shall review
the inspection and testing records prior to the use of any
systems to ensure that all findings and results of the inspection
and testing have been successfully completed befot·e use.
15.4.8.1.1.5 All <locumentation pertaining to inspections an<l
testing shall he maintaine<l on-site within the facility.
15.4.8.1.2 Category 2 Dental Air and Vacuwn SystellLS.
15.4.8.1.2.1 All Category 2 <lental gas an<l vacuum p1p1ng
systems in<licate<l in 15.4.3 shall be initially tested in accord­
ance with 15.4.8.1.
15.4.8.1.2.2 The support gas systems and vacuum systems (i.e.,
dental air, <lental vacuum, and scavenging) shall be final teste<l
in accordance with 15.4.8.1.7 and 15.4.8.1.8.
2021 Edition
99-148 HEALTH CARE FACILITIES CODE
15.4. 8. I. 3 Initial Testing of Piping Systems.
15.4. 8. I. 3. I General.
(A) Whe1·e plastic vacuum and pla�tic scavenging p1pmg
systems are installe<l, they shall be visually inspected for cross­
connections to oxygen an<l nitrous oxide systems before apply­
ing positive test pressm·es to the coppe1· piping systems.
(B) During the process of initial testing, the identification an<l
labeling of the dental gas and vacuum piping shall he checked.
15.4.8.1.4 Initial Cross-Connection Test for Plastic Vacuum
and Plastic Scavenging Piping Systems.
15.4.8.1.4.1 Plastic piping shall be tested before coppe1·
p1pmg.
15.4.8.1.4.2 Tests shall be conducted to determine that no
cross-connections exist between any plastic vacuum piping
systems or pla�tic scavenging piping systems an<l any coppe1-
piping systems.
f 15.4.8.I.7 Standing Pressure Test for Dental Air and Copper
15.4.8.1.4.3 The vacuum 01· scavenging source shutof valves
for the vacuum 01· scavenging piping systems shall remain
close<l during the test�. unless thev are heing used for the cross­
connection test vacuum source.
15.4.8.1.4.4 The cross-connection test vacuum shall be a mini­
mum of300 mm (12 in.) HgV.
15.4.8.1.4.5 1l1e source of test vacuum shall be connected
only to the vacuum or scavenging piping system being teste<l.
15.4.8. 1.4.6 All individual gas system outlets an<l vacuum or
scavenging system inlet� shall be checked to dete1·mine that the
test vacuum is only p1·esent in the vacuum or scavenging piping
system being tested.
15.4.8.1.4.7 The cross-connection test� shall be 1·epeated fo1·
each installed vacuum and scavenging system with pla�tic
piping.
15.4.8.1.4.8 Any cross-connections shall he remove<l an<l the
associated piping repaired an<l leak tested.
15.4.8.1.4.9 The proper labeling an<l identification of system
outlets/inlet� shall be confirmed during the initial test�.
15.4.8.1.5 Initial Pressure Test.
15.4.8.1.5.1 Each section of Ll1e piping in dental air systems
and coppe1- vacuum systems shall he pressure teste<l. Plastic
vacuum and plastic scavenging piping shall not be pressure
teste<l.
15.4.8.1.5.2 Initial pressu1·e test� shall be conducted as follows:
( 1) After installation of station outlet/inlet rough-in assem-
blies
f
(2) P1·io1· to the installation o component� of the distribution
piping system that would be damage<l by the test pressure
(e.g., pressure/vacuum alarm de"ices, pressure/vacuum
indicatoi-s. and line pressure relief valves)
15.4.8.1.5.3 The sout"Ce shutoff valve shall remain closed
during the pressure tests.
15.4.8.1.5.4 The test pressm·e fo1· dental ai1· piping and coppe1·
\-acuum piping shall be 15 times the system opernting pressure
but not less than a gauge pressure of 10:\5 kPa (150 psi).
2021 Edition
15.4.8.1.5.5 The test p1-essure shall be maintained until each
joint has been examined for leakage by means of a leak detec­
tant that is safe for use with oxygen and <loes not contain
ammoma.
15.4.8.1.5.6 Any leaks shall he locate<l, repaired (if permit­
f
ted), or replaced (i 1·equi1-ed) by the installe1·, and reteste<l.
15.4.8.1.6 Initial Piping Purge Test.
15.4.8.1.6.1 The outlet� in each dental air piping system shall
be purged to remove any particulate matte1· from the dist1·ibu­
tion piping.
15.4.8.1.6.2 Using appropriate adapters, each outlet shall be
pm·ged with an intermittent high-volume flow of test ga, until
the purge produces no discoloration in a clean white cloth.
15.4.8.1.6.3 The purging shall be started at the closest outlet
to the piping shutoff valve and continue to the furthest outlet
from the shutoff"-alve.
Vacuum Piping.
15.4.8.1.7.1 After successful completion of the initial pressure
tests in 15.4.8.1, the <lental air systems and copper vacuum
systems shall be s uI� ec t to a stan<ling pressure test.
15.4.8.1.7.2 Tests shall be conducted after the final installation
of station outlet valve hoclies, faceplates, and othe1· distribution
system component, (e.g., p1·essure alarm <levices, p1·essure in<li­
cators. line p1·ess111"e relief valves, manufactured a�semblies. and
hoses).
15.4.8.1.7.3 The source '1-alve shall be closed du1·ing this test.
15.4.8.1.7.4 The piping systems shall be subjected to 24-hour
standing p1-essure test� using oil-free, d1·y nitrogen NF.
15.4.8.1.7.5 Test pressu1-es shall he 20 percent above the
normal system operating line pressure.
15.4.8.1.7.6 At the conclusion of the test�, there shall be no
change in the test pressure, except that attributed to specific
changes in ambient temperature.
15.4.8.1.7.7 Any leaks shall be located, repaired (if permit­
te<l), or replaced (if requi1·e<l) by the installer, and retested.
The piping shall be repurged if necessarv.
15.4.8.1.8 Standing Vacuum Test for Plastic Vacuum Piping.
15.4.8.1.8.1 After successful completion of the initial pressure
test� in 15.4.8. l, ,-acuum distribution piping, including scaveng­
ing, shall be subjected to a standing vacuum test.
15.4.8.1.8.2 Tests shall be con<lucted after instal lation and
connection of all component� of the vacuum system.
15.4.8.1.8.3 The piping systems shall he subjecte<l to a 24-hour
stan<ling vacuum test.
15.4.8.1.8.4 Test pressure shall be between 300 mm (12 in.)
HgV and full ,-acuum.
15.4.8.1.8.5 During the test, the source of test vacuum shall be
disconnected from the piping system.
15.4.8.1.8.6 At the conclusion of the test, there shall be no
change in the vacuum pressure other than that attributed to
changes of ambient tempei-ature.
 DENTAL (;As AND W.CUllM �YSTEMS
15.4.8.1.8.7 Any leaks shall be located. repai1·ed (if permit­
ted), or replaced (if required) by the installer, anct retested.
15.4.9 Operation and Management.
15.4.9. 1 System Shutdowns.
15.4.9.1.1 Gas anct vacuum piping systems shall be shut down
at the end of each workday.
15.4.9.1.2 Emergency shutoff valves or remote actuators shall
not be used fot· ctaily shutdown of the systems. Cylin<ler gas
valves shall be used fix ctaily shutdowns.
15.4.9.2 Prohibi ted Interconnections. Two or more piping
systems for different gases or different vacuums shall not be
inteJ"Connected for testing or any othe1· 1·eason.
15.4.9.3 Manufacturer's Instruct ions.
15.4.9.3.1 Piping system component� shall be installed, adjus­
ted, operated, and maintained in accordance with the manu­
facturer's instructions.
15.4.9.3.2 Copies of the manufacture1·'s instructions shall be
prnvided to the facility anct maintained at the facility.
15.4.9.4 Maintenance.
15.4.9.4.1 Gas and vacuum system equipment shall be main­
tainect by a qualifiect person.
15.4.9.4.2 Eve1·y facility shall establish a prncedure for
manually turning off the gas supply at the cylin<ler valves of
Category 2 ctental g-as and vacuum systems at the end of each
<lay
15.4.9.5 Periodic Testi ng.
15.4.9.5.1 Station outlets for oxygen and nio·ous oxide shall
be tested fot· flow and pt·essure on an apprnvect sche<lule.
15.5 Category 3 Dental Gas and Vacuum Systems.
15.5.1 General.
15.5.1.1 Category 3 dental ga� anct vacuum systems shall be
limite<l to facilities that perform minimal or no sedation.
15.5.1.2 1l1e1·e shall be no medical gases.
15.5.1.3 The <lental support gases shall be provictect from a
<lental ai1· source system.
15.5.1.4 The vacuum system shall be dental vacuum.
15.5.2 Category 3 Dental Air and Vacuum Piping Systems.
15.5.2.1 General. Dental air and vacuum piping systems shall
include <lental support gases and ctental vacuum systems.
15.5.2.2 Vacuum Systems. Dental vacuum systems shall
inclucte dental vacuum and nitrnus oxide scavenging.
15.5.3 Equipment Locations for Dental Air and Vacuum
Systems.
15.5.3.1 General. Any of t he following systems shall be
permitted to be located together in the same room:
( l) Dental ai1· compressor sout·ces anct 1·eserve heade1·s
(2) Dental vacuum sou1·ces
(3) Any other compressor, vacuum pump, or electrically
powered machinery
99-149
15.5.3.2 Cylinders and Containers. Cylinders and containers
for gases shall be handled in accordance with Chapter 11.
15.5.3.3 Ventilation for Motor-Driven Equipment. The follow­
ing source locations shall be adequately ventilated to prevent
accumulation of heat:
( l) Dental comp1-essect air sources
(2) Dental vacuum sources
15.5.4 Dental Gas and Vacuum Source Equipment.
15.5.4.1 General.
15.5.4.1.1 The capacity of source equipment shall be base ct on
the design requi1·ement� for the facility. including the numbe1·
of gas outlet�, vacuum inlet�, anct other connections, and thei1·
indi,ictual capacities.
15.5.4.1.2 The system design 1·equi1·ement� shall be incluctect
in the <lata used for testing anct verilJ-ing the operntion of the
g-as and vacuum piping systems.
15.5.4.2 Dental Air.
15.5.4.2.1 General.
15.5.4.2.1.1 Dental air shall be used as a support gas fo1· d1·iv­
i11g <lental tools and shall be permitted to be used to supply ait0
driven equipment. Dental comp1-esse<l ai1· shall not be usect fot·
respiration.
15.5.4.2.1.2 Dental ai1· outlet� shall not be interchangeable
wiili any othe1· gas outlet�, including oxygen. nio·ous oxide,
medical air, inso·ument air, anct nitrogen.
15.5.4.2.2 Dental Air Compressor Units.
15.5.4.2.2.1 Dental air compressor units shall include dental
air comp1·essorn, vib1·ation isolation, ai1· 1·eceivers. coalescent ai1·
filters, adsorption dryers, exhaust silencer/filte1·s, moisture
indicators, and service access manifolds, electrical disconnects,
motor wiring, and controls.
15.5.4.2.2.2 Air compressors shall be scroll dental, reciprocat­
ing <lental, or the oil-free <lental types.
15.5.4.3 Dental Vacuum.
15.5.4.3.1 General.
15.5.4.3.1.1 Dental vacuum shall be used for oral evacuation
and nitrous oxide scavenging.
15.5.4.3.1.2 Dental vacuum inlet� shall not be interchangeable
wiili any other vacuum inlet�, including dental-surgical
vacuum.
15.5.4.3.2 Dental Vacuum Units.
15.5.4.3.2.1 Dental vacuum unit� shall include dental vacuum
pumps, vibration isolation, separntion tanks, vacuum inlet,
vacuum exhaust, condensate drnin, motor wiring, anct contt·ols.
15.5.4.3.2.2 Dental vacuum pumps shall be dental dry vacuum
01· dental liquid (wet) ring pumps. Pumps shall be oil-free 01·
oil-lubricate<l and suitable for nitrous oxide scavenging.
15.5.5 Piping for Category 3 Dental Gas and Vacuum Systems.
15.5.5.1 General.
15.5.5.1.1 Piping for dental air systems shall comply with
15.5.5.2.
2021 Edition
99-150 HEALTH CARE FACILITIES CODE
15.5.5.1.2 Piping fot· dental vacuum systems and scavenging
systems shall comply with 15.5.5.3.
15.5.5.2 Piping for Dental Air Sy.stems.
15.5.5.2.1 General. Pipe, fittings, and joint� in ptpmg for
dental compressed air systems shall be in acco1·dance with
15.5.5.2.2 thrnugh 15.5.5.2.4.
15.5.5.2.2 Pipe. Pipe under 15.55 shall comply with the
following:
( 1)ASTM B88, Standard Sper.ifir.ation for Seamless Copper lVater
Tube, Type L or K
(2) ASTM B819, Standard Sper.ifir.ation for Smmle.�1 Copf"/Pr Tube
for Ivlfdir.al Gas SystP11ts, Type L or K
(3) ASTM B280, Standard Sper.ijir.ation for Smmless Copper Tube
for 1tir Conditioning and &frigeration Field Senria, ACR tube
(O.D. size)
15.5.5.2.2.1 Copper tube shall be hard tempe1· or annealed
(soft temper).
15.5.5.2.3 Fittings. Fittings for piping unde1· 15.5.5.2 shall be
pe1·mitted to be any of the following acceptable joining meth­
ods:
(1) Brazed or solde1·ed fittings conforming to ASME Blfi.22,
Wrought Copper and Copper Allo-,• Solder-Joint Pressure Fittings
(2) Brazed fittings conforming to ANSI/ASME Blfi.50,
Wrought Copper and Coppfr /illO)• Braze-Joint Pmsure fittings
(3) Brazed fittings conft')l"ming to ASME Bl6.22 with socket
depths equal to or greater than braze:joint pressure
fittings in compliance with ANSI/ASME B1650
(4) Fla1·ed fittings conft')l"ming to ASME Blfi.26, Cast Copper
A.lloy Fittings for flared Copper Tubes
(5) Compression fittings (1/1 in. maximum size)
15.5.5.2.4 Joints. Joints for piping under 15.5.5.2 shall comply
with the following:
(1) Joint� shall be brazed, soldered, threaded, flared, or the
compression type.
(2) Vihere joint� are brazed, they shall comply with the
n�qui1·ement� of 15.4.6.
(3) Soldered joints shall be made in accordance with ASTM
B828, Standard Pmr:tire for Maki ng Capillaryjoints by Solder­
ing of Copper and Copper A.Uoy Tube and Fittings, using a
"lead-free" solder filler metal containing not more than
0.2 percent lead by volume that complies with ASTM B32,
Standard Sf"/Pr.ifir.ationfor Solder Metal.
15.5.5.3 Piping for Dental Vacuum Systems and Scavenging
Sy.stems.
15.5.5.3.1 General. Piping fot· dental vacuum systems and
scavenging systems shall be copper, PVC plastic, or CPVC plas­
tic.
15.5.5.3.2 Copper Piping. Coppe1· piping under 15.5.5.3 shall
be in accordance with 15.5.5.3.2.1 through 15.5.5.3.2.3.
15.5.5.3.2.1 Copper Tube.
(A) Copper tubing shall comply with the following:
(1) ASTM B8l 9, Standard Sper:ifir.ation for Semnle.�1 Copper Tul1e
for Medir.al Gas SystenL1, Type Lor K
(2) ASTM B88, Standard Sperifiration for Seamless Copper Water
Tube, Type Lor K
2021 Edition
(3) ASTM B280, Standard SpPrifir.ation for Sfamless Copper 1iibe
for Air Conditioning and Refrigeration Field Sm,ire, ACR tube
(O.D. size)
(B) Copper tube shall be ha1·d tempe1· 01· annealed (soft
temper).
15.5.5.3.2.2 Cop per Fittings. Copper fittings shall comply
with the following:
(1) Brazed or soldered fittings conforming to ASME Blfi.22,
Wrought Coppfr and CoppfT Alloy Solder-Joint Pms.mre Fittings
(2) Brnzed fittings confrll"ming to ANSI/ASME Blfi.50,
Wrought CoppfT and Coppfr Alloy Brau-joint Pressure Fittings
(3) B1·azed fittings confo1·ming to ASME Bl6.22 with socket
depths equal to 01· greate1· than braze:joint pr·esstffe
fittings conforming to ANSI/ASME Bl6.50
(4) Flared fittings conforming to ASME Bl6.26, Cast Copper
A.flrr;, Fittings for Rared Gipper Tubfs
(5) Comp1·ession fittings (Yi in. maximum size)
15.5.5.3.2.3 Joints for Copper Piping. Joint� in copper tubing
shall be in accordance with the following:
(1) Joint� shall be brazed, soldered, threaded, flar·ed, or the
compression type.
(2) Where joints a1·e brazed, they shall comply with the
1·equirement� of 15.4.6.
(3) Soldered _joints shall be made in accordance with ASTM
B828, Standard Pradia for A1aking Capillaryjoint1 by Soldn­
ing of Copper and Copper Alloy Tube and Fittings, using a
"lead-free" solder fillet· metal containing not more than
0.2 percent lead by volume that complies with ASTM B32,
Standard Sper.ijir.ation for SoldPr Metal.
15.5.5.3.3 PVC Plastic Piping. PVC plastic piping under
15.5.5.3 shall be in accordance with the following:
(1) PVC plastic pipe shall be Schedule 40 or Schedule 80,
conforming to ASTM Dl 785, Standard Spei:ijimtion for
Poly(Vinyl Chloride) (PVC) Plastir. Pipe, S,-hedules 40, 80, and
120.
(2) PVC plastic fittings shall be Schedule 40 or Schedule 80
to match the pipe, confo1·ming to ASTM D2466, Standard
Sper.ijir.ation for Poly(Vinyl Chloride J (PVC) Pla stir Pipe
J-zttings, Sdiedule 40, or ASTM D2467, Standard Specifir.atinn
for Poly(Vinyl Chloride) (PFC) Pla1tir. Pipe J-zttings, Schedule
80.
(3) Joint� in PVC plastic piping shall be solvent-cemented in
accordance with ASTM D2672, Standard Sper.ijir.ation for
Joints for JPS PVC Pipe U1ing Solvent Cnnent.
15.5.5.3.4 CPVC Plastic Piping. CPVC plastic piping under
15.5.5.3 shall be in accordance with the following:
(1) CPVC IPS pla�tic pipe shall be Schedule 40 or Schedule
80, conforming to ASTM F441/F441M, Standard Sper.ijira­
tion for Chlorinated Poly(Vinyl Chloride) (CPVC) Plmtir. Pipe,
S,:hedules 40 and 80.
(2) CPVC IPS plastic fittings shall be Schedule 40 or Sched­
ule 80 to match the pipe, conforming to ASTM F438,
Standard Sper.ifir.ation for Sor.ket-1),pe ('Jilorinated Poly(Vinyl
Chloride) (CPVC) Plastir Pipe Fittings, S,:hedule 40, or ASTM
F439, Standard Sper.ijir.ation for Chl,�rinated Poly(Vinyl Chlnr­
ide J ( CPVC) Plaslil.' Pipe Fittings, Srhedule 80.
(3) CPVC CTS plastic pipe and fittings ½ in. through 2 in.
size shall be SDR 11, conforming to ASTM D2846/
D2846M, Standard Spfrijir.ation for Chlorinated Poly(Vinyl
 DENTAL (;As AND \\'\CUllM �YSTEMS 99-151

Chlori,if) ((:PVC) Plasti,· Hot- and Cold-WatPr Distribution Table 15.5.6.4.5 Maximum Plastic Pipe Support Spacing
Systems.
( 4) Solvent cement for joint� in CPVC plastic piping shall Hanger Spacing
comply with ASTM F493, Standard Sperifimtion for Solvmt
Cnnmts for Chlorinatfd Poly(Vinyl Chloridfj (('PVC) Plastit Pipe Size mm ft
PipP and Fittings. DNl!'i (NPS ½) (% in. O.D.) 1220 4
15.5.6 Installation of Dental Air and Vacuum Piping. DN20 (NPS 1/1 ) ('/4 in. O.D.) 1220 4
DN25(NPS 1) ( l½in.O.D.) 1320 4.33
15.5.6.1 General. DN32 (NPS l 1/1 )( l¾ in.O.D.) 1320 4.33
15.5.6.1.1 Dental ai1· and vacuum piping systems shall be as DN40(NPS 11/..,)( r:;,. in.O.D.) 1420 4.6G
listed in 15.5.2. DN50(NPS 2) (2¾ in.O.D.) 1420 4.GG
DNG!'i(NPS 2½) (2½ in. O.D.) 1520 5
15.5.6.1.2 Piping mate1·ials shall be as liste<l in 15.5.!'i. and large1·
15.5.6.2 Pipe Sizing. Piping systems shall he designed and Venical rise1·s, all sizes, every 3040 10
sized to deliver the reguire<l flow rates at the utilization pres­ floor, but not to exceed
stJl'es.
15.5.6.3 Protection of Piping. 15.5.6.5.2 The installation procedut·e for unde1·ground piping
shall prevent physical damage to the piping while being back­
15.5.6.3.1 Piping shall be protected against freezing, corro­ fille<l.
sion, aml physical damage.
15.5.6.5.3 If the underground piping is protected by a
15.5.6.3.2 Piping exposed in corri<l01·s an<l other locations conduit, cover, 01· othe1· enclosure, the following 1·eguiremenl�
where subject to physical damage from the movement of equip­ shall be met:
ment shall be protected.
(1) Access during consu·uction shall be provided at the joints
15.5.6.4 Pipe Support. for visual inspection and leak testing.
(2) The conduit, cover, or enclosure shall be self'.draining
15.5.6.4.1 Piping shall he supported from the building struc­
and not retain groumlwate1· in prolonged contact with
ture.
copper tubing.
15.5.6.4.2 Hangers and supports shall comply with and he
15.5.6.5.4 Buried piping that is su�ect to surface loads shall
installed in accordance with MSS SP-58, PipP HangPrs and
he buried at a depth that will protect the piping, it� enclosure,
Supparl� - lvfatPriaL1, Design, Manufar:lltrP, SPlel'lion, l1.pplimtian,
or both, from excessive stresses.
and Installation.
15.5.6.5.5 The minimum backfill cover above the top of the
15.5.6.4.3 Hangers and supp01·ts shall be sized for the tube or
piping or its enclosure shall he 900 mm (3G in.), except that
pipe being supported.
the minimum cove1· shall be pe1·mitted to be reduced to
15.5.6.4.4 The maximum support spacing for copper tube 450 mm (18 in.) whe1·e there is no potential fot· damage from
shall be in accordance with Table 15.5.G.4.4. surface loads or surface conditions.
15.5.6.5.6 Trenches shall be excavated so that the piping 01· il�
Table 15.5.6.4.4 Maximum Copper Tube Support Spacing enclosure has firm. substantially continuous bearing on the
bottom of the t rench.
Hanger Spacing
15.5.6.5.7 Backfill shall be clean, free from material that can
Pipe Size mm ft damage the pipe. and compacted.
DN8 (NPS Y1 ) (¾ in. O.D.) 1520 !'i 15.5.6.5.8 A continuous warning tape or market· shall be
DN l0 (NPS ¾) (½ in. O.D.) 1830 6 placed immediately above the piping or its enclosure to clearly
DNl!'i (NPS ½) (% in. O.D.) 1830 f, identify the pipeline hy specific name.
DN20 (NPS 1/i) (½ in. O.D.) 2130 7
15_5,6.5.9 A continuous warning means shall also be place<l
DN25 (NPS 1)( l ¼ in. O.D.) 2440 8 f
above the pipeline at approximately one-hal the depth of
DN32 (NPS 1Y1 ) (l¾ in.O.D.) 2740 9 burial.
DN40 (NPS l½) (1% in.O.D.) 3050 10
and la1·ger 15_5.6.5.10 Vlhere burie<l piping is extended into a building
Vertical 1·isers, all sizes, every 4570 15 through a wall sleeve, the outdoor end of the sleeve shall be
f1001·, but not to exceed sealed watertight to prevent the ent.-ance of groundwater into
the building.
15.5.6.6 Underground Piping Within Buildings.
15.5.6.4.5 The maximum suppmt spacing for plastic pipe shall
15.5.6.6.1 The installation procedure for underground piping
be in accor<lance with Table 15.5.G.4.5.
shall prevent physical <larnage to the piping while being back­
15.5.6.5 Underground Piping Outside of Buildings. filled.
15.5.6.5.1 Buried piping outside of buildings shall be installed 15.5.6.6.2 The piping shall he backfilled with clean san<l or
below the local level of frost penet1·ation. g1·avel.

2021 Edition
99-152 HEALTH CARE FACILITIES CODE
15.5.6.7 Piping Within Floor Slabs Prohibited. Dental ga� and
vacuum piping shall not be installerl within floor slabs.
15.5. 7 Performance Criteria and Testing (Dental air and
Vacuum).
15.5.7.1 Dental Air and Vacuum Systems Testing.
15.5.7.1.1 General.
15.5.7.1.1.1 Inspection and testing shall he performerl on all
new piped rlental ga� anrl vacuum systems, additions, renova­
tions, temporary installations, or repai1·ed systems to ensure, by
a documented procedure, that the following have been
completerl:
( 1) All applicable provisions of this code have been adhererl
to.
(2) Sys tem integrity has been achieved or maintained.
(!)) Piping systems are ready for testing and verification.
(4) Piping systems are pel'forming in accordance with thei1·
design requirement�.
15.5. 7.1.1.2 The inspection anrl testing reports shall be
submitted directly to the party that contracted for the testing,
who shall submit the report� through channels to the Responsi­
ble Facility Authority and any others that a1·e 1·equired.
15.5. 7.1.1.3 Reports shall contain detailed listings of all find­
ings anrl results.
15.5.7.1.1.4 The Responsible F acility Authority shall review
the inspection and testing n�corrls prim· to the use of any
systems to ensure that all finrlings and results of the inspection
and testing have been successfolly completed before use.
15.5.7.1.1.5 All documentation pet'taining to inspections and
testing shall be maintainerl on-site within the facility.
15.5.7.I.2 Required Testing.
15.5. 7.1.2.1 Categor y 3 Dental Air and Vacuum S�tems.
(A) A ll Category 3 dental gas and vacuum piping systems indi­
cated in 15.5.2 shall be initially tested in accm·dance \\�th
15.5.7.1.3.
(B) The support gas systems and vacuum systems (i.e., dental
ai1·, dental vacuum, anrl scavenging) shall be final tested in
accordance with 15.5.7.1.3.4 and 15.5.7.1.3.5.
15.5.7.1.3 Initial Testing of Piping Systems.
15.5.7.1.3.1 General.
(A) Whe1·e plastic vacuum anrl pla�tic scavenging p1pmg
systems a1·e installed, they shall he visually inspected fot· cross­
connections to oxygen and nitrous oxide systems before apply­
ing positive test pressures to the copper piping systems.
(B) Dut·ing the process of initial testing, the irlentification and
labeling of the dental ga� anrl vacuum piping shall be checked.
15.5. 7.1.3.2 Initial Pressure Test.
(A) Each section of the piping in dental ai1· systems and
copper vacuum systems shall be pressure tested. Plastic vacuum
and pla�tic scavenging piping shall not be p1·essure tested.
(B) Initial pt·essut·e test� shall be conducted a� follows:
( l) After installation o f station outlet/inlet rough-in assem­
blies
2021 Edition
(2) Prim· to the installation of components of the distribution
piping system that woulrl be damaged by the test pressure
(e.g., p1·essure/vacuum alarm devices, pt·essure/vacuum
indicators, and line pressure relief valves)
(C) TI1e source shutoff valve shall remain closed during the
pt·essure tests.
(D) TI1e test p1·esst11"e for dental air piping and copper
vacuum piping shall be 1.5 times the system operating pressure
but not less than a gauge pt·essut·e of 10!)5 kPa (150 psi).
(E) The test pt·essure shall be maintained until each joint has
been examinerl for leakage by means of a leak detectant that is
safe for use \\�th oxygen anrl rloes not contain ammonia.
(F) Any leaks shall be located, 1·epaired (if pe1·mitterl), or
replaced (if required) by the installer, and retested.
15.5.7.1.3.3 Initial Piping Purge Test.
(A) The outlets in each dental air p1p111g system shall be
pm·ged to 1·emove any particulate matter from the rlistribution
piping.
(B) Using appropriate adapters, each outlet shall be purged
with an inte1·mittent high-volume flow of test gas until the
put·ge prorluces no discoloration in a clean w hite cloth.
(C) The purging shall be started at the closest outlet to the
f
piping shutof valve anrl continue to the furthest outlet from
the shutoff valve.
15.5.7.1.3.4 Standing Pressure Test for Dental A ir and Copper
Vacuum Piping.
(A) After successful completion of the initial pt·essut·e test� in
155.7.1.3.2, the dental air systems anrl copper vacuum systems
shall be subject to a standing p1·essm·e test.
(B) Test� shall be conducted afte1· the final installation of
station outlet valve bodies, faceplates, and other disu·ibution
system component� (e.g., pressure alarm rlevices, p1·essure indi­
cators, line p1·essu1·e relief valves, manufactured a�semblies, and
hoses).
(C) The source valve shall be closed during this test.
(D) TI1e piping systems shall he subjecterl to 24-hom standing
pressure test� using oil-free, rlry nitrogen NF.
(E) Test pressures shall be 20 pe1·cent above the normal system
operating line pt·essure.
(F) At the conclusion of the test�. there shall be no change in
the test presstlt'e except that attributerl to specific changes in
ambient temperature.
(G) Any leak.� shall be located, repairerl (if permitted), or
f
1·eplacerl (i 1·equired) by the installer, and retesterl. The piping
shall be repu1·gerl if necessary.
15.5.7.1.3.5 Standing Vacuum Test for Plastic Vacuum Piping.
(A) Alter successful completion of the initial pressut·e tests in
15.5. 7.1.3.2, vacuum distribution piping, including scavenging,
shall be subjecterl to a standing vacuum test.
(B) Test� shall be conrlucted afte1· installation and connection
of all com ponenl� of the vacuum sy stem.
(C) TI1e piping systems shall be subjecterl to a 24-hour stanrl­
ing vacuum test.
 FEATURES OF FIRE PROTECTION
(D) Test pt·essme shall be between 300 mm (12 in.) HgV and
filll vacuum.
(E) During the test, the sout·ce of test vacuum shall be discon­
nected from the piping system.
(F) At the conclusion of the test, there shall be no change in
the vacuum pressu1·e other than that attributed to changes of
ambient tempernture.
(G) Any leaks shall be located, repaired (if permitted), or
f
1·eplacerl (i requi1·ed) by the installe1·, anrl 1·etested.
15. 5.8 Operation and Management.
15.5.8.1 System Shutdowns. Gas and ,-acuum piping systems
shall be shut rlown at the end of each workday.
15.5.8.2 Manufacturer's Instructions.
15.5.8.2.1 P iping system component� shall be installed, adjus­
terl, operated, and maintained in acc01·dance with the manu­
facturer's instructions.
15.5.8.2.2 Copies of the manufacture1·'s instructions shall be
prnvided to the facility anrl maintained at the facility.
15.5.8.3 Maintenance. Dental air anrl vacuum system equip­
ment shall be maintained by a qualified 1·ep1·esentative of the
equipment manufactu1·el".
Chapter 16 Features of Fire Protection
16. 1 Applicability.
16.1.1 l11is chapter shall apply to all new and existing health
care facilities.
16.1.2 i\n existing system that is not in stt·ict compliance with
the prnvisions of this corle shall be pe1·mitted to be continued
in use, unless the authority havingjurisdiction has determined
that such use constitutes a distinct haza rd to life.
16.2 Construction and Compartmentation. Buildings or struc­
tures housing a health care facility shall meet the minimum
construction anrl compartmentation requirements of the appli­
cable corle.
16.3 Special Hazard Protection for Flammable liquids and
Gases.
16.3.1 Where requirerl by the prnvisions of Chaptei-s 11
thrnugh 43 of NFPA 101, occupancies with storage, use, anrl
handling of hazardous materials shall comply with the follow­
ing codes unless otherwise modified by other prnvisions ofthis
CudP. NFPA 30, NFPA 54, NFPA 55, NFPA 58, NFPA 400, anrl
NFPA 495. f J0J:8.i.3.1 l
16.3.2* No storage, use, 01· hanrlling of hazarrlous materials
shall he permitted in any location whe1·e such storage, use, or
handling would jeopardize egress from the structure, unless
othenvise pe1·mitted by a document listed in 16.3.1.
f JOJ:8.7.3.21
16.4 Laboratories. Laboratories that use chemicals shall
comply with NFPA 45 unless othenvise modified by other prnvi­
sions of this corle. f 101:8. 7.4. ll
99-153
16.5 Utilities.
16.5.1 General. Utilities shall comply with the requirement5
of 16.5.1.1 through 16.5.1.4.
16.5.1.1 Gas. Equipment using gas and relaterl gas piping
shall be in acc01·dance with NFPA 54 or NFPA 58 unless such
installations are apprnverl existing installations, which shall be
pe1·mitted to be continued in service. f J0J:9.1.1 l
16.5.1.2 FJectrical Systems. Electrical wi1-ing and equipment
shall be in accordance with NI-PA 70 unless such installations
are apprnverl existing installations, which shall be permitted to
be continued in service. l"J0J:9.1.21
16.5.1.3 Emergency Generators and Standby Power Systems.
Emergency generntors and standby powe1· systems, where
requirerl for compliance with this code, shall be installed,
tested, and maintained in accorrlance with NFPA 110 unless
mortified by this corle.
16.5.1.4 Stored FJectrical Energy Systems. Storerl electrical
energy systems shall be installed, tested, and maintainerl 111
accorrlance with NFPA 111. f JOJ:9.1.41
16.5.2 Heating, Ventilating, and Air-Conditioning. f JOJ:9.21
16.5.2.1" Heating, Ventilating, and Air Conditioning. Ai1·­
conditioning, heating, ventilating ductw01·k, and 1-elated equip­
ment shall be in accordance with NFPA 90A, unless such
installations a1·e apprnved existing installations, which shall be
pe1·mitted to be continued in se1·vice.
16.5.2.2 Ventilating or Heat-Producing Equipment. Ventilat­
ing 01· heat-prorlucing equipment shall be in accorrlance with
NFPA 91, NFPA 211, NFPA 31, NFPA 54, or NFPA. 70 a� applica­
ble, unless such installations are approved existing installations,
which shall be permitterl to be continued in service. f J0J:9.2.21
16.5.2.3 Commercial Cooking Operations. Commercial cook­
ing operations shall he prntecterl in accorrlance with NFPA 96
unless such installations are approved existing installations,
which shall be pe1·mitterl to be continued in sen,ice. f J0J:9.2.31
16.5.2.4 Ventilating Systems in Laboratories Using Chemicals.
Ventilating systems in laboratories using chemicals shall be in
accordance with NFPA 45. f J0J:9.2.4 l
16.5.3 FJevators, Escalators, and Conveyors. f JOJ:9.41
16.5.3.l Code Compliance. f J0J:9.4.21
16.5.3.1.1 Except as modifierl herein, new elevators, escala­
t01·s, dumhwaitei-s, and moving walks shall be in acc01·dance
with the requirement� of ASME Al7.l/CSA B44, Safety CodP for
fifvatars and E1mlators. f J0J:9.4.2.1 l
16.5.3.1.2 Except as modifierl herein, existing elevators, esca­
lators, dumbwaiters, and moving walk.� shall be in accordance
with the requirement� of ASME A l7. 3, SafPty CodP for Exi1ting
ElPvatar.1 mid E1mlators. f J0J:9.4.2.21
16.5.3.2 Fire Fighters' Emergency Operations. f J0J:9.4.31
16.5.3.2.1 All new el evatm·s shall conform to the fit-e fighte1·s'
emergency operations requirements ofASME A l7. l/CSA B44,
Sapty Codt for Elfvatars and Esralaturs. f J0J:9.4.3.1l
16.5.3.2.2 All existing elevat01·s having a ti-ave! distance of
25 ft (7620 mm) 01· more above 01· below the level that best
serves the needs of emergency personnel for fire-fighting or
2021 Edition
99-154 HEALTH CARE FACILITIES CODE
rescue purposes shall conform to the fit-e fighters' eme1-gency
operations requirement5 of ASME A l 7.3, Safety Code for Existing
r
Ell'vators andE�ra!.ntors. J0J:9.4.3.21
16.5.3.3* Elevator Machine Rooms. Elevator machine rooms
that contain solin-state equipment for elevators, other than
existing elevators, having a travel distance exceeding 50 fi.
(15 m) above the level of exit discharge or exceeding 30 h:
(9 150 mm) below the level of exit nischarge shall be provided
with independent ventilation or air-connitioning systems to
maintain temperature during fire fighters' eme1-gency opera­
tions for elevator operation (see 9.4.3 af Nf<PA. 101). The operat­
ing temperature shall be established by the elevator equipment
manufacturer's specifications. \'\'hen stannhy powe1· is connec­
ted to the elevator, the machine 1·oom ventilation or air­
r
conditioning shall be connected to standby powec J0J:9.4.51
16.5.3.4 Elevator Testing. Elevators shall be subject to peri­
onic inspections ann tesl� as specified in ASME Al 7.1, Sajfty
Code for 1'.'levatars and Ew:alators. All elevators equippen with fire
fighters' emergency operations in accordance with 9.4.3 of
NFPA IOI shall be subject to a monthly operation with a written
record of the finnings mane and kept on the premises a�
r
requiren by ASME Al 7.1. 101 :9.4.61
16.6 Waste Chutes, Incinerators, and Linen Chutes. Waste
chutes, linen chutes, and incineratm·s shall be installen ann
maintained in accordance with NFPA 82 unless such installa­
tions are approven existing installations, which shall be pe1·mit­
ted to be continued in service.
16.6.1 Any wa.5te chute or linen chute, including pneumatic
rubbish and linen systems, shall be prnvided with automatic
extinguishing protection in acconlance with Section 9.7 of
NFPA 101. [J0J:19.5.4.31
16. 7 Fire Detection, Alarm, and Communications Systems.
r J0J:9.6
16.7.1* General. [J0J:9.6.ll
16. 7.1.1 Buildings or structut·es housing a health care facility
shall meet the fire detection, ala1-m, ann communications
systems requirements of the applicable code.
16.7.1.2 A fire alarm system required for life safety shall be
installen, tested, and maintainen in accordance with the appli­
cable requi1-emenl� of NI-PA. 70 ann NFPA 72.
16.7.1.3 An approved existing installation shall be permitted
to be continuen in use, prnvinen it is tested and maintained in
accordance with the requirements of NFPA 72.
16. 7.1.4 For the purposes of this code, a complete fire alarm
system shall pt·mine functions for initiation, notification, ann
control, and shall peti'orm as follows:
(l ) The initiation function provides the input signal to the
system.
The notification function anvises that human action is
(2)
1·equi1·en in response to a pat'ticular condition.
(3) The control function prmides outputs to control huil<ling
equipment to enhance prntection oflife.
16. 7.2 Signal Initiation.
16. 7.2.1 Buildings or structures housing a health care facility
shall meet the minimum signaling and alarm initiation require­
ment5 of the applicable cone.
2021 Edition
16.7.2.2 Manual fire alarn1 boxes shall be usen only fot· fit·e­
protective signaling purposes.
16.7.2.2.1 Combination fit·e ala1·m ann guarn's tour stations
shall be acceptable.
16.7.2.3 A manual fire alarm box shall be prminen in the
natural exit access path near each requiren exit from an area,
unless modifien by anothe1· section of this code.
16.7.2.4* Adnitional manual fire ala.rm boxes shall he located
so that, on any given floor in any part of the building, no hm·i­
zontal nistance on that floor exceeding 60 m (200 ft) shall
neen to be traversed to reach a manual fire alarm box.
r101:9.6.2.s 1
16.7.2.5 For fit·e alarm systems using automatic fit·e detection
or waterflow detection devices, not less than one manual fire
alarm box shall he prnvinen to initiate a fit·e ala1·m signal.
16.7.2.5.1 The manual fire alarm box shall be located where
requiren by the authority having jurisdiction.
16.7.2.6 Manual fit·e alarm boxes shall he accessible, rnmb­
r
structed, and \isible. J0J:9.6.2.Ti
16.7.2.7 Where a sprinkle1· system provides automatic detec­
tion and alarm system initiation, it shall be provided with an
approven ala1·m initiation ne\ice that operates when the flow of
water is equal to or greater than that from a single automatic
sprinkle1·.
16.7.3 Smoke Alarms.
16.7.3.1 Whe1·e requi1-en by the applicable code, single-station
and multiple-station smoke alarms shall be in accordance with
NFPA. 72.
16.7.3.2 System smoke detectors in accot·dance with NFP.1 72
ann arrangen to function in the same manner as single-11tation
or multiple-station smoke alarms shall be permitted in lieu of
r
smoke alarms. J0J:9.6.2.10.71
16.7.3.3 The ala1·ms shall sounn only within an individual
nwelling unit, suite of rooms, or simila1· area and shall not
actuate the building fire alarm system, unless otherwise permit­
ten by the authority having jurisdiction. Remote annunciation
shall be permitted.
16.7.4 Occupant Notification. r 101:9.6.31
16.7.4.1 Whe1·e 1·equiren by the applicable code, occupant
notification shall he provided to alert occupant� of a fit·e or
other emergency.
16.7.4.2 Occupant notification shall be in accornance \\':ith
16. 7.4.3 unless otherwise provided in 16.7.4.2. l ann 16. 7.4.2.2.
r J0J:9.6.3.21
16.7.4.2.1 * Elevator lobby, hoistway, and associated machine
room smoke detectors usen solely for elevatm· recall, ann heat
detectrn·s used solely for elevatm- power shutdown, shall not be
required to activate the building evacuation alarm if the power
supply ann installation wi1·ing to such detectors are monitot·ed
by the building fire ala1·m system, ann if the activation of such
detectrn·s initiates a supervisory signal at a constantly attended
r
location. J0J:9.6.3.2. l I
16.7.4.2.2* Smoke detectors used solely for closing dampers
or HVAC system shutnown shall not be 1·equiren to activate the
builning evacuation alarm, provided that the power supply and
 FEATURES OF FIRE PROTECTION
installation wiring to the detectors are monitorerl by the build­
ing fire alarm system, and the activation of the rletectors
initiates a supervisory signal at a constantly attended location.
r101:9.6.3.2.21
16.7.4.3 Defend in Place. For new and existing facilities,
whe1·e the response to a fire is to defend in place within a safe
place in the building, occupant notification shall be in accord­
ance with the facility fire plan.
16.7.4.3.1* ''\'here builrlings are requirer! to be subrlivided
into smoke compartment�, fil·e alarm notification zones shall
coincide with one or more smoke compartment boundaries or
shall be in accordance with the facility fire plan.
16. 7.4.3.2* The private operating mode, as defined in
NFPA 72, shall be permitted to be used for the placement of
notification appliances within the health care and ambulatory
health ca1-e occupancies of the building.
16. 7.4.3.3 TI1e notification signal shall readily identify the
smoke zone or the floor area, floor, and building in need of
staff 1·esponse.
16. 7.4.3.4 The notification signal shall be heard in all loca­
tions in accorrlance with the facility fire plan.
16. 7.4.3.5* In patient care spaces where ala1·m notification
adversely a ffect� patient care, as determiner! by a risk a5sess­
ment, al.arm notification appliances shall not be 1·equirerl a5
long as an alternative means of alarm notification is provirlerl.
16. 7.4.3.6 Visible signals shall not be required inside surgical
operating rooms, patient sleeping rooms, or psychiatric care
areas where their operation would intedere with patient n·eat­
ment.
16. 7.4.3. 7 Visible signals shall not be required inside exam
1-ooms, special procedure 1·ooms, rh-essing rooms, and nonpub­
lic toilet rooms where staff is 1·equi1·ed to respond to those areas
in accordance with the facility fire plan.
16.8* Heliports.
16.8.1 New heliport5 shall be rlesignerl and consu·ucted in
accordance with the requi1·ements ofNFPA 418.
16.8.2 Heliport5 shall be maintained in acc01·dance with
NFPA 418.
16.9 Automatic Sprinklers and Other Extinguishing Equip­
ment.
16.9. I Automatic Sprinklers.
16.9.1.1 Buildings 01· structures housing a health ca1·e facility
shall meet the automatic sprinkler system requirements of the
applicable code.
16.9.1.2 ,vhere provided, automatic sp1·inkle1· systems shall be
installer! in accordance with NFPA 13.
16.9.1.3* Defend in Place. Fm new and existing facilities,
whe1·e the 1·esponse to a fire is to defend in place within a safe
place in the building and not to automatically evacuate the
building, sprinkler system zones shall coincirle with smoke
compartment bounrlaries or shall be in acc01·dance with the
faci Iity fire plan.
16.9.1.4* Closets. Sprinklers shall not be required in clothes
closets of patient sleeping rooms in hospitals whe1-e the area of
99-155
the closet does not exceed 6 ft� (0.55 m�) provided the distance
from the sprinkler in the patient sleeping room to the back
wall of the closet does not exceed the maximum distance
r
permitted by NFPA 13. 101:18.3.5. l Ol
16.10 Manual Extinguishing Equipment.
16.10.1 * Portable fire extinguishers shall be selected, in­
stalled, inspecterl, and maintainer! in accordance with
NFPA 10.
16.10.1.1 Fi1·e extinguishe1·s shall be provider! in MRI rooms
and a5sociated spaces.
16.10.1.1.1 * Fire extinguishers and associated hardware rated
a� MR conditional or MR safe shall be provided in MRI rooms
and a5sociated spaces.
16.10.1.2 Class K fa-e extinguishe1·s shall be provided ftx
hazards where the1·e is a potential fo1· fil·es invoh,ing combusti­
ble cooking media (vegetable or animal oils and fat5).
II 0:6.6.1 l
16.10.1.3* Class K fire extinguishers shall not be 1·equired
where residential cooking equipment is user! for foorl \\"drming
or limiter! cooking, or where an occupancy prohibit5 deep fat
f1ying.
16.10.1.4* Clean agent- or water mist-type fire extinguishers
shall be provided in operating rooms.
16.10.1.5 Clean agent-type fa-e extinguishers shall be provi­
rled in telecommunication entrance facilities and telecommu­
nication equipment rooms.
16.10.2 ,vhere prmirled, standpipe and hose systems shall be
in accordance with NFPA 14.
16.10.2.1 ,vhere standpipe and hose systems are installed in
combination with automatic sp1·inkler systems, installation shall
be in accordance with the appropriate provisions establisher! by
NFPA 13 and NFPA 14.
16.10.2.2* Hose 01· hose outlet� shall be pe1·mitterl to be
removed from existing stanrlpipe and hose systems that are not
requi1·erl by the applicable code.
16.11 * Compact Storage. Compact storage shall be protecterl
by sprinklers in accorrlance with NFPA 13.
16.12 Compact Mobile Stora ge.
16.12.1 Rooms with compact mobile storage units greate1·
than 50 ft� ( 4.65 m2) shall be protected a� a hazarrlous area in
accordance with the applicable code.
16.12.2 Smoke detection shall be installer! above compact
mobile storage units g1·eater than 50 ft2 (4.65 m2 ) in acc01·d­
ance with l11rPA. 72.
16.12.3* Compact mobile storage units greater than 50 ft�
(465 m�) shall be protected by automatic sprinklers in accord­
ance with NFPA 13.
16.13 Maintenance and Testing.
16.13.1 All wate1·-baserl fiI·e protection systems shall be inspec­
terl. tester!, anrl maintained in acc01·rlance with NFPA 25.
16.13.2 All non-wate1�baserl fire protection systems shall be
inspected, tested, anrl maintained in acc01·dance with the appli­
cable NFPA standards.
2021 Edition
99-156 HEALTH CARE FACILITIES CODE
16.14 Fire Loss Prevention in Operating Rooms.
16.14.1 Haz.ardAssessment.
16.14.1.1 An evaluation shall be made of haza1·ds that could
be encountered during surgical procedures.
16.14.1.2 The evaluation shall include hazards associate<l with
the propenies of electt·icity, hazar<ls associated with the opera­
tion of surgical equipment, and hazards associate<l with the
natu1-e of the environment.
f control of emergencies that could occur in the operating
16.14.1.3 Periodic 1-eviews o surgical operntions an<l proce­
dures shall be conducte<l with special attention given to any
change in mate1-ials, ope1·ations, or personnel.
16.14.2 Fire Prevention Procedures. Fi1·e p1·evention proce­
dures shall be established.
16.14.3 Germicides and Antiseptics.
16.14.3.I Me<licament� an<l alcohol-based han<l satuttzers,
inclu<ling those <lisperse<l as aerosols. shall be permitted to be
use<l in anesthetizing locations.
16.14.3.2* Flammable liquid germici<les or antiseptics used in
anesthetizing locations, whenever the use of electrosurgery,
caute1y, or a laser is contemplate<l, shall be packaged to ensure
controller! delivery to the patient in unit dose applicators,
swabs, and other similar applicators.
f shall be provided, incident� shall be reviewed monthly, at1d
16.14.3.3 ,vheneve1· the application o flammable liquid
germici<les 01· antiseptics is employed in sut·geries where the
use of electrosurgery, cautery, or a laser is contemplated, time
shall be allowed to elapse between application of the germicide
or antiseptic an<l the following:
( 1) Application of drapes, to allow complete evaporation an<l
dissipation of any flammable vehicle remaining
Use of electrosurgery, cautery, 01· a lase1-, to ensure the
(2)
solution is completely dry and to allow thorough evapora­
tion an<l dissipation of any flammable vehicle remaining
16.14.3.4 Prior to draping or use of electrosu1·gery. cautery. 01-
a la�e1·, any flammable liqui<l-soaked materials shall be
remove<l from the patient care vicinity.
16.14.3.5 Pooling of flammable liquid germicides or antisep­
f
tics shall he avoi<le<l; i pooling occu1·s, excess solution shall he
wicked, and the germicide or antiseptic shall be allowed to
completely dry
16.14.3.6 A preoperative "time out" period shall be conducted
prior to the initiation of at1y surgical proce<lure using flamma­
ble liquid ge1·micide 01· antiseptic solutions to ve1·ify the follow­
ing:
Application site of solution is d1y prior to <lraping an<l
( 1)
use of electrosurge1y, cautery, or a lase1·.
Pooling of solution has not occurred or has been cotTec­
(2)
ted.
Any solution-soaked materials have been remove<l from
(3)
the patient ca1-e vicinity.
16.14.3.7 Whenever flammable aerosols 01· atltiseptics are
employed, sufficient time shall be allowe<l to elapse between
deposition and application of <lrapes to allow complete evapo­
ration an<l dissipation of any flammable vehicle 1·emaining.
16.14.3.8 Health cat·e organizations shall establish policies
and procedut-es outlining safety p1·ecautions related to the use
2021 Edition
of flammable liquid 01· aerosol ge1·micides or atHiseptics use<l in
anesthetizing locations, as requirer! in 16.14.3.9, whenever the
use of electrosu1·gery, caute1y, 01· a laser is contemplated.
16.14.3.9 Emergency Procedures.
16.14.3.9.1 Procechrres for operating room/surgical suite
eme1·gencies shall be developed.
16.14.3.9.2 Procedures shall include alat rn actuation, evacua­
tion, at1<l equipment shutdown procedures and provisions for
room, including specific detailed plans for control operations
by an emergency control group within the organization or a
public fire department.
16.14.3.9.3 Emergency procedures shall be established for
controlling chemical spills.
16.14.3.9.4 Emergency procedures shall be estahlishe<l for
extinguishing <lrapery, clothing, or equipment fit·es.
16.14.3.10 Orientation and Training.
16.14.3.10.1 New operating room/surgical suite pernonnel,
including physicians and surgeons, shall be taught general
safety practices for the a1·ea an<l specific safety practices for the
equipment and procedures they will use.
16.14.3.10.2 Continuing safetv education and supenision
procedtu-es shall be re,iewed annuallv.
16.14.3.10.3 Fire exit <lrills shall be conducted annually or
mm·e frequently as determined by the applicable code.
Annex A Explanatory Material
A.nnex A is not a part of thP rPq11iremPnts o f this NFPA donmtfnt but is
inrluded for injrmnational purposes only. This annex r:ontains explan­
atory 111atMial, nm1tbPrrd to rorrespond with t!u applimblr text para­
graphs.
A.I.I.IO Because no single model of an emergency manage­
ment plan is fea�ible for every health care facility. this chapter
is inten<led to provide criteria for the preparation and imple­
mentation of an in<livi<lual plan. The principles involved are
universally applicable; the implementation nee<ls to be tail01·ed
to the specific facility.
A.1.1.12 Hype1·baric chambe1·s are foun<l in a variety of
settings, including but not limited to hospitals, doctor's oflices,
private clinics, and business occupancies. Not all hyperharic
facilities are <lesigned 01· equippe<l the same. HypedJaric tt·eat­
ment an<l facilities are used for a va1-iety of eme1·gent and non­
eme1·gent conditions, and the acuity of patients ranges from
f
stable to critical. These variations lead to dif erences in hyper­
ba1·ic equipment, at1cillary support equipment, and facility
location. This chapter is inten<le<l to prmide minimum safe­
f
guards for hyperbat-ic patients an<l personnel regardless o the
location of the facility.
f
A.1.3.1.3 This subsection clarifies that i a prmision of this
co<le becomes applicable due to the installation or use of a
system, equipment, or a�semhly 1·egulated he1·ein, the facility
does not automatically become subject to the code in it�
enti1·ety.
A.1.5 Although it is common practice for medical appliances
to use metric unit� on their dials, gauges, at1<l controls, many
 ANNEX A
component� of systems within the scope of this document a1·e
manufactured and used in the United States anrl employ
nonmett·ic dimensions. Since these rlimensions (such a� nomi­
nal pipe sizes) are not establisherl by the National Fire Protec­
tion Association, the Technical Correlating Committee on
Health Care Facilities cannot independently change them.
Accordingly, this document uses rlimensions that are presently
in common use by the builrling trades in the Uniterl States.
Trade uniL� vary from SI to lJ .S. customary uniL�. depending on
the equipment devices 01· mate1·ial.
A.2.1 The documenL� 1·efe1·encerl in this chapte1· 01· ponions
of such document� are referenced within this corle and are
consirle1·ed part of the 1·equirement� of this rlocument.
Documents 1·eferenced in this chapter or portions of such
documenL� are only applicable to the extent called for within
otl1er chapte1·s of this code.
VVhere the 1·equirements of a 1·eferenced corle or standard
f
rliffer from the requiremenL� o this code, the requiremenL� of
this code goven1.
A.3.2.1 Approved. l11e National Fi1·e Protection A.ssociation
rloes not approve, inspect, or certify any installations, proce­
rlures, equipment, or materials; not· does it approve 01· evaluate
testing laboratories. In dete1·mining the acceptability of installa­
tions, procedures, equipment, or materials, the authority
having jurisdiction may base acceptance on compliance with
NFPA 01· other appropt-iate standanis. In the absence of such
stanrlarrls, said authm·ity may require evirlence of proper instal­
lation, procedure, or use. The authority having jurisrliction
may also 1·efer to the listings or labeling pt·actices of an oq�ani­
zation that is concen1ed with product evaluations anrl is thus in
a position to dete1·mine compliance with appropi·iate standarrls
for the current production of listerl items.
A.3.2.2 Authority Havin g Jurisdiction (AHJ). The phrase
"authority having jurisdiction," or its acronym AHJ, is used in
NFPA document� in a broad manner, since jurisdictions and
approval agencies vary, as do their 1·esponsibilities. Whe1·e
public safety is primary, the authmity ha\ing jurisdiction may
be a federal. state, local, or other regional department or indi­
virlual such as a fire chief; fire marshal; chief of a fire preven­
tion btu-eau, labor department, 01· health rlepartment; building
official; electrical inspector; or others having statutot-y author­
ity. For insurance purposes, an insurance inspection depart­
ment, rating bureau, or other insm·ance company
1·ep1·esentative may be the auth01·ity having jtu-isrliction. In
many circumstances, the property owner 01· his or her designa­
ted agent assumes the role of the authority having jurisdiction;
at government installations, the commanding ollice1· 01· depart­
mental official may be the authority havingju1·isrliction.
A.3.2.3 Code. The decision to designate a stanrlard as a
"code" is baserl on such factors as the size and scope of the
document, it� intended use and form of adoption, anrl whether
it contains substantial enforcement and administrative provi­
sions.
A.3.2.6 Listed. The means fot· identifying listed equipment
may vat-y for each organization concernerl with prorluct evalua­
tion; some organizations do not 1·ecognize equipment a� listed
unless it is also labeled. The authority having _ju1·isdiction
should utilize the system employed by the listing organization
to identify a listed product.
99-157
A.3.3.10 Applicator. In the given sense, an applicat01· is not an
electrode, because it rloes not use a conductive connection to
the patient in order to function. A radio frequency "horn .. of a
rliathermy machine is a typical applicator.
A.3.3.12 Atmosphere. i\s employerl in this code, the term
atmnsphPrP can refer to the environment within or outside of a
hypet·baric facility. iVhen used as a mea�u1·e of pressure, atmos­
phere is expressed as a fraction of standard air pressure
[101.4 kPa (14.7 psi)l. (SPP thP first rnlwnn nf Tab!,, D.l in
NJ-PA 99B.)
A.3.3.12.2 Ahnosphere of Increased Burning Rate. The
degree of fire hazard of an m..ygen-enricherl atmosphere varies
with the concentration of oxygen and diluent gas anrl the total
pressure. The definition contained in the cutTent edition of
NFPA 53 anrl in editions of NFPA 56D prior to 1982 did not
necessa1·ily 1·eflect the increased fire haza1·rl of hyperba1·ic and
hypobaric atmosphe1·es.
The definition of atmnspherP nf inrrMsPd burning ratP used in
Chapter 14 and in NFPA 99B defines an m..-ygen-em·icherl
atmosphere with an increased fi1·e hazard as it 1·elates to the
increaserl burning rate of material in the atmosphere. It is
based on a 1.2 cm/sec (0.47 in./sec) burning rate (at
2,\.5 percent oxygen at l atmosphe1·e absolute) as desct"ibed in
Figure A.3.3.12.2.
This rate can be determined as follows:
[A.3.3.12.2]
23.45
.JTP,""'"'
where:
TP"'"'"' = total pressure in atmospheres
A.3.3.19.3 Bulk Oxygen Sy..tem. The oxygen containers can
be stationary or movable, and the oi..ygen can be stored a� gas
or liquid. The bulk oxygen system terminates at the point
whe1·e oxygen at senice pt·essm·e first ente1·s the supply line.
A.3.3.21 Central Supply System. Central supply systems
comprise the equipment necessarv to produce, condition,
crn1tt·ol, anrl monito1· the gases or vacuum. They include all
equipment from the atmospheric intake on air compressors,
exhaust on vdcuum pumps, and cylinders or containers for
pressurized gases through to the source valve (SPP 5.1.4.2).
Examples of central supply systems include air comp1·ess01·
sources, vacuum pump sources, cylinrler anrl container heade1·s
and manifolds, liquid bulk gas systems proportioning systems
anrl combinations the1·eof.
A.3.3.23 Clin ical IT Network. A clinical IT netwmk comprises
the servers, switches, routers, and voice and data communica­
tions equipment that are employed to transport patient patient­
critical clinical data, information, anrl staff communications
over a shared interoperable IT network infrastructu1·e.
A.3.3.25 Combustible liqu id. See NFPA 30 fm further infm­
mation on flash point test prncerlu1·es.
A.3.3.26 Combustion. Combustion is not limited to a chemi­
cal 1·eaction al ways involving oxygen. Certain metals, such as
calcium anrl aluminum, will burn in nitrogen; nitrous oxirle
will support the combustion of phosphorus anrl carbon; and so
2021 Edition
99-158 HEALTH CARE FACILITIES CODE

on. Howevec this document deals with the more common
process of fuels burning in air.
A.3.3.28 Compres.sed Medical Gases (CMG). CMG classifica­
tions a1-e rlefined in 201(g) (1) of the Federal Food. Drug. anrl
Cosmetic Act, 21 USC 32l(g)(l). This inclurles gases recog­
nizerl in the current UnitPrf StatPs Phannar:opfia and Natinnal
Fornmlary (USP-NJ,) or supplement� and gases intended fot·
direct use or a� a component of gases in the rliagnosis, cure,
mitigation, treatment, or prevention of diseases in man or in
animals that achieves it� intended purpose through chemical
rather than phys ical means. [55, 20201 (PIP)
A.3.3.35 Defend in Place. The concept of the term dPjfnd in
plaa includes. but is not limited to, element� related to moving
building occupant� from an area of immerliate rlange1· to a safe
location in the building and containment of the emergency or
dangerous condition.
A.3.3.41 Direct Electrical Pathway to the Heart. Electrodes,
such as those userl for pacing the heart, anrl catheters filled
with conrluctive fluids, a1·e examples of direct electrical path­
ways to the heart.
A.3.3.42 Disaster. A disaster can be either an event that
causes, or th1·eatens to cause, physical damage and i1tjury to
facility pe1·s01rnel or patient� within the facility, or an event that
requires expansion of facilities to receive and care fot· a large
4.5
99.6% 02
4.0
3.5 30.9%
24.9%
3.0
��----, 21.0%
18.0%
E 2.5
numbe1· of casualties resulting from a disaste1· that produces no
damage or injury to the health care facility and staff, or a
combi nation the1·eof.
Such a situation Cl'eates the neerl fot· emergency expansion
of facilities, as well as operation of this expanded facility in an
unfamiliar environment. Unde1· this definition, the recognition
f
o a disa�te1· situation will vary greatly from one facility to
another and from time to time in any given facility. Such recog­
nition and concomitant activation of the Health Care Emer­
gency Preparerlness Plan is dependent on mutual aid
agreements, facility type, geographic location, bed capacity.
bed occupancy at a given time. staff size, staff experience with
rlisaste1· situations, and other factors. F01· example. the routine
workloarl of the emergency department of a la1·ge metropolitan
general hospital would constitute a rlisaster, requiring activa­
tion of the Health Care Emergency Preparedness Plan, were
this same workload to be suddenly applied to a small commun­
ity hospital.
Disa�ters have a variety of causes, all of which should he
considered for effective emergency prepa1·edness planning.
Among the most common are natural disaste1·s such as earth­
quakes, hurricanes, tornadoes, and floods; ma�s food poison­
ing; industrial accident� invohing explosion 01· environmental
release of toxic chemicals; transportation accident� involving
crashes of trains, planes, or automobiles with 1·esulting mass
casualties; civil disturbances; building fires; extensive or
prolonged utility failm·e; collapse of buildings 01· other occu­
pied structures; and toxic smogs in u1·ban areas. Arson attempt�
and bomb threat� have been made on health care facilities and
should, therefore, be considei·ed. Potential admission to the
f
facility o high profile persons should be arldressed. Although a
high profile admission does not involve mass casualties 01· the
potential for mass casualties, the degree of disruption of
normal routine will be sufficient to quality it as a disasterlike
situation.
Disa�ter plans should reflect a facility's location from poten­
tial internal and external disasters. As an example, area� subject
to frequent wildland fit·es should invoke countermea�ures for
smoke management and air quality maintenance.

15.3% A3.3.44 Doubl e-Insulated Applianc es. Double-insulated

Ol
C: 2.0 appliances can be identified by a symbol consisting of a square
.E within a square m· wording such as "double-insulated" marked
on the appliance. Appliance packaging and documents can
1.5 also provide identification. i\lthough double-insulated applian­
ces do not require a thi1·d wire 01· pin. some double-insulated
appliances have a third conductor or pin solely for purposes of
1.0
electromagnetic compatibility (EMC).
A3.3.52 Es.sential Electrical System. The essential electrical
0.5 system can be comprised of three branches: life safety branch,
o-itical bt·anch, and equipment branch.
o�-�--�--�--�--�--�-� A3.3.55 Fac ility Fire Plan. This plan can be either a stand­
0 1.00 2.51 4.03 5.54 7.06 8.57 10.1 ATA
alone plan or be a part of the emergency operations plan.
0 50 100 150 200 250 300FSW
Pressure A3.3.5B FGI Guidelines. When the phrase "the applicable
volume of FGI Guidelines" is used within this code, it is meant
ATA = Atmospheres absolute to allow users to select the FGI Guidelines that are applicable
FSW = Feet of sea water to their facility.

FIGURE A-3.3-12.2 Burning Rates of Filter Paper Strips at A3.3.59 Flammable. Flammables can be solids. liquids. or
an Angle of 45 Degrees in N,-0, Mixtures. (Adapted from gases exhibiting these qualities. Many substances that are
Figure 4 of "Technical Memorandum UCRI-721, Chamber Fire nonflammable in ai1· become flammable if the oxygen content
Safety.") of the ga�eous medium is inct'eased above 0.235 ATA.

2021 Edition
 ANNEX A
A.3.3.62 Flash Point. Note that the fla�h point temperattu·e is
heavily dependent on the test use<l to <letermine it.
A.3.3.64 Flowmeter. A pressure compensate<l flowmeter
should be use<l to in<licate an accurate flow of gas whether the
gas is <lischarged into ambient pressure or into a system at
nonambient p1·essure.
A.3.3.65 Frequency. Formerly, the unit of frequency wa� cycles
per second, a terminology no longer preferred. The waveform
can consist of component� having many different frequencies,
in which case it is calle<l a complex or nonsinusoi<lal waveform.
A.3.3.66 Fume Hood. I.aborato1y fume hoods prevent toxic,
flammable, 01· noxious vapors from entering the laborat01y:
p1·esent a phrical barrie1· from chemical reactions; an<l sei-ve to
contain accidental spills.
This <lefinition does not inclu<le canopy hoods 01· reci1·nlla­
tion laminar-flow biological-safety cabinets that are not
designe<l for use with flammable materials.
A.3.3.68 General A nesthesia and Levels o f Sedation/Analgesia.
It should be noted that these are not static conditions. Minimal
sedation can easily become moderate sedation, and mo<lerate
sedation can progress to deep sedation 01· genera£ anesthesia.
A.3.3.69 Ground-Fault Circuit Interrupter (GFCI). Class A
ground-fault circuit interrupters trip when the current to
ground is G mA or higher and do not trip when the current to
groun<l is less than 4 rrn\. Fo1· further information, see UL 943,
Ground-Fault Circ-uit-JntPrruptPrs. f70, 20201
A.3.3.71 Grounding System. It coordinates with, but can be
locally more e xtensive than, the groun<ling system described in
Article 250 of 1VFPA. 70.
A.3.3. 73 Health Care Facilities. Health care facilities include,
but are not limite<l to, hospitals, nm·sing homes, limited ca1·e
facilities, clinics, medical and dental oflices, and ambulatory
health care centers. whether permanent or movable. This defi­
nition applies to normal, 1·egular operations and does not
pertain to facilities dm·ing decla1·ed local or national disaste1·s.
A health care facility is not a type of occupancy classification a�
defined by NFPA IOI. Therefore, the term hmlth am farility
should not be confused with the te1·m health rarP oi:tupanry. A.JI
health care occupancies (an<l ambulatory health ca.re occupan­
cies) are considered health care facilities; however, not all
health ca1·e facilities are considered health ca1·e occupancies, as
health care facilities also include ambulatory health ca1·e occu­
pancies and business occupancies.
A.3.3. 74 Health Care Facility's Governing Body. This defini­
tion exclu<les political governmental agencies, such as auth01·i­
ties having jurisdiction, that exercise local, regional, or national
legal jurisdiction over the design, construction, inspection, and
operation of a particula1· health care facility.
A.3.3. 75 Health Care Microgrid. The health ca.re microg1·id
can connect and disconnect from the utility to enable it to
operate in both g1·id-connected or island mode. (ELS)
A.3.3. 77 Home Care. For the purposes of this <lefinition, homP
rare should not inclu<le commercially-operated facilities hous­
ing of four or m01·e occupants not related by blood 01· matTi age
1·eceiving personal care or me<lical services.
Facilities, regardless of occupancy classification, that provi<le
01· facilitate the provision of pe1·sonal Gll"e 01· medical services
99-159
to fou1· or more pe1-sons should not be classifie<l as home care
a.n<l shoul<l be su�ject to the applicable provisions of this stand­
ard. An example woul<l be a residential board and ca1·e occu­
pancy or an apanment buil<ling with an oxvgen storage room.
A.3.3.81 Hyp erbaric Operations. Such procedures include
but a1·e not limited to (a) therapy inside a hype1·baric chamber,
(b) changing clothes, (c) vital signs assessments, (d) noninva­
sive transcutaneous oxygen monitoring, (e) clinical and me<li­
cal assessment�, a.t1d (f) minor dressing changes. Debridement
or othe1· surgical proce<lm·es. application of casting material,
application of skin substitutes, an<l application of bioengi­
neered graft� are not recommended in the chamber room.
(HYP)
A.3.3.86 Impedance. The circuit element can consist of any
combination of resistance, capacitance, or inductance.
A.3.3.88 Instrument Air. Instrument ai1· is intended fo1· the
powering of medical devices um·elate<l to human 1·espiration
(e.g., to remove excess moisture from instrument� before
further processing, 01· to operate me<lical-surgical tools, au-.
driven booms. penda.t1t�. or similar applications).
A.3.3.90 Intrinsically Safe. "Abnormal conditions" ca.t1
include accidental damage to any pan of the equipment 01·
wiring, <lamage to insulation or other failm·e of electt·ical
component�, application of overvoltage, adjustment a.t1<l main­
tenance operations, an<l other similar conditions.
A.3.3.93 Isolated Power System. See NJ.PA 70.
A.3.3.95 Laboratory. l11ese laboratories are not intended to
include isolate<l frozen section laboratm·ies; a1·eas in which
oxygen is administe1·ed; blood <lon01· rooms in which flamma­
ble, combustible, 01· other wise hazardous materials normally
used in laboratory procedures a.t·e not present; a.tHl clinical
service a.t·ea� not using hazardous materials.
A.3.3.98 Limited-Combustible (Material). Material subject to
increase in combustibility or flame spread index beyon<l the
limits he1·ein established through the effect� of age. moisture,
or other atmospheric condition is conside1·ed combustible.
See NFPA 259 and NFPA 220.
A.3.3.100 Liquid. ,\'hen not othe1·wise identified, the term
liquid includes both flammable and combustible liquids. (.'ifP
al�o B.11.1.1.)
A.3.3.101 Local Signal. Examples woul<l inclu<le a gauge, a
flag, a light, or some other possible ma.t1ifestation that allows a
maintenance person to stand at the equipment and know what
conditions a.t·e p1·esent (e.g., which hea<ler of cylin<le1·s is in
service). The element.� to be displayed are typically those that
will also be monitored at the ma.�ter alarm, but the local signal
is visible at the equipment 1-ather than remotely.
A.3.3.104 Manufactured A ssembly. Examples are headwalls,
columns, ceiling columns, ceiling-hung penda.tlts, movable
track systems, a.t1d so on.
A.3.3.106 Medical Air. A.ii- supplied from on-site comp1·essorn
a.t1d associate<l air treatment systems (as opposed to medical air
USP supplied in cylinders) that complies with the specified
limit� is considered medical ai1·. Hydroca.t·bon carryover from
the compressor into the pipeline dist1·ibution system coul<l be
detrimental to the safety of the en<l user and to the integrity of
the pip ing system. Mixing of air an<l oxygen is a common clini-
2021 Edition
99-160 HEALTH CARE FACILITIES CODE

cal practice, and the hazards of fire are increased if the air is
thus contaminated. Compliance with these limits is thus consid­
e1·ed important to fit-e and patient safety. The (]Uality of local
ambient air should be determined prior to it� selection fot·
compressors and air treatment e<J uipment.
A3.3.ll0 Medical Office. Examples include a dental office/
clinic, a medical office/clinic, an immediate care facility, and a
podiatry office.
A3.3.125 Nonflammable Medical Gas System. See Chapter 5,
Ga� and Vacuum Systems.
A3.3.129 Oxidizing Gas. O:,,.ygen and nitrous oxide are
examples of oxidizing gases. 1l1ere a1·e many othe1·s, including
halogens.
A3.3.130 Oxygen. Oxygen's outstanding property is it� ability
to sustain life and to support combustion. Although oxygen is
nonflammable, mate1·ials that burn in air will burn much more
vigorously and create higher temperatures in oxygen or in
o:,,.-ygen-enriched atmospheres.
A3.3.130.2 Liquid Oxy gen. If spilled, the li <J uid can cause
frostbite on contact with skin.
A3.3.132 Oxygen Delivery Equipment. If an enclosme such
as a ma�k, hood, incubator, canopy, 01· tent is used to contain
the o:,,.ygen-enriched atmosphere, that enclosure is considered
to be oxygen-delivery e <J uipment.
A3.3.133 Oxygen Hood. For additional information, see
A.3.3.12.2 and Figure A.3.3.12.2.
A3.3.135 Oxygen Toxicity (Hyperbaric). Unde1· the pressures
and times of exposun� n01·mally encountered in hypet·baric
treatment�. toxicity is a direct function of concentration and
time of exposure.
A3.3.140 Patient Care Space. Business offices, con-ido1·s,
lounges, day rooms, dining rooms, or similar areas typically are
not classified as patient care spaces.
A3.3.140.l Category I Space. These spaces, formedy known
as critical care rooms, are typically where patients are intended
to be subjected to invasive procedures and connected to line­
opernted, patient care-1·elated appliances. Examples include,
but a1·e not limited to, special care patient rooms used fot· ct"iti­
A3.3.143 Patient Lead. A patient lead can be a surface
contact (e.g., an ECG electrode), an invasive connection (e.g.,
implanted wise or catheter), or an incidental long-te1·m
connection (e.g., conductive tubing).
It is not intended to include adventitious or ca�ual contact�,
such as a push button, bed sudace, lamp, hand-held appliance,
at1d so forth.
(Alm see 3.3. 92, lrnlated Patient LMd.J
A3.3.149.5 Operating Pressure. The opernting pt·essure for
patient medical ga�es is typically 345 kPA to 380 kPa (50 psig to
55 psig). The operating pressure for medical support gases is
typically 345 kPa to 1275 kPA ( 160 psig to 18:, psig).
A3.3.149.6 Partial Pressure. 1l1e pt·essure contributed by
other gases in the mixture is ignored. For example, oxygen is
one of the constituent� of air; the pat·tial pressure of oxygen in
standard air, at a stat1da1·d air pt·essure of 14.7 psia, is ,l.Oli psia
or 0.208 ATA or 158 mm Hg.
A3.3.150 Pres.sure-Reducing Regulator. In hospitals, the te1·m
rPgzilator is fre(]uenlly used to describe a 1·egulator· that incorpo­
rates a flow-measuring device.
A3.3.152 Producer. Examples of these produce1·s include
vacuum pumps, fans, blowers, and venturis.
A3.3_154 psig. Under standard conditions, 0 psig is e<Juiva­
lent to 14.7 psia.
A3.3.160 Remote. A g-ds storage supply system cat1 be remote
from the single treatment facility, but all use point� must be
contiguous within the facility.
A.3.3.169 Single 'Ireatment Facility. ll1e definition of single
treatment facilitv was established to take into consideration
pt-incipally single-level installations or those of a pt·actice that
could be tw-o-level, but ai·e 1·eached by open stai1·s within the
confines of the single treatment facility. (See Figure A. .3.3.169.)
Examples ol Single Treatment Facllltles
u • t Use Use points

··:":j�;� \
Use points
cal care, intensive ca re, and special care treatment rooms such
as angiography laborntories, cardiac cathete1·ization lab01·ato­
ries, delivery rooms, operating rooms, post-anesthesia care
unit�, trauma rooms, and other simila1· 1·ooms. Balcony, but access
is totally wthin
A3.3.140.2 Category 2 Space. These spaces were fonnedy treatment facility.
known as genernl cai·e rooms. Examples include, but are not
limited to, inpatient bedrooms, dialysis rooms, in vitro fertiliza­ Examples of Two Treatment Facllltles
,--=,-------,
tion rooms, procedural rooms, and similar rooms. Use points
A3.3.140.3 Category 3 Space. These spaces, formedy known Use points Use point Use ENT
location 1 1 point 2
as basic care rooms, are typically where basic medical or dental Use points
care, treatment, or examinations are performed. Examples - ENT
include, but are not limited to, examination 01· treatment Stairwell
rooms in clinics, medical and dental oHices, mu-sing homes, Hall
and limited care facilities. �
Example of adjacent Example of two-level
A3.3.140.4 Category 4 Space. These spaces were formedy operati on, but ace ess operation - access
Use points is from outside hallway. is from outside stairs
known a� support rooms. Examples of support spaces include, location 2
but are not limited to, anesthesia work rooms, sterile supply, Example of across-the-hall operation.
labo1·atories, morgues, waiting rooms, utility rooms, and
lounges. (FUN) FIGURE A3.3.169 Examples of Treatment Facilities.

2021 Edition
 ANNEX A 99-161

A.3.3.170 Site of Intentional Expulsion. This rlefinition (2)
arlrlresses the site of intenrlerl expulsion. Actual expulsion can
occut· at other sites 1·emote from the intenrlerl site rlue to (3)
disconnections, leaks, 01· 1·upture of gas conrluits anrl connec­
tions. Vigilance on the part of the patient care team is essential ( 4)
to ensure system integrity. ( 5)
(6)
For example, fot· a patient receiving oxygen via a nasal
(7)
cannula or face mask, the site of expulsion normally surrounds
(8)
the mask or cannula; for a patient 1·ecei,ing oxygen while
enclosed in a canopy 01· incubator, the site of intentional expul­ A.4.1.1 Major injuty can include the following:
sion normally sutTounds the openings to the canopy 01· incuba­
( l)
tor; for a patient receiving oxygen while on a ventilator, the site
(2)
of intentional expulsion no1·mally sutTounrls the venting port
on the ventilat01·.
(3 )
A.3.3.176 Surface-Mounted Medical Gas luil Systems. It is
the intent that smi"ace-mounted medical gas 1·ail systems would (4)
be permitterl in indivirlual patient rooms hut would not he
permitted to go di1·ectly through room walls to adjacent patient
rooms. However, it is the intent to permit surface-mounted (5)
medical ga� mils to be used in a given Category l space whe1·e
there can be a partition sepamting certain patient ca1·e func­
tions, essentially lea,ing the system within the given Category l (6)
space. As an e xample, tw-o acljacent patient rooms out�ide of a
Category l space care unit would not be pe1·mitted to have a
sudace-mounted medical gas rail interconnect between the two (7)
rooms through the wall. However, in a nursery where there
might be one or tw-o seg1·egated areas for isolation, a merlical
ga� mil system supplying m01·e than one isolation room, but (8)
within the nursery area, would be permitted to he interconnec­
ted with the nursery system.
Reconstrnctive surgeon's office with gene ml anesthesia,
Category l
Procerlural serlation site for outpatient services, Category
2
Cooling Towers in Houston, TX, Category 2
Cooling Towers in Seattle, WA, Category 3
Dental office, no general anesthesia, Catego1y 3
Typical doctor"s office/exam room, Category 4
Lawn sprinkler system, Catego1y 4
Any amputation
Loss of the sight of an eye (whether temporary or perma­
nent)
Chemical 01· hot metal burn to the eye or any penetrating
injury to the eye
Any injm·y that 1·esult5 in electric shock and electric burns
leading to unconsciousness and that 1·equires resuscita­
tion or admittance to a hospital fo1· 24 hou1·s 01· m01·e
Any other injurv leading to hypothermia, heat inrlucerl
illness, or unconsciousness requiring 1·esuscitation 01·
admittance to a hospital for 24 hours or more
Loss of consciousness caused by asphyxia or lack of
oxygen or exposure to a biological agent or ha1·mful
substance
Absorption of any substance by inhalation, skin, 01· inges­
tion causing loss of consciousness or acute illness requir­
ing merlical treatment
Acute illness requiring medical tt·eatment where ther·e is
reason to believe the expostffe wa� to biological agents, it�
toxins, or infected materials

A.3.3.181.1 Endotracheal Tube. An endotracheal tube can he
equipped with an inflatable cuff.
A.3.3.187 Wet Procedure Locations. Routine housekeeping
f
procerlm·es anrl incidental spill age o liquids do not define a
wet procedure location.
A.4.1 Fout· levels of systems categories are defined in this
code, ba�ed on the 1·isks to patient� anrl caregivers in the facili­
ties. 1l1e categories are as follows:
( l) Catego1y l: Systems are expecterl to work or be available
at all times to support patient needs.
(2) Categ01y 2: Systems a1·e expected to provide a high level
of reliability; however, limiterl short durations of equip­
ment downtime can be toleraterl without significant
impact on patient care. Catego1y 2 systems support
patient need� but are not critical for life support.
(3 ) Category 3: Normal building system reliabilities a1·e
expecterl. Such systems support patient neerls, hut failu1·e
of such equipment woulrl not immediately aflect patient
care. Such equipment is not critical for life support.
( 4) Category 4: Such systems have no impact on patient ca1·e
and woulrl not be noticeable to patient� in the event of
failure.
The category definitions apply to equipment operations and
are not intended to consirler intervention by ca1·egive1·s or
others. Potential examples of areas/systems anrl their catego­
f
ries o risk follow. A risk a�sessment should be conrlucterl to
f
evaluate the risk to the patient�, staf , and visito1·s.
( l) Ambulatory sm·gical center, two patients with full OR serv­
ices, Category l
A.4.1 .2 A mi1101· injury means no/ sPriom or involving risk of lip.
A.4.1.5 In some situations, it might be desirable to rlesign to a
higher risk category. Fot· example, it might only be 1·equi1·erl to
design a system to a Category 4 but it is permissible to design to
a Category 1, Category 2, or Categ01y 3. The converse is not
allowerl. For example, a requirerl Category l system must be
designerl to a Catego1y l anrl cannot be designerl to a Catego1y
2, Catego1y 3, or Category 4.
A.4.2 Risk assessment should follow procedures such as those
outlined in ISO/IEC 31010, Risk Managnnn1t - Ri�k i'lsses.,111mt
Tn:hniq11Ps, NFPA 551; SEMI S l 0.0307E, Safety GuidPline for Rish
Assessment and Risk Evaluation Proass; SFPE's EnginePring Guide to
Fire Ri�k A..t�e.mnmt; 01· othe1· formal prncess. The 1·esults of the
assessment procerlu1·e should be rlocumenterl anrl 1·ec01·rls
retained. Figu1·e A.4.2 is a sample risk assessment model that
can be userl to evaluate the categories.
A.4.2.2 Classification of risk categories requires a collaborative
effort between tl1e healtl1 ca1·e facility's governing body and the
authority having jurisdiction.
A.4.4.1 The provisions of 4.4. l do not require inherently
noncombustible materials to be tested in orrle1· to be classified
a, noncombustible materials.
A.4.4.2 Materials subject to inCI"ease in combustibility 01· flame
spread index beyonrl the limit� herein establisherl thrnugh the
effect� of age, moisture, or other atmospheric conrlition are
conside1·erl combustible. (See NFPA. 259 and NFPA 220.)
fJOJ:A.4.6.141

2021 Edition
99-162 HEALTH CARE FACILITIES CODE
Patient Patient has Patient has No impact
dies minor injury discomfort on patien t
Category 1
System Yes
loss Category 2
Yes
Category 3
No Yes
No
Category 4
No
Sample Risk Assessment.
FIGURE A.4.2
A5. I. I Section 5.1 covers Category I piped ga� and vacuum
systems; Section 5.2 cove1·s Categor:y 2 piped gas and vacuum
systems; and Section 5.3 covers Category 3 piped gas and
vacuum systems.
The health care facility's governing bodv should designate a
catego1y in accordance with Chapter 4 for each patient care
space in the facility. This process should include a1·eas being
used fot· medical support (e.g., decontamination 01· ste1·iliza­
tion, lab work, post mortem) that are not strictly patient care
spaces themselves (i.e., there are no patients there) but share
utilities such a� medical gases or medical support gases with
such spaces. Because it is not 1·ealistic to create separate supply
systems for each category, it is desirable that one supply system
be used for spaces of all categories to supply medical gases,
medical support gases, and vacuums to terminals.
The principle is set out at the start of the requirement� for
each category in Chapter 5 (.�PP 5.1.1, 5.2.1, and 5.3.1) that a
higher categ01·y sou1·ce and piping system is pe1·mitted to
supply terminals in any lowe1· Categmy space; a Categ01·y 1
system can supply terminals in Category 2 and Category 3
spaces, but a Category 2 system cannot supply terminals in a
Categmy 1 space.
A5.l.l.3 1l1ese requirement� do not restrict the distribution
of other inert gases through piping systems.
A5.l.l.4 1l1e intent is that an existing system built in acco1·d­
ance with an earlier edition of this code is permitted to be
continued in use as long as no element is disturbed. For this
purpose, ''disturbed" includes 1·eplacing or changing of
element� (except simple like-for-like exchange as part of a
repair or normal maintenance), portions added to or removed
from the system in a manner that requi1·es system shutdown,
and opening of any pan of the system to the atmosphe1·e.
\\'hen any element(s) of the system is disturbed, the follow­
ing should occu1·:
(1) The specific element(s) that wa� disturbed should be
brought into compliance with the most recent edition of
this code.
(2) An evaluation should be conducted and documented fot·
any portions of the system affected by the change.
2021 Edition
(3) 1l1rnugh 1·isk analysis. the Responsible Facility Authority
should document any element� where a distinct hazard to
life is apparent or is created by the changes. These
elements should then he brnught into compliance ½':ith
the currently adopted edition of this code. All other
portions can remain undisturbed.
f
(4) A te1· completion of any corrections and updates 1·esulting
from the risk analys is, and appropriate testing if required
under 5. l.12, the entire system can then be considered an
"existing system" for t he put·poses of this code.
(5) The decisions and result� of the risk analysis and final
testing, if required. should be made pa rt of the perma­
nent records of the facility for future reference.
A.5.1.3 See Figm·e A.5.1.3. Category I source drnwings in this
annex a re representational, demonstrating a possible arrange­
ment of componenrn required by the text. The diagrams are
not intended to imply method, materials of constrnction, or
m01·e than one of many possible and equally compliant
arrangement�. Alternative arrangements are permitted if they
meet the intent of the text. Listed paragraphs might not be the
only paragraphs that apply
A.5.1.3.1.1 Regulations of the U.S. Department of Transporta­
tion (formerly U.S. Inte1·state Comme1·ce Commission) outline
specifications for transportation of explosives and dangerous
articles (49 CFR 171-190). In Canada, the regulations of the
Canadian Transport Commission, Union Station, Ottawa,
Onta rio. apply
A5.l.3.l.2 CGA documents contain both mandatory and
nonmandatory language. Enforceable Language uses the word
"shall"; nonmandatory language uses the word ·'should."' This
section indicates that this code is making refe1·ence onlv to the
mandatory requirement� in the CGA document.
A5.l.3.2.5 Wrappe1·s (or ove1·packs) a1·e intended to prnvide
an outer package for transpon, such as a ca1·dboard box, and
typically present a significant combustible fire load. Cylinders
should not be stored in health care facilities in overpacks when
the overpack is made of a combustible material ,,>ith a signifi­
cant fire load. Valve shrink wraps used to seal valve connec­
tions, and outer netting applied to cylinders that does not
cove1· more than 50 pet-cent of the cylinder sudace and is only
intended to prntect the cylinder paint coatings and side wall
labels from damage, are not considered wrappers.
A.5.1.3.3 The bulk supply sys tem should be installed on a site
that has been p1·epared to meet the 1·equi1·ements of NFPA 55
or CGA G-8.1, Standard far 1'v'itmm Oxidf Systnns al CustmnN SitPs.
A storage unit(s). reserve, pressure regulation, and a signal
actuating switch (es) a1·e component� of the supply system.
Shutoff valves, piping from the site, and electric wiring from a
signal switch(es) to the master signal panels are components of
the piping system.
The hulk supply system is normally installed on the site by
the owner of this equipment. The owner or the organization
1·esponsible for the ope1·ation and maintenance of the bulk
supply system is 1·esponsible fot· ensuring that all components
of the supply system - main supply, reserve supply. supply
system signal-actuating switch(es), and delivery pressure regula­
tion equipment - function properly hefo1·e the system is put in
service.
In the locating of cenu·al supply systems, consideration
should he given to ensuring the 1·esilience of the facility under
 ANNEX A 99-163

1-easonably anticipated advei-se conditions. Examples have A.5.1.3.3.1.10 Examples of inen gases include but a1·e not
included the following: limiterl to helium anrl nitrogen.
(l) Flooding of systems located in basements from extra01·di­ A.5.1.3.3.2 Electric wiring anrl equipment are not requi1·ed to
nary weather, water main breaks, and sprinkle1· head fail­ be explosionproof.
ures
( 2) Seismic event� that 1·endered the supply system inope1·a­ A.5.1.3.3.2.I (6) The fire 1-esistance rating for walls and flom-s
tive is rlete1·mined in accorrlance with ASTM E l 19, Standard Jpst
(3) Degradation of the quality of air at the intake rlue to a Mrthnd� fnr F'irP Jpsts nf Building Cnnslnu:tinn and AiateriaL�. or
nearby fire and chemical release UL 263, StandardJar FirP 11'sts of Building Comtr1.1.1:tinn and Materi­
( 4) Electrical problems, inclurling failure of motor control ak The fire protection rating fot· doors is determined in
centers anrl failure of switchgear to propedy connect accordance with NFPA 252.

Many of these risks can be ameliorated by care when siting
the central supply systems and thei1· utility connections.
A.5.1.3.3.1.1(4) Examples include the concentrator unit, the
oxygen reservoir, anrl regulating devices.
A.5.1.3.3.1.2(5) Examples include the concentrator unit, the
m..-ygen resetvoir, and 1·egulating devices.
A.5.1.3.3.1.3(6) This includes indivirlual components on the
air side of concentrators.
A.5.1.3.3.2.1 (7) Electrical devices shoulrl be physically protec­
terl. such as by use of a protective barrier arounrl the elecu·ical
devices, 01· by location of the electrical rlevice such that it will
avoirl causing physical damage to the cylinders or containers.
For example, the rle'1ice coulrl be located at or above 1.5 m
(5 ft) above finished f1001· 01· othe1· location that will not allow
the possi bility of the cylinders or containe1·s to come into
contact with the electrical device as required by this section.
A.5.1.3.3.2.1 (B) Examples of inrlirect heating inclurle steam,
hot water, and electt·ic heating.

t The point at which the diagram

transitions to the next portion

e
of the system.

The wall of the source enclosure.

A pressure indicator. A gauge type
is shown. but other types are permitted.

D.C. A demand check to allow

disconnection of the device without
shutting down of the system.
A quarter turn ball valve. The type
shown is used for ease of recognition.
but other configurations are permissible.
A check valve. The valve flows in the direction
of the point.
A high-pressure valve. The technology of the
valve is not specified.

Items shown in dashed format

indicate alternative arrangements or A "pigtail" for connecting cylinders to the header.
components required only conditionally. Can be rigid or flexible. depending on the gas
and pressure.

A relief valve vent piped to outside.

A relief valve.
A liquid vessel for containing cryogenic liquefied gas.

A pressure regulator.

A switch or sensor connected to the

alarm panel(s).

A vaporizer for converting cryogenic liquefied

gas from liquid to gas state.
Either of two valve types: a ball valve
or a check valve.

+
Either

A union or other means to disassemble A filter.

components. (Note: These are not illustrated
in every location where they can be required.)

FIGURE A.5.1.3 Legend for Typical Category I Source Drawin gs.

2021 Edition
99-164 HEALTH CARE FACILITIES CODE

A.5.1.3.3.2.1(11) Chapte1· fl specifies medical gas equipment
that should be powered by the essential electrical systems. Elec­
trical equipment that is not essential for the operation of the
supply system can be powe1·erl. by nonessential powe1· (e.g., te­
lemetry, site lighting).
A.5.1.3.3.2.1(14) Considerations for this access inclurl.e prox­
imity to loading docks, access to elevators, anrl. passage of cylin­
ders through public areas.
A.5.1.3.3.4.2 Exhaust fan motors, fan-coil motors, or similar
small motors userl. for ventilation put-poses a1·e not intenrl.erl. to
be prohibited from the storage enclosure.
A.5.1.3.5 See Fig111·e A.5.1.3.5. A fout--valve bypass atTange­
ment is illustrnted. Three-way valves a1·e permitterl. in lieu of the
four valves shown.
A.5.1.3.5.4 Component� include, but are not limiterl. to,
containe1·s, valves, valve seat�. lub1·icant�, fittings, gasket�, anrl.
interconnecting equipment, including hose. Easily ignitable
materials should be avoided.
Compatibility involves both combustibility and ease of igni­
tion. Materials that burn in air will burn "iolently in pure
oJi.-ygen at normal pressure anrl. explosively in pressurizerl.
oxygen. Also. many materials that do not burn in air will do so
in pure oxygen, panicularly unrl.er pressure. Metals fix contain­
ers and piping have to be carefully selecterl., depending on serv­
ice conditions. The various steels are acceptable for many
applications, but some service conditions can call for othe1-
materials (usually copper or its alloys) because of thei1· greate1·
resistance to ignition anrl. lower rate of combustion.
Similarly. mate1·ials that can be ignited in ai1· have lowe1· igni­
tion energies in oxygen. Many such materials can be ignited by
friction at a valve seat or stem packing or by adiabatic comp1·es­
sion produced when oxygen at high pressure is rnpidly intro­
duced into a system initially at low pressure.
A.5.1.3.5.5.1 The intent of 5.1.3.5.5.1 is to ensure that the
p1·essu1·e at the station outlet is steady and maintainerl. safely
f
within the limit� o Table 5.1.11. Trarl.itionally, line pressure
regulators were requirerl. here as the only allowed control-of­
p1·essu1·e devices. Other methods of control are becoming
possible (e.g., variable speed conu·olled on pt·essure). The
present wording is intenderl. to achieve the performance
requireme nt (sn' TablP 5.1.11) and to allow not only traditional
p1·essu1·e regulatm-s but other control methods as well.
A.5.1.3.5.9 See Figure A.5. l .3.5.9(a) and Figure
A.5. l .3.5.9(b). Connection to the gas outlet connection is illus­
trnted. If the liquirl. outlet connection were userl., an external
vaporizer coulrl. be requi1·ed.
A.5.1.3.5.9(1) The appropriate number of cylindel'S should be
rl.etermined afte1· consirl.erntion of rl.elivery scherl.ules, proximity
of the facility to alternate supplies, and the eme1·gency plan.
A.5.1.3.5.10 See Figure A.5.1.3.5.10.
A.5.1.3.5.11 See Figure A.5.1.3.5.11.
Intermediate
pressure
Header check valve gauge

Header pressure regulator

Line Head er contents indicator

pressure
indicator
olating valve D.C. D.C.
��
Line pressure
alarm switch/sensor

- _____J{!:,.:····
�-:.{.I.

V ◄---"1-,.41 Main line shutoff valve

, (not required in some
,.,.,.
© ©
,' cases)
•,V�V(..�-
Wall of source enclosure
••·· (Note: Location of items
: ,.I•,.,,
f) : downstream of the source

. .{:;:,, Pressure,.:::.\.
valve can vary. Refer to the
text.)
\
''
·-·: indicator·•-~·· , ,,---+-V \
• - - - Cylinders
,,
_ ...\;�.-Pressure relief valve(s) \
\
Line pressure
regulators Cylinder pr

Isolation valve

FIGURE A.5.l.3.5.9(a) Header for Gas in Cylinders.

FIGURE A.5.1.3.5 Typical Arrangement for Line Controls at
Pressure Sources.

2021 Edition
 ANNEX A
check valve
Header valve
Cylinders
FIGURE A.5.l.3.5.9(b) Header for Cryogenic Gas in
Containers.
A.5.1.3.5.13 See Figure A.5.1.3.5.13.
If the relief valve on the emergency oxygen supply connec­
tion is moved downstt·eam from the check valve in the emer­
gency oxygen line, it shoulrl be connected to the system with a
demanrl check fitting.
The eme1·gency oxygen supply connection (EOSC) can be
used a� a part of the emergency operation plan (EOP) fot· an
unplanned loss of oxygen supply. However, a risk assessment
shoulrl be conducted by the facility to rletermine the contin­
gency plan fot· vital life support and Category l space. 1l1ei-e
might neerl to be interim mea�ures for dealing with the loss of
oxygen (e.g., high-pressure m..ygen cylinrlers available for back
feeding Category l space).
A.5.1.3.5.13.2(8) Monitot-ing tempornry supply in use is essen­
tial to patient safety. The facility"s emergency operations plan
(EOP) should addt·ess how the facility will monitor the tempo­
rnry supply while in use. The length of time the EOSC will be
f
in use, the availability o staff to monitor temporary supply, and
the tvpe of temporaty supply shoulrl all be considered when
rletermining the means to accomplish this item.
A.5.1.3.6 Air supplied from on-site compressor anrl associated
air treatment systems (as opposerl to medical air USP supplied
in cylinders) that complies with the specified limil� is consirl­
ered medical air. Hydrncarbon carryover from the compressor
into the pipeline distribution system could be detrimental to
the safety of the end user and to the i11teg1·ity of the piping
system. Mixing of air and oxygen is a common clinical practice,
and the hazards of fire are inCt"eased if the air is contaminate cl.
Compliance with these limits is thus considererl important to
fit·e and patient safety. The guality of local ambient air should
99-165
be rletern1ined prior to it� selection for comp1·essorn anrl air
treatment eguipment. See Figure A.5. 1.3.6.
A.5.1.3.6.1 Supply systems for medical ai1· using comp1·ess01·s
rlraw air of the best available guality from a source of clean
local ambient air; add no contaminants in the form of particu­
late matter, odo1·, 01· othe1· gases; and rlry, filter, 1·egulate, anrl
supply that ai1· only via the merlical air piping distt·ibution
system for use exclusively in the application of human respira­
tion.
The utilization of an ai1· treatment system is the joint 1·espon­
sibility of the system rlesigner, the hospital clinical and engi­
neering staffa, and the auth01·ity having jurisdiction. Different
f
types of compressm·s have charncteristics that af ect the selec­
tion of the type of air tt·eatment system. Some air treatment
systems impose an additional load upon the compressors that
has to be accounted for in the sizing of the system (usable
capacity). The compressor duty cycle has to be chosen in
accordance with the manufacturer's recommendation.
The type of ai1· compressor and air condition at the intake
will govern the type of filter prnvided for the ai1· comp1·ess01-
supply system. All filters should be examined guarterly for the
presence of liguids or excessive particulates and replaced
according to the manufacture1·'s instt·uctions.
One procedure fot· reaching a decision on the guality of the
medical air is the following:
(1 ) Test at the intake and at the sample connection valve.
(2) If the two purities ag1·ee within the limit� of accurncy of
the test, the compressor system can be accepted.
(3) If the air is found to exceerl the values for medical
compressed ai1· as rlefined in 5.1.3.G. l, the facilitv can
elect to install purification apparatus for the contami­
nants in guestion.
A.5.1.3.6.2 It is the intent that the medical air piping rlistribu­
tion system support only the intended need for breathable air
for such items a� intermittent positive pressure breathing
(IPPB) anrl long-term respirator)' assistance needs. anesthesia
machines, and so forth. The system is not intended to be used
to provide engineering, maintenance, and eguipment needs
for gene1·al hospital support use. It is the i ntent that the life
sal·ety natu1·e of the medical air be prntecterl by a system dedi­
cated solely for its specific use.
As a comp1·essed air supply source, a medical air compresso1·
should not be used to supply ai1· fot· othe1· purposes, because
such use could ino·ease setvice inte1n1ptions, 1·educe service
life, and introduce additional opportunities for contamination.
A.5.1.3.6.3 See Figu1·e A.5.1.3.6.
A.5.l.3.6.3.4(A) Examples of 5. l.3.6.3.4(A)( l) are liguid ring
and permanently sealed bearing comp1·ess01·s.
An example of 5. l.3.G.3.4(A)(2) is an extenrled head 1·ecip­
rocating compressor with an atmospheric vent between the
comp1·ession chambe1· and the crankcase.
An example of 5. l .3.G.3.4(A)(3) is a rotating element
compressor with the compression chamber being nonlubrica­
ted and separated from the lub1·icated gea1·s by at least one
shaft seal \\>ith an atmospheric vent on both sides. The vent on
the lubt·icated side is provided with a gravity drain to atmos­
phere.
2021 Edition
99-166 HEALTH CARE FACILITIES CODE

Changeover alarm switch/sensor Automating

J ooa<rol(sl

v-----�

Intermediate
relief valve
J
V

,-------+--+V
1 Primary/secondary headers

f - ..:.--.----"T"" V V
.____-+.N\r--
.. ...
�"'+� ,,

.. .
: I

a. • .!'
Header 1 Header

FIGURE A.5.1.3.5.10 Manifold for Gas Cylinders.

2021 Edition
 ANNEX A 99-167

'"'�:-D
relief valve

Reserve header

Reserve-in-use
alarm switch/sensor

Header Alternating
control(s) Changeo ver alarm
switch/sensor

r---------------,

Primary/secondary headers

Header 1 Header
1_ ___________ J

FlGURE A.5.1.3.5.1 I Typ ical Source of Supply for Cryogenic Gas in Containers.

2021 Edition
99-168 HEALTH CARE FACILITIES CODE

A.5.I.3.6.3.14(A)(9) The proportioning system should be

monitored for conditions that can affect air quality during use
or in the event of failm-e, haserl on the type of propo1·tioning
system rlesign userl in the system, inclurling monitoring for the
following systems anrl conditions:
(I) Whe1·e proportioning systems userl a1·e configured with a
Une
pressure primary proportioning system and a reserve medical air
indicator manifold per 5.1.3.5.10
i (2) \,Vhere proportioning systems userl are configured with a
Connect on point
primat)' proportioning system and a 1·ese1·ve proponion­

->------.........-»
�D.C.
FIGURE A.5.1.3.5.13 Emergency Oxygen Supply
Connection.
Bypass operation using Bypass operation using
3 two-port valves 1 two-port valve
1 three-port valve
FIGURE A.5.I .3.6.3.9(D) Receiver Valving Arran gement.
A.5.l.3.6.3.9(D) A typical example of valving the receive1· ts
shown in Figure A.5. l.3.6.3.9(D).
A.5.l.3.6.3.9(F) The two configtll'ations are equally accepta­
ble. The components can be atTangerl in either of the atTange­
menl� shown in Figure A.5.l.3.fi.3.9(F).
A.5.1.3.6.3.10 The intent of 5.1.3.6.3.10 is to ensure that the
pressu1·e at the station outlet is steady and maintainerl safely
within the limit� of Table 5.1.11. Trnditionally, line pressure
regulators were required here as the only allowed control-of'.
pressun· rlevices. Other methods of control a1·e becoming
possible (e.g., va1·iahle speerl controlled on pressure). The
present worrling is intended to achieve the performance
requirement (sf¥ ]hble 5.1.11) anrl to allow not only trarlitional
pressu1·e 1·egulat01·s but other control methorls as well.
A.5.l.3.6.3.14(A)(I) The proportioning system might require
approval from regulatory bodies that have medical de,ice
authority, such as the FDA in the Uniterl States.
ing system
(3) \,\/here proportioning systems used are configured with a
primary proportioning system and a reserve medical air
comp1·ess01· pet· 5.1.3.5.3
(4) Alarm at a prerletern1ined set point. before the reserve
supply begins to supply the system, indicating reserve
supply in use
(5) Alarm at a prerlete1·minerl set point, before the reserve
supply contents fall to one average day"s supply, indicat­
ing reserve low
\Vater-in-receiver alarms are not required for a proponion­
ing system.
The enginee1·ing controls shoulrl include, as a minimum, the
following:
(1) Engineering controls should he in place when the sources
of oxygen USP or nitrogen NF, or both, are the same
sources a� those supplying the oxygen USP or nitrogen
NF pipelines, or both, for other uses within the health
care facility, anrl the following shoulrl apply:
(a) In ca�es whe1·e a new supply system is installerl, or in
cases whe1·e one or more hulk supplies are used to
supply the mixer, bulk systems and vaporizers
should he sized fo1- total peak rlemand flow, includ­
ing peak demand flow to the mixe1· and any other
area� of utilization.
(b) Ope1·ating limits shoulrl be established, at a mini­
mum. f01· the oxygen and nitt·ogen som-ce pres­
sm·es, both high anrl low, anrl for the medical air
oxygen concentration, both high and low, based
upon USP specifications. A process upset can be
rlefined as an exctu-sion in tl1e process winrlows
established for oxygen and nitrogen source pres­
sures or merlical air oxygen concentration, or both.
A means to detect excursion from these p1·ocess
limit� and power failure should be provided.
(c) At lea�t one dedicated valve or other control should
he installed in the proponioning system and/or the
line(s) between the o:i--ygen and/01· nitrogen supply
system(s) and proportioning system. The pm-pose
of the dedicated control (s) is to prevent the cross
contamination of the oxygen anrl nitrogen lines rlue
to product backflow a� follows:
i. The control (s) shoulrl he separate from the
valve(s) or other device(s) used to control
oxygen flow and nitrogen flow 111 normal
operation .
ii. The control(s) shoulrl not cycle in normal
operation .
111. If installerl in the line(s) between the oxygen
or nitrogen supply system(s), or both, and
proportioning system, upon activation of the
control(s). an alarm should he sent to the

2021 Edition
 ANNEX A 99-169

Turned down
-,�nd s creened

Duct ',, or if

�-:'-,,,,.
Note: An intake filter
is required (not shown).

Carbon
monoxide
and
dew point
monitors
Automatic
6 Ball valve
� trap and ¼NPT
sample port

'
Check valve drain l!J
N Pressure
© Pressure '1;l relief

t
indicator valve
Demand check D.P. Dew point Note 1: See also Figure A.5.1.3.6.3.9(F) for
arrangement of control components.
Pressure Pressure switch
� regulator Note 2: Unions or other disconnect means can be

LJ.
Filter with ■ Vibra tion isolator required for maintenance and/or replacement of

=®
change indicator each component.

Compressor that adds

no oil to the air

FIGURE A.5.1.3.6 Elements of a Typical Duplex Medical Air Compressor Source System
(Category I Gas Systems).

facility. The control(s) cannot exist exclusively
via the use of check valves.
(d) In the event of a process upset, the rlerlicated
contrnl (s) should e ithe1· positively isolate the supply
of oxygen or nitrogen. or both. from the mixer. or
the rlerlicaterl control(s) should reduce the mixer
p1·essure to less than half of the minimum final line
p1·essure values, each, fo1· the oxygen anrl nitrogen
lines. In the event of a process upset, the control (s)
should operate. Manual 1·eset should be required to
1·estart the proportioning system.
A.5.l.3.6.3.14(C)(9) The proportioning system should be
monitored for conditions that can affect air quality during use
or in the event of failure, based on the type of proportioning
system rlesign used in the system, including the following situa­
tions:
(1) Where proportioning systems that are confi gured with a
p1·imary proportioning system and a resenre medical ai1·
manifold per 5.1.3.5.10 a1·e userl
(2) ,.vnere proportioning systems that are confi gured with a
pt·imary proportioning system and a reserve proportion­
ing system are used

2021 Edition
99-170 HEALTH CARE FACILITIES CODE
Dryers Filters Regulators
Either Either
Dryers Filters
FIGURE A.5.1.3.6.3.9(F) Alternate Valving S equences for Line Controls in Medical Air.
(3) Where proportioning systems that are configured with a
primary proportioning system and a reserve medical air
compressor pet· 5.1.3.5.10 are userl
(4 ) When proportioning systems a1·e configured to ala1·m at a
prerletermined set point before the reserve supply begins
to supply the system, indicating reserve supply in use
(5) When proportioning systems a1·e configured to ala1·m at a
pt·edeterminerl set point befo1·e the reserve supply
contents fall to one average clay's supply, indicating
1·eserve low
Water-in-receive1· alarms a1·e not requirerl for proportioning
systems.
A. 5. I.3. 7 See Figme A.5.1. 3. 7.
A.5.1.3.8 A functioning ·wAGD system allows the facility to
comply with occupational safety requirements by preventing
the accumulation of waste anesthetic gases in the work environ­
ment.
VI/AGD using an HVAC (heating, ventilation, and air­
conditioning) system a1·e not \\1thin the scope of Chaplet· 5.
Flammable and nonflammable g-dses are known to be incom­
patible with some seals and piping used in medical-surgical
vacuum systems. If WAGD is to be included as pan of the medi­
cal-sut·gical vacuum system, it should be recognized that this
activity might cause deterioration of the vacuum system. The
2021 Edition
Either
Regulators
station inlet perfom1ance test� outlined in 5.1.12.4.10 a1·e
extremely important in maintaining the integrity of the medi­
cal-sm·gical vacuum system, and they shoulrl be made at more
frequent intervals ifWAGD is includerl in the vacuum system.
A.5.1.3.8.1 Interfaces are provirled ,�th overpressure, under­
p1·essure, overflow, and unrlerflow compensat ion to ensure the
breathing ci1·cuit is isolated from the \'\'AGD system.
A.5.1.3.9 See Figure A.5.l.3.9(a), Figure A.5.l.3.9(b), and
Figme A.5.l.3.9(c).
A.5.1.3.9.1 See Figure A.5.1.3.9.1.
A.5.1.3.9.2(2) Oxygen concentt·ators have inherent risks
because they might not be able to instantaneously begin
producing oxygen of the necessary concentration anti quantity
from a "cold start."' For these reasons, cylinder header(s) are
often preferable as one 01· m01·e of the tht·ee sources. The cylin­
rlers ,�II supply the sys tem while the concentrntor presstll"izes
and purges itself to the desirerl concentration of oxygen. Cylin­
ders are also independent of electricity and can provide a
supply of oxygen in the event of power interruption.
A.5.1.3.9.2(5) The method used elsewhere in this rlocument
to pro\1de these characteristics will be found in the final line
regulator 1·equiremenl� unrler 5.1.3.5.5. This method woulrl be
suitable for oxygen supply systems using concentrntor(s) as
well. However, the pressure differential between the output of
 ANNEX A 99-171

Turned down
Vacuum and screened

)---.... ,,-~,
exhausts
I \ I \
I Either \
I bypass I
\ arrangemen} I
I
-
\ I \

' - ..,,, / \. I
Manual
.... ,/

Sour ce
valve

• Filter

c5 Ball valve
Check valve
(point in dir ection of flow)

© Vacuum

t
isolation indicator
Pumps
means
(valve shown) Demand check

Note: Unions or other disconnect means can be

required for maintenance and/or replacement of - V ibration isolation
each component.

FIGURE A.5.1.3.7 Elements of 'fypical Duplex Vacuum Source System (Category I Vacuum Systems).

the concentrat01· and the system line pressure is often very
small, making the use of regulators problematic. In this case,
alternate control arrangements (e.g., pressure control through
variable speed drives) might be more effective.
A.5.1.3.10 For bulk oxygen systems. see NFPA 55. Two possible
choices of reserves are illustrate<l in Figure A.5.1.3. lO(a) and
Figure A.5.1.3.lO(b). Both are not require<l.
A.5.1.3.10.1.1 The cryogenic fluid centrnl supply system
shoul<l be installed on a site that has been prepared to meet
the requi1·ements of NFPA 55. A storage unit(s), reserve, pn·s­
sut·e n·gulation, and signal actuating switch(es) a1·e compo­
nents of the supply system. Shutoff valves, piping from the site,
and electt·ic wiring from a signal switch(es) to the master signal
panels a1·e componenl� of the piping system. f55:A. l 7. l .l]
The ctyogenic fluid central supply system is normally in­
f
stalled on the site by the owner o the equipment. The owner
or the m·ganization responsible fot· the operation and mainte­
nance of the bulk supply system is responsible fot· ensu1·ing that
all components of the supply system - main supply, reserve
supply, supply system signal-actuating switch(es), an<l delive1y
pressure regulation equipment - function properly before the
system is put in sen-ice. 1"55:A.17.1.1 l
A.5.1.3.10.8.3 For example. 2400 psi (16,550 kPa) rated cylin­
ders are not connected to the same manifol<l as 2015 psi
(13,890 kPa) rnted cylinders unless all cylin<lers. including the
2400 psi (16,550 kPa) cylin<lers, are filled no greater than
2015 psi (13,890 kPa). 1"55:A.17.8.31
A.5.1.3.10.1 l.4(A) A typical alternate material is stainless steel.
1"55:A.17.11.4. l l
f
A.5.1.3.10.12 TI1e local signal arose from the simple nee<l o a
maintenance pei-son to know what is going on with any given
piece of source equipment. Note that it is not an alann in the
sense of a local or master alarm. It is simply an indicator, which
might be a gauge, a flag, a light, or some other possible mani­
festation that allows a maintenance person to stan<l at the
equipment an<l know what conditions are present (e.g., which

2021 Edition
99-172 HEALTH CARE FACILITIES CODE

Gau ge and pressure sensor

for internal pressure
low alarm':..

Supply
Source A
Auxiliary connecti on
¥
r:,

Supply
Source B

Supply
Source C
t
·-."'.:..---.. �
...... -�..!•V \

Common line pressure

relief valve
\\,.. �";1

·-... _____1{______
,/,,, 02ffi %

t
Supply source
oxy gen monitor
\1
Source valve

1ine pressure
alarm sensor

Note: Drawing is illus tra t ive, alternative arrangements mi ght be accep table.

FIGURE A.5.I.3.9(a) Elements of an Oxyge n Concentrator Central Supply Sow-ce.

Oxygen Concentrator Unit

1--------------------

(Supply Source B)
V

1 Note: In this example, Source A will act as the

I

Oxygen Cylinder Header

_____________________ J primary source, and B will act as the reserve.

FIGURE A.5.I.3.9(b) Elements of an Oxygen Concentrator Central Supply Sow-ce with Two Sow-ces.

heade1· of cylinders is in service). The element� to be displayed
are typically those that will also be monitored at the maste1·
alarm, b ut the local signal is visible at the equipment rather
than remotely. [55:A.17.121
A.5.1.4 See Figure A.5.1.4.
Area alarms are required in critical care locations (e.g.,
intensive care unit�. coronary care unit�. angiography labornto­
ries, cardiac cathete1·ization laboratories, post-anesthesia recov­
ery rooms, and emergency rooms) and anesthetizing locations
(e.g., opernting rooms and delivery rooms). Refer to rlefini­
tions for these areas.
f
A.5.1.4.3 The presence of a main line shutof valve is optional
where the smu-ce valve can equally or more effectively perfo1·m
the same function. An example is a case whe1·e the source is
within the building or just on the ournirle of the building and,
the1·efore, there woulrl be no great distance separating the two
valves. A source that was physically separate from the b uilding
woulrl requi1·e both valves to enstu-e the intervening piping
coulrl be controlled.

2021 Edition
 ANNEX A 99-173

(Supply Source A)

Oxygen Concentrator Unit

--------------------
(Supply Source B)

Oxygen Concentrator Un it

(Supply Source C)
V

V Note:
I In this example, Source A and B will alternate as
1 primary and secondary source, and C will always
Oxygen Cylinder Header act as the reserve.
_____________________ J

FIGURE A.5.l.3.9(c) One Example of an Oxygen Concentrator Central Supply Source in Practice .

G
Oxygen mon itor for
� concentrator unit
02 %
Automatic and manual
Air Side: � isolation valve
Oxygen Side:
Supply,
Concentrator Storage and
Conditioning,
Treatment
and Storage

J+-Vent to acceptable location

Note: Alternative arrangement might be acceptable

FIGURE A.5.1.3.9.1 Elements of an Oxygen Concentrator Supply Source.

A.5.1.4.6.1(2) A "standing position" is meant to refer to an
average-height individual standing with their feet on the floor
in front of the zone valve.
A.5.1.4.6.1(3) Wheelen equipment, such as what is permitted
to be located in a corrido1· in acconlance with 18.2.3.4 and
19.2.3.4 of NFPA 101, does not 1·ender zone valves inaccessible
if located in front of the zone valve. Those sections permit
wheelerl equipment and eme1·gency equipment in use, merlical
emergency equipment not in use, anrl patient lifi: anrl transport
equipment. The zone valve needs to remain visible.
A.5.1.5 Station outlets and inlet� should be locaterl at an
apprnp1·iate height above the floor to prevent physical damage
to equipment attached to the outlet. The minimum number of
station outlet� anrl inlet� for each system that is installed should
be pro\�ded pet· the applicable volume of FGI guirlelines or
other federal, state. or local codes.
A.5.1.6 Manufacturerl a�sembly examples include headwalls,
columns, ceiling columns, ceiling-hung pendant�, movable
track systems, and so fonh. See Figure A.5.1.6.
A.5.1.7 It is the intent that surface-mounted medical gas rail
systems would be pennitted in inrli�dual patient rooms but
woulrl not be pe1·mitted to go rlirectly through room walls to
a�acent patient rooms. However. it is the intent to permit
surface-mounterl merlical gas rails to be used in a given Cate­
gory l space where the1·e can be a partition separating certain
patient care functions, essentially lea\ing the system within the
given Category l space. A� an example, two adjacent patient
rooms out�ide of a Categm·y l space care unit would not be
pe1·mitted to have a surface-mounted merlical gas rail intercon­
nect between the two rooms through the wall. However, in a
nursery where there might be one or two segregated areas for
isolation, a medical ga� rail system suppl�ng more than one
isolation room, but within the nu1·se1·y a1·ea. would be permit­
terl to be interconnected with the nursery system.

2021 Edition
99-174 HEALTH CARE FACILITIES CODE

Place of Wood frame

public structure
assembly

�--�15m Jm
Parked (50 ft) (5o ft)11m
f ',,
',
Clearance for ventilation
vehicles (35 ft) ', ' (in courtyards and confined areas)
�3.0
(10
1.5m xygen
(5 ft) --------- bul 23m
--- -(75 ft)----�
u
15m
(50 ft)

Nearest
Nearest opening in wall 1 nonambulatory
or other structure t patient
L ______

All classes of flammable and combustible

Solid liquids above ground
rapid-burning material -

0,�lll�f;. /�!'�
4 L-3800 L (1gal 1000gal): Can be reduced to
15m
( ft) [ 7.6 m (25 ft) - } 4.6 m (15ft)for
' over 3800 L (1000 gal): 15m(50 ft) Class IIIBcombustible liquids
__ ]
\_ . ,..
- 4 L 3800 L (1gal 1000gal) liquefied
23m -gas or 707,921- L (25,000 ft 3) Other
Liquefied Oxygen
hydrogen (75 ft) nonliquefied gas , 7.6 m (25 ft) •-----;.., flammable
/ unit
storage Where greater than these quantities, gas storage
7_6 m �---'-
(251t) L 15m(50ft)
\ �

7,�� �
Solid (25 ft) 4.6 m

��;;�J:,��::�0,�
0/" opening All classes of flammable
···,\:t {?i'::\,j:\i(:f
, ··�·- ·-·�· and combustible
- - - - -1 _ _ _ _ _ _ liquids below ground

FIGURE A.5.1 .3.IO(a) Distance Between Bulle Oxygen Systems and Exposures.

A.5.1.8.1.3 1l1is gauge would therefore be suitable for any ( 2) Where the audible alert will best carry throughout the
operating pressure of 690 kPa to 1 380 kPa (100 psig to unit being surveilled
200 psig). ( 3) i-Vhere the panel is visible from the largest number of
rooms, be<ls, or stations within the zone
A.5.1.9.2 See Table A.5.1.9.2. (4) \¾l1ere visualization of the panel ,,'ill not be blocked (e.g.,
A.5.1.9.4 See Table A.5.1.9.4. by cabinet do01·s, c arts, room doors, ctlt"tains, supplies)
( 5) At a height above the floor at which the panel can be
A.5.1.9.4(2) Examples of Category l space include post­ comfortably viewed anct at which the m ute button can be
anesthesia recovery, intensive care unit�, and emergency conveniently accessect
depanrnents.
A.5.1.9.4.4 See Figure A.5.1.4.
A.5.1.9.4.l Area alat·m panels should be place<l in a location
that will most closely fulfill the following criteria (recognizing A.5.1.9.4.4(1) This signal is intendect to provide immediate
that no existing location might fulfill all criteria): warning for loss of, 01· inct"ea�e in, system presstlt"e for each
in<livictual vital life support anct Categ01·y l space.
( l) Neat· 01· within the location where the staff v.'ill most often
f
be present (e.g., a staf ba�e, a nurses· station)

2021 Edition
 ANNEX A 99-175

-------------
, Reserve tank pressure
, switch/sensor
Bulk liquid reserve
,,,
I

Reser ve c'ontents
indicator and switch/sensor
,,,

Final line controls

Economizer

--------
' /
I
I
I
I
I
I

L Check valve
Reserve-in-use alarm
switch/sensor

\.
Intermediate
-.1+...,.:ir.af-�f----------...L---· . .,._ .. _________
relief valve
E ither

Check valve Primary/secondary supp lies

Main

,, .. '
"-----------
I \

Main contents
indicat or and
switch/sensor
•
,,,
I

I 1,
,,_.,J­
,1 .. ...

� u.,
I " •

L----------i
" I

'} , ., - .....-, #' (

\ I'
-, Header
I ,
,... I '
\
\
r - - �' \ - - - Gas cylinder reserve
- I
J; - - :•

FIGURE A.5.1.3.IO(b) Typical Source of Supply for Cryogenic Gas in Bulk.

A.5.1.9.4.4(2) T his signal is intended to provide immediate A.5.1.10.1.4 Operation of piped medical ga� systems at gauge
\varning for loss of, or increase in, system pressure fot· all anes­ pressures in excess of 1275 kPa ( 185 psi) involves certain
thetizing locations supplied from a single branch line - not restrictions because of the limitations in materials.
fot· each individual operating or delivery room.
A.5.1.10.1.4(2) The listing should include a specific system
A.5.1.9.5 Activation of any of the ,varning signals should geometry representative of medical ga� systems.
immediately he 1·eported to the depai-tment of the facility
f
responsible for the medical gas piping system involved. f the A.5.1.10.2.3.2 Such dual labeling should include the somce,
medical gas is supplied from a bulk supply system, the owner or piping, valves, and alarms.
the 01·ganization 1·esponsible for the operation and mainte­ A.5.1.10.3.1 A distinction is made between deep-socket solde1·­
nance of that system, usually the supplier, should also be noti­ joint fittings (ASM:E B16.22, Wrought Copper and Copprr Alloy
fied. As much detail as possible should be provided. See Table Solder-Joint Pl"l'.mm Fittings) and those having shallow sockets for
A.5.1.9.5. brazing (ANSI/ ASME Bl 6.50, Wrought Cnpprr and Copper A.Uoy

2021 Edition
 &
99-176 HEALTH CARE FACILITIES CODE

Note: Single s ervice valves are shown,

but multiple zones can branch off a
single service valve.
Area alarm
switch/sensor
( See Note 2.) Service valve
Future valve
(See5.1.9.4.) Q (See 5.1.4.5.)
Service valve
(See 5. 1.4.B.) 1 (See 5. 1.4.5.)
D.C. r-----�[':IE-...;
[:-�I:'{')-------,-.......--

Outlet(s)/inlet(s)
Q
0Outlet(s)/inlet(s)
Zone
valve�--�
(See 5.1.4.6.)
Critical areas (such as intensive care) Noncritical areas (such as general patient rooms)

Riser

Area alarm
switch/sensor (See Note 3.)
Riser valve(s)
(See 5.1.4.4.)
0 (See 5. 1.9.4.)
D.C.

f
Source or
main valve Service valve
(See5.1.4.2 (See 5.1.4.5.)
and 5.1.4.3.) Indicates a valve that must be secured

0
Zone valve �-� Outlet(s)/
(See 5.1.4.6.) inlet(s)
Notes: Anesthetizing areas
1. Drawing is representational, demonstrating a possible arrangement of components
required by the text. The diagram is not intended to imply a method. materials of
construction, or more than one of many possible and equally compliant arrangements.
Alternative arrangements are permitted if they meet the intent of the text.
2. Area alarms are required in critical care locations (examples might include intensive care units,
coronary care units. angiography laboratories, cardiac catheterization laboratories, post-anesthesia
recovery rooms, and emergency rooms) and anesthetizing locations (examples might include
operating rooms and delivery rooms). Refer to definitions for these areas.

3. Locations for switches/sensors are not affected by the presence of service or in-line valves.

FIGURE A.5.1.4 Arrangement of Pipeline Components.

Bmu-jnint PrP.mire Fittings). The use of shallow-soc ket bt·azing
fittings imprnves the quali ty of the brazement without decreas­
ing its strength, particularly in larger sizes, which are difficult
to heat. See Table A.5.1.10.;U for socket depths conforming to
ANSI/ASME B16.50. The installer can use ANSI/ASME B16.50
fittings (if available) or have the socket� on ASME Bl6.22
fitting� cut down to ANSI/ASME B16.50 depths. Where
shallow-5ocket fittings a1·e used for the medical gas piping, care
should be taken to avoid their use in other piping sy�tems
wherejoints could be soldered instead of brazed.
A.5.1.10.4.5.12 1l1is is to enstn-e a quality joint and to p1·event
the formation of copper oxide on the inside and out�ide suti"a­
ces of thejoint.
A5.I.I0.5.l.5 Gas mixtures are commonly used in GTA¼'
autogenous fusion welding. The identification of a gas mixttlt"e
a� "75He 25Ar" is a common industry term to define a commer­
cially available grade from gas suppliers. If test welding result�
lead to questions about the mixtut·e pet-centage or gas quality,
another bottle should be substituted and test welds performed.

A5.I.I0.4.5 The intent is to prnvide an oxygen-free atmos­ A5.I.I0.8(3) It is intended that the "recommended for
phere ,,�thin the tubing and to pt·event the fonnation of oxygen service"' apply to both polytetrafluornethylene tape as
coppet· oxide scale dming brazing. This is accomplished by fill­ well a� the "other thread sealant ...
ing the piping ,�th a low-volume flow of low pressure inert gas.

2021 Edition
 ANNEX A 99-177

St andard terminal Terminals in manufactured assemblies system should be labeled to indicate medical-surgical vacuum
only.

D.I.S.S.
A.5.1.11.2.8 It is not intended that every room be listed on the
Secondary primary Braze label, but an a1·ea that is easily identifiable by staff needs to be
check coupling indicated. This can be accomplished with text or by graphical
'I
c heck
means such as a map or color coding. The label should be
---,
,a
I I
I I 1-
� pe1·manently affixed outside and nea1· v.1lve box. The label
I�- CD should not be affixed to a removable cover.
,o
Q·
check
,-
lo

�,~��
£. A.5.1.l 1.4.2 It is not intended that every rnom be listed on the
13 3
., label, but an area that is easily identifiable by staff nee<ls to be

[3
I :::,
a,
I le
:::,
C indicated. This can be accomplished with text or by graphical
lw al'
{User}
uC means such as a map or colo1· coding.

'
IQ.
gas-specific 1<=
adapter I iil iil A.5.1.12 All testing should be completed before putting a new
I a.
., a.
., piping system, or an addition to an existing system, into service .
(/)
(/)
(/)
Copper p ipe
I CD
(/)
CD Test procedm·es and the result5 of all test5 should be made part
,3 3
,¥
I
cr
1'<
of the permanent reco1·ds of the facility of which the piping
system fo1·ms a pan. They should show the room and area
Flexible hose L __ I_ __
assembly designations, dates of the tests, and name(s) of the person(s)
Secondary
conducting the tests.

n
check

WI
I I
{User}
Primary
gas-specific
adapter
check
{User} : ,
gas -specific �
adapter
FIGURE A.5.1.6 Terminals in Manufactured Assemblies.
A.5.1. 10.11.4.4 CMT is coate<l with a nonmetallic jacket with
an O.D. equal to a la1·ger copper tube size than CMT. The CMT
manufacturer's installation instructions should identify accepta­
ble solutions.
A.5.1.11 It is recommended that the facility's normal operat­
ing pressure of nitrous oxide be initially set and continually
maintaine<l at least 34.5 kPag (5 psig) below the normal operat­
ing pressm·es of the oxygen and medical air·.
Piping systems that ar·e connected through blending devices
are in effect cross-connected through the device. In the rare
event of a faihu-e of the safeties inside the equipment, the
possibility of having the gases flow across the device exists.
When the device is an anesthesia machine, and one of the
gases is nitrous oxide, a pressure in the nitrous oxide pipeline
greater than the p1·essm·e in the medical ai1· 01· oxygen system
opens the possibility of nitrnus oxide flowing into the other
pipelines. A patient could then receive a lethal quantity of
nitrous oxide from a labeled and indexed medical air or
ox-ygen outlet . Adjusting the pressure as 1·ecommended c:.111
reduce the likelihood of the causative equipment failure and
also reduce the severity of the problem in the event it does
occur.
A.5.1.11.2.3 It is not intended that all valves on a medical­
surgical vacuum system be labeled as both medical-surgical
vacuum an<l \VAGD. Rather, any valve when closed 01· opened
that would affect the medical-surgical vacuum and WAGD
should be labeled to indicate that it controls both of those
systems. Valves that would cause no change in the WAGD
A.5.1.12.2.3.5 Ammonia is known to cause stress cracking in
copper and it5 alloys.
A.5.1.12.2.6.1 Examples of <list1·il.mtion system component�
inclu<le, but are not limited to. p1·ess111"e alarm devices, pressure
indicators. line pressure relief valves, manufactures assemblies,
and hose.
A.5.l.12.2.6.5 The eHect of temperatm·e changes on the pres­
sure of a confined gas is based on the Ideal Gas Law. The final
absolute pressure (P2a) equals the initial absolute pressure
(Pia) times the final absolute temperature (T2a), divided by
the initial absolute temperature (Tla). The relationship is the
same for nitrogen, nitrous oxide. oxygen, and compresse<l air.
Absolute p1·essure is the gauge p1·essure 1·eading plus the
absolute atmospheric p1·essure. See Table A5. l.12.2.6.5 for the
absolute atmospheric pressures for elevations at and above sea
level.
Absolute temperatm·e K ( 0 R) is the temperature gauge 1·earl­
ing ° C ( ° F) plus the absolute zero temperature 273 ° C (460 0 F).
Examples of pressure test data at sea level in SI and IP units
follow.
The initial test pressure is 41!'> kP ag (60 psig) at 27 ° C (80 ° F).
A temperature decrease to l 8'C (65'F) will cause the test pres­
sure to drop to 400 kPag (57.9 psig).
Pig= 415 kPag, Tlg = 27 ° C. T2g= 18 ° C, Pig= 60 psig. Tlg
= 80 0 F. T2g = 65'F
Pla=415+ lOl =5l6 kPa Pla = 60 + 14.7 = 74.7 psia
Tla = 27 + 273 = 300K Tla = 80 + 460 = 540 ° R
T'2a=18 + 273 = 291K T2a =65 + 460 = 525 ° R
P2a= 516 x 291/300= P2a = 74.7 x 525/540=72.6 psia
501 kPa
P2g= 501- l0l= 400 kPag P2g= 72.6- 14.7 = 57.9 psig

2021 Edition
99-178 HEALTH CARE FACILITIES CODE

Table A.5.1 .9.2 Requirements for Category I Master Alarms for Gas and Vacuum Systems

Manifold for
Cryogenic Medico!-
Manifold Liquid Cryogenic Bulk Cryogenic Bulk Medico! Air Surgicol
l'or Gas Cylitders wil.h \,\,·ilh Cryogenic wich Cylinder Proporlioning Medical Air Instru.mem Air Veicuutn WAGD 0X)'g1:!fl
Cylinders Reserve Reserve Reserve System Compr essors Compre�rs Pumps Producers Conceouacor
Alarm Co:nditlo:n (5.1.3.9.1) (5.1.3.5.I 2) (5.1.3.5.13) (5.1.3.5.15) (5.1.3.6.3.13) (5.1.3.6) (5.1.13.3.4) (5.1.3.7) {5.1.3.S) (5.1.3.9)

J\"itrngl·n main lint­ :l.l.9.�.4(7)

prt>.<;.surt" high
1\"itrugc-n main line. 5.1.9.2.-1(7) 5. l .9.�.4 (7 )
pre.�sure- km
J\"itrngl'll rh;uigt>o\'er lo fi. l.3.H.1.0 :l.13.�_J 2.�)( I),
�c-condary !-.1tppl� :l.1 .9.�.4( l) :l. 1.9.2.-1(1 �

:t\ir.mge.n main .�uppl� 5.1.9.2."t(�). 5.1.�(�.-H�).

leM rhan 1 day (lo,,, ,,.l.,!.10.1�(1) !i.1.'.U0.12(1)
COntl:"llt'>)
!i.I.:l.!i.12.\l\:>), :"d.�•.2.4('.1). 5.1.9.2.4('.J),
5. U•.�.-!C1} !i.U.10.12(�) 5.1.'.-U0.1::!(�)
:t\itnJg'r:'11 1't"Sl"'n"e. .�upply 5.1.9.2.-tt•H, 5.1.9.2.-1(5). 5.1.9.�.4(4),
le,�.'I rh�m I day (lo,, :"d.'.-U'i.l�.9(4} 5.U.10.1�(�) 5.U.10.1�(�)

:t\ir.mge.n rtsr:ne 5.1.9.2.-!(6).

prt".'iSUrt" Low (1101. ,,.1.:1.10.\�(-l)
hrnnion<.ll)
Carbon dio'.ll..idf' main 5.1.9.2.4(7}
linC" pn•.,,;;ure high
Carbon dim,.idf" main G.l .9.t.4(7)
Ii ne pr,...,1;tuf" Lm\·
Carbon dio'.ll..id,... 5.1.3.9.1.6 :'J. l .�{.5.1 :?.9( IL
c.hangen\f"r en :'J.1.9.�.-!(l) �.l.� -�.4(1>
➔

.SC"f'unda1:--• suppl �·
Carlmn di oxide: main 5.l.9.2.'t(�). 5.l.�l-�.-1(�),
.supply le. ..,,;;than l day !"1.LJ.10.l:?(l) 5.l.'.U0.12(1)
(km· conu'·nts)
Carlmn diuxide- re-��r\'e 5.1.'.·t�_J '.-?.�}('.{). :i.1.�•-2.4(:{), 5.1.9.2.4('.J),
in tL�f' 5.1.9.�_4(:,S} 5.13.10.12(�) 5.1.;"U0.1::!(�)
c:a.rbon dioxide re-serve- 5.1.3.!"i.l �.9(4) 5.1.9.2.-1(5), 5.1.9.�_4(5),
.supply le."'" 1.h,m I da) :>.1.3.10.1�(3) !i.13.10.1�(�)
(IO\\ C.OlHt'l1LS>
C ;;u·bon dioxide Tf"!-ot"T\'l": 5.1.9.�.4((\),
prt"�1-,ur,... 101.\ ( not :i.l.,!.IO.lt(4)
hmniona.l)
Jl,frdi..-;tl air main line 5.1.9.�.4(7>
prt!i.sur-. high
Medical �1ir main linf" 5.1.9.1.4(7)
prt"�.sur,... Im,·
Jl,frdi..-;tl air ch�rngf"m"f"r 5.1.3.9.l.6
10. St'·condary suppl} :'J.I .�(�.-1(1)
Medical �1ir de\,• p11iu t !i.1.3.h.3.l'.l(l)
high ri.1.9.2.4(1m

J\·1ediral air production

�I. op

Ch:..ygt"n ma.in lin, �. l.9.�.4(7)

prt�N.H'e high
0>:H,{en main linf" :J.1.9.2.4(7)
pre�.sure Im\·
(h:..ygt"n cha..ngeo\'f"l' ,o 5.1.3.9.l.6 :1,I.:t5.l�.9 (l)
:-.econda!)'sltppl) :)_ I .9.�.-1( I) :)_l.� -�.4 (I>
➔

O>:)gen main suppl�· 5.l.9.2.·H2). :J.1.9.2.4(2).

lt".�s rh;m
. I day (lu,,, :>.1.3.10.1�(1) :>.1.�.10.1�(1)
Cl1ntent,;;)
5.1.:t:i.l:?.9('.-t> 5.l.9.2.-1(:1), 5.l.9.2".4(�),
:).J.H.2.4(:l� :i.13.10.1::(t) !\l.'.1.10.12(�)
ru.9.2.4(:i)
Oxygt"n re.�e1;.,,... .<,upply 5.1:110.1�('.I) !\1.'.1.10 121'.I)
lt>.�s f.h;m I rJay (lu\\•
n1ntt"nt,;;)
Ox.ygf'n re. .. t"1�·c !i.l.9.2.4(6),
prt"�1-,ure Im\ ( not :i.I.:!.10.11(4)
functi( 111al)
1\itmm o>,,idf" main lint. :i. l.�•.2.4(7) 5.1.H.2.'±(7> 5.1.9.2.-1(7)
prts.Slfff" high
1\iu·ou.� oxidt' main lint' !i.l.H.2.4(7) :)_J.H.2.4(7) 5.1.9.2.4(7)
JJl't"Sslll' f" lo\.\·
1\itmm o>,,i<]f" :i.l.'.HU,6 5.1.3.:1. l �.9( l)
chang-f'O\"f"r t(1 :),l.9.t.4(1) 5.1.H.�.4(1>
!-oCCond�rr !-lllpply
1\ir.n.iu.� oxk1f" main 5.1.9.2.'t(�). :)_l -�(�_-!(�),
�upply ll"'s.<, 1han . 1 drty :il.,110 12(1) S 1.:11012(1)
.
1\itruu.� oxidf" rl"'SC"l.,.'f" in :'J.1.9.�.4('.{). 5.1.9.2.4(:�). �.1.9.�.4(:{).
l.i..�t" !'"i.l.'.-U'i.l�.�1(:1> !i.13.10.12(2) 5.1.:1:.10.1::(�>

(ronlit11wt)

2021 Edition
 ANNEX A 99-179

Table A.5.1.9.2 Continued

.Manifold for
Cryogen ic Medkal­
Manifold Liquid Cryogenic Bulk Cryogenic Bulk Medico! Air Surgicol
for Gas Cylinders with wic.h Cryogenic wi<h Cylinder Propon.ioning Medical Air Insm.une:ni Air Vacuum WAGD Ox�en
Cylinders Reserve Reserve Reserve s,,.,em Compressors Compressot"S Pumps Producers Conceo.Lrator
Alarm Cond ition (5.1 .3.9. I) \5.I.3.5.12) (5. 1.3.5.13) (5.1.3.5.15) (5.1. 3.6.3.13) (5.1.3.6) (5.1.13.3.4) \5.1.3.7) (5.1.3.8) (5.1.3.9)

Nitrous oxide re--en·e 5. l .3.fi.12.9(4) fl.1.!).2.4(f>), :J.1.9.2.4(5),

.supply le&5 than 1 day 5.U.10.12(3) 5.1.3.\0.12(3)
(low coments)
Nit.rmi.,;; oxide reserve 5.U>.2.4(6).
pressure low (not ,,. 1.3. 10.12(4)
functional)
Medica1---!iurgiral 1nain 5.1.9.2.4(8)
line vacuum low
\.\TA(.;.D main line 5.\.!).2.4(11)
vacuum low
Local alarm :i.t.H.2.4(U), :J.l.3.f).3.1� 5.1.1:�3.4.ll 5.1.3.7.� 5.1.3.H.3.2
�-1-�L�.2 , 5.1.�.2.4(9) 5.Ul.2.4(!l) 5.1.!l.2.4(9) 5.l.!l.2.4(9)
) )
5.l.3.6.3.l 4(C (!l 5.l .!l.5.2 !"t.1.9.5..2 5.1.!l.5.2 5 .1.!l.5.2

lm,crument air main ,.1.i1.2.4( 7l

line pres.o:;ure hig-h
ln..;trument air ma in 5.1.9.2.4( 7)
line prf"S.'HJre low
lnslrument air dew o.1.1 :l.3.4.11(A) (2 )
point high 5.1.9.2.4 (1 2)
Instrument air c.ylindr-r :>.l.13.3.4.11(B)( I)
reserve in uSf' ( if
provided)
Instrument air C-'lllinder ,,. I.I �.3.-U I (B)(2)
resr-rve lr-.'�S than l­
hour supplr

(hygen concr-111rator 5.1.3.9.1.13(2)

low conct"ntration ,,.1.:1.9.2(10) (c)
:..1.3.9.4.1 (5)
r..1.9.2.4(14)(b)
Oxygen concentrator 5.1.3.9.1.12(:i)
,offline f,.1.:1.9.4.l(!i )
:,_ l.9.2.4 (14)(b)
"· J.3.(J.4.3(2)
!i.1.9.2.4(3)
,,.l.9 .2.4(14)(c)
Ox}·gen reserve supply 5.1.3.9.4.3(3)
less than 1 day (Lo,.., r..1.9.2.4(4)
content�) !i.1.9.2.4(14)(rl)
Oxygen main line low r,. l.3.9.4.2(4)
concenu-ation ,,. 1.9.2.4( 14)(gl
Oxygen main linf" high 5.1.3.9.4.2(:i)
concentration !i.1.9.2.4(14) (h)
Oxygen main line r,. l.9.2.4(7)
pre.,;;.surt- high
Oxygen main lint­ 5 .l.!l.2.4(7)
pre.ssure low
Oxygen dun ge of ,,.1.3.9.4.4( I) (a)
source
Oxygen concentrarnr 5.1.3.!l.4.4(2)
inter nal pressm·e- Im.., !i.1.!).2.4(14) (I)
Oxygen C'onrenlrafor
local alarm

2021 Edition
99-180 HEALTH CARE FACILITIES CODE

Table A.5.1.9.4 Requirements for Category I Area Alarms A.5.1.12.4.2 This is the final pt·essure test of the completely
installect system and is i ntended to locate any leak� that would
Alarm Condition Requirement Location be more likely to occur at lower pressut·e (e.g., leaks in station
outlet valve seals).
High line pt·essure (for each ga� 5. l.9.4
piped to the area) 5.1.9.4. l A5.l.12.4.6.4 Odor is checkect by sniffing a moderate flow of
5.1.9.4.2 gas from the outlet being tested. Specific measu1·e of odor in
5.1.9.4.4 gas is impractical. Gas might have a slight odor but the pres­
ence of a pronouncect odor should render the piping unsatis­
Low line pressure (for each ga� 5.1.9.4 facto1y.
piped to the area) 5.1.9.4. l
A.5.1.12.4.8 The detect01· used for total hydrncarbons is cali­
5.1.9.4.2
bratect with a g-as that has a known quantity of methane. 'iVhen
5.1.9.4.4
a sample is run with this calibrated detector, the result will be
Low mectical-surgical vacuum 5.1.9.4 total hydroca1·bons as methane. Since methane is the one
(if piped to the area) 5.1.9.4.1 hyctrncarbon that does not interact with the bocty and is
5.1.9.4.3 present in all air and most oxygen, the actual amount of meth­
5.1.9.4.4 ane in the sample is subtractect from the tolal hydrocarbon
1·esult to give total non-methane hydrncarbons.
Low WAGD vacuum (if pipect to 5.1.9.4
the area) 5.1.9.4. l A.5.1.12.4.10.6 Sleep laboratories are an example of where
5.1.9.4.3 gas flow anct concentt·ation are frequently modified.
5.1.9.4.4 A5.l.12.4.11(3) The committee 1·ecognizes that current clini­
cal practice is to use analyzers that might not be able to analyze
oxygen to cun-ent USP requirements of 99 pe1·cent and that
A5.I.12.2.7.5 The effect of temperature changes on the
these analyze1·s frequently have an error of up to 3 percent.
vacuum of a confinect gas is based on the Ideal Ga, Law. The
final absolute vacuum (V2a) equals the initial absolute vacuum A.5.1.13.1 Medical support gas systems are su�ect to the same
(Vla) times the final absolute temperature (T2a), divided by hazarcts as a1·e present in any pipect mectical gas system, witl1
the initial absolute temperature (Tl a). the additional haza1·ct of opernting at highe1· pt·essures.
Absolute \acuum is the absolute zern p1·essu1·e 101 kPa (30 A.5.1.13.1.2 Examples of medical support gas uses include,
inHg) less the 'vacuum reading below atmospheric. See Table but are not limited to, 1·emoving excess moisture from inst1·u­
A.5.1.12.2.6.5 for the absolute atmosphe1·ic pressures for eleva­ menl� befo1·e funhe1· processing anct operating gas-<lriven
tions at and above sea level. booms, boom brakes, pendanl�, 01· simila1· applications. Air of
other grades anct from sources other than instrument air can
Absolute temperature K ('R) is the temperature gauge read­
be apprnpriate fix general utility use, as well. See Chapte1· 8 for
ing °C ("F) plus the absolute zern temperature 273'C (460"F).
general utility systems 1·equi1·emenl�.
Examples of vacuum test data at sea level in SI anct IP unil�
A.5.1.13.3.7 See Figure A.5.1.13.3.7.
follow.
A.5.1.13.3.7.7 Drawing intake air from out�ide in compliance
The initial test vacuum is 54 kPa or 16 inHg at 18'C (65 °F).
with 5.1.3.6.3.11 is recommended.
A temperat111·e inct"ease to 27° C (80'F) will cause the test
vacuum to decrease to 52.5 kPa ( 15.6 inHg). A.5.1.14 All cylincters containing compressect gases, such as
anesthetic gases, oxygen, or othe1· gases used fot· medicinal
Far SI units:
purposes, whether these gases are flammable 01· not, should
°
V l g = 54 kPa, T l g = 18 ° C, T2g = 27 C comply with the specifications and be maintained in accord­
ance with reb11..Ilations of the U.S. Department of Transporta­
V l a = 101 - 54 = +47 kPaV tion.
T l a = 18 + 273 = 291K Cylinder and conlainer temperatures greater than 52'C
T2a = 27 + 273 = 300K ( l 25 ° F) can 1·esult in excessive pt·essure increase. P1·essure
relief ctevices are sensitive to tempernture anct press1u-e. 'i\'hen
V2a = 4 7 x 300/291 = +48.f', kPaV relief de\ices actuate, contents are ctischarged.
V2g = 101 - 48.5 = 52.5 kPa A.5.1.14.2.1 The process can be a subset of a cun-ently utilized
system, such as a preconstruction risk assessment.
Far IP units:
A.5.1.14.2.2(4) A procedure for the shutdown anct restoration
V l g = 16 inHg, T l g = 65'F, T2g = 80'F f
o medical gases during installation or maintenance of these
V l a = 30 - 16 = +14 inHgV systems can be founct in Annex J, "Recommended Guictelines
for Conducting Planned Medical Ga, Systems Shutdowns and
T l a = 65 + 460 = 525'R Temporary Backfeed," of ASSE 6000, PmfPssinnal Qualifimtinns
T2a = 80 + 460 = 540'R StandardJar M.ediml Gas Systems PPrsonnd

V2a = 14 x 540/525 = +14.4 inHgV

V2g = 30 - 14.4 = 15.6 inHg

2021 Edition
 ANNEX A 99-181

Table A.5.1 .9.5 Requirements for Category I Local Alanns

Medical Air Compressors

Medical­
Oil-less (Sealed Llqu.idRing Surgical
Bearing) Oil-Free (Separated) (Water-Sealed) Instrument Air Vacuum WAGD Oxygen
Alarm Condition 5.l.3.6.3.4(A)(l) 5.l.3.6.3.4(A) (2) 5.l.3.6.3.4(A) (1) Compressors Pumps Producers Concentrators
Low medical air fJ.l.3.6.3.l2(F) fJ.l.3.6.:U2(F) !i.1.3.6.3.12(F)
reserve Capacity 5.1.'f.!i.4(1) fJ.1.9.5.4(I ) 5.1.9.fJ.4 (I)
Low medical vacuum !i.U.7.!-1
reserve ca pad ty 5.1.'l.fJ.4(4)
Low WAGD reserve 5.1.3.8.3.2
capacity !i.l.'i.!i.4(fi)
Low instrument air 'i. 1.1'.D.4.11(A)
reserve capacity :,,l.9.'i.4(7)
Carhon monoxide fJ.l.3.fi.3.l,H2) 'i.l.3.fi.:l. l'.1(2) fJ.l.:J.6.3.1:l (2)
high 5. 1.'1.!i.4(2) 'i.l.!J.!i.4(2) !i.1.9.!i.4 (2)
High discharge air fJ.l.3.6.3.12(0) 'i.13.fi.:l.12(E) (I)
temperature !i. l.9.,lj.4(10) fJ.1.9.fJ.4(10)
High water in receiver fJ.l.3.6.3.l2(8) fJ.l.3.6.:U2(B)
5.1.'f.fJ.4(8) fJ.1.9.5.4(!-I) 5.l.3.li.3.12(B)
'i.l.'l.'i.4(8)
High water in 'i.l.3.6.:U2(C)
separator !i.l.<J.!i.4(9)
Medical air dew point !i.1.3.6.'.U'.i( I) !i.U.6.3.13(I ) !i.l.'.Ui.3.13(1)
high !i. 1.'1.'i.4(3) 5.1.9.'i.4(3) 'i.1.9.!i.4('.\)
Instrument air clew fJ. l.'l.'i.4(6)
point high !i.l.t:\.H.11(A)(2)
Oxygen concentrator !i.U.'1.1.1'.l(l)
low concentration !i.U.9.2(!0) (c)
fJ.t.:1.9.4.1(3)
Oxvgen concentraror 5.1.:\.9.1.13(1)
high concentration !i.l .3.'l.4.1(3)
Oxygen reser,e in use 'i.l.'\.'l.4.'.1(2)
'i.1.9.!i.4 (13) (a)
Oxyg·en resen·e supply !i.l.3.9.4.'\(3)
less than I day (low !i.l.<J.!i.4(13) (h)
contenLs)
Oxygen main line low 'i .1.3.'l.4.2 {'.!)
concentration !i.l.'Ui.4(1'.l) (e)
Oxygen main line !i.U.1 1.4.2 (3)
high concentration fJ.l.').fi.4(13) (I)
!i.l.1 1.!i.4( 13) (c)
Oxvgen change of 5.13.9.4.4(1) (a)
source
Oxygen concentrator 'i.l.'l.9.4.4(2)
internal pressure fJ.l.<J.'i.4 (I 3) (cl)
low

A.5.1.14.3.1 Piping systems fot· the distribution of flammable
gases (e.g., hydrogen, acetylene, natural gas) are outside the
scope of this chapter.
A.5.1.14.3.3 Vacuum systems from station inlets to the exhaust
discha1·ge should be considered contaminated unless proven
othenvise. Methods exist to disinfect the system or portions
thereof.
Clogging of regulators, for example, with lint, dehris, or
dried body fluids, reduces vacuum system performance.
A.5.1.14.3.4 Other examples of prohibited use of medical­
sut·gical vacuum would be scope cleaning, decontamination,
and laser p lume.
A.5.1.14.3.5 ,vhen spaces a1·e converted, the inlets and outlets
should be addt·essed in one of the following v,•,iys:
( 1) Inlets and outlets 1·emoved and tuhing capped
(2) Inlets and outlet� plugged and prm-ided with a hlank-off
plate
(3) Inlets and outlets remain accessihle for· maintenance and
testing
Other means deemed appropt·iate by the AHJ
(4 )
Prope1· decom missioning of systems should include identify­
ing them as not in senice. The a�sociated zone valve box and
alarm panels should be kept up-to-date with the changes made
to rooms no longer served.
A.5.1.14.4.1 The facility should retain a w1·itten or an elec­
tronic copy of all findings and any con-ections pedormed.
A.5.1.14.4.2.2 In addition to the minimum inspection and
testing in 5.1.14, facilities should considn annually inspecting
eguipment and procedures and correcting any deficiencies.

2021 Edition
99-182 HEALTH CARE FACILITIES CODE

Table A.5.1.10.3.l Socket Depths for ANSI/ASME Bl 6.50 (7) Final line regulation for all positive p1-essu1·e systems -
Brazing Fittings delivery pressure
(8) Valves- labeling
Tube Size Socket Depth (9) Alarms anrl ,wrning systems - lamp and aurlio opera­
tion
(in.) (in.)
(10) Alarms and warning systems, as follows:
Vi(¾ O.D.) 0.17
(a) Maste1· alarm signal operation
¾ (½ O.D.) 0.2 (b) Area alarm signal operation
½ (%0.D.) 0.22 (c) Local alarm signal operation
'Vi (¾ O.D.) 0.25 (11) Station outlet�/inlet�, as follows:
I (11/s O.D.) 0.28
11/, (I½ O.D.) 0.31 (a) Flow
(b) Labeling
I½ (1% O.D.) 0.34
(c) Latching/delatching
2 (2½ O.D.) 0.40
(rl) Leaks
2½ (2¾ O.D.) 0.47
(12) Medical gas quality, as follows:
3 (3¼ O.D.) 0.53
4 (4¼ O.D.) 0.64 (a) Ptu-ity- pe1·cent concentration
5 (51/, O.D.) 0.73 (b) Pe1·manent particulates anrl contaminants
6 (6½ O.D.) 0.83 (c) Odor anrl moisture
A.5.1.14.7.11 Accessibility of valves and the visibility and audi­
bility of ala1·ms a1-e inherent to the functions fot· which they a1-e
Table A.5.1.12.2.6.5 Pres.sure Corrections for Elevation
installerl. The hazard involverl in placing any equipment in
front of a valve that block.� the line of sight is obvious.
Elevation Absolute Atmospheric Pressure
Access to alarms involves both seeing and hearing the
(ft) kPa psia mmHg inHg alarms. Any obstruction of sight lines (e.g., with a computer
0 101.33 14.70 760.0 29.92 monitor, signs, boxes, carts) or impairment of the alarm's
500 99.49 14.43 746.3 29.38 audio (e.g., by taping over or plugging the speaker or sounder)
1000 97.63 14.16 733.0 28.86 can rlelay or prevent 1·esponse.
1500 95.91 13.91 719.6 28.33 During routine safety check.�, a facility shoulrl inclurle visual
2000 94.19 13.66 706.6 27.82 checks of the visibility, access, and condition of all zone valves
2500 92.46 13.41 693.9 27.32 and alarms.
3000 90.81 13.17 681.2 26.82
3500 89.15 12.93 668.8 26.33 A.5.l.14.7.11(2)(a) The intended operator's position is where
the person who will operate the valve can see and reach the
4000 87.49 12.69 656.3 25.84
valve to open or close it. This can involve opening access dom·s,
4500 85.91 12.46 644.4 25.37
stanrling on a ladrler, or other actions that woulrl put the opera­
:>000 84.33 12.23 632.:, 24.90
tor into the con-ect position.
A.5.2.l Section 5.1 cove1·s Category 1 piperl gas and vacuum
A.5.1.14.4.3 The following shoukl be consirlered in a routine systems; Section 5.2 covers Category 2 piped g'dS and vacuum
testing, maintenance, and inspection program: systems; and Section 5.3 covers Category 3 piperl gas and
(1) Medical ai1· source, a� follows: vacuum systems.
(a) Room temperature 1l1e health care facility's governing body should designate a
(b) Shafi: seal condition category in accorrlance with Chapter 4 fo1· each patient care
(c) Filter condition space in the facility. This process should include areas being
(rl) Presence of hvrlrocarbons used for merlical support (e.g., rlecontamination 01· ste1·iliza­
(e) Room ventilation tion, lab work, post mortem) that are not str-ictly patient care
(f) Wate1· quality, if so equipped spaces themselves (i.e., the1·e are no patients there) but share
(g) Intake location utilities such as medical gases or medical support gases with
(h) Carbon monoxide monitor calibration such spaces. Because it is not realistic to create separate supply
(i) Air purity systems for each category, it is desirable that one supply system
U) Dew point be userl for· spaces of all categot-ies to supply medical gases,
(2) Medical vacuum source - exhaust location merlical support gases, and vacuums to terminals.
(3) WAGD source- exhaust location
(4) Instr·ument air source - filter condition The pt·inciple is set out at the start of the requirements for
(5) Manifolrl sources (inclurling systems complying with each category in Chapter 5 (sef 5.1.1, 5.2.1, and 5.3.1) that a
5.1.3.5.9, 5.1.3.5.10, 5.1.3.5.11. anrl 5.1.3.5.12), a� highe1· category source anrl piping system is permitterl to
follows: supply terminals in any lower Category space; a Category 1
system can supply terminals in Category 2 and Category· 3
(a) Ventilation spaces, but a Category 2 system cannot supply tenninals in a
(b) Enclosure labeling Category 1 space.
(6) Cryogenic fluid central supply system source inspe cted
in accm·dance with NFPA 55

2021 Edition
 ANNEX A 99-183

Change

i
indicators

Regulator

--,...... �.
I
. .
.. ..,.

: Inlet
.
:
:: · •·
•
·• ·'
'

» _ � isolation
v l s
: :? � �

-�---LH_%
�---
, Standby
---, ,
Filter

: header :
----r---•
,,

Inlet Source
isolation valve
means Com pressor(s)
(valve shown)

___/_,1... �I S ystem
pressure
Outlet I switch/sensor
I
isolation r -)) Demand
, ,;� ..,-, valve(� 1 check
: ,i:' r • J I
}-....L-.L.. »
-"'\_}-, �--;_..\... ...
nlet. �' ,"
I solatlon - �--• Dryer(s)
I alve(s)
I

-"""L.i-----,'
: r-
J
''
I I

Automatic : :..--{ '- .. -'

......
trap and drains,_T'
J

I D.P.

Dew point
monitor
0
Automatic
Ball valve trap and
drain
N Check valve
Pressure
relief
© Pressure
indicator valve

t Demand check �
LJ
Filter with
change

---ciiJ-
indicator Note: Unions or other disconnect means can be
Pressure regulator D.P. Dew point required for maintenance and/or replacement of
each component.

FIGURE A.5.1.13.3.7 Elements of Typical Instrument Air Source.

2021 Edition
99-184 HEALTH CARE FACILITIES CODE

A.5.2.14 Medical gas and vacuum systems should be surveyed Survey of zone valves should include, but not be limited to.
at least annually for the items that follow and deficient items the following:
corrected. (1) Locations (relationship to terminals conu·olled)
Sutvey of medical air and instrument air sorn-ces should (2) Leaks
include, but not he limited to, the following: (3) Labeling
(4) Housekeeping around alat·m
(I) Dew point monit01· (operntion and calibration)
(2) C.at·bon monoxide monit01· (medical air only) (opera­ Sut·vey of medical gas outlet/inlets should include, but not
tion and calibration) be limited to. the following:
(3) Aftercoolet·s (condition, operation of drains) (1) Flow and function
(4) Operating pressures (cut-in, cut-out, and control pres­ (2) Latching/ delatching
sures) (3) Leaks
(5) All local alarms (verify presence of required alarms, (4) General condition (noninterchangeable indexing)
pedorm electrical test, test lag alarm)
(6) Receivet· element� (auto drain, manual drain, sight glass, The facility should retain a written 01· an electronic copy of
pressure 6.-auge) all findings and any corrections performed.
(7) Filters (condition)
(8) Pt·essure regulators (condition, output pressut·e) A.5.3.1 The health care facility's governing body should desig­
(9) Source valve (labeling) nate a category in acc01·dance with Chaplet· 4 for each patient
(10) Intake (location and condition) care space in the facility. This process should include areas
(11) Housekeeping around compn·ss01·s being used fot· medical support (e.g., decontamination or stet·i­
lization, Lah work, post mortem) that are not su·ictly patient
Sutvey of the medical vacuum and the i,VAGD sout-ce(s) care spaces themselves (i.e., thet·e at·e no patients there) but
should include, but not be limited to, the following: share utilities such as medical gases or medical support gases
(1) Operating vacuum (cut-in. cut-<>ut. and control pres­ with such spaces. Because it is not realistic to create separate
sm·es) supply systems for each categ01y, it is desirable that one supply
(2) All local alarms (verify presence of required alarms, system be used for spaces of all categories to supply medical
perfot·m electrical test, test lag alarm) gases, medical support gases, and vacuums to terminals.
(3) Receivet· elements (manual drain, sight glass, vacuum 1l1e pt·inciple is set out at the start of the requirements for
gauge) each category in Chapter 5 (seA 5.1.1, 5.2.1, and 5.3.1) that a
(4) Source valve (labeling) higher category source and piping system is permitted to
(5) Exhaust (location and condition) supply tet·minals in any lmvei- C.ateg01y space; a C.ateg01y 1
(6) Housekeeping around pump system can supply terminals in Category 2 and Category· 3
Sutvey of the medical gas manifold source(s) should spaces, but a Category 3 system cannot supply terminals in
include, but not be limited to, the following: Category 1 01· Category 2 spaces.

(1) Numhet· of cylinders (damaged connect01-s) A.5.3.3.5.10(3) Medical gases include, but at·e not limited to,
(2) Cylinder leads (condition) oxygen. niu·ous oxide. nitrogen. medical air. carbon dioxide.
(3) Cascade (switching from one headet· to another) and helium.
( 4) All local alarms (vet·ify presence of required alarn1s, A.6.1 Although complete compliance with this chaplet· is
perform electrical test. test all alarms) desirable. variations in existing health care facilities should he
(5) Source valve (labeling) considered acceptable in instances where wiring atTangement�
(6) Relief valves (dischat·ge location and condition) are in accordance with prim· editions of this document or
(7) Leaks afford an equivalent degree of performance and reliability.
(8) Security (door or gate lock� and signage) Such variations could occur, particularly with certain wiring in
(9) Ventilation (general opet·ation, housekeeping) separate 01· common raceways, with cenain functions connec­
(10) Housekeeping around manifolds ted to one or anothet· system 01· branch. 01· with certain prm,i­
Sun'ey of medical gas area alarms should include, but not be sions for automatically or manually delayed restoration of
limited to, the following: powet· from the alten1ate (emergency) source of power.
(1) Locations (visible to staff) A.6.2.1 Electrical systems can he subject to the occutTence of
(2) Signals (audible and \isual, use test function) electrical fires. Grounding systems, overcutTent protective devi­
(3) Activation at low p1·essure ces, and other subjects discussed in this code could be inten­
( 4) Activation at high pressm·e ded for fit·e prevention as well as other purposes. This aspect of
(5) Housekeeping around alarm electt·ical systems is the primary focus of other NFPA standards
and will not be emphasized herein.
Sutvey of medical gas mastet· alat·ms should include, but not
be limited to, the following:
(1) Locations (visible to appropriate stafl)
(2) Signals (audible and \isual, use test function)
(3) Activation at low pr·essure
(4) Activation at high pressm·e
(5) Housekeeping around alarm

2021 Edition
 ANNEX A
A.6.2.4 Facilities in which the normal sout-ce of power is
supplied by two or more separate central station-fed services
experience g1·eate1· than normal electrical sen-ice reliability
than those with onlv a single feed. Such a <lual source of
normal power consists of two or more electrical services fed
from separate generato1· sets or a utility diso·ibution netwnrk
that has multiple power input sources an<l is arrange<l to
prov'ide mechanical an<l electrical separation so that a fault
bet\veen the facility and the generating sources is not likely to
cause an intern1ption of mot·e than one of the facility service
feede1·s.
A.6.3.2.1 Assignment of degree of reliability of electrical
systems in health care facilities <lepends on the ca1·eful e\-alua­
tion of the vat-iables at each particular installation. For further
information, see ANSI/IEEE 493, RP,:mmnPndPd Pmdice for the
Design of Reliable Industrial and (',nmmerrial Power Systems.
A.6.3.2.2.1 It is best, if possible, to employ only one type of
1·eceptacle (i.e., stan<lar<l tlu·ee-prong type) fot· a, many recep­
tacles being serve<l by the same line voltage to avoid the inabil­
ity to connect life-support equipment in emergencies. The
straight-blade, tht·ee-prong receptacle is now pe1·mitte<l in all
locations in a hospital. Pre\iously, special receptacles were
specified in ope1·ating room locations and caused compatibility
problems.
Hospital grade requirements are in addition to the basic
constrnction and perfo1·mance 1·equirements for gene1·al­
putpose 1·eceptacles. These requirements enhance the safety of
patient� who might be more susceptible to stray current�. evalu­
ate the integrity of the receptacle's groun<ling path where
subjected to the conditions encountered in health care facili­
ties, and apply to receptacles that are non-locking-q,pe, 125-
volt, 15- or 20-ampere grounding receptacles of NEMA
configmations S-15R, :>-20R, 5-20RA, 6-15R, 6-20R, and 6-20RA.
For the evaluation requi1·ement� of hospital-grade receptacles ,
see lJL 498, Standard for A.ttac/nnent Plug:, and &r.eptarlfs. For
receptacle configuration <limensions, see ANSI/NEMA WD 6,
Wiring Deuires - Dimemional Requirnnents.
A.6.3.2.2.5 Care should be taken in specifying a system
containing isolated ground receptacles, because the grounding
impedance is controlle<l only by the grounding wires an<l does
not benefit from any conduit or building strncture in parallel
wiLh it.
A.6.3.2.2.7 A clinical laboratory is a space whe1·e diagnostic
test� are perfo1·med as part of patient care.
A.6.3.2.3.1 Moisture c an reduce the contact resistance of the
bo<ly, an<l electt·ical insulation is mo1·e subject to failure.
A.6.3.2.3.4 In conducting a risk assessment, the health ca1·e
governing body should consult with all relevant parties, includ­
f
ing, but not limite<l to, clinicians, biomedical engineering staf ,
and facility safety enginee1·ing staff.
A.6.3.2.3.8 The health c are health care facility's governing
body an<l designe1· of 1·ecord should ev-aluate the type of protec­
tion to be provided against electrical shock to patient� and
ca1·egive1·s in wet procedure locations. The application consid­
erations should include but not be limite<l to the reliability of
powe1· to critical equipment and systems.
A.6.3.2.4 ll1e 1·equirement that branch circuits be fed from
not more than one <listrihution panel was introduced for
several reasons. A gene1·al principle is to minimize possible
99-185
potential <lifferences benveen the grounding pins of 1·ecepta­
cles in one area by bringing the grounding con<luctors to a
common point. A specific reason is to simplify maintenance by
making it easier to fin<l the sout-ce fix the receptacles in a
room. 1l1is is particularly a problem in hospitals where emer­
gency conditions might require rapid restoration of power.
A.6.3.2.5.1.5 The 1·equirement for grounding interconnection
between the normal and essential power systems follows the
principle of minimizing possible potential differences between
the grounding pins of receptacles in one area by lxinging the
g1·ounding conductm·s to a common point.
A.6.3.2.5.3 Special grounding methods could be required in
patient vicinities immediately adjacent to rooms containing
high-powe1· 01· high-frequency equipment that causes electrical
interference with monitors or other electromedical devices. In
extreme cases, electt·omagnetic induction can cause the voltage
limits of 6.3.3.1 to he excee<le<l.
Electromagne tic interference problems can be due to a vari­
ety of causes, some simple, othe1·s complex. Such problems are
best solve<l one at a time. In some locations. groun<ling of
stretchers, examining tables, or be<l frames will be helpful.
Where necessary, a patient equipment grounding point shoul<l
be installed. This can usually be accomplishe<l even afte1·
completion of construction by installing a 1·eceptacle faceplate
fitted with grounding posts. Special grounding wires should
not be used unless they a1·e found to be essential fo1· a particu­
la1· location, because they can interfere with patient care proce­
dures or present trip hazar<ls.
A.6.3.2.8.4 Within the const1·ainL� of the equipment p1-mided.
considerntion should be given to coordinating circuit breakers,
fuses, an<l other overcutTent pt·otective devices so that powe1·
interruption in that part of the circuit that prece<les the inter­
rnpting device closest to a fault is not I ikely to occur.
A.6.3.2.9 Patient prntection is prov'ided primarily by an
adequate grounding system. 1l1e ungrnunded secondary of the
isolation transformer 1·e<luces the cross-sectional area of
grounding conductors necessary to protect the patient against
voltage resulting from fault current by reducing the maximum
current in case of a single probable fault in the grnun<ling
sr,tem. The line isolation monitor is use<l to provi<le warning
when a single fault occurs. Excessive current in the groun<ling
conductors will not result in a hazard to the patient unless a
second fault occtlt's. If Lhe cutTent in the grounding system
does not exceed 10 mA, even un<ler fault conditions, the volt­
age across 3 m (9.84 ft) of No. 12 AWG wire will not excee<l
0.2 mV, and the voltage across 3 m (9.84 ft) of No. 18 AWG
grnunding conductor in a flexible cord will not excee<l 0.8 mV
Allowing 0.1 mV across each connector, the voltage between
two pieces of patient-connected equipment will not excee<l
2 mV.
1l1e refe1-ence grounding point is intended to ensure that all
electrically conductive surfaces of the building structure, which
coul<l 1·eceive heavy fault cutTent� from ordinary (grounded)
ci1n1it�, are grounded in a manne1· to byp ass these hea\y
currents from the opernting room.
A.6.3.2.9.2.1 It is desirable to limit the size of the isolation
transfo1·mer to 10 kVA 01· less and to use conductor insulation
with low leakage to meet the impe<lance 1·equi1·ement�. Keep­
ing branch circuits short and using insulation with a <lielectric
constant less than 3.5 and insulation 1·esistance constant greate1-
2021 Edition
99-186 HEALTH CARE FACILITIES CODE
than 6100 megohmmete.-s at l6° C (20,000 megohm-ft at 60'F)
reduces leakage from line to ground.
To correct milliammete1· reading to line impedance, use the
following equation:
[A.6.3.2.9.2.1]
V-LOOO
Line impedance (in ohms)= --­
/
where:
F = isolated powe1· system voltage
I = milliammeter reading made during :impedance test
A.6.3.2.9.3.1 Protection for the patient is provided pt·ima rily
by a grnunding s�tem. The ungrounded secondary of the isola­
tion transformer reduces the maximum current in the ground­
ing s�tem in case of a single fault between either isolated
power conducto1· and ground. The line isolation monit01-
provides warning when a single fault occurn, 01· when exces­
sively low impedance to ground develops, which might expose
the patient to an unsafe condition if an additional fault occurs.
Excessive cutTent in the grounding conduct01·s will not result
from a first fault. A hazard exists if a second fault occurs before
the first fau It is cl eared.
A.6.3.2.9.3.3 It is desirable to reduce this monitor haza rd
current, provided that this reduction result� in an inCl'eased
"not alarm" threshold value for the fault hazard current.
A.6.3.2.9.3.4 It is desirnble to locate the ammeter such that it
is conspicuously visible to pe1·sons in the anesthetizing location.
The line isolation monitm· can be a composite unit, with a
sensing section cabled to a separate display panel section on
which the ala1·m and test functions a1·e located, if the l:\vo
sections are within the same electric enclosure.
A.6.3.3.1.1 In a conventional grounded powe1- distribution
system, one of the line conductm·s is deliberately grounded,
usually at some distribution panel or the service entrance. This
grounded conduct01· is identified as the neutral conductor.
The other line conductor(s) is the high side of the line. The
loads to be served by this distribution sy stem are fed by the
high and neutral comlucto1·s.
In addition to the high and neutral conduct01·s, a grounding
conductor is provided. One end is connected to the neutral at
the point whe1·e the neutral is grounded, and the other end
leads out to the connected loads. For put-poses he1·e, the load
connection point will be considered to be a convenience 1·ecep­
tacle, with the grounding conductor terminating at the ground­
ing terminal of that 1-eceptacle.
This grounding conduct01· can be a separate wire running
from the receptacle back to the remote grounding connection
(where it joins the neutral conductor). If that separate conduc­
tor does not make any inte1·mediate ground contact� between
the receptacle and the remote ground, then the impedance of
the connection bel:\veen the receptacle and the remote ground
is prima1·ily the 1·esistance of the grounding conductor itself
and is, the1·efore, pt·edictable.
If, however, the receptacle is also interconnected with the
remote ground point by metallic conduit or othe1· metallic
building stn1ctures, the impedance of the ci1·cuit between the
receptacle and remote ground is not easily predictable; nor is it
2021 Edition
easy to mea�ure accurately. although one can be sure that the
impedance will be less than that of the grounding wire it�elf
because of the additional parallel paths.
Fortunately, as will become apparent in the paragraphs that
follow, the absolute value of the apparent impeda11ce between
the grounding contact of an outlet and the remote ground
point need not be known or measured with great accuracy.
Ideally, and under no-fault conditions, the grounding s�tem
described earlie1· is supposed to be catTying no cutTent at all. If
this we1·e true, then no voltage differences would be found
between exposed conductive sutfaces of any electrical applian­
ces that were grounded to the grounding contact� of the recep­
tacles that powered them. Similarly, the1·e would be no voltage
differences between these appliances and any othe1· exposed
metal surface that was also interconnected with the grounding
s�tem, provided that no cutTents were flowing in that intercon­
nection.
Ideal conditions, however, do not prevail, and even when
the1·e are no "faults" within an appliance, residual "leakage"
current does flow in the grounding conductm· of each of the
appliances, producing a voltage difference between the cha.�sis
of that appliance and the grounding contact of the receptacle
that feeds it. Furthermore, this cmTent can produce voltage
diffe1·ences among othe1· appliances plugged into va1·ious
receptacles on the system.
If, however, a breakdown of insulation bel:\\leen the high side
of the line a11d the chassis of a11 appliance occut·s, the leakage
condition becomes a fault condition, the magnitude of which is
limited by the natut·e of the breakdown, or, in the case of a
dead short circuit in the appliance, the magnitude of the fault
cutTent is limited only by the 1·esidual 1·esistance of the appli­
ance power cord conductors and that of the power distribution
s�tem. In the event of such a short circuit, the impedance of
the grounding circuit, as measut·ed between the grounding
contact of the receptacle that feeds the defective appliance a11d
the remote ground point where the neutral and grounding
conductorn are joined, should be so small that a large enough
fault current will flow to ensure a rapid breaking of the ci1·cuit
by the overcurrent protective device that serves that receptacle.
Fm· a 20-A branch ci1·cuit, a fault cmTent of 40 A or mm·e
would he requi1·ed to ensut·e a rapid opening of the branch­
circuit overcurrent protective device. This corresponds to a
circuit impedance of :I ohms or less, of which the grounding
system should contt·ibute 1 ohm 01· less.
During the time this large fault current flows in the ground­
ing system, the chassis of the defective appliance is 1·aised many
volt� above othe1- grounded surfaces in the same vicinity. The
hazard represented by this condition is minimized by the fact
that it exist� for only a short time, a11d, unless a patient simulta­
neously contacts both the defective appliance and some other
grounded surface during this short time inter.•al, the1·e is no
hazard. Furthermore, the magnitude of an applied voltage
1·eguired to produce a serious shock hazard increases as it�
duration dect'eases, so the rapidity with which the ci1·cuit is
interrupted helps reduce shock hazard even if such a patient
contact occurs.
If, however, the defect in the appliance is not such as to
cause an immediate circuit intetTuption, then the effect of this
intermediate level of fault current on the voltages appeai·ing on
 ANNEX A
various expose<l con<luctive sui-faces in the patient ca re vicinity
should be considered.
Because all of this fault cuITent flows in the grounding
con<luctor of the <lefective appliance's power cord, the first
effect is to raise the potential of this appliance above that of the
1-eceptacle that feeds it by an amount proportional to the
powe1· cord grounding conductor resistance. This 1·esistance is
reguire<l to be less than 0.15 ohm, so fault currenL� of20 A or
less, which will not t1·ip the branch-circuit overcurrent protec­
tive device, will rnise the potential of the defective appliance
above the groun<ling contact of iL� supply receptacle by only
3 V or less. This value is not hazar<lous for ca�ual contacL�.
The fault cutTent that enters the grounding system at the
groun<ling contact of any 1·eceptacle in the patient ca1·e vicinity
could affect the potential at the grounding contacL� of all the
other receptacles, and, more importantly, it could produce
significant voltage diffe1·ences between them and othe1· groun­
ded sudaces, such as exposed piping and building structures.
If one grounde<l point is picke<l as a reference (a plumbing
fixture in 01· neat· the patient care vicinity, for example), and
the voltage diffe1·ence is then measure<l between that reference
and the grounding contact of a receptacle, pro<luce<l by <lriving
some known cuITent into that contact, a direct measure of the
effectiveness of the grounding system within the patient ca1-e
vicinity is obtaine<l. The "figure of merit" can be stated a5 so
many volL� per ampere of fault cun-ent. The ratio volt� per
ampe1·e is, of course, impe<lance; but because the exact path
taken by the fault cuITent is not known, and because the way in
which the reference point is interconnecte<l with the groun<l­
ing system is not known, it cannot be stated that this value is
the impedance between the 1·eceptacle and some specific point,
such a� the joining of the neutral an<l grounding conductors.
However, it can be stated that this mea�ured \alue of "effective
impedance" is indicative of the effectiveness with which the
groun<ling system minimizes voltage diffe1·ences between
supposedly grounded object� in the patient care vicinity that
are produce<l by ground faults in appliances used in that vicin­
ity. This impe<lance, which charncte1·izes the ability of the
groun<ling system to maintain nearly eguipotential conditions
within the patient care vicinity, is of prime importance in a�s ess­
ing shock hazard; but this impedance is not necessa1·ily the
same as the impedance between 1·eceptacle an<l 1·emote g1·ound
point, which controls the magnitu<le of the short-circuit
CutTent involved in tripping the b1-anch-ci1-cuit ove1·cu1Tent
protective device.
Fault current� on the grounding system can also come from
neutral-to-groun<l faults, which allow some cmTent to flow in
the neutral an<l some in the ground. This type of fault is often
the cause of interference on EEG and ECG eguipment. It is
often not recognized easily because, except for 60 Hz interfer­
ence, the equipment work.5 perfectly propedy. It is most easily
found by causing a substantial change in the line-to-line load
an<l noting changes in the ground-to-reference voltage.
A.6_3.3.1.1.4 The grounding system (1·efe1-ence groun<l and
con<luit) is to be teste<l as an integral system. Lifting of grounds
from receptacles an<l fixe<l equipment is not required or
recommen<le<l fo1· the performance of this test.
A.6.3.3.1.3 Effective grounding to safely han<lle both fault and
leakage currents requires following the requirements of both
Chapter 6 and Article 250 of NFPA. 70; having good workman-
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ship; and using some techniques that are not found in these
documents.
The pedormance of the grounding system is ma<le eflective
through the existence of the g1·een grounding wire, the metal
raceway, an<l all of the other buil<ling metal. Measurements
have shown that it is the metal raceway and building steel that
provide most of the eflective groun<ling path of less than
10 milliohms at the receptacle, inclu<ling plug-to-receptacle
impe<lance. 1l1e green grounding wire becomes a backup, not
a p1-imary grounding path pedormer.
Goo<l practice calls for each receptacle to have a good
jumper grounding connection to the metal raceway at the
receptacle location in addition to having the green groun<ling
wire connecting these point� to the grounding bus in the distri­
bution panel. Good workmanship includes seeing that these
grounding connections are tight at each 1·eceptacle and that all
metal rnceway joints are secut·e and tight.
The voltage <lifference measurement� listed in G.3.3.1.3 in
connection with power <listt·ihution groun<ling systems shoul<l
ideally be made with an oscilloscope or spectrum analyzer in
or<le1· to observe an<l measm·e component� of leakage current
and voltage <lifferences at all frequencies.
For 1·outine testing, such instrument� coul<l he inconvenient.
An alternative is to use a metering system that weighs the
contt·ihution to the meter reading of the various component�
of the signal being measu1·ed in acc01·dance with their probable
physiological eflect.
A meter specifically designe<l for this purpose would have an
impe<lance of approximately 1000 ohms, and a frequency char­
acte1·istic that wa5 flat to l kHz, <lroppe<l at the rate of 20 deci­
bels per <lecade to 100 kHz, and then remaining flat to l MHz
or highe1·. This freguency response cha1·acteristic could be
achieve<l hy proper design of the internal circuit� of the ampli­
fie1· that probably precedes tl1e indicating instrument or by
appropriate choice of a feedback network around the ampli­
fie1·. These details are, of course, left to the instrument
designer.
If a meter specifically designed for these mea�urement� is
not av-ailahle, a general-purpose laboratory millivoltmete1· can
be adapted fot· the purpose by adding a frequency response­
shaping network ahea<l of the meter. One such suggeste<l
netw-ork is shown in Figure A.G.3.3.l .3(a).
The ci1·cuit shown Fi gu re A.G.3.3.l.3(a) in is especially appli­
cable to measurements of leakage current, where tl1e current
being mea�ured is derive<l from a ci1·cuit whose source impe­
dance is high compa1·ed to 1000 ohms. Unde1· these con<litions,
the voltage developed across the millivoltmete1· will be propor­
tional to the impe<lance of the network. The network impe­
dance will be 1000 ohms at low frequencies and 10 ohms at
high frequencies, an<l the transition between these two values
will occur in the freguency range between l kHz and 100 kHz.
The basic low-frequency sensitivity will be l mV of mete1·
1-eading fo1- each l m.A of leakage cutTent.
1l1e millivoltmeter's own input impedance needs to be vety
la1·ge compared to 1000 ohms (100 kilohms), and tl1e mete1·
shoul<l have a flat frequency response to well beyon<l 100 kHz.
(If the mete1· impedance is lower than 100 kilohms, then the
1000 ohm resistor can be raise<l to a higher value, such that the
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99-188 HEALTH CARE FACILITIES CODE
impetiance of that resist01· in parnllel with the meter will still be
1000 ohms.)
The cit-cuit in Figure A.6.3.:l.l .3(a) can be used fot· the volt­
age difference mea�urement� requi1·ed in Section 6.5, but,
because the source impedance will be very low compareti to
1000 ohms, the frequency 1·esponse of the measurement system
will 1·emain flat. If any high-frequency component� produced,
for example, by pickup from nearby radio frequency transmit­
ters appear on the circuit being measured, then they will not
be attenuated, and the mete1· reading will be highe1· than it
should be.
For meter reatiings below any prescribeti limit�, this possible
error is of no consequence. Fm· bot·dedine cases, it could be
significant. To avoid this uncertainty when making voltage­
difference measurements, a slightly more elaborate version of a
frequency response-shaping network is given 111 Figure
A.6.3.3.l.3(b).
Here the source being measureti is separated from the
frequency response-shaping nel:lvork by the combination of
the 900 ohm and 100 ohm resist01·s. The frequency 1·esponse
charncteristic is now indepentient of the circuit being tested.
The millivoltmete1· shoulti have an input impedance of 15 0
kilohms and a frequency response that is flat to well beyonti
100 kHz.
This intiependence is achieveti, however, at a loss in signal
delive1·ed to the millivoltmeter. TI1e basic low-frequency sensi­
tivity of this metering circuit is 1 mV of meter 1·eading for 10A
of leakage current or, on a voltage basis, 1 mV of meter reacting
for 10 rnV at the input te1·minals of the netwot-k.
Fm· either of the suggested netwo1·ks, the 1·esistors anti capac­
itors should be mounteti in a metal container close to the milli­
voltmeter to avoid stray pickup by the leatis going to the meter.
A.6.3.3.1.4 It is not the intent that each receptacle be tested. It
is intentieti that compliance be demonstrated through rantiom
ilkg-o-------t..- --------<.,_-----<C>---,
0.15
µF
Input
of 1000 Q
test load
10 Q Millivoltmeter
- 0-------1..------------------C>----'
i1kg = Leakage current being measured
FIGURE A.6.3.3.1.3(a) Circuit Used to Measure Leakage
Current with High Source Impedance.
900Q 1400Q
i lkg-
0.10
µF
Input
of 100 Q
test load
15 Q Millivoltmeter
- 0-------1----------------<D---'
i 1k9 = Leakage current being measured
FIGURE A.6.3.3.I.3(b) Circuit Used to Measure Leakage
Current with Low Source Impedance.
2021 Edition
testing. The 10 percent random testing shoulti include a
mixture of both normal anti emergency receptacles.
A.6.3.4.1.1 Although several approaches to documentation
exist in hospitals. the minimum acceptable documentation
shoulti itientify what was testeti, when it was testeti, and
whethe1· it performed successfully. Adopting a sy;tem of excep­
tion reporting can be tl1e most eflicient form of record keeping
for routine rechecks of equipment or systems, thereby minimiz­
ing technicians' time in recortiing the value of each measure­
ment taken. Fm· example. once a test protocol is established,
which simply means testing the equipment 01· system consistent
with Chapter 6, the only item (value) that needs to be recorded
is the failut·e 01· the tieviation from the requi1·ement� of the
chapte1· tl1at was tietected when a con-ective action (repair) was
untiertaken. This approach can serve to eliminate, for exam­
ple, the need to keep intiivitiual room sheet� to record mea�­
ured result� on each 1·eceptacle or to recorti measut·ement
values of all types of leakage cutTent test�.
A6.7 Requirement� found in 6.7. 1 through 6.7.4 are general
1·equirement� fot· both T)pe 1 anti Typ e 2 EES.
A6.7.I.I Cnnnedinn tn Dual Snurre nf Nnnnal PnwPr. For the
greatest assurance of continuity of electrical senice, the normal
sout·ce should consist of l:lvo separate foll-capacity services, each
independent of the othe1·. Such services should be selected and
installed with full recognition of local haza rds of interruption,
such as icing and flootiing. Whe1·e more than one full-capacity
service is installeti, they should be connecteti in such a manner
that one will pick up the load automatically upon loss of the
other, and should be so arrangeti that the load of the emer­
gency and equipment systems will be trnnsfetTed to the alter­
nate source (generntor set) only when both utility services a1·e
de-energized, unless this arrangement is impractical and
waived by the authority having jurisdiction. Such services
should be intedocked in such a manner a� to prevent parnlle­
ling of utility services on either primarv 01· seconda r y voltage
levels. Note that, in any installation where it is possible to pa ral­
lel utility supply circuit� (e.g., to prevent interruption of service
when switching from one utility source to anothet') it is impern­
tive to consult the powe1· companies affecteti as to problems of
synchronization. Facilities whose normal source of power is
supplied by two or m01·e separate central station-fed services
(dual sources of normal power) expe1·ience greate1· 1·eliability
than those with only a single feed.
Installation of (',('neratnr Sets. Fo1· additional mate1·ial on tiiesel
engines, see National Research Council Publication 1132. DiPsel
.Engines Jnr Use with (',f'neratars to Supply .t.'JMrgmr.y and Short TPrm
ElPt:trir Power.
A.6.7.1.2.1 A Class X system is intended to give the facility the
flexibility to provitie the appropriate duration before refueling
ope1·ations a1·e needed. TI1e hospital should determine the
appropriate run time for the EES and size the fuel tanks
accordingly. Careful considerntion should be given to the
potential types of outages anticipated and the availability of
fuel. It should be noted that in some situations it might be
permissible to size the fuel system to accommotiate less than
48 hours of fuel. If life safety systems are includeti on the EES,
other coties anti standards might have minimum durations of
required operntion.
A.6.7.1.2.2.2 Some sources, such a� photovoltaic cells, operate
intermittently. The systems should be able to operate with sou1·­
ces out of service and still be able to provitie this 1·eduntiancy.
 ANNEX A
A.6.7.1.2.2.3 1l1e intent of 6.7.1.2.2.3 is as follows:
(l ) Contiguous or same-site nonhospital builrlings can be
se1·ved by the generating equipment. H oweve1·, such loads
should not compromise the integrity of the system serv­
ing the hospital. Thus, any such contiguous or same-site
nonhospital buildin� can be served by the generating
equipment only if the u·ansfer means operates in accord­
ance with fl. 7.1.2.2.3.
(2) Within a hospital builrling, 6. 75.1.3.2( l 0) permits "arldi­
tional" loarls on the CL"itical branch and fl.7.5.1.4.4(9)
permit� "other equipment"' on the equipment system in
order to provide limited flexibility to a facility to arld one
or tw-o loads not otherwise listed in fi.7.5.1.3.2(1) through
fl.7.5.U.2(10), 6.7.5. 1.4.3, or fl.7.5.1.4.4(1) through
fl.7.5.1.4.4(9) to a critical branch panel or an equipment
system panel. This is permitted to prevent the neerl for an
additional panel to se1·ve a small numbe1· of selecterl
ci1·cuits in a particula1· area. These sections are not inten­
ded to permit large blocks of loads not listed in these
sections to be on the critical branch or equipment system.
The intent of the division of the essential system loads
into systems anrl brnnches is to ensm·e maximum 1·eliabil­
ity of service to loads consirlered essential. Evet)' addi­
tional load placed onto a system somewhat inct·eases the
probability of a failure on the system that threatens the
integrity of senice to the balance of loarls served by the
system. Therefore, while "additional" loads and "other
equipment"" are pe1·mitterl to be placed onto the CL"itical
branch anrl equipment sys tem in veq; limiterl situations,
where a facility wants to put large blocks of loads not
listed in 6.7.5.1.3.2(1) through 6.7.5.1.3.2(10), 6.7.5.1.4.3,
or fl.7.5.1.4.4(1) through 6.7.5.1.4.4(9) onto the generat­
ing equipment, the facility is pe1·mitted to do so, but only
by designating these large blocks of loarls as ·'optional
loads" and by complying with fl. 7.1.2.2.3.
A.6.7.1.2.4 Paragraph 12.5.3.3.5 inclurles the 1·equi1·ement�
anrl components for an emergency operations plan. For addi­
tional loads to be considererl, see 6.7.1.2.2. l .
A.6.7.I.2.7.2(B) A� a supplement to ha1·rl-wi1·ed alarm annun­
ciations, it is permissible to have Level l and Level 2 EPS anrl
ATS functions monitored off-site. Monitm·ing stations can
include page1·s, cell phones, and Internet-connected devices.
A.6.7.1.2.7.2(H) An example of a centralized computer system
is a building automation system.
A.6.7.1.3.4 During operation. EPS and related equipment
reject consirlerable heat that needs to be removerl by proper
ventilation 01· air-cooling. In some cases, outdom· installations
1·ely on natural air circulation, but enclosed installations need
properly sizerl, properly positione d ventilation facilities, to
prevent recirculation of cooling ai1·. The optimum position of
ai1�supply louvern and radiator air discha1·ge is on opposite
walls, both to the outdoors. r110:A.7.7. ll
A.6.7.1.3.4.2 See l 10.3(b) of NFPA 70 for more information
on the manufactm·e1·'s installation inst1·uctions.
A.6.7.1.3.5 Refer to the following sections in NFPA 110 for
specific requirements:
(l ) Section 5.3 for 1·equirement� on energy conveners
temperatu1·e maintenance
(2) Section 5.4 for requirement� on energy converters
capacity
99-189
(3) Section 5.5 for 1·equirement� on energy converters - fuel
supply
(4) Subsections 5.fl. l through 5.fl.4.7 fo1· requirement� on
rotating equipment
A.6.7.2 It shoulrl be emphasized that the type of system selec­
ted and its area anrl type of coverage should be appropriate to
the medical procedures being performed in the facility. Fm·
example, a battery-operated emergency light that switches ·'on"
when nm·mal power is interrupted anrl an alternate power
source for suction equipment, along with the immediate availa­
bility of some portable handheld lighting, would be advisable
where oral and maxillofacial surgery (e.g.. extraction of impac­
terl teeth) is pe.-formerl. On the other hanrl, in rlental offices
where simple exu·action, restorntive, prosthetic, or hygienic
procedures are pel"formed, remote corrirlm· lighting for purpo­
ses of egress only woulrl be sufficient. Emergency power for
equipment would not be necessaq;. As with oral surgery loca­
tions. a s111·gical clinic requiring use of life-support 01· emer­
gency rlevices, such as suction machines, ventilators,
caute1·ize1·s, or defib1·illato1·s, would requi1·e both eme1·gency
light anrl powe1·.
Distribution system arrangement� should be designerl to
minimize interruptions to the elect1·ical systems due to internal
failures by the use of adequately raterl equipment.
TI1e following factors should be considered in the design of
the rlistribution system:
(l ) Abnormal voltages, such as single phasing of tlu·ee-phase
utilization equipment; switching or lightning surges, or
both; anrl voltage rerluctions
(2) Capability of achieving the fastest possible restoration of
any given circuit(s) after clearing a fault
(3) Effects of future changes, such as increased loading or
supply capacity, or both
(4) Stability and power capability of the pt·ime mover during
and after abnormal conditions
(5) Sequence reconnection of loads to avoirl large current
inrushes that u·ip overcurrent rlevices or overload the
generator(s)
(6) Byp ass arrangements to allow testing and maintenance of
system component� that coulrl not othetwise be main­
tained without disruption of important hospital functions
(7) Effects of any harmonic current� on neutral conrluctors
and equipment
Careful consideration should be given to the location of the
spaces housing the component� of the essential electt·ical
system (EES) to minimize interruptions causerl by natural
fot·ces common to the area (e.g., storms, floods, or eanh­
quakes; <ll" hazards ct"eated by adjoining structtu-es or activities).
Consideration should also be given to the possible interrup­
tion of nm·mal electt·ical services 1·esulting from similar causes
as well as possible disruption of normal electrical se1·vice rlue to
internal wiring anrl equipment failures. Consideration should
be given to the physical separation of the main feerlers of the
EES from the normal wiring of the facility to pt·event possible
simultaneous destruction as a 1·esult of a local catastrophe.
In selecting electrical rlistribution aITangement� anrl compo­
nents for the EES, high priority should be given to achieving
maximum continuity of the elect1·ical supply to the load.
Higher consideration should be given to achieving maximum
reliability of the alternate powe1· source anrl its feede1·s 1·athe1·
than protection of such equipment, provided that the protec-
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99-190 HEALTH CARE FACILITIES CODE
tion is not reguiretl to p1·event a g1·eate1· tlu·eat to human life.
such as fire, explosion, and electrocution, than would be
caused by the lack of an essential electt·ical supply.
A.6. 7.2.I.I It is important that the various ovei-cutTent de,ices
be coordinated, as far a,; practicable, to isolate faulted circuits
and to protect against cascading operation on short-circuit
faults. In many systems, howeve1·, foll coordination could
compromise safety and system reliability. Primary consideration
also should be given to prevent overloading of eguipment by
limiting the possibilities of la1·ge cutTent inrushes due to instan­
taneous re-establishment of connections to heavy loads. The
terms coordination and coordinated as used in 6.i.2.1.l do not
cover the full 1·ange of ove1-cu1Tent conditions.
A.6.7.2.1.2.l(A) Where special loads require more rapid
detection of power loss, underfrequency monitoring also might
be provided. Upon frequency decay below the lowe1· limit
necessary for prope1· operation of the loads, the transfe1· switch
should automaticallv initiate transfer to the alternate source.
(SPeA.6.2.15 of NI-PA 110.) r110:A.6.2.2.l]
A.6.7.2.I.2.l(A)(2) See 6.2.5 and 6.2.7 of NFPA 110.
r110:A.6.2.2.1(2) l
A.6. 7.2.1.2.3 Authorized pe1·so1rnel should be available and
familiar v.�th manual operation of the transfer sMtch and
should be capable of determining the adequacy of the alter­
nate power source prior to manual transfer. rno:A.6.2.4 l
A.6.7.2.1.2.4 Fm· most applications, a nominal delay of
l second is adequate. The time delay should be shoi-t enough
so that the generator can start and be on the line within the
time specified for the type cla,;sification. r110:A.6.2.5l
A.6.7.2.1.2.7 It is 1·ecommended that the timer for delay on
rett·ansfer to the primary source be set for 30 minutes. The 30-
minute recommendation is to establish a "normalized"' engine
temperatu1·e, when it is beneficial fo1· the engine. NFPA 70
establishes a minimum time requirement of 15 minutes.
r110:A.6.2.s1
A.6.7.2.1.2.11 Fm· maintenance purposes, consideration
should be given to a transfer switch counter. r110:A.6.2.13l
A.6. 7.2.1.2.13 Automatic transfer switches (ATS) can be provi­
ded with accessory controls that provide a signal to operate
remote motor controls that disconnect motors prior to transfer,
and to 1·econnect them aft.et· t1·ansfe1· when the residual voltage
has been substantially reduced. Anothe1· method is to provide
inphase monitors within the ATS in order to prevent 1·etransfe1·
to the primary source until both sources are nearly synchron­
ized. A third method is to use a programmed neutral position
transfer switch. See Section 230.95(8) of NI-PA 70.
fl IO:A.6.2.151
A.6.7.2. 1.2. I7 Standards for nonautomatic transfe1· switches
are simila1· to those for automatic transfe1· switches, as defined
in 3.3.7.l and 3.3.7.3 of NFPA 110 with the omission of auto­
matic controls. r110:A..6.2.16l
A.6.7.2. 1.5.3 Conside1·ation should be given to the effect that
load interruption could have on the load dm·ing maintenance
and se1vice of the transfer switch.
A.6. 7.2.2.5(B) If colm· is used to identify these 1-eceptacles, the
same color should be used throughout the facility.
2021 Edition
A.6.7.4.l.l.5(A) When event,;, such as the issuance of storm
warnings, indicate that power outages might be likely, good
practice recommends the wa1·ming up of generator set.<; by a
1·egular exe1·cise period. Operation of generatm· sel<; for short
intervals should be avoided, particularly with compression igni­
tion engines, since it is harmful to the engines.
Recm·ds of changes to the essential electrical system should
be maintained so that the actual demand likely to be produced
by the connected load will be within the available capacity.
A.6.7.4.1.2.l Main and feede1· circuit breakers should be pe1·i­
odically tested under simulated overload trip conditions to
ensure reliability.
A.6.7.5 General requirement,; from 6.7.1 through 6.7.4 a1·e
also applicable to Type l EES.
A.6.7.5.l Type l essential elect1·ical systems are comp1·ised of
th1·ee separate branches capable of supplying a limited amount
of lighting and power service that is considered essential for
life safety and effective facilitv operation during the time the
normal electrical se1·vice is intetTupted fo1· any 1·eason. These
tlu·ee separate branches are the life safet)'; CI"itical, and equip­
ment branches.
A.6.7.5.1.2.4(3) Departmental installations such as digital dial­
ing systems used for intradepartmental communications could
have impaired use during a failure of electrical se1vice to the
area. In the event of such failure, those systems that have ligh­
ted selector buttons in the base of the telephone instrument or
in the desk unit� known as "director sets" \,ill be out of service
to the extent that the lights will not function and that the
buzzer used to indicate incoming calls will be silenced. The
lack of electt·ical energy ,,ill not prevent the use of telephones
for outgoing calls, but incoming calls v.ill not be signaled, nor
will inte1·communicating calls be signaled. This communication
failm·e should be taken into consideration in planning essential
electt·ical systems.
A.6.7.5.1.3 It is recommended that facility authorities give
consideration to providing and propedy maintaining automatic
battery-powered lighting unit� or systems to provide minimal
task illumination in operating rooms, delivery rooms, and
certain special-procedure radiology rooms, whe1·e the loss of
lighting due to failure of the essential elect1·ical system could
cause severe and immediate danger to a patient undergoing
surgery 01· an invasive radiographic procedure.
A.6.7.5.1.3.2(6) Departmental installations such as digital dial­
ing systems used for intradepartmental communications could
f
have impaired use during a failure o electrical service to the
area. In the event of such failure, those systems that have ligh­
ted selector buttons in the base of the telephone instrument or
in the desk unil� known as "director set�" will be out of service
to the extent that the lights will not function and that the
buzzer used to indicate incoming calls will be silenced. The
lack of electrical energy will not prevent the use of telephones
for outgoing calls, but incoming calls will not be signaled, nor
will inte1·communicating calls be signaled. This communication
failtu-e should be taken into consideration in planning essential
electrical systems.
A.6.7.5.1.4.3 The equipment in 6.7.5. l .4.3(A)(l ) through
6. i.5.l .4.3(A) (3) can be arranged for sequential delayed­
automatic connection to the alternate power source to prevent
overloading the gene1·ator where engineering studies indicate
that it is necessa1y
 ANNEX A
A.6. 7.5.1.4.4 For elevator cab lighting control and signal
system require men t�, see 6.7.5.1.2.4 ( 5) .
In instances where inteITuption of normal power would
1·esult in other elevatm·s stopping between floors. throw-over
facilities shoulrl be prmirlerl to allow the temporary operation
of any elevatm- for the 1-elease of patient� 01- other pe1·sons who
are confined between floors.
A.6. 7.5.1.4.4(2) The out�ide design temperature is based on
the 9 7½ percent design value, as shown in Chapter 24 of the
A.SHRAE Handbook - Fundanumtak
A.6. 7.5.1.4.4( 9) Consideration shoulrl be given to selected
equipment in kitchens, laundries, aml radiology rooms and to
selected central 1·efrigeration.
It is desirable that, where hea\-y interrnption current.� can be
anticipated, the transfer load be rerlucerl by the use of multiple
transfe1· devices. Elevato1· feeders, fix instance, might be less
hazardous to electrical continuity if they are fed through an
individual transfer device.
A.6. 7.5.2.1 See 1VFPA. 70 fm installation 1·equirement�.
A.6. 7.6 General 1·equi1·ement� from 6.7.1 through 6.7.4 a1·e
also applicable to Type 2 EES.
A.6. 7.6.2.1 Type 2 essential electt·ical systems are comp1·ised of
tw·o separate branches capable of suppl)'ing a limited amount
of lighting anrl power service that is considered essential for
the protection of life anrl safety and effective ope1·ation of the
institution rlu1·ing the time normal electt·ical senice is inten-up­
ted for any reason. These two separate branches a1·e the life
safety and equipment branches.
The numbe1· of transfer switches to be used should be based
upon reliability, rlesign, and loarl considerations. Each branch
of the essential electrical system shoulrl have one or more trans­
fe1· switches. One transfe1· switch should be pern1itted to sen·e
one or mm·e branches in a facility with a maximum demand on
the essential electrical system of 150 kVA ( 120 kW).
A.6. 7.6.2.l.5(C)(4) Departmental installations such as digital
dialing svstems userl fot· intradepartmental communications
could have impaired use during a failure of electrical service to
the area. In the event of such failure, those systems that have
lighted selecto1· buttons in the base of the telephone instru­
ment or in the desk unit� known as "directm· set�" will be out of
senice to the extent that the light� will not function and that
the buzzer used to indicate incoming calls will be silenced. The
lack of electrical ene1·gy w ill not pt·event the use of telephones
fot· outgoing calls, but incoming calls will not be signaled, nor
will intercommunicating calls be signaled. This communication
fa.ilu1·e should be taken into consideration in planning essential
electt·ical systems.
A.6. 7.6.2.l.6(E) Other selected equipment can be served by
the equipment branch. Note that consideration shoulrl be
given to selected equipment in kitchens and launrl1·ies anrl to
selected central refrigeration.
It is rlesirnble that, where heavy interrnption cun-ents can be
anticipated. the transfer load be 1·educed by the use of multiple
transfer rle\ices. Elevator feeders, for instance, might be less
hazardous to electrical continuity if they are feel through an
individual transfer device.
99-191
A.6.7.6.2.l.6(E)(l)(a) The out�ide design temperature is
based on the 971/2 percent design value, as shown in Chapter 24
of the ASHRA..E Handbook - Fundammtak
A.6.7.6.2.l.6(E)(2) For elevator cab lighting, control, anrl
signal svstem requirements, see 6.7.6.2.l.5(C) ( 6).
A.6.7.6.3.1 See NFP./i 70for installation n�qui1·ement�.
A.6.7.6.3.2 If color is userl to identify these receptacles, the
same color should be used throughout the facility.
A.6.8.1 The intent of these tests is to a�sure that all electrical
equipment is operational ,vithin industry-recognized standards
and the manufactm·e1·'s tolerances and that equipment is in­
stalled anrl functioning in the system in the manne1· intended.
The test� and inspections should determine suitability for
initial and continued reliable operation and provide a baseline
fot· the ongoing electrical p1·eventive maintenance (EPM)
program.
A.6.8.2 The intent of this requirement is that the components
of the elect1·ical system frerling Category l and Category 2
spaces a1·e tested to ensu1·e that the complete system operates
in the manner anticipated and continues operating reliably.
This requires testing of the individual electrical component� of
the system. as well as the development of functional perform­
ance tests to confirm proper operation of the system as a
whole. Examples of industry-recognized standards for the
development of site acceptance test procedut·es include ANSI/
NETA ATS, Standard for A.rcl'filana ];,sting SpPrijirations for Eln:t,i­
f
wl Power Equip,,nmt and Systems, and Chapter 31 o NFPA 70B.
A.6.9.1.1 The purpose of any elecu·ical preventive mainte­
nance (EPM) program is to establish the condition of equip­
ment, determine what work shoulrl be done, anrl verif)' the
equipment will continue to function until the next scherluled
servicing occm·s. Inspection anrl testing are best <lone in
conjunction ,vith routine maintenance. In this way. many
minor items that require no special tools, training. or equip­
ment can be corrected as they are founrl. The inspection anrl
testing program is probably the most important function of a
maintenance department because it establishes what shoulrl be
<lone to keep the system in service performing the function for
which it is requi1·ed.
A.6.9.3.1 Approp1·iate con-ective measures can inclurle. but
are not limited to, repair, replacement, and adjustment. Follow­
through with necessary repairs. replacement. and adjustment is
the end purpose of an effective EPM program.
A.6.9.4.1 See Table A.6.9.4.l for sources ,vith recommenrlerl
maintenance acti\ities.
A.6.9.4.2 Health ca1·e facilities that choose to establish alte1·­
nate equipment maintenance (AEM) activities and/or sched­
ules must develop, implement, and maintain a documented
AEM program to minimize risk to patients and others in the
facility associated with the use of electrical utility equipment.
Generally, multiple factors must be considered because diHer­
ent types of equipment pt·esent different combinations of
seve1·it:v of potential harm anrl likelihood of failm·e.
A.6.9.4.2.2(1) Stanrla1·rl examples for physical plant equip­
ment maintenance can be found in the Ame1·ican Society fot·
Healthca1·e Enginee1·ing (ASHE) document, Maintmanre
l\ianagnnent fo-r Health Care Farilities, and in NFPA 70B.
2021 Edition
99-192 HEALTH CARE FACILITIES CODE

Table A.6.9-4.1 Recommended Maintenance Activities care microg1·i<l distributed ene1·gy resources (DER) in grid­
connected an<l islan<l mo<les is performed by the conu·oller
Item References based on economic and 1·eliability considerations. The control­
ler determines the health care microgri<l's internction with the
See Sections 11. LO and 15.5 utility grid, the decision to switch between grid-connected and
Medium-voltage switchgear of NFPA 70B. island modes, frequency regulation and voltage control, and
Power distribution See 11.11.2, 11.11.8, 21.2.2.2, optimal operation of local resources. It also provides any <leci­
trnnsformers(� 750 kVA) and 21.3.5 of NFPA 70B. sions on loa<l curtailment and shifting.
Generatot· (alternate source) See G.7.4. l ofthis code.
A.6.10.6.l Health ca1·e microgri<l systems monitore<l remotely
Generator paralleling
should include safegua1·ds to mitigate malicious control of or
sv.'itchgear See 8.3.5 ofNFPA l lO.
damage to the health care microg1·i<l.
Ovm:urrmt Pm/pr,five Devias
See 18.1.2 and 18.2.3 of A.6.10.7.2(2) This should include all those involved in the
Fuses (� 400 A) NFPA 70B. planning, design, constn1ction, installation, and operation of
Low-voltage power circuit See Sections I I.LO an<l 15.4 each sou1·ce and control within the health care microg1·id.
breakers (� 400 A) of NFPA 70B. A.7.1 Ad<litional information on these systems can be found
See Sections 17.7 through in IEEE 602, Rn:mnmmdfd Pra1:tire Jar Elft:lrir Systnns in Hmlth
Low-voltage molded-case 17.11 and 11.10.5 of CarPFarilitifs, and the applicable volume ofFGI guidelines.
ci1-cuit breakei-s (� 400 A) NFPA 70B.
Medium-voltage circuit See Sections 15.4 through A.7.3.1.2 Additional information can be found in ANSI/TL'\
breakers 15.8 ofNFPA 70B. 569-D, 1PlPrmmnunicatinm Pathways and Spar.PS.
Relays (including polyphase A.7.3.l.2.l.4(C) Such systems can inclu<le security, nurse call.
ground-fault equipment See Section 11.12, 13.3.5, cable television, patient education, voice, data, head end equip­
protection) an<l 15.9.7.3 of NFPA 70B. ment for clinical systems, and similar low voltage systems.
Transfr1· equipment See 8.3.4 ofNFPA 110.
Uninterruptible power A.7.3.1.2.1.S(B) Supplying the circuit� serving equipment in
supplies(� 100 k\'V) See NFPA 111. the telecommunications entrance facility through an uninter­
Isolated powe1- panels See G.3.3.3.3 of this co<le. rnpted power system (UPS) provides a desirahle level of redun­
<lancy.
See NEMA ICS 2.3,
Imtrw:tiom fnr the H andling, A.7.3.l.2.l.8(C) Consideration should he given to the 1·eliabil­
Imtallatinn, op,,ration and ity of power supply to the HVAC equipment because of it�
MaintPnance nf Matar Cantml important function within the telecommunications entrance
Cmters Raf Pd Not Afore than facility.
Motor control equipment 600 V
A.7.3.1.2.2.2 In combined spaces, care should be taken to
See ANSI/NEMA PB 1.1,
pnivide separation of, an<l adequate service access for, service
General Instnu:tinm Jar Proper provi<ler equipment.
Imtallatinn, OpPmtion and
lVlaintmanre nf Panelboards A.7.3.3.1.l Depending on the size and scope of the Category l
Branch-circuit panelboar<ls Rated 600 V or Ll'.u. space, an audimisual type system or tone visual type system may
Wiring <levices See 6.3.3.2 ofthis code. be use<l for the nurse call system. ,,Vhile both system types
Battety-powered lighting unit� See G.3.2.6.8 of this co<le. provide au<lible tones and illuminated light sout·ces to annunci­
ate call events, the audiovisual system provides voice communi­
cation capabilities to enable staff to speak with patients or
A.6.9.4.2.2(4) An example of ·'critical equipment" is electrical other stall at locations remote from the patient's room.
utility equipment. Depending on the requi1·ement� for the <lifferent care areas,
combinations of au<liovisual and tone \isual nut·se call system
A.6.10.1.2 Health care facilities are increasingly implementing equipment can be used.
various on-;,ite generation using a \\1de variation in technolo­
gies. These designs optimize the use of different sources both A.7.3.3.1.1.3 The fimdamental operation of a liste<l nu1·se call
f
on and of site and provide numerous a<lvantages, including system provides ale1·t� and notifications of call system event�. In
resilience, efficiency, lowere<l operating costs, an<l re<luce<l ad<lition to the call notifications activated by call stations, a
emironmental impact. Health care microgrids with sophistica­ nurse call system should also provi<le alert notifications for
ted controls and bundles of sources and storage assets can system self'.monit01·ing event� to annunciate tt·ouble conditions
provi<le better outcomes than the conventional <lesign that that can ocnu- within the system it�elf.
etnisions a "normal" an<l an "emergency" source.
A.7.3.3.1.1.5 A mu-se call system can be integrated with a \\1t"e­
A.6.10.1.3 Areas served by health ca1·e microgrids should be less communication system for the purposes of providing
identifie<l. supplemental call notifications to staff-<"an-ied wireless <levices.
Such notifications are considered supplemental unless the
A.6.10.3.2 A method for <letermining reliability for a health \\freless communication system is listed to UL 1069, Standard fiir
care microg1·id can be found in IEEE's 3006 standat·d se1·ies (see Hnspital Signaling and 1\/ursP Call .Equipmmt. Supplemental
li�ted IEJ.i.E refaPnces in D. 2. 7) and in NFPA 70B. communication systems should be provided with appropriate
A.6.10.6 The health care microgrid controller is a decision­ NRTL safety certifications an<l listings that a1·e consistent with
making software and/or har<lware. The sche<luling of health

2021 Edition
 ANNEX A
the intended use as a stand-alone wi1·eless communication
system.
The requi1·ement� in ANSI/IEC/ISO 80001-1-1, App!ir:atirm nf
Risk lvlanagnnimt fnr IT ;\'Ptwurks Inrnrpomting A-Jniii:al Devi,:Ps -
Part 1-1: Risk Ivlanagnnmt of 1vfedir:al IT Nftworks, and
ANSI/IEC/ISO 80001-2-5, App!i,:atinn nf Risk Managnnent frrr IT
Netwmks Inrnrpnrating A1edi,:al Devias - Part 2-5: A.ppliratinn
Guidanre - Guidanre frrr Distn'/mted Alarm Systmis, shoul<l he
followed whenever a nurse call system is integrate<l with a
supplemental communication system.
A. 7.3.3.1.2.1 Patient care spaces and nursing unit support
areas can contain many types of call stations \\�th varying
combinations of call initiation functions (e.g., code call, staff
emergency; medical <levice alarm, help, assistance). A single
call station can be equipped an<l configured to activate a single
call type or a number of <liffe1·ent call types, an<l can have bi­
<lirectional voice communication capability.
A. 7.3.3.1.2.2 Patient stations provi<le a means for patienL� to
summon assistance from the nursing staff. Calling devices such
as liste<l wi1·e<l 01· w i1·eless pillow speakers, pendant controls call
cor<ls, and patient- or staff-worn personal pendanl� a re permit­
te<l to initiate patient or staff calls. A call station that serves two
beds is pe1·mitte<l when beds are locate<l adjacent to each othe1·.
A. 7.3.3.1.2.3 Prima1·y signaling of a medical de\ice ala rm is a
f
requirement of the medical device it�el, per the governing
1·egulatory standat·d, and is beyond the scope of this code.
A. 7.3.3.1.3.1 'When tw·o or more call stations are located in the
same a r e a and all a re visible from any call location, the alarm
should be capable of being cancele<l at any of these locations.
This method of call cancelation can be applied to all call
station types.
A. 7.3.3.1.4 A code call can also be refetTed to as an emer­
gency 1·esuscitation alarm.
A. 7.3.3.1.4.1 \Vhen two or more call stations are locate<l in the
same are a an<l all a re "isihle from any call location, the ala1·m
should be capahle of being canceled at any of these locations.
This method of call cancelation can be applied to all call
station types.
A. 7.3.3.5.2 Cun-ently, no standanl exists for the certification
of a wireless communication system having the specific inten­
<le<l use as a clinical alarm communication and notification
system. While <lesirable fot· enhancing clinical communications
and optimizing clinical workflow, these types of communica­
tion systems have inherent reliability limitations. For example,
there is no notification at a wireless page1· when it is out of
rnnge fo1· receiving messages and the1·e is no alen at the central
station that the communication device is unreachable or return
confirmation that a message has been delivered or received.
A document with info1·mation on how to manage an<l
control risk is ANSI/AAMI/IEC 80001-1, ,4ppli i:atirm of Risk
l\Janagnnent for IT Networks Inr orpnrating I\4.ediral DevirPs -
Part 1: RnlPs, Responsibilitie.1 and Artivities.
There might be manufacturers of FDA-cleare<l medical
equipment that can have wireless communication capabilities
and that might he FDA cleared for a specific intended use.
Such medical equipment would typically be certified to one or
more ANSI/AAMI ES60601 standar<ls (e.g., 60601-1-1, Medii:al
e!n:trii:al n1uipment - Part 1: Gmeml requirements fnr basir safety
and essential perfrrrmanrP, 60601-1-2. lHedii:al ell'ctrical NJuipment -
99-193
Part 2: ('_,nllateml standard : ElPl'tmmagnPtit: dislurban,·es - Require­
ment\ and tests; 60601-1�. Mediral flectrii:al NJuipmmt - Part 8:
01llateral standard: A.lann systems - General requirPments, tests and
guidan,:e fnr alarm .rystnm in 11/.Pdiral eln:triral Pquipment and medii:al
fiPrtrical systnns; and so forth).
TI1e 1·esponsible organization can also contract with a
provider of communication equipment to integrnte a wireless
communication sy stem with nurse call s�tem or with the clini­
cal IT netw01·k for the purposes of enhanced clinical staff
communications. Howeve1·. such an integrntion would not be
listed to any governing standard.
Therefore, where a wireless communication system 1s rnte­
grnte<l with the clinical IT netwo1·k and used as a clinical ala rm
notification 01· enhance<l communicati on system, it is necessary
for the responsihle organization to follow and enact the risk
management requiremenl� estahlished in ANSI/AAMI/IEC
80001-1, Appliratirrn nf Risk Jv!anagrment fnr IT Jlietwrrrks lnr.orporat­
ing Medir:al Devices - Part 1: Rnles, &sprmsi/Jilities and Artivities.
Furthe1· in this context, the end-to-en<l system integration
and il� management nee<l to also conform to the guidelines
established in ANSI/AAMI/IEC 80001-2-5, Af1plir:atinn nf Risk
1vfanagnnmt for IT Netwnrks Inrorprrrating 1vfedii:al Devias -
Part 2-5: ,4pplir:ation Guidani·e - Guidana fnr DistributPd Alarm
Systems.
A.7.3.3.7.1 As the clinical emironment becomes more an<l
more automated, integrnted and evolved there is a need to
enslu-e that the serve1·s and networking equipment that trnns­
port interoperable clinical data an<l communications over a
clinical IT network a1·e properly institute<l and sufficiently
manage<l. ANSI/AAMI/IEC 80001-1, ,4pf1liratian nf Risk ManagP­
ment for IT Netwrrrks Incorprrrating Iviedical Devias - Part 1: Rnles,
RPspnnsi/Jilities and ,4i:tivities, is the governing stan<lar<l hy which
the clinical IT netwo1·k needs to he manage<l.
A. 7.3.3.7.2 While all nu1·se call s�tems need to be listed to
UL 1069, Standard fnr Hospital Signaling and Nurse Call E quifr
mmt, not all ntu-se call systems can be identified for use on a
s ha1·ed clinical IT network. Only those nut·se call s�tems that
are liste<l for use on a shared network are permitted to use the
clinical IT network infrastructure.
f
A.7.3.3.7.3 To ensure an ef ective, reliable, and 1·esilient clini­
cal IT network, two indepen<lent physical pathways pro"i<ling
netw-ork communications nee<l to be provided. Both paths
need to be at operational 1·eadiness at all times. Operational
re adiness can be ensured by continuous self�monitot·ing of
each path. All equipment items comprising e ach clinical IT
netwrn·k path need to be verified for availability by means of
communication. En<l-point terminal equipment items (e.g. .
computers, monitors, disuete medical devices, <liscrete devices
comprising the nurse call system, an<l so forth), which are
connecte<l to hut a1·e not pa rt of the clinical IT network, only
1·equi1·e one ph�ical connection to the clinical IT netwot·k.
A.7.3.3.7.5 Examples for operational monitoring of the clini­
cal IT network inclu<les, but is not limited to, the following:
(1) Environmental changes, including i-isk� associated with
data and system security vulnerahilities
(2) Operational/perfo rmance feedback from both automa­
te<l measurement an<l use1· fee<lback (e.g., spee<l proh­
lems, high error rates, equipment failure, malicious
software attacks, and so forth)
2021 Edition
99-194 HEALTH CARE FACILITIES CODE
A.8.2.1 1l1ere are no inteniependencies for each type of
system (e.g., medical gas, electrical, potable water, nonpotahle
water, nonmedical comp1·essed air, heating). A risk a�sessment
of each system should be conducted to evaluate the 1·isk to the
patient, staff, and visitors.
A.9.2.1 1l1e1·e ar·e no inte1·dependencies for each type of
system (e.g., medical gas, electrical, potable water, nonpotable
water, nonmeciical compressed air, plumbing). A risk a�sess­
ment of each system should be conducted to evaluate the risk
to the patient, staff, and visitors. It is possible when applying
this section to identify multiple categories of systems serving a
single patient. For example, see A.4. 1.
A.9.3.1.3 P1·e,ious editions haci 1·equired smoke purge systems
f
in these locations. The elimination o flammable anesthetics
anti limited use of combustible material in modern ORs makes
this requirement obsolete.
A.9.3.3.2 ASHRAE Guideline 0, Tiu Cmmnissioning Pmass,
ASHRAE Guicieline I .I, HVAC&R Tffhniral RPquirnnmtsfor thf
Cmnmissinning Pmre.��. and ASHR.AE Stanciarci 202, Commiss ion­
ing Pmr.f.�� for Buildings and Systnns. while not mandatory. can
provide guidance for this requirement.
A.9.3.6.3 Paragraph 9.3.6.3 only covers fluids that are storeci
in enclosed spaces.
A.9.3.6.5.1 See Table A.11.3.5.
A.9.3.8.1 Inlet� can be of any design suitable for the plume
capture device in use, provicieci the design noes not permit
interconnection to any medical vacuum, WAGD, or housekeep­
ing vacuum systems.
Flow control for the inlets shoulci be as appropriate for the
plume capture cievice in use.
A wan1ing system, such a� one that uses a builciing automa­
tion system, that monitorn the operation of the sou1·ce equip­
ment should be provicieci.
A.9.3.8.1(1) A dedicated medical plume evacuation system can
senre multiple locations. The discl1a1·ge of a dedicateci system
can be filtereci or unfiltered.
A.IO.I An appliance that yielcis en-oneous data or functions
poorly is potentially ha1·mful. Quality anti assurance of fall
appliance performance is not covered, except as it relates to
di1·ect electt·ical 01· fit·e injury to patients 01· pe1·sor111el.
The matet-ial in this annex, as it relates to electrical safety,
f
interpret� some of the ba�ic criteria by presenting dif erent
methodologies and alten1ative proceciures to achieve the level
of safety defined by the ct"iteria.
A.10.1.3 Risk categorization is not appropriate for this chap­
ter. Much of the chapter deals with electt·ical safety issues. Any
line-powe1·ed device that does not meet these requirement�
poses the risk of electric shock to patient� or personnel, 1·ega1·d­
less of where it is useci or the clinical application of the device.
Shock and fire 1·isk is not ciependent on the required 1·eliability
of the device or the extent to which patient diagnosis and treat­
ment depends on the cievice. Even categorization regarding
clit·ect cardiac connection 01· patient contact are not 1·elevant as
death or i1tjury can occur in any case.
A. I 0.2.3.2.4 ANSI/ AAMI ES60601-1, Medir:al Plei:tn'ral equipwnt
- Part 1: t,fnl"l'lll rPquirmu>nt� for basic safety and essmtial perform­
anr.P, defines the te1·ms protft:tive mrth r.ondurtor and functional
2021 Edition
mrth mndurtor. A protective earth conductor is relied upon for
safety and provides one means of protection from electric
shock. A functional earth conciuct01· has no safety function and
noes not provicie a means of protection against electric shock.
A ciouble-insulated medical product is permitted (but not
1·equired) to have a functional earth conciuctor that is referred
to as a funrtional ground mndurtor.
A.10.2.3.6 Consideration shoulci be given to certification of
relocatable power taps in accorciance with UL 1363A, Outlinf of
Investigation for SpPrial Purpose Relomtable Pm11Pr Taps. which
acid1·esses the 1·equirement� currently in this code anti addi­
tional safety requirements, such as use of hospital-grade recep­
tacle outlet� ai1d plugs, integrity of the enclosm·es, ai1d testing
for grounciing and leakage current.
AI0.2.3.6(1) Tape, adhesive, anti hook-and-loop fasteners are
not considered to be secure means of attachment. A clamp or
bracket that has been hand or tool tighteneci is conside1·ed
securely attacheci.
AI0.2.3.6(2) A means of meeting the requirement is through
summation of nameplate ampacity of connected equipment
and proactive administrative actions (e.g., education, signs). A
circuit protective device (e. g., circuit breaker, surge protector,
supplementai·y protect01·), alone, is not considereci sufficient.
AI0.2.4.3(2) The disconnection meai1s is permitteci only to
facilitate replacement; as such, ceiling drop cords cannot be
disconnected for alternative usage. See Chapte1· 6 f(')l' crite1·ia of
1·eceptades.
AI0.3.1 Visual inspections do not have to be formal or ciocu­
menteci by any particula1· staff member. All staff a1·e expected to
be observant of the condition of the equipment they use,
including power cord assemblies.
AI0.3.2 The1·e a1·e several methocis for measm·ing ground­
w:i1·e resistance accurately. Three examples a1·e described as
follows and shown in Figure A. l 0.,>.2(a) through Figure
A.10.3. 2(c):
(l ) 1wo-lVire RPsistanre Tn:hniqill'. A kn own cutTent is fed
through the unknown resistai1ce. A high-input­
impedance voltmeter mea�m·es the voltage drop across
the resistance, R. anti R is calculated a� voltage divideci by
impeciance, V/ I. This technique measures the lead resist­
ai1ce in series ·with the unknown resistance. When the
unknown resistance :is a ground w:i1·e (less thai1
0.15 ohm), the lean 1·esistance is appt·eciable. This is
accounted for by shorting the lead w:i1·es together and
"zeroing" the voltmeter. The actual resistance, in effect,
subu·act� out the lead wire 1·esistance. In orde1· ft')!' this
technique to be reasonably accurate for measu1·ing
ground wires, an active high-impedance millivoltmeter
has to be used.
(2) Four-VVirP RP.,istanrP 1Prhnique. This technique is vety simi­
la1· to the l:\Vo-wi1·e resistance technique. The diffe1·ence is
that the known current is fed to the resistai1ce to be mea�­
ured through a pair of leans separate from the pai1· of
leads to t he voltmete1·. The voltmeter is measuring the
true voltage across the resistance to be measureci, regai·ci­
less of the resistai1ce of the mea�uring leads. This method
eliminates the need for zeroing out the measuring lead
resistance.
(3) A,C CurrPnt Method. This technique utilizes a step-<lown
transfonne1· of known voltage output to feed cuITent
through the ground wire and measm·e the cun-ent that
 ANNEX A 99-195

flows. The impedance of the ground wi.i-e is then calcula­ 10,000ohms

ted by Ohm's law.
Note that the internal impedance of the measuring ci1·cuit
ha� to be es tablished with the test leads shorted. This value
needs to be subtracted from the test measurement.
A.10.3.3 For complex leak age cut-rent waveforms, a single
1·eading from an appropriate mete1·ing system can represent
the physiologically effective value of the composite waveform,
provided that the contt·ibution of each component to the total
1·eading is weighted in accordance with 10.3.3.
This weighting can be achieved by a frequency response­
shaping network that precedes a flat-response meter, 01· by a
mete1· whose own frequency response charncte1·istic matches
that of 10.3.3.
If the requi1·ed pe1·fo1·mai1ce is obtained by a meter with inte­
gral 1·esponse-shaping properties, then that mete1· should have
a constant input resistance of IO00 ohms. (A high-input­
impedance meter can be used by shunting a 1000 ohm resis tor
across the mete1·'s input terminals.)
If, however, the required frequency response is obtained by a
net\vork that precedes an otherwise flat-response meter, then
the input impedance of the network should be 1000 ohms
± 10 pe1·cent, over the frequency range from 0 to l MHz, and
the frequency response of the net\vork-meter combination
should be subs tantially independent of the impedat1ce of the
signal source.
For maximum chassis leakage current permitted (i.e.,
300 µi\) below l kHz, this net\vot·k will yield the limiting
cut-rent of 10 mA above 30 kHz.
A suggested input net\vork is shown in Figure A.10.3.3.
0.05 microfarad Millivol tmeter
1000ohms
100 ohms
FIGURE A.10.3.3 Leakage Cw-rent Measw-ements (1.0
Millivoltmeter Reading Corresponds to Input Current of 1.0
Microampere).
A.10.3.3.3 This test is not valid when perfo1·med on the load
side of an isolation trnnsformer or an isolated power system,
because the values ob tained will be falsely low.
A.10.3.5.4 Whe1·e existing equipment exceeds 500 µ.<\, meth­
ods to 1·educe leakage cut-rent, such as the addition of small
isolation transformers to that equipment, or methods that
provide equivalent safety by adding 1·edundant equipment
ground, are pe1·missible.
A.10.3.6 Although the touch current value is 500 µ.'\, the
patient lead leakage cutTent limit ft,.- nonisolated input has
been intentionally limited to 100 µA. This decision is in 1·ecog­
nition of the need fot· a greater level of electrical safety fot·
those portions of devices that make direct electrical patient
connection.
A.10.5.2.2 The refe1·ence to ANSI/AAMI ES60G0l-l , Mediral
elei:triral NJuipmmt - Part I: (',mf'fal rPrJuimnmt1 fm- basir sapty
and fssential f!Prfrmnanre, is the U.S. version and incl udes devia­
tions for use in the United States. Other countt·ies often use
the IEC ve1·sion or other versions with deviations.
A.10.5.2.5 Systems should comply with the appropriate medi­
cal device m system standa1·ds such as ANSI/AAMI ESG0fJ0l -1,
I\,fedir:al eln:triral equipment - Part I: (',enaal rP(JUirnnent� fm- bmi1·
safPty nnd e.��ential pfifonnanr:e. Consideration should also be
given to the guidance provided as part of the documentation

J
supplied with the indi"idual medical equipment.
Lead
)
A.10.5.4.5 The use of electrical equipment in spaces where
:e��stance there is a high oxygen content is a matter of concern because
ffi::me ter
fi�;�� of the fire haza1·d. It is pai·ticularly a problem whe1·e the oxygen
t

measured
is "pu1·e," that is, 80 pe1·cent to 90 percent, because materials
},__---) that are not vety flammable in ordinary air become extremely
L ead
flammable in pure oxygen.
In medical practice, particularly in sm·gery, patients are

J
FlGURE A.I0.3.2(a) Two-Wrre Resistance Technique.

-,- often given supplemental oxygen via respirator, anesthesia

machines, and so forth. Such supplemental m..ygen can rat1ge
from mom ai1· to 100 percent m,ygen. Clearly, diffe1·ent levels
of protection ,u-e needed.
Curre nt High­ :e��sta nce
source imp edance V
voltme ter measur ed This code addresses the problem by defining the following
______......_
'---------------
.._ three elements of the situation:
(1) Type of Air. An oxygen-enriched atmosphere (OEA) is air
that ranges from slightly enriched (23.5 percent, rather
than 21 percent) to total oxygen (100 percent).
FlGURE A.I0.3.2(b) Fow--Wrre Resistance Technique.
(2) Type of A.ppamtus. O11.ygen delivery equipment (ODE) is a
device that delivers an OEA to a patient.
(3) Type of SparP. A site of intentional expulsion (SIE) is a
small-volume space where oxygen that ha� been delivered
to the patient is discl1ai·ged to the ambient air.
When an OEA is within ODE, it is much m01·e likely to have
FlGURE A.I0.3.2(c) AC Current Method. a high concentration of oxygen. Pai·agrnph 10.5.4 the1·efore

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99-196 HEALTH CARE FACILITIES CODE
advises manufacturers, and A.10.5.4.5 advises use1·s, of precau­
tions to take to reduce the fire hazard. Paragraph 10.5.4 !isl�
four \Nays of attacking the problem. Note that an OE A can be
created not only in a ventilato1· or oxygen tubing, but also in an
oxygen tent or incubator. Special precautions should be taken.
At the other exu-eme of hazard is a space in the open air, the
site of intentional expulsion (SIE). This space is defined a�
locaterl within 30.5 cm (12 in.) of the exhaust port, because, in
most instances, dilution to ambient levels occurs within a few
inches of the port; 30.5 cm (12 in.) provides an adequate safety
fact01·. Paragraph 10.5.4.1 provirles guirlance to minimize this
hazarrl by requiring that only those parts of the apparatus that
are intenrled to be within the SIE are to he of concern. Even
these components, such as nu1·se call buttons, leads, and so
forth, do not necessarily need to be listed for use in OE A,
because they usually conform to provisions of 10.5.4.1 ( 4); that
is, they do not have hot surfaces, and they meet the require­
ment� of Figure 105.4.l(a) through Figure 10.5.4.l(f).
The intent of A.10.5.4.5 is to arlvise users to specify applian­
ces that meet highe1· requi1·ements where the haza1·d is highe1·
hut not to overspecify whe1·e the hazard is minimal. Thus, as
they are orrlinarily userl, nurse call buttons, pillow speakers,
anrl so forth, do not need to be listed for use in oxygen­
enriched atmospheres.
Note, however, that these requirements apply only to the
intended use. The user shoulrl exercise vigilance to guard
against an unintended use or an accidental failm·e, which can
vastly increa�e the hazard.
AI0.5.4.6 ·where possible, combustible mate1-ials such as hair,
fabric, and pape1· shoulrl be 1·emoverl from the vicinity where
the energy is delive1-erl. Wate1·--soluble surgical jelly has been
shown to dramatically rerluce the combustibility of such materi­
als.
AI0.5.5.I Most laboratory fir·es involve biomedical or othe1-
electronic equipment failures. The most common ignition
factm·s are short circuits or grouml faults. Electt-ical wi1·e 01-
cable insulation is the mate1·ial most likely to first ignite in a
clinical laboratory fire. (Si¥' HnPltgP, G.A., AlillPr, A., Kll'in, /1.R.,
Hamlin, a'.JJ., '�4,aidmtal Fires in Clinical Labomtnries. ")
A 10.5.6.2 1\lthough several approaches to documentation
exist in hospitals, the minimum acceptable documentation
should irlentify what was tested, when it wa� testerl, anrl
whethe1· it pedormerl successfully. Adopting a system of excep­
tion 1·eponing can be the most efficient fo1·m of 1·ecm·rl keeping
for routine rechecks of equipment or systems, thereby minimiz­
ing technicians' time in recording the value of each measure­
ment taken. For example, once a test protocol is established,
which simply means testing the equipment or system consistent
with Chapter 10, the only item (value) that needs to be recor­
rlerl is the failure or the deviation from the requirements of the
chaplet· that was detected when a cm-rective action (1·epai1·) was
undertaken. This approach can serve to eliminate, for exam­
ple, the neerl to keep indivirlual room sheet� to recorrl meas­
urerl results on each receptacle or to recm·rl measurement
values of all types ofleakage cun-ent tests.
AI0.5.8.I "Personnel" includes physicians, n111·ses, nursing
assistant�, enginee1·s, anrl technicians.
AI0.5.8.3 Qualification for equipment servicing rloes not
always include manufacturer t1·aining, as requirerl knowledge
anrl skills can be ohtainerl hy other means.
2021 Edition
A.I 1.1.2 Respiratory therapy is an allied health specialty
employed with medical direction in the treatment, manage­
ment, control, rliagnostic evaluation, and ca1·e of patient� with
rleficiencies and abnormalities of the carrliopulmonary system.
(Courtesy of the American Association for Respiratory Therapy,
1720 Regal Row, Dallas, TX 75235.)
Respiratmy therapy includes the thernpeutic use of the
following: merlical gases and administration apparatus, e1ni­
ronmental control systems, humirlification, aerosols, medica­
tions, ventilatory support, bronchopulmonary rlrainage,
pulmonary rehabilitation, cardiopulmonaty 1·esuscitation, and
airway management. (Courtesy of the American Association for
Respiratory The1·apy, 1720 Regal Row, Dallas, TX 7:>235.)
The1·e is a continual neerl for human diligence in the estab­
lishment and maintenance of safe practices for respirato1y ther­
apy. It is essential for pe1·sonnel having responsibility for
1·espiratory therapy to establish and enfo1·ce appropriate
programs to fulfill the provisions of this chapter.
It is the 1·esponsibility of the arlministrative anrl professional
staff of a hospital, or safety di1·ector, if one is appointed, to
arlopt and enforce appropriate 1·egulations for a hospital. In
other health care facilities, responsibility could be assignerl to a
sal·ety rlirecto1·, or othe1· 1·esponsihle pe1·son, who is, in tun1,
responsible to the administration.
In institutions having a respiratory therapy service, it is
1·ecommenrlerl that this se1·vice be di1·ectly 1·esponsible for the
arlministration of Chapter 1 1. Haza1·ds can be mitigated only
when there is continual recognition anrl understanding.
A.II.IA See Chapte1· 14.
A.I1.1.5 Risk categorization is not appropriate fo1· this chap­
ter. Much of the chapter deals with ga� equipment safety issues.
1\ny storage 01· use of ga� equipment in a health care facility
pt·esenl� 1·isks that the requirement� of this chapter 1·educe. Any
gas-related rlevice that does not meet these requirements poses
the same 1·isk to patients or pe1·sonnel, 1-egardless of whe1·e it is
used or its clinical application.
A.I1.2.7 It is particularly important that the intermixing of
oxidizing anrl flammable gases unrle1- p1·essure be scrupulously
avoided. Such mixing can 1·esult in a violent explosion.
A.I1.3.5 Electric wiring anrl equipment are not required to be
explosionproof. See Table A.11.3.5.
A.I 1.3.5.2(5) The fit·e 1-esistance rating for walls and floors is
determinerl in accordance with ASTM El 19, Standard TPst Meth­
ods fnr FirP Test� of Building Construction and MatPrial�, or UL 263,
Jim &sistancP Rlltin�. The fi1·e protection rating fo1· rloors is
determinerl in accm·dance with NFPA 252.
A.I1.3.5.2(6) Elect1·ical devices should he physically protected,
such as by use of a protective barrie1· around the electt-ical de,i­
ces, 01· by location of the electrical device such that it will avoid
causing physical rlamage to the cylinders or containers. For
example, the device could be located at 01· above 1.5 m (5 ft)
above finished floor or othe1· location that will not allow the
possibility of the cylinrlers or containers to come into contact
with the electrical device as requi1·erl by this section.
A.I1.3.5.2(7) Examples of indi1·ect heating inclurle steam, hot
water, anrl electric heating.
 ANNEX A 99-197

Table A.11.3.5 Typical Medical Gas Cylinders' Volume and Weight of Available Contents [All Volumes at 21.1 °C (70 °F) and
101.325 kPa (14.696 psi)]

Name of Gas
Nominal Mixtures of Oxmen
Cylinder Style and Volume Camon Nitrous
Dimemions [L (in.3)] Contents Air Dioxide Helium Nitrogen Oxide Oxygen Helium
B l.43 kPa 5778 13,IOO
(87) (psig) (838) (1900)
8.89 x 33 cm L (ft'') 370 (13) 200 (7)
(3'1, in. O.D. x 13iu.)
kg (lb-oz) 0.68
(1-8)
D 2.88 kPa 13,JOO 5778 11,032 13,JOO 5137 13,JOO
(176) (psig) ( 1900) (888) (1600) (1900) (745) (1900)
J0.8 x 43 cm L (fr1) 375 (l:-1) 940 (33) 300 (ll) 370 (]3) 940 (:l3) 400 ( 14) 300 (ll) 400 (14)
(4'1, in. O.D. x 17in.)
kg (lb-oz) l.73 1.73 *
(3-13) (3-13)
E 1.80 kPa 13]()() 5778 11,032 13,10 0 5137 13,JOO *
(293) (psig) (1900) 5778 (838) (1600) (]900) (745) (l 900)
10.8 x 66 cm L (ft:1) 625 (22) 1590 (56) 500 (18) 610 (22) 1590 (56) 660 (2'1) 500 ( 18) 660 (23)
(4'1, in. O.D. x 26in.)
kg (lb-oz) �.92 2.92 *
(6-7) (6-7)
21.9 kPa 13,10 0 5778 11,032 15,169 5137 15,169
(1337) (psig) (1900) (8 '.1- 8) (1600) (2200) (745) (2200)
17.8 x l09 cm L (ft'1) 2850 7570 2260 3200 7570 3450 2260 3000
(7 in. O.D. x 43in.) (]OJ) (267) (80) (113) (267) (122) (80) (106)
kg (lh-oz) 13.9 13.9 * *
(30-JO) (30-10)
G 38.8 kPa 13,100 5778 11,032 15,169 5137 15,169 * *
(2370) (psig) (1900) (8:18) (1600) (2200) (745) (2200)
21.6x 130cm L (fr1) 5050 12,300 4000 5000 13,800 6000 4000 5330
(8'1, in. O.D. x 51iu.) (178) (4:-14) (141) (176) (487) (2ll) (141) (188)
kg (lh-oz) 22.7 25.4 * *
(50...{)) (56...{))
HorK 43.6 kPa 15,169 5778 15,169 15,169 5137 15,169t *
(2660) (psig) (2200) (8:18) (2200) (2200) (745) (2200t)
23.5 x 130 cm L (ft'1) 6550 15,810 6000 6400 15,800 6900 6000 15,840
(9'1, in. O.D. x 51in.) (23]) (559) (212) (226) (558) (244) (212) (559)
kg (lb-oz) 29.l (M) 29.1 (64) * *
Notes:
These are computed contents hasecl on nominal cylinder volumes and rounded to no greater variance than ±I percent.
*The pressure and weight of mixed gases will vary according to the composiLion of the mixmre.
t:!i<; ft1/i800 L cylinders at 24'i0 psig are available on request.
Source: Compressed Gas Association, Inc.

All.3.5.2(12) Electrical devices should he physically protec­
ted, such as by use of a prntective b aITiet· arnunrl the electrical
devices, or by location of the electri cal rle,ice such that it will
avoid causing physical damage to the cylinders or containers.
For example, the device could be located at <ll" above 1.5 m
(5 ft) above finished floor 01- other location that will not allow
the possibility of the cylindet·s 01· containers to come into
contact with the electrical device as required by this section.
All.3.5.2(13) Considerntions for this access include prnxim­
ity to loading <locks, access to elevators, and passage of cylin­
ders through public areas.
All.3.6 When determining the volume of stm·age, do not
consider cylinders and containet·s that at-e in use. Only the
volume of stored gas that is in excess of 8.5 m� (300 ft�) is
requi1·ed to be located in an enclosure, since 11.3.7 already
pet·mits up to 8.5 m� (300 ft�) without any special storage
requiremenL�.
A.11.3.B Limited quantities of combustibles applicable to the
cylinde1·s, such as cylinder labels, gauges, posted safety signs,
anrl similar, are permitted.
f
All.4.1.1 I the sole source of supply of nonflammable medi­
cal gases, such as nitrous oxide and oxygen, is a system of cylin-

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99-198 HEALTH CARE FACILITIES CODE
de1·s attached di1·ectly to, and supported by. the device (such as
a gas anesthesia apparatus) used to administer these gases, it is
recommended that two cylinders of each gas be attached to the
administe1·ing device.
A.11.4.1.2 The Pin-Index Safety Svstem consists of a combina­
tion of two pins projecting from the yoke assembly of the appa­
ratus and so positioned a� to fit into matching holes dt·illed
into the cylinder valves. It is intended to protect against the
possibility of error in attaching the flush-type valves, with which
gas cylinde1-s and othe1· sou1·ces of gas supply are equipped. to
gas apparatus having yoke connections.
A.11.4.1.4 Fabrication specifications are contained in CGA V-1
(ANSI B57.l), Standard for ComprPssPd Gas Cylindi'r ValvP Out/J>t
and Inlft Conntrtions. Connection No. 860, shown in that docu­
ment, illustrates the system. Connection No. 870 (Oxygen,
Medical), Connection No. 880 (Oxygen-Carbon Dioxide
Mixture), Connection No. 890 (Oxygen-Helium Mixture),
Connection No. 900 (Ethylene), Connection No. 910 (Nitrous
Oxide), Connection No. 920 (Cyclopropane), Connection
No. 930 (Helium), and Connection No. 940 (Ca1·bon Dioxide)
are for specific medical ga.�es and ga.� mixttu-es and utilize the
ba�ic dimensions of Connection 860.
A.11.5.1.1.2 Out�ide of a patient ca.re room, 11.5.1.1.2 prohib­
its sout-ces of open flames within the site of intentional expul­
r
sion l ft (0.3 m) l of a nasal cannula. No sources of open
r
flame a.re permitted within the area of administ1·ation 15 ft
(4.3 m) l for othe1· types of oxygen delivery equipment or in
patient ca1·e spaces (�ff 11.5.1.1.3).
The amount of oxygen delivered by a na.�al cannula is limi­
ted. One ft (0.3 m) is sufficient separation from an oxygen­
enriched atmosphe1-e produced by a nasal cannula, which is
oxygen delivery equipment used outside of patient care spaces.
In the open air, dilution goes to ambient levels (not oxygen­
enriched atmosphere) within a few inches of the cannula open­
ings, but 12 in. (300 mm) provides an adequate safety factor.
Other oxygen delivery equipment, such a� masks, are not inclu­
ded since ma.�ks would not t ypically be associated with mobile
patient� in health ca1·e facilities and can deliver greater quanti­
ties of oxygen than nasal cannula.
The household-style nursing homes that include kitchens
intended for 1·esidents' use and enclosed gas fit·eplaces pt·esent
a source of flame ignition to which residents will be exposed.
Resident� utilizing a na.�al cannula would potentially not be
allowed to participate in the cooking because it would place
the cooking flame within the site of intentional expulsion.
However. they would be allowed in the kitchen area to assist in
preparing the food and to socialize with othe1· 1·esident� and
staff in the kitchen similar to what happens in the kitchens of
residential emironment�.
The primary concern is that flame-producing equipment
exists in many places in a nursing home and that it would be
impractical to maintain a resident with a nasal cannula a mini­
mum of 15 ft (4.3 m) (Area of Administration) away from the
flame-producing equipment. Typical flame-producing equip­
ment found in a nursing home includes the following:
( l) Candles in chapels
(2) Open kitchens using gas cooking equipment
(3) Fi1·e places
(4) Fuel-fired heating equipment
(5) P1·ivate family dining rooms using fuel-fit·ed equipment
(6) Canned cooking fuel (e.g.. used unde1· chafing dishes)
2021 Edition
Al 1.5.1.1.3 Patient� and hospital pe1-sonnel in the area of
administration should be advised of respiratory therapy hazards
and 1·egulations.
Visito1·s should be cautioned of these haza1·ds through the
prominent posting of signs. (Sff 11. 3.12.)
A.I 1.5.1.1.4 Solid fuel-burning appliances include wood­
bun1ing fireplaces, wood stoves, and simila1· appliances. These
pose a greater risk in locations where oxygen is being provided
than gas-fueled appliances, in pan due to thei1· ability to emit
embe1·s into the environment.
A.I 1.5.1.1.5 Such toys have been associated with fire incidents
in health ca1·e facilities.
A suggested text fot· precautionary signs for oxygen tent
canopies and oxygen hoods used in pediatric nursing units is
the following:
CAUTION: OXYGEN IN USE
ONLY TOYS APPROVED BY
NURSES MAY BE GIVEN TO CHILD
A.I 1.5.1.3.3 Service manuals, instructions, and procedures
provided by the manufacttu-e1· should be considered in the
development of a progrnm fot· maintenance of equipment. The
experience accumulated by the facility and others (evidence­
baserl maintenance) shoulrl be userl to adjust manufacture1·'s
recommendations whenever and wherever appt·opriate, even if
they indicate no maintenance program is required.
Al 1.5.2.1.1 "Personnel" typicallv includes physicians. nurses,
nursing assistant�, 1·espiratory therapist�, enginee1·s, techni­
cians, and others.
A.I 1.5.2.2.2 CGA P-2.5. Tmnsfilling of High PrP.rnm Gaw't.JU�
Oxygm U�td for &spimtion, contains both mandatory and
nonmandatoty language. Enfot-ceable language uses the te1-m
shall; nonmandato1y language uses the term should. This
section indicates that this code is making refe1·ence only to the
mandatoty requi1·ement� in that document.
A.11.5.2.3.2 CGA P-2.6, Tmnsfilling of Liquid Oxygen U.�Pd for
RPspimtion. describes the recommended pt·ecautions and safety
procedtu-es when transfilling liquid oxygen used fot· respira­
tion. Mishandling of oxygen present� potential hazards to both
trained and untrained persons. Organizations engaged in the
ti-ansfilling of liquid oxygen should ensu1·e that personnel are
familiar with the hazards of nyogenic liquid oxygen and that
they comply with applicable regulations and safety practices.
A.I 1.5.2.4 Oxygen concentrat01· filling systems are FDA
approved and have been in use for many yea1·s with excellent
safety records. 1l1e inherent risks a.�sociated with typical trans­
filling do not apply to oxygen concentrator filling compressors.
Limitations were placed on these systems in orde1· to pt·event
the risks associated with larger, higher flow, or higher pressure
systems being introduced into the patient em,ironment. The
cylinder size was limited to cylinde1·s normally used for patient
ambulation. The filling rate was limited to pt·event excessive
heating of the cvlinder content�. The filling pressure wa� limi­
ted based on the existing indust1·y pi-actice.
A.I 1.5.3.2 P1·ecautiona1y signs should be at least 21 cm x
28 cm (8 in. x 11 in.).
 ANNEX A
Any material that can bun1 in air will bun1 more rapidly in
the presence of oxygen.
Special signs and ad<litional precautionaty measu1·es should
be employed whenever fru·eign languages pt·esent a communi­
cation problem. (See Figim A.11.5. 3.2.)
No electt·ical equipment is pe1·mitted within an o:i--ygen
enclosm·e or ,,�thin 1.5 m (5 ft) of the enclosure.
A..11.6.5.5 For furthe1· guidance, refrr to CGA P-50, Site Secur­
ity Standard.
A..11.7.3.1 The seller has a responsibility to provide written
instructions to the user in accordance with 11.7.2. In fulfilling
this responsibility, the seller should explain to the uset· the use
of the equipment being <lelivered and pt·ecautions that are to
be taken. The seller's written instructions are intenctect to make
the uset· awase of the haza1·cts of the matet-ial and to provide
1·ecommen<lations that ,�II a<ldt·ess the location, restraint,
f
movement, and refill o portable containers when these
containers are to be refillect by the user. However, the user has
the responsibility to 1·eceive, react, and understand the w1·itten
mate1·ial rega rding storage and use of liquict oxygen and the
containers anct equipment that are fornished by the seller. In
ad<lition to specific info1·mation or instructions provided by the
seller or equipment manufacturet· rega rding the storage or use
of the equipment anct of the liquict oxygen or the containers
used, the user remains responsible to see that the containers
are used or maintained in accordance with the seller's instruc­
tions to ensure that they a1·e as follows:
Located and maintained i n accorctance with the require­
(l)
ment� of 11.7.3.2
(2) Restraine<l in accor<lance mth the 1·equirements of
11.7.3.3
(3) Handlect or transported in accordance with the requi1·e­
ment� of 11.7.3.4
(4) Refilled in accordance with the 1·equi1·ement� of 11.7.3.6
and the manufacturer's instructions when liquid oxygen
portable containet·s are to be 1·efilled by the uset·
CGA P-2.7, Guide for the Safe Stomge, Handling; and u�e of Small
Portable Liquid Oxygen Systnm in Health Care Farilities. ctescribes
the 1·ecommended pt·ecautions and safety proce<lures to he
followed when liquid oxygen systems are used within health
ca1·e facilities. Mishandling of oxygen present� potential
hazarcts to both trained and untrained persons. Therefore, it is
impot·tant that pe1·so1mel who assume 1·esponsibility fo1· o:i-')'gen
equipment and it� use be familiar ,�th the hazards of oxygen,
the operational characteristic of the equipment, and the
pt·ecautions to he observed while using it.
CAUTION
OXYGEN IN USE
NO SMOKING
NO OPEN FLAMES
FIGURE A.I 1.5.3.2 Suggested Minimum Text for
Precautionary Si gns.
99-199
A..11.7.3.3 Two point� of contact can be provided by using
elements of a room or furnishings in the room, such as the
walls of a cornet· of a room, or a wall anct a furnishing 01· object,
such as a table 01· a desk.
A.11.7.3.5 CGA P-2.7, Guide for the Safe Storage, Handling; and
Use of Small Portable Liquid Oxygen Systnns in Health Cm'/' Farilitifs,
desct·ibes the 1·ecommended precautions and safety procedures
to be followed when liquid oxygen systems are used "ithin
health ca re facilities, such as a 1.5 m (5 ft) separation from
electrical appliances dut·ing filling and use.
Mishandling of oxygen presents potential hazarcts to both
trained anct untrained persons. It is therefore important that
pe1·s01rnel who assume responsibility for oxygen equipment
anct it� use he familiar \�th the hazar<ls of oxygen, the opera­
tional characteristic of the equipment, anct the precautions to
be obse1ved while using it.
A.11.7.3.6.I.I Drip pans or simila1· containment devices are
used in or<ler to protect against liquid oxygen spillage coming
into contact \,�th combustible surfaces, inducting asphalt,
which would elevate the potential for ignition.
A.12.1 Such facilities include, but are not limited to, hospitals,
convalescent 01· nursing homes, and eme1·gency 1·eceivi11g
stations. A government auth01·ity could fot·mally designate such
facilities as ctisa�ter treatment centers. Such facilities woulct not
normally include doctors' or ctentist�' offices, me<lical laborato-
1-ies, or school nurseries, unless such facilities at·e usect for treat­
ment of disaster victims. National hioterrorism preparedness
effort� call for the use of schools and other large public facili­
ties to provi<le facilities fix mass immunization.
A.12.1.1 Throughout this chapter, wherever the term hospital
is usect, the term should also apply to other types of health care
facilities. Applicable facilities inclu<le, hut a1·e not limited to,
hospitals, convalescent or nursing homes, and eme1·gency
receiving stations. A government authority coulct fixmally
designate such facilities as disaster treatment centers. Such
facilities would not normally include doct01·s' or <lentist�• offi­
ces, medical laboratories, 01· school nu1·se1·ies, unless such facili­
ties are usect for treatment of <lisaster victims. National
f
bioterrorism preparedness ef ort� call for the use of schools
and othet· large public facilities to provide facilities fot· mass
immunization. An eme1·gency management progrnm (formerly
known as a ctisaster plan or internal/external plan) encom­
pa�ses activities across fout· phases: mitigation, preparedness,
response, anct 1·ecove1-y. Mitigation activities are those designed
to reduce 01· eliminate the impact of hazat·ds. Prepare<lness
activities include those that build organizational and indi\idual
capabilities to <lea! ,,1th disa�ters. Response activities inclucte all
f
necessary actions to stop ongoing negative ef ect� of a disa�ter.
r
Recovery activities a e those that restore the organization, its
employees, and the community back to n01·mal.
NI-P,1 16()() is an internationally accepte<l framew01·k fot· an
emergency program. Chapter 12 of this code recognizes this
overall stntctm·e and provides a<lditional information useful to
health care organizations. Table A.12.1.1 illustrates the rela­
tionship between the element� ofChaptet· 12 and NFPA 16()()_
A.I 2.2.I In time of disaster, all persons a1·e sul�ject to ce1·tain
constraint� 01· authorities not pt·esent during normal circum­
stances. The eme1·gency operations plans written by a health
care facility should be reviewed and coordinate<l with such
autho1·ities so a� to prevent confusion. Such authorities
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99-200 HEALTH CARE FACILITIES CODE

Table A-12.1.1 How NFPA 99, Chapter 12, Relates to NFPA 1600

NFPA 1600 NFPA 99, Chapter 12

Introduction
Scope 12.1 Applicability
Purpose 12.1.1 Framewm·k
Program Management
Policy 12.2.1 Authmity HavingJurisdiction
Program Co01·dinat01· 12.2.2 Senior Management
Program Committee 12.2.3 Emergencv Management Committee
Program Assessment 12.2.3 Emergency Management Committee
Program Element�
Genernl
Laws and Authority
Hazard Identification and Risk Management A.12.5.3.1.2 Hazard Identification
Hazard Management (Mitigation)
Resource Management 12.5.3.3.6.2 Resource A�sessment
Planning 12.5.3.3.5 Eme1·gency Operations Plan
Direction, Control, and Coordination A.12.2.3.3 Incident Command System
Communications and ,,varning A.12.5.3.3.6.1 (5) Communications
Operations and Procedures A.12.5.3.3.6.3 Identification of Personnel
12.5.3.3.6.5 Essential Utilities
12.5.3.3.6.7 Staff Roles
12.5.3.4.10 Medical Surge Capacity and
Capability
12.5.3.3.6.3 Safety and Security
12.5.3.5 Recovery
Logistics and Facilities 12.5.3.4 Response
Training 12.5.3.3.7 Staff Education
Exercises, E\-aluations, and Corrective Actions 12.5.3.3.8 Testing Eme1·gency Plans and
Operations
Public Education and Information 12.5.3.3.6.1(3) Communication
Finance and Administration

include, but are not limited to, civil authorities (such as a fire A.12.2.3.1 An individual member can represent multiple disci­
department, a police department, a public health department, plines, as appropriate, to the facility. Those department�. serv­
or emergency medical senice councils). Centern for Disease ices, and areas that have a significant role in the facility's
Control, Federal Bureau of Investigation, and eme1·gency eme1·gency management activities can include, but are not limi­
management 01· milita ry auth01·ities. See Comprehensive Eme1·­ ted to, the following key a1·eas:
gency Plan, A.nnex G, for publications explaining how the out­ (1) Senior management
of�hospital response is organized to multiple and mass casualty (2) Medical staf
f
incidents. Furthe1·, an authority having jurisdiction can impose (3) Nursing
upon the senior management of the facility the responsibility (4) Infection prevention
for participating in a community emergency management (5) Emergency department
program. (6) Facility enginee1·ing
A.12.2.3 It is strongly recommended that executive and medi­ (7) Safety/industrial hygiene
cal leadership representatives play a key role in the emergency (8) Security
management committee and planning process. The following (9) Information technology
list is not intended to be all-inclusive, and additional 1·ep1·esen­ (10) Materials management
tatives might be needed based on the level of care provided or (11) Marketing/ public relations
the strncture of the organization: (12) Food services
(13) Em,ironmental se1·vices
(1) BiotetTorism coordination (14) Othe1· key areas within the organization
(2) Communications/data management
(3) Finance A.12.2.3.3 Federal, state, and local governments are requi1·ed
(4) Human resources to use an incident command syi,tem (ICS) based on the
(5) Legal/1·isk management National Incident Management System (NIMS). Although
(6) Public relations private sector hospitals are not required to be NIMS compliant,
(7) Put·cl1asing/materials management many are choosing to comply, not only to integrate with other
(8) Quality management eme1·gency responders but also to remain eligible to 1·eceive
(9) Training and education certain federal grant monies. HICS, the Hospital Incident
Command System, was specifically designed to be NIMS

2021 Edition
 ANNEX A
compliant. aml. therefore. many hospitals use this model,
either as developed or with some customization. HICS can be
customized and adapted to other types of health care facilities.
HICS is led by an incident commander and assisted by
command staff consisting of the public information officer,
safety officer·, and liaison officer, and those medical/technical
specialist� who a1·e appropt·iate to Lhe event. Section chiefs a1·e
responsible for each of the following sections:
Ope1·ations Section: Conduct� the tactical ope1·ations to
(l )
caITy out the incident action plan using defined objec­
tives and directing all necessary 1·esou1·ces
Planning Section: Collect� and evaluates information for
(2)
decision support, maintains resource status info1·mation,
prepares the Incirlent Action Plan, and maintains rlocu­
mentation
(3) Logistics Section: Pro,irles suppm·t. resources. and other
se1·vices to meet the operntional objectives
(4) Finance/Administration: Monitors cost� related to the
incirlent anrl prmirles accounting services, time recorrl­
ing, and cost analyses
Each section is composed of subm·dinate positions that a1·e
rlivided into branches or unit�.
Features of HICS inclurle the following:
Clear chain of commanrl
( l)
(2) Manageable span of control
(3) Common te1·minology
(4) Arlaptabilit:y to unifierl command
HICS tools inclurle the following:
( l) Job action sheets detailing position responsibilities
(2) Fm·ms to rlocument the event
HICS was intenderl to be userl not only for eme1·gencies but
also fot· plannerl event�. Complete HICS rlocumentation is free
anrl available for rlownloarl at www.emsa.ca.gov.
A.12.4.1 Conside1·ation should be given to all sites affiliated
with the 01·ganization. Each component of the health ca1·e
01·ganization should either have their own emergency manage­
ment program and plan or be part of the overall organization's
emergency management program and plan.
A.12.4.1.1 01·ganizations that are part of an integrated heafth
care system can choose to develop an emergency operations
plan (EOP) using a system approach, rnther than individual
facility EOPs.
A.12.4.2 The A�sistant Secretary of Preparedness and
Response (ASPR ) defines the te1·m health rare rnalitinn (HCC) in
201 7-2022 Hmlth Carp PrP/xmdnPss and &sponse Capabilitifs as "A
group of indi\irlual health care anrl response organizations
[e.g., hospitals, emergency medical services (EMS), emergency
management organizations, public health agencies l in a
rlefined geographic location. HCCs play a critical role in rlevel­
oping health care delivety system preparerlness anrl response
capabilities. HCCs senre as multiagency coorrlinating groups
that support and integrate with [Emergency Support
Function-Bl ESF-8 [health anrl medical services l activities in
the context of incident command system (ICS) responsibili­
ties."
Health care facilities should participate in health care coali­
tions to improve community emergency planning, resource
9�201
sharing, and other collaborative effort�. Participation in other
types of collaborative groups can also be beneficial.
A.12.5.3.1.2 By ba�ing the planning of health care emergency
management on realistic conceptual event�, the pt·ogram
reflects those issues or event� that are predictable for the envi­
ronment in which the 01·ganization operates. Thus, such
conceptual planning should focus on issues, such a� severe
weather typical in the locale, situations that can occur due to
close proximity of industrial, government, or transportation
complexes. 01· earthquake possibilities due to locaf seismic
activity. Planning should also incorporate knowlerlge available
in the emergency management research about how individuals,
small groups, 01·ganizations, communities, and societies behave
during eme1·gencies.
A.12.5.3.1.3(1) Continuity of operations can inclurle, but is
not limited to, maintaining staffing levels, resources and a�set�,
ability to obtain support from the out�ide environment, and
leade1·ship sustainability. At a minimum, plans shoulrl inclurle
the following:
(1) Learlershi p succession
f
(2) Delegation o legal authority
(3 ) Restoration of critical systems
A.12.5.3.2.3(7) T his should include additional information on
the rlevelopment, maintenance, anrl evaluation of hazardous
materials first receivers rlecontamination programs.
A.12.5.3.3.6.1(5) Emergency internal and external communi­
cations systems shoulrl be established to facilitate communica­
tion with security forces and other authorities having
jurisdiction, as well as internal patient care anrl service unit� in
the event normal communications methorls are renrle1·erl inop­
erative. 1l1e basic form of communication in a disaster is the
telephone system. A� part of the contingency plan to maintain
communication, a plan fot· 1·estoring telephone systems 01·
using alternate svstems is necessaty. Tvpicafly, the first line of
internal defense for a system outage is strategically placed
power-failure telephones that are designed to continue to func­
tion in the event of system failtll'e (e.g., dedicated lines, fax
lines). Plans for external outages and load control shoulrl
inclurle the use of pay phones, where available, that have first
prim·ity status in external system 1·estoration. Facilities should
preplan restoration activities and pt·ioritization with their tele­
phone service prmiders. A review with the state anrl other
communications agencies (Goven1ment Emergency Telecom­
munications Service, ,vi1·eless Prim·ity Se1vice, Health anrl
Homeland .,\Jert Network) shoulrl be conducted.
Contingency plans should also contain strategies for the use
of rarlio frequency communications to supplement landline
usage. The plan should include a means to distt·ibute and use
two-way radio communication throughout Lhe facility. A plan
fot· the incm-poration and use of amateur rarlio operatorn
should also be considet'erl.
It should be recognized that single-channel radio communi­
cation is less desirable than telephone system restoration due
f
to the limiterl numbe1· o messages that can be managed. Cellu­
lar telephones. although useful in some disa�ter situations,
should not be considered a contingency that has high reliabil­
ity due to thei1· vulnerability to the load control schemes of tele­
phone companies. Text messaging has been proven to be more
reliable than cellular phone calls. Social merlia can be an
important tool for emergency communication, but it must be
managerl so that responses to inquiries can be prnvirlerl. Porta-
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99-202 HEALTH CARE FACILITIES CODE
ble email devices, satellite telephones. and audio- an<l video­
conferencing services are useful tools to link key staff an<l
organizations.
A.12.5.3.3.6.3 Prim· to a disaster, facilities should formally
coordinate their security nee<ls with local law enforcement
agencies. The health care institution will find it necessary to
share it� eme1·gency operations plans with local law enforce­
ment agencies or, better still, involve them in the process of
planning for security support during disasters. The information
should at least include availability of parking for staff, patient�.
an<l visitors, and nm·mal vehicula1·, emergency vehicula1·, an<l
pedestrian tral'fic flow patterns in an<l aroun<l the facility. The
extent of the security and traffic control problems for any given
health ca1·e facility will depend upon its geogrnphical location,
f
physical arrangement, availability o visitor pat·king area�.
number of entrances, and so forth.
Cmwrl Cnntml Visito1·s can he expected to inCl'ease in
number with the severity of the disaster. They should not be
allowed to disrupt the functioning of the facility disa�ter plan.
I<leally, a visitor reception cente1· shoul<l be established away
from the main facility it�elf, particularly in the case of majm·
<lisasters. Volunteer personnel such as community emergency
response teams (CERT), Red Cross, Explorer Scouts, 01· othe1-
helpe1·s can be utilized as liaisons between the visitors and the
health care facility it�elf.
Vehicular Tmffir Control. AtTangement for vehicula r trnffic
control into and on the facility premises shoul<l be ma<le in the
disaster planning pe1·iod. It will be necessary to di1·ect ambulan­
ces and other emergency vehicles carrying casualties to triage
a1·eas or the emergency room entrance, and to <li1·ect incoming
an<l outgoing vehicles canying people, supplies, an<l equip­
ment. Charm showing traffic flow an<l indicating entrances to
be used, evacuation routes to be followed, and so forth, should
be prepared and included in the eme1·gency operations plan.
Pa1·king arrangements should not be overlooked.
Intfrnal Sn:urity and Tmffir Cnntml. Internal security and traf'.
fie control are best conducte<l by facility-traine<l personnel
(i.e., regula r health ca1·e facility security forces) v,1th reinforce­
ments a� necessary. Potential additional a�sistance from the
local law enforcement agencies shoul<l be coon:linate<l in the
disaster planning phase. Upon activation of the eme1-gency
operations plan, security guards should be st.atione<l at all
unlocked entrances and exits to the extent possible. Entrance
to the facility shoul<l be 1·estricted to pe1·sm111el bearing staff
identification ca1·ds and to ca�ualties. In the case of majm­
access corri<lors between key areas of the facility, pedestrian
traffic shoul<l be restricte<l to one side of the con-idor, keeping
the othe1· si<le of the corridor free fot· movement of ca�ualties.
Traffic flow chans fot· internal traffic shoul<l also he prepare<l
in the planning phase, as is the case with external tral"fic
control.
A.12.5.3.3.6.5 Consideration should be given to preemptively
installing parallel component� such that maintenance can be
pel'formed on operating equipment. This will necessitate the
installation of additional valves, ci1·cuits, or controls to isolate
those part� to he removed and replaced, such as air or foe!
filters. 1l1is work should not violate any other code, stan<lard,
or safety <levice. The desire<l outcome is system 1·esiliency
despite part failure.
\Vhen planning for emergency utility systems, consideration
should be given for maintaining tempernture an<l humi<lity
2021 Edition
levels appropt·iate for patients an<l supply storage. This could
be done by provi<ling HVAC on emergency power, by reloca­
tion of patient� an<l supplies to an appropt-iately heated or
coole<l a1·ea of the facility, or evacuation.
Al2.5.3.3.6.8(1) The command structure should also follow
the National Incident Management System (NIMS) as provided
in NI.PA 1600.
A.12.5.3.3.8 Experiences show the importance of drills to
rehearse the implementation of all element� of a specific
1·esponse, including the entity's role in the community, space
management. staff management, and patient management
activities. To document an exercise, the following a�pect� a1·e
typically incorporated. A general overview of the scenario,
<locumente<l activation of the eme1·gency operations plan,
reports from an i<lentified evaluator(s), evaluation of all
involved participants (ciepartments) and any obse1·ver(s), a
written n·itique following the <l1-ill, an<l any identifie<l follow-up
tt·aining m· improvement action(s) to correct or manage any
<leficiencies.
A.12.5.3.3.9.8 \\!hen improvement� requi1·e substantive 1·eso1Jt'­
ces that cannot be accomplishe<l by the next planne<l exercise,
interim improvement� should he put in place until final resolu­
tion.
A.12.5.3.4.l In emergency situations that occm· without warn­
ing an<l impact the facility, staff at the scene of the problem are
expected to follow establishe<l protocols to protect life, notify
othe1·s, and conse1·ve pt·openy. Senior management can estab­
lish a hospital comman<l center (HCC) or participate in
unified command \\1th othe1· responding agencies at a designa­
te<l eme1·gency operations center (EOC). In emergency situa­
tions with warning 01· whose impact� requi1·e extended pe1·iods
to resolve. <lesignate<l lea<lership report� to the HCC. Not all
incidents 1·equire an HCC.
1l1e HCC provides centralize<l locations fot· information
collection, display, coordination, documentation, an<l dissemi­
nation.
Al2.5.3.4.5 Note that ca1·e should be taken to ensu1·e that
i<lentification cards are recalle<l whenever personnel terminate
a�sociation \\ith the health care facility. Members of the news
me<lia should be asked to wea1· some means of identification,
such as a press card, on their out�ide ga rment� so that they are
1·ea<lily i<lentifiable by security guarcis controlling access to the
facility or cenain areas the1·ein. Cle1·gy also \,ill frequently
accompany casualties or arrive later fot· visitations and require
some means of identification. ,-vater storage systems should be
inventorie<l and protecte<l to the greatest extent pos�ible.
A.12.5.3.4.9 For additional infot·mation, see the 2012 Institute
of Medicine (IOM) Report, Crisi� Standards nf Care: A Systnns
FrmnPwnrk fnr rntastmphii· Dimstfr Respnnse.
Al2.5.3.4.10.l Based on the facility's haza1·d vulnerahility
analysis (HVA), consi<leration shoul<l inclu<le, but not he limi­
ted to, preparation to <lo the following:
(1) Provide services to i1tjure<l respon<lei-s and disa�ter
\ictims
(2) Receive large numbe1·s of victims from a mass casualty
incident (trauma or me<lical)
(3) Be a 1-ecei"ing facility for a health ca1·e facility evacuation
(4) Handle uncontrolled increased census (e.g., <lue to a flu
outh1-eak)
 ANNEX A
A.12.5.3.5 Recoveqr measures could involve a simple reposi­
tioning of staff, equipment, supplies, aml information services;
or 1·ecovery could demand extensive cleanup and repair. It can,
unrle1· cenain circumstances, be a means to identify opponuni­
ties for structural and nonstructural mitigation efforts. Filing of
loss claims might require special approaches. Health care facili­
ties should have access to cash 01· negotiable i nstruments to
procure immerliately needed supplies.
A.13.1 This chapter is the sou1·ce for security management in
health care facilities anrl is based on the foundations of
NFPA 730.
A.13.2 A health care facility security plan can be formulated
from security-sensitive a1·ea� that neerl the highest level of
protection outv,ard to the perimete1· of the health care facility
campus in concentric rings. Viewed from the outside, security
is thus open and welcoming to patients and visitors. A� an indi­
virlual proceeds into the inte1·i01·, public spaces might have
minimal surveillance, but those sensitive areas that cannot be
entered are layered with protections and countermeasures.
A.13.2.2 The security plan should be re,iewerl annually or
more frequently if new challenges present themselves.
A.13.3.1 For general information 1·egarding the SVA and
p1-emises security, see NFPA 730.
A.13.4.2(3)(c) The emergency potential inherent in the tele­
f
phoned bomb th1·eat watTant� inclusion o this contingencv in
the health ca1·e eme1·gency operntions plan. Expe1·ience has
shown that facility personnel have to accompany police 01· mili­
tary bomb demolition personnel in searching for the suspected
bomb, because speed is of the essence, and only individuals
familia1· with a given area can rnpidly spot unfamilia1· or suspi­
cious object� or conditions in the area. This is particularly true
in health ca1·e facilities. The facility switchboard operator
shoulrl have a checklist, to be kept available at all times, in
01·de1· to obtain as much in formation as possible from the caller
concerning the location of the s upposed bomb, time of detona­
tion, and other essential rlata, which should be consirle1·erl in
decirling whethe1· 01· not to evdcuate all 01· pan of the facility.
A.13.5.2(1) A visible presence is normally accomplished by the
placement ofa secut·ity officer at the ambulance entrance. This
serves the rlual put-pose of monitoring the secu1·ity cameras
throughout the emergency rlepartment as well as the activity at
the ambulance entrance.
A.13.5.3(5) The facility-wide alening system shoulrl be activa­
ted for all report� of pediatric or infant abduction. The use of a
stanrlarrlizerl "code alert"' system can facilitate the announce­
ment; for example, "code pink" fot· an infant abduction or
"code purple" fot· a pediatric abduction.
A.13.5.4 Video surveillance and motion detection can be userl
as additional protection for these areas. Some conu·olled rlrngs
should be stored in safes.
A.13.5.6(3) Reasons for a contrahaml check procedure would
be to control items such as tobacco, drngs. or tools that coulrl
cause harm to the patient or staff
A.13.5.7(1) Law enfo1·cement personnel should have orienta­
tion on the eme1·gency procedut·es and layout of the facility.
There should be good communication between law enfo1-ce­
ment and health care facility security staff.
9�203
A.13.6.3_1 There can be times where full or partial facility
access or egress is not rlesirable. Planning for these event�
should be conrlucterl in coordination with local eme1·gency
agencies, such as police, fire. and public health agencies.
A.13.7 Patient� that generate media interest should be su�ect
to special security procedures. VIP or media rep1·esentatives
present the need fo1· a unique set of secu1·ity requi1·ement�.
Protection of VIPs is normally accomplished by restricting the
use of names on chart� anrl rooms and by assigning a rlerlicaterl
security watch.
Admission of a high-profile person to a health care facility
creates two set� of problems that might require partial activa­
tion of the health care emergency management plan . These
problems are security and the reception of news merlia.
Provision of security forces in this situation might be provi­
rlerl by a governmental agency 01· private security fot·ces.
However, activation of facility security forces might be 1·equired
to prevent hordes of curious onlookers from entering facility
wo1·k a1·eas anrl intedering with routine facility functioning.
Routine visiting privileges and rnutine visiting hours might
need to be suspenrlerl in parts of the facility.
A.13.7.I.l The marketing department of the hospital might
be best suited to a�sist security personnel with media control.
A.13.7.2 Irleally, news media personnel should be prnvirlerl
with a media briefing a1·ea or a merlia staging area, or both,
with access to telephone communication and, if possible, an
expediter who, though not permitted to act as a spokesperson
for news releases, coulrl provide other assistance to such
pe1·s01rnel. News media pe1·sonnel should not be allowerl into
the health care facility \\�thout proper irlentification. Media
representatives should be requested to wear some means of
irlentification ftx secm·ity purposes. Members of the news
media shoulrl be askerl to wear some means of irlentification,
such as a press card, on their out�ide garment� so that they are
readily identifiable by security guards controlling access to the
facility or certain areas therein.
A.13.B Crowrl control of persons rlemanding access to care
will create additional demands on securitv. Because of the
intense public interest in disaster casualties. news media repre­
sentatives should be given as much considerntion as the situa­
tion will allow. To alert off-<luty health care stalf and to rea%ure
the public, use of broarlcast merlia shoulrl be plannerl.
Whe1·e feasible, photo identification or other means to
ensure positive identification should be userl. Visitor anrl crowrl
f
control create the problem of rlistinguishing staf from visitors.
Such identification should be issuerl to all facility personnel,
inclurling voluntee1· personnel who might be utilizerl in disaster
functions. Note that care should be taken to ensure that irlenti­
fication cards are 1·ecallerl whenever personnel te1·minate asso­
ciation with the health care facility. Cle1·gy also will frequently
accompany casualties 01· aLTi\·e later for visitations anrl 1·equire
some means of identification.
A.13.9.4 Key ca1·ds are p1·efrrable tof trarlitional ke)'ll because
they can be immediately rleactiv-ated i lost or not returned by a
terminated employee.
Facility ke)'ll should not be identified in any manner such
that a person finding a lost key coulrl trace it back to the
facility. A policy should be established to resu·ict duplication of
keys without written pe1·mission. A..11 keys should be ma1·kerl
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99-204 HEALTH CARE FACILITIES CODE
"DO NOT DUPLICATE" to deter the unauthmize<l copying of
keys.
The1·e should be a log of keys issued to empl oyees an<l
vendo1·s maintained at the facility. A responsible individual
should be in charge of issuing keys an<l maintaining complete,
up-to-<late 1·ecords of the disposition of keys, including copies.
The records should show the issuance and return of keys,
including the name of the person to whom the key wa� issued,
as well as the date an<l time. Records of key issuance should be
secured an<l kept separate from keys.
Kevs should be restricte<l to those who need them, and extra
copies of keys shoul<l be kept locked in a secure cabinet with
access control.
Proce<lures should be establisher! for collecting keys from
terminate<l employees, employees on vacation, an<l \'3.Cate<l
tenant�. Lost keys should be 1·eported immediately and proce­
dures establisher! fot· the 1·ekeying or replacement of the affec­
ter! locks.
A master key system shoul<l be designed so that the grand­
master key is the only key that will open every re stricter! area of
the facility. A master key system is used to limit the number of
keys catTie<l by pe1·srn111el 1·equiring access to multiple areas of
the building. It is important that such a system not be <lesigne<l
so that the loss of a single key coul<l provi<le an unauthorize<l
in<lividual unrestricted access to all areas of the buil<ling. The
sophistication of the master key system should depend upon an
assessment of employees· or tenants' nee<ls an<l the ffiticality,
risk, an<l sensitivity of restricte<l areas.
The number of grandmaster keys should be limited to the
lea�t numbe1· necessary for operation of the health care facility.
Master key distribution shoul<l be limited to the personnel
requiring access to multiple restricted area�. A log should be
maintainer! sho\\'ing who is in possession of ma�ter keys.
A.13_10 Background checks shoul<l include criminal recor<l
checks, employment histories, and 1-eferences. This function is
typically managed by the human 1·esou1·ces department.
A.13.11 The number of guards needed at any given time will
depend on the size of the facility, the hours of operation, and
the cuITent 1·isk factm·s. Many states have laws that require
background checks and specific training for secu1·ity personnel.
especially armer! personnel. It is essential that facilities using
secu1·ity personnel train them in the legal and practical applica­
tions of thei1· employment. Training must reflect changes in
regulations and the enactment of new laws.
A.13.1 I .I Post orders should contain a list of the duties of the
security office1· and instrnctions to cover all foreseeable events
the security officer can encounter. Post orders shoul<l list the
name of the facility, the date issued, the eflective date, and the
purpose. Duties of security pe.-sonnel should be listed, includ­
ing job cla�sification, uniforms, caITying of firearms, reporting
f
times, watch tours, hours o coverage, an<l other <luties to be
assigned. Instrnctions should be lawful an<l protect the safety of
the security ollice1· and those they encounter. Reviews of post
orders should be conducted regularly ,,'ith facility management
and security officers. Post orders should be updater! regularly
and at least annually. A proce<lure should be established to
info1·m secu1-ity officers of changes in post 01·<le1·s.
A.13.12.1 The effectiveness of the security plan is tested by
pedorming <lrills. Drills should be con<lucted on all work
2021 Edition
schedules, so that all personnel are familiar ,,'ith the plan. Prac­
ticing the plan helps personnel react as nee<led <luring a secur­
ity i ncident.
Al4.I Chapter 14 does not apply to respiratory therapy
employing o:i..)'gen-enriche<l atmospheres at ambient pressures.
(SPP ChaptPr 11.)
Al4.2.l.l.l For gui<lance on minimum construction requi1-e­
ments, depending on occupancv classification, see NFPA 101.
Al4.2.l.l.6 Characte1·istics of building construction housing
hyp erba1·ic chambers an<l ancillaty facilities a1·e no less impm·­
tant to safety from fire hazar<ls than are the characteristics of
the hyperbaric chambern themselves. It is conceivable that a
fit·e eme1·gency occuITing imme<liately oul�ide a chambe1·,
given sufficient fuel, coul<l seriously endanger the life or lives
f
o those insi<le the chamber. Since the service facilities, such as
compressors, cooling equipment, reserve ai1· supply, oxygen,
and so forth, will, in all probabilitv, be within the same build­
ing, these facilities will also need protection while in themselves
supplying life-maintaining service to those inside.
Al4.2.l.2 In addition to the fi.mctions of buil<ling protection,
the chamber room sprinkler system should be designed to
ensure a <leg1·ee of protection to chambe1· operato1·s who likely
will not be able to immediately evacuate the pt·emises in the
event of a fire.
Al4.2.l.2(1) Where the area to be cove1·ed is small (six sprin­
klers or less), 9.7.1.2 ofNFPA 101 pe1·mits fire sprinkle1· systems
1·equired to be installed in accordance with NFPA 13 to be
supplier! from the local <lomestic water system, provi<led that
the local domestic wate1· system ha� sufficient pt·essut·e and flow
capacity.
Al4.2.l.2(3) When selecting a clean agent fire protection
system, careful consi<leration should be given to the selection
of agent based on pe1·missible exposure levels.
A.14.2.1.3.1 Hyperbaric chamber systems often require piping
mate1·ials, pressut·e ratings, an<ljoining techniques that are not
permitted by Chapter 5 of this code.
A.14.2.2.1 Other chapters in this code contain many require­
ments that could appear to relate to hyperbaric facilities but
coul<l be inappropriate. The requi1·ements of othe1· chaptern in
this code should be applied to hyperbaric facilities only where
specifically invoked by this chapter.
A.14.2.2.4 A <lefinition for the term vil'U!port can be found in
ASME PVHO-1, Sajfty Standmd far PrP.mm l,;,ssd� for Human
Orcupanry.
Al4.2.2.6.I In past e<litions of this code, "high quality epo:i..)'''
was specifier! as interior finish in these chambers, without a
specific fit·e pedormance. Although not the only option, this
type of matet-ial ofle1·s suitable physical properties. The interior
finish of a Class A c hamber shoul<l be smooth, impermeable,
durable, provide corrosion resistance, and be compatible with
i nfection control procedures.
A.14.2.2.6.2 One common hazard of paint fires in ships is rela­
ter! to welding or burning operations on one side of a metal
bulkhead that heal� the metal to a point whe1·e the paint on the
opposite si<le ignites. Most paint� are not flammable when
installed as thin layers over a substantial heat sink, such as the
thick steel walls of a hyperbaric chamber, unless the walls are
heated first. The same paint�, when ground into a powde1· or
 ANNEX A
installed ove1· a very thin metal substrate, can burn readily. The
paint selected for use in the interior walls of a h)perbaric
chamber should be selected both fix suitability to the 1·equi1·e­
ments of the application and fot· its combustibility properties.
The hazard of a fire increa�es as the amount of heat sink is
1·educed. Therefore, combustion is easier to achieve when paint
is applied over thin mate1·ials and when the1·e are multiple
layern of paint. On thin section materials that are easily heated,
care should be exercised in selecting the flammability charac­
te1·istics of the paint and the amount of paint applied.
A.14.2.2.6.4 Many comme1·cial sound-deadening materials
that might be nonflammable are porous and will absorb water
from activation of the fit·e.;;uppression system and retain odo1·.
Metallic panels that contain a la1·ge quantity of small holes or
are made of wire mesh and are installed about 2.5 cm (1 in.)
away from the chamber wall can be used to form an acoustic
baffle. These panels should be made from cotTosive-resistant
mate1·ials. such a� stainless steel 01· aluminum. and are permit­
ted to be painted in accordance with 14.2.2.6.3.
A.14.2.2.7 Prudent design considerations suggest that at least
50 pe1·cent excess pass-through capacity he provided, for futu1·e
use, given the difficulty of adding pass-throughs to the chamber
afte1· it is constructed and tested.
A.14.2.4.1.2 Expe1·ience and practice can dictate the need for
a threshold ventilation rate in excess of the minimum specified
fo1· sanitary 1·ea�ons. It is recommended that consideration he
given, if necessa1y, to the use of odo1· filte1·s in the chamber
circulation system as a means of keeping sanitary ventilation
rate requirement� to a minimum.
A.14.2.4.2.1 If intakes are located where it could be possible
fot· maintenance to be conducted in the immediate vicinity, a
warning sign should be posted.
A.14.2.4.4.1 Ventilation is permitted to be provided hy closed-
01· open-cit"Cuit systems.
A.14.2.5.4 The risk assessment should be documented. \,Vhen
perftxming a 1·isk assessment, consider using available internal
1·esou1Tes (e.g., safety officer, risk management, public safety).
Risk a�sessmenL� should include, but not be limited to, the
following factors:
(1) The time required to evacuate to a safe a1·ea (as 1·equi1·ed
hy 14.3.15.4.1)
(2) Building and room a1·chitectu1·e (e.g., egress ve1·sus
defend-in-place architectut·e)
(3) Accessible means of egress
(4) Room layout, number, and configuration of the chambers
(5) Possible need fo1· slow decompression or decompression
stops
(G) Response time of internal and external emergency
responde1·s
A.14.2.6.1.5 Expe1·ience has shown that fit·e blankets, portable
carbon dioxide extingu ishers, and other methodology inten­
ded to "snuff out"' fires by excluding air a1·e not effective in
controlling fires in oxygen-enriched atmos phe1·es. Valuable
time can be lost in attempting to use such devices.
A.14.2.6.2.4 More than one control station could be 1·equi1·ed
in a compartment (lock), depending on iL� size.
A.14.2.6.2.6 Experience has shown that, when water is
discha1·ged t hrough conventional sprinkle1· heads into a hyper­
baric atmosphere, the sprny angle is reduced because of
9�205
increased 1·esistance to water droplet movement in the denser
atmosphere. This is so, even though the water pressure difler­
ential is maintained above chambe1· pressure. Therefot·e, it is
necessary to compensate by inc1·easing the numhe1· of sprinkle1·
heads. It is recommended that spray coverage tesrn be conduc­
ted at maximum chamber pressure.
Some chamber confi gu rntions, such as small-diameter hori­
zontal cylinders, could have a very tiny floor, or even no floor at
all. For horizontal cylinder chambers and spherical chambers,
the term floor lPvPl should be taken to mean the level at 1/, diam­
ete1· below the chambe1· centedine or actual floor level, which­
ever yields the larger floor area.
A.14.2.6.4.2 Additional detectors are 1·ecommended to avoid
"blind" a1·eas if the chambe1· contains compart.mentation.
A.14.2.9.2.1 A backup generator or backup power system fo1·
the hyperbaric facility might not be necessary, but certain elec­
trically driven feattlt"es of hypet·baric facilities should have some
type of backup. This could be addressed with a single backup
power system 01· with multiple, smaller powe1· sou1·ces. The
source for such backup power and eme1·gency lighting can be
battery supplied.
A.14.2.9.2.1(1) Chamber room emergency lighting should be
provided and does not requi1·e a unique type of eme1·gency
lighting because it is a hyperbaric facility.
A.14.2.9.2.1(2) Chamber emergency lighting 1·equirements
vary. Fm· chambe1·s with a large acrylic window, found in most
Class B chambe1·s, the room emergency lighting is sufficient to
meet this requirement. For chambers made primarily of steel,
with a small window(s), lighting dedicated to the chamber inte­
rim· might be necessary. In this case. at least on light should be
provided with backup power.
A.14.2.9.2.1(3) Chamber intercommunication powe1· 1·equire­
menL� vary. The duration of backup power fot· communications
depends on the type of hyperbaric treatments performed but
should not have to exceed the duration of a hype1·haric treat­
ment conducted in the facility.
A.14.2.9.2.l (4) Class A chambers might employ flame detec­
torn. If employed, these detectors should have backup power.
Flame detectors are typically not employed in Class B cham­
bers.
A.14.2.9.2.1(5) Class A chambe1·s are 1·equi1·ed to have a fire
suppt·ession system. All electrical controls related to activation
and perfo1·mance of the fire suppt·ession system should have
backup power. Fire suppression systems are not typically
employed in Class B chambers.
A.14.2.9.2.1(6) Some Class A and Class B chambers employ
electrical controls as part of the pressurization and ventilation
system of the chamber. These controls should have backup
power.
A.14.2.9.3 This subsection contains requiremenL� for the safe
use of electrical equipment in the hyperba1·ic, oxygen-enriched
environment of the Class A chamber.
A.14.2.9.3.9 It should be recognized that interruption of any
powered circuit, even of ve1·y low voltage, could produce a
spark sufficient to ignite a flammable agent.
A.14.2.9.3.10.1 It is recommended that all control switching
functions inside the chamber he accomplished using intrinsi-
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99-206 HEALTH CARE FACILITIES CODE
cally safe cit-cuit� that conu·ol power and control circuit� loca­
ted out�i<le of the chamber.
A.14.2.9.3.11 It is the intention of 14.2.9.3.11 that eguipment
used in the chamber he incapable of igniting , hy heating, any
material or fabric that coul<l come into contact with the surface
of the eguipment.
A.14.2.9.3.13 It is 1·ecommended that electric motors not be
located inside the chamber. This recommendation is not inten­
ded to apply to a mot01· that is within a piece of portable medi­
cal eguipment.
A.14.2.9.3.14 It is strongly recommended that high-intensity
local task lighting be accomplishe<l using through-hull fiber­
optic light�. Many high-intensity light� will not meet the
temperature reguirement� specified in 14.2.9.3.11.
A.14.2.9.3.15.1 The 1·eguirement for isolation from main
supplv in 14.2.9.3.15.1 is not the same as the reguirement in
14.2.9.4.2 that circuits supplying power to portable utilization
eguipment inside the chamber be isolated, monitored, and
alarme<l.
lt is recommen<led that intrinsically safe sensors and
controls be used wheneve1· possible.
A.14.2.9.3.16 These reguirements are only the nmumum
reguirement� for electrical safety. There are many other safety
concerns that should be a<ldressed on a case-by-case basis.
Meeting the 1·egui1·ement� of 14.2.9.3.16 does not in<licate that
proper device perfo1·mance will occut· in the hyperbaric envi­
ronment and that the device will he safe for use with patient5.
A.14.2.9.3.17 The intent of this section is to mitigate the risks
of fit-e when an electrical device is placed inside the chambe1·
and put un<ler pressure.
f
The 1·eguirement� o this section are not inten<le<l for things
such as approved wristwatches an<l similar approved small
battery-powered devices. See B.145 for additional information
on ine1·t gas or ai1· pm·ging.
A.14.2.9.5.2 It is necessa1·y that these circuit� be protecte<l
from exposure to water from the room sprinkler system
protecting the chamber housing in the event of a fire in the
vicinity of the chamber while it is in operation.
A.14.2.9.6.1.l Limiting current using a suitable current sens­
ing device (e.g., a .-apid acting fuse or circuit breaker, located
out�ide the chamhet") would provide appropriate protection
and prevent circuit� from excee<ling the 4.0 Vv power limit.
A.14.2.10.2 Intercommunications equipment is mandatory fot·
safe operation of a hypet·baric facility.
A.14.2.10.2.l It is recommended that multiple-compartment
(lock) Cla�s A chamhe1·s be eguipped with multiple channel
systems and that, in addition, a sound-powered telephone 01·
surveillance microphone be furnishe<l.
A.14.2.10.2.2 It is 1·ecommended that info1·mation about the
status of an anesthetize<l or otherwise monitored patient be
transmitted to the inside chamber attendant� via the intercom­
munications system. A� an alternative, the monitor indicators
can be place<l a�acent to a chamber ,ie,\port (01· viewp01·t�)
for direct observation by inside personnel.
A.14.2.10.4.2 Oxygen levels in Class A chambers should be
sample<l from at least two sample port� at <lisparate locations in
2021 Edition
the chamber. an<l the chambe1· should be eguippe<l with an
oxygen monitor for each sample port.
Chamber atmosphe1·es a1·e l:)pically not homogenous.
Oxygen can accumulate in pools or pocket� around patient�
with levels that are <langerouslv high. A single oxvgen sample
pon inside the chambe1· might not be sufficient to detect
inct"eased oxygen levels in another area of the chamber. In this
case, a serious increase of oxygen, well above the allowed level
of 2 3.5 percent, can go undetected. Providing at least two
sample po1·t� allows for bette1- assessment of the oxygen levels
insi<le the chambe1·. The size of the vessel shoul<l be fact01·ed
into determining how many port� are necessary.
A dedicated oxygen analyzer on each line p1·events false
1·ea<lings from t wo or more sample lines feeding into one
oxygen sensor.
F01· example, one sample line might come from an area of
21 percent, and the other line might come from an area of
50 percent or more. When both lines come together, they will
mix an<l give a false low oxygen rea<ling. Having a de<licated
oxygen monitor for each sample line will avoid this unsafe
situation.
Al4.2.I0.4.2.2 1l1e ability to spot check for oxygen leaks and
oxygen pooling is essential fot· the safe management of oxygen
levels. If the minimum 30-second 1·esponse time is not compro­
mised, the extension or "snooping wand'' can remain connec­
te<l for easy use.
Al4.2.I0.6 ll1e purity of the various ga� supplies should be
ensure<l. A purity statement for any cryogenic or high pressure
cylinder gas should be supplied by the vendo1·. Gas cylinder
purity statement� should be cross-reference<l. where possible.
with the delivere<l gas.
F01· additional ve1·ification, some facilities have installed
sampling port� for monitoring oxygen an<l other gases.
A.14.2.10.6.l CGA Grade E permit� guantities of hydrocar­
bons an<l water in air. In piping systems whe1·e air and oxygen
might be used inte1·changeahly, hydrocarbon buildup can
occur and increase the risk of fire when oxygen is used. There
is also a concern about pneumatic components being fouled
and functionally impaired by hydroca1·bons 01· wate1· from
compresse<l air. Ideally. there should be no condensed hydro­
carbons in an oxygen system and no liquid water in pneumatic
co11t1·ol systems.
Al4.2.ll.2 Exhaust piping exten<ling from the building can
create a lightning risk. Lightning protection shoul<l he consid­
ered.
Al4.2.l1.2.5 ll1e facility should consider bilingual signage
that is appropriate to the location. The hyperbaric safety direc­
f
tor shoul<l be aware o any work perfo1·med on the roof near
exhaust vent.
See Figure A.14.2.11.2.5 for examples of the pictographs
1·equired by NFPA I 70.
Al4.3.l.2 The haza1·ds involved in the use of hyperbaric facili­
ties can be miti ga ted successfully only when all of the areas of
hazard are fully recognize<l by all personnel and when the phys­
ical protection prmi<le<l is complete an<l is augmente<l hy
attention to detail hy all personnel of administration and main­
tenance ha,ing any responsibility for the functioning of the
hyperba1·ic facility. Since Section 14.3 is expected to be use<l as
 ANNEX A 9�207

No Open Flame -
Flame
Circular field
Red circle
The identification of The identification of areas, such as
and slash
areas in which open combust ible storage areas, gas
Black image
flame is prohibited stations, and hazardous areas
White
background

No Smoking

Circular field
Red circle The identification of areas, such as
The identification of
and slash those for flammable liquid storage,
areas in which smoking
Black image where smoking could lead to fire or
is prohibited
White explosion
background

FIGURE A.14.2.11.2.5 Fire Safety Symbols from NFPA 170.

a text by those responsible for the mltlgation of hazards of A.14.3.1.3.3 It is incumbent upon the health care facility's
hyperba1·ic facilities. the 1·equi1·ements set forth are frequently governing body to insist that rules and 1·egulations with respect
accompanied by explanat01·y text. to practices and conduct in hyperba1·ic facilities, including
qualifications and training of hyperbaric pe1·so1rnel, be adopted
A.14.3.1.3.2 The complexity of hyperbaric chambers is such f
by the medical or administrative staf of the institution, and
that at least one person should be designated safety directo1·, that regulations fot· inspection and maintenance are in use by
such as a person in a position of 1·esponsible autho1·ity. the administrative, maintenance, and ancillary (and, in the
Safety, operational, and maintenance criteria of other organ­ case of a hospital, nursing and other professional) personnel.
izations are published, for example, in Undersea & Hyperha1·ic In meeting its responsibilities for safe practices in hypet·baric
Medical Society Safety Committee documents and Compressed facilities, the administrntion of the facility should adopt 01·
Ga� Association pamphlet� and should be reviewed by the correlate regulations and standard operating procedures to
safety director. The safety director should serve on the health ensure that both the physical qualities and the operating main­
ca1·e facility safety committee. tenance methods pertaining to hyperba1·ic facilities meet the
Due to a conflict of responsibility, the same individual standat·ds set in Chapter 14. The controls adopted should cover
should not serve as both medical director and sal"ety director. the conduct of personnel in and around hyperbaric facilities
and the apparel and footwear allowed. They should cove1· peri­
The te1·m mjety dim:tar is used fot· convenience. It is the odic inspection of static-dissipating materials and of all electri­
intent of 14.3.1.3.2 to establish a set of safety responsibilities for cal equipment, including testing of ground contact indicators.
the responsible person, regardless of the job title.
A.14.3.1.3.4 It is recommended that training of hypet·baric
The safety di1·ect01· responsibilities can he found in the chamber personnel be closely monit01·ed. following the guide­
following paragrnphs: lines and publications of the Undersea & HypedJat·ic Medical
(1) 14.3.1.2 Society, the Baromedical Nurses .<\.ssociation, and the National
(2) 14.3.1.3.2. including 14.3.1.3.2.1 through 14.3.1.3.2.3 Boa1·d of Di,ing and Hypet·baric Medical Technology.
(3) 14.3.1.3.4.1 A.14.3.1.3.5 In the case of a hype1·baric facility located in a
(4) 14.3.1.3.5 hospital, hospital licensing and other approval bodies, in meet­
(5) 14.,U.4.2 ing their responsibilities to the public, should include in thei1·
(6) 14.3.1.5.4 inspections not only compliance with 1·equi1·ement� for physical
(7) 14.3.1.6.2.2 installations in hyperbaric facilities, but also compliance with
(8) 14.3.1.6.3.1 the 1·equirements set fot·th in Section 14.3.
(9) 14.3.1.6.4.3
(10) 14.3.1.6.4.4 A.14.3.1.4.1 It is 1-ecommendetl that all personnel. including
(11) 14.3.2.1.2 trainees and those involved in the operation and maintenance
(12) 14.3.2.1.5 of hyperharic facilities, and including prnfessional personnel
(13) 14.,l.3.4 and (in the case of hospitals) others involved in the di1·ect care
(14) 14.3.4.1.1 and 14.3.4.1.2 of patients undergoing hyperha1·ic therapy, be familiar with
(15) 14.3.4.2.1 Chapter 14. Personnel concerned should maintain proficiency
(16) 14.3.4.3.5.4 in the matters of life and fire safety by pe1·iodic 1·e..,iew of Chap­
ter 14, as well as any other pertinent mate1·ial.

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99-208 HEALTH CARE FACILITIES CODE
Positive mea�u1·es a1·e necessary to acguaint all personnel
with the rules and regulations establishe<l an<l to ensure
enftxcement. Trnining and discipline a1·e necessary.
A.14.3.1.4.6 The complexity of hype1·baric chambers is such
that one person should be <lesignated chamber operator, such
as a person in a position of 1·esponsible authority. Before start­
ing a hype1·baric operation, this person should record, in an
appropriate log, the purpose of the operation or test, the
duties of all personnel involved, an<l a statement that he or she
is satisfied with the condition of all eguipment. Exceptions
should be itemize<l in the statement.
A.14.3.1.5.2 All foll- and part-time personnel should receive
trnining in eme1·gency management appropriate to thei1· job
<lesc1·iptions.
A.14.3.1.5.4 A calm reaction (without
f
panic) to an emergency
situation can be expected only i the 1·ecommendations are
familiar to and rehea1·sed by all concerned.
A suggested outline for emergency action in the case of fire
is containe<l in B.14.2.
A.14.3.1.6.1.l Oxygen-filled chambers dump oxygen into the
room each time the door is opened at the en<l of a treatment.
Oxygen could also be dumped into the room by the chambe1-
pressu1·e 1·elief device. Ai1°filled chambe1·s could leak oxygen
into the room from the breathing gas piping. This oxygen
e111·ichment lowers the ignition temperntu1·e of combustible
materials. 1l1erefore, extra caution shoul<l be used in the area
around the chamber as well as inside the chambe1·.
A.14.3.1.6.1.3 Precautions should be in place for monitoring
items used to p1·epa1-e a patient 01- staff member fo1· entry into
the hyp erbaric chamber to prevent the entry of prohibite<l
items into the hyperbaric chamber.
In addition to monit01-ing prohibited items, the following
items shoul<l be verifie<l:
( l) Patient i<lentity
(2) Prett·eatment orders
(3) Appropriate safety measures
(4) Appropriate staffing
(5) Appropriate textiles
(6) Patient grounding
A.14.3.1.6.2.2(2) Allow able guantities complying with
14.3.1.6.2.2(2) can be determined from the chamber volume,
flammable agent vapor density, and lower explosive limit
(LEL). Experience has shown that increased pressure has little
f
ef ect on LEL for a given flammable ga� and oxygen concentra­
tion. A safety factor of 10 is recommen<led. Flammable liguids
shoul<l be confine<l to nonb1·eakable, nonspill containers.
Sample Detmninalion. An example of limiting guantity of
flammable agent substance:
Isopropyl alcohol (2-propanol)
LEL= 2%/vol. (irrespective of chamber pressure)
Vapor density= 2.1 1·elative to air
Ligui<l density= i86 g/L (49. l lb/ft3 )
Air <lensity= 0.075 lb/ft'l (1.2 kg/m3 ) at STP
The limiting case occurs at the lowest ambient pressure, that
is, l atmosphere:
2021 Edition
Alcohol vapor density at LEL = 0.02 x 2.1 x 0.0i5
<i :i
= 0.00315 lb/h (0.05 kg/m )
3 3
= 1.43 g/ft (0.05 kg/m )
Fm· a relatively small 500 ft3 (14.2 m3 ) chamber, this implies:
1.43 x 500 = 715 g (1.58 lb) alcohol vapor at LEL
Using a safety factm· of 10 to account fo1· uneven vapor
concentrations gives 715 g = 91 mL (3 oz) alcohol.
One could conclude that even 90 mL (3 oz) of alcohol is
mm·e than would be needed for almost any medical procedm·e.
The preceding calculation also <loes not account for the miti­
gating effect of ventilation.
Many "inen'' halogenated compounds have been found to
act explosively in the presence of metals, even under normal
atmospheric conditions, despite the fact that the halogen
compound it�elf does not ignite in oxygen or, in the case of
solids such as polytetrnfluoroethylene, is sell�extinguishing.
Apparently these materials are strong oxidizers, whether gases.
liguids (solvent�, greases), 01· solicl.s (electrical insulation,
fab1·ic, or coatings). Some halogenated hydrocarbons that will
not burn in the presence of low pressure oxygen will ignite and
continue to burn in high pressure oxygen. Customarily, Cla�s A
chambe1·s maintain inten1al o)<-ygen concentration that does
not exceed 23.5 percent.
Parts of Chapter 14 <leal with the elements reguire<l to he
incorpornted into the structm·e of the chambe1· to 1·e<luce the
possibility of electrostatic spark discha1·ges, which are a possible
cause of ignition in hyperbaric atmospheres. The elimination
of static cha1-ges is cl.ependent on the vigilance of administrative
activities in m ate1-ials, pm·chase, maintenance supervision, and
periodic inspection an<l testing. It cannot be emphasize<l too
strongly that an incomplete chain of precautions generally will
increase the electrostatic haza1·d. For example, concl.uctive
flooring can contribute to the hazard unless all pe1·s01111el wear
con<luctive shoes, all object� in the room are electrically contin­
uous with the floor, and humidity is maintained.
The limitations in 14.3.1.6.2.2 on the use in the chambe1· of
alcohol an<l other agent� that emit flammable vapors should be
strictly observed, and such restrictions should be prominently
posted.
A.14.3.1.6.3 The number of occupant� of the chamber should
be kept to the minimum number necessa1y to carry out the
p1·ocedtu-e.
Al4.3.l.6.4 It is recommended that all chamber personnel
shoukl wear garment� of the overall 01· jumpsuit type that
completely cover all skin areas to the extent possible and that
a1·e as tight-fitting as possible. It can be impractical to clothe
some patient� (depen<ling upon their disease or the site of any
surge1y) in such garments. Hospital gowns can be employed in
such a case.
A.14.3.1.6.4.2 Selection of textiles for the hyperbaric chamber
should be basecl. on a variety of factm·s, including comfort, lint
pro<luction, ignition temperatu1·e, static-producing properties,
and fuel load of the material. ll1e amount of polyester in a
f
cotton/polyester blend will likely have an ef ect on all of these
factors.
Histm·ically, all synthetic fabrics were prohibited from the
chamber. Previous ed itions of this code allowe<l an "antistatic
 ANNEX A
blend of cotton and polyeste1·" because of one specific fabric -
a blend of cotton an<l polyester with steel fibers to make it
con<luctive. This blended fab1·ic was intende <l for sm·gical
scrnbs, but its con<lucti\·e properties ma<le it a goo<l choice for
hyperbaric garment�. The polyester in the fabric was acceptable
because the con<luctive properties of the fabric actually affor­
<le<l some protection from static production that cotton fabric
did not. This particular fabric is no longe1· made. Selection of
textiles has always been about balancing various safety
concerns; primarily fire-resistance an<l static pro<luction. For
fi.Jrther gui<lance on selecting approp1·iate textiles, see
A.14.3.1.6.4.3.
A..14.3.1.6.4.3 The textiles <lefinitions an<l risk assessment
process fo1· hyperbaric wound dressings are as follows:
Combustion. A chemical process of oxidation that occurs at a
1·ate fast enough to produce heat in the form of either a glow
01· a flame.
Flammable. Refers to a combustible (soli<l, liquid, or gas) that
is capable of easily being ignited an<l rapi<lly consumed by fire.
Hmh Point. The minimum tempernture of a liquid or soli<l at
which it gives off vapor sufficient to form an ignitible mixture
with oxygen under specified environmental con<litions.
Ignition Tn1tpemture. The minimum temperatu1·e 1·equi1·ed to
initiate or cause self-sustaining combustion un<ler specifie<l
e1nironmental conditions.
Lower 1'.xplosiw Limit (LEL) or Lowl'r Flmmnable Limit (LFL).
The minimum concentration of fuel vapor (percent by
volume) ove1· which combustion will occur on contact with an
ignition source.
(",enl'fal Risk 11..��e.mnmt Information. This risk assessment proc­
ess wa.� designe<l to evaluate woun<l dressing products for use in
a hyperbaric chambe1·. However. the same decision process can
be applied to the evaluation of textiles fo1· hyperbaric use.
Woun<l dressings are commonly use<l insi<le hyperbaric cham­
bers. They play an important role in infection control and
patient outcome. Imp01·tant safety concerns include produc­
tion of heat, production of static electricity, production of flam­
mable vapo1·, ignition temperatu1·e, and total fuel load. Many
wound d1·essings employ fab1-ics and othe1· materials that a1·e
gas-permeable. It is a common misconception that a gauze
bandage will isolate an un<lesirable product from the chamber
environment. Gauze is gas-permeable an<l will allow o}..·ygen
from the chambe1· to internet with the pro<luct an<l vapors from
the pro<luct to interact ,vith the chamber environment. Also,
gas-permeable materials exposed to hyperbaric oxygen ,viii
hol<l additional oxygen fo1· some perio<l of time afte1· the expo­
sm·e. These materials should be kept away from open flames
for at least 20 minutes after the hyperbaric treatment.
Risk Asses.wmnt Pro[l'SS (seP Figure A.14. 3. I. 6.4. 3).
( 1) Is there a more suitable alternative to this <lressing? The
issue of need must first be ad<lressed. There might be a
substitute dressing that has already been deemed accepta­
ble for the hyperbaric environment. The wound <lressing
orders can be change<l to the more desirable substitute
(if there is no negative impact on patient outcome). It
might be viable to remove the d1·essing befo1·e the hyper­
baric treatment, leave it off during the treatment, an<l
replace it after the treatment. Before making this deci­
sion, it is important to 1·emember that some dressings
9�209
should not be <listurbed (e.g.. in the case of a new skin
graft); some dressings are designed to stay in place for
several days; some <lressings are very expensive; and it can
be detrimental fix the woun<l to 1·emain und1·esse<l
during the treatment. If there is a suitable alternative to
using this dressing, the rest of the decision process can be
eliminate cl.
(2) Does this dressing pro<luce heat in the chambe1·? D1·ess­
ings are ma<le from a la rge variety of materials. The
concern is that materials in a d1·essing can 1·apidly oxidize
an<l produce heat (i.e., cause an exothermic 1·eaction)
when expose<l to additional oxygen. Fm· example, air­
activate<l heat patches (commonly used for pain relief)
have been tested in hyperbaric environments. The ave1·­
age operating tempei-ature inct·eased from 48.1 'C
(119° F) in normobaric air to 121.S ° C (25l'F) in hvper­
ba1·ic oxygen. In this ci1-cumstance, the patient's skin
woul<l be burne<l, an<l the heat coul<l ignite combustible
material in the chamber. Information on oxygen compati­
bility can be foun<l in a product material safety <lata sheet
(MSDS).
(3) Does this dressing produce too much static electt·icity? All
common textiles i,vill contribute to static production.
\Vool and synthetic materials generallv contribute more
to static production than cotton. Although static charge is
constantly accumulating, it will <lissipate into the environ­
ment when humidity is present. At less than 30 percent
1·elative humi<lity, static charge can accumulate faste1· than
it can dissipate. At g1·eater than 60 pet-cent relative
humidity, static charge is all but completely eliminated.
Use of con<luctive surfaces and electrical grounding will
allow static charge to <lissipate. Parngi-aph 14.2.9.4.1
1·equires all hype1·baric chambers to be grnundetl. Para­
graph 14.2.11.1 requires any furniture installe<l insi<le a
chambe1· to be grnun<le<l. Paragraph 14.3.1.6.3.2 1·equires
f
all occupants o the chamber to be groun<le<l when the
oxygen percentage in the chamhe1· is above 23.5 percent.
TI1e continuity of electrical groun<ls should be verified
perio<lically.
(4) Does this dressing have a low ignition tempernture/fla.�h
point? ASTM G72/G72M. Standard Test Method for Autoge­
nom Ignition Tm1pm1hm of Li quids and Solid� in a High­
Pres.mre Oxygm-Enrirhed Enuimnmml, can be used to
determine the autogenous ignition temperatu1·es of pro<l­
ucts entering a hyperbaric chamber. In 2016, ASTM G72/
G72M added a new test fo1· oxygen-enriched environ­
ments of less than 300 psi (2068 kPa) of p1·essure. In all
hyp erbaric environments, the partial pressure of oxygen
is higher than at normal atmospheric con<litions. Increas­
ing the partial pressure of o:,,.)'gen can change the classifi­
cation of a material from nonflammable to flammable.
Many materials are flammable in a 100 percent oxygen
environment. Any material used in a hyperbaric chambe1·
should have an ignition temperatm·e higher than it can
be exposed to. Paragraph 14.2.9.3.11 limits electt·ical
equipment insi<le a Class A (multi-place) chamber to a
maximum operating surface temperntu1·e of 85 ° C
( 185° F). Parngrnph 14.2. 9.6.3 limiL� electrical circuiL�
insi<le a Class B (monoplace) chamber to a maximum
operating temperature of 50'C ( 122 ° F). A� the oxygen
percentage inct"eases, it takes less ene1·gy to ignite materi­
als. This leads to more conservative <lecisions in a
100 percent oxygen environment. A greater margin of
safety is achieved when there is a greater diffe1·ence
between the temperatu1·e limit of the equipment inside a
2021 Edition
99-210 HEALTH CARE FACILITIES CODE

Cla�s A or Class B chamber and the ignition temperature

of material in question. A material will release vapor into PRODUCT
the chamber envirnnment as it apprnaches il� flash point
temperature. Once a sufRcient quantity of vapot· is
present in the chamber (LEL), it takes very little energy
for ignition to occur. Paragraph 14.3.1.6.2.2 sets limit� on
flammable agent� inside Class A (multi-place) chambers.
Parngrnph 14.3.1.6.2.3 specifically prohibit� flammable
liquids, gases, and vapors inside Class B (monoplace)
chambers. Information on ignition temperature ancl flash
point in ait· can be found in a procluct MSDS.
(5 ) Is the total fuel load too high? If a fit·e does occur, the
energy produced is a function of the partial pressure of
oxygen and the total fuel load. In a hyperbaric environ­
ment, the panial pressure of oxygen is higher and NO
contributes to greater energy production. Any dressing
procluct placed inside of a hypet·baric chamhet· is a
combustible matet-ial and adds to the fuel load. There­
fore, total fuel loacl inside the chambet· should be mini­
mized to only what is necessaty.
(6) Is the1-e an aclverse effect when this prnduct is usecl inside
the hyperbaric chamber? It has been reported that the
antibacterial agent mafenide acetate, in combination with
hypet·baric oxygen, has a poot·er clinical result than either
one by itself. Thet·e can he other drng interactions with
hypet·bat·ic oxygen that at·e undesirable. The mechanical
effecl� of pressure change can cause a dressing material
to rnpture. If the material is capable of venting/ equaliz­ NO
ing during pressur·e change, this should not occur.
(7) The h)'perbaric facility should maintain a "use list" and a
"do not use list" of items that have been evaluatecl for
hypet·bat·ic use. In addition to this list, it is important to
keep clocumentation on file explaining the 1·isk a�sess­
ment for each item. This 'Nill prevent future duplication
of effot·t. It also serves as evidence that clue diligence was
used.
A.14.3.1.6.9 The use of paper should be kept to an absolute
minimum in hypet·baric chambers.
f
A.14.3.2.2 Users should be aware that many items, i ignitecl in NO
pressurized oxygen-enrichecl atmospheres, are not sell'. �
extinguishing. Iron alloys, aluminum, anrl stainless steel at·e, to 7
various degrees, in this categoty, a.� well as human skin, muscle, Document
and fat, and plastic tubing such as pol)"'inyl chloride. Testing
for oxygen compatibility is vety complicated. Vety little rlata
exists, and many standat·ds still have to be cletermined. Suppli­
et·s do not normally have facilities for testing theit· product� in ADDTO
USE LIST
controllecl atmospheres, especially high pressure m.,gen. Both
static conditions and impact conrlitions are applicable. Self'.
ignition temperatures normally are unknown in special atmos­ Fl GURE A.14.3.1.6.4.3 Risk Assessment Process.
pheres.
A.14.3.2.5 See A.14.3.2.2.
A.14.3.2.6 Radiation equipment, whethet· infrared or roent­ thrnugh the system (i.e., inspector's test). Other vitally impm·­
gen ray, can make hyperbaric chambers even more hazardous. tant benefit� are the activation of ,-rater flow de\-ices, alarm
appliances, and notification ancl annunciator systems.
A.14.3.3.4 Quantities of oxygen stot·ed in the chamber should
be kept to a minimum. A.14.3.4.5.2 Ferrnus metals can cause such sparking, as can
f
magnesium or magnesium alloys, i contact is made with rusted
A.14.3.4.1.6 The frequency of such monitoring shoulrl
steel.
depencl on the location of the air intake 1·elative to potential
sources of contamination. A.14.3.4.6 The elimination of static chat·ges is clependent on
the vigilance of aclministrntive supervision of matet-ials
A.14.3.4.3.5 The primaty focus for the semiannual test of a
purchased, maintenance, and periodic inspection and testing.
wate1�based extinguishing sy,tem is to ensure water flow

2021 Edition
 ANNEX A 9�211

A.14.3.4.6.2 Verification of patient groun<ling should include ,/ Nitrogen or ---,,

actual testing of ground, not just a visual verification. Ideally, / ' compressed air \
the verification will include connecting the patient to the ,' ---''---manifold system :
I
groun<l pathway an<l measut·ing no more than I
./'/ --
,,_

,,:-_/
\
100,000,000 ohms w ith a meter. This value comes from I - -
:a:
:I .__..1
NFPA 77. I /
I .I ---
: QI I
\
A.14.3.4.6.3 See A.14.3.4.6.2. /

I I
I I
' L_ _ _.
I
\
I I
I
I
A.14.3.4.6.5 Materials containing rubber deteriorate rapi<lly in I I
I I I
I
I I
oxygen-em·iched atmosphe1·es. Shown with reiiulators ,' ,' I
I
(pigtails and high-pressure , / I
I
A.14.3.4.7 It is absolutely essential that all areas of, and manifold acceptable) / _,_,
_______ , \

,�:----===::==�ir�:1�i�
\ I
componenrn a�sociated with, the hyperbaric chamber be kept I
\
meticulously free of g1·ease. lint. dirt. and dust. \
\
I
\
A.15.3.3.4 Dental air systems are used primarily to <lrive gas­ : Compressor head \
\
powere<l power devices. See Figure A.15.3.3.4 for an illustration : e�r:: ure relief
\
\
I
of this type of system. Similar applications are foun<l in podia­ I
/ \
try and plastic surge1-y. Examples of these are ai1· use<l to <l1·ive Inlet
\
\

,--:
\
turhine-powered drills and air used to dry teeth an<l gums. \

Some dental han<l pieces have an internal selkontained air L :.J 0 I

I
\
1·etun1 system, while other han<l pieces discharge ai1· into the Gauge \
\
\
atmosphere. Some discharge a mixttll"e of ai1· an<l watel". Nitro­ t Dryer \
'\
gen is often pipe<l a� an alternative or reserve supply to the '\
Flex \
''
compressor system. connection Receiver
\

Dental comp1·essed ai1· is not used for life-support purposes, ',\

'I
such a� respirators, intermittent positive pressure breathing
Manual, automatic, I
(IPPB) machines, analgesia, anesthesia, and so forth. Air or drain plug is
I
\
acceptable.
I
discharged into the oral cavity is incidental and not a p1·imary \
I
source of air to sustain life.
:- - - -7I :
I
I
A dental compressed air system should not be use<l to : Options :
provide power for an ait0powe1·e<l evacuation system without ---------------------------------- L _______ I
:
l

specific attention pai<l to the <lischa1·ge of the evacuated gases Notes: ', ______________}
an<l liqui<ls. An open discharge of evacuated gases into the 1. Dotted lines indicate optional items.
general environment of an operatory coul<l compromise the 2. Either the nitrogen/compressed air manifold system or the
air compressor system can be primary, and the other can
quality of breathing air in the tt·eatment facility. Air discharge be optional.
shoul<l be vente<l to the outsi<le of the building through a <le<li­
cated vent. � Moisture indicator b Drain plug

An air-powe1·ed evacuation system might 1·equire significant 0 Filter(s) � Utility center

$. Check valve Service outlet

*
quantities of air to operate.
�
Manufactut·er's 1·ecommendations should be followed QI Automatic drain Shutoff valve
1·egarding proper sizing of the ai1· comp1·ess01·. Inadequate
sizing can result in overheating, premature compressor fail- FIGURE A.15.3.3.4 Dental Air Supply System.
111·es, an<l inadequate ope1·ating pressures and flows.
A.15.3.3.5 A dental vacuum system is not intended for
medical-surgical vacuum applications. A wet piping system is
designed to accommodate liquid, air-ga�. and solids through
the senice inlet. A dry piping system is <lesigned to accommo­
date air-gas only through the service inlet, with liquids and
solids being trapped before entering the system. {SI¥' Figure discretion of facility management a� to whether a greater bene­
A.. 15.3.3.5(a) thmugh Figzm A.. 15.3.3.5(d).] fit is achieved by immediate access or by higher security. An
enclosure with direct access from a public hallway shoul<l he
A.15.4.2.4.2 Requirement� fo1- the location of these enclo­
locked. See Figure A 15.4.2.4. 6 for examples of enclosures with
sures, including, but not limited to, design and construction,
doors that open to access corridors.
ventilation. and cylinder storage. are located in 5.1.3.3. For
ad<litional info1·mation on ventilation , see 9.3.6. For additional A.15.4.2.6.1 See Figur·e A. l.'",.4.2.6.1 for an illustration of
information on cylinder storage, see Chapter 11. single treatment locations.
A.15.4.2.4.6 When the stornge/supply endostu-e is remote A.15.4.7.4.4.5 Ammonia is known to cause stress cracking in
from the single tt·eatment facility, it should be locke<l fot· secur­ cop pet· an<l it� alloys.
ity reasons (i.e., to prevent tampering). Access should only he
allowed for authorized staff or fire department�. \'\'hen the
enclosu1·e is within the single tt·eatment facility, it is left to the

2021 Edition
99-212 HEALTH CARE FACILITIES CODE

�-------'�e nt to
1-
•' ,-Muffler
---,,' ,,-- ....,,
I I
outside

L_______ J : Air/liquid :
:separator:
I
----r--- J

To drain"

� i� Issi
*
Vacuum relief valve Check valve Solids separator

[Q] Inl e t stati on Pipe isolators H2O Water supply

� Se rvice inlet � Vacuum gaug e I u.c.1 Utility ce nte r

Note: Dotted lines indicate optional items.

•Does not have to be below floor.

FIGURE A.15.3.3.5(a) Typical Wet or Dry Piping System with Single Vacuum Pump Source.

�___.r
--- --71 ,--.!�-�..{-
---�--�--��--ss P==±"- -+I __L_"=='_�J
_r: -�
.___, !1 Air/liquid I
� : s parator: e
....

Ls�J
�
,___ ---
I )

,
I
To drain"

, Options
! Isolators
L_J9_��ai�_________________:
zi I SSI
*
� Vacuum relief valve Ch e ck valve Sol i ds separator

[Q] lnl et stat ion Pipe isolators H2O Water supply

� Service inlet � Vacuum gauge

I u.c.I Utility ce nt e r

Note: Dotted lines indicate opti anal items.

"Does not have to be below floor.

FIGURE A.15.3.3.5(b) Typical Wet or Dry Piping System with Duplex Vacuum Source with
Air/liquid Sep arator.

f, --1, flush
S parator
e

Lc l i e -- - --
;:: r- - -, � - ---,
__
V e nt to
I I
outsid e
---�--�--��--·
i"
- :
: Waste I
I
: ,....JL..........I...., : holding I
I I
I
I : tank I
I
I
I
I
I
I
I
Flexibl e
I I I conne ctors
I
I
!.. _J
I Options
L_ To drain ________________ Isolators
I

To drain"

I u.c.I Utility cent e r [Q] Inl e t station Z! Check valve S Pipe isolators

[Yl Vacuum relief valve � Se rvic e inlet Q Vacuum gauge

Not e : Dott e d line s indicat e optional it e ms.

'Does not have to be be low floor.

FIGURE A.15.3.3.5(c) Typical Wet or Dry Piping System with Single Vacuum Source.

2021 Edition
 ANNEX A 9�213

,- - -- --,
I I
---�--�--��-�• : Check !
f" - : Waste : valves
: : holding :
: : tank :
I I I --Flexible
connectors
I I I
I I I

l L _J
I Options
Isolators
L_ To drain ________________
I

To drain•

I I u.c.
Utility center [Q] Inlet station t ! Check valve t Pipe isolators

[y] Vacuum relief valve [§] Service inlet Q Vacuum gauge

Note: Dotted lines indicate optional items.
'Does not have to be below floor.

FIGURE A.15.3.3.5(d) 'fypical Wet or Dry Piping System with Duplex Vacuum Source with
Waste Holding Tanlc.

A.16.3.2 NFPA 58 pe1·mit� the use of portable butane-fuele<l Example of storage not
appliances in restaurants and in atten<le<l commercial food Use points remote; locking not required
catering operntions whe1·e fueled by a maximum of two 0.28 kg
( IO oz) LP-Gas capacity, nonrefillable butane containers with a
,v,Het· capacity not in excess of 0.4 kg ( 1.08 lb) per container. Storage
Containers a re required to be <lirectly connected to the appli­
ance, and manifolding of containern is not permitted. Storage
Hall
of cylinders is limite<l to 24 containers, with an a<lditional 24
permitted where protected by a 2-hour lire resistance-rate<l
ba.rrie1·. (SPe 4.1.3 rind AnnPx C of NI-PA 101 for rPjfrmred doru- Example of remote storage
1nents on hazardmts material�.) f 101:A.8. 7.3.21 Use points adjacent to use points, but
access to storage is from hall;
A.16.5.2.1 This section is different from 9.2. l of NFPA 101 locking required
because NFPA 90B, 1·ef"erenced in NFPA 101, is not applicable
Storage
to health care facilities.
A.16.5.3.3 Continued operation of solid-state elevator equip­
ment is contingent on maintaining the ambient temperatm·e in Hall
the range specified by the eleYator manufacture1·. If the
machine room ventilation/air-con<litioning is conne cte<l to the
Example of remote storage;
general building system, and that system is shut down <luring a
fit·e, the fire depanment might lose the use of elevators due to Use points - storage on different I eve I;
locking required
excessive heat in the elevator machine room. f JOJ:A.9.4.51
A.16.7.1 The provisions of Section 16.7 cover the ba�ic func­
tions of a complete fit·e alarm system, including fit·e <letection,
ala1·m, an<l communications. These systems are primarily inten­
Storage ,-
ded to provide the indication and warning of abnormal condi­
tions, the summoning of appropriate aid, and the control of
occupancy facilities to enhance protection oflife.
FIGURE A.15.4.2.4.6 Examples of Storage/Supply
Some of the provisions of Section 16.7 originated with Enclosures.
,\'FPA 72. For purposes of this Co<le, some provisions of
Section 16.7 a1·e m01·e stt·ingent than those of NFPA 72, which
should be consulte<l for additional <letails. f 101:A.9.6. l l
A.16.7.2.4 It is not the intent of 16.7.2.4 to require manual A.16.7.4.2.1 Elevator lobbies have been consi<lere<l areas
fire alarm boxes to be attache<l to movable panitions or to subject to unwanted alarms due to factorn such as low ceilings
equipment, nor is it the intent to requi1·e the installation of an<l smoking. In the past several yea1·s, new features have
permanent structures for mounting purposes only. become available to 1·educe this problem. These features are,
f 101:A. 9.6.2.5 l however, not necessarily included in any specific installation.
IJOJ:A.9.6.3.2.1 I

2021 Edition
99-214 HEALTH CARE FACILITIES CODE

µ
Examples of Single Treatment Facilities Al6.9.l.3 It is not the intent of this parngrnph to requit·e
sprinkler system zones to coincide v.�th smoke compartment
Use points Use Use points bourniaries, provided that the facility fit·e plan addt·esses the

\
,,.- 01nts
� rlifferences between sprinklet· systems zones anrl building
\ smoke compartments.
\
I
Al6.9.l.4 This exception is limited to hospitals as nm·sing
Bale on y, but access homes and manv limited care facilities can have more combus­
is totally within
treatment facility. tibles within the' closets. The limiterl amount of clothing found
in the small clothes closern in hospital patient rooms is typically
Examples olTwo Treatment Facilities far less than the amount of combustibles in casework cabinets
.---=.--------, that rlo not require sprinklet· protection such as nurse servet·s.
Use points
In many hospitals. especially new hospitals, it is difficult to
Use point 1 Use
i
Use po nts ENT
point 2 make a distinction between clothes closeL� anrl cabinet work.
location 1
Use points NFPA 13 alt-eady permit� the omission of sprinkler-s in ward­
-===... ENT robes [�1'1' 8. 1.1( 7) of l',;'J,PA 13]. It is not the intent of this para­
f
graph to affect the warrlrobe provisions o NFPA 13. It is the
Hall Stairwell
intent that the spt·inkler protection in the room covers the
� closet as if there was no <loot· on the closet (sPP 8.5. 3.2. 3 of
Example of adjacent Example of two-level
i operation, but access operation - ace ess NFPA. 13j. f 101:A.18.3.5.101
Use po nts 1s from outside hallway is from outside stairs.
location 2 Al6.10.l 1l1e selection of portable fire extinguishers for
Example of across-the-hall operation. health care facilities is a vital step in preparing the facility to
eflectively rleal with a fire in its incipient stage. There are
FIGURE A.15.4.2.6.1 Examples of Single Treatment special extinguisher requir·ements such as nonferrous fit·e
Locations. extinguisher component� of fire extinguishers in an MRI room
or area, and Class K extinguishers in kitchens. Thet·e is a need
f
to consider extinguishing agents for various areas o a facility
A.16.7.4.2.2 The concept adrlressed is that rletectors userl for that are nontoxic, noncon-osive. and/01· nonconductive. Chap­
releasing sen-ice, such a� door 01· rlamper closing and fan shut­ tet"s 5 anrl G anrl theit· Annex A notes of NFPA 10 need very
down, are not requit·ed to sound the building alam1. careful review. Annex C, "Fire Extinguisher Selection" and
f 101:A.9.G.3.2.21 Annex D, "Operation and Use" of NFPA 10 provide additional
valuable guidance.
A.16.7.4.3.1 It is not the intent of this parngraph to require
fire alat·m system zones to coincide with smoke compartment A.16.10.1.1.1 MR safe or MR conditional fire extinguishers
boundaries, prm,irlerl that the facility fire plan arldresses the should meet the requiremenl� of ASTM F2503, Standard Pmrtia
diffet·ences between fit·e alarm system zones anrl building .
Jar l\1. arking Ninliml Droim1 and OthPr Items Jar Sapty in thP
smoke compartments. Afagn Ptir RPsonanrP Envirnnnumt, anrl ASTM F2213, Standard Test
MPtlwd Jar Mmsumnent of AfagnPtimlly lnduarl Tim;ue on Medical
A.16.7.4.3.2 In the private operating mode, audible anrl visi­
Devim1 in thP Nlagnetir Resonance Envirnnmmt.
ble signaling is 1·equi1·erl only to those persons rlirectly
concerned with the implementation and rlirection of emet·­ Extinguishet·s that at·e appropriate for MRI rooms and asso­
gency action. Prmirlerl that those persons 1·eceive alat·m notifi­ ciated spaces (i.e .. safe zones) are typically labeled with infor­
cation, audible and visible signaling is not requirerl to patienL� mation 1·egarding theit· safe use in an MRI environment. See
or othet· building occupant� who are not responsible fot· the Figure A.lG.10.1.1.1 for an example of such a label.
implementation and direction of emergency action.
A.16.10.1.3 1l1is provision is intended to permit appliances
A.16.7.4.3.5 This paragraph allows the omission of either or used fot· reheating, limited cooking, and foorl preparation,
both audible anrl visual notification appliances in any patient such as microwave ovens, hot plates, electt·ic skillet�, toa�tet·s,
care space regat·rlless of the risk category, whet·e a risk a�sess­ and nourishment centers to be exempt from the requit·ements
ment determines the alarm notification can adversely affect for commercial cooking equipment and hazardous area protec­
patient care. Examples of such areas can include but are not tion. Limiterl quantities of butter, cooking spray, or oil can be
limited to. intensive cat·e units, coronaq; cat·e unit�. angiogra­ used. r 101:A18.3.2.5.21
phy laborntories, cat·diac catheterization laborntories, nu1·se1·­
ies, rlelivery rooms. operating rooms, post-anesthesia recovery Al6.10.l.4 Dry chemical fire extinguishers shoulrl not be
rooms, eme1·gency departments, anrl similar areas. provided in opernting rooms. \Vhile a clean agent or water mist
extinguishet· is 1·equirerl by this code for operating rooms, a
A.16.B Health care facilities utilizing heliports should ensure
that they are registered v.1th the U.S. Ferleral Aviation Adminis­
tration's (FAA's) A,irport Master Record program to enstlt"e that MA CONDITIONAL
their heliport and the ait·space senicing it is 1·egiste1·ed. Once THIS EXTING UISH ER HAS BEEN TESTED TO
registered, the health care facility should ensure that theit· OPERATE PROPERLY AND POSE NO SAFETY
airport irlentifier and related information in the FAA's Airport HAZARD IN AN MRI ENVIRONMENT ASS OCIATED WITH
Master Reco1·d is al war up-to-<late. If outside of the FAA's juris­ MR SYS TEMS OPERATING AT 11.7 TESLA OR L ESS.
diction, facilities shoulrl comply with the applicable aviation
authority.
FlGURE A.16.10.1.1.1 Example of a Label on an
Extinguisher for an :MRI Environment.

2021 Edition
 ANNEX B
ca1·bon dioxide fire extinguishe1· sha1·es the electrically noncon­
ductive properties of clean agent and water mist fire extin­
guishe1·s and, on that basis, could he used in lieu of a clean
agent extinguisher. However, it should be noted that carbon
dioxide fire extinguishers do not have Class A ratings. A clean
agent extinguisher for use in an operating room should have a
Cla�s A rating of some fot·m.
A.16.10.2.2 Hose and hose outlet� can be required hy a build­
ing code or by the authority having jurisdiction.
A.16.11 Compact storage is characte1·ized by shelving unit�
that are manually or electrically moved on fixed track� to
provide access aisles. Such systems are also known as mobile
shelving, track files, compaction files. 01· movable files.
A floor loading calculation should be petformed.
A.16.12.3 NFPA 13 contains protection c1·ite1-ia fot· limited
configurations of compact mobile storage unit� and materials
stored. Storage arrangement� not specifically addressed in
NFPA 13 are outside the scope of the standard (i.e., protection
fot· plastic commodities in compact mobile storage units does
not simply follow high piled storage protection crite1·ia for
shelves or racks). Where compact mobile storage configura­
tions outside the scope of NFPA 13 a1·e to be utilized, they must
be addt·essed on a case-by-case basis, with consideration given
to the fact that no known sprinkle1· protection criteria is
currently available. The storage of paper administrative and
medical records with l imited plastic labels 01· folders is typically
a Class III commodity "�th less than 5 percent pla�tics. The
storage of most office supplies, engineering parts, food prod­
ucts. garments. and othe1· general supplies is typically a Cla�s IV
commodity with 5 pe1·cent to 25 pe1·cent plastics. 1l1e storage of
x-rays. medicines. and plastic-based medical supplies is typically
a Group A plastics commodity with greater than 25 percent
plastics.
A.16.14.3.2 Some tinctures and solutions of disinfecting
agent� provide significant clinical benefits in reducing the risk
of surgical infections. However, they can be flammable and can
be used improperly during sm·gical procedures. Tipping
containers, accidental spillage, and the pouring of excessive
amount� of such flammable agents on patient� expose them to
injury in the event of accidental ignition of the flammable
solvent. To control this risk, flammable germicides 01· antisep­
tics that are used when electrosurgery, cautery, or a laser is
contemplated should be packaged to ensure controlled deliv­
ery to the patient (e.g., unit dose applicator, swab) in small
volumes appropt·iate for single application.
Annex B Additional Explanatory Notes
171i� annex is not 11 part of thP m1uirnnmts of this NFP./1 document
but is indudfd for informational pu-rposfs only.
B.l Reserved.
B.2 Reserved.
B.3 Reserved.
B.4 Reserved.
B.5 Additional Information on Chapter 5. Numbers in brack­
ets refer to paragraphs in Chapte1· 5.
B.5.1 General. This section sets out a minimum recommen­
ded guide for testing. Testing requi1-ements a1·e listed in 5.1.12
9�215
and summarized in Table B.5.1. Tests specified in 5.1.12 should
be carried out by an experienced person or persons designated
by the administration of the health care facility. Such a
pe1·son(s) should cenify the result� of test� to the administra­
tion. The designated person(s) should be experienced in medi­
cal gas testing and verification of piping systems \,1th cross­
connection testing. A membe1· of the health ca1·e facility should
be pt·esent to ve1·ify the testing.
B.5.2 Retesting an d Maintenance of Nonflammable Medical
Piped Gas Systems (Category 1 Systems).
B.5.2.1 [5.J.3_5.9) These systems should be checked daily to
ensure that proper pressm·e is maintained and that the change­
over signal has not malfi.mctioned. Pe1·iodic retesting of the
routine changeover signal is not necessary, a� it mll n01·mally be
activated on a regular basis.
B.5.2.2 [5.1.3.5.10) These S}'lltems should be checked daily to
enstu-e that prope1· presstu-e is maintained and that the change­
over signal has not malfunctioned. Periodic retesting of the
routine changeover signal is not 1·equi1·ed. Annual retesting of
the operation of the 1·eserve and activation of the 1·eserve-in-use
signal should be performed.
B.5.2.3 [5.1.3.5.10] If the S}'lltem has an actuating S\\1tch and
signal to monitot· the content� of the 1·eserve, it should be retes­
ted annually.
B.5.2.4 [5.1.3.5.11) Maintenance and pet-iodic testing of the
bulk S}'lltem is the 1·esponsihility of the owner or the organiza­
tion 1·esponsible for the operation and maintenance of that
system.
The staff of the facility should check the supply system daily
to ensure that medical ga� is ordered when the content's gauge
drops to the reorder level designated by the supplier. Piping
sy,tem pressm·e gauges and othe1· gauges designated by the
supplie1· should he checked regularly, and gradual variation,
either increa�es or decreases, from the normal range should be
rep01-tecl to the supplier. These variations might inclicate the
need for con-ective action.
Periodic testing of the master signal panel system, other than
the routine changeover signal, should be perforn1ed. Assis­
tance should be requested from the supplie1· or detailed
instrnction if 1·eadjustment of bulk supply controls is necessary
to complete these test�.
B.5.2.5 [5.1.8.2.3] The main line pressure gauge should be
checked daily to ensu1·e the continued p1-esence of the desired
pressure. Variation, either increases or decreases, should be
investigated and con-ected.
B.5.2.6 [5.1.3.6.3.14) Quanerly rechecking of the location of
the air intake should be made to ensure that it continues to be
a satisfactory sou1·ce fot· medical compressed air.
B.5.2. 7 [5.1.3.6.3.14) Prope1· fi.mctioning of the pressure
gauge and high water level sensor should be checked at least
annually. The 1·eceiver drain should be checked daily to deter­
mine if an excessive quantity of condensed wate1· has accumula­
ted in the receiver.
B.5.2.8 [5.1.3.6) An impo1·tant item t·equired for ope1·ation of
any medical compressed ai1· supply system is a comp1·el1ensive
preventive maintenance program. ''\'orn part� on reciprocating
compressors can cause high discharge temperatures, resulting
in an increase of contaminants in the discharge ga�. Adso1·be1-
2021 Edition
99-216 HEALTH CARE FACILITIES CODE

Table B.5.1 Perfonnance Criteria and Testing-Level I (Gases, Medical-Surgical Vacuum, and WAGD)

Responsibility Test Reference Test (as Applicable) Purpose of Test

Inslaller 5.1.12.2.1 General
Inslaller 5.1.12.2.2 Inilial blow down Dislrihulion piping is blown down lo remove
parliculales
Inslaller 5.1.12.2.3 Ini lial pressure Lesl Dislrihulion piping is free from pressm·e loss
Installer 5.1.12.2.4 Cross-connection test Distribution piping is free from cross-conneclions
Inslaller 5.1.12.2.5 Piping purge lesl Dislrihulion piping is purged lo remove paniculales
Inslaller 5.1.12.2.6 Slanding pressure lesl for posilive Dislrihulion piping is free from excessive pressure loss
pressure medical gas piping
Inslaller 5.1.12.2.7 Slanding vacuum lesl for vacuum Dislrihulion piping is free from excessive vacuum loss
system
Syslem verificalion 5.1.12.4.l General
Syslem verificalion 5.1.12.4.2 Slanding pressure lesl Dislrilmlion piping is free from leaks
Syslem verificalion 5.1.12.4.3 Cross-conneclion lesl Dislrihulion piping is free from cross-conneclions
5.1.12.4.3.1 Individual pressurizalion
5.1.12.4.3.2 Pressure clifferenlial
Syslem verificalion 5.1.12.4.4 Valve lesl Shuloff valves are funclioning and labeled properly
Syslem verification 5.1.12.4.5 Alarm lesl Alarms are funclioning ancl labeled properly
S.1.12.4.5.1 General
5.1.12.4.5.2 .\fasler alarm
5.1.12.4.5.3 A.rea alarm
System vedficalion 5.1.12.4.6 Piping ptll'ge Lest Distribution piping is purged Lo remove particulates
Syslem verification 5.1.12.4.7 Piping parliculale lesl Dislrihulion piping is free from paniculales
Syslem verificalion 5.1.12.4.8 Piping purily lesl Dislrihulion piping is free from excessive waler vapor,
Lola! hydrocarbons, and halogenalerl hydnica.-llons
Syslem verification 5.1.12.4.9 Final tie-in lesl The new and exisling dislrihution syslem is free from
leaks at the point of connection, and no additional
conlamination was added lo lhe exisling syslem
Svslem verificalion .'J.1.12.4.10 Operalional pressure lesl Dislrihulion piping is free from excessive pressure/
vacuum loss
Syslem verification 5.1.12.4.11 .\1edical gas concenlration lesl Proper concenlralion of syslem gas is present al each
outlet
Syslem verificalion 5.1.12.4.12 �kdical air purily lesl (compressor Proper qualily of medical air is presenl
syslem)
Syslem verificalion 5.1.12.4.13 Labeling Dislrihulion piping, oullels/inlels, shuloff valves,
alanns, and source eq uipmenl are labeled correclly
Syslem verificalion 5.1.12.4.14 Source equipmenl verificalion Source equipmenl properly funclions
5.1.12.4.14.1 General
5.1.12.4.14.2 Gas supply sources
5.1.12.4.14.3 �1edical air compresscff syslems
5.1.12.4.14.!', .\kdical-surgical vacuum syslems

beds, if not changed at specified time intervals, can become
saturated and lose their effectiveness. It is important that all
components of the system be maintained in accordance with
the manufacuu·ers' 1·ecommendations. It is important that any
instrnmentation, including analytical equipment, be calibrated
routinely and maintained in operating order. Proper function­
ing of the dew point sensor should be checked at least annu­
ally.
B.5.2_9 [5.L9] \\'hen test buttons are provided with signal
f
panels, activation o the audible and visual signals should be
pedonned on a 1·egular ba�is (monthly).
B.5.2.10 [5.1.9.2.4] Changeover Warning Signals. As these are
routine signals that are activated and deactivated at frequent
intervals, there is no need fo1· retesting unless they fail. If the
reserve-in-use signal is activated because both unit� of the ope1·­
ating supply are depleted without the prior activation of the
changeove1· signal, it should be repai1-ed and retested.
B.5.2.11 [5.1.9.2.4] Reserve-In-Use Warning Signal. All
component� of this warning signal system should be retested
annually. Audible and visual signals should be tested periodi­
cally during the yea1· (monthly).
B.5.2.12 [5.1.9.2.4] Reserve Supply Low (Down to an Average
One-Day Supply) High Pressure Cylinder or Liquid Reserve.
All component� of these signal warning systems should be
retested annually. If test buttons are provided, audible and
visual signals should be periodically tested throughout the year
(monthly).
B.5.2.13 [5.1.9.2.4] The medical comp1·essed ai1· system
alarms in 5.1.3.6.3.12 should be checked at least annually.
B.5-2.14 [5.I.8.2.2(1)] This pressure gauge should he
checked on a daily basis to ensure proper piping system pres­
sure. A change, inCI"ea�e or deCI"ease. if noted, could he
e\idence that maintenance is 1·equi1·ed on the line pressure
regulator and could thus avoid a problem.

2021 Edition
 ANNEX B 9�217

B.5.2.15 [5.1.9] Annual 1·etesting of all components of warn­
ing systems, if it can be done without changing piping system
line p1·essu1·e, should be performed.
B.5.2.16 [5.1.9] If test buttons are provided, the retesting of
audible and visual alarm inrlicators should be performed
monthly.
B.5.2.17 [5.1.4] Shutoff valves should be periodically checked
for external leakage by means of a test solution or other equally
effective means of leak detection that is safe for use with
m..-ygen.
B.5.2.18 [5.1.5] Station outlet� shoulrl be periodically
checked for leakage anrl flow. Manufactut·e1· insu·uctions
should be followed in making this examination.
B.5.3 Oxyge n Service-Related Documents. The following
publications can be used fot· technical refe1·ence:
(I) ASTM G63, Standard GuidP for Evaluating }llnmnNallir Mate­
rial� f()r Oxygen Servia
(2) ASTM G88, Standard GuidP far Designing ,\)'stems far Oxygrn
Servi,·e
(3) ASTM G93, Standard Prartia f()r Clmning Methnds and
Cleanline.t1 Level1 fnr Material and Equipment U1ed in Oxygen­
Enrirhed Envimnmmts
( 4) ASTM G94, Standard Guide fnr Evaluating Metal1 f()r Oxygen
Si'rvire
B.6 Additional Information on Ch.apter 6.
B.6.1 T)pical Hospital Wiring Arrangement. See Figme B.6.1.
Separate transfer s,vitches for each branch, as shown, are
1·equired only if rlictated by load considerntions. Smalle1· facili­
ties can be se1·ved by a single transfe1· switch.
B.6.2 Maintenance Guide for an Essential Electrical System.
This genernlizerl maintenance guirle is provided to assist
administrative, supervisory. and operating personnel in estab­
lishing anrl e\-aluating maintenance programs for emergency
elecu·ic gene1·ating systems. See Figure B.6.2.
B.6.3 Suggested F ormat for Listing Functions to Be Served by
the Essential Electrical System in a Hospital. It might be
advantageous in listing the specific functions for a given
construction project or builrling 1·eview to list them, at the
outset, by geographical location within the project in orrler to
ensure comprehensive coverage. Every room or space should
be 1·eviewed for possible inclusion of the follov.�ng:
(l ) Lighting (partial or all)
(2) Receptacles (some or all)
(3 ) Permanently ,virerl electrical apparatus
l11e fot·mat suggesterl he1·ein is offered as a convenient tool,
not only for identifying all functions to be served and their
respective time intervals for being re-energized by the alternate
electric source, but also for rlocumenting othe1· functions that
were considered, rliscussed, anrl excluded a� nonessential. The
last column in Figure B.6.3 is considererl worthy of attention
(sPe Figure fl.6.3). It might be that the hospital enginee1· or the
revie,ving authority will ,vish to keep on file a final copy of the
list, which would be the ba�is for the elecu-ical engineer's
rletailed enginee1·ing design.
Although this suggested format is intenrled for use by a
hospital, it might, \,�th suitable changes, be useful for other
health care facilities.
B. 7 Reserved.
B.8 Reserved.
B. 9 Reserved.
B. l O Reserved.
B. 11 Additional Information on OJ.apter 11.
B.11.1 Medical Safeguards - Respiratory Therapy.
B.11.1.1 General.

Full capacity normal power sources Alternate source generator

Normally open secondary
tie O\lercurrent device
automatic throwo'l!lr
recommended

0 General General
power power
and and
lighting lighting

'
.,,.,..,,._ Transformer Nondelayed Critical
restoration - branch
Generator automatic /
Delayed Life safety
□ Overcurr ent device with
switching mechanism (OCD)
restoration-
automatic
or manual
Delayed
restoration-
automatic
branch

[f] Automatic transfer switch

�
Automatic or manual transfer
device I· Equipment
branch -1
FIGURE B.6.1 T)pical Hospital Wiring Arrangement.

2021 Edition
99-218 HEALTH CARE FACILITIES CODE
MAINTENANCE GUIDE
Monthly
( 1) Testing of generator sets and transfer switches under
load and operating temperature conditions at least
every 30 days. A 30-minute exercise period is an
absolute minimum, or the engine manufacturer's
recommendations should be followed.
(2) Permanently record all available instrument readings
during the monthly test.
(3) During the monthly test, check the following system
or systems applicable to your installation:
Natural Gas or Liquid Petroleum Gas System:
.J Operation of solenoids and regulators
.J Condition of all hoses and pipes
.J Fuel quantity
Gasoline Fuel System:
.J Main tank fuel level
.J Operation of system
Diesel Fuel System:
.J Main tank fuel level
.J Day tank fuel level
.J Operation of fuel supply pump and controls
Turbine Prime Movers:
.J Follow manufacturer's recommended maintenance
procedure
Engine Cooling System:
.J Coolant level
.J Rust inhibitor in coolant
.J Antifreeze in coolant (if applicable)
.J Adequate cooling water to heat exchangers
.J Adequate fresh air to engine and radiators
.J Condition of fan and alternator belts
.J Squeeze and check condition of hose and
connections
.J Functioning of coolant heater (if installed)
Engine Lubricating System:
.J Lubricating oil level
.J Crankcase breather not restricted
.J Appearance of lubricating oil
.J Correct lubricating oil available to replenish
or change
.J Operation of lubricating oil heater (if installed)
.J Oil pressure correct
Engine Electrical Starting System:
.J Battery terminals clean and tight
.J Add distilled water to maintain proper electrolyte
level
.J Battery charging rate
.J Battery trickle charging circuit operating properly
.J Spare batteries charged (if provided)
© 2020 National Fire Protection Association
FIGURE B.6.2 Maintenance Guide for Essential Electrical System.
2021 Edition
Engine Compressed Air Starting System:
.J Air compressor operating properly
.J Air compressor lubricating oil level
.J Spare compressed air tanks full
.J Main compressed air tanks full
.J Drain water from compressed air tanks
Engine Exhaust System:
.J Condensate trap drained
.J No exhaust leaks
.J Exhaust not restricted
.J All connections tight
Transfer Switch:
.J Inside clean and free of foreign matter
.J No unusual sounds
.J Terminals and connectors normal color
.J Condition of all wiring insulation
.J All covers tight
.J Doors securely closed
General:
.J Any unusual condition of vibration, deterioration,
leakage, or high surface temperatures or noise
.J Maintenance manuals, service log, basic service
tools,jumpers, and supplies readily available
.J Check and record the time intervals of the
various increments of the automatic start-up
and shutdown sequences
.J Overall cleanliness of room
.J No unnecessary items in room
(4) After the monthly test: Take prompt action to correct
all improper conditions indicated during test. Check
that the standby system is set for automatic start and
load transfer.
Quarterly
(1) Generator Sets:
Engine Electrical Starting System:
.J Check battery electrolyte specific gravity
.J Check battery cap vents
Engine Lubricating System:
.J Check lubricating oil (or have analyzed if part of
an engineered lube oil program)
(2) FuelSystem:
.J Drain water from fuel filters (if applicable)
.J Drain water from day tank (if applicable l
.J Check fuel gauges and drain water from main
fuel tanks
.J Inspect all main fuel tank vents
(NFPA 99, 1 of 2)
 ANNEX B 9�219

MAINTENANCE GUIDE (Continued)

Semiannually Exhaust System:

..J Check condition of muffiers, exhauBt lines,
Generator Sets: supports, and connections
Engine Lubricating SyBtem: Ignition System:
..J Change oil filter (if sufficient hourB) ..J Spark ignition engines
..J Clean crankcaBe breather ..J Replace points and plugs
Fuel System: ..J Check ignition timing
..J General inBpection of all components ..J Check condition of all ignition leads
..J Change fuel filter Generator:
..J Change or clean air filter ..J Clean generator windings
Governor: ..J Check generator bearings
.J Check all linkages and ball joints ..J Measure and record resistance readingB of
generator windings using inBulation tester
.J Check oil level (if applicable) (megger)
..J Observe for unusual oil leakage
Engine Control:
Generator: ..J General cleaning
..J Check brush length and pressure ..J Check appearance of all components
..J Check appearance of Blip rings and clean if ..J Check meters
necessary
..J Blow out with clean, dry compresBed air (2) Transfer Switch:
..J Inspect transfer switch and make repairs or
Engine Safety Controls: replacements if indicated
..J Check operation of all engine-operating alarms
and safety Bhutdown devices (generator not (3) On Main Switchgear and Generator Switchgear:
under load during this check) ..J Operate every circuit breaker manually
..J Visually check bus bars, bracing, and feeder con­
Annually nections for cleanliness and signs of overheating
(1) Generator SetB:
Fuel System: Every 3 Years
DieBel: (1) System ControlB:
..J Analyze fuel for condition (replace if required) ..J Reevaluate the settings of the voltage-sensing and
Gasoline: time delay relays.
..J Replace fuel (2) Main Switchgear and Generator Switchgear:
..J Determine whether changes to the electrical supply
Natural Gas or Liquefied Petroleum Gas:
system have been made that require a reviBion of
..J Examine all supply tanks, fittings, and lines the main circuit breaker, fuse, or current-limiting
buB duct coordination.
Lubricating SystemB:
..J Calibrate and load test main circuit breakers. Spot­
..J Change oil check bus bar bolts and supports for tightness.
..J Change oil filter Obtain and record insulation tester readings on
..J Replace carburetor air filter buB bars and circuit breakers. Obtain and record
inBulation tester readings on internal distribution
Cooling System: feeders.
. J Check condition and rod-out heat exchangers Periodically
if neceBsary
..J Change coolant on cloBed ByBtemB (1) Prime Mover Overhaul:
..J Each prime mover should have a periodic overhaul
..J Clean exterior of all radiators
in compliance with the manufacturer's
. J Check all engine water pumps and circulating recommendation or as conditions warrant.
pumps
..J Examine all duct work for looseness (2) Connected Load:
..J Update the record of demand and connected load
..J Clean and check motor-operated louvers and check for potential overload.
© 2020 National Fire Protection Association (NFPA 99, 2 of 2)

FlGURE B.6_2 Contirmed

2021 Edition
99-220 HEALTH CARE FACILITIES CODE

Essential Electrical Systems B.11.2.9 Defibr illate. Use of electrical shock to synchrnnize
heart acti"ity.
Hospital ______________ Date _____
B.11.2.10 Diffusion. Transfr1· of gases across the alveolar
Emergency Equipment capillary membrane.
system system
Life B_ll,2.11 EKG, ECG. Electrocardiogram.
Room Room Function Delayed Delayed Nonessential
i
Salaty Cr tical
No. Name Served' Branch Branch Auto.' M:inu.'.11
8-11.2.12 Hemoglobin. The chemical compound Ill red
blood cells that c arries oxygen.
B.11.2.13 Hyp oxia. An abnormally dec1·eased supply or
concentration of oxygen.
B.11.2.14 IMV. Intermittent mandatory ventilation.
B.11.2.15 IPPB. Inte1-mittent positive pt·essut·e bt·eathing.
B.11.2.16 PEEP. Positive end expiratory pressure.
B.11.2.17 Respiration. The exchange by diffusion of gases
between the alveoli, the blood, and the tissue.
B.11.2.18 Retrolenta.l Fibroplasia. A disease entity of the
pt·emature infant causing blindness.
B.11.2.19 Thorax. The chest; the upper part of the trunk
between the neck and the abdomen.
B.11.2.20 Trachea. The windpipe leading from the larynx to
the bronchi.
B.11.2.21 Ultrasonic Nebulizer. A device that produces sound
waves that a1·e utilized to break up water into aerosol particles.
Indicate precise lighting, receptacles, and/or equi pment. Use a separate line for
each function.
1 Indicate time interval.
B.11.2.22 Ventilation. Movement of air into and out of the
lungs.
FIGURE B.6.3 Essential Electrical Systems. 8-11.2.23 Ventilator. Machine used to support or assist
nonbreathing or inadequately breathing patient.
B.11.1.1.1 Personnel setting up, operating, and maintaining B.11.3 Suggested Fire Response - Respiratory Therapy. The
respiratory therapy equipment, including suction appa ratus, suggested prncedure in the event of fire invohing respiratory
should familiarize themselves with the problems of the use of therapy apparatus is given in B.11.3.1 through B.l1.3.6.
each individual unit.
B.11.3.1 General. Fires in oxygen-enriched atmosphe1·es
B.11.1.1.2 Personnel must be aware of the exact location of spread rapidly, generate intense heat, and prnduce large
equipment in storage to facilitate emergency use. volumes of heated and potentially toxic gases. Because of the
B.11.1.1.3 Suction tubing employed in a hazardous location is immediate threat to patients and personnel, as well a� the
to be electrically conductive. damage to equipment and possible spread to the structut·e of
the building, it is important that all personnel be a\\"dre of the
B.l 1.2 Glossary of Respiratory Therapy Terminology. steps necessary to save life, to preserve limb, and, within
reason, to extinguish 01· contain the fire.
B.11.2.1 Arrhythmia. Irregularity of heartbeat�.
f B.11.3.2 Steps to Take in Event of Fire.
B.11.2.2 Asphyxia. Suf ocation from lack of Oll.')'gen and an
accumulation of cat·bon dioxide. B.11.3.2.1 The following steps are recommended in the event
f of a fire, in the approximate order of importance:
B_ll.2.3 Asp iration. Removal o accumulated mucus by
suction. ( l) Remove the patient or patie nm immediately exposed
from the site of the fire if thei1· ha.it· and clothing are not
B.11.2.4 Bronchi. The l:\Vo pt·imary divisions of the trachea. burning; if they are bun1ing, extinguish the flames. (Sff
B.11.2.5 CPAP. Continuous positive airway pressure. B.11.3.4 and B.11.3.5.)
(2) Sound the fire alarm by whatever mode the hospital fire
B.11.2.6 CPR. Cardiopulmonary 1·esuscitation. plan provides.
(3) Close off the supply of oxygen to the therapy apparatus
B.11.2.7 Croup Tent. Equipment utilized to provide environ­ involved if this step can be accomplished without i1tjury
mental control inside a canopy in relation to oxygen concentra­ to personnel. (Sep B.11.3. 3.)
tion, temperatut·e, humidity, and filtered gas.
(4) Cart)' out any othe1· steps specified in the fire plan of the
B_ll.2.8 Cyanosis. A bluish discoloration of skin and mucus hospital including, but not limited to, the following exam­
membranes due to excessive concentration of reduced hemo­ ples:
globin in the blood. (a) Remove patients th1-eatened by the fit·e.

2021 Edition
 ANNEX B
( b) Close the dooi-s leading to the site of the fire.
(c) Attempt to extinguish or contain the fire (see
B.11.3.4).
(d) Direct fit·e fighte1·s to the site of the fire.
(e) Take whatever steps necessary to protect or evacuate
patient� in adjacent area�.
B.l 1.3.3 Closing Off of O xygen Sup ply.
B.l 1.3.3.1 In the event of a fire involving respiratory therapy
equipment connected to an oxygen station outlet, the zone
valve supplying that station is to be closed.
B.l 1.3.3.1.1 All personnel are cautioned to be aware of the
hazard of the step specified in B.11.3.3. l to othe1· patient�
1·eceiving oxygen supplied through the same zone valve. Steps
should he taken to minimize such hazards, realizing that clos­
ing the valve is of foremost importance.
B.11.3.3.2 In the case of oxygen therapy apparatus supplied
by a cylinder or container of oxygen, it is desirable to close the
valve of the cylinder or container, provided that such closure
can be accomplished without irtjury to pe1·sonnel.
Note that metallic component� of regulators and valves can
f
become exceedingly hot i exposed to flame. Personnel are
cautioned not to use their bare hamls to effect closure.
B.l 1.3.4 Extinguishment or Containment of Fire.
B.l 1.3.4.1 Fi1·e 01·iginating in or involving respiratory therapy
apparatus generally involves combustibles such as ruhbe1·, plas­
tic, linen, blanket�, and the like. \,Vater or Wdter-based extin­
guishing agents are most effective in such fires.
B.11.3.4.1.1 P1·ecautions should be observed if electrical
equipment is adjacent to, or involved in, the fire because of the
danger of electrocution of personnel if streams of water
contact live l lS-V circuits.
B.11.3.4.1.2 Before attempting to fight the fire with water or a
wate1�based extinguishing agent, electrical appa1·atus should be
disconnected from the supply outlet. or the supply ci1-cuit
should be de-energized at the circuit panel.
B.l 1.3.4.1.3 If de-energization at the circuit panel cannot be
accomplished. wate1· should not be employed. (See B.11. 3. 4. 2.)
B.l 1.3.4.2 Fires invohing or a<ljacent to electrical equipment
with live circuits can he fought with extinguishers suitahle for
Cla�s C fires in accordance with NFPA 10.
Note that chemical extinguishers are not effective against
fires in oxygen-enriched atmosphe1·es unless the source of
oxygen is shut off. See B.11.3.3 for closing off the oxygen
supply.
B.l 1.3.5 Protection of Patients and Personnel.
B.l 1.3.5.1 Because of the intense heat generated, serious and
even fatal burns of the skin or of the lungs from inhaling
heated ga�es are possihle sequelae to a fire in an oxygen­
enriched atmosphere. Thus. it is essential that patient� be
1·emoved from the site of the fire whene\·er practical.
Note that, where a nonamhulatory patient is connected to a
burning piece of thernpy equipment, it might be m01·e practi­
cal, as the initial step, to remove the equipment or extinguish
the fire, or hoth, than to remove the patient.
9�221
B.11.3.5.2 The large quantities of noxious gases produced
constitute a threat to life from asphyxia, beyond the thermal
burn problem.
B.11.3.5.2.1 Pe1·s01rnel are cautioned not to remain in the fire
area after patient5 are evacuated if quantities of gaseous
comhustion product� are present.
B.11.3.6 Indoctrination of Personnel. It is highly desirable
that personnel involved in the care of patients, including
nurses, aides, wa.tTI sec1·eta1·ies, and phyi;icians, in-espective of
whethe1· or not they are involved in 1·espiratory therapy practi­
ces. be thoroughly indoctrinated in all aspect5 of fire safety.
including the following:
(l ) Location of zone valves of nonflammable medical gas
systems whe1·e employed, and the station outlets control­
led by each valve
(2 ) Location of electt·ical service boxes and the areas served
the1·eby
(3 ) Location of fire extinguishers, indications for their use,
and techniques fo1· thei1· application
(4 ) Recommended methods of evacuating patients and
routes by which such evacuation is accomplished most
expeditiously, with reference made to the facility's fire
plan
(S) Steps involved in carrying out the fire plan of the hospital
(6) Location of fire alarm boxes, or knowledge of other
methods, for summoning the local fire department
B.11.4 Typical Gas Cylinders. See Table A.11.3.5.
B.12 Additional Information on Chapter 12.
B.12.1 Emergency Mana gement Program Development. The
program development process illustrated in Figure B.12. l is an
example of a tool that can be used to develop an emergency
management program; othe1· tools or processes a1·e acceptable
f
a� long a� the task.� o identification, planning, education, eval­
uation, and improvement are addressed.
B.12.1.1 Program Development Steps and Activities.
B. 12.1.1.1 Review the Hazard Vulnerability Analysis (HVA) and
Determine Priorities f or Developing Standard Operating
Procedures (SOPs). Using the input submitted by operating
unit manage1·s, the Emergency Management Committee
(EMC) must prioritize threats/event� and develop a list of
SOPs that must be developed to address those hazards. Figure
B.12. l . l . l displays a sample standard operating procedure
fo1·mat.
B. 12.1.1.2 Implement Mitigation and Preparedness Strategies.
Using the SOPs developed for prioritized threal�/evenl�,
develop and implement actions that will eliminate or 1·educe
the impact of adverse evenl� to the facility and build capabili­
ties to manage them. The committee should review the SOPs to
identify resources needed for mitigation and preparedness,
develop cost estimates or resources 1·equired, and submit the
resource request to the director for fonding. The committee is
responsible for tracking mitigation and preparedness planning
activities until completed.
B.12.1.1.3 Report Results of Mitigation and Preparedness
Activities to the Emer gency Management Committee. Opernt­
ing unit manage1·s and the emergency program coordinat01-
should regularly report result� of miti gation and preparedness
activities to the committee. Reporl� should include mitigation
activities taken that effectively 1·educed 01· eliminated adverse
2021 Edition
99-222 HEALTH CARE FACILITIES CODE

3>--------,
Develop
Develop Hazard Implement
Form Standard
Vulnerabilit y Mitigation and
Emergency Operating
Analysis and Preparedness
Management Procedures
Complete Activities
Committee
Operating Unit Develop strategies
Establish roles Templates for mitigation, Take action to
and assign preparedness, reduce impacts
Determine threats and build capacity
responsibilities response, and
and impacts
recovery

5J----------------------------,
Report Results al Mitigation and Preparedness to
Emergency Management Committee
Ongoing monitoring

6>----------, SJ--------,

Develop Annual
Conduct Staff Implement
Emergency Evaluation
Education and Emergency
Operations and Corrective
Training Operations
Plan Actions
Plan and Conduct
Understand roles Critique Review and refine
Organizational and build the emergency
concept of Rehearsal or
competencies management
operations actual event
and confidence program

FIGURE B.I 2.1 Emergency Management Program Development Pro cess.

impact� to the facility; mitigation activities that di<l not reduce
or eliminate adverse impact� to the facility operation; an<l
recommendations for mitigation an<l preparedness activities,
bu<lget, an<l timelines.
B.12.1.1.4 Develop, Publish, and Distribute the Emergency
Operations Plan (EOP). Section 3.6 of NFPA. 1600 desct"ibes
four types of planning: strategic administrative (preparedness)
planning, mitigation planning, recove1y planning, and eme1·­
gency operntions planning.
The Federal Emergency Management Agency, now part of
the Department of Homeland Security. issues gui<lance on the
development of emergency operations plans, 01· EOPs. The
EOP is des igned to address all hazards, and it accomplishes this
through it� organization by functions, not department�,
haza1-ds, 01· individuals. Flexibility is a key katme of this type of
format, as only the functions n eeded to address the problems
are activated, not the entire plan. This type of EOP format (a
ba.�ic plan an<l functional annexes) is that used by communi­
ties. states. an<l the Fe<leral Response Plan. (SPe AnnPx D.)
Hard copies of the EOP need not be widely <listributed.
Staff membe1·s need access to incident-specific plans, but not
the entire document. Several copies of the full EOP should be
available in the Hospital Command Cente1·, the adminisu·ative
offices, and with the chair of the Emergency Management
Committee. Posting the EOP on the hospital intranet with
linkages to enhance movement through the plan can also be
very effective; however, a few har<l copies should still be availa­
ble in the event of computer failure.
B.12.1.1.5 Train Staff on the EOP. See 12 .5.3.5.
B.12.1.1.6 Delegate the Emergency Management Committee
(EMC), Identify Department Roles, and Assi gn Responsibili­
ties. The EMC is a multidisciplina1·y committee established to
coordinate and oversee the emergency management program
and should have a close 1·elationship \,�th the Safety Committee
or Environment of Care Committee, or both.
1l1e functions of the EMC include defining the role of the
organization in the communitywide emergency management
program; conducting/revie\\1ng a hazar<l vulnerability analysis
(HVA). which addresses all hazanls that threaten the facility;
developing/1·eviewing standar<l operating proce<lut·es (SOPs)
that address hazar<ls identified in the HVA; developing/review­
ing the emergency operations plan and coor<linating it \\1th
other health care organizations in the communitywide eme1·­
gency management program; assigning mies and responsibili­
ties of operating unit managers an<l key operators/managers;
ove1·seeing the development an<l maintenance of the EMP;
ensuring that all employees have received apprnpriate training;
f
conducting an annual evaluation of the ef ectiveness of the
prngram; an<l ensuring a telephone roster of key personnel
1·esponsible for Cl'itical operations is kept cutTent.
B.12.1.1.7 Test and Evaluate the EOP in Response to a Drill or
Actual Event. See 12.5.3.3.7.

2021 Edition
 ANNEX B

(Name of Facility)

Standard Operating Procedure#: _____________________

(Date)

SUBJECT: __________________________________
(Insert Hazard, Threat, or Event Name)

1. Description of hazard, threat, or event:-----------------------------------

2.Impact on mission-critical systems:-------------------------------------

3. Operating units and key personnel with responsibility: ___________________________

4. Mitigation and preparedness activities

a. Hazard reduction strategies and resource issues: ______________________________

b. Preparedness strategies and resource issues:--------------------------------

5. Response and recovery activities

a. Hazard control strategies and resource issues:-------------------------------

b. Hazard monitoring strategies:______________________________________

c. Recovery strategi es and resource issues:----------------------------------

6. Notification procedures
a.Internal: ___ _ _ _ _ _ _ _ __ _
_ _ _ _ _ _ _________________________

b. External:- - - - - - - --
- - - -
- -----
- -----------------
- - - -
-

7. Specialized staff training: _______________________________________

8. References and further assistance:- - ------------------------

- - - - - - - --
-

9. Review date:-----------------------------------------------

(Name) (Position/Title)

© 2020 National Fire Proteclion Associalion NFPA99

FIGURE B.12.J.J.l Sample Standard Operating Procedure Format.

2021 Edition
99-224 HEALTH CARE FACILITIES CODE
f
B.12.2 Personnel Notification and Recall. Medical staf . key
personnel, and other personnel needed will be notified anrl
recallerl as requirerl. In 01·rle1· to 1-elieve switchboarrl conges­
tion, it is rlesirnble to utilize a pyramirlal system to 1·ecall indi­
viduals who are off duty or othenvise out of the facility. Llnder
the pyramidal system, an indivirlual who has been notified will
notify two other individuals, who, in turn, will each notify two
othe1· inrlividuals, and so on. A current copy of the notification
and recall roster, with current home and on-call telephone
numbers, will be maintainerl at the hospital switchboard at all
times. In case the pyrnmidal system is to be utilized, each inrli­
\irlual invoh·ed in the system ha� to maintain a current copy of
the roster at all times, in order that each knows who they are to
notify and the telephone numbers concerned. It is essential
that key pe1·s01111el roste1·s be kept cutTent.
B.12.3 Special Considerations and Protocols.
B.12.3.1 Fire and Explosion. In the event that the health care
facility does not need to be completely evacuated immediately,
the actions staff should take when they are alerted to a fire are
detailed in Sections 18.7, 19.7, 20.7, and 21.7 ofNFPA 101.
B.12.3.2 During the past rlecade, the health care industry ha�
been struck by numerous natural disasters. A study of these
disastern ha� prmiderl a set-ies of "lessons learnerl." Examples
follow.
B.12.3.2.l Alert. Alerting is often provided through the local
Office of Eme1·gency Management and the National Oceanic
and Atmosphe1·ic Administrntion. Based on the facility's
geographical location, these alerts often come in the form of a
"watch," which inrlicates the strong possibility of a natu1·al disas­
ter, or a "warning," which indicates the immediate threat of a
disaster. A haza rd vulnernbility analysis (HVA) of the a rea
would result in actions that should be taken at different stages
of the alert. Such actions could indicate monitoring 1·epo1·t� by
f
a liaison with the Office o Eme1·gency Management; the lnte1·­
nal Incirlent Commanrl of a facility would assess exis ting staff'.
ing and supply issues and make decisions to activate staff call­
back. plans and augment critical supplies. Some facilities have
also inrlicaterl they have found it useful to complete a pre­
storm patient census reduction to discharge, where possible, or
to move preselected high-acuity patient�. such as neonatal
intensive care patients, bariatt·ic patient�. or patient� with
seve1·e 1·espiratory complications, or a combination the1·eof.
Also, during this pre-storm patient relocation, selecterl patient�
could be moverl to what are conside1·ed to be safer a1·eas within
the facility.
Some natural disa�ters provirle absolutely no warning, such
as an earthquake. During such a situation, staff woulrl have to
assume immediate operations plan procedures.
B.12.3.2.2 Isolation Survival for up to 96 Hours. Recent disas­
ters have shown it coulrl be 96 hours (in some cases, longe1·)
before outside help is able to reach the facility. Those facilities
with sufficient resources in-house for critical areas fared the
best during disa�te1·s. Facilities that had cot-porate strnctures 01-
associations with out-of-area 01·ganizations also 1·eceived help in
a timelv manner.
B.12.3.2.3 Wmd. ·when wind knocked down communications
antennas, the result was severe rlifRculties in facility communi­
f
cation with staf , other health ca1·e facilities, and so forth. One
solution was construction of antennas with hinges so they coulrl
be laid down during a pre-storm warning. In other cases, the
2021 Edition
history of high winrls or the HVA. or both. showed that certain
winrlows shoulrl be boarderl and certain doors should be
braced and sa.nrlbaggerl.
B.12.3.2.4 Flooding. Flooding into a facility's lower levels
where utilities are often housed result� in a disruption of these
sen.•ices. In a recovery effort, the following procedm·es were
helpful:
(l ) Keep the elecu-ical service turned off until the electrical
rle\�ce completely dries.
(2) Secure environmental waste containe1·s anrl ponable
medical gas containers.
One contract01· dealing with the hospitals of the Gulf states
stated that, based on its experience with floorls, it would never
again use "fail return" elevators to a basement level. Many times
elevators returned to the basement level upon loss of power,
resulting in the wires that a1·e locaterl in the cab flom·ing being
soaked, rendering the elevat01- useless.
B.12.3.2.5 Power Loss. Power is lost typically as a result of
high winds and floorling. Generators and transfer switches have
been lost due to their location below the high wate1· mark.
Another problem surfacing with generators is that they often
we1·e not powerful enough to provide HVAC services to the
facility. In some of the Gull" states, this alone forced evdcuation
of the hospital or long-term care facility. Another problem
encountered was fuel, designed for another type of generator
(such a� military). contaminating the unit. When otTle1·ing
backup generat01·s, it is important to know the size neerlerl and
the method to be used to connect the generator to the facility.
Services, in p1·i01·ity, which shoulrl be up and rnnning for the
facility to be operational, are a� follows:
(1) Clinical care:
(a) Life-support systems
(b) Life safety (exit� and fit·e ala rm and fire suppt·es-
sion)
(c) Lab sen,ices
(d) Pharmaceutical services
(e) Diagnostic services
(2) Infrastructure:
(a) Heating, ventilation. and ait0conrlitioning
(b) \'Vater supply and 1·emoval systems
(c) Information technology
(d) Food and liquids
(e) Elevators
B.12.3.2.6 Loss of Communications. Loss of communications
is one of the maj01· problems rlm·ing a disaster. There have
been many suggesterl solutions, inclurling satellite phones and
websites to communicate to staff and responsible parties. A
successful solution has been communications conducted
through Amateut· Radio Emergency Services (ARES). Health
care facilities have also reporterl that it was important to have
either a liaison to, or a liaison position within, the community
eme1·gency ope1·ations center.
B.12.3.2.7 Loss of Water. Loss of V."dte1- can 1-esult in problems
with sewer sen-ice, air-conditioning, generator anrl refrigera­
tion cooling systems, sterilization. dialysis services, liquid
consumption, laundry, dishwashing, staff and patient hygiene,
and fit·e suppression. It is recommended that hospitals perfo1·m
risk. assessment� in these areas anrl prepa re themselves for
 ANNEX B
96 hours of isolation. without out�ide water delivery. If this is
not possible, evacuation might have to be considered.
B.12.3.2.8 Staff Issues. The following staff issues were found
to be important to address:
(1) Transportation, including knowledge of which roads are
f
open and actually trnnsporting staf to the facility. The
health cat·e organization should wo1·k with the state and
local agencies to identify qualified volunteer groups or
othe1· oi·ganizations that could provide tt·ansportation
services to staff.
f
(2) Addressing the sa ety of families of staff.
(3) Provision of food, liquids, and lodging for staff and family
members.
B.12.3.2.9 Civil Disturbance. Civil disturbance resulted mostly
from members of the disa�te1°struck community seeking drugs,
food, and shelter. Dm-ing such disturbances, facilities initiate
lock.down procedures and 1·equest local police a�sistance to
protect the facility. It was noted that police department� were
often ove1·bunlened dut·ing disasters that involved civil disturb­
ance, and facilities had to 1·ely on pt·ivate secut·ity 01· the
Nationa1 Gua1·d, or both.
B.12.3.2.10 Influx of Patients. Even though the facility is
tq,ing to keep it� patients alive and safe, it must be 1·ecognized
that some outside patients might come to the facility due to
serious ir�uries that occur during the disaster or other medical
needs. Othe1·s might have power at home or home health ca1·e
provide1·s to assist them with special needs and may not need to
go to the health care facility. Community members might come
to the facility simply to seek shelter or medications in the event
thei1· normal pharmacy is shut down. Some patients might
come from an e\'acuating facility.
Recognizing these situations, facilities might be able to redi-
1·ect the special needs population to a special needs shelte1· if
the community has set up such provisions. It was found helpful
to establish an oul�ide (under cover) pre-emergency/triage
1·oom to relieve stt·ess from the critical care emer·gency room
within the hospital.
B.12.3.2.11 Evacuation. Often evacuation wa� accomplished
in twu phases. Pha�e I was a pre-storm evacuation. It \'\"dS found
f
that, i this was going to be undertaken, it had to begin early
enough to avoid traffic congestion to get patienl� to their ulti­
mate destination in an acceptable length of time; otherwise,
Pha�e II, or full hospital evacuation, could not take place until
the disa�ter had subsided and trnnsportation was once again
available to move patienl�. Additional problems occurred with
tracking patienl� and moving their medical 1·ecords. Medical
1·ecords that were on the Electronic Health Recot·ds System
we1·e at times unattainable if they could not be accessed from a
remote site. Hard copy records, in some cases, were lost during
transport.
B.12.3.3 Evacuation. Evacuation can be partial or total. It
might involve moving from one story to another, from one
late1·al section 01· wing to another, or moving out of the struc­
ture. Even partial evacuations can involve all catego1·ies of
patienl�. \'\'here patient� are those who would not routinely be
moved. extraordinary measures might he required to support
life. It is also necessary· to ensure movement of supplies in
cor�unction with any evacuation. Decisions to e\'acuate might
be made as a result of internal problems or under the menace
of engulfing exten1al th1·eat�. In all cases, the following consid­
erations should govern:
(1) Move to predesignated a1·ea�. whethe1· in the facility,
nearby, or in remote zones. Evacuation directives will
no1·mally indicate destinations. Note that it is 1·ecommen­
ded to predesign a mutual aid evacuation plan with othe1·
health care facilities in the community. (SPP AnnPx D, U.S.
(',<JvPrnmPnt Publication 3152, Hospital� and Community Emer­
gPnry RPsponse - What fou NPPd to Know, on thP subjN:t of
hPalth rarP r01111nunity mutual aid and euar.uation planning.)
Receiving facilities can also be designated ba�ed on the
scope of the event, activation of state or federal 1·eso111-ces,
or by local emergency medical senices (EMS), based on
availability.
(2) Ensure movement of equipment, supplies, and medical
f
1·ecords to accompany rn· meet patients and staf in the
new location.
(3) Execute predetermined staffing plans. Some staff will
accompany patient�; other·s will 1·endezvous in the new
f
location. Maintenance of shi t� is more complex than
not·mal, especially when some ha1·d-to-move patienl� stay
behind in the threatened location, and when staff might
be separated from their own 1·elocated families.
(4) Protect patients and staff (during and afi:e1· movement)
against the threatening environment.
(5) \Vhen planning, consider transportation arrangement�
and patient tracking.
B.12.3.3.l The Emergency Management Committee oversees
the HVA process to ensure that all major threat5 to the facility
are accounted fo1· and assessed. Input to the HVA by operating
unit managers is very important. Once a list of priority hazards,
threat�, and evenrn has been compiled, managers should
complete an operating unit template for their particula1· service
or department. Some thr·eat� to individual operating units are
so severe that they might inten-upt the continuity of critical
operations in the facility. The operating unit template is a unit
level contingency plan, useful in staff education, drills, and
actual evenl�. Figure B.12.3.3.l(a) illustrntes a sample HVA
format. Figure B.12.3.,\.1 (b) shows a sample operating unit
template.
B.12.3.4 Activation of Emergency Utility Resources. Loss of
utility resources can occur at any time due to a natural disaster,
an internal sy.,tem failure, or even a supply shortage. Redun­
dancy in system design and suppon is fi.mdamental to avoiding
loss of utilities. Critical points of failure in systems and supply
chains should be identified, and their malfunction, disruption,
or loss mitigated.
The key to a successful 1·esponse to a loss of utilities is plan­
ning. Assessment of the organization's utilitv systems is an
excellent starting point and should consist of identifying essen­
tial utility sy.,tems, such as electricity, wate1/sewe1·, piped medi­
cal ga� and Vdcuum systems, HVAC systems, and vertical and
horizonta1 transporl�. Once the sy.,tems are identified, they
should be broken down to the component level and evaluated
fo1· importance. This allows the organization to establish priori­
ties and the capabilities of the systems and their component�.
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99-226 HEALTH CARE FACILITIES CODE

Severity Classification - Low, Moderate, High

Human Property Operational

Probability Impact Impact Impact Rank

Likelihood
this will occur Possibility of Physical losses Interruption Score of 2 or higher in any
Type of Event within 1 year death or injury and damage of services category requires an SOP
O=NIA O=NIA O=NIA O=NIA
1 =Lew 1 =Lew 1 =LOW 1 =LOW
2 =Moderate 2=Moderate 2=Moderate 2=Moderate
Sc ore 3=High 3 = High 3=High 3=High SOP required - yes or no?

(Hazard Type)

© 2020 National Fire Protection Association NFPA 99

FIGURE B.J 2_3_3.1 (a) Sample Hazard Vulnerability Analysis (HVA) Format.

2021 Edition
 ANNEX B 9�227

Operating Unit: ________________ Operating Unit Manager:-----------------

If this mission-critical system

Contact for is interrupted, then:
Mission-Critical Potential Assistance Mitigation
System Problems in Preparing Actions Assess situation for: Action required:

(Lighting)

(Electrical Power)

(Steam Distribution)

(HVAC)

(Room or Hood Exhaust)

(Water Delivery)

(Waste Stream)

(Communications)

© 2020 National Fire Protection Association NFPA 99

FIGURE B.12.3.3.l(b) Sample Operating Unit Template.

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99-228 HEALTH CARE FACILITIES CODE
Organizations shoul<l evaluate their self-sufficiency for at
lea�t 96 hours. This evaluation will assist in establishing gaps in
the utility systems. For example, if a facility loses electricity an<l
has backup generators, the 01·ganization must establish how
f
long it can operate on those generators. By looking at dif erent
components of the generator system, the organization might
determine that only enough fuel fot· 24 hours is maintaine<l. If
the same generator is coole<l by water an<l the water supplv is
disrupted, that is an ad<litional limitation. This concept should
be applied to all systems and key components of each utility.
By establishing the limitations of the utility systems an<l
component5, an organization can i<lentify the nee<l to mitigate
v.'ith alternative means, such as extra equipment, generators,
bottle<l medical gas, bottled water, 01· formal documente<l
agreements and understan<lings ,,'ith other organizations.
Contingency plans should be establishe<l an<l tested for effec­
tiveness on a regular basis. It is essential that an 01·ganization
understands its limitations and uses this information to <lete1·­
mine if it can sustain itseu· for 96 hours or if it is appropriate to
stop or limit services.
B.12.3.5 Civil Disturbance. Large-scale civil distut·bances have
shown that health care facilities and their personnel are not
immune to the direct eflects of human violence during such
distu1·bances. Hospitals in la1·ge urban area.5 have to make
special provisions in thei1· disaste1· plans to ens1u-e the physical
safety of their employees in transit from the hospital exit to an<l
from a secure means of transportation to thei1· homes. In
extt·eme cases, it might be necessaty to house employees within
the health care facility it�elf during such civil disturbances.
A.nother aspect of ci,il <listurbances not to be ovedooke<l in
facility security planning is the possibility that a given health
care facilitv might have to admit and treat la1·ge numbers of
prisoners during such emergencies; however, security guards
for such patient� will normally be provi.<led by the local police
depanment.
B.12.3.6 Hazardous Materials. There are at least three major
sources of concern v.'ith 1·egard to nonradioactive haza1·dous
materials mu-elated to the intentional use of chemical agents to
ha rm people (sPe B.12.3.8). The first is the possibility of a la rge
spill or venting of hazar<lous materials near the facility; this is
especially likely near major rnil or truck shipping routes, nea r
pipelines, 01· neat· heavy manufactut·ing pla.nK Second, every
f
facilitv contains \\'ithin its boundaries v-atying amount5 o such
materials, especially in the labo1·ato1y and custodial a1·eas. A
spill of a highly volatile chemical can quickly contaminate an
entire stntctm·e by way of the ai1· <luct�. Finally, contaminate<l
f
patients can pose a risk to staf , though on a more localize<l
ba5is. Usually, removal of their clothing \,'ill reduce the risk
materially. In any case, stall has to be pt·epared to seek ad"ice
on unlmown hazards. This type of a<lvice is not usually available
from poison centers, but rather from a central referral, such as
CHEMTREC, and it� toll-free emergency inforniation senice
number (800-424-9300).
See A,.nnex D for publications concerning hazardous materi­
als regulations and repo1·t� on va rious types of chemical protec­
tive equipment.
B.12.3.7 Volcanic Eruptions. Although most of the direct
effect� of a volcanic eruption are covered in othe1· protocols fot·
disasters (e.g., fire, explosion), it is necessary· to make special
provisions for functioning in areas of heavy to moderate ash
fall. This hazar<l can exist hundreds of miles downwind from
the eruption.
2021 Edition
Volcanic ash is actually finely pulverized rock blown out of
the volcano. Out5i<le the area of direct damage, the ash varies
from a fine powde1· to a coarse sand. General housekeeping
measures can exclude much ash. It shoul<l be note<l, howeve1·,
that people move about freely during and after ash fall.
i\sh fall pt·esents the following fotu- problems fot· health care
fac iii ties:
( l) People require cleanup (brushing, vacuuming) before
entering the building.
(2) Electromechanical and automotive equipment an<l air­
filtering systems 1·equire special ca1·e because of the highly
abrasive and fine-penetration nature of the ash.
(3) Increa�ed flow of patients with respiratory complaint5 can
be ex pee te<l.
(4) Eye protection is require<l for people who have to be out
in the dust. (No contact lenses should be won1; goggles
a re suggested.) Dust ma�b are available that are
approve<l by the National Institute fot· Occupational
Safety and Health (NIOSH) and a.re marked TC-21 plus
other digit�.
f
B.12.3.8 Weapons of Mass Destruction. V{eapons o mass
destruction, or V11MD, are <lefined as any weapon or device that
is intended to cause, or ha� the capability to cause, <leath or
serious bodily i1tjury to a significant numbe1· of people through
the release, dissemination, or impact of toxic or poisonous
chemicals or their precu1·sors; a <lisease organism; or 1·adiation
or rndioactivity. Many frdernl department� and agencies a1·e
involved in supponing \,VMD preparedness an<l 1·esponse activi­
ties at the state and local level. The Department of Health and
Human Services manages two cooperative grant programs
a<lministet"ed by the Cente1·s fot· Disea�e Control and Preven­
tion (CDC) and the A5sistant Sec1·etary for P1·epa1·edness and
Response (ASPR). These programs are aimed at enhancing the
1·eadiness of the public health and hospital system.
1l1e Department of Justice maintains a help line
( l-800-368-6498) offering technical assistance in nonemer­
gency cases an<l provides info1·mation on the following subject�:
detection equipment; pe 1·sonal protective equipment; decon­
tamination systems and metho<ls; physical properties of WMD
materials; signs and symptoms of \'\'MD exposm·e; tt·eatment of
expostu-e to V\'MD materials; toxicology information; fe<lernl
response asset�; an<l applicable laws and 1·egulations. For
reporting actual or potential act� of terrorism, health care
facilities shoul<l contact their local 01· state health department�.
The National Response Cente1· ( l-800-424-8802) can link call­
ers to technical experts.
See i\nnex D for publications relating to \'\'MD p1·eparedness
for health systems.
B.12.4 Continuing Operations Plan and Recovery. It has been
well documented that a community cannot recove1· without the
health care facilities recovering simultaneously or befo1·ehan<l.
If at all possible, a health care facility nee<ls to remain opera­
tional throughout a disaster to care fo1· it� patients, as well as
for those who are ittjure<l <lut·ing the disaste1·.
It is important to advertise that the facility is open for busi­
ness as soon a.5 it is able to operate.
A5 part of disaste1· recove1y, health ca1·e facilities should
consider the following:
 ANNEX B
( l) Know the sout-ces of funding, such a� msui-ance and
FEM A, and request loans from those sources to initiate
cash flow as soon as possible.
(2) Activate lines of credit with vendors and banks.
(3) Use stock and other investment5 as collateral for loans
and lines of credit.
(4) Have the finance section chief of the Incident Command
System work with othe1· section chiefs to keep p1·ecise
records of disaster-related expenses for reimbursement
follmving the disaste1·.
(5) Ensure that doctors' offices open simultaneously with the
opening of the hospital to provide senices to patients.
Provide office support as soon as possible for physicians,
with the p1·iority being eme1·gency department physicians,
genei-al practitioners, orthopedic surgeons, and ca1-dio­
vascular surgeons.
(6) Activate billing and payroll a� soon as possible.
(7) Consider setting up a bank ,vi thin the hospital fo1· staff.
Credits:
Educational Fact Finding and On-site Resea1·ch in Houston,
Texa�. following Tropical Storm Allison, 2001.
National Fire Protection Association.
Russell Phillips & Associates, LLC.
Also see "Atmospheric Pressure,"' Firf journal, July/August,
2002.
Educational Fact Finding and On-site Resea1·ch for HuITi­
cane Katrina, Louisiana, Mississippi, 2005.
Ame1·ican Society of Healthcare Engineers: Dale ''\'oodin.
Russell Phillips & A�sociates, LLC: Russell Phillips & Scott
Aronson.
B.13 Reserved.
B.14 Additional Information on Chap ter 14.
B.14.1 Nature of Hazards.
B.14.1.1 Fire and Explosion.
B.14.1.1.1 The occut-rence of a fire requires the presence of
combustible or flammable materials, an atmosphere containing
m..-ygen or other oxidizing agent(s), and heat or energy source
of ignition.
Note that ce1·tain substances such a� acetylenic hydrocarbons
can propagate flame in the absence of oxygen.
B.14.1.1.2 Under h)pedJaric conditions utilizing compressed
air, the partial p1·esstu-e of oxygen is increased. Leakage of
m,-ygen into the atmosphere of the chamber (for example,
from improper application of respirato1-y therapy apparatus)
can further inci·ease markedly the oxygen partial p1·essure.
B.14.1.1.2.1 The flammability or combustibility of materials
generally increases as the partial p1·essure of oxygen inCt"eases,
even when the percentage of m,-ygen in the gas mixtm·e
1-emains constant. Materials that are nonflammable 01- noncom­
bustible under normal atmospheric conditions can become
flammable 01· combustible under such ci1·cumstances.
B.14.1.1.3 Sources of Fuel.
B.14.1.1.3.1 Mate1-ials that might not ignite in air at atmos­
phe1·ic pressut·e 01· require relatively high tempei-atures for
9�229
their ignition but that burn ,igornusly in 100 pet-cent oxygen
include, but are not necessarily limited to, the following: tri­
cresyl phosphate (lub1-icant); certain types of flame-1·esistant
fabrics; silicone rnbhe1·; polyvinyl chl01·ide; ashestos-<:ontaining
paint; gla�s fiber-sheathed silicone rubber-insulated wire; poly­
vinyl chloride-insulated asbestos-covered wire and sheet; poly­
amides; epoxy compounds; and certain a5bestos blankets.
Note that flammable lubricant� are used widely in equip­
ment designed for conventional use, including shafts, gear
boxes, pulleys and eastern, and tlu-eaded joint�. which are
coupled and uncoupled.
B.14.1.1.3.2 The flammability of certain volatile liquids and
gases containing carbon and hydrogen is well known. Haza1·ds
and safeguards for thei1· use in oxygen-enriched atmospheres at
ambient pressure are well-documented in the NFPA Firf Proter­
tion Guidf to Hazardous Material� and NFPA 53.
B.14.1.1.3.3 Human tissues will burn in an atmosphe1·e of
100 percent oxygen. Body oils and fat�, as well as hair, will burn
readily unde1· such circumstances.
B.14.1.1.3.4 When a conventional loose cotton oute1· garn1ent,
such a� scrub suit�. dresses, and gowns employed in hospital
operating suites, is ignited in an atmosphere of pure oxygen,
the garment will become engulfed in flame i-apidly and ,viii he
totally destroved \vi thin 20 seconds 01· less.
If such a garment is ignited in a comp1·essed ai1· atmosphere,
the flame spread is increased. When oxygen concentration
exceeds 23.5 percent at elnated total pressure, flame spread is
much more rapid, and at 6 ATA, is comparable to 95
± 5 percent at l ATA. Flame sp1·ead in ai1· (21 percent oxygen)
is somewhat increased at 6 ATA, but not to the level of 95
± 5 percent at l ATA.
Combustible falxics have tiny ai1· spaces that become filled
\vith oxygen when exposed to oxygen-enriched environment�.
Once removed to atmospheric air (e.g., room air outside the
chamber), the fab1·ic mil hum, if ignited, almost as 1·apidly as if
it we1·e still in the oxygen environment. This haza1·d will remain
until the oxygen trapped in the air spaces in the fab1·ic has had
time to diffuse out and be replaced by air.
B.14.1.1.3.5 Oil-based 01· volatile cosmetics (facial creams,
body oils, hair spi-ays, and the like) constitute a sou1-ce of fuel
that is highly flammable in an oll.-ygen-enriched atmosphere.
B.14.1.1.4 Sources ofl gnition.
B.14.1.1.4.1 Sources of ignition that might be encountered in
a hyperba1·ic chamber include, but a1·e not necessa1·ily limited
to, the following: defective electrical equipment, including fail­
ure of high-voltage component� of radiological 01· monitoring
equipment; heated surfaces in broken vacuum tubes or broken
lamps used for general illumination, spot illumination, or illu­
mination of diagnostic instrnment�; the hot-wi1·e caute1·y 01·
high-frequency electrocautery: open or arcing switches, includ­
ing motor s,vitches; bare defibrillator paddles; overheated
motors; and electrical the1·mostat�.
B.14.1.1.4.2 Sources of ignition that should not be encoun­
tered in a hyp erharic facility, but that might be introduced by
inept practice, include the following: lighted matches 01-
tobacco, static sparks from improper use of personal attire,
electrical wiring not complying mth 14.2.9, cigarette lighters,
and any oil-contaminated mate1·ials that present a spontaneous
heating haza1·d.
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99-230 HEALTH CARE FACILITIES CODE
B.14.1.1.4.3 In oxygen-enriche<l atmospheres. the minimum
energy necessary to ignite flammable or combustible materials
is 1·e<luce<l in most instances below the ene1·gy 1·egui1·e<l in
atmosphe1·es of ambient air.
B.14.1.2 Mechanical Hazards.
B.14.1.2.l General.
B.14.1.2.1.l A large amount of potential energy is stored in
even a small volume of compressed gas. In hyperba1·ic cham­
bern of moderate or la1·ge size, the potential energy of the
f
chambe1·'s compressed atmosphere, i released su<ldenly, can
produce devastating destruction to adjacent structures an<l
pe1·sonnel, as well as to structures and personnel remote from
the site of the chambe1·. Such sudden release coul<l 1·esult from
failure of the vessel structure, it� part�, or its piping.
B.14.1.2.1.2 A panicular hazard can be CL"eated if individuals
attempt to d1·ill, cut, or wel<l the vessel in a manne1· contrary to
ASME BoilPr and PrP.mm l-',,sifl CodP.
B.14.1.2.2 The restt·iction on escape an<l the impedance to
rescue and fit-e-fighting effort� pose<l by the chamber CL"eate a
significant hazard to life in case of fire or other emergency.
B.14.1.2.2.l A particular haza1·d exist� to chamber personnel
f
in the event o a fi1·e within the structure housing the chamber.
Inability to escape from the chamber and loss of se1vices of the
chamber operator woul<l pose serious threat� to the lives of all
occupant� of the chambe1·.
B.14.1.2.2.2 All personnel involved in hyperbaric chamber
operation an<l therapy, inclu<ling patient� and family, have to
be made aware of the 1·isks and hazar<ls involved. Fi1·e preven­
f
tion is essential. Extinguishment o a fit·e within a Class B cham­
ber is impossible. Extinguishment of a fire within a Class A
chambe1· is only possible utilizing eguipment alt-eady installe<l
in such a chambei-, and then often only by the effo1·t� of the
occupant� of such a chamber or the chamber operator.
B.14.1.2.3 The necessity for restt·icting viewing po1·t� to small
size limit� the vision of chamber operators and other obse1·vers,
reducing thei1· effectiveness as safety monit01·s.
B.14.1.2.4 Containers and enclosures can be subjected to
collapse 01· ruptm·e as a conseguence of the changing pressures
of the hyperbaric chamber. Items containing e ntrained gas
inclu<le, but are not necessarily limite<l to, the following:
ampuls, partially filled syringes, stoppe1·e<l 01· capped bottles,
cuffed endotracheal tubes. an<l pneumatic cushions employed
for breathing ma�ks or aids in positioning patient�. The
ruptut·e of such containers having combustible or flammable
liquids would also constitute a severe fit·e 01· explosion hazard.
B.14.1.2.4.l The su<lden collapse of containers from high
external pressures will 1·esult in adiabatic heating of the
contents. The1·efore the collapse of a container of flammable
ligui<l would constitute a severe fire or explosion haza1·<l both
from heating and from a spill of the liguid. (SPe 14.3.1.6.2 and
11.14.1.1.3.2.)
B.14.1.2.5 Othe1· mechanical hazards relate to the malfunc­
tion, disruption, or inoperativeness of many standar<l items
when placed in service unde1· p1·essurized atmosphe1·es.
Hazar<ls that might be encounte1·ed in this regar<l are implo­
sion of illuminating lamps and vacuum tubes; overloading of
fans dri\ing gas at higher <lensity; and inaccurate operation of
2021 Edition
stan<lard flowmeters, presstlt"e gauges. and pressure-re<lucing
regulators.
Note that illuminating lamps 01· vacuum tubes, which
implode. or ovedoaded fans, a1·e sources of ignition.
B.14.1.3 Pathophysiological, Medical, and Other Related
Hazards.
B.14.1.3.l Exposure of pregnant chamber occupant5 to hyp er­
ha1·ic atmospheres might result in fetal 1·isk.
B.14.1.3.2 Medical hazar<ls that can he encounte1·ed routinely
include compression problems, niu·ogen narcosis, oxygen
toxicity, and the <lirect effects of sudden pressure changes.
B.14.1.3.2.l Inability to egualize pressme <lifferentials
between nasophary nx (nose) an<l nasal sinuses or the middle
ear can result in excruciating pain and might cause rupture of
the eardrum 01· hemotThage into the ear ca\ity 01· nasal sinus .
B.14.1.3.2.2 The breathing of air (78 percent nitrogen) un<ler
significant pressu1·es (as by chamber personnel hreathing
chambe1· atmosphe1·e) can result in nitrogen na1·cosis, which
r·esembles alcoholic inebriation. The <legree of narcosis is
directly related to the amount of pressurization. Nitrogen
narcosis results in impairment of mental f unctions, loss of
manual dexterity, and interference with alertness an<l ability to
think clearly an<l act quickly and intelligently in an emergency.
B.14.1.3.2.3 O>..')'gen toxicity can <levelop from breathing
oxygen at panial p1·essut·es ahove 0.50 atmospheres absolute fo1·
a significant length of time . Oxygen toxicity can affect the
lungs (pain in the chest, rapid shallow breathing, coughing).
nervous system (impaire<l consciousness an<l convulsions), or
other tissues and organs, or combinations thereof.
B.14.1.3.2.4 Direct eflects of reduction in pressure can
include inability to egualize pressures between the na�ophar­
ynx and sinuses 01· middle ear, expansion of gas pockets in the
gastrointestinal tract, an<l expansion of trappe<l gas in the
lungs.
B.14.1.3.2.5 The presence of pe1·sonnel within the cramped
confines of the hyperbaric chamber in close proximity to
grounded metallic structut·es on all si<les ct"eates a definite
shock hazard if accidental contact is made with a live electrical
conductm· or a defective piece of electrical equipment. Such
accidental contact also could he a source of ignition of flamma­
ble or combustible materials. (SPP B.14.1.1.4.)
B.14.1.3.3 Medical hazar<ls that are not ordinarily encoun­
tered during hyperbaric oxygen therapy. but that might arise
during maUi.mction, fire, or other eme1·gency conditions,
include electric shock and fouling of the atmosphe1·e of the
chamber with oxygen, niu·ous oxi<le. carbon <lioxide, carbon
monoxide, pyrolysis product5 from ove1-heated materials, or the
toxic products of combustion from any fire.
B.14.1.3.3.l Increased concentrations of carbon dioxide
within the chambe1·, as might 1·esult from malfunction of the
systems 1·esponsible fo1· monit01·ing or removal thereof, can be
toxic u nder inct"ea�ed pressures.
B.14.1.3.3.2 The development of combustion product5 or
gases evolved from heated nonmetallics within the close<l space
of the hype1·ba1·ic chamber can be extremely toxic to life
because of the confining nature of the chamber and the
 ANNEX B
increased hazarrls of lxeathing such product� under elevated
pressure.
Note that extreme p1·essu1·e rises have accompanied cata­
strophic fit-es in confined atmospheres. These pressures have
driven hot, toxic ga�es into the lungs of victims as well as
exceeding the strnctural limit� of the vessel in at least one case.
B.14.1.3.4 Physiological haza1·ds include exposure to high
noise levels and decompression sickness. Rapid release of pres­
su1·ized gases can produce shock waves and loss of visibility.
B.14.1.3.4.1 During h}perba1·ic therapy, and especially during
compression, the noise level within the chamber becomes quite
high. Such a level can be hazardous because it is distractive,
intede1·es with communication, and can prorluce pe1·manent
sensory-neural rleafness.
B.14.1.3.4.2 Decompression sickness (benrls, caisson w01·ke1·'s
disea�e) 1·esult� from the elution into the bloorlstream or
exu·avascular tissues of bubbles of inert gas (mainly nitrogen)
that becomes dissolved in the blood and tissue fluids while
b1·eathing air at elevated presstlt' es for a significant period of
time.
Note that rapid decompression of the chamber can occur if
the pressu1·e relief valve is damaged from exposu1·e to a fit·e
external to the chambe1· 01· from the venting of hot product� of
combustion from within the chamber.
f
B.14.1.3.4.3 The use o decomp1·ession procerltlt'es will
p1·event immerliate escape from the Class A chamber by occu­
pants during emergency situations.
Note that these procedm·es are not followerl if chamber
occupant� are exposed to a "no-decompression exposure"'
r compression to Jess than 2 atmospheres absolute (ATA) air l,
01· when comp1·essed to 2 ATA 01· highe1· pressures anrl breath­
ing 100 pe1·cent oxygen.
B.14.1.3.4.4 The sudden release of gas, whether by rupture of
a container or operation of a rlevice such as used in fit·e fight­
ing, will produce noise, possible shock waves, reduced or
obscurerl 11isibility, anrl temperature changes. The initial effect
might be to cool the air, but resulting pressure rises will cause
adiabatic heating.
B.14.1.3.5 In summary, the hazarrls of fire and related prob­
lems in hyperbaric systems are real. By the very nature of the
hyperba1·ic atmosphe1·e, increased partial p1·essures of O>,,')'gen
are p1·esent routinely. Flammability and combustibility of mate­
rials are increased. Ignition energy is lowered. Both immediate
escape and 1·eady entt·y for 1·escue are imperlerl. Finally, attenrl­
ants within the chamber, through effect� of the ele\-aterl noise
level and nitrogen pressur·e, might be unable to responrl to
emergencies quickly and accurately.
B.14.2 Suggested Procedures to Follow in Event of Fire in
Class A Chambers.
B.14.2.1 Fire Inside OJ.amber. Fo1- fit·e inside the chamber,
the following procedures shoulrl be performed:
( 1) The actions of the insirle observer should be a� follows:
(a) Don breathing air device immerliately
( b) Activate fire supp1·ession system anrl/or hanrlheld
hoses.
( c) Ao.vise outside.
9�231
(2) The actions of the chamber operat01· should be as
follows:
( a) Activate the fire supp1-ession system , if needed.
(b) Switch b1·eathing gas to air.
( c) Decompress the chamber as rapirlly as possible.
(d) Deactivate all unnecessary electt·ical equipment.
(3) The actions of the medical personnel (outsirle) should be
as follows:
(a) Di1·ect operations and assist crew members whe1·eve1-
necessary.
(b ) Provide merlical support as required.
(4) The actions of the other personnel (out�ide) should be as
follows:
(a) Notif)' the fin� department by activating fit·e signal­
ing device.
(b) Stand by with a fire extinguishe1·.
( c) A�sist in unloarling chamber occupant�.
B.14.2.2 Fire Outside OJ.amber. For fire outside the chamber,
the following procerlures should be perfo1·merl:
(1) The actions of the chamber opera tot· shoulrl be as
follows:
(a) Notif)i the inside obse1·ve1· to stand by fo1· eme1-gency
retun1 to nonnal atmosphe1·ic pressure.
(b) Notify the fire rlepartment by activating fire signal­
ing device.
(c) Switch b1·eathing gas to air.
f
(rl) Don the operator's breathing rlevice, i applicable.
(2) The actions of the medical personnel (out�ide) should be
a� follows:
( a) Determine whethe1· procedure shoulrl be termina­
terl.
(b) Provide medical suppon as required.
B.14.3 Suggested Fire Procedures for Facilities with Class B
OJ.ambers.
B.14.3.1 Fo1· fit·es within the facility not involving the chamber,
the following procedure shoulrl be pedormed:
(1 ) Don the operator's means for respiratory anrl eye protec­
tion, if applicable (.�ff 14.2.5.4).
(2) Decompress the chambe1·. The urgency of rlecompression
should be determined by the location of the fire.
(3) Remove the patient and evacuate to a sal'e area.
( 4) Turn off the oxygen zone \-alve to the chamber room anrl
close any smoke/fire batTier doorn. These steps are
consistent with the rescue anrl confine element� of the
rescue, ala1·m, confine, extinguish (RA.C.E.) procedure.
It is assumerl that othe1· personnel will e,-acuate othe1-
patients anrl visitot·s from the area and acti,-ate a fire
alarm signaling device (if not already activated).
B.14.3.2 For fire within the chambe1·, the following procedure
should be performerl:
(1) Stop oxygen from flowing into the chambe1· by switching
f
of the chamber ( if the chamber is compressed \\1th
oxygen) or switching the supply gas of a breathing device
from oxygen to air (if the chamber is compressed \\1th
air).
(2) Decompress the chambe1· as rapirlly as possible in accorrl­
ance with the emergency rlecompression procedures.
2021 Edition
99-232 HEALTH C ARE FACILITIES CODE

(3) Stan<l by with a handhel<l fire extinguishet· and spray into safety <lirector. Othet· signattu·es should include the depart­
the chamber (if necessary) when the chamber door is ment manager an<l biome<lical representatives.
opened.
(4) Remove the patient and evacuate to a safe at·ea. Startup and shutdown checklist� should include purge gas
parameters with visual checks and vet·ifications of inside devi­
(5) Turn off the ox ygen zone valve to the chamber room an<l
close any smoke/fire barrier doors. ces, purge gas equipment, an<l alarms.

These steps at·e consistent with the rescue and confine
ered:
element� of the rescue, alarm, confine, extinguish (R.A.C.E.)
procedure. It is assumed that other pet·sonnel will evacuate
othet- patient� and visitoi·s from the at·ea an<l activate a fire
alarm signaling de\ice (if not already activated). The i1tjure<l
patient shoul<l have appropriate me<lical attention imme<liately
after evacuation to a safe at·ea. Many Class B chambet·s require
oxygen supply pressure to opei-ate a rapid decompn�ssion
f
featut·e. If this is the case, do not turn of the oxygen zone valve
or any in line oxygen supply shutoff valve until all patients have
been remove<l from the chamher(s).
B-14.4 See Table B.14.4.
B-14.5 Gas Purging. Inert gas 01· air purging is a means to
mitigate the risk of fit·e from an electrical <levice brought into
the chamber. The three main ol�ectives to inert gas 01· air purg­
ing are to lower the ox ygen level, to purge increase<l heat from
the <le\ice an<l to help pt·event <lust accumulation inside the
device.
Fire research has demonstrated that under normal condi­
tions combustion will not take place when the oxygen level is at
6 pet-cent 01- less. This is t·egardless of the tt·eatment pressure
and is related to the ratio of oxygen to the inert ga�. With an
m..-ygen level of 6 pet-cent and the balancing inert gas level of
94 percent, the high percentage of inert ga� will prevent
combustion.
A cleat· policy an<l prnce<lure should he wt·itten fot· an inert
ga� purging system. It should inc lude the inert gas parametet·s
for each device and instructions fot- the propet· setup of the
system.
All testing to detet·mine the propet· inert gas 01· air flow
should he well documented. At a minimum, approval signa­
tures have to he obtained from the me<lical director and the
\'\'he1·e gas purging is use<l. the following should he consid­
(1) Each electrical device should comply with 14.2.9.3.17.
Gas purging is only one element of the essential risk
a�sessment and management that is critical to safely
managing any electrical de\ice that is introduced into
the chamber. A comprehensive risk assessment with
approved safety procedures and mitigation orders needs
to be documented and signed by the medical director,
sal·ecy director and all who are directly involve<l, prior to
the <levice being used in the chambet·.
(2) Each gas purge device should have it� own dedicated
purgi ng line and flowmeter with each flowmeter clearly
lahele<l identifying the gas used. Splitting a purge line to
supply two or more <le,ices can c t·eate a <lispa1·ity of flow
between the multiple gas lines depending on the length
and resistance of each line. One <levice might be well
protecte<l with high flow and the othet· de\ice ina<le­
quately protected \,�th very little flow. A single line with a
single flowmeter will prevent this and \viii provide a
measurable way to verify the correct flow to the <levice. A
gas flowmeter can he mistaken fot· an oxygen flowmetet·.
(3) When using an inert ga�. oxygen should be maintained
at less than or equal to 6 percent within the electrical
compartment(s) of the device at all treatment levels. For
initial testing and, to establish the prnpet· inert gas flow,
oxygen levels in the electrical compartment.� of the
device shoul<l be teste<l at all treatment pressures.
(4) The manufactut·et·'s safe operating temperatm·e range
shoul<l he maintained at all tt·eatment levels. Gas pm·g­
ing is useful for purging inc rease<l heat from the de\ice.
For initial testing an<l, to establish the proper inert gas
flow, temperatut·e levels in the electrical compartments
of the <levice should be teste<l at all treatment pt-essures.

Table B.14.4 Pressure Table

Equivalent Depth in
mmHg Oxygen mmHg Oxygen
Ahnosphere Seawater Pres.sure of Pres.sure of Oxygen-
Absolute (ATA) mmHg psia psig ft m Compres.sed Air Enriched Air (23.5%)
760 14.7 0 () () 1 60 179
1.5 1140 22 7.35 16.5 5.07 240 268
2.0 l:>20 29.4 14.7 33. l 10.13 320 357
2.5 1900 36.7 22.0 49.7 15.20 400 447
3.0 2280 44. l 29.4 66.2 20.26 480 536
3.5 2660 51.4 36.7 82.7 25.33 560 625
4.0 3040 58.8 44. l 99.2 30.40 640 714
5.0 3800 73.5 58.8 132.3 40.53 800 893
Notes:
l. The oxygen percentage in the chamber emironment, not the oxygen partial pressure, is of principal concern, as concentrations above 2:1.fi percent
oxygen increase the rate of flame spread. Thiny percent oxygen in nitrogen a1 I ATA (228 mm Hg pO0 ) increases burning ra1e. However. fi percem
oxygen in nitrogen will not suppon comhustion. regardless of oxvgen partial pressure (at 5 ATA. ti percem oxvgen gives 228 mm Hg pO0 ).
2. The Suhcnmmiuee on Hyperharic and Hypoharic Facilities recommencls that one unit of pressure measurement he employed. Since a variety of
different unils are now in use. and since chamber operators have 1101 settled upon one single unit. the above rnhle includes the five uniLs most
commonly employed in chamber prac Lice.

2021 Edition
 ANNEX C
(5) Supply pressure for gas purging should be supplied from
a regulator system that will maintain the surface pressure
over the chambe1·'s treatment p1·essm-e, or ove1°bottom
pressu1·e. Maintaining pm·ge ga� p1·essm·e at all treat­
ment levels can be accomplished by means of a tracking
type regulator outside the chambe1· or by placing the
regulat01· insi<le the chamber with an a<leguate supply
pressure for all treatment pressm·es.
(6) An au<lio and visual alarm system should activate at the
operator's console if the1·e is a loss of sufficient p1·essure
to maintain set flowrates to the gas purging system
f
during any pressu1·ization o the chamber. The chamber
operator needs to he alerted to a loss of purge gas flow.
Chamber operations should be aborted if there is a loss
(7)
of suHicient pressm·e to the gas prn·ging system as noted
in (6). Loss of purge ga� pressure creates risks to
patient� an<l staff.
\\'hen using inert gas, oxygen monitoring of the cham­
(8)
ber's atmosphere shoul<l have a low-level ala1·m limit set
at no lower than 19.5 percent. Normal gas purging is
unlikely to lower the oxygen level of the chamber atmos­
phere during hyperbaric oxygen treatment�. However,
because inert ga� is being introduce<l into the chamber,
an oxygen low-level alarm limit of 19.5 percent shoul<l
be set.
(9) Electrical devices that a1·e enclose<l, such a� TV monitors
placed in acrylic boxes, should have some means of
extinguishing the de\ice ·with ·wate1· from the <leluge
system or the handheld hose. Acrylic boxes/endosm-es
are sometimes used to make gas pu1·ging easier. In the
event of a fire or smoke inside this box there should he
some means of <lrenching the device inside with water.
The do01-s to chambe1·s with ga� purging systems using
(10)
inert gas should be kept open <luring nonoperational
hours. Chambe1·s are made to be ai1·tight. If the cham her
do01·s are c lose<l, (e.g., overnight), and the inert gas is
inadvertently left on, the inert gas coul<l potentially
accumulate insi<le the chamber to a dangerous level.
This would <leplete the oxygen level and create a hazard
fo1· anyone entering the chamber.
Annex C Sample Ordinance Adopting NFPA 99
17ii� annex is nnt a part nf tht m711irnnmts nf this NFP.A. dncum.Mt
but i� included frrr infrrrmatinnal purpnses nnly.
C.l The following sample ordinance is provided to a�sist a
jurisdiction in the adoption of tl1is code and is not part of this
code.
ORDINANCE NO. ____ _
An ordinance of the [jurisdictinn] a<lopting the 2021 edition
of NFPA 99, Health Care Facilities Cnde, and document� listed in
Chapter 2 of that code; presc1·ibing 1·egulations governing
con<litions haza1·dous to life an<l property from fit·e or explo­
sion; providing for the issuance of permit� an<l collection of
fees; 1·epealing O1·dinance No. ___ of the ljuri�dii:tinn] and
all other ordinances and parts of ordinances in conflict the1·e­
witl1; providing a penalty; prmiding a severability clause; and
providing for publication; and providing an effective date.
BE IT ORDAINED BY THE {hmlth mre facility\ gnVl'rning
hnd,•] OF THE [jurisdictinn]:
SECTION I That the Health Crm Fa1:ilitifs CndP and docu­
ment� adopted by Chapter 2. three (3) copies of which are on
9�233
file an<l are open to inspection by the public in the office of the
[jurisdfrtinn '.� kfeper nf rerord�] of the [jurisdictinn], are hereby
adopted an<l incorporated into this 01·dinance a� folly as if set
out at length herein, an<l from the date on which this ordi­
nance shall take eflect, the provisions thereof shall he control­
ling within the limits of the [jurisdil:tinn]. The same are hereby
a<lopte<l as the code of the [juri�dirtinn] for the purpose of
prescribing 1·egulations governing conditions hazardous to life
and property from fire or explosion and providing for issuance
of permit5 and collection of fees.
SECTION 2 Any pe1·son who shall violate any provision of
this code or stan<lar<l hereby adopte<l or fail to comply there­
\\'ith; or who shall violate or fail to comply with any or<ler made
thereunder; or who shall build in violation of any detaile<l state­
ment of specifications or plans submitted and approved there­
un<ler; or fail to operate in accordance with any certificate or
pe1·mit issue<l the1·eunde1·; an<l from which no appeal has been
taken; 01· who shall fail to comply with such an orde1· as
affirmed or modified by a court of competent jurisdiction,
within the time fixed herein, shall seve1·ally fo1· each an<l every
such violation an<l noncompliance, 1·espectively, he guilty of a
mis<lemean01-, punishable by a fine of not less than$ _ _ _ nor
more than$___ or by imprisonment for not less than ____
days nor m01·e than _ _ _ days or by both such fine and
imprisonment. The imposition of one penalty for any \iolation
shall not excuse the violation or permit it to continue; an<l all
such persons shall be reguire<l to correct or remedy such viola­
tions or defect� within a rea�onable time; and when not othe1·­
\\'ise specifie<l the application of the above penalty shall not be
held to prevent the enforced removal of prohibited conditions.
Each day that prohibited conditions are maintaine<l shall
constitute a separate offense.
SECTION 3 Addit.ions, insertions, and changes - that the
2021 e<lition of NFPA 99, Health Care Farilities CndP, is amen<le<l
and change<l in the following respect�:
List Amen<lment�
SECTION 4 That ordinance No. _ _ _ of [jmisdirtinn]
entitled {fill in the title nf the nrdinana or nrdinances in if/Pd al the
pr1'sMt time] and all other ordinances or parts of ordinances in
conflict he1·ewith are hereby repeale<l.
SECTION 5 That if any section, subsection, sentence, clause,
or phrase of this ordinance is, for any reason, hel<l to be invali<l
or unconstitutional, such <lecision shall not affect the validity
or constitutionality of the 1·emaining portions of this or<li­
nance. The {health care Jarility '.� gnverning hndy] hereby <leclares
that it would have passe<l this ordinance. and each section.
subsection, clause, 01· phrase hereof, irrespective of the fact
that any one or more sections, subsections, sentences, clauses,
an<l phrases be <leclare<l unconstitutional.
SECTION 6 That the [jurisdictinn'.� kwper nf m:ords] is he1·eby
orde1-ed and directed to cause this m·dinance to be published.
rNOTE: An a<lditional prmision may be reguired to <lirect the
number of times the ordinance is to be publishe<l and to spec­
ify that it is to be in a newspape1· in general ci1nilation. Posting
may also be reguired. l
SECTION i That this onlinance and the rules. regulations.
provisions, 1·egui1·ement�, 01·ders, and matte1·s established an<l
adopted he1·eby shall take effect and he in full force and eflect
[time pPrind] from an<l after the <late of it5 final pa5sage an<l
adoption.
2021 Edition
99-234 HEALTH CARE FACILITIES CODE
Annex D Informational References
D.I Referenced Publications. T he ciocument� 01· portions
the1·eof listed in this annex are refe1·enceci within the informa­
tional sections of this code anci are not part of the require­
ment� of this ciocument unless also listed in Chapter 2 for
othe1- rea�ons.
D.1.1 NFPA Publications. National Fire Protection A�socia­
tion, I Batte1ymarch Park, Quincy, MA 02169-7471.
NFPA W, Standard fm- Pnrtablf Fire .I.-.xtinguishn:,, 2018 edition.
NFPA 1 :'I, Standard fnr the Installation nf Sprinfa.ler S)•stnns, 2019
edition.
NFPA 30. Hmnmable and Cmn/Jmtible Liquid, CnrlP. 2021
edition.
NFPA 53, Re,-mmnn1.ded Pra,:tia on A1aterial,, Equipmn1.t, and
Systnn, U,ed in Oxygm-Enrirhed A tnwsph eres. 2016 eciition.
NFPA 55. G.nnpre.t,ed Gase.1 and C,yngmir Fluid, Code, 2020
eciition.
NFPA 56D, Standard fnr Hypni!arii: Fiuilitil's, 1982 edition
(withdrawn).
NFPA f',8, Liquefied Petmlezw1 (',a_, Cnde, 2020 edition.
NFPA 7rfD, NatinnalElertriral Cnd/0, 2020 edition.
NFPA 70B, Rn:mmnended Prar.tire fnr F.!Prtrir.al Equipmmt Main­
tmanre, 2019 e diti on.
NFPA 7P, National Fire A.lann and Sign aling Cndl', 2019
eciition.
NFPA 77, Rn:mmnmded Practire nn Statir Elfftrici ty, 2019
edition.
NFPA 90B, Standard for the Installatinn nf Wann Air Heati ng and
Air-Cnnditinning Systnn,. 2021 edition.
NFPA 99B. Standard fnr Hypnbarir: Farilities . 2021 edition.
NFPA 101® . Life Safety Cndifi', 2021 edition.
NFPA 110, Standard fnr Eme1gmry and Standl,y Pnwer Systems.
2019 edition.
NFPA 111, Standard ,m Stnred Elfftriral Energy fanergenr.y and
Standby Pnwer System.,, 2019 edition.
NFPA 170. Standard for Firn Sapty and Emergen,:y ,�\•11d)()l,. 2018
eciition.
NFPA 220, Standard on Types nf Building Comtrur.tinn, 2021
edition.
NFPA 252, Standard Methnds nf Fire 1Psts of Dnor A.tw,mbliPs,
2017 edition.
NFPA 259, Standard Test Methnd fnr Pntmtial Hmt nf Building
l\.1aterial,, 2018 edition.
NFPA 551, Guide fnr the Evalual inn nf Fire Risk Asse.mnenl1,
2019 eciition.
NFPA 730, Guide for Pmnisf.l Smtrity, 2020 edition.
NFPA 160()il, Standard nn Cnntinuity, Emergency, and Cri-i.,
Afanagnnm t. 2019 edition.
Fire Pmte,:tion GuidP tn Haz.rrrdmts J\,fateriafr. 2010 edition.
2021 Edition
D.1.2 Other Publications.
D.1.2.I AAMI Publications. A�sociation for the Advancement
of Medical Instrumentation, North Glebe Roaci, Suite 300,
Arlington, VA 22203.
ANSI/A<\MI ES60601-1, Medir.al elertriral equipmmt - Part 1:
GenP ml requirements fnr /Jasir sapty and essential pfrfnnnan ,:e, 2012.
ANSI/AAMI ES60601-2, Medir.al Pier.trim! equipment - Part 2:
G.illateml standard: ElNtrmnagnPlir di1turbanr:es - &quiremmts
and test,, 2014.
ANSI/AAMI ES60601-8, Mediral elertriral equipment - Part 8:
Cnllaleml standard: lHann systnns - (',eneral requiremmts, tests and
guidance fnr alarm systems in mediral elertriral equipmmt and mediral
electriral systnm. 2006.
D.1.2.2 ASHE Publications. Ame1·ican Society for Health Care
Engineering of the American Hospital Association, 155 N.
Wacker Drive, Suite 400. Chicago, IL 60606.
J\IIaintmana Management for Health Care Farilities, 2009.
D.1.2.3 ASHRAE Publications_ ASHRAE, 1791 Tullie Circle.
NE, Atlanta, GA 30329-2:'105.
ASHRAE Guideline 0, 17ie Cmmnissinning Pmress, 2013.
ASHRAE Guicieline 1.1, HVAC&R Tedmiral &quirnnmt, fm­
the Cmnmissinning Pmress, 2007, errata 2012.
ASHRAE H andbonk - ht ndamental,, 201 7.
ASHRAE Standard 202, Cmmnis,inning Pmcess for Buildings
and Systnns, 2013.
D-1.2.4 ASME Publications. American Society of Mechanical
Engineers, Two Park Avenue, New York, NY I00IG-5990.
ASME B16.22, Wmught Capper and Cnpper 1Hloy Solder-Jnint Pres­
sure fzttings, 201 '.l.
ANSI/ASME B16.50, Wrought Cnpper and Capper Allny Braz.e­
Jnint PrPssurP Fittings. 2013.
ASME PVHO-1. Safety Standard fnr Pre.mm \!iz,sel, fnr Human
01:rupanr.y, 2016.
Boiler and Pr1,ssure ¼ssel Cnde, 2017.
D.I.2.5 ASSE Publications. American Society of Sanitaty Engi­
neering, 18927 Hickory C1·eek Drive, Suite 220, Mokena, IL
60448.
ASSE 6000, Profe.t,innal Qualifirations Standard fnr Mediral l>fL,
Systnns Persnnnel, 2015.
D.1.2.6 ASTM Publications. ASTM International, 100 Ban­
Harbor Drive, P.O. Box C700, \Vest Conshohocken, PA
19428-2959.
ASTM E l19, Standard 1Pst l\1etlwd, fnr Fire Tests nf Building
OJmtrur.tinn and Material,, 2018c e1.
ASTM F2213, Standard 1Pst J\.1etlwd fm- MN1.rnremmt nf Magm'li­
rally lndur.ed Tnrque nn Aiediral Devires in the Maguetir &sonanr.e
Envimnmmt, 2017.
ASTM F250:l, Standa-,d Prar.tir:e fm- Marl1ing Mediral Dfvir:es and
Other ltnn, for Safety in the 1'v!agm'tir &sonana Envimnmmt, 2013.
ASTM G6:'I, Standard Guide for Evaluating Nnmnetallir. Maten.al,
fm- Oxygen Snvire, 201:>.
 ANNEX D
ASTM G72/G72M, Standard 1;,s1 AlPthod for A.utogenom Igni­
tion Temperature of Liquid� and Solids in a High-Prl'ssure Oxy gm­
Enrirhed Environment, 2015.
ASTM G88, Standard Guide far Designing Systnn� for Oxygen
Si'rViff, 2013.
ASTM G93, Standard Pm,:tia for Clmning l'vlPthod� and Clmnli­
ness Le,ll'ls far l'vlaterial and Equiftmmt Uwd in Oxygrn-Enrirhed
t:nvironment1, 2003, reapproved 2011.
ASTM G94, Standard Guide for J.-.'valuating Mnal1 far Oxygm
ServirP, 2005, reapproverl 2014.
D.I.2.7 CGA Publications. Compressed Gas A�sociation,
14501 Gemge Carte1· Way, Suite 103, Chantilly, VA 20151-2923.
CGA G-8.1, Standard for Nitrous Oxide System,1 at Customer Sites,
2013.
CGA P-2.5, Transfilling of High Pressure Gaseous Oxygen U1ed for
Respiration, 2011.
CGA P-2.G , Tmnsfilling af Liquid 0xygrn u�ed far Respiration,
2011.
CGA P-2.7, Guide for the SafP Storage, Handling, and U1e of Small
PortablP Liquid Oxygen Systnns in Hmlth Care FadlitiPs, 2011.
CGA P-i',0, Site SPntrity Standard, 2014.
CGA V-1, Standard far Cmnpre.�1ed Gas Cylinder Valve OutM and
Inlft Connertions (ANSI B57.l), 2013.
D.1.2.8 FGI Publications. Facility Guidelines Institute, 1919
McKinney Avenue, Dalla�. TX 75201.
Guiddines for Design and Constructian of Hospital1, 2018.
D.1.2.9 IEC Publications. International Electrotechnical
Commission, 3, rne de Varembe, PO. Box 131, CH-1211
Geneva 20, Switzerland.
ANSI/AAMI/IEC 80001-1, Appliration of Risk Afanagnnmt for
IT Networks Incarparating J\'frdiral Droias - Part 1: Roles, Responsi­
bilities and A,:tivities, 2010.
ANSI/IEC/ISO 80001-1-1, A.ppliration af Ri�k Managnnmt for
IT Networks Inmrpm·ati ng lviediral Droias - Part 1-1: Risk /'.fanage­
ment of l'vlediral!T Netwmks, 2010.
ANSI/IEC/ISO 80001-2-f>, Application of Ritk Managemmt for
IT Nflwarks Incarparating l\frdiral Dmias - Part 2-5: A.ppliration
Guidance - Guidanre for Distributed Alarm Systnn1, 2014.
ISO/IEC 31010, Ri1k M.anagmient - Risk A.ivssment Tl'Chni­
ques, 2009.
D.I.2.10 IEEE Publications. IEEE, 3 Park Avenue, 17th Floor,
New York, NY 10016-5997.
ANSI/IEEE 493, &ronmtended Pmrtire for the Design of &liable
Industrial and Cm11111errial Power Systmis, 2007.
IEEE 602, Rermm1umded Prartire far Hfftri,: Systems in Health
Care Facilities, 2007.
D.1.2.11 NEMA Publications. National Electrical Manufactur­
ers A�sociation, 1300 North 17th Street, Suite 900, Arlington,
VA 22209.
9�235
ANSI/NEMA PB 1.1, General Inslrurtions far Proper Installation,
operatian and Maintenance of Panelboard.1 Rated 6()() F ar Le.ii,
2007.
ANSI/NEMA WD 6. lViring Droires - Dimensional Require­
ments, 201G.
NE?v1A ICS 2.3, Instrw:tions far the Handling, Installation, oper­
ation and Afaintenanr:e of Afotor Control Centen Rated Not Afore than
6()() t-; 1995, revised 2008.
D.1.2.12 NETA Publications. InterNational Electrical Testing
Association, 3050 Old Centre Ave, Suite 101, Portage, MI
49024.
ANSI/NETA AT S, Standard for Ar:ceptan,:e Testing Specijirations
far Hfftriml Power J,.quipmenl and Systnns, 2017.
D.1.2.13 Ocean Systems, Inc., Publications. Ocean Systems,
Inc., Resea1·ch anrl Development Laboratory, Tarq,town, NY
10591.
T. C. Schmirlt, VA. Dorr, anrl R. W. Hamilton.Jr., "Technical
Memmanrlum UCRI-721, Chamber Fin� sa1·ety." (Figure
A.3.3.12.2 i1 adapted fmm Figure 4 of this mnnarandwn.) \,l,,'ork
carried out under U.S. Office of Naval Research, Washington
DC, Contract No. N00014-67-A-0214-0013.
G. A. Cook, R E. Meierer, and B. M. Shields, "Saeening of
Flame-Resistant Materials anrl Comparison of H elium with
Nitrogen for Use in Di\iding Atmospheres." Fi1·st summary
report unde1· O NR Contract No. 0014-li6-C-0149. Tonawanda,
NY: Union Carbide, 31 March 19G7. DDC No. Ad-651583.
D.1.2.14 SFPE Publications. Society of Fire Protection Engi­
neers, 9711 Washingtonian Blvd, Suite 380, Gaithe1·sbu1·g, MD
20878.
Enginming Guide to Fire Risk A.sses.'ilnent, 2006.
D.1.2.15 TIA Publications. Telecommunications Industry
Association, 1320 North Courthouse Road, Suite 200, Arling­
ton, VA 22201.
ANSI/TL-\ 569-D, Tele,-mmnuniratians Pathway.1 and Spaces,
2015.
D.1.2.16 UL Publications. Unrle1w1·ite1·s Laboratories Inc.,
333 Pfingsten Road, Northbrook, IL G0062-2096.
UL 2G3, Standard far Fire Ti>sts of Building Conslrurtion and
Material1, 2011, 1·eviserl 2018.
UL 498, Standard far Attachwnt Plug:, and Re<:Pptarles, 2017.
UL 943, Ground-Fault Cir,:uit-ln terrupters, 201G.
UL 10G9, Standard far Hospital Signaling and Nurse Call Equifr
mmt, 2007, revised 2018.
UL 1363A, Outline of Inwstigation for Sperial Purpose &loratable
Power Taps, 2010.
D.1.2.17 U.S. Government Publications. U.S. Government
Publishing Office, 732 North Capitol Stt·eet, NiV, Washington,
DC 20401-0001.
Crisis Standard1 of Care: A Systnns Framework far Catastrophic
Disaster Response, Institute ofMerlicine (IOM) Report, 2012.
Title 21, United States Code, Part 321 (g) (1), "Federa l Foorl,
Drng, anrl Cosmetic Act."
2021 Edition
99-236 HEALTH CARE FACILITIES CODE
Title 49. Code of Federal Regulations. Subchapte1· C.
"Haza rdous Materials Regulations," and Part 190, "Pipeline
Safety Enforcement and Regulatory Prncedut·es."
U.S. Government Publication 3152, Hospital� and Community
Eml'rgmry &spnnsl' - What rim Nn'd to Know, 1997.
D.1.2.IB USP Publications. U.S. Pharmacopeia, 12601 Twin­
brnok Parkway, Rockville, MD 20852-1790.
Unitl'd States Phannaropl'ia and Nationa!Fommlary (USP-NJJ
D.1.2.19 Other Publications.
2017-2022 Health Care Prl'parednfs� and &sponse ('.,apabilities,
A.ssistant Sec1·eta1y for Prepa1·edness and Response (ASPR),
Novembe1· 2016.
Hoeltge, G.A., A. Miller, B.R. Klein, ,,v.B. Hamlin. "Acciden­
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Publication 1132. Dil'sl'lEngims for u�e with (',ent'ratnrs to Supply
Eml'rgenry and Short-ll'nn Eliir:trir Power, National Academy of
Sciences - National Resea1·ch Council. 1963.
SEMI S l0-0307E, Sajfty GuidelinP for Ri�k A ss!'-mnmt and Risk
Evaluation Prnass.
"Atmospheric Pressure," Firf jouma!July/ August 2002.
D.2 InfonnalionaJ References. The following documents 01·
portions thereof a1·e listed he1·e as infm·mational resources
only. They are not a part of the requi1·ements of this document.
D.2.1 Published Articles on Fire Involving Respiratory Ther­
apy Equipment and Related Incidents.
Benson, D. M., and C. H. Wecht. "Conflagration in an ambu­
lance oxygen system.'' journal of Trawna 15, no. 6 (1975):536-
649.
Dillon, J. J. "Cty fire!" &spiratory Care 21. no. 11 (1976):
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Gjerde, G. E., and R. Kraeme1·. "An oxygen therapy fire."
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197 (1960) :44-46.
\\'ebre, D. E., R. Leon, and N. W. Larson. "Case History; Fire
in a nebulizer." Anl'sthl'-�ia and Analgesia 52 (1973):843-848.
D.2.2 References for A..14.3.1.6.4.3.
NASA BMS Document GRC,.M8300.001. 2005. Chapter 5,
Paragraph 5.6.3.
Raleigh, G., et al. "Air-Activated Chemical ,-Varming Devices:
Effect� of Oxygen and Pressure." Undn:�ea & Hypni!ari1: i\frdirinP
32,110. 6 (2005): 445-449.
Workman, ,-v·. T 1999. Hypl'rbmir Facility Safety: A Prartiral
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K.indwall, E. P.. and H. T. Whelan. 2004. Hyperbarir Mfdirine
f
Pmi:tire, p. 86. Flagstaf , AZ: Best Publishing.
Burman, F. 2015. Risk A.ssessmenl GuidP Jar the Installation and
Opi'ration of Clini1:al Hypni!arir Fa,-ilities. San Antonio, TX: Inte1·­
national ATMO.
2021 Edition
D.2.3 Other Organizations that Publish Standards or Guide­
lines.
American Conference of Governmental Imlustrial Hygien­
ist�, 1330 Kemper Meadow D1·ive, Cincinnati, OH 45240-1634.
American Industrial Hygiene Association, 3141 Fairview Park
Dr., Suite 777, Falls Chmch, VA 22042.
U.S. Department of Health an<l Human Services, Office of
the A�sistant for Prepa1·edness and Response (ASPR), National
Disa.�ter Me<lical System (NDMS).
National Emergency Management A�sociation, Council of
State Government�, Emergency Management Assistance
Compact, 2760 Research Park Dt-ive, Lexington, KY.
Laboratory Products i\ssociation, 1114 Faitfax Place, Box 12,
White Post, VA 22663.
Natural Hazards Cente1· (Unive1·sity of Colmado), 483 UCB,
Boulder, CO 80309-0483.
Disaster Resea1·ch Center (University of Delawa1·e), 166
Graham Hall, 111 Academy Street, Newa1·k, DE 19716.
American Society for Healthcare Engineering. 155 North
Wacker Drive, Suite 400, Chicago, IL 60606.
D.2.4 Addresses of Organizations and Agencies That Provide
Health Care Emergency Preparedness Educational Materials.
D.2.4.1 Publications.
National Fire Protection Association, l Battetymarch Park,
Quincy, MA 02169-7471.
American Health Ca1·e Association, 1201 L Street, NW, Wash­
ington, DC 20005.
American Hospital Association, 155 North ,-\Tacket· Drive,
Chicago, IL 60606.
American Medical Association, i\MA Plaza, 330 North
Wabash Ave. Suite 39300, Chicago. IL 60611-5885.
American Nurses' Association, 8515 Georgia Avenue, Suite
400, Silver Spring, MD 20910-3492.
American Red Cross, National Hea<lquarters, 431 18th
Street, NW. Washington, DC 20006.
A�sociation of American Railroa<ls. 425 3rd Street, s,-\!, Wash­
ington, DC 20024.
Charles C. Thomas Publisher, 2600 South First Street,
Springfield, IL 62704-4730.
Federal Eme1·gency Management Agency, 500 C Street, s,-\',
Washington, DC 20472.
Flm·ida Health Care Association, 307 \.V. Park Avenue, P.O.
Box 1459, Tallahassee, FL 3230 l.
Helicopte1· Association International, 1920 Ballenger
Avenue, 4th flom, Alexandt-ia, VA 22314-2898.
Hospital Emergency Incident Comman<l System, State of
California Eme1·gency Medical Services Authority. 10901 Gold
Center Drive, Suite 400, Rancho Cot·<lova, CA 95670.
International Association of Fire Chiefa, 4025 Fair Ridge
Drive, Suite 300, Faidax, VA 22033-2868.
 ANNEX D
The Joint Commission (lJC), One Renaissance Blvd.,
Oakbrook Terrace, IL 60181.
National Interagency Fire Centei-, 3833 Development
Avenue, Boise, ID 83705-5354.
Pan American Health Organization, 525 23nl St1·eet, NW,
Washington, DC 20037.
Stanrlarrlizerl Emergency Management Sys tem, State of Cali­
fornia Governor·s Office of Emergency Services, 3650 Sclu·iever
Avenue, Mathe1·, CA 95655-4203.
Disaster Research Center (Universitv of Delaware), 166
Graham Hall , 111 Acarle myStreet, Newa1k DE 19716.
U.S. Department of Transportation, available from the U.S.
Government Publishing Office, 732 North Capitol Street, NW,
Washington. DC 20401-0001.
D.2.4.2 Audiovisual Materials.
National Fire Protection A�sociation. l Batterymarch Park,
Quincy, MA 02169-7471.
Abbott Laboratm·ies (Corporate Headquarters), 100 Abbott
Park Roarl, Abbott Park. IL 60064-6500.
Federal Eme1·gency Management Agency, :,00 C Street, SW,
Washington, DC 20472.
National Aurlimisual Center, General Senices Arlminist1·a­
tion, 1800 F Stt·eet, NW, Washington, DC 20405.
Helicopter A�sociation International, 1920 Ballenger
Avenue, 4th flom·, Alexandria, VA 22314-2898.
Pyramid Merlia, 3200 Airport Ave, Ste 19, Santa Monica, CA
90405.
University of Illinois Hospital anrl Health Sciences System,
1740 West Taylor Stt·eet, Chicago, IL 60612.
D.2.5 Additional U.S. Government Informational Sources.
Kidney Community Emergency Response Coalition, 3000
Bayport Dr.. Suite 300. Tampa. FL 33607.
"'National Response Frnmewot-k." June 2016. Ferleral Emer­
gency Management Agency, 500 C Street, SW, Washington, DC
20472.
"National Disaster Recovery Frnmewo1·k" January 2017,
Federal Emergency Management Agency, 500 C Street, SW,
Washington, DC 20472.
(The following is available from the U.S. Government
Publishing Office, 725 North Capitol Street, NW, "Washington,
DC 20401-000 l.)
Title 29, Code of Federal Regulations, Part 1910.1030,
"Bloodborne Pathogens."
Title 29, Code of Federal Regulations, Part 1910.1450,
"Occupational Exposure to Hazar·rlous Chemicals in Laborato-
1·ies."
Title 49, Code of Ferleral Regulations, Subchapter C and
Part 190 (U.S. Dept. ofTrnnspm·tation. Specifications fot· Trnns­
portation of Explosives and Dangerous Articles). (In Canada,
the regulations of the Board of Transport Commissioners,
Union Station, Ottawa, Canada, apply. )
9�237
Title 49. Code of Federal Regulations. Part 173, "Shippers -
General Requirements for Shipment� and Packagings."
Commercial Standard 223-59, CastPrs, VVhePL�, and Glides for
Hospital Equipmn1f.
Environmental Protection Agency, Chemical Eme1·gency
Prepa1·edness anrl Prevention.
National Research Council Publication 1132, DiPsd Enginfs
for U�f with t,fnPrators to Supply EmPrgem:y and Sh(/rf J;,nn Elfrtric
Power. (Also available as Order No. O.P.52870 from University
Microfilms, P.O. Box 1366, Ann Arbor, MI 48106.)
(The following is available from the U.S. Department of
Health and Human Se1·vices, 200 Inrlependence Avenue, S"\,V,
Washington. DC 20201.)
HHS Publication No. 93-8395. fliosajfty in Micmbiologi,ml and
Bimnediral Laboratoril's, Cente1·s fot· Disease Control anrl P1·even­
tion.
"Public Health Preparedness and Response for BiotetToris m
Program," Centers fot· Disease Control and Prevention.
·'Emergencv Response Resources: Personal Protection Equip­
ment,'' National Institute for Occupational Safety and Health
(NIOSH).
"Protecting Building Environments from Airborne Chemi­
cal, Biologic, 01· Radiologic Attack.�," CDC's M(/rbidity and
Mortality WPPkly Riprrrt 51, no. 3 (6 September 2002): 9.
(The following is available from the U.S. Department of
Homeland Secmity. 3801 Nebraska Ave N\V. Washington. DC
20016.)
IS-120.C: An Introrluction to Exercises" (interactive web­
based course).
Guidf f(/r All-Hazard EmMgl'rll.Y Opm,tions Plnnning, Septembet·
1996.
"National Health Security Strategy," Office of the Assistant
Secretary for P1·eparedness and Response (ASPR).
Health Professional Pre-Disaster Identification (ESAR-VHP),
Office of the A�sistant Secretary fot· Preparedness and
Response (ASPR).
"Hospital Preparedness Program," Office of the A�sistant
Secretary for P1·eparerlness and Response (ASPR).
"National Disaste1· Medical System," Office of the i\.ssistant
Secretary for Preparedness and Response (ASPR).
"Strategic National Stockpile," Office of the Assistant Secre­
tary for Preparedness and Response (ASPR).
Publications Lib1·a1y, Office of Domestic P1·eparerlness, U.S.
f
Department o Justice.
(The following is available from the U.S. Department of
Labor, 200 Constitution Ave, N\1/, Washington, DC 20210.)
Title 29, Corle of Federal Regulations, Part 1910.38, "Emer­
gency Action Plans."
Title 29, Corle of Federnl Regulations, Subpart H, "Hazard­
ous Materials," specifically Part 1910.120, "Haza1·dous \'\'aste
Operations and EmergencyResponse" (HAZ\'\'OPER).
2021 Edition
99-238 HEALTH CARE FACILITIES CODE
Title 29. Code of Federal Regulations. Subpart I. "Pe1·sonal
Protective Equipment," specifically Part 1910.132, "General
Requi1-ements," Pan 1910.133, "Eye and Face Protection,"
Pan 1910.1,\4, "Respirntory Protection," Pan 1910.136, "Foot
Protection," Part 1910.138, "Hanrl Protection,'' anrl Appendices
A-D.
Title 29, Corle of Ferleral Regulations, Subpan Z, "Toxic and
Hazarrlous Substances," specifically Part 1910.1200, "Hazard
Communication" (including Appenrlices A-E).
Publication 3114, Hazardous H'ilstP Opemtiom and EmPrgmry
&sponw.
Publication 3152. Hospital1 and Cmmnunity l.•.'lnPrgpnr:y &spome
- H'hat You Need to Know.
D.2.6 Additional Resources for Emergency Management.
Ba1·bern, J. Emergm.ry I\'Ianagemmt Prinr.iplPs and Pm,:tires for
Hmlthrare Systn11s, Institute of Crisis, Disaster anrl Risk Manage­
ment, 2010. George Washington University, for the Veterans
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Ba1·bern, J. A., and A. G. Macintyre. 2007. Ivfrdiral Surge
Capar.ity and Capability Handbo-ok: A IVlanagnnent S�stem for Inte­
grating 1\'Iediral and Health &.rnura.1 During Large-Srale Enwrgen­
ries, Contract No. 233-03-0028, Department of Health anrl
Human Services. Washington. DC.
NFPA 3000TM (PS). Standard fo-r an A.i:tive Shooter/Hostile Event
&spnnse (ilSH.l!.R) Program, 2018 edition.
D.2.7 Other Publications.
Ba1·bern, J. anrl A. G. Macinty1·e. 2002. Mediral and Health
Inrident Managnnmt (Afo.HINI) Systnn: A Cm11prehn1sive I-lmr.tional
System Desi:riptiom fo-r IVfoss Crmwlty lVIediml and Health Inddmt
f
Nianagnnmt, George ,,vashington University, School o Engi­
neering and Applied Sciences, Institute fo1· Crisis, Disaste1· and
Risk Management.
DuPont Safety News.June 14, 1965.
Da�Iet- anrl Baue1·, Ind. l•.'ng. Chnn. A.nal, Erl. 18, 52 (1964).
IEEE 3001.2, &r.mnmended Pmrtir;, fo-r Evaluating the Hn:triral
SPrvire &quirmient.s of Industrial and Cmmnerrial Po-we:r Systeim.
2017.
2021 Edition
IEEE 3001.5, &rnnmimdPd Prartia for the AfiPliralinn of Power
Distribution Apparatm in Industrial and Cmmnn'r.ial Power Systnn�,
2013.
IEEE 3003.2, Rer.mmmndPd Practire for E' quipment Grounding
and Bonding in Industrial and Gnnmerrial Power Systnns, 2014.
IEEE 3006.2, RecmmnendPd Prartir.e for J.,."valualing the &liability
of E'fisting Industrial and Cmmnm:ial Power Systnns, 2016.
IEEE 3006.3, Rerommended Prartire for Determining the. Impa,:t of
Prevmtative Maintmanr.e on the Reliability of Industrial and Commer­
rial Power Systems, 2017.
IEEE 3006.5, RP1:mmnended Prartire fo-r thP u�e of Probability
Methods fo-r Condurting a &liability A.nalysis of Indmtrial and
Cmnmm:ial Power Systnm. 2014.
IEEE 3006.7. &rmmnmded Prartir.e fo-r Detmnining the &liability
of 7x24 Continzwm PowPr Systems in Industrial and Cmmnerdal
Farilitie.\, 2013.
IEEE 3006.9, Rem111111ended Prm:tice for CollPr.ting Data fo-r u�e in
Reliability, Availability, and Maintainability ilssessment� of Industrial
and Cmnmerrial Pm.11er System1, 2013.
IEEE 3007.1, &rmmnmded. Pmctir.e for the operation and
Management of Indmtrial and CmnmPrr.ial Power Systems, 2010.
IEEE 3007.2, &rmmnended Prartirefo-r the Maintmanre of Indus­
trial and Cmmnerrial Power Systnns, 2010.
IEEE P3007.3, &,wnmended Prai:tice for Hectriral Safety m
Industrial and Cmmnerr.ial Power Syste,m, 2017.
D.3 References for Extracts in In formational Sections.
NFPA 55, Compressed (',ases and Cryogmir Fluids Cod.P, 2020
edition.
NJ.PA 7r-P. National Elniriml Cod.I-'. 2020 edition.
NFPA JO?!. Life Safety Cod.�. 2021 edition.
NFPA 110. Standard for E'liu,rgenry and Standby Power Systnns.
2019 edition.
 INDEX 9�239

Index
Co py1·ight © 2020 National Fire Prntection A5sociation. All Rights Reserved.

The copyright in this index is separate and distinct from the copyright in the document that it indexes. The licensing provi­
sions set forth for the document a.re not applicable to this index. This index may not be reproduced in whole or in part by any
means without the express w1·itten permission of NFPA.

-A- Hyperbaric chambers, 14.2.1.4.6. 14.2.6.1.4, 14.2.6.4, 14.2.8.2,

Absolute atmosphere (ATA), B.14.1.3.4.3, Table B.14.4 14.2.<J.3.l 5, A.14.2.6.4.2, A.14.2.9.3.15.1
Definition, 3.3.12.1 Labeling, 5.1.11.4, A.5.1.11.4.2
Local. ci.1.3.5.8, 5.1.3.6.3.12, 5.1.3.7.8, 5.1.3.9.5, 5.1.9.l, 5.1.'l.5,
Absolute pressure
5.1.13.3.6.7, 5.1.13.9.4, 15.3.2.7, 15.4.3.4.4,
Definition, 3.3.149.1 A.5.1.9.5: .,;,ie alrn Local signal
Access, 13.6, A.13.6.3.l Definition, 3.3.3.3
Adapters, 10.2.4, 10.5.2.3 Master, .5.l.3.6.3.14(C) (9), 5 . .1.3.95.l (3), 5.1.3.9.5.3, 5.1.8.1.6,
Adiabatic heating, B.14.1.2.4.1, B.14.1.3.4.4 5.1.9.1, 5.1.9.2, 5.1.12.4.5.2, 5.l.13.\U!, 15.3.2.7,
Definition, Jl.Jl.l 15.4.3.4.2, A.5.l.3.6.3.l 4(C)('l), A..5.l.9.2, B.5.2.10
Aerosols, 11.5.1.2.1, 16.14.3.1 to B.5.2.13
Definition, 3.3.2 Computer systems as substitutes for, 5.1.9.3
Aftercoolers, 5.1.3.6.3.5, 5.l.3.6.3.9(C), 5.l.3.6.3.9(H), Definilion, '.l.3.3.4
5.1.13.3.7.9(1), 5.2.3.5(1), 15.3.2.1.5(1) Occupam nolificalion, lfi.7.4
Air Remote comrol, 6.7.1.2.7, A..6.7.l.2.7.2(B), A.6.7.L2.7.2(H)
Compressors, see alrn Dent.al air compressors; Medical air Signal initiation, lfi.7.2, A.lfi.7.2.4
compressors Silencing means, 6.7.L.2.7 .2(E), 6.7.l.2.7.2(F)
Hyperbaric chambers, 14.2.4.2 Alternate power sources, fi.7. 1.2, 6.7.2.2.4, A.6.7.l.2.2 to
lnstrumem air, 5.1.13.3.7.12 A.6.7.1.2.4; see alrn Generator sets
Starting devices, 6.7.1.3.6 Connection to, fi.7 .5. l.4.2
Dental, see Dental air Definilion, 3.3.4
Medical, Sl'J! Medical air Failure of; 6.7.3.6
Monitoring, hyperbaric chamber, 14.2. I0.6, A.14.2.l 0.6, Maintenance and tesling of, 6.7.4.1.1. 6.9.4.2, A.6.7.4.1.1.5 (A).
A.14.2.10.6.l A.fi.9.4.2
Nonmedical compressed air, 8.3.5 Transfer to, see Transfer switches
Air conditioning, ue Healing, venlilating, and air conditioning Alternative equipment maintenance (AEM) program, fi.9.4.2,
(HVAC) systems A.6.9.4.2
Air dryers, 5.1.3.6.3.3, 5.1.3.6.3.7, 5. L3.6.3.9(E), 5.l.3.6.3.9(F), Ambient atmosphere, sfe Aunosphere
5.1.3.6.3.9(1), 5.1.13.3.7.9(3), 5.2.3.5( I), Ambient pressure, Sl'J! Pressure
A.5.l.3.6.3.9(F) Ambient temperature, see Temperature
Alarm systems, 16.7, A.16.7.2.4 to A.16.7.4.3.2; see alrnNurse call Ambulatory health care occupancies, 16.7.4.3.2
systems
Definition, 3.3.5
Annunciat or, remote, (j.7.1.2.7, A.6.7.l.2.7.2(B),
Ampacity, 10.2.3.1.1, 10.2.3.6
A.6.7.l.2.7.2(H)
Area, 5.1.8.l.6, 5.1.9.l, 5.1.9.4, 5.1.12.4.5.3, 5.1.13.9.3, 15.3.2.7, Definilion, 3.3.6
15.4.3.4.3, A.5. 1.9.4 Anesthetic apparatus, 11.4.1.1, A.11.4.1.1
Definition, 3.3.3.1 Anesthetics, see al.<0 specijir gases
Category I, 5.1.3.10.12, 5.1.8.l.6, 5.1.9, 5.1.14.7.11, 15.3.2.7, Definition, 3.3.7
A.5.1.3.10.12, A.5.1.14.7.ll, B.5.2.9 to B.5.2.13, Flammable, 5.1.14.3.1, A.5.1.14.3.1
B.5.2.15, B.5.2.16; sl'l! also Area, Local, Master Nonflammable aneslhelic agent (definilion), 3.3.124
Instrument air, 5.1.13.3.7.11 Wa5te, see Waste aneslhelic gas disposal (\NAGD) systems
Medical air compressors, s11e Medical air compressors Anesthetizing locations, 1.3.4.2, 16.14 .3, A. lfi.14.3. 2; Jee alrn \.Vaste
Support gases, 5.1.13.9 anesrhelic gas disposal (WAGD) systems
Tests, .5.l.12.4.5, 5.1.14.7.8 Animal chambers, 14.1.2.2(3), 14.2.2.3
\\iaste anesthelic ga5 disposal (WAGD ), see Via5te anesthetic Antiseptics, 16.14.3, A.16.14.3.2
gas disposal (WAGD) systems Apparatus, see Anesthetic apparatus; Equipment
Category 2. 5.2.9, 15.4.2.10, 1.5.4.3.4 Appliances, see alrn Elec trical equipment; Equipmem
Category 3, 5.3.9 Bauery-powered, 14.2.9.3. lfi.4
Definition, 3.3.3.2 Definition, 3.3.8
Changeover signals, [,.l.'l.2.4(1), BS2.IO to B.ci.2.13 Double-insulated, 10.2.2. 1.2, 10.4.2.3
Essenlial electrical systems, 6.7.ci.1.2.4(7), 6.7.6.2.l.5(C) (3) Definilion, 3.3.44, A.3.3.44
(;enerator sets, 6.7.1.3.8.1 Applicable c ode (definition), 3.3.'l
Application of standard, 1.3, A.l.3.1.3

2021 Edition
99-240 H.E.AlTH C ARE FACILITIES CODE

Applicator, 16.14.3.2, A.16.14.3.2 Nitrous oxide (definition), 3.3.19.2

Definition, 3.3.10, A.3.3.10 Oxygen (definition), 3.:U 9.3, A.3.3.19.3; see alrn Cryogenic
Approved (definition), 3.2.1, A.3.2.l liquids, Bulk systems
Area of admin istration, 11.5.1.1.3, 11.5.l.l.4, A.11.5.l.l.2 B:,,pass-isolation switch, 6. 7.2.1.5, A.6.7.2.1.5.3
Definition, 3.3.11
-C­
Atmosphere
Absolute (ATA), B.14.1.3.4.3, Table B.14.4 Cannula, nasal, see Nasal cannula
Definition, 3. 3.12.1 Carbon dioxide
Ambient. 5.1.10.4.5.5, 14.2.4.3.1, B.14.1.1.4.3; see nlrn DesignaLion colors/operaLing pressures, Table 5.1.ll
Temperature, Ambient Monitoring, 14.2.10.5
Chamber, 14.2.4.1.3, 14.2.4.2, 14.2.9.2.4, 14.2.10.3.1, 14.2.10.4.l, Supply systems, 5.l.l.3, 5.1.3.3.1.8, 5.1.3.3.l.'l, 5.1.3.5.2,
14.2.10.5, 14.3.1.6.2.2, 14.3.2.6.1, A.14.2.9.3, .'U.3.10.2.7, A.5.1.l.3; see also Medical ga5 systems
A.14.3.1.6.2.2(2), B.14.1.3.2.2 Carbon monoxide monitors, 5.1.14.7.7(2)
Definition, 3.3.12.3 Cardiac defibrillators, see Defibrillators
Definitjon, 3.3.12, A.3.3.12 Carts, for cylinders, 11.4.3.1
Of increa5ed b urning rate (definiLion), 3.3.12.2, A.3.3.12.2 Casters, 14.3.4.5.2, 14.3.4.5.3
Oxygen-enriched, .iee Oxygen-enriched atmosphere (OF.A) Category I emergency management requirements, 12.3, 12.5.
Attachment plugs, see Plugs (auachment plugs, caps) A.12.5.3.1.2 to A.12.5.3.5
Authority having jurisdiction Category 2 emergency management requirements, 12.3, 12.5,
Definition, 3.2.2, A.3.2.2 A.12.5.:U.2 to A.12.5.3.5
Emergency planning responsihiliL.ies, 12.2.l, A.12 .2.1 Category I information technology and communications
s,.stems, 7.3
Automatic (definition), 3.3.13
Infrastructure, 7.3.l
Automatic sprinklers, see Sprinklers, automalic
Cabling pathways and raceway requirements, 7.3.1.2.4
-B- Entrance facility (EF), 7.3.1.2.1, A.7.3.l.2.l.4(C) to
A.7.3.1.2.l.S(C)
Basic care rooms, see Palient care spaces
Premises distribulion system (fiber and copper), 7.3.l.l
Bathrooms
Remote primary· data center, 7.3.1.2.l.3
Definition, 3.3.14
Telecommunicalions eqwpment room (TER), 7.3.1.2.1.1,
Electrical receptacles, 6.3.2.2.l (D), 6.3.2.2.2(D) 7.3.1.2.2, A.7.3.1.2.2.2
Nurse and staff emergency assistance calls, 7.3.3.1.2.5, 7.3.3.1.8.2 Telecommunications room (TR), 7.3.1.2.3
Wet procedure locations, 6.3.2.3.3 Telecommunicalions systems spaces and pathways, 7.3.1.2,
Batteries, 6.7.l.4 A.7.3.1.2 to A.7.3.1.2.2.2
Appliances, hauery-powered, 14.2.9.3.16.4 Nurse call systems, 7.3.3.1, A.7.3.3.l.l to A.7.3.3.1.4.1
Automatic detect.ion system, for, 14.2.6.4.3 Category 2 information technology and communications
Cranking , 6. 7.1.3.5, A.6.7.1.3.5 S)Stems, 7.4
Maintenance, 6.7.4.1.2.3 Infrastructure, 7.4.l
Battery-powered lighting units, 6.3.2.6 Nurse call systems, 7.4.3.1
Definition, 3.3.15 Category 3 information technology and communications
Bends, B.14.1.3.4.2 S)Stems, 7.5
Definition, 3.3.16 Category I patient care spaces, see Patient care spaces, Category· 1
Bilge, hyperbaric faciHties, 14.2.2 5.2 Category 2 patient care spaces, see Patient care spaces, Category· 2
Branch circuits Category 3 patient care spaces, 1.3.4.l, 6.6
Definition, 3.3.17 Definilion, 3.3.140.3, A.3.3.140.3
Patient bed locations, 6.3.2.4, 6.3.2.4.2, A.6.3.2.4 Category 4 patient care spaces, 1. 3.4. I, 6.6
Branch (lateral) lines, piping, see Pipe and piping, ga� Definition, 3.3.140.4, A.3.3.140.4
Brazing, 5.1.6.10, 5.1.7.8, 5.1.10.3.1(1), 5.1.10.3.3, 5.1.10.4, Category I piped gas and vacuum systems, 5.1, A.5. I.I to
5.1.10.l1.11, rn.3.3.7.2.4, 15.4.2.1.3, 15.4.4.2.3.2, A.5.1.14.7.11 (2)(a), B.5.1, B.5.2; s1>1 also C entral supply
15.4.4.2.4.1, 15.4.6, 15.5.5.2.3, 1.5.5.5.2.4, 15.55.3.2.2, systems; Medical-surgical vacuum systems; Wa�t.e
15.5.5.3.2.3 anesthetic gas disposal (WAGD) systems
Breathing a pparatus, hyperbaric chambers, 14.2.4.1.3, 14.2.4.4.3 Alarms, se,, Alarm systems
Building system categories Applicability of requirements, 5.1.1, A.5.1.1
Application, 4.3 Cross-connections, 5.1.12.2.4, 5.1.12.4.3, B.5.1
Plumbing system, 8.2, A.8.2.1 Dental air, 15.3.3, A.15.3.3.4, A.15.3.3.5
Bulk s,.stems, 5.1.3.6.1 (I) Dental gas and vacuum systems, 15.3, A.15.3.3.4, A.15.3.:l.5
Cryo genie I iquids, see Cryogenic liquids, Bulk systems DesignaLion colors/o peraLing pressures, Table 5.1.11
Definition, 3.3.19, A.3.3.19.3 Distrihulion, 5.1.10, 5.1.13.10, 15.3.2.8
Inert gas, 5.1.3.3.1.10, A.5.1.3.3.1.10 Filtration, 5.1.3.7.4
Definition. 3.3.19. l Hazards, nature ot; 5.1.2. 5.1.13.2

2021 Edition
 INDEX 99-241

Labeling and identification, 5.1.11, 5.1.12.4.13, 5.1.13.11, Category 3 piped gas and vacuum systems, 5 .3; see alrn Category 3
5.1.14.5, 15.3.2.9,A.5.l.ll vacuum systems; Central supply systems; Scavenging
Maintenance, .5.1.14.4, 5.1.14.7, 15.3.2.12, B.5.2 Alarms, 5.3.9
Manufactured a5semblies, see l\fanufactured a5semhlies Definition, 3.3.3.2
Operation and management, 5.1.14, 15.3.2.12, A.5.l.14 Applicability of requirements, 5.3.l, A.5.3.1
Performance criteria and tesL5, 5.1.6. l, .,.1.6.2, 5.1.12, 5.1.13.12, Dental gas and vacuum systems, 15.!i
15.3.2.IO, A.5.1.12, B.5.1 Distribution, 5.3. LO
Pressure and vacuum indicators, 5.1.8, 5.1.13.7, 1.,.3.2.6, B.5.2.5, Hazards, nature of: 5 .3. 2
B.5.2.14 Labeling and identification, 5.3.3.1, !i.3.11
Reserve supply, 5.1.9.2.4, B.5.2.10 to B.5.2.13
Manufactured assemblies, 5.3.6
Sources, 5.1.3, A.5.1.3, B.5.2.l to B.5.2.4, B.5.2.6 to B.5.2.H; see Medical-surgical vacuum systems, 5.3.3.7
also Central supply systems
Operations and management, 5.3.3.2
Dental air systems, 15.3.3.3
Oxygen central supply systems using concentrators, 5.3.3.5.11
Instrument air supply systems, see Instrument ai,; Supply
systems Performance criteria and tests, 5.3.12
Medical air supply systems, 5.1.3.6, 15.3.2.1.5, A..,.1.3.6, Pressure and vacuurn indicators, 5.3.8
B.5.2.6 to B.5.2.8 Scavenging systems, s,;,e Scavenging
Medical,surgical vacuum supply systems, 5.1.3.5 (.,), 5.1.3.7, Sources, 5.3.3
5.1.12.4.14.6, 15.3.2.1.7, A..5.1.3.7 Medical air supply systems, 5.3.3.6
Reserve supply, see Resen'e supply Station inlets, .5.3.5
Support gases, 5.1.13.3, A.. ,.1.13.3.7 Station oulleL5, 5.3.5
Verification of equipment, 5.1.12.4.14, 5.1.14.7.6 Surface-mounted medical ga5 rail systems, 5.3.7
Waste anesthetic ga5 disposal (WAGD), 5.1.3.8, A.5.1.3.8 TesL5, performance, 5.3.12
Station inlet5, s,?e Station inleL5 Valves, S£e Valves
Station oulleL5, see Station outleL5 Wa5te anesthetic gas disposal (WAGD) systems, ,. .3.3.8. 5.3.12
Support gases, 5.1.13, .,.1.14.4, 15.3.2.11, A.5.1.13.1, A.5.1.13.1.2 Category 3 vacuum systems, see also Category 3 piped gas and
Breaching or penetratin!( of medical !(as vacuum systen1s
piping, 5.1.10.11.12.l Definition, 3.3.20
Central supply system for, 5.1.3.5.3 Management, 5.3.14
Joints, 5.1.10.3.l, 5.1.10.,�.2 Operation, 5.3.14
Surface-mounted medical !(as rails, 5.1.7, 15.3.2.5, A.5.1.7 Performance criteria and tests, 5.3.12
Tests Source equipment, 5.3.3.7, 15.5.4
Maintenance program, 5.1.14.4.3, 5.1.14.7.1, 5.1.14.7.5 to Support gases, 5.3.13
5.1.14.7.7, A.5.1.14.4.3, B.5.2 Central su pply systems
Performance, see Performance criteria and tesL5 Category 1
ReteSt5, B.5.2 Components, 5.1.3.5, A.5.Ul.5, B.5.2.1 to B.5.2.4
Valves, see Valves Control equipment. 5.1.3.4, 5.1.13.3.5, 5.1.13.3.6.4
Category 2 piped gas and vacuum systems, 5.2; see nlrn Central Headers, see Headers
supply systems
Labeling and identification, 5.1.3.l, 15.3.2.1.1, A.5.1.3.l.l,
Alarms, 5.2.9, 15.4.2.10, 15.4.3.4 A.5.1.3.1.2
Applicahility of requirements, .,.2.1, A.5.2.1 Locations, 5.1.3.3, 15.3.3.2,A.5.1.3.3
Dental air and p iping systems, 15.4.3 Operations, 5.1.3.2, 15.3.2.1.2
Dental gas and vacuum systems, 15.4, 15.4.2,A.15.4.2.6.1 Reserve supply, see Reserve sup ply
Distribution, 5.2.10 Category· 2, ., .2.3.1 to 5.2.3.4
Hazards, nature of� 5.2.2 Labeling and identification, 5.2.3.l, 15.4.2.2
Installers, qualification of, 15.4.2.1, 15.4. 7.3 Locations, 5.2.3.3, 15.4.2.4
L'lheling and identificatio n, 5.2.3.l, .5.2.11, 15.4.2.11 Operations, 5.2.3.2, 15.4.2.3
Manufactured a5semblies, 5.2.6, 15.4.2.8 Category 3, 5.3.3.5
Operation and management, 5.2.3.2, 5.2.14, 15.4.!J, A.5.2.14 Labeling and identification, ,. .3.3.1
Performance criteria and test5, 5.2.12, 15.4.7, 15.4.8 Locations, 5.3.3.3
Piping, 15.4.4 to 15.4.!J Operations, 5.3.3.2
Pressure and vacuum indicators, 5.2.8, 15.4.2.!J Definition, 3.3.21, A.3.3.21
Source equipment, 15.4.2.5, 1.,.4.3.3 Hyperbaric oxygen systems, 14.2.1.4.4.1, 14.2.1.4.5.1, 14.2.1.4.7.1
Sources, 5. 2.3 Chamber atmosphere, s,;,e ALmosphere
Station outlets/inleL5, 5.2.5, 1.,.4.2.7 Check valves, 5.1.3.5.13.2(4), 5.1.4.9, l 5.3.2.11(2)(d)
Support gases, .,.2.13 Chutes, waste/linen, rn.6
Surface-mounted medical gas rails, 5.2.7 Circuit breakers, 6.7.4.1.2.l, A.6. 7.4.1.2.1
Valves, 5.2.4, 15.4.2.6, A.14.2.6.l.5

2021 Edition
99-242 H.E.AlTH CARE FACILITIES CODE

Circuits Filling, 11.7.3.5.3, 11.7.3.6.1, A.ll.7.3.6.l.l

Branch, see Branch circuiL� Handling, 5.1.3.2.2, .5.l.3.2.12, 5.l.3.3.l.8, .5.l.3.3.l. 9, 11.4.2.3,
Maintenance and tes1ing ot; 6. 7.4.1.2, 14.3.4.3.2.1, A.6.7.4.1.2.1 ll.5.2
Pa1ient bed loca1ions, 6.3.2.4.1 Labeling, 5.1.3.1, A.5.1.3.1.1, A..5.1.3.l.2
TclecommunicaLions facili1y, 7.3.1.2.1.7, 7.3.1.2.2. 7, 7.3.1.2.3.7 Liquid oxygen base reservoir containers, 11.7, A.11.7.3.1 10
Clean agent
A.11.7.3.6.l.l
Defini1ion, 3.3.22 DefiniLion, 3.3.29.l
Liquid oxygen portable containers, 11.7, A.11.7.3.1 to
ExLinguishers, A.14.2.1.2(3)
A. I I.7.3.6. 1.1
Cleaning, hyperbaric facilities, 14.3.4.7, A.14.3.4.7
DefiniLion, 3.3.29.2
Clinic.al IT network, 6.7.5.1.3.2(8), 7.3.3.5.1, 7.3.3.7, A.7.3.3.7.1 10
A.7.3.3.7.5 Safer;,· mechanisms, 11.6.4
Source, 11.2
Definilion, 3.3.23, A.3.3.23
Clinic.al support activities, emergency plan for, 12.5.3.3.6.4
Storage, 5.1.3.2.3, 5.1.3.2.7, 5.l.3.2.11, 11.3, 11.65
Controls
Closets, sprinklers in, 16.9.l.4, A.16.9.1.4
Central supply system, 5.1.3.4, 5.1. 13.3..5, .5.1.13.3.6.4
Clothing in hyperbaric chambers. 14.3.1.6.5. l. 14.3.1.6.8,
B.14.1.1.3.4 Electricaf equipment, 14.2.10.1.4(1)
Code Conveyors, 16.5.3
AdopLion Cooking operations, Ifi..'i .2. 3
Requirement�, 1.6 Cooling, essential electrical system generator sets, 6.7.1.2.6
Sample ordinance, Annex C Cords, see Power cords
Defini1ion, 3.2.3, A.3.2.3 Cover plates, 6.7.6.3.2, A.6.7.6.3.2
Enforcement, 1.6.2 Cranking batteries, 6. 7.1.3. 5, A.6.7 .1.3.5
Code calls, 7.3.3.1.4. A.7.3.3.1.4, A.7.3.3.l.4.l Critic.al branch, 6.7.5.1.1(2), 6.7.5.1.3, 6.7.5.l.4.3(B), 7.3.l .2.3.7(B),
14.2.6.4.3, 14.2.9.2.3.2, A.6.7.5.1.3, A.6.7.5.1.3.2(6)
Combustible (definition), 3.3.24
Combustible liquids
DefiniLion, 3.3.30
Critical care area (definition), Sf!i! PaLient care spaces, Category· I
Definition, 3.3.25, A.3.3.25
Critical equipment
Use of, 11.5. 1.2 .3
DefiniLion, 3.3.31
Combustion (definition), 3.3.26, A.3.3.26
Cross-connections, tests, 5.1.12.2.4, 5.1.12.4.3, l.'i.4.7.4.3, 15.4.7.5.3,
Communications, Sl!e Information technology and communicaLions
sys1ems 15.4.8.1.4, B.5. l
Crowd control, 13.8, A.13.8
Compact storage
Cryogenic fluid central supply system
Definition, 3.3.27
Bulk, 5.l.3.3.2.2, 5.1.3.5.5.2, 5.l.3.5.8.1( 4), 5.1.3.5.12, 5 . .l.3.10,
Fire protecLion, 16.ll, 16.12, A.16.11, A.lfi.12.3
A5.l.3.10
Mobile, 16.12, A.16.12.3
Bulk ni1rous, .5.l.3.3.l.7
Compartmentation of facility, 16.2
DefiniLion, 3.3.32.1
Compressed air starting devices, 6.7.1.3.6
DefiniLion, 3.3.32
Compressed medic.al gases (CMG), 5.l.3.10.l.l, 5.1.3.10.3.3.
Cryogenic liquids, 5.1.3.l.4 ro 5.1.3.1.6, 5.1.3.2.7, .5.l.3.2.8,
5.1.3.10.5.1, 5.l.3.10.7.l, 5.1.3.10.7.3 to .5.l.3.10:7.5,
A.5.1.3.10.1.1 5.l.3.3.l.l, 5.l.'.U.l.2(2), 5.l.3.5(2), 5.1.3.5(3).
15.4.2.2.4 to 15.4.2.2.6, 15.4.2.3.7, 15.4.2.3.8
Definition, 3.3.28, A.3.3.28
Bulk systems, 5.1.3.3.1 .10 , .5.l.9.2.4, 5.1.14.7.2, 5.1.14.7.3.
Conductive accessories, 14.3.4.fi.l A.5.l.3.3.l.IO, B.5.2.4, B.5.2.10 to BS2.13
Conductive surfaces, exposed Manifolds, cylinder, 5.1.3.5.8.1 ( 3), 5. .1.3.5 .11, A ..5.1.3.5 .11,
Definition, 3.3.54 B.5.2.2, B.5.2.3, B.5.2.4
Tests, 6.3.3.l.1.2, 6.3.3.1.1.3 Storage or transfilling. ventilaiion for, <J.3.6, A.9.3.6.3, A.9.3.6.5.1
Conductors Cylinders
Isolated ungrounded systems, 6.3.2.9.4 Connections, l l.2.1 to 11.2.3, l 1.2.8, 11.2.9, 11.6.3
IsolaLion of neutral, 6.7.2.1.2.13, A.6.7.2.1.2.13 DefiniLion, 3.3.33
Connections, 15.4.1.5 Handling, 5.l.3.2.2, 5.1.3.2. 7 to 5. l.3.2.10, 5.1.3.2.12, 11.4.2.3,
Exterior, 12 .5.3.3.6J; I U.2, 11.6, 11.6.5.5
Future, valves for, 5.1.4.8 Headers, see Headers
Connectors, flexible, see Flexible connecrnrs Labeling, 5.l.3.1, A.5.l.3.1.l, A.5.l.3.l.2
Construction Management, 11.6, 11.6.5.5
Central supply systems and storage, 5.l.3.3.2, A.5.1.3.3.2 Manifolds for, .<ee Manifolds
Healrh care facility, 16.2 Regulaiors, 11.2.4 10 11.2.6
Hyperbaric facili1ies, 14.2, A.14.2.1.1.1 10 A. 14.2. l.3. l Reserves, 5.l.<J.2.4, B.5.2.10 10 B.5.2.13
Containers, Sf!i! also Cylinders Safety mechanisms, 11.6.4
ConnecLions, l l.6.3 Source, 11.2
Definition, 3.3.29

2021 Edition
 INDEX 99-243

Storage, 5.1.3.2.3 to 5.1.3.2.7, 5.1.3.2.9, 5.1.3.2.11, 5.1.3.2.12, Health care microgrid system commissioning report, 6.10.7.3
5.1.3.3.4, 11.3, 11.6.5, B.l1.4 HVAC, 9.3.3.2, A.9.3.3.2
Supply systems, 5.1.3.fi.l(l), 14.2.1.5.4.7(2) Installers, 5.1. I0.1.8
Transfilling, 11.5.2.2, 11.5.2.3, 11.7.3.fi, A.11.7.3.6.1.1 Liquid oxygen, 11.7.2
Maintenance, -�.l.14.4.1, S.1.14.7.2, 10.S.3.l, 10.5.3.2, 14.:l.4.2,
-D- A.5.l.14.4. I
Decompression sickness, B.14.1.3.4.2 Manufacturers, 5.1.6.3, I0.5.3.1, 10.5.3.2
Definition, 3.3.34 Test procedures, 5.1.12.l.l, 5.1.14.4.3.1 (F). 6.3.4.l. A.6.3.4.1.1
Defend in place, lfi.7.4.3, lfi.9.1.3, A.16.9.1.3 Test records and reports, see Tests
Definition, 3.3.35, A.3.!t35 Double-insulated appliances. I0.2.2.1.2, 10.4.2.3
Defibrillators, l0.5.2.4, 10..'i.4.6. A.10.5.4.6 Definition, 3.3.44, A.3.3.44
Definitions, Chap. 3 Drains
Delayed-automatic connection, equipm ent for, 6.7.5.1.4.3, Hyperbaric chamber wiring enclosures, 14.2.9.3.7
fi. 7.5.1.4.4, fi.7.fi.2.l.6(D), fi.7.6.2.1.fi(E), A.fi.7.5.l.4.3, Drills
A.6.7.5.1.4.4 to A.fi.7.5.1.4.4(9), A.6.7.fi.2.1.6(E)
Emergency plans and operations, 12.5.3.3.8, B.12.1.1.7
Deluge systems, 14.2.6.2, 14.2.li.4.4, A.14.2.6.2.4. A.14.2.6.4.2
Fire, 14.3.1.S.4, 16.14.3.10.3
Demand check, 5.1.8.2.3, 5.1.8.2.4
Security management. 13.12.1, 13.12.2, A.13.12.1
Definition, 3.3.36
Dental air, 15.3.3.4, 15.5.4.2, A.15.3.3.4 -E­
Definition, 3.3.37 Egress, 13.fi, A.13.fi.3.l
Piping systems, 15.3.3, 15.4.3, A.15.3.3.4, A.15.3.3.5 Flectrical equipment, 5.1.3.3.2.l(11 ), 5.1.3.3.2.1 (13), Chap. I0,
So urce equipment, 15.4.3.3.2 A.!U.3.3.2, A.5.1.3.3.2(7) to A.5.1.3.3.2( 11); see alrn
Dental air compressors, I5.3.3.4.2, 15.4.3.3.2.2, 15.5.4.2.2 Patient-care-related electrical equipment
Dental gas and vacuum piping systems, Chap. 15 Administration, 105, A.10.5.2.2 to A.10.5.8.3
Applicability, 15.1 Cord- and plu!(•Connected (portable), 10.2.2, I0.4.2.
Category 1, 15.3, A.15.3.3.4, A.15.3.3.5 14.2.9.3.16.5
Dental air and vacuum piping systems, 15.3.3, A.15.3.3.4. Electrical preventive maintenance (EPM), 6.9, A.6.9.1.1 to
A.15.3.3.5 A.6.'l.4.2.2 (4)
Medical gas systems, 15.3.2 Emergency power supply systems (EPSSs), 6.11
Category 2, 15 .4 Fire protection, 16.5.1.2
Category 3, 15.5 Hazards, fi.2, A.6.2
Hazards, 15.2 Health care microgrids, 6.10, A.6.10.1.2 to A.fi.10.7.2(e)
Operation and management, l.�.5.8 Hyperbaric facilities, 14.2.IO.l.l, 14.3.4.4
Performance criteri a and testing, 15.4.7, 15.5.7 Instructions for, 10.5.3.1, 10.5.3.2, 10.5.fi.l
Dental office (definition), 3.3.38 Laboratory, 10.5.5, A.10.5.5.l
Dental vacuum, 1 5.3.3.5, 15.4.3.3.3, 15.5.4.3, A.15.3.3.5; see alrn Life support
Dental gas and vacuum piping systems Definition, 3.3.45
Tests, 15.4.8. 1.8, 15.5.7.1.3.5 Maintenance, 10S3
Dental vacuum/scavenging, l.�.4.3.3.4 Nonpalient, 10.4
Definition, 3.3.39 Not supplied by facility, I0.5.2.6
Dental vacuum systems, 15.5.2.2 Performance criteria, 10.2, A. I0.2.3.2.4
Dental vacuum units, 15.5.4.3.2 Permanently connected (fixed), I0.2.I
Detonation (definition), 3.3.40 Portable, 10.2.2, I0.4.2, 14.2.9.3.16, A. I0.2.6, A.10.,U to
Direct electrical pathway to heart A.10.3.6, A.14.2.9.3.16
Definition, 3.3.41, A.3.3.41 Protection, 6.3.2.8.4, A.6.3.2.8.4
Protection of pa lien Ls. 10.5.2.2. A.10.5.2.2 Qualification and training of personne 1, LO.!i. 8, A. LO .5.8.1,
A.10.5.8.3
Disasters (definition), 3.3.42, A.3.3.42; see alrn Emergency
management Recordkeeping, 10.5.fi, A. I0.5.6.2
D.LS.S. connectors, 5.1.14.4.3.l(D) Respiratory therapy apparatus, B.11.3.4.1.1 to B.11.3.4.2
Definition, 3.3.43 Site acceptance testing, 6.8, A.6.8.1, A.6.8.2
Distribution piping, 5.1. 13. IO System demonstration, I0..5.2.5. A.I0..5.2..5
Documentation Testing, 6.8, 10.3, I0.5.2.l, A.6.8.1, A.6.8.2, A.I0.3.1 to A.10.3.6
Brazing procedure, 5.1.10.11.I0.5, 5.1.10.ll.ll.4 Flectrical equipment branch, 6.7.5.1.1 (3), 6.7.5.1.4, A.fi.7.5.1.4.3 to
A.6.7.5.1.4.4(9)
Electrical equipment, records of, 10.2.3.6(5), 10.5.3.1, 10.5.3.2,
10.5.6, 14.2.9.3.2, 14.2.9.3.16.2, A.10.5.6.2 Flectrical hazards, 6.2, A.6.2
Electrical preventive maintenance program, 6.9.2, 6.9.3.l, Flectrical preventive maintenance (EPM), 6.9, A.6.9.1.1 to
A.6.9.3.1 A.6.9.4.2.2 (4)
Emergency management, 12.4.1, 12.5.3.3.2, 12.5.3.3.6.4(10), Defini lion, 3.3.4fi
14.3.l.5.4, A.12.4.1, A.12.4.1.1 Flectrical receptacles, see Receptacles

2021 Edition
99-244 HE.AlTH CARE FACILITIES CODE
Flectrical systems, l.1.4, Chap. 6; see c,lrn Essential elecrrical systems
Adminisrration of; 6.3.4, A.6.3.4.1.1
Design consideraLions, 6.7.1.1, A.6.7.1.1
Disrribution, 6.3.2, A.6.3.2
Isolared power sys rems, see Isolarcd power sysrems
Parient bed locarions, 6.3.2.4, A.6.3.2.4
Emergency plan, 12.5.3.'.l.6.5 ( I)
Equipment branch, 6.7.5.l.1(3), 6.7.5. 1.4, A.6.7.5.1.4.3 10
A.6.7.5.1.4.4 (9)
Fire protect.ion, 16.5.l.2 to 16.5.1.4
Hyperbaric facilities, 14.2.10.1.1
Information rechnology and communicalions
systems, 7.3.l.2.l.7, 7.3.1.2.2.7, 7.3.1.2.3. 7, 7.5.1.1.2
Insrrument air supply sysrems, 5.1.13.3.7.12
Isolared power sysrems, see Isolared power sysrems
Medical air systems, 5.1.3.6.3.10
Medical-surgical vacuum supply sysrems, 5.1.3.7.6
Patient care spaces
(;rounding systems, (j.3.3.1, A.6.3.3.l.l to A.6.3.3.1.4
Insrruclions for appliances, 10.5.3.1, 10.5.3.2, 10.5.(j_ I
Performance criteria and resLs, 6.3.3, A.6.3.3.1. I to A.6.3.3.1.4
Grounding systems in parient care rooms, 6.3.3.1, A.6.3.3.1.1
(0 A.6.3.3.1. 4
Isolared power systems, 6.3.3.3
Recepracle tesLing in parient care rooms, 6.3.3.2
Sources of power, 6.3.1, 6.7.I, A.6.7.1.1 to A.6.7.1.3.5
Alrernate, s� Alrernare power sources
Failure of, 6.7.3.3 to 6.7.,t7
Performance criteria and resLs, 6.7.!i.3.l, 6. 7.6.4.l
Power loss, emergency management of: B.12.3.2. 5
Transfer to, see Transfer switches
Type I essenlial cleCLrical sysrems, 6.7.l, A.6.7.1.l to
A.6.7.1.3.!i
Tests, 6.3.3, 6.3.4, A.6.3.3. I.l to A.6.3.3.1.4, A.6.3.4.1.1
Waste anesthelic gas disposa l (WAGD) systems, 5.1.3.8.4
Flectrica l wiring, B.6.1
EssenLial elecrrical systems, 6.7.5.2. 6.7.6.3, A.6.7.5.2.l,
A.6.7.6.3.l, A.6.7.6.3.2
Fire prorecLion, 16.5.1.2
Hyperbaric faciliries, 14.2.9.3 10 14.2.9.6
Isolared power systems, 6.3.2.9.2
Flectrocautery equipment, 14.3.2. 1.2 (2), 16.I4.3.2, 16.14.3.3,
A. I 6.14.3.2
Flectrode, 5.1.14.3.2, 6.3.2.9.3.7
Definirion, 3.3.47
Flectrostatic safeguards, hyp erbaric chambers, 14.3.4.6, A.14.3.4.6
to A.14.3.4.6.5
Flectrosurgery, lfi.14.3.2, 16.14.3.3, A.16.14.3.2
Flevators, 16.5.3, A.16.5.3.3, B. 12.3.2 ..�(2)
Alarm systems, 16.7.4.2.1
Essenliaf elecrrical systems, 6.7.5.1.2.4(5), 6.7.,,.1.4.4(3),
6. 7.6.2.l.'i(C) (6)
Temporary operarion ot; 6.7.6.2.l.6(E) (2), A.6.7.6.2.l.6(E)(2)
Emergency care, policies for, 1.3.3
Emergency generators, 16.5.l.3; see alto Generator seL,
Emergency management, l.l.10, Chap. 12. A.1.1.10; see fll<n
Emergency procedures
Adminisrration, 12.5.3.6
2021 Edition
Category I and Category 2 requiremenL,, 12.3, 12.5, A.12.5.3.1.2
to A.12.5.3.5
Commit1ee for, 12.2.3, A.12.2.3 to A.12.2.3.3, B.12.1.1.3,
B.12.l.l.6, B.12.3.3.1
Continuing operarions plan and recovery, B.12.4
Defini Lion, 3.3.48
General requirements, 12.4, A.12.4.1 10 A.12.4.2
Medical air, loss ot; 5.2.3.5(2)
l\tiLigaLion, 12.5.3.2, A.12.5.3.2.3(7), B.12.1.1.2
Preparedness, 12.5.3.3, A.12.5.3.3.6.1 (5) 10 A.12.5.3.3.9.8,
B.12.1.1.2
Program development, B.12.1
Responsibilities, 12.2
Aurhority having jurisdiction, A.12.2.1
Emergency management commit1ee, 12.2.3, A.12.2.3 to
A.12.2.3.3, B.12.1.1.3, B.12.1.1.6, B.12.3.3.1
Senior management, 12.2.2
sat·ery and securiry, 12.5.3.3.6.3, A.12S3.3.6.3
Special consideraLions and prorocols, B.12.3
Sraff educaLion, I 2.5.3.3.7
Surge capaciry ofviclims, 12.5.3.3.8.5, 12.5.3.4. IO,
A.12.5.3.4.10.1
Wa,te anesthetic gas di,posal (WAGD), loss of; 5.2.3.H (2)
Emergency operations plan, 12.2.3.3, 12.5.3.3.5, 12.5.3.3.8.
A.12.2.3.3, B.12.1.1.4 to B.12.1.1.7
Emergency oxygen supply connection (EOSC), 5.1.3.5.13,
A.5.1.3.5.13
Definilion, 3.3.49
Emergency power supply systems (EPSSs), 6. I I
Emergency power system (EPS) room HVAC S)Stems. 9.3.9
Emergency procedures, see fllso Emergency management
Hyperbaric faciliLies, 14.3.1.4.3, 14.3.1.5, A.14.3.1.5.2,
A.14.3.1.5.4, B.14.2, B.14.3
OperaLing room, 16.14.3.9
Emergency recovery, 12.5.3.5, A.12.5.3.5
Emergency response, 12.5.3.4, A.12.5.3.4.1 to A.12..'i.3.4.IO.l, B.12.3
Emergency systems, see Critical branch; Equipment branch; Life
safety branch
Employees
Emergency roles, 12.5.3.3.6.7, 12..'i.3.3. 7, B.12.2, B.12.3.2.8
(;as equipment cylinders and containers, handling of; 11.5.2.1,
A.11.5.2.1.l
(;as equipment senicing, 11.5.3.3.5, I 1.6.1.2
Hyperbaric chambers, 14.3.1.3, 14.3.1.6.3, 14.3.1.6.5,
A.14.3.1.3.2 to A.14.3.1.3.5, A.14.3.1.6.3, B.14.1.1.3.3
to B.14.1.1.3 ..5, B.14.1.2.2, B.14.1.3, B.14.3
Medical gas and vacuum sysrems, 5.l.10.11.10, 5.l .l0.11.11,
5.l.12.2, 5.1.14.4.2.5, .'i.l .14.7.4, B.5.1
Operating rooms, 16.14.3.10
Protection, 6.3.2.8.5
Respirarory rherapy, B.11.l.l.l , B.11.1.1.2, B.11.3.5, B.l UHi
Responsible facility authoricy, 5.1.14.1, .'i.1.14.2, A..5.1.14.2.1,
A.5.l.14.2.2(4)
Securiry management, 13.4, 13.10, 13.11, A.13.4.2(3) (c),
A.13.10, A.13.11
Training, .�eTraining, employee
Enclosures, gas system, 11.3.6. I, 11.4.2.2
Endotracheal tube, B.14.1.2.4
Definilion, 3.3.181.1, A.3.3.181.1
Energy converters, 6. 7.1.3.5, A.6.7.1.3.5
 INDEX
Equipment, see alw Electrical equipment
Critical
Definition, 3.3.31
Hyperbaric, 14.2, 14.3.2, A.14.2.1.l.l to A.14.2.1.3.1, A.14.3.2.2
to A.14.3.2.6
Portable
Electrical, see Elecu-ical equipment
Patient care gas equipment, 11.4.l, A.11.4.1.1 to A.11.4.1.4
Rack or cart, 11.4.3.1
Equipment branch, 6.7.6.2.1.2(2), 6.7.fi.2.l.6, 7.3.l.2.2.8(8)
Definition, 3.3..�0
Equipment grounding bus, I 0.2.1
Definition, :LU; I
Equivalency to standard, 1.4
&calators, 16.5.3
&sential electrical systems_, 5.1.3.3.'.U (II),A.5.1.3.3.2(11 ), B.6.2,
B.6.3
Definition,3.3.52, A.3.3.52
Fuel cell systems, 6.7.1.5
Information technology and communicalions systems, see
Informal.ion technology and comni'unicalions
systems
Sources, 6.7.l,A.fi.7.l.l to A.fi.7.l.3.5
T}pe I, fi.7.5, A.6.7.5 to A.6.7.5.2.1
Administration, 6.7.4, A.6.7.4.l.l.5 (A), A.6.7.4.l.2.l
Alternate power sources, 6.7.l.2, 6.7.4.l.l, A.6.7.l.2.l to
A.6.7.l.2.7.2 (H), A.6.7.4.l.1.5(A)
Branches, 6.7.2.2, A.fi.7.2.2.5(8)
Distribution, 6.7.2, A.6.7.2 to A.6.7.2.2.5(B)
Fuel cell systems, 6.7.1.5
Generator sets, fi.7.1.3, A.6.7.I.3.4 to A.6.7 .l.3.5
l\faintenance and testing, 6.7.4.1, A.6.7.4.1.l.S(A),
A.6.7.4.1.'.U
Performance criteria and tesLs, 6.7.5.3
Sources, 6.7.l, A.6.7.l.l to A.6.7.1.3.5
Type 2, 6.7, 6. 7.6, A.6.7.6 to A.6.7.6.3.2
Distribution, 6. 7.2, A.6.7.2 to A.6.7.2.2.5(8)
Performance criteria and tesLs, 6.7.6.4
Sources, 6.7.l, 6.7.6.4.1, A.6.7.1.1 to A.6.7.1.3.5
Evacuation, waste gas, see 'Waste anesthetic gas disposal (WAGD)
systems
Evacuation of occupants
Emergency plan, B.12.3.2.11, B.12.3.3
Hyperbaric facilities, B.14.3.1
Natural disasters, due to, B.12.3.2.11
Oxygen-enriched aunosphere (OEA), B.11.3.2.1
E.xh.aust systems, 6.7.5.l.4.3(A)(5), fi.7.5. l.4.3(A) (6),
6. 7.5.1.4.4(4); sn; r,/so Ven Lila Lion
Emergency systems, 6.7.5.1.4.4(4)
Hyperbaric facilities, 14.2.l 1.2, A.14.2.11.2, A.14.2.11.2.5
Medical gases storage or transfilling areas, 9.3.6.5.3
Vacuum or scavenging source, 5.1.3.7.7
Waste anesthelic gas disposal (WAGD) systems, 5.1.3.8.5
E.xposed conductive surfaces
Definition, 3.3.54
Tesrn, 6.3.3.1.l.2, 6.3.3.1. 1.3
E.!{tension cords, 10.2.4, 10.5.2.3; see alw Power cords
Exterior connections, 12.5.3.3.6.6
99-245
Extinguishers, portable fire, 14.2.6.1.5, 16.10.I, A.14.2.6. 1.5,
A.16.10.1, B.11.3.4.2, B.14.2.1, B.14.3.2
E.xtinguishing systems, see Fire exlinguishing systems and
equipment
-F-
Facility fire plan, B.11.3.2.I (2), B.12.3.1; see alw Emergency
operalions plan
Definition, 3.3.55,A.3.3.55
Failure
Power sources, 6.7.3.3 to 6.7.3.7
Fault current, 6.3.2.3.2, 6.3.2.9.'.U, 6.7.2.1.1.1, 14.2.9.3.6.4,
A.6.3.2.9.3.1
Definilion, 3.3.56
Fault hazard current, 6.3.2.9.3.2 to fi.3.2.'l.3.5
Definilion, 3.3.72.l
Feeders
From alternative source, 6.7.2.2.6
Circuit breakers, inspect.ion ot; 6.7.4.1.2.1, A.!i.7.4.1.2.1
Definition, 3.3.57
Insulation resistance, 6.7.4.1.2.2
FGI guidelines, 8.3.1 to 8.3.3, 8.3.6, 8.3.8, 8.3.12, 9.3.IO, A.'i.1.5,
A.7.1
Definilion, 3.3.58, A.3.3.58
Filters, air
Instrument air, 5.1.13.3.7.8
Medical air, 5.1.3.6.3.8, 5.l.3.6.3.9(E), !i.l.3.6.3.9(F),
5.1.3.6.3.9(1), 5.2.3.5(1), A.5.l.3.6.3.9(F)
Final tie-in tests, 5.1.12.4.9, 15.4.7.5.7
Fire alarm systems, see Alarm systems
Fire blankets, 14.2.6.1.5, A.14.2.6.1.5
Fire dampers or shutters, 6.7.l.3.4.2(C). 6.7.1.3.4.5, 16.7.4.2.2
Fire detection systems, 16.7; see alrn Alarm systems; Smoke alarms/
detectors
Hyperbaric facililies, 14.2.6.4, 14.2.8.2, A.14.2.6.4.2
Fire extinguishing systems and equipment, 16.9,16.10, 16.12.3,
16.13, A.16.10.1 to A.16.10.2.2, A.16.12.3, B.12.3.2. 7; see
nlm Fire protect.ion
Hyperbaric chambers, 14.2.6, B.14.2.1
Respiratory therapy apparatus, B.11.3.4
Telecommunicalions facililies, 7.3.1.2. 1.8 (D), 7.3. l.2.3.8(8)
Fire fighters' emergency operations (elevator), 16.5.3.2
Fire hazan:ls
Dental gas and vacuum piping systems, 15.2
Electrical systems, 6.2.1, A. 6.2.l
Gas systems, 5.1.2, 5.3.2
H}perbaric facililies, B.14.l.l
Oxygen delivery equipment, 11.5.l.l.6, I1.5. 1.2.2
Oxygen-enriched aunospheres (OEA�), I 1.5.1.2.1
Respiratory therapy, 11.5.l.l, 11.5.1.2, A.11.5.1. 1.2, A. ll.5.1.1.3,
B.11.3.1
Fire preventfon
Hyperbaric facililies, 14.3.1.6, A.14.3.1.6.1.l, A.14.3.l.fi.1.3
Operating rooms, 16.14,A.16.14.3.2
Fire protection, 12.5.3.3.!i.5(fi), Chap. 16
Construct.ion and compartmental.ion, 16.2
Hyperbaric facililies, 14.2.6 to 14.2.8, B.14
Respiratory therapy, B.11.3
Flammable (definition), 3.3.59, A.3.3.59
2021 Edition
99-246 H.E.AlTH CARE FACILITIES CODE

Flammable ga.�es, 14.3.l.6.2; see also Cylinders; Gases DefiniLion, 3.3.68.2

Definition, 3.3.60; see alrn Cylinders DefiniLion , A.3.3.61'
Hy perbaric facilities, 14.3.2 .6.1, 1 4.3.3. 3, l4.3.4. 1.4.l General anesthesia, 5.l.1.2(1), 5.1.3.3.1.5(2), 5.1.9.4(1) ,
Special hazard protect.ion for, lfi3, A.16.3.2 5.1.9.4.4(2), 6.3.2.6.1, 15.3.1, A.5.l.9.4(2)
Storage, 14.3.3.3, 14.3.4.1.4.l Definition, 3.3.68. l
Valves, 5.1.4.1.5 Minimal sedation (anxiolysis), 3.3.38, 3.3.110, 5.2.I.2, 5.3.l.2,
Flammable liquids, 16.14.'.l.2, A.16.14.3.2
l.5.1.2, 15 .4.1.1
Definition, 3.3.68.4
Definition, 3.3.61
Moderate sedation/analgesia (conscious
In hyperbaric chambers, 14.3.1.6.2, A.14.3.1.6.2.2 (2)
sedaLion ), 5.1.3.3.l.5(2), 5.1.9.4(1), 5.1.9.4.4(2),
Special hazard protect.ion for, 16.3, A.16.3.2 ASI.9.4(2)
Use ot; ll. 5. 1.2 .3 DefiniLion, 3.3.68.3
Rammable substances and agents, misuse of, ll .5.1.2 Generator sets
Flash point, 3.3.25 Alarm annunciator, 6.7.l.2. 7, A.fi.7 .l.2.7.2 (B), A.6.7. 1.2.7.2 (H)
Definition , 3.3.62, A.3.3.62 Design considerations, 6.7.l. l, A.6.7.l. l
Rexible connectors Fire protection, I6./i. 1.3
Category I, 5.1.6.4, 5.l.6.5, fi.l.6.8, 5.1.10.11.6, 5.1.14.4.3.l Fuel cell systems, 6.7.1.5
Cate11:ory 2. 15.4.5.10 Fuel supply, 6.7.1.3.7
Flexible cords, see Power cords Hyperharic chambers, 14.2.9.2.3.1
Row-control valves, 11.5.3.3.l Maintenance and cesLing , fi.7.4.l.l. A.6.7.4.l .l.5(A)
Definition, 3.3.63 Power loss, emergency management ot; B.12.3.2.5
Flowmeters Safety devices, 6.7.1.3.8
Definition, 3.3.64, A.3.3.64 Type l essential electric at systems , 6.7.1.2.4, fi.7.1.3, 6.7.2,
Labels on, 11.5.3.1.3 A.fi.7.1.3.4 to A.6.7.1.3.5, A.6.7.2 to A.6.7.2.2.!i(B)
Footwear, nails in, 14.3.l .6.3.3 Germicides, 16.14.3, A.16.14.3.2
Frequency (definition), 3.3.65, A.3.3.65 Governing body, 6.!i.2.3.4, 6.3.2.3.5, 6.7.!i.l .3.2(7), 8.2, 9.2,
Fuel supply or sources, 6.7.l.3.7, 12.5.3.3.2, 12.5.3.3.6.5. A.6.3.2.il.4, A.6.3.2.3.8, A.8.2.1, A.9.2. l
A.12.5.3.3.6.5, B.14.l.l.3 Grease interceptors, 8.3. 7
Fume hoods, 6.7.5.l.4.3(A) (6) Ground-fault circuit interrupters (GFCis), fi.3.2.3.8, 6.3.2.3.<J.
Definition, 3.3.66, A.3.3.66 6.3.2.8.5
FundamentaJs, Chap . 4 Definition , 3.3.69, A.3.3.69
Furniture, hyp erbaric facilities, 14.3.4.5 Ground-fault protection, 6.3.2.8, fi.3.3.4, 14.2.<J.4, A.6.3.2.8.4
Grounding, 6.3.2.2..5, A.6.3.2.2.5; see alrn Grounding systems
-G­ Appliances, 10.2.2.l, 10.4.2.3
Gas cylinders, see Cylinders Hyperbaric chambers, 14.2.2.fi.3, 14.2.9.4, 14.2.11. l
Ga.� equipment, Chap . 11 PaLient care spaces, 6.3.2.5, 6.3.3.1, A.6.3.2 ..5.l.5, A.6.3.2.5.3,
Administration, 11.5, A.l lSl.l .2 to A.ll.5.3.2 A.fi.3.3.l.l to A.6.3.3. l.4
Cylinders and containers, 11.2, lUi, l l.6.5 Piping system, 5.l.14.3.2
Fire protect.ion, 16.5.l.l Special, 6.3.2. 3.1, A.6.3.2.'.U
Performance criteria and test�, 11.4, A.ll.4.1.l to A.ll.4.1.4 Grounding circuit integrity, 6.3.2..5.1.1
Qualification and training of personnel, 11.5.3.3.5 Grounding conductors, 10.2.3.2, A.10.2.3.2.4
Source, 11.2 Grounding point
Transport, storage, and use, 11.5.3.3 PaLient equipment, fi.3.2.5.2
Use, 11.5.3 Definition, 3.3.142
Gases, se,e also Viaste anesthetic 11:as disposal (WA(,D ) systems: Reference, see Reference grounding point
specific gases Grounding systems
Flammable, see Flammahle gases DefiniLion, 3.3. 70, A.3.3. 71
Handling, 14.3.3, A.14.3.3.4 TesL�, fi.3.3.l.l, A.6.3.3.l.l
Medical, s& Medical gases Guide (definition), 3.2.4
Monitoring, hyperbaric chambers , 14.2.10.3 to 14.2.10.6
-H­
Nonflammable, 11.3.5; see also Medical gases
Oxidizing, see Oxidizing ga� Handlines, 14.2.6.3
Gasket material, 1 4.2.3.l (2) Hand trucks, 11.4.3. l
Ga,;.powered systems (definition), 3.3.67 Hazard current
Gas systems, see Medical gas systems Defini Lion, 3.3. 72
Gas tungsten arc welding (GTAW), 5.1.10.5.l, A.5.1.10.5.1.5 Fault hazard current, .<1� Fault hazard current
General anesthesia and levels of sedation/analgesia Monitor, fi.3.2.9.3.4, A.6.3.2.9.3.4
Deep sedaLion/analgesia, .5.1 .I.2( l), 5.1.3.3.I.5(2), 5.1.9.4(1 ), DefiniLion, 3.3.72.2
.5.1.9.4.4(2), 6.3.2.6.1, 15.3.1, A..5.1.9.4(2)

2021 Edition
 INDEX 99-247

Total, 6.3.2.9.3.2, 6.3.2.9.3.4, 6.3.2.9.3.6 Oxygen, A.11.5. l. l. 3

Definition, 3.3.72.3 Definition, 3.3.133, A.3.3.133
Hazards Hose
Fire, see Fire hazards Gas and vacuum systems, .5.l.6.4, .'i.1.6.5, 5.1.fi.7 to 5.1.6.9,
Nature of 5.1.10.11.6
Hyperbaric facilities, 1-:1.3.1.2, 14.3.1.6, A.14.3.l.2, Standpipe and hose systems. 16.10.2, A. Hi. I0.2.2
A.14.3.l.6.l.l, A.14.3.l.6.l.3, B.14.1 Hospitals
Piped gas and vacuun1 systen1s, 5.1.2, 5.2.2, 5.3.2, 15.2 Definition, 3.3.78
Hazard vulnerability analysis (HVA), 12..5.2, 12.5.3.1, A.12.5.3.l.2. Governing body, s1:e Governing body
A.12.5.3.1.3(1), B.12.1.1.1, B.12.3.2.1, B.12.3.3.1 Humidification, 11.4.2.4, 14.2.4.3.3
Headers Humidifiers, 11.4.2.5, 11.4.2.fi
Instrument air, 5.1.3.5.9, 5.1.3.5.10.4 to 5.1.3.5.10.6, 5.1.3.5. l1.2 Definition, 3.3.79
to 5.1.3.5.11.9, 5.1.13.3.6.8, 5.1.13.3.7.10,
Humidity control, 7.3.l.2.1.8(A), 7.3. l.2.2.8(A), 7.3.l.2.3.8(A),
5. l.13.3.7. ll (B), A.5.l.3.5.9
14.2.4.3
Local signals, 5.1.3.5.8.1 (6) Hydrostatic tests, 14.2.l.l.9.l
Reserve, 5.1.3.3.l.4, .5.1.3.3.-:1.2, 5.1.3.5.11.3, 5.1.3.!U 1.4(2),
Hyperbaric facilities, 1.1.12, Chap. 14, A.l.l.12
5.1.3.5.11.8, .5.l.3.5.11.9, 5.1.9.2.4(4)
Administration and maintenance, 14.�\, A.14.3.l.2 to A.14.3.1.6.9
Standby, 5.1.3.3.l.2 ( 4)
Air supply, monitoring of, 14.2.10.6, A.14.2.I0.6, A.14.2.10.6.l
Medical air, 5.l.3.6.3.4(C), 14.2.1.5.4.7(2)
Chambers, classification, 14.1.2
Health care facilities (definition), 3.3.73, A.3.3.73
Communications and monitoring equipment, 14.2.IO
Health care facility's governing body, 4.2.1 to 4.2.2, A.4.2.2
Construction and equipment, 14.2, 14.3.2, A.14.2.l.l.I to
Definition, 3.3.74, A.3.3.74
A.14.2.1.3.1, A.14.3.2.2 to A.14.3.2.fi
Health care rnicrogrid, 6.7. l.6, 6.10, A.6. I0.1.2 to A.6.IO. 7.2 (e)
Definition, 3.3.80
Definition, 3.3.75, A.3.3.75
Electrical equipment, 14.3.4.4, A.10.5.4.5, A.10.5.4.6
Health care microgrid control system, fi.HUi, A.6.10.6
Electrical systems, 6.7.5.1.4.4(5), 14.2.9, A.14.2.9.2.1 to
Definition, 3.3.76 A.14.2.9.6. l.l
Heart, direct electrical pad1way to Emergency depressurizal.ion capabil ity, 14.2.5
Definition, 3.3.41 Emergency procedures, 14.3.1.4.3, 14.3.l.5, A.14.3.1.5.2,
Protection of paLienLs, 10.5.2.2, A.I0.5.2.2 A.14.3.1.5.4, B.14.2, B.14.3
Heating, adiabatic, see Adiabatic heating Fabrication of chamber, 14.2.2, A.14.2.2.1
Heating, ventilating, and air conditioning (HVAC) systems, Chap. 9 Fire prevention, 14.3.1.6, A.14.3.1.6.l. l , A.14.3.1.6.1.3
Commissioning, 9.3.3, A.9.3.3.2 Fire protection, 14.2.6 to 14.2.8, B.14
Ductwork, 9.3.5 Gases
Emergency plan, 12.5.3.3.65(5), B.12.3.2.5(2) Handling of; 14.3.2.2 to 14.3.2.4. 14.3.3, A.14.3.3.4
Emergency power system room, 9.3.9 Monitoring ot; 14.2.10.3 to 14.2.10.6
Energy c onsen•atio n, 9. 3.2 Hazards, nature ot; 14.3.l.2, 14.3.l.6,A.14.3.I.fi.l.l,
Fire protection, 16.5.2, A.16.5.2.1 A.14.3.l.6. l.3, B.14.l
Information technology and communications Housing for, 14.2.l
systems, 7.3.l.2.1.8(B), 7.3.l.2.2.8(B), 7.5.1.1.3, Ignition sources, 14.3.l.6. l, A.14.3.l.6. l.l, A.14.3.l.fi.3
A.7.3.l.2.l.8(B) Illumination, 14.2.3
Medical plume evacuation, 9.3.8 Intercommunications equipment, 14.2.10.2, A.14.2.10.2 to
Piping, 9.3.4 A.14.2.l0.2.2
Smoke detectors, 16.7.4.2.2 Other fixtures and equipment, 14.2.l I, 14.3.2, A.14.2.11.2,
System category criteria. 9.2, A.9.2.1 A.14.2.11.2 ..'i, A.14.3.2.2 to A.14.3.2.fi
Waste gas, 9.3.7 Personnel, 14.3.1.3, 14.3.1.6.3, 14.3.l.fi.5, A.14.3.l.3.2 to
Heating eq uiprnent
A.14.3.1.3.5, A.14.3.1.fi.3
Essential electrical system generator sets, 6.7.1.2.6, 6.7.1.3.4, Rules and regulations, 14.3.1.4, A.14.3.1.4.1
6. 7.6.2.1.6(E) ( 1), A.6.7.1.3.4, A.6.7.6.2.1.6(E)( I) (a) Ventilation of chambers, 14.2.4, 14.2.11.2, A.14.2.4.l.2 to
\Vater healing, 8.3.3 A.14.2.4.4. l, A.14.2.11.2, A.14.2.ll.2.5
Viewports, 14.2.2.7, A.14.2.2.7, B.14.1.2.3
Heliports, 16.8, A.16.8
Helium, see Medical gas systems
Wiring and service equipment, 14.2.9.3 to 14.2.9.fi
Hyperbaric operations (definition), 3.3.81, A.3.3.81
High-energy devices, 14.3.2.1.2(3)
Hyperbaric stand-alone oxygen system, 14.2.1.4.5, 14.2.1.4.7.
High pressure, see Pressure
14.2.1.5.4.3, 14.2.1.5.4.6
Horne care, 1.3.l
Definition, 3.3.82
Definition, 3.3.77, A.3.3.77
Hypobaric facilities
Ho od�
Definition, 3.3.83
Fume, 6.7.5.1.4.3(A)(6)
Electrical systems, 6.7.5.l.4.4(fi)
Definition, 3.3.fi6, A.3.3.fi6
Hypoxia (defmition), 3.3.84, B.11.2.13

2021 Edition
99-248 H.E.AlTH CARE FACILITIES CODE

-1- Supply systems, 5.1.1.3, A.5.1.1.3; see also Medical gas systems
ldentification, see Labeling and identification Category 1 piped gas and vacuum systems, 5.1.3.5(7), Table
5.1.11, 5.1.13.3. 7
Ignition sources, set alw Fire hazards
Alarms, 5.1.9.5, 5.1.13.3.7.11, A.5.1.9.5
Hyperbaric facilities, 14.3.1.6.1, A.14.3.1.6. 1.1, A.14.3.1.6.3,
B.14.1.1.4 Headers, 5.1.13.3.6.8, 5.1.13.3.7.10, 5.1.13.3.7.11 (B)
Respiratory· therapy locations, 11.5.1.1, A.11.5.1.1.2, A.11.5.1.1.3 Category 2 piped gas and vacuum systems, 5.2.3.9
Immediate restoration of service (definition), 3.3.85 Category 3 piped gas and vacuum systems, 5.3.3.9
Impedance Insulation resistance, circuitry, 6.7.4.1.2.2
Definition, 3.3.86, A.3.3.86 Integrity tests, 10 .3.1, A. l 0. 3.1
Of isolated wiring, 6.3.2.9.2 Intentional expulsion, site of, Jee Site of intentional expulsion
Limit, 6.3.3.1.6.2 Intermittent positive-pressure breathing (IPPB)
Measuring, 6.3.3.1.4 Defini Lion, 3.3. 89, B.11.2.15
Incident command s,,stem (ICS), 12.2.3.3, 12.5.3.3.7.3, 12.5.3.3.7.5. Internal combustion engines, 6.7.1.3.8.1
A.12.2.3.3, B.12.3.2.1 Intrinsically safe
Definition, 3.3.87 Circuits, hyperharic chamber, 14.2.6.1.3.1, 14.2.9.3.6.5
Incinerators, 16.6 Definition, 3.3.90, A.3.3.90
Inert gas bulk systems, 5.1.3.3.1. LO, A.5.1.3.3. 1.10 Invasive procedure (definition), 3.3.91
D efinition, 3.3.19.1 Isolated ground receptacles, 6.3.2.2.5, A.6.3.2.2.5
Inert gases Isolated patient leads, 10.5.2.2, A.10.5.2.2
DL�tribution of; A.5.1.1.3 Definition, 3.3. 92
P urging of; B.14.5 Isolated power systems, 6.3.2.3. 7, 6.3.2.3.8, 6.3.2.9, A.6.3.2.9 to
Information technology and communications systems, Chap. 7, A.6.3.2. 9.3.4
16.7; see also Alarm systems Definition, 3.3.93, A.3.3.93
Category I, see Category 1 information technology and Tests, 6.3.3.3, fi.3.4.1.3
con1n1unicaLions systems Isolation switch, bypass, 6. 7.2. l..'i, A. 6.7 .2.1.5. ,l
Category 2, 7.4 Isolation transformers, 6.3.2.9. l
lnfrastrucmre, 7.4.1 Definition, 3.3.94
Nurse call systems, 7.4.3.1
Category 3, 7.5 -J-
Circuit�, mechanical protection ot; 6.7.!i.2.2 Joints, 5.1.10.3, 15.3.3.7.3.2(D), 15.4.4.2.4, 15.4.4.3.4, 15.4.4.4.2.3,
Clinical information systems, 7.3.3.7, A.7.3.3.7.1 to A.7.3.3.7..'i A.!i.1.10.3.1
Emergency plan, 12.5.3.3.6.1, A.12.5.3.3.6.1(5 ), B.12.3.2.5(2), Axially swaged, 5.1.10.3.1(4), 5.1.10.7, 15.4.4.2.3.1, 15.4.4.2.3.5
B.12.3.2.6 Brazed, 5.1.10.3.1(1 ), 5.1.10.4, 5.1.10.11.11, 15.3.3.7.2.4,
Essential electrical systems, 6.7.6.2.1.5(C) ( 4), 7.3.l.2.2.7(B). 15.3.3.7.2.5, 15.3.3.7.3.2(C), 15.3.3.7.3.2(D),
7.3.1.2.2.B(B), A.6.7.6.2.1.5(C) ( 4) 15.4.4.2.3.1, 15.4.4.2.4.1, 15.4.6.2, 1.5.4.6.4, 1.5.4.6.7,
Hyperharic facilities, 14.2.10 15.4.6.8, 15.5.5.2.3, 15.5.5.2.4, 15.5.5.3.2.2,
15..5.5.3.2.3
Life safety branch, 6.7.5.1.2.4(3)
Memory metal, 5.1.10.3.1 (3), 5.1.10.6, 15.4.4.2.3.1, 15.4.4.2.3.4
Wireless phone and paging integration, 7.3.3.5, A.7.3.3.5.2
Prohibited, 5.1.10.10, 15.4.4.2.4.3
Inhalation anesthetics, see Anesthetic apparatus; Anesthetics;
Anesthetizing locations Special fittings, 5.1.10.9
Inlets, see Siation inlet� T hreaded, 5.1.10.3.1(5), 5.1.10.8, 15.4.4.2.4.2, 15.5.5.2.4(1),
15..5.5.3.2.3( I), A.5.1.10.8(3)
In-line valves, 5.1.4.7, 5.1.4.9
Welded, 5.1.10.3.1 (2), 5.1.10.!'i
Inspections
Category I piped gas and vacuum systems. 5.1.12.3, 5.1.14.4.2.2, -L-
.5.1.14.4.2.3, 5.1.14.4.3, 5.1.14.7.4, A.5.1.14.4.2.2,
A.5.1.14.4.3 Labeled (definition), 3.2.5
Category 2 piped ga� and vacuum systems, 15.4.7 ubeling and identification
Circuit breakers, 6.7.4.1.2.1, A.6.7.4.1.2.1 Cylinders and containers, 5.1.3.I, 11.3.12, A.5.1.3.1.1, A.!i.1.3.1.2
Health care microgrid system, 6.10.8 Gas equipmem, 11.5.3.1, 11.5.3.2, A.11.5.3.2
Instructions Gas/,,1cuum systems, 5.1.11, 5.1.14.5, 5.2.3.1, 5.2.11, 5.3.3.1,
Category I piped ga5 and vacuum systems, 5.1.3.5.1, 5.1.I0.3.3, 5.3.11, 1.5.3.2.9, 15.4.2.2, 15.4.2.11, A.5.1.11
5.1.10.6.2, 5
. .l.10.7.2, .5.1.10.11.8, 5. l .12.4.l4.3(A), Alarm panels, 5.1.11.4, A.5.1.11.4.2
.5.l.12.4.14.5(B), 5.1.13.3.6.l (B) Outlets and inlets, 5.1.11.3
Category 2 piped ga� and vacuum systems, 15.4.9.3 Pipes, 5.1.11.1, A.5.1.11
Category 3 piped ga5 and vacuum systems, 1.5.5.8.2 Shutoff valves, 5.1.11.2
Electrical equipment, 10.5.3.1, 10.5.3.2, 10.5.6.1 Support gas, 5.1.13.11
Liquid oxygen equipment, 11.7.2 Verification of; 5.1.12.4.14
Instrument air, see also Support gases Hyperharic facilities, 14.2.6.l .7, 14.2.8.1
D efinition, 3.3.88, A.3.3.88 Oxygen, 11..'i.3. l, 11..'i.3.2, A.11.5.3.2

2021 Edition
 INDEX 99-249

Respiratory therapy, 11.5.3.1, 11.5.3.2. A.11.5.3.2 Cry•ogenic liquid containers, 5.1.3.5.8.1 (3), 5.1.3.5.11, 5.1.'.U0.8,
Valves, 5.1.4.1.3 5.1.13.3.6.9, 5.1.13.3.6.10, 5.3.3.5.12, 5.3.3.5.13,
Laboratories
9.3.6.5, A.5.1.3.5.l l, A.5.1.3.10.8.:\, A.9.3.6.5.1,
B.5.2.2, B.5.2.3, B.5.2.4
Definition, '.{.3.95, A.3.3.9!i
Cylinders without reserve supply, for, 5.1.3.5.8.1 (1)
Electrical equipment and appliances, l0.5.5, A.10.5.5.1
Definition, 3.3.103
Electrical outlet.sin, 6.3.2.2.7, A.6.3.2.2.7
Ventilation of manifold areas, 9.3.6.5, A.9.3.6.5.1
Fire protection, 16.4, 16.5.2.4
Manual extinguishing equipment, 16.IO, A.16.10.1 to A.16.10.2.2
Heating, ventilating, and air conditioning (HVAC)
Manufactured assemblies
systems, 9.3.1.2
Category I piped gas and vacuum systems, 5.1.6, 5.1.13.6,
Ventilation, 16.5.2.4
5.1.14.4.3.1, 15.3.2.4, A.5.1.6
Lasers, 14.3.2.1.4, 16.14.3.2, 16.14.3.3, A.16.14.3.2
Category 2 piped gas and vacuum systems, 5.2.6, l'i.4.2.8
Leakage current, see alrn T ouch current
Category· 3 piped gas and vacuum systems, 5.3.6
Fixed equipment, I0.3.4
Definition, 3.3.104, A.3.3.104
Limits, 10.3.3.4, l0.3.6, A.10.3.6
Manufacturers
Portable equipment, I0.3.6, A.10.3.6
Documentation, 5.1.6.3, 10.5.3.1, 10.5.3.2
Tests, 10.3.3, 10.3.4.l, 10.3.6, A. 10.3.3, A.10.3.6
Instructions, see Instructions
Leak detectant, 5.1.12.2.3.5, 5.1.12.4.9.2
Masks
Definition, 3.3.96
Definition, 3.3.IO'i
Life safety branch, 6. 7.5.1.1 (1), 6.7.5.1.2, 6.7.6.2.l.2 (l), 6.7.6.2.l.5,
Oxygen mask microphones, 14.2.I0.2.3
A.6.7.5.1.2.4 (3), A.6.7.6.2.1.5(C) ( 4)
Measurement, units of, 1.5, A.l.5
Definition, '.\.'.\.97
Media control, 13.7, A.13.7 to A.13.7.2
Life supp ort equipment, electrical, B.12.3.2.5 (I)
Medical air, 5.1.l.3, A.5.1.l.3; see alrn Dental air; Medical gas systems
Definition, 3.3.45
Alarms, 5.1.3.6.3.12
Lighting, B.6.3
Hyperharic chambers, 14.2.9.3.14, A.14.2.9.3.14 Category I supply systems, 5.1.3.5.2, 5.1.3.6, I 'i.3.2.1.'i, A.'i.1.3.6,
B.5.2.6 to B.5.2.8
Photographic lighting equipment, 14.3.2.1.3
Category 2 supply systems, 5.2.3.5
Limited-combustible material, 4.4.2, A.4.4.2
Definition, 3.3.IOfi, A.3.3.106
Definition, 3.3.98, A.3.3.98
Designation colors/operating pres.sures, Table 'i.l.11
Line isolation monitor, 6.3.2.9.3
Dryers, 5.1.3.6.3.3, 5.1.3.6.3.7, 5.l.3.6.3.9(E), 5. l.3.6.,t9(F),
Definition, 3.3.99 5.1.3.6.3.9(1), 5.2.3.5(1), 15.3.2.U(l),
Tests, 6.3.3.3.2 A.5.l.3.6.3.9(F)
Linen chutes, 16.6 Filters, 5.1.3.6.3.8, 5.l.3.6.3.9(E), 5.l.3.6.3.9(F), 5.1.3.6.3.9(1),
Liquids (definition), 3.3.IO0, A.3.3. LOO; Jee alrn Combustible liquids; l'i.3.2. I.'i (I), A.5.l.3.6.3.'l (F)
Flammable liquids; Oxygen Hyperbaric facilities, 14.2.l.5
Listed (definition), 3.2.6, A.'.1.2.6 Proportioning system for medical air (USP), 5.1.3.5(8),
Local signal 5.1.3.6.3.14, A.5.l.3.6.3.14(A), A.5.l.3.6.3.14(C)(\!),
Definition, 3.3.101, A.!t3.l01 B.'i.2.6, B.5.2.7
Proportioning syst.em for medical air, 5.l.3.6.3.l4(C)(9). Components, 5.l.3.6.3.l 4(C), A.5.l.3.6.3.14 (C)('l)
A.5.l.3.6.3.l4(C)(9) Definition, 3.3. l06.l
Lubr icants, 14.3.2.3 ( 4), 14.3.2.4, 14.3.4.5.3, 14.3.4.5.4 Location, 5.l.3.6.3.14(B)
TesLs, 5.1.12.4.14.5
-M- Purity tesL, 'i.1.12 .4.12
mA (definition), 3.3.102 Qualicy monitoring, 5.1.3.6.3.13
Main lines, p i ping Receivers, 5.1.3.6.3.6, 5. l.3.6.3.9(D), A.'i.l.3.6.3.'l(D)
Definition, 3.3.146.2 Regulators, .,.I.3.6.3.9(E), 5.l.3.6.3.9(F), 5.1.3.6.3.9(1),
Valves, 5.1.4.3, 5.1.11.2.5, A.5.l.4.3 15.3.2.l.!i (1), A.5.l.3.6.3.9 (F)
Maintenance Medical air compressors, see also Dental air compressors
Electrical preventive maintenance (EPM) program, 6.9, Category 1, 5.1.3.5(4), 5.1.3.6.1 (I), 5.l.3.6.3, 5.l.3.6.3.9(B).
A.6.9.1.1 to A.6. 9.4.2.2 (4) 5.l.14.7.7(1), 15.3.2.1.5(1), A.5.1.3.6.3, B.5.2.6,
B.!>.2.7
Essential electrical systems, B.6.2
Fire protection systems, 16.13 Alarms, .,.l.3.fi.3.12, 5.1.9.5, A.5.l.9.5
Heal Lh care mi crogrid system, (i LO. 8 Electrical power and c ontrol, 5.1.3.6 .3.10
Intake, 5.1.3.6.3.11
Piped gas and vacuum systems, Category 1, see Category 1 piped
gas and vacuum systems TesLs, 5.1.12.4.14.3
Piped gas and vacuum systems, Category 2, 15.4.9.4 Category 2, 5.2.3.5(1)
Piped gas and vacuum systems, Category 3, 15.5.8.3 Category 3, 5 .3.3.6.1
Manifolds, 5.1.3.3.1.l, 5.1.3.3.1.2, 5.1.3.5 (I), 5.1.3.5(2), 5.1.3.5.10, Definition, 3.3. !07
5.1.9.2.4(1), 11.6.2, 15.3.2.11 (2) (h), A.5.1.3.5.IO Electrical power and c ontrol, 6.7.5.l.4.3(A) (3)

2021 Edition
99-250 HEAlTH CARE FACILITIES CODE

Intake, 14.2.4.2.2 Definition, 3.3.114

Medical devices not for patient care, 11.4.3.2 mV (definition), !l.3.115
Medical gases, 5.1.1.3, A.5.1.1.3; see nlrn specific gases
Concentration test, 5.1.12.4.11, I.5.4.7 ..5.9,A.5.1.12.4.11(3) -N­
Definition, 3.3.108 Nasal cannula, 11.5.1.1.2, A.11.5.1.1.2
P atient medical gas, see Patient medical gas Definition, 3.:U 16
Permitted locations, 5.1.3.5.2 Natural disasters, B.12.3.2, B.12.3.7
Medical gas rails (MGR�), see Surface-mounted medical gas rail Nebulizers, 11.4.2.5, 11.4.2.6
systems Definition, 3.3.117
Medical gas systems, Chap. 5; ste alrn Cylinders: Gas equipment: Negative pressure, see Pressure
Medical gases; Medical-surgical vacuum systems; Supply Nitrogen, 5.1.1.3, A.5.1.1.3; see also Medical gases; Medical gas
systems; Waste anesthetic ga.s disposal (WAGD ) systems systems; Support gases
Category I, see Category I piped ga.s and vacuum systems Category· l medical air proportioning system, 5.1.:\.6.3.14,
Category 2, see Category 2 piped gas and vacuum systems A.5.l.3.6.3.14(A), A.5.I.3.6.3.14(C) (9)
Category 3, see Category 3 piped gas and vacuum systems Category l medical air supply systems, 5.1.3.6.1(l), 5.1.13.3.6,
Definition, 3.3.109 15.3.2.11
Disrrihution, piped;, see Piped distribution systems Definition, 3.3.119
Emergency plan, 12.5.33.6.5 (9) Joint�, purging ot; 5.1.10.4.!>, 1.5.4.6.6, A.5.1.10.4.5
Manufactured assemblies to use with, see Manufactured NF (oil-free, dry)
assemblies Category· I medical air supply systems, 5.1.3.6.l(I), 5.1.13.3.6
Storage or 1ransfilling of gases, ventilation for. 9.3.6, A.'l.3.6.3, Definition, 3.3. 119.1
A.9.3.6.5.l For purge, 5.1.10.4.5.1
Medical office (definition), 3.3.1 LO, A.3.3.1 IO For tests, 5.l.12.2.1.2, 5.1.12.2.2, 5.1.12.3.1.2, 5.1.12.4.5. l(F),
Medical plume evacuation, 9.3.8, A.9.3.8. I, A.9.3.H. I( I) 5.1.12.4.7.5, .5.1.12.4.8.L 15.4.7.4.1.2, 1.5.4.7.5.1.3
Medical-surgical vacuuru (definition), 3.3.112 Piping, 15.4.4.5
Medical-surgical vacuum systems, Chap. 5 Nitrogen narcosis, B.14.1.3.2
Alarms, .5.1.3.7.8 Definition, 13.3. 120
Category l, 5.1.3.5(5), 5.1.3.7, 5.1.10.3.1 to 5.1.10.3.3, Nitrous oxide, 15.4. 1.2
5.1.12.4.14.6, 5
. .1.14.5, 1.5.3.2.1.7, 15.3.2.10, A.5.1.3.7 Definition, 3.3.121
Area alarms, 5.1.9.4, A.5.1.9.4 Scavenging, 15.3.3.6
Conversion to gas system, .5.1.10.11.9.2 Storage, 5.1.3.3.2.l (6), l1.3.6.2, 11.3.fi.3
Designation colors, Table 5.1.11 Nitrous oxide systems, 5 . .1.1.3, A.5.1.1.3; SM also Medical gas s.·stems
Electrical power and control, 5.1.3. 7.6 Bulk (definition), 3.3.19.2
Filtration, 5.1.3.7.4 Designation colors/o perating pressures, Table 5.1.11
Maintenance, 5.1.14.4, 5.1.14.7.7(3) Locations for, 5.1.3.3.1.5, 15.4.2.4
Operating pressures, Table 5.1.11 Piping, 15.4.4.2
Piping, 5.1.3.7.5, 5.1.10.2, 5.1.14. 7.7(3) Supply systems, 5.1.3.3.1.7, 5.1.3.5.2. 5.1.3.5.4(2), 5.1.3.10.2.8,
Shutoff valves, 5.1.4.1.1 15.4.2.3
Special precautions,5.1.14.3, 5.1.14.3.3, A5. l.14.3.3 to Noncombustible material, 4.4. I, A.4.4. l
A.5.1.14.3.5 Nonflammable (definition), 3.3.123
Standard designation colors and operating pressures, Table Nonflammable anesthetic agent (definition), 3.3.124; see aLrn
5.1.I l Anestl1etics
Station outlets/inlets, 5.1.5, A.5.1.5, B.5.2.18 Nonflammable anestl1etizing location, see Anesthetizing locations
Category 2, 5.2.3.7 Nonflammable gases, 11.3.5, A.11.3.5, A.11.3.6; see also Medical
Category 3, 5.3.3.7, 5.3.10, 5.3.12 gases
Definition, 3.3.113 Nonflammable medical gas systems, SM Medical gas systems
Emergency plan,12.5.3.3.fi.5 (!}) Nonmedical compressed air, 8.3.5
Exhaust, 5.1.3.7.7 Definition, 3.3.126
Installers, qualification of, 5.1.10.11.10, 5.1.10.11.11 Nurse call S)'!tems, 6. 7.5.1.3.2( 4), 7.3.3.1, 7.4.3.l, A.7.3.3.l.l to
Laheling, 5.1.14.5 A.7.3.3.1.4.l
1\fanufactured assemblies to use with, see Manufactured Nursing homes (definition), 3.3.127
assemblies
Tests, 5.3.12; SM al.m Cross-connections, rests -0-
Source system, 5.1.12.4.14.6 Occupant notification, 16.7.4
Standing vacuum tests, 5.1.12.2.7, A.5.l.12.2.7.5 Odor, positive pressure outlets, 5.1.12.4.6.4, A.5.1.12.4.6.4
Microphones, oxygen mask. 14.2.10.2.3 Operating rooms
Monitor hazard current. see Hazard current Electrical receptacles for, 6.3.2.2. I ( C), 6. 3.2 .2.2 (C)
Motor load transfer, 6.7.2.1.2.12 Emergency procedures, 16.14.3.9
Multiple treatment facility, 15 .4.2 .5.13 Fire loss prevention, UU4,A.16.14.3.2

2021 Edition
 INDEX 99-251

Personnel oriemaLion and training, 16.14.3.10 Supply systems, 5.1.3.3.1.fi, 5.1.3.5.2, 5.1.3.5.4, l:>.4.2.3,
Wet procedure locations, 6.3.2.3.4, 6.3.2.3.8, 6.3.2.!l.9.. A.5.1.3.5.4
A.6.3.2.3.8 Closing off supply, B.l l.3.2.l (3), B.l 1.3.3, B.14.3.2 (1)
Operating su pply, 3.3.161, 5.1.9.2.4, fi.7.1.3.8.3 Emergency oxygen supply connect.ion (EOSC), see
Definition, 3.3.175.l Emergency oxygen supply connect.ion (EOSC)
Opportunity for improvement Oxygen USP
Definition, 3.3.l28 Category I medical air proportioning system, 5.1.3.6.3.14,
Outlets , electrica l, see Receptacles
A.5.l.3.6.3.l4(A), A..'i.l.3.6.3.l4(C) (9)
Category I medical air supply systems, 5.1.3.6.1 (I)
Outlets, gas, see Station ouLleL�
Definition, 3.3.136
Overcurrent protection, 6.3.2.4.4, 6. 7.2. l. L l
Oxygen 93 USP
Oxidizing gas, 11.3.(i.2, 11.3.6.3; see alro Nit.rous oxide; Oxygen
Definition, 3.3.134
Definition, 3.3.129, A.3.3.129
Oxygen, 15.4.1.2; see alrn Medical a.ir; Medical gases
.p.
Ambulatory patients receiving, 11.5.2.5
Paper, 14.3.1.6.9, A.14.3.1.6.9
Compatibility, 14.3.2.3, 14.3.2.4
Partia l pressure, see Pressure
Definition, 3.3.130, A.3.3.130
Particulate test, piping, 5.1.12.4.7, 1".4.7.5.5
Designation colors/ operating pressures, Table 5.1.11
Patient area call stations, 7.3.3.l.2, A.7 .3.3.1.2.1 to A.7.3.3. 1.2 .3
Gaseous (ctefinilion), 3.3.130.l
Patient bed locations
Handling, 11.6.2, 14.3.2.2 to 14.3.2.4
Call station, 7.3.3. l.2.l, 7.3.3.1.2.3, A.7.3.3.l.2.l, A.7.3.3.l.2.3
Liquid, 14.3.3.2
Definition, 3.3.138
Definition, 3.3.130.2, A.3.3.130.2
Elec u-ical receptacles for, 6.3.2.2.1 (CJ, 6.3.2.2.1(D), 6.3.2.2.2(A),
Equipment, 11.7, A. I I. 7.3.1 to A. I I. 7.3.6.1.1
6.3.2.2.2(8)
Transfilling, 11.5.2.3, 11.7.3.6, A.11.5.2.3.2, A.11.7.!\.6.l.l Electrical systems, 6.3.2.4.l
Monitoring, 14.2.10.4, A.14.2.l0.4.2, A.14.2.10.4.2.2 Liquid oxygen storage, 11.7.4
Storage, 5.1.3.l.9, 5.1.3.3.2.1 (6), I1.3.6.2, ll.3.6.3, 14.3.2.2, Patient-care-«"elated electrical equipment, 10.2, 10.3.2, I0.5.6,
A.14.3.2.2 14.2.9.3.16, A.10.2.3.2.4, A.l0.3.2, A. 10.5.6.2,
Therapy, see Hyperharic facilities A.14.2.9.3. Hi
Toxicity (hyperbaric), B.14.1.3.2 Definition, 3.3. 139
Definition, '.-l.3.1%, A.3.:\.135 Patient care spaces, 1.3.4, 6. 7.6.2.l .6(E) ( I)
Transfilling, 11.5.2.2, 11.5.2.!l, 11.7.3.6, A.11.5.2.2.2, Category· l
A.11.7.3.6.l.l Definition, 3.3.140.1, A.3.3.140.l
Oxygen concentrator units, 5.1.3.9, 5.1.12.4.14.4, 5.3.3.5.11,
Electrical receptacles, 6.3.2.2.l (D), 6.3.2.2.2 (B)
A.5.1.3.9 to A.5.l.:l.9.2(5)
Electrical systems, 6.4
Definition, 3.3.131
Category 2
Oxygen cylinders, see Cylinders
Definition, 3.3.140.2, A.3.3.140.2
Oxygen delivery equipment, I0.5.4.5, 15.4.2.5, A. I0.5.4.5; see also
Cylinders; Pipe and piping, gas Electrical receptacles, 6.3.2.2 .l (D)
Definition, 3.3.132, A.3.3.132 Electrical systems, 6.5
Hazards, 11.5.1.l.6, 11.5.l.2.2 Category 3, 1.3.4.l, 6.6
Maintenance of, l 1.5.1.3.3, A.I 1.5.1.3.3 Definition, 3.3.140.3, A.3.3.1403
Oxygen enclosures, 11.4.2.2 Category· 4, 1.3.4.l, 6.6
Oxygen-enriched atmosphere (OFA), see alrn Hyperharic facilities DefiniLion, 3.3.140.4, A.3.3.140.4
Definition, 3.3.137 Definition, 3.3.140, A.3.3.140
Electrical appliances in, 10.5.4, A.l0.5.4.5, A.10.5.4.fi Electrical systems, 6.3.3.l, 6.3.3.2, 6.3.3.3.l, A.fi.3.3.1.1 to
A.6.3.3.1.4
Equipment transport, storage, and use, 11.5.3.3
Liquid oxygen storage, 11.7.4
Fire protect.ion, B.11.3.1
Receptacles, 6.3.2.2.1(D)
Hazards of, 11.5.1.2. I
Sprinklers, 16.9.1.4, A.16.'l.l.4
Labeling of equipment for use in. llS,U.l
Patient care vicinity
Oxygen hoods, A.115.1.1.3
DefiniLion, 3.3.141
Definition, 3.3.133, A.3.1\.133
Electrical equipment , resting ot; I 0.3.4.1
Oxygen systems, 5.1.l.3, A.5.1.l.3, B.5.3; see also Cvlinders· Medical
gas systems; Oxygen delivery equipm;nt; Pipe' and Patient equipment grounding point, 6.3.2..5.2
piping , ga� Definition, 3.3.142
Bulk (definition), 3.3.19.3, A.3.3. 19.3; see alrn Cryogenic liquids, Patient leads, I0.3.6, A. I0.3.6; see alw Electrical wiring
Bulk systems Definition, 3.3.143, A.3.3.143
Hyperbaric facilities, 14.2.1.4 Isolated, 10.5.2.2, A.10.5.2.2
Locations for, 5.1.'.l.3.l.5, 15.4.2.4 Definition, 3.3.92
Piping , 14.2.1.:\, 15.4.4.2 Patient medica l ga�, .tee al.rn Medical air; Nitrous oxide: Oxygen

2021 Edition
99-252 HE.AlTH CARE FACILITIES CODE

Definition, 3.3.144 Plumbing, Chap. 8

Identification, 5.1.11.1.1 Building system categories, criteria for. 8.2, A.8.2.l
Permitted locations for, 5.1.3.5.2 Drainage systems, 8.3.12
Positive pressure piping, 5.1.10.11.12.1 Fixtures, 8.3.8
Performance tests (;eneral requirements, 8.3
Category 1 piped gas and vacuum systems, 5.1.6.1, 5.1.6.2, (;rease interceptors, 8.3.7
5.I.12, 5.1.13.12, A.5.1.12, B.5.1 Nonmedical compressed air, 8.'.l.5
Category 2 piped gas and vacuum systems, 5.2.12, 15.4.7, 15.4.8 Potable and nonpotable water, 8.3.1, 8.3.2
Category 3 piped gas and vacuum systems, 5.3.12, 15.5.7 Special use water systems, H.3.6
Permit-to-work system, .5.1.14.2, A.5.1.14.2.l, A.5.1.14.2.2( 4) Wastewater, 8.3.9 to $.3.11
Photographic lighting equipment, 14.3.2.1.3 Water conditioning, 8.3.4
Physicians, discretionary use of nonconforming Water healing, 8.3.3
materials, 14.3.1.6.4.4
Plume (medical), 9.3.8.l
Pin-index safety system, 11.4.1.2
Definition, 3.3.148
Pipe and piping, gas
Portable equipment
Branch (lateral) line, !i.l.3.6.3.9(G), 5.1.4.5, 5.1.10.3.'.5, Electrical, se,• Electrical equipment
5.1.10.3.4, 5.1.10.11.l.2, 5.l.10.11.1.3
Patient care gas equipment, 11.-!.l, 11.4.2, A.11.4.1.1 to
Definition, 3.3.146.1 A.11.4.l.4
Breaching or penetrating, 5.1.10.11.12, .5.1.14.7.6
Positive pressure
Category 1, 5.1.3.6.3.9, A.5. l.3.6.3.9(D), A.5.1.3.6.3.'l(Fl Breaching or penetrating of medical gas piping, 5.1.10.11.12.l
Disu-ibution, 5.1.10, 5.1.13.10
Change in system, 5.1.10.11.9.1
Supply, 5.1.3.6.3.9, 5.1.3. 7.5, A.5.l.3.6.3.9(D),
Definition, lt3.149.7
A.5.l.3.6.3.9(F)
Indicators, 5.1.8.1.3, A.5.1.8.1.3
Category 2 distribution piping, 5.2.10, 15.4.4
Category 3 distribution piping, .5.3.10, 1.5.5.5 .JoinLs for positive pressure gas systems, 5.1.10.3.1, 5.1.10.3.2
Labeling of systems, 5.1.11.l.2, 5.l.11.2.2
Copper, 15.3.3.7.3.2, 15.4.4.4.2, 15.4.6, 15.5.5.2.2.1. 15.5.5.3.2
Odor from outleis, 5.1.12.4.6.4, A.5.1.12.4.6.4
Definitions, 3.3.146
Storage of positive-pressure gases, 5.1.3.3.2.1, A.5.l.3.3.2
Denial air and vacuum systems, 15.3.3.7, 15.4.4 to 15.4.6
Telecommunications facilities, for, 7.3.l.2.l.8(C), 7.3.l.2.2.8{C),
Denial air systems, 1.5.5.5.2
A.7.3.1. 2.1.8(C)
Fire protection, 16.5.1.1 Power cords, 10.2.3, 10.5.2.3, A.10.2.3.2.4
Ground, me as, 5.1.14.3.2
Hyperbaric chambers, 14.2.9.3.8, 14.2.9.3.16.5
Hyperbaric facilities, 14.2.1.3, A.14.2.11.2, A.14.2.11.25
Patient care spaces, 6.3.2.3.6
Installation, 5.1.10.11, 15.4.5, 15.5.6 Power systems, see Electrical systems
Interconnections, prohibited, 5.1.10.11.7, 15.4.9.2
Pressure
Labeling, 5.1.11.1
Absolute (definition), 3.3.149.1
Main line, 5.1.4.3, 5.1.11.2.5
Ambient, 14.2.5.1, 14.2.5.2, B.14.1.1.3.2
Definition, 3.3.146.2
Defini lion, 3.3.149.2
Manufacturer's instructions, 5.1.10.11.8
Gauge (definition), 3.3.149.3
Materials, 5.1.10.1, 5.1.10.2, A.5.1.10.1.4
High
PVC plastic, 15.3.3.7.3.3, 15.3.3.7.3.4, 15.4.4.4.3, 15.4.4.4.-!,
Definition, :i3.149.4
15.5.5.3.3, 15.5.5.3.4
Intermixing of gases, 11.2.7, A.ll.2.7
Special precautions, 5.1.14, A.5.1.14
Pressure reducing regulators and gauges, 11.2.4, I 1.2.5,
Support, .5.1.10.l1.4, 15.4.5.6, 15.5.6.4, A.5.1.10.11.4.4
11.5.3.3.4
Tests
Valve, 11.6.2.2(2)
Blowdown, 15.4. 7.4.2 Multiple, cenu-al supply system, 5.1.3.5.7, 5.1.13.3.(i.6
Installer performed tests, 5.1.12.2, 15.4.7.4, 15.4.8. 1.3,
Negative, 9.3.6.5.3.l, 9.3.7.1.l
15.5. 7.1.3, B.5.1
Definition, 3.3.ll8
System verification, 5.1.12.4, 5.1.14.7.6, 15.4.7.5, A..5.l.12.4.2
Operating, 5.1.12.2.3.4, 11.2.5, 11.6.3.1 (6), 14.2.6.3.4
Underground piping out5ide of buildings, 5.1.10.1 l.5, 15.4.5.7,
15.!i.6.5 Definition, 3.3.149..'>, A.3.3.149.5
Underground piping within buildings/within floor Partial, B.14.1.1.2, B.14.1.3.2.3, B.14.1.3.5, Table B.14.4
slabs, 15.4.5.8, 15.5.6.6 Definition, 3.3.149.6, A.3.3.149.6
Piped distribution systems, 5.1.10, 5.2.10, 5.3.10, 15.3.2.8; see also Positive, see Positive pressure
Central supply systems Standard operating pressures, gas and vacuum systems, Table
Definition, 3.3.145 f>.l.11
Piped gas systems, Si'I! Medical gas systems Working (rated), 5.l.3.5.6.1 (3), 14.2.9.3.14.1
Piping, heating, cooling, ventilating, and process systems, 9.3.4 Definition, 3.3.149.8
Plugs (attachment plugs, caps), 10.2.2.2, 14.2.9.3.16.5(3) Pressure indicators, 5.1.8, 5.1.13.7, 5.2.8, 5.3.8, 15.3.2.6, 15.4.2.9,
Definition, 3.3.147 B..5.2.5, B.5.2.14

2021 Edition
 INDEX 99-253

Pressure-reducing regulators, 11.2.4 to 11.2.6, 11.5.3. 1.2, 11.5.3.1.3. Reference grounding point, 6.3.2.9.2.1, 6.3.2.'J.3.6, 6.3.3. l.2(1)
11.5.3.3.4, 15.3.2. ll Definition, 3.3.158
Definition, 3.3.150, A.3.3.150 Reference point, 6.3.3.l.2, 6.3.3.1.4.l, 6.3.3.1.4.2
Pressure regulators, 5.1.12.4.3.2(Fl; .,ee alrn Pressure-reducing References, Chap. 2, A.2.1, Annex D
regulators
Refrigerating equipment, B.12.3.2.7
Final line, 5.1.3.5.5, 5.1.3.5.10.4(1 ), 5.1.3.5.11.4, 5. l.3.6.3.9(Kl.
Regulators
5. l.3.6.3.14(C) (IO), A.5.1.3.5.5.l
Cylinders, ll .2.4 to ll .2.6
Headers, 5.1.3.5.9(8), 5.1.3.5.10.4, 5.1.3.5.11.4
Medical air, 5.l.3.6.3.9(E), 5.1.3.6.3.\l(F), 5.1.3.6.3.9(1).
Nitrogen purge, 5.1.10.4.5.3
5.2.3.5(1), 15.3.2.1.5(1) , A.5. l.3.6.3.9(F)
Pressure relief valves, 14. 3.4 .1.1.1
Pressure-reducing;, see Pressure-reducing regula tors
Central supply systems, 5.1.3.3.3.2. 5.1.3.5.6, 5.1.3.10.10,
Relocatable power tap (RPT), 10.2.3.6
5.1.13.3.6.5
Definilion, 3.3.159
Emergency oxygen supply connection (EOSC), 5.1.3.5.13.2(5)
Remote (Level 3 supply source), 15.4.2.5.12, 15.4.2.6.4
Medical air supply systems, 5.1.3.6.3.'J(J), 5.l.3.6.3.14(C) (8)
Definition, 3.3.160 , A.3.3.160
Pressure tests
Reserve supply
Individ ual pressurization, 5.1.12 .4. 3.1
Category I
Initial pres.mre, 5.1.12.2.3, 15.-1.7.4.4, 15.4.8.l.5, 15.5. 7.1.3.2.
A.5.l.12.2.3.5, A.15.4. 7.4.4.5 Bulk cryogenic liquid systems. 5.1.3.10.5
Operational pres.sure, 5.1.12.4.IO, 15.4.7.5.8, A.5.l.12.4.I0.6 In-building emergency reserves, 5.1.3.5.8.1(5). 5.1.3.5.14
Pressure differential, 5.1.12.4.3.2 Warning signals, 5.1.9.2.4, B.5.2.10 to B.:>.2.13
Standing pressure, 5.1.6.1(4), 5.1.6.2, !i.1.12.2.6, 5.1.12.4.2, Definition, 3.3.161
15.4.7.4.6, 15.4.7.!i.2. 15.-1.8.1.7, L� ..'i.7.1.3.4, Reservoir jars, 11.4.2.4
A.5.1.12.2.6.1, A.5.1.12.2.6.5, A.5.l.12.4.2 Resi<Jtance tests, 10.3.2, 10.3.3.2, A.10.3.2
Pressure vessels, set, Hyperbaric facilities Respiratory therapy, B .11; see al,o O xygen-enriched a1mosphere
Procedure room, 16.7.4.3.7 (OEA)
Definition, 3.'.U51 Administration and maintenance, Jl..lj, A.11.5.1.1.2 to A.11.5.3.2
Producer (defmition), 3.3. l!i2, A.3.'.U52 Apparatus for, 11.4.2
Psia (pounds per square inch absolute) (definition), 3.3.153 Equipment labeling, 11.5.3.1
Psig (pounds per square inch gauge) (defmition), 3.3.154. A.3.3.154 Equip ment servicing and maintenance, 11.5.1.3
Pumps, vacuum, see Vacuum pumps Equipment transport, storage, and use, 115.3.3
Purge test, piping, 5.1.12.2.5, 5.1.12.4.6, 15.4.7.4.5, 15.4.7.5.4, Fire hazards, 11.5.l.l, 11.5.l.2, A.1 1.5.l.l.2, A.11.!U.l.3,
15.4.H.l.6, 15.5.7.1.3.3, A.5.1.12.4.6.4 B.11.3.1
Purity test Responsible facility authority (RFA), 5.1.14.l, 5.1.14.2, A.5.1.14.2.1,
Medical air, 5.l.12.4.12 A.5.1.14.2.2(4)
Piping, 5.1.12.4.8, 15.4.7.4.5, 15.4.7.5.fi, A.5.1.12.4.8 Ri<Jers, piping, 15.4.2.7
Purpose of standard, 1.2 Definition, 3.3.146.3
Valves, -�-1.4.4, 5.1.11.2.6
-Q­ Risk assessment, 4.2, A.4.2
Qualified person (definition), 3.3.155 Risk categories, 4.1, A .4.1
Category 1, 4.1.1, A.4.1, A.4.I.I
-R- Definition, 3.3.162.1
Radiation equipment, hyperbaric chambers. 14.3.2.6, A.14.3.2.6 Category 2, 4. I. 2, A.4.1 , A.4.1.2
Reactance (defmition), 3.3.156 Definition, 3.3.162.2
Receptacles, 6.3.2.2, A.6.3.2.2.1 , B.6.3 Category 3, 4.1.3, A.4.1
Definition, 3.3.157 Definition, 3.3.162.3
Grounding ot; 6.3.2.2.5, 6.3.2.5, A.6.3.2.2.5. A.6.3.2.5.1.5, Category· 4, 4.1.4, A.4.1
A.6.3.2..�.3 Definition. 3.3.162.4
Hyperbaric chambers, 14.2.9.3.9, A.14.2.9.3.9 Risk assessment procedure, determination using, 4.2, A.4.2
Life safety and equipment branches, 6.7.6.3.2, A.6.7.li.3.2
Number ot; 6.3.2.2.2 .S­
Other services, for, 6.3.2.2.4 Safety mechanisms, 11.6.4
Polarity ot; 6.3.2.2.3 Scavenging, sm al.m Waste anesthetic gas disposa l (WAGD) systems
Retractable power taps, 10.2.3.6, A.10.2.3.6 to A.I0.2.3.6(2) Category 3 systems
Selected (definition), 3.3.164 Piping, 15.5.5.3
Special-purpose outleLs, 6.3.2.2.6 Definition, 3.3.163
Telecommunications facilities, 7.3.l.2.l.7(C), 7.3.l.2.3.7(C) Dental air and vacuum piping systems, 15.3.3.6, 15.3.3.7.3,
Tests, 6.3.3.2 15.4.3.3.4, 15.4.4.4
Types of, 6.3.2.2.1, A.6.3.2.2.1 Ventilation system, 'l.3.7
Wet procedure locations, 6.3.2.3.6, 6.3.2.3.'J Active system, 9.3.7.1.1

2021 Edition
99-254 HEAlTH CARE FACILITIES COD£
Passive systems, 9.3.7. 1.2
Scope of standard, 1.1,A.l.1.IO, A.1.1.12
Security management, Chap. 13
Access control equipment, 13.9, A.13.9.4
Emergency, 12.5.3.3.6.3, A.12.5.3.3.6.3
Information technology and communicaLions
systems, 7.3.1.2.2.6,7.3.1.2.3.6
OperaLions,13.11, A.13.11.A.13.ll.l
Plan, I :l.2, 13.12.'.l to 13.12.5, A.13.2, A.13.2.2
Program evaluaLion, 13.12, A.13.12.1
Responsible person, 13.4, A.13.4.2 (3) (c)
Security"'ensitive areas, 13.5, A.13.5.2(1) to A.13.5.7(1)
Security vulnerability assessment,13.3, A. 13.3.l
Selec ted receptacles (definition), 3.3.164
Self-extinguishing (definition), 3.3.16.�
Semipermanent connection (definition), 3.3. rn6
Sensors, inside hyperbaric chambers, 14.2.10. 1.2
Service inlets, 3.3.20
Definition, 3.3.167
Service outlets
Definition, 3.3.168
Service valves, 5.1.4.5, 5.1.11.2. 7
Shall (defini tion), 3.2.7
Should (definition), 3.2.8
Shutoff valves
Emergency oxygen supply connection (EOSC), 5.1.3.5.13.2(3).
15.4.2.6, A.14.2.6. 1.5
Ga�, 5.1.4.l.l, 5.l.4.2.l, 5.1.4.3.l, 5.1.4.4,!U.4.7, 15.4.9.1.2,
A.5.l.4.3
Hyperbaric facilities, 14.2.1.3.2
Labeling and idenLitication, 5.l.l 1.2
Vacuum, 5.1.4.l. l
Signs, see Labeling and identification
Single treatment facilities, 15.4.2.5.12, 15.4.2.5.14, 15.4.2.6.1
Definition, 3.3.169, A.3.3.169
Si te of intentional expulsion, 10.5.4.1, 10.5.4.2, 11.5.l.l.6, 11.5. 1.2.3
Definition, 3.3.170, A.3.3.170
Smoke alarms/de tectors, 16.7.3, rn.7.4.2.1, 16.7.4.2.2, 16.12.2
Smoke compartments, 16.7.4.3.1, 16.9.1.3,A.16.9.1.3
Smoke control, 6.7.5.l.4.3(A)(4), 6.7.6.2.1.6(0)(4)
Smoke zones, 16.7.4./l.3
Smoking, 11.5.l.l.l,11.5.2.5, 11.5.3.2,14.3.1.6.1.1 (1), A.11.5.3.2
Sound-deadening materials, 14.2.2.6.4, A.14.2.2.6.4
Source valves, -�.1.4.2, 5. I.I 1.2.3, 5.1.11.2.4,A.5.1.11.2.3
Spaces (definition}, 3.3.171; see alrnPatiem care spaces
Sprinklers, automatic, 7.3. l.2.l.8(O), 7.3.1.2.1.H(B},16.9, l(U I,
16.12.3, A.16.11, A.16.12.3
Hyperbaric facilities, 14.2.1.2,A.14.2.1.2 to A.14.2.1.2(3)
Staff, s,� Employees
Staff emergency calls, 7.3.3.1.3, A.7.3.3.l.3.l
Standard cubic fee t per minute (SCFM} (definition}, 3.3.172
Standard (defini tion), 3.2.9
Standby power systems, 16.5.1.3
Standpipe and hose systems, 16.10.2, A.16.10.2.2
Station inlets
Category l, 5.1.4.6.1, 5.1.5, 5.1.6.8, 5.1.6.10, 5.1.7.5 to 5.1.7.7,
5.1.l0.10(l), 5.1.10.11.1.4, 5.1.11.3, 5.1.12.1.2,
5.1.12.1.10. 5.1.12.2.1.3(3), 5.1.12.2.4.6,
2021 Edition
5.1.12.4.3.I (D),5.1.12.4.3.2 (E), 5.1.12.4.10.
:d.12.4.13.5.1.14.7.9, 15.3.2.3, A.5.1.5,
A.5.1.12.4.10.6
Category 2, 5.2.5
Catego11• 3, 5.3.5
Denni Lion, 3.3.17'.l
Station out lets
Category I, 5.1.4.6.1, 5.1.5, 5.1.6.8, 5.1.6.10, 5.1.7.5 to 5.1.7.7,
5.1.10.1.1, 5.1.10.10(I), 5.1.10.11. l.4, 5.1.11.3,
5.1.12. 1.2, 5.1.12.1.10, 5.1.12.2.1.3(3),5.1.12.2.4.6,
5.1.12.2.6.l, 5.1.12.4.3.1 (D}, 5.l.l 2.4.3.2(E),
5.l.12.4.3.2(G), 5.1.12.4.6.1, 5.1.12.4.6.3,
5.1.12.4.6.4, 5.1.12.4.7.2 to 5.1.12.4.7.4, 5.1.12.4.8.2,
5.1.12.4.8.6, 5.1.12.4.10,5.1.12.4.13, 15.3.2.3,
15.3.3.4.1.2, A5. l .3.6.3.10, A.5.1.5, A5. l.l 2.2.6. l,
A.5.1.12.4.6.4, A.5.1.12.4.10.6, B.5.2.18
Category 2, 5.2.5, 15.4.1.6, 15.4.2. 7
Category 3, 5.3.5
DefiniLion, 3.3.174
Storage
Compact, sf.If Compact stora!(e
Containers, Siie Cont.ainers
Cryogenic liquids, venLilaLion for stora!(e of, 9.3.6, A.9.3.6.3.
A.9.3.6.5.l
Cylinders, see Cylinders
F1ammahle and combustible liquids, 16.3, A.16.3.2
F1am mable gases, 14.3.3.3, 14.3.4.1.4.l, 16.3, A.16.3.2
Gas equipment, 11.5.3.3
Hyperbaric faciliLies, 14.2.1.6, 14.3.2.2.14.3.3.3, 14.3.4.1.4,
A.14.3.2.2
Nonflammable gases,11.3.5, 11.3.6, A.11.3.5,A.11.3.6
Oxy!(en, 5.1.3.l.9,14.3.2.2, A.14.3.2.2
Ventilation for medical !(as storage, 9.3.6, A.'l.3.6.:l, A.9.3.6.5.1
Stored electric a l energy systems, 16.5. I. 4
Supply source, see also Category l piped gas and vacuum systems.
Sources; Category· 3 piped gas and vacuum systems,
Sources
Category• 2 piped gas and vacuum systems, 5.2.3
Defini lion, 3.3.175
OperaLing supply, 3.3.161, 5.1.9.2.4,6.7.1.3.8.3
Definition, 3.3.175.1
Portable, 11.4.l, A.11.4.1.l to A.11.4.1.4
Primary supply, 5.l.3.6.3.14(C) (6)
Definition,3.3.175.2
Reseive supply (definition), 3.3.17.,.3; se,, alrnResenie supply
Secondary supply, 5.1.12.4.14.2
Definition, 3.3.175.4
Supply systems, Sf.If also Category I piped ga� and vacuum systems;
C'�'ltegory 2 piped gas and vacuum systems; Catego11· 3
piped gas and vacuum systems; Central supply systems:
Pipe and piping, gas; Piped distribution systems
Hyperharic faciliLies, 14.2.4.1.3.2
Support gases, see alrn Instrument air; Nitrogen
Category l piped gas and vacuum systems, see Category I piped
gas and vacuum systems
Category 2 piped gas and vacuum systems, 5.2.13
CategorJ 3 piped gas and vacuun1 systen1s, 5.3.13
Medical, 5.1.1.3, 5.3.12, A.5.1. l.3
Central supply system,5.1.13.3
DefiniLion, 3.3.111
 INDEX 99-255

Surface-mounted medical gas rail systems, 5

. .1.7. 5.2.7, 5.3.7. Limits, 10.3.3.4
15.3.2.5, A.5.1.7 Portable equipment, 10.3.5, A.10.2.6
Definition, 3.3.176, A.3.3.176 Test proced ure, 10.3.5.3
Switches, see alio Transfer switches Training, employee
Essential electrical systems, 6.7.2.1.2, 6.7.2.1.5, 6.7.2.2.1, Electrical equipment, 10.5.8, A.10.5.8.1, A.10.5.8.3
A.6.7.2.1.2.1 (A) to A.6.7.2.1.2.17
Emergency management, 12.5.3.3.6.7(8), 12.5.3.3.7
Hyperbaric facilities, 14.2.9.3. IO, A.14.2.9.3.IO.l
Emergency operations plan, B.12.1.1.5
lsolalion switch, bypass, 6.7.2.1.5, A.6.7.2.1.5.3 Gas equipment and systems, 11.5.2.1, 11.6.1.2, A.11.5.2.1. l
Test, 6.7.2.1.2.10 Hyperbaric facililies, 14.3.1.4.3, 14.3.1..5.2, 14.3.1.5.3, 14.3.4.7.1,
Synthetic materials, see Textiles, hyperharic chamher use A.14.3.1.5.2
OperaLing rooms, 16.14.3.10
-T-
Security personnel, 13.l1.2
Task illumination, 6.7.5.1.2.4(4), 6.7.5.1.3.2, 6.7.6.2.l.5(C)(5 ), Transfer switches, 6.7.2.1.2, 6.7 .2.2.l, 6. 7.2.2.3, A.6.7.2.1.2.l (A) to
6. 7.6.2.l.6(D)(I), A.6.7.5.1.3.2(6) A.6.7.2. 1.2.17, B.6.1, B.12.3.2.5; .1ee also Switches
Definition, 3.3.177 Automatic, 6.7.2.1.2, 6.7.2.1.2.16, 6.7.3.5, A.6.7.2.1.2.1 (A) to
Telecommunications entrance facility (EF), 7.3.1.2.1, 7.5.1.1.1 to A.6.7.2.1.2.17
7.5.1.1.3, A. 7.3.l.2.l.4(C) to A. 7.3.l.2.l.8(C) Isolating, 6.7.2.1.5, A.6.7.2.1.5.3
Definition, 3.4.1 Nonautomatic, 6. 7.2.1.2.17, 6.7.2.1.3, 6.7.2.1.--1, 6.7.2.1.5. 6.7.3.7,
Telecommunications equipment room (TER), 7.3.1.2.1.l. 7.3.1.2.2, A.6.7.2.1.2.17, A.6.7.2.1.5.3
7.5.1.1.2, A. 7.3.1.2.2.2 Performance criteria and tests, 6.7.3.l. 6.7.4.1.l, A.6.7.4.1.1.5 (A)
Definition, 3.4.2 Rating, 6.7.2.1.1.2, 6.7.2.1.2.15
Telecommunications room (TR), 7.3.1.2.3, 7.5.1.1.2, 7.5.1.1.3 'Iransfilling, 9.3.6, 11.5.2.2, 11.!i.2.3, 11.7.3.6, A.9.3.6.3, A.9.3.6.5.l,
Definition, 3.4.3 A.11..5.2.2.2, A.11.7.3.6.1.l
Temperature Definition, 3.3. 180
Ambient, 5.1.3.6.3.1(3), 5.1.3. 7.1(3), 5.1.3.8.1.3( 4), Transformers, isolation, 6.3.2.9.l
5.1.3.8.1.4(2), 5.1.10.11.3.3, 5.1.12.2.6.5, Definition, 3.3.94
5.1.12.2.75, 6.7.1.3.4, 6.7.1.3.4.6, A.5.1.12.2.6.5.
Tube, endotracheal, B.14. 1.2 .4
A.5.l.l2.2.7.5. A.6. 7.1.3.4
Definition, 3.3. 181.l, A.3.3.181.1
Generator sets and, 6.7.1.3.3
Tube (pipe), .1ee Pipe and piping, gas
Hyperbaric chambers, 14.2.4.3. 14.2.9.3.11, A.14.2.9.3.11
Temperature control, 7.3. l.2.1.8(A), 7.3.l.2.2.8(A), 7.3.l.2.3.8(Al, -U­
14.2.4.'.,
Terminals Units of measurement, 1.5, A.l.5
Definition, ,l.:\.178 Use points, 3.3.169, 15.4.2.4.10, 15.4.2.6.1, 15.4.2.6.2
Inlets, see Sta Lion inlets Defini Lion, 3.3. 182
Test equipment, 6.3.3.1.5 U tilities
Tests, see also Performance tests Emergency plan for, 12.5.3.3.6.5, 12.5.3.3.6.6, A.12.5.3.3.6.5,
B.12.3.4
Dental gas and vacuum systems, 15.4.7, 15.4.8, 1.5.4.9.5, 15.5.7
Fire protection for. 16.5, A.16.5.3.3
Ele vators, 16.5.3.4
Emergency plans and operations, 12.5.3.3.8 -V­
Fire protecLion systems, 16.1 :\
Vacuum, dental, see Dental vacuum
Health care microgrid system, 6.10.8
Vacuum indicators, 5.1.8, 5.2.8, 5.3.8, 15.3.2.6, 15.4.2.9, B.5.2.5,
Hyperbaric chambers, electrical equipment for, 14.2.9.'.{.2, B.5.2.14
14.3.4.3.2 to 14.3.4.3 ..5
Vacuum pumps
Maintenance program
Alarms, 5.1.9.5, A.5.1.9.5
Gas and vacuum systems, 5.1.14.4.3, 5.1.14.7.1, 5.1.14.7.5 to
5.1.14.7.7, A.!U.14.4.3, B.ci.2 Category I systems, 5.1.3.7.2, 5.1.3.7.5.l(3)
Vacuum receivers, 5.1.3.7.3, 5.1.3.7.5.2
Records and reports, .5.1.12.1.6 to 5.1.12.1.9, 5.1.12 .1.11,
5.1.12.'.U.l, 5.1.14.4.3.l(F), 5.l.l4.7.l, 6.3.4.l, Vacuum systems, see Medical-surgical vacuum s ystems
Ci.7.4.2, 6.8.3, l0.5.6.2, 10.5.Ci.3, 15.4.7.1.1.2 to Vacuum terminals, .1ee Sta Lion inlets
15.4. 7.1.1.5, 15.4.8.1.1.2 to 15.4.8.1.1.5, A.6.3.4.1.1, Valves, Sf!R, also C heck valves; Pressure relief valves; Shutoff valves:
A.10.5.6.2 Zone valves
RetesLS, B.5.2 Accessibility, 5.1.4.1.4
Site acceptance, 6.8, A.Ci.8.1, A.6.8.2 Category 1, 5.1.3.2.10, 5.1.3.3.3.2, 5.1.3.5.6, 5.1.3.5.13.2,
Test switches, 6.7.2.1.2.10 5.1.3.6.3.!l(G), 5.1.3.6.3.9(1), 5.l.3.6.3.l4(C) (8),
Textiles, hyperbaric chamber use, 14.3.1.6.4, A.14.3.1.6.4 to 5.1.3.IO.ll, 5.1.4, !i.1.8.2.3.1, 5.1.11.2, 5.1.12.1.2,
A.14.3.1.6.4.3 5.1.12.2.5.2, 5.1.12.4.2(1), 5.l.l2.4.4, !U.13.4,
Total hazard current, s,r Hazard current 15.3.2.2, 15.3.2.11(2), A..5.1.3.5. 13.2(8),
A.5.l .3.IO. l l.4(A), A.5.1.4, B.5.2.17
Touch current
Category· 2, 5.2.4
Definition, ,\.'.U 79

2021 Edition
99-256 HEAlTH CARE FACILITIES CODE

Category 3, 5. 3.4 Category I piped gas and vacuum systems, 5.1.3.3.1.3(3).

Flow-control, 11.5.3.3.I 5.1.3.5(6), 5.1.3.8, 5.1.10.2.3, 5.1.10.3.3, 5.1.14.3,
Definition, 3.3.63 5.1.14.4, 5.1.14.7.7(4), 15.3.2.l.8, 15.3.2.10,
A.5.1.3.8, A.5.1.10.2.3.2
Future connections, for, 5.1.4.8
Category 2 piped gas and vacuum systems, 5.2.3.8
Gas equipment, cylinder and container sources for, 11.2.1,
Category• 3 piped gas and vacuum systems, 5.3.3.8, 5.3.12
11.2.8, 11.2.9, Il.6.2.2
Definition, 3.3.185
High pressure, 11.6.2.2(2)
Designation colors, Table 5.1.11
Hyperharic facilities, 14.3.2.2(2). 14.3.2.3(1 ), 14.3.4.1. I.I
In-line, 5.1.4.7, 5.1.4.9 Electrical power and control, !i.1.3.8.4
Exhaust, !i.1.3.85
Labeling, 5.1.4.1.3
Maintenance, 5.1.14.4, 5.1.14.7.7(4)
Protection caps, 5.1.3.2.IO
Operating pressures, Table 5.1.11
Security, 5.1.4.l.2
Senice, 5.1.4.5, 5. LI 1.2.7 Producers, 5.1.3.8.1.1, 5. Ul.8.2
Sources, 5.1.3.8.1, A.5.1.3.8.1
Source, 5.1.4.2, .5.1.11.2.3, 5.1.11.2.4, A.5. LI 1.2.3
Special precautions, 5.1.14.3
Types, 5.1.4.1.6
Vaporizers, .5.l.3.10.7, 5.1.10.4.1.8
Ventilation system, 9.3.7
Waste chutes, 16.6
Definition, 3.3.183
Waste water, 8.3.9 to 8.3.11
Ventilation, 6.7.5.1.4.4 (4); st:e al50 Exhaust systems; Healing,
ventilating, and air conditioning (HVAC) systems Black, 8.3.9
Alternate power sources, 6.7.1.2.6, 6.7.I.3.4, 6.7.5.l.4.3(A) (6), Definition, 3.3.186.1
6. 7.5.l.4.3(B), A.6.7.1.3.4 Clear, 8.3.11
Central supply systems and storage, gas, 5.1.3.3.3, 5.1.13.3.3 Definition, 3.3.186.2
Construction, during, 9.3.10 Gray, 8.3.10
Cryogenic liquids, storage or transfilling of; 9.3.6, A.9.3.6.3, Definition, 3.3.186.3
A.9.3.6.5.l Water, potable and nonpotable, 8.3.1, 8.3.2, 12.5.3.3.65,
Definition, 3.3.184 A.12.5.3.3.6.5, B.12.3.2.5(2), B.12.3.2.7
Deneal air and vacuum piping systems, 15.3.3.2.3, 15.5.3.3 Water conditioning, 8.3.4
Emergency systems, (i7.5.l.4.4(4) Water heating, 8.3.3
Hyperharic chambers, 14.2.4, 14.2.11.2, A.14.2.4.1.2 to Welded joints, 5.1.10.3.I (2), 5.1.10.5
A.14.2.4.4.1, A.14.2.11.2, A.14.2.11.2.S Wet procedure locations, 1.3.4.3. 6.3.2.3, A.6.3.2.3
Laboratories, 16.5.2.4 Definition, 3.3.187, A.3.3.187
Medical gas, storage or transfilling of, 9.3.6, A.9.3.6.3, A.9.3.6.5.1 Wiring, see Electrical wiring
Waste gas, 9.3.7 Working pressure, see Pressure
Venting, see Ventilation ,Nork space or room
Voltage limit, 6.3.3.1.6.1 Telecommunications faciliiy, 7.3.1.2.2.5, 7.3.1.2.3.5
Voltages
Measuring, 6.3.3.1.2 to 6.3.3.1.3.:l -X­
Voltage sensing, 6.7.2.1.2.1 (B) X-ray equipment, 14.3.2.1.2(1)

-W- -Z­
Warning signs, see Labeling and identification Zone valves
Warning systems, see Alarm systems Category l, 5.1.4.1.4, 5.1.4.1.5, !i.1.4.6, 5.1.8.2.2(3), 5.1.8.2.3.1,
Waste anesthetic gas disposal (WAGD) systems 5.1.11.2.8, 5.1.12.1.2, 5.l.12.2.5.2, 5.1.12.4.2(1),
Alarms, -�-1.3.8.3 A.5.l .4.6.1 (2), A.!i.l.4.6.I (3), A.5. I.I 1.2.8
Area, 5.1.9.4, A.5.I.9.4 Gas equipment, B.11.3.'.t l
Local, 5.1.9.5, A.5.1.9.5 Hyperbaric facilities, B.14.3.1, B.14.3.2
Master, 5.1.9.2.4( II)

2021 Edition
 Sequence of Evenf,S for the Standards
Develo-pment fucess
Once the current edition is publi�hed, a Standard i� ofwnedfor
Public In/mt.
Step 1- Input Stage
• Input accepted from the public or other committees for
consideration to develop the First Draft
• Technical Committee holds First Draft Meeting to revise
Standard (23 weeks); Technical Committee(s) with Cor­
relating Committee ( IO weeks)
• Technical Committee ballots on First Draft (12 weeks);
Technical Committee(s) with Correlating Committee
(11 weeks)
• Conelating Committee First Draft Meeting (9 weeks)
• Conelating Committee ballots on First Draft (5 weeks)
• First Draft Report posted on the document information
page
Step 2 - Comment Stage
• Public Comments accepted on First Draft (IO weeks) fol­
lowing posting of First Draft Report
• If Standard does not receive Public Comment� and the
Technical Committee chooses not to hold a Second Draft
meeting, the Standard becomes a Consent Standard and
is sent directly to the Standards Council for issuance (see
Step 4) or
• Technical Committee holds Second Draft Meeting
(2 I weeks); Technical Committee(s) with Correlating
Committee (7 weeks)
• Technical Committee ballot� on Second Draft (11 weeks);
Technical Committee(s) with Correlating Committee
(IO weeks)
• Conelating Committee Second Draft Meeting (9 weeks)
• Conelating Committee ballots on Second Drnft
(8 weeks)
• Second Draft Report posted on the document infonna­
tion page
Step 3 - NFPA Technical Meeting
• Notice oflment to Make a Motion (NITMAM) accepted
(5 weeks) following the posting of Second Draft Report
• NITMAMs are reviewed and valid motions are certified
by the Motions Committee for presentation at the NFPA
Technical Meeting
• NFPA membership meet� each.June at the NFPA Techni­
cal Meeting to act on Standards with "Certified A mend­
ing Motions" (certified NITMAMs)
• Comrnittee(s) vote on any successful amendments to the
Technical Committee Reports made by the NFPA mem­
bership at the NFPA Technical Meeting
Step 4 - Council Appeals and Issuance of Standard
• Notification of intent to file an appeal to the Standards
Council on Technical Meeting action must be filed within
20 days of the NFPA Technical Meeting
• Standards Council decides, based on all evidence,
whether to issue the standard or to take other action
Notes:
I. T ime periods are approximate; refer to published sched­
ules for actual dates.
2. Annual revision cvcle document� with certified amend­
ing motions take �pproximately 101 weeks to complete.
3. Fall revision cvcle documents receiving certified amend-
ing motions t;ke approximately 141 weeks to complete.
6/16-A
Committee Membership
Classifications1 '2' ' 34
The following classifications apply to Committee members
and represent their principal interest in the activity of the
Committee.
I. M Manufacturer: A representative of a maker or mar­
keter of a product, assembly, or system, or portion
thereof, that is affected bv the standard.
2. U User: A representative of�n entity that is subject to
the provisions of the standard or that voluntarily
uses the standard.
3. IM Installer/Maintainer: A representative of an entity that
is in the business of installing or maintaining a prod­
uct, assembly, or system affected by the standard.
4. L Labor: A labor representative or employee concerned
with safety in the workplace.
5. RT Apjilitd Resean:h/Testin{{ Laboratory: A representative
of an independent testing laboratory or indepen­
dent applied research organization that promulgates
and/or enforces standards.
6. E Enforr:ing A. uthority: A representative of an agency or
an organization that promulgates and/or enforces
standards.
7. I Imumncf': A representative of an insurance company,
broker, agent, bureau, or inspection agency.
8. C Consumer: A person who is or represent� the ultimate
purchaser of a product, system, or senice affected by
the standard, but who is not indL1ded in (2).
9. SE SJ)('(:io.l Ex/wr"t: A person not representing (I) through
(8) and who has special expertise in the scope of the
standard or portion thereof.
NOTE I: "Standard" connotes code, standard, recom­
mended practice, or guide.
NOTE 2: A representative includes an employee.
NOTE 3: \-Vhile these classifications will be used by the
Standards Council to achieve a balance for Technical Com­
mittees, the Standards Council may determine that new
classifications of mern ber or unique interests need repre­
sentation in order to foster the best possible Committee
deliberations on any project. In this connection, the Stan­
darci� Council may make such appointments as it deems
appropriate in the public interest, such a.� the classification
of "Utilities" in the National Electrical Code Committee.
NOTE 4: Representatives of subsidiaries of any group are
generally considered to have the same classification as the
parent organization.
Submitting Public Input/ Public Comment Through the Online Submission System
Following publication of the current edition of an NFPA standard, the development of the next edition
begins and the standard is open for Public Input.

Submit a Public Input

NFPA accepts Public Input on documents through our onlinc submission system at www.nfpa.org. To use
the onlinc submission system:
• Choose a document from the List of NFPA codes & standards or filter by Development Stage for
"codes accepting public input."
• Once you arc on the document page, select the "Next Edition" tab.
• Choose the link "T he next edition of this standard is now open for Public Input." You will be asked
to sign in or create a free onlinc account with NFPA before using this system .
• Follow the onlinc instructions to submit your Public input (sec www.nfpa.org/puhlicinput for de­
tailed instructions).
• Once a Public input is saved or submitted in the system, it can be located on the "My Profile" page
by selecting the "My Public inputs/Commcnts/NlTMAMs" section.

Submit a Public Comment

Once the First Draft Report becomes available there is a Public Comment period. A ny objections or fur­
ther related changes to the content of the First Draft must he submitted at the Comment Stage. To sub­
mit a Public Comment follow the same steps as previously explained for the submission of Public input.

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4/19-B
 lnfonnation on the NFPA Standards Development Process

I. Applicable Regulations. The primary rules governing the processing of NFPA standards (codes, standards,
recommende<l practices, and guides) are the NFPA RPgulations Gove rning the Dewlopment of NFPA Standard� (Regs). Other
applicable rules inclu<le NFPA IJylnws, NFPA Tffhniml A1ePling Convention RulPs, NFPA Guide for the ('.,()ndur:t of Partiripant� in
the NFP/1. Standards Developmmt Pmress, an<l the NFPA Regulatiom Governing Petitions to the /Joard of Dim:tors from IHr.isions of
the Standard� Coundl. Most of these rules and regulations are containe<l in the NI-PA Standards Directory. For copies of the
Dim:tory, contact Codes and Stan<la1·<ls Administration at NFPA hea<lquarte1·s; all these <locuments are also available on the
NFPA website at "www.nfpa.org/regs."
The following is general information on the NFPA process. All participants, however, should refer to the actual rules an<l
regulations fot· a full understanding of this process and for the Cl'iteria that govern pa1·ticipation.
II. Technical Committee R ep ort. The Technical Committee Report is <lefined as "the Report of the responsible
Committee(s), in accordance with the Regulations, in preparation of a new or revise<l NFPA Standard." The Technical
Committee Report is in two pa1·t� and consists of the First Draft Report and the Secon<l Draft Report. (See Regs at
Section 1.4.)
Ill. Step I: First Draft Report. The First Draft Report is <lefined as "Part one of the Technical Committee Report, which
document� the Input Stage.'' The First D1·an Repon consists of the First Draft, Public Input, Committee Input, Committee
and CotTelating Committee Statement.�. Cot-relating Notes, and Ballot Statements. (See Regs at 4.2.5.2 and Section 4.3.)
Any objection to an action in the First Draft Report must he raised through the filing of an appropt·iate Comment for
consideration in the Second Draft Report or the objection will he considered resolved. I See &gs at 4.3. l (b). I
IV. Step 2: Second Draft Report. The Secon<l Draft Report is define<l as "Part two of the Technical Committee Repon,
which documents the Comment Stage." The Second Drafi: Repon consist� of the Second Drafi:, Public Comment� with
corresponding Committee Actions an<l Committee Statements, Correlating Notes and their respective Committee
Statement�, Committee Comment.�, CotTelating Revisions, an<l Ballot Statement�. (See &gs at 4.2.5.2 an<l Section 4.4.)
The First Draft Report and the Second Drnft Repon together constitute the Technical Committee Report. Any outstanding
ol�jection following the Second Dral't Report must be raise<l through an appropriate Amen<ling Motion at the NFPA
Technical Meeting or the objection will be conside1·e<l resolved. fSee Regs at 4.4.1(h). l
V. Step 3a: Action at NFPA Technical Meeting. Following the publication of the Secon<l Drnft Repon, there is a pe1·io<l
<luring which those wishing to make proper Amending Motions on the Technical Committee Report� must signal their
intention by submitting a Notice of Intent to Make a Motion (NITM.AM). (See Regs at 4.5.2.) Standards that receive
notice of prope1· Amending Motions (Certified Amending Motions) will be presented for action at Lhe annual June NFPA
Technical Meeting. At the meeting, the NFPA membe1·ship can consi<ler an<l act on these Certifie<l Amending Motions as
well as Follow-up Amending Motions, that is, motions that become necessary as a result of a previous successful Amen<ling
Motion. (See 4.5.3.2 through 4.5.3.6 and Table 1, Columns 1-3 of &gs fot· a summary of the available Amending Motions
and who may make them.) A.ny out�tanding objection following action at an NFPA Technical Meeting (and any further
Technical Committee consi<leration following successful Amen<ling Motions, see &gs at 4.5.3. 7 through 4.6.5) must be
raise<l through an appeal to the Stan<lar<ls Council or it will be considered to be resolve<l.
VI. Step 3b: Documents Forwarded Directly to the Council. Where no NITMAM is receive<l and certified in accordance
with the '[i,,:hnirallvleeting Convention Rules, the standard is forwarded directly to the Standards Council for action on
issuance. Objections are <leemed to be resolve<l for these document�. (See Regs at 4.5.2.5.)
VU. Step 4a: Council Appeals. Anyone can appeal to the Standar<ls Council concerning procedural or substantive matters
relate<l to the <levelopment, content, or issuance of any document of the NFPA or on matters within the purview of the
authority of the Council, a, establishe<l by the IJylaws and as determined by the Board of Di1·ectors. Such appeals must be in
w1·itten fot·m an<l filed with the Secretar y of the Standards Council (see Regs at Section 1.6). Time constrnint� fot· filing an
appeal mmt be in acc01·dance with 1.6.2 of the &gs. O�jections a1·e <leemed to be 1·esolved if not pursued at this level.
VU[. Step 4b: Document Issuance. The Standar d, Council is the issuer of all documents (see Article 8 of IJylaws). The
Council acts on the issuance of a document presente<l fot· action at an NFPA Technical Meeting within 75 <lays from the
<late of the 1·ecommendation from the NFPA Technical Meeting, unless this period is exten<le<l by the Council (see Regs at
4. 7.2). For document5 forwar<le<l directlv to the Standards Council, the Council acts on the issuance of the document at its
next scheduled meeting, or at such othe,1· meeting as the Council may dete1·mine (see Regs at 4.5.2.5 and 4.7.4).
IX. Petitions to the Board of Directors. The Standat·ds Council ha� been delegated the responsibility for the
administration of the codes and standards development process and the issuance of <locuments. However, where
extrao1·dinary circumstances requiring the inte1·vention of the Board of Directm·s exist, the Boar<l of Directors may take
any action necessary to fulfill its obli ga tions to prese1·ve the integrity of the codes and s tandat·ds development process
and to protect the interests of the NFPA. T he rules for petitioning the Boa1·d of Directors can be found in the Regulations
(',owming Petitions to the /Joard ofDim:tors from Dfl."ision.s of the Standards Counril an<l in Section 1. 7 of the Regs.
X For More Information. The progrnm for the NFPA Technical Meeting (as well as the NFPA website as information
becomes available) shoul<l be consulte<l fo1· the date on which each report sche<luled for consideration at the meeting will
f
be presented. To view the First Dra t Report and Second Draft Report as well as information on NFPA rules and for up-to­
date info1·mation on schedules and deadlines for processing NFPA document�, check the NFPA website (Y,'\'l'\V.nfpa.org/
<locinfo) m contact NFPA Codes & Standar<ls Administrntion at (617) 984-7246.

4/19-C